Faculty Bibliography

Collagenase clostridium histolyticum (CCH, Xiaflex, Xiapex) is the only FDA-approved medication for treatment of Peyronie's disease. It is unclear how practitioners actually use CCH in their own practices. The objectives of the study were: (1) to identify variability in practice patterns for CCH among practitioners, (2) to assess adherence to the package insert instructions, and (3) to evaluate whether provider satisfaction was associated with adherence to instructions. A 30-question online survey was distributed to 1270 members of the International Society for Sexual Medicine (ISSM) from the EU, USA, Canada and Australia. Of the 30 questions, 10 survey questions had only one response consistent with the CCH package insert recommendations. An "adherence" score was calculated for each survey participant depending on how many of these questions were answered correctly. The average adherence scores of various groups were compared using a student's t-test. A chi-squared test was used to determine association between categorical variables. Of 202 total responses, 132 practitioners reported using CCH out of 1270 ISSM members from countries where CCH is available (10.4% response rate). Practitioners from outside the USA were more likely to be satisfied with CCH (p = 0.006), and more experienced users (>20 uses) were more likely to be satisfied than less experienced users (<10 uses) (p = 0.046). Satisfied users of CCH did not have significantly different adherence scores than non-satisfied users. Even though 67% of practitioners believed they followed the package insert guidelines, only 11% adhered to all the recommendations evaluated by the survey. Treatment adherence to package insert guidelines does not appear to be associated with provider satisfaction. We believe there is utility in seeing a snapshot of these practice patterns so practitioners may feel more comfortable adapting their own practice in light of newer data supporting alternative administration methods.

BACKGROUND:The influence of serious mental illness (SMI) on the treatment and survival of patients with high-grade prostate cancer is not well understood. We compared the initial cancer treatment and cancer-specific mortality of SEER-Medicare patients with locoregional high-grade (nonmetastatic) prostate cancer with and without preexisting SMI. METHODS:We identified SEER-Medicare patients who were 67 years of age or older diagnosed between 2006 and 2013 with locoregional high-grade (nonmetastatic) prostate cancer. Preexisting SMI was identified by claims indicative of bipolar disorder, schizophrenia, and other psychotic disorder, during the 2 years before cancer diagnosis. We used multivariable binary logistic regression to examine associations between SMI and receipt of surgery or radiation concurrent with hormone therapy (definitive initial treatment) within 1 year after cancer diagnosis. We used Kaplan-Meier survival curves, as well as Cox proportional hazards and competing risk models to evaluate unadjusted and adjusted associations between SMI and 5-year cancer-specific survival. RESULTS:Among 49 985 patients with locoregional high-grade (nonmetastatic) prostate cancer, 523 (1.1%) had SMI and 49 462 (98.9%) had no SMI. Overall, SMI was associated with reduced odds of receiving surgery (OR = 0.66, 95% CI: 0.49-0.89) or radiation concurrent with hormone therapy (OR = 0.81, 95% CI: 0.67-0.98) as initial treatments in the year after cancer diagnosis. Additionally, SMI was associated with higher hazard of 5-year cancer-specific death (HR = 1.41, 95% CI: 1.06-1.89) after accounting for competing risks of non-cancer death. CONCLUSION:Among SEER-Medicare patients with locoregional high-grade (nonmetastatic) prostate cancer, those with preexisting SMI-relative to those without these conditions-were less likely to receive definitive initial treatment in the year after diagnosis and had poorer cancer-specific survival 5 years after diagnosis.

BACKGROUND:Removal of the penile prosthesis reservoir can be technically challenging because of its difficult locations either deep in the pelvis or high in the abdominal wall. AIM:To describe a detailed surgical technique for reservoir removal through a penoscrotal approach. METHODS:We describe our preferred method for removal of prosthetic reservoir and present a retrospective review of patient outcomes after reservoir removal. MAIN OUTCOME MEASURE:Primary outcomes included immediate or late complications. Secondary outcomes included operative time. RESULTS:34 patients underwent reservoir removal with the use of our described technique. 23 patients (67.6%) had reservoirs removed because of device malfunction and 11 (32.4%) because of infection. A total of 18 reservoirs (52.9%) were found in the space of Retzius (SOR), whereas the other 16 (47.1%) were in an alternative/ectopic space. 2 cases (5.9%) required a counterincision to remove the reservoir. Mean overall operative time was 96.2 minutes (range 35-175). There were no complications in this series. There was no statistical difference in operative time between reservoirs removed because of malfunction when compared with infection (P = .283). However, there was a difference in operative time between reservoirs removed from the SOR when compared with those removed from an ectopic space, with mean operating room times of 104.5 and 75.4 minutes, respectively (P = .001). CLINICAL IMPLICATIONS:Reservoir removal through a penoscrotal incision is feasible and safe. STRENGTH & LIMITATIONS:This is the first report, to our knowledge, describing surgical techniques and outcomes for reservoir removal. Limitations include its retrospective nature and lack of validated questionnaires to assess patient satisfaction. CONCLUSION:Although removal of a reservoir deep in the SOR or placed in alternate/ectopic locations can be challenging, the use of a lighted retractor, meticulous dissection, and a few technical maneuvers described allow for safe removal of the reservoir completely intact while avoiding complications. Our technique for a secondary incision in particularly difficult cases is also described. Clavell-Hernández J, Aly SG, Wang R, et al. Penile Prosthesis Reservoir Removal: Surgical Description and Patient Outcomes. J Sex Med 2019;16:146-152.