Pinkhasov, Aaron

Abstract Introduction The Penuma ® implant is a medical-grade silicone implant used in the cosmetic augmentation of the penis. Reportedly 3-11% of devices are being removed over time for reasons such as infection, pain, and dissatisfaction with the device. Objective Despite this, there remains a paucity of information demonstrating safe removal of this device. In this video, we outline intra-operative considerations to promote the safe removal of the Penuma device. Methods Sharp and blunt dissection to the level of the capsule is performed via the original incision line. The proximal end of the device is identified via sharp dissection through the capsule. The penis is then everted to expose the distal attachments of the implant, which are subsequently dissected. Superficial and sharp dissection to remove the mesh is performed. We avoid the use of cautery to prevent damage to the nearby neurovascular bundle. Once the mesh and all permanent material is removed, haemostasias is achieved. A drain may be placed. The incision is irrigated and closed in a multi-layer fashion. Results Here we demonstrate a safe and feasible method to surgically remove the Penuma (Himplant) device. Conclusions In conclusion, the Penuma ® implant is a medical-grade silicone implant used in the cosmetic augmentation of the penis that can be safely removed surgically in the event of infection, pain, or dissatisfaction with the device. Disclosure No

Abstract Introduction Traditional vasectomy reversals are performed in the operating room under general anesthesia, which poses logistical, financial, and clinical drawbacks. A shift toward office-based vasectomy reversal under local anesthesia may address these limitations. Objective To demonstrate the feasibility and technical approach of performing microsurgical vasovasostomy in an office-based setting using local anesthesia, without compromising patient comfort or surgical technique. Methods In this video we outline a step-by-step microsurgical vasovasostomy in an office-based setting. Results Office-based vasovasostomy is technically feasible in the office-based setting. Conclusions Office-based microsurgical vasovasostomy is safe, feasible, and well tolerated in the office-based setting, offering multiple patient- and provider-centered advantages. Disclosure No

Abstract Introduction Convective water vapor thermal therapy (Rezum) can have varied outcomes based on prostate architecture. Objective We sought to compare the efficacy of traditional Rezum therapy with steam treatment of the median lobe to transurethral resection for the median lobe, and Rezum treatment for the lateral lobes of the prostate (Rezurp). Methods A single-surgeon series between 2019 and 2024 analyzed standard BPH outcomes. The rate of retreatment, complications, and a global assessment: “Knowing what you know now, would you like to repeat the procedure?” were utilized. Significant median lobe was defined as ≥1 cm of intravesical protrusion for Rezurp patients and ≥ 2 median lobe treatments required for standard Rezum. Results Follow-up assessments were performed for 89/105 patients in the Rezurp group and 107/138 patients in the Rezum group. There was no significant difference in baseline characteristics between the two groups, as shown in Table 1. In the Rezum group, the median IPSS before surgery was 25 (20–28), while the median score after surgery was 9 (5–15), and in the Rezurp group, the median IPSS before surgery was 22.5 (19–28), and the median score after surgery was 5 (3–9.7). The changes were statistically significant for both groups (P < 0.001). For the IPSS quality-of-life (QoL) scores, the median in both groups was 4 (mostly not satisfied) before surgery and 2 (mostly satisfied) after surgery. The changes in QoL scores were significant in both (P < 0.001). In the Rezum group, the median Q-max was 7.9 and 13.1 before and after surgery, while in the Rezurp group, it was 8.0 and 17.1, respectively, and the changes were significant for both (P = 0.001). In addition, changes in post-voiding residue were significant in both groups (P = 0.001) (Table 2). In the Rezum group, 62% (67 patients) were on alpha-blockers before surgery, whereas only 15.8% (17 patients) continued after surgery. For the Rezurp group, 71.9% (64 patients) were on alpha-blockers before surgery, compared to 10.1% (9 patients) afterward. The discontinuation of alpha-blockers was significant for both groups (P = 0.001). Furthermore, changes in stopping the use of 5-alpha reductase inhibitors were significant for both groups (P = 0.001). The changes in stopping PDI-5 were not significant in both groups (P = 0.38). Regarding retreatment, 5.6% (5 out of 89) of patients in the Rezurp group required a retreatment procedure, compared to 14.9% (16 out of 107) in the Rezum group. The retreatment rate was significantly higher in the Rezum group (P = 0.03). When asked if they would repeat the procedure, 91% (81 out of 89) in the Rezurp group expressed interest, compared to 72% (77 out of 107) in the Rezum group. The interest in repeating the procedure was significantly higher in the Rezurp group (P = 0.001). Conclusions Although both Rezum therapy and Rezurp resulted in significant improvements in Q-max, PVR, IPSS, and QoL, the Rezurp group had a significantly lower rate of retreatment. Disclosure No.

Abstract Introduction Penile prosthesis (PP) implantation is associated with high patient satisfaction and improved sexual quality of life in medically refractory erectile dysfunction (ED). Despite the current surgical advances and patients’ satisfactions after PP implantation, there has been paucity of data on reported partner satisfaction. We aimed to evaluate changes in partner satisfaction after PP placement. Objective We aimed to evaluate changes in partner satisfaction after PP placement. Methods We initiated a registry of patients undergoing surgery for placement of a PP. After consent, Perioperative study assessments and follow-ups were conducted. After surgery, patients were directed to fulfill a survey at 6 months and 12 months. Patients who fulfilled both items were included in the analysis. Results A total of 304 patients had a PP placement, of these 101 completed the survey. At 6 months, 62 patients (61.4%) reported a moderate to high partner’ satisfaction, and this positive response was sustained at 12-months (82.3%). 73.3% of partner’s reported no-pain after 6 months and this increased to 79.7% after 12 months. 67.3% of partners stated they would recommend the procedure to a friend or family at 6-months. This increased significantly to 84.8% at 12-months (p = 0.012). Conclusions Penile prosthesis placement is associated with high partner satisfaction rates, with a sustained positive perception over time when comparing 6 and 12-month follow-up outcomes. Further study is warranted to assess partner satisfaction after penile prosthesis implantation. Disclosure Yes, this is sponsored by industry/sponsor: COLOPLAST. Clarification: Industry funding only - investigator initiated and executed study.

Abstract Introduction Resistance training by recreational sportspeople in fitness settings has become increasingly popular worldwide, moreover an increasing landscape of social media (SM) influencers in bodybuilding have arisen since 2021, specially on short-duration videos (clips). Some Image enhancer drug users, including anabolic androgenic steroids (AAS) are known to mistrust medical health professionals and seek out information and advice from online sources. Objective we aimed to quantitatively assess the quality of social media videos as an information source for AAS usage in the general population. Methods A search was performed on the most popular short-clips social media platforms in the US (TikTok, YouTube) with the most searched terms for AAS. The first 50 results with any search term listed by relevance were selected in each platform. Video features (views, likes, subscribers) and video sources were collected. Each video included in the study was assessed using DISCERN score to quantify the source quality. Results A total of 100 videos were included and analyzed. Most videos (84%) were from non-health professionals (influencers/clip source/podcasts), only 7% of the videos came from a health educator/physician. Most videos were rated as “very poor” (85%) and “poor” (7%) According to the DISCERN classification, there was a statistically significant difference (p < 0.001) by both content creator type, and platform with the highest scores among physicians [37 (33-41)] and YouTube [19(17.7-30.2]. [Fig]. Conclusions Image-centric social media use is positively associated with the use of AAS. Despite the increasing number of information, the overall quality was poor. The misleading, inaccurate and incomplete information may pose a health risk to the viewers. Further efforts in health policies are strongly encouraged to assess this problem. Disclosure No.

Abstract Introduction Penile prosthesis (PP) implantation is associated with high patient satisfaction and improved sexual quality of life in medically refractory erectile dysfunction (ED). While reported patient satisfaction with this surgery is high, there are a variety of factors that can influence patient satisfaction after PP surgery. Objective We aimed to identify factors responsible for patient dissatisfaction after PP surgery. Methods We initiated a registry of patients undergoing surgery for placement of a PP. After consent, Perioperative study assessments and follow-ups were conducted. After surgery, patients were directed to fulfill a survey at 6 months and 12 months. Patients who completed both surveys were included in the analysis. Results A total of 304 patients had a PP placement, of these 101completed at least the first survey. Patients reported using their PP a median of 4 (2-8) times per month at 6 months, and 5 (2-9) at 12 months (p = 0.651). Main reasons of lack of use of the PP can be seen in Fig. 1A. The most frequent reported reason was lack of interest from partner (20.3% at 6-months, 18.8% at 12-months). Patient reported reasons for dissatisfaction are seen in Fig. 1B. Examples include penile pain (19% at 6-months, 11% at 12-months), difficulty with orgasm (39% at 6-months, 37% at 12-months), unsatisfactory penile cosmesis (28% at 6-months, and 25% at 12-months), problems inflating of the prosthesis (14.9% at 6-months, and 21.5% at 12-months), and problems deflating of the prosthesis (33.7% at 6-months, and 31.6% at 12-months). Despite these concerns, most patients found PP easy to use (83.2% at 6-months, and 82.1% at 12-months) and a reported a very or somewhat natural sensation with their erections (66.4% at 6-months, and 62.8% at 12-months) Fig. 1C. Conclusions There was a higher than anticipated rate of penile pain, difficulty achieving climax, and unsatisfactory cosmesis that warrant further investigation. Despite this, the majority of patients found their PP easy to use and a reported natural sensation when having erections. Disclosure Yes, this is sponsored by industry/sponsor: Coloplast. Clarification: Industry funding only - investigator initiated and executed study.

Abstract Introduction Penile prosthesis (PP) implantation is associated with high patient satisfaction in patients with medically refractory erectile dysfunction (ED). There remains a paucity in the literature regarding the temporal evolution of patient satisfaction and well-being following PP surgery. Objective We aimed to identify factors responsible for patient satisfaction after surgery. Methods We initiated a registry of patients undergoing surgery for placement of a PP. After consent, perioperative study assessments and follow-ups were conducted. After surgery, patients were directed to a survey at 6 months and 12 months. Patients who completed both items were included in the analysis. Results A total of 304 patients had a PP placement, of these 101 completed the initial surveys. Overall patient satisfaction was favorable and durable and 6- and 12-months (87% and 82% respectively, p = 0.11). Confidence with device use was reported by 92% at 6 months, without significant change at 1 year (vs. 95%, p = 0.91). At 6 months, 81% of patients reported that their PP met or exceeded expectations, 83% of patients reported that they would undergo the procedure again, and 80% would recommend to a friend/family member. [Figure 1] At 6 months, 78 patients (77%) reported a moderate to high improvement in their overall sense of well-being related to their PP. This percentage further increased to 91% at 12-months (p < 0.001). Additionally, 36% of patients reported that they had made significant improvements to their overall lifestyle since receiving the PP, and this increased to 48% by 12 months post-operatively (p = 0.082). Conclusions Penile prosthesis satisfaction is evident and durable as early as 6 months following surgery. Factors such as perceived overall well-being continued to significantly improve past 6 months, and nearly half of patients reported overall lifestyle improvement following surgery. Disclosure Yes, this is sponsored by industry/sponsor: Coloplast. Clarification: Industry funding only - investigator initiated and executed study.

Abstract Introduction Spongiosal sparing non-transecting anastomotic bulbar urethroplasty has rapidly become the preferred technique for many reconstructive urologists due to reported improvement in postoperative erectile function outcomes. For strictures <2cm, non-transecting techniques without the use of graft augmentation are typically deployed. However, for lengthy bulbar strictures (≥2cm), many advocate for oral mucosa substitution urethroplasty due to the theoretical concern of penile shortening, tethering, or other erectile function related side effects. Although effective, substitution bulbar urethroplasty is associated with additional graft harvest morbidity and may have lower success rates relative to non-substitution non-transecting techniques. Objective We describe outcomes of an extended non-transecting excision-anastomosis urethroplasty for lengthy urethral strictures without the use of graft augmentation. Methods A tertiary center’s urethroplasty database was queried for patients that underwent non-transecting bulbar urethroplasty from 2017-2023. Patients with penile urethral strictures or concurrent urethroplasty procedures were excluded. Stretch penile length (SPL) was assessed by applying gentle traction on the penis and measuring from the base of the penis to the tip of the glans. SPL was assessed perioperatively and at 3-6 month follow-up. Urethral stricture recurrence was defined as need for repeat urethral intervention. Urethral stricture length was determined by intra-operative measurement. Accordingly, patients were then stratified based on stricture length (<2 cm vs ≥2 cm) and tested for association between categorical outcomes (worsening erectile function and reconstructive success) and continuous outcomes (change in SPL) using Fischer’s exact test and Mann Whitney U test. Results A final cohort of 90 patients were identified, with a median urethral stricture length of 1.5 cm (range 0.5-6cm). In addition to dorsal urethrotomy (median 3cm), ventral mucosectomy was performed in 29 (32%) patients (median 2cm). Early postoperative complications occurred in 13 (15%) including UTI (N=4), contrast extravasation at VCUG (N=3), and epididymo-orchitis (N=3). At a median follow up of 13 months (IQR 4-18), a total of 5.5% (5/90) developed stricture recurrence. The overall median change in SPL was 0% (IQR 0-6.7%). De novo ED occurred in 7% (5/67). When stratified by stricture length ≥2cm (N=41) and <2cm (N=49) median length of urethrotomy was 3 cm (2.6-4.0) vs 2 cm (2.0-3.0; p <0.001), respectively. Those with strictures ≥2 cm had greater decreases in relative SPL (median 3.5% vs. 0%, p = 0.003) and higher absolute PVR (median 71 ml vs. 34 ml, p =0.03) at 3 months after surgery. There were no significant differences in relative improvement of Qmax or PVR, stricture recurrence (8% vs 4%), worsening erectile function (10% vs 6%), or complication rates (15% vs 14%) between groups (p-value> 0.05 for all comparisons). Conclusions Spongiosal sparing non-transecting urethroplasty is an effective surgical option for patients with lengthy urethral strictures. It offers comparable relative improvement in functional (Qmax, PVR) and erectile function outcomes, while having a modest impact on SPL all while avoiding the morbidity of graft harvesting. Disclosure No.