bluuebunny/crossref_metadata_2025 huggingface dataset:
Toroidal mantle flow beneath the NE termination of the Kuril–Kamchatka subduction zone from seismic anisotropy
Authors: Kaviani Ayoub , Rümpker Georg , Sens-Schönfelder Christoph , Komeazi Abolfazl , Shapiro Nikolai
Published: February 2024

This study presents the findings of a splitting analysis conducted on core-refracted teleseismic shear waves (SKS, SKKS and PKS, called together as XKS) and local shear waves, obtained from a dense seismological network spanning the Kamchatka Peninsula. The objective of the study is to examine the pattern of mantle flow beneath the study area through the investigation of seismic anisotropy. The peninsula is situated at the northeastern end of the Kuril–Kamchatka subduction zone, where the Kuril trench intersects with the western boundary of the Aleutian trench. The data set utilized in this study comprises waveform data from a dense network of seismic stations (99 broad-band and short-period stations for the local shear wave splitting analysis and 69 broad-band stations for the SKS splitting analysis). The seismograms were downloaded from publicly available data repositories including the IRIS Data Management Center and the GFZ Data Services (GEOFON program). The dense station coverage allows us to investigate the lateral variations in anisotropy, providing insights into the flow patterns within the mantle. The processing of the combined data sets of local shear wave and teleseismic XKS waves allowed us to partially decipher the source of anisotropy in the mantle. Small delay (splitting) times (∼0.35 s) observed from the local-S data suggest that anisotropy in the mantle wedge is relatively weak with lateral variations. Larger splitting times (∼1.1 s) observed for the XKS waves relative to local S suggest that the main part of splitting on the XKS waves occurs in the subslab mantle. On the other hand, the rotational pattern of seismic anisotropy observed by both the local S and XKS waves suggests the presence of a toroidal flow at the NE edge of the subducting slab, which affects both the mantle wedge and subslab mantle. For the regions away from the edge of the slab, the mantle flow seems to be governed mainly by the drag of the lithospheric plate over the underlying asthenosphere.
SARS-CoV-2 Variants Genotyping and Diagnostic Performance of a 2-Genes Detection Assay
Authors: Matheka Cyrus , Kilonzo Joshua , Mbugua Ephantus , Munshi Zubair , Nyasinga Justin , Gunturu Revathi , Njau Allan
Published: February 2024

Background

The emergence of the COVID-19 pandemic resulted in the unprecedented expansion of molecular testing technologies. This study aimed at evaluating the performance of the FluoroType® SARS-CoV-2 plus assay for SARS-CoV-2 detection as well as describing the detection of SARS-CoV-2 variants using the FluoroType® SARS-CoV-2 varID Q kit.

Methods

The study utilized 679 archived nasopharyngeal samples. Analytical performance and the diagnostic performance of the FluoroType® SARS-CoV-2 plus assay were determined using 320 samples and reference material. Variants identification on the FluoroType® SARS-CoV-2 varID Q assay was performed on 359 samples. The study was approved by the Aga Khan University Hospital Institutional Review Board.

Results

The FluoroType® SARS-CoV-2 plus assay’s limit of detection was verified as 1.2 copies/µL. The repeatability SD and %CV were 2.45 and 9.8% while reproducibility had an SD and %CV of 1.39 and 5.68%, respectively, for the RdRP gene. The positive and negative percent agreement were determined to be 99.4% (95% CI; 98.1%–100%) and 99.4% (95% CI; 98.2%–100%) respectively. In the variants identification, samples from the original wave had no mutations identified while 12.3%, 49%, and more than 90% of the samples during the Alpha, Delta, and Omicron waves, respectively, had detectable mutations.

Conclusions

The FluoroType® SARS-CoV-2 plus assay demonstrated analytical performance comparable to the reference method with a diagnostic sensitivity and specificity of >99%. The FluoroType® SARS-CoV-2 varID Q assay achieved rapid detection of circulating variants.
Robotic-assisted minimally invasive repair surgery for progressive spondylolysis in a young athlete: a technical note
Authors: Yamashita Daisuke , Yamashita Kazuta , Sugiura Kosuke , Morimoto Masatoshi , Manabe Hiroaki , Tezuka Fumitake , Sairyo Koichi
Published: February 2024

Presently, the invasiveness of direct repair surgery for lumbar spondylolysis is relatively high. Thus, high school and junior high school students who play sports often cannot return to sports before graduation because of the invasiveness. The use of a robotic system enabled an accurate and minimally invasive procedure. Robotic-assisted minimally invasive direct pars repair surgery is useful for young patients with progressive spondylolysis.
(020) Comparing Postoperative Outcomes and Risk Factors for Patients Undergoing Partial vs Total Penectomy for Penile Carcinoma
Authors: Liu A , Kalidoss S , Yeaman C , Bryk D , Fustok J , Shelton T , Alhameedi H , Payakachat N , Khalil M , Raheem O
Published: February 2024

Introduction

The American Cancer Society estimates that 2,200 men develop penile cancer annually and 440 men will die from the disease. Partial penectomies (PP) and total penectomies (TP) are both performed for penile cancer in the United States. Compared to TP, PP is performed more frequently to preserve functional urinary outcomes.

Objective

To date TP and PP outcomes have not been compared, in this study we compared clinical characteristics and post-operative outcomes between TP and PP conducted between 2006-2016.

Methods

We conducted a retrospective review of penile cancer patients from National Surgical Quality Improvement Program (NSQIP) database for the years 2010-2016 using international classification of diseases clinical modification (ICD-CM) ninth revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included.

Results

Partial penectomy patients were less likely to be transferred patients (7.3% vs 20.9%, p=0.002), less likely to be suffering from diabetes (25.9% vs 40.3%, p=0.026), and were more likely to have preoperative laboratory values within normal limits. TP was associated with increased preoperative white blood cell count x109, preoperative white blood cell count > 7.5x109 (p<0.001), preoperative hematocrit (p<0.001). PP patients were, in contrast, shown to have higher pre-operative creatinine levels (p=.037) and lower platelet levels than TP patients (p=.045). PP patients had shorter operation times (78.8 vs 145.5 min, p<0.001). PP patients also had decreased levels of inpatient stay length (1.67 vs 4.31, p<0.001), any 30-day post-surgery complication (7% vs 31%, p<0.001), deep incisional surgical site infection (0.5% vs 6% p=0.017), wound disruption (0.5% vs 6.0%p=0.017), intraoperative or postoperative transfusion (1.6% vs 7.5%, p=0.029), and sepsis (0.5% vs 7.5%, p=0.005), when compared to patients who underwent TP. TP patients displayed a significantly greater number of concurrent surgical procedures (p<0.001), when compared to PP patients. There was no information on urinary, sexual, and erectile outcomes in the database.

Conclusions

PP is associated with fewer post-operative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures. Total penectomy is associated with a greater proportion of patients suffering from comorbid conditions, suggesting that TP patients are at higher risk for post-surgical complications and longer hospital stays. There is a gap in reported data pertaining to post-operative sexual function and erectile outcomes for PP at a national level.

Disclosure

No.
(031) Effects of Gender Affirming Hormone Therapy vs. Puberty Blockers on Sexual Function and Desire
Authors: Finegan J , Anger J , Okamuro K , Marino-Kibbee B , Newfield R , Marinkovic M
Published: February 2024

Introduction

Many transgender and nonbinary (TGNB) individuals seek out puberty blockers (PB) to stop the progression of unwanted changes from endogenous puberty and/or gender affirming hormone therapy (GAHT) to aid in their medical transition. There has been limited research assessing the effect of these hormone therapies on sexual function and desire, especially in comparing GAHT and PB+GAHT.

Objective

Our aim was to compare the effect of GAHT and PB+GAHT on sexual function and desire of TGNB individuals during or following hormone therapy.

Methods

We performed an IRB approved two institutional study on the effect of GAHT and/or PB on sexual function and desire in adults. The GAHT group (n=12) included individuals who started GAHT (estrogen or testosterone) >18 years old. The PB group (n=10) included subjects with current or past history of GnRH agonist use (>10 years old). Enrolled subjects completed the validated Changes in Sexual Functioning Questionnaire (CSFQ). The CSFQ was validated in adults to assess medication-related changes in sexual functioning. The questionnaire is specific to sex assigned at birth with a male and female version. The answers were scored in total and separated into sexual function and sexual desire subscales. Scores in each group were compared using unpaired t-tests.

Results

A total of 22 TGNB (16 assigned male at birth and 6 assigned female at birth: 14 transgender women, 5 transgender men, 3 non-binary) subjects ages 18-25 completed the CSFQ about the effect hormone therapy had on sexual function and desire. There was no difference between groups in total scores (t = 0.8, p = 0.05) or in categories of sexual function (t = 0.3, p = 0.05) and desire (t = 0.8, p = 0.05). There were an equal number of participants in both groups whose results showed sexual dysfunction in total (n=2 per group) and in categories of sexual function (n=7 per group) and desire (n=3 per group). The cause of their dysfunction is unclear at this time and is to be investigated in the future. Interestingly, despite meeting quantitative criteria for sexual dysfunction, 6 participants answered that their sexual life brings them “much” or “great” enjoyment or pleasure.

Conclusions

Based on our results, while there were >70% of subjects in each group with impaired sexual function, there were no differences in effect on sexual function and desire between subjects on GAHT vs. PB+GAHT. Additionally, the scores for both groups did not differ substantially from scores of cisgender individuals (Keller, et al 2006). In fact, both the GAHT and PB+GAHT groups scored higher on average in the sexual desire category compared to cisgender individuals. Prospective data collection will help us clarify further whether starting age of pubertal blockers and hormone therapy affects sexual function and desire.

Disclosure

No.
(032) Experience with Gender Affirming Hormones and Puberty Blockers: A Qualitative Analysis of Sexual Function
Authors: Finegan J , Marinkovic M , Okamuro K , Marino-Kibbee B , Newfield R , Anger J
Published: February 2024

Introduction

Gender affirming hormone therapy (GAHT) is part of the transition for many transgender and nonbinary (TGNB) individuals. Additionally, it has become increasingly more common for TGNB youth to receive puberty blockers (GnRH agonist) to halt the pubertal progression. There have been few studies investigating sexual function and desire either during or after puberty blockers (PB) and/or GAHT.

Objective

Our aim was to qualitatively evaluate the sexual experience of TGNB individuals during or following PB and/or GAHT, and outline any potential differences between the two groups.

Methods

We performed an IRB approved two institutional study on the effect of PB and/or GAHT on sexual function and desire. The GAHT group (n=16): individuals who started GAHT (estrogen or testosterone) >18 years. The PB+GAHT group (n=10): subjects with current or past GnRH agonist use +GAHT. All 26 enrolled subjects were interviewed using an open-ended topical guide. Qualitative analysis was performed by hand coding the interview transcripts using Constructivist Grounded Theory qualitative methods.

Results

A total of 26 TGNB (20 assigned male at birth, 6 assigned female at birth: 18 transgender women, 5 transgender men, 3 non-binary) subjects ages 18-25y were interviewed about the effect of PB and/or GAHT on their sexual function and desire. Our analysis uncovered several themes that were consistent between groups (Table 1).

Conclusions

Themes were similar for both groups. Half the participants in each group reported feeling no regrets regarding hormone therapy, and the other half reported that they wished they had started hormones sooner. Two notable differences were identified between groups: those on PB+GAHT reported “less dysphoria” as a positive change in sexual desire, and the GAHT group reported more enjoyable sexual experiences since being on hormones. Interestingly, results did not reveal any significant differences between groups. The most prominent theme that arose in both groups was that the positive changes in sexual function and desire outweighed any negative changes that arose.

Disclosure

No.
(047) Practice Patterns for Inflatable Penile Prosthesis Revisions Within a Large Fully Integrated Healthcare System
Authors: Krug A , Ye N , Lee J , Abdelsayed G
Published: February 2024

Introduction

Revision Inflatable Penile Prosthesis (IPP) surgery is considered to be more surgically complex than virgin IPP implantation. Not all implanters perform revision surgery. Moreover, there is a paucity of data on the practice patterns of implanters regarding revision surgery. We aimed to evaluate the practice patterns of revision vs virgin inflatable penile prosthesis implantation within a large fully integrated healthcare system.

Objective

We aimed to evaluate the practice patterns of revision vs virgin inflatable penile prosthesis implantation within a large fully integrated healthcare system.

Methods

After Institutional Review Board approval, we reviewed the Kaiser Permanente Southern California (KPSC) database for all IPPs implanted within a 10 year period (2009-2019) at 15 medical centers. Patients undergoing virgin and revision penile prosthetic surgery were identified using CPT codes. Preoperative patient characteristics, intra-operative and postoperative outcomes were obtained via retrospective chart review. Univariate and multi-variate logistic regressions were performed.

Results

Between 2009 and 2019, 1,093 IPP surgeries were performed at KPSC, 115 of which were revision cases (10.5%). A total of 66 surgeons performed at least 1 IPP surgery (median=5 IPPs/surgeon, Range 1-160). Yet, revision IPPs were performed by only 32 surgeons, of which 4 surgeons were responsible for 61 of the revisions (p<0.05). When compared to virgin cases, revision cases had a longer median operative time (121 mins vs 96 mins, p <0.001), were more likely to be a penoscrotal approach (OR 3.17, p<0.05), have an ectopic reservoir placement (63.5% vs 35.7%, p<0.001), and significantly less likely to have a concurrent procedure done (OR 0.21, p<0.05) all based on multivariable logistic regression analysis. Nevertheless, device infection rates were not significantly different (revision 2.6% vs virgin 4.5%, p=0.43). There was no difference in intra-operative complications between revision and virgin cases (2.6% vs 1.4%, P=0.5). Median follow up was 4.1 years.

Conclusions

To our knowledge, this is one the largest series of revision IPPs done at multiple centers among more than 30 surgeons with long term follow up. Our data suggests that most IPP revisions are done by a select few implanters. Despite longer operative times, device infection rates were less than virgin cases, though not statistically significant. Within our large fully integrated healthcare system, in the hands of high-volume revision implanters, device infection and intraoperative complications rates remain quite low. These findings could help implanters counsel future patients regarding revision IPP surgery.

Disclosure

No.
(051) Safety of Novel Hyaluronic Acid Dermal Filler Injections for Penile Girth Enhancement
Authors: Pearlman A , Gumpf K , Moore W , Clavell J , Kansal J , Milhouse F , Tatem A
Published: February 2024

Introduction

Limited data exist regarding safety of penile girth enhancement treatments. Reported options for girth enhancement include injections of autologous fat, liquid silicone, hyaluronic acid (HA), or polymethyl-methacrylate, grafting with dermal fat, porcine dermal acellular matrix, or acellular collagen matrix, and surgical placement of a silicone implant.

Objective

The purpose of our study was to retrospectively evaluate safety in a cohort of men undergoing penile girth enhancement with HA dermal filler at a single site by reporting on post-procedure complications.

Methods

We performed a retrospective review of men who underwent penile girth enhancement with HA dermal filler from August 2020 through April 2023.

Results

471 men underwent penile girth enhancement with HA dermal filler. Two patients experienced injection site infections related to non-compliance post treatment with infection resolution after completing a course of oral antibiotic. One patient reported urinary tract infection symptoms shortly after HA dermal filler procedure and subsequently underwent additional filler injections without recurrence of urinary symptoms. One patient underwent reversal with hyaluronidase after his initial treatment. Three patients developed granulomas which were completely resolved with a single treatment of hyaluronidase. All three of these patients underwent additional HA injections without granuloma formation. Three patients experienced priapism treated without long term sequelae when intracavernosal injection (ICI) therapy was used for tumescence at time of filler injection. Once ICI was no longer used, no patients reported priapism. No patients reported erectile dysfunction or loss of sensitivity.

Conclusions

Our study suggests that injection of HA dermal filler may be a safe option for men interested in penile girth enhancement. While rare complications may occur, our research suggests they are easily treatable in the outpatient setting without long term sequelae.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: PhalloFill.
(052) Penile Length Enhancement with Suspensory Ligament Release, Corporal Advancement, and Periosteal Stabilization
Authors: Cook B , Rubin J , Brennan M
Published: February 2024

Introduction

Penile shortening is a common complaint with multiple etiologies. To date, safe and efficacious options have been limited. Release of the penile suspensory ligament has been described for penile augmentation with a reported increase in penile length, However, a simple release of the suspensory ligament sacrifices the stability of the erect penis. We propose a novel technique of dividing the penile suspensory ligament while simultaneously advancing the corporal bodies and maintaining penile stability with periosteal anchoring of the corpora to the pubic symphysis.

Objective

We demonstrate a method to increase penile length by releasing the suspensory ligament while simultaneously performing corporal body advancement and anchoring of the corpora to the periosteum of the pubic symphysis.

Methods

An IRB protocol was submitted to the State University of New York at Buffalo IRB committee. The project was found to be IRB-exempt. A test procedure was performed on a male cadaver. A 3cm transverse infrapubic incision was made one fingerbreadth superior to the dorsal aspect of the penis. Scarpa’s fascia and the fundoform ligament were dissected to expose the suspensory ligament and dorsal phallus. Stretched penile length was measured. The suspensory ligament of the penis was released and the corporal bodies were advanced. A 2-0 Ethibond suture was placed through the periosteum of the inferior aspect of the pubic symphysis and tunica albuginea bilaterally in an intervascular manner. Stretched length was again measured with an increase of approximately four centimeters observed.

Results

In our cadaveric model, simultaneous penile suspensory ligament with corporal advancement and reattachment resulted in a four-centimeter increase in stretched penile length.

Conclusions

Simply releasing the suspensory ligament may lead to penile instability, scar tissue formation, and retraction of gained penile length. In this cadaveric model, we demonstrate suspensory ligament release with stabilization of the phallus is viable and may offer a method to increase stretched penile length.

Disclosure

No.
(055) LRRC8A-VRAC Controls Superoxide Anion Flux in Diabetic Vasculogenic Erectile Dysfunction
Authors: Vieira Dos Santos C , Rodrigues Dos Passos Jr. R , Choi H , Panja S , Wilczynski S , Lamb F , Facholi Bomfim G , Webb RC , Priviero F
Published: February 2024

Introduction

Erectile dysfunction (ED) may be an early marker for cardiovascular diseases, and it is often associated with an hypercontractility of the corpus cavernosum (CC) as a consequence of increased reactive oxygen species (ROS), which favors the flaccid state of the penis. Leucine Rich Repeat Containing 8 (LRRC8A) Volume Regulated Anion Channels (VRACs) regulates Nox1 and modulates the extracellular production of superoxide anion (O2•-). Downregulation of LRRC8A is associated with decreased production of O2•- and we have demonstrated improved relaxation and reduced contraction of the pudendal artery in LRRC8A knockout mice.

Objective

We hypothesized that the role of LRRC8A in contractile responses to phenylephrine (PE) and electrical field stimulation (EFS) in the CC of diabetic mice would be exaggerated compared to that in normal mice.

Methods

To test this hypothesis, the CC of diabetic (dbdb-/-) mice was mounted in a myograph, and contraction elicited by PE or EFS was performed in the presence of apocynin (non-selective NOX inhibitor), GKT137831 (NOX1/4 inhibitor) and montelukast (LRRC8A inhibitor). In LRRC8A KO dbdb-/- mice, contractions to PE and EFS were obtained in the absence or in the presence of GKT137831.

Results

In the CC, the maximal contraction to PE was increased in diabetic animals, and in the presence of 3 mM of apocynin, the contractile response was markedly diminished in both control and diabetic mice. The LRRC8A inhibitor, montelukast, significantly reduced PE-induced contraction of the CC reaching maximal contraction of 69 + 7% and 65 + 10% in the control and diabetic group, respectively, compared to the contraction in the absence of the inhibitor. In the presence of the Nox1/Nox4 inhibitor, GKT137831, the contraction elicited by PE was reduced only in the diabetic group (68 + 9% of the maximal contraction), whereas in the control group this reduction was not significant (82 + 14% of the PE-maximal contraction). In the LRRC8A KO dbdb-/- mice, the contraction to EFS was similar to dbdb-/-, however, GKT137831 reduced the contraction to EFS with lesser magnitude of inhibition in the LRRC8A KO dbdb-/- mice (35% of inhibition) compared to dbdb-/- mice (50% of inhibition), suggesting that the participation of O2•- in the contractile response was reduced by the lack of functional LRRC8A.

Conclusions

LRRC8A modulates the contractile response of the CC induced by α-adrenergic stimulation and in diabetes, this may be associated with O2•- production, which plays a role in the development of ED. Inhibition of LRRC8A may be a therapeutic target to prevent hypercontractility of arteries and CC in vasculogenic ED.

Disclosure

No.
(060) Evaluation of the Mechanical Properties of the Human Tunica Albuginea
Authors: Colombo A , Chuang E , Kandabarow A , Mckenna K , Le B , Mcvary K
Published: February 2024

Introduction

The penis is in its essence a biomechanical implement and the Tunica Albuginea is the main load-bearing tissue during erection and its biomechanical properties are critical to understanding the penile physiology and the expansion of corpora cavernosa. There is surprisingly a paucity of data surrounding the biomechanical properties of the (TA) in literature.

Objective

We previously quantified the Young’s modulus and ultimate tensile strength (UTS) of TA in primates and we now compare these values with human TA tissue.

Methods

Strips of TA were dissected from patients undergoing penectomy in both longitudinal and circumferential orientations. We measured the thickness, the width and the length of every sample in three different locations for statistical purposes and we generated stress-strain curves via mechanical extensometry using an Instron machine. From this curve the Young’s modulus (a measure of stiffness) and ultimate tensile strength were calculated. Comparisons between human and baboon values were performed with a t-test.

Results

Six samples from 3 penes produced a mean Young’s modulus of 8.1 MPa (SD 1.7) longitudinally (n=3) and 10.3 MPa (SD 3.1) circumferentially (n=4). The mean ultimate tensile strength was 1.8 MPa (SD 0.6) longitudinally and 1.7 MPa (SD 0.1 MPa) circumferentially. These values show that human tunica albuginea has a stiffness between cartilage and cancellous bone. In comparison with baboons (Papio anubis), human samples had a lower Young’s modulus longitudinally (8.1 vs 34.0, p <0.01) but not circumferentially (10.3 vs 11.7, p=0.32). Additionally, the human samples had a lower maximum stress longitudinally (1.8 vs 4.3, p=0.01) but not circumferentially (1.7 vs 2.0, p=0.29). These data show that baboon TA is stiffer and stronger longitudinally than human TA.

Conclusions

These measures of fresh human TA show some variation between human and primate models and support the need for fresh human tissue measurements to characterize the mechanical properties of the penis. These data will be critical in developing in silico models that can be used to investigate mechanical disease states of the penis and predict tissue/prosthesis interactions.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Uronext.
(069) Markers of Neovascularization and Neurogenesis May Change After Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction
Authors: Matthew A , Coffey S , Nguyen T , Sapao P , Klausner A , Smith R , Teves M , Krzastek S
Published: February 2024

Introduction

Low-intensity extracorporeal shockwave therapy (LiESWT) is thought to treat erectile dysfunction (ED) but the mechanism remains elusive. It is believed that LiESWT may work by stimulating neovascularization and nerve regeneration as demonstrated in animal models by histologically increased angiogenesis-related growth factors and neuronal factors including vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), neuronal NOS (nNOS) and brain derived-neurotropic factor (BDNF). Given its prolific use, a thorough understanding of the mechanism of action of this therapy at a cellular level is critical prior to recommendation of this therapy on a larger scale.

Objective

Objective data post LiESWT is sparse. In this study, we aimed to determine whether markers for neovascularization and nerve regeneration can be detected in the serum of penile tissue in men following LiESWT treatment. We hypothesized that LiESWT results in appreciable increases in vascular and neuronal factors post therapy.

Methods

Patients were prospectively enrolled in a clinical trial of LiESWT for ED. Patients received 12 bi-weekly LiESWT treatments of 0.2mJ/mm2 at 5Hz, 1500 shocks delivered per treatment, with follow up at 1-2 weeks, 4-6 weeks, 3 months and 6 months post-treatment. Cavernosal penile blood samples were obtained prior to treatment and at each visit post-treatment. The concentrations of eNOS, nNOS, VEGF, and BDNF in penile plasma samples were measured using Enzyme-Linked Immunosorbent Assay (ELISA) with specific commercial kits, following the protocols provided by the manufacturer.

Results

Twenty-five patients completed all five study visits. Mean patient age was 63. Mean baseline IIEF-EF score prior to treatment was 14.24 (±1.21). At the time of data analysis, plasma samples from 9 men were analyzed for BDNF, eNOS, and nNOS levels using the ELISA assay, and samples from all 25 men were analyzed for VEGF. BDNF levels demonstrated a sustained decrease after the first treatment (P = 0.0001, Figure 1A). Levels of eNOS were noted to trend upward, but no significant changes in eNOS, nNOS or VEGF levels were noted.

Conclusions

To our knowledge, this is the first study in human tissues to attempt to quantify objective measures of neurogenesis and neovascularization in penile tissue following LiESWT for ED. Though our N is small, our results suggest that LiESWT may decrease BDNF levels after initial LiESWT treatment while VEGF, eNOS and nNOS levels remain unchanged. The clinical significance of these findings is currently unknown, as our findings are not consistent with histological studies in animals which demonstrate upregulation of these markers in penile tissues. However, we believe this represents a promising first step in attempting to understand the effect of LiESWT at a tissue level in men undergoing LiESWT.

Disclosure

No.
(077) Development of a Vaginal Dilator and Home Insemination Device for Cis-And Transgender People, Based on Actual Pelvic Anatomy
Authors: Sandhu S , Mallavarapu S , Garcia M
Published: February 2024

Introduction

Genital gender-affirming surgery (gGAS) is a rapidly evolving surgical field. Specific to feminizing gGAS, one surgical option pertains to vaginoplasty with creation of a neovaginal canal. Given this canal is commonly lined with skin, peritoneum, or colon, women who undergo these procedures as part of their gender affirmation must commit to life-long self-dilation and douching to maintain canal patency and hygiene. Current commercially available dilators and douches are designed for cisgender anatomy, and are either straight, or, have an abrupt upward curve at the tip, inconsistent with neovaginal canal anatomy, which also lacks the elasticity of a cisgender woman’s vagina, making it sensitive to dilator shape, and douche nozzle length. In addition, many LGBTQ+ individuals with a uterus seek pregnancy without a male sexual partner, but few devices exist which cater to this specific population.

Objective

1) To design a vaginal dilator which more accurately reflects pelvic and vaginal canal anatomy, 2) Design a novel dilator which combines dilation, douching, and depth measurement functions, and 3) Modify our new dilator-douche device for use with semen for home insemination by both cis- and transgender women, and, transgender men seeking to become pregnant.

Methods

A radio-opaque catheter was placed into the neovaginal canal of 12 transgender women who underwent vaginoplasty with canal creation. C-Arm fluoroscopy delineated canal curvature based on the catheter. In addition, gynecologic texts and instruments were examined to ascertain the shape of a cisgender woman’s vaginal canal. Based on these findings, a novel dilator was designed and 3-D printed.

Results

A smooth “S-shape” was found in the vaginal canal of both cis- and transgender women, consistent with the shape of cervical dilators. In cisgender women, the vaginal vault, which is elastic, is closer to the introitus than that of transgender women. The cervix is typically anteriorly located between 0.5 to 4cm proximal to the posterior fornix. Our vaginal dilators (Figure 1a) (five, each 8-12cm circumference) and insemination device (Figure 1b-c) (9cm circumference) reflect the same smooth S-shaped design. Our dilators have depth markings, side-wall grooves to allow air and liquid to pass, and, can be fitted with a douche-bulb to maintain hygiene. Our insemination device can accommodate a 10cc syringe and has a recessed anterior wall 0.5-4cm from the tip to deposit semen around the cervix for conception.

Conclusions

The design improvements shown with respect to this dilator-douche device should make dilation and douching more comfortable, improve hygiene, and, decrease the incidence of granulation tissue. Our inseminator offers a private, at-home means of achieving fertilization for both cisgender and transgender individuals. (U.S. Patent 11638808; Neovaginal and vaginal health devices)

Disclosure

No.
(101) Erogenous Zones of the Head and Neck: A Comparison Study Between Cisgender Men and Women
Authors: Stelmar J , Zaliznyak M , Isaacson D , Duralde E , Gaither T , Topp K , Sandhu S , Mallavarapu S , Smith S , Garcia M
Published: February 2024

Introduction

Erogenous zones (EZ) of the body elicit feelings of sexual arousal in response to tactile stimulation. While previous studies have defined general whole-body maps and detailed maps of the genitalia, there is limited data that defines extragenital structures and compares findings between cisgender men (CM) and cisgender women (CW).

Objective

This study aims to describe EZs of the head and neck, and to describe differences in EZs that exist between CM and CW.

Methods

A total of 403 CM and 451 CW (mean age 47.2 ± 16.8 and 48.9 ± 15.5y respectively, p>0.05) were recruited and administered an anonymous, online questionnaire via Qualtrics. Standardized anatomic illustrations with 11 predefined areas of the head and neck were presented to respondents, who were instructed to select which structure(s) bring them pleasure when touched during sex. For each EZ selected, the respondent was asked to rate its importance to their sexual pleasure on a 10-point Likert scale, from “1-not at all important” to “10-extremely important.” Differences in frequency of selection and importance ratings were analyzed via Qualtrics Stats iQ software using Fisher’s exact test and t-tests, with p>0.05 indicating statistical significance.

Results

Of the 11 head and neck EZs, the tongue, neck, ear, and lips were the most frequently selected structures (Figure 1). A comparison between CM and CW revealed that CM were significantly more likely to indicate erogeneity of the tongue (51.4% vs 41.3%, p<0.05) and nose (5.2% vs 2.0%, p<0.02). CW were more likely to indicate the posterior neck as erogenous (40.1% vs 30.3%, p<0.01). Statistically significant differences in ratings revealed that CM were more likely to indicate higher levels of importance to sexual pleasure of the cheek (6.3 ± x vs. 5.1 ±, p<0.03) and forehead (5.3 vs. 2.8, p<0.001).

Conclusions

EZs of the head and neck were centralized around the mouth, neck, and ears. CM were more likely to select structures around the mouth while CW selected the anterior and posterior neck. While some statistically significant differences were found in EZs between CM and CW, the majority of similarly selected and rated EZs indicate a pattern of comparable overall distributions of extragenital EZs. Findings from this study highlight the presence of extragenital erogeneity, and the importance of prioritizing the preservation of tactile sensation in head and neck surgeries (or communicating these risks to patients during preop consultations). These EZ maps may furthermore be used in future studies to compare pre- versus postoperative changes in erogenous sensation amongst patients who undergo head and neck surgery.

Disclosure

No.
(114) Mathematical Model for Peyronie's Disease
Authors: Machado B , Marsh J
Published: February 2024

Introduction

Peyronie's disease may affect up to 20% of men worldwide. After the curvature, penile length loss is the most common complaint. The severity of the curve angle is associated to with penile length and volume loss.

Objective

Create a theoretical mathematical formula to help clinicians and patients to estimate the penile length and volume loss in patients with Peyronie's Disease.

Methods

Applying Euclidean Trigonometric principles an geometric axioms a mathematical formula was created. Inserting measurements that are commonly retrieved from patients with Peyronie's disease, i.e., Penile girth, length, and curvature angle in the formula, a 2-d dimensional triangle is created. Applying the torus equation the arc length and angular deviation is found and the the penis volume and lenght loss can be calculated.

Results

A mathematical formula to evaluate the penile volume and length loss was created accounting for the deviations in the penile geometry occuring in patients with monoplanar and multiplanar Peyronie’s disease deviations.

Conclusions

This formula provides a mathematically accurate method to predict potential loss of penile length and volume in patients with monoplane or multiplanar Peyronie's disease. The model can be an additional tool for advising patients between shortening or lengthening procedures and help physicians and patients set expectations for results after surgical procedures.

Disclosure

No.
(119) Impact of Ethnicity on Clinical Outcomes of Intralesional CCH in Peyronie's Disease Patients Across Kaiser Permanente Southern California Database
Authors: Okene M , Hsieh T , Mirheydar H
Published: February 2024

Introduction

Intralesional CCH injection is an effective treatment for Peyronie’s disease (PD) that utilizes collagenolytic enzymes to break down collagen plaque, thus reducing the penile deformity. The IMPRESS I and II clinical trials demonstrated efficacy of CCH in a predominant Caucasian population of men (95.8%). Little is known about treatment efficacy in the non-Caucasian population.

Objective

Using Kaiser Permanente’s ethnically diverse database, we sought to study the impact of race on CCH treatment outcomes.

Methods

This study examined the efficacy of intralesional CCH injection in a large healthcare system over 15 years. We defined treatment efficacy as percent change in penile curvature abnormality from baseline after a maximum of 4 treatment cycles. Impact of comorbidities on CCH efficacy was also examined. Patients with ventral curvature or initial curvature <30 ̊ or >90 ̊ were excluded from analysis. Standard statistical analysis was performed.

Results

112 patients underwent CCH therapy and were included in this analysis. 46.4% of men completed all 4 cycles. Among men who received CCH, 66.1% were Caucasian, 22.3% Hispanic, and 9.8% African American. For co-morbidities, 87.5.% of men were not diabetic, while 22.3% of men had erectile dysfunction. The mean baseline pre-injection penile curvature was 51.63 degrees (range was 32-87 degrees). Caucasian men had the largest treatment response to CCH (45.6% decrease in penile curvature) compared to African American men (43.7%) and Hispanic men (40.5%), p = 0.9554. Non-diabetic men had a larger treatment response to CCH (44.9% decrease in curvature versus 39.3% in diabetics, p = 0.4726). Younger Men (age 18-44) also experienced a greater treatment response compared to other age groups (57.9% reduction in curvature, p = 0.171). There was a significant difference in number of cycles completed across different ethnicities (p = 0.0220). Hispanic men were significantly less likely to complete all 4 cycles of CCH compared to Caucasian and African American men (p=0.0004). Only 28.2% of Hispanic men completed all 4 treatment cycles. 48% of Hispanic patients report the need of language interpretation services during health appointments.

Conclusions

This is the largest post-market analysis of CCH treatment outcomes in a racially diverse PD population. Caucasian men had a greater treatment response after CCH injection possibly due to higher rate of completing all 4 treatment cycles. Nondiabetic men and younger men (aged 18 to 44) also had a greater treatment response after CCH injection. Hispanic men were significantly less likely to complete 4 cycles of injection therapy; possible explanations include language barriers. Future study is needed to determine if patient resources prepared in Spanish can improve treatment outcomes in Hispanic men with PD, and reduce these health care disparities observed in our study.

Disclosure

No.
(131) Predictors of Success with Early Antibiotic Therapy for Penile Implant Infection: Patients from a Prospective Randomized Study Comparing DNA Sequencing versus Traditional Cultures
Authors: Henry G , Stuart A , Chung P , Diaz N , Lentz A , Natale R , Perito P
Published: February 2024

Introduction

Traditional culture is the current standard-of-care to determine therapeutic antibiotics for patients suffering from penile prosthesis (PP) infections. However, approximately 30% to 50% of PPs removed for infection are culture negative. Next-generation sequencing (NGS) of DNA has proven to be beneficial in its thorough analysis of biofilm composition. However, there are no existing clinical measures for identifying presenting characteristics of patients of successful or failed antibiotic treatments.

Objective

The purpose of this early dataset is to identify patient characteristics predicting success or failure with early antibiotic therapy in the setting of penile implant infection.

Methods

Upon institutional review board approval, adult men undergoing treatment for mild to moderate clinical (non-systemic) PP infection are enrolled after providing informed consent. Enrollees are randomized into one of two analytic arms – traditional culture or NGS. Traditional culture and NGS samples are collected upon clinical presentation prior to initiation of antibiotics. Patients are started on set empiric antibiotics and randomized to traditional culture or NGS. Patients follow up within ten days of antibiotic initiation and at six months complete a safety and compliance questionnaire which assesses symptoms, device function, and patient satisfaction.

Results

Of the 8 patients enrolled in the study, 4 eventually underwent device explantation due to worsening infection within 7 days of initiating empiric antibiotic treatment. The other 4 patients went on to the next step in the protocol. In evaluating these 2 groups: if there was penile shaft tenderness (2/4) this required PP removal prior to 7 days; while if there was no penile tenderness, the patient ended up with the device surviving at least 10 days. Patients on the NGS arm included those that survived the entire 6-month period. Currently, there are 11 active sites already participating; more patients and more centers are being enrolled in the study.

Conclusions

Penile shaft tenderness was a more common presentation in patients who failed early antibiotic treatment for penile implant infection. Recruitment of additional patients to this prospective, randomized controlled trial will help to identify additional favorable presentations of penile implant infection in addition to comparing the utility and outcomes of NGS and culture.

Disclosure

Yes, this is sponsored by industry/sponsor: Microgen Dx.

Clarification: Industry initiated, executed and funded study.

Any of the authors act as a consultant, employee or shareholder of an industry for: Microgen Dx.
(144) Contemporary Trends in Testicular Prosthesis Placement: An Analysis Of U.S. Claims Data
Authors: Seranio N , Muncey W , Cox S , Glover F , Belladelli F , Del Giudice F , Li S , Zhang C , Eisenberg M
Published: February 2024

Introduction

Testicular prosthesis placement (TPP) is a procedure associated with high patient satisfaction that improves body image and quality of life following orchiectomy. However little information exists regarding contemporary TPP as placement for metastatic prostate cancer has fallen out of favor and gender affirming surgery is on the rise.

Objective

This study sought to describe current trends in TPP in the United States.

Methods

Using the IBM® MarketScan® Research Databases (DOI 10.57761/ray7-1g16) we performed a retrospective analysis from 2007 to 2021 and identified 1,059 adult men who had undergone placement of a testicular prosthesis based on ICD-9 codes.

Results

The median age of TPP was 34 (IQR 23-44; range 18-80). At least 433 (35.5%) men were married. A total of 536 (43.8%) men had orchiectomy concurrently at the time of TPP. Just under half of the cases prescribed antibiotics postoperatively (44.9%). The five most common indications at the time of TPP were malignancy (54.7%), gender dysphoria (10.4%), cryptorchidism (9.6%), atrophy/hypofunction (6.6%), and testicular torsion (3.9%). A total of 46 (3.8%) of men underwent subsequent removal of their prosthesis. A diagnosis of gender dysphoria was associated with prosthesis removal (odds ratio (OR) 4.51, 95% CI 2.10-9.86). No significant associations were seen for other indications, Charlson Comorbidity Index scores, post-operative antibiotic use, tobacco use, psychiatric diagnoses, or prior pain diagnoses. Rates of testicular prosthesis placement for a diagnosis of gender dysphoria are rapidly increasing while placement for prostate cancer is increasingly rare.

Conclusions

Among the studied population the primary indication for testicular prosthesis placement is for testicular cancer, contradicting the findings of earlier series. We also show that TPP for gender dysphoria is increasingly common. Additionally, we report rates of explanation and complications related to prosthesis that are higher than what is described in the literature.

Disclosure

No.
(145) Utilization of Crowdfunding for Genital Gender Affirmation Surgery
Authors: Sun H , Pei E , Rhodes S , Mishra K , Gupta S
Published: February 2024

Introduction

Though the incidence of gender-affirming surgery (GAS) is increasing within the United States (US), many transgender and gender diverse individuals are denied insurance coverage for these procedures. Some turn to crowdfunding for financial assistance.

Objective

We aimed to determine characteristics of fundraisers for genital GAS within the US and factors associated with greater funding.

Methods

GoFundMe is the largest individual crowdfunding platform in the US and was queried in January 2023 using search terms related to genital GAS such as “bottom surgery”, “gender affirming surgery”, and “transgender surgery”. Duplicate, outside the US, non-English, and non-relevant campaigns were excluded. For each campaign, organizer’s state, fundraising goal, amount raised, number of donors, and campaign description were retrieved. Generalized additive models were created to determine the relationship of predictors with achieving full funding. An additional Bayesian estimation approach model was created to determine the relationship of predictors with overall campaign progress.

Results

From 4,921 viewable campaigns, 1,497 met inclusion criteria for analysis. All states were represented with the greatest number in California (n = 155, 10.4%). The median amount raised was $195 (IQR 0-2,270) of a goal of $12,000 (IQR 5,000-30,000); 87 (5.8%) campaigns were fully funded, while 555 (37.1%) had no funding. Three-quarters of campaigns were less than one-third funded. Of 1,315 campaigns where transition type was indicated, 76.6% (n = 1,007) were for FGS and 22.7% (n=298) were for MGS. Though the average marginal effect of increasing the goal was to decrease funding progress (FGS -0.329, 95% CI -0.445 to -0.0248, MGS -0.589, 95% CI -1.071 to -0.347), an increase in funding progress was seen with increasing the goal from $1,000 to $10,000 for FGS. The average marginal effect of increasing word count was +0.26 (95% CI 0.18 to 0.36) with the greatest effect between 100 to 500 words. The average marginal effect of increasing campaign age on progress was +0.35 (95% CI 0.27 to 0.47), with the greatest effect between 500 to 1000 days.

Conclusions

Crowdfunding is an attractive option for TGD individuals who need financial support for genital GAS and related expenses, but the majority of individual fundraisers on GoFundMe will only raise one-third or less of their goal. Specific windows of funding goal, word count, and campaign age are associated with greater odds of campaign progress. Such information can be used to counsel patients who are seeking financial assistance for genital GAS.

Disclosure

No.