The Tubing, Hitch and Lasso, Intussusception Anchor (THALIA) Technique: A Novel Approach to Fixate the Penile Implant Reservoir.

BACKGROUND: Penile implant reservoir herniation or migration after inflatable penile prosthesis (IPP) placement may occur with standard or submuscular placement. Additionally, fixating the tubing in patients with retained reservoirs may be helpful for future prosthetic surgeons. AIM: We describe a novel technique to fixate IPP reservoirs in the preferred position. METHODS: We present our preferred technique to fixate IPP reservoirs to prevent migration or herniation. OUTCOMES: We evaluated our success in preventing reservoir herniation or migration. RESULTS: 35 cases successfully underwent our new technique. 30 cases involved reservoirs that were thought to be at a high risk for migration. 5 cases were performed in non-infected retained reservoir scenarios where a reasonable attempt at removal either failed or was considered high risk. No immediate reservoir or infectious complications occurred. Mean follow-up was 5 months. The technique extended the case time by 5-10 minutes. CONCLUSION: Our novel technique is feasible, and although further follow-up and power are needed, fixating the pump tubing may reduce reservoir complications. Yang D, Heslop D, Houlihan M, et al. The Tubing, Hitch and Lasso, Intussusception Anchor (THALIA) Technique: A Novel Approach to Fixate the Penile Implant Reservoir. J Sex Med 2021;18:224-229.

A Review of Treatment-Related Outcomes in Female Partners of Men With Peyronie's Disease-An Opportunity for Improved Assessment.

INTRODUCTION: Peyronie's disease (PD) is a disorder of the penile tunica albuginea, causing penile deformity, shortening, pain, and sexual dysfunction. While studies have shown treatment efficacy for patients, research on treatment-related outcomes for sexual partners is lacking. OBJECTIVES: We sought to review the literature on clinical characteristics and treatment-related outcomes from the perspective of female sexual partners of PD patients. METHODS: We performed a comprehensive literature search of PubMed, Embase, and MEDLINE databases to identify all studies pertaining to PD and partner satisfaction through December 2019. 13 articles that discussed partner satisfaction with treatments of PD including oral, intralesional, and surgical therapy were found in the literature review. RESULTS: At baseline, female partners of men with PD report lower sexual satisfaction and dyspareunia. Results showed that intralesional injection of collagenase Clostridium histolyticum resulted in partner satisfaction in approximately 70% of patients based on differing definitions. Penile plication demonstrated variable partner satisfaction ranging from 34% to 88% whereas plaque incision or partial excision with grafting achieved rates ranging from 90% to 100%. Penile prosthesis implantation resulted in partner satisfaction rates ranging from 40% to 75%. CONCLUSION: PD has a negative impact on psychological and emotional well-being for both patients and their female partners. Surgical and non-surgical treatment for PD has the ability to improve sexual satisfaction of partners. Studies discussed focus on the various forms of treatment for men with PD; however, the available studies were notably limited by small sample sizes, inconsistent use of validated questionnaires, and lack of control groups. In addition, the topic of partner satisfaction discussed in the articles mainly examined the response of female partners and did not discuss effects of the disease on male partners. Clinicians should consider carefully screening PD partners for sexual dysfunction to optimize couple-focused therapy. Further studies are needed to evaluate effects on male sexual partners of PD patients. Parikh NN, Heslop DL, Bajic P, et al. A Review of Treatment-Related Outcomes in Female Partners of Men With Peyronie's Disease-An Opportunity for Improved Assessment. J Sex Med 2020;8:548-560.

Examining the association of health literacy and numeracy with prostate-related knowledge and prostate cancer treatment regret.

INTRODUCTION: Educational materials used in prostate cancer shared decision-making are often written above the health literacy levels of the patients that may benefit the most from such tools. Poor understanding the oncologic and functional outcomes of prostate cancer treatment may influence patient regret during this process. In this study, we assess the association between health literacy, numeracy, prostate-related knowledge and treatment regret in a diverse population. MATERIALS AND METHODS: Patients obtaining care between June and August of 2016 at both community-based and academic tertiary care facilities were assessed for health literacy and numeracy using validated instruments. Prostate knowledge was tested in those patients without a history of prostate cancer using a 29-item questionnaire and patient-level predictors of knowledge were assessed. Prostate cancer treatment regret was assessed in those patients who had a history of prostate cancer. RESULTS: A total of 90 patients were enrolled, 38 (42%) of whom had a history of prostate cancer. African American race (I = 0.039), financial strain (P < 0.001), and educational attainment (P < 0.001) were all associated with lower health literacy on multivariable analysis. Possessing a professional degree (P = 0.021) and higher health literacy (P = 0.001) were associated with greater prostate-related knowledge. Of those with a history of prostate cancer, 9 (24%) expressed treatment regret. Patients with regret were more likely to be African American (n = 6, 66.7% vs. 5, 17.2%, P = 0.004), not married (P = 0.016), and score lower on the literacy (1.0 vs. 8.0, P = 0.009) and numeracy (10.0 vs. 16.0, P = 0.016) scales. CONCLUSIONS: We identified lower health literacy among African American men, and lower prostate-related knowledge in those with poor health literacy. To our knowledge, this is the first study to show an association between health literacy and prostate cancer treatment regret.

The Influence of Indentation Deformity on Outcomes With Intralesional Collagenase Clostridium Histolyticum Monotherapy for Peyronie's Disease.

OBJECTIVE: To identify patient-specific factors associated with patient-reported improvements in functional outcomes after intralesional Collagenase Clostridium histolyticum (CCH) for Peyronie's Disease (PD). METHODS: We retrospectively explored our prospectively maintained CCH registry. We sought to identify patient-specific factors that prevented the need for surgical straightening and/or improved ability to engage in penetrative intercourse. RESULTS: Eighty-six patients underwent CCH monotherapy and had objective follow-up data available. Mean PD symptom duration was 25 months (SD 44) and baseline curvature was 65o (SD 24). Prominent indentation/hourglass deformities (defined as girth discrepancy >10%) were present in 40 patients (47%). Mean objective curve improvement was 19o (SD 20), and 60% achieved improvement ≥15o. Greater baseline curvature was associated with greater absolute improvements in curvature, although there was no association between baseline curvature and relative (%) improvement. Three of 40 patients (8%) with indentation achieved girth improvement. Patients with baseline indentation/hourglass were less likely to report that CCH prevented the need for surgery (35% vs 64%, P = .018). Patients with curve improvement <15o were also less likely to report that CCH prevented the need for surgery (25% vs 63%, P = .0086) or improved penetration (54% vs 89%, P = .018). There were no differences in outcomes based on age, BMI, symptom duration, and presence of biplanar curvature. CONCLUSION: Baseline indentation/hourglass deformity and curve improvement <15o are associated with less favorable functional improvements such as preventing the need for surgery and improving penetration.

Alteplase Instillation for Upper Urinary Tract Clot Dissolution.

Background: We report the first case of instillation of alteplase, a tissue plasminogen activator, to dissolve occlusive upper urinary tract blood clot. Case Presentation: A 67-year-old Caucasian man with a solitary kidney became dialysis dependent because of upper urinary tract clot obstruction after ureteral stent placement for obstructing ureterolithiasis. After failure of more conservative measures, 10 mg of alteplase was instilled through nephrostomy tube daily for 2 consecutive days 30 minutes before manual irrigation with physiologic saline. After alteplase instillation, the occlusive blood clot dissolved with rapid improvement in urinary output and creatinine. Conclusions: Alteplase instillation through nephrostomy tube is a viable option to dissolve obstructing upper urinary tract blood clots.

Development and Initial Testing of the FLOW Instrument: Novel Assessment of Lower Urinary Tract Symptoms in Men.

PURPOSE: We sought to develop a method to assess lower urinary tract symptoms regardless of literacy and numeracy. MATERIALS AND METHODS: We convened focus groups and developed a questionnaire based on 4 identified domains of urinary function, including frequency, incontinence (leakage), nocturia (overnight voiding) and weak stream. We pilot tested the novel FLOW (frequency, leakage, overnight voiding and weak stream) questionnaire in 64 men and performed quantitative analysis to determine internal consistency. Criterion validity was established via direct comparison to the AUA (American Urological Association) symptom score in a larger cohort of 161 men. RESULTS: Median time to complete the FLOW questionnaire was 18.0 seconds (IQR 15.8-21.0). The mean number of positive responses to the FLOW instrument was 1.7. Test-retest reliability was 0.91 and the Cronbach α was 0.67. In the validation cohort there was a significant correlation between FLOW scores and AUA symptom score (r = 0.63, p <0.001). All men regardless of health literacy completed FLOW. However, fewer men with low health literacy completed the AUA symptom score compared to men with adequate health literacy (81% vs 100%, p <0.001). For FLOW health literacy was unrelated to the median completion time (21.5 seconds), the median number of prompts needed (0) or the median score (2). CONCLUSIONS: A critical analysis of the AUA symptom score using valid health literacy scales revealed that it is frequently not completed, requires prompting and takes longer to complete for men with low health literacy. The FLOW instrument represents a novel method to assess lower urinary tract symptoms in all men. It represents a valid alternative to the AUA symptom score.