bluuebunny/crossref_metadata_2025 huggingface dataset:
(163) Efficacy of Collagenase Clostridium Histolyticum in Calcified Peyronie’s Disease
Authors: Zucker I , Atuluru P , Ibrahim E , Kava B , Ramasamy R , Masterson T
Published: May 2023

Introduction

Peyronie’s disease (PD) affects between 0.4% and 13% of the male population. It leads to inelastic scar tissue in the tunica albuginea which in turn leads to penile curvature, deformity, and shortening. Collagenase clostridium histolyticum (CCH) is the only FDA approved intralesional medication for PD, but its efficacy in calcified PD remains controversial. The two large, double-blind, placebo controlled randomized clinical trials, known as the IMPRESS trials, excluded men with calcified plaques, which occurs in 25-30% of all patients with PD.

Objective

We aimed to evaluate change in penile curvature in men with calcified PD plaques after 8 injections of CCH in a large cohort of men

Methods

We prospectively evaluated men with PD presenting to our clinic from October 2018 to November 2020 electing CCH treatment. All men received a pre-treatment penile duplex ultrasound with artificial erection to assess degree of calcification and curvature. We used a grading system to assess calcification: Type 1: The plaque appears as a thickening of the tunica albuginea without acoustic shadowing; Type 2: A moderately calcified plaque with a typical ultrasound shadow, and Type 3: A severely calcified plaque with complete ultrasound shadowing. All men received CCH (0.58 mg) injected directly into the primary plaque at the point of maximal penile curvature using a standardized injection technique following the manufacturer's instructions. Cycles were terminated early if the patient was satisfied with the curvature or subjects reached less than 15 degrees. We remeasured the curvature in patients 4-6 weeks after the final CCH with artificial erection. All results are presented as mean ± standard deviation (SD)

Results

In total, 60 patents presented with calcified PD plaques with 32 (53.3%) receiving all 8 injections and another 5 patients were satisfied with results and elected to stop treatment. The remaining 23 (38.3%) discontinued before finishing; on average they received 5.6 injections. There were no differences in baseline characteristics between men who completed treatment and those that discontinued. In patients who were satisfied there was significant (p<0.0001) mean change per subject of -21.6 ± 19.9 degrees or 37.3% (Table 1). In the discontinued there was a mean change per subject of -12.8 ± 13.9 degrees (p=0.05). There was no significance difference in change in curvature between grade 2 (-24 ± 14.9 degrees) and grade 3 (-21.3 ± 23.4 degrees) calcified plaques (p=0.71) (Table 1).

Conclusions

Overall, CCH appears effective in the treatment of patients with calcified PD plaques. In patients who successfully completed 8 injections or was satisfied there was a significant difference in curvature after treatment and can help inform patients about treatment benefits despite calcification.

Disclosure

Yes, this is sponsored by industry/sponsor: Endo Pharmaceuticals

Clarification

Industry funding only - investigator initiated and executed study
(164) Real-World Practice in Peyronie’s Disease Management: Results from a National Survey of Urologists
Authors: Brant A , Basourakos S , Lewicki P , Kang C , Marinaro J , Punjani N , Kashanian J
Published: May 2023

Introduction

There are many treatment options for men with Peyronie's disease, some which have been shown in randomized controlled trials to be more effective than placebo in reducing curvature and plaque size and others which do not have strong evidence of efficacy for use. It is unclear which of the many Peyronie's disease treatment choices are preferred by practicing urologists.

Objective

To survey practicing urologists on their preferred methods for diagnosing and treating Peyronie's disease.

Methods

A 34-item survey was distributed via REDCap to urologists in all American Urological Association (AUA) sections. Questions elicited demographic information as well as practices in diagnosis and treatment of Peyronie’s disease. Comparisons were made with Pearson’s chi-squared test.

Results

A total of 145 respondents completed the survey, of whom 19% were fellowship trained in andrology/sexual medicine, 36% practiced in an academic setting, and 50% had at least 20 years in practice. Only 60% of respondents reporting performing in-office curvature assessment prior to commencing intralesional injection or surgical treatment, with higher prevalence in andrology/sexual medicine fellowship-trained vs. non-fellowship trained urologists (85% vs. 54%, p=0.003). The most popular treatment modalities were collagenase clostridium histolyticum (CCH) (61% of respondents), phosphodiesterase-5 (PDE-5) inhibitors (54%), and penile traction (53%). Twenty-one percent of respondents reported currently using a treatment that is explicitly discouraged by the AUA guidelines (extracorporeal shockwave therapy for curvature, L-carnitine, omega-3 fatty acids, procarbazine, tamoxifen, or vitamin E).

Conclusions

We found reported use of a variety of Peyronie's disease treatments, despite poor evidence of efficacy for several of these therapies. PDE-5 inhibitors, penile traction, and CCH were among the most popular non-surgical treatments, with a significant proportion of urologists reporting “off-label” use of CCH. Efforts are needed to identify optimal regimens for Peyronie's disease treatment and to better educate urologists on the up-to-date evidence and guidelines in Peyronie's disease management.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Roman Health
(177) Female Sexual Dysfunction: Can it be Addressed During Infertility Treatment?
Authors: Schaub A , Dubinskaya A , Pisarska M , Eilber K
Published: May 2023

Introduction

Female sexual dysfunction (FSD) is a highly prevalent and distressing condition in the general population. Women undergoing fertility treatments are at even higher risk of developing sexual dysfunction due to sexual activity being perceived as an obligation to conceive versus for pleasure, stress of whether the current act of intercourse will result in conception, and a sense of sexual activity as being part of a demanding medical treatment regimen.

Objective

The purpose of this review is to investigate currently used interventions and/or treatments of FSD in the settings of infertility treatment.

Methods

We conducted a systematic review on the current approaches to treat FSD while undergoing fertility treatments. PubMed, PMC and Google Scholar were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria for this review were female subjects undergoing infertility treatment, sexual health was described and measured, interventions were performed or recommended to the subjects with measured outcomes, and the manuscript was written in English between January 2000 to June 2022. Case reports and studies that did not address conditions of interest were excluded from analysis.

Results

Queries identified 2,341 studies of which title and summary were screened. Fourteen articles met inclusion criteria and underwent full text review. Although multiple studies described an association between infertility and different types of FSD, no study described outcomes for FSD interventions in the infertility setting.

Conclusions

There is a complete lack of FSD treatment options for infertility patients. Clinicians treating infertility patients should consider discussing FSD and its treatment options in this population.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie, Coloplast, Sprout Pharmaceuticals.
(178) Prospective Urology Resident Exposure to Genital Gender Affirming Surgery
Authors: De Rosa P , Pearlman A
Published: May 2023

Introduction

Genital gender affirming surgery (GGAS) is a component of transgender and gender expansive healthcare. Transgender health has been increasingly covered in undergraduate medical school curricula, however the prevalence of education on GGAS is not well known. We sought to learn about urology applicants’ exposure to GGAS.

Objective

To investigate prospective urology resident exposure to GGAS and impact on residency applications.

Methods

An online Redcap survey was distributed via Twitter in Spring 2022. Recent or prospective urology residency applicants were invited to participate. The survey collected demographic data and assessed level of exposure to GGAS in medical school and perceived importance of GGAS training in choice of urology residency program.

Results

42 respondents completed the survey. 21.4% (9) of respondents identified as a member of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA) community. 73.8% (31) identified as White. 59.5% (25) reported experience with LGBTQ health. 59.5% (25) reported no clinical or didactic exposure to GGAS. 57.1% (24) reported training in GGAS was “moderately important” to “extremely important” in their selection of residency programs. Didactic exposure to GGAS was weakly associated with importance of GGAS training (LR 0.335, p = 0.03). LGBTQIA respondents were more likely to have greater didactic exposure to GGAS (LR 7.776, p = 0.021).

Conclusions

The majority of respondents had no clinical or didactic exposure to GGAS in medical school. Over half of respondents indicated that GGAS was an important factor in residency program selection. Our findings emphasize the importance of GGAS training as part of comprehensive urology graduate medical education.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(189) Sexual Abuse and Vesico-Sphincter Dysfunction
Authors: Jamali M , Boukhlifi Y , Melang Mvomo A , Mohammed A , Ameur A
Published: May 2023

Introduction

Even though urologists know that there may be an association between sexual abuse and urinary disorders, finding sexual abuse (SA) is often not part of their standardized questioning.

Objective

Evaluate the incidence of sexual abuse (SA) in women with vesico-sphincter dysfunction, to understand the cause-and-effect relationship in order to adapt their management.

Methods

A multi-parametric, cross-sectional study was conducted by a female doctor looking for sexual assault, the latter interviewed 214 women (42 years, extremes 19-75 years), followed by specialists between January 2017 and December 2019. All patients were evaluated by voiding schedule, MHU score (a measure of urinary disability), bladder fibroscopy, and urodynamic workup and spinal MRI to exclude neurological injury. The results are presented in Tables 1 and 2.

Results

The possible recollection of a memory of sexual abuse leads to a categorical refusal of the urogynecological clinical examination or an attitude of opposition during a urodynamic or proctological examination. No correlation between the painfulness of this memory and the seriousness of what induced it has been demonstrated; sometimes a simple examination may have been experienced as aggression. The observation of a "frozen" perimeter, which does not contract with the effort of restraint and does not relax with the push or the request for relaxation, will draw our attention even more to the fact that it is a hypertonic perimeter.

Conclusions

Sexual assaults are very frequent and their management is multidisciplinary due to the physical, psychological, or psychosomatic consequences. They concern men as well as women, regardless of the socio-economic context, and this has been shown in all epidemiological studies. This proves the strong causal link between LUTS and sexual abuse.

Disclosure

No
(198) How to Use VSI HoloMedicine for Beginners: Imaging and Surgical Instrument’s Sharing
Authors: Hakky T , Carrion R , Simhan J , Shridharani A , Steinhorst B , Henry M , Henry G
Published: May 2023

Introduction

Extended Reality-Assisted Surgery (XRAS) is a novel technology that superimposes a computer-generated image in the physicians’ visual field to integrate common elements of the surgical process in advanced detail. Although XRAS has already been utilized by several medical disciplines, many face challenges with implementation and perceive integration between the hardware and software for XRAS to be quite burdensome. Nevertheless, the present group has successfully reported XRAS in complex penile implant revision surgery. In order to help reduce the learning curve, we present this introductory video demonstrating how users may sign into the software for XRAS, download patient imaging, demonstrate imaging to other doctors, and employ surgical tools “live” with other colleagues.

Objective

Video for beginners to XRAS to learn how to sign onto VSI HoloMedicine®, download patient imaging, demonstrate the imaging to other doctors and usage of surgical tools and penile implants ‘live” with other surgeons.

Methods

The hardware utilized for XRAS was XR Microsoft HoloLens (Microsoft, Redmond, WA, USA) while VSI HoloMedicine (XX, Dusseldorf, Germany) was the software program. Raw data from CT scans were downloaded onto VSI HoloMedicine. Local Wi-FI was used for connecting different surgeons remotely to discuss patient care decision-making and surgical tool usage.

Results

Signing onto VSI HoloMedicine and downloading patient imaging is detailed. Two (2) de-identified patient’s imaging was shown to surgeon colleagues for discussion and clinical assistance in making patient care decisions. Surgical tool and penile implant components were demonstrated while connected to another surgeon.

Conclusions

With proper instructions as shown on this video, getting on and connecting with other surgeons through XRAS can be straightforward. Here, we demonstrate how to download patient imaging, show the imaging details in-depth and how surgical tools and penile implants can be successfully implemented during XRAS.

Disclosure

Yes, this is sponsored by industry/sponsor: Coloplast

Clarification

Industry funding only - investigator initiated and executed study

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.
(208) Coital Positions and Clitoral Blood Flow: A Biomechanical and Sonographic Analysis
Authors: Marashi A , Lovie K
Published: May 2023

Introduction

The purported benefits of various coital positions are described in numerous magazines, books, and public forums. However, there is little scientific research that evaluates the association between different coital positions and the ability to produce female orgasm.

Objective

To create biomechanical models of five coital positions, and evaluate the degree of contact and forces against the clitoris. To evaluate clitoral blood flow before and after engaging in these positions.

Methods

Biomechanical models were rendered of a male and female pelvis in the following coital positions: face-to-face/female above, sitting/face-to-face, face-to-face/male above (with and without pillow), and kneeling/rear entry. The thrusting force and gravitational force were estimated for the pelvis(es) providing the main forces. The areas of contact between the pelvises were identified and highlighted. Sonography of the clitoris was performed before and after a healthy volunteer couple engaged in each position, using a Philips Lumify™ ultrasound (Koninklijke Philips N.V., Amsterdam, Netherlands) with a L12-4 linear array transducer (4-12 MHz).

Results

The biomechanical models for each position, with the exception of kneeling/rear entry, reveal a large amount of contact with the clitoris. Clitoral blood flow increased after engaging in each position except for kneeling/rear entry. Positions in which the gravitational force of the thrusting partner was in the same direction of (and thereby augmenting) the thrusting force resulted in intense clitoral blood flow (face-to-face/female above, and face-to-face/male above). Augmenting the face-to-face/male above position with a pillow generated a component of the male pelvic gravitational force in the direction of the clitoris; this resulted in more blood flow to all components of the cavernous body.

Conclusions

From a biomechanical perspective, different coital positions vary in their potential to stimulate the clitoris. These positions lead to variable increases in clitoral blood flow, concordant with our biomechanical models.

Disclosure

No
(213) Sexual Dysfunction in Young Women with Recurrent Urinary Tract Infections
Authors: Schulz A E , Axler E , Loloi J , Abraham N
Published: May 2023

Introduction

Sexual intercourse is the risk factor most commonly associated with recurrent UTI in young women. Few studies have analyzed how rUTIs subsequently impact women’s sexual health and function

Objective

To investigate whether young women with rUTIs experience sexual dysfunction.

Methods

This is a prospective study with preliminary data collection from May – June 2022. A survey was posted on five subreddits, r/Healthyhooha, r/Interstitialcystitis, r/CUTI, r/WomensHealth and r/badwomensanatomy, which included questions on demographics, rUTI history and the 13-question Female Sexual Distress Scale-Revised (FSDS-R). Women were asked to answer the questionnaire in terms of their rUTI frequency and severity, with a scale from 0 (never) to 4 (always). Women between 18 – 35 years, not currently pregnant, and had UTIs at least every 3-4 months were included in the analysis. A score ≥ 11 indicated female sexual dysfunction (FSD). Severity of FSD was categorized as: mild (11 – 20), mild-moderate (21 – 30), moderate (31 – 40) and severe (≥41).

Results

One hundred fifty-one women completed the survey with 120 included in the analysis (79.5%). The average age was 27±4.9 years, majority self-identified as white (85.7%), and over half had a comorbidity (57.5%), with the most common being irritable bowel syndrome (33.3%) and autoimmune illnesses (23.2%). Half of women (50%) experienced UTIs every 3-4 months, 36.7% every month, and 13.3% every week. Women had rUTIs for an average of 9.2±8.4 years. Over half of women (59.2%) had a complication from their rUTIs, with 43% having pyelonephritis and 26.6% urosepsis. In the FSDS-r, frustration about sexual problems received the highest average score (2.9), with 42.5% of women reporting frequently and 30% reporting always feeling frustrated. Guilt over sexual problems had the second highest average score (2.7), with 35% of women frequently and 29.2% always feeling guilty. More than a third of women (40.8%) responded that they frequently avoid sex due to sexual distress. We found 111 (92.5%) participants qualified as having FSD, with an average FSDS-r score of 31.9±12.3. In terms of FSD severity, 10.8% had mild, 28% mild-moderate, 33.2% moderate and 28% severe. There was no significant difference between ethnicity, comorbidities, complications, and UTI frequency with worsening FSD score.

Conclusions

Many young women experience rUTIs. In our study, over 90% of young women with rUTIs qualified as having FSD measured by the FSDS-R. Our findings highlight the importance of screening women who experience rUTIs for sexual dysfunction to potentially improve their sexual health and quality of life.

Disclosure

No
(214) Female bmg Urethroplasty and 2nd Degree Vaginal Tear Repair
Authors: Stanojevic N , Ruffo A
Published: May 2023

Introduction

Pregnancy and childbirth bring biological, psychological, and social changes which may influence women's health.

Objective

Second degree tears are the most common type of tear. A female urethral stricture is a less common condition. Buccal mucosa graft (BMG) is widely used tissue for urethral stricture repair.

Methods

We present a 38-year old female who suffered a 9-year long history of urethral stricture disease and dyspareunia after two vaginal child births. The patient (pt) had urethral injury and 2nd degree tear in vaginal wall and pelvic muscle. Despite repeated attempts of urethral dilations, the stricture and the obstructive complaints persisted. Additionally, lack of sexual arousal and painful intercourses, affected the patient’s quality of life. The pt was treated with a dorsal onlay urethroplasty using a buccal mucosa graft, excision of vaginal wall scar, pelvic floor muscle repair, and repair of vaginal opening The surgery was carried out with a suprameatal approach. A semicircular incision was performed and the urethra was dissected from the ventral aspect of the clitoris with a sharp and blunt dissection up to the proximal part of stricture. Then, a dorsal sagittal incision is performed over the stricture and the BMG is sutured dorsally for the edges and quilted with 4.0 polyglactin sutures. A 16Fr Foley catheter was left in place for two weeks. Then, we performed hydrodissection of posterior vaginal wall, scar excision from episiotomy and 2nd degree tear, approximation of levator ani muscle, vaginal wall and opening repair.

Results

Two weeks after surgery the patient urinates without strain and with no post voiding residual urine. Uroflow 6 weeks after surgery showed Qmax of 28ml/sec and urethra was easily passable for 20Fr Nelaton catheter. Eight weeks after surgery the patient reported having a normal sexual life without pain and lack of sexual satisfaction

Conclusions

Female dorsal onlay urethroplasty and vaginal wall tear repair are feasible and give great functional and aesthetical results

Disclosure

No
(217) “Vagina” is Not a Bad Word: Historical and Contemporary Censorship of the Word “Vagina”
Authors: Popat S , Horwitz R , Eilber K , Lee U
Published: May 2023

Introduction

The first recorded use of the word “vagina” was in 1680. It is the only contemporary anatomic term for the female reproductive canal and has no anatomically accurate substitute. For the last 350 years, use of the word has been intentionally avoided in media, print, and society in general.

Objective

We sought to characterize instances of “vagina” censorship to better understand perceptions and behaviors surrounding the word “vagina.”

Methods

An internet and relevant database (PubMed, Academic OneFile, Proquest, Health Business Elite, etc.) search was conducted for “vagina, “censor,” and related wildcard terms. Search results were filtered by three independent reviewers for relevance. Related articles were summarized and reviewed for common themes.

Results

Examples of censorship of the word “vagina” were compiled in Table 1, and several themes were identified: (1) Policies surrounding censorship are unclear. Affected parties typically receive generic responses – for instance, that content “does not comply” with standards. Censoring parties oftentimes will not explicitly identify language or elements of concern. (2) Policies appear highly variable. In advertisements for similar products on the same social media platforms, some companies successfully use the word “vagina” while others are barred, highlighting puzzling inconsistencies. (3) Another related theme that emerges is differing standards between references to male and female genitalia. For example, “penis” and associated references were often allowed by the same television shows that mandated censorship or omission of “vagina.” (4) Objections often call the use of “vagina” overtly sexual, profane, or unprofessional. However, “vagina” refers to an anatomical term for which there is no suitable, biologically accurate alternative. Censorship of the word forces inaccurate, over-generalized, ambiguous references to female genitalia.

Conclusions

The word “vagina” is censored across multiple platforms: print, film and television, social media, politics, education, and more. It has been censored for centuries and continues to be today. This erects barriers to care for women. Patients increasingly turn to the internet and other media platforms as accessible sources of high-quality health information about their bodies. Pervasive censorship of the word “vagina” perpetuates a culture of ignorance and shame about women’s bodies. Until we normalize the term “vagina,” we cannot make progress on women’s pelvic health.

Disclosure

No
(223) Sexual Therapy: Patient-reported Barriers to Care
Authors: Jefferson F , Ziegelmann M , Vencill J , Helo S , Kohler T , Collins C S
Published: May 2023

Introduction

Sexual therapy for male sexual dysfunction has been used to help patients address a variety of sexual dysfunction-related conditions. While this intervention is frequently recommended for patients by male sexual health experts, the rate of adherence to the recommended therapy and associated factors is unknown.

Objective

To understand factors leading to completion of sex therapy consultations and barriers that prevent it.

Methods

A survey was developed by experts in the management of male sexual dysfunction and sex therapy at our institution. The survey included questions focusing on the decision to pursue sex therapy (or not), barriers or facilitating factors, patient perceptions regarding the referral, and treatment success. A retrospective chart review was performed to identify those patients who were referred for sexual therapy after undergoing evaluation for male sexual dysfunction at an academic Men’s Health urology clinic from 2017 - present. The survey was mailed out to these patients, and respondent survey data was compiled to evaluate survey responses.

Results

To date, 23 patients completed the survey (20% response rate). Sixty-five percent of survey respondents were ≥ 50 years of age, 87% were straight, and 71% were married. Reasons for sex therapy referral were frequently multi-factorial and included erectile dysfunction (65%, n=15), low libido (43%, n=10), ejaculatory dysfunction (39%, n=9), performance anxiety (30%, n=7), relationship problems (30%, n-7), and genital pain (14%, n=3). Seventy-eight percent of patients (n=18) felt that sex therapy consultation was a reasonable part of their treatment plans. Six (26%) patients did not attend their recommended sex therapy consultations. Reported barriers included sense of shame (n=2), embarrassment (n=2), scheduling conflicts (n=1), lack of anticipated benefits (n=1), and feeling dismissed by the referring provider (n=2). Those who attended sex therapy frequently reported the perception that referral made sense based on their symptoms (n=10, 59%) and/or a feeling of desperation to “do anything do get better” (n=11, 65%). Seventy-eight percent of patients who attended sex therapy found it helpful and would recommend it to a friend with a similar concern.

Conclusions

The majority of male patients who are referred to sexual therapy feel it is beneficial. However, one in four men choose not to pursue this line of treatment despite recommendations from their treating physicians. Future work is needed to address barriers to pursuing sex therapy.

Disclosure

No
(231) Endogenous Vasoactive Peptides in the Control of Human Penile Erectile Tissue: Is There a Significance of the Neuropeptide Y (NPY)?
Authors: Maerker V , Ueckert S , Becker A , Bannowsky A , Kuczyk M
Published: May 2023

Introduction

Aside from the neurotransmitters of the sympathetic adrenergic system, vasoconstrictor peptides may also play a role in mediating the constant tone of the erectile tissue during penile flaccidity and in returning the erect penis to the flaccid state. Neuropeptide Y (NPY) is present in high concentrations in the male genital tract. The peptide has been shown to induce contraction of isolated human penile tissue (corpus cavernosum, penile arteries) and potentiate its response to noradrenaline.

Objective

The purpose of our study was to measure in the cavernous and systemic blood of healthy male volunteers the course of NPY through different stages of sexual arousal.

Methods

Whole blood was drawn from the corpus cavernosum and the cubital vein of 15 healthy male volunteers during penile flaccidity (Fl), tumescence (Tu), rigidity (Ri) and detumescence (Det). Penile tumescence and erection were induced by applying audiovisual and tactile stimulation. Plasma levels of NPY (given in pmol/L) were determined by means of an enzyme-linked immunoassay (ELISA, IBL GmbH, Hamburg, Germany).

Results

NPY significantly decreased in the cavernous blood with the beginning of sexual arousal, when the flaccid penis became tumescent and finally rigid (Fl: 88.8 ± 35.8, Tu: 62.4 ± 22.7, Ri: 62.3 ± 19.7). In the phase of detumescence, only a slight increase was noted (64.8 ± 23). In the systemic circulation, no pronounced alterations in the concentration of NPY were registered through the different penile stages (Fl: 64.4 ± 27, Tu: 65.8 ± 19, Ri: 59.6-25, Det: 67.6 ± 29.3).

Conclusions

Our findings are in favor of the hypothesis that NPY could contribute to the maintenance of the resting state of cavernous smooth muscle. It remains to be elucidated whether the peptide may play a role in the pathophysiology of erectile dysfunction.

Disclosure

No
(248) Utility of Fine-needle Vasography in Men with Obstructive Azoospermia
Authors: Mian A , Huang E , Starke N , Trost L , Helo S
Published: May 2023

Introduction

Obstructive azoospermia accounts for up to 14% of patients presenting for fertility evaluation. Fine-needle vasography (FNV) is a diagnostic procedure that can be performed to identify an obstruction proximal to the ejaculatory duct. Compared to traditional vasography, FNV utilizes a less-invasive method to perform imaging of the vas deferens and distal ejaculatory structures. Herein we report our experience performing FNV in a series of patients with suspected complete or near-complete obstruction.

Objective

To report our experience using FNV to identify a site of obstruction and determine candidacy for reconstructive procedures in patients presenting with suspected obstructive azoospermia or cryptozoospermia.

Methods

We report a multi-Institutional case series of patients with suspected complete or partial obstructive azoospermia. Patients that were included had azoospermia or severe oligoasthenospermia, presence of palpable vasa, testicles ≥12 ml, and FSH <7.6 IU/L. All patients underwent testicular biopsy prior to or at the time of FNV to confirm spermatogenesis. Fine-needle vasography was performed using a 25F angiocatheter, with radio-opaque dye visualized under fluoroscopy. Descriptive statistics are reported as median and interquartile range (IQR).

Results

A total of 16 patients underwent vasography between 2014 and 2022 with three surgeons. Twelve patients presented with azoospermia, and four with severe oligoasthenospermia. Median age at vasography was 35.0 (IQR 17) years. Median pre-vasography semen parameters were sperm concentration 0 million/mL (IQR 0.3), sperm motility 0% (IQR 1), semen volume 2.5 mL (IQR 2.5), and semen pH 8.0 (0.7). Median total testosterone was 445 ng/dL (IQR 433), and FSH 4.5 IU/L (IQR 3.6). Half of patients had a history of inguinal hernia repair, unilateral in two and bilateral in six cases. History of genitourinary infection was present in six (35.3%) patients. A total of 7 (44%) men were found to have distal obstruction on FNV, while 8 (50%) were offered epididymovasal reconstruction. Of the seven patients diagnosed with obstruction/atresia of the vas deferens within the inguinal canal and/or pelvis, only two were related to prior inguinal hernia repair. Of the eight men with prior inguinal hernia repairs, two were confirmed to have an obstruction at the level of the inguinal canal. Of the six patients with a history of genitourinary infection, four had an obstruction at the level of the epididymis (with normal FNV), while two had atresia of the vas deferens in the pelvis.

Conclusions

Fine-needle vasography is an effective, minimally-invasive way to identify the site of complete or partial obstruction in patients presenting with suspected obstructive azoospermia or severe oligoasthenospermia. It additionally permits identification of men who are candidates for epididymovasostomy reconstruction and helps to differentiate between ejaculatory duct obstruction and other causes of blockage.

Disclosure

No
(257) Ultrasound Classification System for Peyronie's Disease
Authors: Baird B , Haehn D , Gibbs E , Wajswol E , Anderson A , Alexander L , Broderick G
Published: May 2023

Introduction

Peyronie’s Disease (PD) is characterized by a fibrous scar of the tunica albuginea. PD is typically imaged with 2D ultrasound. We propose a classification system of these ultrasound findings in the evaluation of PD.

Objective

The purpose of this study is to establish a functional sonographic classification system for evaluating PD and to examine the relationship between PD grading and curvature, duration of PD, and vascular erectile status.

Methods

In our study, 395 patients with PD underwent intracavernosal injection with an erectile agent (ICI) followed by Color Doppler Duplex Ultrasound (CDDU). All CDDU studies were performed by a single examiner and all PD grading was done by two independent reviewers using saved images. Ultrasound findings including peak systolic velocities (PSV) and resistive indices (RIs) were recorded. PD grades of 2D images were classified into three grades: Grade 1 acoustic shadowing without calcification; Grade 2 focal microcalcifications of the tunica, pillars, or septal fibers; Grade 3 confluent calcification of the dorsal, septal, ventral tunica albuginea.

Results

There were 250 patients classified with Grade 1 (63%) sonographic changes, 75 with Grade 2 (19%), and 70 with Grade 3 (18%). All groups had similar median ages and body mass index (BMI): Grade 1 (59.3 yr), Grade 2 (59 yr) and Grade 3 (60.3 yr), p = 0.711; BMI 27.6, 28.2, 27.7, p = 0.813. Additionally, medical and surgical risk factors for erectile dysfunction were similar across the three groups; these included hypertension, heart disease, diabetes mellitus, hyperlipidemia, smoking history, and history of prostate surgery. Most patients had previously used PDE5-Inhibitors (293/395). History and/or physical findings of Dupuytren’s palmar contracture was noted in 30/395 (7.6%) of men. The median duration of PD was not significantly different across the three groups (12, 12, 14 months p = 0.639). Neither CDDU diagnoses (Table 1) nor curvature varied by sonographic grades (Table 2).

Conclusions

The scar resulting from PD seals together the outer longitudinal and inner circular layers of the tunica albuginea causing deformity of the erect shaft. PD plaques are usually palpable and associated with focal thickening of the tunica. On 2D ultrasound, the typical appearance is an acoustic shadow. Most of our patients presented with Grade I acoustic shadowing and no calcifications 250/395 (63%). On the other hand, 19% had acoustic plaque shadowing and additional findings of focal tunica or deep microcalcifications and 18% had confluent calcification of the dorsal, septal or ventral tunica. We propose a unique and reproducible classification system for Peyronie's Disease. This grading system is based on grayscale ultrasound of Peyronie’s plaques may serve the purpose of diagnostic evaluation, didactic teaching and integrated research.

Disclosure

No
(258) Agatston Calcium Score Assessment of Plaque Calcification in Peyronie’s Disease
Authors: Baird B , Gibbs E , Wajswol E , Geldmaker L , Haehn D , Alexander L , Broderick G
Published: May 2023

Introduction

Peyronie’s disease (PD) is characterized by penile pain, penile deformation and curvature, sexual dysfunction, and psychological implications. Fibrosis and plaque formation are often part of PD pathophysiology. Calcified plaques can alter treatment planning. Penile ultrasound with Doppler (PUS) is used to exclude erectile dysfunction and identify plaques. However, plaque extent and distribution can be obscured by acoustic shadowing, limiting complete plaque characterization. Non-contrast pelvis computed tomography (CT) provides a noninvasive method to identify plaques in 3 dimensions and quantify plaque Ca burden.

Objective

Our objective was to utilize Agatston Ca scoring measure Ca burden in patients with Peyronie's disease.

Methods

A retrospective database from 1/1/2017 and 6/30/2021 identified 25 men with calcified plaques on CT after PUS performed by a single urologist. Two abdominal radiologists reviewed CTs in consensus to measure calcified plaque size and distribution on Visage PACS. Semiautomated Agatston Ca scoring values were obtained with Syngo.via. Total Ca volume (mm3), total Ca score were correlated with hourglass deformity on clinical exam, plaque complexity on CT (>2 discrete calcified plaques, circumferential corpus cavernosum involvement, septal involvement), and surgical management using descriptive statistics and t-test.

Results

Mean Ca volume was 1417 mm3 (range 1.4-5425.7, standard deviation (SD) 1570); mean Ca score was 1691 (range 1.6-6048; SD 1862) with significantly higher Ca volume in patients with complex plaques (265 mm3 vs 472 mm3, p<0.05), and significantly longer plaque dimension for longest plaque dimension measured by CT vs US (31 vs 23, p<0.05). There was no significant difference in Ca volume for nonsurgical vs surgical (1791 vs 893, p=0.06) or for no hourglass vs hourglass deformity (1173 vs 1904, p=0.19).

Conclusions

CT scan and calcium scoring are useful tools in the assessment of PD. Semiautomated Ca scoring may help noninvasively identify complex calcified penile plaques to guide medical and surgical therapy for Peyronie’s disease.

Disclosure

No
(259) Computed Tomography for Evaluation of Complex Calcified Peyronie's Disease
Authors: Baird B , Gibbs E , Wajswol E , Haehn D , Geldmaker L , Alexander L , Broderick G
Published: May 2023

Introduction

The presence and extent of penile calcifications is an important factor in disease management of Peyronie’s Disease (PD). Calcified plaques may necessitate plaque excision and grafting (E&G) in addition to other therapies or surgeries. PD pathology such as corporal septal involvement, multifocal calcifications, and circumferential corporal calcification can be difficult to assess on color doppler ultrasound (CDDU) due to device limitations. Computed tomography (CT) can be utilized for further characterization of PD.

Objective

The objective of our study was to review patients who underwent CT imaging for characterization of their Peyronie's Disease.

Methods

Twenty-three patients with a diagnosis of PD were retrospectively evaluated between 2017 and 2021. Patients underwent CDDU examination with artificial erection and were evaluated based on erectile function, plaque dimension, hourglass deformity, plaque septal involvement, and suspected calcification status. Patients with CDDU examination suggestive of calcification or significant complexity underwent non-contrast CT scan for 3-dimensional evaluation of the plaque prior to surgical discussion. CT complexity was defined as concern for multifocal calcified plaques (>2), partial/complete circumferential corpus cavernosum involvement, or septal involvement.

Results

All 23 patients had concerning findings on initial examination for calcified plaque which led to their CT evaluation; 9 of 23 (39.1%) patients had exam findings with hourglass deformity. On CT evaluation, calcification was confirmed in 22 of 23 patients (95.7%). Plaque dimensions on CT scan ranged from 0.4 x 0.2 x 0.5 cm to 4.0 x 2.0 x1.7 cm. Many of these measurements were approximations due to circumferential calcified plaque. A classic “gull-wing” appearance was noted in 6 of 23 (26%) patients; 12 of 23 (52.2%) of patients had septal involvement on CT; 8 of 23 patients (34.8%) had significant multifocal disease; 8 of 23 patients (34.8%) decided to proceed with surgical correction via E&G (n = 3), IPP with E&G (n =1), or via IPP with manual remodeling via Wilson technique (n = 4).

Conclusions

Non-contrast penile CT scan identifies calcification well in patients with Peyronie's Disease. CT allows for increased accuracy of surgical planning especially when evaluating for multifocal disease, circumferential plaque and/or septal involvement. These elements are critical for for providing accurate surgical recommendations and preoperative discussions.

Disclosure

No
(281) Pelvic Floor Dysfunction in Premenopausal Women with Recurrent Urinary Tract Infections
Authors: Jesse E , Van Dorn C , Badreddine J , Rhodes S , Edwins R , Pope R
Published: May 2023

Introduction

Urinary tract infections (UTI) are the most common outpatient infections in the United States. Recurrent urinary tract infections (rUTI) are 30 times more common in women than men, suggesting differences in genitourinary anatomy and physiologic factors exist that could explain an increased susceptibility in females. One in three women are diagnosed with a UTI by age 24, with a recurrence rate of approximately 2.6 infections/year. A bidirectional relationship exists between rUTI and pelvic floor dysfunction (PFD) in women, however, little is known about the role of pelvic floor dysfunction in the pathogenesis of UTI in premenopausal women.

Objective

We aimed to document the occurrence of PFD among a group of premenopausal women with rUTI to further understand the relationship and identify factors associated with pelvic pain and dyspareunia. We hypothesize PFD will have a high prevalence in this population.

Methods

The Electronic Medical Record Search Engine (EMERSE) database for a single institution was utilize to identify eligible patients. Inclusion criteria included women aged 18-49 with an ICD code for UTI, who still have their ovaries, and who have who have seen a urologist, gynecologist, or urogynecologist within the past 5 years. A total of 610 eligible patients were identified and contacted via email and asked to participate in our survey study. The survey included queries on demographics, medical history, personal experience with UTI symptoms, diagnosis, and treatment. Survey responses were analyzed using chi-squared tests to analyze factors associated with dyspareunia. Pelvic floor dysfunction was defined as baseline pelvic pain outside of the context of UTI or dyspareunia. Internal Review Board approval was obtained for this study (STUDY20211407).

Results

Of the 610 women contacted, 65 (10.7%) responded. Outside the context of UTI, 52 (80%) women reported some degree of pelvic pain (Figure 1) and 40 (62%) women reported dyspareunia. The presence of pelvic pain was significantly associated with dyspareunia (90% with dyspareunia vs 64% without, p<0.05). On multivariable analysis, patients with pelvic pain were more likely to have dyspareunia (aOR 6.6). There was no association between degree of dyspareunia and duration, number, or severity of UTI.

Conclusions

PFD is highly prevalent among premenopausal women with rUTI, and screening for pelvic pain and dyspareunia should be performed in this population. Patients who report pelvic pain are more likely to have dyspareunia. Further investigation is needed to evaluate causation between PFD and rUTI in premenopausal women.

Disclosure

No
(288) Risk Factors and Real-World Short-Term Outcomes of a Failed Trial of Void After Rezum in a Multiethnic Population
Authors: Babar M , Labagnara K , Loloi J , Tang K , Ines M , Singh S , Iqbal N , Ciatto M
Published: May 2023

Introduction

A failed trial of void (TOV) following surgery for benign prostatic hyperplasia (BPH) predisposes patients to have trouble voiding, increases hospital stays and office visits, and increases detrusor muscle injury due to bladder over-distention. Rezum is a minimally invasive surgical therapy that utilizes convective radiofrequency water vapor thermal energy to ablate obstructive lobes of the prostate, resulting in improvement in lower urinary tract symptoms (LUTS) secondary to BPH. Identifying risk factors for a failed Rezum TOV can help identify a group of BPH patients who may need to be counseled preoperatively for an increased risk of postoperative urinary retention and therefore have their period of postoperative catheterization extended.

Objective

The purpose of the study was to identify risk factors for a TOV following Rezum and assess the impact of a failed TOV on real-world short-term outcomes.

Methods

A single office, retrospective study was conducted on patients treated with Rezum between December 2017 and October 2019. Patients were included if they had a follow-up for catheter removal after Rezum. Patients were excluded if they were in urinary retention requiring catheterization on the day of the procedure. A urinary catheter was placed in all patients following treatment. Demographic data and outcome measures, including International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF)-Erectile and -Orgasmic function, maximum urinary flow rate (Qmax), postvoid residual (PVR), and adverse events were analyzed at baseline, 1-, 3-, and/or 6-months postoperatively. Risk factors were identified through multivariate logistic regression analyses.

Results

A total of 289 patients were included, with the majority being Asian (36.0%), followed by non-Hispanic Black (28.7%), Hispanic (22.5%), and non-Hispanic White (12.8%). Thirty-five patients (12.1%) failed their TOV while 254 (87.9%) had a successful TOV. All patients were given a TOV after a median of 5 days (4-5). Those who failed their TOV spent a mean of 13.7 days (SD: 13.3) with a catheter. Patients who failed their TOV were more likely to get a urinary tract infection (20.0% vs. 4.7%, p 200 ml failed their TOV (40.0%) when compared to patients with a baseline PVR <200 ml (10.9%, p=0.008).

Conclusions

Following Rezum, approximately 1 in 8 patients were not able to pass their initial TOV. Baseline PVR was the only independent risk factor for a failed TOV. Nevertheless, all patients experienced significant relief in LUTS with preservation of sexual function. Patients with large baseline PVR, particularly >200 ml, should be counseled on possibly failing their TOV and requiring a catheter for an extended period. These patients should also be counseled on alternative BPH treatment options for which they may be a better candidate for.

Disclosure

No