bluuebunny/crossref_metadata_2025 huggingface dataset:
(310) MSM ARE NOT SMALLER THAN HETEROSEXUAL MEN AND HAVE LONGER PENISES THAN STRAIGHT MEN. THE TBORNOTTB STUDY: 8755 MSM
Authors: Herrero R , Bourmaud A , Boizeau P , Ohayon M
Published: December 2024

Introduction

Research regarding the anal penetrative roles in men who have sex with men (MSM) is still in its infancy. Studies have aimed to determine the frequencies of anal positioning in MSM but have arrived at contradictory results. Studies researching the effects of physical characteristics (PC) on anal positioning are scarce. Some studies have found that gay men were shorter than heterosexual men, but others have found the opposite. PC are important as they have been shown to affect sexual behavior and because differences in PC may suggest sexual orientation and anal penetrative orientation may have, in part, a biological foundation.

Objective

Sexual anal positioning amongst MSM is central to the understanding of this population, with important repercussions on the sexological and physical fulfillment of these individuals. The purpose of our study was to determine the real frequencies of the anal positions frequently referred to as “bottom,” “top,” “versatile,” and “side,” and to determine the factors that might participate in the conclusion of sexual negotiations. We present here some PC of MSM related to anal sexual positioning. Previous research studying PC in men have found gay men to be smaller than heterosexual men. We do not find this to be the case.

Methods

An on-line anonymous questionnaire was made available in the French language to all cisgender MSM of at least 18 years of age between June 25, 2020 and October 26, 2020 on the subject of anal positioning. The questionnaire presented 104 questions, with a total of 190 items being evaluated. Data is declarative and results are descriptive.

Results

9734 people clicked on our questionnaire. 8755 people met all the inclusion criteria for statistical analysis. Mean height of respondents was 178 cm (SD = 7.0) and mean weight was 76 kg (SD = 13) [mean BMI = 24.0 kg/m2]. For anal identity, 40.8% declared to be “bottom,” 30.8% “versatile,” 24.0% “top,” and 2.9% “side” (nonpenetrative). Among MSM, “tops” and “versatile” men were taller in height than “bottoms” (p < .0001). The median erectile penile length of the respondents in our study was 17.0 cm (mean = 16.9; SD = 2.2), with “tops” and “versatiles” having a longer erect penis than “bottoms” (p < .0001).

Conclusions

TBornotTB is the largest study to date on anal sexual positioning amongst MSM. The most common anal identity is “bottom.” The height of the MSM in our study is above the average height of men in France and its neighboring countries. Erect penis length is larger in MSM than in the general population. Most MSM do not vary their positioning according to a partner’s physical characteristics, although for a good proportion these can be determinant. Our study confirms that penis size and beautiful buttocks are significantly related to sexual positioning.

Disclosure

No.
(314) 6-NITRODOPAMINE IS A MAJOR MEDIATION THAT POTENTIATES CONTRACTIONS OF HUMAN ISOLATED EPIDIDYMAL VAS DEFERENS INDUCED BY NORADRENALINE AND ELECTRIC FIELD STIMULATION
Authors: Lima A , Jabbour S , Britto-Júnior J , Antunes E , Fregonesi A , De Nucci G
Published: December 2024

Introduction

Contractions of the vas deferens have an important role in the propulsion of the spermatozoa and occur due to excitatory inputs from a network of sympathetic nerves. When stimulated, these nerves co-release noradrenaline and ATP as the primary chemical messengers. However, 6-nitrodopamine (6-ND) was recently identified as a novel mediator of rat and human epididymal vas deferens (HEVD) contractility providing a new insight on the physiological process of the male ejaculation.

Objective

We sought to investigate the interaction of 6-ND in contractions induced by noradrenaline and electric-field stimulation on the HEVD.

Methods

Human epididymal vas deferens was obtained from 35 patients aged 28-59 years old who had undergone vasectomy surgery at Hospital e Maternidade Salvalus, São Paulo, BR. The HEVD strips (1.5 cm) were mounted in a 10-mL glass chamber filled with a warm (37°C) and oxygenated (95%O2: 5%CO2) Krebs–Henseleit solution. The tissues were allowed to stabilize for 45 minutes under a resting tension of 10 mN, and the isometric tension was registered using a PowerLab system (ADInstruments). The HEVD strips viability was tested with potassium chloride (80 mM). HEVD strips were pretreated with 6-ND (0.1, 1, 10 and 100 nM for 30 min) and a cumulative concentration-response curve to noradrenaline was performed. Also, the strips pretreated with 6-ND and its respective controls were submitted to electric-field stimulation (EFS) (60 V for 20 sec, at 2–32 Hz in square-wave pulses, 0.3 ms pulse width, and 0.1 ms delay), using a Grass S88 stimulator.

Results

Pre-incubation with 6-ND 0.1 nM had no effect on the noradrenaline-induced contraction curve. However, at 1, 10 and 100 nM, 6-ND causes significantly leftward shift on the noradrenaline concentration-response curve (6-ND 100 nM; pEC50: 4.9 ± 0.1 vs 4.5 ± 0.2; Emax: 54.8 ± 3.2 vs 31.2 ± 3.3; 6-ND vs control, respectively; p < 0.05. Similar results were found on contractions induced by EFS. Preincubation with 10 and 100 nM of 6-ND, but not 1 nM, significantly increased the contractions induced by EFS at the frequencies of 4 to 32 Hz.

Conclusions

The findings establish the 6-nitrodopamine as an important mediator of HEVD contractions by causing remarkable potentiation of noradrenaline and EFS induced- contraction.

Disclosure

No.
(008) SONIC HEDGEHOG TREATMENT SUPPRESSES LONG TERM PENILE REMODELING AFTER CAVERNOUS NERVE INJURY
Authors: Deng J , Triko A , Harrington D , Mcvary K , Podlasek C
Published: December 2024

Introduction

Cavernous nerve (CN) injury, which occurs in prostatectomy and diabetic patients, initiates penile remodeling, including smooth muscle apoptosis and increasing collagen in the corpora cavernosa, which are underlying causes of erectile dysfunction (ED); Sonic hedgehog (SHH) is a critical regulator of penile smooth muscle and SHH treatment suppresses corpora cavernosa remodeling that occurs with CN injury.

Objective

We examined if SHH treatment by peptide amphiphile (PA) in the first week after CN injury is sufficient to prevent long term penis remodeling and examined if apoptosis inhibitors also suppress penile remodeling.

Methods

Bilateral CN crush was performed on adult (P115-120) Sprague Dawley rats that underwent one of three treatments using novel extended-release nanofiber PA hydrogels for delivery: 1.) SHH protein (n = 10), 2.) Mouse serum albumin (MSA) protein (control, n = 7), or 3.) Caspase 3 inhibitor (AC-DEVD-CHO, n = 10). Rats were sacrificed after 18-24 days. Additional rats underwent CN injury (n = 6), or CN injury and SHH PA treatment for 2 and 4 days (n = 8), sham controls (n = 3), and non-surgery controls (n = 3). Trichrome stain, hydroxyproline assay, and western analysis for -actin (smooth muscle) and GAPDH, were performed to examine smooth muscle retention and collagen abundance.

Results

Smooth muscle decreased with CN injury. Corpora cavernosa showed increased smooth muscle at 2, 4 and 18-24 days after CN injury with SHH PA treatment in comparison to MSA treated CN injured controls. Caspase 3 inhibited penis showed little smooth muscle preservation. Collagen was decreased 23% with SHH PA treatment (p < 0.001), at 18-24 days after CN injury. Collagen was unchanged with caspase 3 inhibitor treatment (p = 1.000).

Conclusions

SHH treatment by PA in the first week after CN injury is sufficient to suppress penile remodeling, and to preserve penile smooth muscle over time, which is critical to prevent ED. It is important to know that treatments given at the time of CN injury have a sustained effect on preserving penile architecture, and thus erectile function, making them valuable for clinical translation.

Disclosure

No.
(015) NO, YOUR PENIS IS NOT SMALLER: A COMPARATIVE ANALYSIS OF PRE AND POSTOPERATIVE PENILE SIZE MEASUREMENTS FOLLOWING INFLATABLE PENILE PROSTHESIS PLACEMENT
Authors: Arnold PJ , Rust JO , Pereira TA , Good J , Bernie HL
Published: December 2024

Introduction

One of the most common concerns expressed by patients before and after inflatable penile prosthesis (IPP) insertion is the fear of penile length loss, which causes significant anxiety. Long-term erectile dysfunction (ED) can indeed result in penile length loss. Since many patients suffer from ED for several years before receiving an IPP, they might perceive a subjective decrease in penile length after surgery compared to their pre-ED younger state. Providing objective evidence of actual penile length is crucial for setting realistic patient expectations before surgery, which may optimize their experience and increase satisfaction post-operatively.

Objective

Compare the overall penile length and width before and after IPP placement. As a secondary objective, we compared penile length and girth outcomes using different prosthesis models.

Methods

Patients who underwent primary IPP implantation at a high-volume penile implant center in the United States between May 2023 and May 2024 were included in the study. Demographics and primary versus revision surgery were recorded. Both Boston Scientific (BSC) and Coloplast implants were utilized. All measurements were taken by the same surgeon intraoperatively using a flexible ruler, immediately before and after IPP placement. Measurements were taken from the pubic bone to the tip of the glans in a straight line. The initial measurements were taken with the penis maximally stretched, and the postoperative measurement was taken with the IPP fully inflated. The width was measured using the same flexible ruler at the base of the penis. Clinical significance for all statistical analyses was assessed at p < 0.05. All statistical analyses were conducted using SPSS.

Results

A total of 151 patients were included in this analysis. Patients’ demographics are listed in Table 1. The mean post-implant length was significantly higher than the pre-implant length (15.24 cm vs. 14.71 cm, p < 0.001). Postoperative width also increased compared to preoperative measurements (4.80 cm vs. 3.59 cm, p < 0.001). For all implant brands, there was a significant increase in length post-operatively. Both Coloplast prostheses (Titan and Titan Narrow Base) and all BSC implants (LGX, CX, CXR) demonstrated similar improvements. Patients with a prior history of implant infection, or revision cases, more commonly received Coloplast implants.

Conclusions

Both BSC and Coloplast IPPs improve mean penile size, including length and width measurements, irrespective of model type, immediately after surgery compared to preoperative measurements. This topic of potential loss of penile length is an essential preoperative counseling point for inflatable penile prosthesis patients.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific; Coloplast; BK Ultrasound.
(038) SATISFACTION AFTER COLLAGENASE CLOSTRIDIUM HISTOLYTICUM MAY BE IMPACTED BY THE ACCURACY OF PATIENT-PREDICTED PENILE CURVATURE
Authors: Miller J , Hammad M , Saffati Grunhaus G , Rendon D , Hinojosa-Gonzalez D , Kronstedt S , Angulo-Llanos L , Garrett G , Sandler M , Tran D , Raheem O , Masterson T , Khera M , Yafi F
Published: December 2024

Introduction

Intralesional injection of collagenase clostridium histolyticum (CCH) remains one of the most common, non-surgical, treatment options for Peyronie’s disease (PD). While CCH is often linked to high patient satisfaction rates, discrepancies between a patient’s measured and subjective penile curvature may lead to lower patient satisfaction.

Objective

To determine the impact of discrepancies between subjective and measured penile curvature and patient satisfaction following CCH.

Methods

Patients receiving CCH for PD from four Urology clinics were reviewed between 2013 and 2024. Patient charts were reviewed for patient-reported penile curvature prior to treatment, urologist-measured penile curvature before and after CCH, complications during treatment, and patient-reported treatment satisfaction. Patients were deemed over-estimators or under-estimators if their predicted penile curvature was over or under 15 degrees respectively when compared to a urologist’s measurement. Associations between subjective improvement following CCH and accuracy of penile curvature prediction were tested using multiple regression, controlling for age, absolute change in urologist-measured penile curvature before and after treatment, and complications during treatment.

Results

221 patients received CCH for PD with an average age of 57 years (range: 23– 79 years). The average penile curvature as measured by a urologist prior to CCH was 45.7 degrees (range 10– 110 degrees). The average penile curvature by patient estimation was 47.9 degrees (range 10– 110 degrees), with 153 patients (69.2%) accurately estimating their penile curvature within 15 degrees. Overall, 38 (17.2%) and 30 patients (13.6%) overestimated and underestimated their penile curvatures by greater than 15 degrees, respectively. Overall, 128 patients (57.9%) noted satisfaction with treatment, with increases in the absolute change of penile curvature being significantly associated with improved satisfaction (p = 0.002). Patients who underestimated their baseline curvature were with higher post treatment satisfaction rates (OR 5.62, p = 0.005) compared to all other patients. Patients who accurately predicted or overestimated their baseline penile curvature were with similar satisfaction rates (p > 0.05). (Table 1).

Conclusions

In this series, satisfaction with CCH was higher in patients who initially underestimated their penile curvature. While further work is needed to reproduce and further examine these associations, discrepancies between patient and urologist estimates of penile curvature may have important implications in the treatment of PD.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Endo International.
(052) A NOVEL PATIENT-COMPLETED CARDIOVASCULAR DISEASE SCREENING INSTRUMENT FOR MEN PRESENTING WITH ERECTILE DYSFUNCTION
Authors: Kehm A , Staff I , Mclaughlin T , Dougherty K , Bieniek J
Published: December 2024

Introduction

Erectile dysfunction (ED), a prevalent condition commonly due to penile vascular changes, is increasingly recognized as an early warning sign of cardiovascular disease (CVD). Despite the association, ED is not incorporated as an algorithm variable in commonly used CVD screening tools, leaving a gap in comprehensive risk assessment. Urologists, who often see men for ED, would be uniquely positioned to assess cardiac risk, but often do not have access to the required data inputs commonly included in the existing screening tools (eg, lipid panels, family history of early cardiac disease). To address this gap, we initiated a QI process which included the development of a novel patient-completed CVD screening questionnaire for men presenting to urology with ED.

Objective

This project aims to describe the newly developed patient-completed CVD screening questionnaire for men with ED, its workflow implementation, and initial screening patterns.

Methods

Our multidisciplinary men’s health team including cardiology developed an ED-CVD questionnaire suitable for the urological office setting (Figure). A goal was to minimally disrupt normal workflows, therefore the form was made to be patient-completed. The point-based screening tool provides a cardiac risk score based on epidemiological studies and validated algorithms. A score of 4 or above indicates potentially increased CVD risk. Descriptive statistics were used to describe findings from screening implementation including questionnaire scores, preventive cardiology referrals, and referral completion.

Results

Between June 1, 2022 and May 31, 2024, a total of 427 men presenting to three urologists with erectile dysfunction have been screened with the ED-CVD questionnaire. Preventive cardiology referral was recommended for 76 (17.8%) men with ED and an elevated ED-CVD score (≥4) who had not seen a cardiologist in the past three years. Each positively-screened man was contacted by a nurse navigator who reviewed the reason for CVD screening and offered cardiology referral. A total of 39 (51.3%) of these men accepted cardiology referral with 31 completing evaluation to date.

Conclusions

A CVD screening and referral workflow can be easily implemented into the urology outpatient setting. Over 17% of men presenting with ED had a positive screening on an ED-CVD questionnaire without recent cardiology evaluation and more than half accepted a referral to preventive cardiology. Future efforts will examine the findings of cardiac evaluation to inform potential questionnaire validation.

Disclosure

No.
(057) IS POOR SLEEP ASSOCIATED WITH POOR SEX? AN ANALYSIS OF SEXUAL DYSFUNCTION IN MEN WITH SLEEP DISORDERS UNDERGOING FERTILITY TESTING
Authors: Seyer A , Nolte D , Kenfield S , Belarmino A , Civello D , Smith J , Helo S
Published: December 2024

Introduction

Sleep disorders can negatively impact multiple facets of health including sexual function. In men undergoing fertility testing, optimization of general health is of utmost importance to maximize fertility outcomes.

Objective

To determine the relationship between sleep disturbance and sexual function in men undergoing fertility testing.

Methods

This study evaluated men undergoing fertility testing who completed an at-home semen analysis kit developed by Fellow Health, Inc. Men ≥18 years were included if they consented to participate in research and completed survey questionnaires on both their quality of life and sexual function. Sleep disturbance level (normal, mild, moderate, or severe) was derived using a validated survey assessment, developed by the Patient-Reported Outcomes Measurement Information System (PROMIS), which queried sleep quality, sleep depth, and restoration associated with sleep. The sexual function survey assessed libido, orgasmic and ejaculatory dysfunction, Erection Hardness Score, and IIEF-5 score. Descriptive statistics were reported and chi squared tests were used to test for independence of categorical variables with statistical significance reported at the 0.05 alpha level.

Results

Of the 1919 men included in this analysis, 7.7% were assessed to have a mild level of sleep disturbance and 4.4% had moderate to severe sleep disturbance. Compared to those with “normal” levels of sleep disturbance, those with mild to severe levels more often reported low libido (20.7% vs. 13.8%; p = 0.01), ejaculatory dysfunction (31.3% vs. 19.9%; p < 0.01), and orgasmic dysfunction (15.3% vs. 5.1%; p < 0.01). Of men with mild to severe sleep disturbance, 28.3% reported pursuing treatment for erectile dysfunction compared to those with normal levels of sleep disturbance (17.8%; p < 0.01). Further, only 57.2% of men with mild to severe sleep disturbance were assessed to have “No signs of ED” compared to 71.0% of men without elevated levels of sleep disturbance (p < 0.01).

Conclusions

Sleep disturbance is associated with reduced libido, ejaculatory, orgasmic, and erectile function in men undergoing fertility testing. Providers should assess for sleep-related symptoms during initial evaluation to optimize fertility potential.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Fellow Health.
(059) A NOVEL APPROACH TO REDUCING ANXIETY AND INCREASING PREPAREDNESS IN PATIENTS UNDERGOING INTRACAVERNOSAL INJECTION TRAINING
Authors: Strumeier S , Ernst N , Huwe V , Nelson C , Mulhall J , Amaya B , Flores J
Published: December 2024

Introduction

According to the World Journal of Urology, ICI demonstrate efficacy in approximately 54-100% of patients (Duncan et al., 2019). A barrier to adequate ED treatment is the high correlation between anxiety and ICI (Duncan et al., 2019). Nelson et al. (2013) notes that despite several reports of patient anxiety related to penile injections, anxiety has rarely been assessed. At the present time, there are limited studies evaluating anxiety and perceived preparedness of men with erectile dysfunction scheduled to undergo penile injection training (ICI).

Objective

The purpose of this quality improvement project was to evaluate anxiety and preparedness while pending medical procedure trainings such as ICI.

Methods

This project utilized a pre- and post- test survey design comparing anxiety and preparedness prior to the initial penile injection appointment and after a video education intervention. The Pre- test survey was administered to the patient at home prior to the patient watching the video intervention. The intervention was a eight-minute recorded video demonstrating ICI on a penile model. The video was sent via link to a patient portal once the pre- test survey was completed. Post- test surveys were then administered at time of visit to assess anxiety and preparedness for the ICI training appointment. Time spent face to face with patients comparing those who watched the video intervention and those who did not were also compared.

Results

A total of 78 participants who met inclusion criteria were identified and recruited. 58 participants completed the pre- and post- test survey using a validated Likert tool to assess anxiety and perceived preparedness. 22 men were excluded for incomplete data collection or failure to watch the video intervention. 19 of the excluded men who did not watch the video were utilized to compare time spent face to face with patient. There was no decrease in anxiety before intervention and after, however preparedness amongst individuals increased after the video. Additionally, time spent face to face with the provider decreased post video education.

Conclusions

Findings suggest a video intervention to prepare patients prior to their penile injection training visits have a clinical and statistical impact on men undergoing penile injection training. However, there is no conclusive evidence to support a video intervention’s impact on patient anxiety prior to the ICI injection training.

Disclosure

No.
(061) CASE SERIES: PERSISTENCE OF FUNCTIONAL PENILE CAVERNOSAL TISSUE FOLLOWING EXPLANT OF PENILE PROSTHESIS
Authors: Huang J , Stocks B , Tran L , Oppenheimer A , Lipshultz L
Published: December 2024

Introduction

Placement of a penile prosthesis is a safe, reliable treatment for erectile dysfunction. Unfortunately, regardless of patient satisfaction, some prostheses must be removed for select indications. It is widely believed that after explant of a penile prosthesis, patients will have no chance of penetrative intercourse without another penile prosthesis. Implantation of a penile prosthesis disrupts the inner corporal cavernosal sinusoidal tissue, and it is believed that remaining tissue cannot attain meaningful erections. However, we have observed several patients with varying degrees of persistent erectile function following explant, challenging this dogma.

Objective

We present a series of patients who pursued medical management of erectile dysfunction following penile prosthesis explant.

Methods

We identified all patients at our practice that underwent explant of penile prosthesis and wished for salvage of erectile function from June 2023 to December 2023. Chart review was performed to abstract demographic and clinical data. Descriptive statistics were not applicable.

Results

Following explant of penile prosthesis, 4 patients were motivated to continue management of erectile dysfunction. Three of these patients underwent penile duplex ultrasonography, results in Table 1. Arterial sufficiency is demonstrated in each ultrasound. One patient progressed to salvage medical management with intracavernosal injections and attained functional erections.

Conclusions

The patients identified demonstrate evidence of functional, viable corporal cavernosal tissue several years following penile prosthesis placement. Our data presents both objective and subjective evidence of successful erectile potential. This is a small case series with short-term follow up, but these results directly counter the current paradigm-some patients can experience efficacious medical management of erectile dysfunction following explant of penile prosthesis. Further investigation with larger patient cohorts is warranted to better define treatment options for patients’ sexual health following prosthesis explantation.

Disclosure

No.
(064) TESTOSTERONE THERAPY IS PROTECTIVE AGAINST FALL RISK
Authors: Kassab J , Oppenheimer A , Huang J , Stocks B , Lipshultz L
Published: December 2024

Introduction

Falls continue to be a prominent cause of injury and disability in the elderly. One in three adults 65 and older will fall each year. A significant number of these accidents are severe enough to result in an emergency room visit. Higher levels of endogenous testosterone are protective against falls in elderly men.

Objective

This study aims to evaluate the relationship between Testosterone Therapy (TTh) and fall risk in elderly men.

Methods

We identified elderly male patients (65+) receiving Testosterone Therapy at a large university hospital from 9/2010 to 9/2022. We found 6151 patients who were tracked for falls that prompted emergency room visits. As a presumed positive control, we also identified elderly male patients with metastatic and/or castrate resistant prostate cancer presumed to be receiving androgen deprivation therapy who fell (n = 415). We hypothesized that fall incidence would be greater in this chemically hypogonadal population. Fall incidence rates were then calculated against national age-adjusted fall data for men to yield the standardized incidence ratios (SIR) and the 95% confidence interval range (CI). SIR and CI were calculated using SPSS.

Results

The incidence rate of men aged 65 years and older on TTh requiring emergency room visits for fall injuries was found to be 3.04% at our university hospital. This significantly deviates (p < .05) from the national age-adjusted rate of 6.05%. The SIR was 0.502 (95% CI [0.43-0.58]), indicating that the patients on TTh faced at least a 43% lower deviation from the expected rate. Chemically hypogonadal men in the same demographic demonstrated a 5.09% rate of emergency room visits for fall injuries at our university hospital, which, surprisingly, was comparable to the national expectation.

Conclusions

We demonstrate that elderly men on TTh are at a lower risk of falls, resulting in fewer emergency room visits compared to the general population. This is consistent with some of the protective factors demonstrated in men with high levels of endogenous testosterone. Although we hypothesized that chemically hypogonadal men would demonstrate higher fall risk, our negative finding may be limited by lack of stratification of men on intermittent v. continuous androgen deprivation. Future studies should focus on the use of TTh in a blinded prospective manner to better define its efficacy regarding fall prevention.

Disclosure

No.
(067) EFFECTS OF ORAL TESTOSTERONE UNDECANOATE ON SEMEN PARAMETERS IN HYPOGONADAL MEN: AN INTERIM ANALYSIS OF A PROSPECTIVE PILOT STUDY
Authors: Saffati G , Orozco Rendon D , Kronstedt S , Hinojosa-Gonzalez D , Khera M
Published: December 2024

Introduction

Testosterone replacement therapy (TRT) is commonly prescribed for men with hypogonadism. While injectable testosterone preparations are widely used, oral testosterone formulations have become an increasingly popular treatment option due to their ease of administration and avoidance of repeated intramuscular injections. However, the effects of oral testosterone on semen analysis (SA) parameters and male fertility potential remain understudied.

Objective

To evaluate changes in semen analysis parameters, including sperm concentration, motility, and morphology, among hypogonadal men receiving oral testosterone undecanoate therapy.

Methods

A pilot prospective study was conducted enrolling hypogonadal men. Exclusion criteria included prior TRT, use of clomiphene citrate or human chorionic gonadotropin, and azoospermia. Participants received oral testosterone undecanoate for 3 months. SA evaluating sperm concentration, motility, and volume were performed at baseline and 3 months. Concurrent biochemical assessment included measurement of reproductive hormone levels and hematocrit. An interim blood draw was made for drug titration to the therapeutic testosterone range. Baseline and follow-up semen parameters and hormonal values were compared using paired statistical tests. The primary outcome was a change in semen parameters after 3 months of oral testosterone therapy.

Results

At the interim analysis with 5 patients enrolled thus far, the mean age was 39.6 years (SD: 5.36). Overall, only one patient became azoospermic. When excluding him, a statistically significant increase in total testosterone levels was observed between baseline and follow-up (220.60 ± 42.54 ng/dL vs. 704.67 ± 188.83 ng/dL, p = 0.02), as well as for free testosterone (62.64 ± 9.78 ng/dL vs. 221.98 ± 43.78 ng/dL, p = 0.01). No significant differences were detected between baseline and follow-up values for estradiol, follicle-stimulating hormone, luteinizing hormone, or hematocrit levels. Semen analysis parameters, including sperm concentration, motility, and volume, did not demonstrate statistically significant changes from baseline to 3-month follow-up. These preliminary findings are summarized in Table 1.

Conclusions

In this pilot study expected increases in total and free testosterone levels were achieved, confirming adequate treatment. No significant changes in semen parameters or other reproductive hormones were observed after 3 months of treatment. Larger scale studies are needed to fully evaluate the effects of oral testosterone formulations on semen quality and male fertility potential.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast, Halozyme Investor: Sprout.
(084) THE SECURED VAS TECHNIQUE: A SIMPLE STEP TO REDUCE POST-VASECTOMY HEMATOMA COMPLICATIONS
Authors: Kassab J , Joshi P , Ngai M , Mendez Serrano C , Schoor R
Published: December 2024

Introduction

The most common adverse events following routine vasectomy procedures consist of infection and scrotal hematoma. Scrotal hematomas pose a challenge for patients due to their related pain and potential for extraneous procedures such as operative drainage. With a current documented prevalence of hematoma following vasectomy as ranging from 0–29% depending on institution and technique, we sought to decrease this relatively common complication. With the addition of one simple step following the incision of the vas deferens, our institution has successfully mitigated risk of scrotal hematoma.

Objective

To evaluate the effectiveness of a novel surgical technique in reducing the prevalence of scrotal hematomas following vasectomy.

Methods

Upon ideation and deployment of our technique in February 2021, we then documented procedural notes as well as any observed adverse events as part of the standard of care. The referenced technique involves securing the peri-vasal fascia with chromic suture during fascial interposition. As opposed to the traditional approach of cutting both suture-ends, we leave one intact, acting as a tether, to enable repeated reinsertion and inspection of the vas deferens’ hemostatic measures, as needed. Following over three years of implementation, we retroactively queried our electronic medical records to assess the efficacy of this new technique in curtailing subsequent scrotal hematomas compared to national rates. Relative risks and Clopper-Pearson Binomial Confidence Intervals (CI) were calculated for both institutional and national data utilizing SPSS software.

Results

Upon incorporation of this novel technique, commencing in February 2021, there has been one instance of significant hematoma following the secured vasectomy procedure based on ICD-10 codes associated with the encounter and subsequent follow-up visits. With 579 documented procedures performed utilizing this technique at our institution, we observed a 0.17% prevalence rate (95% CI [0.00004, 0.0096]). Compared to national data of 2%, this resulted in a significant relative risk reduction of scrotal hematoma (p = .0023) (Table One).

Conclusions

Though a generally innocuous, yet irritating, complication for patients, scrotal hematomas following vasectomy have become regarded as a relatively common ramification of standard procedure. However, there is reason to contest this complacency and attempt to decrease the frequency of this adverse event. With the implementation of this simplistic step intraoperatively, we can assess bleeding from the vasal artery in both the current and assess risk for delayed bleeding. This technique allows for greater autonomy for the physician, allowing them to maintain prolonged control of the vas deferens until they are confident in the cessation of bleeding. These early favorable results warrant further investigation into this circumspect approach.

Disclosure

No.
(087) PEDIATRIC BILATERAL INGUINAL HERNIA REPAIR IMPACTS FUTURE FERTILITY
Authors: Langston D , Slade A , Malhotra N , Schaeffer A , Hotaling J , Lau G
Published: December 2024

Introduction

Inguinal hernia repair and orchiopexy are common to both pediatric Urologist and Surgeons. Unilateral intervention would be expected to have limited impact on fertility given contralateral testis has been unaffected, which has been confirmed in the literature. Given this, a decrease in fertility would be expected for bilateral intervention. In adults, bilateral hernia repairs have limited impact on fertility; however, there is limited data to suggest the same in pediatric patients. Given the paucity of pediatric literature on the implications of bilateral inguinal surgery on future fertility and sperm parameters, providers are currently unable to adequately counsel parents about the risks this surgery may carry to fecundity.

Objective

We aimed to assess the impact of B/L IHR on male fertility and paternity, hypothesizing significant implications.

Methods

We conducted a case–control study utilizing a statewide database, which encompasses demographic, medical, and residential data for over 90% of the state's pediatric population. Cases, matched 1:1, comprised males who had B/L IHR and males who underwent pediatric BO before age 18 from 1996-2022. Controls were those without a history of pediatric B/L IHR or BO (matched 3:1). Multivariate Cox proportional hazards models assessed the association between BO or B/L IHR and infertility and paternity. For models, patients were followed from either age 18, first residence in Utah, or 1996 (study initiation), until receiving an infertility diagnosis or until appearing as a father on a birth certificate. An infertility diagnoses, unidentified partners, or children prior to 18/residence in Utah/1996, were excluded.

Results

1156 B/L IHR and 494 BO cases with 5780 non-surgical controls were included. The cohort was predominantly white (87.8%) and non-Hispanic (68.4%). 20.5% having at least one child. Multivariate Cox regression showed higher likelihoods of infertility for B/L IHR cases (HR = 2.07, [1.20-3.58], P = 0.01) and BO cases (HR = 2.01, [1.03-3.94], P = 0.04) versus non-surgical controls. No significant trend in paternity likelihood was observed for B/L IHR cases (HR = 0.97, [0.84-1.13], P = 0.7), while BO individuals showed a trend toward reduced paternity (HR = 0.84, [0.70-1.02], P = 0.08) compared to controls.

Conclusions

Pediatric B/L IHR and orchiopexy elevate infertility rates compared to controls, with orchiopexy suggesting a potential trend towards reduced paternity. The risk of male-factor infertility post-pediatric B/L IHR is notably higher, akin to that of patients undergoing bilateral orchiopexy.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: StreamDx, Inherent Bioscience, Turtle Health, Maimus, Carrot Fertility.
(112) DO TRANSGENDER WOMEN TAKING GENDER-AFFIRMING HORMONE THERAPY, AND WITH OR WITHOUT BILATERAL ORCHIECTOMY, EXPERIENCE PENILE ERECTION, AND DO ALL, OR ONLY SOME, REPORT BOTHER FROM ERECTIONS?
Authors: Dadashian E , Sandhu S , Mallavarapu S , Smith S , Garcia M
Published: December 2024

Introduction

Gender-affirming (GA) hormone therapy (GAHT) and bilateral orchiectomy (GABO) reduce gender dysphoria in transgender women (TW). A key source of dysphoria in TW is related to erections before patients undergo their vaginoplasty. To date, no studies have described erectile function (EF) among TW pre-vaginoplasty.

Objective

We aimed to: 1) Evaluate EF in TW only taking GAHT >6 months, and GAHT + >6 months post-GABO; 2) Determine the incidence of erections among TW based upon using their penis for sexual activity; 3) Query interest for any treatment to reduce/eliminate erections pre-vaginoplasty.

Methods

Pre-vaginoplasty TW on GAHT were surveyed anonymously. Participants were grouped based on GABO status. We queried EF using the Sexual Health Inventory for Men (SHIM) questionnaire pre-GAHT, >6 months on GAHT, and > 6 months post-GABO. We also queried the incidence of any erections in these three states, and, whether patients would undergo a procedure to reduce/eliminate erections.

Results

50 participants were surveyed (29 GAHT-only; 21 GAHT+GABO). Median age was 36.5 years (IQR 23.8 years) and median years on GAHT was 5 years (IQR 5 years). 35/50 (70%) participants reported they do not use their penis for sexual activity. TW on GAHT and GAHT+GABO showed reduced SHIM scores, with lowest scores in TW not using their penis for sexual activity (Fig. 1a). Spontaneous erections were significantly reduced in GAHT+GABO women not using their penis during sex, but both groups reported a higher incidence of erections with sexual arousal and activity (b). The majority of TW showed a high interest in any procedure which could reduce/eliminate their erections (c).

Conclusions

Our study is the first to show that GAHT reduces SHIM scores, with greater reductions in TW who do not use their penis for sexual activity. GAHT+GABO significantly reduced spontaneous erections vs. GAHT, but did not impact erections with sexual arousal/activity. The majority of women reported an interest in surgically reducing/eliminating their erections. Further study with larger numbers is warranted.

Disclosure

No.
Pelvic floor muscle activation in response to pressure stimuli applied to the vulvar vestibule: an observational study comparing women with and without provoked vestibulodynia
Authors: McLean Linda , Antonio Flavia Ignacio , Rodrigues Marina Petter , Pukall Caroline
Published: December 2024

Background

The nature of pelvic floor muscle (PFM) involvement in provoked vestibulodynia (PVD) is poorly understood.

Aim

We aimed to determine if PFM electromyographic (EMG) activity in anticipation of or response to pressure applied to the posterior vaginal fourchette differs between those with and without PVD, and if the magnitude of PFM response is associated with pressure pain sensitivity, psychological or psychosexual function.

Methods

This was an observational case–control study. Forty-two volunteers with PVD and 43 controls with no vulvar pain participated. Five on-line questionnaires were completed, then participants underwent a laboratory-based evaluation of vulvar pain sensitivity. EMG activation of the PFMs, hip adductor, and upper trapezius muscles was measured before, during, and after pressure stimuli (low, moderate) were applied, in random order, to the posterior vaginal fourchette and the posterior thigh (control site).

Outcomes

EMG amplitude of the pubovisceralis (PV), bulbocavernosus (BC), and external anal sphincter (EAS) muscles. Secondary outcomes were EMG activation of the hip adductor brevis and upper trapezius muscles, questionnaire scores reflecting psychological/psychosexual outcomes, pressure pain threshold (PPT) at the vulvar vestibule, pain reported on a tampon test, and heart rate/heart rate variability.

Results

Compared to controls, EMG activation of the PV and EAS, but not the BC, was higher in anticipation of the pressure applied to the vaginal fourchette, was higher in all PFMs while the pressure was applied, and remained higher than baseline after the pressure was removed among those with PVD. EMG response amplitudes were modulated by the intensity of the pressure applied, with the largest responses reaching over 40% MVC in the EAS among those with PVD. PFM EMG amplitudes were associated with greater pain sensitivity and lower sexual function, but not with pain catastrophizing, central sensitization, depression, anxiety, or stress.

Clinical implications

While some anticipatory activation was observed, EMG responses were primarily observed during and after the application of the pressure. Among those with PVD, digital assessment of PFM tone might reflect PFM responses to pain at the vulvar vestibule, and interventions to reduce local pain sensitivity may be an important first step to successful improvements in vaginal function.

Strengths and limitations

This study includes a robust analysis of EMG activation. However, the cross-sectional design precludes the determination of causal relationships.

Conclusions

Those with PVD demonstrate higher PFM responses and a higher prevalence of anticipatory activation in the PV and EAS muscles than controls in response to pressure applied at the vulvar vestibule,
Trichoderma gets by with a little help from Streptomyces: fungal–bacterial symbiosis in plant growth promotion
Authors: Reid Tessa E , Gifford Miriam L
Published: December 2024

This article comments on:

Kabir AH, Thapa A, Hasan R, Parvej R. 2024. Local signal from Trichoderma afroharzianum T22 induces host transcriptome and endophytic microbiome leading to growth promotion in sorghum. Journal of Experimental Botany 75, https://doi.org/10.1093/jxb/erae340.
Analysis of the bamboo SWEET gene family reveals that Dendrocalamus farinosus SWEET14 is involved in source-sink carbohydrate partitioning
Authors: Gu Xiaoyan , Peng Jiahui , Ou Qian , Chen Sen , Feng Wei , Huang Yiqin , Deng Bin , Cao Ying , Hu Shanglian
Published: December 2024

In higher plants, SWEET genes play a crucial role in source-sink carbohydrate partitioning. Dendrocalamus farinosus is an economic bamboo species because of its high fiber content and rapid growth. The transportation of photosynthetic products is essential for bamboo growth. Here, we identified 50 major SWEET genes in D. farinosus. Phylogenetic analysis indicated that DfSWEET14 and DfSWEET44 were homologs of OsSWEET11 and OsSWEET4, respectively. DfSWEET5, DfSWEET14 and DfSWEET44 were highly expressed in leaf veins, stems and roots, respectively, and their expression was responsive to glucose and sucrose. DfSWEET9 and DfSWEET28 were involved in photosynthetic product distribution, ABA/MeJA signaling and pathogen responses. DfSWEET14 was localized to the plasma membrane, and was highly expressed in lateral buds and young shoots only. The overexpression of DfSWEET14 in wheat resulted in higher root/shoot biomass ratio under drought stress and increases in grain-filling duration, seed yield, net photosynthetic capacity, soluble sugar content, seed size and grain weight. This suggests that DfSWEET14 is involved in sucrose partitioning from leaves to grains. These results provide new insights into genetic improvement of bamboo and into the breeding of other economic crops for high yield by manipulation of source-sink carbohydrate partitioning and drought responses.
Debts, Credits, and Dealings
Authors: Derham Rory
Published: December 2024

This chapter covers the key concepts of debts, credits, and dealings. It clarifies that the insolvency set-off provision applies when there are mutual credits, mutual debts, or other mutual dealings, but the original bankruptcy set-off section in 1705 referred only to mutual credit. The insertion of ‘other’ before mutual dealings appears to qualify both mutual credits and mutual debts, which then suggests that they should also have arisen out of dealing between the parties to the proposed set-off. The chapter considers different dealings and contracts before discussing the liability of insolvent. It elaborates on the claim and provability of insolvent
Commensurable Demands
Authors: Derham Rory
Published: December 2024

This chapter examines the extent of commensurable demands. It starts with the requirement of commensurability, while referencing the principle concerned with value measurable with precision in money. In Rolls Razor Ltd v Cox case, a set off in respect of a claim to recover property was permitted. The chapter discusses the notion of insolvency as a repudiation and the set-offs where contracts involve non-money obligations, such as commodities or securities. It explains the discussions surrounding the requirement of commensurability under the context of foreign exchange contracts due to the conflicting views concerning the nature of foreign money and foreign exchange contracts.
Sureties
Authors: Derham Rory
Published: December 2024

This chapter examines contracts of suretyship, and the availability of rights of set-off as between a creditor, the debtor, and a guarantor of the debt. If a principal debtor has a cross-claim against the creditor which is available as a set-off against the debt, equitable considerations dictate that the creditor should not be able to avoid the set-off by proceeding against a guarantor. The chapter then discusses the set-off available to the guarantor and the guarantor’s rights to rely on the principal debtor’s set-off. Meanwhile, a contract of suretyship may take the form of a mortgage given to secure a debt owed by another person to a creditor. The chapter also considers the surety’s right to rely on a co-surety’s set-off.
Methodological problems in every black-box study of forensic firearm comparisons
Authors: Cuellar Maria , Vanderplas Susan , Luby Amanda , Rosenblum Michael
Published: December 2024

Reviews conducted by the National Academy of Sciences (2009) and the President’s Council of Advisors on Science and Technology (2016) concluded that the field of forensic firearm comparisons has not been demonstrated to be scientifically valid. Scientific validity requires adequately designed studies of firearm examiner performance in terms of accuracy, repeatability, and reproducibility. Researchers have performed “black-box” studies with the goal of estimating these performance measures. As statisticians with expertise in experimental design, we conducted a literature search of such studies to date and then evaluated the design and statistical analysis methods used in each study. Our conclusion is that all studies in our literature search have methodological flaws that are so grave that they render the studies invalid, that is, incapable of establishing scientific validity of the field of firearms examination. Notably, error rates among firearms examiners, both collectively and individually, remain unknown. Therefore, statements about the common origin of bullets or cartridge cases that are based on examination of “individual” characteristics do not have a scientific basis. We provide some recommendations for the design and analysis of future studies.
Uroderma magnirostrum (Chiroptera: Phyllostomidae)
Authors: Carneiro Lucas , Viana Milena , Monteiro Leandro R , Nogueira Marcelo R
Published: December 2024

Uroderma magnirostrum Davis, 1968, the Brown Tent-making Bat, is a medium-sized frugivorous phyllostomid. It is characterized by poorly defined facial and dorsal stripes, large bifid upper inner incisors, and a laterally expanded mesethmoid bone. Uroderma magnirostrum is widely distributed between western Mexico and southeastern Brazil, and across its distribution, it inhabits different types of environments (e.g., pristine tropical forests; farmlands; mangroves; savannas; urban green areas). It is listed as “Least Concern” (LC) by the International Union for Conservation of Nature and Natural Resources but appears in national red lists, such as those from Guatemala and Nicaragua, due to the significant impact of the human activities in these countries.