bluuebunny/crossref_metadata_2025 huggingface dataset:
Universal Owners and Climate Change
Authors: Gosling Tom
Published: December 2024

Universal ownership theory proposes that widely diversified investors have a financial self-interest at the portfolio level in reducing market-wide risks relating to environmental or social (ES) issues. This article sets out a double test for determining when universal owner theory justifies investor action and applies these tests to the case of climate change. When applied to the commonly adopted goal of limiting global warming to 1.5°C, universal owner theory runs into problems on both tests. First, it is uncertain whether this goal is financially optimal at the portfolio level. Second, even if it were optimal, investors have limited efficacy to achieve this outcome. This article considers goals that climate-concerned investors might set and the actions they could take that would be consistent with the tests. The actions best supported by evidence involve four areas of focus. First, engagement with investee companies based on realistic goals. Second, positive engagement on policy. Third, modest and bounded impact investments that can credibly be considered as reducing climate risk. Fourth, working to ensure that transition and physical risks are fully incorporated into investment models. Through targeting a more modest set of ambitions, climate-concerned investors can be more impactful while avoiding conflicts with fiduciary duties to clients.
Unusual bot fly larva removed from the scalp of a returning traveler
Authors: Goddard Jerome , Cross David , Huston Carla
Published: December 2024

An aberrant bot fly specimen was removed from the scalp of a patient 3 wk after returning from Belize. The specimen showed little resemblance to the typical human bot fly larva, Dermatobia hominis, prompting a molecular identification using cytochrome oxidase I and II (COI and COII, respectively) mitochondrial DNA sequence regions. A BLAST search was subsequently performed, and both our COI and COII amplicon sequences showed 99–100% match with Dermatobia hominis, despite the specimen’s clearly aberrant morphology. These findings suggest there is much wider variation in Dermatobia larval morphology than previously known or perhaps that there are new or cryptic species within this group.
Popliteal deep vein thrombosis in a pediatric patient with Streptococcus viridans osteomyelitis: a case report
Authors: Hansen Joshua , Ngatuvai Micah , Bermudez Alexys , Salisbury Joshua , Klahs Kyle , Handel Gilbert , Abdelgawad Amr , Thabet Ahmed M
Published: December 2024

An 11-year-old male presented with severe pain in the left knee after a minor twisting injury. Magnetic resonance imaging (MRI) revealed a large fluid collection posterior to the distal femur. CT and intraoperative findings revealed left popliteal vein thrombosis. Irrigation and debridement were performed, and intraoperative cultures confirmed osteomyelitis due to pan-sensitive Streptococcus viridans (S. viridans). Treatment included antibiotic and anticoagulation therapy. At 6 months, the patient was asymptomatic and cleared for full activity. This case demonstrates that deep vein thrombosis (DVT) can occur with S. viridans osteomyelitis, a previously undescribed association. Clinicians should maintain suspicion for DVT with any causative organism in osteomyelitis.
Double naso-enteric tubes stenting in afferent limb syndrome with concomitant proximal efferent limb obstruction after loop gastrojejunostomy bypass: a case report
Authors: Leelapatanadit Jirat , Waratchanont Rawat , Asanprakit Wichitra , Kaewkangsadan Viriya , Satthaporn Sukchai
Published: December 2024

Endoscopic or fluoroscopic guided naso-enteric placement for stenting and decompression has been used in mechanical enteric limb obstruction after gastrectomy or gastric bypass surgery. However, the use of double naso-enteric tube for treatment of multiple enteric limbs obstruction has not been described to date. We present a 61-year-old female with afferent limb syndrome with concomitant efferent limb obstruction which caused by kinking of anastomosis after loop gastrojejunostomy for benign gastric outlet obstruction. Two naso-enteric tubes were placed in efferent limb and afferent limb by endoscopic and fluoroscopic guidance. The patient was able to resume oral intake after 2 weeks of tube placement.
(004) SURGICAL OUTCOMES IN INFLATABLE PENILE PROSTHESIS SURGERY ARE NOT NEGATIVELY INFLUENCED BY DIVERSELY TRAINED ASSISTANTS: MULTICENTER UPDATE
Authors: Atwater BL , Gross MS , Madden-Fuentes RJ
Published: December 2024

Introduction

Inflatable penile prostheses (IPP) implantation is often performed with the help of surgical assistants to facilitate and expedite surgery. Surgical assistants vary and include residents, advanced practice providers, and registered nurse first assistants (RNFA). We have previously published literature suggesting that inflatable penile prosthesis (IPP) surgeries involving residents have similar outcomes and complications as compared to cases performed with non-resident assistants. These findings are now updated to include multiple centers.

Objective

The primary objective was to assess whether overall operative time and complication rates were different between resident and RNFA cohorts at multiple centers.

Methods

A multicenter retrospective review was performed including patients undergoing primary IPP insertion from 2017-2024 with residents or RNFA as assisting surgeons. Data was compiled from two experienced implant surgeons with similar IPP operative techniques at two separate hospitals. All patients had a 3-piece Coloplast Titan Touch IPP (Coloplast, Minneapolis, MN, USA) or a Boston Scientific AMS CX or LGX IPP (Boston Scientific, Marlborough, MA, USA) implanted. Operative times, intraoperative complications, postoperative complications, and postoperative emergency room visits were analyzed. Revision cases and concomitant surgeries were excluded. Rigorous statistical analysis was performed using Microsoft Excel (Microsoft, Redmond, WA, USA).

Results

A total of 356 IPP patients at two institutions were included. Residents assisted in 36% on cases (n = 128), whereas the other 64% of cases were assisted by RNFA (n = 228). Resident postgraduate years (PGY) and RNFA experience levels were similar within the two cohorts. The mean IPP patient age was 64 ± 8 years old for resident cases as compared to 62 ± 11 years old for RNFA cases (p = 0.0001). The mean overall operative time for all cases was 72 ± 19 minutes. Cases assisted by residents took an average of 80 ± 21 minutes, whereas cases with RNFA were shorter at 68 ± 16 minutes (p = 0.0001). Intraoperative and postoperative complications were rare and not significantly statistically different between groups. Postoperative emergency room visits were rare and not significantly statistically different between groups.

Conclusions

These updated multicenter findings confirm earlier research regarding the influence of assistants on IPP surgical outcomes. Cases assisted by RNFA were performed on younger patients with shorter operative times and showed similar complication rates to those completed with residents. Longer operative times during resident cases may indicate that the additional time devoted to teaching residents does not result in an increase in complication rates.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, MenMD, Boston Scientific.
(014) RATES OF INFLATABLE PENILE PROSTHESIS INFECTION WITH INTRAOPERATIVE 0.05% CHLORHEXIDINE GLUCONATE ANTIBIOTIC IRRIGATION COMPARED TO TRADITIONAL ANTIBIOTIC IRRIGATION
Authors: A Pereira T , Good J , Egemba C , O Rust J , Bajic P , L Bernie H
Published: December 2024

Introduction

Primary inflatable penile prosthesis (IPP) surgery carries a 1-3% reported infection rate, but the necessary revision/explant rises to a 10% risk of infection. Intraoperative antibiotic irrigation is employed throughout surgery for this reason. 0.05% Chlorhexidine Glucoronate solution (Irrisept) is an antibacterial, antifungal, and antiviral alternative to traditional antimicrobials.

Objective

In this study we aim to assess the efficacy of intraoperative Irrisept irrigation in preventing post-operative infection in comparison to vancomycin, gentamicin, fluconazole and bacitracin.

Methods

This was a retrospective review of all patients undergoing primary IPP placement or revision, from January 2019-September 2023, at a single institution. Patient demographics, comorbidities, surgery type, operative time, prosthesis type, and 90-day post-operative complications were reviewed. Chi-square analysis was performed to determine statistically significant (p < 0.05) differences in postoperative infections among various groups.

Results

415 men were included in this study, 27% received Irrisept, 31% received bacitracin, 20% received vancomycin + gentamicin, and 23% received some other antibiotic irrigation combination. We found no significant difference in the infection rate between Irrisept and non-Irrisept irrigation (p = 0.523). There was no significant difference in post-operative infections when comparing Irrisept and vancomycin + gentamicin (p = 0.756), bacitracin (p = 0.785), and other combinations (p = 0.304). Additionally, there was no significant difference in infection rates between different prosthesis types. (p = 0.568).

Conclusions

The use of intraoperative Irrisept for antibiotic irrigation is effective in preventing post-operative infections in men undergoing IPP surgery. Irrisept is comparable and at least equally effective to conventional antibiotic irrigation.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast and BK Ultrasound.
(016) ENHANCING SEXUAL AND MENTAL HEALTH THROUGH TANTRA MINDFULNESS THERAPY (TMT®): NEUROPHYSIOLOGICAL INSIGHTS FROM QEEG MEASUREMENTS
Authors: Gentry M
Published: December 2024

Introduction

Emerging psychotherapeutic treatments have increasingly recognized the importance of mindfulness practices in mental and sexual health. Tantra Mindfulness Therapy (TMT®), a synthesis of ancient meditative techniques with modern psychological practices, promises significant health benefits by influencing brain activity. Prior research indicates that mindfulness can profoundly affect emotional well-being and interpersonal dynamics through modifications in neural oscillations.

Objective

The purpose of this study is to explore the impact of TMT® on specific brain wave frequencies-including Gamma waves, associated with cognitive functions like altruism and love-and to examine its effects on psychological states among participants. In addition to how it would affect their sex lives.

Methods

Participants enrolled in a series of TMT® sessions were monitored using quantitative electroencephalogram (QEEG) tools, including the Muse and Mind Monitor systems, which tracked changes in Alpha, Theta, Delta, Beta, and Gamma wave activity. Psychological health was assessed before and after the therapy sessions using a Likert scale (0-10) to evaluate levels of anxiety, depression, and stress.

Results

Post-TMT®, there was a significant elevation in Gamma wave activity, correlating with improved emotional processing and empathy. Concurrently, Beta waves showed dual behavior with initial decreases followed by increases, suggesting enhanced focus and concentration. Alpha waves, typically associated with relaxation, and Theta waves, linked to deep meditation, also saw increases. These changes were accompanied by statistically significant reductions in anxiety and stress (p < 0.05), with notable decreases in depression symptoms reported by participants. Additionally, enhanced feelings of relaxation and euphoria were consistently documented, highlighting the therapy’s positive psychological impact. In addition participants experience less sexual anxiety and erectile dysfunction.

Conclusions

Tantra Mindfulness Therapy (TMT®) effectively induces neurophysiological changes that align with better emotional and mental health outcomes. The complex modulation of Beta, Alpha, and Theta wave activities underlines the therapy’s capacity to enhance focus, relaxation, and meditative depth, thereby making it a valuable psychotherapeutic tool for enhancing sexual and mental wellness. These findings support the integration of TMT® into broader psychotherapeutic practices, offering a new avenue for treating sexual and psychological health issues.

Disclosure

No.
(024) EFFECT OF DAILY PHOSPHODIESTERASE 5 INHIBITOR USE ON TRIMIX INTRACORPOREAL INJECTION DOSAGE IN MEN WITH SEXUAL DYSFUNCTION FOLLOWING RADICAL PROSTATECTOMY
Authors: Khalaf Alla K , Mahdi M , Majzoub A , Jacob J , Slovacek H , Wang R
Published: December 2024

Introduction

Trimix intracavernosal injections (ICI) is believed to be a reliable treatment option for men who underwent radical prostatectomy resulting in satisfactory erections suitable for penetration. Nonetheless, higher doses of trimix ICI may illicit penile pain and are associated with a higher incidence of priapism.

Objective

The aim of this study was to explore whether daily PDE5i use may potentiate the effect of ICI allowing patients to achieve the desired response with lower Trimix ICI dosage.

Methods

We conducted a retrospective analysis of our institutional database to identify patients experiencing erectile dysfunction due to prostate cancer treatment. Data about 155 Patients who underwent Ultrasound Penile Doppler (US PD), utilized Trimix ICI with/without daily PDE5i between 2020 & 2022, and had a follow-up for at least 1 year were included. Correlations were made between demographic data, ultrasound penile doppler readings, and changes in Trimix ICI dosage. Patients were divided into 2 groups based on their PDE5i usage (group 1: No PDE5i intake n = 84; group 2: PDE5i intake n = 71) and chi-squared test was used to explore the effect of PDE5i on changes in ICI dosage.

Results

Overall, 20.6% of the patients had diabetes, 52.3% had hypertension, 76.2% had prostatectomy, 29% had a previous history of radiation treatment, 18.7% had a history of androgen deprivation therapy, and 18.1% reported using B blockers. Additionally, 57% of the patients utilized vacuum erection devices. No significant correlation was observed between changes in ICI dosage and the parameters listed in Table 1. Significantly higher percentage of patients from group 1 reported an increase in Trimix ICI dose during follow-up compared with group 2 (59.1% vs 40.9%, p = 0.04). None of the 155 patients experienced priapism during the follow-up period.

Conclusions

While additional comprehensive follow-up is required, these preliminary results suggest that consistent daily use of PDE5i is not only safe but also has the potential to diminish the requirement for increased doses of Trimix ICI within this specific group of patients.

Disclosure

No.
(031) “INNOVATIVE STRATEGIES FOR ERECTILE DYSFUNCTION: STRATIFY AND DIAGNOSE TO REGENERATE AND RESTORE”
Authors: Rajiwate FL , Ss DV
Published: December 2024

Introduction

Current treatments for erectile dysfunction (ED) prioritize symptom management over addressing root causes, often failing to provide a cure. Transitioning to an “intent to cure” strategy is crucial, focusing on cellular and molecular mechanisms of erection and stabilizing erection homeostasis. A systematic approach to diagnosis and therapy, grounded in understanding erection physiology, is vital for developing effective regenerative and restorative ED therapies. Validating research findings on erection physiology’s intricate mechanisms enables tailored therapeutic strategies targeting specific etiological factors. This abstract underscores the urgent need for regenerative and restorative ED therapies, revolutionizing management and enhancing patient outcomes.

Objective

1. To assess the Vascular Reactive Index (VRI) and Augmentation Index (ALX) in Vasculogenic erectile dysfunction (VED) patients. 2. To correlate the results with the clinical condition to assess the diagnostic sensitivity. 3. Categorization of VED based on VRI and ALX value.

Methods

Conducted at Ankur Health Care, Bangalore, India from September 2021 to January 2023, this prospective study included 199 patients (n = 199). Among them, 115 had no comorbidities, while 44 had comorbidities. Patients diagnosed with vasculogenic erectile dysfunction (VED) via standard penile Doppler criteria, regardless of age, were included. Exclusion criteria comprised 40 patients with psychogenic ED. Vascular Reactive Index (VRI) and Augmentation Index (ALX) were measured using Vendys 5000 and SphygmoCor® XCEL, respectively, adhering to standardized techniques.

Results

In vasculogenic erectile dysfunction (VED), prevalence peaks among individuals aged 31 to 40 years. Regarding IIEF scores, 40.7% showed mild to moderate, 30% moderate, 29% severe, and 5.3% mild scores. EHS grades were predominantly grade 2 (67%), followed by grades 1, 3, and 0. VRI analysis revealed poor diagnostic sensitivity (47.7%), while ALX exhibited good sensitivity (92.9%). Penile Doppler had 85% sensitivity, VRI 47%, ALX 92%, and PWV 17.60%. These findings underscore the importance of comprehensive diagnostic approaches in managing VED.

Conclusions

Our study reveals the diagnostic sensitivity of vascular parameters in Vasculogenic Erectile Dysfunction (VED). ALX emerges as the most sensitive marker, followed by Penile Doppler and VRI. Arterial stiffness prevails over endothelial dysfunction in VED, albeit less severe. These findings underscore the complexity of vascular factors in VED and highlight the need for comprehensive assessment. Advancements in sexual physiology research are crucial for developing restorative therapies aiming to cure ED. Future research should focus on unraveling the cellular and molecular mechanisms underlying erection homeostasis to improve treatment outcomes.

Disclosure

No.
(039) ERECTION DURATION AND FIRMNESS: A DESCRIPTIVE ANALYSIS FROM A POPULATION-BASED STUDY
Authors: Saffati G , Orozco Rendon D , Daily R , Khera M , Justin E
Published: December 2024

Introduction

Erectile function is a critical aspect of male sexual health, governed by complex physiological mechanisms, and its evaluation is essential for diagnosing erectile dysfunction and understanding broader sexual health issues. While traditional assessment methods like self-reports and laboratory techniques have limitations, the advent of wearable penile ring devices enables continuous, real-world monitoring of erections with unprecedented objectivity.

Objective

This study synthesizes data from the FirmTech penile ring to provide insights into average erection characteristics and enhance our understanding of erectile function and its implications for overall well-being.

Methods

This study retrospectively collected data from all patients who used the FirmTech TechRing, a device designed to monitor erectile data, between August 14, 2023 and February 14, 2024. The collected data were de-identified and anonymized in accordance with FirmTech’s privacy policy, ensuring user confidentiality. FirmTech’s proprietary algorithm processes the recorded penile activity data to detect erections and generate graphical representations, which are reported through the accompanying application.

Results

The dataset comprised 2446 recorded observations from 795 participants, with a mean age of 50 years (SD = 13.46) and a mean BMI of 27.03 kg/m2 (SD: 5.14). Diabetes prevalence stood at 10.7%, with 11.4% of all patients being current smokers. For recordings less than 1 hour (n = 218), the median recording duration was 25.2 minutes, during which 276 erection events were documented, with a median duration of 12.1 minutes and a firmness rating of 8.6/10. In contrast, for recordings exceeding 1 hour (n = 2228), the median recording duration was 7.25 hours, with 5599 erection events identified. These lengthier recordings featured a median erection duration of 30.5 minutes, a median of 2 erections per recording, and a median firmness of 7.25/10. Histograms depicting erection durations for recordings lasting less than 1 hour and those exceeding 1 hour are illustrated in figs. 1A and 1B, respectively.

Conclusions

This study provides an unprecedented, objective look at male erection characteristics in real-world settings through wearable technology, paving the way for deeper insights into sexual health and function as well as improved strategies for addressing erectile dysfunction and other related concerns.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: FirmTech.
(046) SEXUAL HEALTH AMONG WOMEN WITH POLYCYSTIC OVARIAN SYNDROME
Authors: Gharbi I , Kaabia O , Smaali MH , Guefrech O , Bahri YM
Published: December 2024

Introduction

Polycystic ovary syndrome (PCOS) is a common hormonal disorder in young women. It is associated with several physical changes such as excessive facial hair, acne, and obesity. PCOS can lead to hormonal imbalances that may affect sexual health.

Objective

This study aims to explore the association between PCOS and female sexual function.

Methods

We conducted a nested case–control study where the cases were self-reported PCOS patients and controls were self-reported healthy women matching for medical history, age, and relationship status. Data was collected through an online self-administered questionnaire. The sexual function was assessed through validated translations of the Female Sexual Function Index (Female sexual dysfunction is defined by an FSFI score ≤ 26.55).

Results

In this study, we included 42 females with PCOS who were compared to 84 controls. Age and other main socio-demographic components were similar between groups. The prevalence of female sexual dysfunction among PCOS patients was 40.5% compared to 47.6% in the controls. (p = 0.44). There was no statistical difference between both groups in terms of total FSFI score (p = 0.43). There was also no difference between the groups among the six FSFI domains’ scores (Desire, Orgasm, Excitation, Lubrication, Pain, and Satisfaction).

Conclusions

This case–control study shows no difference in terms of sexual function between PCOS patients and healthy young women. Although the literature may claim that PCOS might be associated with an altered sexual health, our population was under treatment at the time of study and PCOS hormonal treatment may have interacted with patients’ sexuality.

Disclosure

No.
(050) EFFECT OF VAGINAL ESTRIOL ON MOOD DISORDER SYMPTOMS IN POSTMENOPAUSAL WOMEN WITH DYSPAREUNIA: A RANDOMIZED CLINICAL TRIAL
Authors: De Paula SR , Sanches Carneiro P , Henrique Pires Okano S , Mendes MC , Alves Da Silva L
Published: December 2024

Introduction

The climateric is a period of notable physical and social changes, often accompanied by emotional problems, especially in women experiencing symptoms of the genitourinary syndrome of menopause (GSM), notably dyspareunia. There is orrelation between dyspareunia and depression, adversely affecting the quality of life during this period. While acknowledging its complexity and multifaceted nature, it is understood that a substantial aspect of the pathophysiology of depression in menopausal and postmenopausal women is sustained by hypoestrogenism. The estriol is the primary estrogen specifically targeting issues associated with estrogen deficiency, including dyspareunia.

Objective

To investigate the relationship between the risk of anxiety and depression in women with dyspareunia undergoing estriol treatment on proximal and distal vaginal wall.

Methods

this is a randomized controlled trial. A total of 176 postmenopausal women aged 40 to 65 years, diagnosed with dyspareunia, were randomly allocated into three groups: proximal estriol group (PEG), distal estriol group (DEG), and a vaginal water-based lubricating gel group during sexual intercourse (GL). The treatment duration spanned 12 weeks, with follow-up assessments conducted accordingly. Main Outcome Measures: The HADS instrument was utilized to evaluate mood disorder symptoms.

Results

The sample was homogeneous among the groups concerning baseline data (Age, BMI, FSH, Glucose, TSH, and estriol). Serum estriol levels after treatment did not significantly increase and remained within normal parameters. When comparing the baseline assessment to three months after intervention, a notable decrease in the scores of the Hospital Anxiety and Depression Scale (HAD) was observed in both the PEG group (15.95 ± 7.61 to 6.53 ± 3.4, p < 0.01) and the distal estriol groups (15.46 ± 8.11 to 6.68 ± 4.71, p < 0.01), while there was a non-significant decrease in the GL group (15.67 ± 6.26 to 7.26 ± 4.01, p = 0.08). For the anxiety domain, all treatments were effective in reducing scores (PEG: 8.47 ± 4.64-5.62 ± 3.35, p < 0.01; DEG: 8.35 ± 4.83-5.31 ± 3.61, p < 0.01; LG: 8.14 ± 3.89-7.01 ± 4.17, p = 0.04). In the depression domain, a significant reduction was observed for the estriol-treated groups (PEG: 7.47 ± 3.91-12.24 ± 6.18, p < 0.01; DEG: 7.11 ± 3.79-11.97 ± 7.77, p < 0.01; LG: 7.52 ± 3.19-14.36 ± 7.35, p = 0.34). In the comparison between groups, PEG and DEG interventions were superior to the GL.

Conclusions

All treatments resulted in reductions in mood disorder scores. However, estriol treatments exhibited superiority in improving the HADS scores for anxiety and depression compared to GL. Despite this, there was no significant increase in serum estriol levels. Therefore, it can be inferred that the treatment of dyspareunia may have positively influenced the mood of these women.

Disclosure

No.
(109) PROFESSIONAL QUALIFICATION OF CONTENT CREATORS IN PENILE AESTHETIC PROCEDURES ON SOCIAL MEDIA PLATFORMS IN BRAZIL
Authors: Messina L , Fregonesi A , Messina C
Published: December 2024

Introduction

Social networks have become a source of information on various topics, including genital aesthetics. But these data are not always reliable, as the authors are not necessarily trained in these procedures.

Objective

This study aims to assess the professional qualifications of individuals disseminating penile aesthetic techniques on popular social media platforms in Brazil, analyzing the credibility of the information shared in relation to the professional status of the content creators.

Methods

A comprehensive internet search was conducted across YouTube, Facebook, and TikTok using keywords such as “male genital aesthetics,” “penile thickening,” “penile enlargement,” “penile bioplasty,” and “penile harmonization.” The first 30 results for each keyword on each platform were analyzed to classify the content creators into medically qualified professionals (doctors) and non-medical professionals, further subdividing the latter based on their disclosed qualifications.

Results

TikTok displayed the highest number of views at 3121889 but had the lowest proportion of medical professionals (30%) sharing content on penile aesthetics. YouTube had 830 873 views with a higher presence of medical professionals (27 doctors versus 3 non-doctors). Facebook, while having the least views (24000), maintained a high ratio of medical professionals (28 doctors versus 2 non-doctors).

Conclusions

The findings indicate a significant public interest in penile aesthetic procedures in Brazil, with social media being a primary source of information. While a majority of the content is produced by medical professionals, the platform with the highest engagement, TikTok, shows a concerning trend with only 30% of the content creators being medically qualified. This disparity highlights the need for enhanced regulation and public education to ensure the credibility and safety of information regarding penile aesthetic procedures.

Disclosure

No.
(123) OUTCOMES OF VAGINOPLASTY IN PATIENTS WITH DISORDERS OF SEX DEVELOPMENT
Authors: Monteiro Filho M , Bruno Z , Nacle L , Ciriaco M , Bruno P
Published: December 2024

Introduction

The use of autologous skin grafts through the McIndoe technique for neovagina construction is the most common approach for patients with vaginal malformation, atresia, or agenesis. However, this technique leaves a scar at the donor site with potential for infection and dehiscence. A novel technique developed in Ceará, using Nile tilapia skin, has been performed since 2016 with great results.

Objective

To describe the main etiologies, epidemiological data, and gynecological examination findings of a group of patients with differences in sex development (DSD) who underwent neovaginoplasty at a tertiary university hospital.

Methods

This is a retrospective, cross-sectional, and quantitative study through the review of medical records of patients who underwent neovaginoplasty from April 2004 to April 2024. The collected data were organized in a spreadsheet and presented as mean, number, and percentages.

Results

Records of 62 patients were obtained during this time period, of which 74% were diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome; 17% with 46,XY DSD; 3% with other Müllerian anomalies; 1% with Fraser syndrome; 1% with the classical form of congenital adrenal hyperplasia; and 1% with ovotesticular DSD with 46,XX karyotype. The average age at diagnosis was 17.9 years and the average age at surgery was 20.8 years. Regarding the technique used, 68% underwent neovaginoplasty with Nile tilapia skin, 29% with autologous skin, and 1% with the sigmoid colon, the latter performed at another hospital. During the first consultation, 82% had a vaginal canal length of less than two cm, with an average of 0.6 cm (two patients had attempted vaginal dilation with silicone molds prior to surgery, reaching a maximum of two cm). Out of all cases, 51 had information on vaginal length in postoperative follow-ups. Vaginal length was measured at the first, third, sixth month, and one year postoperatively, with an average of 8.2 cm. Four patients, who were not sexually active and did not use the silicone mold as instructed postoperatively, experienced a regression to less than four cm in vaginal length one year after surgery. Half of the patients reported satisfactory sexual activity with penetration; six complained of a short vagina and dyspareunia, while this information was not found in the records for the remaining patients.

Conclusions

Neovaginoplasty using Nile tilapia skin has proven to be an important tool for promoting the quality of life and sexual health of patients with DSD associated with vaginal atresia or agenesis.

Disclosure

No.
(131) SHAEER’S CAVERNOTOME: IMPLANTATION OF A FULL-SIZE INFLATABLE PROSTHESIS IN POST-PRIAPISM FIBROSIS
Authors: Shaeer O
Published: December 2024

Introduction

Implantation of a penile prosthesis in cases of corporeal fibrosis is a challenging procedure. Cavernotomes aid excavation of fibrous tissue in scarred corporal bodies. However, in many cases, the track established -with risk and difficulty- barely suffices for a narrow base inflatable or girth-9 malleable rods. The patient may have this exchanged with a full-size implant after several months, in another surgery. Shaeer’s Cavernotome is a corer, that cores out and grinds fibrous tissue in gentle rotatory movements rather than forceful forward thrusting. The process is therefore safer, and with lower risk of perforation. By choosing the maximum size of Shaeer’s cavernotome (6-13 Hegar), a track wide enough for full-size cylinder – rather than down-sized cylinders - can be established in one pass.

Objective

To demonstrate coring the scarred corpora cavernosa using Shaeer’s Cavernotome in cases of post-priapism cavernous fibrosis, enabling the implantation of a regular size inflatable implant.

Methods

Surgery was performed in 11 cases of post-priapism fibrosis, average duration post-priapism being 9.7 months +/−3. Incision was penoscrotal. Dilatation with blunt dilators failed. Corpora cavernosa and crura were fully excavated using Shaeer’s cavernotome, followed by dilatation of the track up to the maximum possible Hegar size with blunt dilators.

Results

Excavation succeeded up to size 13.5 Hegar in 7 cases and up to size 12.5 in 4 cases. One proximal crossing over occurred. No perforations were encountered. Three-piece inflatable penile prosthesis was implanted in all cases, with regular cylinders rather than down-sized. Average operative time was 65 minutes +/−12.2.

Conclusions

Shaeer’s Cavernotome renders penile prosthesis implantation in fibrotic cases safer and easier, and enables implantation of regular sized inflatable cylinders rather than down-sized ones.

Disclosure

No.
(132) GELATIN SPONGE (GELFOAM®) AS A HEMOSTAT IN PENILE PROSTHESIS IMPLANTATION
Authors: Mahmoud O
Published: December 2024

Introduction

Gelfoam® Sterile Compressed Sponge is a hemostatic that is directly applied to bleeding surfaces. This cost-effective hemostatic agent is prepared from purified porcine skin, Gelatin granules and Water for Injection. It is water insoluble, however is completely absorbed within 4-6 weeks with minimal scar formation. Gelfoam is available sterile for intra-operative use, and is applied in a multitude of surgical specialties.

Objective

In this work, we demonstrate for the first time the of Gelfoam to minimize the risk of bleeding in penile prosthesis implantation.

Methods

Eight cases received a three-piece inflatable implant (Rigicon Infla10®) through a peno-scrotal incision. Following cylinder insertion, corporotomies were closed by tying the stay sutures rather than water-tight sewing. Gelfoam was soaked in antibiotic-supplemented saline. Air bubbles were squeezed out followed by soaking. Gelfoam was then applied to the corporotomies, pump space and entry rout to the reservoir space. It was secured over the corporotomies by closing a pre-fashioned layer of Buck’s fascia. A suction drain was inserted. Mummy wrap was not used. Drain output was monitored and complications recorded.

Results

In two cases, drain output was an average of 80 cc’s in the first 24 hours, then 20 cc’s in the following 24 hours. However, in 6 cases, drain output was an average of 18 cc’s in the first 24 hours, mostly sero-sanguinous, then none in the following 24 hours. No cases of hematoma formation, infection, foreign body reaction, mass formation or hypersensitivity reaction were encountered.

Conclusions

The initial results of the current small case series demonstrate that Gelfoam is well-tolerated in penile surgeries, with possible value at minimizing post-operative bleeding, encouraging a multi-center larger study. Applying Gelfoam to the closed corporotomies, pump and reservoir spaces may help reduce the risk of bleeding, upon penile prosthesis implantation.

Disclosure

No.
(149) NEW FINDINGS REGARDING PERIOPERATIVE INFLATABLE PENILE PROSTHESIS ANTIMICROBIAL PROPHYLAXIS PATTERNS FROM A LARGE MULTINATIONAL COLLABORATION
Authors: Hammad MAM , Azad B , Gross MS , Swerdloff D , Miller J , Abou Chawareb E , Alkhayal A , Alrabeeah KA , Andrianne R , Burnett AL , Gross K , Hatzichristodoulou G , Lentz A , Osmonov D , Jones A , Modgil V , Perito P , Hotaling JM , Park SH , Pearce I , Sadeghi-Nejad H , Sempels M , Suarez-Sarmiento Jr. A , Van Renterghem K , Warner JN , Ziegelmann M , Hsieh TC , Jenkins L , Jones J , Simhan J , Yafi FA ,   on behalf of the PUMP (Prosthetic Urology Multi-institutional Partnership) collaborators, Barham DW
Published: December 2024

Introduction

Inflatable penile prosthesis (IPP) surgery is a well-established treatment for erectile dysfunction (ED). There is little information in the literature regarding the utilization of perioperative antimicrobial prophylaxis in primary and revision IPP surgeries.

Objective

We investigated the patterns of perioperative antimicrobial prophylaxis among a large multinational cohort of primary and revision IPP surgeries.

Methods

We conducted a retrospective analysis of 5400 patients (4187 primary IPP patients and 849 revision IPP patients) from our Prosthetic Urology Multi-Institutional Partnership (PUMP) institutions. Usage data for intravenous (IV), preoperative oral, and postoperative oral antimicrobials were analyzed. We specifically assessed patient profiles, antimicrobial selection, and antimicrobial duration. Multivariate statistical analyses were conducted to identify significant variations between primary and revision surgeries.

Results

For patients undergoing primary IPP placement, 81.9% received IV antibiotics for <24 hours whereas 18.1% received IV antibiotics for >24 hours. Preoperative oral antimicrobials were used in 59.4% of patients and 99.4% received postoperative oral antimicrobials. The overall infection rate for primary implants was 2%. Notably, quinolone administration shows a higher postoperative infection rate (11.4%) compared to gentamicin (1.9%), cephalosporin (0%), and vancomycin (1.0%). Multivariable regression analysis identifies factors such as a history of infection, diabetes, and priapism as predictors for postoperative infections. Furthermore, the study finds that perioperative antifungal use is associated with a decreased risk of infection.

Conclusions

This study provides valuable insights into the patterns of perioperative antimicrobial prophylaxis. Duration, type, and route of antibiotics given preoperatively or postoperatively do not affect postoperative infection rates among high volume prosthetic urologists. Giving IV antibiotics for more than 24 hours does not affect postoperative infection. Perioperative antifungals are a protective factor.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus.
(180) VIRTUAL REALITY AND PORNOGRAPHY: THE IMPACT OF IMMERSIVE EFFECTS ON PORNOGRAPHY CONSUMPTION
Authors: Marques JM , Scanavino MDT , Figueiredo CPM
Published: December 2024

Introduction

Virtual reality (VR) technology contributes by providing a useful approach to behavioral observation and methodological safety to improve ecological validity and offers a promising tool for sex therapy interventions. We still lack information about the impact of VR when used in pornography consumption, since this technology is too recent, but authors hypothesize about its stimulus effects of immersion in sexual arousal.

Objective

This study investigates the impact of VR pornography on sexual behavior and its potential clinical applications. We contribute to a present review of the effects of stimuli immersion in VR on pornography consumption and describe in a synthesis of studies this effect in diverse sexual response outcomes.

Methods

Following PRISMA guidelines, we designed a research strategy describing types of studies, participants, data collection and outcomes, and search in four electronic databases (Pubmed, EMBASE, PsycInfo and Scielo) and made a full-text screening process, and last, assess studies based on GRADE protocol.

Results

The search found 149 articles and 11 meet eligibility criteria. The review highlights the limited research on VR pornography. Synthesis shows that most studies focused on the impact of level of immersion on diverse sexual responses. The existing studies primarily focus on correlations between VR immersion and physiological arousal during pornography consumption. The most frequent sexual response was erectile response, sexual attraction, and subjective sexual arousal. Most of the studies presented a significant methodology limitations like samplse size, randomization and allocation which in assessment studies show an uncertain risk of bias.

Conclusions

The literature is scarce and need to improve their methodology, even though it already shows relevant data for sex therapy intervention in pornography related problems. From this perspective, it could be a technology to improve psychological sexual dysfunctions because due to the immersion effect that has a greater impact on sexual arousal. Even with studies been applied to treat sexual related problems, more feasibility tests are still needed. On the other perspective, studies show concern about the use of VR in pornography consumption. Even though VR is not as widely consumed at domestic situations as other forms of pornography, its higher impact on sexual arousal due to level of immersion in virtual environment could worsen the impact of problematic pornography behavior. Further research on VR’s therapeutic applications and potential risks is crucial.

Disclosure

No.
(185) MEDICAL KNOWLEDGE AND PREJUDICE FROM THE PERSPECTIVE OF ANDROGENIC ANABOLIC STEROID USERS
Authors: Camara L , Freire M
Published: December 2024

Introduction

The abuse of androgenic anabolic steroids (AAS) has been increasing over the years, with prevalence rates reaching 6% among men and 3% among women in the general population. However, in specific groups such as recreational strength training enthusiasts, bodybuilders, and athletes from various sports, these figures can exceed an alarming 30%. Consequently, many medical societies and sports organizations consider AAS abuse a significant public health issue. This critical situation is further exacerbated by users who seek information from non-scientific (empirical) sources, the lack of adequate medical training on the subject, and societal prejudice. This prejudice can lead users to conceal their use or can manifest in the medical community through stigmatizing campaigns and refusal to provide clinical care. Enhancing medical knowledge is essential for the effective care and guidance of individuals using AAS, and can play a crucial role in mitigating the potential long-term harms associated with steroid abuse.

Objective

To conduct a survey among current and former users of AAS to delineate various characteristics of their abuse profiles. The survey includes specific questions related to the topic of interest, such as the users perception of medical knowledge and the prejudices they encounter during healthcare interactions.

Methods

An entirely anonymous survey was conducted using Google Forms, comprising 50 questions to delineate the profile of AAS abuse among Brazilian users and former users. The survey, promoted by various health professionals on social media platforms (Instagram, Facebook, Twitter) and WhatsApp groups, is ongoing. It includes a term of free and informed consent and does not require any personal user data, thereby ensuring that anonymity cannot be compromised in any of the responses. Subsequently, the data were transferred to analysis software and stored in a research database.

Results

Partial data from 917 respondents indicate that 9.7% believe doctors have no knowledge about AAS, 68.8% believe their knowledge is insufficient, 15% consider it good, and only 6.5% believe it is outstanding. Additionally, outside of medical consultations, 64.6% have witnessed prejudice from doctors regarding AAS use, while only 9.8% have never witnessed it. Notably, 25.6% of respondents declared they never reported AAS use to any doctors. Among those who reported AAS use during medical consultations, 27% received a comprehensive and positive response from the doctor, 34.1% received a poor response, 14.5% did not report use, and 24.3% have never been to a doctor.

Conclusions

The analyzed data indicate that, according to the perspectives of AAS users and ex-users, doctors often lack adequate knowledge, exhibit prejudice, or respond inappropriately when reports of use are mentioned during consultations.

Disclosure

No.
(188) CAUSAL ASSOCIATIONS BETWEEN PROSTATE DISEASES, RENAL DISEASES, RENAL FUNCTION, AND ERECTILE DYSFUNCTION RISK: A 2-SAMPLE MENDELIAN RANDOMIZATION STUDY
Authors: Dilixiati D , Lu J , Kadier K , Xie S , Azhati B , Xilifu R , Rexiati M
Published: December 2024

Introduction

Previous observational studies have found a potential link between prostate disease, particularly prostate cancer (PCa), and kidney disease, specifically chronic renal disease (CKD), in relation to erectile dysfunction (ED), yet the causal relationship between these factors remains uncertain.

Objective

The study sought to explore the potential causal association between prostate diseases, renal diseases, renal function, and risk of ED.

Methods

In this study, 5 analytical approaches were employed to explore the causal relationships between various prostate diseases (PCa and benign prostatic hyperplasia), renal diseases (CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, and kidney ureter calculi), as well as 8 renal function parameters, with regard to ED. All data pertaining to exposure and outcome factors were acquired from publicly accessible genome-wide association studies. The methods used encompassed inverse variance weighting, MR-Egger, weighted median, simple mode, and weighted mode residual sum and outlier techniques. The MR-Egger intercept test was utilized to assess pleiotropy, while Cochran’s Q statistic was employed to measure heterogeneity..

Results

Genetically predicted PCa demonstrated a causal association with an elevated risk of ED (odds ratio, 1.125; 95% confidence interval, 1.066-1.186; P < .0001). However, no compelling evidence was found to support associations between genetically determined benign prostatic hyperplasia, CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, kidney ureter calculi, and the renal function parameters investigated, and the risk of ED.

Conclusions

The results of this study suggest a potential link between PCa and a higher risk of ED.

Disclosure

No.
(191) QUESTIONNAIRE: WHAT HELPS HETEROSEXUAL MALE SEXUAL AROUSAL?
Authors: Brendler J
Published: December 2024

Introduction

There is little research studying the emotional factors and behaviors that cause erection (function), as opposed to the number of studies on the organic factors that cause erection and erectile dysfunction. The results of applying the questionnaire can help healthy men and men with sexual dysfunction (which is very common, especially after 50 years of age.

Objective

To develop an auxiliary method to identify behaviors/factors that help male sexual arousal during sexual intercourse, for patients treated in clinical sexology, as well as to be applied to the general population.

Methods

The questionnaire consists of general items such as age, marital status, occupation (work and school), education. There are specific questions about sexuality, which list 41 behaviors/factors that can positively interfere with male emotional and/or physical sexual arousal; there is an open option, “other” (which allows you to write about other factors/behaviors), item 41. 20 listed items cover the man’s behavior and 14 cover the woman’s behavior, 6 items list the couple’s behavior. First, they choose up to 10 factors (out of 41 options) and then the 5 that most help with sexual arousal. The questionnaire was applied to two populations: men who were undergoing a private sexological consultation and among people who access websites with information about sexuality and sexual dysfunctions/problems.

Results

The questionnaire interested men when searching for scientific information (website www.terapiadosexo.med.br) about sexuality and its problems, being the first questionnaire for men most answered spontaneously. In men who consulted in clinical sexology, the questionnaire “mapped” the function of sexual arousal and the sexologist emphasized items that help erection to increase awareness of these behaviors and factors. Among dysfunctional men, he pointed out what helped erections in the past and may still work.

Conclusions

The questionnaire is useful as an auxiliary method in identifying behaviors/factors that support/help sexual arousal in both populations studied. In the general population (access via website) the findings can be used for sexual education and to disseminate what helps most men to have an erection. In clinical sexology, this identification aimed to guide the use of all behaviors and factors that help to initiate and maintain an erection, contributing to sexual health. The man was instructed to share the findings of his questionnaire with his sexual partner, improving intimacy and sexual life.

Disclosure

No.