Introduction The SARS-CoV-2 virus and associated COVID-19 infection is known to cause endothelial cell dysfunction. This has led some to hypothesize that COVID-19 infection may increase the risk of erectile dysfunction. Initial studies evaluating this association have been limited to small, single institution studies or have utilized electronic medical record databases that lack universal follow-up given they only capture follow-up care at a small proportion of health care facilities. Objective To assess if COVID-19 infection recovery is associated with increased rates of newly diagnosed erectile dysfunction (ED) using an insurance claims database. Methods Using IBM MarketScan, a commercial claims database, men with prior COVID-19 infection between January 2020 and January 2021 were identified using ICD-10 diagnosis codes. Using this cohort along with an age-matched cohort of men without prior COVID-19 infection, we assessed the incidence of newly diagnosed erectile dysfunction (ED). Men with ED secondary to prostatectomy or radiation were excluded. Covariates were assessed using a multivariable model to determine association of prior COIVD-19 infection with newly diagnosed ED. Results 42,406 men experienced a COVID-19 infection between January 2020 and January 2021 of which 610 (1.44%) developed new onset ED within 6.5 months follow up. On multivariable analysis while controlling for diabetes, cardiovascular disease, smoking, obesity, hypogonadism, thromboembolism, and GU malignancy, prior COVID-19 infection was associated with increased risk of new onset ED (HR 1.27; 95% CI 1.1-1.5; P=0.001). COVID-19 infection carried a similar association with new onset ED as did diabetes and BMI 25-30, HR 1.3 and 1.29, respectively. Conclusions Prior to the widespread implementation of the COVID-19 vaccine, the incidence of newly diagnosed ED is higher in men with prior COVID-19 infection compared to age-matched controls. Prior COVID-19 infection was associated with a 27% increased likelihood of developing new-onset ED when compared to those without prior infection. Additional longitudinal studies are needed to evaluate the risk of erectile dysfunction after following asymptomatic infection and in the setting prior vaccination. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Cooper Medical, Boston Scientific, Acerus, Coloplast, Endo, Turtle Health, Maximus, FirmTech, StreamDx, Inherent Bioscience.

Introduction Transfeminine genital reconstructive surgery is an important part of gender affirmation for many transgender women. Currently, various vaginoplasty techniques are performed by different surgeons across the United States. Surgical outcomes of individual surgeons and groups have been published in the literature, however complications using an insurance claims database have yet to be reported. Objective Our objective is to present post-vaginoplasty complication rates among surgeons in the United States using a large claims database. Methods A retrospective review was conducted of all transgender women who underwent vaginoplasty using IBM MarketScan insurance claims database between 2011-2020. Baseline patient characteristics, including age, obesity, smoking status, Charlson Comorbidity Index (CCI) and the region the surgery was performed were obtained. Patients were followed after surgery to identify complications. Common surgical complications, such as bleeding/hematoma, wound dehiscence, postsurgical infection, DVT, PE, and MI, and complications specific to gender affirming surgery, such as pelvic pain, dyspareunia, rectal injury, urinary issues, urethral stricture, loss of neovaginal depth, and prolapse, were investigated using ICD-9/ICD-10 and CPT codes. Hazard ratios (HRs) were calculated to determine how baseline factors influenced complications. Results A total of 1588 privately insured patients who underwent vaginoplasty for gender affirmation with 414 different surgeons were identified. The mean age was 34 years (22-53 years), 16% were obese and 8% were smokers. The majority (70%) of patients had a CCI of 0. Overall, at a mean follow-up of 14 months (5-28 months), 66% of patients had a complication. A common surgical complication occurred in 19% of patients and a gender affirming surgery complication occurred in 61% of patients. Among those with a gender affirming surgery complication, 17% had pelvic pain, 3% had dyspareunia, <1% had a rectal injury, 21% had urinary issues, 19% had a urethral stricture, 16% had loss of neovaginal depth and 15% had prolapse. A CCI of 2 had a HR of 1.82 (p=0.004) for a common complication and age had a HR of 1.01 (p<0.001) for a gender affirming complication. Smoking was associated with a statistically significant HR for both common complications and gender affirming complications (1.48 and 1.26, respectively; P<0.05). Conclusions Post-vaginoplasty, the majority of patients have at least one complication based on insurance claims data. All patients should be counseled on smoking cessation prior to surgery to potentially decrease the risk of complications. Disclosure No

Introduction The significant overlap of risk factors for erectile dysfunction and venous thromboembolism (VTE) may disproportionally increase the risk of VTE in men undergoing inflatable penile prosthesis (IPP) surgery. Owing to the absence of available literature, AUA and EAU perioperative VTE guidelines do not address VTE risk with IPP surgery and generally recommend against pharmacologic prophylaxis with outpatient surgery. The Caprini Score is a validated scoring system to estimate VTE risk in the perioperative period. Objective We sought to assess the risk of VTE by calculating Caprini Scores in men undergoing IPP surgery. Methods We retrospectively reviewed and calculated Caprini Scores for patients undergoing IPP surgery at our institution between July 2017 and June 2019. Results 215 patients undergoing IPP surgery were identified with a mean and median Caprini score of 5.96 (SD, 1.63) and 6 (IQR 5,7), respectively. 84% of the cohort was classified as high or highest risk for VTE (Figure 1). This is in part due to our cohort's mean age of 64, mean BMI of 31 and history of prostate cancer treatment as the cause of ED. Prior history of VTE (deep vein thrombosis(DVT) or pulmonary embolism (PE)was identified in 17 (8%) patients with 5 (2%) have a history of both DVT and PE. Conclusions Men undergoing IPP surgery are high risk for VTE based on Caprini score assessment. VTE prophylaxis should be considered in men undergoing penile implant surgery. Before widespread application, long-term data is necessary to assess safety and efficacy of VTE prophylaxis in the IPP surgery population. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author consultant for Coloplast