Citations

ABSTRACT Introduction Operating room (OR) noise during holmium laser enucleation of the prostate (HoLEP), particularly from laser activation, may impair surgical workflow and staff performance. Methods 84 HoLEP procedures were recorded at three academic institutions between June 2024 and January 2026. Laser platforms included Lumenis Moses 2.0, Quanta Litho 150, Quanta Magneto, and Dornier Thulio. Sound measurements were obtained using a standardized smartphone‐based system during three phases: laser‐off (baseline), idle (not firing), and active lasing. Acoustic metrics included average sound level (LAeq), peak sound level (Lcpeak), and sound levels exceeded for 10%, 50%, and 90% of the recording time (L10, L50, and L90). Background noise correction was performed using baseline measurements to account for ambient noise and isolate laser‐related sound. OR staff completed a validated survey assessing perceived noise burden (0–10 scale). Results Background‐corrected noise during active lasing differed significantly by platform. Litho demonstrated lower mean noise levels compared to Thulio for LAeq (60.6 vs. 68.2 dB, p = 0.023) and L10 (61.5 vs. 70.6 dB, p = 0.023), while Moses had higher LAeq compared to Litho (63.1 vs. 60.6 dB, p = 0.043). Overall, Litho had the lowest noise levels, whereas Thulio had the highest. Survey responses paralleled these findings. Litho was associated with lower perceived overall effort (2.1 ± 0.9), while Moses demonstrated higher overall effort (3.6 ± 1.2) for communication and concentration (Figure 2). Significant pairwise differences were observed between Moses and Litho (all p < 0.05). Trends were consistent across sites. Conclusions Noise levels during HoLEP varied by laser technology and correlated with differences in perceived communication and cognitive effort. Litho demonstrated the lowest acoustic burden, while Moses and Thulio had higher noise exposure. These findings highlight the impact of laser selection on the OR environment and intraoperative team performance.

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&lt;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&lt;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

Abstract Introduction Holmium laser enucleation of the prostate (HoLEP) is a safe, effective and durable surgical treatment for benign prostatic hyperplasia (BPH). With increased longevity, there is expanded interest in assessing the safety and efficacy of HoLEP in patients aged 90 years and older. Additionally, these patients are particularly interested in HoLEP when dealing with chronic retention secondary to BPH. Objective To evaluate the safety and functional outcomes of HoLEP in nonagenarian patients. Methods We conducted a retrospective review of patients aged 90 years or older who underwent HoLEP by a single surgeon at our institution from January 2019 to May 2024. Data collected included preoperative prostate volume, postoperative length of hospital stay, complication rates, postoperative American Urological Association Symptom Score (AUASS), quality of life (QOL) scores, and catheter status. Results Eighteen patients met inclusion criteria, with a mean preoperative prostate volume of 106 grams. Fourteen patients were on anticoagulation therapy but all were able to stop their medications at least 2-3 days prior to surgery. Six postoperative complications occurred, including three major events: aspiration, congestive heart failure exacerbation, and one death during admission. At last follow-up, four patients had passed away due to unrelated events, with only one death occurring during the HoLEP hospitalization. Among surviving patients, the mean AUASS was 7 and mean Michigan Incontinence score was 0.9. Preoperatively, 15 patients were catheter-dependent; postoperatively, only one patient required catheter reinsertion after trial of void. Discharge occurred on postoperative day (POD) 0 for six, POD 1 for four, POD 2 for three, and POD 3 for four patients. Conclusions HoLEP is a feasible and effective surgical option for patients aged 90 years and older, providing significant improvement in urinary symptoms, low rates of reported incontinence, and high rates of catheter independence. Nonagenarians anecdotally seem more likely to experience complications, highlighting the importance of careful patient selection/counseling and perioperative management. The 30-day mortality was ultimately due to the patient’s family’s desire to withdraw care and proceed with hospice. Although it’s difficult to objectively evaluate, we believe that overall, these patients do stand to benefit from HoLEP as their catheter-dependency often leads to recurrent infections, admissions, decreased mobility and falls. These medical issues can also lead to poor outcomes in this age group. Disclosure No