bluuebunny/crossref_metadata_2025 huggingface dataset:
(292) Underneath the White Coat: Testosterone Deficiency in Male Resident Physicians
Authors: Krishingner G , Mallory C , Moy L , Campbell K
Published: February 2024

Introduction

Resident physicians are a vulnerable population often subjected to long working hours, atypical sleep schedules, and high stress working environments. These conditions have been associated with hypogonadism in other populations, but hypogonadism has been inadequately studied in this unique population. Symptoms of hypogonadism have a high degree of overlap with conditions such as burnout and depression, both of which have been well-established in this population.

Objective

This study aims to examine the prevalence of hypogonadism among male resident physicians, a demographic susceptible to conditions contributing to hormone deficiencies due to their demanding work environment.

Methods

This is a prospective study to evaluate male physicians in medical training who voluntarily participated in wellness screening at our institution. Following approval by the Institutional Review Board, residents at a high-volume tertiary referral center were contacted via e-mail regarding participation in men’s health screening. Baseline demographics were obtained including age, specialty, and post-graduation year (PGY). Participants were asked to complete the Androgen Deficiency in the Aging Male (ADAM) and 36-Item Short Form Health Survey (SF-36) questionnaires in additional to obtaining lab work: BMP, CBC, Lipid panel, thyroid panel, testosterone, FSH, LSH, and estradiol. Survey questionnaire data was obtained through Research Electronic Data Capture (RedCAP).

Results

Out of 651 male residents and fellows contacted, 27 residents responded (4.1%) with 66.7% (18/27) completing surveys and 33.3% (6/18) undergoing lab tests. Two-thirds (4/6) of these participants had total testosterone levels <400ng/dl and two participants met serum criteria for hypogonadism. Half (9/18) of participants scored positively in their ADAM responses. 44.4% (8/18) reported their health as worse compared to a year prior (Table 1).

Conclusions

The preliminary findings suggest a significant prevalence of hypogonadism symptoms among male resident physicians. Given the severe impact of hypogonadism on overall health and work productivity, implementing wellness screening among this population could lead to earlier detection and management. However, additional research is required, especially considering the low response rate of this study.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Tolmar Pharmaceuticals.
(295) Characterizing Testosterone Transference Risk Among Men Undergoing Evaluation for Low Testosterone
Authors: Thorogood SL , Novaes LF , Mulhall JP , Flores JM
Published: February 2024

Introduction

Pre-pubertal exposure to exogenous testosterone (T) is known to cause virilization and precocious puberty (PP). Thus, the AUA and the US Food and Drug Administration have warned of the risk of transference associated with T gels/creams. Yet, little is known about the testosterone transference risk (TTFR) profiles of men undergoing evaluation for low T.

Objective

We aimed to identify the prevalence of TTFR in men undergoing evaluation for low T.

Methods

This retrospective analysis included all men with TTFR documented during evaluation for low T at our institution. Total/free T were measured using LCMS/equilibrium dialysis in an early morning fashion. Patients were asked for frequency of contact with at least one child ≤ 12 years old. TTFR was deemed as high if the patient reported a frequency of contact ≥1/month with a pre-pubertal child; all other patients were classified as having low TTFR. Demographic, comorbidities and hormone profile at the time of TTFR assessment were analyzed.

Results

118 men had TTFR documented. Median age was 62 (48, 70) years; 20% were ≤ 40 years, 27% were 41-60 years, 53% were ≥ 61 years. Median number of comorbidities was 2 (0, 2); 36% of men had two or more comorbidities. 17% had diabetes. 97% of men had a history of cancer: prostate 57%, testis 22%, bladder 4%, hematologic 8%, pituitary neoplasm 2%. Median T level was 220 (170, 310) ng/dL, free T 6.6 (5.3, 10.7) ng/dL, estradiol 14 (11, 19) pg/mL, luteinizing hormone 4.3 (2.5, 8.9) IU/L, hemoglobin A1c 5.6 (5.3, 6.1)%, and hematocrit 43 (40, 45)%. Regarding TTFR, 53% of men were classified as high-risk for T transference based on the a priori definition utilized. In the overwhelming majority of instances, high TTFR was associated with family contact (children and grandchildren). Patient occupation (pediatrician, counselor) was the second most cited reason for high TTFR.

Conclusions

Among men being evaluated for low T, more than half had a high TTFR. These findings suggest that the TTFR assessment prior to start T therapy is critical, that high TTFR is highly prevalent, and that TTFR should be documented and discussed with the patients during T therapy counseling.

Disclosure

No.
(320) Erectile Dysfunction and Men’s Health Websites: How diverse is our Racial, Ethnic, and Sexual Orientation Representation?
Authors: Channa L , Reynolds E , Staff I , Mclaughlin T , Pinto K , Olivo Valentin L , Bieniek J
Published: February 2024

Introduction

Images featured in patient educational materials can enhance comprehension of medical conditions, particularly those associated with sensitive issues like erectile dysfunction (ED). Past research indicates that minority men are often underrepresented in online urological content and thus may not relate to the material.

Objective

The present study aims to evaluate the representation of racial, ethnic, and sexual orientation diversity in ED and men’s health content on reputable urology program websites.

Methods

Websites of the top urology departments from U.S. News & World Reports 2022 rankings were reviewed as sources of high quality content. All subpages were reviewed to identify ED and men’s health sites with extraction of photo and video imagery depicting human subjects. A three-person review team interpreted race, ethnicity, and sexual orientation categorically. Race was also interpreted using a numeric scale, Fitzpatrick skin rating, and median ratings classified as white (1-3) or non-white (4-6). Consensus ratings were summarized descriptively. Spearman’s rank correlation was used to measure inter-rater reliability of Fitzpatrick ratings and MedCalc’s z-test used to compare diversity proportions to national rates from census data.

Results

The top 50 ranked urology program websites were reviewed. Seven programs did not have any patient-facing ED or men’s health web pages. Nearly half of programs with sites did not contain any human images (n=19/43, 44%). A total of 113 images were collected and reviewed. Race in the 102 (90.3%) interpretable images included 6 (5.9%) Asian, 16 (15.7%) black, 75 (73.5%) white, and 5 (4.9%) other men. Latino men were represented in 3/70 (4.3%) images. Utilizing Fitzpatrick ratings, 94 (83.2%) subjects were classified as white and 19 (16.8%) non-white. Most images [67 (59.3%)] demonstrated a man without a partner which precluded sexual orientation evaluation. Of those pictured with a partner, 25 (92.6%) were interpreted as heterosexual and 2 (7.4%) as same sex. Between reviewer correlation coefficients for Fitzpatrick ratings ranged from 0.66-0.69. Table 1 compares interpreted image data to population benchmarks from United States census data.

Conclusions

Limited imagery on academic urology ED websites continues to underrepresent some groups, namely Latinos. Although men in same sex relationships were depicted, the absolute number of such images was low. Conscious effort to improve diversity in online men’s health, and namely ED, content is needed.

Disclosure

No.
(324) History of Priapism Treatment in the 20th Century
Authors: Kulkarni A , Ikedionwu I , Singh A , Penukonda S , Bloom D , Raheem O
Published: February 2024

Introduction

Priapism, defined as a prolonged erection in the absence of sexual arousal, leads to decreased quality of life, physical health, and increased erectile dysfunction. The modern priapism treatments of vasoconstriction and cavernous aspiration stem from strides made throughout the last century.

Objective

As a result, we seek to chronicle the history of priapism treatment throughout the 20th century.

Methods

We reviewed over two dozen academic articles and medical textbooks from 1872 to 1990 with relevant information on priapism treatment.

Results

In the 19th century, treatment of priapism solely involved symptomatic management with morphine and medicinal leeches. In 1928, Dr. Robert McKay and Dr. John Colston discovered that a thrombotic condition is sufficient to sustain an erection and that removing clots from the penis is sufficient to alleviate the erection. They recommended the newly-discovered anticoagulant heparin as a potential remedy. Dr. Rita Franklin then established in 1940 a positive association between testosterone propionate levels and priapism in eunuchoid men. Priapism therapies improved exponentially beginning in the late 1950s. Dr. H. Stephen Brody conducted the first successful penile aspiration in 1957 by aspirating blood from the base of each corpus cavernosum in a hypotensive patient. This groundbreaking procedure is conducted to this day for patients who do not respond effectively to medication management. Nine years after Dr. Brody’s study in 1966, Dr. Robert Garrett and Dr. Donald Rhamy reported penile flaccidity and sexual satisfaction in five patients who underwent a corpus-saphenous shunt to improve venous drainage. In 1997, Dr. Pierre Bondil and colleagues conducted a novel experiment demonstrating the efficacy of vasoconstrictive alpha agonist agents in decreasing penile blood flow to decrease erections and preserve erectile function.

Conclusions

The last one hundred years has shown significant innovation in the treatment of priapism. Some of the major developments in the first half of the 20th century included the use of heparin and the establishment of a relationship between testosterone and priapism. The second half of the 20th included treatment still in use today, such as carvenoglandular shunts and vasoconstrictive agents. Therapies from the 20th century will continue to play a vital role in the treatment and research of priapism management.

Disclosure

No.
(330) Testosterone Replacement Therapy in Hypogonadism: A Single Center Longitudinal Analysis of Treatment Patterns and Clinical Outcomes
Authors: Iacobucci A , Naeem T , Saffati G , Gadiwalla Q , Mody-Bailey N , Green C , Lipshultz LI , Khera M
Published: February 2024

Introduction

Male hypogonadism impacts the production of hormone production, which plays a key role in masculine growth. It has also been shown to impair certain male reproductive functions or delay development.

Objective

The goal of this study is to describe the characteristics and treatment outcomes for patients with a diagnosis of Hypogonadism (HG) presenting to an academic urology center.

Methods

An IRB was approved to conduct a longitudinal study on the outcomes of male hypogonadism at a high-volume tertiary referral center. Men diagnosed with hypogonadism were identified by ICD 10 code (E 29.1). Clinical, demographic, laboratory, and testosterone replacement therapy and outcomes were extracted from the EMR.

Results

This retrospective study included 537 patients with a median age of presentation of 52 years (IQR: 42-68). At the initial visit, 66% presented with low libido, 65% with erectile dysfunction (ED), and 6% with depression. On initial hormonal evaluation, median (IQR) measurements for testosterone, free testosterone, and estradiol were 294 (217.5-417), 6.1 (4.45-8.0), and 4 (2-17) respectively. 227 (56.5%) patients elected to begin Testosterone Replacement Therapy (TRT). Of these, five treatment types of TRT were observed: 114 (53%) patients elected for intramuscular TRT, 25 (12%) utilized a pellet implant, 74 (34%) utilized topical treatment TRT, 3 (1.4%) used pellet and topical, and 1 (0.5%) used topical and intramuscular. Following TRT, 143 (79%) patients endorsed an improvement in ED, 175 (84%) reported improved libido, 176 (84%) reported increased energy levels, and 88 (59%) showed improvement in muscle mass. Follow-up labs measuring testosterone, free testosterone, and estradiol demonstrated medians of 486 (IQR: 296.5-802.8), 15.3 (IQR: 6.9-88.7), and 16.45 (IQR: 3-28.85) respectively. Adverse events while on TRT were 32 (15%) polycythemia, 3 (1.4%) VTE’s, and 3 (1.4%) MI.

Conclusions

Sexual dysfunction is a prominent symptom encountered by men with hypogonadism. However, only 56.5% of hypogonadal men pursue TRT, with intramuscular injections being the most commonly prescribed formulation. In our longitudinal cohort, we report that polycythemia and cardiovascular events are uncommon sequela after TRT. Further randomized control trials are warranted to better understand cardiovascular events' association with TRT.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(332) Predictors of being at High Risk for Obstructive Sleep Apnea in Men Presenting for Low Testosterone Evaluation
Authors: Novaes LF , Salter C , Tan M , Flores JM , Mulhall JP
Published: February 2024

Introduction

Obstructive sleep apnea (OSA) is a common condition and is more common in men with obesity and low testosterone (T). In men with OSA, T therapy is associated with the development of polycythemia (POLY). It has been shown that men with OSA have a higher risk of POLY with T therapy.

Objective

We aimed to identify the predictors of being at high risk for OSA in men presenting for low T assessment.

Methods

The study population included men undergoing low T assessment who completed the OSA risk assessment questionnaire, the STOP-BANG (SB). SB contains 8 questions: STOP (Snoring, Tiredness, Observed apnea during sleeping and high blood Pressure); BANG (BMI ≥ 35, Age ≥ 50, Neck circumference ≥ 17 inches, Gender). Each question is scored as yes (1) or no (0) and is scored 0-8. Using this score, patients are categorized as low risk of OSA (score 0-2), intermediate risk (score 3-4), or high risk (score ≥ 5 or ≥ 3 plus a BMI ≥ 35 or a neck circumference ≥ 17 inches). We also measured total T and free T levels, hematocrit (HCT), and recorded BMI and demographics. Multivariable analysis (MVA) was performed to define predictors of having a high risk of OSA. Parameters in the model included: age, comorbidities (hypertension, diabetes, dyslipidemia, coronary arterial disease), total T, HCT, and BMI. Receiver operating characteristic (ROC) analysis was performed to identify a BMI cut-off point associated with high risk OSA.

Results

321 men were analyzed. Median age was 64 (56, 69) years. Median SB score was 4 (3, 5), 55% were high risk, 25% moderate risk, and 19% low risk. 46% had 2 ≥ comorbidities. 57% had T levels ≤300 ng/dL. Median total and free T were 281 (222, 373) and 7.5 (5.4, 10) ng/dL and median LH was 3.7 (2.2, 6.7). Median HCT was 44% (41, 46). 33% had HCT ≥ 45%, and 4% had HCT > 50%. Median BMI was 29 (26, 33) kg/m2 and 42% had obesity (BMI ≥ 30 kg/m2). On MVA, BMI and ≥2 comorbidities predicted high risk for OSA. ROC analysis showed cut-off point BMI ≥ 27 kg/m2 is associated with high risk for OSA by SB (sensitivity=0.8; specificity=0.6; AUC=0.77; p<0.001). For men with BMI ≥27 kg/m2, the rate of high risk OSA was 71%, versus 29% rate of high risk in men with BMI <27 kg/m2.

Conclusions

BMI ≥ 27 kg/m2 or higher and the presence of 2 or more comorbidities are the main predictors of high risk OSA.

Disclosure

No.
(334) Worldwide Interest in Testosterone Replacement Therapy
Authors: Lumbiganon S , Hammad M , Miller J , Chawareb E , Azad B , Yafi F
Published: February 2024

Introduction

Testosterone therapy has gained popularity in recent decades, with various methods of administration available, such as oral, topical, injection, and implantable routes. As a wider variety of treatment options arise, knowledge regarding the public interest in varying modalities may give providers an insight to patient preferences and assist in the counseling of patients seeking to initiate testosterone replacement therapy.

Objective

To examine public interest in the different methods of testosterone administration across the United States and compare their relative popularity to intramuscular injections.

Methods

Utilizing Google Trends, data pertaining to searches related to diverse testosterone administration methods were collected over a ten-year duration. The categories under analysis encompassed 1) testosterone injections, 2) implanted testosterone, 3) oral testosterone, and 4) topical testosterone. Controlled search terms, including news and weather queries, were employed. Search term trends were quantified in arbitrary units (a.u.) and plotted against the corresponding time period.

Results

Testosterone injection had the highest average search intent from Google Trends during the past 10 years (63.08 +/- 12.7 a.u.), followed by testosterone pills (60.56 +/- 13.4 a.u.), testosterone pellets (53.14 +/- 19.4 a.u.), testosterone patches (51.03 +/- 16.2 a.u.), and lastly testosterone gel (17.29 +/- 21.5 a.u.) A notable upward trend was recorded for all searches, with the highest increase in searches seen for implanted testosterone (m = 0.433), testosterone injections (m = 0.297), oral testosterone (m = 0.222), and lastly topical testosterone (m = 0.050) (Figure 1).

Conclusions

This study provides compelling evidence that all modes of testosterone administration had increasing search trends, most notably implantable testosterone therapies followed by testosterone injections, and oral testosterone, which may be in line with recent FDA approvals since 2019 for newer oral (Jatenzo, Tlando, Kyzatrex) and implantable (ex: Xyosted) options.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma, Clarus Therapeutics, Coloplast.
(341) First-time Orgasm in a Man with Flibanserin Use: A Case Report
Authors: Saffati G , Naeem T , Khera M
Published: February 2024

Introduction

Anorgasmia is a poorly understood phenomenon defined as either a lifelong or an acquired consistent inability to achieve ejaculation. Despite the prevalence of anorgasmia, there is currently no established treatment.

Objective

In this abstract, we present the unique case of a patient with lifelong anorgasmia who was able to achieve his first orgasm with off-label use of flibanserin.

Methods

A 28-year-old male presented to our office with complaints of lifelong anejaculation and anorgasmia, without any signs of erectile dysfunction. He reported good libido and energy levels and denied any urinary symptoms or history of depression. Physical examination revealed normal genital anatomy without lesions. Testicular size was within normal limits, and a palpable varicocele was noted. Hormonal evaluations revealed total testosterone levels of 590 ng/dl and prolactin levels of 12 ng/ml. The baseline International Index of Erectile Function (IIEF) score was 41, with an orgasmic function sub-domain (IIEF-OF) score of 2. The patient had no history of major surgeries. He denied any neurological, infectious, or endocrine cause of anejaculation or anorgasmia. He was not taking medications that could cause these symptoms, except for over-the-counter allergy medications. Upon further questioning, the patient equated orgasm with ejaculation and reported having never experienced any previous orgasms.

Results

The patient was prescribed 150 mg of bupropion daily, which was increased to 300 mg daily after two weeks, in combination with sex therapy. Despite having received four–five sex therapy sessions over three months, the patient reported that this treatment approach was not effective. Subsequently, bupropion was tapered and discontinued. The patient was then started on bremelanotide, administered at a dose of 10 mg/mL, injecting 0.2mL (2 mg) before sexual activity. Although various forms of stimulation were attempted, the patient was unable to achieve orgasm with bremelanotide, and experienced penile pain. Flibanserin was then initiated, and after 28-32 doses over four weeks, the patient achieved his first orgasm. Notably, the patient also experienced nocturia and insomnia after initiating this medication. The follow-up IIEF score marginally improved by two points without any improvement in IIEF-OF.

Conclusions

This case highlights the challenges in managing anorgasmia and anejaculation in a young male patient. A stepwise approach, involving pharmacotherapy and sex therapy, was unsuccessful. However, off-label use of flibanserin ultimately resulted in the patient achieving his first orgasm, albeit with some side effects. Further studies are required to evaluate the efficacy and safety of flibanserin for this indication.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(345) Sexual Health Outcomes After Gender Affirming Metoidioplasty: A Systematic Review
Authors: Dolendo I , Goldstein B , Okamuro K , Peters B , Anger J , Uloko M
Published: February 2024

Introduction

Previous studies have evaluated surgical outcomes and aesthetic results of Genital Gender Affirming Surgery (GGAS) while few studies have examined sexual outcomes after GGAS.

Objective

We sought to systematically review the literature on sexual health outcomes of metoidioplasty in the transmasculine population.

Methods

PubMed, Embase, and Web of Science was used to identify studies through April 29, 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Figure 1 shows search terms, inclusion, and exclusion criteria.

Results

Fourteen papers were included. Findings on arousal/desire ranged from 86% (n=48) reporting desire for sex to 100% (n=1455) reporting no difficulty in arousal. Preserved erogenous sensation and no issues with masturbation was reported in 100% of people across studies (n=1164;1455). Orgasm ability ranged from 66-70% (n=115) who were able to orgasm during sexual activity or masturbation to 100% (n=1455) who had no problems with orgasm. Orgasm satisfaction was found to be 100% (n=48). A study found that 80% (n=15) had challenges with erections, with 83% (n=18) of Erection Hardness Scores were ‘larger but not hard’ or ‘hard but not hard enough for penetration.’ Earlier studies reported 100% of people had an erection (n=1599), and ratings of ‘satisfied’ or ‘partially satisfied’ in 94% (n=145). Across studies, 87-100% were unable to have penetrative sex (87% unable, n=15; 100% unable, n=737). For some, the inability to penetrate was the most dissatisfactory aspect of the metoidioplasty for 39% of patients (n=28).

Conclusions

Current literature on transmasculine people undergoing GGAS shows high ratings of arousal/desire, preservation of erogenous sensation, masturbation, and ability to orgasm following metoidioplasty. Data on the ability and adequacy of erection is less definitive. Overall ratings of sexual health appear high, but inability to have penetrative sex remains a source of persistent dissatisfaction for some. Further studies using surveys validated in transmasculine populations are needed to definitively describe sexual function after GGAS.

Disclosure

No.
(352) High Genital Satisfaction is Associated with Increased Sexual Frequency and Larger Perceived Penile Anatomy
Authors: Choi U , Nicholson R , Cohen A
Published: February 2024

Introduction

Satisfaction with personal genitalia has profound impacts on quality of life and sexual health. Prior studies of men correlated genital dissatisfaction with decreased sexual activity; however, the association between satisfaction and perceptions of “normal” genital anatomy is unknown.

Objective

We aimed to assess the interplay between genital satisfaction, sexual activity, and genital anatomy expectations.

Methods

A 54-item RedCap survey was distributed to volunteers aged ≥18 years through the ResearchMatch database from January to March 2023. Responses were split into: 1) high genital satisfaction (≥7/10 satisfaction rating) and 2) low satisfaction (<7/10). We collected data on perceptions of “normal” genital anatomy and function in addition to sexual function and preferences. Analysis was performed using JMP Pro 16.

Results

649 respondents initiated and 558 respondents completed the survey (86% completion rate). Median genital satisfaction was 7/10. 27.9% of respondents identified as male and 72.1% as female. The mean age was 45.8 years, 83.2% were white, 47.9% married or 25.0% never married, and 75.5% had at least a bachelor’s degree. More low-satisfaction respondents reported perceived “normal” erect penis girth <2 inches (7.8% vs. 3.8%, p=0.04), flaccid penis length <2 inches (11.1% vs. 5.1%, p<0.01) and semen volume <2 mL (5.8% vs. 1.3%, p<0.01). More high-satisfaction respondents believed women had orgasms over half the time (20.8% vs. 13.2%, p=0.02). More high-satisfaction respondents were sexually active (81.1% vs. 71.6%, p<0.01). Of the respondents who were sexually active, high satisfaction was more associated with sexual encounters 1-3 times weekly (44.5% vs. 32.1%, p<0.01).

Conclusions

Genital satisfaction impacts perceptions of male anatomy and female sexual activity. Frequency of sexual activity was higher among high-satisfaction respondents, thus genital satisfaction may be a useful screening tool to determine sexual activity.

Disclosure

No.
(359) Vasectomy Trends in Western NY Following Dobbs v. Jackson Women’s Health Organization
Authors: Greenstein A , Farah G , Vecellio P , Bradin A , Chevli K , Brennan M
Published: February 2024

Introduction

On June 24, 2022, the United States Supreme Court ruled on Dobbs v. Jackson Women’s Health Organization (Dobbs) that the Constitution of the United States does not confer a right to abortion. The court’s decision overruled both Roe v. Wade (1973) and Planned Parenthood v. Casey (1992), giving individual states the full power to regulate any aspect of abortion not protected by federal law.

Objective

Our study aims to identify the difference, if any, in the number of vasectomies performed in Western NY before and after the ruling on Dobbs v. Jackson Women’s Health Organization.

Methods

We performed a retrospective chart review of 2428 patients who had vasectomies in Western New York from August 2021 – March 2023. Leveraging a dataset containing de-identified patient information, we compared the rates of all men undergoing vasectomies in the six-month period before and after the ruling. Vasectomy case information collected by urologists in Buffalo dating back to 1996 was collected and tabulated using Excel. Statistical analyses were performed to compare differences in both the overall change in frequency of vasectomies among all men in the six-month period before and after the court decision, as well as by specific demographic groups. Statistical analyses were performed in R and SAS.

Results

Men with no children had a statistically significant increase (p=0.009) in the number of vasectomies in the six-month period after the Dobbs decision (n=138) compared to before (n=98). Rates of vasectomies pre- and post- Dobbs were organized by age quartiles (<33.20, 33.20-36.65, 36.66-40.59, ≥40.60). In the “No Child” group, men with ages <33.2 (p=0.0137) and ages 33.2-36.65 (p=0.0394) had significant increases in frequency of vasectomy after the court decision.

Conclusions

Our data demonstrates that in the wake of Dobbs v. Jackson Women’s Health Organization (2022), the number of vasectomies among men with no children significantly increased after the court decision. There were significant increases in the number of vasectomies within different age groups of men without children following the decision. Future aims of this study will seek to create statistical models to determine the underlying reasons that influenced the observed change in frequency of vasectomies following the court decision in men without children.

Disclosure

No.
(386) Eight-Dot Extended Corporotomy Versus Conventional Corporotomy for Malleable Penile Prosthesis Implantation
Authors: Ragheb A , Emadeldin M , Abdallah R , Mohamed A , Elmarakby A
Published: February 2024

Introduction

To date, malleable type penile prosthesis implantation (MPPI) remains the more popular in developing countries, owing to its relative economic cost. Despite the simplicity of the procedure, there still may be areas of improvement and refinement to optimize procedure efficiency and accuracy subsequently improving postoperative outcomes while reducing complication risk.

Objective

We aimed to compare between the eight-dot extended corporotomy technique and the conventional corporotomy techniques for MPPI with regards to operative time and postoperative complications.

Methods

We conducted a prospective randomized interventional clinical study on 51 subjects. Patients were randomized into 2 groups: eight-dot group (n=27) and conventional group (n=24). The eight-dot group underwent MPPI using the eight-dot extended corporotomy as previously described (VJPU - Eight-dot Extended Corporotomy: A More Secure, Aesthetic and Time Efficient Technique for Semirigid Penile Prosthesis Implantation, n.d.). The conventional group underwent MPPI using conventional limited corporotomies that were closed via continuous running sutures. We compared between both groups in terms of corporotomy opening to closure time, overall procedure time and perioperative complications. The follow up period was 3 months.

Results

Upon timing in seconds (s), a significant time difference between the 2 groups was demonstrated for suture placement, corporotomy incision and implant placement, corporotomy closure, and total procedure duration. Although patients in the eight-dot group required longer time for suture placement vs the conventional group (486 vs 201 s, respectively, p < 0.001), the durations for the remaining implantation steps as well as the whole procedure were significantly shorter for the former group. Corporotomy opening followed by implant placement took significantly less time for the eight-dot group (1090 s) vs the conventional group (1313 s), p <0.001. Moreover, insertion of implant rods were subjectively easier with no need for aggressive bending owing to the extended corporotomy length. Similarly, corporotomy closure using the 8-dot technique was 10.13 minutes swifter than the conventional group (220 s vs. 828 s, respectively, p < 0.001). The total procedure length was over 8 minutes shorter for the eight-dot group opposed to the conventional group (2527 vs 3027 s, respectively, p < 0.001). In terms of postoperative complications in the form of pain, swelling, hematoma, and infection, there were no significant differences between both groups.

Conclusions

The eight-dot extended corporotomy technique is a safe and time-saving approach compared to the conventional limited corporotomy technique, making the MPPI procedure more efficient. A swifter procedure decreases both patient exposure to anesthesia and device exposure to air which in turn lowers the risk for potential postoperative complications.

Disclosure

No.
(388) Arab Patient and Partner Satisfaction Following Malleable Penile Prosthesis Implantation in the Middle East and North Africa
Authors: Ragheb A , Abdallah M , Abdelbary A , Emadeldin M , Mohamed A , Elmarakby A
Published: February 2024

Introduction

Due to the sensitivity of the topic of penile implants for the treatment of refractory erectile dysfunction (ED) in the Middle East and North Africa region, a scarce body of related research is available.

Objective

We aimed at investigating the levels of patient and partner satisfaction after malleable penile prosthesis implantation among the Arab population and its dynamics during and after the first 6 months of surgery.

Methods

This was a prospective 6-month follow-up study of 120 patients undergoing malleable penile prosthesis implantation at our unit by a single surgeon. Three telephone encounters were conducted for each couple at 1 month, 3 months, and 6 months postoperative (PO). We utilized our validated Arabic version of the Modified Erectile Dysfunction Inventory of Treatment Satisfaction (AM-EDITS). During the 1st first encounter, we inquired about the general patient perioperative experience, starting from preoperative counseling till the first month after surgery. The 2nd and 3rd encounters focused on patient and partner satisfaction after implant utilization.

Results

The average ages of the men and their partners were 54.7±8.4 and 32.9±4.6 years, respectively. Levels of anxiety decreased in over 82% of the men in our study upon receiving proper preoperative counseling. Almost all of the patients were happy (96%) with their early PO days with over 50% of them exceeding their expectations. After 3 months, 82.5% of the men were satisfied, describing their erections to be 80% close to natural. Of the 92.5% satisfied partners at 3 months, nearly 80% were highly satisfied. Over 93% of them reported feeling sexually desirable by their husbands. As opposed to the significant rise in men’s overall satisfaction and AM-EDITS index by 11.6% and 5.2 ± 0.8% (P < 0.001), respectively after 6 months PO, partners demonstrated a 12.4% and 5.9 ± 0.8 decline (P < 0.001), respectively, compared to the 3 months follow up.

Conclusions

Malleable penile implants still represent a good quality of life treatment option for middle to low-income countries. Time has a positive effect on Arab men’s PO satisfaction as opposed to their partners’. The explanation behind these findings should be investigated in further studies. A proper understanding of the dynamics of patient and partner satisfaction over time may be useful for proper perioperative counseling of both parties to ensure their sustainable satisfaction.

Disclosure

No.
(397) Investigating the Psychological Bother and Depression Among Gay Men with Peyronie's Disease
Authors: Novaes LF , Elshafei A , Jenkins L , Terrier J , Taniguchi H , Nascimento B , Carlsson S , Nelson C , Mulhall JP , Flores JM
Published: February 2024

Introduction

I: Peyronie's disease (PD) is associated with psychological bother, including depression and relationship dissatisfaction.

Objective

Our objective is to describe the prevalence of psychosocial issues using validated instruments, comparing gay and non-gay males.

Methods

We included patients diagnosed with PD who completed two validated questionnaires. The questionnaires were the Peyronie's Disease Questionnaire (PDQ) and the Center for Epidemiologic Studies Depression Scale (CES-D). The PDQ has 3 domains that evaluate psychological and physical symptoms, penile pain, and bother signs. Higher PDQ scores indicate a greater negative impact, and a score ≥ 9 on the bother domain indicates significant distress. A CES-D score ≥ 16/60 suggests clinical depression. All gay and non-gay patients were matched, and potential indicators of psychological distress were examined in both populations. Our multivariable analysis (MVA) models included age, sexual orientation, pain, and curvature. Additionally, we collected demographic information and PD-related characteristics.

Results

74 individuals were matched based on age, curvature direction, and curvature degree: 37 gay and 37 non-gay. The median age was 57 (50, 62) years. Gay population characteristics: 60% were partnered; 54% had ≥ 2 comorbidities; median PD duration of 9 (4, 17) months; median curvature of 35 (29, 49) degrees; 66% had penile instability; 57% in a dorsal direction curvature, and 73% were located at the mid-shaft; 18% had multiplanar curvature. The PDQ scores in the gay vs. non-gay population: median score on psychological and physical domain of 10 (7, 18) vs. 11 (5, 16); median score on pain domain was 3 (0, 9) vs. 3 (0, 6), with 43% of the gay population with pain vs. 21% in non-gay; median score on bother domain was 8 (4, 10) vs. 8 (6, 11), with 65% of gay patients with significant bother (score ≥ 9) compared to 51% in non-gay. Regarding the CES-D scores, 38% of individuals in both populations demonstrated meaningful depression (score ≥ 16), with a median score of 12 (4, 19) in the gay population and a median of 12 (5, 23) in non-gay. In the MVA, sexual orientation was not a predictor for bother or depression (Table 1).

Conclusions

More than half of both groups had meaningful bother, and 1 in 3 had clinical depression; however, sexual orientation was not a predictor of bother or depression.

Disclosure

No.
(404) National Trends of Penile Fracture Encounters 2016-2019
Authors: Marte J , Lee J , Ingram J , Han D , Joice G
Published: February 2024

Introduction

Penile Fracture (PF) is an acute urological emergency resulting from the rupture of the tunica albuginea and one or both of the corpus cavernosa. Immediate surgical intervention is crucial in avoiding long-term complications, however the epidemiology and treatment patterns remain understudied, especially with the introduction of the 10th Revision of the International Classification of Diseases (ICD-10).

Objective

To evaluate national trends of PF encounters as well as predictive factors of inpatient admission from the emergency department (ED).

Methods

All patients admitted to the ED for PF between 2016-2019 were extracted from the NEDS using the ICD-10 Diagnosis Code S39.840 and its modifiers. Multivariable logistic regression was performed to identify predictors of this inpatient admission.

Results

Between 2016-2019, there were an estimated 7,091 weighted encounters related to PF in the US with an overall 13% increase in cases (Figure 1). About 20.8% (1,477) of these encounters led to inpatient admission. The average age of a patient presenting with PF was 41 years old. The majority of encounters took place in the South (44.12%) at non-trauma center rural hospitals (63.99%) and involved private insurance holders (44.42%). For those admitted to inpatient service, the average length of stay was 1.44 days, with a maximum of 26 days. The average total charge for patients discharged from the ED was $11,224 USD and those admitted were faced with charges averaging $33,474 USD. Predictors of inpatient admission included an Elixhauser Comorbidity Score > 1, encounters in the Northeast, Midwest, and Western states, and being covered by Medicaid (p < .05).

Conclusions

Penile fractures have seen a small increase in incidence from 2016-2019. Although inpatient admissions are less common, they carry significantly higher costs. Further studies of treatments and regional analysis may be warranted to decrease the amount of inpatient admissions.

Disclosure

No.
The centrality of redox regulation and sensing of reactive oxygen species in abiotic and biotic stress acclimatization
Authors: Denjalli Ibadete , Knieper Madita , Uthoff Jana , Vogelsang Lara , Kumar Vijay , Seidel Thorsten , Dietz Karl-Josef
Published: February 2024

During land plant evolution, the number of genes encoding for components of the thiol redox regulatory network and the generator systems of reactive oxygen species (ROS) expanded, tentatively indicating that they have a role in tailored environmental acclimatization. This hypothesis has been validated both experimentally and theoretically during the last few decades. Recent developments of dynamic redox-sensitive GFP (roGFP)-based in vivo sensors for H2O2 and the redox potential of the glutathione pool have paved the way for dissecting the kinetics changes that occur in these crucial parameters in response to environmental stressors. The versatile cellular redox sensory and response regulatory system monitors alterations in redox metabolism and controls the activity of redox target proteins, and thereby affects most, if not all, cellular processes ranging from transcription to translation and metabolism. This review uses examples to describe the role of the redox- and ROS-dependent regulatory network in realising the appropriate responses to diverse environmental stresses. The selected case studies concern different environmental challenges, namely excess excitation energy, the heavy metal cadmium and the metalloid arsenic, nitrogen or phosphate shortages as examples for nutrient deficiency, wounding, and nematode infestation. Each challenge affects the redox-regulatory and ROS network, but our present state of knowledge also points toward pressing questions that remain open in relation to the translation of redox regulation to environmental acclimatization.
The ‘Candidatus Phytoplasma ziziphi’ effectors SJP1/2 negatively control leaf size by stabilizing the transcription factor ZjTCP2 in jujube
Authors: Ma Fuli , Zheng Yunyan , Zhang Ning , Deng Mingsheng , Zhao Meiqi , Fu Gongyu , Zhou Junyong , Guo Chenglong , Li Yamei , Huang Jinqiu , Sun Qibao , Sun Jun
Published: February 2024

Phytoplasmas manipulate host plant development to benefit insect vector colonization and their own invasion. However, the virulence factors and mechanisms underlying small-leaf formation caused by jujube witches’ broom (JWB) phytoplasmas remain largely unknown. Here, effectors SJP1 and SJP2 from JWB phytoplasmas were identified to induce small-leaf formation in jujube (Ziziphus jujuba). In vivo interaction and expression assays showed that SJP1 and SJP2 interacted with and stabilized the transcription factor ZjTCP2. Overexpression of SJP1 and SJP2 in jujube induced ZjTCP2 accumulation. In addition, the abundance of miRNA319f_1 was significantly reduced in leaves of SJP1 and SJP2 transgenic jujube plants and showed the opposite pattern to the expression of its target, ZjTCP2, which was consistent with the pattern in diseased leaves. Overexpression of ZjTCP2 in Arabidopsis promoted ectopic leaves arising from the adaxial side of cotyledons and reduced leaf size. Constitutive expression of the miRNA319f_1 precursor in the 35S::ZjTCP2 background reduced the abundance of ZjTCP2 mRNA and reversed the cotyledon and leaf defects in Arabidopsis. Therefore, these observations suggest that effectors SJP1 and SJP2 induced small-leaf formation, at least partly, by interacting with and activating ZjTCP2 expression both at the transcriptional and the protein level, providing new insights into small-leaf formation caused by phytoplasmas in woody plants.
Cosmic evolution early release science survey (CEERS): multiclassing galactic dwarf stars in the deep JWST/NIRCam
Authors: Holwerda B W , Hsu Chih-Chun , Hathi Nimish , Bisigello Laura , de la Vega Alexander , Haro Pablo Arrabal , Bagley Micaela , Dickinson Mark , Finkelstein Steven L , Kartaltepe Jeyhan S , Koekemoer Anton M , Papovich Casey , Pirzkal Nor , Cook Kyle , Robertson Clayton , Casey Caitlin M , Aganze Christian , Pérez-González Pablo G , Lucas Ray A , Jogee Shardha , Wilkins Stephen , Burgarella Denis , Kirkpatrick Allison
Published: February 2024

Low-mass (sub)stellar objects represent the low end of the initial mass function, the transition to free-floating planets and a prominent interloper population in the search for high-redshift galaxies. To what accuracy can photometry only classify these? JWST/NIRCam has several advantages over Hubble Space Telescope (HST)/WFC3 near-infrared (NIR): more filters, a greater wavelength range, and greater spatial resolution. Here, we present a catalogue of (sub)stellar dwarfs identified in the cosmic evolution early release science survey (CEERS). We identify 518 stellar objects down to mF200W 28 using half-light radius, a full three magnitudes deeper than typical HST/WFC3 images. A k-means nearest neighbour (kNN) algorithm identifies and types these sources, using four HST/WFC3 and four NIRCam filters, trained on IRTF/spex spectra of nearby brown dwarfs. The kNN with four neighbours classifies well within two subtypes: e.g. M2±2, achieving ∼95 per cent precision and recall. In CEERS, we find 9 M8±2, 2 L6±2, 1 T4±2, and 15 T8±2. We compare the observed long wavelength NIRCam colours – not used in the kNN – to those expected for brown dwarf atmospheric models. The NIRCam F356W−F444W and F410M−F444W colours are redder by a magnitude for the type assigned by the kNN, hinting at a wider variety of atmospheres for these objects. We find a 300–350 pc scale height for M6±2 dwarfs plus a second structural component and a 150–200 pc scale height for T6±2 type dwarfs, consistent with literature values. A single M8±2 dwarf is spectroscopically confirmed at 4 kpc distance.
Performance analysis and optimization of solar multiconjugate adaptive optics systems
Authors: Ke Zibo , Zhang Lanqiang , Yang Ying , Rao Changhui
Published: February 2024

Multiconjugate adaptive optics (MCAO) stands as an essential technology for the development of future large-aperture solar telescopes. Its primary objective is to empower telescopes to achieve nearly diffraction-limited performance while substantially extending the correction field of view (FoV). Conventional solar MCAO relies on the combination of adaptive optics and high-altitude correction (AO + HAC) modules for multiconjugate correction. However, this architectural approach excels in correction performance primarily at the central position, with performance deteriorating as one moves farther from the centre. Consequently, it results in poor consistency of FoV correction performance. To address these limitations, a new architectural approach was introduced, which combines ground layer AO with HAC (GLAO + HAC). Preliminary results have shown that, compared to AO + HAC, this approach significantly enhances FoV correction uniformity. Building upon these initial findings, this paper undertakes a more extensive research of the GLAO + HAC system. Its objective is to compare various solar MCAO system architectures, including AO + HAC, GLAO + HAC, and general MCAO, to finally propose optimization tailored to GLAO + HAC. Through this analysis, the paper conducts the performance comparison between GLAO + HAC and general MCAO. It underscores that, under equivalent configuration parameters, the differences between these two systems are marginal. However, due to the advantage of the independent control of dual correction modules in GLAO + HAC, it can introduce an optimization strategy by increasing the number of subapertures at the cost of reducing the GLAO guide star sensing FoV. Finally, the results of this strategy demonstrate an obvious enhancement in performance and FoV correction consistency within the GLAO + HAC system.
Search for brown dwarfs in IC 1396 with Subaru HSC: interpreting the impact of environmental factors on substellar population
Authors: Gupta Saumya , Jose Jessy , Das Swagat R , Guo Zhen , Damian Belinda , Prakash Prem , Samal Manash R
Published: February 2024

Young stellar clusters are predominantly the hub of star formation and hence, ideal to perform comprehensive studies over the least explored substellar regime. Various unanswered questions like the mass distribution in brown dwarf regime and the effect of diverse cluster environment on brown dwarf formation efficiency still plague the scientific community. The nearby young cluster, IC 1396 with its feedback-driven environment, is ideal to conduct such study. In this paper, we adopt a multiwavelength approach, using deep Subaru HSC along with other data sets and machine learning techniques to identify the cluster members complete down to ∼ 0.03 M⊙ in the central 22 arcmin area of IC 1396. We identify 458 cluster members including 62 brown dwarfs which are used to determine mass distribution in the region. We obtain a star-to-brown dwarf ratio of ∼ 6 for a stellar mass range 0.03–1 M⊙ in the studied cluster. The brown dwarf fraction is observed to increase across the cluster as radial distance from the central OB-stars increases. This study also compiles 15 young stellar clusters to check the variation of star-to-brown dwarf ratio relative to stellar density and ultraviolet (UV) flux ranging within 4–2500 stars pc−2 and 0.7–7.3 G0, respectively. The brown dwarf fraction is observed to increase with stellar density but the results about the influence of incident UV flux are inconclusive within this range. This is the deepest study of IC 1396 as of yet and it will pave the way to understand various aspects of brown dwarfs using spectroscopic observations in future.