Citations

Abstract Introduction Microdissection testicular sperm extraction (MicroTESE) is a procedure traditionally performed in the operating room for men with nonobstructive azoospermia. Sperm are extracted for use in IVF-ICSI with thawed eggs harvested from female partners. Our practice has evolved to largely perform microTESE in the office with an oral anxiolytic and spermatic cord block, thereby avoiding the risk of general anesthesia and the increased cost of OR utilization. Objective To report sperm retrieval outcomes, embryo development outcomes, and live birth rate amongst patients undergoing office-based fresh microTESE for nonobstructive azoospermia. Methods A review was conducted of all patients who underwent office-based microTESE for nonobstructive azoospermia with a partner that who underwent concurrent oocyte retrieval for an intended in-vitro fertilization (IVF) intracytoplasmic injection (ICSI) cycle 2022-2025. All male partners underwent Y chromosome microdeletion testing, karyotype analysis, and hormonal testing preoperatively. Patients with a diagnosis of hypogonadism were offered medical therapy and those diagnosed with a varicocele were offered varicocelectomy prior to microTESE. Office-based microTESE was performed using a surgical operating microscope, spermatic cord block, and oral anxiolytic. Female partners underwent oocyte retrieval with oocyte cryopreservation prior to microTESE. Oocyte warming and ICSI was performed only following the collection of motile sperm from the fresh microTESE samples. Relevant demographic and clinical data were collected for patients and their partners. Descriptive data analysis was performed and reported as mean ± standard deviation. Results Nineteen patients underwent 20 office-based microTESE procedures. One patient had repeat microTESE after an initial successful sperm extraction and live birth with the intention of having a second child. Overall sperm retrieval rate was 53% for first time microTESE with mean search time 174±74 min. Amongst couples with successful sperm retrieval, normal fertilization rate was 40%. Early cleavage arrest was seen in 84% of normally fertilized oocytes with a 16% blastocyst rate. Embryo development arrested entirely in three couples, while the remaining seven couples had at least one blastocyst on day 5 and underwent embryo transfer. Of these, five resulted in a clinical pregnancy (71%) and all five of these couples had a successful live birth. Conclusions Our small series over 3 years demonstrates high sperm retrieval rates from office-based microTESE. Fertilization rates are comparable with those reported in the literature, and viable pregnancy rate and live birth rate amongst those with successful blastocyst development is high (71%). Given the financial cost associated with microTESE and IVF/ICSI for nonobstructive azoospermia patients, office-based microTESE may be a solution to make the process more financially accessible for couples. Disclosure No

Abstract Introduction Significant clinical variations exist in the definitions of acute/active vs chronic/stable Peyronie’s Disease (PD). While the American Urological Association’s 2015 guidelines define the acute phase as involving symptoms that change and the presence of pain, they do not specify a timeframe. Historically, acute-phase features include penile pain and worsening curvature, with symptom duration ranging from less than 3 to 18 months. Although temporally categorizing PD may have academic value, it may unnecessarily limit or delay treatment. In the United States, collagenase clostridium histolyticum (CCH) is the only FDA-approved treatment for adult men with PD who have a palpable plaque and a curvature deformity of at least 30 degrees. Several real-world studies suggest CCH is safe and effective during the acute phase. Objective To evaluate differences in outcomes by penile pain and symptom duration and to determine whether these factors should inform timing of CCH treatment in men with Peyronie’s disease. Methods A post hoc analysis of pooled data from 2 phase 3 randomized double-blind trials of CCH in PD (IMPRESS I, NCT01221597; IMPRESS II, NCT01221623). Men treated with CCH were stratified by baseline penile pain (Any Pain vs No Pain), based on both investigator-assessed and patient-reported measures. A subgroup analysis further stratified men with Any Pain by disease duration. The primary efficacy endpoint in the phase 3 study was the percentage change in penile curvature from baseline to week 52. A 2-sample t test was used to compare group means for each pain-related measure. Results A total of 364 CCH-treated men were included. Mean penile curvature improvements at week 52 were similar across all 4 investigator-assessed and patient-reported penile pain measures (35.0%-36.7% improvement for the No Pain group vs 32.2%-33.9% improvement for the Any Pain group, P=0.14-0.65). Among those experiencing Any Pain, no statistical differences were observed in men with disease durations that were shorter (12-18 months; 21.8%-34.8% improvement) vs longer (greater than 18 months; 31.4%-36.8% improvement, P=0.20-0.95). Conclusions This study found similar curvature improvements among men treated with CCH regardless of baseline pain or disease duration. Results align with prior studies showing no outcome differences by pain status or disease phase. These findings suggest that pain and disease duration should not be viewed as contraindications to CCH or used to guide clinical decision-making. 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 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 Oncologic testicular sperm extraction (oncoTESE) remains a poorly defined concept that is a heterogeneous and understudied fertility preservation option for cancer patients with male gonads. Given variation in practice patterns, reproductive insurance coverage, and provider availability, there is significant diversity among the accepted indications, desired evaluations, and surgical practices afforded to patients facing a cancer diagnosis. Objective This study aimed to characterize and help further define oncoTESE practice patterns across the United States. Methods A 34-item, anonymized survey assessed provider demographics and oncoTESE practice patterns, including indications, contraindications, workflows, and institutional barriers surrounding OncoTESE procedures. A survey was created and electronically distributed to reproductive urologists across the United States using email addresses obtained via society membership websites. Results Thirty-eight urologists (20%, 38/189) from 21 states responded to the survey. Most (95%, 36/38) were fellowship-trained reproductive urologists, and nearly all (87%, 33/38) reported offering oncoTESE to indicated patients. The most cited indications for oncoTESE were azoospermia (78%, 28/36), anejaculation (72%, 26/36), and severe oligozoospermia or cryptozoospermia on ejaculated specimen (53%, 19/36). Less commonly reported indications included prepubertal or peripubertal status (33%, 12/36) and elevated sperm DNA fragmentation (19%, 7/36). Relative contraindications included inability to consent (86%, 31/36), clinical instability (83%, 30/36), thrombocytopenia (61%, 22/36), and a history of remote chemotherapy (58%, 21/36). When asked how many semen analyses are obtained to confirm azoospermia before proceeding to oncoTESE in patients able to ejaculate, the majority reported two analyses (67%, 24/36), while 28% (10/36) reported one. There was stronger consensus that oncoTESE includes sperm retrieval during back-table orchiectomy (94%, 34/36) and ipsilateral microTESE during partial orchiectomy (86%, 31/36). Greater variability was noted regarding contralateral microTESE at the time of orchiectomy (64%, 23/36), procedures for non-genitourinary malignancies (61%, 22/36), and delayed procedures performed years after diagnosis (42%, 15/36). (Figure 1) Estimated patient costs for oncoTESE were most commonly reported as $2,000–$5,000 (39%, 14/36), followed by $500–$2,000 (22%, 8/36), $5,000–$10,000 (19%, 7/36), and over $10,000 (3%, 1/36); 14% (5/36) were unsure. On a 10-point Likert scale, the most significant barriers to performing oncoTESE were logistical challenges (mean 6.6, median 8), followed by patient cost (mean 5.4, median 5.5) and patient illness (mean 5.3, median 5.0). Conclusions This multi-institutional survey found strong agreement among reproductive urologists on core procedural elements, but substantial variation on oncoTESE definition, patient selection criteria, pre-procedural evaluation, and fertility preservation management. Similar institutional barriers across centers highlight opportunities to improve accessibility and standardize oncoTESE practices. Disclosure No

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 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.