bluuebunny/crossref_metadata_2025 huggingface dataset:
(317) Lay People´s Myths Regarding Pedophilia and Child Sexual Abuse: A Systematic Review
Authors: Glina F , Carvalho J , Barroso R , Cardoso D
Published: May 2023

Introduction

The term “paedophilia erotica” was first coined in 1886 by the psychiatrist Krafft-Ebing and it was considered a “psycho-sexual perversion”. It was at the beginning of the twentieth century that the term “pedophilia” was adopted and it started to appear in medical dictionaries. Sexual abuse is legally defined as the engagement in sexual contact with a person below a specified age or who is incapable of giving consent. Both, pedophilia and Child Sexual Abuse (CSA) are worldwide phenomena requiring deep scientific knowledge in order to improve prevention strategies. Individuals’ misconceptions of pedophilia and CSA may legitimize sexual violence, which can influence prevention strategies and policies.

Objective

This review aimed to summarize existing research to help answer the question: “What are laypeople´s myths regarding pedophilia and child sexual abuse?”.

Methods

This systematic review followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify as many relevant articles as possible. A literature search was conducted using PubMed, Web of Science, Scopus, and EBSCOhost databases for articles published before January 2022. Sixty-one articles were included in the current review.

Results

Overall, findings revealed a significant number of myths regarding pedophilia and CSA, organized into the following categories: 1) blame diffusion, 2) denial of abusiveness, 3) restrictive stereotypes, 4) victim age and consequences, 5) social stigma, 6) punitive attitudes, and 7) treatment.

Conclusions

Findings suggested that laypeople’s perceptions should be taken into account when devising prevention policies. Additionally, perceptions should also be a target of prevention since there is evidence of social stigma and prejudice involving individuals with pedophilia. Such phenomena can contribute to social, emotional, and cognitive problems, amongst said individuals as well as causing these individuals to exhibit a higher risk for abusive behavior and less help-seeking.

Disclosure

No
(325) The Role of Advanced Practice Providers Who Treat Men’s Health Urologic Conditions: An Analysis of Medicare and Commercial Claims in the United States
Authors: Raheem O , Xing M , Cooper C , Hyman M , Modi P
Published: May 2023

Introduction

The role of advanced practice providers (APPs) had expanded in the recent years according to the AUA. This increase of APPs had been endorsed by AUA to offset the increasing burden on the urologist workforce. Moreover, contemporary literature on the involvement of APPs in men’s-specific disease conditions is lacking.

Objective

We aim to clarify the role of APPs for publicly and privately insured patients in the treatment of mens’ urologic conditions commonly encountered in Men’s Health Clinics.

Methods

Medicare and commercial insurance claims from the Physician/Supplier Procedure Summary and IBM® MarketScan® Commercial Database, were queried for procedures submitted by APPs between 2010 and 2020. Common urologic conditions were identified using Current Procedural Terminology codes and grouped into six categories: overactive bladder (OAB), testicular hypofunction, erectile dysfunction (ED) and Peyronie’s disease (PD), benign prostatic hyperplasia (BPH), genital warts, and scrotal pain. The proportion of procedures submitted by APPs was calculated for each year and category.

Results

The proportion of claims submitted by APPs treating OAB, genital warts, and testicular hypofunction rose steadily from 2010 to 2020. Proportion of submitted service counts under OAB, genital warts and testicular hypofunction increased approximately 5, 8, and 4-fold among the privately insured compared to 3, 6, and 10-fold among the publicly insured (Figures 1 and 2). For BPH, ED and PD, and scrotal pain the proportion of APPs in both the MarketScan and Medicare groups was higher in 2020 than 2010, but with less dramatic and stable growth rates compared to other procedures. The proportions of APPs for all conditions were higher in the Medicare group compared to the MarketScan group. The Medicare data captured more year to year fluctuations in the proportion of claims submitted by APPs per condition than that of the MarketScan data.

Conclusions

APPs play a critical role in urologic care and can help address impending physician workforce shortages in urology, specifically in men’s health. The role of APPs in men’s urologic health, particularly OAB, testicular hypofunction, and genital warts, is increasing for both privately and publicly insured patient populations. Further research on implementation and utilization of APPs, as well as the health outcomes of such workforce modifications, is warranted.

Disclosure

No
(345) The Pathophysiology of Peyronie’s Disease Following Radical Prostatectomy
Authors: Megson M , Shaw G , Cellek S , Ralph D
Published: May 2023

Introduction

Peyronie’s disease (PD) is defined as a fibrotic disease of the penis resulting in plaque formation and abnormal penile curvature. In the general population the incidence of PD is 0.7%, however, this increases to 16% after radical prostatectomy (RP).

Objective

Our aim is to document the incidence of PD after radical prostatectomy seen in our hospital.

Methods

A prospective and a retrospective audit recruiting men undergoing RP. Both documented demographics, operative details and PD risk factors. The retrospective audit has reviewed men undergoing a RP in 2018. After identification the patients were contacted to clarify any development of curvature after RP. The prospective audit has reviewed men prior to their RP with an IIEF, PD questionnaires and examinations for existing plaques. Then again at 6 weeks, 3 months and 6 months post-operatively.

Results

For the retrospective audit; 511 men were identified, of which 194 were recruited. Of these 16% (n=31) described a new curvature. 7 were Non-Nerve Sparing (NNS), 11 Unilateral Nerve-Sparing (UNS) and 13 Bilateral Nerve-Sparing (BNS). These had a mean curvature of 20 degrees (SD=8). For the prospective audit; 524 men have joined the study of which 267 have had their 6-month review. 47% (n=126) of those reaching 6 months post-op had a new plaque. 29 were NNS, 39 UNS (14 intra-facial: extra-facial and 25 inter-facial: extra-facial) and 58 BNS (30 intra-facial: intra-facial), 18 intra-facial: inter-facial and 10 inter-facial: inter-facial).

Conclusions

These are ongoing audits which still require further investigation. However, a larger proportion of men than thought develop a new plaque. The retrospective study collaborates the previous indicated 16% of new PD diagnoses after RP.

Disclosure

No
(351) Cross Cultural Adaptation and Psychometric Validation of The Arizona Sexual Experiences Scale (ASEX) into Bangla
Authors: Mian D M S , Qusar M M A S , Hossain R , Chowdhury T , Roy K
Published: May 2023

Introduction

Sexual Dysfunction affecting all age groups. We need standard tool for proper assessment and management of patient with Sexual Dysfunctions. However, there is severe scarcity of validated tool in Bangla to assess Sexual Dysfunctions in our cultural context. The Arizona Sexual Experience Scale is widely used validated tool to screen and assess severity of Sexual Dysfunctions for clinical management and research.

Objective

To develop a culturally adapted and validated Bangla version of The Arizona Sexual Experience Scale (ASEX) to assess Sexual Dysfunctions.

Methods

This was a cross sectional validation study conducted from June, 2019 to Mar, 2021. After receiving the approval from original author of The Arizona Sexual Experience Scale (ASEX), it was forward and backward translated followed by the expert committee review the initial Bangla version of the scale was developed. Afterward this scale was applied on 56 patients with Sexual Dysfunctions and evaluated validity (Content validity, Face validity and Construct validity) and reliability (Internal consistency). Data analysis performed by Statistical Package for Social Science (SPSS) version- 24.

Results

The Bangla Arizona Sexual Experience Scale (ASEX) showed very good psychometric property with a Cronbach’s alpha value of 0.756. The Factor analysis based one the Eigen value revealed the Bangla version has one component.

Conclusions

The study commented the Bangla version of the ASEX (ASEX- Bangla) can be used for assessment of Sexual Dysfunctions in Bangladesh and it will help in further management of the sexual dysfunction in the country and will also help in future research in this area.

Disclosure

No
(365) Contraceptive Refusal
Authors: Choucroun D
Published: May 2023

Introduction

In France in 2019 the level of abortion is the highest for thirty years. Between 2010 and 2013, the use of oral contraception fell from 50% to 41% to reach 32% in 2018 (Women aged 15 to 49) Hormone phobia is often cited when the woman refuses œstrogen-progestins, but use of the morning after pill continues with one million "levonorgestrel 1,5 mg" sold each year in France. Remember this after morning pill contains 15 times more levonorgestrel than the pill. The situation is therefore more complex, and we need to understand the multiples factor that contribute to non-use medical contraception

Objective

Understand the possible causes of contraceptiv refusal in France We want to expose how the obligation of medical prescription to obtain oral contraception build a negativ representation of the pill by cognitiv distorsion.

Methods

We have etablished a statistical inventory concerning the evolution of the use of hormonal contraception in France since the contraceptive crisis in 2012 and put into perspective the number of abortions performed in France We carried out a review of literature by introducing in Pub Med the keywords "contraception over-the-counter" for a period of 5 years until 06/2022 the information obtained was confronted with the study of the effects of new information and communication techniques on perceptions and on constructions of mental representations

Results

The literature review from 06/2017 to 06/2022 reports that dispensing of contraception over-the-counter would promote its use, reduces the interruption of treatment,,would reduce the risk of unwanted pregnancies and would support the empowerment of women and girls. At the same time, in the "ATAWAD" era, anytime-anywhere- any device, the non accessibility to an object confers a representation and an imaginary of a dangerous product. This mechanism may be involved in contraceptiv refusal.

Conclusions

People who want to use contraception face many barriers: time, transport, cost, stigma, moral and even religious prejudices of prescribers. We recall that since 2012 the American College of Obstetricians and Gynecologists recommends that contraceptives must be available over-the-counter, This is already the case in several states. in 2017 in France the Family Planning has supported a petition to obtain hormonal contraception without prescription and we want this to become possible.

Disclosure

No
(381) Comparing Erectile Dysfunction (ED) Outcomes Following Priapism as an Adverse Effect of Intracavernosal Injectable Medications to Priapism due to Recreational use of Intracavernosal Injectable
Authors: Masterson J , Choi E , Zhao H , Kim H , Anger J
Published: May 2023

Introduction

Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. We previously identified a large portion of ischemic priapism cases presenting to our institution caused by recreational use of intracavernosal injectable medications (ICI) for which patients did not have a prescription.

Objective

In the present study we identified a nearly equal number of men who presented with ischemic priapism as an adverse effect of ICI for which they did have a prescription. Our goal was to compare erectile function outcomes between these two populations in follow up.

Methods

Men presenting for ischemic priapism as an adverse effect of prescription ICI from January 2010 to December 2018 were contacted by mail, then via telephone. Standardized questions were asked of all participants on the topic of erectile dysfunction (five-item international index of erectile function (IIEF-5)). IIEF-5 results were compared to our previously described population of men with ischemic priapism caused by recreational use of ICI using the Student’s T-test of means.

Results

13 men aged 23 – 68 (mean 51.9) were recruited. Ten men (77%) were white; the remaining three (23%) were black. All men confirmed diagnosis of ED prior to their priapism episodes and all men had their own prescription for ICI from a urologist. Seven men (54%) required phenylephrine irrigation, five (38%) achieved detumescence with cavernosal aspiration and saline irrigation alone, one (8%) required a distal shunt. Mean IIEF-5 for the population at time of phone interview was 12.5 (□ 7.4) signifying mild-moderate ED, which was not significantly different from the mean IIEF-5 of our priapism population due to recreational use of ICI (13.3 □ 4.0; p = 0.87; table 1).

Conclusions

Men who present with ischemic priapism as an adverse effect of prescription ICI appear to have similar functional outcomes compared to men with ischemic priapism due to recreational use of ICI as assessed by IIEF-5. This could also be interpreted as a better functional outcome considering that this population had pre-existing ED prior to their priapism episode and therefore did not lose erectile function. The adverse effect population also appears to require a shunt in the treatment of their priapism less frequently than the recreational ICI population.

Disclosure

No
(405) Penile Prosthesis Implantation and Peyronie's Disease: How to Approach the Residual Curvature – A Detailed Demonstration of Moulding Technique and Grafting Procedure
Authors: Chiriaco G , Maher E , Lee W G , Ralph D
Published: May 2023

Introduction

Insertion of a penile prosthesis is the treatment of choice in men with Peyronie’s disease and concomitant erectile dysfunction. The aim of surgery is to straighten the penis and allow adequate rigidity for sexual intercourse. A conundrum arises when there is residual curvature during device testing.

Objective

This video highlights strategies that will aid the implanter when faced with these intraoperative challenges.

Methods

This video illustrates three different scenarios and suggests strategies that can be used when there is a residual penile curvature following inflatable penile prosthesis insertion: 1) Manual moulding – In this scenario, a persistent left lateral curvature is successfully straightened by moulding the plaque following device insertion. The cylinders are fully inflated and the tubes to the pump are double clamped. One hand is positioned distal to the apex of the curvature while the other is proximal. The penis is manipulated in the opposite direction to the curvature. 2) Residual curvature after manual moulding – The plaque can be incised at the point of maximal curvature and grafted If there is a significant persistent curvature (>30 degrees) following moulding. A fibrin sealant patch was used in this patient and it offers a quick and effective choice for grafting the tunical defect. 3) Upfront plaque incision and grafting - Some patients are not suitable for moulding following penile prosthesis insertion. Examples include ventral penile curvature and ossified plaques. In this patient with a ventral curvature, the plaque was incised and the tunical defect grafted with bovine pericardial graft prior to corporal dilatation.

Results

All three patients had an uneventful post-operative outcome. They were encouraged to cycle the device from 3 weeks and allowed to commence sexual intercourse after 6 weeks post-surgery.

Conclusions

Manual moulding is a safe and effective first line option for residual penile curvature following inflatable penile prosthesis insertion. Plaque incision and grafting can be considered if moulding fails or where manual moulding is contraindicated. There are several choices for graft material including fibrin sealant patch or bovine pericardium.

Disclosure

No
(413) Obturator Fenestration Technique for the Woody Indurated Penis
Authors: Suarez-Sarmiento A , Ghomeshi A , Castillo M P , Levit B , Perito P
Published: May 2023

Introduction

Performing penile implant surgery can be challenging especially in the presence of a woody indurated penis (e.g. post priapism, post infection, prolonged h/o ICI, etc.) The loss of corporal smooth muscle cells and excess of collagen deposition caused by corporal fibrosis can create challenges and increase risk of perforation, crossover and certainly infection. Clinically, these fibrotic corpora make placement of a penile prosthesis a difficult surgical procedure.

Objective

We demonstrate how the Obturator Fenestration Technique facilitates placement of a penile implant in the woody indurated penis.

Methods

48 y/o male w/ Hx of a 3-day Priapism treated with a shunt at the time. Patient was not offered a penile implant until 8 months following event. At the time of penile implant surgery the urologist placed a malleable halfway up on the right corpora and did not attempt the other side and case was aborted. Physical examination revealed diffusely woody indurated corporeal tissue throughout the left corpora and distally on the right corpora

Results

Penile implant was successfully implanted using the obturator fenestration technique in the woody indurated penis in the patient with a previously failed attempt at implantation.

Conclusions

The use of the Obturator Fenestration Technique can help facilitate increasingly complex cases This can help reduce unnecessary complications and repeat revision surgery. However, there is a learning curve while using the Obturator Fenestration Technique and should not be performed by a novice surgeon We hope to improve our techniques and surgical approaches to improve surgical times and post-operative outcomes for the woody indurated penis

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific
(414) Double Distal Fixation Stitch
Authors: Suarez-Sarmiento A , Ghomeshi A , Castillo M P , Levit B , Perito P
Published: May 2023

Introduction

Distal cylinder extrusion is not a common complication of penile prothesis surgery when compared to mechanical device failure but can have very serious complications if not addressed properly. Reported revision surgery for IPP implantation is more commonly required for cosmetic and erosion problems as opposed to mechanical failure. Complications such as distal crossovers, delayed distal crossovers, and impending lateral extrusion can be treated with a double distal fixation stitch. This technique addresses stabilization issues and keeps penile implant secure and in place.

Objective

We demonstrate the Double Distal Fixation Stitch for the meandering distal cylinder

Methods

62 y/o white male Hx of erectile dysfunction and Penile implant No significant past medical history Presents with pending left lateral cylinder extrusion Implant functional Patient underwent a corporoplasty and double distal fixation stich in order to ensure distal aspect of cylinder remains in place

Results

A lateral sub-coronal incision is used on the affected side where cylinder should be positioned. Dissection is carried through the Buck fascia, followed by a transverse incision of the tunica albuginea, where the distal aspect of the affected cylinder is delivered. Two 2-0 Ethibon sutures are threaded through the distal cylinder islet of the implant. A new, properly positioned intracorporal channel is created using a longitudinal capsulotomy and dilation with a 9 Hagar. Two 2-0 Ethibon sutures are passed through the distal islet of the implant cylinder. The first suture is passed through the glans with the cylinder in the native corpora position, a second suture is passed through about .25cm apart from first suture creating a small bridge. A small incision is made connecting the two suture exit sites. Both sutures are then tied down individually leaving one suture on each side to be tied across the bridge. The knots are then buried in the glans by elevating the skin and closing the skin with 3-0 chromic.

Conclusions

This technique ensured that the cylinder remained in the newly created, appropriately positioned channel. The double distal fixation stitch is safe and effective in securing the distal cylinder of an inflatable penile prosthesis and preventing recurrence. This technique is a useful surgical adjunct to treating patients with prosthetic lateral extrusions or crossovers that can be applied in almost all cases and can ensure distal stabilization of a migrating distal cylinder in weak tunica.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: coloplast, boston scientific.
(461) Health Insurance Coverage for Infertility in the United States
Authors: Sandozi A , Khurgin J
Published: May 2023

Introduction

As many as one in five heterosexual couples in the United States experience infertility. Medical advances can help resolve infertility, however access to treatment is often out-of-pocket and can be prohibitively expensive. State benchmark health insurance plans detail minimum coverage standards that all other state offerings must match with some exceptions.

Objective

The objective of this study was to evaluate differences in health insurance coverage for infertility.

Methods

The most recent state benchmark health insurance plans submitted to Centers for Medicare and Medicaid were examined. We identified provisions to cover or exclude treatment of infertility. A literature search was also performed to identify states with legislation relating to health insurance coverage for infertility.

Results

Data was available for all 50 states and the District of Columbia. Fifteen states had legislation requiring coverage of infertility benefits, and two states required employers to offer at least one such plan. In benchmark offerings, 19 states did not provide any minimum coverage for diagnosis or treatment of infertility. Twenty-five states offered some type of treatment, of which 9 covered treatments of underlying cause of infertility only (ie. Fibroids, ductal obstruction). Ten states offered coverage for prescription medications, 10 states offered coverage for artificial insemination, and six states provided coverage for assisted reproductive technologies such as in vitro fertilization. Only two states covered cryopreservation of ova, but only for patients actively undergoing treatment for infertility.

Conclusions

Diagnosis and treatment of infertility is not guaranteed to be covered by health insurance, and nearly half of states do not provide any minimum level of coverage in state benchmark plans. Health insurance coverage for the diagnosis and treatment of infertility is highly variable and continues to be a barrier faced by patients desiring to conceive.

Disclosure

No
(481) Experience with Plaque Excision and Dermal Grafting in the Surgical Treatment of Peyronie's Disease
Authors: Mai Ba Tien D , Dang Guang T
Published: May 2023

Introduction

Plaque incision and grafting (PIG) is indicated for men with complex or severe penile curvature, several surgical options to treat PD have been performed. Surgical treatment use graft, as these procedures aim to maintain penile length.

Objective

To assess outcomes following plaque excision and dermal grafting in the surgical treatment of Peyronie's disease.

Methods

A prospective study, was performed at Binh Dan Hospital (Ho Chi Minh City – VietNam), from 1/2016 – 12/2020. Surgical correction for curvature is indicated when the PD duration is >12 months, and when the stable phase of PD is >6 months, all case use plaque excision and dermal grafting technique.

Results

our study have 52 patients, - History illnes: 42.1% diabetes, 26.3% hypertension, 36.84% hyperlipid. - Age mean: 58.31 ± 8.5 years (min: 48 – max 72). - Chief complaine: penile deformities (36.8%), pain (31.6%), palpable lumps (26.3%). - 52.6% have psychological effects. - Fibrous plaque on corpus: Anterior (5.2%), Mid (47.37%), Posterior (47.37%). - Plaque size: 72.59 ± 75.78mm2 (15.51 mm2 – 207 mm2). + Primary outcome measures - Complications (follow one month): alter sensation (16.7%), edema (21.05%), infection (1.9%), pain (10.53%) - Penile straightening: 89%. - Penile length: no changes (82.7%), shorter (17.3%). + Secondary outcome measures - Recurrent curvature: 3 cases – 01 case need operation second time. - Post-operative erectile dysfunction: 7 cases (13.46%). - Patient satisfaction: 82.3%

Conclusions

Surgical correction of penile curvature is the mainstay for PD treatment. Dermal graft: effectiveness in terms of satisfaction, length change, straightening, economic efficiency and complications. Suitable for patients with underlying medical conditions. Adequate preoperative patient counseling.

Disclosure

No
(488) Pooled Outcomes from over 300 Controlled Subjects Reveal Improvements in Sexual Function and a Majority Shift to Lower IPSS Symptom Severity after Treatment with PUL
Authors: Eure G , Roehrborn C , Gange S , Chin P
Published: May 2023

Introduction

The Prostatic Urethral Lift (PUL) is the most thoroughly studied minimally invasive surgical therapy (MIST) for BPH with over 300 patients studied in a controlled trial setting.

Objective

In this combined analysis from 5 PUL controlled studies we examine the meta-effect of the procedure on outcomes including sexual function and the proportion of subjects who move from higher to lower IPSS symptom severity grades.

Methods

Five PUL controlled studies were utilized for the analysis, including L.I.F.T. (RCT: PUL vs Sham [n = 140]), Crossover (crossover of L.I.F.T. sham subjects [n = 51]), MedLift (single arm, subjects with OML [n = 45]), BPH6 (RCT; PUL vs TURP [n=44]), and LOCAL (Single arm, PUL under local anesthesia in office [n=51]]. Sexual function was evaluated with SHIM and MSHQ-EjD, as well as IPSS, QoL, Qmax at baseline and through 12M post-PUL. Post-op AEs, catheterization, surgical retreatment, BPH medication usage, IPSS severity level shift, and IPSS responder rate (≥3pt improvement from baseline) were examined through 12M.

Results

331 subjects were treated with PUL among the five studies and had largely similar baseline characteristics. 266 subjects were sexually active at baseline, and notable improvements were found in SHIM (13%, p<0.01) and MSHQ-EjD (30%, p<0.01) at 12mo. Post-PUL, mean IPSS improved at 1, 3, 6, and 12M at least 11.1 points from baseline (48.5%, p <0.0001). QoL improved up to 52.8% (p <0.0001) and Qmax was increased by at least 4.3 ml/sec (p <0.0001). Most AEs were mild to moderate and resolved within 2 weeks. 33% (73/121) of void trial-tested subjects required catheterization (mean duration 3.7d). 15 subjects underwent surgical retreatment and 7 needed BPH medication through 12M post-PUL. 79% (261/331) of subjects were IPSS responders and 66% (219/331) moved into a lower IPSS severity grade (Table 1). Subjects who underwent a shift in symptom severity on average had lower baseline QoL (1.8 vs 3.1, p<0.000), higher Qmax (13.3 vs 11.9, p<0.05) and were treated with more implants (median 5 vs 4 implants, p<0.01).

Conclusions

The largest analysis of PUL controlled subjects including over 300 men demonstrates the procedure provides significant improvement in IPSS symptom severity grades. Subjects who were sexually active experienced improvements in sexual function through 12 months.

Disclosure

Yes, this is sponsored by industry/sponsor: Neotract, Inc./Teleflex.

Clarification

Industry initiated, executed and funded study.

Any of the authors act as a consultant, employee or shareholder of an industry for: Neotract, Inc./Teleflex.
(493) Utilization of Intracavernosal Injection and Penile Ultrasound in the Evaluation of Erectile Dysfunction and Peyronie’s Disease
Authors: Ebbott D , Prebay Z , Li M , Chung P
Published: May 2023

Introduction

Intracavernosal injections (ICI) and penile duplex Doppler ultrasound (DDUS) play a diagnostic role for patients with erectile dysfunction (ED) and Peyronie’s disease (PD). They can help to identify vascular and anatomical changes that may guide medical and surgical management; however, contemporary utilization rates of ICI and penile DDUS have not recently been described. Here we use a multicenter database to determine utilization of ICI and penile DDUS in patients with ED and PD.

Objective

To evaluate the rates of ICI and penile DDUS in patients with ED and PD using a global database.

Methods

TriNetX is a research network of real-time data from 58 Healthcare Organizations globally. Using the International Classification of Diseases Tenth Edition (ICD-10) codes, we queried the network for adult men with ED (N52) being medically treated with phosphodiesterase (PDE)-5 inhibitors from 2002 - 2022. This included sildenafil, tadalafil, vardenafil, and avanafil. Current Procedural Technology (CPT) codes were utilized to identify patients who received penile DDUS (93980, 93981) and penile prosthesis (54400, 54401, 54405). ICD-10 codes were utilized to query the network for those with PD (N48.6) from 2002 – 2022. We then used CPT codes to search within this cohort for those who had ICI (54235) excluding patients that also had penile DDUS (93980, 93981). We separately queried for patients that had penile DDUS (93980, 93981). Finally, we queried for patient who received either evaluation method and had injection therapy (54200), penile plication (54360), or plaque excision +/− grafting (PEG) (54110, 54111, 54112). The analysis was run on June 30, 2022.

Results

The cohort with ED on a PDE-5 inhibitor in the TriNetX database included 613,323 patients. The cohort had a mean age of 63 +/− 13 years and racial demographics of 18% black and 70% white. 8,540 patients (1.4%) had a penile DDUS and 868 (0.1%) went on to penile prosthesis (Figure 1A). A second study cohort included 46,743 patients with Peyronie’s disease with a mean age of 62 +/− 13 years and racial demographics of 8% black and 73% white. ICI was performed in 2,960 (6.3%) PD patients: 568 (1.2%) then underwent injection therapy, 1,128 (2.4%) penile plication, and 142 (0.3%) PEG (Figure 1B). Penile DDUS was performed in 4,972 (10.7%) patients with PD: 955 (2.0%) then underwent injection treatment, 474 (1.0%) penile plication, and 255 (0.5%) PEG (Figure 1B).

Conclusions

For ED, penile DDUS is used in a low percentage of evaluations. For PD, penile DDUS is used more commonly than ICI only. After evaluation with penile DDUS, the most common therapy is injection. After an evaluation with ICI only, the most common therapy is penile plication.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.
(523) Changes in Testosterone Levels in Patients with Erectile Function
Authors: Corredor H , Benites J , Sandoval C , Laborda E
Published: May 2023

Introduction

Erectile dysfunction (ED) is a disease that affects approximately 20% of adult men. Androgen deficiency is one of the organic etiologies described for this sexual dysfunction.

Objective

To estimate the frequency of alterations in the sex hormone binding globuline (SHBG), total testosterone (TT), calculated free (FT) and bioavailable testosterone (BT) in Spanish men with a clinical diagnosis of erectile dysfunction in Madrid, Spain.

Patients and methods

Cross-sectional study. Men over 18 years of age with a clinical diagnosis of erectile dysfunction and a score in the international index of erectile function (IIEF-EF) < 26 were included. Serum levels of SHBG, TT, TL and TB were evaluated and the proportion of men was estimated. with hormonal alterations defined as: a) serum levels <2.49 ng/mL of TT in men under 50 years and <1.93 ng/mL in men of 50 years or older; b) TL for calculated value <2% of total testosterone; c) TB for calculated value <40% of total testosterone; d) serum SHBG levels >54.1 nmol/L in men younger than 50 years and >76.7 nmol/L in men 50 years and older.

Results

30 subjects participated in the study. The mean age was 50.6 years (+/− 13.2), the median scores for IIEF-EF, Erection Hardness Score (EHS) and Aging Male Symptoms Score (AMS) were 15 (range 1-24), 2 (range 1-3) and 29.5 (range 11-62) respectively. 6 patients (20%) had severe erectile dysfunction, 13 (43.3%) moderate, 8 (26.7%) mild to moderate, and 3 (10%) mild erectile dysfunction. The mean TT was 4.94 ng/mL (+/− 1.91), FT 1.94% (+/− 0.605), BT 45.6% (+/− 14.2), and SHBG 33.3 nmol/L ( +/− 14.5). Only 6.7% of the patients (n=2) presented alterations of the TT, while in 60% (n=18) an alteration of the FT was found, in 36.7% (n=11) an alteration of the BT and in 3.3% (n=1) SHBG alterations, alterations being more frequent in men with moderate ED.

Conclusions

Our study found alterations in total testosterone in a small percentage of patients with ED, however the alterations in Free Testosterone calculated turned out to be much higher. This study suggests that future research should be carried out to identify a relationship between changes in calculated free testosterone levels and the presence of erectile dysfunction.

Disclosure

No
(532) An Innovative Combination of Penile Corporeal Girth Enhancement and Erection Restoration
Authors: Hsu G
Published: May 2023

Introduction

It has been controversial in penile venous surgery for erection restoration and penile enhancement across three centuries thus far.

Objective

Based on the De Novo penile fibro-vascular assembly, we report an anatomy-physiology-based combination of a physiological penile corporeal diameter expansion and erection restoration surgery in recent decades.

Methods

From 2012 to 2022, intractable impotence and subjective micropenis prompted 23 men to seek penile venous stripping (PVS) and factual penile enhancement (TPE). All patients received dual cavernosography demonstrating penile venous anatomy and veno-occlusive dysfunction. PVS entailed the venous stripping of one deep dorsal vein and two cavernosal veins after every emissary's vein was double ligated 0.3 cm apart closest to the outer tunica with a 6-0 nylon suture. In addition, the para-arterial veins were just segmentally ligated. In TPE, a longitudinal incision was performed bilaterally over 3 and 9 O'clock positions along the pendulous penis. Every tunic defect was then water-tight sutures with a 7x3 cm rectangle venous stripe as an inner tunica bilaterally, subsequently covered with a piece of 7x3 venous wall, fascia tense lata, or a controlled tissue integration material sheet for surrogating the outer layer bilaterally. On penile girth and glans penis, the diameter was measured preoperatively and postoperatively in six months when a cavernosography was conducted, if available. Radio-opacity was used to compare the femoral cortex and the penile crus on preoperative and postoperative cavernosography. Additionally, the abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) was used to confirm improvement preoperatively and postoperative follow-up yearly either by telephone or INTERNET.

Results

The average follow-up period was 5.3±0.8 years. The operation time was 7.2±1.8 hours. The material of outer patches was fascia tense lata (n=3), Surgifrom (n=6), penile vein (n=8), internal spermatic vein (n=3), and cephalic vein (n=3). The radiopacity was unexceptionally enhanced postoperatively. It was a significant difference between the preoperative and postoperative IIEF-5scores (9.7±2.8 vs. 20.8±2.3; P<0.01). The EHS improved at least one scale. The diameter of the glans and distal penile shaft is increased from 2.78±0.33 cm and 3.41±0.41 cm (n=18) to 2.98±0.32 cm and 3.49±0.31 cm, respectively. Although the satisfaction rate is only 70.0% (16/23), the intracorporeal retention and erection quality improvement were unexceptional.

Conclusions

This novel combination strategy of factorial penile enhancement and erection restoration is feasible. However, it requires a more significant sample size and longer-term follow; the surgery technology is conspicuously challenging.

Disclosure

No
(535) A Novel Approach for Penile Venous Stripping Surgery and Bilateral Varicocelectomy on an Ambulatory Basis
Authors: Hsu G , Chang Y , Chang C
Published: May 2023

Introduction

There are varied approaches for conducting varicocelectomy and penile venous surgery, which are not unified or conspicuously, being not above controversy in the later type either in methodology or routes for accessibility thus far.

Objective

We sought to present this innovative method in a novel combination of a physiological penile venous stripping and bilateral varicocelectomy via a single longitudinal pubic wound on an ambulatory basis.

Methods

From July 2012 to December 2021, 63 consecutive patients underwent this combined surgery. Primary diagnosis tools are dual cavernosography and doppler sonography. A 4-5cm longitudinal pubic incision is two-thirds above the penile pubic fold. A blunt dissection maneuver using a hemostat or finger creates a space between the Colles' and Buck's fascia. The entire penis is then released with an inside-out maneuver resulting in Buck's fascia being exposed exclusively, followed by firmed ligation of every emissary vein of the corpora cavernosa via 6-7 open-to-open schemes on Buck's fascia, subsequently stripping of the deep dorsal vein (DDV) and paired cavernosal veins (CVs). In contrast, the para-arterial veins are just ligated segmentally. Reduction of the penis is made after Buck's openings are repaired with not too tight square knots with 6-0 nylon. The stripping of the DDV and CVs is completed after 125-137 ligatures until the infra-pubic angle. Finally, the spermatic cord is hooked below the inguinal canal outlet level. On each side of the varicocele, ligation of 8-11 spermatic veins is macroscopically performed at no expense of ruining all other tissues, even the fragile lymphatic vessel. Then meticulous repair is obtained layer by layer. This novel approach is likely the most appropriate method for making a milking maneuver which is helpful in vascular differentiation on both corpora cavernosa and pampiniform plexus during the entire procedure to prevent residual veins from offensive.

Results

The average follow-up period is 5.3±0.5 years. There is a significant (9.6±2.7 vs. 20.9±2.3; P<0.01) between the preoperative and postoperative IIEF-5 scores. So does the EHS scale (1.6±0.3 vs. 2.9±0.3; P<0.01) between the preoperative and postoperative status. The radiopacity was unexceptionally enhanced postoperatively. Although the intracorporeal retention and erection quality improvement were unexceptional, the satisfaction rate is just 71.4% (45/63). Penile length resumed 3.5 months postoperatively, although two patients initially complained about 1-2 cm postoperative shortage.

Conclusions

From the physiology viewpoint, we would like to recommend this promising method with which the shortcut to express.

Disclosure

No
SEPPA-mAb: spatial epitope prediction of protein antigens for mAbs
Authors: Qiu Tianyi , Zhang Lu , Chen Zikun , Wang Yuan , Mao Tiantian , Wang Caicui , Cun Yewei , Zheng Genhui , Yan Deyu , Zhou Mengdi , Tang Kailin , Cao Zhiwei
Published: May 2023

Identifying the exact epitope positions for a monoclonal antibody (mAb) is of critical importance yet highly challenging to the Ab design of biomedical research. Based on previous versions of SEPPA 3.0, we present SEPPA-mAb for the above purpose with high accuracy and low false positive rate (FPR), suitable for both experimental and modelled structures. In practice, SEPPA-mAb appended a fingerprints-based patch model to SEPPA 3.0, considering the structural and physic-chemical complementarity between a possible epitope patch and the complementarity-determining region of mAb and trained on 860 representative antigen-antibody complexes. On independent testing of 193 antigen-antibody pairs, SEPPA-mAb achieved an accuracy of 0.873 with an FPR of 0.097 in classifying epitope and non-epitope residues under the default threshold, while docking-based methods gave the best AUC of 0.691, and the top epitope prediction tool gave AUC of 0.730 with balanced accuracy of 0.635. A study on 36 independent HIV glycoproteins displayed a high accuracy of 0.918 and a low FPR of 0.058. Further testing illustrated outstanding robustness on new antigens and modelled antibodies. Being the first online tool predicting mAb-specific epitopes, SEPPA-mAb may help to discover new epitopes and design better mAbs for therapeutic and diagnostic purposes. SEPPA-mAb can be accessed at http://www.badd-cao.net/seppa-mab/.
Faith, Migration, and Trauma
Authors: Lynch Gordon
Published: May 2023

This chapter reviews religious involvement in UK child migration programs—particularly in the post-war period—with particular attention to how this work harmed children in their care. The UK child migration programs can also be understood as part of wider nation-building projects in Commonwealth countries that also included native assimilationist policies, including the removal of children from Indigenous communities in Australia and Canada. It is helpful to reflect on what this case study suggests about how religion and migration can intersect in ways that can harm vulnerable people. Such harm can arise not only through the ideas, assumptions, and practices of individual religious actors or organizations, but as a consequence of wider organizational and policy contexts as well. In a number of important respects, British child migrants were harmed because of an over-complex and fragmented system of governance, in which children were insufficiently protected from the competing interests of government departments and voluntary societies. The chapter then illustrates how the internal cultures of religious organizations also contribute to these harms. For those religious organizations involved in the UK child migration programs, their work was always underpinned with a sense of spiritual and moral legitimacy that proved resistant to critiques made of it at the time.
On Persuasion in Plato’s Republic
Authors: Frank Jill
Published: May 2023

Reading the Republic’s critique of rhetoric not as a blanket condemnation of persuasion but as rejecting modes of speech that fail to preserve the distinction between persuasion and force, this chapter establishes the dialog’s interest in discursive practices in which speakers and listeners willingly, actively, and jointly participate in their own persuasion. Treating such practices as exemplifications in life of the grammatical middle voice of Attic Greek and exploring the operations of this kind of persuasion in analogical argumentation, the chapter brings to light the critical role of middle-voice persuasion in the Republic’s understandings of both justice and philosophy.
Social Movements and Democratization Processes in Latin America
Authors: Inclán María
Published: May 2023

This chapter offers a review of the most salient cases of social movements and democratization processes in Latin America. Bridging the literature on Latin American social movements and democratic transitions, it first revises the different types of transitions that developed in the continent. Second, it assesses the effects that democratic transitions have had on the emergence, development, and outcomes of emblematic Latin American social movements. In doing so, it evaluates the role that these social movements have played in triggering democratizing processes in the region. Third, it explores the movements that have emerged as democracy has deepened in the region. Finally, the chapter concludes by offering some insights as to why we still know relatively little about the success that social movements have had in the democratization of the continent, the type of studies we need to develop theories on the relationship between social movements and democratic transitions in Latin American, and possible generalizations suitable to other similar cases around the world.
Human Rights Movements across Latin America
Authors: Wolff Jonas
Published: May 2023

This chapter reviews the development of, and the existing research on, human rights movements in Latin America. Following a brief history of the emergence of human rights movements across the region under authoritarian rule, it revisits key general elements of human rights movements in Latin America and discusses the evolution of human rights activism in the region since the 1990s. In tracing the expansion of the human rights agenda in terms of issues and actors, the chapter identifies two major trends: from human rights towards citizenship rights, as well as towards social rights. This expansion of the human rights agenda is reflected in a broadening of the field of movements and movement organizations that make human rights-oriented claims. Today, many—if not most—social movements across Latin America include human rights claims in their collective action frames. Consequently, the narrow focus on a rather minimalist conception of human rights that had characterized the first generation of human rights movements has been replaced by a much broader human rights agenda that encompasses social, economic, and cultural rights, as well as by more specific demands based on issue- or group-specific rights. As a consequence, even if many and quite active human rights organization persist throughout the region, Latin America’s traditional human rights movements have lost in relative importance. Yet this does not reflect a diminishing relevance of human rights claims in the struggles of social movements.
Urban Social Movements and the Politics of Inclusion in Latin America
Authors: Oxhorn Philip
Published: May 2023

Manuel Castells’ work from the 1960s and early 1970s on urban social movements was both seminal and transitional. While most social movement research adopted a class-based theoretical perspective focusing on the working and middle classes, Castells’ work looked at how economically and politically marginalized urban residents mobilized based on where they lived, surprisingly independently of their social class. This reflected how Latin America’s unique capitalist economy distorted the evolution of class struggle. Castell therefore retained a Marxist theoretical perspective that postulated the necessity of an anti-capitalist revolution to achieve social equality and meaningful democracy—a revolution that would be led urban residents rather than the working class. Because Castell’s research largely ended before the region became dominated by violent authoritarian regimes, it was transitional. In the 1980s and 1990s, the legacy of violence and neoliberal economic reforms associated with those regimes contributed to the emergence of a growing number of urban social movements and a focus on democratic politics and citizenship rights associated with a new model of citizenship in the region: citizenship as agency. The region’s commitment to relatively free and fair elections based on universal suffrage creates a unique opportunity for the mobilization of urban social movements demanding improved collective consumption, respect for community culture and political self‐governance that urban social movements champion—the definition of urban social movements developed by Castells in his seminal work. The chapter ends with a discussion of the lack of resilience of these movements in the twenty-first century and future research priorities.