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OBJECTIVE The evidence on ankylosing spinal disorders (ASDs), including ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH), in the context of spinal fracture stems from studies with relatively small sample sizes. There are no studies addressing the patient-reported outcome measures (PROMs) and health-related quality of life (HRQOL) outcomes associated with spinal fracture in this population. The aim of this study was to investigate differences in complications, mortality, PROMs, and HRQOL in patients with and without ASD who had been treated for spinal fracture. METHODS This is a nationwide multicenter retrospective study of prospectively collected data from the Swedish Fracture Register. All patients with fractures of the cervical, thoracic, or lumbar spine treated surgically and conservatively between January 2015 and December 2021 were eligible for inclusion. Two groups of patients were formed based on the presence or absence of concomitant ASD. Primary outcomes of interest included death and PROMs. For surgically treated patients, data on complications and reoperation rates were retrieved. Propensity score matching with a ratio of 1:1 was used to balance the groups prior to intergroup comparison. Variables included in the matching process were age, sex, mechanism of injury, neurological function on admission (Frankel grade), injury type (high vs low energy), fracture type, injured spinal level, time to treatment, and type of treatment (surgical vs conservative). Kaplan-Meier analyses were used to study overall survival following injury. RESULTS A total of 14,604 patients without ASD and 1368 patients with ASD were included in this study. High-energy injuries were less frequent in patients with ASD (13% vs 24%, p < 0.001). Moreover, patients with ASD were less likely to be neurologically intact on admission (90% vs 94%, p < 0.001). There were 1707 surgically treated patients without ASD and 559 with the disorder. After matching, a higher overall risk of reoperation was found among patients with ASD (9.1% vs 3.4%, p = 0.007). Surgical site infections requiring reoperation (p = 0.012), but not construct failure or CSF leakage requiring reoperation (p ≥ 0.05), were more common among the patients with ASD. Postmatching, there were no differences in overall survival between ASD and non-ASD cases (p > 0.05). Moreover, patients with and without ASD had similar PROMs, as indicated by the EQ-5D-3L index at 1 year after injury (p = 0.59). CONCLUSIONS Self-reported recovery 1 year after spinal fracture occurred to a similar extent in patients with and without ASD. Moreover, ASD alone was not a significant risk factor for death. Finally, surgically treated patients with ASD experienced higher rates of postoperative complications and reoperations following surgery.

BACKGROUND AND OBJECTIVES: Vertebral artery injury (VAI) because of traumatic subaxial cervical spine injury is a rare but potentially devastating condition as it could lead to stroke. The aim of this study was to examine the incidence, risk factors, outcomes, and radiographic predictors of VAI in patients surgically treated for subaxial cervical spine injuries at a tertiary care trauma center. METHODS: This is a retrospective population-based cohort study, including all patients surgically treated for traumatic subaxial cervical spine injuries at the study center between 2006 and 2018. Primary outcomes included mortality and morbidity after the injury. Propensity score matching, survival, univariable, and multivariable analyses were used to study the outcomes of interest. RESULTS: Traumatic VAI primarily occurred after high-energy traumas such as motor vehicle accidents and falls from heights. The median age was 64.4 years (47.4-69.1), and 69% were male. In the cohort of patients with subaxial cervical injury, 54% had a spinal cord injury (SCI). In the subgroup with VAI, the frequency of SCI was 66% and a concomitant SCI and VAI were associated with a more severe American Spinal Cord Injury Association Impairment Scale grade ( P = .015). However, after accounting for age, sex, and associated injuries, VAI did not affect postoperative complications, short- or long-term outcomes, or mortality rates. Facet joint dislocation was a unique radiographic predictor of VAI (odds ratio 3.8 [CI 1.42-10.7], P = .009). CONCLUSION: The findings suggest that clinical outcomes of patients with traumatic cervical spine injuries were not negatively affected by the presence of a VAI. Several radiographic factors were associated with VAI; however, only facet joint dislocation remained as an independent predictor of this injury.

BACKGROUND AND OBJECTIVES: Carotid endarterectomy (CEA) is a well-established treatment option for carotid stenosis. The choice between general anesthesia (GA) and nongeneral anesthesia (non-GA) during CEA remains a subject of debate, with concerns regarding perioperative complications, particularly myocardial infarctions. This study aimed to evaluate the outcomes associated with GA vs non-GA CEA using a large, nationwide database. METHODS: The National Surgical Quality Improvement Project database was queried for patients undergoing CEA between 2013 and 2020. Primary outcome measures including surgical outcomes and 30-day postoperative complications were compared between the 2 anesthesia methods, after 2:1 propensity score matching. RESULTS: After propensity score matching, a total of 25 356 patients (16 904 in the GA and 8452 in the non-GA group) were included. Non-GA compared with GA CEA was associated with significantly shorter operative times (101.9, 95% CI: 100.5-103.3 vs 115.8 95% CI: 114.4-117.2 minutes, P < .001), reduced length of hospital stays (2.3, 95% CI: 2.15-2.4 vs 2.5, 95% CI: 2.4-2.6 days, P < .001), and lower rates of 30-day postoperative complications, including myocardial infarctions (0.8% vs 1.2%, P = .003), unplanned intubations (0.8% vs 1.1%, P = .016), pneumonia (0.5% vs 1%, P < .001), and urinary tract infections (0.4% vs 0.7%, P = .003). These outcomes were notably more pronounced in the younger (≤70 years) and high morbidity (American Society of Anesthesiologists 3-5) cohorts. CONCLUSION: In this nationwide registry-based study, non-GA CEA was associated with better short-term outcomes in terms of perioperative complications, compared with GA CEA. The findings suggest that non-GA CEA may be a safer alternative, especially in younger patients and those with more comorbidities.

AbstractBackgroundThe advent of antibiotic-coated devices has reduced the rate of inflatable penile prosthesis (IPP) infections; however, this may have altered microbial profiles when infections do occur.AimTo describe the timing and causative organisms behind infection of infection retardant–coated IPPs in the context of our institution’s perioperative antimicrobial protocols.MethodsWe retrospectively reviewed all patients undergoing IPP placement at our institution from January 2014 to January 2022. In all patients, perioperative antibiotic administration was congruent with American Urological Association guidelines. Boston Scientific devices are impregnated with InhibiZone (rifampin and minocycline), and all Coloplast devices were soaked in rifampin and gentamicin. Intraoperative irrigation was performed with betadine 5% irrigation prior to November 2016 and with vancomycin-gentamicin solution afterward. Cases involving prosthesis infection were identified, and variables were extracted from the medical record. Descriptive and comparative statistics were tabulated to identify clinical characteristics, including patient comorbidities, prophylaxis regimen, symptom onset, and intraoperative culture result. We previously reported an increased infection risk with Betadine irrigation and stratified results accordingly.OutcomesThe primary outcome was time to infectious symptoms, while the secondary outcome was description of device cultures at the time of explantation.ResultsA total of 1071 patients underwent IPP placement over 8 years with an overall infection rate of 2.6% (28/1071). After discontinuation of Betadine, the overall infection rate was significantly lower at 0.9% (8/919) with a relative risk of 16.9 with Betadine (P &lt; .0001). Primary procedures represented 46.4% (13/28). Of 28 patients with infection, only 1 had no identified risk factors; the remainder included Betadine at 71% (20/28), revision/salvage procedure at 53.6% (15/28), and diabetes at 50% (14/28). Median time to symptoms was 36 days (IQR, 26-52); almost 30% of patients had systemic symptoms. Organisms with high virulence, or ability to cause disease, were found in 90.5% (19/21) of positive cultures.Clinical ImplicationsOur study revealed a median time to symptoms of just over 1 month. Risk factors for infection were Betadine 5% irrigation, diabetes, and revision/salvage cases. Over 90% causative organisms were virulent, demonstrating a microbial profile trend since antibiotic coating development.Strengths and LimitationsThe large prospectively maintained database is a strength along with the ability to follow specific changes in perioperative protocols. The retrospective nature of the study is a limitation as well as the low infection rate, which limits certain subanalyses from being performed.ConclusionIPP infections present in a delayed manner despite the rising virulence of infecting organisms. These findings highlight areas for improvement in perioperative protocols in the contemporary prosthetics era.

ABSTRACT Introduction The significant overlap of risk factors for erectile dysfunction and venous thromboembolism (VTE) may disproportionally increase the risk of VTE in men undergoing inflatable penile prosthesis (IPP) surgery. Owing to the absence of available literature, AUA and EAU perioperative VTE guidelines do not address VTE risk with IPP surgery and generally recommend against pharmacologic prophylaxis with outpatient surgery. The Caprini Score is a validated scoring system to estimate VTE risk in the perioperative period. Objective We sought to assess the risk of VTE by calculating Caprini Scores in men undergoing IPP surgery. Methods We retrospectively reviewed and calculated Caprini Scores for patients undergoing IPP surgery at our institution between July 2017 and June 2019. Results 215 patients undergoing IPP surgery were identified with a mean and median Caprini score of 5.96 (SD, 1.63) and 6 (IQR 5,7), respectively. 84% of the cohort was classified as high or highest risk for VTE (Figure 1). This is in part due to our cohort's mean age of 64, mean BMI of 31 and history of prostate cancer treatment as the cause of ED. Prior history of VTE (deep vein thrombosis(DVT) or pulmonary embolism (PE)was identified in 17 (8%) patients with 5 (2%) have a history of both DVT and PE. Conclusions Men undergoing IPP surgery are high risk for VTE based on Caprini score assessment. VTE prophylaxis should be considered in men undergoing penile implant surgery. Before widespread application, long-term data is necessary to assess safety and efficacy of VTE prophylaxis in the IPP surgery population. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author consultant for Coloplast

ABSTRACT Introduction IPP revision after implant malfunction yields rare insight into patient preference and perception of penile implant variations in brand and size. Objective To assess patients’ perception of their penile implant after IPP revision. Methods Retrospective review of all patients undergoing revision surgery for purely mechanical malfunction (fluid leak) at our institution since 2017. Patients with greater than 6 months follow-up after revision were contacted to comment on changes in penile size and device preference. Patients were asked 1. “Did you notice any change in penile length or girth after your last surgery, explain, and 2. “Please describe your preference (if any) of implant and why”. We utilize the Coloplast Titan with “classic” (genesis) pump in most cases, with AMS Cx cylinders being used in cases with attenuated corpora (aneurysm). Results 21 patients were identified that met criteria with an average age of 70. 15/21 were successfully contacted. 9 Coloplast, 2 Mentor, and 12 AMS devices (Cx =7, LGX =4, Ultrex =1) were revised. Device brand used to replace the broken IPP was n= 19 for Coloplast and n=3 for AMS (Cx =2, Lgx =1). Mean and median time to revision was 9 years overall (2-26) and was similar between Coloplast and AMS. Fluid leak location showed no discernable pattern. Total average implant length increased 2.2 cm from 20.6 cm to 22.8 cm. 8/10 patients were reached that had had both AMS and Coloplast devices (all AMS initially). 12 patients stayed within the manufacturer. Despite change in implanted length, most patients did not discern a definitive change in penile length unless cylinders increased by &gt; 3 cm (perhaps reflecting under-sizing of initial implant). All patients correctly described improvement or no change in penile girth when compared to actual cylinder sizes. Patients preferred Coloplast (6 – girth/erection quality/pump), AMS (1 pump/flaccidity) and undecided (1). Several patients felt consistently cycling the device after revision led to relative length improvement and ease of use. Conclusions Our small cohort of IPP revision patients for mechanical failure reveals that revision often requires longer cylinders but this is often imperceptible to the patient. Increased cylinder girth was a key factor in driving device preference. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author consultant for Coloplast

ABSTRACT Introduction The inflatable penile prosthesis (IPP) is a widely accepted surgical treatment for refractory ED. It has the highest satisfaction rates of all ED treatment modalities; however, 7-8% of patients will require reoperations. Mechanical failure, infection, erosion, and extrusion are some of the common indications for reoperations. Objective Our video highlights our IPP revision approach that is aimed to lower the risk of future cylinder extrusion/displacement. We also share a rare case of a retained rear tip during device explanation. Methods Our video demonstrates our standard technique of obtaining corporal exposure, performing distal corporotomies to explant the cylinders, and utilizing long-acting sutures to prevent future device extrusion. We also demonstrate an encounter with a retained rear tip and our management approach in that scenario. Results Our video successfully demonstrates our intraoperative techniques and surgical approach during IPP revision procedures. It also highlights our experience with postoperative cylinder extrusion from 2017-2021. Conclusions Our surgical approach during IPP revision using distal corporotomies and long-acting absorbable sutures for corporotomy closure aims to reduce the risk of potential cylinder extrusion. The technique was developed based on our own experience with this complication. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dr. Kohler is a consultant for Coloplast

ABSTRACT Introduction Glanular hypermobility (GH) or supersonic transporter (SST) deformity are occasionally encountered during or after penile prosthesis (PP) implantation. The “frozen pump” is a phenomenon that patients experience postoperatively where they encounter difficulty inflating the device due to a rigid capsule formation around the pump leading to pump failure. Objective In our video we describe our surgical approach in the management of GH, and the Frankenstein technique we utilize to address a "frozen pump". Methods Our video demonstrates our standard technique of using permanent sutures to repair GH with bilateral distal dorsal anchoring sutures and a deep glans suture. It also demonstrates our Frankenstein pump revision technique where a different brand device component may be utilized to replace the original device pump to ease device inflation. Results Successful repair of GH/SST deformity and revision of a non-functioning PP pump. Conclusions Glanulopexy with permanent suture successfully corrects severe GH or SST in men with inflatable PP. Using different brand components to revise PP pump can be done without compromise to mechanical function. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Tobias Kohler is consultant for Coloplast