bluuebunny/crossref_metadata_2025 huggingface dataset:
QbD-Based Stability-Indicating RP-HPLC Method Development and Validation for the Estimation of Favipiravir—An Eco-Friendly Approach
Authors: Chandana M. Siri , K. Sujatha , A. Ajitha , Narendra Pentu , K. Sonia
Published: February 2024

Background

Analytical quality by design (AQbD) affords a systematic scaffolding to triumph a continuously validated, robust assay as well as life cycle management. The resuscitative repurposed drug favipiravir, an oral drug approved for reemerging pandemic influenza in Japan in 2014, is used for the treatment of life-threatening pathogens such as Ebola, Lassa virus, and currently COVID-19. Favipiravir is gaining a great deal of medical importance due to its pharmaceutical applications.

Objective

To develop and validate a risk-based stability-indicating RP-HPLC method employing an AQbD approach using Central Composite Design (Design Expert Software 13.0) for the estimation of favipiravir.

Method

The Quality Target Product Profile optimized were flow rate and mobile phase composition, thus assessing the critical analytical attributes (retention time, tailing factor, and number of theoretical plates) as the constraints of method robustness. The proposed technique was optimized with a C18 (150 × 4.6 mm, 5 µm) column and 0.1% orthophosphoric acid buffer–acetonitrile (50:50, v/v) as the mobile phase at a flow rate of 1 mL/min using diode-array detector (230 nm) eluted favipiravir at 2.3 min.

Results

The optimized method validated as per ICH guideline Q2 (R1) was found to be eco-friendly, simple, precise (RSD 0.0051–1.2%), accurate (99.86–100.22%), linear (25–150 µg/mL), rugged (RSD 0.70%), and robust (RSD 0.6–1.6%) with a limit of detection and limit of quantitation of 1.140 µg/mL and 4.424 µg/mL, respectively.

Conclusion

Forced degradation studies (acidic, alkaline, thermal, photolytic, and oxidative conditions) revealed the suitability of the AQbD method for the analysis of favipiravir in tablet formulation.The developed and validated AQbD method is less time consuming and can be used in the industry for routine quality control/analysis of bulk drug and marketed Favipiravir products.

Highlights

A robust Design of Experiment enhanced stability-indicating analytical method was developed and validated for the estimation of favipiravir. Furthermore, the contemporary method would aid in extending the analysis of favipiravir in other formulations.
(025) Compliance with GMC Guidelines for the Use of a Chaperone in Urology Outpatient Clinic
Authors: Desouky E , Ibrahim M , Jallad S , Kalsi J
Published: February 2024

Introduction

Intimate physical examination is an integral part of our urological practice. There is a paucity of literature regarding the use of chaperones among urologists. As per GMC guidelines: The offer, and use, of a chaperone, including their full name and designation, should be clearly documented in patients’ notes.

Objective

Given the importance of this ethical topic for both patient safety as well as in providing support for the urologist, we decided to assess our performance as per the GMC guidelines for good medical practice.

Methods

We completed an audit loop to evaluate the performance of 12 members in our urology team as regards compliance with GMC guidance for the documentation of chaperone use in urology clinic. Based on our scoring system, we objectively assessed both overall team performance as well as individual scores for documenting chaperone use. • For each urologist, We checked records for 10 patients who attended urology clinic AND had a physical examination as evidenced in the notes and/or clinic letter •N= 120 patient records checked • Each urologist was given a score; NO mention of a chaperone= 0 point A chaperone JUST mentioned= 1 point The chaperone specified (name/signature)= 2 points

Results

Initial audit revealed overall chaperone documentation in clinical notes was 75.25% which may be acceptable while in the clinic letters, it was only 14.6%. At individual level, results were quiet variable reflecting the actual difference in practice between individuals in real life. Following the discussion of the 1st audit results in the urology clinical governance meeting, posters were made to raise awareness of the audit outcome as well as direct discussions with the urology team members to encourage them to improve their score. Six months later, re-audit showed significant improvement was achieved for individual as well as overall documentation to 85% of clinical notes and more than 50% of clinic letters.

Conclusions

Documenting chaperone presence during patient examination in urology clinics, is mandatory given the intimate nature of urological examination. We present the first report using a scoring system for objective assessment of a pertinent topic such as the use of chaperone and its documentation. This managed to achieve a significant improvement in our practice in accordance with GMC guidance for Good Medical Practice.

Disclosure

No.
(042) Reasons For and Time to Failure Associated with Inflatable Penile Prosthetics: A Multi-Center, High, Volume Experience
Authors: Griggs R , Stuart A , Henry G , Karpman E
Published: February 2024

Introduction

Despite technological advancements in the composition material, pump design, and infection retardant coatings, inflatable penile prosthetics (IPPs) remain prone to mechanical failure due to pump malfunction and/or fluid loss.

Objective

We aim to distinguish IPP component failure etiologies at the time of device replacement and/or repair between the two most common manufacturers: American Medical Systems/Boston Scientific (BSCI) and Coloplast (CP).

Methods

We performed an IRB approved, retrospective chart review of two private, high volume IPP surgeon revision and virgin cases (CPT codes 54405, 54408 and 54410) from January 2018 to May 2023. Mechanical revision indications were stratified by manufacturer and component location (pump, tubing, cylinder, and reservoir). Non mechanical revision cases were excluded (planned upsizing, patient dissatisfaction, herniation without replacement, impending erosion/eroded, crossover, and infection). Other exclusions included missing data (reason for failure, device type, op note, patient specific data, and/or prior institution operative details).

Results

Between the two surgeons, we identified a total of 646 cases during the study period. 120 were revision IPP cases, 66 of which, met inclusion criteria (57 BSCI and 9 CP). Of the BSCI mechanical inflatable penile prosthetic failures, 24/57 (42%) were due to cylinder rupture, 5/57 (9%) were due to tubing leaks, 3/57 (5%) were associated with reservoir perforation, 5/57 (9%) were due to cylinder aneurysm, and 20/57 (35%) were due to pump failure. Coloplast device mechanical failure was predominantly due to tubing fracture 7/9 (77.8%) while reservoir rupture and cylinder aneurysm each were 1/9 (11.1%). Between manufacturers, cylinder rupture and pump failure were more common in BSCI devices (25/57 vs 0/9, p=0.036; CI 95%) and (21/57 vs 0/9, p=0.064; CI 90%). While tubing fracture was more common in CP devices (5/57 vs 7/9, p=0.002; CI 95%). Cylinder aneurysm and reservoir rupture did not significantly differ between manufacturers. Similarly, log rank analysis illustrates similar time to mechanical failure between BSCI and CP (median 48 vs 41months respectively, p=0.277; CI 95%).

Conclusions

BSCI and CP device time to failure appears to be similar; this was also shown in recent published literature. BSCI pump failure appears to be greater than the previously described rate of 2% during their recall period from 2018-2020 and they fail significantly more than CP devices. BSCI devices most commonly fail due to cylinder rupture then other component failure. CP devices fail most commonly due to tubing rupture and this adds to the prior published literature. Further, multi-center studies are needed to validate these findings.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific Consultant.
(104) Zzz’s and the Big O: Investigating the Impact of Orgasm on Sleep Quality in Women
Authors: Yarborough C , Codrington J , Muthigi A , White J , Ramasamy R
Published: February 2024

Introduction

Sleep quality and sexual satisfaction are contributors to overall well-being, yet little research has investigated the impact of orgasms on subsequent sleep quality in women. This study aims to address this gap by analyzing sleep data from the Fitbit Versa 3 and self-reported sexual encounters to determine if sleep quality improves following orgasm. This data can contribute to an overall understanding of the connection between sexual experiences and sleep quality and strategies to improve overall health.

Objective

The primary objective of this study was to investigate whether sleep quality following a sexual encounter with orgasm improves sleep in women using sleep data collected from the Fitbit Versa 3 and self-reported sexual encounters.

Methods

Sexually healthy women, aged 18 and above, wore Fitbit Versa 3 devices for a duration of 6 weeks. The participants transmitted encrypted and de-identified data through the Fitbit app, ensuring privacy and confidentiality. Weekly online surveys were conducted to record the number, timing, and type of sexual encounters reported by the participants as well as if orgasm was achieved. During sexual encounters, the Fitbit devices measured heart rate, which was normalized to the participants' resting heart rate. Additionally, sleep data including proprietary sleep efficiency scores from the Fitbit devices were collected over the entire study period. Orgasm was self-reported by participants after every sexual encounter.

Results

A total of 17 sexual encounters were documented within six weeks. 14 representative encounters with full sleep data from the night before, and sleep directly after orgasm were included. For all sexual encounters, sleep data from the Fitbit device for the corresponding night and the previous night were examined. Linear regression analysis was conducted to evaluate any changes in sleep quality during this period. The results revealed a positive trend between improvements in minutes slept (a 54% increase in minutes slept among women with orgasm compared to women without orgasm, R-squared = 0.2434, p = 0.073) as defined by Fitbit with orgasm compared to the night before, respectively.

Conclusions

The findings of this study suggest a positive correlation between orgasms and improvements in sleep quality, as indicated by increased minutes slept and enhanced sleep efficiency. These results contribute to our understanding of the potential benefits of sexual activity on subsequent sleep. Further research with a larger sample size and controlled variables is warranted to validate and expand upon these findings. These initial findings highlight the potential role of orgasms in promoting better sleep quality, underscoring the importance of considering sexual experiences in the context of overall sleep health.

Disclosure

No.
(116) Breaking the Silence: Should I Be Concerned About Penile Fracture when Injecting Collagenase Clostridium Histolyticum?
Authors: Miller J , Hammad M , Loeb C , Azad B , Jenkins L , Yafi F
Published: February 2024

Introduction

Collagenase clostridium histolyticum (CCH) was first approved by the FDA in December 2013 for the nonsurgical management of Peyronie’s disease (PD) in men who are otherwise healthy. Penile fracture (PF) is a rare but concerning adverse event with known association with CCH administration.

Objective

To determine the risk of PF in men with PD who are receiving CCH and correlations between the risk of PF and comorbidities previously excluded in studies investigating the safety of CCH, namely the IMPRESS trial.

Methods

The TriNetX database was used to measure the rate of hospital visits for penile fracture using the ICD-10 code S39.840A. Results were limited to patients who were diagnosed with PD (ICD-10 N48.9) and were seen between July 2013 to July 2023. Patients were excluded if they had a history of surgical intervention for PD, including plaque excision and grafting, penile plication, and insertion of inflatable penile prosthesis. An odds ratio (OR) was calculated to compare the rates of PF between patients who had and had not received CCH. For those who received CCH, OR’s were calculated to determine if the presence of certain comorbidities increased the risk of PF.

Results

Within the examined time period, 44,542 patients with PD experienced 280 PF’s. The rate of PF in those who had and had not received CCH were 1.25% (N = 37) and 0.59% (N = 243) respectively, OR 2.122 (95% CI: 1.499-3.001, p<0.0001). Tobacco use, diabetes mellitus, peripheral vascular disease, hypertension, hyperlipidemia, erectile dysfunction, and hypogonadism were not associated with an increased risk of PF in men receiving CCH (p>0.05) (Table 1).

Conclusions

While the rate of PF following CCH use for PD was low at 1.25%, this was significantly higher than in those who did not receive CCH. Despite this, men who were previously excluded from studies examining the safety of CCH use for PD due to comorbidity burden were without an increased rate of PF, suggesting that these men may be able to receive CCH without additional risk of PF.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma, Clarus Therapeutics, Coloplast.
(201) The Need for Enhanced Wellness Among Male Resident Physicians: A Critical Look at Participation Rates
Authors: Krishingner G , Mallory C , Moy L , Campbell K
Published: February 2024

Introduction

The demanding nature of medical residency-characterized by long working hours, irregular sleep schedules, and high-stress environments-poses significant health risks to resident physicians. These challenging work environments often interfere with resident’s ability to seek healthcare and wellness opportunities. This is further compounded in males who, studies suggest, are less likely to visit a doctor than their female counterparts. While numerous studies have explored specific health concerns such as resident burnout and depression, there remains a pressing need to prioritize overall wellness in this vulnerable population.

Objective

Our study aims to evaluate the male resident physician response to health and wellness initiatives.

Methods

This is a prospective study to evaluate male physicians in medical training who elected to undergo wellness screening at our institution. Following approval by the Institutional Review Board, participants were contacted via e-mail regarding participation in men’s health screening. Baseline demographics were obtained including age, specialty, and post-graduation year (PGY). Participants were asked to complete the Androgen Deficiency in the Aging Male (ADAM) and 36-Item Short Form Health Survey (SF-36) questionnaires in additional to obtaining lab work: BMP, CBC, Lipid panel, thyroid panel, testosterone, FSH, LSH, and estradiol. Survey questionnaire data was obtained through Research Electronic Data Capture (RedCAP).

Results

Out of 651 male residents and fellows, only 27 residents expressed interest in participation (response rate 4.1%). Of those, 66.7% (18/27) completed the surveys, and a mere 33.3% (6/18) completed the lab tests. While physical parameters scored highly (Table 1), role limitations due to emotional problems and energy/fatigue raised significant concerns with median scores of 50% and 47.5%, respectively. Similarly, perceived health change was stagnant with a median score of 50%. General health perception was middling at 62.5% whereas emotional well-being (72%) and social functioning (68.8%) were comparatively better, but not reaching optimal levels.

Conclusions

The low participation in voluntary health screenings among male resident physicians underscores a pressing need for enhanced wellness programs tailored to this group. It is vital for medical institutions to address barriers to participation and create a culture that prioritizes the health and wellbeing of its residents. These efforts may lead to better detection and management of health issues, improved overall wellness, and a more positive experience during the demanding period of residency.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Tolmar pharmaceuticals.
(216) Efficacy of Novel Hyaluronic Acid Dermal Filler Injections for Penile Girth Enhancement
Authors: Carey B , Baylor A , Pearlman A , Gumpf K , Moore W , Clavell J , Kansal J , Milhouse F , Tatem A
Published: February 2024

Introduction

There has been renewed public and professional interest in the topic of cosmetic penile girth enhancement. Hyaluronic acid (HA) injections have been proposed as a safer alternative to surgical options, however limited data exist regarding efficacy.

Objective

The purpose of our study was to evaluate average girth changes and related metrics in men undergoing penile girth enhancement with sequential administration of HA dermal filler at a single site.

Methods

We performed a retrospective review of men who underwent penile girth enhancement with HA from May 17, 2022 to April 28, 2023.

Results

155 men underwent penile girth enhancement with HA filler and were instructed to follow a strict post-injection protocol. On average, men experienced a 0.633 cm increase in girth per treatment receiving an average of 12.5 total syringes over 2.2 treatments. Ultimately, all men receiving multiple treatments experienced an average girth increase of 1.8 cm as measured prior to their final treatment. 23 men who received 4 treatments or more experienced an average girth increase of 2.952 cm as measured prior to their final treatment. Of the 155 men treated, 19 (12.3%) required cosmetic correction with either hyaluronidase or abobotulinumtoxinA.

Conclusions

Our study suggests that injection of HA dermal filler is an effective option for men desiring non-surgical penile girth enhancement. Further studies are needed to better characterize outcomes and optimal treatment protocols.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: PhalloFill.
(278) Peyronie's Disease Among Men Who Have Sex With Men: Perceptions, Characteristics, and Psychosocial factors
Authors: Paulsen O , Louters M , Good J , Pereira TA , Bernie H
Published: February 2024

Introduction

Peyronie’s Disease (PD) is a condition characterized by the development of fibrous scar tissue causing penile curvature and often painful erections. From a sexual health perspective, PD is commonly researched in heterosexual men; however, there is a paucity of data assessing the impact that PD has on men who have sex with men (MSM) population.

Objective

This prospective survey study sought to collect data on how PD affects MSM from a biopsychosocial and sexual perspective and compare this population’s experience with non-MSM.

Methods

An anonymous online survey was deemed IRB exempt and administered to the following online platforms: Reddit to include r/PeyroniesSupport, r/lgbtstudies, r/sex, and on Facebook to the Peyronie’s Disease Support group in July 2023. Participants were asked demographic info, sexual orientation, type of sexual intercourse, family history of PD, history of trauma, immune disease, PD symptoms, partner and self-bother, degree of curvature, care seeking, medical interventions, impact on mental health, disease progression, as well as the Peyronie’s Disease Questionnaire (PDQ) survey. Descriptive statistics were performed.

Results

Thirty-six men completed the survey, nine being MSM (11.8% “men and others” and 14.7% “strictly men"). Reported sexual interactions included anal (50%), vaginal (77%), and oral (79%) intercourse. History of penile trauma occurred in 32% of respondents. None of the respondents reported a family history of PD, and two subjects disclosed autoimmune diseases. The most common symptoms, experienced by 91% of subjects, were “shortening and/or narrowing of the penis,” followed by: erectile dysfunction (69%), difficulty with sexual intercourse (44%), painful erections (31%), and painful sexual intercourse or masturbation (28%). 85% of surveyed men and 100% of MSM stated PD negatively impacts their mental health. Assessment of partner satisfaction revealed women express greater disapproval (12%) compared to men (3%). The majority of men (91%) reported seeing a urologist with only 35% seeing one regularly and 50% being MSM. A negative experience with a urologist was reported in 40% of MSM and 20% of non-MSM. Degrees of reported curvature were: 77% with less than or equal to 45 degrees, 6% between 46-60 degrees, and 18% between 61-90 degrees. Greater than 60% and 27% were offered medical and surgical interventions, respectfully. 62% reported their PD has remained stable.

Conclusions

In conclusion, the results of this survey suggest that PD may have a greater negative effect on mental health and experience with a urologist for MSM. However, non-MSM are more likely to experience partner disapproval. Overall, the characteristics of PD do not grossly vary between MSM and non-MSM but the psychosocial aspect may possess greater consequences for MSM. More data is needed on this understudied population affected by PD.

Disclosure

No.
(284) A Preliminary Investigation on the Incidence of Complications and Patient Contentment Following the Surgical Implantation of Inflatable Penile Prosthesis After Salvage Radical Prostatectomy
Authors: Khalaf Alla K , El-Achkar A , Mehr J , Wang R
Published: February 2024

Introduction

Erectile dysfunction (ED) is a common complication post salvage radical prostatectomy (RP). Yet, there is scant data in the literature on complication rates and patient satisfaction in those that undergo inflatable penile prosthesis (IPP) insertion post salvage radical prostatectomy (RP) following targeted radiotherapy for treatment of localized prostate cancer. It is understood that these patients have a higher rate of complications as they have experienced both radiation and prostatectomy adverse events which could alter their overall satisfaction after prosthetic surgeries.

Objective

Our aim is to conduct a preliminary analysis of IPP complication rates and satisfaction rate in patients that had 3-piece IPP implantation following salvage radical prostatectomy.

Methods

A retrospective chart review from our institutional database was done from 2018 to 2021. The inclusion criteria were patients that had an inserted 3-piece IPP and a history of salvage RP following radiation therapy. Only patients that participated Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire at least 6 months from implant date were included. Data on satisfaction, IPP infection rates, mechanical failure rates, and overall complications was also collected. Complications include hematoma, erosion, reservoir hernia.

Results

A total of 22 patients were included in the study. The median age (IQR) is 65 (64-67) years and the median time (IQR) from RP to IPP insertion is 23 (11-49) months. All patients were approached in a penoscrotal manner with submuscular placement of reservoir (Table 1). The satisfaction rate was high at 91.8% on follow up. Overall complications rate was observed in 2 patients. One patient had a mechanical pump failure at 37.9 months while another patient had signs and symptoms of scrotal wall infection at 15 months. Both devices were easily replaced with no post op complication and remained functional on further follow up.

Conclusions

In patients that underwent salvage prostatectomy IPP insertion, they reported high satisfaction rates and low complication rates despite the exposure to both prostate cancer treatments adverse events. Further research is needed to confirm the results obtained and to investigate the underlying causes for the observed outcomes. The scientific process is iterative, and the answers obtained from one study often lead to more questions and the need for additional investigations.

Disclosure

No.
(289) Has the COVID-19 Pandemic Impacted Penile Implant Public Interest in the US?
Authors: Hammad MAM , Nakamura H , Miller J , Azad B , Yafi FA
Published: February 2024

Introduction

The COVID-19 pandemic has significantly impacted various aspects of society, including healthcare-seeking behaviors. Online search trends have become valuable indicators of public health concerns and interests.

Objective

This study focuses on the search trends for penile implants to understand how these trends have changed in different metro/county income levels pre- and post-COVID-19.

Methods

Data on Google search trends for penile implant procedures were collected for specific metropolitan areas before and after the COVID-19 pandemic. The metropolitan areas with the highest search intents were further analyzed. Average household income and per capita income, based off 2021 US Census Bureau, were calculated for the top five metropolitan hot spots (household income, per capita income before and after the pandemic) then visualized in a linear model.

Results

Between 2016 and 2023, pre- and post- COVID-19, the interest in penile implants has been steadily increasing on average in the US (figure 1). Within these interest groups, a handful of counties account for the most searches that result in the following surges, and are associated with specific socioeconomic backgrounds and events. Before COVID-19, the average household income of counties most interested in penile implants was $53,215.80 (39th percentile) and the per capita median income was $34,626.80 (37th percentile). Post-COVID-19, both of these averages decreased over time to $50, 945.17 (37th percentile) and $31, 435.17, respectively (34th percentile) (figure 2).

Conclusions

This study demonstrates significant increases in Google search trends for penile implant procedures after the COVID-19 pandemic. Before the pandemic, higher-income regions demonstrated more interest in penile implant searches, potentially linked to affluence and investment in men’s health, compared to more interest in lower income regions post-pandemic.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.
(317) Significant Cost Savings for Erectile Dysfunction Medications are Available Using Discount Online Pharmacies Compared to Medicare
Authors: Miller JA , Loeb CA , Moukhtar Hammad MA , Nguyen M , Azad B , Yafi FA
Published: February 2024

Introduction

The Mark Cuban Cost Plus Drug Company (CPD) is an online retailer launched in January 2022 that sells generic prescription medications directly to consumers at cost of ingredients and manufacturing plus a fixed 15% margin in addition to a small pharmacy dispensing fee and shipping fee. GoodRx is an online tool which offers coupons redeemable at pharmacies for discounts on prescription medications. The combination of these two tools offers physicians a way to provide prescription medications to patients at lower costs, which may lead to improved medication adherence and lower medication expenditures nationally.

Objective

To compare the cost of various erectile dysfunction medications when purchased through retail pharmacies, reimbursed through Medicare, or obtained utilizing CPD and GoodRx.

Methods

A review of publicly available data from CPD and GoodRx was performed to obtain average retail and discounted prices for generic sildenafil, tadalafil, and vardenafil. GoodRx prices were obtained using prices from Costco, CVS, Walgreens, and Walmart pharmacies in the most from populous zip code from each of the 3 most populous U.S. states: California, New York, and Texas. Prices were adjusted to account for dosage and prescribed quantity to estimate an average cost per dosage unit ($/adu). The Medicare Part D Drug Spending and Utilization data from 2021 were used to report the average spending per dosage unit and total expenditure for each of the listed medications. These data were compared to create an estimate of average national savings after use of CPD or GoodRx.

Results

Average spending per dosage unit for sildenafil, tadalafil, and vardenafil was less when GoodRx or CPD were used (0.28 $/adu, 0.31 $/adu, and 6.17 $/adu respectively), compared to Medicare pricing (2.14 $/adu, 8.08 $/adu, and 27.84 $/adu respectively) or retail pricing (0.52 $/adu, 2.82 $/adu, and 8.35 $/adu respectively). When adjusted for total dosage units, use of CPD over Medicare pricing for the three medications would result in a combined annual national saving of $149M. Use of either CPD or GoodRx compared to retail pricing would similarly result in a combined annual nation saving of $40M.

Conclusions

The utilization of CPD and GoodRx in the prescription of common erectile dysfunction medications may lead to significant reductions in pricing compared to retail and Medicare estimates. Knowledge of these prescription tools may lead to significant reductions in national expenditures on medications and decreased cost burden for patients seeking treatment.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.
(335) Motivation for Vasectomy Reversal Among U.S. Military Population
Authors: Swargaloganathan P , Maloney T , Hawksworth D
Published: February 2024

Introduction

Vasectomy is a relatively common procedure performed for the purposes of sterilization; however, an estimated up to 6% of men that undergo vasectomy wish for reversal at some point. Few studies have examined the motivation behind vasectomy reversal, and very limited research within special populations, such as U.S. military members.

Objective

The aim of this study was to explore the motivations of U.S. military servicemen who opted for vasectomy reversal (VR) surgery, considering their unique access to this surgical care.

Methods

We conducted a retrospective review of patient records of microsurgical vasectomy reversal performed by a single surgeon (DJH) between 2020 and 2023. We evaluated the age at which vasectomy was performed, age at vasectomy reversal, reasons for seeking VR surgical care, number of children fathered before the vasectomy, and the age of the current partner.

Results

During the specified period, 106 patients underwent vasectomy reversal, and 102 of them had their medical records available for evaluation. The average age at the time of vasectomy was 31.3 years, while the average age at vasectomy reversal was 40.2 years. The average age of the partners they were with at the time of seeking care was 34.8 years. Before undergoing vasectomy, the subjects had fathered an average of 2.7 children. Among the patients, 73% (76) cited having a new partner after divorce as the primary motivation for seeking vasectomy reversal. Within this group, 57 mentioned remarriage, 3 were newly engaged, and 15 were in a new relationship. One individual mentioned seeking VR after their spouse's passing to explore the possibility of fertility with a potential future partner. Additionally, 20.6% (21) of the subjects sought vasectomy reversal to have more children with the same spouse as before vasectomy. Among them, 2 men mentioned an improvement in their financial status, and 2 cited an improvement in their wife's health condition as reasons for seeking VR. Two patients opted for vasectomy reversal due to non-fertility reasons, such as scrotal pain that affected their quality of life, and one patient cited religious beliefs as their motivation.

Conclusions

The primary driver for seeking VR surgical care among these men was the desire for fertility with a new partner, often after divorce. However, approximately 20% of the men cited the wish to have more children with the same partner as their motivation. Non-fertility reasons, such as religious beliefs and scrotal pain after vasectomy, were also observed as motivations for seeking VR, albeit less frequently.

Disclosure

No.
(348) Gender-Affirming Bilateral Orchiectomy Prior to Vaginoplasty versus with Vaginoplasty: A Comparison of Preoperative Goals and Postoperative Satisfaction
Authors: Stelmar J , Zaliznyak M , Mallavarapu S , Sandhu S , Smith S , Garcia M
Published: February 2024

Introduction

Gender-affirming bilateral orchiectomy (GA-BO), defined here as either a standalone procedure and/or precursor to vaginoplasty, is associated with a decrease in dosage of gender-affirming hormone therapy (GAHT). In comparison to bilateral orchiectomy at time of gender-affirming vaginoplasty (GA-V), GA-BO is associated with shorter waitlist times, procedure duration, and outpatient recovery. While objective benefits of GA-BO have been described, there is limited qualitative data that assesses the preoperative goals and postoperative satisfaction of patients who elect GA-BO. We aim to assess the decision-guiding factors that led patients to select GA-BO, and to compare measures of patient satisfaction between GA-BO and GA-V patients.

Objective

We aim to assess the decision-guiding factors that led patients to select GA-BO, and to compare measures of patient satisfaction between GA-BO and GA-V patients.

Methods

A retrospective chart review identified 170 patients who underwent GA-BO (n=106; 64%) or GA-V (n=64; 36%) at our institution between 4/2017 and 12/2020. Patients were emailed a link to an anonymous, online questionnaire (QualtricsTM).

Results

The questionnaire was completed by 136/170 (80%) patients: 86/136 (63%) respondents were GA-BO patients and 50/136 GA-V (37%). 78/86 (91%) of GA-BO respondents had either subsequently undergone vaginoplasty, or, planned to do so in the future. For patients who later underwent vaginoplasty, the mean reported time interval between GA-BO and vaginoplasty was 15 months [Range: 1-34 months]. Respondents prioritized the following expectations in their decision to undergo GA-BO: potential to decrease GAHT medications and dosages (reported as important by 67%), low rates of complications (56.5%), short recovery time (51.6%), and low postoperative pain (46.2%). GA-BO and GA-V patients reported high postoperative improvement in various indices of gender dysphoria and body image, with only 1/4 indices of gender dysphoria differing significantly between the two groups (Figure 1). Unsurprisingly, GA-V patients reported a significantly greater improvement in 3/3 body image indices.

Conclusions

GA-BO is a low-risk procedure that provides a more immediate option to decrease gender dysphoria and improve QOL. All patients who were assigned male at birth and are interested in genital gender-affirming surgery should be made aware of the advantages of GA-BO and offered GA-BO alongside GA-V.

Disclosure

No.
(360) National Trends in Male Artificial Urinary Sphincters: 2016-2019
Authors: Han D , Marte J , Lee J , Joice G
Published: February 2024

Introduction

The artificial urinary sphincter (AUS) remains the gold standard for male stress urinary incontinence. However, current understanding of which patient- and facility-level characteristics that are associated with inpatient versus (vs.) outpatient AUS procedures is limited on a national scale.

Objective

We therefore sought to evaluate contemporary national trends of AUS procedures.

Methods

We performed a retrospective review of male AUS procedures using the National Inpatient Sample and the Nationwide Ambulatory Surgery Sample – the largest publicly available all-payer inpatient and ambulatory healthcare databases in the United States – from 2016 to 2019. AUS insertion, repair, replacement, and removal were identified by Current Procedural Terminology and International Classification of Diseases (10th Revision) Procedure Coding System codes. Our unit of analysis was inpatient or outpatient encounters, and we performed stratified cluster sampling to create weighted national estimates. The primary outcome was the proportion of AUS procedures performed in the inpatient and outpatient settings over time. We performed multivariable logistic regression to evaluate factors associated with an inpatient encounter.

Results

There were 21,916 weighted AUS procedures analyzed from 2016 to 2019 (6% inpatient vs. 94% outpatient). There was a 15% increase in total number of annual surgeries (n=5066 to n=5843), and the proportion performed outpatient increased from 92% to 95% over the study period [Figure]. Mean total charge for inpatient AUS surgery was $92,045 vs. $72,887 for outpatient (p<0.05). Inpatient AUS surgery was associated with greater Elixhauser Comorbidity Index, non-private insurance, and Western hospital region (vs. Northeast) (p<0.05) [Table]. Predictors of outpatient AUS procedures included older age, 3rd quartile of median income by Zip Code (vs. 1st quartile), and Midwest/Southern hospital region (vs. Northeast) (p<0.05).

Conclusions

With an increasing rate of AUS procedures in the United States, the majority of these procedures continue to be performed on an outpatient basis. Outpatient procedures have lower hospital charges compared to inpatient encounters, and outpatient AUS is associated with private insurance in older patients with fewer comorbidities. Hospital geographic region appears to affect encounter type, and further work may elucidate how these factors affect patient outcomes nationally.

Disclosure

No.
(391) A Comparative Meta-analysis of Revision Strategies for Malfunctioning Inflatable Penile Prosthesis: Partial Vs Complete Component Replacement With or Without Retained Reservoir
Authors: El-Achkar A , Khalafalla K , Nguyen T , Mahdi M , Wang R
Published: February 2024

Introduction

In cases of non-infected malfunctioning Inflatable penile prosthesis (IPP) device, surgeon often opt to exchange all the device rather than the defective component for fear of increased infection rate and future mechanical dysfunction.

Objective

To assess whether partial component exchange of IPP device has comparable outcomes to complete explant and replacement of IPP device with or without retained reservoir.

Methods

A meta-analysis was completed in line with PRISMA 2020 and AMSTAR guidelines. A comprehensive search was done on MEDLINE (OVID), PubMed, and Cochrane Library electronic databases from their inceptions until May 2023, identifying studies that reported on outcomes and complications of revision surgery for non-infected malfunctioning IPP device. Three groups were compared: the first group underwent a single or two-component exchange, the second group had a complete explant replacement of the entire device, and the third group had replacement of all components with a 'drained and retained' primary reservoir.

Results

A total of 9 articles were included in the analysis. 12,152 patients had complete replacement of their device, 128 had partial exchange of their device and 151 patients had “drained and retained” reservoir following revision. The mean age was similar among the 3 groups between 62-68 years. The median follow up time ranged between 12 and 79 months. Partial component exchange had a higher rates of mechanical failure 10.3% versus 1.3% and 2.3 % (p=0.03) for complete and “drain and retain” groups respectively. (Figure 1) Similarly, partial component exchange had higher perioperative complications at 21.2% compared to complete replacement group 9.5% and “drain and retain” group 14.5% (p=0.022). However, the infection rate was similar among the three groups, 7.7%, 2.7% and 3.3% respectively (p= 0.301). (Figure 2)

Conclusions

Partial component exchange during IPP revision has higher rates of perioperative complication and future mechanical failure but has similar rate of infection compared to complete component replacement with or without “drain and retain” of original reservoir.

Disclosure

No.
Dark matter measurements combining stellar and H i kinematics: 30 per cent 1σ outliers with low dark matter content at 5Re
Authors: Yang Meng , Zhu Ling , Lei Yu , Boardman Nicholas , Weijmans Anne-Marie , Morganti Raffaella , Oosterloo Tom , Duc Pierre-Alain
Published: February 2024

We construct the Schwarzschild dynamical models for 11 early-type galaxies with the SAURON and Mitchell stellar IFUs out to 2–4Re, and construct dynamical models with combined stellar and H i kinematics for a subsample of four galaxies with H i velocity fields out to 10Re obtained from the Westerbork Synthesis Radio Telescope, thus robustly obtaining the dark matter content out to large radii for these galaxies. Adopting a generalized-NFW dark matter profile, we measure an NFW-like density cusp in the dark matter inner slopes for all sample galaxies, with a mean value of 1.00 ± 0.04 (rms scatter 0.15). The mean dark matter fraction for the sample is 0.2 within 1Re, and increases to 0.4 at 2Re, and 0.6 at 5Re. The dark matter fractions within 1Re of these galaxies are systematically lower than the predictions of both the TNG-100 and EAGLE simulations. For the dark matter fractions within 2Re and 5Re, 40 and 70 per cent galaxies are 1σ consistent with either the TNG-100 or the EAGLE predictions, while the remaining 60 and 30 per cent galaxies lie below the 1σ region. Combined with 36 galaxies with dark matter fractions measured out to 5Re in the literature, about 10 per cent of these 47 galaxies lie below the 3σ region of the TNG-100 or EAGLE predictions.
An optimal ALMA image of the Hubble Ultra Deep Field in the era of JWST: obscured star formation and the cosmic far-infrared background
Authors: Hill Ryley , Scott Douglas , McLeod Derek J , McLure Ross J , Chapman Scott C , Dunlop James S
Published: February 2024

We combine archival ALMA data targeting the Hubble Ultra Deep Field (HUDF) to produce the deepest currently attainable 1-mm maps of this key region. Our deepest map covers 4.2 arcmin2, with a beamsize of 1.49 arcsec $\, {\times }\, 1.07\,$ arcsec at an effective frequency of 243 GHz (1.23 mm). It reaches an rms of 4.6 μJy beam$^{-1}$, with 1.5 arcmin2 below 9.0 μJy beam−1, an improvement of ${\gt }\,$5 per cent (and up to 50 per cent in some regions) over the best previous map. We also make a wider, shallower map, covering 25.4 arcmin2. We detect 45 galaxies in the deep map down to 3.6$\sigma$, 10 more than previously detected, and 39 of these galaxies have JWST counterparts. A stacking analysis on the positions of ALMA-undetected JWST galaxies yields 10 per cent more signal compared to previous stacking analyses, and we find that detected sources plus stacking contribute (10.0 ${\pm }$ 0.5) Jy deg−2 to the cosmic infrared background (CIB) at 1.23 mm. Although this is short of the (uncertain) background level of about 20 Jy deg−2, we show that our measurement is consistent with the background if the HUDF is a mild (${\sim }\, 2\sigma$) negative CIB fluctuation, and that the contribution from faint undetected objects is small and converging. This suggests that JWST has detected essentially all of the galaxies that contribute to the CIB, as anticipated from the strong correlation between galaxy stellar mass and obscured star formation.
Discovery and timing of pulsar J2016+3711 in supernova remnant CTB 87 with FAST
Authors: Liu Qian-Cheng , Zhong Wen-Juan , Chen Yang , Wang Pei , Zhou Ping , Yue You-Ling , Li Di
Published: February 2024

We report on our discovery of the radio pulsar, PSR J2016+3711, in supernova remnant (SNR) CTB 87, with a ∼10.8σ significance of pulses, which confirms the compact nature of the X-ray point source in CTB 87. It is the first pulsar discovered in SNRs using Five-hundred-meter Aperture Spherical radio Telescope (FAST). Its integrated radio pulse profile can be well described by a single component, with a width at 50 per cent of the peak flux density of about 28.1○ and an effective width of about 32.2○. The mean flux density at 1.25 GHz is estimated to be about 15.5 $\mu$Jy. Combined with the non-detection of the radio pulse at lower frequencies, the radio spectral index of the pulsar is constrained to be ≲2.3. We also present the timing solution based on 28 follow-up FAST observations. Our results reveal a period of 50.81 ms, period derivative of 7.2 × 10−14 s s−1, and dispersion measure of 428 pc cm−3. The strength of the equatorial surface magnetic dipole magnetic field is inferred to be about 1.9 × 1012 G. Using the ephemeris obtained from the radio observations, we searched Fermi-LAT data for gamma-ray pulsations but detected no pulsed signal. We also searched for radio pulses with FAST towards the X-ray counterpart of the gamma-ray binary HESS J1832−093 proximate to SNR G22.7−00.2 but found no signal.
From total destruction to complete survival: dust processing at different evolutionary stages in the supernova remnant Cassiopeia A
Authors: Kirchschlager Florian , Sartorio Nina S , De Looze Ilse , Barlow M J , Schmidt Franziska D , Priestley Felix D
Published: February 2024

The expanding ejecta of supernova remnants (SNRs) are believed to form dust in dense clumps of gas. Before the dust can be expelled into the interstellar medium and contribute to the interstellar dust budget, it has to survive the reverse shock that is generated through the interaction of the preceding supernova blast wave with the surrounding medium. The conditions under which the reverse shock hits the clumps change with remnant age and define the dust survival rate. To study the dust destruction in the SNR Cassiopeia A, we conduct magnetohydrodynamical simulations of the evolution of a supernova blast wave and of the reverse shock. In a second step, we use these evolving conditions to model clumps that are disrupted by the reverse shock at different remnant ages. Finally, we compute the amount of dust that is destroyed by the impact of the reverse shock. We find that most of the dust in the SNR is hit by the reverse shock within the first  350 yr after the SN explosion. While the dust destruction in the first  200 yr is almost complete, we expect greater dust survival rates at later times and almost total survival for clumps that are first impacted at ages beyond 1000 yr. Integrated over the entire evolution of the SNR, the dust mass shows the lowest survival fraction (17 per cent) for the smallest grains (1 nm) and the highest survival fraction (28 per cent) for the largest grains (1000 nm).