Citations

Abstract Introduction Infection following inflatable penile prosthesis (IPP) placement is an uncommon yet serious complication, and its management poses significant clinical challenges. IPP infection management strategies continue to evolve, however, multicenter and robust studies evaluating and describing current practice patterns are lacking. Objective Using a large cohort from tertiary IPP referral centers in the United States to evaluate current infection management practice patterns and to identify factors that could predict the approach to managing IPP infections. Methods We queried a retrospective 14-center multi-institutional database for patients with IPP infections between April 2017 and January 1/2025. Patients were categorized by infection management strategy, which included device explant, malleable salvage, and 3-piece IPP salvage. Patient characteristics were compared using chi-square and independent t-tests. Multinomial analysis was performed to investigate patient and perioperative factors associated with management strategy at the time of infection. Results Among 2,934 cases, 85 (2.9%) patients developed IPP infection at a median of 40 (22-78) days after IPP implantation. Infections occurred after primary IPP surgery in 59 (69%), revision in 25 (29%), and after infection salvaged with IPP in 1 (1%). Infections were managed with device explant in 32 (38%), malleable salvage in 43 (51%), and IPP salvage in 10 (12%). A significantly higher proportion of non-White patients underwent salvage (either with malleable or IPP) compared to White patients (p=0.01). Multinomial regression showed no association between patient and perioperative characteristics and infection management (p>0.05). Conclusions In this multi-institutional cohort of experienced implanters, infections were most commonly managed with malleable salvage. Patient and perioperative factors did not predict management approach, suggesting that the decision between explanation and salvage is primarily driven by individual surgeon preference. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston scientific

Abstract Introduction With the growing use of 0.05% Chlorhexidine Gluconate (CHG) as irrigation and dip for inflatable penile prosthesis (IPP) surgery, understanding the possible relationship between CHG use and non-infectious complications is imperative. Such information may guide provider decision-making during implant surgery. Objective We therefore sought to determine whether the use of 0.05% Chlorhexidine Gluconate (CHG) during inflatable penile prosthesis (IPP) surgery was associated with non-infectious wound complications. Methods We performed a multi-institutional retrospective cohort study of patients undergoing IPP surgery from January 2017 to March 2024. The primary outcome was wound complications (ex. rash, wound dehiscence, edema). Secondary outcomes included other non-infectious complications (Table 1). The primary exposure was whether patients received intraoperative CHG either as irrigation or dip. Descriptive comparisons were used to compare CHG and non-CHG cohorts. Univariable logistic regression was utilized to assess if CHG use was associated with any non-infectious complication. Multivariable logistic regression was subsequently performed to assess factors associated with certain non-infectious complications after IPP surgery – controlling for age, body mass index, race, diabetes, and hypertension as covariables. Results Across 2,933 patients, there were 1,573 non-CHG and 1,359 CHG patients. Non-infectious complications occurred in 83 (5%) non-CHG patients and in 65 (5%) CHG patients. Median follow-up was 22 months (IQR 7-59) for non-CHG patients and 8 months (IQR 3-16) for CHG patients. The incidence of wound complications was greater among CHG patients than non-CHG patients (1.0% vs. 0.1%, p<0.01). On univariable logistic regression, CHG use was associated with increased odds of wound complications (OR 7.34, 95% CI 1.65-32.71) but was not associated with any other non-infectious complication (Table 2). On multivariable logistic regression, CHG use remained associated with an increased odds of wound complications (OR 13.86, 95% CI 1.80-106.44). Conclusions Among patients experiencing non-infectious complications after IPP, CHG use during IPP surgery appears to be associated with an increased odds of wound complications. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Corporation and Boston Scientific

Abstract Introduction The EROS (Erectile Restoration Outcomes and Satisfaction) registry provides prospective questionnaire-based follow-up after IPP was founded in 2020 at the Mayo Clinic, Rochester. Objective We sought to assess general trends in the open-ended responses portion of the questionnaire. Methods Data were collected from 2020 to 2025, with a total of 568 responses. The survey included six open-ended questions pertaining to lifestyle change since IPP, reasons not to repeat the procedure, impediments to use, dissatisfaction, what patients wish they had known more about the procedure, and other recommendations. Evaluable data included 6-month responses from Rochester, Jacksonville, and Phoenix. Results Open-ended feedback was given by 66% of patients on what they wished they had known, 54% gave other recommendations, 38% gave lifestyle feedback, 7% elaborated upon reasons not using, 3% on reasons for dissatisfaction, and 2% on reasons they would not repeat IPP. There was an overall very positive response (“Significant Improvement”, n=74.3%) from those who underwent the IPP placement, with some patients reporting that it was far more convenient than other forms of treatment, and even increased spontaneity in their sexual lives, leading to improved relationships. Among the reported responses are increased confidence (n=39.4%), increased sexual activity (n=13.3%), and improved health and exercise levels (n=6.6%). When questioning patients on why they would not repeat the procedure and what their sources of dissatisfaction were, of those who responded to each question (n=12, n=16), the most report complaint was exaggeration of pre-existing curves (n=41.7%, n=25.0%), particularly due to Peyronie’s disease. When questioned about what prevents use, the main response was partner-related or due to personal problems (n=45.2%). The patients did not have many recommendations but hoped for a better way to deflate and inflate the device (n=20.4%) and reported adequate pre-operative education and use of the pump. The table below outlines the categories of responses and the percentage of each keyword reported per question type. Conclusions In addition to standard pre-operative IPP counseling, providers should provide additional focus on potential difficulty with device inflation/deflation, length loss (IPP not in glans), pain/ recovery expectations, potential of new or worsened curve (erect or flaccid), and potential change in sensation. IPP satisfaction is high, as only 2% of patients gave responses on why they would not repeat the IPP, with many men expressing an increased level of overall confidence. Disclosure No

Abstract Introduction Glans ischemia and subsequent necrosis is a rare but devastating complication of inflatable penile prosthesis (IPP) placement. Differentiating true glans ischemia from severe ecchymosis can be difficult but is critical, particularly in light of the adage, “when in doubt, take it out.” However, post-operative glans discoloration can be misleading and result in premature device explantation. Objective To present clinical cases and identify distinguishing features between true glans ischemia and pronounced post-operative ecchymosis, with emphasis on risk factors and evaluation techniques. Methods A retrospective case series was conducted on four IPP patients in 2025 who presented with significant glans discoloration concerning for ischemia. Key operative variables, physical exam findings, and postoperative images were reviewed. Additionally, a prospective database of 298 implants placed under local anesthesia since 2024 was analyzed for glans bruising severity on postoperative day (POD) 3, using a 0–4 scale. Results Common ischemia risk factors included tight circumferential wrap (e.g., Coban), vasculopathy (e.g., prior arterial bypass), prolonged catheterization, and concomitant procedures. Case 1: History of pelvic radiation with ecchymotic meatus and glans. Improved after wrap removal and better lighting. Case 2: Extensive ecchymosis and discoloration of glans and scrotum noted on POD1 after uneventful IPP under local. Case 3: Patchy glans discoloration after multiple Keith needle passes. Skin tone complicated assessment. Case 4: Severe glans bruising immediately post-op following multiple needle passes due to suture breakage. In all cases, the glans was warm, well-perfused, and not painful out of proportion to appearance. No patients required explantation. Glans bruising rates in 298 implants under local anesthesia were: 0 (3.7%), 1 (48.7%), 2 (25.5%), 3 (21.1%), 4 (0.3%), notably higher than with general anesthesia. Key Clinical Indicators: Favors Hematoma: • Vascular corpora • Small/no catheter • Bruising elsewhere • Wrap excluded glans • No blistering • No paresthesias • Glans warm to touch Favors Ischemia: • Avascular corpora • Large indwelling catheter • Minimal bruising elsewhere • Coban wrap on shaft • Blistering present • Pain or paresthesias • Glans cold to touch Conclusions Significant glans bruising can mimic ischemia, particularly in IPPs placed under local anesthesia. Factors such as multiple Keith needle passes, tight wrapping, and poor photographic lighting may contribute to this diagnostic confusion. Warm, non-painful glans with widespread ecchymosis are reassuring. Avoiding premature explantation requires thorough clinical assessment, device unwrapping, and close patient monitoring. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: UroFill, Coloplast, Boston Scientific, Rigicon

Abstract Introduction Sacral neuromodulation (SNM) is an effective third line treatment for overactive bladder (OAB). It is estimated that 10-27% of men suffer from OAB, however, prior studies on SNM have only reported on female-predominant cohorts. OAB in the male patient has gender-specific complexity given the effects of prostatic anatomy and associated therapeutics on voiding function, which may influence treatment outcomes and underutilization of SNM in this population. Objective We sought to assess a dedicated cohort of male patients undergoing SNM for refractory OAB by a single surgeon at our institution. Methods A retrospective cohort study was conducted, analyzing medical records of male patients who underwent SNM implantation for OAB by a single surgeon between February 2023 and September 2024. Data extraction encompassed demographic characteristics, urological history, and micturition parameters. The latter were assessed by using validated bladder diaries completed pre- and post-SNM implantation. Comparative analysis was conducted using independent t-tests and chi-square tests. Results Over the study period, 39 patients underwent either a peripheral nerve evaluation (PNE) or first stage SNM procedure, of which 32 (82.1%) had greater than 50% improvement in symptoms and underwent second stage implantation. 97.4% of the cohort had previously failed OAB medications, 25.6% had previously undergone bladder Botox, and 15.4% had previously undergone percutaneous tibial nerve stimulation. 30.8% had undergone a previous bladder outlet procedure (Table 1). In the cohort that underwent second stage implantation, average total voids in 24 hours improved from a median of 20.9 to 10.3 (Table 2, p<0.001), daily leakage episodes improved from 3.9 to 1.3 (p=0.001) and pad usage improved by >50%. Conclusions In this exploratory cohort, SNM demonstrated safety and efficacy in improving symptoms and quality of life for men with treatment-refractory OAB. Disclosure No

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 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 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