[48] The role of penile rehabilitation for Peyronie’s disease, does it really work?

Objective: To assess the role of penile rehabilitation for Peyronie’s disease (PD). PD causes penile deformity and erectile dysfunction (ED) in sexually active men with an incidence of 3–9%. Penile rehabilitation is recommended (European Association of Urology 2016) to limit the progression of the disease. Methods: A single-centre analysis of the management of patients with PD over a 2-year period. Data were collected retrospectively via case note review. Results: A total of 68 new patients were seen from July 2015 to October 2017, with a mean (range) age of 55 (23–74) years. All patients were asked to complete a Peyronie’s Disease Questionnaire (PDQ). Penile deformity ranged between 20 and 60°. Vacuum treatment (SOMAcorrect©, iMEDicare Ltd, Watford, UK) was offered in 51 patients as primary therapy. Surgery was offered as primary treatment in 10 patients, and seven patients were discharged with no treatment. In those that received vacuum treatment, subjective improvement was seen in 49% (25 patients). In this group, there was a significant increase in the ability to perform penetrative intercourse, 48% (12 patients). Those that failed SOMAcorrect therapy were offered surgery (26 patients) in the form of Nesbitt’s procedure. The failure group showed only a 38% improvement in the ability to perform penetrative intercourse pre-surgery. In all, 10 patients were offered Nesbitt’s as a primary treatment method with a 60% improvement in ability to perform penetrative intercourse. Pre-treatment mean curvature in those that improved with SOMAcorrect was noted to be 38°. In contrast, those that failed SOMAcorrect or underwent primary surgery had a pre-treatment angle of 44–45°. Conclusion: SOMAcorrect is a valuable tool in select patients to treat PD. It has the potential to prevent significant surgical intervention in a large proportion of patients with minimal adverse effects. Preliminary results show comparable efficacy to surgery with a minimally invasive approach. Subjective outcomes are promising, and it should be considered as primary treatment method in appropriate patients

[84] Management and outcome of peri-urethral lesions

Objective: To present a series of cases of peri-urethral lesions that presented to the urology and gynaecology department over the last 5 years. Peri-urethral lesions are unusual presentation to uro-gynaecology clinics. Clinical diagnosis can be challenging due a broad differential including urethral diverticulum, caruncle, prolapse, peri-urethral cyst, vaginal wall cyst, and neoplasms of urethral or vaginal origin. Methods: A retrospective review of all patients who presented with peri-urethral lesions between November 2013 and June 2018. Data collected included presenting signs and symptoms, preoperative assessment, imaging, surgical management, and outcome. Results: In all, 26 patients were identified (age range 24–83 years). The most common presenting symptom was vaginal pain ± dyspareunia in 18/26 (69%). In eight of the 26 (31%) the main symptom was a vaginal lump, seven (27%) had recurrent urinary tract infections, four (15%) had stress urinary incontinence, three (12%) had voiding dysfunction, and one (4%) was asymptomatic. On clinical examination, all patients were found to have a solitary vaginal lump measuring 1–4 cm. Five (19%) patients were treated conservatively. In all, 21 (81%) had trans-vaginal complete excision. Histological examination confirmed the diagnosis of urethral diverticulum in 15 patients (58%), Skene’s duct cysts in three, and Müllerian cyst and arterio-venous malformation one of each. There were no significant postoperative complications. Magnetic resonance imaging (MRI) findings did not match the histological diagnosis in nine of the 26 (35%) patients. The median follow-up period was 6 months and 10/21 (48%) had complete resolution of their symptoms. Five of 21 (24%) patients had persistent pain and have been treated conservatively by the pelvic floor physiotherapist or pain team, three of 21 (14%) had recurrent urinary symptoms and repeated MRI in two of them was negative. Three patients are still awaiting follow-up. Conclusion: Peri-urethral lesions are uncommon but can be a challenging. MRI can be useful in diagnosis and to plan intervention, but in up to one-third the findings did not match the histological diagnosis. Surgical excision will alleviate symptoms with a small risk of recurrence of symptoms

[47] Management and outcomes of mesh complications in female pelvic floor surgery: Results of the York Mesh Salvage Centre

Objective: To review the management and outcome of complications (erosion, extrusion, pain and obstruction) following urinary incontinence (UI) surgery. Stress UI (SUI) has been treated with synthetic mesh and implants procedures for >20 years with good success rates. A recent review indicated safety and efficacy of mid-urethral slings (MUS) for women with SUI. With increasing public and legal interest in litigation cases related to mesh complications, there is a growing need for surgeons to share their experiences to establish best practice care. York is one of the nationally recognised salvage centres for management of women with mesh-related problems. Methods: Retrospective review of all women who presented with complications related to mid-urethral tapes and implants to our unit since 2012. Results: In all, 64 patients referred with complications related to SUI surgery were included; the majority had their initial UI procedure in other units. The International Continence Society (ICS)/International Urogynecological Association (IUGA) Standardised Graft Complication Classification was used for adverse effect assessment. Patients were discussed in the pelvic floor multi-disciplinary team and reported to the Medicines and Healthcare Products Regulatory Authority (HMRA). Urethral erosions (14), five macroplastique resected and 10 MUS were excised ± Martius vaginal flap. Bladder erosions (seven): four tension-free vaginal tapes (TVTs), two transobturator tapes (TOTs), and one single-incision mini-sling (SIMS), excised laparoscopy + cystoscopy and two required open excision, with one still awaiting treatment. Vaginal extrusions (26) 12 TVTs, eight TVT-obturator, one SIMS, and in the remaining the type of tape was not clear from the history, 19 had excision of tape ± Martius vaginal flap and five are still awaiting treatment. In all, 17 patients had voiding dysfunction or pain and needed urethrolysis or tape excision. Recurrent SUI after salvage surgery occurred in 23% of patients, with the majority treated successfully with autologous pubovaginal slings or Bulkamid. Conclusion: Our centre follows NHS England Mesh group, British Association of Urological Surgeons (BAUS) and British Society of Urogynaecology (BSUG) recommendations. Such complications can result in disabling and catastrophic consequences and should be managed in specialist centres. This had led to growing surgical interest in other treatment options for SUI