Browsing by Author "Bernie, Helen L."
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Item A review of the literature and proposed algorithm for penile fracture management(Oxford, 2024-01) Hardesty, Juliet; Burns, Ramzy T.; Soyster, Mary E.; Mellon, Matthew; Bernie, Helen L.; Urology, School of MedicineIntroduction In the management of penile fractures, immediate surgical repair has resulted in better outcomes when compared with a conservative approach; however, there is currently no consensus on the treatment of patients presenting beyond the immediate period (>24 hours) following injury. Objectives To examine the latest literature on management strategies in penile fracture and propose an optimal algorithm for the treatment of patients with delayed presentation. Methods A comprehensive search was conducted following the PRISMA-P 2020 guidelines. A search was performed in several databases with the following strategy: (“Penile fracture” OR “fracture of penis” OR “rupture of corpora cavernosa” OR “rupture of tunica albuginea”) AND (management OR treatment OR surgery OR “surgical reconstruction” OR “surgical repair”). This resulted in 108 relevant articles. Two independent reviewers screened these articles according to the inclusion criteria. Full-text review of 56 articles was performed, and ultimately 20 studies were selected. Measures included the use of diagnostic imaging, timing of surgical repair (immediate, <24 hours after injury; delayed, >24 hours), surgical approach, and long-term complications (ie, erectile dysfunction and penile curvature). Results The review highlighted the benefits of immediate surgical repair in penile fractures, demonstrating improved patient outcomes. Furthermore, it found that surgical repair should be considered even in cases with delayed presentation (>24 hours after injury). To better evaluate the long-term impact of delayed surgical intervention on patient outcomes, we recommend standardized postoperative follow-up, with routine assessments of erectile function and penile curvature. Conclusion Contemporary literature suggests that immediate and delayed surgical repair of penile fractures leads to adequate postoperative outcomes, and patients presenting >24 hours after injury should still be considered for surgery.Item Frailty in Surgical Patients: Is it Relevant to Sexual Medicine?(Elsevier, 2022-03) Burns, Ramzy T.; Bernie, Helen L.; Urology, School of MedicineBACKGROUND: As the age of our surgical population continues to rise, there is an increased need for adequate preoperative evaluation and risk stratification to ensure the best possible surgical outcomes for patients. AIM: We sought to describe the 3 main models currently used to evaluate patient frailty and explore how they are being utilized in the field of surgery and sexual medicine. METHODS: We reviewed online resources including Pubmed with relevant search criteria centered around frailty, surgery, sexual medicine, and prosthetics. OUTCOMES/RESULTS: All relevant studies were reviewed and several models for patient frailty emerged; the Phenotype Model, the Frailty Index, the Clinical Frailty Scale, and the modified Frailty Index. Worse frailty indices were seen to be linked to higher rates of complications and mortalities postoperatively. CLINICAL IMPLICATIONS: Although the adoption of patient frailty in the field of sexual medicine has been sluggish, few studies have shown that its use could help predict which patients are at increased risk of complications and may require more support when it comes to postoperative care and teaching. STRENGTH & LIMITATIONS: Overall there is a paucity of literature as it relates to sexual medicine and patient frailty and this paper provides a limited look at the usage of patient frailty in sexual medicine. CONCLUSION: We implore all sexual health providers to begin to incorporate frailty metrics when caring for this population to help reduce postoperative complications and help better predict surgical success.Item Inflatable penile prosthesis placement in Peyronie’s disease: a review of surgical considerations, approaches, and maneuvers(AME, 2024) Good, Jacob; Crist, Nikos; Henderson, Brittney; Karcher, Christian; Sencaj, John; Bernie, Helen L.; Urology, School of MedicinePeyronie's disease (PD) is a fibrotic disorder of the tunica albuginea that results in penile deformity and/or curvature. Patients usually present complaining of penile pain, shortening and deformity resulting in dissatisfaction with intercourse. Many patients with PD will present with concomitant erectile dysfunction (ED). This disease is a significant concern for patients as it impacts both sexual function and overall quality of life. While there are several interventions available for PD treatment, inflatable penile prosthesis (IPP) implantation is considered the gold standard approach for those with moderate to severe concomitant ED, refractory to medical therapy. The goal of treatment is to give a man a functionally straight erection. Placement of an IPP alone may achieve this. However, when curvature still exists, several adjunct procedures may be performed to include manual modeling, plication, plaque incision or excision and grafting. Additionally, advanced lengthening procedures may also be used. In this paper we will present a comprehensive review of the adjuvant straightening techniques that can be used during IPP placement in men with PD and refractory ED when curvature still exists. Patient selection is a key predictor of implant success, as is preoperative and postoperative management to optimize overall patient care and satisfaction. These topics along with the different surgical approaches to IPP insertion for PD will also be discussed, including the benefits and shortcomings of each. A flowchart to aid surgeons in their intraoperative decision making based on curvature characteristics and specific patient concerns is presented.Item Predictors of Curvature Improvement in Men With Peyronie’s Disease Treated With Intralesional Collagenase Clostridium Histolyticum(Oxford University Press, 2022) Flores, Jose M.; Nascimento, Bruno; Punjani, Nahid; Salter, Carolyn A.; Bernie, Helen L.; Taniguchi, Hisanori; Miranda, Eduardo; Terrier, Jean-Etienne; Schofield, Elizabeth; Jenkins, Lawrence; Mulhall, John P.; Urology, School of MedicineIntroduction: Penile curvature is the most common abnormality that is observed by men with Peyronie's disease (PD). Collagenase Clostridium histolyticum (CCH) has become a standard treatment for PD patients. Aim: To identify predictor factors associated with improvements of penile curvature outcomes in men with PD treated with CCH. Methods: We retrospectively collected the data of patients with PD treated with CCH up to 8 injections divided into 4 cycles between January 2014 and July 2020. Per protocol, penile curvature was assessed at baseline, and after the second and ford CCH cycle. If after cycle 2, curvature demonstrated no improvement, or penile curvature was significantly improved and the patient was happy, no further treatment was recommended. However, if penile curvature was significantly improved and the patient remained dissatisfied, 4 cycles were completed. Three categories of response were evaluated: improvement (≥10 degrees or ≥20%, either 1 happens), unchanged (±10 degrees or ±20%) or worsened (≥10 degrees or ≥20%, either 1 happens). Logistic regression analyses were performed to evaluate predictive factors associated with penile curvature improvements. Outcomes: Degrees of the curvature changes between the baseline and after the cycles of CCH. Results: A total of 114 patients underwent CCH treatment. Median age was 57 years. Median PD duration was 11 months. At baseline, mean curvature was 47 degrees, 65% had dorsal curvature, 53% mid-shaft location, and 15% calcification. After CCH treatment, the mean final curvature was 40 degrees. A total of 44% improved the curvature, 39% had no change while 17% worsened after CCH treatment. Of men who had penile curvature improvement with CCH treatment, the mean curvature decreasing in degrees and percentage were 22 degrees and 41%, respectively. Men with baseline curvature ≤ 30, 31-59, and ≥ 60 degrees, the percentage curvature improvement were 29%, 43%, and 60%, respectively. Baseline curvature was the only significant predictor of penile curvature improvement after CCH (OR 1.33, 95% CI = 1.1, 1.7). Clinical implications: We confirmed baseline penile curvature is the most important predictive factor, and this is the first report describing proportions of penile curvature improvement with CCH treatment. Strengths and limitations: This study has several strengths, including the use of validated instruments. Nonetheless, there are limitations: the retrospective nature of the study, a single institution; and modelling device was not controlled. Conclusion: Penile curvature improvement was significantly more common in patients with greater baseline curvature, reaching up to 60% for patients with ≥ 60 degrees. Flores JM, Nascimento B, Punjani N, et al. Predictors of Curvature Improvement in Men With Peyronie's Disease Treated With Intralesional Collagenase Clostridium Histolyticum.Item Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy(Oxford, 2022-12) Salter, Carolyn A.; Tin, Amy L.; Bernie, Helen L.; Nascimento, Bruno; Katz, Darren J.; Benfante, Nicole E.; Carlsson, Sigrid V.; Mulhall, John P.; Urology, School of MedicineBackground: Prior studies suggest that men with good erectile function shortly after radical prostatectomy (RP) can subsequently have worsened erectile function. Aim: To determine the prevalence and predictors of early erectile function recovery post-RP and of worsening erectile function after initial erectile function recovery. Methods: We retrospectively queried our institutional database. Men who underwent RP during 2008-2017 and who completed the International Index of Erectile Function erectile function domain both pre-RP and serially post-RP, constituted the population. Functional erections were defined as International Index of Erectile Function (IIEF)-6 erectile function domain scores ≥24. We analyzed factors predicting functional erections at 3 months post-RP as well as factors predicting a decrease in functional erections between 3 and 6 months, defined as ≥2-point drop in the erectile function domain. Multivariable logistic regression models were used to identify predictors of early erectile function recovery and also of subsequent decline. Outcomes: Erectile function recovery rates at 3 months post-RP and predictive factors; rates of erectile function decline between 3-6 months and associated predictors. Results: Eligible patients comprised 1,655 men with median age of 62 (IQR 57, 67) years. Bilateral nerve-sparing (NS) surgery was performed in 71% of men, unilateral NS in 19%, and no NS in 10%. Of this population, 224 men (14%; 95% CI 12%, 15%) had functional erections at 3 months post-RP. On multivariable analysis, significant predictors of early erectile function recovery included: younger age (OR 0.93, P < .001), higher baseline erectile function domain score (OR 1.14, P < .001) and bilateral NS (OR 3.81, P = .002). The presence of diabetes (OR 0.43, P = .028) and a former smoking history (OR 0.63, P = .008; reference group: never smoker) was associated with the erectile dysfunction at 3 months post-RP. Of the men with early functional erections, 41% (95% CI 33%, 48%) had a ≥ 2-point decline in erectile function between 3 and 6 months. No factors were identified as predictors for this decline. Clinical implications: Only a small proportion of men have functional erections at 3 months post-RP and a notable number of them will experience a decline in erectile function between 3 and 6 months. Strengths and limitations: Strengths: large patient population and the use of validated questionnaire. Limitations: single-center retrospective study. Conclusion: A minority of men had functional erections 3 months post-RP, about half of whom had a decline in erectile function by month 6. We recommend appropriately counseling post-RP patients on the risk of such a decline in erectile function. Salter CA, Tin AL, Bernie HL, et al. Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy. J Sex Med 2022;19:1790-1796.Item Sexual Function in Men Undergoing Androgen Deprivation Therapy(Mary Ann Liebert, Inc., 2022-10-22) Gryzinski, Gustavo M.; Fustok, Judy; Raheem, Omer A.; Bernie, Helen L.; Urology, School of MedicineWith an increase in the use of androgen deprivation therapy (ADT) in men diagnosed with prostate cancer, there are several adverse effects that accompany its utilization. Among these, sexual dysfunction has contributed to significant deleterious effects on quality of life (QoL) and overall satisfaction. This has prompted clinicians to pursue modalities of ADT that may mitigate these adverse sexual effects, which include continuous versus intermittent ADT, changes in the duration of ADT, and novel methods of cyclical androgen exposure during treatment. Importantly, this must not come at the expense of oncological outcomes. In addition, some men treated with ADT experience persistent hypogonadism and side effects from these medications that linger well after treatment is completed. In this systematic review we discuss the pharmaceutical, mechanical, and psychological methods that play an important role in the mitigation of these sexual side effects, including erectile dysfunction and decreased libido, and their uses and benefits are further discussed. Ultimately, the benefits of ADT and the possible morbidity that these men may experience from use of ADT, as well as options to minimize their side effects need to be discussed with the patient and their partner to make an informed decision and ensure patient autonomy while providing the most up-to-date evidence. Given the prevalence of prostate cancer in the aging male population, this systematic review aims to further explain the different ADT regimens and options for men, as well as discuss the sexual side effects that accompany these treatments and ways in which to mitigate these side effects to improve patient QoL.Item The Relationship Between PSA and Total Testosterone Levels in Men With Prostate Cancer(Oxford University Press, 2022) Flores, Jose M.; Bernie, Helen L.; Miranda, Eduardo; Nascimento, Bruno; Schofield, Elizabeth; Benfante, Nicole; Carlsson, Sigrid; Mulhall, John P.; Urology, School of MedicineBackground: Prostate-specific antigen (PSA) secretion is a testosterone (T) dependent process. Published data suggest that a low T level is an independent predictor of higher-grade prostate cancer (PC). Aim: To evaluate the relationship between T and PSA in patients with PC. Methods: All men diagnosed with PC with a recorded pre-treatment total T level measurement were included in this analysis. We analyzed demographic, clinical, and pathological data. Patients were stratified according to pretreatment PSA levels: <2 ng/mL, 2-4 ng/mL, >4 ng/mL. Low T was defined as total T < 10.4 nmol/L (300 ng/dL), very low T < 6.9 nmol/L (200 ng/dL). Outcomes: T levels by PSA groups according to the PC pathology. Results: In this retrospective study, mean patient age was 61 years among 646 men. The distribution by PSA group was: 8% (<2), 17% (2-4), and 76% (>4). The mean T level across the entire cohort was 13 nmol/L (374 ng/dL). Overall, 30% had a T level < 10.4 nmol/L (300 ng/dL). The mean total T level by PSA group was: <2 ng/mL, 7 nmol/L (206 ng/dL); 2-4 ng/mL, 13 nmol/L (362 ng/dL); >4 ng/mL, 14 nmol/L (393 ng/dL), P < .001. PSA <4 ng/mL was a significant predictor of low T in men with PC GS ≥8. PSA <2 ng/mL was a significant predictor of very low T independent of the PC pathology. Clinical implications: These findings suggest that clinicians should consider measuring T levels when a patient diagnosed with PC GS ≥8 and PSA level <4 ng/mL, and for each patient with PSA level <2 ng/mL independent of the PC pathology. Strengths & limitations: Our study has several strengths including (i) inclusion of a large population of men, (ii) use of a database which is audited and reviewed for accuracy annually, and (iii) use of an accurate T assay (LCMS). Nonetheless, there are limitations: (i) the subjects of the study are from a single institution, and (ii) we did not measure free T levels. Conclusion: In men with PC with GS ≥8, PSA level <4 ng/mL predicts low T. PSA <2 ng/mL predicts very low T independent of the PC pathology.