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Introduction: Wave therapy (WT) and platelet rich plasma (PRP) have been evaluated in multiple medical contexts, but there is paucity of long-term data to support their applications in erectile dysfunction (ED) and Peyronie's disease (PD). Despite the American Urological Association and Sexual Medicine Society of North America (SMSNA) recommending against the use of these therapies for ED and PD outside of a clinical trial, many practices offer WT and PRP as penile regenerative therapies. Objective: We aim to understand current perceptions and practice patterns of SMSNA members in offering penile regenerative and aesthetic therapies. Methods: An anonymous online survey was deemed IRB exempt and administered to current members of SMSNA electronically from 4/2023 to 6/2023 asking practitioner's demographics, practice information, their familiarity and offering of various types of penile regenerative therapy (focused shockwave therapy [fSWT], radial wave therapy [RWT], PRP, stem cell therapy [SCT], penile botulinum toxin [Botox] injection) and penile aesthetic procedures including girth and length-enhancement. We included current SMSNA members who are physicians in practice or Advance Practice Providers (APPs) that practice in the US. We excluded those who are trainees and practice outside the US. We conducted descriptive statistics using RedCap. Results: Of the 500 active SMSNA members, 46 completed the survey (response rate 9%). Participants were predominantly male (N=42, 91%), physician (N=43, 93%), fellowship-trained (N=39, 85%), and in practice for a median of 5 years. Participants mostly practiced in academic settings (N=33, 72%), and saw 10 or more patients with ED weekly (N=35, 76%). Most respondents reported being comfortable describing the differences between types of wave therapy (N=28, 61%). A minority of respondents offered RWT (N=3, 7%) and most indicated that there was no to low evidence to support its use (N=31, 67%). Ten respondents offered fSWT (N=10, 22%) and only a minority reported no to low evidence to support the use of fSWT (N=18, 39%). Five respondents (11%) offered PRP and most reported that there was no or low evidence to support use of PRP (N=31, 67%). None of the respondents offered SCT and most reported that there was no to low evidence to support the use of SCT (N=26, 57%). One respondent (2%) reported offering penile botox treatment while 19 (41%) reported that there was no to low evidence to support its use. A minority of survey respondents offered girth-enhancement procedures with three respondents (7%) offering hyaluronic acid. For length-enhancing procedures, eight respondents (17%) offered cosmetic scrotoplasty and three (7%) offered suprapubic lipectomy. Conclusions: Penile regenerative and aesthetic therapies are not common practice among SMSNA members. With the notable exception of fSWT, majority of survey respondents felt that there was little to no evidence supporting penile regenerative and aesthetic therapies. Further understanding the practice patterns of SMSNA members will help identify future opportunities for multi-institutional collaborations to further evaluate the efficacy of these experimental therapies. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: As the prevalence of erectile dysfunction (ED) in the U.S. continues to rise due to an aging population, the use of penile prostheses (PP) to treat refractory ED is expected to increase. In 2017, Onyeji et al analyzed a New York state surgical database and found that the highest quartile implanters had lower re-operation rates in long-term follow-up. Due to a higher risk of infection and morbidity in PP reoperations, compared to primary surgery, minimizing PP reoperations is important. Objective: This study evaluates the association between patient/clinical characteristics and reoperation rates at 90-days and 1-year among men undergoing PP implantation using a national database. Methods: This retrospective claims data analysis used the 100% Medicare Standard Analytical Files (SAF) to identify men aged ≥65 who received PP (malleable and inflatable) between 2017 and 2020. The patients were required to have a continuous enrollment 1-year pre- and post-index PP encounter. The outcomes of interest were reoperation rates (defined as removal, repair, and removal and replacement of PP with or without infection) at 90 days and 1 year following initial implantation. Multivariable logistic regression was used to examine the relationship between reoperation rates and patient demographics and comorbidities: age, geographic region, race (White, Black, and Others [American Indian, Asian, Hispanic, Other, Unknown]), urbanization, baseline Charlson Comorbidity Index (CCI) and comorbidities (diabetes and prostate cancer therapy), primary diagnosis at the index PP implantation, type of index PP procedure, and prosthetic surgeon procedure volume. Urbanization was categorized as urban vs rural based on patient's county of residence and the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. The prosthetic surgeon procedure volume was split into low (1-24 surgeries) and high-volume (≥25 surgeries) based on the 2022 PP International Consensus Forum definition. Results: This study included 12,350 patients who underwent PP implantation. Nearly 50% were aged 65-69 years, 77.2% White, 82.6% in urban areas, and 56.2% had a CCI score of 0 (Table 1). Most of these men (96.0%) received an inflatable PP and 91.2% had ED as their primary diagnosis. The overall reoperation rates at 90-day and 1-year post-implant were 2.19% and 6.15%, respectively. Logistic regression found that low-volume implanters were associated with a 34% (OR 1.34; 95% CI 1.01, 1.78) and 35% (OR 1.35; 95% CI 1.14, 1.60) higher odds of reoperation at 90-day and 1-year post-implant, respectively, compared to high-volume implanters. Men with a baseline CCI of 0 had 19% higher odds of 1-year reoperation (OR 1.19; 95% CI 1.01, 1.40) compared to their counterparts with a CCI of ≥1. Black patient race was associated with 35% lower odds of 90-day reoperation compared to White patients (OR 0.65; 95% CI 0.43, 0.99) but this difference did not persist at 1-year of follow-up. Conclusions: This study highlights that higher case volume reduces the risk of reoperation in the short to medium term, consistent with state-specific data of long-term follow-up. The impact of race and comorbidities warrants further evaluation to optimize patient counseling as they seek surgical treatment of ED. Disclosure: Yes, this is sponsored by industry/sponsor: Boston Scientific. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast, BK Medical. [ABSTRACT FROM AUTHOR]