Dalkin, Bruce L.

Abstract Introduction Peyronie’s disease (PD) and ED can coexist, affecting the patient’s perception of erectile function. The AUA guidelines recommend intracavernosal injection, with or without doppler ultrasound, prior to invasive interventions. Our objective was to assess vascular erectile integrity in patients with PD. Objective The objective of our study was to assess vascular erectile integrity in patients with PD. Methods We retrospectively reviewed 2309 patients who underwent color doppler duplex ultrasound (CDDU) at our institution. CDDU findings such as peak systolic velocities and resistive indices were recorded following injection of low dose Alprostadil and again after a period of privacy and visual sexual stimulation. Among patients diagnosed with PD, comparisons of patient characteristics between those with PD only and those with PD and ED were made using ANOVA (continuous characteristics) or Chi-squared test (categorical characteristics). Results Of men that underwent CDDU, 1468/2452 (63%) were diagnosed with PD. Among those with PD, 327 (14%) were diagnosed with PD only and 1141 (49.4%) were diagnosed with both PD and ED. Those with PD only had lower BMI (27.1 vs 28.4), were less likely to have hypertension (37% vs 46%), less likely to have Diabetes Type 2 (16% vs 31%), less likely to have used PDE-5 inhibitor (39% vs 82%), and less likely to have failed to a PDE-5 inhibitor (30% vs 73%) compared to men with both PD and ED, all p<0.005. Average SHIM scores were higher among those with PD only compared to PD and ED (18 vs 12). CDDU diagnoses for men with PD and ED were: AI (32%), CVOD (43%), mixed vascular ED (26%). Conclusions In a large cohort of men with PD we identified multiple potential risk factors for erectile dysfunction. CDDU of men with PD demonstrates that three-quarters of patients have some form of vascular erectile dysfunction. Counselling for surgical interventions should include a Doppler assessment to ensure patients are appropriately triaged to PD-corrective surgery versus penile implant. Future AUA Guidelines should reclassify the recommendation for evidence-based testing prior to surgical interventions from ‘Expert Opinion’ to ‘Clinical Principle’. Disclosure No

Abstract Introduction Vasectomy is a highly effective, permanent method of contraception. Vasectomy is commonly performed in the outpatient urology clinic with the patient awake. There is clearly anticipation of pain as well as anxiety associated with the procedure. Objective The objective of our study was to evaluate anticipated versus experienced pain associated with office-based vasectomy. Methods We studied men who underwent vasectomy in May and June of 2022. Men who had no history of scrotal surgery of any kind were asked to score the anticipated pain associated with an office based vasectomy with a score of 0-10. After the vasectomy, patients were asked to rate the pain they perceived with the vasectomy on the same scale (0-10). Results A total of 17 men were asked to rate their pain as discussed in the method section. The median age of men sampled was 38 years of age. All men we treated were given 15 mg of Valium before the procedure and instructed to take the medication 30 minutes prior to their procedure. The average pre vasectomy prediction pain score was 7.5+/- 1.9; the average post-injection perceived pain score was 2.9+/- 1.9. Thus there was an average decrease of over 4 points in the predicted pain versus perceived pain. A two-sample T test was performed; in addition Wilcoxson Signed Rank Test was performed. Both tests showed a statistical significance in the difference between pre and post vasectomy pain scores (p<0.001). Conclusions We found that patients who are undergoing office based vasectomy for the first time have a significantly higher perception of pain versus perception of pain after the injection. We have utilized this data in our clinic to explain to patients that while most patients will predict a high pain score associated with the vasectomy, the vast majority of patients report minimal pain after the procedure. Our study can be particularly helpful in patients who have had significant anxiety about office based vasectomy and for those patients who are deciding between office based vasectomy and vasectomy performed under general anesthesia. Disclosure No

Abstract Introduction Introduction: Peyronie’s disease (PD) is a fibrosing condition of the tunica albuginea characterized by a palpable plaque with varying impacts on the patient’s erection: curvature, shortening, indentations, hinging, and narrowing. Stepwise intralesional injection of collagenase clostridium histolyticum (CCH) is the only FDA approved medical treatment for PD. We retrospectively reviewed Xiaflex® treated patients for satisfaction with therapy or pursuit of subsequent surgery. Objective Objective: To assess global satisfaction with intralesional Xiaflex based on whether patients subsequently elected surgery. Methods Methods: This is a retrospective review of patients presenting with PD to a single center and managed by a single provider from 2020-2024 with six-month follow-up post-treatment. Patient presentations were recorded in an Institutional Review Board approved database. Data storage and analytics were conducted using REDCap. Results Results: The cohort for this study was 159 men treated with intralesional Xiaflex. 18 of the 159 were excluded from analysis due to ongoing treatment. 48.9% of patients (69/141) were satisfied with CCH outcomes and sought no further therapy. 51.1% of patients (72/141) were not satisfied with their outcomes. Of the patients not satisfied with treatment, 48/72 (66.7%) elected subsequent surgical interventions: 18 penile plications, 8 incision and grafting and 22 inflatable penile prostheses. 51.7% (73/141) of patients completed (8) CCH treatments. Among the 73 men who had a complete set of CCH injections, 24.6% (18/73) elected subsequent surgery. Among the patients who had fewer than 8 treatments 46.9% (30/64) elected surgery following Xiaflex. Conclusions Conclusion: If successful medical management of Peyronie’s disease is defined by men who decline subsequent surgical interventions, Xiaflex® was highly successful 75% (55/73). Patients who have Peyronie’s disease are highly motivated and will pursue surgical interventions following a trial of CCH. Disclosure No