bluuebunny/crossref_metadata_2025 huggingface dataset:
(092) Racial/ethnic Differences in Semen Parameters and Male Reproductive Hormones in the United States: A Systematic Review and Meta-Analysis
Authors: Dehghanbanadaki H , Kim B , Fendereski K , Ramsay JM , Horns JJ , Jimbo M , Gross KX , Pastuszak AW , Hotaling JM
Published: February 2024

Introduction

Semen quality and reproductive hormones are key indicators of male fertility potential, but studies have reported inconsistent results on racial/ethnic differences in these factors in the United States.

Objective

To perform a meta-analysis evaluating pooled differences in semen analysis parameters and male reproductive hormones across racial/ethnic groups in the United States through a systematic literature search.

Methods

PubMed, Scopus, and Web of Science were systematically searched up to December 17, 2022, with no language limitation. All studies on racial/ethnic variations in semen parameters and male reproductive hormones among the general population of the United States were included in this meta-analysis. Standardized mean difference (SMD) and its 95% confidence interval (95%CI) between races/ethnicities were pooled using the random-effects model. Newcastle–Ottawa Quality Assessment Scale (NOS) was used for risk of bias assessment. Heterogeneity was assessed by the I2 index.

Results

Our search yielded 731 articles. After screening, 9 studies were included. These studies had a low risk of bias (NOS ≥ 7) and involved a total of 7,641 participants. The pooled analysis showed no significant differences between White and Black men in the percent of total motility (p-value=0.513; I2=99.76%), total testosterone (p-value=0.272; I2=99.79%), free testosterone (p-value=0.220; I2=99.78%), and estradiol (p-value=0.876; I2=96.90%). However, higher sperm concentration (SMD=3.64; 95%CI: 0.18, 7.09; p-value=0.039; I2=99.53%) and total sperm count (SMD=6.04; 95%CI: 0.09, 11.99; p-value=0.046, I2=99.68%) were estimated for White men compared to Black men. Additionally, higher sperm concentration (SMD=1.39; 95%CI: 0.56, 2.23; p-value=0.001, I2=92.06%) and total motility (SMD=3.06; 95%CI: 0.09, 6.02; p-value=0.043, I2=99.14%) were estimated for Hispanic men compared to non-Hispanic men, with no differences in total sperm count (p-value=0.579, I2=97.79%) or total testosterone (p-value=0.078, I2=95.95%) (Figure 1).

Conclusions

This meta-analysis demonstrated reductions in semen analysis parameters, especially sperm concentration, for Black and non-Hispanic men relative to White and Hispanic men in the United States.

Disclosure

No.
(153) Hyperbaric Oxygen Therapy as a Treatment for Erectile Dysfunction: A Meta-analysis
Authors: Saffati G , Naeem T , Guhan M , Abello A , Hinojosa-Gonzalez DE , Kaaki B , Khera M
Published: February 2024

Introduction

Hyperbaric oxygen therapy (HBOT) is a medical treatment in which the patient is exposed to 100% oxygen at a higher than atmospheric pressure. Over the past few decades, HBOT has been used to treat a variety of medical conditions, including radiation cystitis, decompression sickness and carbon monoxide poisoning. In recent times, there has been a rising curiosity regarding the potential therapeutic benefits of hyperbaric oxygen therapy in the treatment of erectile dysfunction (ED), a prevalent condition that affects a vast number of men globally.

Objective

The aim of this study was to review and meta-analyze available data regarding the use of HBOT for erectile dysfunction, including its potential mechanisms of action and effectiveness.

Methods

Two investigators (GS and TN) screened 54 articles and included only those that evaluated the impact of HBOT on ED symptoms using the IIEF score. Prospective non-randomized studies or randomized controlled clinical trials were included, while non-original studies, conference abstracts, and case reports were excluded. Data extraction was performed in duplicate. Data analysis was conducted using Review Manager 5.41, and the presence of heterogeneity between studies was evaluated. The results were presented as the Mean Difference (MD) with 95% confidence intervals (CI). The significance level was set at P = 0.05.

Results

A total of five studies that reported outcomes using the IIEF scores were included in this analysis, which comprised a total of 175 patients who received HBOT and 178 control patients. The IIEF scores were analyzed by stratifying the studies according to the indication for HBOT or the cause of ED. In patients with post-robotic assisted laparoscopic prostatectomy (RALP)-induced ED, the analysis showed a significant Mean Difference (MD) of -4.13[-6.08, -2.18] p<0.0001 in favor of the control group. Conversely, patients who received HBOT for reasons other than ED exhibited a MD of 4.58[2.63,6.52] p<0.00001. In the group that received HBOT for pure vasculogenic ED, the MD was 10.50[9.92,11.08] in favor of HBOT. Patients with urethral strictures exhibited a MD of 4.25[2.29-6.21] favoring the HBOT intervention. Meta-analysis of these data revealed a nonsignificant difference in erectile function scores, with an MD of 3.86[-2.13, 9.86] p<0.00001.

Conclusions

The use of HBOT in the treatment of ED appears to be a promising approach. While further research is needed to establish the efficacy and long-term effects of this treatment, preliminary studies have shown encouraging results in terms of improving erectile function in men with vasculogenic ED.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(154) Safety and Efficacy of Platelet-rich Plasma Injection for the Treatment of Erectile Dysfunction; A Randomized Prospective Study
Authors: Ragheb A , Fahmy M , Lotfy A , Elmarakby A
Published: February 2024

Introduction

Platelet-rich plasma (PRP) intracorporeal injection is one of the popular regenerative therapies that has been gaining much interest in recent years as an adjunct or alternative treatment for erectile dysfunction (ED). Nevertheless, scientific evidence to support its clinical efficacy remains controversial.

Objective

The aim of this study was to evaluate the safety and efficacy of PRP injections for the treatment of ED.

Methods

A prospective, randomized, double-blinded, placebo-controlled, interventional clinical study was conducted on 52 subjects. Patients were randomized into two groups: the PRP group (n=26) and the placebo (saline) group (n=26). Each participant received three sessions (at two-week intervals) of PRP or saline injections according to his assigned group. International index of erectile function-5 (IIEF-5) scores and safety-related observations were collected during the 1st, 3rd, and 6th months of follow-up.

Results

The median age and ED duration were statistically comparable for both groups, 52.2 versus 52.5 years and 12.87 versus 11.8, respectively (P = 0.285). With regards to the efficacy of PRP, there were no statistically significant differences between both groups after 1, 3, and 6 months of treatment. After 1 month of treatment, the mean IIEF-5 score for the PRP group was 16.12 ± 1.25 versus 15.99 ± 1.21 for the placebo group (P = 0.683). After 3 months, the IIEF-5 score for the PRP group was 16.44 ± 1.17 compared to 16.31 ± 1.06 for the placebo group (P = 0.653). Also after 6 months, the IIEF-5 score for the PRP group was 16.35 ± 1.45 close to 16.23 ± 1.19 for the placebo group (P = 0.727). No transient hemorrhagic adverse events (hematuria, local petechial bleeding, or ecchymosis) or other side effects were reported during the injection and follow-up period for both groups.

Conclusions

The results of this trial suggest that although the treatment of ED with 3 injections of intracavernosal PRP separated by two-week intervals may be safe, it is not more effective than a placebo injection.

Disclosure

No.
(162) Evaluating the Effectiveness of Testosterone Therapy Combined with PDE5 Inhibitors in Enhancing Erectile Function in Eugonadal Men
Authors: Iacobucci A , Naeem T , Saffati G , Applewhite J , Pierce H , Lipshultz LI , Khera M
Published: February 2024

Introduction

Historically, testosterone therapy (TTh) is not indicated in eugonadal men with erectile dysfunction (ED). Moreover, the 2018 AUA Guidelines state that TTh is not indicated as monotherapy for men suffering from ED but should be considered as combination therapy with PDE5i, as TTh may increase the efficacy of PDE5i therapy.

Objective

We investigated the benefits of providing TTh in combination with PDE5i therapy in marginally eugonadal men to determine its efficacy in improving erectile function.

Methods

A retrospective chart review was performed on men presenting with ED to an academic institution’s Men’s Health Clinic from 2010 to 2022. Objective data was gathered on key variables that affected patient-reported outcomes of ED, including age at presentation and comorbidities, as well as use of TTh and use of oral PDE5i. 177 eugonadal men were selected with the criteria of testosterone levels >300 ng/dL on initial presentation. Results were then statistically analyzed using a two-tailed student’s T test in R and p-values to determine the significance between variables and outcomes in ED.

Results

Out of our cohort of 179 eugonadal men presenting with ED, 42 patients were continued or started on concurrent TTh with oral PDE5i therapy added, and 83 were started on PDE5i monotherapy. Men in the dual-therapy group excluding those already on TTh began with a pre-therapy testosterone mean of 412.3 ng/dL compared to 443.0 ng/dL which was insignificant (p=0.22). There were no significant differences in presenting age (p=0.61) or comorbidities including hypertension (p=0.89) and diabetes (p=0.63) between the two groups. Additionally, there were no significant differences in lab values of HgA1c (p=0.34), cholesterol (p=0.80), triglycerides (p=0.27), or LDL (p=0.89). However, there was a lower initial HDL in the combination group of 45.1 mg/dL compared to 55.8 mg/dL (p = 0.036). Men in the dual-therapy group were more likely to report subjective improvement in ED symptoms compared to men taking PDE5is alone. This was supported by 33/42 (78.6%) of men in the dual therapy group reporting improved erectile function compared to 49/83 (59.0%) of men in the PDE5i only group (p = 0.029).

Conclusions

In conclusion, these results demonstrate that treatment of eugonadal men with concurrent TTh and PDE5i therapy demonstrated a significant improvement in erectile function as compared to PDE5i therapy alone. These findings suggest consideration of testosterone therapy in addition to PDE5i in clinical practice when treating marginally eugonadal men presenting with ED.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(173) Initial Experience with ReSheyP Device for Intraoperative Modeling of Peyronie’s Disease After Placement of a Penile Prosthesis
Authors: Mossack S , Desouky E , Levine L
Published: February 2024

Introduction

Manual modeling to correct penile curvature associated with Peyronie's disease (PD) during penile prosthesis has been a recognized procedure since the 1st publication by Wilson et al in 1992. A key component to optimizing results and minimizing complications (i.e. distal urethral laceration) with manual modeling is proper technique. Manual modeling can be technically challenging as the inflated prosthesis must be maintained bent in the direction opposite to the curvature for up to 60-90 seconds and repeated several times. This can be challenging for the operating surgeon with respect to hand fatigue or even accomplishing the adequate modeling pressure. The purpose of this report is to present initial results with ReSheyP, a device designed to facilitate manual modeling in a more controlled fashion to make it easier to perform and potentially less risky than when done simply by hand. In addition, the device can be used in the postoperative setting to resolve residual curvature.

Objective

We present on 5 men who underwent placement of an inflatable penile prosthesis with manual modeling using the ReSheyP device. Pre- and post-modeling curvature measurement was performed with a goniometer. Men who had severe indentation deformity were excluded from the study.

Methods

A retrospective review was performed on patients who underwent penile prosthesis placement followed by ReSheyP modeling in 2023. During the procedure, the ReSheyP was deployed at least 2-3 times for 60-90 seconds per modeling. Data collection included demographics, pre- and post-operative assessment of penile curvature, adverse events and patient satisfaction with postoperative straightening.

Results

Mean pre-modeling curvature was 62 degrees (range 50-70 degrees) (Table 1). Direction of curvature was dorsal in 3 patients and lateral in 2 patient. The average intraoperative post ReSheyP modeling curvature was 11 degrees and the average change in curvature was 45 degrees. All men reported satisfaction with post-op curve correction. There were no intraoperative or postoperative complications. No patient has felt that further at home modeling was needed. Penile sensation and prosthesis function was uncompromised.

Conclusions

This pilot study using the ReSheyP device for intraoperative modeling to correct penile curvature after penile prosthesis placement suggests that this tool may be an effective procedure for correcting penile curvature in men with PD. Further experience is necessary and longer follow-up will be reported.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(180) Unveiling Consumer Interest and Regional Disparities: Comparative Analysis of Online Search Trends for Penile Aesthetic Procedures
Authors: Hammad MAM , Banton J , Miller J , Yafi FA
Published: February 2024

Introduction

In recent years, the introduction of Penuma, an implantable silicone penile sleeve, offers urologists a tool in the cosmetic enhancement of the penis, specifically for individuals who are concerned regarding the perceived size of their penis, with buried penis, and with mild to moderate penile curvature. With the increasingly widespread adoption of Penuma, it is crucial to understand how public interest in Penuma compares to other related interventions such as hyaluronic acid injections.

Objective

To assess the online search interest over time for Penuma and other penile enhancement terms on a national and regional scale.

Methods

Google Trends data from 2018 to March 2021 were utilized to analyze online traffic for the search terms “Penuma”, “penile implant”, “penile girth”, “HLA injection”, and “penis injection”. Trendlines were generated to assess the changes in search interest over time. The highest search interest locations were identified for each term.

Results

While online searches for Penuma increased between 2018 through 2021, interest in Penuma has since been in decline (Figure 1). While interest in penile implants remained higher than Penuma throughout the study period, Penuma remained a more popular term compared to other cosmetic treatments including penile injections and HLA injections. In terms of regional disparities, the highest search interest for Penuma was observed in San Antonio, TX, while penile girth searches were highest in OKC, OK. Penile implant searches were prominent in Mobile, AL, and Birmingham, AL. Notably, HA injection searches peaked in New York, NY, and penis injection searches were most prevalent in Los Angeles, CA.

Conclusions

This study highlights the dynamics of online search interest of Penuma in relation to other penile enhancement terms. While general interest in penile implants and penile girth surpasses that of Penuma, regional disparities in search patterns are evident. The findings emphasize the need for further research to understand the factors driving these disparities and the implications for consumer decision-making in different regions. Such insights can assist healthcare professionals and policymakers in tailoring educational initiatives and resource allocation to meet the diverse needs and preferences of individuals seeking penile enhancement procedures.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.
(190) Modified Technique for a Mini-Jupette Urethral Sling
Authors: Liaw A , Armitage S , Alexander A
Published: February 2024

Introduction

In this video we present our technique for mini jupette sling (MJS) placement during the placement of an inflatable penile prosthesis (IPP). The technique is initially described by Dr Andrianne, and our technique is modified from the mini-jupette as employed by Dr Yafi.

Objective

MJS could be considered in patients who are experiencing incontinence or climacturia, common complications of radical prostatectomy and prostate cancer treatment.

Methods

The standard dissection and exposure is done using a typical penoscrotal or subcoronal approach. The corporotomies and dilation are done in the typical fashion. However, instead of placing stay sutures on either side of the corporotomies, we only place them on the lateral sides. When the mini jupette is placed it is secured with a running suture, and a loop is tied in the middle and divided to create four free ends, after the start and end of the running suture are completed. These four free ends match up with the four stay sutures placed lateral to the corporotomies. The pairs are tied together once the cylinders are placed, closing the corporotomies and securing the mini-jupette at the same time. The corporotomies are eventually closed by tying the stay sutures across the incision.

Results

This technique allows for a secure sling placement, without bunching of the sling. Since the corporotomies can be tied closed, there is no risk of needle injury to the cylinders

Conclusions

Operative time is not significantly increased when adding this procedure. We have encountered no complications related to the mini-jupette with this method

Disclosure

No.
(197) The Impact of Connective Tissue Disorders on Rates of Penile Fracture and Peyronie’s Disease
Authors: Mandel A , Simhal R , Sholklapper T , Sun K , Poluch M , Wang K , Shah Y , Chung P
Published: February 2024

Introduction

Ehlers Danlos Syndrome (EDS) and collagen-related hypermobility disorders are well known to cause frequent joint dislocations, easy bruising, and poor wound healing. Marfan syndrome is caused by a mutation in the protein fibrillin, a key component of collagen and elastin connective tissue, whose dysfunction causes the marfanoid phenotype. Currently, little is known regarding the impact of connective tissue disorders on men’s sexual health. As a first step in exploring this association, we investigated two physical phenomena that may be impacted by collagen disorders, penile fractures and Peyronie’s disease.

Objective

This study aims to investigate rates of penile fracture and Peyronie’s disease in EDS and Marfan syndrome patients.

Methods

A multi-center, international, electronic health record network (TriNetX) was queried to identify adult male patients with or without EDS between 1993 and 2023 using ICD-10 codes Q79.6, Q79.60, and Q79.62 specific for EDS and EDS related hypermobility syndrome. TriNetX was separately queried for Marfan syndrome using ICD-10 code Q87.4. Incidence and prevalence of penile fractures and Peyronie’s disease were compared between patients with and without the diseases of interest. Penile fractures were identified using ICD-10 codes S39.840, S39.84A, S39.84S, S39.84D. Peyronie’s disease was defined using ICD-10 code N48.6. Odds ratios were generated with 95% confidence intervals. All statistical analyses were conducted within the TriNetX platform.

Results

Data was queried from 82 healthcare organizations to yield 11,937 EDS patients, and from 101 healthcare organizations to yield 13,705 Marfan syndrome patients. 109 healthcare organizations contributed data to yield a control group of 63,790,628 men. Men with EDS had a 25 times higher rate of penile fractures (0.09%) compared to men without EDS (OR 25; 95% CI [13.8-47.8]). Men with Marfan’s syndrome had a 23 times higher rate of penile fractures (0.08%) compared to men without Marfan’s syndrome (OR 23; 95% CI [12.4-43.1]). Men with Marfan’s syndrome also had a significantly higher incidence of Peyronie’s disease compared to men without Marfan’s syndrome (OR 1.9; 95% CI [1.2-3]). The difference in rates of Peyronie’s disease was not significantly higher for men with EDS (OR 1.4; 95% CI [0.8 – 2.5]).

Conclusions

Patients with EDS and Marfan syndrome are at an over 20 times higher risk for penile fracture. These increased risks may be due to EDS’s and Marfan syndrome’s effects on collagen and fibrillin/elastic fibers, respectively, which are significant structural components of the corpora cavernosa. Patients with these syndromes should be aware of this increased risk and further research is needed to establish how to council these patients about taking appropriate precautions.

Disclosure

No.
(200) The Fertility and Childbearing Experiences of US Male Physicians
Authors: Jesse E , Tay K , Sellke N , Rhodes S , Muncey W , Hijaz A , Thirumavalavan N
Published: February 2024

Introduction

Recent attention has been brought to physician fertility in the last decade, most notably amongst female physicians who suffer an increased risk of infertility compared to the general population. Various factors related to a career in medicine play a role, such as a delay in pursuit of childbearing, a demanding work schedule, shift work, and stress associated with the profession. However, risk of infertility in the male physician population has yet to be studied.

Objective

Therefore, we sought to evaluate the experiences and childbearing patterns of a sample of American male physicians with special attention to timing of conception and childbearing, reflections upon professional and personal decision-making, and general knowledge regarding fertility. The primary objective of this study was to determine the incidence of infertility among American male physicians.

Methods

Utilizing a third party to access the American Medical Association (AMA) database, licensed US physicians registered as male and between the ages of 18-65 were identified. Within this cohort, 690 men were randomly selected and contacted via paper mail (340) or email (350) and asked to participate in the survey study. Surveys were administered electronically via REDCap (obtained through a QR code) and included questions regarding the physicians’ demographics, medical specialty, and whether they have attempted to conceive. Those who have attempted to conceive were also surveyed on their work experience at the time of their first attempt at conception and their experience and partner’s experience with fertility and childbearing. Internal Review Board approval was obtained for this study (STUDY 20211036).

Results

Fifty-three men responded to the survey (7.7%). All respondents were cisgender males with cisgender female partners. The majority (94.3%) had attempted to conceive and occurred most during residency (46.0%). The average age when first attempting conception was 31.6 years, and this was most commonly during residency (46.0%) or after training (30.0%). During this time, many (72.0%) were responsible for night shifts, overnight call duties, or both. In addition, as many as 34 men (68.0%) had no access to paid parental leave during this time. Of 50 men who attempted conception, 14 (28.0%) of their partners experienced a miscarriage. Eight men (17.0%) underwent a fertility workup, and 6 underwent infertility treatment(s). Only 4 respondents had insurance partially covering their infertility treatments, while the other two had no insurance coverage.

Conclusions

Male physicians are often exposed to long work hours, nighttime duties, and sparse paid parental leave during the time of their first attempt at conception, most commonly in residency. Our cohort shows a high rate of miscarriage (28.0%) and infertility assessment (16.0%) among this population. Future studies are needed to continue characterizing fertility amongst physicians.

Disclosure

No.
(219) Prevalence of Sexual Incontinence in Men with Stress Urinary Incontinence After Radical Prostatectomy
Authors: Elshafei A , Ljubetic BM , Novaes LF , Benfante N , Cheung F , Sandhu J , Mulhall JP , Flores JM
Published: February 2024

Introduction

Sexual incontinence (SI) includes arousal incontinence and climacturia. SI is under-reported after radical prostatectomy (RP), significantly bothering the patient and the partner.

Objective

This study aimed to evaluate the prevalence of SI based on the SUI severity and identify predictors of SI during the first year after RP.

Methods

This study included men with RP and a follow-up until 1 year post-surgery. Patients who received ADT or radiation therapy either pre or post-RP were excluded. We performed a descriptive assessment of demographics, comorbidities, pre-RP prostate-specific antigen (PSA), Gleason group of the surgical pathology, nerve-sparing status (NSS), and erectile function (EF) based on the IIEF score. SI was defined as the presence or absence of climacturia or arousal incontinence reported by the patient at 3, 6, 9, and 12 months post-RP. SUI was described based on the number of pads used per day. These were categorized as 0 to 1 pad per day (No SUI or mild SUI), 2 pads per day (moderate SUI), and ≥ 3 pads per day (severe SUI) at 3, 6, and 12 months post-RP. We determined the prevalence of SI for each SUI category at each time period. We analyzed predictors of SI using a logistic regression model at 3, 6, 9, and 12 months post-RP. Factors entered into the model included: patient age, number of comorbidities (≥ 3, yes), NSS both resected (yes) and severe SUI (≥ 3 pads per day, yes).

Results

Our study included 2768 men with a median age of 60 (55-66). 11% had diabetes. 27% obstructive sleep apnea, and the median number of comorbidities was 1 (1-2). The median preoperative PSA was 5.6 ng/ml. The median Gleason grade group was 2 (2, 3). 71% had bilateral NSS, 22% unilateral, and 7% had both sides resected. The prevalence of SI was 26%, 24%, 23%, and 27% at 3, 6, 9, and 12 months post-RP, respectively. The prevalence of SI was higher among men with severe SUI compared to men with 0 to 1 pad per day at 6, 9, and 12 months post-RP. At 3 months, men with 0 to 1 pad per day reported 25% SI, vs. men with severe SUI described 28% SI. At 6 months, for men with no SUI/mild SUI, 19% described SI, vs. men with severe SUI, 32% had SI. At 9 months, for men with no SUI/mild SUI, 20% described SI vs. men with severe SUI, 33% had SI. And at 12 months, men with 0 to 1 pad per day reported 23% SI, vs. men with severe SUI described 36% SI. On the logistic regression model, severe SUI ≥ 3 pads/day was the only independent predictor of SI at 6, 9, and 12 months postoperative (Table 1).

Conclusions

Approximately one-quarter of our cohort experienced SI within 12 months after RP. SI was more prevalent among patients with severe SUI, particularly at the 6-month mark and beyond after RP during the first-year post-surgery. Severe SUI significantly predicted SI during the first year following surgery.

Disclosure

No.
(250) NLRP3 Inflammasome Might Contribute to Erectile Dysfunction Induced by Chronic Unpredictable Stress in Male Mice
Authors: Priviero F , Rodrigues Dos Passos Junior R , Dos Anjos Moraes R , Arishe O , Wilczynski S , Crockett A , Frambes N , Wood S , Spinale F , Ryan M , Hollis F , Webb C
Published: February 2024

Introduction

Introduction: The association of stress with erectile dysfunction (ED) is well known, however, it is not clear whether psychological stressors affect the vasculature and the erectile tissue in a manner that could contribute to a vasculogenic erectile dysfunction. Besides hormonal changes, cellular damage induced by stress could lead to the activation of the NLRP3, to increase production of cytokines associated with ED. In this study, we aimed to evaluate the reactivity of the corpus cavernosum and pudendal artery of male mice undergoing chronic unpredictable stress (CUS).

Objective

Objective: We hypothesize that CUS leads to mitochondrial damage and activates the NLRP3 inflammasome leading to impaired reactivity of the pudendal artery and corpus cavernosum which might cause erectile dysfunction.

Methods

Methods: Male C57Bl/6 mice were submitted to 28 days of chronic unpredictable stress (CUS). The pudendal artery and corpus cavernosum were removed and mounted in a myograph to evaluate reactivity. Tissues were kept in physiological salt solution at 37°C, constantly aerated with 95%O2/5%CO2 and concentration-response curves to acetylcholine (ACh; 1 nM – 30 uM) and phenylephrine (PE; 1 nM – 30 uM) were obtained. Using non-linear regression, we obtained the maximal response (Emax) and potency (pEC50) of ACh and PE. Expression of NLRP3, pro-caspase1 and caspase1 were measured in arteries by Western blot. Data are expressed as mean ± S.E.M. P<0.05 was considered statistically different.

Results

Results: CUS led to a significant decrease in the maximal relaxation induced by acetylcholine in the pudendal artery (Non-CUS: 96 ± 3% vs CUS: 84 ± 7%, n=6 and 7, respectively) and in the corpus cavernosum (Non-CUS: 88 ± 4% vs CUS: 75 ± 4%, n=7 each group) as well as an impaired contraction to PE in the corpus cavernosum (non-CUS: 1.72 ± 0.17% vs CUS: 1.07 ± 0.15%, n= 7 each group). In arteries, there were no differences in the expression of NLRP3, however, the ratio of caspase1/pro-caspase-1 was increased in CUS, suggesting that CUS increases the NLRP3 inflammasome pathway. Taken together, our data suggest that CUS led to an activation of the NLRP3 inflammasome pathway, and impaired the relaxation of the pudendal artery and corpus cavernosum by a mechanism that might be associated with decreased nitric oxide bioavailability (endothelium-dependent relaxation), whereas impaired contraction might be associated with desensitization of alpha-adrenergic receptors in response to stress.

Conclusions

Conclusion: Our findings demonstrate that stress impairs the reactivity of the corpus cavernosum and pudendal artery likely associated with the activation of NLRP3 inflammasome, which might play a role in the development of erectile dysfunction in stressed males.

Disclosure

No.
(259) Providing a Post-Vasectomy Semen Analysis Cup at the Time of Vasectomy Rather Than Post-Operatively Improves Compliance
Authors: Bernstein A , Zhu E , Saba B , Hernandez H , Rapoport E , Najari BB
Published: February 2024

Introduction

Post-vasectomy semen analysis (PVSA) completion rates after vasectomy are poor, and minimizing the need for an additional in-person visit may improve compliance. We hypothesized that providing PVSA specimen cup at time of vasectomy instead of at a postoperative appointment might be associated with higher PVSA completion rates. We also hypothesized that performing virtual postoperative visits after vasectomy might improve PVSA completion rates.

Objective

To evaluate PVSA completion rates between patients receiving specimen cups at time of vasectomy versus at post-operative appointment.

Methods

We performed a retrospective review of all patients seen by a single provider for vasectomy consultation between October 2016 and June 2022. All patients who underwent vasectomy were included. Patients who underwent vasectomy prior to May 2020 had PVSA specimen cup given at postoperative appointment and those who underwent vasectomy after May 2020 were given PVSA specimen cup at time of vasectomy. PVSA completion and postoperative visit type were recorded. Demographic and clinical outcomes data were collected. Logistic regressions were used to investigate associations between PVSA completion rates and both timing of providing PVSA specimen cup and postoperative visit setting.

Results

491 patients were seen for vasectomy consultation between October 2016 and June 2022. 370 (75.4%) of all patients seen for consultation ultimately underwent vasectomy. 173 (45.7%) patients underwent vasectomy prior to May 2020 and were given PVSA specimen cup at postoperative visit. 197 (53.2%) patients underwent vasectomy after May 2020 and were given PVSA specimen cup at vasectomy. 160 (47.2%) of patients were seen virtually for postoperative visit, whereas 179 (52.8%) were seen in-person. Providing PVSA specimen cup at time of vasectomy was associated with higher odds of PVSA completion than providing PVSA specimen cup at postoperative visit (62.4% vs. 49.7%; OR = 1.68; 95% CI: 1.11, 2.55). No association was noted between PVSA completion rate and whether the postoperative visit was virtual or in-person (63.8% vs. 55.3%; OR = 1.42; 95% CI: 0.92, 2.20).

Conclusions

PVSA specimen cup provided at time of vasectomy versus at postoperative appointment is associated with higher rates of PVSA completion. Virtual postoperative visit after vasectomy is feasible and has no detectable association with PVSA completion rates. These findings together support the growing role of telehealth in urology practices.

Disclosure

No.
(315) Evidence Analysis for Contemporary Vascular Therapies for Erectile Dysfunction
Authors: Zakkar B , Cabral J , Le B , Raheem O
Published: February 2024

Introduction

Erectile Dysfunction (ED) is a common male sexual disorder that is caused by various conditions including vascular dysfunction. Different treatment options can be implemented, like lifestyle modifications, pharmacological intervention, or surgical procedures. In select ED cases, vascular procedures such as penile revascularization and venous ligation could be an alternative option.

Objective

We herein evaluated the current evidence and outcomes of penile revascularization, venous ligation and other vascular surgery with specific emphasis on complications and patients’ satisfaction.

Methods

A literature search was conducted using PubMed and Google Scholar to examine papers from 1993 to present day. Keywords, such as, “Erectile dysfunction”, “ED vascular surgery”, “Penile venous ligation”, “Penile revascularization”, and “Arterial bypass surgery”, were used in this search. All the papers were in the English language.

Results

A total of four studies met inclusion criteria for penile arterial bypass and dorsal penile venous ligation procedures with erectile function, clinical outcomes, satisfaction rates and post operative complications. Regarding penile arterial bypass, two studies identified. First study reported inferior epigastric artery (IEA) to the penile dorsal artery of 1500 patients reported success rates of erectile function were 67% and satisfaction rates of 89%. Postoperative complications were anastomotic disruption, penile skin sensation loss and pain. Regarding venous ligation of penile dorsal vein, two studies identified. First study of 100 patients reported success rates of erectile function were 62% at 1 year. Second study of 26 patients reported success rates of erectile function were 42.3% and satisfaction rates of 57.7% at 3.7 years. Postoperative complications were painful erections, skin necrosis, and penile shortening (Table 1).

Conclusions

Vascular therapies including penile arterial bypass and penile dorsal venous ligation for ED could provide improved clinical outcomes and satisfactions in select patients’ population. Future studies are warranted to further evaluate its surgical outcomes and long-term safety and efficiency.

Disclosure

No.
(349) Shining a Light on Women's Sexual Health: Insights from Patients Presenting with Sexual Dysfunction
Authors: Naeem T , Saffati G , Kaaki B , Khera M
Published: February 2024

Introduction

Sexual health is an essential component of overall health and wellbeing, and its importance in women's lives has often been neglected in clinical practice due to cultural, social, and educational barriers. Fortunately, in recent years, there has been a growing awareness and emphasis on women's sexual health, with increasing research attention dedicated to addressing this issue.

Objective

In this context, this study aims to contribute to the growing body of knowledge on women's sexual health by examining the characteristics of women who present for treatment of sexual dysfunction.

Methods

Women who presented with sexual dysfunction to our clinic from July 2022 to June 2023 were enrolled in this study and administered the PHQ-9 and FSFI surveys. In addition, hormone levels, demographic data, and pertinent medical history were collected at this time. Descriptive statistics and logistic regression analyses were used to identify factors associated with presentation for treatment.

Results

A total of 26 women with a mean age of 52 (SD=2.4) participated in this study. 10 (38.5%) women presented with low estradiol levels, and 4 (15.4%) women with low testosterone, although mean levels thereof were 53.7 (SD=18.9) and 72 (SD=16.8), respectively. Most women (15, 57.7%) reported mild to moderate depressive symptoms on PHQ-9 with a mean score of 7.53 (SD=1.08), but only 2 reported a formal diagnosis of depression. Somewhat expectedly, 24 (92.3%) women report an FSFI score less than 26 (mean=17.9, SD=1.63), corroborating their subjective experience. Additionally, logistic regression demonstrates that depressive symptoms have a strong relationship (R=0.63) with increased pain during intercourse (p=0.014) and decreased sexual satisfaction (p=0.002).

Conclusions

These results provide valuable insights into the characteristics of women who present for treatment of sexual dysfunction. The findings suggest that low hormone levels, particularly estradiol, may be a contributing factor to sexual dysfunction in some women. The high prevalence of depressive symptoms reported in our study highlights the need for clinicians to recognize and address the mental health concerns of these patients as well. It also underscores the importance of comprehensive sexual health assessments, including hormone level evaluations and mental health screenings, in the management thereof, though our findings are limited by a small sample size and lack of follow up and further studies are still needed.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast.
(353) Gender-Specific Variations in Perception of Normal Genital Anatomy and Function
Authors: Nicholson R , Choi U , Cohen A
Published: February 2024

Introduction

Understanding perceptions of “normal” genitalia and function can explain and predict trends in cosmetic and sexual health treatments. Previous studies reported male preferences for female genitalia appearance, but female opinion remains understudied.

Objective

We aimed to assess gender-specific variations in perceptions of “normal” genital anatomy and function.

Methods

A 54-item survey was developed using RedCap and distributed to volunteers aged ≥18 years through the ResearchMatch database from January to March 2023. We collected data on public perceptions of "normal" genital anatomy and function and sexual activity. Analysis was performed using JMP Pro 16.

Results

649 participants initiated and 558 completed the survey (86% completion rate). 27.9% of respondents identified as male and 72.1% as female (Table 1). Compared to men, women believed men had larger testicles (24.5% vs. 10.3% believed one testicle was 60.1-90 mL, p<0.01), smaller breasts (45.5% vs. 35.9% felt “none” was normal, p<0.04), and shorter orgasms (55.0% vs. 44.9% felt orgasms lasted 2.6-5.0 seconds, p=0.03) (Table 2). 73.0% women vs. 56.4% men felt labia were darker than surrounding skin (p=0.01). More men than women felt the average woman required no supplementary vaginal lubrication (p=0.02) and that female orgasms lasted longer (12.2% vs. 5.7% believed orgasms lasted >12.5 seconds, p<0.01). Fewer men than women considered their genitals normal (75.0% vs. 89.4%, p<0.01).

Conclusions

Our results reveal gender-specific variations in perceptions of “normal” genital anatomy and function. Variations in perceived female sexual function were striking, with more men than women expecting spontaneous vaginal lubrication during sexual encounters and longer female orgasms. These differences have important implications for counseling patients on sexual health.

Disclosure

No.
(375) Assessing Infertility Literacy and Knowledge Gaps Amongst Patients with Cystic Fibrosis
Authors: Rahman F , Campbell K , Deebel N , Ghomeshi A , Husni Zarli M , Domaradzki L , Tupayachi Ortiz M , Ramasamy R
Published: February 2024

Introduction

As patients with cystic fibrosis live longer into their reproductive years, fertility concerns are rising. We hypothesized that while patients with CF may be informed of the impact of their disease on their reproductive potential, they remain unaware of the promising role of assisted reproductive technology (ART) in helping them conceive biological children.

Objective

Employ a cross-sectional survey to understand experiences, preferences, and current concerns in the CF community around infertility education and infertility healthcare access.

Methods

This study was reviewed and approved as exempt status by the Institutional Review Board (IRB) exemption as non-human research. We distributed a voluntary and anonymous Qualtrics survey to CF patients and CF advocacy organizations to assess patient understanding of infertility within CF. The survey consisted of 21 questions and aimed to capture demographics, reproductive education specific to CF, preferences on infertility education, current conception practices, and any infertility treatment. Preference questions were assessed using the Likert Scale, and personal experiences questions were answered through free text.

Results

Forty-one respondents completed the survey (median age of 36 ± 14 years). The median age reported for learning about CF-associated infertility was 18 years. Respondents preferred that reproductive and infertility education be provided early; 43% reported the optimal age of education was younger than 18 years while 50% reported between 18-24 years. Of the respondents trying to conceive, 43% of patients have been trying to conceive for 1-3 years qualifying for infertility. Yet, the majority of those patients (69%) have not been offered semen analysis and 90% have not had previous fertility treatments.

Conclusions

Patients with CF are highly educated and empowered regarding the chronic treatment of their disease. Historically, issues regarding infertility and conception have been cast to the side, given the severity of other issues, such as lung function and survival. As CF patients live longer and healthier lives, they seek healthcare in other facets, including reproduction and infertility. The findings in our study highlight the importance of discussing reproduction and its limitation in CF at a young age to preemptively empower and prepare patients and their future partners. Furthermore, our study demonstrates a strong need to strengthen the communication between CF care teams and fertility specialists. Both men and women with CF would benefit from receiving respective guidance from embryologists and andrologists to maximize their chances of conception.

Disclosure

Yes, this is sponsored by industry/sponsor: Cystic Fibrosis Foundation.

Clarification: No industry support in study design or execution.
Neutrophil extracellular traps (NETs) and Th-2 dominant immune responses in chronic granulomatous chromoblastomycosis
Authors: Huang Huan , Li Minying , Luo Mingfen , Zheng Jinjin , Li Qian , Wang Xiaoyue , Liu Yinghui , Li Dongmei , Xi Liyan , Liu Hongfang
Published: February 2024

Chromoblastomycosis (CBM), a chronic, granulomatous, suppurative mycosis of the skin and subcutaneous tissue, is caused by several dematiaceous fungi. The formation of granulomas, tissue proliferation, and fibrosis in response to these pathogenic fungi is believed to be intricately linked to host immunity. To understand this complex interaction, we conducted a comprehensive analysis of immune cell infiltrates, neutrophil extracellular traps (NETs) formation, and the fibrosis mechanism in 20 CBM lesion biopsies using immunohistochemical and immunofluorescence staining methods. The results revealed a significant infiltration of mixed inflammatory cells in CBM granulomas, prominently featuring a substantial presence of Th2 cells and M2 macrophages. These cells appeared to contribute to the production of collagen I and III in the late fibrosis mechanism, as well as NETs formation. The abundance of Th2 cytokines may act as a factor promoting the bias of macrophage differentiation toward M2, which hinders efficient fungal clearance while accelerates the proliferation of fibrous tissue. Furthermore, the expression of IL-17 was noted to recruit neutrophils, facilitating subsequent NETs formation within CBM granulomas to impede the spread of sclerotic cells. Understanding of these immune mechanisms holds promise for identifying therapeutic targets for managing chronic granulomatous CBM.
Impacts of the Local arm on the local circular velocity inferred from the Gaia DR3 young stars in the Milky Way
Authors: Almannaei Aisha S , Kawata Daisuke , Baba Junichi , Hunt Jason A S , Seabroke George , Yan Ziyang
Published: February 2024

A simple one-dimensional axisymmetric disc model is applied to the kinematics of O type and B type stars (OB stars) near the Sun obtained from Gaia Data Release 3 catalogue. The model determines the ‘local centrifugal speed’ Vc(R0) – defined as the circular velocity in the Galactocentric rest frame, where the star would move in a near-circular orbit if the potential is axisymmetric with the local potential of the Galaxy. We find that the Vc(R0) values and their gradient vary across the selected region of stars within the solar neighbourhood. By comparing with an N-body/hydrodynamic simulation of a Milky Way-like galaxy, we find that the kinematics of the young stars in the solar neighbourhood is affected by the Local arm, which makes it difficult to measure Vc(R0). However, from the resemblance between the observational data and the simulation, we suggest that the known rotational velocity gap between the Coma Bernices and Hyades-Pleiades moving groups could be driven by the co-rotation resonance of the Local arm, which can be used to infer the azimuthally averaged circular velocity. We find that Vc(R) obtained from the D < 2 kpc sample is well matched with this gap at the position of the Local arm. Hence, we argue that our results from the D < 2 kpc sample, Vc(R0) = 234 ± 2 km s−1, are close to the azimuthally averaged circular velocity rather than the local centrifugal speed, which is influenced by the presence of the Local arm.