bluuebunny/crossref_metadata_2025 huggingface dataset:
(234) How Age and Obesity Influence Erectile Dysfunction: Evaluation Based Upon Penile Color Duplex Doppler Ultrasound
Authors: Sikka S , Panner Selvam MK , Shalaby H , Hellstrom W
Published: February 2024

Introduction

Color duplex Doppler ultrasound (CDDU) is an objective and reliable diagnostic tool for documenting penile hemodynamics. Objective vascular testing provides a physiologic diagnosis of erectile dysfunction (ED) and helps direct appropriate therapy even in this age of ED management including oral drugs. Although age and diabetes are known to be the major etiological factors in development of ED, it is not clear whether obesity as such also plays any role or not.

Objective

The main objective of this study is to retrospectively assess the penile CDDU hemodynamic parameters of obese men with ED in comparison to non-obese ED men in relation to age.

Methods

A total of 271 men including obese and non-obese who were diagnosed with ED visiting our Andrology clinic were included in this study. Initial ED was determined by using the International Index of Erectile Function (IIEF) score. Penile CDDU data was retrospectively collected from these ED patients, and parameters mainly peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were used for analysis. RI (=PSV-EDV/PSV) was calculated, and different types of penile vascular status were established based on our previously published SOP guidelines for standardization of penile CDDU parameters. Statistical analysis was performed using MedCalc statistical software version 22.009 (MedCalc Software bv, Ostend, Belgium).

Results

Our study results revealed that with advancement of age the occurrence of vascular changes in obese men were higher in comparison to non-obese men with ED. Table 1 summarizes the influence of obesity on the prevalence of penile vascular status in different age groups of obese and non-obese men with ED. Surprisingly, higher number of obese men showed non-vascular, venous and mixed vascular components compared to non-obese ED patients. Among these obese groups of all ages, the venous leakage was prevalent than arterial or mixed components.

Conclusions

Our current analysis indicates that besides age, obesity is also one of the major risk factors in altering the penile hemodynamics with increased incidence of veno-occlusive dysfunction (VOD) in ED patients. In addition, this demonstrates the utility of performing CDDU and diagnosing the presence of VOD in further understanding the pathophysiology of obesity associated ED, and an important determining factor in such patient care.

Disclosure

No.
(243) Frenular Delta Excision with Neurectomy of Ventro – Lateral Branches of Penile Dorsal Nerves (Alaa Aglan4 Operation)
Authors: Aglan A
Published: February 2024

Introduction

Neurectomy is one of the surgical options used for treatment of premature ejaculation, variable degrees of neurectomy could be done, aggressive neurectomy may cause severe demenishion in sensations as occurs in cases of perovic technique for penis elongation or in cases of sliding techniques used in treatment of peyronie`s disease also it increases the risk of erectile dysfunction. In our old trials in phalloplasty and penile implantation we were doing neurectomy routinely with few exceptions, the success rate at that time was 78% and some side effects were reported e.g neuroma, numbness, and recurrence. After application of prediction test (spraying local anesthesia procomail at frenular area (temporary excision) and local injection around the chosen nerve/s) the picture has been changed. as we could predict the expected gained time post-surgery. The classic neurectomy is related to neural supply of glans. once we was doing classic Alaa Aglan operation (cutting bulbospongiosus muscles bilaterally plus frenular delta excision) but we found the muscles congenitally absent so we excised part of frenular delta with neurectomy to neural supply to the same area (i.e. ventro – lateral branches of dorsal nerves) the results were satisfactory to the patient. Many patients were afraid of muscles cutting at our early trials, so this operation was the alternative option, dorsal neurectomy could be done with it according to prediction tests in some cases (usually with implants).

Objective

Presentation of new operation for treatment of premature ejaculation (Alaa Aglan4).

Methods

Study was done between 3/12/2011 – 8/2/2017 (5 years following up), 247 patients were operated (after prediction test), partial excision of frenular delta plus neurectomy to ventral branches of RT and LT penile dorsal nerves. Neurectomy was done at middle third of penile shaft before branching. Dissection of proximal part till penis root and retraction of the proximal end and placing it at penis root area (to avoid reunion or recurrence).

Results

Numbness was reported in 13 patients disappeared within 3 months, neuroma was obvious in 7 patients treated by vitamin B injection in 5 patient’s. Re-excision of 2mm of proximal neural end (under local anesthesia) in 3 patients. No recurrence was reported. The dissection of nerves and covering the proximal end with inverted skin graft or silicone cap as a barrier between the nerves ends to prevent reunion and recurrence was done outside this study, but this technique is simple and easy. Erectile dysfunction was not reported in all patients. after 4 months all patients were satisfied by the ejaculation time.

Conclusions

Alaa Aglan4 operation is simple, effective, safe and permanent treatment for premature ejaculation guided by prediction test.

Disclosure

No.
(246) Age Dependent Effect on Contralateral Testicular Compensation Following Testicular Loss
Authors: Nassau D , Deebel N , Kresch E , Loloi J , Bernstein A , Temple D , Kulandavelu S , Arora H , Ramasamy R
Published: February 2024

Introduction

The human testicle is susceptible to loss from events like torsion, trauma, cancer, or cryptorchidism. Most paired organs are known to undergo compensatory hypertrophy following unilateral organ loss. The testicle is physiologically distinct in that it is thought to undergo a period of quiescence in childhood. Previous work has demonstrated testicular hypertrophy occurs if the loss of the contralateral testis occurs before puberty. However, it is unknown if compensatory physiology and growth differs by age of pre-pubertal loss.

Objective

This study aimed to investigate compensatory changes in testicular growth and the hormonal axis following unilateral orchiectomy in a neonatal, pre-pubertal and pubertal/adult murine model.

Methods

C57BL/6 mice were divided into experimental groups: neonatal (days of life 2-4), pre-pubescent (days of life 12-21), and post-pubescent (days of life 42-44) to undergo unilateral orchiectomy. A control group that did not undergo orchiectomy was utilized. Mice were sacrificed at maturity (over 80 days of life), blood samples were drawn, and the remaining testis was removed. Body and testis weight and testicular length in the long axis were measured in blinded fashion. Similarly, testosterone, luteinizing hormone (LH), and Follicle stimulating hormone (FSH) were assessed and expressed as a median and an interquartile range.

Results

Contralateral testes from neonatal and pre-pubertal mice who underwent orchiectomy weighed more (110.5, 12.2 and 103.0, 7.2 mg respectively. Figure 1.) (p < 0.05) than the control mice (91, 11.9 mg, respectively). There was no difference between post-pubertal group and control group. The degree of compensatory hypertrophy was greater in the neonatal group but not the pre-pubertal group when compared to the post-pubertal group. When examining the ratio of testicular weight to body weight, only the neonatal group was significantly higher than that of the control. Differences in FSH and testosterone were not statistically significant between experimental and control arms (p > 0.05). LH was significantly elevated in all experimental groups as compared to the control (p < 0.05).

Conclusions

This is the first study to assess testicular compensatory hypertrophy following contralateral testicular loss using a neonatal mouse survival surgery model. Testicular hypertrophy occurs when unilateral loss occurs prior to puberty, but not in adulthood in mice. Earlier testis loss may contribute to a greater degree of growth. Functionally, the unilateral testis can maintain eugonadal testosterone levels, but higher levels of LH are required following hemicastration to sustain eugonadal testosterone levels. Future studies are warranted to identify testicular transcriptomics in this model to evaluate for candidate genes potentially responsible for this phenotypic change.

Disclosure

No.
(254) Extracorporeal Shock Wave Therapy Combined with Cannabidiol Reduces Prostatic Inflammation by Regulating TLR4-NFκB Signaling Pathway
Authors: Bae WJ , Piao JJ , Kim S , Park S , Kim SW
Published: February 2024

Introduction

Chronic prostatitis is a refractory male disease that has bothered patients and confused urologists for a long time. Recently, extracorporeal shockwave therapy (ESWT), has evolved as a promising treatment approach in several inflammatory disease. Cannabidiol (CBD) is a minor cannabinoid with reported analgesic and anti-inflammatory properties.

Objective

To evaluate the effect of CBD and ESWT in lipopolysaccharide(LPS)-induced prostatic inflammation \

Methods

RWPE-1 cells were randomly divided into five groups: (a) RWPE-1 group (normal control), (b) LPS group (LPS-induced inflammation) and (c) CBD group (LPS-induced RWPE-1 treated with 0.1ug/ml of CBD), (d) ESWT group (LPS-induced RWPE-1 treated with ESWT), (e) CBD+ESWT group (LPS-induced RWPE-1 treated with CBD and ESWT). After administration of treatment, cells were collected for immunocytochemistry and Western blot analysis, respectively.

Results

CBD and ESWT improved the inflammation of LPS-induced RWPE-1 cells, with the most significant improvement in the CBD+ESWT group (p <0.01). Compared with the LPS group, CBD, ESWT decreased cyclooxygenase 2 (COX-2) expression by inhibiting the TLR4-NFκB pathway (p<0.01).

Conclusions

CBD and ESWT reduce inflammation by degrading COX-2 in the microenvironment through the TLR4-NFκB inhibition pathway. ESWT combined with CBD improves inflammation significantly, thus suggesting that the combination treatment may be a potential and promising therapeutic approach for prostatitis.

Disclosure

No.
(257) Is Adderall Effective in the Treatment of Delayed Ejaculation? A Continued Retrospective Analysis
Authors: Johnson A , Dymanus K , Quesada-Olarte J , Levine L
Published: February 2024

Introduction

Numerous treatments have been evaluated for delayed ejaculation (DE), but many are considered sub-optimal and have limited data support. This results in significant patient distress and leads to confusion for providers on the best treatment recommendations for this difficult sexual medicine condition. Preliminary studies have shown as needed low dose Adderall (amphetamine/dextroamphetamine) to provide improvement in symptoms and orgasmic latency time in patients with delayed orgasm or anorgasmia.

Objective

The objective of this study is to retrospectively assess the efficacy of Adderall treatment in men with DE, as well as associated comorbidities. The first phase of this study establishes baseline characteristics of patients that were prescribed Adderall for DE. The second phase of this study includes a survey to assess optimal frequency and dosage based on patient satisfaction and any side-effect profile.

Methods

Patients were identified from an AllScripts query using ICD-10 codes of “Retarded Ejaculation” (N53.11) and “Other ejaculatory dysfunction” (N53.19) and retrospective record review identifying men with DE over 18 years old having been prescribed Adderall. Objective data was collected including biothesiometry results, total testosterone levels, penile prosthesis placement, previous circumcision, and presence of co-morbidities such as erectile dysfunction, diabetes, depression, prostate cancer, smoking and neurologic disorders. Success was defined as subjective reduced time to orgasm per patient report. The second phase of this study includes contacting this study group via survey (RedCAP and phone) to assess the effective dose and side effects of using Adderall for DE.

Results

35 men were treated with Adderall for DE. In total, Adderall was shown to be preliminarily effective in 31% of patients (11/35) with 40% unable to be determined from retrospective review. The majority of patients were started on 5mg Adderall and titrated up to 20mg as needed taken 1-4 hours before sexual activity. Baseline patient characteristics are detailed in Table 1. The average age of patients was 59 years old with 57% of patients over the age of 70 years old. 65% (20/35) patients had abnormal biothesiometry results. There were no adverse events reported.

Conclusions

Low dose Adderall resulted in preliminary improvement in at least 31% of patients with DE. Further patient surveillance is planned, in part to determine if particular patient characteristics may be better for this approach. It is critical to avoid misuse of this drug and larger prospective studies are still needed. This study supports the use of Adderall as another treatment option for this difficult and poorly understood condition.

Disclosure

No.
(274) Sexual Assault Resulting in Hemoperitoneum and Multiple Genital Tract Injuries
Authors: Idowu OC , Ogunkuade MF , Adewumi BA , Olayemi OO
Published: February 2024

Introduction

The sexual experience ought to be pleasant and desirable, this case however demonstrates one of such unusual sexual events with catastrophic ending that may have resulted in fatality but for timely surgical intervention. The first coital experience for women may be associated with discomfort but when it is non-consensual the damaging effect of the trauma is deeper and may last for a lifetime.

Objective

To demonstrate unusual presentation of coital injuries with hemoperitoneum and its management in low resource settings to reduce immediate and long-term effects including death.

Methods

A case report of an 18-year old nulliparous lady with no prior sexual exposure who presented with vagina bleeding of 18hours following non-consensual penetrative sexual intercourse perpetrated by her religious cleric. Bleeding was in excess of 500mLs with associated lower abdominal pain and dizziness. She presented in hypovolaemic shock with severe anemia (hematocrit - 15%). There was ongoing vagina bleeding with mild abdominal distension. No skin injuries.

Results

She had genital tract exploration with findings of a 3cm peri-urethral vaginal laceration and a 6cm longitudinal rent on the posterior upper vagina extending to the cervix. The apex of the vaginal laceration could not be visualized from the vagina, necessitating exploratory laparotomy. Findings at surgery include 1.7L of hemoperitoneum and a transverse laceration on the posterior cervix extending into the lower uterine segment about 5cm long. The lacerations were repaired per vagina and per abdomen respectively with hemostasis secured. She had other supportive care including antibiotics, blood transfusion, analgesics, tetanus prophylaxis, Post-exposure prophylaxis for HIV and Hepatitis B immunoglobulin as well as emergency contraceptives. She was counselled with empathy and referred to the clinical psychologist for mental health support to prevent long term mental health effects. The assailant was arrested by the police and charged to court

Conclusions

Sexual assault may be associated with significant morbidities including unusual presentation such as hemoperitoneum and cervico-uterine laceration even in the absence of obvious skin injuries. Early presentation and appropriate intervention can help limit the adverse outcomes that may be associated as well as long term sequelae.

Disclosure

No.
(281) Linguistic and Cultural Validation of the Satisfaction Survey for Inflatable Penile Implant (SSIPI) for Brazilian Portuguese and Tri-Continental Spanish Speakers
Authors: Furtado T , Novaes LF , Thorogood S , Becher E , Carrion R , Carvajal A , Fernandez E , Glina S , Martinez-Salamanca JI , Miranda E , Nascimento B , Quesada J , Torremade J , Torres LO , Teloken P , Valenzuela R , Nelson C , Salter C , Mulhall J , Flores J
Published: February 2024

Introduction

The Satisfaction Survey for Inflatable Penile Implants (SSIPI) has been validated in English. No validated Portuguese and Spanish versions currently exist.

Objective

We aimed to linguistically validate SSIPI in Portuguese and Spanish to evaluate satisfaction outcomes with a validated instrument.

Methods

Our methodology adhered to best practices established by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and involved: forward translation of the 16-item SSIPI into Portuguese and Spanish by 2 independent IPP surgeons, reconciliation, back translation into English by 2 different independent bilingual IPP surgeons, and comparison to the original SSIPI for conceptual equivalence. The translated SSIPI versions underwent in-parallel cognitive debriefing (CD) at the US, Colombia, Spain, and Brazil centers. All interviews were recorded in person or via secure video conference to determine if misunderstandings or modifications were needed.

Results

12 and 17 native Portuguese and Spanish speakers, respectively, with IPPs, participated in the CD process for their native language SSIPI. Interviews lasted approximately 1 hour each. The Portuguese SSIPI validation was conducted at 2 different centers in Brazil, resulting in 83% of the patients reporting that the survey was easy to answer. Of 16 questions, only 3 (Q7, Q11, and Q16) raised concerns for 6 patients. 5 patients had issues with the concept of the word “naturalness” and “spontaneity” from Q7 and Q16. One patient struggled with interpreting the word “conceal” in Q11. Regarding the duration taken to answer, 10/12 patients said it was acceptable. The Spanish SSIPI was tested at 4 US, Colombia, and Spain academic centers. 63% indicated the survey was easy to answer. In most cases, replacing a single word in the item with another was proposed. 53% had difficulties comprehending the answer choice options with Q3; however, all participants perceived the time required to complete the SSIPI as reasonable.

Conclusions

While the Portuguese SSIPI has been demonstrated to be easier to read and interpret than the Spanish SSIPI, with minor changes to wording/phrasing, both versions have the potential to improve IPP outcomes literature globally. Concerning questions will be modified before conducting the final validation steps.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Roman.
(285) Evaluation of Penile Prosthesis Implantation in Older Adults with Bladder Cancer After Radical Cystectomy
Authors: Abello A , Kaul S , Fleishman A , Morgenthaler A , Korets R , Chang P , Wagner A , Kim S , Olumi A , Gershman B
Published: February 2024

Introduction

Erectile dysfunction (ED) is common after radical cystectomy (RC), but ED treatment in this setting remain understudied. Many such patients will be unresponsive to oral pharmacotherapy, often requiring penile prosthesis (PP) implantation.

Objective

The objective of this study was to evaluate PP implantation in a contemporary, national cohort of older adults with bladder cancer following RC.

Methods

We used the SEER-Medicare database to identify male patients 66 years and older diagnosed with Tany Nany M0 bladder cancer from 2000 to 2017 and treated with RC. We estimated time to PP implantation using the Kaplan-Meier method, and evaluated the associations of baseline characteristics with PP implantation using Cox proportional hazard regression.

Results

The study cohort included 4,468 men who underwent RC, including 75% who were married or had a domestic partner. A total of 334 (7%) patients had baseline ED. Median follow-up after RC was 38.0 (IQR 16.0-84.0) months. After RC, only 71 (2%) patients underwent PP implantation, with a median time to PP implantation of 12 (IQR 5-32) months. In univariable analysis, younger age, black race, and undergoing RC at small bed size hospitals, comprehensive NCI Cancer Centers, higher RC volume hospitals, and hospitals in the West and South/Southeast regions were associated with higher rates of implantation (Table 1). Disease characteristics were not related to PP implantation.

Conclusions

Despite the expected prevalence of ED following RC, contemporary, real-world rates of PP implantation are very low. Univariable analyses suggest that both patient characteristics and features of the hospital performing RC are associated with treatment for post-RC ED with PP implantation.

Disclosure

No.
(287) A Patient's Journey with Erectile Dysfunction: Prediction Progression to Penile Implant
Authors: Hernandez N , Naeem T , Saffati G , Guhan M , Pierce H , Lipshultz LI , Khera M
Published: February 2024

Introduction

Inflatable penile prosthesis (IPP) is seen as the gold standard for surgical treatment for ED, specifically for patients that are not amenable to lifestyle changes or oral medications.

Objective

This study aims to explore which patients progress to seeking treatment with an IPP along their journey with erectile dysfunction.

Methods

This retrospective study identified patients with ED as a chief complaint during the primary visit or follow-up from 2009-2022. If patients eventually progressed to treatment with IPP, data was collected to find common features and analyzed.

Results

Of our cohort of 361 men presenting with erectile dysfunction (ED), 21 men progressed to the placement of an inflatable penile prosthesis (IPP). 20 men classified as non-Hispanic, with 13 white, 6 African American/black, and 1 Asian males. Only 1 man was Hispanic. 5 men had either hypertension (n = 11), hyperlipidemia (n = 10), or DM (n = 3), with 6 having both hypertension and hyperlipemia, 1 with hypertension and diabetes, and 1 with hypertension, hyperlipidemia, and diabetes. Median age of the group at surgery was 76 years (IQR: 71 – 82), with median time from initial presentation to surgery of 12 (IQR = 11.5-27.5) months. N = 10 men had trialed oral phosphodiesterase inhibitor type 5 (PDE-5i) therapy, and 7 men failed intracavernosal injection (ICI) therapy. 8 men had been treated for hypogonadal symptoms with testosterone replacement therapy (TRT). Of patients who had data available on their reason for IPP placement, indications included were Peyronie’s disease inhibiting intercourse (8/21), longstanding ED refractory to medical therapy (4/21), post-prostatectomy ED (4/21), history of priapism requiring surgical intervention (1/21), and history of spinal cord tumor (1/21). Among those treated with IPP, the median patient waited almost 1 year from initial presentation following failure with PDE5i, ICI, and TRT. 17/21 men reported satisfaction after IPP treatment. In those who progressed to IPP, the majority of indications were organic forms of ED (Peyronie’s disease, neurogenic, surgery).

Conclusions

Only 5.8% of men in this cohort went on to proceed with an IPP. In summary, our results indicate that IPP is best suited for those presenting with organic ED who have failed more conservative management techniques. Further studies are needed to assess why so few men go on to proceed with an IPP and wait an average of 2 years.

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.
(288) Trends in Penile Prosthesis Placement in Men with Erectile Dysfunction
Authors: Schardein J , Svare N , Jimbo M , Horns JJ , Driggs N , Das R , Hotaling J
Published: February 2024

Introduction

Erectile Dysfunction (ED) is a common problem impacting 20% of all men. Current treatment options include oral medications, vacuum erection devices, intraurethral suppositories, intracavernosal injections, and penile prosthesis placement (PPP). A shared decision-making framework is increasingly utilized for treatment decisions where an appropriate treatment is selected from all options based on the values and priorities of the patient and their partner.

Objective

Our objective is to identify trends in PPP, including the proportion of patients who pursue PPP as an initial treatment as well as the time from ED diagnosis to PPP.

Methods

We retrospectively reviewed all men with an ED diagnosis based on ICD9/ICD10 codes using the IBM MarketScan insurance claims database. The initial treatment option processed through an insurance claim following an ED diagnosis was identified and categorized using ICD, HCPCS, NDC, J, and CPT codes. Time from ED diagnosis to PPP was also recorded. Only patients with at least one year of enrollment pre-ED diagnosis and with at least one year of follow-up were included. Linear regressions were performed to investigate the trends of each year based on the time of initial ED diagnosis.

Results

We identified a total of 670,096 patients diagnosed with ED between 2012-2019. The mean age was 56 years (47-62). Of those patients, 11% were smokers, 29% had diabetes, 24% had cardiovascular disease, 65% had hypertension, and 29% were obese. Among those who received treatment, the most common initial treatment was oral medications in 26% of patients. PPP was an initial treatment in <1% of patients. The proportion of patients who underwent this surgical intervention as an initial treatment significantly decreased from 2012-2019 (P<0.001) as patients utilized other initial treatment modalities more commonly. Over the same period, the time from ED diagnosis to PPP significantly decreased from approximately 500 days in 2012 to <200 days in 2019 (P=0.001).

Conclusions

Although the proportion of patients who utilize other ED treatment options prior to PPP is higher, patients diagnosed with ED more recently undergo PPP in a significantly shorter timeframe. Utilization of other treatment modalities as an initial treatment option may stem from changes in insurance coverage. Patients moving more quickly from an ED diagnosis to PPP is likely due to several factors, including improvements in the device leading to less mechanical and infectious complications, familiarity with the device due to marketing, and an earlier discussion with the physician about the device based on a shared decision-making model.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Inherent bio, Paterna bio, Firmtech, Turtle health, Maximus, Carrot.
(291) Seasonal Variation in Serum Testosterone Levels: Evidence from Two Large Institutional Databases
Authors: Miller D , Gurayah A , Weber A , Schuppe K , Zarli M , Hwang K , Ramasamy R , Dullea A
Published: February 2024

Introduction

For accurate evaluation clinicians must consider the variations that testosterone undergoes in the human body. The diurnal variation of testosterone is well characterized, levels peak in the morning and decline during the day. Seasonal variations in testosterone levels have been reported in some studies, but the results are inconsistent. Thus, there is a lack of consensus on whether there are significant seasonal variations in serum testosterone levels.

Objective

In this study, we aimed to determine if clinically relevant seasonal variability in testosterone levels exists using a large cohort of men from two different institutions, one located in an area with seasons (Pittsburgh, Pennsylvania) and one without seasons (Miami, Florida).

Methods

Using two institutional databases, testosterone levels were obtained for men ages 18-99 from 2010-2021 who had at least 2 morning testosterone levels drawn within a 2-year period. All samples were analyzed with liquid chromatography with tandem mass spectrometry (LC-MS/MS). To avoid potential confounding by testosterone altering medications patients who were currently or previously on exogenous testosterone, endogenous testosterone stimulating medications, testosterone suppressing medications, and aromatase inhibitors were excluded from the study.

Results

There were 9495 and 16171 total testosterone levels measured from Miami and Pittsburgh respectively, with all men having 2 or more levels (Table 1). There was no statistically significant variation in T levels for the overall cohort in Pittsburgh or Miami, respectively (Table 2). Additionally, when stratified by age group, no individual groups were found to have significant seasonal variability (Table 3).

Conclusions

Our findings suggest that although there is differing total testosterone levels between men who reside in two different climates, there is no significant variability in testosterone levels between seasons. Therefore, testosterone levels can be checked and interpreted without the need to account for the season during which they were drawn.

Disclosure

No.
(300) Systematic Review and Meta-analysis of Seasonal Variation on Human Semen Quality in the United States
Authors: Dehghanbanadaki H , Randell Z , Fendereski K , Ramsay JM , Horns JJ , Gross KX , Pastuszak AW , Hotaling JM
Published: February 2024

Introduction

Different environmental exposures such as daylight hours and temperature influence spermatogenesis, which vary across seasons. However, studies on the variation of semen analysis across different seasons reported inconsistent results.

Objective

To investigate the seasonality of human semen parameters in the United States through a systematic review and meta-analysis.

Methods

We systematically searched PubMed, Scopus, and Web of Science for studies on seasonal variation of human semen parameters in the United States from conception to December 11, 2022, without language restriction, and also scrutinized the reference list of included studies for any additional related study. We determined the pooled standardized mean difference (SMD) and its 95% confidence interval (95%CI) between seasons using the random effect model in a case of substantial heterogeneity (I2 index≥50%) and the fixed-effect model in a case of low heterogeneity (I2 index<50%) in STATA version 17. The methodological quality was checked using Newcastle–Ottawa Quality Assessment Scale (NOS).

Results

Our search yielded 548 studies. After screening, 7 studies on 131,306 semen analyses were included for meta-analysis. All included studies had high methodological quality (NOS ≥ 7). Figure 1 shows the pooled SMD of semen parameters between seasons. Semen analysis in winter had a higher volume than those in spring (p-value=0.010; I2=4.63%). Winter had better semen quality than summer in terms of concentration (p-value=0.014; I2=0%) and total sperm count (p-value=0.044; I2=47.80%). Semen quality was also better in winter than in fall, in terms of volume (p-value=0.001; I2=0%), concentration (p-value=0.016; I2=23.68%), and total sperm count (p-value=0.022; I2=13.95%). Spring had better semen quality than summer in terms of concentration (p-value<0.001; I2=33.74%) and percent of normal morphology (p-value<0.001; I2=0%), and also had higher concentration than fall (p-value<0.001; I2=42.82%). Semen analysis in summer had a lower percentage of total motility than those in fall (p-value=0.045; I2=0%).

Conclusions

Semen parameters follow a seasonal pattern, with winter and spring showing better sperm quality regarding concentration and total sperm count than other seasons.

Disclosure

No.
(307) Prevalence of Sexual Dysfunction and Pursuit of Sexual Medicine Evaluation Among Male Physicians
Authors: Lin J , Greenberg D , Dubin J , Aguiar J , Brannigan R , Halpern J
Published: February 2024

Introduction

While the epidemiology of male sexual dysfunction in the general population is well studied, little is known regarding the prevalence of sexual dysfunction in male physicians and their likelihood of seeking treatment.

Objective

To characterize the prevalence of sexual dysfunction, evaluation patterns, and barriers to treatment among male physicians.

Methods

Between June 2022 and October 2022, male physicians were invited to complete a questionnaire regarding sexual function. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT).

Results

235 responses were included in the final analysis. The mean age of respondents was 36.3 ± 7.4 years. 27 (11.5%) reported having seen a doctor for sexual health. Of these 27,11 (40.7%) saw a physician for erectile dysfunction, 8 (29.6%) for low libido, 6 (22.2%) for premature ejaculation, 2 (7.4%) for delayed ejaculation, and 9 (33.3%) for some other concern. An additional 29 (13.9%) respondents considered establishing care for sexual issues but didn’t, mostly due to being too busy (N=18, 62.1%). Of the 56 respondents who had either seen or thought about seeing a physician for sexual health issues, the mean IIEF score was 24.4 ± 8.7 with 18 (32.1%) qualifying as having at least mild ED and 7 (12.5%) having severe ED (Table 2). 46 (19.6%) respondents reported having taken medication to improve erectile function. Only 12 (5.1%) respondents reported having ever been diagnosed with low testosterone. Among the 56 respondents who had either seen or thought about seeing a physician for sexual health issues, those who worked more hours (>60 hours per week) were least likely to see a physician (7.2%) compared to those working the fewest hours (33.3%), p=0.02.

Conclusions

In a cohort of young male physicians, 25.4% had seen or considered seeing a doctor for sexual health concerns, and nearly 1 in 5 had taken medication for erectile dysfunction. Given the highly demanding work schedules, occupational stress, and a variety of other factors associated the medical profession, male physicians appear to be at higher risk for sexual dysfunction than the general population. Moreover, male physicians face significant and unique barriers in access to care for sexual dysfunction.

Disclosure

No.
(308) Vasectomy Regret: Is Having Children Protective?
Authors: Charles D , Dietrich P , Sandlow J
Published: February 2024

Introduction

Vasectomy is reliable form of male contraception with prior data suggesting low levels of regret in child-bearing men. We recently published similarly low regret in childless men. There is a paucity of data comparing these two cohorts head-to-head.

Objective

Compare incidence of post-vasectomy regret in men with children and childless men.

Methods

The records of all patients who underwent vasectomy via a single surgeon between 2006 – 2021 were retrospectively reviewed. We created two cohorts: one of childless and one of child-bearing men. Childless cohort was the limiting factor; thus we randomly chose an equal number from our child-bearing cohort. We analyzed demographics of age at time of vasectomy, marital status, number of children and time since vasectomy. Patients’ regret was queried, both immediately after vasectomy and present day. We devised a 6-question survey inquiring about regret and thoughts on vasectomy reversal and assisted reproductive technology (ART). The questions are listed in Table 1.

Results

There were 4,812 overall patients who underwent vasectomy in this time interval, with 205 (4.3%) who were childless. The response rate for child-bearing men was 41.9% (86/205) and 33.2% (68/205) for childless men. Average age for child-bearing men was 35.3 years and 36.6 years in childless men, with time since vasectomy at time of phone call was 6.2 and 5.5 years, for child-bearing and childless men, respectively. The majority of patients 150/205 (73.1%) were married in both childless, 150/205 (73.1%) and child-bearing, 192/205 (93.6%). Average number of children was 2. When comparing our cohorts, regret rates (answering 4 or 5) immediately were 1.2% in child-bearing vs. 4.4% in childless men (p<0.0001), compared to 3.5% vs. 7.4% in present day regret (p<0.0001).

Conclusions

Regret in childless men is more prevalent than child-bearing men, suggesting raising children is protective.

Disclosure

No.
(309) A Novel Circumferential Reconstructive Surgery For Male Erection Restoration and Corporoplasty Based on De Novo Penile Fibro-vascular Assembly
Authors: Chueh J , Chueh J
Published: February 2024

Introduction

Albeit the present human penile anatomy has remained unchanged for three thousand centuries, and extensive study has been conducted on anatomical architecture and male potency reconstructive strategies for many centuries, it might not above be sustainable.

Objective

Given only evidence can speak volumes, and practice is the criterion for testing truth, we sought to report an innovative circumferential approach for fulfilling penile erection restoration and morphology reconstruction on an ambulatory basis microsurgical in recent years.

Methods

From October 2013 to October 2020, 33 men aged 21–59 underwent penile venous stripping (PVS) and corporoplasty via a circumferential approach on an ambulatory basis. The abridged five-item version of the International Index of Erectile Function (IIEF-5), erection hardness scales (EHS), and cavernosography was used for assessment, as required. The PVS entails stripping one deep dorsal vein and two cavernosal veins after every specific emissary vein is microscopically ligated closest to the outer tunica, whereas the para-arterial veins are segmentally ligated. Subsequently, a tunic corporoplasty is conducted before and after artificial erection with autologous venous wall bi-layered patches, whereby a water-tight running suture is undertaken for the inner layer and interrupted for the second layer for idealizing penile morphology using 6-0 nylon.

Results

The average follow-up period was 5.1±1.3 years, and the surgery time was 5.2±1. 4 hours, respectively. The radiopacity was unexceptionally enhanced postoperatively. There was a significant difference (P<0.01) between the preoperative (9.8±2.7) vs. Postoperative IIEF-5 scores (20.7±2.3). The EHS improved on at least one scale. The penile shape (<10°) was deemed reported in 93.9% (31/33) patients.

Conclusions

This combination of physiologically penile venous stripping and anatomy-based corporoplasty is ideally suited to the simultaneous restoration of penile erectile function and morphological reconstruction via a circumferential approach.

Disclosure

No.
(316) Age Is Not a Number When It Comes to Penile Prosthesis Implantation. A Mini–Case Series
Authors: Slovacek H , Khalafalla K , Wang R
Published: February 2024

Introduction

Given the overall aging of the population, erectile dysfunction has become an increasingly relevant issue among the elderly. When elective surgery is offered, the patient's age is often taken into consideration as a potential limiting factor. Moreover, the importance of addressing the quality of life and sexual satisfaction of older men tends to be overlooked in the management of erectile dysfunction.

Objective

The aim of this study is to investigate the safety of implanting penile prostheses (PP) in patients aged 90 years and older, as well as the potential complications associated with this age group.

Methods

The database of patients was screened between the years 2003 and 2023, to identify patients at least 90 years and older who underwent the implantation of penile prosthesis by a single surgeon at two large volume centers. We collected demographic information for the patients, including their past medical and surgical history, medication list, anesthesia peri-operative assessment and recommendations, details of the surgical procedure, intra-operative and postoperative recovery period, as well as clinic follow-up.

Results

Between 2003 and 2023, a total of 2000 men underwent PP surgery at the two centers. Out of the total number of patients, only two were 90 years or older at the time of implantation. One patient was a first timer, while the other had two previous PP surgeries over the span of 15 years for mechanical failure reasons. Both surgeries were performed using different device types, without any intra-operative or postoperative complications. At their three and six months follow up visits, both patients demonstrated the ability to cycle the implant smoothly, reported satisfactory penetrative intercourse with their partners, and improved sexual intimacy through Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. They were followed for a total of 1 year with no long-term negative effects.

Conclusions

Despite reporting only two cases in this specific cohort, it demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED. Maintaining satisfactory sexual activity in this age group is vital and achievable through inflatable penile prosthesis (IPP) insertion. There are several complex factors that must be considered prior to operating on an older patient due to medical co-morbidities and age. However, with proper patient selection, pre-operative counseling and optimization, this operation can be effectively performed in patients who are at least 90 years old. Simply, age is not a limitation to undergo penile implant.

Disclosure

No.
(319) Evaluating the Racial Distribution of Clinical Trial Participants for Drugs Leading to FDA Approval of Novel Biologics for the Treatment of Hypoactive Sexual Desire Disorder (HSDD)
Authors: Matthew-Onabanjo A , Bjurlin M , Rogers M
Published: February 2024

Introduction

Hypoactive sexual desire disorder (HSDD) is defined as a persistent deficiency or absence of sexual desire or sexual fantasies that result in significant personal distress and relationship difficulties. It is considered one of the most prevalent diseases impacting the sexual function of women. Prior studies suggest that the prevalence of HSDD ranges between 8%-20%. Recently, two novel drugs gained FDA approval for the treatment of HSDD. This includes both Addyi and Vyleesi. Although multiple reports suggest that HSDD is more prevalent in white women, HSDD still impacts minority women.

Objective

Our study aim was to determine the distribution of race and ethnicity among trial participants leading to FDA approval of novel drugs for HSDD.

Methods

A retrospective review of FDA Center for Drug Evaluation and Research Drug Trials Snapshot (DTS) was conducted utilizing the DTS FDA website (https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshots). The DTS highlights who participated in the clinical trials that supported the FDA approval of a drug that is novel. This includes new molecular entities or original biologic products. DTS was searched for drugs created for the treatment of HSDD and clinical trial enrollment data was stratified by race and ethnicity.

Results

A total of 2 clinical trials were identified that led to the FDA approval of 2 novel drugs for HSDD including Addyi (flibanserin) and Vyleesi (bremelanotide injection) Trials for Addyi included 2743 participants of which 89% were white, 8% Black, 1% Asian, 8% Hispanic, <1% American Indian/Alaska Native, <1% Native Hawaiian/Pacific Islander, 2% unknown. Trials for Vyleesi approval had 1067 participants of which 86% were white, 12% Black, 1% Asian, 8.5% Hispanic, <1% American Indian/Alaska Native, 1% unknown. Limitations include the unknown race category which included both not reported, multiracial, and true unknowns in some trials.

Conclusions

Participants in clinical trials leading to FDA approval of novel drugs for HSDD are overwhelmingly white in spite of the fact that other women including minorities are impacted by this disorder. Although white women are more likely to report low sexual desire, studies likely underestimate the the impact on minority women. Involving stakeholders who represent the needs and interests of underrepresented populations in the design and implementation of clinical trials of novel agents may be a strategy to increase diversity, equity, and inclusion among drugs designed to impact low sexual desire and treatment of HSDD.

Disclosure

No.
(322) Predictors of Erection Reversal After Penile Doppler Ultrasound
Authors: Ljubetic BM , Novaes LF , Gonzalez A , Mulhall JP , Flores JM
Published: February 2024

Introduction

Erection hardness (EH) is a physiologic response graded subjectively on the Erection Hardness Grading Scale during penile Doppler ultrasound (PDUS).

Objective

This study aims to gather data on the reversal rate following persistent EH sufficient for penetration or higher after PDUS and identify associated predictors.

Methods

The study population consisted of (i) men with poor response to PDE5i and ICI or (ii) who need curvature assessment due to Peyronie’s disease (PD), (iii) and underwent penile duplex Doppler ultrasound (PDUS), (iv) using a vasoactive agent redosing schedule were included and reviewed retrospectively. Patients with incomplete data were excluded. We performed a descriptive assessment of demographics and comorbidities, including a history of cancer, PD, depression, or anxiety. EH was evaluated by a sexual medicine-trained physician for each case and reported before and 30 minutes after PDUS. EH was assessed on a scale between 0 (no erection) to 10 (erection hard as a rock), with 6 being good enough for penetration. We also described the number of injections, the dose, and PDUS hemodynamic parameters, including peak systolic velocity (PSV) and end-diastolic velocity (EDV). Arterial insufficiency (AI) diagnosis was made with PSV values ≤25 cm/sec bilaterally and corpora veno-occlusive dysfunction (CVOD) with EDV values ≥5 cm/sec bilaterally. We also reported a reversal procedure rate performed due to persistent erection after PDUS, and predictors were assessed. Factors entered into the model included: patient age, EH for PDUS (8 or greater), and dose of vasoactive agent used (Table 1). A p-value ≤0.05 was considered statistically significant.

Results

2439 individuals were included. The median age of 59 (50,67) years. 12% had diabetes, 13% reported ≥ 3 comorbidities, 44% had prostate cancer, 17% had a history of depression, and 14% had a history of anxiety. 44% described PD. The vasoactive agent used for PDUS was Trimix 86% and 14% others. The median dose used was 20 (10, 50), and the median of injections applied was 2 (1, 2). The EH median was 8 (6, 9) for PDUS, and 65% had an EH of 8 or greater. The PDUS diagnosis was normal in 62% of the patients; 8% had AI, 29% had CVOD, and 1% had AI+CVOD. The reversal procedure rate was 41%. In the MVA, significant predictors of erection reversal were higher vasoactive agent dose used, age 50 years or younger, and EH 8 or greater for PDUS (Table 1).

Conclusions

Erection reversal in our redosing PDUS was highly prevalent; predictors of reversal were younger age, greater EH for PDUS, and higher vasoactive agent dose.

Disclosure

No.