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Introduction: Urethral stricture disease (USD) is found in approximately 0.9% of all men in developed countries; however, the prevalence of USD is expected to increase with time due to an aging population, a rising incidence of prostate cancer, the use of radiotherapy, and increasing utilization of endoscopic procedures in urology. Due to an increasing prevalence of USD, surgeons may encounter an undiagnosed urethral stricture at increasing rates during penile prosthesis (PP) implantation, and there is currently limited data to evaluate the risk of treating the stricture at that time. Objective: Our study aims to monitor the outcomes of PP placement in the event of a urethral stricture. Methods: A retrospective IRB-approved review (IRB00205900) was performed using the Johns Hopkins EMR for patients that had undergone PP implantation and incidentally found USD at the time of procedure from 2009 to 2023. Patients undergoing PP implantation without incidentally finding USD were excluded. Cases that could proceed as planned were classified as "completed," while cases that could not proceed were classified as "aborted." Stricture characteristics (location, size), procedural information, pertinent demographic data, and comorbidities were noted. Successful management was defined as the absence of complications requiring explantation, including device infection, erosion, or failure, within 90 days of the procedure. Recurrence of stricture was defined as the presence or worsening of obstructive lower urinary symptoms at any post-operative follow-up visits. Results: Of the 2375 PP implantations performed from 2009 to 2023, twenty-four cases were identified in which an incidental USD was found. Out of the twenty-four patients, eighteen patients (75%) had IPPs implanted, while six patients (25%) had their procedures aborted. Of the eighteen patients, thirteen (13/18, 72.2%) underwent urethral dilation with Amplatz dilators, three patients (3/18, 16.7%) had passive dilation with a 16 F flexible cystoscope, and two patients (2/18, 11.1%) received a direct vision internal urethrotomy (DVIU). Within 90 days after the procedure, only one patient presented with urinary retention four days after the procedure (1/18, 5.6%). No PP infections were reported within 90 days in any patient. Only one patient (1/18, 5.6%) had their device explanted due to extrusion five years after the procedure. One patient had a recurrence of their stricture after four years (1/18, 5.6%). Of the six patients that had their procedures aborted, three patients (3/6, 50.0%) underwent urethroplasty. One patient (1/6, 16.7%) underwent urethral dilation and suprapubic tube placement, and two patients (2/6, 33.3%) underwent a DVIU. Five of these six cases had strictures greater than 2 cm with urethral lumens between 8-10F (5/6, 83.3%), while one patient had an obliterated urethra (1/6, 16.7%). Conclusions: This retrospective case study of patients receiving synchronous USD management and PP implantation yielded high success and low complication rates. While a large, multi-institutional study should be performed, our study displays promising results and creates a framework that other surgeons may follow. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: The conventional approach for managing ischemic priapism (IP) involves a stepwise process that includes corporal aspiration and irrigation, intracavernosal sympathetic agent injection, shunt surgeries with or without snaking, and penile prosthesis implantation. It is crucial to determine the most appropriate surgical shunt procedure for patients who do not achieve detumescence with medical treatment, as complication rates are known to increase with ischemia time. Objective: This study compared the effectiveness and clinical outcomes of distal penile shunt procedures with or without corporal Burnett "Snake" maneuver in patients presenting with IP. Methods: We conducted a retrospective study involving patients who presented to our emergency department with IP and underwent surgical treatment at our institution between 2005 and 2021. The patients were divided into two groups: Group 1 (n = 26) underwent distal shunt + Burnett snake maneuver, and Group 2 (n = 56) underwent distal shunt-only. Clinical history, clinical parameters of IP, medical and surgical treatment details, and follow-up information, including IP recurrence, erectile function (EF), and complications, were determined through physician-patient interviews during preoperative assessment and postoperative visits. Successful priapism resolution was defined as pain relief, detumescence, and no further intervention required until discharge. Priapism recurrence was defined as a new presentation to the hospital with IP. EF was assessed before distal shunt surgeries and during post-op visits. EF was graded on a 4-point patient-reported scale: 1 = fully rigid, always capable of penetration, 2 = diminished erection, capable of penetration with phosphodiesterase-5 inhibitors, 3 = diminished erection, capable of penetration with intracavernosal/intraurethral injection or vacuum pump, 4 = insufficient erection despite non-surgical treatment methods. Results: The patient's demographic characteristics are shown in Table 1. IP resolution was observed in 24 out of 26 patients (92.3%) in Group 1 and in 30 out of 56 patients (53.6%) in Group 2 (p < 0.001) with a single surgical intervention. IP recurrence was observed in 1 out of 24 patients (4.2%) in Group 1 and in 18 out of 30 patients (60%) in Group 2 among those successfully treated with a single surgical intervention (p < 0.001). When comparing the EF status between groups, 6 out of 14 patients (42.8%) in Group 1 compared to 13 out of 26 patients (50%) in Group 2 had functional preservation of EF (level 1 + level 2) after priapism surgery, among those successfully treated with a single surgical intervention which had EF data in their charts (p = 0.66). Conclusions: Our study demonstrates that Burnett snake maneuver is more effective than distal shunt-only procedures in resolving acute IP. Furthermore, this technique shows greater success in preventing IP recurrences. Regarding EF recovery, Burnett snake maneuver is at least as successful as distal shunt-only procedures, even in cases with longer ischemia times. Disclosure: No. [ABSTRACT FROM AUTHOR]