BackgroundDietary and illness factors affect risk of growth faltering; the role of enteropathogens is less clear. As part of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, we quantify the effects of enteropathogen infection, diarrhoea and diet on child growth.MethodsNewborns were enrolled and followed until 24 months. Length and weight were assessed monthly. Illnesses and breastfeeding practices were documented biweekly; from 9 to 24 months, non-breast milk intakes were quantified monthly. Routinely collected non-diarrhoeal stools were analysed for a broad array of enteropathogens. A linear piecewise spline model was used to quantify associations of each factor with growth velocity in seven of eight MAL-ED sites; cumulative effects on attained size at 24 months were estimated for mean, low (10th percentile) and high (90th percentile) exposure levels. Additionally, the six most prevalent enteropathogens were evaluated for their effects on growth.ResultsDiarrhoea did not have a statistically significant effect on growth. Children with high enteropathogen exposure were estimated to be 1.21±0.33 cm (p<0.001; 0.39 length for age (LAZ)) shorter and 0.08±0.15 kg (p=0.60; 0.08 weight-for-age (WAZ)) lighter at 24 months, on average, than children with low exposure. Campylobacter and enteroaggregativeEscherichia coli detections were associated with deficits of 0.83±0.33 and 0.85±0.31 cm in length (p=0.011 and 0.001) and 0.22±0.15 and 0.09±0.14 kg in weight (p=0.14 and 0.52), respectively. Children with low energy intakes and protein density were estimated to be 1.39±0.33 cm (p<0.001; 0.42 LAZ) shorter and 0.81±0.15 kg (p<0.001; 0.65 WAZ) lighter at 24 months than those with high intakes.ConclusionsReducing enteropathogen burden and improving energy and protein density of complementary foods could reduce stunting.

Introduction Patients with Peyronie’s disease (PD) suffer from a variety of penile deformities including curvature, indentation, hourglass, penile shortening, as well as erectile dysfunction. The presence of a hinge effect can be appreciated at time of penile duplex evaluation as buckling or folding of the shaft when axial pressure is placed on the glans. Patients with hinge effect can experience bothersome buckling of the erection and instability during penetrative sex. The actual characteristics that cause this hinge effect and its clinical implications are not fully understood. Objective We aim to determine the PD factors that cause hinge effect. Furthermore, we seek to assess the role of hinge effect on subsequent surgical intervention. Methods Retrospective chart review was conducted on 1483 patients presenting with PD from 2016 to 2021. 1223 patients who had a complete penile duplex evaluation and hinge assessment were included for analysis. Baseline demographics, penile duplex assessment, and clinical outcomes were recorded. Univariate and multivariate analyses were performed to assess for predictors of hinge effect. Results Hinge effect was observed at the time of penile duplex evaluation in 33% of PD patients. The degree of indentation (1.82 OR, p &lt; 0.001), rigidity of erections (0.82 OR, p=0.002), and degree of primary curvature (1.03 OR, p &lt; 0.001) predicted presence of hinge effect. Furthermore, hinge effect greatly affected the type of surgical intervention required to correct PD deformity. Patients with presence of hinge effect were more likely to require plaque incision/excision and grafting as opposed to tunica albuginea plication in PD patients with good quality erections. When controlling for erectile rigidity, patients who underwent partial plaque excision and grafting were more likely to have hinge when measured girth discrepancy was &gt;1 cm (p &lt; 0.001). In patients requiring penile prosthesis, incision and grafting was more commonly required when hinge effect was present. Conclusions The presence of hinge effect can be extremely bothersome and cause instability of erections during penetrative sex. Multiple factors may predispose to a hinge effect, including quality of erection, severity of curvature. But when controlling for rigidity, a girth discrepancy of &gt;1 cm did appear to pre-dispose to a hinge. Additionally, assessment of hinge effect pre-operatively was important in terms of determining the optimal surgical intervention to correct PD deformities. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

Introduction Peyronie’s Disease (PD) is a debilitating condition characterized by progressive scarring of the tunica albuginea. The resulting deformities are often emotionally devastating to patients, and include erectile dysfunction, painful erections, penile curvature, indentation, hourglass, and hinge deformities. According to previously published surgical algorithm for PD in 1997, partial plaque excision and grafting (PEG) is recommended for patients with &gt;60 degree curvature +/− hinge and strong pre-operative erections while placement of an inflatable penile prosthesis (IPP) is recommended when rigidity is sub-optimal.* Nevertheless, many patients counseled to undergo an IPP refuse and insist on proceeding with PEG due to personal preference. We hypothesize that men counseled to undergo IPP but choose to undergo PEG will report lower satisfaction rates and reduced ability to engage in sexual intercourse post-operatively. Objective Our objective was to evaluate and compare long-term patient-reported outcomes in men who underwent PEG at a single institution between 2007 and 2021. Methods A retrospective chart review was conducted from 2007 to 2021 on PEG surgeries performed at a single, tertiary-care institution in patients ≥18 years old who had &gt;3 months of follow up. Results 251 patients underwent PEG with a mean follow up was 35.5 months. 54 patients (22%) were initially advised to undergo IPP but elected for PEG. Of these 54 patients, 17 (32%) had pre-operative 9-10 subjective erectile rigidity, relative to 110 of 197 (56%) patients who were initially counseled to undergo PEG (p=0.002). On duplex penile ultrasound, patients counseled to undergo IPP had a mean objective erectile rigidity of 7.8, compared to a mean objective rigidity of 8.6 in patients initially counseled to undergo PEG (p 15 units for pre-operative duplex ultrasound evaluation were less likely to be able to engage in post-operative intercourse following PEG surgery (48.6%) relative to those who needed &lt;15 units (71.1%) (p=0.02). Conclusions Patients who were initially counseled to undergo IPP due to sub-optimal erectile rigidity but elected for PEG procedure had worse post-operative ability to engage in penetrative intercourse. Significantly more of these patients also eventually underwent IPP. Pre-operative trimix dosing &lt;15U is a predictor of post-operative erectile function as it may be reflective of better pre-operative erectile quality. Subjective and objective measures of erectile function appear to be critical predictors of post-operative erectile function in patients who had underwent PEG, confirming the previously published 1997 algorithm on the surgical management of PD.* *J Urol 1997; 158: 2149-52. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific (Consultant)

Introduction Peyronie’s disease (PD) is a progressive wound-healing disorder resulting in plaque formation within the tunica albuginea. PD continues to be poorly understood and an area of investigation, with increased awareness by patients and clinicians. Most commonly, PD patients will have a singular plaque and uniplanar curvature in the dorsal or lateral direction. However, previous studies have categorized less common deformities as “atypical”, which includes ventral curvature, multiplanar curvatures, unilateral indentations, hourglass deformity, and severe loss of penile length. Objective We aim to characterize the presenting features of PD within a large cohort of patients presenting to a tertiary referral center. Furthermore, we seek to elucidate the pre-operative factors that correlate with subsequent surgical intervention. Methods 1483 consecutive patients presenting with PD from 2016 to 2021 were retrospectively identified. Patients were excluded if they only had virtual visits, refused penile duplex evaluation, or had PD surgical correction prior to presentation. Baseline demographics, prior treatments, physical exam findings, penile duplex assessment (PDDU), subsequent interventions, and clinical outcomes were documented. Univariate and multivariate analyses were performed to assess pre-operative predictors of subsequent surgical intervention. Results In total, 1263 patients met inclusion criteria. Mean age at presentation was 55.4 ± 11.1 years with a mean duration of PD at presentation of 33.2 ± 42.5 months. Mean primary curvature was 49.8 ± 20.8°. Primary ventral curvature was present in 11.4% and 36.5% of patients had a multiplanar curvature. Mean composite curvature was 60.4 ± 28.2°. Subjective penile shortening was reported by 64.8% of patients with a mean reported loss of 3.8 ± 2.1 cm. During PDDU, indentation/narrowing deformities was appreciated in 73.7%, hourglass deformity in 10.1%, and hinge effect in 33.0% of patients. Calcification was seen in 30.1% of patients. Operative intervention occurred in 35.3% of patients. Hypogonadism (1.56 OR, p=0.04), severity of primary curvature (1.03 OR, p&lt;0.001), hourglass deformity (1.82 OR, p=0.01), decreased tunical elasticity (1.20 OR, p=0.03), and prior intralesional Xiaflex injections (2.94 OR, p &lt;0.001) predicted subsequent surgical correction. Negative predictors of surgical intervention included use of any oral PD treatment (0.43 OR, &lt;0.001) and ability to perform penetrative sex (0.72 OR, p=0.04). 446 (35.3%) patients underwent surgical intervention with 170 (38.1%) plaque incision/excision and grafting, 110 (24.7%) tunical plication, and 166 (37.2%) inflatable penile prosthesis cases. Conclusions Peyronie’s disease remains an incompletely understood disease and presenting features may be changing as a result of more sophisticated evaluation and physician experience. Ventral curvature, multiplanar curvatures, indentation deformity, hourglass deformity, and severe loss of penile length have been described as “atypical”, but these changes are not rare in our cohort of referred patients. Patients with worse erectile function and more severe PD characteristics were predictors of surgical intervention. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.