Introduction Low-intensity extracorporeal shockwave therapy (Li-ESWT) is postulated to have physiologic effects including neo-angiogenesis, upregulation of vasoactive endothelial growth factors, nerve recovery, reduction of fibrotic changes, cavernosal tissue remodeling, and reduction in sympathetic tone. To date, randomized clinical trials have failed to demonstrate a change in penile curvature, with mixed results on erectile function, in Peyronie's disease (PD) patients. Objective To evaluate the treatment effect of Li-ESWT for amelioration of PD-associated fibrosis and PD-associated erectile dysfunction using a rat model of PD. Methods 32 adult male Sprague-Dawley rats were divided evenly into four groups: sham (S), control (T), low setting Li-ESWT (TL), and high setting Li-ESWT (TH). Normal saline was injected into the tunica albuginea (TA) of the sham group. Transforming growth factor beta-1 (TGF-B1) was injected into the TA of the remaining groups to induce Peyronies-like fibrosis. After 5 weeks of TGF-B1 induction, treatment with Li-ESWT shockwave (UroGold 100™) was initiated. Treatment was delivered biweekly for 3 weeks (6 total sessions). Device settings were 600 shocks at 3 Hz, at level 6 (0.093 mJ/mm2) for the Low group and at level 12 (0.125 mJ/mm2) for the High group. Two weeks after the end of treatment, erectile function was measured by ratio of intracavernosal pressure (ICP) to mean arterial pressure (MAP). Histological analysis by H&E and Trichrome staining was performed. Western blot analysis of Collagens I (COL1A1), III (COL3A1), elastin, alpha-smooth muscle actin (a-SMA), and TGF-B1 was performed. Results There was no significant difference demonstrated in erectile function between T control group and TL and TH groups (P > 0.05). However, there seems to be a trend in decreased amount of fibrosis upon examination of the prepared histologic sections. Animals in the TL and TH groups had decreased COL1A1, COL3A1, elastin, and TGF-B1 expression in the TA compared to the T group. a-SMA expression in the treatment groups was found to be increased compared to both S and T groups. Conclusions Our preliminary data shows that Li-ESWT treatments, at different intensities, may decrease fibrosis induced by TGF-B1 TA injections. Additionally, Li-ESWT was not found to have conclusive positive effects on erectile function. Disclosure Yes, this is sponsored by industry/sponsor: Sexual Medicine Society of North America Clarification Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals

Introduction Surgical indications for Peyronie's Disease (PD) may constitute severe penile curvature or deformity including unilateral/bilateral corporal indentation/hinging, hour glassing, and concomitant erectile dysfunction. Penile plication, incision/excision of tunical plaques with grafting techniques are widely used. Recently, extratunical grafting has emerged as newer surgical technique that aims to treat corporal indentation, deformities, or tunical tissue loss in select PD cases. Objective In this video, we demonstrated step by step surgical technique for concurrent penile plication and extratunical pericardial grafting via circumcision incision in patient with severe ventral PD. Methods Video demonstration was edited using surgical footage with additional explanatory slides and audio. Results Video demonstration attached. Conclusions This video demonstrates step by step surgical technique for concurrent penile plication and extratunical pericardial grafting that can be used as an adjuvant surgical technique in treating corporal indentation, hinge effect or deformity with or without penile plication. Disclosure No

Introduction Society has perpetuated the misconception that penis shape and size are a marker of masculinity and sexual ability. Unfortunately, many men experience small penis anxiety syndrome (SPS), a body dysmorphic disorder in which a patient believes their penis to be small even when it is clinically average in length and girth. In these situations, patients who have received proper psychological evaluation may choose to pursue clinical procedures to augment their penis. There is a lack of consensus on current approaches for aesthetic penile augmentation in patients with small penis anxiety. As cosmetic surgery becomes more widely accepted, management of SPS may present a challenge for urologists. Objective We aim to provide a updated review of aesthetic penile augmentation procedures that are available for physicians to discuss with this unique patient population. Our review focuses on procedures and techniques that have been of interest in the scientific literature over the last five years. Methods A PubMed literature review was performed to identify articles published between 2015-2021 on penile aesthetic augmentation procedures. Relevant prospective studies, retrospective studies, and systematic reviews were included, while abstracts and opinion papers were excluded. Search terms included “penis”, “penile,” “augmentation,” “enhancement,” “aesthetic,” “girth,” and “length.” Results After thorough psychological counseling, patients with small penis syndrome may choose to undergo penile augmentation. Augmentation procedures range from invasive to non-invasive. Surgical solutions include grafts and flaps, suspensory ligament release, and suprapubic lipectomy. Minimally invasive solutions include injections of fillers (hyaluronic acid, polylactic acid, and polymethyl methacrylate). Noninvasive solutions include external devices such as vacuum pumps and traction devices. Conclusions In the current climate, aesthetic penile augmentation is becoming a desirable option for many patients but remains clinically controversial. While there are a multitude of treatment options with varying degrees of invasiveness, there is no standardized recommendation for patients who are pursuing penile enhancement. Our review of the literature summarizes recent and relevant studies and demonstrates the need for further research and consensus on penile augmentation procedures. Disclosure No

Introduction The etiology of the uncommon presentation of persistent genital arousal disorder (PGAD) can provide an insight into the hormonal imbalances that effect sexual function and dysfunction in females. We examine, review, and analyze the correlation of the known cases of PGAD that involved hormonal imbalances with a focus on hormone imbalances (HI) from a urological perspective. Objective To review the literature regarding hormonal imbalances in females with PGAD with a focus on HI. Methods A literature review of articles and clinical studies was performed to define the diagnosis, etiology, and treatment outcomes of PGAD. Search terms included hormone imbalances and/or, persistent genital arousal disorder, diagnosis of persistent genital arousal disorder, defining persistent genital arousal disorder, as well as treatment of persistent genital arousal disorder. Results We found the of onset of PGAD on average was 49.2± 13.1 years with the average length of symptoms 4.7± 11.2 years. The common etiology of cases presented as hormonal imbalances with most individuals experiencing this as their only etiology. Overall, individuals who underwent treatment had a 72.2% rate of symptoms being resolved. The treatments administered involved pharmacological, clinical intervention, diet modification, and hypnotherapy. Clinical intervention was used the less than pharmacological treatment but was more successful. Conclusions There was a high frequency of PGAD presentation and treatment involving dopamine medications such as selective serotonin receptor inhibitors (SSRI). When evaluating for this rare disease it is important to keep in consideration the effect of hormone imbalances. Further studies are needed to get a more thorough understanding of the effects of dopamine may have on sexual dysfunction disorders such as PGAD. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific

Introduction Penile imaging for Peyronie's disease (PD) can be challenging. Traditional cross-sectional imaging modalities such as computerized tomography (CT) or magnetic resonance imaging (MRI) can delineate and characterize pathological penile anomalies; however, limitation in imaging interpretations do exist. Optimal imaging of the penis aids in surgical planning and patient counseling. Objective In this study, we aim to utilize a novel three-dimensional (3D) MRI fusion penile imaging modality for men undergoing surgical reconstruction for PD. Methods Men with PD, palpable plaques, and deformed corpora were included in this study. We obtained preoperative cross-sectional MRI penile images and Sexual Health Inventory for Men Questionnaire (SHIM) scores on all included patients. We fused MRI images with Ceevra (Ceevra, Inc., San Francisco, CA, USA) 3D imaging software to develop detailed imaging aiding surgical reconstruction. 3D models were used for preoperative patient counseling and surgical planning as well as intraoperatively. Results A total of six patients were included, 3 African American men and 3 White men. The mean age was 65 and mean BMI was 35. There was no difference in preoperative SHIM scores (4 severe and 2 mild erectile dysfunction). Preoperative MRI images were fused with Ceevra software to develop detailed 3D models of corporal plaques and its related structures. The 3D models were easily accessible to surgeons during preoperative clinic visits and at time of reconstruction (Figure 1). Conclusions In this study, 3D MRI fusion penile imaging for PD has emerged as a potential preoperative advanced imaging modality useful for preoperative counseling and planning, especially in complex PD cases. Further evaluation is prerequisite to evaluate its potential role in aiding intraoperative decision making. Disclosure No