bluuebunny/crossref_metadata_2025 huggingface dataset:
(262) AN UPDATED PROFILE OF THE VASECTOMY REVERSAL PATIENT
Authors: Kassab J , Oppenheimer A , Huang J , Stocks B , Lipshultz L
Published: December 2024

Introduction

The average age for a vasectomy reversal is reported as 35.2 years in the 1980s and 36.0 in the 1990s.

Objective

We sought to quantify the vasectomy reversal patient profile over the subsequent decades so that urologists may be better informed to counsel patients regarding their current and future fertility options.

Methods

A retrospective chart review was performed on patients undergoing vasectomy reversal from 2010-2023 by a single surgeon. We identified 361 patients. Descriptive statistics were used to obtain demographic data including age at procedure, partner’s age at procedure, time from vasectomy, biologic children prior to vasectomy, indication for procedure, and sperm cryopreservation rates. Independent T-test calculations and one-way ANOVA were used to compare groups using SPSS software.

Results

The average age at time of vasectomy reversal was 42.0 years in the 2010s v. 44.1 years in the 2020s. The average age of the partner at time of vasectomy reversal was 33.2 years in the 2010s v. 33.2 years in the 2020s. The average number of years since vasectomy was 9.69 years and the average age at vasectomy procedure was 32.45 years old in both groups. The average number of biological children born before vasectomy & vasectomy reversal was 2.09 children. 45.7% of vasectomy reversal patients engaged in cryopreservation (sperm banking) at time of their surgery. The most frequently reported cause of seeking a vasectomy reversal was due to a change of marital partner (78.5%). The other main motivations for the surgery were due to a change of mind with their same partner (14.6%), or due to pain or an adverse event related to the original vasectomy procedure (8.23%). The f-ratio of the one-way ANOVA performed on these rates is 13.236 (p-value < .00001).

Conclusions

Our data demonstrate a continued increase in age in our patient cohort at time of vasectomy reversal procedure, exhibiting an average age of 42.0 years old in the 2010s and 44.1 years old in the 2020s. Interestingly, the average age of the partner has remained consistent at 33.2 years old in both time frames studied. It seems that those patients electing vasectomy reversal are getting older with time, perhaps due to advancements in fertility technology or due to an overall shift in family planning ideologies.

Disclosure

No.
(263) IS THERE STILL A ROLE FOR TESTICULAR FINE NEEDLE ASPIRATION MAPPING IN THE TESTICULAR MICRODISSECTION ERA?
Authors: Joshi P , Schoor R
Published: December 2024

Introduction

Finding sperm in men with non-obstructive azoospermia (NOA) can be challenging. Over the years, reproductive urologists have used a number of different strategies to maximize sperm retrieval rates and the testicular microdissection (mTESE) has been crowned the winner.

Objective

Some urologists perform testicular fine needle aspiration mapping (TFNA mapping) despite the fact that mTESE is the sperm retrieval surgery of choice. Why is this? The present investigation investigated the role of TFNA mapping in the present era.

Methods

We obtained from the “Find an SSMR Doctor” section of the Society for The Study of Male Reproduction (SSMR) email addresses of fellowship-trained male reproductive urologists and sent to them an 8-question survey. We queried the clinician’s attitudes toward TFNA mapping and how, if at all, this procedure fits into their own practices.

Results

Out of 96 surveys sent, we received a total of 32 responses (33% response rate). Of the 32, only 10 had any experience whatsoever with TFNA mappings. 6/10 reported that they currently used TFNA mapping with 4/10 respondents reporting that they used to use it but no longer do. Reasons cited for abandoning mapping included poor results (50%), limited or no access to a laboratory for interpretation (25%), and other (25%). The 6 clinicians that currently used TFNA mapping answered subsequent follow-up questions regarding their usage. If mapping failed to find any sperm at all, then urologists were split 50/50 on either referring for donor sperm or proceeding to mTESE. If mapping found rare sperm only then the majority of respondents proceeded to targeted TESE (75%) as opposed to mTESE (25%). In the event that a mapping resulted in copious amounts of sperm, 75% of clinicians indicated that they would proceed to testicular sperm aspiration as opposed to standard TESE (75% vs 25%). 100% current users of TFNA mapping found that the information gained from the procedure was valuable when counseling patients with non-obstructive azoospermia.

Conclusions

The mTESE is a difficult operation that requires a high level of andrology and embryology support that is simply outside the reach of many urologists that practice male reproductive urology. In contrast, the TFNA mapping is quick and easy to perform. The present study, with all its obvious limitations, demonstrates that some fellowship trained male reproductive urologists utilize TFNA mapping and find it helpful. Urologists that use mapping can avoid mTESE for their patients in certain situations and use the information gained from mapping to guide further management. The survey also indicates that inadequate access to quality laboratories for interpretation is an impediment to TFNA mapping usage.

Disclosure

No.
(268) PREDICTORS FOR USE OF ADVANCED ERECTILE DYSFUNCTION THERAPY FOLLOWING ROBOTIC ASSISTED RADICAL PROSTATECTOMY
Authors: Oppenheimer A , La T , Huang J , Stocks B , Kadmon D , Lipshultz L
Published: December 2024

Introduction

Despite improvements in nerve-sparing techniques offered by Robotic Assisted Laparoscopic Radical Prostatectomy (RARP), nearly all patients undergoing this procedure will demonstrate some degree of erectile dysfunction (ED) thereafter. Emerging data indicate that older age and pre-surgical hypogonadism correlate with worsened post-surgical erectile dysfunction.

Objective

Herein, we sought to determine real world outcomes of erectile dysfunction therapy as they related to patient age, pre-surgical testosterone level, and testosterone replacement therapy (TRT) at time of RARP.

Methods

We identified patients undergoing RARP by a single surgeon at our institution from 2015-2023. We then collected demographics, pre-surgical total testosterone levels, type of erectile dysfunction therapy (none [No Tx], phosphodiesterase 5 inhibitor [PDE5], or intracavernosal injection [ICI]) and TRT use for each patient. Data were analyzed using GraphPad Prism Software. We performed statistical analysis using One-way ANOVA for comparison of multiple groups followed by Tukey’s post-test. P values less than 0.05 were deemed significant.

Results

We identified a total of 179 patients undergoing RARP (mean age 64 +/- 7 years) who had pre-operative testosterone levels measured (mean testosterone level 396 +/- 299 ng/dL). 74 patients (41%) were found to have untreated hypogonadism. 42 patients (23%) were found to already be receiving testosterone therapy pre-procedurally. Younger patients and those with a higher natural pre-surgical total testosterone level were more likely to proceed with erectile dysfunction therapy (Table 1). Interestingly, while patients on no testosterone therapy were more likely to utilize either no ED therapy or PDE5, those on testosterone therapy were considerably more likely to utilize more invasive ED therapy, namely ICI (Table 2).

Conclusions

Younger age, higher pre-RARP testosterone levels, and Testosterone Replacement Therapy as controlled for by a single surgeon’s operative technique correlate with a patient’s use of erectile dysfunction therapy. Knowledge from this study will aid the urologist in identifying those patients most likely to seek and benefit from post-RARP erectile dysfunction therapy.

Disclosure

No.
(272) EXPLORING THE IMPACT OF VARICOCELE ON PROSTATE CANCER PATIENTS: A PROPENSITY-SCORE MATCHED ANALYSIS USING GLOBAL REAL-WORLD DATA
Authors: A Moukhtar Hammad M , Miller J , Ahlering T , Yafi FA
Published: December 2024

Introduction

Varicocele is the most common cause of male infertility. Emerging evidence has raised questions about a potential association between infertility and aggressive prostate cancer (PCa).

Objective

Our aim was to investigate whether having a varicocele affects PCa.

Methods

We queried the TriNetX database with access to electronic medical records from 108 partner healthcare organizations worldwide, covering over 129 million patients. We focused on adult males with prostate cancer between 2003 and 2023. Scrotal varices (ICD-10-CM: I86.1) were used to identify varicocele, while prostate cancer patients were identified by ICD-10-CM: C61 codes. We compared the baseline characteristics of PCa patients with and without varicocele, including erectile dysfunction (ED) (ICD-10-CM: N52) and “rising PSA level following PCa treatment” (coded as R97.21). We adjusted for age, BMI, diabetes mellitus, hypertensive diseases, total and free serum/plasma PSA levels, and Gleason score through logistic regression with a 1:1 propensity score matching (PSM). Calculated risk ratios (RR) and Kaplan Meier survival (KM) were calculated after PSM.

Results

Following PSM, 3,809 PCa patients were divided into two groups, with an average age of 66.9 +/- 10.6 years. Of the varicocele group, 50.97% were coded for “elevated PSA levels”, compared to 33.87% in the non-varicocele group, (p = < 0.001). Additionally, 33.89% of the varicocele group experienced ED, compared to 11.84% in the non-varicocele group, (p = < 0.001). Rising PSA level following PCa treatment was observed in 1.60% of the varicocele group, significantly higher than the non-varicocele group at 0.53%, (p = <0.001). Varicocele patients also exhibited a significantly higher rate of PCa screening, biopsy, and ultrasound-guided needle placement. On KM 5-year survival analysis for ED, patients without varicocele had 78.04% survival probability compared to 70.96% for patients with varicocele, (p = < 0.001).

Conclusions

Our study suggests a potential hypothetical association between varicocele and adverse outcomes in prostate cancer patients, including elevated PSA, ED, and rising PSA after PCa treatment. Further research is warranted to understand the clinical implications of this association and determine the usefulness of varicocelectomy on PCa outcomes.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus.
(276) DISRUPTION OF BIOFILM BY LOW INTENSITY SHOCKWAVE THERAPY TO SUCCESSFULLY TREAT AN INFLATABLE PENILE IMPLANT INFECTION: THREE YEAR FOLLOW-UP
Authors: Goldstein I
Published: December 2024

Introduction

Bacterial infection of an inflatable penile implant (IPP) is usually managed by device explantation that is often associated with severe penile fibrosis and decreased length. The decision of device explantation is based on the observation that the infecting bacteria secrete an extracellular biofilm polymer matrix that protect them from systemic intravenous/oral antibiotic therapies. A variety of other infected medical devices, including breast and hip prostheses, and the lines from ventricular assist devices have been successfully treated with low intensity shockwave therapy (LiSWT). To the best of our knowledge, this is the first report of LiSWT successfully treating an infected IPP.

Objective

To report a case of an infected IPP successfully managed using LiSWT combined with systemic antibiotics.

Methods

A 49 year old patient presented 4 weeks post-operatively with an obvious IPP infection: fever (101°F), elevated WBC count (15,400), purulent drainage from a swollen, tender scrotum, and IPP device tenderness. Culture of scrotal drainage prior to antibiotic administration grew serratia marcescens, enterococcus faecalis and citrobacter freundii. He was admitted for broad spectrum IV antibiotics and antifungal agents. Within 6 days, he became afebrile and WBC count normalized (8,000), however his renal and liver function tests became abnormal and he continued to have persistent scrotal drainage/device tenderness. The patient adamantly refused device explanation. He wished to try conservative treatment and was offered LiSWT combined with oral levofloxacin. LiSWT (SoftWave TRT/Urogold 100 MTS, energy flux density 0.13 mJ/mm2, Hz 3.0) was applied to the reservoir, penile shaft and scrotum (600 shocks each) daily for 2 weeks, twice weekly for 2 weeks, and once weekly for 4 weeks.

Results

At 1 week post-LiSWT and systemic antibiotic treatment, the patient remained afebrile with normal WBC count; liver and renal function tests normalized. At 2 weeks, scrotal drainage stopped. At 2.5 weeks, pain/tenderness of IPP components and scrotum stopped. At 3 weeks, inflation/deflation of the IPP occurred without pain. At 5 weeks, intercourse with orgasm was achieved. With greater than 3-year follow-up, he continues to have a fully functional, infection-free IPP.

Conclusions

This obvious IPP infection did not require device explanation. It is hypothesized that LiSWT induced rupture of the biofilm polysaccharide matrix, resulting in bacteria being exposed and thereby enabling systemic antibiotic therapy to access and treat the bacterial infection. LiSWT is a non-invasive, non-operative strategy that has already shown efficacy in treating other medical device infections and may be considered before performing IPP explanation.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Softwave/TRT.
(283) USE OF DECELLULARIZED CADAVERIC DERMAL ALLOGRAFT FOR REVISIONS FOLLOWING GENDER-AFFIRMING GENITAL SURGERY
Authors: Quesada Olarte J , Hale G , Sauer R , Kocjancic E , Acar O
Published: December 2024

Introduction

Gender-affirming vaginoplasty is a complex procedure. Approximately one-third of cases require revisions after penile inversion vaginoplasty (PIV) due to functional and/or cosmetic concerns.

Objective

We aim to describe our experience using a cadaveric decellularized dermal allograft (DDA, DermaPure®;) for PIV revisions.

Methods

We performed a retrospective review of patients who required revision after PIV between October 2020 and October 2023. In our cohort of 19 vaginoplasty revisions, 6 were performed using DDA. We reviewed 5 patients who had adequate follow-up data. Patient characteristics are summarized in Table 1.

Results

The interval between PIV and revision surgery ranged between 3-217 (118.4 mean, SD+/-77.0) weeks. Indications for revisions were neovaginal stenosis, wound dehiscence, or graft loss. Surfaces grafted with DDA were treated with an antiseptic solution. The packing and urinary catheter were removed in 5 days. At this time point, neovaginal self-dilation protocol (TID, 15 minutes/session) was initiated. Signs of graft take and reepithelization were noted two weeks after DDA application in all patients who remained compliant with vaginal dilation at a mean follow-up of 27.2 (SD +/- 12.7) weeks. No allograft-related side effects were encountered. The outcomes of vaginoplasty revision are summarized in Table 2.

Conclusions

Grafting with DDA is a viable option for revisions following PIV and facilitates wound healing and cosmesis with minimal postoperative wound care.

Disclosure

No.
(284) EVALUATION OF URETHRAL COMPLICATIONS IN A LARGE COHORT FOLLOWING TRANSMASCULINE GENDER AFFIRMATION SURGERY
Authors: Gobbo A , Li VY , Christopher NA , Ralph D , Lee WG
Published: December 2024

Introduction

Currently, literature regarding complications of transmasculine gender affirmation surgery (tGAS) is scarce and based mostly on small retrospective cohorts. The most frequent complications are strictures and fistulas, that frequently require additional surgical procedures to be corrected.

Objective

The purpose of this study is to describe our cohort and identify factors associated with the development of strictures and fistulas at the time of the neophallus construction and join-up stage.

Methods

We included patients undergoing tGAS in a three-stage procedure (neophallus-join up-penile prosthesis) between 2014 and 2019 collected from our prospective institutional database. Complications from the neophallus construction and join-up stage were extracted and analyzed using Chi-squared test, McNemar test, and univariable logistic regression.

Results

314 individuals with a median follow-up of 4.3y were included. Types of phalloplasty include forearm flap (80.6%), anterolateral thigh flap (7.6%), and abdominal flap with free flap urethroplasty (11.8%). 138 patients experienced at least one complication, with an overall number of 195 complications recorded. Fistulas and strictures accounted for 48.7% and 37.4% of the complications, respectively. There was no association between experiencing fistulas/strictures before and after join-up, although there was a significantly lower incidence after join-up (p = <.001; 31.8% vs 15.7%). Vaginectomy did not significantly decrease the number of fistulas after join-up however, there was a possible trend (4.3% vs 11.5%). Waiting longer between the neophallus construction and the join-up significantly decreased both all-level complications (OR = .93, p = .039) and scrotal/perineal complications (OR = .92, p = .05) after the join-up.

Conclusions

Fistulas and strictures are the most frequent complications in tGAS but are significantly less frequent after the join-up when compared to after the neophallus construction. Vaginectomy does not associate with a lower number of scrotal/perineal fistulas however, our sample may be underpowered. A longer timeframe between the first and second stage proved to be protective against scrotal/perineal complications.

Disclosure

No.
(286) LEARNING CURVE OF ANTEROLATERAL THIGH FLAP PHALLOPLASTY (ALT) FOR TRANSMASCULINE GENDER AFFIRMATION SURGERY
Authors: Gobbo A , Adasonla K , Christopher NA , Ralph D , Lee WG
Published: December 2024

Introduction

The anterolateral thigh flap phalloplasty (ALTP) offers the advantages of an easily hidden scar, security of vascular supply and improved flexibility in the length of the flap.

Objective

The aim of the study is to define for the first time the surgical learning curve of ALTP.

Methods

To compute the surgical learning curve for ALTP we defined as the surgical outcome measure all complications that occurred after the phalloplasty, excluding complications related to the join-up and erectile device to avoid confounding. 30-day complications, total/partial flap loss, urethral strictures, and urethral fistulas were included. The number of cases performed was used as a proxy for surgical experience. To build the curve we first fitted a multivariable logistic regression model including all clinically significant covariables (case number, flap area, age, presence of urethra, number of vascular pedicles > = 2) and then proceeded with the stepwise backward variable selection to obtain a model with only significant covariables. We then built the surgical learning curve by graphing the marginal predicted complications probability over the number of cases performed, ordered in chronological order, adjusted by the number of vascular pedicles.

Results

From 2009 87 patients underwent ALTP. The median age was 31 (IQR 26-43) and median BMI was 23.5 (21.0-26.0). The cohort had few comorbidities where only 3 patients had diabetes mellitus and none had cardiovascular disease. The median follow up of the cohort was 64 months (43-80). Eighty-one (93%) patients had a pedicled flap, with the remainder requiring free flap transfer. Overall, 31 patients experienced at least one complication as defined previously for the surgical outcome. The multivariable regression model found the case number and the number of vascular pedicles predictors of all complications after the phalloplasty (respectively: OR = .97, p = .003, 95% CI = .95-.99; OR = 4.19, p = .036; 95% CI = 1.09-15.9). More specifically, the probability of complications decreases as more cases are performed and increases when the flap has > = 2 vascular pedicles. The surgical learning curve shows a constant decrease in the adjusted probability of complications from an initial 65% to 10%. Although there was a slight horizontal trend in the last cases, a clear plateau was not reached.

Conclusions

ALTP is a difficult procedure performed only is specialized centers. The learning curve takes several years to accomplish, and we may have not reached its end yet. The relatively low number of cases performed over an extended period may have affected the rendering of the curve.

Disclosure

No.
(288) DOES HAVING ERECTILE DYSFUNCTION IMPACT THE PREFERENCE BETWEEN PENILE CONSTRICTION DEVICES?
Authors: Orozco Rendon D , Saffati G , Whitehead C , Zuckerman C , Hom A , Daily R , Khera M , Cheng P
Published: December 2024

Introduction

Penile constriction devices offer a noninvasive approach to improve sexual performance and erectile function, making them an attractive option for men. With the increasing variety of these devices available on the market, it is crucial to assess and compare patient preferences and device effectiveness to provide valuable insights into their clinical utility and patient satisfaction.

Objective

Our aim was to assess and compare the preference and effectiveness of two medical-grade penile constriction devices between those with erectile dysfunction and those without.

Methods

Between May and July of 2023, males were recruited via social media and prospectively enrolled into an IRB-approved, randomized, questionnaire-based study. Upon enrollment, the participants completed the Sexual Health Inventory for Men (SHIM) and Androgen Deficiency in Aging Males (ADAM). Participants were randomized to which device (FirmTech (FT) vs Eddie by Giddy) they received first. In a two-week timeframe, they used the device twice either during masturbation or intercourse. Once utilized, the participants completed a 17-question, five-point Likert scale device satisfaction questionnaire, in which lower numbers indicated more positive responses. The process was repeated with the second device. Paired T-test and McNemar Chi-Square analysis were run for statistical analysis. A p-value is considered significant if less than 0.05.

Results

Fifty men were enrolled and 49 completed the study. Having some degree of erectile dysfunction (ED) was determined based on SHIM scores <22. After matching the patients 2 to1 by age, 48 were included in the analysis. No significant preferences were determined between having ED and not having ED for the FT device. However, for Eddie by Giddy those with ED felt that they had a higher degree of firmness than those without ED when using the device (Mean Difference (MD): -0.28, p = 0.0244). Both those with ED and without ED would be more likely to use FT in partnered sexual activity than Eddie by Giddy (MD: -0.53, p = 0.0171 and MD: -0.94, p = 0.0178). Table 1 summarizes other selected responses from the questionnaire.

Conclusions

The findings suggest that Eddie by Giddy may have an advantage in improving firmness for those with ED. However, when it comes to using the devices in partnered sexual activity regardless of ED status, both cohorts were more likely to use FT.

Disclosure

Yes, this is sponsored by industry/sponsor: FirmTech.

Clarification: Industry funding only - investigator initiated and executed study.

Any of the authors act as a consultant, employee or shareholder of an industry for: FirmTech.
(291) NOVEL PENILE TUMESCENCE MONITORING DEVICE OBJECTIVELY DEMONSTRATES SHORTER-LASTING SPONTANEOUS ERECTIONS IN MEN WITH ERECTILE DYSFUNCTION
Authors: Jimbo M , Liang S , Daily R , Schardein J , Manektala Y , Gross K
Published: December 2024

Introduction

Tools to assess a man’s erectile function (EF) are currently limited. The Sexual Health Inventory of Men (SHIM) is a validated questionnaire that is easy to administer, but suffers from significant subjectivity, need for patient to actively attempt intercourse, and inability to distinguish vasculogenic from psychogenic erectile dysfunction (ED). Penile Doppler ultrasound (US) can provide objective measurements of cavernosal arterial blood flow, but suffers from high cost, invasiveness, and unreliability in the setting of suboptimal erections. The presence of nocturnal, spontaneous erections is considered a marker of EF, but is difficult to objectively measure. The FirmTech Tech Ring is a novel penile constriction ring with built-in sensors that connect with a smartphone app to record the number and duration of erections.

Objective

We conducted a small pilot study to assess the utility of the FirmTech Tech Ring to measure the quality of spontaneous, overnight erections in men.

Methods

Following Institutional Review Board approval, 9 male patients (aged 23–82 years) presenting to a Men’s Health clinic were recruited. 7 patients endorsed ED and 2 patients denied ED. Each patient was asked to fill out a SHIM, then provided with a device and asked to wear it overnight while asleep. Data were collected through the smartphone app and sent to a centralized database. Pearson’s correlation coefficient was used to determine the association between SHIM scores and erection parameters. 1-way ANOVA was used to compare the +ED and -ED groups.

Results

There were no significant correlations between SHIM scores and the measured parameters (# of overnight spontaneous erections; average duration of each erection). However, when comparing the +ED group against the -ED group, the former had significantly shorter average duration of erections (23.8 min vs. 38.9 min, p = 0.018). The number of spontaneous erections/night did not differ between the +ED and -ED groups (2.67 vs. 3, p = 0.77).

Conclusions

We report preliminary data suggesting that the FirmTech Tech Ring may be a convenient, noninvasive tool to objectively measure patients’ EF. Despite the small sample size, we noted that patients with self-reported ED had significantly shorter duration of spontaneous erections compared to patients who denied ED. Additionally, the # and duration of erections have no correlation with SHIM scores, highlighting the latter’s limitation in assessing a patient’s EF. However, further studies with larger patient cohorts, with various severities of ED and comparison against penile Doppler US results, are needed to validate these findings.

Disclosure

Yes, this is sponsored by industry/sponsor: FirmTech Inc.

Clarification: Industry funding only - investigator initiated and executed study.

Any of the authors act as a consultant, employee or shareholder of an industry for: FirmTech Inc.
(301) TREATMENT MODALITIES IN POST-ORGASMIC ILLNESS SYNDROME: A SYSTEMATIC REVIEW
Authors: Chapalamadugu M , Ponce S , Levine S , Stokes C , Radillo K , Paulsen O , Bronson I , Rubin R
Published: December 2024

Introduction

Post Orgasmic Illness Syndrome (POIS) is a rare, poorly understood condition that is characterized by feeling ill after orgasm. Despite its significant impact on quality of life, POIS remains poorly understood, and effective treatment options are limited without clear guidelines. In fact, only 18% of sexual medicine experts report symptom improvement in more than 30% of the patients. Current treatments that have been used to address the various presentations such as flu-like state, mood disturbances and/or irritability, as well as congestion and inflammation. Given the lack of standardized therapeutic approaches, there is a critical need for a systematic review to document and evaluate various treatments tried for POIS management.

Objective

This systematic review aims to evaluate current treatment modalities for POIS and compile solutions that have been studied and tested.

Methods

A search was conducted in June 2024 of three of the most relevant databases (PubMed, Embase, and Scopus) of clinical studies, RCTs and case reports analyzing treatment modalities of patients with diagnosed or suspected POIS.

Results

Of 48 studies found, 14 matched our inclusion criteria. Our systematic review consists of 1 cross-sectional study, 1 cohort study, and 12 case reports. Only one paper included female patients, the rest studied only male patients. Eleven papers discussed pharmacologic treatment modalities, including antihistamines, ibuprofen, NSAIDs, hormone replacement therapy, steroids, SSRIs, alpha-blockers, beta-blockers, calcium channel-blockers, and triptans. Two papers mentioned immune treatment, one being the intracutaneous injection of autologous semen, and the other being intralymphatic immunotherapy with the injection of allergen-specific immunotherapy. One paper mentioned surgical treatment with bilateral epididymectomy and bilateral vasoligation.

Conclusions

The largest limitation to continued research is related to the rarity and low recognizability of POIS; however, POIS research is on the rise. Scientists across the world are collaborating to better understand the pathophysiology behind this condition and investigate treatment modalities to address the associated symptoms. From reassessing the diagnostic criteria to collecting further data on varied presentations and possible treatment options, researchers are hopeful about the future of POIS.

Disclosure

No.
(302) THE PREVALENCE OF PHOSPHODIESTERASE-5 INHIBITOR USAGE IN MEN WITH RETROGRADE EJACULATION
Authors: Zhou C , Mumtaz M , Kulla A , Wiseman B , Campbell K
Published: December 2024

Introduction

Retrograde ejaculation (RE) represents a disruption and reversal in the normal antegrade seminal pathway, frequently resulting in sexual dissatisfaction and potential subfertility among men. Established etiologies of RE include alpha-adrenergic blockers used for benign prostatic hyperplasia (BPH) and certain psychotropic medications; however, the exact mechanism of action is not yet understood. Phosphodiesterase-5 inhibitors (PDE5Is), which like alpha-adrenergic blockers similarly result in vasodilation, are commonly administered for lower urinary tract symptoms, including erectile dysfunction and BPH. Despite their widespread use, there is limited literature exploring the association between PDE5I administration and the onset of retrograde ejaculation.

Objective

The purpose of this study is to elucidate if a relationship exists between PDE5I usage and retrograde ejaculation.

Methods

An IRB-approved retrospective review at a tertiary referral center identified men with a diagnosis of retrograde ejaculation via ICD-9 or ICD-10 codes and through retrograde semen analysis. Exclusion criteria included men without retrograde ejaculation based on semen analysis or electronic health record review. Baseline demographics included comorbidities, medications, and PDE5I usage. Data were analyzed using descriptive statistics and chi-square tests.

Results

Search criteria resulted in 98 male patients with a diagnosis of retrograde ejaculation (93 via ICD-9 or 10 code, 5 confirmed via semen analysis with post-ejaculatory urinalysis) with a mean age of 51.68 ± 15.99 years. 19 of these patients (19.4%) had recorded use of PDE5I at the time of RE diagnosis. 26 of the resulting patients (26.5%) were previously exposed to PDE5Is at the time of RE diagnosis. Men who were previously prescribed PDE5Is were more likely on average to be older at time of diagnosis (58.19 ± 13.31 years, p = 0.016). There were no statistically significant differences in BMI, race, ethnicity, smoking status, or presence of diabetes between men with previous PDE5I usage versus those without (p > 0.062). Of the men exposed to PDE5Is at any point, 34.6% were on sildenafil, 30.8% were on tadalafil, and 34.6% were on a combination of the two. There was no significant difference between concomitant alpha blocker use or use of psychotropic medications in men who had a history of PDE5Is usage compared to those who had not (p > 0.086).

Conclusions

In our findings, 19.4% patients had noted concurrent PDE5I use at the time of diagnosis of retrograde ejaculation. The use of PDE5I therapy is not uncommon in men with retrograde ejaculation. Further prospective studies to navigate this association are warranted.

Disclosure

No.
(304) THE OVER/UNDER OF PEYRONIE’S DISEASE
Authors: Hampton S , Schommer J , Haehn D , Broderick G
Published: December 2024

Introduction

Over/Under is a sportsbook wager term. Peyronie’s disease (PD) affects men of all ages with an estimated prevalence of up to 9% of the population. The Peyronie’s Disease Questionnaire (PDQ) Scale provides an opportunity to assess patient perception of their disease and the impact it has on quality of life. A potential discrepancy between patient-perceived and physician-measured curvature is important aspect of triaging care for patients with PD. Counseling, management and treatment risks are impacted by PD triage.

Objective

To investigate patient accuracy in perceived degree of curvature in Peyronie’s disease. Are patients over estimating or underestimating PD curvature?

Methods

A retrospective chart review was performed on 57 patients with diagnosis of Peyronie’s disease at our institution. Patients in the study completed a Peyronie’s Disease Questionnaire (PDQ) Scale with additional prompts including, but not limited to, penile curvature with erection, number of penile curvatures, and degree of each penile curvature. All patients had office based testing with intracavernous injection of Alprostadil and color duplex Doppler assessment (CDDU). The primary outcome was estimation of concordance of curvature estimated by patient and measured by provider. Patient overestimation was defined as perceived curvature more than 15 degrees greater than measured curvature. Underestimation was defined as patient-estimated curvature 15 degrees less than measured curvature.

Results

Of the 57 patients, 51 patients met study criteria with a completed questionnaire, documented physician-measured curvature, and absence of an hourglass deformity on examination. Patient concordance with physician-measure curvature within 15 degrees was observed in forty patients (78%). Overestimation of curvature was recorded in eight patients (16%), while three patients (6%) underestimated their curvature.

Conclusions

The PDQ Scale is a useful tool in assessing degree of curvature in patients with PD. We carefully selected men who had normal vascular erection responses to Alprostadil in office and compared provider measurements to patient’s home estimate of curvature. Our study finds that in men with no co-existing erectile dysfunction and no hourglass deformities the majority (78%) accurately estimate their penile curvature within 15 degrees of measured curvature. PDQ cannot replace physical examination of Peyronie’s disease or office based intracavernous induced erections as discordance between percieved and measured curvature is 22%.

Disclosure

No.
(307) EXPERT OPINIONS ON INTRACAVERNOSAL INJECTIONS AND THEIR LINK TO PEYRONIE’S DISEASE AND PENILE FIBROSIS: A SURVEY OF SUPS, GURS, AND SMSNA MEMBERS
Authors: Nosé BD , Sury K , Foreman JR , Gross M , Lentz AC
Published: December 2024

Introduction

The development of penile curvature is recognized as a potential adverse effect of intracavernosal injection (ICI) therapy. Literature often cites Peyronie’s disease as a possible consequence of ICI therapy. However, despite this widespread belief, there is a notable lack of data supporting a causal relationship between intracavernosal injection therapy and the onset of Peyronie’s disease.

Objective

To assess the current opinions of experts in sexual medicine, reconstructive urology, and prosthetic urology regarding the association between intracavernosal injection therapy and the development of Peyronie’s disease and penile fibrosis.

Methods

A 20-question survey was digitally distributed to the listservs of members of the Society of Urologic Prosthetic Surgeons (SUPS), Society of Genitourinary Reconstructive Surgeons (GURS) and the Sexual Medicine Society of North America (SMSNA). Responses were collected over an 8-month period allowing for up to three reminder emails to be sent from the participating societies. Results were then analyzed for descriptive statistics.

Results

A total of 100 surveys were completed. 70% of respondents completed fellowships with the most common being GURS. Respondents’ years in practice were evenly distributed with 49% above and 51% below ten years in practice. Overall, 68% of respondents stated that they counsel patients that ICI can cause Peyronie’s disease and 57% stated that they believe ICI causes corporal fibrosis. When looking at respondent demographics, 70% of fellowship trained respondents stated that they counsel patients that ICI can cause Peyronie’s compared to 57% of non-fellowship trained respondents. This was in contrast to priapism for which 40% of respondents stated that they counsel their patients that priapism may result in Peyronie’s disease with no significant difference in respondents’ completion of a fellowship.

Conclusions

The belief that ICI can cause Peyronie’s disease remains prevalent but not unanimous members of SMSMNA, GURS and SUPS. Urologists who have completed a fellowship are more likely to counsel patients on the risk of Peyronie’s and penile fibrosis with the use of ICI.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.
(308) ASSESSING PATIENT SATISFACTION FOLLOWING TUNICAL EXPANSION PROCEDURES FOR PENILE LENGTHENING: AN INITIAL REVIEW
Authors: Feldman-Schultz O , Desouky ES , Katz D , Levine L
Published: December 2024

Introduction

Salvaging penile length procedurally has become a captivating aspect of reconstructive urology and men’s health, addressing both a functional and psychological health. Patients experience penile shortening due to a variety of medical conditions including Peyronie's disease, priapism with corporal fibrosis, or traumatic scarring. Maintaining or restoring penile length has become an option for ensuring satisfactory sexual function and overall quality of life in such patients. Tunical expansion has emerged as a promising surgical technique aimed at elongating the penis via short coordinated incisions within the tunica albuginea. Compilation of postoperative satisfaction following such procedures has been a mystery as no long term follow up on patient fulfillment and performance has been made.

Objective

The purpose of this study is to evaluate the effectiveness of tunical expansion in enhancing penile length when correlated with patient satisfaction, providing a comprehensive analysis of clinical outcomes and potential benefits for patients undergoing TEP.

Methods

7 patients who underwent TEP during IPP placement from 2020-2024 were contacted and provided a phone call survey designed to assess their satisfaction with postoperative penile length. Survey consisted of a 1-5 scale ranging from “highly dissatisfied” to “highly satisfied” on topics including but not limited to postoperative length, curve, sensation, sexual satisfaction, and overall outcome.

Results

4/7 (57%) of men responded to the survey with an overall satisfaction of 4/5, corresponding to a subjective measurement of “satisfied.” In regard to penile length, patients were overall satisfied with an average rating of 75% satisfied. Penile curvature was also measured given the nature of most pathophysiologies. 100% of patients reported “high satisfaction” with their post operative curvature results.

Conclusions

Tunical expansion offers a viable option for improved post operative penile length following contractile pathologies. Our preliminary study shows that in the small group of men who have received the procedure, they are overall satisfied with their post operative penile length results. Further themes also showed high levels of satisfaction among respondents. It should be noted that tunical expansion is a highly technical procedure with known side effects if not done in the properly trained urologist. However, with efficient education and training, TEP can lead to improved post operative penile length satisfaction.

Disclosure

No.
(314) A WRAP UP ON THE HISTORY OF MALE CONDOMS
Authors: Lavold AL , Furtado T , Loeb C , Bash J , Andino J , Jayadevan R , Mills J
Published: December 2024

Introduction

While there are numerous options for female contraceptives, male contraception remains relatively limited. Currently, men have access to barrier contraception with condoms, vasectomy and withdrawal methods. Although there are numerous male hormonal contraceptives in development, condoms remain the most accessible and widely used means of birth control and protection against sexually transmitted diseases.

Objective

To provide a comprehensive overview of the history of male barrier contraception.

Methods

An extensive literature review was performed to unearth the rich history of male condoms.

Results

The origins of the condom trace back to 3000 BC when King Minos of Crete employed a goat’s bladder as a protective sheath against his semen, which was believed to contain “scorpions and serpents.” In 1000 BC, ancient Egyptians used linen sheaths secured with ribbons to safeguard their penises from diseases. Interestingly, the early use of condoms was for disease prevention, with contraceptive potential not yet realized. Even the Romans, despite their sophistication, did not recognize condoms as contraceptives but rather tools for public health. The modern history of condoms witnessed a shift towards their contraceptive utility. During the English Civil War, soldiers were provided with animal intestine sheaths to prevent the spread of syphilis, a common cause of mortality. Around the same time, King Charles II, who was troubled with illegitimate offspring, was advised by his doctor, aptly named Colonel Condom, to use animal sheaths for protection. By the 1700s, condom use for contraception was well documented, and England’s fertility rate had significantly reduced due to its widespread adoption. The 1800s brought new developments, including chemical treatments to enhance the comfort of the condom with “skin-like feel.” In the late 1800s, American inventor Charles Goodyear introduced the first rubber condom, revolutionizing the industry with a more malleable, durable, and cost-effective to those made from animal intestines or bladders. The 1900s saw the mass production of condoms and easier access for the general population. Ongoing innovations, such as latex, further improved their durability, flexibility, stretchability, comfort, and pleasure.

Conclusions

The historical journey of condoms sheds light on the evolution of men's health and reproductive practices. Initially driven by concerns in public health and disease prevention, condoms have played a vital role in influencing societal issues such as gender equitable birth control, religious perspectives on contraceptives, and societal attitudes towards sexuality. Understanding this history is instrumental in shaping the future of male contraception.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Halozyme Therapeutics and Endo Pharmaceuticals.
(319) ARE ANTIFUNGALS NEEDED IN PATIENTS UNDERGOING INFLATABLE MULTICOMPONENT PENILE IMPLANT PLACEMENT: SINGLE SURGEON EXPERIENCE
Authors: Gheiler E
Published: December 2024

Introduction

Recently the use of antifungal medications during Inflatable penile prosthesis (IPP) placement has been recommended. Due to published series showing that fungal infections are common in cultures from patients undergoing salvage procedures. Unfortunately, by the time the patients present for salvage procedures, many patients have received so many antibiotics that cultures can only grow fungal elements. Leaving one guessing whether the fungal elements are the primary cause of these implant infections.

Objective

Our objective is to determine if antifungal use is necessary during inflatable penile implant procedures.

Methods

A retrospective chart review was done on patients undergoing an IPP, between Jan 2021 and Dec. 2023. In patients that where not exposed to any anti fungal medications. Neither Pre-operatively, intra-operatively nor in the irrigating fluid.

Results

A total of 811 case where performed, 37% of our patients had diabetes and 19.6% were implant revisions. We had 3 cases of infections, Virgin case- 1 was due to a large hematoma that had to be drained in a patient with Myelodysplastic syndrome- Pseudomonas Aeruginosa. Revision cases - 2, one diabetic- Streptococcus Agalactiae and one non-diabetic- Methicillin resistant staph aureus.

Conclusions

None of our IPP infections could have been prevented by using antifungal medications. Guidelines recommending these medications should be re-evaluated.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific Corp.
(320) COMPARISON OF TENACIO™ PUMP AND MS™ PUMP EFFICIENCY USING SURFACE ELECTROMYOGRAPHY (SEMG)
Authors: Lee J , Schoenfeld D , Joice G
Published: December 2024

Introduction

Inflatable penile implant (IPP) pumps can be difficult to inflate, especially in older men. Efforts to increase the ease of use for IPP pumps should allow for more men to benefit from IPPs.

Objective

This study compares the muscular effort required to use the TENACIO and MS pumps in an ex-vivo bench top trial.

Methods

Two pumps (Boston Scientific’s MS™ and TENACIO™ Pumps) were utilized in an ex-vivo, head-to-head trial. Four separate tasks were performed on identical AMS 700™ IPP with: 1] Fill from empty to max (3 consecutive pumps where pump is not fully compressed), 2] Fill from 10 ml to 40 ml, and 3] 10 full pump squeezes (allowing for complete refill of pump between pumps). sEMG (Delsys Trigno®) data was collected from the thenar, flexor digitorum superficialis (FDS), and extensor digitorum (ED) muscles. The sEMG was normalized to the max voluntary contraction (MVC) (Fig. 1). Cumulative muscular workload (CMW) was calculated as time integral of the MVC. Average muscular work per second (AWS) was calculated by dividing CMV by time to completion. Pumps and IPPs were supplied by Boston Scientific.

Results

A total of 18 trials were performed by 7 participants (1 attending, 4 residents, 2 medical students). Time to completion of each task was significantly faster in the TENACIO group (Fig. 2) compared to the MS group with 30% faster maximal filling (Task 1) for the TENACIO group. There was no difference in CMW between the two pumps for any task across all muscle groups. However, the AWS for TENACIO was significantly higher for all three tasks across all three muscle groups (Table 1). The TENACIO pump was up to 31% more efficient in the thenar group for Task 1, compared to the standard MS device.

Conclusions

The TENACIO pump is significantly faster at filling and pumps more efficiently compared to the MS pump in an ex-vivo, head-to-head trial utilizing sEMG data. Future studies are needed to understand efficacy in-vivo and patient satisfaction with this pump.

Disclosure

Yes, this is sponsored by industry/sponsor: Boston Scientific.

Clarification: Industry funding only - investigator initiated and executed study.

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