bluuebunny/crossref_metadata_2025 huggingface dataset:
(22) A PROTOCOL FOR THE DEVELOPMENT OF TWO INTERNATIONAL CORE OUTCOME SETS FOR GENITAL GENDER AFFIRMING SURGERY
Authors: Marleen Vallinga , Pip Roijer , Dr. Tom Pidgeon , Dr. Aline Ceulemans , Alex Bakker , Brenda Carrière , Dr. Tina Rashid , Dr. James Bellringer , Dr. Javier Belinky , Prof. Marlon Buncamper , Shane Morrison , Prof. Walter Bouman , Prof. Mark-Bram Bouman , Prof. Margriet Mullender
Published: July 2023

Objectives

Various procedures and techniques for genital surgery are available to transgender and gender diverse individuals. Prior research on feminizing (i.e., vaginoplasty, vulvoplasty, labiaplasty, and clitoroplasty) and masculinizing (i.e. phalloplasty, metoidioplasty, scrotoplasty and coronaplasty) genital gender affirming surgery measures and reports a heterogeneous and non-standardised range of outcomes. It is not known whether these outcomes used by researchers are important or relevant to the population. Yet, no attempt has been made to reach consensus on a standardized set of outcomes and uniform definitions. This inconsistency precludes the comparison and combination of data between studies on similar procedures. In order to advance the practice of genital surgery towards a robust evidence-based one, it is necessary to standardize outcome measurements in retrospective and prospective intervention studies. The aim of this project is to develop a Core Outcome Set (COS) for feminizing- and one for masculinizing genital gender surgery. A COS; i.e., the minimum set of outcomes recommended to be reported in clinical trials, pertaining to this subject will ensure that the most relevant outcomes are measured and reported in a standardized way.

Methods

The stages of development are; i) A systematic review to identify all outcomes measured and reported in previous research; ii) Identifying outcomes important for transgender and gender diverse individuals during focus groups; iii) Combining these outcomes into preliminary lists iv) Distribute e-Delphi surveys among experts- by experience and profession, in which all potential outcomes will be rated v) An online consensus meeting to decide on the final COS. See figure 1.

Results

This project will produce two minimum sets of outcomes for genital surgery, based on an international consensus from expert stakeholders, including the population.

Conclusions

The development and implementation of these COS for genital surgery will ensure that relevant outcomes will be reported. This will facilitate guideline-development and evidence-based informed decision-making.

Conflicts of Interest

None.
(237) LONG TERM FOLLOW-UP OF GENDER AND SEXUALITY IN EARLY TREATED TRANSGENDER ADOLESCENTS
Authors: Frédérique B B de Rooy , Marijn Arnoldussen , Thomas D Steensma , Prof. Arne Popma , Prof. Baudewijntje Kreukels , Annelou de Vries
Published: July 2023

Objectives

This study is the first to gain insight into long-term effects into adulthood of early gender affirming medical treatment in transgender adolescents on the development of gender identity and sexuality.

Methods

Transgender adolescents who started medical treatment between 1989-2000 and were treated with gender-affirming hormone treatment (GAHT), as well as transgender adolescents who received gonadotropin-releasing hormone agonist and subsequently started GAHT at least 9 years ago, were recruited for participation. Gender identity, experienced gender dysphoria and sexuality were measured with the Gender Diversity Questionnaire (GDQ), Utrecht Gender Dysphoria Scale (UGDS) and self-developed questions on sexuality and relationships.

Results

All 101 participants had used GAHT and 74 also used puberty suppression before starting hormonal treatment. Most identify as either “man” or “woman”, with 25% also identifying as “transgender”. In 81.2% the gender identity remained stable over time. On the UGDS, a mean total score of 14.5 (standard deviation 2.92) was found, indicating little to no experienced gender dysphoria. Over two-thirds of participants have had a relationship. For women, this was in 81.0% with a cisgender man and in men, this was in 83.1% with a cisgender woman. 73.3% of women reported to be attracted only to men and 13.3% to mostly men, but also women. 62.7% of men reported to be attracted only to women and 19.4% mostly to women, but also men. In both men and women, in almost 80% of participants the sexual attraction has never changed.

Conclusions

In this first long term follow-up into adulthood of transgender adolescents who received early medical gender affirming treatment, it was seen that after treatment participants experience gender congruence and experience little to no dysphoria. Gender identity and sexual attraction remain mostly stable throughout life. Sexual attraction is mostly to the opposite gender of particpants’ gender, with slightly more variety being seen in men.

Conflicts of Interest

The authors declare that they have no competing interests.
(198) THE EFFECT OF PUBERTY SUPPRESSION ON SEXUAL FUNCTIONING IN TRANSWOMEN AFTER GENDER AFFIRMATIVE SURGERY
Authors: Isabelle van der Meulen , Anna van der Miesen , Sabine Hannema , Annelou de Vries
Published: July 2023

Objectives

To improve informed and evidence based care for transgender adolescents by gaining insight into the long-term effects on sexual development and functioning of early treatment with puberty suppression in transgender adolescents. This is the first study to specifically evaluate postoperative sexual function in transgender women who have not gone through endogenous pubertal development, with a special focus to their ability to orgasm.

Methods

A questionnaire on sexual experiences was used approximately one year after genital gender affirmative surgery. We then compared the answers of transwomen that were treated with puberty suppression in early puberty (Tanner stage 2 or 3), with those that were treated with puberty suppression in late puberty (Tanner Stage 4 or 5), under more with the use of Pearson ChiSquare tests.

Results

37 transwomen that received gender affirmative treatment, consisting of puberty suppression, cross-sex hormones and vaginoplasty, were included. Of all transwomen, 76% was able to reach an orgasm after vaginoplasty. Of the transwomen that were treated with puberty blockers early in puberty, 81% was able to experience an orgasm postsurgery. When looking at the ability to reach an orgasm after vaginoplasty, we found that there was no difference (p=0,278) between those that were treated with puberty blockers in early versus those that were treated in late puberty. Of the transwomen who did not experience an orgasm before surgery, 75% was able to reach one after. Approximately half to three quarters of the transwoman experienced sexual difficulties when having sexual intercourse.

Conclusions

Both transwomen treated with early and late puberty suppression are equally able to experience an orgasm after vaginoplasty. Likewise, it is not necessary to experience desire, arousal or orgasms presurgery to be able to experience these postsurgery. The majority of transwomen sometimes experience some difficulties in their sex life, but this is not dependent on the puberty stage they started blockers in.

Conflicts of Interest

We have no conflicts of interest to disclose.
(215) IS THERE A ROLE OF HISTAMINE IN THE PATHOPHYSIOLOGY OF ERECTILE DYSFUNKTION?
Authors: Dr. Viktoria Maerker , Prof. Stefan Ueckert , Prof. Armin Becker , Harrina Rehardjo , Priv-Doz. Andreas Bannowsky , Prof. Markus Kuczyk
Published: July 2023

Objectives

Histamine is a bioactive amine related to the control of vascular tissue and the vasorelaxation mediated by nitric oxide and cyclic GMP. The role and function of histamine in the control of penile erectile tissue (corpus cavernosum penis) is only poorly understood. The aim of our study was to evaluate the course of histamine plasma levels through different stages of sexual arousal in the systemic and cavernous blood of healthy males and in patients with erectile dysfunction.

Methods

34 healthy adult males (mean age 26) and 46 patients with ED (mean age 52) were exposed to erotic stimuli in order to elicit sexual arousal. Blood was simultaneously aspirated from the corpus cavernosum and a cubital vein during the penile conditions flaccidity, tumescence, rigidity and detumescence. Plasma levels of histamine were determined by means of a radioimmunoassay.

Results

In the healthy individuals, histamine slightly decreased in the cavernous blood with the beginning of sexual arousal, when the flaccid penis became tumescent (0.95 ± 0.5 to 0.87 ± 0.36), decreased further during rigidity (0.8 ± 0.3) and remained unaltered in the phase of detumescence. In the systemic circulation, no alterations in plasma histamine were observed with the initiation or termination of penile erection. In the ED patients, a moderate rise in cavernous histamine was registered from flaccidity/tumescence to detumescence (1.2 ± 0.3 to 1.33 ± 0.52). In the patients, at all penile conditions, plasma histamine was significantly higher in the cavernous blood than in the systemic circulation.

Conclusions

Based on the results, it seems unlikely that histamine has excitatory function in the control of penile erection. It remains to be established whether in the patients with ED the amine, potentially acting as a mediator of a neuroendocrine feedback system, may mediate local biological events modulating sexual function in terms of counteracting erectile capability.

Conflicts of Interest

no conflict of interest.
(75) ERECTILE DYSFUNCTION IS ASSOCIATED WITH LEFT VENTRICULAR DIASTOLIC DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Dr. Emil Durukan , Christian F S Jensen , Dr. Kristoffer G Skaarup , Peter B Østergren , Prof. Jens Sønksen , Prof. Tor Biering-Sørensen , Prof. Mikkel Fode
Published: July 2023

Objectives

Erectile Dysfunction (ED) is associated with an increased risk of cardiovascular morbidity and mortality. It is suggested that ED precedes CVD by 3-5 years due to progressive or concomitant microvascular endothelial dysfunction and/or vascular obstruction. This systematic review and meta-analysis evaluated cardiac structure and function in men with ED.

Methods

A meta-analysis on studies evaluating cardiac structure and function in men with ED compared to controls without ED using echocardiography was performed. We assessed and analyzed mean differences in left ventricular ejection fraction (LVEF), the ratio of early transmitral filling velocity to early diastolic mitral annular velocity (E/e’), early to late diastolic transmitral flow velocity (E/A), isovolumic relaxation time (IVRT), and left ventricular mass index (LVMi) in a random effects model computed using means and standard deviations.

Results

We included 10 studies with 763 men diagnosed with ED (mean age of 55.6 years) and 358 control men (mean age of 54.4 years). Figure 1 displays the pooled analyses. E/e’ was significantly higher in men with ED compared to controls (mean absolute difference = 1.17, 95% CI [0.68, 1.65], p < 0.005). Meanwhile, no significant differences were observed in LVEF, E/A, IVRT, or LVMi.

Conclusions

In this meta-analysis, LV diastolic dysfunction, as assessed by E/e’, was more frequent in men with ED compared to matched controls without ED.

Conflicts of Interest

The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript.
(86) IS PSYCHODIAGNOSTIC THE USEFUL INSTRUMENT FOR DIFFERENTIAL DIAGNOSIS BETWEEN PSYCHOGENIC AND ORGANIC FORMS OF ERECTILE DYSFUNCTION?
Authors: Zurab Marshania , Nino Chochnidze , Marika Injgia , Mariam Samteladze
Published: July 2023

Objectives

Erectile Dysfunction (ED) is a fairly common problem, affecting millions of men depending on their age group. It is a common difficulty to differentiate between different forms of ED. When we say about the psychogenic form of ED, we should remember that the ways that people think, feel, and behave - can powerfully affect their erectile response. Consequently, objective assessment of psychogenic factors can help physicians in the correct diagnostic and treatment of patients with ED.

Methods

In our study, participants were 109 men with ED aged 25 to 45. All patients had some emotional problems, due to which a psychodiagnostic. For assessment of psycho condition, we used four diagnostic tests: MMPI-I, STAI (State-trait Anxiety Inventory), Beck's Depression Inventory, and OCI-R (Obsessive-compulsive-inventory-revised).

Results

As the result of the examination, we detected anxiety disorder in 38 patients. 10 patients had dysthymia, and 14 had depression. Five patients had Obsessive-compulsive disorder. In 43 men with ED, we could not find any psychogenic problems. Psychodiagnostic allowed us to suppose that 66 patients (60%) had psychogenic ED and 43 (40%) had organic ED. Together with PDE 5 – inhibitors, all 66 patients with psychogenic ED received Serotonin and Dopamine Selective reuptake Inhibitors (SSRI). 100 mg Trazodone per day had received in 43 patients. 19 patients received 30 mg Duloxetine per day, and four received 10 mg. Citalopram per day. The treatment mentioned above was very successful. After several months of treatment, erectile function had been restored. Also, anxiety and depression decreased. The well-being and quality of sexual life improved.

Conclusions

The psychodiagnostic examination we used in our study is quite an effective objective method for differential diagnoses between the psychogenic and organic forms of ED among 25-45 aged men. It can be considered a simple and routine tool in the algorithm for diagnosing and treating ED.

Conflicts of Interest

There is no conflict of interest.
(100) PREVALENCE AND CLINICAL PROFILE OF VERY YOUNG MEN WITH ERECTILE DYSFUNCTION – FINDINGS FROM A REAL-LIFE CROSS-SECTIONAL STUDY
Authors: Dr. Edoardo Pozzi , Dr. Federico Belladelli , Dr. Simone Cilio , Dr. Giuseppe Fallara , Dr. Christian Corsini , Dr. Francesco Lanzaro , Dr. Alessandro Bertini , Dr. Massimiliano Raffo , Fausto Negri , Ludovica Cella , Margherita Fantin , Dr. Luigi Candela , Dr. Paolo Capogrosso , Dr. Luca Boeri , Dr. Alessia d'Arma , Prof. Francesco Montorsi , Prof. Andrea Salonia
Published: July 2023

Objectives

To assess and compare the sociodemographic and clinical characteristics of young (30-40 yr) and very young (18-29 yr) ED patients and to explore the changes in patterns of reported ED in men with ≤ 29 yr over a 17-yr period at a single academic centre.

Methods

Data from 519 consecutive patients < 40 yr complaining of ED between 2005 and 2022 were analysed. All patients completed the International IIEF. Patients were segregated into two groups: 18-29 vs. 30-40 yr. Descriptive statistics tested sociodemographic and clinical differences between the two cohorts. Linear regression and local polynomial models were applied to explore and graphically display the trend of assessing 18-29 vs. 30-40-yr ED patients over the analysed time-frame.

Results

Overall, 191 (36.8%) were < 29 yr and 328 (63.2%) were 30-40 yr. The two groups did not differ in terms of commonly recognised ED risk factors. Rates of severe ED according to IIEF-EF did not differ between the two cohorts at presentation (20.9% vs. 18.6%). Younger patients were less likely to report a stable partner (45.5% vs. 61.6%, p<0.001), to suffer of arterial hypertension (3.7% vs. 8.5%) and had lower median BMI (22.8 vs. 24.5 kg/m2) but higher total testosterone (5.6 vs. 5.1 ng/mL), all p<0.05 respectively. At linear regression analysis, patients assessed throughout the 17-yr time frame were progressively younger (Coeff –0.09, p<0.001). Figure 1 graphically displays the probability of assessing younger patients over the 17-yr time-frame with median (IQR) age in 2005 of 34 (32-34) yr vs. 29 (25-32) yr in 2022.

Conclusions

Among young men seeking first medical help for new onset ED, one out of three has less than 29 yr. Of those, one out of five reports criteria suggestive of severe ED. The probability of assessing very young men complaining of ED (18-29 yr) has worrisomely increased over the last two decades roughly.

Conflicts of Interest

N/A
(58) “THE COMBINATION OF PRP AND STEM CELLS IMPROVES ERECTILE FUNCTION AFTER PENILE RESTORATION FOR PEYRONIE'S DISEASE WITH GRAFTS”
Authors: Dr. Christos Fliatouras , Dr. Nikolaos Karypidis , Dr. Theodoros Spinos , Dr. Konstantinos Konstantinidis
Published: July 2023

Objectives

The purpose of this presentation is to report the role of the combination of mesotherapy (Platelet Rich Plasma, PRP) and stem cells in improving erectile function after the restoration of Peyronie's disease with grafts (tachosil).

Methods

Erectile dysfunction is the most frequent and severe complication after penile grafting. Patients with large penile curvature underwent penile surgery with tachosil by a single high-volume Urological surgeon who washighly experienced in the field of Andrology. All patients were older than 42 years and had a penile curvature which was greater than 45°, attributed to Peyronie's disease. Some patients had a synchronous hourglass deformity, while many of them presented several comorbidities. All patients underwent repair of their curvaturewith tachosil graft, with or without simultaneous plaque removal, and were subjected to the combinationtreatment of PRP and stem cells, either intraoperatively or postoperatively, while some of them underwent shockwave therapy too.

Results

All of them were able to have sex with or without the use of PDE5 inhibitors or penile self-injections.

Conclusions

We thus concluded that the intraoperative or postoperative administration of the combination of mesotherapy and stem cells seems to be particularly efficient, regarding improvement of erectile dysfunction which resultsfrom penile grafting for Peyronie's disease with tachosil. Penile grafting is a particularly important surgical approach for Peyronie’s disease, as it manages to preserve penile length during penile curvature reconstruction.

Conflicts of Interest

The authors declare no conflicts of interest.
(249) DO ANTIPLATELET DRUGS USE CONTRIBUTE TO CLINICAL OUTCOMES IN PATIENTS RECEIVING PENILE LOW-INTENSITY SHOCK WAVE THERAPY (LI-SWT) FOR ERECTILE DYSFUNCTION?
Authors: Dr. Serdar Geyik , Dr. Mutlu Deger , Dr. Nebil Akdogan , Dr. Nazim A Kankilic , Dr. Ismail O Yilmaz , Prof. Ibrahim A Aridogan
Published: July 2023

Objectives

Low-intensity extracorporeal shock wave therapy (Li-SWT) is one of the recommended treatment options in patients with erectile dysfunction (ED). Li-SWT is safe in patients using antiplatelet drugs (APs), however, there are no specific studies on the contribution of APs use to clinical improvement in erectile function. We aimed to evaluate the early clinical results of Li-SWT administration and whether the use of APs had an additional positive contribution to clinical improvement and safe in ED patients.

Methods

Patients with ED for more than 6 months despite using (5 mg/day) PDE5i were included in our study. Patients treated with Li-SWT and using PDE5i were classified as Group 1, patients treated with Li-SWT and using APs and using PDE5i were considered Group 2. The evaluation results of the International Index of Erectile Function-Erectile Function Area (IIEF-EF) in all patients baseline and after treatment were examined.

Results

There are 25 patients in each group. Analysis of IIEF-EF scores showed significant increases in both groups after treatment [group 1 (p=0.001); group 2 (p=0.001)]. When the IIEF-EF scores of the groups before and after the treatment were compared with each other; it was shown that baseline scores were similar (p=0.746) and that APs use had no statistically significant effect on post-treatment scores (p=0.613) No side effects were seen in APs.

Conclusions

This study showed that penile Li-SWT significantly increases the IIEF-EF scores and response of (5 mg/day) PDE5i in ED patients and safe, also in AP users. However, Using AP in Li-SWT does not contribute positively to clinical results.

Conflicts of Interest

The authors declares that there is no conficts of interest.
(274) VACUUM DEVICE USAGE AFTER A RADICAL PROSTATECTOMY
Authors: Matthew Megson , Chi-Ying Li
Published: July 2023

Objectives

Within the first year after a radical prostatectomy (RALP) the majority of men experience erectile dysfunction (ED) and penile shortening.

One the treatments option is a vacuum device. Raina et al and Kohler et al showed that early use of vacuum device (VED) after a RALP facilitates early sexual intercourse, early patient sexual satisfaction and helped to maintain penile size.

The aim of this audit is to assess the effectiveness and compliance of VED use in patients after RALP.

Methods

The patients who were attending the andrology clinic for ED treatment after a RALP at our Hospital were asked short questions (Table 1).

Results

46 patients are included and asked the audit questions.

The median follow-up time was 16 months (min=3, max=21).

96% (n=44) wanted a VED in their management plan and 87% (n=40) have received one.

85% (n=34) of these with the devise were prescribed via their GP, 7.5% (n=3) self-funded and 7.5% (n=3) had prescribed at the hospital.

77.5% (n=31) were using only for rehabilitation, 2.5% using only for intercourse and 20% (n=8) for both.

77.5% (n=31) told us it created an erection. However, 25% (n=10) of the patients stopped using the device during the follow-up period. 30% (n=3) due to pain, 40% (n=4) because they felt it didn’t work and the rest either for psychological reasons or they didn’t need it anymore.

They had used it for a median of 5 months (min=2, max=8 months) before stopping.

Conclusions

A large proportion of men undergoing RALP are motivated to use a VED.

Although a high proportion found it effective, only a small proportion use it for intercourse and the compliance rate is low raising the question of the cost effectiveness of routine recommendation of this device.

Improved patient support and motivation is required for encouraging long term use.

Conflicts of Interest

No conflict of interest to disclose.
(78) SURGICAL AND FUNCTIONAL OUTCOMES OF THE A MODIFIED SHORTENING CORPOROPLASTY FOR CONGENITAL AND ACQUIRED PENILE CURVATURE
Authors: Marco Falcone , Mirko Preto , Lorenzo Cirigliano , Massimiliano Timpano , Carlo Ceruti , Federica Peretti , Ilaria Ferro , Natalia Plamadeala , Prof. Paolo Gontero
Published: July 2023

Objectives

Nesbit corporoplasty was proposed to address penile curvature (PC), both congenital (CPC) and acquired (APC). The study evaluates surgical, functional, and patient-reported outcomes (PROs) of a modified shortening corporoplasty.

Methods

Single center retrospective analysis of patients undergone modified corporoplasty from May 2005 to June 2022 was carried out. Penile complete straightening, operative time, intra and postoperative complications were considered as surgical outcomes. Functional outcomes were evaluated through the International Index of Erectile Function (IIEF) and Sexual Encounter Profile (SEP, items 2-3) questionnaires administered preoperatively and 12 months after surgery. Moreover, PROs were assessed through an "ad hoc" created questionnaire.

Results

118 patients with complete clinical data were included in the study. CPC was noted in 76 patients whilst APC was present in 42 patients. The most frequent curvature was ventral (48.3%). Preoperative mean PC was 60° (SD ±21). The median follow-up time was 125 months (IQR 35-150). Median operative time was 120 minutes (IQR 105-140). 80% of the patients reported a straight penis while a minor residual curvature (<20°) was detected in 16.2%. IIEF and SEP 2-3 scores improved in both groups. Long-term de novo postoperative erectile dysfunction was observed in 3% of CPC patients and in 39% of APC cases (P = 0.001). Multivariate analysis revealed that etiology (APC), patient age (>35 years), and postoperative complications represented independent risk factors for the development of postoperative erectile dysfunction. Postoperative complications occurred in 10.2% of patients. 26.4% of patients declared to be dissatisfied of postoperative penile length, with a higher incidence in the APC group (P = .001). Overall, a significant improvement in sexual life was observed in both categories.

Conclusions

The modified shortening corporoplasty may represent an excellent option for PC correction, with limited complications and high patients satisfaction rate. Overall, APC patients may experience less favorable outcomes when compared to CPC.

Conflicts of Interest

The authors have no conflicts of interest to disclose.
(169) MEDICAL TREATMENT OF PEYRONIE’S DISEASE WITH COLLAGENASE CLOSTRIDIUM HISTOLYTICUM: PROSPECTIVE OUTCOMES FROM 150 PATIENTS
Authors: Dr. Aliki Germanou , Dr. Edouard Fortier , Prof. Rodolphe Thuret , Dr. Antoine Faix
Published: July 2023

Objectives

To evaluate the efficacy and safety of collagenase Clostridium Histolyticum (CCH; Xiapex®) in patients with acute or chronic phase of Peyronie’s disease.

Methods

Patients 18 years of age or older with Peyronie’s disease were enrolled to a retrospective study. All patients received at least one injection of CCH by a single surgeon. The angle of curvature before and after treatment was measured. Peyronie’s Disease Questionnaire (PDQ) and its sub-scores, PDQ-PS (psychological symptoms), PDQ-PP (penile pain) and PDQ-BD (bother disease) were completed to assess at the baseline and at the last observation carried forward. In between injections, patients applied the modeling protocol at home.

Results

Overall, 150 patients were enrolled. The penile curvature improved from 53.07° ± 16.35° before treatment to 38.65° ± 16.08° after treatment, representing a mean change of 14.42°. There was a statistical improvement in all three PDQ domains independently of the initial penile curvature, PDQ-PS (-1 (-6;2), p=0.005), PDQ-PP (-1 (-6;0), p<0.001) and PDQ-BD (-2 (-6;0), p<0.001)) from baseline to last observation carried forward. CCH was well tolerated. One adverse event was reported, managed conservatively.

Conclusions

CCH is a safe and effective injectable drug for all curvature directions regardless the phase of the disease. Millions of PD patients can benefit by this treatment modality and its return in European market should be reexamined.

Conflicts of Interest

No conflicts of interest
(332) THE EFFECT OF PDE5-INHIBITORS IN THE MANAGEMENT OF PEYRONIE’S DISEASE IN THE ACTIVE PHASE: A RETROSPECTIVE COHORT STUDY
Authors: Dr. Emil Durukan , Rune H Kraglund , Dr. Shad A Rashid , Dr. Tine Thorkilgaard , Christian F S Jensen , Prof. Mikkel Fode
Published: July 2023

Objectives

Experimental models and preliminary human trials have implied that continuous treatment with PDE-5 inhibitors may be a viable treatment of Peyronie’s disease (PD) in the active phase. The purpose of this study is to assess the effect of PDE-5 inhibitors on penile curvature in the management of PD in the active phase.

Methods

We performed a retrospective cohort study of patients with PD in the active phase seen between 2017 and 2021. Patients were included if they had at least two recorded visits with curvature measurements. Patient characteristics and PD characteristics including pain, treatment and, curvatures at each visit were registered. The primary outcome was the change in penile curvature between visits in patients receiving daily PDE-5 inhibitor compared to patients receiving no treatment.

Results

135 patients were identified, with 102 (75.6%) receiving treatment with daily PDE-5 inhibitors and 33 (24.4%) receiving no treatment. The mean age in the treatment group and control group was 58 (±10.1) and 58.4 (±13.5) years, respectively. The mean time between the onset of symptoms and the first clinical visit was 11.3 (±8.6) months in the treatment group and 13.3 (±18.7) months in the control group. The mean change in penile curvature between the first and last observations in the treatment group and control group was 1.67° (±9.7) and -0.3° (±12.9), respectively (p = 0.9). A multivariate analysis controlling for baseline curvature and time from onset and the first visit showed no statistically significant differences in penile curvature changes (-0.28, 95% CI [-4.4, 3.8] p = 0.9).

Conclusions

Continuous PDE-5 inhibitor treatment appeared to have no influence on the progression of PD in the active phase. The main limitation of the study is its retrospective nature. This may have masked a potential effect as it can be speculated that patients with clinically significant improvements in curvature are less likely to show up for follow-up visits.

Conflicts of Interest

The authors declare no conflicts of interest.
(183) FROM WATERLOO TO THE GREAT WALL: A RETROSPECTIVE, MULTICENTER STUDY ON THE CLINICAL PRACTICE AND CULTURAL ATTITUDES IN THE MANAGEMENT OF PREMATURE EJACULATION, IN CHINA
Authors: Dr. Andrea Sansone , Jianlin Yuan , Guangdong Hou , Lei Zhang , Ming Gao , Zhe Zhang , Jiang Hui , Fu Wang , Jun Guo , Qiang Geng , Ming Wang , Xiansheng Zhang , Xi Yu , Zhang Yan , Jin-Chuan Liu , Yong-Gong Duan , Dinesh Nagrale , Zhiguo Chen , Prof. Emmanuele A Jannini ,   on behalf of the MAPS-GOSH (Marco Polo Study Group on Sexual Health)
Published: July 2023

Objectives

To carry out a real-life retrospective, multicenter survey on the prevalence, subtype, and proposed treatments of premature ejaculation in China.

Methods

Real-life data were provided by 8 major Centers from China, selected as active in basic and clinical research on PE and participating to international meetings of sexual medicine and andrology. Centers provided a filled survey containing relevant information concerning PE prevalence, pathogenesis and treatment.

Results

In 2019, among 156,486 patients coming to the centers, 32,667 visits having PE as the chief complaint were performed (20.9%). Almost all patients received treatment prescriptions (32,641 patients, 99.92%); 23,273 patients came back for a follow-up visit in the subsequent 12 months (71.2% of those who initially received treatment). Dapoxetine, either alone or in combination with another therapy, was the most prevalent treatment, prescribed to 22,767 patients (69.7% of treated patients), followed by Traditional Chinese medicine (TCM) (39.4%). At follow-up, 8174 patients were unsatisfied with treatment, and a new treatment was proposed (35.12%). Dapoxetine was the best treatment, with an overall 27.1% switching rate when used either alone or in combination: while the switching rate for Dapoxetine alone was 44.2%, the association of the same drug with psychotherapy resulted in much lower rates (19.5%) and reached a minimum of 12% when also combined with TCM demonstrating how cultural aspects and medical attitudes may dramatically impact on the therapy of a multifaceted, complex, and culture-grounded sexual symptom such as PE.

Conclusions

Taking switching rates as surrogate markers of treatment failure, this real-life study – the largest in the field - shows that in a more patient-oriented (as in Chinese medical culture), and less symptom-oriented (as in Western medical attitudes), Dapoxetine is a successful treatment for PE patients, with higher reliability when used alone or as part of combined and integrated therapies.

Conflicts of Interest

EAJ is or has been a speaker and/or paid consultant for Bayer, Ibsa, Lundbeck, Menarini, Merk-Serono, Otsuka, Pfizer, Shionogi, and Viatris. AS has been a paid consultant for Menarini. All others declare not to have any competing interest for the present manuscript.
(275) THE ROLE OF TESTOSTERONE TREATMENT IN PATIENTS WITH TYPE 2 DIABETES MELLITUS:RESULTS FROM A META-ANALYSIS STUDY
Authors: Dr. Walter Vena , Dr. Nicola Bianchi , Dr. Francesca Frizza , Prof. Giulia Rastrelli , Prof. Linda Vignozzi , Prof. Arcangelo Barbonetti , Prof. Edoardo Mannucci , Dr. Alessandra Sforza , Prof. Mario Maggi , Dr. Alessandro Pizzocaro , Dr. Giovanni Corona
Published: July 2023

Objectives

Type 2 diabetes mellitus [T2DM] and hypogonadism are common conditions afflicting the aging male, often present together. The specific role of testosterone [T] replacement therapy [TRT] on glycometabolic profile and body composition, particularly in patients with T2DM, is still the object of an intense debate. The aim of the present study is to meta-analyze the role of TRT in T2DM considering all placebo and non-placebo-controlled randomized clinical trials [RCTs].

Methods

An extensive Medline, Embase and Cochrane search was performed. We did not employ search software but hand-searched bibliographies of retrieved papers for additional references. All RCTs studies investigating the impact of TRT on glycometabolic outcomes without any restriction were included.

Results

Overall, 12 studies were available including 684 patients with a mean follow-up of 38.4 weeks. These trials differ in basal TT levels and type of T preparation used. In addition, only 10 were placebo controlled

Conclusions

The overall data analysis indicates that TRT favorably affects glycemic control in diabetic subjects reducing fasting glycaemia, HbA1c and HOMA index and decreasing triglyceride levels and fat mass. All these differences were confirmed when only placebo-controlled studies were evaluated, with the exception for HbA1c decrease, where only a trend towards a decrease was apparent. Conversely no effects on TRT on erectile function was observed.

Conflicts of Interest

No conflict of interest to delcare.
(87) PRELIMINARY RESULTS OF A RANDOMIZED CONTROLLED STUDY COMPARING MICRO TESE AND TESE PERFORMED WITH SURGICAL LOUPES IN MALE PATIENTS WITH NON-OBSTRUCTIVE AZOOSPERMIA
Authors: Dr. Mirko Preto , Marco Falcone , Dr. Boeri Luca , Prof. Giorgio I Russo , Dr. Massimiliano Timpano , Dr. Federica Peretti , Dr. Lorenzo Cirigliano , Dr. Ilaria Ferro , Dr. Natalia Plamadeala , Prof. Carlo Ceruti , Prof. Paolo Gontero
Published: July 2023

Objectives

To compare surgical outcomes and retrieval rates between conventional microsurgical-assisted testicular sperm extraction (m-Tese) AND TESE PERFORMED WITH SURGICAL LOUPES (L-TESE) IN ADULT MALES AFFECTED BY NON-OBSTRUCTIVE AZOOSPERMIA (NOA).

Methods

A multicentric prospective randomized trial (Ethics Committee N°: 202/2022) was conducted starting in March 2022 including NOA-affected patients. In the present study, we present our preliminary results after the first 6 months of enrollment. Adult males with NOA without genetic alterations who agreed to participate in the study and signed the required informed consent were included. Sperm retrieval rate (SRr), intra and post-operative complication rate (according to Clavien-Dindo classification), hormonal profile trends were considered as outcomes during the follow-up period.

Results

6 patients were enrolled between March 2022 and June 2022. Median follow-up was 5 months (IQR 3-6). Median age was 40 (IQR 35-44). Preoperative median FSH was 18.3 UI/l (IQR 15 -32) and total Testosterone was 3.95 ng/mL (IQR 2.7-4.9). Overall, SRr occurred in one patient (16.6%) from both sides. In patients with a negative SRr the histopathological report highlighted a Sertoli cells only syndrome (SCOS) in 4 cases and a tubular scleroyalinosis associated with early spermatogenic arrest in the last patient. No intraoperative complications were recorded. As regards postoperative complications, no significant differences were recorded between the two surgical approaches, there was a single case of wound infection (Clavien Dindo I) following the procedure. Considering the operative L-TeSE proved to be faster than m-TeSe with a median saving of 20 minutes (IQR 14-28) for each procedure.

Conclusions

According to our preliminary the two procedures may guarantee comparable outcomes in term of SRr. Additionally, L-Tese may allow to save operative time when compared to the m-Tese apparently.

Conflicts of Interest

The authors declare no conflict of interest.
(197) IS PENILE SIZE IN GRADE 3 ERECTION HARDNESS SCORE (EHS 3) COMPARABLE WITH EHS 4?
Authors: Dr. Manuel Alonso-Isa , Dr. Borja García-Gómez , Dr. Guillermo Celada-Luis , Dr. Alessandro Fiorillo , Dr. Daniel Tueti-Silva , Dr. Esther García-Rojo , Eduard García-Cruz , Javier Romero-Otero
Published: July 2023

Objectives

EHS 3 is defined like: “Penis is hard enough for penetration, but not completely hard” and EHS 4 is defined like: “Penis is completely hard and fully rigid”. In both cases we speak of penile hardness but not of penile size. We aim to analyze if there are significant differences between penile growth in ESH 3 and EHS 4

Methods

We retrospectively review a total of 225 patients from February 2021 to October 2022 who underwent penile ultrasonography with prostaglandin injection (10 mcg). Demographic, vascular and other relevant variables were recorded for analysis. A history of Peyronie disease or penile surgery (excluding postectomy and frenuloplasty) were exclusion criteria. We measured the penile length (in cm) in the flaccid state. After injecting prostaglandin, penile measures were taken only EHS 3 and EHS 4 were included.

Results

Mean age 48 (range 17-98). Mean penis size (flaccid) 10.07cm (range 4-17). Mean erect penile length (EPL) 14.37 (range 9.0-19.5). Mean EPL (EHS 3) 14.05 (range 9.0-19.5). Mean EPL (EHS 4) 14.76 (range 11.0-19.0). Mean penile growth (EHS 3) 42.3 % (range 1.8-279.5) Mean penile growth (EHS 4) 48.5% (range 1.5-107.2).

The Mann-Whitney U test indicates that the difference between penile growth in EHS 3 compared to EHS 4 is statistically significant (p < 0.05). However, difference in growth between EHS3 and EHS 4 is only 6.2%.

Conclusions

Differences in growth between EHS 3 and 4, although statistically significant, are not clinically relevant. Penile growth evaluation could be done together in EHS 3 and 4.

Conflicts of Interest

Authors have no potential conflict of interest to report.
(256) SEXUALITY AFTER TOTAL ABDOMINAL HYSTERECTOMY FOR BENIGN GYNECOLOGICAL CONDITIONS
Authors: Ons Kaabia , Rim Bouchahda , Raouf Ben Abdesslem , Ryadh Ncibi , Khouloud Ikridih , Hedi Khairi
Published: July 2023

Objectives

Since antiquity, the uterus has been associated with femininity and sexuality in addition to its reproductive function. This work proposes to evaluate the medium-term impact of hysterectomy for a benign pathology on the sexual function of patients.

Methods

This is a descriptive cross-sectional study that included initially non-menopausal women with hysterectomy without abdominal adnexectomy for a benign pathology at our Department, between January 2017 and December 2019. Patients reporting sexual complaints prior to surgery were excluded. A self-administered questionnaire was distributed during the first follow-up visit to confirm the benign nature of the pathology after the anatomopathological examination of the surgical specimens. The female sexual function was evaluated by the questionnaire translated into Arabic and validated that is the Female Sexual Function Index (Ar FSFI).

Results

The study thus recruited 88 patients whose mean age was 48.9 years (from 40 to 55 years). Preoperatively, 50% of the participants had contraception, 60% of which was hormonal. Preoperatively, 40% reported regular sexual activity. Hysterectomies were indicated for myomatous and/or adenomyotic uterus in 88% of cases and for premenopausal metrorrhagia resistant to medical treatment in the other cases. Per and postoperative hemorrhagic complications were reported in 7.84% of cases. Postoperatively, low sexual desire was found in 50%, subjective arousal disorder in 44% of cases, lubrication disorder in 18%, and orgasm disorder in 26%. The overall satisfaction rate was 84%. Dyspareunia was reported in 18% during intercourse versus 12% after intercourse.

Conclusions

Total abdominal hysterectomy without adnexectomy for benign pathology in previously non-menopausal women alters sexual function with essentially a decrease in desire and subjective arousal.

Conflicts of Interest

Nothing to declare.
(172) SEXUAL FUNCTION AND QUALITY OF LIFE IN WOMEN WITH LICHEN SCLEROSUS
Authors: Dr. Hevy S Gibrael , Signe Linhardt , Prof. Christian Graugaard
Published: July 2023

Objectives

Lichen sclerosus (LS) is a chronic inflammatory skin disease that most commonly affects the anogenital region in women. LS can be asymptomatic in some patients. In others, it can lead to irreversible anatomical changes in the vulvar area, such as reabsorption of the labia minora, burial of the clitoris, labial fusion and introital stenosis. Symptoms can include severe itch, paresthesia, and dyspareunia. However, there is a paucity of data concerning the effects of LS on sexual functioning. The aim of this study was to evaluate sexual function and quality of life in women with LS.

Methods

A literature review was performed based on extensive searches in PubMed. References were assessed for relevance by title and abstract by 2 independent reviewers, yielding 14 research papers for inclusion in the study.

Results

Women with LS had significantly decreased sexual activity and less satisfying sexual activity when compared with controls with no history of LS, and this included all types of sexual activity (vaginal, oral, anal and masturbation). Sexual function was significantly reduced among women with LS compared to controls, and this applied for all subdomains (desire, lubrication, arousal, orgasm, and pain). Women with LS had significant worse genital self-image, more anxiety, more depressive symptoms, and impaired health-related quality of life compared to controls. Despite adequate medical treatment, women with LS continued to have significant sexual distress. Sexual distress decreased but did not resolve.

Conclusions

LS can have a considerable impact on sexual function and quality of life. Thus, it is important that healthcare professionals consider LS from a bio-psycho-social perspective, where focus is not restricted to the biological aspects of the disease, but also on its psychosocial ramifications.

Conflicts of Interest

No interest of conflict.
(160) THE ALETTA CLINICAL STUDY: DESIGN OF A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED STUDY INVESTIGATING THE EFFICACY AND SAFETY OF LYBRIDOTM IN PREMENOPAUSAL WOMEN WITH ACQUIRED FSIAD
Authors: Prof. Yacov Reisman , Prof. Linda Vignozzi , Prof. Rossella Nappi , Giovanni Corona , Wil den Hollander , Dr. Jan van der Mooren , Prof. Annamaria Giraldi
Published: July 2023

Objectives

Low sexual desire is the most common sexual complaint in women. As a result, many women suffer from sexual dissatisfaction and related distress which often negatively interferes with their quality of life. Currently, limited drug treatments are available globally to treat women with Female Sexual Interest & Arousal Disorder (FSIAD). As a result, there is an unmet need, and relevance to develop a drug treatment for women with sexual dysfunction. LybridoTM (Freya Pharma Solutions, Amsterdam, the Netherlands) is a novel on-demand dual route/dual release fixed dose combination tablet of sublingual testosterone and oral sildenafil. It has shown a promising efficacy and safety profile in Phase 2 and is ready for Phase 3 testing.

Methods

Design: A double-blind, randomized, placebo-controlled, 3-arm, 6-month study to evaluate the efficacy and safety of LybridoTM in premenopausal women with acquired FSIAD. Study Population: European premenopausal women, at least 18 years of age, with a clinical diagnosis of acquired FSIAD. Interventions: The study drug is a fixed-dose combination tablet consisting of an inner core containing sildenafil with an outer delayed immediate release coating and an additional outer film coating containing testosterone. Two dose strengths will be evaluated and compared with placebo.

Results

Outcome Measures: Primary endpoint: change from baseline to Week 24 Female Sexual Function Index Desire Domain (FSFI-D) (Items 1 and 2). Secondary efficacy endpoints: Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO) score; Elements of Desire Questionnaire (EDQ) ‘event-based’; FSFI Arousal Domain (FSFI-A); FSFI total score; FSDS-DOA total score; Sexual Satisfaction of an Event Questionnaire (SSEQ), reported within 24 hours; Patient Global Impression of Improvement (PGI-I) Scale; Patient Global Impression of Severity (PGI-S) Scale; and total number of sexual events. Safety outcomes: frequency of (serious) adverse events.

Conclusions

Study Planning: First Patient In: Q2 2023; Interim Analysis: Q4 2023; Last Patient Out: Q2 2024.

Conflicts of Interest

Study supported by Freya Pharma Solution.
(177) ROLE OF SEXUAL EDUCATION ON INTENTIONAL ABORTION RATE IN IRAN
Authors: Dr. Mohsen Ghorbani , Prof. Mahnoosh Foroughi
Published: July 2023

Objectives

Background: The lack of sex education (due to the religious beliefs in traditional population) is palpable in Iran, which has led to social problems and medical issues. Objectives: The propose of this study was to investigate the role of lack of sex education in the rate of the sexual problems and induced abortions in the last 25 years in Iran

Methods

This retrospective study was designed according to data collection through official statistical data from Legal Medical Organization and Statistical center of Iran during 1995-2020.

Results

Due to the lack of sex education for general population, society’s sexual knowledge is very limited. Sexual health and family planning training have been deleted in the universities. The prevalence of female and male sexual dysfunctions were 67.9% and58.2%, respectively. Overall prevalence has been increased significantly in recent years. Only 1.4 % of induced abortion were legally licensed during this period. The majority of induced abortions are due to unwanted extramarital pregnancies. According to the law, pregnancy outside the marriage is an unforgivable crime in Iran. Considering with 25% decrease in marriage rate and 4.8 fold increase in divorce rate, the rate of intentional abortion has been increased about 5 times.

Conclusions

This study can be considered a model for all similar societies. This study might suggest the importance role of public knowledge about sexual health and family planning from school to university, breaking the taboo of treating sexual problems, and its protective effect for reducing the number of intentional abortions as well as the complications of abortions.

Conflicts of Interest

Our abstract is free from commercial influence or bias.