bluuebunny/crossref_metadata_2025 huggingface dataset:
(081) Comparing the Contributions of Nitric Oxide and Estrogen to Methamphetamine-Induced Alterations of Vaginal Blood Flow in Rats
Authors: Mott M , Goeders N
Published: May 2023

Introduction

Vaginal dryness is a frequent complaint, especially in post-menopausal women. The physiology underlying the production of vaginal lubrication in response to arousing stimuli is established; however, no current pharmacological agents successfully target mechanisms utilizing this physiology. Previous research from our lab has demonstrated that female methamphetamine (meth) users experience the production of excessive vaginal lubrication immediately following an intravenous injection of methamphetamine, and we have recapitulated this in an anesthetized rodent model. We have also found that this vaginal lubrication, as well as vaginal blood flow increased by meth, are heavily nitric oxide dependent.

Objective

The purpose of the current study is to determine if increased vaginal blood flow correlates with increased vaginal lubrication in response to meth, and to determine if alterations in this blood flow are dependent upon nitric oxide, estrogen, or both.

Methods

Adult female Wistar rats were implanted with chronic indwelling jugular catheters and allowed at least one week to recover from surgery. Rats anesthetized with isoflurane gas were intravenously infused with meth or saline via the implanted catheter. Vaginal blood flow, measured using a Periflux System 5000 and a small laser probe inserted 5-10 mm into the vaginal canal, was continuously recorded before and for at least twenty minutes following drug administration. After establishing meth-induced alterations in vaginal blood flow, rats were pre-treated with L-NG-Nitro arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor or fulvestrant, an estrogen receptor antagonist, followed by meth administration using the same procedure for measuring blood flow to determine the contribution of nitric oxide and estrogen.

Results

Meth immediately increases vaginal blood flow, followed by a decrease in perfusion, which is characteristic of a drug that induces such profound sympathetic activation. L-NAME reduced meth-induced increases in vaginal blood flow, and we predict that fulvestrant will be less effective.

Conclusions

Nitric oxide and estrogen are molecules critical to the production of vaginal lubrication. Nitric oxide, important for the vasodilation cascade leading to the production of vaginal transudate, contributes to meth-induced increases in vaginal blood flow and vaginal lubrication. Estrogen signaling likely contributes to meth-induced increases in vaginal blood flow, and thus, vaginal lubrication, but not as substantially as nitric oxide, making nitric oxide a better potential target for those suffering from vaginal dryness.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Embera NeuroTherapeutics & JanOne, both affiliations unrelated to current research
(109) Transdermally Powered, MRI Conditional Pump-in-Reservoir Implant Inflator System: Preclinical Studies
Authors: Burnett A , Horowitz M , Newman M , Newman H , DuComb W
Published: May 2023

Introduction

Inflatable medical implants have been used in the treatment of erectile dysfunction and both urinary and fecal incontinence. However, commercially available devices have required manual operation, which present difficulty in their use for patients lacking strength and dexterity to use such pumps. In women with urinary incontinence, anatomical constraints limit the use of manually operable inflatable devices.

Objective

The aim of this study was to conduct preclinical testing of a wirelessly powered inflatable medical implant system consisting of a medical provider software application, a patient external controller, and a magnetic resonance imaging (MRI)-conditional nonferrous pump-in-reservoir implant system.

Methods

An inflatable medical implant system was designed and tested. Serial prototypes designs included a nonferrous, reservoir-submerged package containing electronic motor and pump with piezoelectric valves, and an external controller resembling a TV remote. The implant system was evaluated after being connected to commercially available penile prosthetic cylinders. Power settings were tested at various thresholds; testing requirements considered to be clinically applicable were set as fluid transfer of 60 ml of normal saline at 25 psi within 45 seconds. The effectiveness of power transmission across the human abdominal wall was tested using an interface of a steak slab placed between the external controller and the implant system.

Results

Device testing at 24 and 36 volts determined that the latter was more efficient and afforded a smaller motor and pump package. Full penile cylinder inflation was recorded at 23 seconds. Effective power transmission was demonstrated across steak slabs.

Conclusions

A nonferrous pump-in-reservoir medical implant inflator system for penile prostheses is legitimate. It offers an improvement over manually operated inflatable devices, and because it eliminates a manual pump component there is feasibility of constructing a modified device for fluid transfer of urethral cuffs for treating urinary incontinence in men and women. The pump package within the reservoir is advantageous as a heatsinking feature that may limit implant overheating. Finally, the device design without ferrous components affords MRI compatibility.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Novartis
(117) Should Men Eat More Plants? A Systematic Review of the Literature on the Effect of Plant-Based Diets on Men’s Health in Urology
Authors: Feiertag N , Tawfik M , Loloi J , Patel R D , Green B , Zhu M , Klyde D , Small A C , Watts K
Published: May 2023

Introduction

There is considerable evidence describing the benefits of a plant-based diet and cardiovascular and metabolic disease. Emerging studies have evaluated the association between plant-based diets and urologic conditions affecting men’s health.

Objective

We performed a systematic review of the literature on the potential role plant-based diets may play in the following men’s health topics: prostate cancer (PCa), erectile dysfunction (ED), and benign prostatic hyperplasia (BPH).

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system (PRISMA) criteria were followed to search PubMed and Medline databases for the following search terms: “Diet [Mesh]” OR “Diet Therapy [Mesh]” AND “Prostatic Hyperplasia [Mesh]” OR “Prostatic Neoplasm [Mesh]” OR “Erectile Dysfunction [Mesh]”. Articles in English published from 1989 to 2022 using human participants were analyzed. Data were summarized and bias assessment of the literature performed.

Results

Initial literature search yielded 345 articles. We excluded 121 articles based on title and abstracts not being pertinent to the study. The remaining 224 articles were screened for relevance resulting in 23 articles that met inclusion criteria. Ultimately, 12 PCa articles, 4 BPH articles, 5 ED articles, and 2 articles related to both BPH and ED were reviewed.

Conclusions

Several studies support the protective nature of plant-based diets in PCa, ED, and BPH patients. The use of plant-based diets for PCa had the greatest amount of literature supporting positive benefits, with reasonable data from large registry trials supporting the protective effects of a plant-based diet on incident prostate cancer. Strength of association between plant-based diets and condition were variable, and no studies reported a non-association or harmful effects of plant-based diets. Most trials are limited to observational and cohort studies which rely on patient-reported evaluations of diet, limiting the generalizability of most findings. Currently, there is a lack of evidence to guide urologists and men definitively toward plant-based diets for prevention and/or treatment of PCa, ED, or BPH, and thus further studies may be helpful to evaluate this relationship, particularly in the setting of a rising public consumer interest in these diets.

Disclosure

No
(140) Penile Length and Girth Restoration in Mb Peyronie: Less Invasive Approach for Complex Composite Graft Corporplasty and Implantation of Inflatable Penile Prosthesis
Authors: Stanojevic N , Ruffo A
Published: May 2023

Introduction

Peyronie's disease (PD) is a fibrotic disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, narrowing and shortening, which eventually compromise sexual function.

Objective

The presented technique is a less invasive approach that gives few complications, has a natural cosmetic outcome with preserved preputium, and high patient satisfaction.

Methods

In the period between December 2017 and May 2022, 65pts aged 33y to 78y underwent complex corporoplasty with inflatable penile prosthesis implantation. Mean penile curvature was 70 o (60 o -95 o ). Average penile shortening was 3.2cm (1 - 5.5cm), and girth narrowing 2.5cm (0 - 4cm). The surgical approach was thru penos-crotal incision, followed by direct dissection of NVB from tunica albuginea, penile eversion, composite corporoplasty (for transversal grafting 0.5mm thick porcine dermal graft, and for longitudinal graft composite semi-resorbable soft mash), and 3-piece inflatable penile prosthesis implantation. Postoperative vacuum drainage and compressive dressing were left in place for one week.

Results

Follow-up was 2-58 months (mean 21). Penile shape (corrected curvature, length and girth) was restored in all patients. In the first 4 weeks postoperatively 12pts had mild scrotal oedema; 8pts developed mild scrotal haematoma; 7pts developed penile skin oedema; 5pts had a transitory loss of sensitivity. All patients 5 weeks postoperatively started with sexual intercourse. All patients 12 weeks after surgery reported satisfactory aesthetical and functional results with no visible scaring related to surgery. Five pts (12-23 months after surgery) had prosthesis malfunction that needed reimplantation of the prosthesis.

Conclusions

Penile eversion thru peno-scrotal incision with preserving the prepuce for complex reconstructive surgery of PD is safe and gives the natural aesthetic appearance and good functional result with low complication rate. The high satisfaction rate for the patients is the most important aspect of this surgical method.

Disclosure

No
(151) Development of a New Peyronie’s Disease Self-Assessment Screening App
Authors: Tayi R , Broderick G A , Rosen G , Khera M , Hu Y , Sajan A
Published: May 2023

Introduction

Peyronie’s disease (PD) is a connective tissue disorder associated with the formation of fibrotic plaques in the tunica albuginea, leading to penile curvature. PD is underdiagnosed, and this may be related to the reluctance of some men to seek consultation with a health care provider (HCP).

Objective

The aim was to develop an English-language digital application (app) to increase PD awareness, give men concerned about penile curvature a self-screening tool, and provide a link for locating HCPs with expertise in PD.

Methods

The Peyronie’s Disease Self-Assessment App is Android- and iOS-compatible. It was developed as a self-assessment tool for screening purposes only. It is not intended to diagnose, treat, cure, or prevent any medical condition, disease, or health problem and should not be considered a replacement for a consultation with a physician. The app provides instructional videos on general features and how to perform a penile scanning procedure.

Results

The PD Self-Assessment App includes a questionnaire related to penile curvature, penetration difficulty, degree of bother for partner, and impact on sexual activity. An innovative feature of the app is a live scanning technology, which uses the phone’s camera to detect the contours of the penis from multiple angles and applies an algorithm that determines the degree of curvature. The resulting image is a 3D penile simulation in the app, which allows the user to mark the location of any “lumps.” The app will also produce a 2D outline to determine the maximum curvature. External links are provided to a PD education website and to locate an HCP. The patient can share both the questionnaire responses and penile curvature simulation with his HCP via the user’s native email. This tool has password protection features and encrypts sensitive data. The scan images are representations of the penis, not photographs. Images are stored in the app library and are not stored in the user’s photo gallery. To enhance security, all data are erased when the app is uninstalled. The app is adaptable and scalable as needed for future updates.

Conclusions

The PD Self-Assessment App will help improve patient knowledge of the condition, document penile deformity, and facilitate consultation with an HCP. For men with PD, the app will help ease their journey with PD. The app will assist HCPs with evaluation and diagnosis. Sequential documentation of penile curvature during medical treatment, during mechanical traction protocols, or following surgery will provide an evidence basis for tracking long-term outcomes in PD.

Disclosure

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

Clarification

Industry initiated, executed and funded study

Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals Inc.
(204) Predictors of Non-Prescription PDE-5 Inhibitor Use in Adult Men - Results of a Community-Based Survey
Authors: Cabo J , Johnsen N
Published: May 2023

Introduction

PDE-5 inhibitors have long been the mainstay of medical management for erectile dysfunction but do carry the risk for potentially significant side effects, particularly when combined with other medications. The increased availability of these medicines from sources outside of a physician’s office may present risks to patients due to incomplete counseling or medication reconciliation and may also expose individuals to counterfeit medication. Prior work has shown PDE-5i inhibitors obtained online are frequently counterfeit with inaccurate dosing of the active ingredient. Factors associated with non-prescription PDE-5 inhibitor use remain incompletely characterized.

Objective

We sought to characterize associations of demographic variables, sexual function, and sexual orientation with PDE-5i obtained from non-prescription means.

Methods

Males 18 years and older were recruited through a national registry of volunteers (Research Match) to participate in an online survey. We assessed PDE-5 inhibitor use and the source of this medication within the last year. Validated scores for erectile function (IIEF-5) and ejaculatory function (PEDT) were obtained in addition to demographic data and sexual partner information. Univariable and multivariable logistic regression was performed to identify associations with obtaining PDE-5 inhibitors from a non-prescription source.

Results

Of the 1033 men who completed the survey, 348 reported using PDE-5 inhibitors in the past year (Table 1). Of this cohort, 88 (25.1%) reported obtaining PDE-5 inhibitors from an online source, purchase from non-pharmacy source, or obtained from family or friends. Men obtaining PDE-5i outside a physician’s office tended to be younger (median age 51.5 vs. 62, p<0.001) than those obtaining it with a standard prescription. Sexual function characteristics including IIEF and PEDT scores were similar between groups. Men who have sex with men (MSM) were nearly twice as likely to have obtained PDE-5i from a non-prescription or online source (37.3 vs. 22.5%, P=0.018). Married men were less likely than single men to purchase PDE-5i from a nonprescription source (22.3 vs. 35.9%, P=0.017On multivariable analysis, only younger age was associated with increased odds of obtaining PDE-5i from an online or non-prescription source (OR 0.97, 0.95-0.98, P<0.001; Table 2).

Conclusions

In this large, community-based study of adult men, we found that a quarter of PDE-5i users had obtained medication from either an online source or from family or friends. Furthermore, we found that younger men and men who have sex with men were more likely to obtain these medicines from alternative sources. While these medicines are typically well tolerated, medication obtained from unreliable sources is more likely to be counterfeit and may place individuals at higher risk for adverse events.

Disclosure

No
(216) Insufficient Medical School Sexual Health Curriculum Leads to Inadequately Prepared Trainees
Authors: Kemble J , Köhler T , Helo S , Warner J N , Ziegelmann M
Published: May 2023

Introduction

Sexual Health Curriculum (SHC) in medical schools has been insufficiently training medical students for many years. While most medical schools report teaching a SHC, many medical students and residents report being inadequately trained in sexual health. This has led to infrequent physician screening for sexual problems due to insufficient knowledge and a lack of training about sexual function and dysfunction.

Objective

To investigate the current body of literature for changes in SHC in medicals schools in the last 20 years, and to identify any discrepancies between SHC taught in medical school and resident and medical student comfort in treating Sexual Health Dysfunction.

Methods

A literature review was conducted in PubMed on “sexual health education in medical school”, and of 16,962 results 37 relevant papers published in the U.S. and Europe were identified and analyzed.

Results

In 2003 86% of medical schools reported teaching over 3 hours of SHC, but by 2021 only 65% of students and 50% of PGY 4/5 Urology residents recalled a dedicated SHC in medical school. Consistently 50% of medical students are unsatisfied with their SHC, 52% are rarely or never evaluated on their sexual history taking skills, and 7% report not learning about human sexuality at all. Most German medical students believe that sexual health courses should be mandatory. Medical students have overall positive attitudes towards sexual and gender minority populations but lack adequate knowledge, especially about transgender and intersex health. Only 55% of 3rd/4th year OBGYN residents reported feeling comfortable in performing a targeted sexual dysfunction exam, and 66% of residents in Family Med, IM, OBGYN, and Psych had no previous educational experience in sexual problem management.

Conclusions

Sexual health curriculum in medical schools has not significantly improved in the last 20 years, leading to students and residents inadequately prepared to treat sexual health dysfunctions. The adoption of previously proposed SHC competencies for medical schools should be strongly considered.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
(242) Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery: Trends after Publication of the AUA Best Practice Statement
Authors: Brant A , Lewicki P , Punjani N , Kang C , Marinaro J , Thirumavalavan N , Halpern J , Shoag J , Kashanian J
Published: May 2023

Introduction

In April 2008, the American Urological Association (AUA) released a Best Practice Statement on antimicrobial use in urologic surgery, in which the combination of an aminoglycoside with either vancomycin or a 1st/2nd generation cephalosporin was recommended as the preferred antimicrobial regimen for inflatable penile prosthesis (IPP) implantation. This recommendation has come under scrutiny due to weak evidence supporting these combinations.

Objective

To assess changes in antibiotic prophylaxis for IPP surgery following publication of the AUA Best Practice Statement in April 2008.

Methods

The Premier Healthcare Database, an all-payer dataset that captures approximately 20% of hospital discharges in the United States, was queried for IPP surgeries from January 2000 to March 2020. The primary outcome was administration of an AUA-adherent antimicrobial regimen and secondary outcome was 90-day explant. Piecewise linear regression was used to compare antimicrobial trends before vs. after guideline publication. Multivariable logistic regression models were constructed for primary and secondary outcomes.

Results

A total of 26,574 patients who underwent IPP surgery were identified, of whom 17,754 (67%) received AUA-adherent antibiotics. After guideline publication, there was a 42% relative increase in AUA-adherent regimen usage, with an increase in the usage trend on piecewise linear regression (from 0.1% to 0.8% of encounters per quarter, R2=0.75, p<0.001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0% of encounters per quarter, R2=0.84, p<0.001) and vancomycin (0.1% to 0.7%, R2=0.77, p<0.001). On multivariable regression, odds of AUA-adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54 – 1.80, p<0.001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07 – 2.35, p<0.01). The risk of 90-day IPP explant was not associated with adherence to an AUA-recommended regimen (OR: 0.94, 95% CI: 0.75 – 1.18, p=0.6).

Conclusions

Publication of the AUA Best Practice Statement on Antimicrobial Prophylaxis was associated with a subsequent increase in the usage of AUA-recommended antibiotic regimens, with gentamicin and vancomycin being the most frequently used combination. No association was observed between AUA-adherent regimens and risk of 90-day explant. These findings suggest that the AUA Best Practice Statement, among other relevant communications on antimicrobial use at the time, led to significant changes in prophylactic antibiotic choice in IPP surgery, despite the absence of level-1 evidence regarding a superior choice.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Roman Health.
(262) Grumpy Young Men? Factors Associated with Bother in Men with Peyronie’s Disease
Authors: Tyler A , Green B , Savage J , Brearton K , Ziegelmann M , Helo S , Kohler T , Trost L
Published: May 2023

Introduction

Age is often correlated with various medical conditions, including bother with the condition itself. Peyronie’s disease (PD) is a condition which is most often associated with men in their 50-60’s, however, it does affect younger men as well. Anecdotally, younger men with PD appear to be more bothered by their condition compared to older men. We therefore sought to evaluate whether there is a difference among older vs younger men as to the degree of bother linked to PD.

Objective

To evaluate age as a potential predictor of bother associated with PD.

Methods

A prospective database has been maintained of men seeking treatment for PD. Beginning in Feb 2020, we began implementing men routinely completed standardized intake questionnaires relating to PD, including the Peyronie’s Disease Questionnaire (PDQ). The PDQ consists of 15 questions broken down into three key subdomains: psychological and physical, penile pain, and symptom bother. Men who had completed the PDQ questionnaire were evaluated to determine the correlation between various clinicopathologic variables and the PDQ-bother domain.

Results

A total of 645 men were seen for symptoms of PD and had PDQ questionnaire data available for review. Baseline demographics included a mean age was 51.8 years (SD 17.6), mean PD symptom duration 31.3 months (SD 65.3), estimated curve of 40.9 degrees (SD 26.8), and mean PDQ-Bother score 8.9 (SD 3.1 – Note: lower is better). Several clinicopathology variables were found to be associated with increased PDQ-bother scores, including age (younger = less bothered, parameter estimate -.0.03, p=0.03), the presence of indentation or hourglass (yes 9.4, no 8.4, p<0.05), pain (yes 9.3, no 8.5, p=0.16), PD preventing penetrative intercourse (yes 9.5, no 8.7, p=0.07), penile shortening (yes 9.3, no 8.7, p=0.10), subjective erectile dysfunction (yes 9.6, no 8.5, p<0.01), and subjective premature ejaculation (yes 9.8, no 8.4, p<0.01). Interestingly, several variables did not correlate, including the duration of relationship, frequency of intercourse, duration of symptoms, direction of curve, degree of curvature, partner pain with intercourse, or libido.

Conclusions

Several notable factors are associated with PD bother (as assessed by the PDQ-bother domain), and equally importantly, several factors are surprisingly not associated (e.g. curvature degree and direction). These factors provide useful information to the practicing clinician to help better identify men who may be at greater risk for bother associated with the condition.

Disclosure

No
(263) Collagenase Clostridium histolyticum for Peyronie’s Disease: No Need to Postpone, but No Need to Rush
Authors: Roshandel R , Byrne E R , Alom M , Helo S , Kohler T S , Ziegelmann M J
Published: May 2023

Introduction

There is no agreed-upon definition for acute/chronic phases of Peyronie’s Disease (PD). Collagenase Clostridium histolyticum (CCH) is the only FDA-approved treatment for PD, but original phase-3 trials included patients with symptom duration > 12 months (“chronic phase”).

Objective

Here, we sought to evaluate the influence of time between symptom onset and starting CCH on treatment outcomes.

Methods

Men receiving CCH from 2014-2021 were included in an IRB-approved database. Pertinent data were reviewed, including demographics and curvature assessments. The duration between symptom onset and starting treatment with CCH was assessed to determine if the time from symptom onset to treatment impacted objective outcomes.

Results

One hundred forty-five patients completed the entire series of 8 injections and had complete data for review. Mean baseline curvature 53.2o (SD 18). The mean time between symptom onset and CCH was 14.8 months (SD 18). Mean absolute and percentage improvements were 20.3o (SD 16) and 39.4% (SD 35). Symptom duration did not significantly impact curvature improvement (Figure 1). Similarly, symptom duration did not significantly impact the risk for CCH-related side effects.

Conclusions

The time between symptom onset and treatment did not significantly impact outcomes with CCH. Our findings support the utility of using CCH early in the course of PD and emphasize the opportunity to delay if necessary without compromising efficacy.

Disclosure

No
(269) Research Action on Massive Open One line Courses (MOOCs) Rights, Sexual Health & Education
Authors: Troussier T , Dinh M , Itodo O , Gerbase A , Ward S
Published: May 2023

Introduction

The general objective of this Rights, Sex & Education MOOC, composed of 6 to 8 units, is inviting our learners and empowering them to act autonomously in their interventions in sexual health, by ensuring that their speeches, behavior and attitudes will follow and respect human rights values. In this context, learners are not only (medical) health professionals but rather engaged citizens.

Objective

To advance knowledge and practice in the priority area of human rights in relation to sexual health. This includes a variety of aspirations: ➢ the protection of young people from sexual violence, ➢ the fight against gender inequality, incest, sexual mutilation, sexual exploitation, ➢ the fight against sexist and homophobic prejudices.

Methods

The modules and sub-modules are combination of several formats: animated videos, podcasts, video interviews, infographics, cartoons, and evaluation, pedagogical and post-evaluation quizzes. This variation of formats allows us to keep learners engaged. This MOOC is also part of a Blended-learning approach. Therefore, we worked on animating throughout the opening sessions of the MOOC private groups on social networks, where learners discussed and exchanged material regularly. Our aim is the creation of a horizontal learning dimension as well as a group entity.

Results

This MOOC is a training tool designed at its core to be adapted and carried worldwide. Its first French version, in 2021, has been created with formats easily adaptable to the contexts and contents that will be imagined and redrawn in an English version. With a satisfaction rate of 93%, 4500 subscribers and more than 600 certifications.

Conclusions

We used the international format of a MOOC to fulfill the role that UNESCO chair plays in promotion of sexual health and human rights. Our ambition is to become an international reference in the field of sexual health and human rights. To take this project to the international level by consulting experts from each region in order to add and enrich this MOOC with information needed and adapted to each population and ecosystem and to respond to concerns raised by the context in which the region or the target population lives. Therefore UNESCO Chair Sexual health and Human rights created a network UNITWIN “EducationS and health for human sustainable development”.

Disclosure

No
(294) Trends and Clinical Practice Patterns of Prostatic Urethral Lift (PUL): An Analysis of the American Board of Urology Case Logs
Authors: Thorogood S , Zhang T , Sze C , Strasser M , Demeo G , Lee R , Chughtai B , Te A , Hu J
Published: May 2023

Introduction

Prior studies have shown that among benign prostatic hyperplasia (BPH) surgical treatments, PUL has a higher likelihood of preserving sexual function. As a result, the 2021 AUA guidelines on management of BPH note that PUL may be offered as a treatment option to those eligible patients who desire preservation of erectile and ejaculatory function.

Objective

We investigated practice trends associated with PUL utilization and hypothesized that PUL would be performed more frequently for younger patients and by urologists subspecializing in andrology (infertility and/or sexual medicine).

Methods

We obtained de-identified, self-reported American Board of Urology (ABU) case logs from 2015-2021. We identified 4,131 urologists who performed 48,610 surgeries with an indication for BPH per ICD codes. CPT codes distinguished PUL from transurethral incision, electrosurgical resection, laser coagulation/vaporization, laser enucleation, and thermotherapy. We identified 786 urologists who performed 7,895 PUL procedures representing 19.2% of all BPH surgeries. Additionally, 24 urologists only performed PUL, and 3,345 urologists did not perform any PUL. A logistic regression model assessed factors independently associated with performing PUL.

Results

The number of annual PUL performed has ranged from 101 to 2,852, comprising an increasing proportion of BPH surgeries from an initial 1.6% in 2015 to 32.5% of all BPH surgeries performed in 2020. In adjusted analyses, factors associated with higher odds of performing PUL included subspecialization in andrology (odds ratio [OR] 4.01, 95% CI 1.94-8.29); practice area population >1,000,000 (OR 1.55, 95% CI 1.01-2.38); and government (OR 4.22, 95% CI 1.83-9.74), private practice group (OR 2.68, 95% CI 1.53-4.68), and salaried hospital employment (OR 1.94, 95% CI 1.00-3.96). The operative year (OR 1.66 per year, 95% CI 1.54-1.80) and surgeon BPH surgical volume (OR 1.02 per case increase, 95% CI 1.01-1.02) were associated with increased odds of performing PUL. Endourology subspecialization was associated with lower odds of PUL (OR 0.40, 95% CI 0.2-0.8). Geographic region, surgeon age, surgeon gender, certification vs recertification status, and patient age were not associated with use of PUL.

Conclusions

Based on 7 years of ABU case log data, PUL is more likely to be performed by andrologists, urologists practicing in large metropolitan areas, higher volume BPH surgeons, and urologists in private practice group, government, or hospital salaried employment. Contrary to our hypothesis, lower patient age was not associated with a higher odds of undergoing PUL. The use of PUL has increased significantly and currently comprises one third of all BPH surgeries. More study is needed to determine the extent to which patient demand for ejaculation preservation is driving the rapid adoption of PUL reflected in the ABU case logs.

Disclosure

No
(295) Prostatic Urethral Lift (PUL) is Superior to TURP in the Preservation of Ejaculatory Function in Patients with Obstructive Median Lobes (OML)
Authors: Eure G , Gratzke C , Barber N , Sievert K , Gange S , Mueller T
Published: May 2023

Introduction

For the past several years, the AUA has recommended PUL as a treatment option for eligible patients who desire preservation of erectile and ejaculatory function.

Objective

This analysis serves as the first detailed assessment of sexual function and symptom outcomes among patients treated with PUL, TURP or sham in controlled and real-world studies of PUL.

Methods

Outcomes including MSHQ bother and ejaculatory function scores were compared for the following groups through 12 months: 66 patients from the L.I.F.T. pivotal RCT with lateral lobe (LL) obstruction randomized to sham, 36 men with LL obstruction in the BPH6 RCT randomized to TURP, and 45 men with OML in MedLift, the FDA-approved IDA extension of the LIFT trial. Patients in the large RWR study were filtered to approximate the MedLift population and results for the 187 OML patients were compared with MedLift.

Results

OML patients treated with PUL demonstrated superior ejaculatory function and bother scores compared to TURP LL only at all timepoints (Figure 1); at 1- and 3 months, MedLift subjects also experienced significantly better IPSS and QoL improvement post-PUL compared to TURP. IPSS improvement was 170% greater for MedLift subjects than sham LL at 3 months; MedLift subjects experienced significantly better QoL, Qmax, and BPHII improvements over the same time period. IPSS, QoL, Qmax, and PVR outcomes were equivalent for MedLift and RWR OML groups at 3-, 6-, and 12 months post-PUL; overall adverse events were not elevated in the RWR OML group.

Conclusions

Compared to TURP, PUL provides quicker symptom improvement during the early post-operative period with superior ejaculatory function outcomes through 12 months post-treatment in patients with OML. PUL continues to preserve sexual function for BPH patients despite LL or OML obstruction.

Disclosure

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

Clarification

Industry initiated, executed and funded study

Any of the authors act as a consultant, employee or shareholder of an industry for: Neotract, Inc./Teleflex.
(307) Is Vitamin D Deficiency Associated with Low Testosterone Levels in Asian LUTS Patients?
Authors: Lee J , Cho M C , Choi H , Son H , Kim S W
Published: May 2023

Introduction

It has been hypothesized that vitamin D and testosterone levels are associated, but the evidence is still unclear.

Objective

We aimed to investigate the association between hypogonadism and vitamin D deficiency.

Methods

A retrospective analysis was performed on 471 Asian male who visited for the first time with LUTS (mean age 60.56±10.79 year) of two medical centers between 2014 and 2018. Serum vitamin 25(OH)D and testosterone levels in morning samples were measured. 25(OH) D was also classified as sufficiency (>30ng/mL), insufficiency (30-20ng/mL), deficiency (<20ng/mL), and testosterone as hypogonadism (<300ng/dL) and non-hypogonadism (≥300ng/dL). The association between 25(OH) D and total testosterone (T), free testosterone (FT), bioavailable testosterone (BT), and international index of erectile function (IIEF)-5 was analyzed using t-test, partial correlation analysis, and propensity matching (propensity score 1:2). The seasonal variation of 25(OH) D and testosterone were also analyzed by one-way ANOVA.

Results

Mean testosterone level and ages of hypogonadism (n=88) were 2.3±0.6ng/dL and 60.0±10.8 year, and those of non-hypogonadism (n=383) were 5.3±1.8ng/dL and 63.0±10.3 year. The mean value of 25(OH)D (20.6±11.4ng/mL vs. 20.1±8.5ng/mL, p=0.649) and number of 25(OH)D classification (sufficiency=13 [14.8%], insufficiency=24 [27.3%], deficiency=51 [58.0%] vs. sufficiency=52 [13.6%], insufficiency=124 [32.4%], deficiency=207 [54.3%], p=0.648) did not differ between hypogonadism and non-hypogonadism groups. There was no significant difference of 25(OH)D even after propensity matching for the ages, BMI, diabetes, coronary heart disease, cerebrovascular disease of the two testosterone groups (p=0.811). 25(OH)D also showed no association with the level of T, FT, BT or IIEF-5 total scores even after adjusting for age by partial correlation analysis (p=0.470, p=0.375, p=0.735 and p=0.461, respectively). In one-way ANOVA analysis, 25(OH)D was significantly higher in summer than winter (26.8±12.5ng/mL vs. 19.0±8.6ng/mL, p=0.02), whereas testosterone showed no seasonal variation.

Conclusions

We could not find a significant association between vitamin D deficiency and hypogonadism in elderly Asian LUTS patients, even after adjusting for age, BMI, diabetes, coronary heart disease, cerebrovascular disease. The association of vitamin D levels on sexual function and seasonal variation of testosterone remains still unclear. Further large and well-designed studies are needed to determine the association between vitamin D and testosterone levels in healthy individuals.

Disclosure

No
(316) In Search of the Client Characteristics in an Embedded LGBT Health Clinic in Vietnam
Authors: Nguyen H V P , Tran N T , Nguyen N A T , Dinh B Q , Truong T K T , Mai D T B
Published: May 2023

Introduction

Today in Vietnam, LGBT people face barriers in accessing healthcare services mainly due to the lack of reliable and friendly healthcare facilities. The limited knowledge about gender diversity makes it difficult for LGBT people to be accepted. The percentage of transgender people taking hormones without medical supervision is up to 70%. In order to help LGBT people avoid risks, get psychology counseling, and be able to treat physical problems, a hospital that specializes in andrology and sexual medicine opened an LGBT Health Clinic was established in June 2019. This was the first and only embedded clinic for LGBT people in a Vietnamese public hospital.

Objective

This study aimed to ascertain the salient characteristics of the clients who come to Binh Dan Hospital LGBT Health Clinic in the first 24 months of implementation. From these findings, there will be appropriate content and communication channels strategies for reaching local LGBT people.

Methods

One hundred fifty-eight clients were included in a cross-sectional descriptive study from June 2019 to June 2021. The data on demographic characteristics, how customers know about the clinic, and unmonitored gender-affirming hormone therapy (GHT) behavior are all noted.

Results

There are 50.6% transgender, 29.1% gay, 11.4% lesbian, 5.1% bisexual, and 3.8% heterosexual. The primary demand of 42.4% of transgender people is to receive advice and follow-up on transgender procedures. Hormonal users without medical supervision accounted for 32.5% and are associated with a low level of education (r=-0.348, p<0.01). The chief demand of 38% of the LGB group is check-up programs for gender-diverse and gender-non-conforming or counseling for family acceptance. LGB group knew about the clinic through mass media (48.61%) equivalent to word-of-mouth (51.39%), while the majority of transgender (65%) used word-of-mouth. While the majority of transgender (65%) used word-of-mouth, 51.39% of the LGB group knew about the clinic through word-of-mouth.

Conclusions

There are differences in demands and communication channels for approaching the transgender and LGB group. There is an inverse correlation between unmonitored GHT behavior and education level in transgender clients.

Disclosure

No
(382) Trimodal Therapy for Erectile Dysfunction: Combination of Low-intensity Shock Waves, Platelet Rich Plasma (PRP) Injections and Vacuum Erectile Device Physiotherapy
Authors: Ruffo A , Esposito F , Iacono F , Stanojevic N
Published: May 2023

Introduction

Nowadays it is proved that low intensity shockwave therapy (LISW) have a positive effect in men with erectile dysfunction (ED). Platelet rich plasma (PRP) as well is used to treat ED. PRP contains many growth factors, such as IGF-1, BDNF and VEGF play a significant role in neural regeneration and up-regulation nNOS, as well as in the recovery of erectile function. Vacuum erectile device is used as physiotherapy to treat many penile disease.

Objective

The goal of our study is to investigate the efficacy of this trimodal treatment (Rigenerection ®) to treat ED

Methods

This prospective, randomized, controlled, interventional study enrolled 150 pts and randomly divided in two groups: Group A receiving LISW alone (1 weekly sessions) for 6 weeks and Group B receiving LISW + PRP (1 shot a week per 6 weeks) + Vacuum erectile device physiotherapy (15 minutes/daily per 3 months). Main outcome measures were: erectile function (evaluated through the IIEF5 questionnaire) and the peak systolic velocity (PSV) of the cavernosal artery (evaluated through color Doppler ultrasonography). Follow-up was at 3 months. The Mann-Whitney and Wilcoxon tests with a p<0.05 where used to analize the data.

Results

In both groups, at 3 months follow-up, mean IIEF score and mean PSV ameliorated significantly. Intergroup analysis revealed a statistically significant higher mean IIEF score and PSV increase in patients receiving the trimodal treatment (p<0.03; p<0.001 respectively). Group A: IIEF score from a baseline of 14.2 to 17.9 at 3 months. PSV from 24.4 +/− 12.4 at baseline to 33.8 +/− 8.2 at 3 months. Group B: IIEF score from a baseline of 13.8 to 21.4 at 3 months. PSV from 27.3 +/− 42.6 +/− 7.3 at 3 months.

Conclusions

The trimodal therapy proved to be a valid tool in the treatment od ED. The combination of these procedures leads to better outcomes compared with the only therapy with LISW.

Disclosure

No
(392) The Impact of Radical Prostatectomy (RP) On Testosterone (T) Levels
Authors: Flores J , Benfante N , Mulhall J P
Published: May 2023

Introduction

Severe illness is associated with a decrease in T levels and in particular, radical cystectomy has previously been shown to result in a decrease in T levels. There is a lack of data on the impact of RP on T levels. This analysis aimed to address this question.

Objective

To evaluate the impact of RP on T levels.

Methods

The study population included (i) men who underwent RP (ii) with morning total T (TT) levels pre and post-RP (iii) measured using LCMS. We considered men who had TT levels measured ≤ 12 months before and after RP. Patients with radiation therapy, androgen deprivation therapy, or T therapy pre or post-RP were excluded. Differences in TT level pre and post-RP were measured. Low total T was defined as total T levels < 300 ng/dL. Difference ≥ 100 ng/dL between pre and post-RP was considered clinically significant. Multivariable analysis was performed to define predictive factors associated with low T after RP. A p-value <0.05 was considered statistically significant.

Results

569 patients were analyzed. Mean age was 62 ± 7 years, median pre-RP PSA level was 6.1 (4.3, 8.9) ng/mL, mean pre-RP TT level 402 ± 172 ng/dL. Median Gleason score (GS) was 7 (6,7). Post-RP, the mean TT levels were 425 ± 169 ng/dL. 30% of men had low T pre-RP, 27% post-RP. No significant difference was observed between the rate of low T pre and post-RP. 13% of the men had a significant decrease and 23% a significant increase in total T levels between pre and post-RP. After multivariable logistic regression assessments, lower baseline T was a predictor associated with low T post-RP (Pre-RP Testosterone (per 100 ng/dL decrease) OR = 3.96, 95% CI = 3.03-5.18).

Conclusions

Approximately 1 in 4 men with prostate cancer and RP had low T before and after surgery in our cohort. One tenth of men had a significant drop in TT level and about a quarter had a significant increase. Only lower pre-RP TT levels were a significant predictor of low T post-RP.

Disclosure

No
(448) Sexual Emergencies
Authors: Dominguez-Bali A , Rey C , Dominguez-Bali C , Sharma R , Baqer A
Published: May 2023

Introduction

Urologist, gynecologist, surgeons, sexologists, and ER physicians are familiarized with some of the sexual emergencies that called the attention of everybody. However, the broad spectrum of those disorders is not well-known.

Objective

1. Show the magnitude of sexual emergencies in an important hospital of South Florida. 2. Show the magnitude of sexual emergencies nationally and internationally. 3. Describe how they can vary according with the place, culture, and societies. 4. To learn the methods of diagnosis and treatment of these ample variety of conditions.

Methods

Based on the multiple cases seen in our ER in Hialeah Hospital in Miami, Florida, extensive review of the literature was done, and the cases are presented to show the magnitude, variety, and diversity of cases in the different areas of the medical field.

Results

The review includes: I. The common coital emergencies in neurology (benign coital headache, subarachnoid hemorrhage, intracerebral bleeding, subdural hemorrhage, cerebral vascular accidents), urology (penile fracture, priapism, preputial tears, penile vessel rupture, penile strangulation, penile necrosis, ureterovesical foreign bodies, epididymitis., obstructive uropathies), cardiology (sudden cardiac death, myocardial infarction), gynecology (vaginal laceration and/or evisceration with/without previous gynecological surgeries), obstetrical (postpartum dyspareunia secondary or not to episiotomy or vaginal lacerations; postcoital preterm labor), immunological (local or systemic, anaphylactic allergic reactions). II. Common autoerotic emergencies in gastroenterology (foreign objects in rectum, vagina, oropharyngeal/mandibular lesions), as well as “body packers” cases (swallowed latex balloons for smuggling in the GI tract, rectum, or vagina). III. Sexual assault IV. Sexual dysfunction: Hyperactive arousal disorders (compulsive hunt for orgasms with/without attempt or real suicide, hypersexuality related to SSRI use). V. Sociosexual issues: Killings for jealousy during sex, infidelity, castration like Lorena Bobbitt case. gynecologicalgynecological

Conclusions

The epidemiology of these pathologies varies from country to country and includes subjects of any age, sex, race, religion, and culture. Finally, a review of these diagnostic methods and treatment are presented.

Disclosure

No