bluuebunny/crossref_metadata_2025 huggingface dataset:
(418) Corpora Cavernosa Reconstruction for Penile Prosthetics Surgery Using a Lightweight Mesh: A Viable Alternative? A Single Center Experience
Authors: Gordon P , Ralph D
Published: May 2023

Introduction

Options for reconstruction of the corpora cavernosa are limited. Synthetic grafts like Dacron™ and GORE-TEX™ are used but have high infection rates. Lightweight macroporous mesh is a promising alternative due to better integration and surrounding tissue ingrowth. We present the first experience of using a lightweight mesh for this indication in a single high-volume institution.

Objective

To evaluate long term outcomes of corporal reconstruction using a lightweight mesh measuring where previous options had failed.

Methods

The medical records of all patients undergoing insertion or revision of penile prosthesis between May 2016 and November 2019 were reviewed retrospectively. Patient characteristics, management and outcomes (including patient satisfaction) including any complications were extracted with long term follow up (24-month minimum)

Results

Twenty patients required corpora cavernosa reconstruction during penile prosthesis surgery (median age 56, range 18 to 74 years). Reasons for reconstruction included severe corporal fibrosis due to multiple revisions and deficient tunica (n=7), impending erosion (n=6), congenital corporal agenesis (n=2), aneurysm of cylinder (n=1) ossified Peyronie’s disease plaque excision grafting (n=1) and crossover/perforation (n=3). All but two patients (with corporal agenesis) presented for revision penile prosthesis surgery. Coloplast Titan® OTR inflatable penile prostheses were used in all patients. Two patients (13%) required explant after a mean follow-up period of 7.4 months (+/−2.6 SEM). The first experienced erosion of the prosthesis through the distal corpora 6 months after surgery while the other required explant due to debilitating chronic pain after 3 months. There was no other complication (including infection). All patients (who did not require explantation) were satisfied with their penile prosthesis and are currently sexually active.

Conclusions

Our early results suggest that a lightweight macroporous mesh may be an alternative synthetic graft for corporal reconstruction in experienced high-volume hands experienced in revision, reconstruction and salvage procedures. The poliglecaprone-25/polypropylene mesh (ULTRAPRO®, Ethicon LLC, USA) is ideal because it is partially absorbable while providing a strong scaffold, easy to handle and not bulky. Further long-term follow-up is required, and with increasing advances in stem cell tissue engineering perhaps even better graft material choices will be available in the future.

Disclosure

No
(425) Counterincision for High Submuscular Penile Prosthesis Reservoir Placement
Authors: Kavoussi M , Badkhshan S , Nealon S , Langford B , Vandyke M , Sanders S , Morey A
Published: May 2023

Introduction

Inflatable penile prosthesis (IPP) reservoir placement into the high submuscular (HSM) space is safe and well tolerated. Recent studies have proposed that reservoirs placed via an abdominal counterincision (CI) may offer more precise positioning with herniation rates comparable to a transinguinal (TI) approach.

Objective

Our objective was to evaluate the CI-HSM technique with respect to operative time, pain control, and complications.

Methods

We retrospectively reviewed our patient database to identify all men who underwent IPP reservoir placement via the CI-HSM technique. From this database, a similarly sized and matched control group of TI-HSM patients was identified based on concomitant procedures, date of surgery, age, and medical history. Operative time, intraoperative and postoperative complications, morphine milligram equivalents (MME) prescribed, and postoperative patient phone calls were also compared between TI-HSM and CI-HSM patients. Statistical analysis was performed using Student’s T-test and Fisher’s Exact test for continuous and discrete variables, respectively.

Results

Among 580 IPP cases identified, CI-HSM technique was used in 44 (7.6%). Of these, thirty-five (80%) were primary implants, nine (20.4%) were remove/replace revisions, and seven (15.9%) were combined with other ancillary procedures (i.e. artificial urinary sphincter, urethral slings, or penile plications). The TI-HSM technique was used in 536 patients (92.4%); of these, 44 matched controls were identified for comparison to the CI-HSM cohort. Thirty-four (77%) of these patients underwent primary implants while ten (23%) were revision cases. Cases employing the CI-HSM technique had a longer mean operative time (90 minutes) compared to those using the TI-HSM technique (75 minutes) (Table). A similar number of CI-HSM patients (3/44, 6.8%) were treated for infection versus TI-HSM patients (1/44, 2.2%). Reservoir herniation was not observed in the CI-HSM cohort, however one (2.2%) patient in the TI-HSM matched control cohort required revision secondary to herniation. No differences were identified between TI-HSM and CI-HSM patients with regards to outpatient medications, narcotic medication refills, or postoperative phone calls.

Conclusions

IPP reservoir placement via CI-HSM technique is safe and well tolerated. Operative times were similar as compared to reservoirs placed via TI-HSM technique.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.
(431) Frailty Does Not Predict Postoperative Complications Following Inflatable Penile Prosthesis Surgery
Authors: Johnsen N , Cabo J , Marvi T , Koch G , Gambrah H , Zwaschka T A , Milam D , Kaufman M , Johnsen N
Published: May 2023

Introduction

Frailty, an approximation of a patient’s reserve resulting from age-associated decline across multi-organ systems, has been shown to be an independent predictor of adverse outcomes. Amongst penile prosthesis surgery however, frailty is an underutilized risk factor with conflicting data regarding its impact on surgical outcomes.

Objective

To evaluate the association between the modified Frailty Index (mFI) and adverse outcomes following inflatable penile prosthesis (IPP) surgery.

Methods

A retrospective chart review of men who underwent IPP surgery between 1/1/13 and 7/31/20 at a single-institution was conducted. Patient frailty was defined using the mFI, a previously validated measure, which consists of 11 patient characteristics. Each variable is allotted 1 point with aggregate scores ranging from 0 (no frailty) to 11 (highest degree of frailty). Complications were defined as mechanical failure, erosion, infection, hematoma, intractable pain, or other (ex. herniated reservoir, pump revision). Logistic regression was used to determine the association between mFI and complications after controlling for predetermined covariates.

Results

The final cohort consisted of 337 IPP patients with a median age of 64.6 years (IQR 58.5-68.4) and a median time from surgery to data collection of 66.6 months (IQR 39.0-85.4). The overall complication rate was 9.8% (n=33) with 63.6% of those (n=21) requiring a surgical intervention (ex. explant, remove/replace, revision). The median mFI for patients with a complication was 2 (IQR 1-3) while the median mFI for those without a complication was 1 (IQR 1-2) (Table 1). When adjusting for confounding variables on multivariable analysis, mFI was not associated with either overall (p=0.20) or operative complications (p=0.69) (Table 2).

Conclusions

While specific frailty metrics such as handgrip strength have been shown to be associated with complications following IPP placement, our results suggest that overall mFI was not associated with adverse outcomes following IPP surgery.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(432) Efficacy of Low-Intensity Shockwave Therapy on Hard Flaccid Syndrome: Initial Report of Three Cases
Authors: Hammad M A M , Barham D W , Loeb C , Serefoglu E C , Yafi F A
Published: May 2023

Introduction

Hard flaccid syndrome (HFS) is characterized by chronic pain in the penis and perineum and firmness or rigidity of the penis even while not erect and may have a devastating impact on patient sexual quality of life. Although this syndrome has been discussed in myriad patient forums, there is no established evidence-based definition nor specific standard established treatment modalities in the literature. Current treatment options may include a combination of medical pain management, pelvic floor physical therapy, biofeedback, and stress reduction. In patients with other chronic pain conditions who fail traditional therapies, low-intensity shock wave therapy (LiSWT) has been increasingly utilized as management with positive response. We report a series of three patients with managed with LiSWT.

Objective

To report our initial experience of men with HFS managed with LiSWT.

Methods

Three patients, aged 36, 24, and 20 diagnosed with HFS were treated with LiSWT for a course of six sessions. In each session, LiSWT settings were: energy flux density of 0.13 mJ/mm2 and frequency of 3 Hz. While penis was held in stretched position, 600 shocks were delivered to each of the dorsum, left, ventral, and right aspects of penis along the shaft. The scrotum was then held up, and 600 shocks were delivered to each of the right and left crural areas, adding up to 3600 total number of shocks that were allocated evenly. All patients answered a questionnaire to assess improvement in symptoms after completion of the treatment sessions (Table 1).

Results

All patients reported initially alleviated symptoms after 3 treatment sessions, particularly with respect to penile rigidity in the flaccid state. Patient 1 elected for a combination of LiSWT and tadalafil. 5 months after treatment completion, Patient 1 has had complete resolution of HFS symptoms. Patient 2 had no response with tadalfil alone before he elected for LiSWT only, and patient 3 opted for LiSWT alone. After each LiSWT session, patient 2 reported relieved symptoms for 3-4 days, while patient 3 reported significant improvement lasting for 24 hours. Both patients 2 and 3 reported gradually returning to their pre-treatment baseline in 5 months’ follow-up.

Conclusions

While HFS is becoming increasingly recognized amongst sexual medicine clinicians, there are currently no established efficacious treatment options. LiSWT shows potential as a treatment modality and may have increased efficacy if used in combination with PDE5 inhibitors, as demonstrated in this pilot study. Nevertheless, a larger case series is necessary to establish LiSWT as a standardized treatment option and may require a more comprehensive approach to properly manage this condition.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus.
(445) A Full Bladder Is Not Needed To Grade Male Stress Incontinence For Prosthesis Patient Selection
Authors: Lopategui D , Mallory C , Demus T , Nolte A , Nagoda E , Bui A , Cordon B
Published: May 2023

Introduction

Stress urinary incontinence (SUI) resulting from prostate surgery can have devastating consequences in men’s quality of life. Patient selection is crucial for successful treatment of SUI with urethral sling or artificial urinary sphincter (AUS). The ideal SUI evaluation tool for determining severity and guiding surgical treatment remains unknown. The Male Stress Incontinence Grading Scale (MSIGS) uses a standing cough test to provide a simple, non-invasive assessment of post-prostatectomy SUI severity, and can facilitate procedure selection. However, uncertainty remains as to whether MSIGS underestimates SUI severity if performed with insufficiently full bladder, increasing the risk of treatment failure.

Objective

We present our sling and AUS outcomes using the MSIGS for selection. We assessed bladder fullness with random bladder scans (BS) at the time of evaluation to determine if emptier bladder carries increased risk of failure.

Methods

We conducted a retrospective chart review of male patients undergoing sling and AUS placement. MSIGS and BS were documented at initial evaluation. Additional collected data included age, pads per day (PPD) pre- and post-surgery, post-operative MSIGS, and need for revision or conversion. Success and failure groups were defined as the post-operative use of ≤1 PPD or >1 PPD, respectively. Descriptive and comparative statistics were performed using SAS software.

Results

From April 2017 to September 2021, 40 male patients underwent sling and 43 naïve AUS placement. Average age was 71.9 for slings and 70.3 for AUS. 80/83 had prior prostatic surgery. Average follow up was 12.5 months. 34/40 slings had complete SUI resolution or reduction of pad use to no more than one PPD vs 40/43 of AUS (85 vs 93%, p=0.4). 4 sling patients (10%) had persistence or recurrence of SUI, of whichone patient underwent AUS placement. MSIGS scores were similar between sling success (83% patients grade 0, 3% grade 1, 14% grade 2) and failure groups (67% grade 0, 33% grade 1). 73% of AUS patient mostly had MSIGS scores 3 or 4. BS was available for 35 sling and 25 AUS patients. Average was 18.5cc in the sling failure group (range 17-161) and 38cc in the sling success, (17-161), with 32% of success patients having a BS of 0cc, and 80% of <60cc. Average BS for AUS patients was 45cc (14-224). 10 patients with BS 0 and 7 patients with BS<30cc demonstrated MSIGS 4 on exam.

Conclusions

MSIGS is a non-invasive, reliable test to assess SUI severity. Our preliminary data suggests that a full bladder at time of assessment is not necessary to accurately select patients for male sling vs AUS, with high rate of success and patient satisfaction.

Disclosure

No
(446) Synchronous Surgical Management of Erectile Dysfunction and Stress Urinary Incontinence: A Systematic Review and Meta-analysis of Reoperation Rates
Authors: Pyrgidis N , Barham D W , Hammad M A M , Sokolakis I , Hatzichristodoulou G , Lentz A C , Simhan J , Yafi F A , Gross M S
Published: May 2023

Introduction

The efficacy, safety, and postoperative outcomes of synchronous surgery for concomitant erectile dysfunction (ED) and stress urinary incontinence (SUI) remain unclear.

Objective

We performed a systematic review and meta-analysis to evaluate the available synchronous surgical approaches for concomitant ED and SUI and to assess the reoperation rates compared to asynchronous surgery and surgery only for ED or SUI.

Methods

We searched PubMed, Cochrane Library, and Embase databases until June 2022 for relevant studies. Based on data availability, we performed a meta-analysis of odds ratios (ORs) comparing reoperation rates after synchronous surgery in patients with concomitant ED and SUI versus asynchronous surgery, as well as surgery solely for ED or SUI (PROSPERO: CRD42022326941).

Results

We included 18 studies in the systematic review (16,517 patients) and 5 in the meta-analysis. Comparing synchronous implantation of penile prosthesis and artificial urinary sphincter (AUS) versus asynchronous surgery, no statistically significant differences were observed in the reoperation rates [OR:0.98, 95% confidence interval (CI): 0.52-1.84, I2:0%). Comparing synchronous implantation of both penile prosthesis and AUS versus implantation of only a penile prosthesis or an AUS, combined surgery was associated with higher reoperation rates (OR:2.02, 95%CI: 1.29-3.16, I2:36% and OR:1.7, 95%CI: 1.25-2.32, I2:0%, respectively). Synchronous surgery led to high satisfaction rates and significant improvement in ED and SUI. Evidence for the combination of penile prosthesis with a male sling or the ProACT device is low, but data suggests it may be safe and effective. The synchronous placement of a Mini-Jupette sling and penile prosthesis represents a promising treatment modality for the correction of ED and mild SUI and/or climacturia.

Conclusions

Synchronous penile prosthesis and AUS implantation appears safe and effective in patients with severe ED and SUI. Further high-quality studies are mandatory to strengthen the current scarce evidence for synchronous surgery in patients with ED and SUI.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Cynosure, Coloplast, Clarus Therapeutics, Antares Pharma, Acerus
(451) Human Rights and Sexual Health to Reproductive Health, A Research Project on Massive Open One line Courses (MOOCs)
Authors: Ward S , Troussier T , Choucroun D , Brival M , Gerbase A
Published: May 2023

Introduction

Faced with alarming and persistent reproductive health indicators, the raise in refusal of oral contraception by young people and the decline in access to abortion in some developed countries, United states more precisely, UNESCO Chair is creating a mini MOOC in the MOOC Rights, sexual health in Educations, "What sexual health and human rights bring to reproductive health?

Objective

To raise awareness and advance knowledge, empower citizens and their practice in the area of human rights in relation to reproductive health. This includes a variety of aspirations: the protection of young people from sexual violence, infertility; the fight against gender inequality, incest, sexual mutilation, sexual exploitation, unsafe abortion.

Methods

This mini MOOC is composed of 6 mini modules with different formats: • What are the contributions of sexual health to reproductive health? • What are the contributions of human rights to reproductive health? • The desire for a child • Contraception, historical abortion and current issues • Reduction of unwanted pregnancies? • The role of man in reproductive health, a challenge for achieving the 2030 SDGs This mini-MOOC is blended-learning approach, at opening sessions of the MOOC, learners register on a social network (WhatsApp, Fb….) and create private groups to discuss and exchange regularly different materials (testimonies, useful links, files…). This learning technique, which mixes a top down and a horizontal approach, aims at creating a community of learners, a strong group entity that can positively impact public opinion to thrive change.

Results

Past MOOCs results 2021, 93% of learners were satisfied and would recommend UNESCOs’ MOOC. We have had more than 40,000 learners in total in only two years (2019-2021). More than one thousand members of our community on Facebook dedicated to the MOOC and more than one thousand participants of contests/polls and quizess on social media.

Conclusions

What we want to do with ISSM is create an intercultural MOOC available in English and/or more your local languages (Spanish?), that promotes reproductive health and human rights and reflects both our values and vision. A process of co-creation taking into account intercultural diversity as well as the United Nations human rights framework and the Sustainable Development Goals (SDGs)

Disclosure

No
(453) Seasonal Variation in Serum Testosterone Levels
Authors: Miller D , Weber A , Dullea A , Ramasamy R
Published: May 2023

Introduction

Variation in testosterone levels by season and month have been reported, however results have been inconsistent across studies. Large series are conflicting with reported peaks in June, October, December, and January. Testosterone levels in most of these studies nadir in the spring. The etiology for the variability remains unknown but is likely multifactorial including sunlight exposure, sleep duration, and outdoor temperature.

Objective

To determine if there is seasonal variability in testosterone levels in a large cohort of men and if this variability may be clinically relevant.

Methods

Using a single institutional database, testosterone levels were obtained for men ages 18-99 from 2010-2021 who had at least 2 testosterone levels drawn within a 2-year period. Patients who were currently or previously on exogenous testosterone, testosterone stimulating medications, testosterone suppressing medications, and aromatase inhibitors were excluded from the study. Climate data including mean monthly temperature for Miami-Dade County, FL was obtained from the PRISM Climate Group. Minutes of daylight on the fifteenth day of each month was applied as the representative daylight duration for each month.

Results

There were 3,377 total patients included in the study, there were 9495 total testosterone levels measured with all patients having 2 or more levels. The mean age was 58.8 years old. In the winter the mean testosterone level in the was 422 ng/dl (Figure 1.), the average time of daylight was 682 minutes, and the average temperature was 68 F. In the spring the mean testosterone level was 412 ng/dl, the average time of daylight was 801 minutes, and the average temperature was 78.4 F. In the summer the mean testosterone level was 416 ng/dl, the average time of daylight was 780 minutes, and the average temperature was 83.6 F. In the fall the mean testosterone level in the fall was 417ng/dl, the average time of daylight was 661 minutes, and the average temperature was 75.3 F.

Conclusions

Our findings suggest seasonal variability in testosterone levels with the highest testosterone levels in the winter, the lowest levels in the spring and a steady increase in testosterone levels in the summer and fall. However, this variation is minor and not likely to be clinically relevant.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceuticals Consultant, Grant Recipient Boston Scientific Consultant, Grant Recipient Coloplas tConsultant, Grant Recipient Endo Pharmaceuticals Consultant, Grant Recipient Empower Pharmacy Grant Recipient Nestle Health Consultant Olympus Grant Recipient Hims, Inc Advisory Board.
(455) The Modern Eunuch: A Historical Review of Voluntary Castration and Modern Perspective On the Practice
Authors: Anglin C , Baas W
Published: May 2023

Introduction

Voluntary castration in men has existed for several centuries with popularity in many different cultures. The practice is still prevalent today in the Western world with varying reasoning for why men still seek the identity of a Eunuch.

Objective

We aim to explore the natural history of voluntary castration including examination of its presence in different cultures, associated societal roles, and the methodology and historical reasoning behind the practice. We also examine roles and reasoning in contemporary society with investigation of how and by who this service is provided.

Methods

We reviewed both historical literature of voluntary castration as well as more updated literature including recent questionnaires, surveys, and internet forums regarding the practice.

Results

Eunuchs have occupied many important historical roles in many different societies and the practice of voluntary castration has continued to be prevalent to this day. There are many different inspirations as to why modern Eunuchs continue this practice. We explore the written evidence of these roles while also focusing on contemporary voluntary castration, what roles Eunuchs fulfill or desire in modern society, and motivations for doing so.

Conclusions

In this historical review, we explore written evidence of the roles Eunuchs traditionally held in historical societies while also focusing on contemporary inspirations for the practice, which continues to be a prevalent interest among some men.

Disclosure

No
(457) Comparing Longevity and Need for Revision Between 2- and 3-piece Inflatable Penile Prostheses
Authors: Berk B , Ernandez J , Gu C , Kathrins M
Published: May 2023

Introduction

The management of pharmacotherapy-refractory erectile dysfunction includes placement of an inflatable penile prosthesis (IPP). Although invasive, placement of an IPP is considered a safe procedure with high patient satisfaction rates. Broadly, these devices have two different inflation mechanisms: a two-piece (2p) device consisting of a pump and inflation cylinders, and a three-piece (3p) device, which incorporates a low-pressure reservoir. The relative difference in concealability has long been considered a major factor in patient decision-making. However, the difference in durability and subsequent need for revision amongst the two types of devices have not yet been explored.

Objective

To investigate differences in longevity and need for revision in patients with 2p and 3p IPPs.

Methods

After receiving institutional review board approval, a retrospective chart review was performed on all patients that underwent IPP revision or exchange for mechanical failure from 2001 to 2021 at our institution. Only patients who underwent revision of the initial device placed were included in the analysis. Men with retired IPP models or who underwent salvage protocol for infected prosthetics were excluded. Baseline characteristics, including history of diabetes or cardiovascular disease, smoking history, prior radical prostatectomy and/or pelvic radiation, and prior incontinence surgery were recorded. Cox proportional hazard models adjusted for age were developed comparing time to revision between 2p and 3p devices. Baseline characteristics were compared with descriptive statistics. Statistical significance was defined as p < 0.05.

Results

A total of 64 men underwent IPP exchange or revision during the study period, including 38 and 26 men undergoing revision of 2p and 3p devices, respectively. Baseline characteristics are included in Table 1. The median number of days until first revision was 2,695 for 2p IPP compared to 2,101 for 3p IPP (p = 0.27). On unadjusted proportional hazard analysis, there was a significant longevity benefit for 2p IPP compared to all 3p devices [HR: 1.80 95% CI (1.09, 3.00), p = 0.02]. When controlled for patient age, 2p IPPs continued to have a significant longevity benefit compared to 3p devices [HR 1.87 95% CI (1.13, 3.09), p = 0.02].

Conclusions

Amongst our institutional cohort, 2p IPPs have significantly longer durability compared to 3p devices. These findings may be used to counsel patients who are deciding between different devices for management of their erectile dysfunction.

Disclosure

No
(467) Outcomes Of Penile Implant Surgery In The Elderly Patient
Authors: Habous M , Almannie R , Binsaleh S , Ralph D , Bittocchi C , Mulhall J
Published: May 2023

Introduction

Penile prosthesis implantation (PPI) is a highly effective therapy for erectile dysfunction (ED) with high satisfaction rates reported.

Objective

We aimed to investigate if age has an impact on the outcome and complications of PPI, and to compare the outcomes of PPI in elderly men compared to men of younger age.

Methods

The data analyzed in this study based on a huge multicenter prospective study of patients who underwent PPI at our centers between 2010 to 2015.The data included patient’s demographics, comorbidities, preoperative data, type of implant used, postoperative adverse events (early and late) and overall satisfaction. Patients were stratified according to age into two groups: group I less than 70 years, and group 2 equal or more than 70 years. Satisfaction was measured using a 5-point Likert scale, given to patients 1 year postoperatively, scored from 0-5 where 0 is dissatisfied and 5 is most satisfied.

Results

913 patients were included in this analysis, 814 in group 1 and 99 in group 2. Comorbidity profile and smoking habits were similar between groups, but hypertension was more frequent in group 2 (p less than 0.001). Preoperative glycated hemoglobin (HBA1c) was similar in both groups (8% and 7.8% respectively, p = 0.18).75% had a malleable implant group 1 and 83% group 2 (p = 0.21). The remaining had an inflatable implant placed. There was no difference in early, or late complications between the two groups (p = 0.11). Furthermore, there was no difference in the satisfaction between the two groups (p=0.13)

Conclusions

Penile implant surgery is effective with high satisfaction rate independent of age. It seems to be that age has no impact on increasing complication rate.

Disclosure

No
(473) Simultaneous Multidisciplinary Gender Affirming Surgery during COVID-19: Improving Access to Care for Military Patients
Authors: Luther R , Salter C , Hohman M , Teixeira J , Sabino J , Llewellyn C
Published: May 2023

Introduction

Access to surgical care for the transgender population has been a persistent challenge. Frequently cited barriers include long waiting lists, strict insurance prior authorization protocols, surgeon scarcity, financial cost, and social stigma. These issues have been magnified throughout the COVID-19 pandemic response, as the diversion of resources has led to the postponement of surgeries deemed “routine” or “non-essential.” Many medical societies and healthcare organizations have classified gender-affirming surgery (GAS) as such despite the World Professional Association for Transgender Health (WPATH) defining surgical care for gender dysphoric individuals as medical necessity. Unfortunately, delays in care for this population contribute to prolonged mental health distress. Another important barrier to access centers on the issue of surgical timing. Many patients cannot afford to postpone school and work obligations to undergo multiple surgeries each with long recovery times. Furthermore, staffing shortages nationwide have limited operating room (OR) availability. To respond to these issues, our center organized a multidisciplinary collaboration among various surgical subspecialties to perform simultaneous GASs (e.g., top and bottom surgeries). In this way, the patient can undergo multiple GASs in a single procedure, thus limiting anesthesia exposure, expediting postoperative recovery, improving patient satisfaction and maximizing limited healthcare resources.

Objective

To describe a multidisciplinary model for GAS involving simultaneous top and bottom surgery to improve access to care for the transgender population in a resource-limited environment.

Methods

Case report describing successful multidisciplinary surgical management of a transgender female desiring multiple simultaneous GAS.

Results

Patient is a 24-year-old active duty transgender female who met WPATH criteria for top and bottom surgery. She desired numerous procedures including simple orchiectomy, breast implants and facial feminization. Given our limited OR availability during COVID-19, the decision was made to perform all of these surgeries under the same anesthetic. She underwent breast augmentation and fat harvesting with plastic surgery, which was immediately followed by simultaneous simple orchiectomy by urology and facial feminizing surgery with otolaryngology. Total operative time was 8.3 hours. Patient was discharged on post-op day 1 and had an uneventful recovery without surgical or anesthetic complications.

Conclusions

Simultaneous GAS is an effective approach to improve access to care during the COVID-19 pandemic. A single anesthetic enables the patients to achieve their surgical goals sooner and to lessen their overall recovery time compared to staged procedures.

Disclosure

No
(475) Comparison of Female Sexual Function Index in Premenopausal Women and Postmenopausal Women
Authors: Kong M K , Cho J , Bai S
Published: May 2023

Introduction

Menopause is known to have a significant impact on mental health, women's quality of life, and sexuality.

Objective

The purpose of this study is to evaluate the impact of menopause on sexual function in women. The associations of sexual function with demographic and clinical variables were evaluated.

Methods

We performed a retrospective study comparing the relationship between female sexual function index and menopause in premenopausal women and postmenopausal women. Patients with a diagnosis of benign gynecologic disease who admitted for gynecological surgery at our institution from January 2009 to December 2012 were evaluated. Total 349 women were enrolled in this study and complete the Female Sexual Function Index (FSFI) questionnaires. Risk factors for female sexual function were examined using logistic regression models. Patients were separated into two groups: premenopausal women (group 1), postmenopausal woman (group 2). Women with prior gynecologic surgery were excluded. Continuous variables was compared using the two sample t-test, while non-continuous variables using the Chi-squared test.

Results

The mean age of the premenopausal women group was 41.7 years, and the average age of the postmenopausal women group was 58.8 years. There was no difference in parity, body weight, height, BMI, disease incidence, and smoking rate between the two groups. Comparing the female sexual function between the two groups, there was a significant relationship between menopause and female sexual function; Desires disorder (p value=0.00), Arousal disorder (p value=0.002), Lubrication disorder (p value=0.003), Orgasm disorder (p value=0.019), Satisfaction disorder (p value=0.002), Pain (p value=0.001), Total FSFI (Premenopausal women; 20.3/postmenopausal women; 15.3, p value=0.001). The result of the FSFI study between the two groups, the postmenopausal women group showed a significant decrease compared to the premenopausal women in all areas.

Conclusions

Female sexual dysfunction (FSD) is a complex disorder which has an impact on women regardless of their age and race, and related to a variety of biological, psychological, and social determinants. Sexuality impact quality of life through effects on the emotional and psychological health of a woman. Consequently, clinicians who take care of women appreciate when they may be vulnerable to sexual dysfunction. The menopausal transition, a time characterized by hormonal, physiologic, and social changes, is often associated with sexual dysfunction. As postmenopausal woman population is increasing, the further study will be needed in a larger subgroup of women with long-term follow up period.

Disclosure

No
(479) Diabetic ED Treatment by Treating Psychosocial Factors
Authors: Nasim M A F , Farooq U
Published: May 2023

Introduction

ED is either predominantly psychogenic or predominantly organic. Psychosocial factor prevalence in diabetic ED varies in different cultures and societies. Psychosocial factor is quite prevalent in Pakistan for e.g in Pakistani national language (Urdu) ED is named ‘NAMARDI’ meaning that ‘he is not a man’, so ED has a lot of psychosocial effect on a patient and treatment of this factor is significant in restoring normal sexual functions

Objective

The aim of this study is to find the outcome by treating psychosocial factors in diabetic ED patients by sex therapy, counselling and psychotropic drugs supported by good glycemic control and methyl cobalamin.

Methods

74 patients of diabetic ED were treated at Nasim Fertility Centre during Sep 2020 - Jan 2021 Aging from 42 years to 62 years. Duration of diabetes was from 3 to 24 years. Diagnostic work up included detailed medical and sexual history. HbA1c, testosterone and prolactin level were documented. These patients were treated on weekly basis for 10 weeks by sex therapy and counselling. Minimum effective doses of SSRI’s, benzodiazepines, yohimbine and I/M Testosterone were also prescribed. PDE-5 Inh were also prescribed as per requirement. Patients were also advised a healthy change in lifestyle, good glycemic control and regular sexual activity.

Results

Patients were divided in three groups depending upon the presenting complaints A- 36 out of 74 patients had presenting complaint of less erection and less time. By treatment mentioned above, normal sexual functions were restored in 30 patients (83%) and 6 patients (17%) needed PDE- 5 inh. B- 16 out of 74 patients had presenting complaint of using PDE-5 inh which was becoming less effective. By treatment mentioned above in 11 patients (69%) natural sexual functions were restored and 5 patients (31%) they had to use PDE-5 inh in less dose with better effects C- 22 out of 74 patients had presenting complaint that PDE-5 inh has become non effective. In 6 patients (27%) normal sexual functions were restored, in 12 patients (55%) PDE -5 inh became effective and in 4 patients (18%) PDE-5 inh was still non effective so they were advised I/D inj or vacuum constriction device.

Conclusions

Psychosocial factors in diabetic ED is quite prevalent in Pakistani society and treating this psychosocial factor helps to restore natural normal sexual response or improve the efficacy of PDE-5 inh in less dose.

Disclosure

No
(486) Different Methods Penile Girth Enlargement
Authors: Knigavko O , Tryfonyuk L
Published: May 2023

Introduction

Male dissatisfaction with the size of the penis is the most common manifestation of penile dysmorphophobia. Despite the variety of penis girth enlargement methods, a single safe technique that satisfies patients has not yet been developed.

Objective

The aim of the work was to compare the results of a combined operation to install a collagen-like matrix impregnated with autologous stem cells with simultaneous ligamentotomy to increase the circumference of the penis and Polylactic Gel injection.

Methods

In 2017-2022, penis enlargement surgeries were performed in 2 centers. In 38 patients from Ukraine and Poland, . performed the implantation of the Max Pol porous matrix, and injections of the polylactic acid gel were performed at the other Clinic. The results of penis enlargement were evaluated in the early (2 months) and long-term (36 months) terms.

Results

When using a collagen-like matrix -Scaffolf made of polymerized polylactic acid impregnated with own stem cells in 38 patients, we did not encounter complications that caused the removal of the matrix. However, 5 patients required additional polylactic acid gel injections between 6 and 36 months to optimize the shape or volume of the penis. In 4 cases (10.5%), patients underwent circumcision in the period up to 3 years, as the head did not open well due to the enlarged trunk. 34 (89.5%) patients noted an improvement in the sexual function and sexual sensations of their partner, harmonization of relationships in a couple, and 36 (94.7%) men - an increase in a sense of self-sufficiency and self-confidence. In 68 patients, Polylactic Acid Gel was used to enlarge the penis. It was injected under the skin of the penis in a volume of 15 ml per 1 procedure. As a rule, we performed 2-4 treatments (30-60 ml) with an interval of 1 month. No significant complications were noted. In 11 cases (16.4%), patients had to undergo circumcision within 3 years, due to the impossibility of retracting the foreskin. Most of patients noted an improvement in the sexual function and sexual sensations of their partner, harmonization of relationships in a couple, and 61 (91.%) men - an increase in a sense of self-sufficiency and self-confidence.

Conclusions

Thus, modern implants can improve the size and appearance of the penis, improve the quality of sexual life and the feeling of self-sufficiency in operated men. The use of a polymer matrix impregnated with one's own stem cells requires a special laboratory, more time for perioperative preparation and postoperative rehabilitation. The use of polylactic acid gel injections does not require anesthesia, operating room, is more physiological, and can be considered as the standard of safe penis enlargement. The frequency of the need for circumcision after gel injection is slightly higher at 3 years of follow-up compare with scaffold implantation, possibly due to the greater addition of penile volume.

Disclosure

No
(500) What Do Women Want? Vibrators To Be Prescribed by Their Doctors
Authors: Dubinskaya A , Shoureshi P , Eilber K
Published: May 2023

Introduction

Traditionally vibrator use has been a taboo topic that is rarely discussed between patient and physician. Nevertheless, the vibrator industry has flourished the past several years with vibrators now available at mainstream retailers. While these devices are readily available to the public, the role of medical professionals in regards to vibrator use and female pelvic health is not well known.

Objective

The purpose of this study was to describe the interest among women responding to a clinical trial for female sexual wellness and the use of vibrator.

Methods

We reviewed the responses to a female sexual wellness clinical trial posted on various medical platforms (clinicaltrials.gov, Medscape, Medege, Medpage). Using qualitative content analysis, we reviewed the inquiries made by women interested in participating in the study. Those women who were ineligible for the study due to their geographical location but desired to have an in depth discussion were offered telephone calls.

Results

A total of 260 emails and 12 voice mails were received from 148 women within a two-week time frame who had inquired about the female sexual wellness study and vibrators. The locations of the respondents included 31 states within the United States and Canada. The average age of the respondents was 60 years, and 62 (42%) of the women worked in the medical field (medical doctors, osteopathic doctors, and registered nurses). Five women (3.3%) received a link about the study from their male partners. The most common conditions that women were hoping to improve with vibrator use in descending order: sexual dysfunction (dyspareunia, desire/libido, orgasm), urinary incontinence, prolapse/pelvic floor, and menopause.

Conclusions

Our review demonstrated that women are interested in vibrators, particularly in a clinical trial setting, and are seeking to use them for multiple conditions including FSD and pelvic floor disorders. Clinicians should consider discussing vibrator use with patients, as it normalizes vibrator use.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie, Coloplast, Sprout Pharmaceuticals.
(503) The Impact of HEPA/Ultraviolet air recirculation system (HUAIRS) During Penile Prosthesis Surgery
Authors: Hakky T , Carrion R , Henry G
Published: May 2023

Introduction

Airborne bacteria are a major source of wound contamination during penile prosthesis surgery. 80% of bacteria found in the wound after surgery comes from the air. Crystalline ultraviolet C (C-UVC) filter units were designed to disinfect and recirculate the air in the operating room (OR).

Objective

We assess the particle-reducing capacity of C-UVC units in a highly controlled operating room setting in the office and surgery center during penile prosthesis surgery.

Methods

A particle counter was deployed in a positive-pressure operating room and a standard office HVAC system to measure total and viable particle counts (TPC). A HEPA/Ultraviolet air recirculation system (HUAIRS) was purchased and placed into the ORs in both locations. Weekly particle count experiments were performed for 6 months in both office OR and surgery center OR settings. A C-UVC unit was kept 4 meters from the door in both settings and the particle counter was used near the operative field.

Results

After 6 months of weekly office-based procedure collection of data using a particle counter an 83.4% particle reduction was seen at the 5 micron level. Initially, reads were 14,143 particles and after implementation of the HUAIRS, a total particle count was 2,299 during office penile prosthesis. In the OR at the surgery center, the same weekly data collection was employed. The initial 5 micron particle count dropped 81.74% from 6,143 particles to 1,122 once the HUAIRS system was employed.

Conclusions

C-UVC units have shown to be capable of significantly reducing TPC in the office and operating room setting. Reducing airborne particles using C-UVC units may reduce infection rates following penile prosthesis surgery.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.
(506) Histology Appears to Reveal Good Sealing of the Human, Porcine and Dog Vasectomy Specimens using the Vasectomy Sealing Procedure
Authors: Henry G , Hakky T , Griggs R , Nighan W , Fuselier A , Jones L
Published: May 2023

Introduction

The Sealed Vasectomy Procedure (SVP) is a new bipolar radiofrequency sealing tool for transdermal vasectomy in hopes of making the procedure a faster, simpler, and safer office procedure. Testing has been successful in rabbits with excellent wound healing, complete vas occlusion on histology, and no sperm in post-procedural semen analysis. The study data was presented last year as a video submission and subsequently won the AUA 2022’s “Best Video” of the andrology / infertility / sexual dysfunction session. Further studies in larger animals were indicated and FDA approval is needed before its application in humans. The issue of “does the SVP effectively seal the vas deferens in animals larger than a rabbit and in humans?” is a critical one for treating physicians.

Objective

Evaluate the effectiveness of the SVP in sealing the vas deferens in animals larger than a rabbit and in humans.

Methods

Animal (rabbit) studies have been previously described. We performed microscopic evaluation of the vas deferens tissues from canines treated with the SVP at either 40 or 60 watts, euthanized at 14 days post-treatment under the conditions of this study. Human vas deferens specimens after removal from the patient were then immediately treated with SVP tool on benchtop. Porcine vas deferens samples were procured and underwent benchtop testing. Specimens were sent for pathologic evaluation by a third-party professional vendor [Crisp County Regional Medical Center in Cordele, Georgia].

Results

4 canine, 6 human, and 26 porcine vas deferens were included in SVP testing. Human, porcine, and canine specimens demonstrated tissue coagulation and fibrosis in the treated vasa deferentia. (See Figure 1 Human and 2 Canine)

Conclusions

SVP is a potentially exciting novel vasectomy procedure that appears to provide good sealing of the vas deferens in the canine animal model and on benchtop for the human and porcine vas deferens. FDA approval is still needed before use in humans.

Disclosure

Yes, this is sponsored by industry/sponsor: Signati Medical

Clarification

Industry initiated, executed and funded study

Any of the authors act as a consultant, employee or shareholder of an industry for: Signati Medical.