bluuebunny/crossref_metadata_2025 huggingface dataset:
72 Eight injections of Collagenase Clostridium Histolyticum May Be Effective in Calcified Plaques
Authors: Masterson T , Ranier Q , Hauser N , Kava B , Ramasamy R
Published: April 2022

Introduction

Peyronie's disease (PD) is the result of abnormal tissue healing in the tunica albuginea resulting in an inelastic plaque. In some instances, plaques will calcify. Several studies question the efficacy of Collagenase Clostridium Histolyticum (CCH) in calcified plaques leading to a belief that calcification is associated with failure of medical treatment and an increased risk of surgical intervention. Our objective is to measure changes in curvature before and after treatment of calcified plaques with CCH.

Objective

To determine change in curvature of calcified plaques treated with 8 injections of CCH

Methods

We prospectively evaluated PD plaques using ultrasound in all men presenting with PD starting November, 2018. Plaques were evaluated in the flaccid state and curvature was measured after the injection of intracavernosal Trimix using goniometer. We utilized a standardized system of plaque typing: type 1: thickening of the tunica albuginea without acoustic shadowing, type 2: a moderately calcified plaque with a typical ultrasound shadow, type 3: a severely calcified plaque complete acoustic shadowing. We measured pre and post CCH curvature 6 months after all eight injections using he standard manufacturer protocol. All patients were instructed on home modeling. Paired T-t was used to compare pre and post measurements. Results presented as means± standard deviations.

Results

We identified 19 men with calcified PD who completed all 8 injections of CCH. Mean age and curvature were 61±7 years and 55±22 degrees. Of the 19 men, 7 had type 3 plaques and 12 had type 2 plaques. There were no differences in patient age however there was a difference in baseline curvature between type 2 and 3 plaques (55±17 vs 75±17 degrees p<0.05). Curvature improved by an average of 25±20 degrees p<0.05. Interestingly, as a group, type 3 plaques improved by 37±23 degrees compared to 18±15 degrees for Type 2, however this difference was not significant

Conclusions

In our small cohort, 8 injections of CCH appear to be an effective therapy for men with calcified PD plaques. Interestingly, CCH remained effective even in severely calcified PD. A larger study including a comparison of non-calcified PD is needed.

Disclosure

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

Clarification

Industry funding only - investigator initiated and executed study

Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
79 Outcomes of Collagenase Clostridium Histolyticum in Men with Congenital Penile Curvature
Authors: Burgon H , Tyler A , Green B , Savage J , Brearton K , Granberg C , Ziegelmann M , Kohler T , Helo S , Trost L
Published: April 2022

Introduction

Congenital penile curvature is a relatively uncommon condition characterized by penile angulation. Similar to Peyronie's Disease (PD), this condition has historically been managed with various surgical techniques. Given the efficacy of Collagenase Clostridium Histolyticum (CCH) in men with PD, our team has elected to treat men with CPD with CCH injections.

Objective

To describe outcomes of CPD men treated with CCH injections and to compare against a traditional PD cohort.

Methods

A prospective database has been maintained of all men undergoing CCH injections by our team since Jan 2014. The specific CCH administration protocol has been modified over time and currently includes combined use of RestoreX traction therapy, sildenafil, 0.9 mg of CCH diluted into 0.7 ml, injections performed at the point of maximal curvature, and aggressive manual modeling. Curvatures were measured in two planes (dorsal and lateral), with the combined measure reported as a composite. Outcomes were reported based on the most recent curvature assessment obtained minus baseline. Men were included if they received at least one series of CCH injections and had at least one baseline and follow-up curvature assessment available.

Results

A total of 272 men comprised the current cohort, with 23 exhibiting CPD and 249 PD. Mean age was higher in PD men (57.4 vs 38.4, p<0.0001), and mean PD duration was 18 months in PD men. Median baseline curvature was non-statistically higher in PD (65 vs 55 degrees, p=0.06). Baseline curvature directions for PD and CPD, respectively were: dorsal (82% vs 35%, p<0.0001), lateral (58% vs 78%, p<0.05), ventral (11% vs 35%, p<0.01). Following treatment with CCH, median curvature improvement was similar between cohorts, with 20 degrees (IQR 5, 35) for PD and 20 degrees (IQR 5, 30) for CPD, p=0.62. Percentage improvement from baseline was non-statistically higher in PD men (33% vs 29%, p=0.99).

Conclusions

Treatment of CPD men with CCH is a viable therapeutic option and provides similar benefits to those observed in men with PD.

Disclosure

No
81 Assessing Online Symptom Checker Accuracy in Diagnosing Men's Health Conditions
Authors: Patel R , Swanton A , Gross M
Published: April 2022

Introduction

Many medical sites offer algorithm-based tools where patients can enter symptoms to receive potential diagnoses. The efficacy of these online symptom checkers (OSCs) in properly diagnosing male sexual health issues has not been explored.

Objective

We analyzed the accuracy of the four most commonly used OSCs in diagnosing erectile dysfunction (ED), scrotal pain (SP), Peyronie's disease (PD), and low testosterone (LT).

Methods

One-hundred and sixty artificial vignettes were created by de-identifying recent initial outpatient consults presenting to discuss ED (40), SP (40), PD (40), and LT (40). ED and PD were selected for assessment because they were straightforward diagnosis. In contrast, SP and LT was selected because of varied etiologies and clinical presentations. The vignettes were entered into the 4 most frequently used OSCs as determined by web traffic analysis tools. The top 4 OSCs in order of use are WebMD (WMD), MedicineNet (MN), Everyday Health (EH) and Sutter Health (SH). The top 5 conditions listed in the OSC differential diagnosis were recorded and scored. If less than 5 conditions were offered, the available conditions were recorded and scored. The primary outcome was the accuracy of primary (Top 1) condition listed. The secondary outcome was frequency of the correct diagnosis appearing in the Top 3, or 5 of the suggested conditions.

Results

WMD did not offer the correct diagnosis for any ED or PD regardless of the number of conditions included from the differential vignettes (Table 1). However, WMD did successfully diagnose SP and LT in 22.5% and 95% of patients, respectively. Comparatively, EH was only able to diagnose SP 20% of the time, and failed to diagnose ED, PD, or LT on all occasions. MN successfully diagnosed ED, PD, SP, and LT in 100%, 98%, 27.5%, and 0% of patients, respectively. On average, MN was the most accurate OSC when including Top 1 (48.25%), Top 3 (53.88%), and Top 5 (56%) suggested conditions. Lastly, SH saw the largest overall improvement in accuracy when using the Top 5 suggested conditions compared to Top 1 (50% vs. 18%). SH correctly diagnosed ED, SP, and LT in 100%, 20%, and 80% of patients, respectively. The OSCs were most accurate diagnosing ED and least accurate diagnosing SP when using the Top 1 (37.5% vs. 6.88%), Top 3 (47.5% vs. 17.5%) and Top 5 (50% vs. 24.5%) of the suggested conditions.

Conclusions

WebMD, which receives nearly five times the web traffic of the next leading online symptom checker, and Everyday Health were both incapable of diagnosing ED and PD in this series. Only MedicineNet offered diagnoses for PD. All OSCs were routinely poor at suggesting precise diagnoses for scrotal pain, even when including 5 potential options in the differential. LT was only diagnosed by WMD and SH. Patients should be cautioned regarding the accuracy of OSCs.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
91 Impact of Neoadjuvant Androgen Deprivation Therapy (NADT) on Erectile Function Recovery (EFR) after Radical Prostatectomy (RP)
Authors: Flores Martinez J , Jenkins LC , Benfante N , Touijer K , Mulhall JP
Published: April 2022

Introduction

NADT has gained increasing recognition in the management of men with high risk disease prior to RP No large study to date has examined EFR in such patients

Objective

We aimed to define such outcomes with this analysis.

Methods

Men who underwent NADT pre-RP with ≥2-year follow-up post-RP constituted the study population. Patients who received ADT post-RP and radiation therapy pre and post-RP were excluded. Demographics, comorbidity, hormone and pathological parameters were recorded. EFR was assessed using the International Index Erectile Function-Erectile Function Domain (EFD) score. Predictors of EFR were analyzed using logistic regression models.

Results

260 men were analyzed. Mean age of 63.6 ± 7.1 years. 11.2% had diabetes, 55% hypertension, 54.2% dyslipidemia, and 16.9% and 5.8% history of sleep apnea and coronary artery disease respectively. Regarding smoking history, 6.9% was current smoker, and 33.1% former smoker. Baseline testosterone was 352.1 ± 225.9 ng/dL, PSA 9.6 ± 8.4 ng/mL, and median EFD score 24 (IQR = 14-30). Median Gleason sum was 7 (IQR = 7-9). 43.4% patients had bilateral nerve sparing status (NSS), and 34% unilateral. 13.1% received NADT. Median duration of NADT was 1 (IQR = 1-3) months. At 2 years post-RP, median EFD was 7 (IQR = 3-22) for men without NADT and 4 (IQR = 2-13) for men with NADT; 8.8% and 21.2% had an EFD score ≥ 24 in men with and without NADT. 73.5% and 55.3% had an EFD score ≤ 10 in men with and without NADT.

Conclusions

Men with NADT had lower EFR at 2 years post-RP, however NADT did not predict EFR in our cohort.

Disclosure

No
99 Comparison of Sexual Concerns Between Patients with Prostate Cancer and Their Partners
Authors: Loeb S , Salter C , Nelson CJ , Mulhall JP , Byrne N , Sanchez Nolasco T , Ness M , Gupta N , Cassidy C , Crisostomo-Wynne T , Li R , Wittmann D
Published: April 2022

Introduction

Prostate cancer diagnosis and treatment have a significant impact on sexual function and quality of life. Although prostate cancer is often called a “couples disease,” there is limited research on the needs of partners who are affected by the patient's sexual dysfunction.

Objective

The objective of our study was to compare the sexual health concerns and unmet needs of patients with prostate cancer and partners using real-world data from an online prostate cancer community.

Methods

We performed a mixed-methods analysis of data from the Inspire UsTOO Prostate Cancer Online Support & Discussion Community. This online health community about prostate cancer has more than 30,000 members, including both patients and partners. Through a data use agreement, we obtained anonymized text from public postings to the Sexual Health & Intimacy Forum on this community. Quantitative and qualitative data were examined from a random sample of 10% of the posts by women about sexual health (n=66), and were compared to an equal number of randomly selected posts by men.

Results

Among 6193 posts about sexual health and intimacy in prostate cancer, 661 (11%) were by female contributors. Of posts with cancer treatment details, surgery was the most common treatment discussed followed by hormonal therapy. Erectile dysfunction was the most common sexual complaint for both men and women. Posts by women were most likely to discuss problems with communication, relationship conflict, their partner's loss of libido, and the importance of intimacy. Common themes of the posts included coping with a “new normal” in their relationship, lack of access to and expense of erectile aids, and insufficient information and support from clinicians surrounding sexual recovery. A greater proportion of female posts conveyed emotion compared to male posts. The most common positive emotions were satisfaction and hope; while the most common negative emotions were frustration and loss of familiar sexual interaction. Although many posts discussed a variety of medical and surgical therapies for sexual recovery, very few discussed counseling or other psychosocial treatments.

Conclusions

Patients with prostate cancer and their partners experience a wide range of sexual health issues related to prostate cancer diagnosis and treatment. Online communities are widely used to give and receive peer-to-peer advice and support during sexual recovery. These findings highlight an unmet need for more extensive education and support surrounding sexual health for couples during the prostate cancer journey.

Disclosure

No
155 Requirement of Mental-health Referral Letters for Staged and Revision Genital Gender-Affirming Surgeries:  An Unsanctioned Barrier to Care
Authors: Yuan N. , Chung T. , Ray E. , Sioni C. , Jimenez A. , Garcia M.
Published: April 2022

Introduction

The World Professional Association for Transgender Health (WPATH) recommends referral letters from two mental-health providers within one year of gender-affirming genital surgery (gGAS) to ensure patient readiness before primary surgeries. Many U.S. health-insurance plans will not authorize second- and third-stage surgeries or revision surgeries without two referral letters. Such requirements are not supported by WPATH guidelines.

Objective

This study investigates insurance requirements for referral letters and their negative impact on care.

Methods

We retrospectively reviewed all gGAS cases over a 4-year period at our tertiary care medical center. Referral-letter requirements for insurance authorization were documented. The nation's largest insurance companies, including commercial, state-, and federally funded plans, were contacted to confirm requirements. We prospectively recorded time needed to complete insurance authorization for a patient subset. WPATH publications were reviewed.

Results

Nearly all reviewed U.S. health-insurance plans required annually updated referral letters for each gGAS procedure, including staged and revision surgeries. No updated letters changed clinical management. Referral-letter requirements delayed care. WPATH states that letters should not be needed for staged surgeries. Some plans required letters even for initial surgical consultation, a practice not supported by WPATH.

Conclusions

Insurance companies’ requirements for referral letters impede care and contradict WPATH guidelines. We advocate that referral letters should not be required for surgical consultations or for staged or revision surgeries after a patient has already had first-stage primary gGAS. Universal referral-letter requirements for secondary surgeries provide minimal clinical value, delay care, increase costs, and exacerbate gender dysphoria by invalidating gender transition. As with all procedures, surgeons themselves should be responsible for assessing patients’ surgical readiness. Significant changes in mental-health status or social situation should prompt surgeons to seek reassessment. WPATH recommendations regarding referral letters should be clarified and consolidated into a single document.

Disclosure

No
170 Uncontrolled Diabetes Mellitus is associated with Complications of Peyronie's Disease
Authors: Karakus S. , Burnett A.L. , Joseph C. , Dai X. , Hawksworth D.
Published: April 2022

Introduction

Peyronie's disease (PD) is a connective tissue disorder of the penis characterized by an abnormality in the collagen structure of the penile tunica albuginea resulting in plaque formation and penile deformity. The prevalence of PD is estimated to be 3.2-8.9% overall and as high as 20.3% in men with diabetes mellitus (DM). However, the impact of the severity of DM on PD complications is unclear.

Objective

We aimed to investigate the association between uncontrolled DM and PD complications.

Methods

We performed a retrospective study of patients with PD and DM presenting to our institution between December 2015 and June 2020. Clinical history, PD complications, erectile status, and clinical parameters of DM were analyzed. Penile deformities were determined by physical exam, photographs, and penile Doppler ultrasound. HbA1c level greater than 7% at the time indicated uncontrolled DM.

Results

A total of 119 patients were evaluated. HbA1C levels were documented in 68 patients (median level of 7.2%). Thirty-six patients (36/68, 52.9%) had an HbA1c level >7% (uncontrolled DM). Data collection parameters have been shown in Table 1. Regression analysis indicated a significant association between the degree of penile curvature and status of uncontrolled DM after adjustment for age, body mass index, presence of hypertension, hyperlipidemia, and cardiovascular disease, and smoking status (B=13 degrees, 95% CI=1-25 degrees, p=0.04). An increase in HbA1c level after the initial diagnosis of PD positively correlated with a formation of penile plaque (rho=0.34, p=0.04).

Conclusions

Our study suggested that uncontrolled DM and a further increase in HbA1c levels after the PD diagnosis significantly impact the severity of PD. Revealing mechanisms behind this will help us develop better management strategies in diabetic PD patients.

Disclosure

No
174 Sub-Coronal Inflatable Penile Prosthesis Placement: Patient Satisfaction and Outcomes
Authors: Feng C. , Langbo W. , Anderson L. , Cao D. , Bajic P. , Amarasekera C. , Levine L.
Published: April 2022

Introduction

Placement of an inflatable penile prosthesis (IPP) is a common surgical treatment of multiple disorders of male sexual function, including erectile dysfunction (ED) and Peyronie's disease (PD). The infra-pubic and peno-scrotal approaches have classically been favored for IPP placement since the first description of IPP placement in 1973 given reliably good outcomes. A sub-coronal incision was then described in 2016 for the implantation of a multicomponent IPP. The benefits of a sub-coronal approach to IPP placement includes exposure and access to the entire pendulous penis back to the mid bulb to allow for additional reconstructive procedures, such as plaque incision and grafting for Peyronie's disease, which previously would require an additional incision.

Objective

Although the sub-coronal approach has been described to be operatively feasible with advantageous operating times, the aim of this project is to report outcomes of the sub-coronal approach, such as patient satisfaction, rate of revision, infection, and wound complications.

Methods

A retrospective chart review from 5/11/2012 to 12/28/2020 was conducted on IPP placements performed at a single, tertiary-care institution to identify patients with IPPs placed via a sub-coronal approach. Data was collected at most recent follow-up date to determine outcomes measures such as satisfaction and complication rates.

Results

Forty-six patients had IPPs placed through a sub-coronal incision. Mean time to follow-up was 9.81 months (0.46-45.6 months). Of these patients, 22 (47.8%) explicitly expressed satisfaction with the procedure at follow-up. Four (8.7%) had wound complications. Additionally, only one (2.2%) experienced a post-operative prosthetic infection. Revision was performed in 3 IPPs (6.5%). One revision was performed to primarily release prothesis tubing that had become adherent to the left base of penile shaft, which was causing patient discomfort. The same revision served additional cosmetic purpose to reduce redundant skin along the patient's circumcision line. The other two revisions were performed for prosthesis malfunctions: one prosthesis acquired “buckling” leading to a ventral curvature requiring release of scar contraction, and the other prosthesis developed a proximal aneurysm requiring removal and replacement.

Conclusions

The sub-coronal approach for placement of an IPP is a promising alternative to the infra-pubic and peno-scrotal incisions with high patient satisfaction, low complication, and low revision rates.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
177 Differences in Patient Characteristics and Surgical Outcomes in Inpatient vs Outpatient Surgery for Peyronie's Disease: Contemporary Data from the National Surgical Quality Improvement Program Database
Authors: Raheem T.M. , Fustok J. , Voznesensky I. , Pandit A. , Machado B. , Payakachat N. , Davis R. , Benson C. , Raheem O.
Published: April 2022

Introduction

Peyronie's disease (PD) is a fibrotic condition of the tunical layer of corporal penis that can cause deformity, erectile dysfunction, and reduced quality of life in men. Surgical therapy remains an integral treatment of the condition in severe cases. However, there is a paucity of data describing trends in surgical practices.

Objective

To characterize the differences between inpatient (IP) and outpatient (OP) practice patterns for PD surgery. We utilized the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach.

Methods

NSQIP database was queried for men undergoing PD surgery between 2005-2019. Patients were classified as either OP (<24 hours) or IP(>24 hours). Baseline demographics, operating time, and complications were compared between the two groups. Multivariate logistic regression evaluated factors associated with discharge times and 30-day complications.

Results

A total of 924 patients were identified and classified as IP in 157 and OP in 767 patients. Operative time was shorter in OP (89 minutes) compared to IP (126 minutes, p<0.001). A statistically significant difference was noted in comorbidities favoring IP surgery between the groups including chronic obstructive pulmonary disease, anemia, and pre-operative dyspnea. The 30-day complication rates between both groups differed notably for any complication (9.6% IP, 1.6% OP, p< 0.001), any readmission (3.8% IP, 0.7% OP, p 0.005) superficial incisional surgical site infection (5.1% IP, 0.7% IP, p< 0.001), and unplanned intubation (1.3% IP, 0 % OP, p 0.029).

Conclusions

Surgical treatment for PD is increasingly utilized as an OP procedure. Patients with shorter operative times and fewer comorbidities appear to be the best suited candidates OP procedures. Beginning in 2015, trends began to shift toward OP procedures. In the era of increasing hospital costs, a shift toward OP surgery for PD has been rising.

Disclosure

No
183 AdVance and AdVance XP Male Sling Comparison, an Institutional Experience
Authors: Ahmadieh K. , Parker N. , Campagna J. , Powell J. , Wolter C.
Published: April 2022

Introduction

The AdVance male sling has been used for many years for the treatment of male stress urinary incontinence with multiple previous studies evaluating its efficacy. More recently, a new generation AdVance XP was designed with modifications in its design and surgical tools in hopes to improve patient outcomes.

Objective

The aim of our study was to provide our institution's outcomes comparing objective and patient-reported outcomes of the AdVance male sling to the AdVance XP.

Methods

All patients who have had placement of an AdVanceXP male urethral sling were retrospectively reviewed. Inclusion criteria included the necessity of one year post-operative follow up. We then identified a comparative cohort who had the most recent placement of the AdVance sling. We compared patient demographics, baseline characteristics, functional outcomes, voiding studies and complications.

Results

A total of 11 patients who received the AdVanceXP were compared to 11 patients who received the AdVance male sling. There were no statistically significant differences in baseline demographics between the two groups (Table1). When comparing the AdVance XP to Advance, there was no difference in change in average flow rate (-1.26mL/s vs -5mL/s, p=0.476) or peak flow (-5.11mL/s vs -5.73mL/s, p=.936). Patient's pre-surgical pad usage was greater in the AdVanceXP than the AdVance sling groups (2.64 vs 1.60, p=0.019). The mean decrease in pad usage was 1.95 pads in those with the AdVanceXP compared to 1.36 pads with the AdVance (p=.227). There were no statistically significant differences in operative times between the AdVanceXP and the AdVance male sling (64.5min vs 68.8min, p=.249). Both groups had one patient who had issues with post-operative pain and neither group had any patients with post-operative retention, infection or need for reoperation within one year.

Conclusions

Patient's who had placement of the AdVanceXP were found to have a greater reduction in pad usage when compared to the AdVance sling, though not reaching statistical significance.

Disclosure

No
190 Self-reported Post-vasectomy Fournier's Gangrene Complication Among Practitioners
Authors: Huynh L. , Raza S. , Deibert C.
Published: April 2022

Introduction

While several cases of Fournier's gangrene have been reported following vasectomy, the prevalence of this complication is yet to be elucidated.

Objective

Determine the prevalence, presentation and outcome of Fournier's gangrene post-vasectomy.

Methods

We developed a brief IRB exempt survey that was disseminated by email to the 250 high volume vasectomy practitioners who are part of a global networking list-serve to gather prevalence, presentation and outcome of this debilitating complication. The data was organized and analyzed via Microsoft Forms and Excel.

Results

83/250 members responded to the survey (33%).Practitioners were: family practitioners 74.6% (62), urologists 19.2% (16), general surgeons 3.6% (3), internist 1.2% (1) and 1 Ob/Gyn. The mean self-reported number of vasectomies performed per provider was 574. 8.4% (7) of all practitioners routinely provide antibiotics prior to the procedure. The self-reported complication rate for Fournier's gangrene in this population was 6% (5). Of which majority noted the typical clinical presentation of fever (80%), pain (60%) and skin discoloration (60%). Among the practitioners who experienced Fournier's gangrene, none of them provided antibiotics prior to the procedure. However, these practitioners performed twice as many annual vasectomies than the non-Fournier's gangrene practitioner pool, 1160 versus 577, respectively. Among those with Fournier's gangrene post-vasectomy, all of them were managed with antibiotics and surgical debridement of which 60% (3) did not require ICU stay, 60%(3) had either temporary or permanent disability with only 20%(1) with complete resolution.

Conclusions

Globally, multiple specialties perform vasectomies. Fournier's gangrene is a rare yet debilitating complication that can result uncommonly after a vasectomy. The likelihood of encountering a Fournier's gangrene complication is positively associated with the number of vasectomies performed by a practitioner.

Disclosure

No
194 Environmental Toxicants and Male Sexual Dysfunctions
Authors: Ferry K. , Alzweri L. , Burnett A.
Published: April 2022

Introduction

Understanding how substances in the environment impact sexual function is a broad and ever-expanding field. While some toxicants are well understood to disrupt the male sexual response cycle or impact the ejaculation pathway, other are just being understood.

Objective

We reviewed current articles detailing how heavy metals, industrial chemicals, pesticides, lifestyle and behaviors, climate, and radiation affect the male sexual function and the suspected mechanisms these toxicants have as sexual function disruptors.

Methods

We used SCOPUS and PubMed to review literature from 2016-2020 pertaining to the topics of environmental toxicants including those relating to heavy metals, industrial chemicals, pesticides, life style and behavioral exposures, climate, and radiation. Studies were also included if the paper included research on the toxicant specified and the authors hypothesized on the pathophysiological effect the toxin had on the male sexual response cycle. Studies were also included if the research demonstrated that the toxicant was shown to have no impact on male sexual health or a mixed conclusion.

Results

A total of 109 papers were collected and 79 were analyzed in this review. While every one of these categories had articles that were inconclusive or did not find that the toxicants had a significant effect on male sexual function, the majority of studies showed that heavy metals, industrial chemicals, pesticides, and climate had a positive correlation between male sexual dysfunction and exposure to these toxicants. Lifestyle and behaviors showed a positive correlation, but the studies done on bicycling and diet were not as numerous as in the other categories. Radiation was the only category that did not have a definitive answer for whether it causes male sexual dysfunction or not. Our study identified that heavy metals, industrial chemicals, and pesticides effected the hormones involved in sexual function and decreased the quality of sperm in those studied. Sperm quality was also decreased in those exposed to climate and radiation. Impairment and injury to sexual organs caused by the toxicants were observed in both the industrial chemical and climate category. The increased risks these toxicants impose on male sexual function is shown in table 1.

Conclusions

These results show that the field of research devoted to understanding the connection between many of these agents and male sexual function has grown in recent years, but still needs focus and attention brought to it.

Disclosure

No
208 Misrepresentation of Female Sexual Behavior in Pornography
Authors: Dubinskaya A , Dallas K , Scott V , Anger J , Eilber K
Published: April 2022

Introduction

Female sexual wellness is a highly complex condition that builds not only on biological factors, but also on social norms, background, religion, education, and social media. One source where both women and men learn about sexual behavior, interactions, and expectations is pornography. This resource has become widely available to anyone with access to the internet. While pornography is a way of expanding sexual horizons, like any media it may misrepresent more common behaviors and expectations for both genders. The impact of pornography on male attitudes towards sex and women in general has previously been described. This not only harming males, but it also potentially has negative effects on female sexual wellness as well.

Objective

The purpose of this review is to evaluate how women's sexuality is portrayed in the most commonly viewed pornography videos in order to understand its role in female sexual health.

Methods

Videos from the category “most viewed videos” based on internet ratings were viewed. We analyzed the content and female and male sexual behaviors.

Results

We reviewed the 25 most viewed videos by the general public from the five most popular free pornography websites. The two most commonly viewed contexts were sexual encounters between step relatives (16%) and during casting sessions (16%). With the majority of videos having two participants (92%), two videos included three and five participants. Overall, only 9 (36%) videos demonstrated at least one female orgasm with 5 (20 %) videos showing clitoral stimulation before reaching orgasm. Only 4 (16%) videos did not demonstrate male orgasm. Similarly, only 8 (32%) videos pictured a female as the recipient of oral sex, whereas all but 3 (12%) videos showed the male as the recipient. Only in one (4%) video did a woman have more than one orgasm. Anal sex was represented in 4 (16%) of videos, with novelty toy uses in one (4%) video.

Conclusions

The most viewed videos on popular pornography sites did not represent the most common sexual scenarios as these were between step relatives and during casting sessions. Pornography demonstrates preference for male-centered pleasure. Although the majority of women climax with clitoral stimulation, this was not represented by popular pornography sites. Inaccurate portrayal of female sexuality can contribute to sexual performance anxiety, unfulfilled expectations among both partners, and sexual dysfunction. More research is needed to determine the best referral websites representing more realistic female sexual behavior.

Disclosure

No
209 Hormonal Imbalances Association to Persistent Genital Arousal Disorder in Females
Authors: Tannenbaum J , Greenberg J , Raheem O , Hellstrom W
Published: April 2022

Introduction

The etiology of the uncommon presentation of persistent genital arousal disorder (PGAD) can provide an insight into the hormonal imbalances that effect sexual function and dysfunction in females. We examine, review, and analyze the correlation of the known cases of PGAD that involved hormonal imbalances with a focus on hormone imbalances (HI) from a urological perspective.

Objective

To review the literature regarding hormonal imbalances in females with PGAD with a focus on HI.

Methods

A literature review of articles and clinical studies was performed to define the diagnosis, etiology, and treatment outcomes of PGAD. Search terms included hormone imbalances and/or, persistent genital arousal disorder, diagnosis of persistent genital arousal disorder, defining persistent genital arousal disorder, as well as treatment of persistent genital arousal disorder.

Results

We found the of onset of PGAD on average was 49.2± 13.1 years with the average length of symptoms 4.7± 11.2 years. The common etiology of cases presented as hormonal imbalances with most individuals experiencing this as their only etiology. Overall, individuals who underwent treatment had a 72.2% rate of symptoms being resolved. The treatments administered involved pharmacological, clinical intervention, diet modification, and hypnotherapy. Clinical intervention was used the less than pharmacological treatment but was more successful.

Conclusions

There was a high frequency of PGAD presentation and treatment involving dopamine medications such as selective serotonin receptor inhibitors (SSRI). When evaluating for this rare disease it is important to keep in consideration the effect of hormone imbalances. Further studies are needed to get a more thorough understanding of the effects of dopamine may have on sexual dysfunction disorders such as PGAD.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific
210 A Review of Sexual Function Following Genital Burns: An Understudied, Morbid, and Rare Condition
Authors: Ferry K , Alzweri L
Published: April 2022

Introduction

Genital burns are rare but devastating injury that can impart long term physical and emotional distress to patients. Most victims of genital burns are male patients while the highest prevalence occurs during 0-12 years of age. While the techniques to either conservatively or surgically repair genital burns have been detailed, to our knowledge there have not been a retrospective review following up on the sexual function of these patients after their reconstruction.

Objective

We aim to call attention to articles that analyze sexual function after genital burns and identify the lack of research in this subject.

Methods

We conducted a retrospective analysis by searching through PubMed for key words including “Genital burns, male female, genital, burns” and excluding the word “burning” as it commonly describes a symptom rather than the injury. We selected papers that described techniques for how they treated genital burns regardless of whether they followed the sexual function of the patient after treatment. We found 31 papers that fit our criteria with many of the papers focusing on surgical intervention. These 31 papers were analyzed and categorized on whether they analyzed sexual function. For the purpose of this review, sexual function was divided into the broad categories of aesthetic, function, sensation, psychological, and reproduction.

Results

Of the 31 papers reviewed, there were 8 studies that assessed aesthetic satisfaction, 7 that assessed function, 9 that assessed sensation, 1 that assess psychological impact, 3 that assess reproduction capabilities, and 13 studies did not address any of these categories in their findings (table 1). Papers that studied surgical interventions for genital burns in any capacity were more likely to also study sexual function as opposed to studies that focused on conservative management. Some gaps in the literature that we noted were that while the papers acutely followed up in sexual function, we could find no incidence of a long-term retrospective review on sexual function after repair.

Conclusions

Given that many of the patients suffering from genital burns are children, it is difficult to adequately understand the long-lasting effects some of these treatments have as they mature. While it would be difficult to follow up with these patients, it is important to understand the best treatment option for patients with genital burns.

Disclosure

No
246 Effect of Prescription Drug Monitoring Programs on Testosterone Prescriptions
Authors: Mulloy E , Eisenberg M , Li S
Published: April 2022

Introduction

Symptoms of testosterone deficiency are increasingly prevalent in the aging male population. Oftentimes, this is managed medically with exogenous testosterone supplementation. Pharmacologic testosterone is classified as a schedule III controlled substance by the Food and Drug Administration. In recent years, many states have implemented prescription drug monitoring programs (PDMP) to help track the prescribing and dispensing of controlled substances in an effort to curb the opioid epidemic. Many states also require a provider query of an online system prior to prescribing controlled medications, which has led to a reduction in opioid prescriptions.

Objectives

We sought to determine if the implementation of a state mandated query of PDMP prior to prescribing testosterone impacted provider prescribing behavior.

Methods

State PDMP requirements were determined by examining state regulatory websites. Only states who had recently implemented PDMP query mandates (since 2016) for testosterone were included. Using an insurance claims database, we evaluated all men aged 40-70 in each state who were enrolled for at least 1 year and did not move to another state during follow up. From this, a sub-cohort of men who enrolled within 3 and 6 months before and after the start date of their respective state's mandate in attempt to identify any immediate effect. Men were also stratified by race/ethnicity (White, Black, Hispanic, Asian) to observe any demographic trend. In a similar fashion, the total number of men who ever or never filled prescriptions for testosterone were identified. Rates before and after mandate implementation were compared using the generalized estimating equations test.

Results

11 states (AK, CA, FL, HI, MI, NM, NV, PA, SC, WI, WY) were identified has having recent PDMP mandates for testosterone. A total of 2,297,290 men who met enrollment criteria were identified. Rates of testosterone prescriptions varied around the country (from 5.02 to 32.80 per 1000 person years). Moreover, there were no consistent changes in the rates of testosterone prescriptions after mandate implementation, regardless of the timeframe evaluated. Testosterone prescriptions increased in a majority of the states after implementation of a PDMP mandate (6 of 11 states, p<0.05) or showed no change (3 states). South Carolina and Wisconsin showed a decrease in the number of prescriptions after mandate implementation (p<0.05). While differences in the rates of testosterone prescriptions existed between races, the association with PDMP mandates were similar to the statewide analyses.

Conclusion

The implementation of state mandated PDMP query prior to prescribing testosterone does not appear to have a reliable effect on testosterone prescription patterns. Men with symptomatic hypogonadism do not appear to be negatively affected by new regulatory controls largely meant to curb opioid prescriptions.

Disclosure

No
104 Reporting of Level 1 Evidence in Peyronie's Disease Publications- A Systematic Review
Authors: Bole R , Gottlich HC , Ziegelmann M , Mulhall J , Corrigan D , Levine L , Bajic P
Published: April 2022

Introduction

Despite an increasing number of publications on Peyronie's disease (PD), evidence-based clinical decision making remains challenging due to the small number of well-designed clinical trials. The quality of available PD literature has not been assessed to date.

Objective

We sought to evaluate the quality of the methodology and reporting of systematic reviews and meta-analyses in PD literature

Methods

Study protocol registration was performed on the Open Science Framework platform. In January 2021, a systematic electronic search of the Medline/PubMed, Embase, Ovid, Scopus, Joanne Briggs Institute and Cochrane databases was performed. Search terms included “Peyronie's disease” and “systematic review OR meta-analysis OR meta analysis”. Eligibility criteria were relevance to Peyronie's disease and specification of “systematic review” or “meta-analysis” in the title or abstract. A database was created to summarize the relevant methodological and reporting criteria for each article. The outcomes included review type, authorship, journal, publication date, “A MeaSurement Tool to Assess systematic Reviews” (AMSTAR-2) score and “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) score. Risk of bias was assessed using the ROBIS tool. Data were tabulated and reported as means with standard deviation, median with interquartile range (IQR) and t-testing as appropriate. Strength of association between variables was calculated using the Pearson correlation coefficient. Statistical analyses were performed on RStudio (version 1.4.1106).

Results

From 1974 to 2021, 340 articles were identified. After review 23 full length articles were included. Seventeen were systematic reviews, 4 meta-analyses and 2 were combined. Twenty-one (87.5%) articles were published after the year 2009 when the PRISMA guidelines were published. There was median 53.8% (IQR 38.2%) adherence to AMSTAR-2 criteria and 66.7% (IQR 38.9%) adherence to PRISMA criteria. The overall AMSTAR confidence rating was Critically Low in 15/23 studies, indicating more than one critical flaw. Correlation analysis revealed very high positive association between AMSTAR 2 and PRISMA adherence (+0.97). ROBIS revealed “High” concern regarding methods used to collect data and appraise 17/23 studies (73.9%), and “High” concern regarding synthesis and findings in 14/23 studies (60.9%).

Conclusions

Transparent reporting of methodology and findings in SRs and MAs is crucial to maintaining research integrity and allowing for accurate interpretation of results. Despite an increasing number of publications in PD, many of these studies fail to meet accepted methodological criteria for reporting. More high quality randomized controlled trials in PD are necessary; while systematic reviews and meta-analyses should focus on these high-quality studies with uniform use of accepted reporting guidelines.

Disclosure

No
119 Current Practices in High and Low Volume Centers Regarding Corporotomy Localization During Penoscrotal Inflatable Penile Implant Surgery
Authors: Barnard J , van Renterghem K , Jacobs B , Yafi FA , Barnard J , Osmonov D , Ralph D , Venturino L , Ziegelmann M , Wang R , Kannady C , Lentz A , Garcia EL , Adrianne R , Bettochi C , Hatzichristodoulou G , Gross M , Faix A , Otero JR , Martinez-Salamanca JI
Published: April 2022

Introduction

Literature concerning corporotomy location in multi-component inflatable penile prosthetic surgery via a penoscrotal approach is scarce if not non-existent. However, corporotomy location represents an important issue that may influence immediate and long-term outcomes regarding patient and partner satisfaction as well as device durability.

Objective

To report practices in low- and high-volume penile implant centers regarding corporotomy location.

Methods

Data from 18 (13 European and 5 American) implant centers were collected retrospectively between September 1st, 2018 and August 31st, 2019. Variables included: intraoperative proximal and distal corpus cavernosum length measurement, total corporal length measurement, total penile implant cylinder length, and length of rear tip extenders. Additionally, patient characteristics, indication for penile implant, operative time, type of implant utilized, reservoir characteristics and short term complications were reported.

Results

809 virgin penile implant cases were included in the analysis. Mean age of participants was 61.5 +/- 9.6 years old. In total, 299 AMS 700TM (Boston Scientific) and 510 Coloplast Titan® devices were implanted. The mean proximal/distal corporal measurement ratio during corporotomy was 0.93 +/- 0.29. A statistically significant correlation between lower proximal /distal measurement ratio and higher age (p=0.0013), lower BMI (p<0.0001), use of rear tip extenders (RTE) (p=0.04), lower RTE length (p<0.0001) and absence of diabetes (p=0.0004) was reported. In a 3-month follow up period 49 complications and 37 revision procedures were reported.

Conclusions

This is the first study reporting and evaluating the current practices regarding corporotomy location during IPP placement in a multicenter cohort, particularly when including such a high number of patients. Nevertheless, the retrospective design limits the study outcomes. Even in experienced hands proximal length measurement in relation to distal length measurement in penoscrotal IPP surgery is in many cases sub-optimal, particularly when the tubing-cylinder connection of each device is taken into account.

Disclosure

No
136 Small Diameter Penile Implants: A Survey on Current Utilization and Review of Literature
Authors: Campbell S , Kim C , Allkanjari A , Nose B , Selph JP , Lentz A
Published: April 2022

Introduction

The small diameter penile implant (SDPI) is a modified IPP with a smaller diameter cylinder utilized in cases of anatomically small corpora or severe corporal fibrosis. SDPIs allow for patients to obtain useable erections, sometimes with the intent to upsize in the future. There is a dearth of literature on the optimal clinical scenarios for utilization of SDPIs, volume of SDPIs placed nationwide, and patient satisfaction results.

Objective

Our aim is to identify current usage patterns and perceived patient satisfaction of SDPIs among urologic prosthetic surgeons.

Methods

A 23-question online survey was distributed via email to physician members of the Sexual Medicine Society of North America (SMSNA) and Society of Urologic Prosthesis Surgeons (SUPS). The survey included questions regarding surgeon experience and volume, frequency of SDPI utilization, indications for SDPI, surgical strategy in the setting of SDPI (approach, use of concordant modeling/grafting), reservoir and pump management, and perceived infection risk and patient satisfaction.

Results

50 individuals responded to the survey, 48 of whom routinely utilized SDPIs. The most common indication for SDPI placement was corporal fibrosis from prior infection, followed by anatomically small corpora and priapism. The most common maximal dilation diameter was 10 mm (47%), with an additional 23% of respondents utilizing SDPI with 11 mm dilation. 75.4% of respondents sometimes or always intended to upsize to standard diameter cylinders in the future. 68.8% of surgeons routinely counseled patients on the possibility of reduced girth and rigidity with SDPI. Patient satisfaction was perceived to be comparable to standard diameter cylinders in 56.3% of respondents, while the remaining 43.6% believed it to be lower than traditional cylinders.

Conclusions

SDPI are utilized by prosthetic surgeons in a variety of clinical situations and are frequently effective. Future research is needed to better characterize patient satisfaction and define which patients are best suited for SDPI.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific