Citations

Abstract Introduction Rezum therapy demonstrates efficacy for benign prostatic hyperplasia (BPH), but outcomes in large prostates remain unclear. Objective To evaluate Rezum efficacy in large prostates, assess success rates, and identify predictors of treatment outcomes. Methods Retrospective analysis of 597 patients undergoing Rezum therapy (2019-2023). We identified 133 patients with large prostates receiving ≥8 steam treatments and a minimum 3-month follow-up. Outcomes included symptom scores (IPSS, IPSS-QoL), uroflowmetry (Q-max), post-void residual (PVR), sexual function, and retreatment rates. Multivariable regression identified predictors of treatment failure. Results Among 133 patients with complete follow-up, sexual function preservation was a primary concern for 112 patients, while 21 patients had ASA class 3 comorbidities. 19 of 21patients received local anesthesia, and 2 patients received brief general anesthesia. At three-month follow-up, sexual function outcomes were favorable: 96.2% (107/112) of patients reported no change in erectile function, with 4 patients reporting deterioration and 1 reporting improvement. Regarding ejaculatory function, 94.6% (106/112) reported no changes, 3 patients reported improvement, 2 patients experienced decreased semen volume, and 1 patient developed anejaculation. Significant improvements in urinary symptoms were observed at three months. Median IPSS decreased from 23 (IQR: 18-26) preoperatively to 9 (IQR: 5-13) postoperatively (P<0.001). Similarly, median IPSS-QoL scores improved from 4 (IQR: 4-5) to 2 (IQR: 1-3) (P<0.001). Objective uroflowmetry parameters also showed substantial improvement: median Q-max increased from 8 mL/s (IQR: 5.6-11) to 13 mL/s (IQR: 9.6-16.5) (P<0.001), while median post-void residual volume decreased from 155 mL (IQR: 65-291) to 57 mL (IQR: 27-121) (P<0.001). During a median follow-up period of 27 months (IQR: 12-47), 20.3%(27/133) of patients required retreatment, with a median time to retreatment of 18 months (IQR: 31-48). Multivariable analysis identified significant predictors of treatment outcomes: larger prostate size was associated with higher odds of treatment failure (OR = 0.963, 95% CI: 0.936-0.990, P=0.009), while better Q-max at three-month follow-up was predictive of sustained treatment success (OR = 1.27, 95% CI: 1.1-1.83, P=0.045). Conclusions Rezum therapy is effective for large prostates with excellent sexual function preservation. However, larger prostate size increases retreatment risk. Early Q-max improvement could be predicting long-term success treatment. Disclosure No

Abstract Introduction While Rezum therapy has demonstrated efficacy in treating lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH), its outcomes in catheter-dependent patients remain poorly characterized. Objective This study evaluates the efficacy of Rezum therapy in catheter-dependent patients, assesses treatment success rates, and identifies predictors of successful catheter independence. Methods We conducted a retrospective analysis of 597 patients who underwent Rezum therapy for BPH between 2019-2023, identifying 53 catheter-dependent patients (45 with indwelling catheters, 8 requiring clean intermittent catheterization). Voiding trials were attempted at one-month post-procedure, with follow-up stratified into three intervals: 3 months, 6-9 months, and 1-3 years. Univariable and multivariable regression modeling identified predictors of persistent urinary retention. Results Among the 53 patients, 45 had indwelling catheters while 8 required CIC. The majority of patients (90.5%, 48/53) had an American Society of Anesthesiology (ASA) score of 2 or 3, limiting them to procedures under local anesthesia or brief general anesthesia. Sexual function preservation was a priority for all ASA 1 patients (5/5) and approximately half of ASA 2 patients (6/13). Among the 11 sexually active patients, 90.9% (10/11) reported no change in erectile function at three months, with one patient reporting improvement. Regarding ejaculatory function, 81.8% (9/11) reported no changes, one patient reported improvement, and one patient experienced intermittent antegrade ejaculation. At one-month post-surgery, 47% of patients (25/53) achieved spontaneous voiding, including 24 patients with previous indwelling catheters and one patient with prior CIC. By three months, 60.4% of patients (32/53) were voiding spontaneously, comprising 30 patients who previously had indwelling catheters and 2 patients who had performed CIC. Among the 32 patients voiding spontaneously at 3 months, uroflowmetry was available for 18 patients, showing a median maximum flow rate (Qmax) of 12.8 ml/s (IQR: 10.5–16.4) and median post-void residual volume of 59 ml (IQR: 29–167). Quality of life significantly improved, with median IPSS-QoL scores decreasing from 5 (IQR: 4–5) preoperatively to 2 (IQR: 1–3) postoperatively (p<0.001). At 6-9 months follow-up, 62.5% of patients (25/40) with documented visits remained catheter-free, while 8 patients continued CIC and 5 retained indwelling catheters. At the final follow-up period of 1-3 years, 69% of patients (17/25) remained catheter-free, with 6 patients performing CIC and 2 patients maintaining indwelling catheters. Multivariable analysis revealed that patients receiving more Rezum treatments had significantly higher odds of treatment success compared to those receiving fewer treatments (OR = 4.08, 95% CI: 1.12–14.8, p = 0.033). Additionally, larger prostate size was associated with increased odds of treatment response (OR = 1.015, 95% CI: 1.002–1.044, p = 0.042). Conclusions Rezum therapy represents a well-suited treatment option for catheter-dependent BPH patients, particularly those prioritizing sexual function preservation or limited to procedures under local anesthesia. The treatment success positively associated with the number of Rezum treatments administered and larger prostate size. 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

Abstract Introduction 0.05% Chlorhexidine Gluconate (CHG) has increasingly been used as an irrigant for inflatable penile prosthesis (IPP) surgery. Recent in vitro data shows mixed results regarding efficacy, but clinical data is lacking. Objective To explore the cultured organisms and infection characteristics of IPP infections with and without intraoperative CHG use from a large multi-institutional cohort. Methods We queried a retrospective multi-institutional database of patients who underwent IPP placement for cases resulting in IPP Infection. We stratified cases by intraoperative use of CHG as an irrigant or dip. We compared patient and infection characteristics using chi squared tests and independent t-tests. Culture data from IPP explant was reviewed for descriptive analysis. Results We identified 70 IPP infections, 43 with intraoperative CHG use. Patient demographics were similar between infection cohorts. (Table 1). Median time to infection was similar, 46.5 days in the CHG cohort and 34 days in the non-CHG cohort (p=0.518). Culture data were available for 57 (81.4%) patients. For CHG IPP infections, 8 had Escherichia coli cultured at time of explant and 6 grew methicillin sensitive Staphylococcus aureus. For non-CHG IPP infections, Staphylococcus epidermidis (4) and Pseudomonas aeruginosa (3) were the most common cultured organisms. A total of nine unique organisms were cultured for both CHG and non-CHG infections. Negative growth cultures were recorded for 2 patients in both the CHG and non-CHG infection groups. (Figure 1) Conclusions In a large, multi-institutional cohort, IPP infections after intraoperative CHG use were associated with a variety of cultured organisms, most commonly Escherichia coli and Methicillin sensitive Staphylococcus aureus. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast: Advisory board, speaker; Endo: Advisory board; Haleon: Advisory board; Halozyme: Advisory board, speaker; Masimo: Intellectual property; Softwave: Advisory board; Sprout: Consultant; Vertica: Research investigator; Xialla: Advisory board.

Abstract Introduction While most patients with Peyronie’s disease (PD) present with dorsal or lateral curvature, a significant number have ventral curvature (VC). These patients face limited treatment options, as they were excluded from initial clinical trials of collagenase clostridium histolyticum (CCH) due to safety concerns related to the proximity of the injection site to the urethra. However, urethral involvement is rare, as PD plaques develop in the tunica albuginea rather than the corpus spongiosum surrounding the urethra. Moreover, multiple prospective and retrospective studies have demonstrated favorable outcomes with CCH treatment in men with VC. Objective To evaluate the effectiveness and safety of CCH in men with PD and VC in a multicenter, real-world, retrospective study. Methods This is an ongoing phase 4, multicenter, retrospective review of medical records from 15 US physician sites. Eligible patients consisted of patients who are: age ≥18 years with a diagnosis of VC in PD with a palpable plaque that was treated with CCH from 2014 to the study start date at each site. Patients missing baseline (BL; pretreatment) or final (last measurement within 6 months of final CCH treatment) penile curvature measurements were excluded. Effectiveness endpoints included percentage change in VC from BL to last visit, mean change in VC (in degrees) from BL to last visit, and proportion of patients with ≥30% improvement in VC from BL to last visit. Safety was assessed as proportions of patients reporting treatment-related adverse events (TRAEs) throughout the study period. Results As of April 22, 2025, there were 116 patients with mean (SD) age of 58 (10.3) years who were eligible for analysis. Mean baseline VC decreased from 58 degrees to 37 degrees at last visit (37% improvement). An improvement in VC of ≥30% was seen in 73/116 (63%) of patients, with 81/116 (69.8%) experiencing ≥20% improvement. At least 1 TRAE was reported by 12 (10%) patients. TRAEs were mild-to-moderate in severity in 9 (75%) patients and unknown in 3 patients, with most events (14/17 [82%]) related to injection site reactions. As of the data cut, there were no treatment-related serious or treatment-related severe AEs, no reports of urethral involvement or injury, and no reports of corporal rupture. Conclusions Men with PD who present with ventral curvature represent an underserved patient population. Concerns about potential urethral injury pose a significant barrier to both minimally invasive and surgical treatments, thereby limiting available therapeutic options. These updated results from a multi-institutional real-world clinical cohort align with previous findings, and demonstrate that the clinical effectiveness and safety profile of CCH is consistent with the profile of CCH seen in other clinical presentations of PD. Disclosure Yes, this is sponsored by industry/sponsor: Endo USA, Inc Clarification: Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Endo USA, Inc.

Abstract Introduction Penile implant (PI) surgery is a well-recognized strategy for erectile dysfunction (ED) with excellent functional/satisfaction outcomes. To date, little attention has been paid to the attitudes and satisfaction outcomes of female partners of such patients. Objective To qualitatively assess how female partners feel about PI surgery to inform the development of a female partner specific questionnaire. Methods Female partners of men who had undergone PI surgery (3-piece inflatable) underwent concept elicitation interviews. Prior to this, a panel of experts in female sexual health and PI surgery was convened to define potential domains of interest. Women were interviewed by one of two female sexual medicine clinicians to elicit concepts. As part of the spontaneous item generation phase, participants were asked about their attitudes, hopes and concerns prior to PI surgery, as well as changes in partner post-surgery. Participants were then asked whether they identified domains raised by the expert panel that were not mentioned during the spontaneous phase. Additional open-ended questions were asked about experiences before and after PI surgery. Interviews were transcribed verbatim for subsequent qualitative analysis by 2 trained members of the study team. Results 12 women have been interviewed. Mean partner age = 60 years, relationship duration = 20 years. Interviews were held <12 months post-PI for 17% of partners, 12-24 months for 25%, >24 months for 58%. Partner communication and involvement in decision to get the implant were uniquely raised as pre-surgical concerns, whereas PI attributes were uniquely mentioned as post-surgical concerns. How the PI has impacted the man’s self-esteem, whether impacts to self-esteem have affected the partner, and overall satisfaction with sex were most common concepts raised across pre- and post-surgery (See Table). Conclusions Using rigorous qualitative methodology, we have identified concepts that are unique to pre-surgery, post-surgery, and common across the surgical experience among partners of men who have undergone penile implant surgery. These data will facilitate development of a tool to assess female partner attitudes, beliefs and satisfaction prior to and after PI surgery. Disclosure No

Abstract Introduction Inflatable penile prosthesis (IPP) implantation is a common and effective surgical treatment for erectile dysfunction. However, the presence of comorbidities and the use of anti-thrombotic therapy (AT) can complicate surgical decision-making. Due to the correlation between erectile dysfunction and cardiovascular disease, the preoperative comorbidities of surgical patients are important to examine. Objective The goal of this study was to assess the outcomes of IPP implantation in men on active AT therapy compared to a non-AT therapy cohort. Methods A retrospective analysis from 2015 to 2023 was conducted using data from three high-volume implant centers. The study focused on men who underwent three-piece IPP placement. Demographics, comorbidities, secondary procedures, drain information, and complications were recorded. The three centers each have different techniques and approaches to the surgery. Center 1 utilizes a penoscrotal approach, never places a drain, and places the reservoir in an ectopic location. Center 2 utilizes an infra-pubic approach, places a drain which remains in place for 3 days, and utilizes various reservoir locations depending on patient profile. Lastly, center 3 utilizes a penoscrotal approach, places a drain with removal when output is less than 50 mL over 8 hours, and places the reservoir in an ectopic location. Outcomes were analyzed using multivariate and univariate analysis. Results A total of 210 patients on active AT therapy and 128 non-AT patients were included. The AT and non-AT groups showed significant differences in baseline comorbidities, with the AT group exhibiting higher rates of cardiovascular disease, hypertension, and thrombosis (p<0.05). Among patients on anti-thrombotic therapy, 27.6% required revision surgeries and had increased rates of ectopic reservoir placement compared to the non-AT group (p<0.001). Despite these differences, there were no statistically significant variations in overall complication rates between the two groups. Drain output was notably higher in the AT cohort on postoperative days 1 (mean 110.5 cc vs 60 cc, p<0.001) and 2 (mean 78 cc vs 20 cc, p<0.001); however, hematoma rates remained comparable between both groups (p=0.667). Importantly, neither the type of anti-thrombotic therapy nor the surgical approach used appeared to influence postoperative outcomes. Eleven patients (5.2%) experienced complications in the AT arm and 5 patients (3.9%) experienced complications in the non-AT arm (p=0.793). Conclusions IPP implantation is feasible and safe in men on active anti-thrombotic therapy when performed in high-volume centers with appropriate perioperative management. Further studies with larger cohorts and longer follow-up are needed to refine protocols and determine long-term outcomes for these high-risk patients. Disclosure No

Abstract Introduction 0.05% Chlorhexidine Gluconate (CHG) has gained popularity as an irrigant and dip for inflatable penile prosthesis (IPP) surgery. Prior in vitro data is conflicting on the impact of CHG use with hydrophilic coated devices. Objective We sought to identify possible associations between CHG use and hydrophilic IPP infection rate. Methods We conducted a retrospective cohort study of 2,933 patients undergoing IPP implantation across 14 referral centers. Data collection spanned from January 1, 2017 to March 1, 2024. Each surgeon contributed patients who underwent IPP implantation with CHG used as an irrigant and/or dip as well as an equal number of consecutive control patients without CHG use. The primary outcome was IPP explant for postoperative infection. Univariable analysis was used to compare patient demographics, and logistic regression analysis was performed to assess factors associated with infection. Results Hydrophilic devices were implanted in 2,150 patients. Median follow-up for non-CHG patients was 13 months (IQR 18) and four months (IQR 9) for CHG patients. The incidence of infection with intraoperative CHG use was significantly higher compared to those without CHG use (4.6%, 46/1,001 vs. 2.1%, 24/1,148, p<0.001). On multivariable logistic regression analysis, intraoperative CHG use was associated with infection (OR 2.07, 95% CI 1.24-3.47, p=0.01). Additional variables associated with infection included immunosuppression, prior IPP infection, prior priapism, and revision surgery (p<0.01, Table). On subgroup analyses, the increased infection risk of CHG was most clear when CHG was used as both irrigation and dip (OR 2.03, 95% CI 1.19-3.46, p=0.01) and when CHG was used during revision surgery (OR 3.36, 95% CI 1.15-9.82, p=0.03). Conclusions In a large multi-institutional cohort, intraoperative CHG use was associated with an elevated incidence of hydrophilic IPP infection. Providers may take these findings into consideration when performing IPP surgery with hydrophilic devices, especially during revision surgery. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Corporation and Boston Scientific

Abstract Introduction While previous research has explored overall satisfaction following IPP surgery, the specific relationship between final implant length and perceived satisfaction in both patients and their partners remains underexplored. Objective We aim to evaluate the association between IPP cylinder length and postoperative satisfaction in both patients and their sexual partners, and to determine whether perceived adequacy of length restoration correlates with overall sexual and psychosocial outcomes. 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 237 patients had a PP placement and completed the first survey and 158 the 12-month survey. The median IPP length was 22 cm (20-23). At 6 months, .189 patients (79.7%) reported moderate to high satisfaction, and this positive response was sustained at 12-months (n=132; 83.5%). At 6 months, 178 patients (75.1%) reported moderate to high partner’ satisfaction, and this positive response was sustained at 12-months (n=129; 81.6%). A regression analysis at 6 months showed a correlation of r=0.148 (p=0.029) and r=0.027 (p=0.743) at 12 months, implying that while significant statistically, it is not strongly related, and other factors are likely contributing to the response. Partner satisfaction showed a correlation of r=0.184 (p=0.008) at 6 months and r=0.032 (p=0.702) at 12 months, again showing no causal relationship between length of the IPP device with perceived satisfaction. A secondary analysis was performed in patients who had prostatectomy and were using vacuum devices before IPP placement (n=51). Of these, 12 (5.1%) reported decreased penile size during pre-op counseling. The median IPP length was 22 cm (19.5-23) and 21 cm (19.6-22) among patients who reported a decrease in size before IPP placement (p=0.574). There was no correlation between this statement and IPP length (p=0.572), nor satisfaction levels in both patients r=0.180 (p=0.221) and partners r=0.015 (p=0.921) at 6 months or 12 months r=0.060 (p=0.701) & r=0.078 (p=0.636). Conclusions IPP length showed a significant correlation but a weak association with patient and partner satisfaction. Our findings underscore the need for a multimodal approach when looking for patient and partner satisfaction and not only to perceived cosmesis. Comprehensive preoperative counseling should address these multidimensional aspects to better align expectations and outcomes. Disclosure Yes, this is sponsored by industry/sponsor: Coloplast Clarification: Industry funding only - investigator initiated and executed study

Abstract Introduction The opioid epidemic has encouraged increased efforts to minimize postoperative opioid use, particularly in urologic procedures. While short-acting local anesthetics are often used in inflatable penile prosthesis (IPP) placement, their effects diminish quickly, potentially leading to higher opioid requirements. Liposomal bupivacaine (LB), a long-acting local anesthetic, may reduce opioid requirements, but its cost and limited prospective data in IPP patients warrant further investigation. Objective To compare the efficacy of long-acting liposomal bupivacaine with short-acting ropivacaine in reducing postoperative pain and opioid consumption following inflatable penile prosthesis (IPP) placement. Methods This randomized controlled trial enrolled adult males undergoing primary IPP placement via a penoscrotal approach. Participants were randomized to receive either LB (20 mL Exparel + 20 mL bupivacaine 0.25%) or ropivacaine (40 mL of 0.5%) as part of a standardized multimodal analgesia protocol. All patients received acetaminophen, gabapentin, and meloxicam perioperatively, with oxycodone prescribed as needed postoperatively (figure 1). The primary outcome was postoperative opioid consumption measured in oral morphine equivalents (OME). Secondary outcomes included pain and anxiety scores assessed on postoperative days (POD) 3, 7, and 14 using visual analog scales. Results Only 13 patients completed the study due to difficulties in recruitment (9 in the long-acting group, 4 in the short-acting group). The long-acting group demonstrated consistently lower opioid consumption at all follow-up points. On POD 3, the median cumulative OME was 7.5 vs. 41.25 in the short-acting group. By POD 14, cumulative OME was 15.0 vs. 93.75. (Figure 2) Pain scores followed a similar pattern, with the long-acting group reporting lower median scores on POD 3 (4 vs. 6) and POD 7 (4 vs. 6). Anxiety scores were also lower in the long-acting group throughout the follow-up. Use of non-opioid analgesics was similar across both groups. Conclusions Despite a limited sample size, this trial showed consistent trends favoring LB over ropivacaine for reducing opioid use and pain following IPP placement. These findings suggest potential clinical benefit but require validation in larger, multicenter studies. The trial also illustrates the difficulty of conducting randomized studies when institutional practices strongly favor one approach. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo pharmaceuticals.