bluuebunny/crossref_metadata_2025 huggingface dataset:
214 European Male Aging Study Gonadal State Related to the Outcomes of Microsurgical Varicocele Repair
Authors: Komiya A , Kato M , Sazuka T , Imamura Y , Sakamoto S , Ichikawa T
Published: May 2022

Introduction and Objective

In European Male Aging Study (EMAS), hypogonadism is classified in four groups as normal or eugonadal [total testosterone (TT) ≥10.5nmol/L and luteinizing hormone (LH) ≤9.4IU/L; N/E group], secondary hypogonadism (TT<10.5nmol/L and LH ≤9.4IU/L; S/H group), primary hypogonadism (TT<10.5nmol/L and LH>9.4IU/L; P/H group), compensated hypogonadism (TT≥10.5nmol/L and LH>9.4IU/L;C/H group). Symptoms and co-morbidities were different among groups. In the present study, incidence of EMAS hypogonadism and the relationship between gonadal state and treatment outcomes of microsurgical varicocele repair.

Patients and Methods

Enrolled were 88 patients who underwent microsurgical varicocele repair with pretreatment measurement of sex hormones. We retrospectively analyzed incidence of EMAS hypogonadism, presurgical difference in semen quality according to gonadal state, and change in semen parameters after microsurgical varicocele repair. Student T test was used to compare two groups. This study was proved by institutional review board of Chiba University (#2557).

Results

Seventy-five patients were classified as eugonadal (N/E group, 84.3%), and 13 (15.7%) were hypogonadal [8 in S/H group (9%), 0 in P/H group (0%), and 5 in C/H group (5.7%)]. Mean testicular volume was significantly higher in N/E group than in hypogonadal (S/H, P/H and C/H) groups (mean volume of the right testis 17mL vs. 12mL, p=0.0283; mean volume of the left testis, 16mL vs. 11mL, p=0.0281). Out of 54 patients with male infertility, 44 were in N/E group and 8 (15.4%) were hypogonadal and total sperm count was significantly higher in N/E group than in hypogonadal patients (10.1 × 106 vs.1.3 × 106, p=0.0033). Post-surgical semen analyses were performed after 6.4 months in average. Sperm count, sperm motility and total sperm count were significantly higher in N/E group than in hypogonadal patients (in average, 33.4 × 106/mL vs. 2.8 × 106/mL, p<0.001; 41.4% vs. 22.3%, p=0.003; 116.8 × 106 vs. 7.7 × 106, p<0.001, respectively). Change rate before and after surgery was significantly better in N/E group than in hypogonadal patients (sperm count, 8.1 times increase vs. 2.5 times increase in average, p=0.0242; total sperm count, 10.7 times increase vs. 2.5 times increase in average, p=0.0159).

Conclusion

Hypogonadism should be evaluated using not only testosterone level but also LH level. EMAS hypogonadal state were related to semen parameters and outcomes of microsurgical varicocelectomy.

Disclosure

Work supported by industry: no.
217 Sexual Activity of Patients Undergoing Testicular Sperm Extraction
Authors: Taniguchi H , Matsuda T , Nakaoka Y , Morimoto Y
Published: May 2022

Introduction

For couples who wish for a baby, sexual activity (though intercourse) is the only way to conceive naturally. However, the sexual activity of men undergoing testicular sperm extraction (TESE) and factors that influence it among affected couples are not clearly understood.

Objective

To examine sexual activity among infertile men undergoing TESE and identify factors that influenced

Methods

Married Japanese male patients undergoing TESE were included. Sexual activity during the previous month was surveyed using a questionnaire, and potential predictive factors influencing sexual activity were examined.

Results

226 married men who answered a questionnaire regarding sexual frequency were reviewed retrospectively. Patients’ mean age was 35.8 ± 7.5 years (range 23–67) and that of their partners was 32.9 ± 4.5 years (range 23–44). Most couples (n = 193) were in their first marriage, and 33 were re-married. The mean marriage duration was 52.6 ± 42.2 months (range 1–192). Micro-dissection TESE and conventional TESE were performed for 152 and 74 patients, respectively. Overall, the mean sexual activity during the last month was 3.6 ± 2.6 times (range 0–15). Marriage duration was negatively correlated with the frequency of sexual activity (r = −0.23; P < .01). There were no correlations between sexual activity and patients’ age, partners’ age, marriage type (first marriage/re-married), testicular volume, or serum total testosterone concentration. Regression analysis showed marriage duration (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.003–1.019, P = .009) and testicular volume (OR 0.94, 95% CI 0.88–0.99, P = .033) were significant predictors of low sexual activity (0–1 times/month). There were no significant differences in sexual activity per month between patients treated with micro-TESE and c-TESE; between those in a first marriage and those re-married; and between patients with Klinefelter syndrome and patients who underwent c-TESE.

Conclusions

The sexual activity of patients undergoing TESE was almost the same as reported previously. Patients’ age, partners’ age, testicular volume, and serum total testosterone concentration had no correlations with the reported frequency of sexual activity.

Disclosure

Work supported by industry: no.
225 Effect of Long-Term Administration of Tadalafil on Arteriosclerosis: A Prospective Cohort Study
Authors: Hayashi K , Sasaki H , Mugita T , Tomiyama T , Koizumi S , Kurokawa I , Matsubara E , Saito K , Fuji K , Ishikawa K , Fukagai T
Published: May 2022

Introduction

Tadalafil is a phosphodiesterase type 5 (PDE-5) inhibitor, and it is used globally as a highly effective and safe drug for the treatment of erectile dysfunction (ED) and lower urinary tract symptom (LUTS). Tadalafil relieve ED or LUTS by relaxing vascular smooth muscle and increasing blood flow to the lower urinary tract tissue. PDE is distributed in pelvic organs, including the corpus spongiosum of the penis and the urethra and prostate, as well as in the lung, heart, and vascular smooth muscle. In other words, PDE is distributed throughout the body. Thus, we hypothesized that the administration of tadalafil might reduce not only systemic arteriosclerosis but also ischemia of the lower urinary tract.

Objective

To prospectively investigate whether the long-term administration of tadalafil, which is commonly used for erectile dysfunction, could reduce arteriosclerosis.

Methods

This study included 85 patients who presented to one of three hospitals with lower urinary tract symptoms. Tadalafil was administered daily (5 mg/d), and pulse wave velocity was measured before administration and at weeks 12, 24, 36, and 48. The International Prostate Symptom Score, Overactive Bladder Symptom Score, and Erection Hardness Score were simultaneously assessed at the same time points. Further sub analyses were performed in patients with a high risk of cardiovascular events, those aged 75 years or older, and those younger than 75 years. The Wilcoxon signed rank test was used for statistical analysis.

Results

Compared with pretreatment values, the pulse wave velocity did not show any statistically significant decrease at any time point. However, the three aforementioned scores significantly improved compared. The group at high risk of cardiovascular events showed significant improvement at weeks 24 and 36, whereas the 75 years or older group showed significant improvement at only week 24.

Conclusions

The long-term administration of tadalafil (5 mg daily) reduced arteriosclerosis or inhibited its progression, and relieved dysuria and improved erectile function. In particular, the drug was revealed to be more effective in patients at a high risk of cardiovascular events and those aged 75 years or older. Hence, tadalafil may have the potential to be used as an anti-aging medicine, although further studies with longer observation periods are needed to confirm its effectiveness and safety.

Disclosure

Work supported by industry: no.
246 Peyronie's Disease - Outcomes of Collagenase Clostridium Histolyticum Injection: A Systematic Review
Authors: Mefford A , Alzweri L , Raheem O , Yafi F
Published: May 2022

Introduction

Peyronie's Disease (PD) is a condition characterized by abnormal and excessive wound repair causing fibrous plaquing of the tunica albuginea. Intralesional (IL) therapies are for patients who prefer to avoid surgical intervention and associated adverse complications. Currently, among available IL injection therapies (Collagenase Clostridium histolyticum (CCh) (Xiaflex, Endo Pharmaceuticals, Dublin, Ireland), verapamil, IFN-a-2b, OnabotulinumtoxinA (Botox) (AbbVie, Chicago, Illinois), Hyaluronic acid). The only FDA approved intralesional treatment option is CCh, which recently expanded its indications for atypical PD.

Objective

This study aims to review recent literature pertaining to CCh and other intralesional therapies in treatment of PD.

Methods

A systematic search of literature using exclusively PubMed was performed. There were no specific inclusion or exclusion criteria, however a preference was placed on recent and high impact articles. The review represents many types of studies including randomized control trials, meta-analyses, as well as phase 2 and 3 clinical trials. The use of CCh was compared to other IL therapies and evaluated for efficacy. This included Lastly, CCh use in atypical Peyronie's Disease was assessed for rate of success and complication.

Results

Recent literature supports the notion that CCh is the most superior IL treatment for typical and atypical PD patients. The capstone CCh study was the IMPRESS trial that showed a 34% reduction in curvature with a mean -17.0 ± 14.8 angle reduction with IL CCh, while men in the placebo saw an average 18.2% decrease in penile bend with a mean -9.3 ± 13.6 degree of change per person (p<0.0001). A shortened protocol for IL CCh treatment offered a 31.4% reduction in curvature while decreasing cost and office visits, potentially increasing patient compliance. Lastly, the literature shows CCh is used most commonly in atypical cases with about 64.8% of patients being treated with CCh – this is probably because of the high efficacy and superb safety profile that it offers. The most serious complications associated with CCh including urethral injury, corporal rupture and penile fracture are rare in all types of PD.

Conclusion

Since the approval of CCh by the FDA in 2013, it has been a staple in the treatment of PD, and here we report the continued success and superiority of this therapy. CCh is an effective, minimally invasive therapeutic option in most PD populations, however recent changes have made CCh unavailable for commercial use out of the United States, thus impacting many patients who have previous benefited from it.

Disclosure

Work supported by industry: no.
251 Adults Apply Different Criteria for Virginity Loss Depending on the Context of the Judged Behavior
Authors: Komlenac N , Herzig R , Pittl M , Perkhofer S , Tucek G , Hochleitner M
Published: May 2022

Introduction

Health care practitioners may rely on abstract concepts such as “virginity loss” when assessing emerging adults’ sexual history. Additionally, virginity loss can be an important life event or “a turning point” in a person's sexual life. Sometimes, virginity loss has social implications and can be associated with potential social status changes. Therefore, it is important to understand emerging adults’ definitions of “virginity loss”.

Objective

The current study analyzed whether emerging adults apply different criteria for virginity loss depending on the context of the judged behavior.

Methods

The online study included 987 persons (75% women/25% men; M  age = 23.7, SD = 3.8) from German-speaking countries. Each participant was assigned one of 16 vignette conditions. Each vignette described a situation in which two persons engage in intimate partnered behavior. The main character's gender, sexual orientation, the partner's gender and the commitment of the two persons to each other were manipulated. Participants had to indicate whether 13 intimate partnered behaviors qualified as virginity loss in the given context. Multinomial logistic regression models were calculated for the analysis.

Results

Almost all participants agreed that penile-vaginal intercourse constituted loss of virginity. However, other intimate partnered behaviors were more likely judged to constitute loss of virginity only when the two partners had the same gender. For instance, penile-anal intercourse was often perceived as virginity loss only when two men engaged in this intimate partnered behavior.

Conclusion

Emerging adults do not agree on whether intimate partnered behaviors other than penile-vaginal and penile-anal intercourse between two men constitute virginity loss. Even though participants seem to apply different standards for virginity loss definitions depending on the gender of the involved partners, they mostly judge close physical partnered behaviors as virginity loss when the behavior is or resembles penile-vaginal intercourse. Thus, participants seem to base their virginity loss definitions on heteronormative beliefs. The devaluation and non-acceptance of close physical partnered behaviors that do not resemble penile-vaginal intercourse as constituting virginity loss may lead some emerging adults to feel pressured to engage in non-preferred close physical partnered behaviors in order to not be denied social implications or social status changes that may result from virginity loss. For health care practitioners it is recommended to use descriptions of concrete behavior and not rely on abstract concepts such as “virginity” when taking a patient's sexual history.

Disclosure

Work supported by industry: no.
260 A New Paradigm in the Treatment of Compulsive Sexual Behaviours
Authors: Neves S
Published: May 2022

Introduction

Compulsive sexual behaviours have been misunderstood for years using the controversial conceptualisation of ‘sex addiction’, a disorder that had not been clinically endorsed. In 2018, the ICD-11 has agreed on a clinical definition of compulsive sexual behaviour disorder (CSBD) with diagnostic criteria.

Objective

Thanks to the ICD-11 diagnostic criteria for CSBD, it is now possible to formulate a treatment protocol that is in line with the clinical understanding of sexual compulsivity, and not based on addiction-thinking. This presentation will summarise the definition of compulsive sexual behaviours disorder (CSBD) and highlight the difference between the disorder and the various patient clinical presentations of sexual compulsivity that may not reach the disorder criteria. Based on the various clinical materials of case studies from different populations, this presentation will propose a treatment protocol based on the three-phase model according to the speaker's clinical experience, explaining the relevance of each phase, including expected outcomes.

Methods

The three-phase treatment protocol takes into account the more recent and evidence-based understanding of sexual compulsivity to address different aspects of the problems: addressing impulse control, treating compulsivity and re-integrating the meaning of sexual behaviours and eroticism. It is a treatment protocol that is flexible and compatible with established psychotherapeutic modalities and interventions.

Results

Based on the speaker's own clinical work and various case studies, a sex-positive, evidence-based treatment provides much better and permanent behavioural change than an addiction-focused treatment (or a 12-step programme mindset).

Conclusion

The conceptualisation of ‘sex addiction’ and its addiction-focused treatments are no longer appropriate with the new understanding of compulsive sexual behaviours. The ICD-11 diagnostic criteria have precipitated a paradigm shift bringing the field of sexual compulsivity into the 21st century. The contemporary clinical understanding of sexual compulsivity opens the discussion for better, less dogmatic treatments. The success of the three-phase protocol rests upon the treatment being congruent with compulsivity and well-established therapeutic modalities, rather than addiction, offering patients more choices with a pluralistic approach.

Disclosure

Work supported by industry: no.
272 The Prevalence and Combination of Gonorrhea and Chlamydia in Patients with Urethritis and Treatment Outcome
Authors: Nguyen Q , Bui Van Q , Nguyen Duy K , Nguyen Huu T , Cao Dac T , Nguyen Thi V
Published: May 2022

Introduction

Urethritis is a common urinary tract infection, in which urethritis due to sexually transmitted infection accounts for a large proportion, especially among sexually active men. The most common causes include gonorrhea and chlamydia.

Aim

To evaluate the prevalence and combination of gonorrhea and chlamydia in patients with urethritis and treatment outcome.

Material and Methods

A retrospective study was caried out on all patients with urethritis due to gonorrhea and/or chlamydia at the Center for Andrology and Sexual Medicine (Vietnam-Germany University Hanoi, Vietnam) from January 2021 to March 2021. The patient's urethritis was confirmed by culture and Polymerase Chain Reaction (PCR) testing of fluid from the patient's penis. Patient data were collected and analyzed.

Main Outcome Measure

The number of urethritis patients were caused by gonorrhea and/or chlamydia were collected during 3 months is 54, the combination of two bacteria was 15% and overall treatment results were good.

Results

The mean age of patients was 29.56 ± 6.7 (18-54) years old. There were 17/54 (31%) patients with simple gonococcal infection, 29/54 (54%) patients were diagnosed with urethritis solely due to chlamydia, 8/54 (15%) patients had urethritis due to both gonorrhea and chlamydia. Of the 25 patients with gonococcal urethritis (mono and chlamydia co-infection): 18/25 patients (72%) were culture positive, while 7 patients (28%) were positive with gonorrhea by PCR. Antibiogram results of 18 patients diagnosed with gonorrhea showed that 18/18 patients were sensitive to spectinomycin, followed by cefoxitin (15/18 patients - accounting for 83.3%), cefotaxime (12/18 patients - accounting for 66.7%) and ceftriaxone (11 out of 18 patients -61.1%). All patients diagnosed with gonococcal urethritis alone or co-infection with chlamydia recovered after the treatment. One of 29 patients with chlamydial urethritis remained symptomatic after completion of the treatment and was tested positive for chlamydia by PCR; while 28 of 29 patients showed good results.

Conclusion

The physician should note the presence of gonorrhea and/or chlamydia and their combination in the diagnosis of urethritis. People who are diagnosed with this disease need to be treated early with the right antibiotics for a good outcome.

Disclosure

Work supported by industry: no.
273 Comparative Study of RARP and Heavy Ion Radiotherapy Sexual Functional Changes for Prostate Cancer Using the Propensity Score Matching Method
Authors: Miyazawa Y
Published: May 2022

Introduction

We mainly perform Robotic-Assisted laparoscopic Radical Prostatectomy (RARP) and Heavy Ion Radiotherapy (HIRT) as curative treatment for prostate cancer. Several factors such as cancer control and quality of life after treatment are considered to be important, but there are few reports comparing sexual function changes before and after treatment between RARP and HIRT.

Objective

We performed retrospective study comparing the evaluation of sexual function after RARP and HIRT cases using the propensity score matching method.

Methods

127 patients treated by RARP from 2014 to 2018 and 190 patients treated by HIRT monotherapy from 2010 to 2019 were evaluated. We evaluated Expanded Prostate Cancer Index Composite (EPIC) score before and after treatment. The EPIC was compared before, 12 months, and 24 months after treatment. Propensity score matching was performed using the age at treatment, PSA value, T stage, and pretreatment EPIC comprehensive score of sexual function as covariates. A cohort of 101 patients in each group was prepared and examined.

Results

The mean ± standard deviation of each of the RARP and HIRT groups were age; 65.1 ± 5.9, 65.3 ± 6.5 years, PSA value; 6.31 ± 2.07, 6.34 ± 2.46 ng / ml, pretreatment EPIC sexual function overall score; 46.4 ± 15.6, 48.2 ± 16.2. In both groups, T1N0M0 was 16%, T2N0M0 was 83%, and T3N0M0 was 1%. The total EPIC sexual function scores before, 12 months, and 24 months after treatment were 46.4, 27.9, 28.2 in the RARP group, and 48.2, 41.4 in the HIRT group, respectively. In both groups, there was a significant decrease in score after 12 months and 24 months compared to before treatment (p <0.05). At 12 and 24 months, the total EPIC sexual function score in the HIRT group was significantly higher than RARP group (p <0.001).

Conclusion

In prostate cancer cases adjusted by propensity score matching, the decrease in EPIC sexual function score was significantly smaller in the HIRT group than RARP group. The results of this study seemed to be useful information for decision making with patients.

Disclosure

Work supported by industry: no.
277 Evaluation of the Sexual Desire Disorders in the Post-Partum Period
Authors: Halouani S , Bettaeib H , Mbarki W , Abidi I , Boufarguine R , Frikha M , Souayeh N , Mbarki C , Oueslati H , Gabsi H
Published: May 2022

Introduction

A woman's sexuality changes throughout her life and varies according to endogenous and exogenous factors. In this perspective, pregnancy and childbirth create a state of sexual desire dysfunction. Eastern culture has always dissociated parents from their intimate life, making the resumption of postpartum sexuality more taboo.

Objectives

To study women's sexual desire disorders after childbirth in order to identify factors that influence it.

Methods

Prospective, cross-sectional study over 200 women followed from the third trimester of the pregnancy until the 6th month postpartum. The evaluation of sexual desire was based on the parameters of the FSFI score (Female Sexual Function Index) in Arabic version.

Results

The average age of the women in our study was 31 years with extremes ranging from 15 to 45 years. The mean parity was 2.4 with extremes ranging from 1 to 4. 94% of our patients were married. 56% of the study population delivered vaginally, of whom 6% required instrumental extraction.20% had a scheduled cesarean section, and 24% had an emergency cesarean section during labor. Over the half the population (56%) did not use any contraception after delivery. 32% opted for the combined pill, while 10% used condoms and 2% had a tubal ligation during cesarean delivery.46% of women breastfed their childs. A decrease in sexual desire has been reported in the postpartum period. At the FSFI, the mean score of the sexual desire before childbirth was 3,33. A minimum sexual desire score of 1,2 was noted in 12% of the women, and 4% of the women had a maximum sexual desire score of 6.After childbirth, the mean score was 3.25. with a minimum of 1,2 noted in 8% of women, and a maximum of 6 found in 4% of women. Regarding the frequency of sexual desire,46% of women reported having sexual desire less than half the time (38%) or almost never (8%). During pregnancy, this rate was 38%.The qualitative evaluation of sexual desire found that 46% of women reported a feeling of decreased sexual desire, whereas this disorder affected 40% of the population before delivery. On the other hand, 26% of women reported a high sexual desire. The occurrence of sexual desire and its intensity were correlated with the following parameters: marital status, breastfeeding, route of delivery and the presence of perineal lesions.

Conclusion

The postpartum period is accompanied by physical and psychological changes that affect female sexual function. A medical approach to the evaluation of sexual desire disorders must be lead in order to identify their cause's and treat them.

Disclosure

Work supported by industry: no.
278 Sexual Function after Gender Affirming Phalloplasty
Authors: Boskey E , Jolly D , Ganor O
Published: May 2022

Introduction

Gender-affirming phalloplasty involves the construction of a neophallus using one or more flaps, most often a radial forearm free-flap. Although numerous articles have reported on short-term surgical outcomes of phalloplasty, relatively few studies have followed phalloplasty patient prospectively, starting from before surgery, in order to determine how surgery affects sexual function, including orgasm.

Objective

As part of a prospective, longitudinal study of barriers to and outcomes of masculinizing gender affirming surgery, researchers assessed patients’ sexual function both prior to and after phalloplasty. This represents a sub-analysis of a larger, ongoing research study addressing psychosocial outcomes of gender affirming surgery, including decision regret.

Methods

The population included in this analysis includes 7 patients who had been followed for at least 6 months after phalloplasty – at which time post-operative sexual function was initially assessed. Six of those patients were also assessed at one year about other psychosexual outcomes of surgery. Both of these assessments involved custom instruments developed for this study. All patients included in this analysis has been assessed at least once prior to surgery. The most recent assessment was used for all patients.

Results

Of the included participants, five identified as male and 2 as transgender male. All were White and not Hispanic. All patients who had been assessed for sexual function after phalloplasty reported having been able to experience an orgasm after surgery. Five patients stated that they were satisfied or very satisfied with their sexual sensation during the most recent assessment, and 4 stated they were satisfied with their non-erotic (tactile) sensation. However, only one patients reported being satisfied with being able to urinate as they chose. Despite no patients having undergone penile prosthesis insertion at the time of assessment, one patient reported having been able to engage in sexual penetration with a partner. Of the 6 patients who had completed at least one year of follow-up, all reported their masculine self-image was either slightly or much better. Five reported that their nude appearance was slightly or much better, and all reported an increase in comfort in public locker rooms and showers.

Conclusions

Overall, preliminary longitudinal data suggests that patients who have undergone gender affirming phalloplasty are satisfied with their sexual function, even when they are unsatisfied with their ability to urinate as they choose. These results support previous research showing that orgasmic function can be maintained after gender affirming phalloplasty. Future data will help determine if phalloplasty can improve orgasmic function in the subset of gender affirmation patients who report no history or orgasm prior to surgery.

Disclosure

Work supported by industry: no.
010 Satisfaction Rates of Inflatable Penile Prosthesis in Men Who Have Sex With Men
Authors: La J. , Loeb C. , Chung E. , Gross M. , Hatzichristodoulou G. , Park S.H. , Perito P. , Sarmiento A.S. , van Renterghem K. , Yafi F.
Published: May 2022

Introduction

Men with erectile dysfunction have high patient satisfaction after placement of inflatable penile prostheses (IPP), but the impact on satisfaction and quality of life has never been studied in men who have sex with men (MSM) with erectile dysfunction.

Objective

To assess the satisfaction rates and quality of life of MSM after placement of IPP for erectile dysfunction.

Methods

A multi-institutional, retrospective study enrolled adult men who self-identified as MSM and underwent inflatable penile prosthesis placement with either AMS 700TM LGX, AMS 700TM CX or Coloplast TitanTM models. Two questionnaires were administered at one timepoint post-operatively. The Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) is a 11-item validated questionnaire measured on a 0-100 scale. The Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) is a 16-item questionnaire subcategorized into 4 domains: functional, relational, social, and personal. Fisher's exact test and paired t-test were used to calculate significance with p-values <0.05 considered significant.

Results

Forty-nine MSM were assessed with a median age of 62 years (interquartile range [IQR], 53-69) with median follow-up of 14.2 months (IQR, 8.1-21.9). AMS 700TM LGX, AMS 700TM CX or Coloplast TitanTM IPPs were placed 2, 2 and 45 men, respectively. For the entire cohort, the median EDITS score was 93 (IQR, 91-95) and the median QoLSPP scores each domain were functional 23/25 (IQR, 22-24), relational 17/20 (IQR, 15-18), social 15/15 (12-15), personal 18/20 (IQR, 17-19) with a total of 72/80 (IQR, 68-76).

Conclusions

MSM report high satisfaction rates and quality of life after IPP placement for ED.

Disclosure

Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Coloplast, Boston Scientific/AMS, Urofill, ).
013 Testosterone Positively Regulates Vagina NO-Induced Relaxation: An Experimental Study in Rats
Authors: Comeglio P. , Cipriani S. , Cellai I. , Filippi S. , Maseroli E. , Stasi V. Di , Todisco T. , Fambrini M. , Rastrelli G. , Maggi M. , Vignozzi L.
Published: May 2022

Introduction

Female sexual response is a result of a complex interplay between central and peripheral mechanisms and the nitric oxide (NO)-mediated relaxation of clitoris and distal vagina vascular bed leads to clitoris tumescence and vagina lubrification.

Objective

The aim of this study was to evaluate sex steroids regulation of the relaxant/contractile pathway in vagina, using a validated animal model of ovariectomized (OVX) Sprague-Dawley rats.

Methods

Subgroups of OVX rats were treated with 17β-estradiol (10 mg/kg/die), testosterone (T, 30 mg/kg/week), or testosterone and letrozole (2.5 mg/kg/die) for 6 weeks. The experimental groups were compared with a group of intact rats. In vitro contractility studies were carried out in order to investigate the effect of OVX and in vivo treatments on vaginal smooth muscle activity. RNA from vaginal tissue was analyzed by semi-quantitative RT-PCR.

Results

In vitro contractility studies were performed on noradrenaline pre-contracted distal vaginal strips, isolated from each experimental group. Acetylcholine (Ach; 0.001-10 µM) stimulation induced a concentration-dependent relaxation, which was significantly reduced by NO-synthase inhibitor L-NAME (100 µM) and by guanylate cyclase inhibitor ODQ (1 µM). OVX resulted in a decreased responsiveness to Ach, restored by T supplementation, with or without letrozole, but not by 17β-estradiol. Vaginal strips sensitivity to the NO-donor SNP (1 nM - 100 µM) was higher in OVX than in the control. Vardenafil (100 nM), a PDE5 inhibitor, enhanced SNP effect in OVX+T as well as in control, suggesting that T positively modulates PDE5, as supported by RNA expression analysis.

Conclusions

In vitro contractility studies and mRNA expression analysis highlight the positive regulation of T on Ach- and NO-dependent muscle relaxation by modulating the NO/cGMP/PKG pathways.Our data demonstrate that testosterone improves the NO-mediated vascular smooth muscle vaginal cells relaxation confirming its critical role in maintaining the integrity of muscular relaxant machinery. Our study confirms the decisive role played by androgens, rather than estrogens, in maintaining the functionality and integrity of the vagina. This study might provide support for the use of androgens in the treatment of genitourinary syndrome of menopause (GSM) and/or sexual arousal disorders related to ageing related-hormonal deficiency.

Disclosure

Work supported by industry: no.
015 Testosterone Level in Seminal Vesicle Fluid is a Better Indicator of Sexual Function than Serum Testosterone in Patients with Prostate Cancer
Authors: Kashiwagi E. , Shiota M. , Monji K. , Lee K. , Matsumoto T. , Takeuchi A. , Inokuchi J. , Eto M.
Published: May 2022

Objective

Semen comprises prostatic fluid and seminal vesicle fluid, which makes up the largest proportion. Seminal vesicle fluid contains various factors such as prostaglandin E2 (PGE2), zinc, and testosterone, which play important roles in sperm motility. Although serum testosterone is important in sexual function, many points are unclear regarding correlations between serum testosterone level and erectile function. We hypothesized that testosterone in seminal vesicle fluid may affect sexual function.

Methods

After receiving institutional review board approval, we collected seminal vesicle fluid samples from 132 Japanese patients with localized prostate cancer who underwent robot-assisted prostatectomy at Kyushu University Hospital from May 2017 to August 2020. We examined the relationship between results of the Sexual Health Inventory for Men (SHIM), Erection Hardness Score (EHS), an original questionnaire (presence or absence of sexual desire), and concentrations of testosterone in seminal vesicle fluid as well as serum testosterone level.

Results

Median participant age was 68 (range 51–77) years. Median concentrations were as follows: seminal vesicle testosterone 1.85 (range 0.17–4.32) ng/mL, serum testosterone 4.59 (range 1.75–10.82) ng/mL. When SHIM score was divided into two groups, seminal vesicle testosterone concentration was significantly increased (P=0.001) in participants with SHIM score ≥17; no significant difference was observed in serum testosterone (P=0.716). EHS score was also correlated with seminal vesicle testosterone (P=0.031) but not serum testosterone (P=0.380). Multivariate analysis revealed that seminal vesicle testosterone was significantly correlated with SHIM score (≥17 vs. <17, odds ratio: 2.374, 95% confidence interval: 1.244–4.529, P=0.008). Seminal vesicle testosterone was not correlated with age (R2=0.032) or serum testosterone (R2=0.014).

Conclusions

Testosterone levels in seminal vesicle fluid can reflect sexual function in patients with prostate cancer, suggesting that seminal vesicle testosterone may affect male sexual function.

Disclosure

Work supported by industry: no.
022 Leucine Rich Repeat Containing 8A Anion Channels Modulate Vascular Reactivity in the Pudendal Artery
Authors: Choi H. , Nguyen H. , Priviero F. , Webb R.C. , Lamb F.
Published: May 2022

Introduction

Erectile dysfunction (ED) is characterized by an inability to develop or maintain penile erection during sexual activity. The internal pudendal artery (IPA) is the primary supplier of genital blood flow. Reactive oxygen species (ROS) generation is necessary for intracellular signaling, but excessive ROS production can promote ED. NADPH oxidase (Nox) produces extracellular superoxide (O2  •-) in the vasculature and we have demonstrated that Leucine Rich Repeat Containing 8 (LRRC8)

Volume Regulated Anion Channels (VRACs) physically associate with and regulate Nox1. LRRC8A downregulation or channel inhibition decreases extracellular O2  •- production by Nox1 and dramatically reduces the inflammatory response to tumor necrosis factor alpha.

Objective

We hypothesize that smooth muscle-specific LRRC8A knockout (KO) increases vascular relaxation in IPA.

Methods

The IPAs from male wildtype (WT) and LRRC8A KO (smooth muscle-specific) mice were used in wire myograph studies.

Results

Following phenylephrine (PE, 2x10-6 M)-induced contraction, cumulative relaxation-response curves to acetylcholine (ACh, 10-9 to 3x10-6 M), sodium nitroprusside (SNP, 10-9 to 10-5 M), and a soluble guanylyl cyclase activator (BAY60-2770, 10-9 to 10-6 M) were measured. Endothelium-dependent relaxation to ACh was increased in LRRC8A KO compared to WT (WT LogEC50 -7.3 ± 0.08; LRRC8A KO LogEC50 -7.7 ± 0.12; *p<0.05, n=5). Relaxation to SNP or BAY60-2770 showed no difference between WT and KO. The LRRC8A-targeted VRAC inhibitor, montelukast (10 μM) reduced PE (10-6 M)-induced contractile responses in the IPA (56 % decrease).

Conclusions

These data demonstrate that LRRC8A plays an important role in controlling vascular reactivity that may be associated with ED. We speculate that LRRC8 channels are novel pharmacologic targets. Inhibition of the channels may reduce oxidative stress and improve sexual function.

Disclosure

Work supported by industry: no.
031 The Rigicon Infla10® IPP Implantation via the Penoscrotal and Subcoronal Approaches: The UKSH Experience
Authors: Osmonov D. , Ragheb A.
Published: May 2022

Introduction

Penile implant manufacturers compete to introduce the latest technologies within their devices. They all aim to develop the optimal implant with the best functionality and highest durability. One of the relatively new companies that has recently joined the competition is Rigicon which has lately introduced its new Infla10® inflatable penile prosthesis (IPP). This video was recorded at the University Hospital Campus Kiel, Germany which is one of the first European centers of excellence to implant Rigicon devices.

Objective

The German experience with the new Infla10® penile implant, represented by the Kiel School of Prosthetic Urology, is demonstrated via a step-by-step instructive video of two penile prostheses implantations. While elaborating the steps of the procedures, we highlight the various unique features of the new Infla10® device related to the cylinders, reservoir, and pump.

Methods

We utilized the penoscrotal approach for our first patient and the subcoronal approach for our second. For our first implantation, we chose the high submuscular reservoir location leaving the traditional retropubic reservoir implantation for our second patient.

Results

Both patients demonstrated an eventless surgery and postoperative follow-up period and were satisfied with their implants.

Conclusions

We consider the Infla10® device to be a promising addition to the available devices in the market. The Infla10® implant comprises a number of advanced device technologies that add to both the durability and reliability of the implant.

Disclosure

Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Coloplast).
035 Vaginal Reconstruction: Progress by Perforator Flaps
Authors: Koshima I. , Roh S.
Published: May 2022

Introduction

Gracilis and rectus abdominis myocutaneous flaps have been used for reconstruction of a wide range of vaginal defects, but recently, minimally invasive reconstruction with various perforator flaps has become popular. Vaginal reconstruction for the past 41 years is reported.

Patients Summary

15 cases of vaginal defects were surgically treated. The case was that the age at surgery was 23 to 87 years, with an average of 55 years. The original disease is vesico-vaginal fistula 6 cases, Paget cancer 4 cases, labial1 cancer 1 case, pudendal radiation ulcer associated with lymphedema 1 case, Rokitansky syndrome 1 case, GID (Male to female)1 case, vaginal stenosis 1 case. Flaps for reconstruction are: gracilis musculocutaneous flap 5, superficial circumflex artery perforators (SCIP) flap 4, pudendal artery perforator flap 3, medial femoral perforator Flap 2, scrotal flap 1, gracilis perforator flap 1, free latissimus dorsi musculocutaneous flap 1. Reconstruction using multiple flaps was performed for extremely widespread defects.

Results and Conclusion

Postoperative follow-up was 2weeks to 20 years with an average of 2.5 years. As complications, recurrence of bladder-vaginal fistula occurred in 2 of 6 cases (33%), and partial necrosis of the flap was observed in 1 of 16 cases (6%). For vaginal reconstruction, the surrounding myocutaneous flap or perforator flap can be selected depending on the depth and extent of the defect. Donors can be closed by using combined flaps, especially for a wide range of defects. Irradiated bladder-vaginal fistulas may require a bilateral approach from the bladder and vagina. In the future, reconstructive surgery that considers sexual function will be required for GID as well.

Disclosure

Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Luxanos).
037 Differences in the Gut Microbiome Composition Between Men with Erectile Dysfunction and a Matched Cohort: A Pilot Study
Authors: Osman M.M. , El-Khatib F.M. , Dianatnejad S. , Nguyen J. , Choi E. , Towe M. , Yafi F.A.
Published: May 2022

Introduction

The gut microbiome (GM) plays an important role in human health, ranging from supplying essential nutrients, synthesizing vitamin K, to promoting angiogenesis and enteric nerve function. It has also been recently associated with a variety of chronic health conditions. To date, however, there have been no studies that have attempted to establish any association between the GM and erectile dysfunction (ED).

Objective

To analyze stool samples from patients with ED and compare them to matched controls for differences in their GM.

Methods

We collected stool samples from 37 patients with ED and matched them with 37 controls. All samples were processed by a third-party company, Viome Inc. The samples were analyzed by metatranscriptome sequencing which allows for data to show both the taxonomy of the microbiome and its KEGG orthology (KO). We compared richness, prevalence and expression of the taxa and KOs between the ED and control groups.

Results

There were 224 species (16.85%) with significantly differential prevalence and 135 species (10.31%) with significantly differential expression. There were 565 KOs (10.42%) with significantly differential prevalence and 653 KOs (12.05%) with significantly differential expression. Richness is the number of microbial species detected in a sample. Diversity assesses the abundance and evenness of a species to assess how diverse an individual sample is. The ED group demonstrated significantly lower taxonomic richness and diversity, p= 1.33 x 10^-5 (see figure below).

Conclusions

This is the first study to look at associations between the GM and ED. Patients with ED have significantly lower taxonomic richness and diversity. Further analyses are needed to better understand the implications of these findings and uncover potential targets for early targeted treatment or prevention of ED.

Disclosure

Work supported by industry: yes, by Viome Inc.. A consultant, employee (part time or full time) or shareholder is among the authors (Antares. Clarus. Coloplast. Promescent.).
060 Intramuscular Testosterone Cypionate vs Subcutaneous Testosterone Enanthate: Comparing the Outcomes in Hypogonadal Men
Authors: Choi E. , Xu P. , Loeb C. , El-Khatib F. , Yafi F. , Kavoussi P.
Published: May 2022

Introduction

Intramuscular testosterone cypionate (IM-TC) is the conventional treatment option for hypogonadal men with baseline serum total testosterone (TT) less than 300 ng/dL; however, significant peaks in testosterone cause adverse effects including polycythemia and rise in estradiol (E2). Subcutaneous testosterone enanthate-autoinjectors (SCTE-AI) were designed with a lower testosterone peak-to-trough ratio of 1.8.

Objective

This dual-institutional study compared the TT, hematocrit (HCT), E2, and prostate-specific antigen (PSA) response to treatment with IM-TC versus SCTE-AI.

Methods

263 hypogonadal men were treated with testosterone replacement therapy (TRT) via IM-TC or SCTE-AI. TT, HCT, E2, and PSA levels were obtained at baseline and 6- to 12-weeks post-treatment. Significant differences in baseline and post-treatment levels were identified by univariate analysis. Linear regression models determined whether treatment modality was independently associated with post-TRT levels of TT, HCT, E2, and PSA.

Results

Patients treated with SCTE-AI were significantly younger, had higher baseline TT levels, and lower baseline E2 levels (Table 1). Post-TRT, the SCTE-AI cohort had significantly lower HCT and E2, while TT and PSA levels were not significantly different between the treatment arms. After adjusting for significant differences with linear regression, SCTE-AI was associated with a 14% greater increase in trough TT levels compared to IM-TC (p=0.027) (Table 2a). Furthermore, SCTE-AI was independently associated with 41% and 26.5% lower post-therapy HCT (p<0.001) and E2 (p<0.001) levels, respectively, when compared to IM-TC (Table 2b-c). Neither TRT modality was associated with post-therapy elevation of PSA (p=0.691).

TT: Total Testosterone; HCT: Hematocrit; E2: Estradiol; PSA: prostate-specific antigen

Conclusions

While IM-TC and SCTE-AI provide a significant increase in testosterone, SCTE-AI is associated with lower levels of post-therapy HCT and E2 compared to IM-TC after adjusting for significant covariates. SCTE-AI is an effective testosterone delivery system with a preferable safety profile over IM-TC.

Disclosure

Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome).
069 Prevalence of and Depression, Anxiety and Stress Associated with Premature Ejaculation among the Patients Attended in the Sex Clinic of a Tertiary Level Psychiatric Hospital, Dhaka, Bangladesh
Authors: Nahar S. , Shaheen M.M. , Islam T. , Alim S.A.H. Mostafa , Alam M.F.
Published: May 2022

Introduction

Premature Ejaculation (PE) has been considered as the most common male sexual dysfunction having significant detrimental impact on both men and their partners. But in many cases, it remains undetected and untreated. The relationship between depression, anxiety and stress with PE might be bi-directional. Depression, anxiety and stress may impair male sexual function and couple's sexual relationships. On the other hand, the poor sexual functioning and satisfaction can produce feelings of frustration and anxiety between partners.

Objective

The objective of this study was to determine the proportion of PE and to find out the depression, anxiety and stress associated with PE among the men who perceive themselves as having little control over ejaculation attending in the sex clinic of a tertiary psychiatric hospital.

Methods

This was a cross-sectional study conducted from August 2017 to June 2018, among 280 male patients who perceived themselves as having little control over ejaculation aged from 18 to 60 years and were selected by convenient sampling technique. A semi-structured, self-administered questionnaire containing socio-demographic variables, the Bangla version of the Premature Ejaculation Diagnostic Tool (PEDT), the Bangla version of the short version of Depression Anxiety Stress Scales (DASS 21-BV) were applied to assess their PE and associated depression, anxiety & stress respectively.

Results

It showed that, mean (+ SD) age of the respondents was 38.8 (+8.44) years and 26.4% of the respondents were found to have premature ejaculation. Presence of PE was slightly higher (55.4%) among the older age group (aged 41-60 years) than the younger age group (aged 18-40 years). Chi-square test showed significant association with depression, anxiety and stress with PE (p<0.05 for all comparisons).

Conclusions

This high prevalence and associated psychological factors illustrate the need for promoting awareness regarding PE and for better outcome. During assessment psychological factors should be identified properly and psychosocial management should be emphasized along with pharmacotherapy during management of the PE patients.

Disclosure

Work supported by industry: no.