bluuebunny/crossref_metadata_2025 huggingface dataset:
(239) SIMULTANEOUS IMPLANT OF VIRTUE MALE SLING AND TITAN TOUCH PENILE PROSTHESIS
Authors: Roger Matheu , Dr. Josep Torremade , Meritxell Costa , Dr. Juan Manel Corral , Dr. Lluis Peri , Maurizio D'Anna , Prof. Antonio Alcaraz
Published: July 2023

Objectives

Stress Urinary Incontinence (SUI) and Erectile Dysfunction (ED) are major adverse effects of Radical Prostatectomy (RP). The oncological result is always a priority but functional result should not be forgotten. After a period of rehabilitation, the treatment of iatrogenic complications should be a priority. In the following video we show a simultaneous surgical treatment of post-RP SUI and ED.

Methods

The patient is a 64-year-old male who received a Robotic assisted Radical Prostatectomy with bilateral Lymph Node Dissection in January 2018 with the result of a Gleason 7 (4+3) T2bN0. Correct oncological follow-up. He developped a Bladder Neck Sclerosis for wich a Bladder Neck Incision (BNI) was performed in March 2019. It relapsed so a new BNI was done in March 2020. After more than a year the post-prostatectomy vesicourethral stenosis was stable as confirmed by a cistoscopy. He presents SUI with a Pad-Test of 80 grams and urodinamyc study with an Abdominal Leak Pressure Point of 127 cm H20 for wich a Virtue Sling is indicated. Also, he presents an ED not responding to medical treatment, a Titan Touch Penile Prosthesis is also indicated.

Results

The first part of the video demonstrates the implant of a Virtue Sling with prepubic and transobturators arms placement within the perineal membrane and new subcutaneous passage and fixation between them. The second part is the simultaneous implant of a Tricompartimental Titan Touch Penile Prosthesis of 18 cm with and extensor tip of 1 cm bilateral and a Retzius reservoir placement. Surgical time was 90 minutes and patient was succesfully discharged the next day. Two weeks after the surgery, a flowmetry was performed demonstrating a non post-voidal urinary volume. The patient does not present SUI anymore and he is satisfied with his sexual intercourses.

Conclusions

Simultaneous implant of an Incontinence Sling and a Penile Prosthesis is safe and feasible.

Conflicts of Interest

None.
(226) SCLEROSING GRANULOMA AFTER PARAFFIN INJECTION FOR PENILE AUGMENTATION: A COMPARISON BETWEEN TWO SURGICAL TECHNIQUES
Authors: Dr. Carlo D'Alterio , Dr. Lorenzo Cirigliano , Dr. Angelo di Giovanni , Dr. Alessandro Giordano , Dr. Claudio Marino , Dr. Luigi Napolitano , Dr. Claudia Mirone , Dr. Roberto La Rocca , Dr. Massimiliano Creta , Prof. Alessandro Palmieri , Prof. Ciro Imbimbo , Dr. Marco Capece
Published: July 2023

Objectives

Our aim is to compare two different surgical techniques for the treatment of penile paraffinoma in order to identify the most suitable technique for the characteristics of each patient.

Methods

We described two different surgical techniques for the correction of penile paraffinoma performed in our Urological Unit.

In this video we report two cases. The first patient was a 23 years-old Bulgarian male admitted to our hospital in 2020 with penile swelling and sexual discomfort due to paraffin injected 1 year before to increase penile girth. The patient underwent a 2-stages surgical technique: during the first stage the paraffinoma was excised. The penis was buried into the scrotum. Three months later a scrotoplasty was performed. The second patient a 40 years-old Serbian men presented to our hospital in 2019 with a severe penile deformity due to multiple paraffine self-injection resulting in pain and sexual discomfort. The patient underwent a paraffinoma excision and split-thickness skin graft in one stage. Two different questionnaires, the international index of erectile function (IIEF-5) and a 6-items questionnaire on the satisfaction of genital aesthetics, were delivered to the paients by email at 3, 6 and 12 months.

Results

Erectile dysfunction was not reported and the scores of the IIEF-5 were comparable during the follow up. Both patients were satisfied with the aesthetic of their genitalia, however the first patient scored better in the 6-items questionnaire. No intra/post-operative complications were observed in both techniques.

Conclusions

In our experience patients with no scrotal involvement and suitable scrotal size benefit a dual stage technique with scrotoplasty in terms of better aesthetic outcome rather than a split-thickness skin graft. Otherwise patients with small scrotum size or scrotal involvement might undergo split thickness skin graft which provides good aesthetic outcome and a comparable sexual function. From our experice the surgeon should be skilled in both technique and a careful evaluation of patient's charactheristics should suggest wich technique fits the patient.

Conflicts of Interest

The Authors declair no conflict of interest.
(90) ERECTILE FUNCTION IN AMATEUR CYCLISTS
Authors: Dr. Duarte Brito , Dr. Jose Alberto , Dr. Ana Fereira , Dr. Gustavo Gomes , Dr. Miguel Eliseu , Dr. Mario Lourenço
Published: July 2023

Objectives

Cycling is a popular means of transport and recreational activity; bicycles are also a source of genitourinary injuries and there is the idea that cycling may have a significant impact on sexual function. To evaluate the effect of amateur cycling on erectile function

Methods

We used a questionnaire comparing amateur cyclists (n=199) and footballers (n=43), regarding sexual related comorbidities and hours of practice per week. The cyclists were also characterized in terms of road vs cross-country, breaks during cycling, saddle, and shorts. To evaluate erectile function, the International Index of Erectile Function questionnaire was applied.

Results

There was no difference in International Index of Erectile Function total score between groups. Age and presence of erectile dysfunction associated comorbidity were negative factors in the International Index of Erectile Function score in cyclists but not in the footballers.

Conclusions

Cycling is usually associated with perineal numbness, but that numbness did not lead to lower International Index of Erectile Function scores.

Amateur cycling has no effect on EF.

Conflicts of Interest

None
(24) INTRODUCING THE PENILE IMPLANT INTRAOPERATIVE MEASUREMENTS PLANNING (PIIMP) CHART: A CHART USED FOR INTRAOPERATIVELY DOCUMENTING PENILE DIMENSIONS DURING PENILE PROSTHESIS IMPLANTATION PROCEDURES.
Authors: Prof. Adham Zaazaa , Dr. Ramzy Elnabarawy , Dr. Mahmoud Elbitar
Published: July 2023

Objectives

In this study, the Penile Implant Intraoperative Measurements Planning (PIIMP) chart was used to find out whether inflatable penile implants were more likely to procure a longer penile length in comparison to malleable implants.

Methods

193 men undergoing penile prosthesis implantation were included in the study. 153 had malleable implants, while 40 had three piece inflatable implants. Penile measurements were recorded intraoperatively using the PIIMP chart. Penile length and circumference were taken in both a stretched and unstretched state. Measurements were repeated after pharmacologically induced tumescence by means of a PGE1 intracorporal injection (ICI). Postoperative penile dimensions were re-taken after implantation and documented together with cylinder dimensions.

Results

In malleable penile implants, postoperative penile length ranged between pre-operative pre-ICI stretched length and post-ICI stretched length 71.4% of times (n = 110/153). It fell below pre-operative pre-ICI stretched length in 26.2% of cases (n=40/153) and reached beyond pre-operative post-ICI stretched length in 1.96% of cases (n=3/153).

In inflatable penile implants postoperative penile length ranged between pre-operative pre-ICI stretched length and post-ICI stretched length 60% of times (n= 24/40). It fell below pre-operative pre-ICI stretched length in 27.5% of cases ( n = 11/40) and reached beyond pre-operative post-ICI stretched length in 12.5% of cases (n = 5/40).

Using Fisher's exact test, it was found that postoperative penile length was 6.37 times more likely to rise above preoperative post-ICI stretched length in inflatable penile implants compared to malleable implant cases (12.5% vs 1.96%) (P value=0.0105)

Conclusions

The PIIMP Chart demonstrated that aggressive penile sizing was more attainable with inflatable rather than malleable implants. The chart may be used as an intraoperative measurements guide for surgeons as well as serving as an objective postoperative counseling tool for patients, where their pre and postoperative penile dimensions would be documented and easily comparable.

Conflicts of Interest

I hereby declare no conflict of interest for all authors free from any commercial influence or bias, that the entire contents of this abstract are the sole work of the authors credited and that all authors credited herein are aware of their name being used and are in agreement with it being used in this manner. I hereby agree that this abstract may be openly published and may be used in the planning of this conference and that I have read the guidelines for submitting an abstract and that I agree with all of them in their entirety.
(134) EFFICACY AND SAFETY OF TREATMENT WITH THE USE OF INTRAURETHRAL ALPROSTADIL (VITAROS©) ON DEMAND IN MEN WITH SPINAL CORD INJURY AND MULTIPLE SCLEROSIS. A PROSPECTIVE STUDY.
Authors: Dr. Charalampos Thomas , Dr. Panagiotis Kartsaklis , Dr. Charalampos Konstantinidis
Published: July 2023

Objectives

To evaluate the efficacy and safety of intraurethral alprostadil (Vitaros©) on-demand in men with neurogenic ED due to SCI or MS.

Methods

We prospectively collected data of 54 men suffering from SCI and 50 from MS who used Vitaros© for ED. The treatment protocol required a minimum administration of intraurethral alprostadil for at least twice a week, even without a subsequent sexual intercourse for a period of 6 weeks. Inclusion criteria included absence of ED prior the accident or the onset of the disease (IIEF-5 score >21, Erection Hardness Score-EHS ⩾3, affirmatively answers to Sexual Encounter Profile Questions 2 and 3 -SEP2 & SEP3) and absence of moderate/severe cardiovascular disease, diabetes mellitus and metabolic syndrome. All men with SCI were performing intermittent catheterizations (ICs) and 75% of MS group (35 patients) respectively. Average age was 43.5 and 38.5 respectively, mean IIEF score prior the therapy 15 and 16 and EHS score 1.7 and 1.9.

Results

After 6 weeks, 6 patients dropped out from the group of SCI due to hypotension or urethral pain and 3 from MS group due to urethral pain. Vitaros© implied an improvement of 4.4 points for the IIEF-5 score and 1.0 for the EHS score in the SCI group, while the improvement for the MS group was 4.1 points and 1.3 points respectively. The subgroup of MS patients who did not perform ICs benefited the most in comparison with the other patients and none of them discontinued the treatment. At the end, 23 SCI patients and 27 MS patients selected Vitaros© to be added in their treatment agents of choice, as an alternative.

Conclusions

It seems that Vitaros© is an alternative treatment for neurogenic patients suffering from SCI and MS, less effective though in ICs users, and the most apparent reason of failure might be the alteration of urethral epithelium to squamous due to repetitive injuries as catheters pass through, making the agent less absorbable through it.

Conflicts of Interest

None
(227) PROGNOSTIC VALUE OF DOPPLER ULTRASOUND PRIOR TO PENILE PROSTHESIS IMPLANTATION
Authors: Rodrigo Garcia-Baquero , Carolina Valle Herrera , Araceli Ogalla García , Luis Alvarez-Ossorio Jose
Published: July 2023

Objectives

Penile Doppler ultrasound prior to penile prosthesis implantation is useful for aetiological diagnosis and to assess the response to intracavernous injections. The objective of our study was to analyze the relationship between the parameters collected in the preoperative Doppler ultrasound of the penis, performed per protocol, and postoperative complications and patient satisfaction.

Methods

We conducted a retrospective observational study, selecting patients undergoing penile prosthesis implantation in our center from 2017 to 2020, with at least 1 year of follow-up after surgery. The baseline characteristics of the cohort, basic parameters of penile Doppler ultrasound, surgical aspects, postoperative complications according to the Clavien-Dindo classification, and postoperative pain were collected. In addition, satisfaction was assessed by telephone interview.

Results

A total of 36 patients were selected, of whom 28 participated in the study (77.8% response rate). The mean age was 64.6 years and the mean time of evolution of erectile dysfunction prior to surgery was 5.7 years. Using Doppler ultrasound, 36.1% were diagnosed with arterial insufficiency and 22.2% with failure of the venocorpo-occlusive mechanism. Neither the maximum peak systolic velocity (p 0.58), nor the minimum end-diastolic velocity (p 0.99), nor the maximum resistance index (p 0.41), were related to the rate of complications or the level of satisfaction after surgery. Using linear regression, it was found that the shorter the corporotomy time (p 0.0001) and the shorter the surgical time (p 0.0001), the greater the satisfaction with the implant.

Conclusions

Doppler ultrasound prior to penile prosthesis implantation does not seem to have any prognostic value after surgery, neither in relation to the rate of complications nor in relation to satisfaction. A shorter surgical time, possibly reflecting a simpler surgery and a lighter postoperative period, seems to be related to greater satisfaction after implantation.

Conflicts of Interest

No conflict of interest with this presentation.
(246) SEXUAL FUNCTION RESULTS AFTER FOCAL CRYOTHERAPY FOR THE TREATMENT OF LOCALIZED PROSTATE CANCER
Authors: Dr. Raphael Curvo , Dr. Esaú Fernandez-Pascual , Celeste Manfredi , Dr. Cristina Martín , Dr. Claudio Martinez-Ballesteros , Dr. Carlos Balmori , Dr. Enrique Lledó-García , Dr. Luis Miguel Quintana , Prof. Joaquin Alberto Carballido , Jr Dr. Fernando Bianco , Ignacio Martinez-Salamanca Juan
Published: July 2023

Objectives

To assess the sexual functional results in patients with primary localized PC treated with FC guided by MRI/US fusion.

Methods

Prospective, monocentric study with patients with localized and primary PCa, low or intermediate risk, with unifocal or multifocal lesions, PSA ≤ 15 ng/mL, undergoing FC. The main variables studied were the International Index of Erectile Function-Erectile Function domain (IIEF-EF) and the ejaculatory function. The follow-up included evaluation before treatment, at 6 months and at 12 months. Recurrence was defined as the presence of clinically significant PCa in the treated areas. Other functional outcomes were assessed (continence, lower urinary tract symptoms).

Results

A total of 75 patients were recruited. The median age was 67 (62-72) years. Pretreatment PSA and IIEF-EF were 6.56ng/ml (IQR 5.1-8) and 17 (IQR 7-22), respectively. The volume of the lesions was 1cc (IQR 0.5-2.5), the majority (76%) were peripheral and the Gleason-Score was 6 in 44%, 7 (3+4) in 26.7% and 7 (4+ 3) in 22.7%. Ten subjects developed a recurrence (RR: 15.2%), with a median follow-up of 25 (18-38) months. At 12 months, we found a statistically significant difference (p<0.001) in the IIEF-EF (17 (7-22) VS. 16.5 (8-20)), although not clinically significant. In addition, 15/69 (21.7%) subjects had started or increased the dose of PDE5i. Before treatment, 7 patients had ejaculatory disorders (alpha-blockers). At 12 months, there were 8 affected patients. No significant differences (p>0.05) were observed in urinary functional results (IPSS, ICIQ-UI), all patients were continents at one year.

Conclusions

FC in selected patients with localized PCa is an option to consider in patients who wish to preserve sexual function and who assume a low, although not negligible, recurrence rate.

Conflicts of Interest

None
(206) EFFICACY AND SAFETY OF INTRALESIONAL INJECTION OF HYALURONIC ACID (HA) FOR THE TREATMENT OF CHRONIC PHASE PEYRONIE’S DISEASE (PD): PRELIMINARY RESULTS FROM A PILOT STUDY
Authors: Dr. Claudio Marino , Dr. Carlo D'Alterio , Dr. Alessandro Giordano , Dr. Angelo di Giovanni , Prof. Paolo Verze , Dr. Lorenzo Cirigliano , Prof. Marco Capece , Prof. Roberto La Rocca
Published: July 2023

Objectives

HA is a natural component of the human body. It fulfills several biological functions including immune-modulation and anti-inflammatory effects. HA is considered to treat several andrological issues such as premature ejaculation, penile enlargement and recently Peyronie disease.

The aim of this study is to evaluate the safety and the efficacy of a new protocol based on intraplaque injection of cross-linked hyaluronic acid plus modeling and stretching, in men with the chronic phase of Peyronie's Disease.

Methods

At baseline all the patients were evaluated via intra-cavernous injection of a vasoactive agents and performed also the PD Questionnaire (PDQ) and the International Index of Erectile Function (IIEF) questionnaires.

The protocol consisted in an intraplaque injection of HA (under block of 15 mL plain mepivacain 1%) every other week for a total of three injections in six weeks, plus penile modeling after each injection. Each patient also performed a daily use of vacuum erection device and (self) modeling and stretching in the days following the injections.

Results

23 patients were recruited in the study. Two patients were excluded because they did not correctly performe home protocol. Median curvature at baseline was 55° (IQR= 45 - 65).

Nineteen out of 21 patients (90%) showed a reduction in the degree of curvature by a mean of 11.9 ± 7.3°. A statistically significant improvement in IIEF - Intercourse satisfaction domain (from baseline: 6.41 ± 3.8 to 8 week: 8.76 ± 2.8; p<0.001) and PDQ- Symptoms Bother domain (from baseline: 8.75 ± 4.1 to 8 week: 7.4 ± 3.3; p<0.001) was also detected.

Conclusions

The findings of the study show that this new protocol based is able to significantly reduce penile curvature in patients suffering from a chronic phase of PD.

Our intent is to continue the study further to better understand the impact that IIHA therapy on the management of PD in terms of patient satisfaction and reduction in the need for surgery.

Conflicts of Interest

The authors involved in this study certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
(185) SELF-EXPANDABLE, METALLIC, PTFA-COVERED URETHRAL STENT WITH ANTI-MIGRATION FLAPS (UVENTA). COMPLICATION REPORT AND OUTCOMES FROM THE LARGEST MULTICENTER SERIES
Authors: Omid Sedigh , Ettore Dalmasso , Andrea Gobbo , Devis Collura , Andrea Formiconi , Marisa Kurti , Ernesto Giargia , Nicola Faraone , Paolo Caccia , Alessandro Giacobbe , Maria Buffi Nicolò
Published: July 2023

Objectives

In the last years a new generation of temporary urethral stent was designed. We report complications and outcomes from the largest case history available of self-expandable, metallic, PTFA-covered urethral stents with anti-migration flaps.

Methods

225 patients that underwent urethrotomy with Uventa stent placement between April 2016 and August 2021 in 7 different centers were included. Indication was patient preference as a first surgical approach or failed urethroplasty not willing to undergo a second invasive surgery. Surgical success was defined as absence of strictures requiring further treatments. The outcomes measured were complications during the stent indwelling time and treatment success.

Results

The stricture was located at a proximal bulbar level in 190 patients, distal bulbar in 29 and penile in 6. Median follow-up was 37.9m. 109 (48.4%) patients had at least 1 complication, the figure shows the percentage distribution. Low flow (LF) after stent placement (17, 7.6%) was reported in a significantly higher proportion in penile strictures (2/6, p=0.025). Proximal bulbar strictures had a higher number of per-patient complications (p=0.024). 23 patients (12.9%) underwent early stent removal (ER, before 6m), of these 20 stents were dislocated. ER was more likely in penile strictures (3/6, p=0.047). LF and penile strictures were predictors of ER at univariable logistic regression (p<0.001, p=0.017). Penile stricture was also predictor of LF occurrence (p=0.034). 32/150 (21.3%) experienced treatment failure. Kaplan-Meier estimates by LF occurrence were significantly different (cumulative treatment success: 80.4% vs 42.8%; p=0.011) and Cox regression HR was 3.4 (p=0.022).

Conclusions

Urethrotomy with Uventa placement is a feasible treatment for simple strictures. A detailed discussion about complications, with particular attention to stent displacement, and expectations should be carried out. LF after placement is suggestive of a subsequent ER and treatment failure. Penile strictures should not undergo urethral stent placement considering the association with ER and LF.

Conflicts of Interest

None.
(257) SHOULD ALL AZOOSPERMIC KLINEFELTER MEN UNDERGO ENDOCRINE STIMULATION THERAPY PRIOR TO MICROSURGICAL TESTICULAR SPERM RETRIEVAL (mTESE)?
Authors: Dr. Giovanni Chiriaco , Katy Naylor , Elizabeth Williamson , Prof. David Ralph , Dr. Philippa Sangster
Published: July 2023

Objectives

Klinefelter syndrome (47XXY) is a common genetic cause of non obstructive azoospermia (NOA) and hypogonadism. MTESE has provided potential for these men to experience fatherhood although surgical sperm retrieval (SSR) rates are low. This study aims to evaluate the role of endocrine stimulation therapy prior to mTESE in men with NOA secondary Klinefelter syndrome (KS).

Methods

Retrospective study on KSmen who underwent mTESE with-or-without prior endocrine stimulation therapy. Demographic data, previous exogenous testosterone therapy, duration and type of stimulation, pre-and post-stimulation hormone levels (T, FSH, LH), SSR, average Johnsen score and total number of vials cryopreserved were all recorded. The success criteria for mTESE was defined as at least 1 vial of viable sperm retrieved.

Results

64KSmen underwent mTESE out of which 39men received prior endocrine stimulation therapy for a mean duration of 11.8±8.5month. Thirty patients received human chorionic gonadotropin and 9 clomiphene. The mean pre-stimulation serum testosterone level was 6.1±3.7nm/L increased to 9.4±6.9nm/L post-stimulation. Testosterone levels significantly increased after endocrine stimulation (6.1±3.7nm/Lvs9.8 ± 6.9nm/L, p<0.001) with mean change in serum testosterone (ΔT) of 4.9nm/L. In the stimulated Johnsen score was 1.6±0.8 and successful sperm retrieval (SSR) rate 28.2%(17/39). The 25 men who did not received stimulation had pre-mTESE serum Testosterone of 10.5±4.9, Johnsen score of 1.6 the average Johnsen score 1.5±6 and SSR of 28%(7/18). Comparing men who had successfulvs unsuccessful mTESE - higher level of serum T seemed to correlate with successful sperm retrieval (p: 0.036). Among men who received endocrine stimulation therapy ΔT before and after stimulation did not correlate with successful outcome. Age had no affect success.

Conclusions

Our study shows that there is a significant improvement of serum T concentration following endocrine stimulation therapy in KSmen. Overall the hormonal stimulation seems not to be related to a higher success rate of mTESE but our data do suggest positive correlation between higher level of preoperative serum Testosterone and successful mTESE in patient suffering from KS.

Conflicts of Interest

None
(173) ONCO-TESE DURING ORCHIECTOMY FOR TESTICULAR TUMOR IN PATIENTS WITH AZOOSPERMIA/OLIGOZOOSPERMIA: OUR EXPERIENCE
Authors: Andrea R Serrano , Esau F Pascual , Maria Belen A Bartolomé , Cristina B Ruiz , Carlos T Vázquez , Álvaro Javier Y Alonso , Luis M Piñeiro-Lorenzo
Published: July 2023

Objectives

Patients with testicular cancer are at increased risk of infertility or semen quality abnormalities. Due to the high cure rates of testicular tumors (especially germ cell tumors), fertility protection is becoming increasingly important. For this reason it is mandatory to offer sperm cryopreservation prior to treatment. In patients with oligo/azoospermia prior to orchiectomy, other cryopreservation options can be considered. The aim of this paper is to analyze the results of a cohort of patients undergoing Onco-testicular Sperm Extraction (Onco-TESE).

Methods

A retrospective review of patients undergoing orchiectomy for testicular tumor in the last 5 years was performed. Those in whom sperm cryopreservation was impossible were offered to undergo, in the same procedure, a Sperm retrieval testicular biopsy (Onco-TESE), from the contralateral testicle or from the same testicle (if this was possible or necessary).

Results

A total of 108 patients underwent radical orchiectomy between 2016 and 2022 in our center. Of these, 67.5% of patients were considered suitable for seminal cryopreservation (due to age, future genomic desires). Of all of them, 11/73 (15.1%) presented azoospermia or severe oligozoospermia. Six patients underwent simultaneous radical orchiectomy and Onco-TESE. Another orchiectomized patient underwent contralateral testicular biopsy after being diagnosed with azoospermia in the cryopreservation attempt prior to chemotherapy. The mean age was 35.7 years. One patient had a diagnosis of Klinefelter's disease (karyotype 47XXY), and another had a childhood history of orchiectomy of unknown cause. Sperm retrieval was achieved in 3 patients (they did not present any previous genetic alteration). Pathological anatomy showed seminoma in 5/7 patients, TGNS in 1/7 and benign Leydig cell tumor in the last one.

Conclusions

Seminal cryopreservation should always be performed prior to radical orchiectomy because in case it is not valid, the performance of Onco-TESE can be resorted to as an attempt of Sperm retrieval.

Conflicts of Interest

None of the authors have any conflict of interest.
(12) CONCEPTUALIZING FEMININITY THROUGH ANALYSIS OF PSYCHOSOCIAL DIMENSIONS OF MENSTRUATION IN INDIGENOUS PAKISTANI CONTEXT
Authors: Dr. Ahmad Bilal , Sehba Sadiq
Published: July 2023

Objectives

Menstruation has been an integral part of traditional woman’s body. In modern times, women derive meanings to form and shape their feminine identity in context of menstrual discourse. But the experiences of South Asian especially Pakistani women are different from the modern Western women. Therefore, the present study was conducted to conceptualize the femininity by analyzing the menstruation discourse of Pakistani women.

Methods

A total of 11 women of reproductive age living in South Punjab province of Pakistan were interviewed. The open ended interview format was employed for gathering detailed discourses regarding menstrual experiences. The qualitative thematic analysis technique was used to extract themes related to menstruation experiences of women.

Results

Several myths and themes were extracted from the thematic analysis. The myths and themes were categorized as; (i) Initial Menstrual Experiences (ii) Obscure Menstruation Terminologies used by women (iii) Non Scientific Cultural Experiences related to Menstruation (iv) Personal Hygiene during Menstruation (v) Use and Availability of Sanitary Products during Menstruation (vi) Use of Medication during Menstruation (vii) Interpersonal Interaction during Menstruation. Each category had its specific myths and subthemes related to menstruation experiences.

Conclusions

The study concluded that menstrual experience comes as a trauma and is considered a taboo to be discussed. It is suggested that development and gender specific sex education should be introduced at educational institutions to make the women desensitize regarding their menstrual experiences. The male members of the society should also get education about menstruation so that they may treat women more empathically. Further, the public places should have availability of sanitary products and the women should be given 1-2 monthly leaves at their workplaces.

Conflicts of Interest

The authors declare no conflict of interest.
(142) THE INFLUENCE OF SEXUAL ACTIVITY ON SLEEP: A DIARY STUDY
Authors: Carlotta F Oesterling , Dr. Charmaine Borg , Elina Juhola , Dr. Marike Lancel
Published: July 2023

Objectives

As previous literature has shown that sexual activity affects sleep but has yielded discrepant findings, a cross-sectional and a longitudinal (diary) study have been conducted to clarify to what extent the type of sexual activity (i.e., sexual intercourse versus masturbation) impacts the effect of sexual activity on sleep, whether having an orgasm is necessary for such effects to become apparent, and lastly, whether the effect of sexual activity on sleep differs between men and women.

Methods

The effect of sexual activity on sleep is investigated by combining a cross-sectional survey based on previous work by Pallesen et al. (2020) and Lastella et al. (2019) with a longitudinal design in the form of a diary study. 256 male and female participants, mainly students, completed a pre-test set of questionnaires and thereafter a diary during 14 consecutive days. The cross-sectional study was analyzed using ANCOVA and follow-up analyses of weighted means (separately for men and women) with 95% confidence intervals. Accounting for the nested structure of the data, the diary data was analysed by building two separate Multilevel Linear Models. The analyses included 2076 cases at level one, which were nested within 159 participants at level two.

Results

The cross-sectional study demonstrated that both men and women perceive sexual intercourse and masturbation with orgasm to improve sleep latency and sleep quality, while sexual activity without orgasm exerts negative effects on these sleep parameters, most strongly in men. The longitudinal data analyses revealed that only sexual intercourse with orgasm significantly shortens sleep latency and increases sleep quality and to a similar extent in men and women.

Conclusions

The present studies confirm and significantly substantiate findings indicating that sexual activity and intimacy may improve sleep and overall wellbeing in both men and women and serve as a directive for future research.

Conflicts of Interest

There are no conflicts of interests to be declared.
(317) THE UNIQUENESS OF NONVERBAL EXPRESSIONS IN RELATIONSHIPS AMONG WOMEN WITH SEXUAL DYSFUNCTION
Authors: Ronit Basher Lazar , Dr. Einat Shuper Engelhard , Dr. Anna Petruseva , Prof. Ilan Gruenwald , Dr. Arik Shechter
Published: July 2023

Objectives

Recently, studies emphasized the importance of “embodiment knowledge” (EK) - the lifetime experience in relationships as internalized, in understanding women’s sexual function. While studies found a high prevalence of insecure attachment patterns among women with sexual dysfunctions (SD), and other studies revealed movement characteristics that were unique to insecure attachment, we aimed to examine nonverbal expressions of EK as expressed in interpersonal communication among women with SD. We hypothesized EK will be expressed as a diminished capacity for playfulness and exploration in movement among women with SD.

Methods

We included women with (n=28) and without (n=14) SD. Female Sexual Function Index and Experiences in Close Relationships questionnaires were completed. EK, as expressed via nonverbal behavior was examined during a Mirror Game (MG) and analyzed utilizing the Mirroring Game Scale (MGS). Results were analyzed using the Shapiro wilk test, T-TEST or Mann Whitney and Pearson correlation for evaluating differences and correlations between SD and EK.

Results

A significant difference was found between the groups (p<0.05), in the competitiveness item in MGS, i.e women without SD demonstrated higher competitiveness in their nonverbal communication during the MG compared to women with SD. A further analysis found a significant correlation between greater sexual arousal (r=0.403; p<0.01) & more orgasms (r=0.368; p<0.05) and higher levels of competitiveness in their movement. In addition, less pain during sex correlated with a higher pleasure (r=0.387; p<0.05) & exploration in movement (r=0.327; p<0.01) items; women who experienced less pain during sex expressed more pleasure and exploration during the MG. In this category the groups also differed significantly in movement flow (p<0.05).

Conclusions

This study expands our of knowledge on women's SD and embodiment by empirically supporting the uniqueness of nonverbal expressions in relationships among women with SD. These novel findings contribute to the development of additional modes of diagnosis and treatment of female SD.

Conflicts of Interest

No conflict of interest.
(224) CLIMACTERIC SYNDROME: LESBIANS VERSUS HETEROSEXUAL WOMEN
Authors: Pavel Turčan , Dr. Pavel Pokorny , Dr. Jana Kvintova , Dr. Peter Kepic , Eva Sedlata Juraskova
Published: July 2023

Objectives

Climacterium is a physiological period in a woman’s life, reached by both heterosexual women and lesbians. There are several difficulties associated with the transition to menopause, which is referred to as climacteric syndrome (CS). There are differences between women as to the perception of climacteric difficulties. In our study, we focus on the differences in the perception of CS between heterosexual women and lesbians.

Methods

We assessed a group of 48 heterosexual women and 42 lesbians using a self-assessment scale of a modified version of the Kupperman index (KI), which focuses not only on the so-called acute (vegetative) but also in part on the subacute (organic) symptomatology of CS. We used the Mann-Whitney U-test to evaluate the results of individual symptoms and we chose Fisher’s exact test to compare the percentages of women according to the severity of CS.

Results

Similar results were found in most of the monitored parameters, regardless of sexual orientation. The most important finding of the study is that lesbians tolerate menopausal difficulties statistically significantly better and have a lower incidence of pain during sexual intercourse than heterosexual women. Heterosexual women in whom no form of CS was present according to KI accounted for 37.5% compared with 57.1% of women in the lesbian group, mild CS was observed in 18.8 of HW compared with 31% of LW, moderate severe CS in 43.8% of HW vs. 11.9% of LW. We did not observe severe CS in either group.

Conclusions

Similar results were found in most of the monitored parameters in both groups. Among other things, psychological factors, such as better communication and mutual understanding of lesbian partners, may contribute to better tolerance. The statistically significantly lower incidence of painful coitus is certainly influenced by the fact that lesbians have a wider range of non-penetrative sexual practices than heterosexual women.

Conflicts of Interest

We have no confilct of interest.
Discovery of five Green pea galaxies with double-peaked narrow [O iii] lines
Authors: Lin Ruqiu , Zheng Zhen-Ya , Wang Jun-Xian , Yuan Fang-Ting , Rhoads James E , Malhotra Sangeeta , An Tao , Jiang Chunyan , Zhu Shuairu , Rahna P T , Ji Xiang , Singha Mainak
Published: July 2023

Although double-peaked narrow emission-line galaxies have been studied extensively in the past years, only a few are reported with the Green pea (GP) galaxies. Here we present our discovery of five GP galaxies with double-peaked narrow [O iii] emission lines, referred to as DPGPs, selected from the LAMOST and SDSS spectroscopic surveys. We find that these five DPGPs have blueshifted narrow components more prominent than the redshifted components, with velocity offsets of [O iii]λ5007Å ranging from 306 to 518 $\rm km\, s^{-1}$, and full widths at half maximums of individual components ranging from 263 to 441 $\rm km\, s^{-1}$. By analysing the spectra and the spectral energy distributions (SEDs), we find that they have larger metallicities and stellar masses compared with other GPs. The H α line width, emission-line diagnostic, mid-infrared colour, radio emission, and SED fitting provide evidence of the AGN activities in these DPGPs. They have the same spectral properties of type 2 quasars. Furthermore, we discuss the possible nature of the double-peaked narrow emission-line profiles of these DPGPs and find that they are more likely to be dual active galactic nuclei (AGNs). These DPGP galaxies are ideal laboratories for exploring the growth mode of AGNs in the extremely luminous emission-line galaxies, the co-evolution between AGNs and host galaxies, and the evolution of high-redshift galaxies in the early Universe.
Varieties of Grounding Skepticism
Authors: Kovacs David Mark
Published: July 2023

Skepticism about grounding is the view that ground-theoretic concepts shouldn’t be used in meta­physical theorizing. Possible reasons for adopting this attitude are numerous: perhaps grounding is unintelligible; or perhaps it’s never instantiated; or perhaps it’s just too heterogeneous to be theor­­­­­etically useful. Unfortunately, as currently pursued the debate between grounding enthusiasts and skeptics is insufficiently structured. This paper’s purpose is to impose a measure of conceptual rigor on the debate by offering an opinionated taxonomy of views with a reasonable claim to being “skeptical.” I argue that carving up logical space into pro- and anti-grounding views isn’t especially helpful; rather, we should recognize various degrees of ground-theoretic involvement depending on how inflationary our understanding of the theoretical term ‘ground’ is.
Werner syndrome associated with poorly differentiated thyroid carcinoma and systemic sclerosis-like skin manifestations: A case report
Authors: Sugawara Eri , Shibata Yuhei , Katsumata Kazuaki
Published: July 2023

Werner syndrome (WS) is an autosomal recessive disorder characterised by premature ageing. WS patients often experience scleroderma-like manifestation including skin sclerosis and skin ulcer, making it difficult to differentiate WS from systemic sclerosis (SSc). Moreover, there is a high incidence of malignancy and arteriosclerosis-related disease in WS patients. We herein describe a 36-year-old woman with WS who had poorly differentiated thyroid carcinoma, one of the rare phenotypes of thyroid tumour. This case suggested the importance to distinguish WS from SSc and early diagnosis of malignancy.
Evaluating hematologic parameters in newly diagnosed and recurrent glioblastoma: Prognostic utility and clinical trial implications of myelosuppression
Authors: Deng Davy , Hammoudeh Lubna , Youssef Gilbert , Chen Yu-Hui , Shin Kee-Young , Lim-Fat Mary Jane , McFaline-Figueroa Jose Ricardo , Chukwueke Ugonma N , Tanguturi Shyam , Reardon David A , Lee Eudocia Q , Nayak Lakshmi , Bi Wenya Linda , Arnaout Omar , Ligon Keith L , Wen Patrick Y , Rahman Rifaquat
Published: July 2023

Background

Glioblastoma (GBM) patients are treated with radiation therapy, chemotherapy, and corticosteroids, which can cause myelosuppression. To understand the relative prognostic utility of blood-based biomarkers in GBM and its implications for clinical trial design, we examined the incidence, predictors, and prognostic value of lymphopenia, neutrophil-to-lymphocyte ratio (NLR), and platelet count during chemoradiation (CRT) and recurrence.

Methods

This cohort study included 764 newly diagnosed glioblastoma patients treated from 2005 to 2019 with blood counts prior to surgery, within 6 weeks of CRT, and at first recurrence available for automatic extraction from the medical record. Logistic regression was used to evaluate exposures and Kaplan–Meier was used to evaluate outcomes.

Results

Among the cohort, median age was 60.3 years; 87% had Karnofsky performance status ≥ 70, 37.5% had gross total resection, and 90% received temozolomide (TMZ). During CRT, 37.8% (248/656) of patients developed grade 3 or higher lymphopenia. On multivariable analysis (MVA), high NLR during CRT remained an independent predictor for inferior survival (Adjusted Hazard Ratio [AHR] = 1.57, 95% CI = 1.14–2.15) and shorter progression-free survival (AHR = 1.42, 95% CI = 1.05–1.90). Steroid use was associated with lymphopenia (OR = 2.66,1.20–6.00) and high NLR (OR = 3.54,2.08–6.11). Female sex was associated with lymphopenia (OR = 2.33,1.03–5.33). At first recurrence, 28% of patients exhibited grade 3 or higher lymphopenia. High NLR at recurrence was associated with worse subsequent survival on MVA (AHR = 1.69, 95% CI = 1.25–2.27).

Conclusions

High NLR is associated with worse outcomes in newly diagnosed and recurrent glioblastoma. Appropriate eligibility criteria and accounting and reporting of blood-based biomarkers are important in the design and interpretation of newly diagnosed and recurrent glioblastoma trials.
Perceptions of COVID-19 vaccine side effects by political affiliation
Authors: Farabee David , Hawken Angela
Published: July 2023

Background

We sought to assess the extent to which subjective experiences of COVID-19 vaccine side effects among US adults are associated with political party identification.

Methods

An online survey was conducted of a national sample of US adults (N = 1259) identifying as either Republican or Democrat.

Results

There was no significant difference by party identification in the perceived severity of vaccination side effects; however, Republicans were significantly less likely to recommend the vaccine to others in light of their experience (OR = 0.40; 95% CI, 0.31–0.51; P < 0.001). Republicans also reported having a larger share of COVID-19-vaccinated friends and family who experienced notable side effects (OR = 1.31; 95% CI, 1.02–1.68; P < 0.05). There was a positive association between respondents’ perceived side-effect severity and the proportion of peers who also reported notable side effects (r = 0.43; P < 0.001).

Conclusion

Subjective appraisals of the vaccinated may affect broader vaccine acceptability.
Assessment of digital perfusion as a surrogate outcome in Raynaud’s phenomenon clinical trials
Authors: Guigui Alicia , Liaigre Léa , Manceau Marc , Gaget Olivier , Cracowski Jean-Luc , Blaise Sophie , Khouri Charles , Roustit Matthieu
Published: July 2023

Objectives

Measurement of digital perfusion, sometimes coupled with a cold challenge, has been widely used as an objective outcome in trials evaluating drug therapies in RP, in addition to patient-reported outcomes or to establish the proof-of-concept in preliminary studies. However, whether digital perfusion is a valid surrogate for clinical outcomes in RP trials has never been explored. The principal aim of this study was to evaluate the potential surrogacy of digital perfusion, by combining individual-level and trial-level data.

Methods

We used individual data from a series of n-of-1 trials, and trial data from a network meta-analysis. We estimated individual-level surrogacy through coefficients of determination between digital perfusion and clinical outcomes (R2ind). We further calculated the coefficients of determination between treatment effect on the clinical outcomes and on digital perfusion, at the individual level (R2TEind) and at the trial level (R2trial), using non-weighted linear regression, with their 95% CI calculated through bootstrapping.

Results

Results from 33 patients and 24 trials were included in the final analysis. At the individual level, there was no correlation between digital perfusion and clinical outcomes at rest and in response to various cooling tests (the highest R2ind was 0.03 [−0.07, 0.09]), and R2TEind was also very low 0.07 (0, 0.29). At the trial level, the highest value of R2trial was 0.1 (0, 0.477).

Conclusions

Digital perfusion, at rest or in response to a cold challenge, and whatever the method used, does not fulfil the criteria of a valid surrogate for existing patient-reported outcomes in RP trials.
Adapting a transdiagnostic digital mental health intervention for use among immigrant and refugee youth in Seattle: a human-centered design approach
Authors: Fabian Katrin E , Foster Katherine T , Chwastiak Lydia , Turner Morgan , Wagenaar Bradley H
Published: July 2023

Digital mental health interventions show promise in addressing mental health needs, especially among youth and marginalized communities. This study adapted the World Health Organization -developed STARS (Sustainable Technology for Adolescents to Reduce Stress) digital mental health intervention for use among youth and young adults aged 14–25 from immigrant and refugee communities in Seattle, Washington. Human-centered design methods centered around qualitative semi-structured interviews were used to contextually and culturally adapt the intervention and prioritize the needs and preferences of the intended end user. Intervention prototypes were modified and then presented to the target groups in iterative cycles until saturation was achieved. Qualitative interviews occurred in three iterations of five participants each. Modifications were documented according to the Framework for Reporting Adaptations and Modifications—Expanded (FRAME) implementation science framework. Modifications aligned with the FRAME process elements: (a) tailoring/refining, which included adapting language to less resemble digital phishing scams; (b) changes in packaging or materials, which included naming the chatbot and adopting a corresponding avatar; (c) adding/removing, which included changing existing emojis and adding additional media types including graphics interchange format images, pictures, and voice memos; (d) shortening/condensing, which included shortening the length of individual text sections as well as deleting redundant language; (e) lengthening/extending, which included allowing the user to choose to receive content catered to teenagers or to adults; and (f) loosening structure, including giving users options to skip parts of modules or to engage with additional material. The modified STARS intervention shows promise for engagement with immigrant and refugee youth in Seattle and can be examined for clinical effectiveness. Adaptations increased the relevance of content to the intended end user, expanded options for personalization and customization of the user experience, and utilized language that was age appropriate, engaging, and did not invoke feelings of stigma or distrust. Adaptations of digital mental health interventions should focus on modifications that maximize acceptability and appropriateness to intended audiences.