bluuebunny/crossref_metadata_2025 huggingface dataset:
Status of gastrointestinal nematode infections and associated epidemiological factors in sheep from Córdoba, Colombia
Authors: Tachack Elisa Brunal , Oviedo-Socarrás Teresa , Pastrana Misael Oviedo , Pérez-Cogollo Luis Carlos , Benavides Yonairo Herrera , Pinto Clara Rugeles , Garay Oscar Vergara
Published: April 2022

Gastrointestinal nematodes cause serious economic losses in sheep production systems. To determine the prevalence and risk factors associated with these parasites, a study was conducted on 595 sheep in Córdoba, Colombia. Prevalence and parasite burden were determined using the McMaster technique. Larvae were cultured from feces to identify the nematode genera. For the analysis of associated factors and parasite burden, data means, medians, and confidence intervals were compared. A georeferenced data analysis was performed and an epidemiological map was constructed. An overall prevalence of 88.2% was found, with the highest prevalence and parasite burden for Strongylida (83.2%) and Strongyloides (41%) nematodes. The mean parasite burden was 1255 eggs per gram. The gastrointestinal nematode genera identified were Trichostrongylus, Strongyloides, Haemonchus, Oesophagostomum, Bunostomum, and Cooperia. In general, a significant association was found between parasite burden and dewormed animals, anthelmintic used, date of last deworming, and breeds. The FAMACHA® method and body condition showed a significant association with the Strongylida parasite burden. Clusters with higher intensity of gastrointestinal nematode burden and high prevalence were observed in the regions of Bajo Sinú, Sinú Medio, and San Jorge.
Proposing a Model of Proactive Outreach to Advance Clinical Research and Care Delivery for Patients Who Use Tobacco
Authors: Burris Jessica L. , Borger Tia N. , Baker Timothy B. , Bernstein Steven L. , Ostroff Jamie S. , Rigotti Nancy A. , Joseph Anne M.
Published: April 2022

There are evidence-based treatments for tobacco dependence, but inequities exist in the access to and reach of these treatments. Traditional models of tobacco treatment delivery are “reactive” and typically provide treatment only to patients who are highly motivated to quit and seek out tobacco treatment. Newer models involve “proactive” outreach, with benefits that include increasing access to tobacco treatment, prompting quit attempts among patients with low motivation, addressing health disparities, and improving population-level quit rates. However, the definition of “proactive” is not clear, and adoption has been slow. This commentary introduces a comprehensive yet flexible model of proactive outreach and describes how proactive outreach can optimize clinical research and care delivery in these domains: (1) identifying the population, (2) offering treatment, and (3) delivering treatment. Dimensions relevant to each domain are the intensity of proactive outreach (low to high) and the extent to which proactive outreach activities rely on human interaction or are facilitated by information technology (IT). Adoption of the proposed proactive outreach model could improve the precision and rigor with which tobacco cessation research and tobacco treatment programs report data, which could have a positive effect on care delivery and patient outcomes.
Asymptomatic bacteriospermia and infertility—what is the connection?
Authors: Volz Yannic , Ebner Benedikt , Pfitzinger Paulo , Berg Elena , Lellig Ekaterina , Marcon Julian , Trottmann Matthias , Becker Armin , Stief Christian G. , Magistro Giuseppe
Published: April 2022

Objective

To determine the impact of asymptomatic bacteriospermia on semen quality in subfertile men.

Methods

We conducted a retrospective, single-centre cohort study in 1300 subfertile men. In those diagnosed with asymptomatic bacteriospermia we performed univariate and multivariate logistic regression models to evaluate the strain-specific association with semen parameters.

Results

Asymptomatic bacteriospermia was diagnosed in 3.2% of patients. The microbiological semen analysis revealed a poly-microbial result in 60%. The most common bacterial species were coagulase-negative Staphylococci species (71.4%), Streptococcus viridans (50.0%) and Enterococcus faecalis (26.2%). Sexually transmitted pathogens were identified in 11.9% of semen samples. The detection of Streptococcus viridians or Haemophilus parainfluenzae correlated with impaired sperm morphology (p < 0.05). The presence of coagulase-negative Staphylococci species or Enterococcus faecalis was associated with pathological low counts of live spermatozoa (p < 0.05). In multivariate analysis only Enterococcus faecalis showed a significant impact on sperm concentration (OR 4.48; 95% CI 1.06–22.10; p = 0.041).

Conclusions

Asymptomatic bacteriospermia has always been a subject of great controversy. There is still an ongoing debate whether to treat or not to treat. Here, we demonstrate that asymptomatic bacteriospermia is clearly associated with impaired semen quality. Our findings speak in favour of strain-specific interactions with semen parameters. Especially Enterococcus faecalis seriously affects sperm concentration.
Spülung mit Leitungswasser oder Natriumchlorid nach Augenkontamination
Authors: Schuster Michael , Frambach Daniel , Oberlinner Christoph , Simons Franz-Josef , Claus Matthias
Published: April 2022

Hintergrund

Ziel des Beitrags war es, die Verwendung von Leitungswasser und/oder Natriumchlorid als Augenspüllösung nach Augenkontaminationen anhand von Sehtestergebnissen zu untersuchen und ggf. Empfehlungen sowie Optimierungsmaßnahmen hinsichtlich der Notfallversorgung abzuleiten.

Material und Methoden

Es handelt sich um eine retrospektive Auswertung aller zwischen dem 01.01.2011 und 31.12.2020 dokumentierten Augenkontaminationen in einem Großunternehmen der chemischen Industrie. Verglichen wurde als Zielgröße die Sehschärfe (Visus) vor und nach Produktkontamination mittels Wilcoxon-Vorzeichen-Rang-Tests.

Ergebnisse

Innerhalb des Beobachtungszeitraums erlitten, nach Ausschluss von Fremdfirmenmitarbeitenden, 393 Personen eine Augenkontamination. Darunter befanden sich 299 Fälle, für die Sehtestergebnisse vor und nach Produkteinwirkung zur Verfügung standen. Zwischen Produkteinwirkung und nachfolgendem Sehtest vergingen im Median (Interquartilsabstand) 0,3 Jahre (0,1–0,9). Der Visus betrug vor Produkteinwirkung 1,0 (0,8–1,0) auf beiden Augen und nach Produkteinwirkung ebenfalls 1,0 (0,8–1,0) auf beiden Augen. Zwischen dem Visus vor und nach Produkteinwirkung konnte sowohl bei einseitiger Augenbeteiligung (n = 180) auf dem betroffenen und nicht betroffenen Auge als auch bei beidseitiger Augenbeteiligung (n = 119) auf dem linken und rechten Auge kein signifikanter Unterschied festgestellt werden. Zu den Fällen, die extern weiterbehandelt wurden und eine Visusminderung aufzeigten, waren in der elektronischen Anamnese keine Langzeitschäden dokumentiert.

Diskussion

Im Rahmen der Notfallversorgung konnte nach chemischer Augenkontamination und anschließender Spülung mit Leitungswasser und/oder Natriumchlorid keine Visusminderung festgestellt werden. Maßnahmen und Investitionen in Prävention und Aufklärungsarbeit könnten zur Reduzierung von chemischen Augenkontaminationen führen.
The Current and Future Role of Technology in Respiratory Care
Authors: Honkoop Persijn , Usmani Omar , Bonini Matteo
Published: April 2022

Over the past few decades, technology and improvements in artificial intelligence have dramatically changed major sectors of our day-to-day lives, including the field of healthcare. E-health includes a wide range of subdomains, such as wearables, smart-inhalers, portable electronic spirometers, digital stethoscopes, and clinical decision support systems. E-health has been consistently shown to enhance the quality of care, improve adherence to therapy, and allow early detection of worsening in chronic pulmonary diseases. The present review addresses the current and potential future role of major e-health tools and approaches in respiratory medicine, with the aim of providing readers with trustful and updated evidence to increase their awareness of the topic, and to allow them to optimally benefit from the latest innovation technology. Collected literature evidence shows that the potential of technology tools in respiratory medicine mainly relies on three fundamental interactions: between clinicians, between clinician and patient, and between patient and health technology. However, it would be desirable to establish widely agreed and adopted standards for conducting trials and reporting results in this area, as well as to take into proper consideration potentially relevant pitfalls related to privacy protection and compliance with regulatory procedures.
Quantitative Evaluation of Flood Control Measures and Educational Support to Reduce Disaster Vulnerability of the Poor Based on Household-level Savings Estimates
Authors: Nakamura Risa , Kawasaki Akiyuki
Published: April 2022

In developing countries, where budget constraints make it difficult to invest in disaster risk reduction, disasters worsen the poverty trap. To alleviate poverty by reducing the risk of disasters, not only the immediate direct impacts of disasters but also their long-term and indirect impacts should be considered. However, since the effects of individual policies are often evaluated based on the extent of damage reduction, the impact on the poor, who have few assets and thus small losses, is generally ignored. Here, we aimed to quantitatively evaluate the effects of flood control measures and educational support in terms of the flood vulnerability of the poor at the household level. We constructed a model to calculate the savings of individual households and used the flood damage-to-savings ratio to determine their flood vulnerability. Next, we estimated the extent to which the flood vulnerability is reduced by various policies. We found that educational support is suitable for reducing the flood vulnerability of the poor cost-effectively, especially when the budgets are small. Gini coefficient predictions confirmed that educational support is effective in reducing income inequality. The novelty of this study is that it quantitatively links flood damage, savings, and education, which are factors that affect the flood vulnerability of the poor, and it compares the effects of various flood control measures and educational support at the household level in terms of the flood vulnerability. While the model was developed using household survey data from Bago, Myanmar, the framework should be applicable to other regions as well.
Monolithic perovskite/c-Si tandem solar cell: Progress on numerical simulation
Authors: Gao Chao , Du Daxue , Shen Wenzhong
Published: April 2022

Perovskite/c-Si tandem solar cell (TSC) has gradually become the hottest research topic in photovoltaic field for global carbon neutrality. Here we review the recent progress of numerical simulation studies of monolithic perovskite/c-Si TSC in terms of the methodology, light harvesting management, and energy yield aspects. It is summarized that the integration of physical fundamentals of the methodology, optimization of modeling and parameter correction can bring simulation results closer to experiments. Based on theoretical analysis of light harvesting management, we have demonstrated that textures can enhance light trapping capability and resonance absorption. The advances of bifacial perovskite/c-Si TSC have been particularly reviewed in simulation calibration (current matching loss approach) and low-cost strategy (ultrathin Si). Finally, through the energy yield analysis of the monofacial and bifacial TSC, we have innovatively proposed that spectral variables, effective albedo and top-cell bandgap should be integrated into cell preparation and module installation. This in-depth numerical simulation review provides a guidance for experimental preparation of low-cost and high-efficiency perovskite/c-Si TSC.
Drug flibanserin–in hypoactive sexual desire disorder
Authors: Thangaraju Pugazhenthan , Velmurugan Hemasri , TY Sree Sudha
Published: April 2022

Hypoactive sexual desire disorder (HSDD) is a widely known type of female sexual dysfunction that could also cause emotional distress and relationship problems. Flibanserin, a benzimidazole, was being studied as a treatment for premenopausal women with hypoactive sexual desire disorder because there was no accurate drug therapy available at the time (HSDD). The US Food and Drug Administration (FDA) approved Flibanserin in 2015 for the treatment of generalised acquired HSDD in premenopausal women. It has a high affinity for postsynaptic 5-HT-1A receptors (agonist) and 5-HT-2A receptors (antagonist), and it tends to work by increasing dopamine and noradrenaline levels in the brain while decreasing serotonin levels. This review was to assess Flibanserin efficacy and safety and it is found the drug Flibanserin benefits did not outweigh the risks in premenopausal and postmenopausal women.
9 Safety of Human Chorionic Gonadotropin Monotherapy for Men with Hypogonadal Symptoms and Testosterone >300 ng/dL
Authors: Rainer Q , Pai R , Masterson T
Published: April 2022

Introduction

Human chorionic gonadotropin (hCG) is homologous to luteinizing hormone (LH) and is known to stimulate endogenous testosterone (T) production and may be an option for testosterone replacement therapy (TRT). Current guidelines recommend TRT for men with two T levels <300 ng/dl and symptoms of low T. A challenging patient population are men with symptoms of low T who do not meet biochemical criteria for TRT as there are not current treatment recommendations. We hypothesize that hCG may be a safe and effective therapy for men with hypogonadal symptoms and T >300ng/dl.

Objective

Our objective was to evaluate for symptom improvement and side effects of hCG monotherapy in men with hypogonadal symptoms and T >300 ng/dL.

Methods

We retrospectively reviewed the charts of 31 men treated with hCG monotherapy for hypogonadal symptoms with a T average (latest two lab results) >300 ng/dL who had follow-up labs at least 1 month after initiation of hCG therapy. We evaluated changes in hormones [T, LH, follicle stimulating hormone (FSH), and estradiol], hematocrit (HCT), glycated hemoglobin (A1c), and prostate specific antigen (PSA). Results presented as means standard deviation. Student t-test was used to compare pre- and post-treatment values, significance was set at p=0.05. We also evaluated for incidence of thromboembolic events, including stroke, deep vein thrombosis, and myocardial infarction.

Results

The average age of patients was 49.0±15.8 years with a BMI of 28.6±4.8 kg/m2. Average follow-up after starting hCG therapy was 292 days, range 77 to 857 days. Average weekly hCG dosage was 1500 IU. Serum T increased from 431.27±117.22 ng/dL to 461.05 ±185.19 ng/dL (p=0.61, n=31). No change was seen in FSH (6.79±10.85 to 7.12±12.07 mIU/mL, n=8), PSA (1.55±1.44 to 1.90±1.81 ng/mL, n=10), HCT (43.43±2.27 to 44.48±2.86 %, n=12), estradiol (27.44±6.92 to 30.63±10.25 pg/mL, n=8), or A1c (6.15±0.95 to 6.33±0.93 %,n=4). A statistically significant decrease was seen in LH (4.93±1.98 to 3.66±1.85 mIU/mL,n=11). When evaluated for improvement of erectile dysfunction (ED, n=22), low libido (n=25), and low energy (n=19), 86%, 80%, and 79% of patients reported improvement of each symptom, respectively. All patients with ED were noted to be on another medication or therapy specifically for ED. No thromboembolic events were observed.

Conclusions

Weekly hCG dosing appears to safely improve hypogonadal symptoms even with baseline T levels >300 ng/dL. No changes were noted in HCT, PSA, A1c and no thromboembolic events were recorded.

Disclosure

No
11 Prevalence and Severity of Obstructive Sleep Apnea (OSA) in Men with Testosterone Deficiency (TD)
Authors: Salter C , Flores J , Schofield E , Tan M , Mulhall J
Published: April 2022

Introduction

OSA is a common condition in the general population. Since untreated OSA can contribute to elevated hematocrit (HCT) levels and other negative health consequences, there may be value to screening men prior to initiation of testosterone therapy (TTH).

Objective

The purpose of this study was to describe OSA rates in men with TD prior to initiation of TTH.

Methods

This ongoing study included men seen in a sexual medicine clinic with TD. They were asked to complete two screening questionnaires for daytime sleepiness and OSA, respectively: the Epworth Sleepiness Scale (ESS) and the STOP-BANG (SB). ESS ranges from 0-24 and SB 0-8. Men whose scores indicated intermediate to high risk of OSA were advised to undergo a diagnostic sleep study which evaluated apnea hypoxia index (AHI, normal <5 events/h), total duration SpO2 saturation <88% and SpO2 nadir. Descriptive statistics are presented.

Results

152 men have completed the questionnaires with a mean age of 62±10 years. Baseline total T level was 296±103 ng/dL, baseline HCT was 43±4%. Median SB score was 4 (IQR 3-6). Median ESS score was 5 (IQR 3-8). 58% screened positive for OSA and were referred for sleep study; 88% of sleep studies resulted in a diagnosis of OSA. Mean AHI of the group was 19±14 events/hour (range 0.7-54.3 events/hour) with 52% having moderate or severe OSA (AHI >15/hour). SpO2 nadir was 80±7% (range 63-90%) with 67% having a nadir in the 80s, 24% in the 70s and 10% in the 60s. Mean total duration SpO2 ≤88% was 25±32 minutes (range 0.1-151.6 minutes) with 47% of men <10 minutes and 6% >80 minutes.

Conclusions

These data demonstrate that about half of men with TD screen positive for OSA using the SB questionnaire and the vast majority of them were formally diagnosed with OSA. Given the health risks associated with untreated OSA, especially developing polycythemia on TTH, we advocate screening such men for OSA prior to commencement of TTH.

Disclosure

No
22 Drain Volume Output Following IPP Implantation: An Analysis by Surgical Approach
Authors: Tonzi M , Shridharani A
Published: April 2022

Introduction

Inflatable penile prosthesis (IPP) is the gold standard therapy in the surgical treatment of erectile dysfunction. Hematoma and seroma formation have been described following implantation. These fluid collections may be a significant source of patient pain and infection. Use of closed system drains after penile implantation has been described previously to manage these proactively, and are typically removed on post-op day one. Upon previous analysis, we demonstrated that an extended, three-day postoperative drain course resulted in a modest but significant decrease in postoperative use of pain medication without changing infection rates.

Objective

Herein, we evaluated post-operative drain output volumes to detect differences based on operative approach.

Methods

A total of 151 patients had IPP placement by a single surgeon between November 2017 and November 2019. After excluding patients who underwent additional procedures for Peyronie's disease, those who had a concomitant procedure for post-prostatectomy stress urinary incontinence, or those who underwent a revision procedure, 133 patients remained. 104 of these had their drain removed on postoperative day three. Of these, drain output data was available for 37 patients. Drain output volumes were evaluated based on surgical approach and compared using a one-way ANOVA statistical analysis.

Results

Granular drain output data was available for 37 patients. 8 of these patients underwent IPP placement by infrapubic approach, 13 underwent IPP placement by penoscrotal approach, and 16 patients underwent IPP placement by subcoronal approach. Patients who underwent infrapubic IPP placement trended towards increased drain output compared to those who underwent placement via a penoscrotal or subcoronal approach. These observations did not achieve statistical significance. At 72 hours post-op, drain output among all three groups was comparably low.

Conclusions

As previously demonstrated, an extended post-operative drain duration of three days is not associated with an increased risk of infection in patients undergoing IPP implant. Especially in patients undergoing IPP placement via infrapubic approach, drain output was significant until approximately 72 hours post-op. This data supports the utility in keeping a post-surgical drain for three days in order to maximize drainage and minimize postoperative discomfort. Given the low volume output across all three groups at 72 hours post-op, post-surgical drainage for greater than 3 days is not likely to provide additional benefit.

Disclosure

No
23 Does Medicaid Cover Penile Prosthesis Surgery? A State-by-State Analysis
Authors: Barnard J , Grimaud L , Yafi F
Published: April 2022

Introduction

Malleable [MPP] and inflatable [IPP] penile prosthesis surgery for the management of erectile dysfunction is a reliable treatment option with high success rates and excellent patient satisfaction; however, Medicaid coverage transparency is poor leaving a knowledge gap in this population.

Objective

The present study seeks to assess Medicaid coverage for MPP and IPP by state as evidenced by inclusion in publicly available physician fee schedules.

Methods

State Medicaid websites were utilized to access public physician fee schedules. Individual search queries were performed for CPT codes 54400 and 54405 which represent insertion of MPP and IPP, respectively. Data were recorded for each device including the coverage status, physician fees, and the presence of clear documentation of a prior authorization requirement.

Results

Medicaid physician fee schedules were accessible for 49 out of 50 US states, and 28 states reported coverage for at least one type of penile prosthesis (Figure). Two states reported coverage for MPP only, one state reported coverage for IPP only, and 24 states reported coverage for both devices. One state reported that it did not cover either device, but listed coverage for a self-contained IPP (CPT 54401) only. Mean physician reimbursement was $477.15 (290.82–$1175.50) for MPP placement and $691.76 (421.68–$1794.27) for IPP (Table 1). Eleven states documented prior authorization requirements within their fee schedules, while the remaining 17 states did not. Criteria for approval for prior authorization were not clearly stated in any fee schedule.

Conclusions

Efforts to clearly document approval criteria and educate Men's Health providers on available coverage could result in a significant improvement in sexual satisfaction in the Medicaid population. Graphical representation of states offering Medicaid penile prosthetic coverage and physician reimbursement ranges are provided with comparison to Medicare rates (Figure). Limitations include heterogeneity in fee schedules, lack of prior authorization requirement details, inability to correlate to successful claims data, and the evolving nature of Medicaid coverage for the given procedures. Medicaid coverage exists for penile prosthetic surgery in 28 states, although often with significant non-transparent prior authorization criteria.

Disclosure

No
35 Ethnic Underrepresentation in Validation of Female Sexual Dysfunction Questionnaires
Authors: Redmon C , Alzweri L
Published: April 2022

Introduction

Female sexual dysfunction (FSD) is a significant cause of morbidity that affects an estimated 30-50% of women. FSD is characterized by conditions which cause distress in at least one area – desire, arousal, orgasm, or pain – and can be challenging to diagnose depending on the patient-provider relationship and/or individual levels of comfort in having such discussions. Several questionnaires have been developed over the past four decades to assess FSD. This repertoire of tools includes assessments of overall sexual function, quality of life, and specific dysfunctions (i.e., hypoactive sexual desire disorder).

Objective

The purpose of this review is to evaluate the ethnic representation of sample populations used in the studies to validate questionnaires used to assess FSD.

Methods

A literature search was performed to gather information on questionnaires that have been developed to assess FSD. Subsequent searches were targeted to obtain the published studies used to validate each tool. Collective averages from the combined ethnic data were compared to population data from US census data and healthcare workforce reports to evaluate epidemiologic diversity. Ethnicity data from each questionnaire were investigated longitudinally to evaluate trends in representation of these sample populations over the past 40 years.

Results

Nineteen questionnaires were evaluated for ethnic representation based on published validation studies. Each questionnaire was tabulated to include the domain(s) assessed, number of items in each questionnaire, validation sample population size and description, and available ethnicity breakdown for each questionnaire. The average ethnic representation of the questionnaires relative to the US general population and US female health care workforce, respectively, was: Caucasian (78.3% vs. 62.7% and 68.5%), African American (3.3% vs. 13.3% and 8.3%), Hispanic (2.3% vs. 16.0% and 9.6%), American Indian (0.0% vs. 0.8% and 0.3%), Asian (0.6% vs. 6.4% and 6.2%), and Other (0.7% vs. 0.7% and 1.4%).

Conclusions

FSD is a common condition affecting women and causes significant impacts on quality of life. Review of the sample populations used to validate the questionnaires used to evaluate FSD in routine practice shows underrepresentation of ethnic minorities when compared to general population demographics. FSD questionnaire is an important research tool, helps increase health care providers and patients awareness of FSD, in addition, eventually improving access to care for ethnic minority women.

Disclosure

No
57 Pathway Enrichment Analysis of Microarray Data from Human Penis of Diabetic and Peyronie's Patients, in Comparison with Diabetic Rat Erectile Dysfunction Models
Authors: Searl T , Ohlander S , McVary K , Podlasek C
Published: April 2022

Introduction

Erectile dysfunction (ED) is a debilitating medical condition in which current treatments are minimally effective in diabetic patients due to neuropathy of the cavernous nerve, a peripheral nerve that innervates the penis. Loss of innervation causes apoptosis of penile smooth muscle, remodeling of corpora cavernosa (penile erectile tissue) morphology, and ED.

Objective

In this study, microarray and pathway analysis were used to obtain a global understanding of how signaling mechanisms are altered in diabetic patients and animal models as ED develops, in order to identify novel targets for disease management, and points of intervention for clinical therapy development.

Methods

Human corpora cavernosal tissue was obtained from diabetic (n=4) and Peyronie's (control, n=3) patients that were undergoing prosthesis implant to treat ED. Rat tissue was obtained from BB/WOR diabetic (n=5) and diabetes resistant (n=5) rats. RNA was extracted using TRIzol, DNase treated, and purified by Qiagen mini kit. Microarray was performed using the Human Gene 2.0 ST Array. 1) Alterations in patient and diabetic rat pathway signaling were examined using several analytical tools (ShinyGO, Metascape, WebGestalt, STRING) and databases, 2) Strengths/weaknesses of the different pathway analysis tools were compared, and 3) Comparison of human and rat (BB/WOR and Streptozotocin) pathway analysis was performed. Two technical replicates were performed. P value (FDR) < 0.15 was used as threshold for differential expression. FDR<0.05 was considered significant.

Results

Microarray identified 182 differentially expressed protein-coding genes. Pathway analysis revealed similar enrichments with different analytical tools. Down regulated pathways include development, tubular structure, sprouting, cell death, ischemia, angiogenesis, transcription, second messengers, and stem cell differentiation. ED patients, who have diabetes, incur significant loss of normal regulatory processes required for repair and replacement of injured corpora cavernosal tissue. Combined with loss of apoptotic regulatory mechanisms, this results in significant architectural remodeling of the corpora cavernosa, and loss of regenerative capacity in the penis.

Conclusions

Penis from diabetic ED patients lacks capacity for maintenance of corpora cavernosal architecture and regeneration, which are critical points for intervention for therapy development. The analysis of tissue specific gene expression profiles provides a means of understanding drivers of disease and identifying novel pathways for clinical intervention. This first report of microarray and pathway analysis in human corpora cavernosa, is critical for identification of novel pathways pertinent to ED and for validating animal models.

Disclosure

No
62 Changes in Point of Maximal Curvature During Collagenase Clostridium Histolyticum Injections for Peyronie's Disease
Authors: Price T , Burgon H , Green B , Brearton K , Savage J , Ziegelmann M , Kohler T , Helo S , Trost L
Published: April 2022

Introduction

Collagenase Clostridium Histolyticum (CCH) is commonly injected at the point of maximal curvature (POMC) for Peyronie's Disease (PD). However, many providers only evaluate the POMC at baseline and do not reassess during CCH injections. As PD plaques often extend over an extended region, it is currently unknown how much the POMC may change throughout a course of CCH treatment.

Objective

We sought to evaluate for changes in POMC between series among men undergoing CCH injections.

Methods

A prospective database has been maintained of PD men undergoing CCH injections at two institutions. POMC assessments were obtained prior to each series of injections after pharmacologic erection and were measured from the coronal margin to POMC. An analysis was performed comparing changes in POMC throughout the CCH course, including associated baseline demographic and disease characteristics.

Results

A total of 445 men (mean age 55.9, mean PD duration 30.6 months) underwent CCH injections from Jan 2014 through Feb 2021. The mean baseline composite curvature was 63.7° (SD 23.7), and the mean distance to curvature was 3.1 cm. Among men who completed 4 series of CCH injections, the mean improvement was 21° (SD 20.6) or 31.7% (SD 33%). In reviewing changes in POMC, the largest change observed at any point within the CCH series was a median 1 cm (IQR 0.5, 2 cm; range 0, 9.5 cm). Compared to baseline, 58% of men experienced a POMC change of 1 cm or greater, 25% 2 cm or greater, and 12% 3 cm or greater during the course of CCH treatment. Age, duration of PD, and baseline curvature were not associated with changes in POMC, although the POMC itself was associated with extent of changes, with proximal curves more likely to experience more notable changes compared to distal ones (p<0.0001). The total improvement in curve was also variably associated with change in POMC, with those experiencing greater improvements noted to have larger change in POMC (p<0.05 for changes in composite curvature and p=0.07 for percent change from baseline). These findings would suggest significant evolution of the POMC during a course of CCH, particularly among men with mid shaft or proximal curves and among those with greater curve improvements. Findings would support a role for repeat curvature assessments prior to each series of CCH injections.

Conclusions

Based on data from a prospective, two-institution series of PD men undergoing CCH injections, the POMC changes by ≥1 cm in the majority of men. Given the small volume injected with each CCH series, the clinical relevance of these findings and their impact on injector protocols merit further investigation.

Disclosure

No
80 Does the Risk of Obstructive Sleep Apnea (OSA) Affect Erectile Function Recovery (EFR) After Radical Prostatectomy (RP)?
Authors: Martinez JM Flores , Salter CA , Ruiz K , Benfante N , Schofield E , Tan M , Laudone V , Mulhall JP
Published: April 2022

Introduction

Obstructive sleep apnea (OSA) affects as many as 7% of adult men in the general population, higher in men with obesity and large neck sizes. OSA is associated with ED. No data to date has assessed EFR after RP in men with OSA.

Objective

The objective of this study was to define EFR rates 2 years post-RP.

Methods

Records of men who underwent RP with 24-month post-RP follow-up were reviewed. ADT and radiation therapy were exclusions. Men completed the OSA screening questionnaire, STOP-BANG (SB) pre-RP. Men were divided into OSA risk groups: high, intermediate, and low. EFR was recorded using IIEF-EFD score, with a score of at least 24 indicating recovery. Univariable and multivariable logistic regression analyses assessed predictors of EFR.

Results

454 men were analyzed. Mean age 62 ± 7 years. Of the studied population,12% had a history of OSA,10% had diabetes,12% were current smokers, and 37% were former smokers. The median STOP-BANG (SB) score was 2. High, intermediate, and low risk of OSA scores were 8%, 41% and 51% respectively. Mean baseline testosterone (T) was 495 ng/dL, PSA 7.4 ng/mL, and EFD score 22. Most men had a Gleason sum of 7 (87%). 73% of patients had bilateral or unilateral neurovascular bundle preservation. At the 2-year follow up, median EFD score in high, intermediate and low OSA risk groups: were 9, 16, and 18 respectively. The low OSA risk group was significantly more likely to recover (OR = 1.6, 1.1 – 2.4) than the moderate/high group. Younger age (OR = 0.92, 0.89 – 0.95), absence of diabetes (OR = 0.31, 0.14 – 0.72), higher baseline T (OR per 100 units = 1.40, 1.04 – 1.89), higher baseline EFD score (OR = 1.16, 1.11 – 1.22), and lower Gleason score (OR = 0.53, 0.34 – 0.82) were also associated with recovery at 2 years.

Conclusions

In our cohort, at 2 years post-RP, increasing OSA risk is associated with poorer EFR in men post-RP.

Disclosure

No
88 Lidocaine Incorporated Alprostadil-phentolamine Urethral Gel for Erectile Dysfunction: Patient Tolerability and Satisfaction
Authors: Pham R , Palasi S , Blum K , Howell S , Beetz J , Santarelli S , Panuganti S , Green T , Wang R
Published: April 2022

Introduction

Localized therapy remains an important tool in the armamentarium against ED in patients who decline surgical intervention. Options include intracavernosal injections (ICI) and intraurethral (IU) therapies. For patients averse to injections, IU can be an option. Discomfort is a common side effect of IU therapies.

Objective

Herein, we assess the use, tolerability and satisfaction of a lidocaine incorporated IU gel treatment including phentolamine and alprostadil.

Methods

In this single-center study, 75 patients were telephonically surveyed following the prescription of IU lidocaine-alprostadil-phentolamine gel for ED. Prior to IU therapy, all patients had ICI incorporated penile Doppler exams as part of their routine ED workup. Each survey consisted of 5 questions from the validated Sexual Health Inventory for Men (SHIM) questionnaire and 4 questions regarding satisfaction with IU therapy. Patients were excluded if they did not fill their IU prescription, did not answer after 3 attempted calls, declined participation, or were non-English speaking. Clinico-demographic factors were analyzed using chi-square, t-tests, and logistic regression to determine associations of treatment satisfaction.

Results

Out of 75 patients, 39 had treatment data available for analysis. Median age of the cohort was 61 years (IQR 56-66). Hypertension and hyperlipidemia were the most common comorbidities within the group at 21 (53.8%) patients and 13 (33.3%) patients, respectively. Surveys were conducted a median 128 days after initial prescription. In total, 15 (38.4%) patients were satisfied with IU treatment. Thirty-seven (94.9%) patients did not report pain with IU gel usage. Prior success with <10 units of ICI alprostadil-papaverine-phentolamine (during penile Doppler or as a previous therapy) was associated with increased treatment satisfaction (p=0.039). Post-treatment SHIM scores were also associated with increased treatment satisfaction (p=0.047). Factors such as age, time since initial insult, hypertension, or hyperlipidemia were not found to influence treatment satisfaction.

Conclusions

IU therapy is an acceptable alternative in patients interested in localized ED therapy who are averse to ICI. Patients who responded to <10 units of ICI was associated with IU treatment satisfaction. IU therapy has a success rate of ∼33%, with the most common adverse event being discomfort. In this study, lidocaine incorporated IU gel offered similar efficacy (38.4%) and is well-tolerated with 94.9% reporting no discomfort.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientic, Coloplast, Neotract
95 Initial Validation of the Radical Prostatectomy Questionnaire (RPQ): A New Patient Reported Outcome (PRO) to Assess Sexual Function following Radical Prostatectomy (RP)
Authors: Nelson C , Flaherty K , Joshi N , Schofield E , Mulhall J
Published: April 2022

Introduction

The only PRO validated for men after RP is Extended Prostate Cancer Index (EPIC). However, EPIC has weaknesses, including the lack of assessment of function in response to ED medication use, inclusion of ejaculation and absence of penile morphology assessment.

Objective

To develop the RPQ to address weaknesses in current PROs that assess sexual function following RP.

Methods

RPQ is a 41-item scale assessing 5 domains: erectile function (EF), sexual desire (SD), orgasm (O), sexual satisfaction (SS), and penile morphology (PM). The EF domain assesses erections in response to no medication, PDE5i, intracavernosal injections (ICI). We used a multi-step process to develop the RPQ including: extensive literature review; development of primary domains; item generation and winnowing; feedback from 8 sexual medicine experts; and cognitive interviewing with 10 patients to verify content, wording, and response format. For validation, post-RP men completed the RPQ and the following PROs: IIEF, EPIC, SEAR, and the PROMISE measures. Participants completed the RPQ again within two weeks. Analyses include internal consistency (Cronbach's alpha), test-retest reliability, and convergent/discriminant validity. Cronbach's alpha and test-retest reliability ≥0.7 were considered acceptable.

Results

Mean age of the 311 men was 62±7. All domains of the RPQ demonstrated strong internal consistency (Cronbach's alpha=0.70-0.98) and test-retest reliability (ICC= 0.82-0.99). There was sound convergent validity for the RPQ EF domains with/without medication demonstrate by correlations with the IIEF Erectile Function Domain (EFD) (r=0.31 to 0.70, p<.05). Discriminate validity was demonstrated for RPQ EF domains with/without medication with moderate correlations with the SEAR and PROMIS scales (r=0.23 to r=0.59, p<.01). There was also sound convergent validity for RPQ SD, O, and SS domains with strong correlations with the PROMIS desire, orgasm, and satisfaction scales (r=0.66 to r=0.77, p<.01), with discriminant validity demonstrating moderate correlations with SEAR Self-Esteem (r=0.38 to r=0.46, p<.01) and Sexual Bother (r=-0.43 to 0.66, p<.01). The RPQ PM domain demonstrated convergent validity with moderate correlations with the IIEF EFD and Orgasm domain (r=-0.20; r=0.33, p<.01, respectively) and discriminant validity with low, non-significant correlation with EPIC Urinary function.

Conclusions

Initial validation of the RPQ supports the reliability and validity of the scale.

Disclosure

No
162 Defining Factors Predictive of Persistent Climacturia After Radical Prostatectomy
Authors: Martinez J. Flores , Benfante N. , Schofield E. , Mulhall J.P.
Published: April 2022

Introduction

Climacturia (Cl) is defined as the involuntary leakage of urine around the time of orgasm. Cl is a common clinical condition after radical prostatectomy (RP). Cl is a barrier to sexual satisfaction. Rates as high as 60% have been reported with little data on the chronology of recovery.

Objective

This study aimed to evaluate the natural history of CI after RP.

Methods

Men who underwent RP and completed a proprietary sexual incontinence questionnaire at 12 and 24 months (±3 months) constituted the study sample. Pre or postop ADT or radiation therapy were exclusions. We assessed demographics, comorbidities, baseline testosterone (T), pre-RP prostate specific antigen (PSA), Gleason group, nerve sparing status (NSS), and the presence of stress urinary incontinence (SUI) post-RP. Primary end-point was Cl rate at 12 and 24 months post-RP. Predictors of Cl were analyzed using a series of logistic regression models. Factors entered into the model included age, diabetes, smoking history, baseline T, baseline PSA, Gleason score sum, and NSS score.

Results

Data on 152 men were analyzed. Mean age 61±8 years. 45% had hypertension, 60% hyperlipidemia, 10% had diabetes, 18% obstructive sleep apnea, 8% were current smoker, and 27% former smokers. Baseline T and PSA were 421±176 ng/dL and 7±6 ng/mL. The median Gleason score was 7, 82% of patients had bilateral NSS, 13% unilateral. Median NSS score was 3 (IQR 2, 4). Cl prevalence at 12 and 24 months post-surgery were 38% and 39%. No patient characteristics were associated with CI at either 12 or 24 months post-RP.

Conclusions

Cl is highly prevalent at 12 months post RP and when present at this juncture appears to be unlikely to recover.

Disclosure

No
168 Extratunical Grafting and Penile Plication for Peyronie's Disease
Authors: Sawyer K. , Leahy S. , Kongnyuy M. , Baumgarten A. , Selph P.
Published: April 2022

Introduction

Extratunical grafting is a surgical option for men with Peyronie's disease who have an hourglass deformity or indentation defect. Rather than necessitating neurovascular bundle elevation and tunical incision, the procedure can be done without mobilization of the bundle. This benefit limits the risk of de novo erectile dysfunction and glans hypoesthesia. Here we present a case of a penile plication combined with extratunical grafting for a man with dorsal curvature and a right sided indentation defect.

Objective

To present a video presentation of extratunical grafting during penile plication for Peyronie's disease

Methods

An artificial erection is done to confirm the location and extent of the penile deformity and curvature. A midline ventral penile incision is made and carried down to the tunica albunigea as is standard for a penile plication. A penile plication is performed with 2-0 polyester suture to correct the dorsal curvature. At the site of the indentation defect, a pericardium allograft is doubly-folded on itself and sewn to the tunica albuginea. The indentation repair is demonstrated, and the surgical site is closed.

Results

The patient reports high satisfaction with the indentation correction and improvement in dorsal curvature with no new erectile dysfunction or hypoesthesia.

Conclusions

Extratunical grafting is a viable, straightforward option for men with Peyronie's disease and indentation defects or an hourglass deformity that can be combined with penile plication to treat symptomatic men.

Disclosure

No
180 A Novel Sacral Erector Spinae Block Reduces Opioid Use After Gender-affirming Vaginoplasty
Authors: Sawyer K. , Ceballos B. , Kukreja P. , Kalagara H.
Published: April 2022

Introduction

Surgeries that affirm a person's gender identity can be the ultimate end to the distress associated with the discordance between one's gender identity and sex assigned at birth. Gender-affirming vaginoplasty (GAV) is increasingly being performed as a critical component of gender transition for individuals assigned male at birth transitioning to female. As GAV becomes offered at more centers around the United States (US), it is important to understand and consider surgical outcomes that are unique to this operation without losing sight of the larger context of surgical care in the US. In this vain, it is known that post-surgery prescriptions for opioids are a catalyst for opioid addiction in nearly 1 in 16 surgery patients; furthermore, individuals with gender dysphoria are twice as likely to abuse prescription opioids. Regional anesthetic blocks have been adopted in many urologic surgeries to reduce opioid consumption both during and after surgery. The sacral erector spinae plane block (ESP) is a novel block that can block the S2-S4 pain levels in addition to some of the lumbar plexus with benefits over a neuraxial/epidural block including being a superficial block, no significant motor weakness, reduced risk of epidural hematoma, and less risk of intraoperative hemodynamic lability.

Objective

We sought to review complications and opioid usage after a novel sacral erector spinae plane block as an adjunct for pain control in the perioperative period in patients undergoing robotic-assisted penile inversion vaginoplasty.

Methods

We reviewed all charts of patients undergoing robotic-assisted penile inversion vaginoplasty or vulvoplasty at our institution. On the morning of surgery, patients were placed in a prone position and administered midazolam and fentanyl for sedation. Median sacral crests and the erector spinae muscle/plane (ESP) were identified using ultrasound guidance, and 0.2% ropivacaine was injected at the S4 and S2 sacral crest.

Results

A total of 13 patients received the ESP block. There were no complications either in the immediate post-block period or after surgery related to the block. Mean opioid consumption in the first 24 hours after surgery, 24-48hr, 48-72hr, 72-96hr, and 96-120 hours after surgery were 29.1, 50.9, 46.0, 36.5, and 38.7 oral morphine equivalents (OMEs), respectively. There was a significantly reduced amount of OME consumption in the 24 hours after surgery compared to the 24-48 hour period (p=0.017).

Conclusions

Sacral erector spinae plane block is a safe and efficacious way to reduce opioid consumption in the postoperative period after gender-affirming robotic-assisted penile inversion vaginoplasty or vulvoplasty.

Disclosure

No
182 Real World Experience with ProACT for Post-prostatectomy Incontinence: First 14 Cases
Authors: Fish P. , Bowen A. , Colvert J.
Published: April 2022

Introduction

While there are several treatment options available for post-prostatectomy incontinence (PPI), the goal of this study is to describe the first United States (US) post-market, real world experience with adjustable balloon devices (ProACT) for PPI.

Objective

Demonstrate real-world learning curve and efficacy of a novel device for male post-prostatectomy incontinence.

Methods

After institutional IRB approval, a retrospective review of prospectively collected data was performed on men treated with percutaneous ProACT implantation from December of 2019 to October of 2020. Data collected on 14 men from an academic practice and a private practice . Data were analyzed using the paired students t-test to determine statistical significance.

Results

The mean patient age was 75.2 years, and the average time from prostatectomy was 7.4 years. A total of 35.7% of patients had mild PPI (0-2 pads per day (ppd)), and 57.1% had moderate PPI (2-5 ppd), and 7.1% had severe PPI (> 5 ppd). Other relevant demographic information includes 7.1% of the study population had previous radiation, and 42.9% of the patients had failed prior surgical treatments (some multiple) for PPI including 2 bulking injections, 3 slings, 1 TUIBNC, an indwelling AUS, and an eroded AUS. At follow up, patients saw a dramatic improvement in continence from 3.2 ppd at baseline to 1.9 ppd at 1 month follow up (p < 0.05), 1.3 ppd at 2 months (p < 0.01), 2.3 ppd at 3 months, 1.4 ppd at 4-6 months (p < 0.01), and 1.3 ppd at 7-9 months (p < 0.01), 0.67 ppd at 10-12 months (p < 0.05), and 0.8 ppd at 13-15 months (p < 0.001). Average length of follow-up data was available for 12.4 months for this cohort. At the most recent clinic visit for each patient 79.6% were dry using ≤ 1 ppd. There was a 28.6% rate of complication, one involving local wound infection cleared by antibiotics and 3 erosions of the device requiring revision. Two of the three revision patients ultimately attained improved continence levels (1.5 ppd and 0 ppd) and one erosion is still pending revision at this time.

Conclusions

Initial real-world experience in the US demonstrates that ProACT adjustable balloons for PPI is safe and efficacious. Longer follow up needed but short-term results are encouraging and statistically significant.

Disclosure

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