bluuebunny/crossref_metadata_2025 huggingface dataset:
(201) REAL WORLD COMPLICATIONS FOLLOWING BURIED PENIS REPAIR WITH SKIN GRAFTING
Authors: Furuyama W , Dwyer K , Johnsen N
Published: December 2024

Introduction

With rising prevalence of obesity in the United States, adult acquired buried penis (AABP) is an increasingly widespread problem. It impacts sexual function, personal hygiene, urination, self-esteem, and quality of life. As surgery is the cornerstone of definitive management, understanding complication rates in the real world is essential for adequate counseling and setting patient expectations.

Objective

In this study, we sought to describe our experience managing AABP and discuss rates of complications following surgery. We also sought to understand risk factors for complications.

Methods

We performed a single-institution, single-surgeon retrospective study of AABP managed with escutcheonectomy and skin grafting. Complications included wound infection, urinary tract infection, dehiscence, recurrence of AABP, any degree of graft loss, and mortality. We also collected demographic data, including age, comorbidities, and BMI.

Results

We identified 29 cases between February 2020 and March 2024. Of those, 26 patients (90%) had a complication – the most common being wound infection (55%) and partial or complete graft loss (41%). Those with complications following surgery had a higher body mass index than those without complications (46 kg/m2 vs 32 kg/m2, p = 0.017). Two post-operative deaths occurred, both secondary to pulmonary emboli.

Conclusions

While the literature supports high patient satisfaction following surgery for AABP, complications are common. Adequate counseling, vigilant follow-up, and realistic expectations remain critical to the management of AABP. Based on our data and experience, all patients are now sent home on venous thromboembolism prophylaxis and surgical intervention is withheld until the patient’s BMI is less than or equal to 40 kg/m2.

Disclosure

No.
(203) RISK FACTORS FOR REPEAT EROSION IN RADIATED PATIENTS UNDERGOING REIMPLANTATION OF ARTIFICIAL URINARY SPHINCTER DEVICES
Authors: Gaines T , Ivan S , Loh-Doyle J , Foreman J , Lentz A , Peterson A , Klein R , Myrga J , Rusilko P , Michel J , Matluck N , Cordon B , Mikhail M , Hwang A , Shridharani A , Tryfonyuk L , Martins F , Gonzalez R , Van Der Voort G , Simhan J
Published: December 2024

Introduction

With limited alternatives to achieve continence, radiated patients with prior artificial urinary sphincter (AUS) erosion represent a challenging population at risk for a subsequent erosion event. Though prior analyses have assessed risk factors for the development of subsequent AUS erosion after an initial erosion event, these investigations are often limited by the inclusion of non-radiated erosion patients in the study design.

Objective

We analyze a multi-institutional cohort to identify independent predictors of repeat erosion events in a large series of radiated prostate cancer survivors.

Methods

A multi-institutional, retrospective review was performed of all radiated patients with history of prior AUS erosion. Clinical features, procedural specifics and surgical outcomes were collected for all patients who experienced an erosion event and underwent repeat AUS implantation. Univariate and multivariate logistic regression analyses were performed to identify independent factors predictive of secondary AUS erosion event.

Results

A total of 118 patients with history of pelvic radiation (55% salvage, 32% adjuvant, 13% primary radiation) underwent a second AUS implantation at a median of 6.2 months after a prior AUS erosion event. Median age at time of second AUS implantation was 76.6 years and 35% of patients had a history of low testosterone (low T). The overall rate of second AUS device erosion was 47%. The median time to AUS erosion of the initial device was 22.4 months compared to 14.2 months for the second AUS device (p < 0.01). On univariate analysis, history of radiotherapy in the adjuvant (OR 2.54, CI 1.113-5.432, p = 0.034) and salvage (OR 2.66, CI 1.234-4.345, p = 0.012) settings were associated with increased risk of erosion. Uncorrected (OR 2.43, CI 1.143-6.432, p = 0.032) and corrected (OR 2.22, CI 1.116-6.345, p = 0.041) low T as well as history of urethroplasty (OR 2.23, CI 1.231-4.324, p = 0.08) also conferred additional risk of erosion. On multivariate analysis, independent risk factors for a secondary AUS erosion event in radiated patients included uncorrected low T (OR 2.03, 95% CI 1.435-3.456, p = 0.041), history of urethroplasty (OR 2.14, 95% CI 1.123-4.237, p = 0.045), and salvage radiotherapy (OR 2.23, 95% CI 1.24-5.435, p = 0.026).

Conclusions

Radiated patients with a history of salvage radiotherapy, prior urethroplasty, and uncorrected low T contemplating AUS re-implantation following initial AUS device removal for erosion events are at increased risk of repeat erosion events.

Disclosure

No.
(206) COMBINED CLOMIPHENE AND HIGH-DOSE ORAL TESTOSTERONE THERAPY IN HYPOGONADAL MEN: A CASE SERIES
Authors: Yoon G , Vo J , Sun AY
Published: December 2024

Introduction

Clomiphene is often used in the treatment of hypogonadal men who wish to preserve endogenous testosterone production, however symptomatic responses are often suboptimal. Exogenous testosterone replacement, while effective, typically suppress the hypothalamic–pituitary-gonadal (HPG) axis. This case series investigates the efficacy of combining clomiphene with high-dose oral testosterone undecanoate (TU) (Kyzatrex, Marius Pharmaceuticals).

Objective

To report the outcomes in a series of patients treated with combined clomiphene and oral TU therapy.

Methods

Three hypogonadal men who initially received clomiphene therapy (50 mg every other day) but did not achieve satisfactory symptomatic improvement despite numerical improvement were identified. Subsequently, they were given oral TU 400 mg once daily with lunch. Subjective symptomatic outcomes, total testosterone (TT), sex hormone binding globulin (SHBG), calculated free testosterone (fT), estradiol, hematocrit (Hct), and HPG axis markers luteinizing hormone (LH) and follicle stimulating hormone (FSH) were monitored at baseline, after 3 months of clomiphene monotherapy, and after 3 additional months of combined clomiphene and oral TU therapy.

Results

The patients had baseline serum testosterone levels of 303, 223, and 230 ng/dL. After 3 months of clomiphene 50 mg QoD, TT rose to 418, 680, and 667 ng/dL respectively, however these patients reported continued symptoms of hypogonadism. After adding 400 mg oral TU once daily for 3 months, TT rose to 1001, 1055, and 1120 ng/dL, and the patients reported significant improvement in symptoms such as erectile dysfunction, fatigue, libido, and exercise tolerance. Both SHBG and Estradiol levels rose with clomiphene monotherapy but subsequently decreased after adding oral TU. Hct was unchanged throughout. FSH and LH levels both rose on clomiphene and subsequently dropped after initiation of oral TU, but remained near baseline, indicating preserved HPG axis function. No significant adverse events were reported.

Conclusions

In these patients for whom clomiphene monotherapy failed to generate a sufficient symptomatic response, the addition of high-dose oral TU therapy (Kyzatrex 400 mg) at a once-daily dosing resulted in substantial symptomatic improvement while maintaining endogenous FSH and LH levels at baseline. These findings suggest a novel approach to hypogonadism management, balancing effective symptom relief with preservation of endogenous testosterone production, with potential downstream ramifications on fertility preservation.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author serves as consultant for Marius Pharmaceuticals, Boston Scientific, Endo Pharmaceuticals.
(210) EXPLORING HERBAL MEDICINE IN TESTOSTERONE TREATMENT: MYTHS AND EFFICACY UNVEILED
Authors: Espinosa G
Published: December 2024

Introduction

Herbal medicine has a long history for its potential benefits in various health domains, including testosterone management. The effectiveness and safety of these natural remedies remain subjects of debate among medical professionals. This presentation aims to provide a comprehensive overview of herbal supplements used in testosterone treatment, addressing common myths and evaluating their efficacy based on current research and clinical experience.

Objective

The primary objective of this presentation is to assess the role of herbal medicine in testosterone treatment critically. I aim to identify evidence-based practices, understand potential drug-herb interactions, and evaluate the integration of these natural remedies with conventional treatments to improve patient outcomes.

Methods

Numerous peer-reviewed articles reviews were conducted, encompassing, clinical trials, and meta-analyses published over the past two decades. The focus was on herbal supplements commonly used for testosterone enhancement, including but not limited to Tribulus terrestris, Fenugreek, and Ashwagandha. Data on efficacy, safety, dosage, and patient-reported outcomes. Additionally, clinical insights on the use of herbal medicines for sexual dysfunction is presented.

Results

In the literature, there are mixed results regarding the efficacy of herbal supplements in testosterone treatment. Some studies demonstrated modest improvements in testosterone levels and related symptoms, while others showed no significant benefits compared to placebo. Safety profiles varied, with some herbs showing potential for adverse interactions with conventional medications. Clinical experience suggests’ using botanicals for testosterone treatment proper use of certain botanicals may show benefit in the right patient population.

Conclusions

Herbal supplements may offer benefits in testosterone treatment for certain patients, but their efficacy and safety are not universally supported by the evidence. Sexual medicine practitioners should approach these remedies with some caution, emphasizing evidence-based practices and considering potential interactions with conventional treatments. Further research is needed to establish standardized guidelines for the use of herbal medicine in testosterone management. This presentation will equip healthcare providers with the knowledge to navigate the complex landscape of herbal supplements, enabling them to offer informed, holistic care to their patients.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: XY Wellness, LLC.
(216) BENIGN PROSTATIC ENLARGEMENT IS ASSOCIATED WITH ERECTILE DYSFUNCTION IN UNITED STATES
Authors: Paulsen O , Son Y , Wu E , Demario V , Patel V , Devincentz D , Mueller T
Published: December 2024

Introduction

Benign Prostatic Hyperplasia (BPH) is common in older men with an approximated prevalence of 70-80% in men greater than 65. BPH has been associated with lower urinary tract symptoms, but its relationship to erectile dysfunction (ED) has not been explored in nearly the same detail, despite both conditions hosting similar risk factors.

Objective

This study aims to determine whether there is an association between BPH and erectile function in the United States.

Methods

A retrospective review was performed using data from the 2003-2004 National Health and Nutrition Examination Survey in patients who were diagnosed with BPH. Erectile function was assessed using a questionnaire “ability to maintain an erection.” Descriptive statistical analysis was performed on patient demographics and a logistic multivariate regression was completed to ascertain if BPH was associated with erectile function.

Results

This cohort comprised 6,089,425 males, with a 12% prevalence of BPH. The majority were aged 40-59 and non-Hispanic white. Age greater than 40 and veteran status were significantly correlated with BPH (p < 0.0001). Married individuals showed a higher BPH prevalence, with 84% diagnosed, but this was not statistically significant. The lowest prevalence was among separated individuals (0.2%). Household income did not correlate significantly with BPH prevalence, though those with incomes over $75,000 had the highest prevalence of 31%. Racial differences in BPH prevalence were not statistically significant; non-Hispanic whites represented 88% of the pool, while Mexican Americans represented only 2%. Educational attainment also did not significantly affect BPH prevalence, but higher rates were noted among college graduates (31%) compared to those with less than 9th-grade education (5%). Erectile dysfunction was significantly more prevalent in individuals with BPH (p < 0.0001), with almost 50% of those with BPH sometimes or never able to hold an erection, compared to approximately 30% without BPH.

Conclusions

BPH is an independent risk factor for erectile dysfunction in the United States. Early recognition and intervention are crucial to maintaining erectile function, especially in the aging population. In our study, we show that there were two-fold odds of erectile dysfunction if benign prostatic enlargement was reported.

Disclosure

No.
(218) PHYSICIAN AWARENESS AND INDICATIONS OF 5-ALPHA REDUCTASE INHIBITOR USE FOR BENIGN PROSTATIC HYPERPLASIA IN THE PRIMARY CARE SETTING
Authors: Loloi J , Alicea D , Babar M , Shah J , Azhar U , Labagnara K , Salam A , Tang K , Robles J , Maria P
Published: December 2024

Introduction

Primary care physicians (PCPs) commonly prescribe 5-alpha-reductase inhibitors (5-ARIs) for benign prostatic hyperplasia (BPH). 5-ARIs can affect prostate-specific antigen (PSA) kinetics by decreasing PSA levels by approximately half, and therefore delay early detection of prostate cancer (PCa). Our team previously presented preliminary findings revealing a general low level of knowledge regarding the effects of 5-ARIs on PSA kinetics.

Objective

Thus, the objective of this study is to now present further, expanded data investigating PCPs’ level of awareness and indications of 5 ARI use for BPH in the primary care setting.

Methods

An anonymous 14-question survey was emailed to PCPs in the specialties of Family Medicine or Internal Medicine at a diverse, urban academic institution. Questions focused on residency graduation year, patient volume, medical practice characteristics, knowledge of 5-ARIs and their effects on PSA kinetics, role of 5-ARIs in PCa prevention, and indications for prostate biopsy referral.

Results

221 PCPs were emailed. Overall, 85 PCPs responded, yielding a response rate of 38.5%. All PCPs reported to see men >40 years of age and the majority (78.8%) reported to have prescribed 5-ARIs in practice. Approximately 39% of PCPs were not aware of the suppressive effects of 5-ARIs on PSA and 63.5% were not sure or incorrectly answered when asked about calculating the corrected PSA of a patient who is taking 5-ARIs. Furthermore, nearly 80% were not sure or would not refer a patient who is taking 5-ARIs and has an elevated corrected PSA for a prostate biopsy. 63.5% were not sure or believed that 5-ARIs may decrease the risk of high-grade PCa and 49.4% were not sure or believed that 5-ARIs are approved for the prevention of PCa.

Conclusions

Overall, our expanded culmination of data within an academic, urban institution reveals a low level of knowledge amongst PCPs as it relates to the effect of 5 ARIs on PSA kinetics and subsequently the indications for biopsy referral in these patients. Thus, this gap in knowledge may represent an important initiative to work with our primary care colleagues in caring for patients taking 5 ARIs for BPH.

Disclosure

No.
(224) ROBOTIC UNILATERAL SEMINAL VESICULECTOMY FOR CHRONIC HEMATOSPERMIA
Authors: Alwaal A , Gillan E , Popovic A
Published: December 2024

Introduction

Hematospermia is typically self-limited and warrants no surgical intervention. Chronic hematospermia however can be quite concerning and requires further investigation. We present here an unusual case of chronic hematospermia lasting 5 years in a 22-year-old patient. He had no other symptoms besides painless hematospermia which was present in every ejaculation. Patient had a PMH of depression and congenitally absent left kidney. Physical examination was within normal limits. STI/Urine testing, lab work, and scrotal ultrasound were all normal. Patient was treated with several antibiotic courses which were unsuccessful. After failing conservative medical management, he was successfully treated eventually by robotic unilateral seminal vesiculectomy in the absence of seminal vesicle cyst/tumor.

Objective

Describe a unique cause of chronic hematospermia characterized by blood pooling the left seminal vesicle in the absence of trauma, infection, tumors, and cysts. We also describe a technique in using robotic unilateral seminal vesiculectomy as a form of successful treatment.

Methods

In order to lateralize which SV was causing hematospermia, a pelvic MRI was obtained which revealed a pooling of blood in the left SV with no cysts nor tumors noted. After being counseled on the risks of surgery including erectile and ejaculatory dysfunction, the patient agreed to undergo surgical removal of the left SV. In the OR, the patient was placed supine with 30 degrees of Trendelenburg. The bowels were mobilized cranially and the DaVinci robotic arms were used to mobilize the left SV. The base of the SV duct was ligated with suture and subsequently transected. Bipolar cautery and hemostatic agents were used to achieve hemostasis.

Results

Patient stayed one night in the hospital before being discharged. He re-presented on POD#3 with abdominal pain and was found on CT scan to have a pelvic hematoma which was evacuated via robotic assisted laparoscopic approach. Patient was discharged the next day without further issue. At 6 months follow up, the patient had no symptoms. His hematospernia completely resolved. He had adequate erections with good ejaculate force and volume. Pathology of the left SV revealed chronic inflammation and vascular congestion.

Conclusions

Robotic-assisted laparoscopic unilateral seminal vesiculectomy is a viable treatment option of chronic hematospermia when the etiology of hematospermia can be lateralized to one SV. To our knowledge, this appears to be the first ever case of seminal vesiculectoy for a reason other than SV cyst or SV tumor. Erection and ejaculatory potency are risks of seminal vesiculectomy but these risks can be mitigated with good surgical technique. We suggest that the risk of post-operative pelvic hematoma from seminal vesiculectomy is not higher than that of any other pelvic surgery.

Disclosure

No.
(227) THE IMPACT OF VACUUM ERECTION DEVICES USE ON PENILE DOPPLER ULTRASOUND READINGS AND INTRACORPOREAL INJECTION DOSAGE IN PATIENTS FOLLOWING PELVIC SURGERIES
Authors: Khalaf Alla K , Mahdi M , Majzoub A , Jacob J , Slovacek H , Wang R
Published: December 2024

Introduction

Vacuum erection devices (VEDs) are widely considered to be integral in penile rehabilitation post-pelvic surgery by enhancing penile blood flow, preserving length, and facilitating erection.

Objective

This study aims to investigate the impact of VED usage on penile Doppler ultrasound (PDU) readings and the subsequent dose adjustments of intracorporeal injection (ICI) therapy in men following pelvic surgery.

Methods

We conducted a retrospective review of our institution's database to identify patients experiencing erectile dysfunction as a result of pelvic surgery. The study involved individuals from a single institution who visited the Sexual Medicine clinic, underwent PDU, utilized Trimix ICI, and had a follow-up for a minimum of one year. Our investigation comprised data gathered from 232 patients meeting these outlined criteria between 2020 and 2023. Patients were categorized into two groups: Group 1 comprising individuals using VED with ICI for a duration of at least 1 year (minimum of at least 3 times per week) & Group 2 without VED. Student T-test was used to compare various numerical variables between both groups.

Results

In general, out of the 232 patients included, 17.2% were diabetic, 51.9% were hypertensive, 24.5% had radiation therapy & 18.5% had Androgen deprivation therapy. B blocker intake was reported in 15.9% of patients. With regards to surgery type, 41.6% underwent bilateral nerve sparing prostatectomy, 25.3% underwent partial nerve sparing while 3.9% had a non-nerve sparing technique. Cystoprostatectomy was observed in 5.2% while the remaining 3.9% had other pelvic surgeries. Results of the patient demographic and clinical parameters along with the PDU readings between both groups are reported in Table 1. Notably, no statistically significant differences were observed between both groups in terms of age, HbA1c, Testosterone levels, PDU readings, or in relation to the alterations in the ICI Trimix dosage.

Conclusions

Our preliminary analysis suggests that the use of vacuum erection devices (VED) in the rehabilitation of patients following pelvic surgery does not significantly impact erectile function as measured by penile Doppler ultrasound (PDU) readings or the requirements for Trimix intracorporeal injections (ICI) in the postoperative period. While advising patients on the use of VED in conjunction with Trimix injections currently lacks robust supporting evidence, it remains a theoretically beneficial approach. Further studies are needed to definitively determine its clinical significance and move beyond the current inconclusive status.

Disclosure

No.
(231) SOLID ORGAN TRANSPLANT IS NOT ASSOCIATED WITH INCREASED COMPLICATION RATES AFTER PENILE PROSTHESIS: A TRINETX STUDY
Authors: Ward B , Thompson A , Thirumavalavan N
Published: December 2024

Introduction

Erectile dysfunction (ED) has increased prevalence among solid organ transplant (SOT) recipients than the general population. Penile prosthesis placement (PPP) allows efficacious treatment, though with concern for increased complications in this population. Here we utilize a large de-identified database to compare complication rates between men who received PPP after SOT and immunosuppression.

Objective

To determine whether risk of solid organ transplant is associated with an increased risk of penile prosthesis-related complications.

Methods

Using TriNetX Research Network, we identified men aged ≥18 who underwent PPP and SOT (kidney, lung, heart, liver, intestine, pancreas). Men were grouped into cohorts: patients with PPP excluding transplant status (control), and those with an IPP after SOT. Penile prosthetic-related complications include infection-related, mechanical, thromboembolism, hemorrhage, pain, stenosis, removal without replacement, removal with replacement, and all complications. Kaplan–Meier analysis was performed on the TriNetX platform to compare the occurrence of penile prosthesis complications between cohorts and hazard ratios were calculated.

Results

12282 patients were included in the control group and 253 patients were included in the solid organ transplant group. Multiple significant differences were observed in baseline comorbidities including Black or African American race (20% control vs 36% SOT, p < 0.0001), White race (57% vs 38%, p < 0.0001), Hypertensive disorders (52% vs 96%, p < 0.0001), cerebrovascular diseases (7% vs 19%, p < 0.0001), atherosclerosis (5% vs 21%, p < 0.0001), diabetes mellitus (31% vs 79%, p < 0.0001), overweight and obesity (20% vs 44%, p < 0.0001), nicotine dependence (11% vs 23%, p < 0.0001), malignant neoplasms of male genital organs (27% vs 16%, p0.0001), and major depressive disorder (3% vs 8%, p = 0.0002). No statistically significant differences in post-PPP complications were observed in comparison between control and SOT groups including infection-related (HR = 0.56, p = 0.832), mechanical (HR = 0.738,p = 0.95), removal without replacement (HR = 1.033, p = 0.22), removal with replacement (HR = 0.659, p = 0.661) (see Table 2). Thromboembolism, hemorrhage, pain, and stenosis outcomes all had less than 10 instances in the SOT group and could thus not be accurately assessed.

Conclusions

SOT status itself does not appear be associated with an increased risk of penile prosthesis-related complications when compared to a control population despite increased prevalence of multiple comorbid conditions.

Disclosure

No.
(241) BEYOND STRAIGHTENING: LONG-TERM SATISFACTION WITH A MODIFIED TUNICA ALBUGINEA PLICATION TECHNIQUE
Authors: Desouky E , Katz DO , Feldman-Schultz O , Levine LA
Published: December 2024

Introduction

The Tunica Albuginea Plication (TAP) procedure is a corrective surgery for penile curvature, addressing both congenital (chordee) and acquired (Peyronie’s disease(PD)) deformity. Like any surgical intervention, TAP carries potential side effects including penile shortening, palpable stitches/nodules, changes in penile sensation, incomplete correction of curvature, and potential impacts on sexual function. The modification of the Duckett-Baskin procedure, employs a minimal number of permanent sutures per case (1-3), can mitigate problems associated with the use of only permanent sutures without a higher recurrence rate. While the primary aim of TAP is to achieve a functional straightening of the penis (curvature <20 degrees), there's limited data available regarding patient perspectives and long-term satisfaction.

Objective

This study aims to evaluate patient satisfaction over the long term following the modified TAP procedure.

Methods

We collected data of patients who underwent TAP between 2019 and 2023. An 8-question survey was conducted via telephone. Satisfaction levels were graded from 1 (very disappointed) to 5 (very satisfied). Survey questions encompassed aspects such as penile length, residual curvature, penile sensation, palpable sutures, pain, erectile function, ability to engage in penetrative sex, and overall sexual satisfaction.

Results

A total of 233 patients underwent TAP, aged 15-77 years, with a follow-up period ranging from 11 to 71 months. So far, 91 patients have completed the survey (72 with PD & 19 with Chordee). Penile length emerged as a primary concern for 12% of PD patients who were dissatisfied with their length following the procedure, while none of the chordee patients expressed such concern. Dissatisfaction with palpable nodules or sutures was reported by only 2%, and dissatisfaction with residual or recurrent curvature was reported by 8%. 96% were satisfied with penile sensation. Pain/discomfort was reported as very satisfying by 99% of respondents. Erectile function was satisfactory for 94% of the cohort, with 93% reporting overall sexual satisfaction as satisfactory and very satisfactory.

Conclusions

Overall, patients perceive the long-term outcomes of our modified TAP procedure positively. Dissatisfaction primarily centered around penile length, with lesser concerns about penile sensation, indicating the necessity for increased attention to these known side effects, particularly in addressing the impact on penile length, potentially associated with PD itself.

Disclosure

No.
(242) THE IMPACT OF ENVIRONMENTAL FACTORS AND CHRONIC MEDICAL CONDITIONS ON SEMEN PARAMETERS: A TEN-YEAR LONGITUDINAL ANALYSIS
Authors: Venishetty S , Scott M , Rodriguez A , Lundy S
Published: December 2024

Introduction

The environmental and chronic medical conditions including metabolic risk factors appear to continue to negatively impact the semen qualities in men worldwide including United States. Poor semen parameters is often used as marker for underlying men’s health and can be associated with increased morbidities and overall mortality.

Objective

In this large longitudinal analysis, we aim to evaluate the correlations between variable risk factors and medical conditions and semen analysis in adult men at a large reproductive urology center.

Methods

In this ten-year retrospective chart review, male patients ≥18 of age with documented semen analyses were included. Data collected included the patients’ demographics, comorbid medical conditions recreational alcohol, tobacco or marijuana use. Semen analysis as per WHO 10th reference included sperm concentration, count and motility. Data analyzed using multivariate and univariate linear regression and logistic regression.

Results

A total of 2,322 patients were included in the study. White and black non-Hispanic men had higher rates of oligospermia and/or azoospermia compared with Asian men (p < 0.001) and had higher body mass index (BMI) (p = 0.019). Among the comorbidities, type 2 diabetes (p = 0.046), hypertension (p = 0.014), anemia (p = 0.001), chronic kidney disease (p = 0.013), and heart failure (p = 0.001) were associated with higher rates of oligospermia and/or azoospermia. Among recreational use, tobacco and marijuana use were associated with oligospermia. (p = 0.043) (Table 1).

Conclusions

In our study, environmental and metabolic risk factors and conditions appear to be significantly associated with reduced semen qualities particularly sperm concentration, count and motility. This analysis underpins this critical association between men’s health marker ie, semen analysis and underlying environmental and chronic medical conditions in men at-risk. Future studies are warranted to further exploit these association and provide appropriate medical counseling and treatment.

Disclosure

No.
(243) DELAY OF CARE NEGATIVELY IMPACTS FEMALE PARTNERS OF PATIENTS WITH MALE FACTOR INFERTILITY
Authors: Kassab J , Garcia Keeme-sayre A , Oppenheimer A , Huang J , Stocks B , Lipshultz L
Published: December 2024

Introduction

Approximately half of couples with infertility will be found to have a male factor. However, historical data has revealed that infertility is preferentially attributed to the female partner. This often-wrong assumption may cause female partners to undergo invasive and expensive procedures and treatments when the couple’s lack of fertility is ultimately due to male-related factors.

Objective

We aimed to quantify the impact of delayed urologic care for male-factor infertility.

Methods

An electronic survey was delivered through REDCap to patients who were evaluated in our clinic for male-factor infertility from January 2023 to June 2024. The survey assessed each couple’s reproductive care quantitatively and qualitatively prior to seeking urologic services at our institution. Descriptive statistics were employed to analyze the data.

Results

A total of 121 couples completed the anonymous survey. 35.5% of the couples reported experiencing early focused female gynecologic care and 13.3% sought out reproductive endocrinology and female fertility counseling prior to seeing a urologist for male infertility evaluation. Of those who first sought other specialties before investigating the possibility of male-related infertility, respondents stated that they spent a range of 2 months to 6 years on solely female reproductive care. Additionally, 51.5% considered their treatments invasive and costly. Almost half (48.7%) of all respondents wish they sought out urologic care sooner.

Conclusions

Delayed urologic care for male-related factors can result in significant premature costs, both financially and in time invested, and in invasive treatments for female partners, who are often presumed to be the primary cause of infertility. These findings highlight the need for early and equitable evaluation of both partners in infertility cases to optimize patient care and minimize unnecessary procedures. Further, the results indicate patients who did not seek urologic care earlier regretted not doing so. This delay underscores the significance of better patient education and awareness regarding male-factor infertility.

Disclosure

No.
(244) MEDICAID COVERAGE OF INFERTILITY TREATMENTS
Authors: Popovic A , Gillan E , Jain K , Alwaal A
Published: December 2024

Introduction

Infertility is experienced by 15% of couples, with up to 50% of cases related to male factors. Unfortunately, infertility treatments are expensive and infrequently covered by insurance, burdening patients and deterring access to care. However, Medicaid patients are even less likely to pursue treatments. Of 92 million Medicaid enrollees, 31 million are between the ages of 18 to 44, prime age for fertility intervention. However, transparency of Medicaid coverage of fertility interventions is low.

Objective

In this study, we evaluated Medicaid coverage status and physician reimbursement for the most common infertility-related interventions.

Methods

Physician fee schedules were accessed through state Medicaid websites for the year 2023. The fee schedules were searched for current procedural terminology (CPT) codes used for male infertility interventions. The Medicaid physician fee index was accessed for each state and linear regression analysis was performed to assess if state reimbursements were attributable to a tendency for that state to reimburse more for Medicaid services.

Results

Of the 50 US states analyzed, 49 publish accessible physician fee schedules. Tennessee requires patient claim data to be submitted before releasing fee schedules. No states offered reimbursement for microscopic testicular extraction of sperm thus requiring alternatives for coding, or the use of out-of-pocket billing. Certain procedures were covered by every state, such as testis biopsy, while others were rarely covered, such as vasovasostomy (table 1). Reimbursement patterns for several CPTs significantly varied based on the state physician fee index, although these were typically weak correlations (table 2).

Conclusions

Discrepancies in state coverage and reimbursement for fertility procedures is evident. Some of the discrepancies can be explained by state fee indexes, however the absence of clear methodology behind a state’s decision to cover fertility procedures and physician reimbursement rates both contribute to overall lack of transparency within Medicaid. This lack of transparency may be partially responsible for underutilization of infertility treatments in Medicaid patients.

Disclosure

No.
(252) INDUCING BUSINESS OR IMPROVING PRACTICE? AN ANALYSIS OF EXISTING STEM CELL TRAINING PROGRAMS FOR PHYSICIANS
Authors: Ellythy L , Addani M , Master Z
Published: December 2024

Introduction

Most US businesses offering unproven stem cell interventions (SCIs) are run by physicians, many of whom operate outside their scope of training. To date, little effort has been made to educate practicing physicians about SCIs. To circumvent the need, several businesses have begun advertising training opportunities for physicians.

Objective

To understand the current training landscape for physicians, we undertook a systematic content analysis of stem cell courses advertised on the internet.

Methods

We conducted Google searches using keywords and included onsite, online, and hybrid training programs targeting physicians or other clinicians. We systematically examined all information and identified 14 courses (6 onsite, 4 online, and 4 hybrid) offered by 11 different organizations. Courses ranged from single-day workshops to year-long programs with an average cost of $4,919 and ranged from $500 to $22,000.

Results

Nine courses listed a practicum component and ten courses listed 63 affiliated clinics, companies, and non-profit institutions. Eight organizations included learner testimonials as text and/or video with most authored by physicians and all expressed a positive tone. We analyzed marketing language used by training organizations that 6 of 14 explicitly mentioned offering assistance in marketing and/or revenue growth to learners. We also examined the backgrounds of physician faculty among organizations. Of the 7 businesses which listed faculty, a total of 172 faculty were found ranging from 4 to 71 individuals. Among the 172 faculty, 121 were physicians where we were able to determine whether they provided unproven, questionable or proven treatments within their practice. The majority of physician faculty (66%) were associated with unproven treatments, 21% offered proven treatments, and 13% offered questionable treatments. Nearly half the faculty (48%) provided 3-5 unproven therapies, 35% provided 1-2 unproven therapies, and 17% provided 6 or more unproven therapies.

Conclusions

Our results indicate that current pedagogical offerings for physicians interested in SCIs are likely to offer questionable training that is not rooted in evidence. Physicians interested in SCIs should seek training from nationally accredited organizations. The scientific community should invest in physician training surrounding SCIs.

Disclosure

No.
(255) “WHAT PUSHED IT FOR ME WAS THE OVERTURNING OF ROE V. WADE”: ASSESSING THE PATIENT-REPORTED INFLUENCE OF SOCIOPOLITICAL ISSUES ON POST-DOBBS VASECTOMY DECISIONS
Authors: Cheng L , White K , Mcnally K , Wecht A , Jarlenski M , Hwang K
Published: December 2024

Introduction

Following the June 2022 US Supreme Court decision on Dobbs v Jackson Women’s Health Organization overturning the federal constitutional right to abortion recognized since Roe, high levels of vasectomy interest and confusion regarding male reproductive healthcare options have persisted despite no direct impact to male contraception. To the best of our knowledge, the patient-reported influence of sociopolitical issues on male patients’ vasectomy decisions has not been studied.

Objective

Our objective was to characterize the impact of sociopolitical issues, including the Dobbs reversal of the right to abortion recognized since 1973, on male patients’ vasectomy decisions and timing.

Methods

Patients of a men's reproductive health outpatient clinic within a large academic healthcare system in Southwestern Pennslyvania who had initiated a vasectomy consult from July 2022 – February 2024 were eligible to participate in a survey questionnaire. Patients were called retrospectively or approach prospectively in-person. Demographics, factors influencing vasectomy, and general economic and political interest data were collected via modified Likert and short free-text answers. Chi-square, logistic regression, Mann–Whitney U, and Kruskal-Wallis tests were performed as indicated.

Results

311 patients completed the survey. Mean age of patients was 37 years of age (range: 21, 61); 11.7% (n = 30) were under 30 at time of appointment. Median number of biological children was two (IQR: 1, 3); 19.6% (n = 50) had no biological children. Patients spent on average 2.9 years (range: 0, 33) considering a vasectomy prior to deciding. Regarding factors influencing vasectomy, 31.3% (n = 80) of participants indicated sociopolitical issues as very influential in deciding to undergo a vasectomy, with 17 participants writing in the “reversal of Roe v Wade” or “abortion legislature” in response to a free-text question asking what prompted their vasectomy decision. Men with no children were seven times more likely than men with to cite sociopolitical issues as influencing their vasectomy (sociopolitical: OR = 7.3, p < 0.001). When asked how Roe would influence access to male reproductive healthcare options in their home state, 21.9% (n = 56) answered Roe would limit or prevent access to the listed options (ie, hormone replacement therapy, IVF, vasectomy, or sperm cryopreservation).

Conclusions

While recent sociopolitical and legislative issues may not directly impact male patients’ reproductive healthcare, our results demonstrate the influence broader events have on male patients’ contraceptive decisions and reproductive healthcare understanding. Furthermore, clinicians may need to proactively address uncertainty and confusion around the impact of reproductive healthcare legislature on male patients’ reproductive healthcare options.

Disclosure

No.
(257) TURNING TO TIKTOK: PRECONCEIVED NOTIONS AMONG PATIENTS ABOUT VASECTOMIES
Authors: Cheng L , Wang V , Hwang K
Published: December 2024

Introduction

TikTok, a short-form video social media platform, is used by hundreds of millions daily to share experiences and learn new information. Millennials (born between 1981 to 1996) have indicated increased trust in healthcare information accessed over TikTok; a recent study demonstrated one in five surveyed went to TikTok for health information before a physician. As vasectomy interest rises, awareness and understanding of the most commonly available information is critical for physicians to better aid patients.

Objective

Explore the reach, content, and quality of vasectomy-related TikTok content created in 2022 before and after the reversal of Roe v. Wade.

Methods

Using a proprietary TikTok application program interface (API) program, we queried the 100 most-viewed vasectomy-related videos created across two time periods in 2022: January 24–June 23 and June 24–December 23. We segmented our time periods to best represent the increase of reproductive healthcare content created following the June 24th, 2022 Dobbs v Jackson Women’s Health decision overturning Roe v. Wade (hereafter, Roe). Videos in a language other than English, lacking textual or verbal content, or deemed unrelated to vasectomies were excluded. Included videos were categorized by two raters as primarily educational, experiential, or entertainment in purpose, as well as positive, neutral, or negative tone.

Results

158 videos met inclusion criteria. Since their creation, these videos garnered more than 137.5 million views, 20.7 million likes, and 1.25 million shares. Mentions of reproductive rights increased more than 300% in videos created after Roe compared to those created before (n = 25 vs n = 7, respectively). The two raters’ Cohen’s kappa on tone and purpose categorization agreement were 0.85 (95% CI: 0.81, 0.89) and 0.91 (95% CI: 0.87, 0.94). Videos were overwhelmingly neutral to positive in vasectomy portrayal, with only 3.2% (n = 5) videos categorized as negative in tone. 22 videos (13.9%) were categorized as educational in purpose, 73 (46.2%) as entertainment, and 63 (39.9%) as experiential. Among educational videos, only seven videos were created by a board-certified MD, and only two were created by urologists.

Conclusions

Patients are increasingly turning to social media for healthcare information. Given the dearth of educational videos on social media about vasectomies and men’s reproductive health, we urge physicians to be aware of, and even actively engage in creating, this informational presence.

Disclosure

No.
(258) VASECTOMY ON TIKTOK: AN ANALYSIS OF THE TOP 50 VIDEOS
Authors: Cahill E , Reddy S , Rotker K , Honig S
Published: December 2024

Introduction

Vasectomy is a safe and effective procedure for men desiring permanent sterility. Recent research has shown a trend towards rising vasectomy volume since the Dobbs decision, especially in men under age 30. Social media is commonly used by patients seeking information prior to proceeding with surgical procedures.

Objective

We aimed to analyze videos discussing vasectomy on TikTok, with specific attention to the type of user, video content, and video engagement (ie, likes, comments, and views).

Methods

TikTok was queried for “vasectomy” and the top 50 results were analyzed. Video information collected included source of video (physician v. non-physician user), likes, comments, views, followers, and video length. Videos were further analyzed for specific content including discussion of procedure itself, permanence, failure, need for post-vasectomy semen analysis (PVSA), and reversal.

Results

50 TikTok videos were reviewed by one physician. Of the videos reviewed, 41 (82%) were created by non-physicians and 9 (18%) were created by physicians. Of the physician users, four (44.4%) were urologists. Between these two groups (table 1), videos from non-physician creators had significantly more views, likes, and comments whereas physician users had significantly more followers. Physician users were significantly more likely to discuss permanence of procedure, possible failure and need for PVSA, whereas non-physician users were significantly more likely to discuss side effects/post-procedure experience.

Conclusions

TikTok users are more likely to view and engage with non-physician user posts discussing their vasectomy experience. Physician users are more likely to mention the risks of the procedure including intent of permanence, possibility of failure, and need for PVSA. Social media is a common way for patients to obtain information about procedures. Due to 23 times more views of non-physician created videos, vasectomists should continue to counsel patients regarding the risks, benefits and alternatives of a vasectomy prior to proceeding.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Endo Pharma, Fellow, Posterity Health, HIMS, WIN fertility, Haleon.
(259) ARE COST OF LIVING AND AFFORDABILITY CONCERNS CAUSING MORE MEN TO HAVE VASECTOMY WITH NO CHILDREN? A PRE- & POST-PANDEMIC ANALYSIS
Authors: Grober E , Krakowsky Y , Fageeh A
Published: December 2024

Introduction

Most men elect for a vasectomy after the desired number of children in their family unit is complete. Generational lifestyle priorities, cost of living and affordability may also influence the decision and timing of a vasectomy. Following the global pandemic, pressures related to the affordability have meaningfully increased.

Objective

The current initiative investigates the potential impact of post-pandemic lifestyle priorities, cost of living and affordability on decision to have a vasectomy.

Methods

A prospectively maintained database of vasectomy patients of 2 high-volume urologic surgeons was analyzed. Patients were categorized into 2 groups: Group 1 (pre-pandemic) - vasectomy performed between 2018 to 2019 (inclusive); Group 2 (post-pandemic) - vasectomy performed between 2022 to 2024 (inclusive). The groups were compared with respect to patient age, martial/relationship status and the number of children prior to vasectomy. The primary study outcome was the frequency of men undergoing vasectomy with no prior children.

Results

A total of 565 vasectomy patients were analyzed including 152 men in group 1 (pre-pandemic) and 413 men in group 2 (post-pandemic). Table 1. Compares the two groups with respect to patient age, relationship status and the number of children prior to vasectomy. The percentage of men undergoing vasectomy with no previous children was significantly higher (2.7-fold) among men who completed their vasectomy following the pandemic (6% vs. 16%, X2 = 3.9, p = 0.04). The mean number of children among men who underwent vasectomy following the pandemic (1.8 children) was significantly lower compared to mem completing their vasectomy prior to the pandemic (2.1 children).

Conclusions

Following the global pandemic, significantly more men elected for vasectomy with no prior children and the mean number of children among men presenting for vasectomy was lower. Generational lifestyle priorities, cost of living and affordability may have a significant influence on the decision to complete and timing of a vasectomy.

Disclosure

No.