bluuebunny/crossref_metadata_2025 huggingface dataset:
(126) Long-term Functional Outcomes for Men with Priapism Secondary to Recreational Use of Intracavernosal Injectables: A Multi-center Follo- up Study
Authors: Masterson J M , Li K D , Diaz P , Gurayah A A , Zizzo J , Breyer B N , Ramasamy R , Kim H H , Anger J T
Published: May 2023

Introduction

Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. There is a dearth of studies evaluating long term erectile function after episodes or treatment for priapism.

Objective

We evaluated the functional outcomes of a larger, multi-institutional population of men with priapism due to recreational use of ICIs.

Methods

Men who presented with ischemic priapism due to recreational use of ICIs to Cedars-Sinai Medical Center (Los Angeles, CA), University of California at San Francisco (San Francisco, CA), and Jackson Memorial Hospital (Miami, FL) from January 2010 to December 2018 were contacted via telephone. All participants completed the five-item international index of erectile function (IIEF-5).

Results

A total of 19 men aged 24 – 59 (mean 47.9) were recruited from the 3 sites. Mean follow up was 77.2 months (+/− 27.6). 17 men (89%) were white; the one man was Asian (5.5%) and one man was Hispanic (5.5%). Seven men (37%) had been diagnosed with ED prior to their priapism episode however none of the men had a prescription for ICIs. Four men (21%) required no intervention at all, eleven men (58%) required phenylephrine irrigation alone, four men (21%) required distal shunting. No men required proximal shunting. None of the men had no ED, 31.6% had mild ED, 36.8% had mild-moderate ED, 26.3% had moderate ED, and 5.3% had severe ED. Mean IIEF-5 for the population was 13.4 (+/− 3.9). Strengths of our study included the large population size give the relative rarity of this condition as well as the geographic diversity of our population. Limitations include our low overall recruitment rate and lack of objective measures of erectile function prior to priapism.

Conclusions

Men who suffer ischemic priapism secondary to recreational use of ICIs appear to retain some erectile function following their priapism episode. Nevertheless, 100% report some level of ED. This is likely due a combination of adequate erectile function at baseline and expeditious treatment of priapism in a minimally invasive manner.

Disclosure

No
(128) Complication Rates in Patients Using Intracavernosal Injection Therapy for Erectile Dysfunction With or Without Concurrent Anticoagulant Use—A Single-Center, Retrospective Pilot Study
Authors: Blum K , Mehr J , Green T , Conroy L , Marino V , Kim D , Murphy K P , Murphy L , Panuganti S , Wang R
Published: May 2023

Introduction

Intracavernosal injection therapy (ICI) is an effective intervention used to treat erectile dysfunction (ED). It has been proposed that caution should be exercised when prescribing ICI to patients currently taking anticoagulants (AC) due to the theoretical increased risk of bleeding, however, there is limited literature describing complication rates of actively anticoagulated patients utilizing ICI.

Objective

We sought to determine whether there was a difference in bleeding and other complications in a cohort of patients using ICI therapy with or without concurrent AC use.

Methods

We reviewed our institutional electronic health record and identified 168 patients who were seen in our clinic from January to August 2020 who had either currently or previously utilized ICI therapy for ED treatment. These patients were surveyed regarding their ICI therapy as well as given the Erectile Dysfunction Inventory for Treatment Satisfaction (EDITS) questionnaire. Data from 85 patients was obtained; 43 concurrently using AC during ICI therapy and 42 with no AC use. Documented bleeding events (e.g. bruising, hematoma), complications, and mean EDITS scores were compared between the two groups. Fisher’s exact test for categorical variables and a two-tailed t-test were used with p<0.05 considered to be significant.

Results

There were more absolute bleeding complications in the AC group versus the no AC group, with 3/43 AC patients (7%, 95% CI: 2.4-18.6) and 0/42 no AC patients (0%, 95% CI: 0-8.4) experiencing some type of bleeding complication on ICI. However, there was no statistically significant difference found in overall or stratified documented bleeding events and complications between the two groups.

Conclusions

Findings from a single-center cohort of patients suggest that ICI therapy may be a safe and effective treatment modality for ED in patients with concurrent anticoagulant usage, however, given the higher rate of absolute bleeding events in our AC cohort, future assessment in a higher-powered study is warranted in determining a more accurate estimation of risk or propensity for bleeding complications in patients on AC using ICI therapy.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Run Wang, MD, FACS is a consultant for Boston Scientific and Teleflex.
(142) Proposed Algorithm for Decision Making During Microdissection Testicular Sperm Extraction (m-TESE) in Men with Non-Obstructive Azoospermia (NOA)
Authors: Naber E , Mecca D , Hawksworth D
Published: May 2023

Introduction

Microdissection testicular sperm extraction (m-TESE) is currently proven to yield the highest sperm retrieval rates in men with non-obstructive azoospermia (NOA). Although considered a low-risk procedure in experienced hands, performance of bilateral m-TESE may result in increased complication rate. Several studies examine preoperative factors as candidates for surgical counseling and prediction of m-TESE success, with most suggesting their combination.

Objective

We propose an intra-operative algorithm which may aid with patient counseling and ultimately prediction of success, while minimizing the surgical risks.

Methods

Consecutive records of patients with NOA who underwent m-TESE at our institution between August 2019 and June 2022 were queried retrospectively. Patient demographics, pre-operative workup, intra-operative maneuvers and post-operative follow-up data were analyzed with use of standard statistics.

Results

Records of seventeen men were identified. Average patient age was 38 years (range: 29-46yo). Eight men had prior testis biopsy results available and two others had prior m-TESE performed. Seven men underwent a bilateral m-TESE. Sperm was successfully identified in ten men (58.8%). Eight of these men (80%) underwent a unilateral m-TESE. Men with the successful m-TESE had an average pre-operative FSH level of 10.1 IU/ml (5.4-21.6 IU/ml) and Inhibin B (INHB) level of 90.2 pg/ml (23.3-186.5 pg/ml). The remaining seven men had no sperm identified (41.2%). Two of these men had prior testicular interventions (testis biopsy with SCO, prior unsuccessful m-TESE) and thus underwent a unilateral (28. 6%), while the remaining five underwent a bilateral m-TESE (71.4%). Their FSH and INHB were 16.9 IU/ml (3.6-26.6 IU/ml) and 56.5 pg/ml (6.9-209.5 pg/ml), respectively. A cut-off value of 30pg/ml of INHB and presence of SCO on prior testis biopsy results were used to develop an intra-operative algorithm (Figure 1).

Conclusions

This study proposes a straightforward decision-making process for men with NOA undergoing m-TESE. Systematic use of few predictive factors may improve patient preoperative counseling, decrease surgical times and complication risk. Additional work is necessary to fully examine the validity and applicability of the proposed algorithm.

Disclosure

No
(145) Is LIM-15 an Important Marker in Patients Who Performed Second Micro–testicular Sperm Extraction after Failed First Micro–testicular Sperm Extraction in Men with Nonobstructive Azoospermia?
Authors: Ibis M A , Unal S , Baltaci V , Aydos K , Yaman O
Published: May 2023

Introduction

LIM15, also known as DNA meiotic recombinase 1 (DMC1), is a meiosis-specific recombinase. LIM15 is specifically expressed as a meiotic recombination protein in spermatogenesis.

Objective

Does the LIM15 gene expression value measured in the ejaculate predict the success of the second micro–testicular sperm extraction (mTESE) after the failed first mTESE?

Methods

Data from 111 men who failed the first mTESE and underwent the second mTESE between August 2018 and March 2022 were prospectively collected. LIM15 gene expression level was determined by real-time PCR in the materials from the ejaculate.

Results

Sperm was recovered successfully in 23 out of 111 (20.7%) men with second mTESE. The mean age of men for whom sperm could not be retrieved and men with successful sperm recovery were 34.6 ± 3.5 and 33.7 ± 5.2, respectively. The mean patient age, serum total testosterone and FSH levels, and testicular volume did not show any statistical difference between men with successful sperm recovery and men with failed sperm recovery (Table 1). According to the testicular histology, the sertoli cell-only, maturation arrest, and hypospermatogenesis in men with successful sperm recovery were 26.1%, 65.2%, and 8.7%, and in men for whom sperm could not be retrieved were 0%, 27.3%, and 72.7%. Comparing the groups in terms of testicular histology demonstrated meaningful correlation between sperm retrieval rate (SRR) and testis histology (p<0.001). The LIM15 gene expression level measured in ejaculate significantly correlated with the SRR in mTESE (p = 0.039). As shown in Figure 1, the maximal sensitivity (50%) and specificity (87%) were obtained for the LIM15 gene with a cutoff point of 4.61 and AUC of 0.65.

Conclusions

According to our results, LIM15 measured in the ejaculate before the second mTESE can provide information on sperm retrieval and reduce the potential complications and unnecessary costs associated with assisted reproductive techniques.

Disclosure

No
(192) The Perceptibility Difference between Glans Penis and Penile Shaft in Primary Premature Ejaculation
Authors: Jiang T , Wei L , Zheng L , Jiang H , Tang Q , Wang K , Liu W
Published: May 2023

Introduction

The penis is a vital perceptor that transmits perceived signals to ejaculation-related centers. The penis consists of the glans and the shaft, and histology and innervation differ considerably. Does this difference affect their perceptibility?

Objective

This paper aims to investigate whether perceived signals are different using the glans penis or penile shaft as the perceptor zone and whether hypersensitivity of the penis is the whole or the part.

Methods

Through somatosensory evoked potentials, thresholds, latencies, and amplitudes were recorded in 290 cases of primary premature ejaculation, using the penis and penile shaft as the perceptor areas, respectively.

Results

(1) Thresholds, latency, and amplitude of the glans penis and penile shaft in patients were significant differences (P< 0.05) (2) The latency of the glans penis or penile shaft was shorter than average (hypersensitivity) in 141 cases (48.62%), of which 50 cases (35.5%) were sensitive to both the glans and shaft of the penis, 14 cases (9.93%) were sensitive to the glans only and 77 cases (54.6%) were sensitive to the shaft only. (P <0.05)

Conclusions

There are differences in the signals perceived with the glans penis and the penile shaft as the perceptive zone. Penile hypersensitivity does not necessarily mean that the whole penis is hypersensitive. We classify the penile hypersensitivity into three categories: the glans, the shaft, or the whole penile hypersensitivity, and we put forward the new penis high sensitivity zone concept.

Disclosure

No
(220) Penile Enhancement Supplements: The Only Thing Getting Bigger is Demand & False Hope
Authors: Roshandel R , Koo K , Kohler T S
Published: May 2023

Introduction

Penile dysmorphophobia is common, with up to 20% of men reporting dissatisfaction with their genital size. The global market for Sexual Enhancement Supplements is estimated at $300 Million in the year 2020 and is projected to reach $608 Million by 2027 in the US alone. Evidence for efficacy is minimal, and purported claims are hyperbolic.

Objective

We sought to assess penile elongation internet offerings, quantify cost, ingredients, and risk and investigate scientific literature of product ingredients when available.

Methods

Three online marketplaces (Amazon, Google market, and Walmart) were queried for dietary supplements available without a prescription to improve penile size. Product labels were reviewed to compile penile size-related claims and active ingredients. The one-course (60-day) cost of treatment and consumer star rating were assessed. MEDLINE, Web of Science, and Google Scholar were queried with labeled ingredients to assess the scientific evidence from published and lay sources.

Results

A total of 84 dietary supplements claimed either increased penile length, girth, enhanced sexual performance, or a combination thereof. Of these 84 products, 90 ingredients were listed. The Mean 60-day cost was $52 (range of $12–$222). The median score by consumers in the markets with a possibility of star rating was 3.5 (range 2.4-4.2) with obvious repetitive and self-promotional tactics. Unsurprisingly, no scientific evidence supporting change in penile size was found for any products in our search. Actual described physiologic activity from active ingredients included were described as antidepressant, lipid and glucose lowering/metabolizing, blood pressure effecting, anti-inflammatory, renally protective, cognitive function effecting, antioxidant, and several ingredients weakly enhancing erectile activity. Renal failure, warnings against long-term use, heart problems, neuropathy, blood pressure effects, fertility toxicity, bleeding, liver disease, and numerous interactions with diabetes, blood thinning, immunosuppressant, and PDE5 medications were found for the ingredients.

Conclusions

Dietary supplements claiming to enhance penile size contained ingredients with conflicting or no scientific evidence to support their claims. Several ingredients were dangerous. Clinician awareness of these sham “solutions” and their continued mass consumption highlight the magnitude of misinformation, unrealistic expectations, shame, and enhancement desperation regarding penile size in the male public psyche.

Disclosure

No
(264) Reasons of Discontinuation from Collagenase Clostridium histolyticum treatments in Peyronie’s Disease
Authors: Atuluru P , Masterson T
Published: May 2023

Introduction

Peyronie’s disease is an acquired fibrotic condition that impacts quality of life and sexual function. Intralesional Collagenase Clostridium histolyticum (CCH) is the only FDA approved medication to correct curvature. The treatment consists of 8 injections over 26 weeks and previous studies indicate that greater improvement is associated with a greater number of injections; however, reasons for early discontinuation are not well studied.

Objective

We aimed to understand the reasons for early discontinuation of CCH treatment in a major academic system.

Methods

We retrospectively reviewed charts of PD patients from October 2018 to October 2020 who underwent CCH treatment. Complete treatment consists of four cycles of two injections, each separated by approximately 5-6 weeks, for a total of 8 injections. Treatment completion was defined as receiving 8 injections or stopping because curvature decreased to <15 degrees. Patients who did not complete 8 injections were contacted and surveyed about reasons for discontinuation. Data was gathered and analyzed on Microsoft Excel.

Results

A total of 73 patients elected for CCH. Only 43 (58.9%) completed all 8 injections and another 5 (6.8%) stopped due to treatment satisfaction, for a total of 48 (66%) reaching endpoint. There was no significant difference in age, duration of symptoms or Peyronie’s Disease Questionnaire scores between patients who completed treatment and those who didn’t (Table 1). Similar number of patients dropped out in the first half and second half of treatment. Out of the 30 (41.1%) of patients who discontinued therapy before 8 injections, 4 (13.3%) wanted to try another treatment, 6 (20%) experienced side effects, 3 (10%) had insurance issues, 5 (16.7%) was satisfied after a few injections, 4 (13.3%) was disappointed in treatment and 8 (26.7%) were unable to be contacted to return to the hospital (Table 2).

Conclusions

We found that shifts in financial/insurance status and onset of adverse events, such as an autoimmune flair, were predictive of dropouts in our cohort. Most of the patients who wanted to attempt another treatment did so with the same surgeon but wanted a faster solution. Further, in our cohort, difficulty contacting patients was the biggest reason of discontinuation; this is likely skewed due to the COVID19 pandemic as patients relocated or underwent fewer elective treatments and procedures. To reduce CCH discontinuation, we propose that counseling should focus on potential adverse events, speed of change and financial assistance.

Disclosure

No
(265) Socioeconomic Factors Affecting Patient Engagement with Sensitive Urologic Social Media Content
Authors: Leelani N , Bole R , Lundy S D , Bajic P , Hyatt D
Published: May 2023

Introduction

As the use of social media becomes more prevalent within healthcare practices, it is important to understand how patients may engage with social media posts by their physicians. The conditions addressed within the field of urology are often particularly sensitive in nature, particularly within the realm of sexual medicine. Therefore, patients might be less likely to engage with social media posts from their urologists based on their own comfort levels and privacy concerns. A previous study evaluating this interaction determined the likelihood to engage varied based on age and gender. However, social media engagement patterns in sensitive topics based on socioeconomic background have not been previously evaluated.

Objective

This study aims to determine the likelihood of patients in a community urology practice to engage with sensitive social media posts by their urologist according to socioeconomic factors. The likelihood to engage actively (defined as commenting or sharing) versus passively (defined as liking a post) on two different topics within the scope of urology was determined. The two topics used were erectile dysfunction (ED)/urinary incontinence and kidney stone prevention.

Methods

Participants completed a survey that included basic demographic questions as well as questions determining their potential likelihood to engage on the different topics using a visual analog 5-point Likert scale. Responses on the Likert scale were given a value of one (very unlikely) to five (very likely), and a two-tailed Mann-Whitney U test with an α of 0.05 was used to determine the significance of differences in responses. For analysis of the Likert scale responses, only those respondents who had social media accounts were included.

Results

The final sample consisted of 293 responses with a 93.0% response rate. Of respondents, 65.7% had a social media account. Of those respondents that had a social media account, 50.5% had an annual income under $50,000. There was no significant difference in the likelihood to follow their urologist on social media for those with an annual income under $50,000 in comparison to those over $50,000. When looking at the overall likelihood of engagement, those with an annual income of less than $50,000 were more likely to actively engage compared to those making over $50,000 (p-value = 0.02. When stratifying by topic, those making less than $50,000 were more likely to actively engage on the topic of ED/urinary incontinence than those making more than $50,000 (p-value = 0.02).

Conclusions

Patient education via social media is an effective tool for urology practices to engage with patients. Engagement with this content is greater among lower-income patients. Further investigation is needed to determine whether increased engagement with online content translates to improved health outcomes.

Disclosure

No
(274) Sexual Behaviors and Social Barriers to Access Public Health of Brazilian Transgender Men
Authors: Leônidas G , Carneiro G , Peixoto R , Britto D , Neto J , Frota I
Published: May 2023

Introduction

There is a need of information about transgender individuals and their health needs. This work has as object of study sexual behaviors and social barriers to access health of transgender men. There is a need for information about transgender men and their health needs. Globally, transgender people face discrimination and social exclusion. Available data indicate numerous healthcare inequities between trans and cisgender (non-trans) people.

Objective

The aim of this study was to evaluate transgender men at a public university hospital linked to brazilian´s public healthcare, analyzing sexual practices and barriers to access affirmative care.

Methods

The medical records of seventeen patients (range 18-42 of age) followed between 2016 and 2018, were used to collect data retrospectively and descriptively with quantitative and qualitative approach. Through a structured interview, there was a focus on data concerning difficulties to reach healthcare and medical inequities.

Results

It was noticed that transgender men face social barriers to health access, such as insistent non-respect of the use of the social name, the lack of knowledge of health demands by health professionals and the barriers imposed by family and/or spouse. The sexual practices performed by these men, who proved to be widely diverse and changing, are mostly penetrative (70,58%), and such practices may be passive and / or active. It was also observed variable sexual orientation among the patients, although most of them (88,23%) maintain a relationship with a cisgender woman. Gynecological follow-up was also the subject of discussion in this study, and despite the fact that 23,52% of patients had gynecological complaints, 29,41% had never done a gynecological consultation, being the resistance to do gynecological exams very commun. Only 28,57% of the patients had not yet started hormone therapy, and they declared that they would like to start this process. The majority of transgender men have also the need of body change.

Conclusions

Therefore, it is necessary to develop strategies in public and universal health that are effective to provide transgender men with their need to body change or hormone therapy, as well as to guide them to the gynecological examination. Additionally, health care providers need to guarantee proper and free of prejudice assistance.

Disclosure

No
(275) Health Care Disparities in the Transgender Population
Authors: Parikh N , Gargollo P , Granberg C
Published: May 2023

Introduction

The transgender population has largely been marginalized by society, causing inequities in health care delivery. The dearth of provider knowledge on transgender health issues further exacerbates these disparities.

Objective

A survey of the transgender population was conducted to help call attention to the often-overlooked aspect of care: fertility preservation prior to hormone therapy or gender affirmation surgery.

Methods

A survey of 65 transgender individuals was conducted, with participants recruited through Reddit transgender groups and local transgender associations, to assess their knowledge regarding fertility preservation and their experience with healthcare providers. Results were compiled and analysis was performed.

Results

Out of the 65 individuals who responded to the survey, approximately 88% were between the ages of 18 and 39. Seventy-four percent were assigned male gender at birth and 26% female. Sixty-two percent of individuals identified as female, 20% as male, and 18% as gender non-conforming. Only 35% of individuals had ever been cared for in a multidisciplinary transgender clinic. Interestingly, while 100% of surveyed individuals were aware that fertility would be irreversibly lost after hormonal or surgical affirmation surgery and 43% believed this to be an important issue, only 46% had any health care providers discuss fertility preservation options with them.

Conclusions

Hormonal therapy and gender affirming procedures affect the long-term reproductive potential of transgender individuals. While oncofertility is a prominent area of discussion, transgender care is still lagging. With an increase in medical and surgical therapy in younger individuals, health care providers must discuss fertility preservation options prior to affirmation therapy.

Disclosure

No
(276) Sexual Health of Transfeminine Individuals: A Chance to Educate Medical Providers
Authors: Denisenko A , Bulafka J , Spigner S , Swaminathan V , Stauffer P , Shumaker A , Frasso R , Chung P H
Published: May 2023

Introduction

Providers may be unfamiliar with the sexual health needs of transgender patients. This hinders chances to provide comprehensive care, as many patients require prompting to discuss sensitive sexual issues. To increase awareness of these issues, we developed a questionnaire which assessed the sexual health of transfeminine individuals.

Objective

We sought to describe the sexual experiences and preferences of transfeminine individuals, and to categorize sexual health needs in this population.

Methods

IRB approval was obtained to develop (with transgender community feedback) a questionnaire assessing urinary and sexual health. Sexual preferences, symptoms, and quality of life (QOL) responses were compared among vaginoplasty (VP) and non-vaginoplasty (NVP) groups. NVP respondents were evaluated based on the International Index of Erectile Function (IIEF) categories: erectile function (EF), orgasmic function (OF), and sexual desire (SD).

Results

53 transfeminine individuals (11 vaginoplasty, 10 orchiectomy, 32 no procedure) with mean age of 40 years (range 21-80) participated. Sexual QOL was similar for both groups (Table 1). There was an association between self-reported sexual activity and VP/NVP status, where a higher proportion of NVP respondents reported sexual activity with others and penetrative anal sex (p<0.05). Among NVP respondents, 38 (90.4%) of whom were undergoing hormone therapy, 23 (55%) indicated penile function was important to them. NVP IIEF EF, OF, and SD categories mean scores were 13.3, 5.8, and 5.6, respectively, compared to 25.8, 9.8, and 7.0 from the cis-gender controls in the initial IIEF study. 5 (11.9%) individuals used oral medications for erectile assistance, while 1 (2.3%) had a prosthesis.

Conclusions

When comparing VP and NVP respondents, we found similarities in sexual QOL while noticing differences in sexual preference, highlighting the diversity of this population. While many NVP respondents reported importance of penile function and presence of erectile dysfunction, only a minority were on treatment. This highlights an opportunity for providers to discuss sexual health with transfeminine patients and offer appropriate treatments.

Disclosure

No
(279) Total Phalloplasty with Latissimus Dorsi Myocutaneous Flap. Our Italian Experience
Authors: Stanojevic N , Ruffo A
Published: May 2023

Introduction

Total phalloplasty (TP) is used for the creation of a penis in female to male sex reassignment surgery (FTM SRS).

Objective

We focused our work on free flap transfer technique using latissimus dorsi myocutaneous flap (MLDF) in order to create a neophallus that allows safe performance of urethroplasty and two cylinders prosthesis implantation.

Methods

Five patient underwent surgery. A necessary precondition for this technique was the normal body mass index. The donor site was prepared preoperatively by skin massage at least one month before surgery to enable easier donor site closure. The first surgical step includes removal of female genitalia (transvaginal hysterectomy, adnexectomy, colpocleisis), proximal urethroplasty, perineoplasty, the formation of external male genitalia (scrotoplasty, free flap transfer phalloplasty), and 1st stage distal urethroplasty. The second stage includes distal tubularizing urethroplasty, glans plasty, and testicular prosthesis implantation. In the third stage implantation of a 2-cylinder penile prosthesis is performed through the infrapubic approach. The time between stages was 6-9 months.

Results

The five pts underwent just the first two stages. Penile length varies from 12-18cm and penile girth from 11-16cm. One partial flap loss occurred. Penile urethral stricture developed in 3 pts; 1 pt developed proximal urethral diverticulum. Donor site healed satisfactorily in three pts, two of them required additional scar correction.

Conclusions

This surgery is a high-risk, complex staged procedure, but with a satisfactory functional and esthetic outcome

Disclosure

No
(291) Long-term Assessment of the Safety and Efficacy of the Mini-Jupette Sling: 5-year Follow-up of the Original Series
Authors: Hammad M A M , Barham D W , Osmonov D , Hatzichristodoulou G , Van Renterghem K , Andrianne R , Park S H , Kohler T S , Hellstrom W J G , Jenkins L , Yafi F A
Published: May 2023

Introduction

Climacturia has been reported in up to 64% of patients following radical prostatectomy (RP). In 2017, a prospective multicenter, multinational, investigational pilot study was conducted examining outcomes using a novel surgical technique, the Mini-Jupette sling, for the management of men with post-RP erectile dysfunction (ED) and climacturia and/or minimal stress urinary incontinence (SUI). We sought to report the 5-year outcomes from this original cohort.

Objective

To assess long-term safety and efficacy of the mini-jupette sling in the treatment of ED and concomitant mild SUI and/or climacturia

Methods

We identified patients who were enrolled in the previous multicenter study with post-RP ED and climacturia and/or mild SUI (2 ppd) and underwent IPP insertion with simultaneous placement of a Mini-Jupette sling. Data including current ppd, improvement in climacturia, complications, need for revision of IPP or additional urinary incontinence surgery, and date of most recent follow-up were collected.

Results

Of the original 38 patients, 5 have since died and 10 were lost to follow-up with 23/38 (61%) patients available for evaluation of long-term outcomes. The average follow-up time was 59 months (SD= 8.8) with a mean age of 69 years (SD= 6.8). Most patients (n=21, 91%) had subjective improvement of SUI and climacturia. One patient with persistent bothersome incontinence underwent artificial urinary sphincter (AUS) placement in 2018 with no complications, while the other is still considering a repeat procedure due to minor but persistent SUI. The mean ppd decreased from 1.4 preoperatively to 0.3 at a mean 5 years of follow-up. Most patients reported satisfaction in their urinary symptoms with 91% and 73% reporting improvement in SUI and climacturia respectively, compared to 86% and 93% respectively in the original series. One (4.3%) patient had an IPP revision for pump malfunction. There were no device infections reported.

Conclusions

The Mini-Jupette sling appears to be a safe and effective procedure with durable improvements in SUI and climacturia at 5 years of follow-up.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus, Intuitive Surgical, Fidalis, Hims & Hers Health Inc
(306) U-shaped Curvilinear Relationship Between the Prevalence of Testosterone Deficiency and Low-density Lipoprotein Cholesterol (LDL) Levels in Nonstatin Users
Authors: Lee J H
Published: May 2023

Introduction

Contradictory data have been reported about the association between testosterone levels and the levels of low-density lipoprotein cholesterol (LDL).

Objective

The aim of this study was to elucidate the association between testosterone and LDL levels.

Methods

A cross-sectional study was conducted that included 7,268 men who had participated in a health examination. Men who took agents that influence serum lipid profiles within the previous 6 months were excluded. A full metabolic work-up and serum testosterone level checks were performed. The main outcome measures included the testosterone level and testosterone deficiency (TD) prevalence of each decile of LDL and their polynomial trendlines and the odds ratio (OR) of TD according to the LDL level.

Results

The polynomial trendline suggests an inverted U-shaped curvilinear relationship between LDL and testosterone levels (figure 1) and a U-shaped curvilinear relationship between LDL levels and the prevalence of TD (figure 2). The adjusted ORs of TD in men in the lowest and highest deciles were significantly higher than those of men in the 10th – 90th deciles of LDL (90th LDL, OR for TD: 1.277, 95% CI: 1.006–1.621), which reinforces the U-shaped curvilinear relationship between LDL levels and the prevalence of TD.

Conclusions

There was a U-shaped curvilinear relationship between LDL levels and the prevalence of TD. Both low LDL and high LDL levels were significantly and independently associated with TD. Care should be taken to screen for TD in men with low LDL levels or high LDL levels. Further study to elucidate the effect of extremely lowering LDL levels on TD is needed.

Disclosure

No
(314) An Evaluation of Race-Based Representation Among Men Participating in Clinical Trials for Prostate Cancer and Erectile Dysfunction
Authors: Saltzman R , Zucker I , Campbell K , Gandhi D , Otiono K , Weber A , Masterson T , Ramasamy R
Published: May 2023

Introduction

Inclusion of ethnic/racial minorities in clinical trials is essential to fully assess therapeutic efficacy. It is well-known that populations respond dissimilarly to interventions. This concept has been research ed thoroughly in the context of urologic oncology research, however research into the impact of demographic characteristics in andrology trials is lacking.

Objective

To analyze the inclusion of historically under-represented minority men in clinical trials for Erectile Dysfunction (ED) in comparison to Prostate Cancer (PC) trials.

Methods

We searched ClinicalTrials.gov for the disease keyword: “Erectile Dysfunction” and used “Prostate Cancer” trials for comparison. Completed trials that had available demographic data were included for analysis. Literature was reviewed to determine the prevalence of ED and PC diagnosed among Hispanic, Black, White, and Asian men. The proportion of individuals of each group that participated in trials is divided by the proportion of each group in the disease population to calculate the “Participation to Prevalence Ratio” (PPR). PPRs between 0.8-1.2 indicates adequate representation, 1.2 is over-representation.

Results

A total of 312 trials were assessed: 289 for prostate cancer and 23 for ED. Hispanic men comprised 11.8% of ED trial participants and 4.61% of prostate cancer trial participants, yet represented 18% of ED patients and 7.3% of PC patients. Black/African-American (AA) men accounted for 10.2% of ED trial participants and 9.4% of PC trial participants, but comprised 16% of ED patients, and 16.3% of PC patients. Hispanic and AA men are under-represented in trials for ED and Prostate Cancer (Hispanic ED PPR=0.66; Hispanic PC PPR=0.63; AA ED PPR=0.42; AA PC PPR=0.58).

Conclusions

Our findings show that both Hispanic and AA men are underrepresented in both ED and PC clinical trials. A greater emphasis must be placed on achieving representative enrollment in clinical trials for ED and PC in order to address this disparity and improve generalizability of the findings.

Disclosure

No
(318) Evaluating the Readability of Online Testosterone Search Results
Authors: Pominville R , Callegari M , Pei E , Sarica E , Prunty M , Jesse E , Loeb A , Abou Ghayda R , Thirumavalavan N
Published: May 2023

Introduction

Patients and physicians are increasingly utilizing online platforms to disseminate health information. With the explosive interest and growth in testosterone therapy (TTh) amongst patients, providers and business interests, online health information plays a significant role in patients' healthcare decisions. Nearly all patients engage some form of online tool, search engine or resource when learning about a condition, treatment and alternatives that may exist. While the availability of information can be helpful, left unchecked it could preclude or even obstruct accurate and timely information dissemination to the very target audience.

Objective

Our study evaluated the source and readability of web-based information available to patients regarding TTh found through online search engine results.

Methods

The first 50 web results from Google search terms “Testosterone Therapy” (TTh) and “Testosterone Replacement” (TR) were analyzed. Sources were categorized as Academic, Commercial, Institutional, or Patient Support before being evaluated using validated readability and English language text assessment tools including the Flesch Reading Ease score, Flesch Kincade, Gunning Fog, Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index and Automated Readability index.

Results

77 unique sources were identified. The average grade level required for understanding academic sources was 16 (college senior); commercial, institutional, and patient support sources were 13 (college freshman); 8 and 5 grade levels, respectively above the average U.S. adult. Patient support sources were most prevalent, while commercial sources were the least at 35% and 14%, respectively. The average reading ease score was 36.8, indicative of difficult-to-read material overall. Academic sources utilized 296% and 228% more words compared to commercial and institutional/patient support sources, respectively.

Conclusions

The most immediate online sources for TTh information grossly exceeds the average reading level and understanding of most adults within the U.S. Within the growing realm of TTh, more attention should be taken to publish accurate, accessible, and readable material in order to improve patient health literacy and empower patients.

Disclosure

No
(331) Whole Exome Sequencing Identifies Rare CFTR Variant in Two Brothers with CBAVD and CUAVD
Authors: Dullea A , Khodamoradi K , Campbell K , Schuppe K , Griswold A , Masterson T , Arora H , Ramasamy R
Published: May 2023

Introduction

Congenital Bilateral Absence of the Vas Deferens (CBAVD) is a condition leading to obstructive azoospermia and male infertility. CBAVD is associated with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Congenital Unilateral Absence of the Vas Deferens (CUAVD), where only one vas deferens is missing, is also associated with mutations in the CFTR gene. However, the genetic causes of both conditions are not fully understood and warrant further investigation. We present two brothers, one with CBAVD and one with CUAVD, who were subjected to whole exome sequencing.

Objective

To assess genetic similarities using whole exome sequencing between two brothers with differing reproductive capacities.

Methods

Whole exome sequencing was performed in two brothers. Subject A was 39-year-old-male who had previously fathered a child and was diagnosed with CUAVD during his vasectomy. Subject B was a 37-year-old male diagnosed with CBAVD, and genetic testing significant for one copy of a mutated cystic fibrosis gene (unaffected CF carrier). Whole blood was collected. DNA was extracted and quality assessed. Finally, whole exome sequencing was completed.

Results

Whole exome sequencing results were subjected to annotation and filtering. Both subjects were noted to share a rare mutation in the CFTR gene (p.R347H). CFTR mutations are the most common cause of CBAVD and have also been linked to CUAVD. However, this is a unique case of two brothers with the same genetic mutation but different phenotypic expressions of the mutation.

Conclusions

We have identified a rare CFTR variant (p.R347H) in two brothers with different reproductive capacities. We present evidence that absence of the vas deferens (unilateral or bilateral) may be associated with CFTR mutations, even in the absence of diagnosed cystic fibrosis. Understanding the phenotypic spectrum of CFTR gene mutations is pivotal to treating associated male infertility.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceuticals, Boston Scientific, Coloplast, Endo Pharmaceuticals, Empower Pharmacy, Nestle Health, Olympus, Hims Inc.
(333) Association Between TNP2 G1272C Polymorphism and Human Male Infertility: A Meta-analysis
Authors: Zulfiqar N , Arshad A , Irfan M , Bibi A
Published: May 2023

Introduction

Infertility is defined as the incapability to achieve fertilization after 1 year following sexual intercourse without any contraceptive measure. Poor sperm quality contributes to 90% of male infertility. Spermatogenesis takes place in the seminiferous tubules of the testis by proliferation followed by complex morphologic, physiologic, and biochemical modifications that result in the formation of mature spermatozoa. These specific events are supported by spermiogenesis-specific gene products. During spermiogenesis, sperm chromatin undergoes a series of modifications in which histones are lost and replaced with transition proteins and subsequently with protamine. Replacement of histones to protamine is impotent in the formation of mature spermatozoa. Histones are important for DNA replication but in spermatogenesis histones replacement with protamine prevents DNA replication and causes sperm maturation. Any problem in this replacement may cause male infertility. The nuclei of elongated and condensing spermatids contain nuclear transition protein 1 (TNP1) and nuclear transition protein 2 (TNP2) but tnp2 is more effective. TNP2 plays a critical role in shaping sperm nucleus, displacement of histones with protamine condensation of chromatin, and binding of protamines to DNA.

Objective

This review aims to determine the association of a TNP2 polymorphism (G1272C) with the risk of male infertility.

Methods

PUBMED, CENTRAL, Google Scholar and PMC articles were searched, whereas case-control, published studies regarding TNP2 polymorphism (G1272C) and male infertility were selected for this meta-analysis.

Results

Based on literature search and inclusion criteria, 3 case-control studies out of the total 16 articles were selected, ranging from 2005 to 2019. The included case-control studies observing G1272C polymorphism in the TNP2 gene contained 534 cases and 516 controls. No significant association (p > 0.05) between G1272 polymorphism and male infertility was found, based on all of the three genetic models. Whereas, when we pooled the data of two population of same region i.e. Iran, significant association (p < 0.05) was found between G1272C polymorphism and male infertility on the basis of additive model (CC vs GG: OR= 0.34, 95% CI [0.20-0.56], I2 = 81%), dominant model (CC+CG vs GG: OR= 0.46, 95% CI [0.32-6.67], I2 = 91%) & recessive model (CC vs CG + GG: OR= 0.48, 95% CI [0.31-0.76], I2 = 85%), showing that this polymorphism might contribute to the male infertility, depending upon the ethnicity.

Conclusions

TNP2 G1272C may play role in male infertility suggested by the significant association in the Iranian population.

Disclosure

No
(336) Penile Rehabilitation Programs after Nerve-sparing Prostatectomy: What are the Expectations of the Partners?
Authors: Bannowsky A , Bannowsky S , Osmonov D , Maerker V , Ueckert S
Published: May 2023

Introduction

Several strategies are published for postoperative erectile function rehabilitation after nerve-sparing radical prostatectomy (nsRP). Expectations of the partners of the patients are rarely subject of most of these rehabilitation studies.

Objective

The aim of our study was to evaluate the expectations of the partners of patients undergoing nerve-sparing radical prostatectomy and penile rehabilitation programs.

Methods

We performed a questionnaire sent to the partners of all enrolled patients of 3 different penile rehabilitation studies after nsRP with a regular dose of different PDE5-inhibitors (sildenafil/vardenafil/tadalafil). 124 patients (mean age 69 years) had been enrolled in the rehabilitation studies and their partners (mean age 66 years) were included in this study. The survey consists of different questions, e.g. if the partners believe in the rehabilitation concept and what they expect with regards to the outcome.

Results

78 partners of the 124 patients (63%) completed and returned the questionnaire. Before rehabilitation treatment 51 partners (65%) believed in the concept of rehabilitation, but only 32 partners (41%) expected partly to fully rehabilitation of erectile function of the partners caused by the initiated penile rehabilitation program. After the end of the study treatment, 2 years after nsRP, 45% of the partners are satisfied by the recovery of erectile function of their partners.

Conclusions

Only 41% of the partners of patients within penile rehabilitation programs expect partly to fully recovery of erectile function after nsRP. Satisfaction rate with erectile function recovery was reported by 45% of the partners 2 years after nsRP.

Disclosure

No
(341) Prevalence of Sexual Disorders in a Sample of Patients Suffering from Breast Cancer
Authors: Elfeqi R
Published: May 2023

Introduction

There is scarce evidence on prevalence of sexual disorders at large and particularly in the region where I work and practice psychiatry and sexology. Not to mention, lack or research and evidence in regard to sexual disorders among females suffering from Breast Cancer.

Objective

Assess the prevalence of females suffering from a sexual disorder in my region is a challenge on its own - checking in the prevalence of females suffering from a sexual disorder while in the course of treatment from Breast Cancer is another challenge since sex could be the last thing they want to talk about – possibly.

Methods

1000 female patients were randomly selected at the outpatient clinic of a national cancer hospital over the course of four consecutive months by initial simple questionnaire inquiring about mood, sleep, appetite, level of energy, relationship with partner, intimacy with partner and frequency of having sex and if there is any problems or pain experienced during sex. Those reported to have any sexual symptoms or complaints were taken to sexual interview using the PLISSIT model. When necessary, the partner was called in for assessment too. To implement the first simple survey - I had to psychosexual educate personnel in Pain clinic - where the survey was distributed beside psychiatry clinic - and recruit 4 psychology students under training to help conducting the survey - so I could reach the 1000 sample within the course of four months. Symptoms of depressive mood, disturbed appetite and disturbed sleep, lack of energy, were associated with sexual disorder.

Results

N 708 patients 70 % reported turbulent marital relationship and distant partners before or after illness. N 738 patients reported suffering from a diagnosable sexual disorder mainly Female Sexual Interest/Arousal Disorder plus or minus vaginal dryness as a sequel of chemotherapy regimen indicated at the time. N 200 patients 20% reported partners to be suffering from a diagnosable sexual disorder mainly erectile disorder and/or sexual disorder due to substance use disorder. While N 292 30% reported good relationship with their caring husbands and flowing sexual life fostered by warm intimacy.

Conclusions

Sexual disorders are widespread and remarkably under diagnosed and overlooked in the treatment of breast cancer while prevalence is approaching 80 %. It would be interesting to take this research to the next level and study the prevalence of female sexual interest/arousal disorder in relation to each and every chemotherapeutic agent versus surgery and radiotherapy as well as hormonal therapy between females who underwent female genital mutilation surgery (circumcised) versus those who are not circumcised. It is very important to early diagnose and treat sexual disorders to restore intimacy and create a better quality of life for females suffering from breast cancer - better adherence on follow up and less stress to counteract relapse of cancer.

Disclosure

No