Metabolic Syndrome and Cardiovascular Disease after Hematopoietic Cell Transplantation: Screening and Preventive Practice Recommendations from the CIBMTR and EBMT

Metabolic syndrome (MetS) is a constellation of cardiovascular risk factors that increases the risk of cardiovascular disease, diabetes mellitus, and all-cause mortality. Long-term survivors of hematopoietic cell transplantation (HCT) have a substantial risk of developing MetS and cardiovascular disease, with an estimated prevalence of MetS of 31% to 49% among HCT recipients. Although MetS has not yet been proven to impact cardiovascular risk after HCT, an understanding of the incidence and risk factors for MetS in HCT recipients can provide the foundation to evaluate screening guidelines and develop interventions that may mitigate cardiovascular-related mortality. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal to review literature and recommend practices appropriate to HCT recipients. Here we deliver consensus recommendations to help clinicians provide screening and preventive care for MetS and cardiovascular disease among HCT recipients. All HCT survivors should be advised of the risks of MetS and encouraged to undergo recommended screening based on their predisposition and ongoing risk factors

244 Penile Entrapment by Metal Ring: A Video Guide to Surgical Removal

ABSTRACT Introduction Penile rings may be used to enhance sexual function. Prolonged constriction greater than 30 minutes may lead to pain, edema and ultimately ischemic end organ damage. Failure to remove the ring warrants prompt evaluation and can be a surgical emergency. Objective The purpose of this video abstract is to review and demonstrate the management strategies to remove a constricting penile ring. Methods Conservative interventions which can be attempted at the bedside are reviewed. These include but are not limited to sliding the penile ring off of the penis using available lubrication as well as cutting the rings using pliers or bolt cutters. Interventions performed under general anesthesia include repeated attempts at sliding off or cutting the ring, and when these maneuvers fail, utilization of mechanical drills or saws may be indicated. Results The case presented is a 41 year old gentleman who presented with a thick silver metallic ring placed on the base of his penis. The penis had been entrapped for greater than 24 hours. Conservative measures at the bedside were not successful and the ring was ultimately removed in the operating room using a microsurgical saw. The patient experienced a complete cosmetic recovery and did not experience any long-term detriment to his voiding habits. Conclusions Prolonged penile entrapment by placement of a constricting ring risks ischemic end organ damage and is a rare surgical emergency. The conservative and more invasive management approaches are demonstrated in this video. Disclosure No </jats:sec

136 Small Diameter Penile Implants: A Survey on Current Utilization and Review of Literature

ABSTRACT Introduction The small diameter penile implant (SDPI) is a modified IPP with a smaller diameter cylinder utilized in cases of anatomically small corpora or severe corporal fibrosis. SDPIs allow for patients to obtain useable erections, sometimes with the intent to upsize in the future. There is a dearth of literature on the optimal clinical scenarios for utilization of SDPIs, volume of SDPIs placed nationwide, and patient satisfaction results. Objective Our aim is to identify current usage patterns and perceived patient satisfaction of SDPIs among urologic prosthetic surgeons. Methods A 23-question online survey was distributed via email to physician members of the Sexual Medicine Society of North America (SMSNA) and Society of Urologic Prosthesis Surgeons (SUPS). The survey included questions regarding surgeon experience and volume, frequency of SDPI utilization, indications for SDPI, surgical strategy in the setting of SDPI (approach, use of concordant modeling/grafting), reservoir and pump management, and perceived infection risk and patient satisfaction. Results 50 individuals responded to the survey, 48 of whom routinely utilized SDPIs. The most common indication for SDPI placement was corporal fibrosis from prior infection, followed by anatomically small corpora and priapism. The most common maximal dilation diameter was 10 mm (47%), with an additional 23% of respondents utilizing SDPI with 11 mm dilation. 75.4% of respondents sometimes or always intended to upsize to standard diameter cylinders in the future. 68.8% of surgeons routinely counseled patients on the possibility of reduced girth and rigidity with SDPI. Patient satisfaction was perceived to be comparable to standard diameter cylinders in 56.3% of respondents, while the remaining 43.6% believed it to be lower than traditional cylinders. Conclusions SDPI are utilized by prosthetic surgeons in a variety of clinical situations and are frequently effective. Future research is needed to better characterize patient satisfaction and define which patients are best suited for SDPI. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific </jats:sec

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

The majority of patients who die in hospital have a "Do Not Resuscitate" (DNR) order in place at the time of their death, yet we know very little about why some patients request or agree to a DNR order, why others don't, and how they view discussions of resuscitation status

Male urinary incontinence: Artificial sphincter

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize procedures to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.Univ Fed São Paulo, Soce Brasileira Urol, São Paulo, BrazilAC Camargo Canc Ctr, Soc Brasileira Urol, São Paulo, BrazilSoc Brasileira Urol, Rio De Janeiro, BrazilAMB, São Paulo, BrazilUniv Fed São Paulo, Soce Brasileira Urol, São Paulo, BrazilWeb of Scienc