Sustained Glycemic Control Observed in Diabetic Men Who Improve Hemoglobin A1c Values to Allow for Elective Penile Prosthesis Placement.

OBJECTIVES: We hypothesize that men with diabetes mellitus whose inflatable penile prosthesis (IPP) implantation is delayed for unacceptably high hemoglobin A1c (HbA1c) will have durable improvements in their glycemic control after achieving acceptable HbA1c levels for surgery. METHODS: Per institutional protocol, an A1c <9% must be documented prior to IPP placement. After IRB approval, a single surgeon IPP database was retrospectively queried for data specific to diabetes mellitus management. Men without HbA1c values at ≥1-year follow-up were excluded. Univariate and multivariate statistical analyses were performed to assess associations with sustained HbA1c control. RESULTS: From January 2011 to March 2019, 138 diabetics undergoing IPP were identified. Thirty-seven were excluding for insufficient follow-up. Nineteen of the 101 analyzed men (18.8%) were delayed a median 4 months (range 2-17) for elevated HbA1c values (median 10.1, range 9.1-12.3). Following improvements, median preoperative HbA1c remained higher (8.2% vs 7.0%) in delayed men (P < .001). Among delayed recipients, 11 (58%) improved without medication changes while insulin was newly initiated (5) or dosage was increased (5) in 42%. At 32 months follow-up, a HbA1c <9% was similarly maintained in delayed and nondelayed men (74% vs 87%, P = .17). Delayed men more commonly required insulin therapy at follow-up (89.5% vs 54.9%, P = .008), but had a similar median change in BMI (+0.1 vs +0.1, P = .65). Device infection occurred in 1 nondelayed patient (0.7%). CONCLUSION: Men who improve HbA1c for IPP surgery are likely to demonstrate persistent improvement. IPP implantation appears to be safe in diabetic men with HbA1c <9%.

Vasectomy Simulation Curriculum and Trainer with Enhanced Face, Content and Construct Validity.

INTRODUCTION: We assessed the face, content and construct validity of a newly created vasectomy simulation module. METHODS: Pre-simulation and post-simulation surveys quantifying simulation effectiveness, impact on confidence level and critiques of the overall design were obtained in July 2015 to assess face and content validity. Residents were subdivided based on year of residency and construct validity was ascertained via a 20-objective checklist and individual Likert score as graded by a single attending physician in a blinded fashion. RESULTS: Two medical students and 8 residents (2 Pre-Urology, 2 Uro-1, 2 Uro-2 and 2 Uro-3) were included in the analysis. The response rate was 100% (10 of 10) for the simulation exercise and all residents (100%, 8 of 8) were used in the metric data analysis. Simulation increased the confidence to perform a vasectomy independently on average 1.58 points based on pre-simulation and post-simulation questionnaire analysis (95% CI 1.09-2.89, p=0.02). Training year had a significantly positive association (overall p <0.01) with number of objectives completed. CONCLUSIONS: Our enhanced vasectomy simulation module demonstrated excellent face, content and construct validity.