bluuebunny/crossref_metadata_2025 huggingface dataset:
(202) Exploring Erectile Hemodynamics in Men Complaining of Hard-Flaccid Syndrome (HFS)
Authors: Sullivan J , Salter C , Flores J , Ghuring P , Parker M , Mulhall J
Published: May 2023

Introduction

There is increasing awareness of a condition, vernacularly termed HFS, in which men complain of subjective and palpable abnormalities in the flaccid penis (hardness, heaviness) often associated with erectile dysfunction (ED).

Objective

We attempted to define erectile hemodynamic profiles in this population.

Methods

The study population consisted of (i) males ≥18 years of age (ii) who presented with self-diagnosed HFS (iii) who underwent comprehensive history and examination (including genital and lower extremity neurological) and (iv) penile duplex Doppler ultrasound (PDDU). PDDU was performed using redosing of vasodilators. PSV ≥35 cm/s and EDV ≤3 were considered normal. Patients with Peyronie’s disease or a history of intracavernosal injection therapy were excluded.

Results

88 men were analyzed. Mean age was 28 ± 12 years. Median number of vascular comorbidities was zero (0, 1). 66 (75%) had a history of depression or anxiety, 60 of whom had used pharmacotherapy for such at some time and 40 were actively using anxiolytics or anti-depressants at time of evaluation. No patient had a history of neurological conditions and neurological exam was normal in all. Mean duration of symptoms was 14 ± 20 months. Median number of prior physician consultations was 1 (1,4). All complained of impaired erectile function, 50% being incapable of having penetrative sexual relations. 91% had or were using PDE5 inhibitors. On examination all patients had a hypertonic flaccid penis with excellent stretch on traction. At PDDU, median number of penile injections was 2 (1, 3). 50% of men required phenylephrine reversal. All patients had normal PSV with 2/88 having abnormal EDV values, both of whom required reversal. Mean PSV was 45 ± 35 cm/s, mean EDV was 2 ± 11 cm/s. No patient had elevated echogenicity on B-mode scanning.

Conclusions

In this analysis, all men presenting with self-reported HFS had normal hemodynamics and an absence of fibrosis, suggesting the absence of vascular or gross cavernosal smooth muscle structural changes.

Disclosure

No
(205) Erectile Dysfunction is an Independent Risk Factor for Major Adverse Cardiovascular Events
Authors: Mann U , Brar R , Patel P
Published: May 2023

Introduction

Erectile dysfunction (ED) and cardiovascular disease share similar risk profiles which include: aging, hypertension, diabetes, smoking, obesity, and dyslipidemia. Previous literature has suggested ED as a potential harbinger of future cardiovascular disease.

Objective

As such, we sought to investigate the association between ED and major adverse cardiovascular events (MACE) using a large population based database. As a secondary objective, we sought to investigate the relationship of place of residence (rural or urban) in regards to the incidence of MACE.

Methods

A propensity-weighted, retrospective cohort study was conducted by accessing provincial health administrative databases. Eligibility criteria included men 18 years and older, with no prior ED or MACE, who had at least 1 year of provincial health coverage from their index date between June 1st 1996 to March 31st 2018. ED was defined as having at least two ED prescriptions filled within one year (including oral, intraurethral, and/or injection therapies). MACE was defined as myocardial infarction, coronary revascularization procedures, ischemic stroke, or hospitalizations for heart failure. We then classified study groups into ED Urban, ED Rural, No ED Urban and No ED Rural. Multiple logistic regression model that included age categories, socioeconomic status, index year, diabetes, hypertension, dyslipidemia and renal disease was used to determine the propensity score. Stabilized inverse propensity treatment weighting was then applied to the propensity score. A cox proportional hazard model was used to examine our primary outcome of time to a MACE.

Results

The median time to a MACE was 2721, 2620, 2520, and 2438 days in the ED Urban (N=32,138), ED Rural (N=17,821), No ED Rural (N=145,209) and No ED Urban (N=233,073) study groups, respectfully. The ED Rural, ED Urban and No ED Rural study groups had a 54% (Hazard Ratio [HR] 1.54, 95% CI [1.45 – 1.63]), 26% (HR 1.26, 95% CI[1.20 – 1.32]) and 14% (HR 1.14, 95% CI[1.11 – 1.18]) higher risk of a MACE event as compared to the No ED Urban group, in weighted analyses, respectfully. Among individuals with ED, men from a rural setting had a 22% (HR 1.22, 95% CI[1.14 – 1.32]) higher risk of a MACE event, as compared from an urban setting.

Conclusions

Our study demonstrates that men diagnosed with ED had a higher risk of MACE as compared to controls. ED is demonstrated to be an independent risk factor for MACE when controlling for comorbidities. In addition, men residing in rural communities had a higher risk of MACE as compared to other urban counterparts. It is imperative for health care professionals who manage patients with ED to discuss the risk of future cardiovascular disease and identify comorbid conditions to mitigate risk.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(210) Clitoral Blood Flow After Use of Gel Containing L-Arginine and L-Citrulline
Authors: Marashi A , Lovie K
Published: May 2023

Introduction

L-arginine and its precursor, l-citrulline, are two amino acids involved in the production of nitric oxide (NO); as a result, they increase blood flow and have been used to treat male sexual dysfunction (Alatas and Yagci, 2004). Some lubricants and gels contain l-arginine and are applied directly to the genital area to increase blood flow. Although these products have been evaluated subjectively through patient reports of increased warmth, arousal, and orgasm, to our knowledge, they have not been evaluated quantitatively in women. Moreover, the effect of gels combining both l-arginine and l-citrulline have not been reported in the medical literature.

Objective

To evaluate whether a topical gel containing l-arginine and l-citrulline increases blood flow to the clitoris.

Methods

Sonography of the clitoris was performed on a healthy 32-year-old volunteer before and after applying the gel externally to the vulva. The “before” scans were obtained using a neutral ultrasound gel (without l-arginine or l-citrulline). This allowed us to verify that the observations were due to the active ingredients of the gel, and not from massage associated with its application. Control images without gel could not be obtained, since acquisition of ultrasound images requires ultrasound gel in order to reduce acoustic impedance. The scans were obtained with a Philips Lumify™ ultrasound (Koninklijke Philips N.V., Amsterdam, Netherlands) with a L12-4 linear array transducer (4-12 MHz). Clitoral blood flow was assessed qualitatively (color Doppler images), as well as quantitatively (peak systolic velocity, end diastolic velocity, and resistive index of the deep artery of the clitoris).

Results

Blood flow to the clitoris increased after application of the gel containing l-arginine and l-citrulline at both evaluated time points. The maximum PSV of the deep artery of the clitoris also increased from 6.2 cm/s (before), to 8.6 cm/s (5 minutes) and 13.9 cm/s (15 minutes). The maximum EDV of the deep artery of the clitoris increased from 1.4 cm/s (before), to 1.7 cm/s (5 minutes) and 9.5 cm/s (15 minutes). The RI was 0.8 before and at 5 minutes. After 15 minutes, the RI decreased to 0.3, explained by a disproportional increase in EDV compared to PSV.

Conclusions

The results of this pilot study suggest that clitoral blood flow increases with the use of a gel containing l-arginine and l-citrulline. These findings can help clinicians inform patients with female sexual dysfunction. Difficulty achieving clitoral stimulation is a major cause of sexual dysfunction. Clinicians can use these findings to counsel patients about using gels to increase clitoral blood flow.

Disclosure

No
(224) Icilin, a TRPM8 Agonist, Induces Relaxation and Reduces Sensitivity to Phenylephrine in Pudendal Artery from Control and Diabetic Mice
Authors: Dos Anjos Moraes R , A  Araujo F , Arishe O , L  C  de Jesus R , B  Da Silva L , Priviero F , Webb C , F  Silva D
Published: May 2023

Introduction

Diabetes mellitus (DM) is a chronic metabolic disease with epidemiological relevance worldwide. One of the most common and most underestimated complications of diabetes is erectile dysfunction (ED). It is estimated that approximately 35-90% of diabetic men present ED as an early complication. Previous studies have shown that TRPM8 activation triggers relaxation of pudendal artery with increased sensitivity in the hypertensive rats. However, despite the correlation between ED and diabetes, research on the role of TRPM8 channels in the vasculature responsible for sexual function in diabetic condition still needs to be elucidated.

Objective

In this way, the aim of this study was to investigate TRPM8 channels in arteries vital to erection of the penis. We hypothesized that TRPM8 activation would induce relaxation and reduce sensitivity to alpha-adrenergic stimulation in pudendal arteries from diabetic mice.

Methods

Male control and db/db mice were euthanized, and the internal pudendal arteries were mounted on DMT wire myographs for the measurement of isometric force.

Results

Cumulative administration of icilin (10-8 to 10-4M), a TRPM8 agonist, induced endothelium-dependent and endothelium-independent relaxation in pre-contracted rings with phenylephrine (Phe,1μM). Relaxant effect induced by icilin was similar between pudendal arteries from db/db (Emax: 56.31 +/− 1.90%, n=5) and control (Emax:46.57 +/− 4.45%, n=5) mice. Diabetes increased the contractility of the pudendal artery in response to phenylephrine in concentration of 3x10-6M (99.40 +/− 4.65%, n=4) compared to control (85.44 +/− 2.36%, n=4). Interestingly, pre-incubation with icilin (10-4M) decreased the potency of the contraction induced by phenylephrine (10-9 to 3x10-5M) compared to untreated rings in both diabetic (pD2: 6.39 +/− 0.07 vs 6.67 +/− 0.05, n=4) and control (pD2: 6.43 +/− 0.09 vs 6.82 +/− 0.05, n=4) animals. In the pudendal artery, diabetes decreased the sensitivity to acetylcholine compared to control (pD2: 7.17 +/− 0.06 vs 7.42 +/− 0.03, n=4). However, the relaxation induced by acetylcholine (10-9 to 3x10-5M) was not changed by pre-incubation with icilin.

Conclusions

Icilin is able to promote relaxation with the same magnitude in pudendal arteries from diabetic and control mice. Increased responses to phenylephrine in pudendal artery may contribute to the development of ED. In addition, pre-incubation with icilin reduced sensitivity to phenylephrine, suggesting that the icilin could be a helpful treatment for ED.

Disclosure

No
(225) Rabbits Provide a Viable Model for Preclinical Penile Implant Studies
Authors: Chung P , Liu J , Machado P , Shah Y , Simhal R , Wang K , Wessner C , Isguven S , Delaney L , Hickok N , Forsberg F
Published: May 2023

Introduction

Inflatable penile implants (IPP) are the mainstay treatment for refractory erectile dysfunction (ED), but device infection is common and confers significant morbidity. Besides the addition of antibiotic and hydrophilic coatings, improvements targeting this complication are lacking. Preclinical in vivo studies to study methods of decreasing biofilm and mitigating infection sequelae are hindered by the lack of animal models containing functional IPPs. Previously, IPP fragments have been subcutaneously placed to study antimicrobial strategies, but the placement of complete, functioning IPP cylinders has not been demonstrated.

Objective

This biocompatibility study aimed to demonstrate the feasibility of placing and inflating IPPs in rabbits, with the goal of developing a viable model to study penile implant infections.

Methods

This study utilized 2 cadaveric and 2 live male New Zealand White rabbits. Experimental protocols were approved by IACUC (21-08-418). Cadaveric rabbits were utilized to evaluate surgical technique and ultrasound parameters prior to in vivo study. Following anesthesia and surgical site preparation, functioning IPPs were placed into the rabbits’ flanks. Upon dissection down to the plane between the panniculus carnosus and underlying muscle fascia, a subcutaneous pouch was developed to accommodate the implant. Following implantation, unrestricted ambulation was permitted, and the rabbits were observed daily for activity and recovery. Wounds were inspected daily for drainage, erythema, warmth, and swelling. Inflation-deflation cycling was performed following a 3-day post-implantation recovery period and evaluated via ultrasound. Surveillance was conducted for 14 days, after which the animals were euthanized.

Results

A single cylinder 14 cm implant without rear tip extender was successfully placed into each rabbit. IPP cycling mimicking the inflation protocol was successfully completed without tissue damage or harm to the animals. All IPP components were successfully visualized via ultrasound, which demonstrated the superficial position of the implant (Figure 1). Over a 14-day observation period, no concerns were identified, and signals of pain or distress, including gait disturbance, hypoactivity, restlessness, weight loss, dehydration, or reduced eating/drinking, were not observed, indicating the biocompatibility of functioning penile implants in the back of rabbits.

Conclusions

Preclinical in vivo models are the primary representative way to investigate IPP infection. This rabbit model may serve as an effective tool for the evaluation of novel infection prevention strategies following penile prosthesis implantation for ED.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: PHC: Boston Scientific and Coloplast.
(226) Mito-Q, a Mitochondrial-targeted Antioxidant, Partially Improves Relaxation of the Corpus Cavernosum in Aged Diabetic Mice
Authors: Priviero F , Garnto A , Garnto D , Dos Anjos Moraes R , Webb C
Published: May 2023

Introduction

Erectile dysfunction is associated with increased contraction and decreased relaxation of the corpus cavernosum (CC). Excessive reactive oxygen species produced by mitochondria play a key role in aging- and diabetes-induced erectile dysfunction. Erectile dysfunction is associated with increased contraction and decreased relaxation of the corpus cavernosum. Mitochondrial deterioration is part of normal physiological aging, and it plays a role in the pathogenesis of age-related disorders by producing reactive oxygen species (ROS). It is also known that excessive ROS produced by mitochondria plays a key role in aging- and diabetes-induced erectile dysfunction.

Objective

We aimed to test the hypothesis that in vitro inhibition of mitochondrial oxidative stress improves the reactivity of the CC.

Methods

To test this hypothesis, the CC of young (3 to 4-month-old) and old (10 to 14-month-old) male lean and diabetic (dbdb-/-) mice were mounted in myographs. Concentration-response curves to acetylcholine (ACh 1 nM – 30 uM) and relaxation induced by electrical field stimulation (EFS – 1, 2, 4, 8 and 16 Hz) were obtained. All curves were repeated after 30 minutes of incubation with the antioxidant Mito-Q (100 nM).

Results

Results: Relaxation to ACh was significantly reduced in the CC of diabetic mice (Lean: 87 ± 8% vs dbdb-/-: 60 ± 6%). Similarly, aged lean mice presented impaired relaxation to ACh (Lean old: 54 ± 6%) while old diabetic mice displayed a further decrease in the relaxing response to ACh (35 ± 6%). After 30 minutes of incubation with Mito-Q, the relaxation produced by ACh was improved in the CC of the aged lean mice (62 ± 3%) and aged diabetic mice (44 ± 1%). Relaxing responses to EFS were significantly decreased in obese and aged mice compared to the lean young animals. However, no improvement in the relaxing response to EFS was seen after incubation with Mito-Q.

Conclusions

Impairment in the endothelium-dependent relaxation of the CC induced by aging and diabetes is associated with increased production of mitochondrial reactive oxygen species. The use of the mitochondrial-targeted antioxidant Mito-Q improved at least in part the relaxation of the CC in both aged and diabetic mice.

Disclosure

No
(239) Readability Assessment of Online Educational Information on Premature Ejaculation
Authors: Lee J , Khurgin J
Published: May 2023

Introduction

Approximately one-third of US adults have trouble reading and acting on health-related information. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that patient education materials should not exceed a sixth-grade reading level. Given the difficulty in defining premature ejaculation (PE) and the lack of a US Food and Drug Administration (FDA) - approved drug therapy, many patients may seek information about PE through online resources. We sought to assess the readability and quality of online educational information on PE in light of these standards.

Objective

To assess the quality and readability of available online educational information on premature ejaculation using a Google search.

Methods

The search term “premature ejaculation” was queried on Google and the first 100 web pages were assessed. Duplicate websites, scientific publications, sub-pages of identical websites, or websites with paywalls were excluded from the analysis. Readability was assessed by three validated indices: the Flesch-Kincaid grade level (FKG), the Simple Measure of Gobbledygook (SMOG), and the Coleman-Liau Index (CLI). The quality of websites was assessed using the DISCERN instrument and the presence of Health on the Net (HON) code certification.

Results

After applying the exclusion criteria, a total of 43 websites were included in the data analysis. There were 15/43 (36.6%) web pages with HON code certification. On average, patient education materials about PE were written at a grade level of 12.2 (range 8.1-17.9). The mean DISCERN score for all web pages was 48.9 out of 80, which is considered “fair” quality. Web pages with HON code certification had a higher mean DISCERN score of 51.7 versus 47.3, which was not found to be significantly different (P=0.19).

Conclusions

Most of the online educational information on PE is of mediocre quality. In addition, the average web page on PE is written at a senior high school level, exceeding the recommended readability standards set by the AMA and NIH. It is imperative to place an emphasis on improving the quality and readability of online health information on PE to optimize patients’ abilities to make informed decisions.

Disclosure

No
(241) Shaeer’s Cavernotome: A New Cavernotome to Facilitate Penile Prosthesis Implantation into Scarred Corporal Bodies
Authors: Shaeer O
Published: May 2023

Introduction

Penile prosthesis implantation into scarred corporal bodies is one of the most challenging prosthetic urology procedures, with high risks of corporal perforation, urethral laceration & lack of success. Objective: We introduce a novel Cavernotome (patent application number PCT/EG2021/050003) which cuts the channel as it is passed forward. The instrument relies on controlled coring rather than forward stabbing, with resected tissue accumulated into the hollow core.

Objective

We introduce a novel Cavernotome (patent application number PCT/EG2021/050003) which cuts the channel as it is passed forward. The instrument relies on controlled coring rather than forward stabbing, with resected tissue accumulated into the hollow core.

Methods

After ethical committee approval, we utilized the cavernotome in 18 patients with severe corporal fibrosis. Scarring was due to penile prosthesis removal after infection in twelve patients, and neglected ischemic priapism in six. Surgical Procedure: Surgery is performed through a peno-scrotal incision with urethral catheter placed for identification. Corporotomies are 2-5 cm long depending on the implant to be used. A 2cm core of fibrous tissue is excised with scalpel or electrosurgical pencil. The appropriate size for Shaeer’s Cavernotome (ShC) is determined according to the maximum that fits in the fore mentioned excavated space, mostly size 11 Hegar. ShC is advanced proximally and distally in a screwing / coring motion, rather than the customary oscillating or forward thrusting motion. To prevent inadvertent direction, the stretched corpus is held between the thumb and index fingers of the non-dominant hand ahead of the tip. ShC doubles as a sizer with a ruler marked on the shaft. Following coring, the excavated corpora and crura are dilated with minimal resistance using Hegar or Brook’s dilators. Penile prosthesis implantation proceeds in the usual fashion. The surgical technique is available at VJPU: https://www.vjpu-issm.info/videos/peer-reviewed/1-penile-prosthesis-malleable-inflatable-penile-prosthesis-ipp/1-a-first-time-implant/item/198-shaeer-s-cavernotome

Results

Prosthesis implantation was successful in 17 out of 18 patients. In one patient, coring was not possible. the corpora were thinned out and calcified. Size 6 ShC could not be introduced. Corporal reconstruction was performed. Average coring time was 8 minutes. Dilation to 13mm Hegar in 12 patients, and 11mm in 5. The implant used was Rigicon Rigi10® (n=12), Rigicon Infla10® (n=2) and Coloplast Genesis® (n=3). No perforations or infections in the 17 successful implantations.

Conclusions

Shaeer’s Cavernotome is a new instrument that, in its initial study by the inventor, facilitates penile prosthesis implantation into scarred corporal bodies.

Disclosure

No
(243) Irrisept Washout at the Time of Revision Surgery Decreases Tissue Culture Positivity: Single Center Experience
Authors: Fuselier A , Griggs R , Henry G , Chung P , Karpman E
Published: May 2023

Introduction

The presence of biofilm, which resist eradication, at the implant site during inflatable penile (IPP) replacement surgery for infectious or non-infectious reasons appears to increase infection rates. Irrigation at the time of salvage rescue surgery has been shown to work in patients with clinically infected IPPs. Similarly, washout at the time of non-infectious revision surgery has been shown to lower subsequent infection rates. Positive cultures confirm bacterial presence on IPPs in both the clinically infected and uninfected settings. 0.05% chlorhexidine gluconate in sterile water (Irrisept, Irrimax Corporation, Lawrenceville, GA) has been shown to reduce biofilm in the orthopedic literature.

Objective

We investigated capsule tissue cultures before and after dilute chlorhexidine irrigation in a series of patients who underwent revision surgery.

Methods

A total of 31 patients with indwelling IPPs underwent revision surgery for both infectious and noninfectious reasons between May 2021 and March 2022. A section of capsule tissue surrounding the pump was sent for culture / gram staining. After implant removal, we performed a washout of all implant spaces with 0.05% chlorhexidine gluconate irrigation (2 bottles of 450mL each). A second tissue culture was obtained post washout. No other additional antibiotic solutions were utilized for irrigation. All patients received clindamycin, gentamicin, and fluconazole for intravenous prophylaxis.

Results

Of the 31 patients (4 with infection, 27 had noninfectious etiologies), 4 (13%) had evidence of positive bacterial presence prior to washout. All 31 (100%) of these patients had negative cultures after dilute chlorhexidine washout.

Conclusions

Early results of revision washout with 0.05% chlorhexidine gluconate solution appears to decrease the bacterial load and potentially sterilize the implant capsule at revision surgery of inflatable penile prostheses for both infectious and noninfectious reasons.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Signati, Endo, Pfizer, Irrimax, Procept.
(245) Outcomes of Penile Reconstruction for Salvage of Penile Gangrene
Authors: Lee W G , Assiri H , Reid T , Christopher N , Ralph D
Published: May 2023

Introduction

The most catastrophic complication of penile implant surgery results in either total/partial loss of the penis to such an extent that salvage penile reconstruction or phalloplasty is required. Penile gangrene (or necrosis) is rare and is associated with several patient factors (smoking, diabetes) and surgical factors (sliding technique, revision or a subcoronal incision). Irreversible ischemia with tissue loss will ensue if the prosthesis is not removed immediately. Nevertheless, subsequent corporal fibrosis and penile length loss may preclude an adequate functional penile length. In this situation, total penile reconstruction would be the only option to restore the ability for sexual intercourse and to void while standing.

Objective

The aim of this series is to assess the risk factors that predispose a select group of patients that require phalloplasty following penile gangrene and their surgical and functional outcomes following reconstruction.

Methods

All patients following phalloplasty for penile necrosis were identified from a comprehensive prospective database. Potential risk factors for penile necrosis were identified and the type and outcomes of reconstruction summarized. Functional outcomes were assessed by non-validated questionnaire.

Results

Thirteen patients with a median age of 57 years (range 27-68 years) required phalloplasty following penile necrosis with no incidence of flap loss. Reasons for erectile dysfunction were diabetes (37.5%), Peyronie’s disease (31%) and pelvic trauma (25%). The most common identifiable risk factors was diabetes (60%), followed by smoking (53%), adjunctive procedures like sliding technique or grafting (40%), revision surgery (27%) and infection with delayed explantation (27%). All patients had more than one risk factor for penile necrosis. Penile reconstruction was achieved with the radial artery forearm free flap (62%) and the anterolateral thigh flap (38%). All flaps were designed with an integrated urethra requiring anastomotic urethroplasty. Urethral complications occurred in 46.2% of men (fistulae and strictures) requiring surgical repair (Clavien 3b) while 2 had partial skin graft loss from the donor arm that improved with dressings and antibiotics (Clavien 2). Following phalloplasty, all responders had sensation (46% could orgasm with the neophallus) and 86% were able to void while standing. Most men were satisfied with the esthetic outcome (92%). The questionnaire response rate was 67%.

Conclusions

Penile necrosis following penile prosthesis insertion is rare and occurs in the presence of risk factors, particularly diabetes and smoking. Penile prosthesis surgery should be considered carefully in this cohort of patients especially for revision surgery or where adjunctive procedures are planned. Infection requires immediate explant of the device. Phalloplasty has good surgical and functional outcomes should reconstruction be required although there is a significant risk of surgical complications.

Disclosure

No
(254) Women in Healthcare: Is Fertility an Issue?
Authors: Parikh N , Alom M , Ahmed M , Robinson M , Mcgriff S , Olive E , Helo S
Published: May 2023

Introduction

Women in healthcare are faced with unique challenges that may increase the risk of infertility including irregular work hours, occupational hazards due to radiation or chemicals, and advanced maternal age.

Objective

We therefore sought to investigate live birth rates of female healthcare workers presenting with infertility compared to their non-healthcare counterparts.

Methods

After obtaining IRB approval, a retrospective review of hospital employees and partners presenting for a fertility evaluation between 2013-2019 was conducted. Patient age, BMI, history of previous live birth, occupation, use of assisted reproductive technology and female fertility factor were recorded. Couples with at least 12 months of follow up from initial presentation as well as a documented semen analysis were included in the study. Normal semen parameters were defined by the World Health Organization 2010 criteria. Logistic regression analysis was conducted to identify factors associated with increased likelihood of live birth.

Results

Of the 934 female partners identified, 445 were healthcare workers and 489 non-healthcare workers. Female age, BMI, smoking status, and history of previous live birth were not statistically significant between groups. No differences in male partner age, BMI, semen parameters and presence of male factor were noted. As an overall group, female age, male age, and abnormal concentration were noted to impact live birth rates (p<0.016). Live birth rates were higher in female health care workers compared to non-healthcare workers, 76.1 vs. 69.6%, respectively, p=0.042. The cohort was then further analyzed to determine if there was a difference in between females holding a Doctor of Medicine (MD) and other medical occupations (91 MDs vs 357 other occupations). Live birth rates, pregnancy complications, and preterm labor were not statistically significant, however MDs were found to have higher rates of use of assisted reproductive technologies (IUI or IVF) and were more likely to be older at time of evaluation (p=0.0015). After controlling for age at delivery, female physicians were still more likely to utilize ARTs, but this was no longer statistically significant (p=0.0806).

Conclusions

In this cohort of hospital employees, female healthcare workers had a higher live birth rate despite no differences in age, BMI, female factor infertility, use of assisted reproductive technology, or male partner factors. However, when the subgroup of female hospital employees was further analyzed, MDs were noted to have higher use of assisted reproductive technologies and older age. This indicates increased difficulty achieving pregnancy, likely a reflection of advanced maternal age. Further research is needed to identify subgroups within the healthcare population that may be at greater risk for infertility.

Disclosure

No
(260) Further Characterizing Treatment Success with Intralesional Collagenase for Peyronie’s Disease
Authors: Mian A , Roshandel R , Alom M , Byrne E , Helo S , Kohler T S , Zieggelmann M J
Published: May 2023

Introduction

Intralesional Collagenase Clostridium histolyticum (CCH) is approved for men with Peyronie’s Disease (PD). Most studies use curve improvement ≥ 20% to define treatment success.

Objective

Here, we sought to further characterize objective and subjective treatment outcomes with CCH.

Methods

We reviewed our prospectively maintained database for all patients who underwent CCH at our institution from 2013 through the present. We specifically identified those who completed four series of CCH (or elected to discontinue prior to completing four series due to satisfactory penile straightening or lack of results) and had available curvature assessment data. Treatment outcomes were broken down by level of curve improvement (0%, 10%, 20%, 30%, and > 40% improvement). Treatment success was also evaluated by improvements in the ability to engage in penetrative sexual intercourse and perceived surgery avoidance. Statistical analyses were performed using JMP Pro 14.1.0 (SAS Institute, Cary, NC).

Results

127 patients had complete data available. The mean age was 57 years (SD 8.4). The mean PD duration was 27 months (SD 59). The mean baseline curvature was 66.1O, and the mean post-treatment curvature was 45.1O (p<0001). The mean curvature improvement was 32% (SD 33). 68% of patients achieved a 20% or greater improvement in penile curvature, including 38% who achieved ≥ 40% improvement. 72% (n=48/67) felt that CCH prevented the need for surgery, and 68% reported CCH restored the ability to penetrate. Stretched flaccid penile length (SPL) increased by ≥ 1 cm in 50% of patients who used concurrent penile traction (PTT) and CCH, including 28% of patients who experienced ≥ 2 cm of length gain. In contrast, only 16% of patients who did not perform concurrent PTT had a ≥ 1 cm increase in SPL (p<0.0001).

Conclusions

CCH may restore the ability to penetrate with intercourse, and most patients feel that CCH prevents the need for surgery. Almost 40% of patients experienced a 40% or greater curvature improvement. However, 13% of patients may go through the entire series with minimal improvement. Concurrent PTT allows for simultaneous penile length gain in some patients. These data are helpful when counseling patients on expected outcomes.

Disclosure

No
(272) Novel Men’s Health Curriculum Increases Fraternity Members’ Knowledge, Confidence, and Willingness to Seek Help for Health Concerns
Authors: Gutierrez W , Gannon M , Scherer A , Pearlman A
Published: May 2023

Introduction

Limited data exist regarding knowledge of male-specific health concerns in young men. We developed a novel men’s health curriculum for undergraduate fraternity members and assessed its impact on knowledge related to, confidence in understanding, and likelihood of seeking help for common men’s health concerns.

Objective

The purpose of this study was to evaluate baseline men’s health knowledge, confidence in understanding men’s health concerns, and likelihood of seeking help for men’s health concerns in a cohort of undergraduate fraternity members and to assess the impact of a novel men’s health curriculum on each of these measures.

Methods

Members of six undergraduate fraternities viewed a 45-minute presentation about men’s health concerns related to sexual health, urinary function, hormones, and fertility. Interested subjects completed pre- and post-presentation surveys evaluating health knowledge, confidence in understanding men’s health concerns, and likelihood of seeking help for men’s health concerns.

Results

189 fraternity members completed at least one of the surveys, of whom 105 completed both pre- and post-presentation surveys. Prior to the presentation, participants answered 57.7% of health knowledge questions correctly. This increased to 88.7% after the presentation (p<0.001). The number of participants who indicated that they are likely to seek help for men’s health concerns also increased from 43.6% to 79.8% (p<0.05) following the presentation. The percentage of participants likely to seek help for concerns about urine stream, erectile dysfunction, low testosterone, and sexually transmitted illness (STI) screening increased by 28.7%, 23.4%, 25.8%, and 12.9% respectively (p<0.05). No changes were observed in participants’ likelihood of seeking help for STI symptoms. Participants’ confidence in their understanding of men’s health concerns and knowing when/where to seek help significantly increased from 2.99 to 4.05 (5-point Likert scale). Confidence, but not health knowledge, correlated with participants’ likelihood of seeking help for health concerns. The strength of this relationship (correlation coefficient) increased from 0.45 to 0.796 (p<0.001) following the presentation.

Conclusions

Our pilot study suggests that a short presentation on common men’s health concerns increases health knowledge, confidence, and likelihood of seeking help for these concerns. Increased self-efficacy (i.e., increased confidence), rather than knowledge, was associated with increased willingness to seek help.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Endo Pharmaceuticals, FirmTech
(280) Second Stage Surgery After Ring Flap Metoidioplasty: Technique and Outcomes
Authors: Sun H , Isali I , Tay K , Mishra K , Sellke N , Gupta S , Chen M
Published: May 2023

Introduction

Metoidioplasty is an option for creation of external male-appearing genitalia in transmasculine individuals. Many individuals report good sensory, functional, and aesthetic outcomes following single-stage metoidioplasty with urethral lengthening and scrotoplasty. However, an average of 12% of patients require a second-stage surgery to improve aesthetic appearance, place testicular implants, address complications, and maximally lengthen the neophallus. These procedures are risky to perform at the time of initial metoidioplasty as this may disrupt the vascular supply to the neoscrotum via the anterior branches of the external pudendal artery. We report outcomes of second-stage ring-flap labial metoidioplasty involving monsplasty, upper labia majora dermatolipectomy, and scrotoplasty with testicular implant insertion.

Objective

Transmasculine individuals who have had metoidioplasty with rotational advancement labia majora flap and (Ghent style) scrotoplasty often desire monsplasty, upper labia majora tissue resection, and testis implant insertion to optimize aesthetics, reduce dysphoria and improve voiding function. We describe our technique and surgical outcomes with dermatolipectomy of the mons pubis (monsplasty) and upper labia majora with simultaneous testis implant insertion.

Methods

We retrospectively reviewed the outcomes of ring flap metoidioplasty patients who underwent second stage surgery involving monsplasty and upper labia majora dermatolipectomy, and testis implant insertion. Monsplasty is performed by excising excess skin and adipose tissue to better expose the penis and lift the genitals. Upper labia majora tissue is subsequently resected, followed by development of pockets into each hemiscrotum inferiorly. Silicone carving implants are then individually sized and inserted to serve as testicular prostheses.

Results

From November 2017 to January 2022, 13 patients underwent second stage metoidioplasty and scrotoplasty with testis implant insertion. Mean follow-up was 22 months. Monsplasty was not desired/necessary in two (15%) patients. Implant malposition occurred in one (7.7%) patient, and one (7.7%) patient was unhappy with the overall aesthetics prompting him to seek a second opinion. To date, no surgical revision was desired nor performed. There were no wound or implant infections, and no scrotal necrosis.

Conclusions

Monsplasty and upper labia majora dermatolipectomy with simultaneous testis implant insertion is a safe and reliable combination of surgeries after metoidioplasty with Ghent style scrotoplasty.

Disclosure

No
(282) Impact of Lichen Sclerosus on Menopausal Women's Sexual Health
Authors: Marino J , Myers A , Pope R
Published: May 2023

Introduction

Lichen sclerosus (LS) is a vulvar dermatosis of unknown origin that affects 1 in 70 women. There is a higher incidence in menopausal women, which may be due to detection bias. LS presents with skin texture changes, hypopigmentation, and scarring. Common symptoms include vulvar burning, pruritus, and dyspareunia.

Objective

This study was to understand the sexual health experience for menopausal women with LS and was part of a larger study on the microbiome and genetics of menopausal women with LS.

Methods

We interviewed 25 women with biopsy proven LS and 5 post-menopausal women who do not have LS or any other vulvar symptoms. This was part of a larger study on the microbiome and genetics of postmenopausal women with LS. We specifically surveyed them regarding the impact their diagnosis had on their sexual health.

Results

The majority (n=10) of the women reported a satisfactory sex life prior to being diagnosed with LS. However, the majority (n=11) of respondents reported that it negatively changed since being diagnosed and most reported their sex life as not being satisfactory (n=8). When asked how their sex life changed women responded with “too uncomfortable at times so hesitant to cause irritation,” “pain, avoidance for intercourse,” “no sex life,” or “no desire no sex.” Unfortunately, the majority (n=10) of the women were not told when they were diagnosed with LS about the possible changes to their sex life. Furthermore, the majority (n=28) were not prescribed medications or had procedures done to improve their sexual health.

Conclusions

Our study revealed that LS had a negative impact on our participants' sexual health and yet the women were not informed of this or given treatment options. We hope this study will call attention to providers to the need for patient education regarding LS' potential negative effects on women's sexual health.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Scynexis
(303) Patient Satisfaction with Oral Testosterone Undecanoate (Jatenzo) in Men with Previous Testosterone Therapy: An Open-Label Single-Center Phase IV Clinical Trial
Authors: Rivero M , Reddy R , Patel M , Muthigi A , Ramasamy R
Published: May 2023

Introduction

Testosterone therapy is available in multiple delivery systems such as gels and injections; however, oral formulations have been unavailable in the United States due to hepatotoxicity and variable bioavailability. Oral formulations of testosterone are convenient, easy to use, and avoid the problems of other forms of testosterone therapy. Jatenzo (testosterone undecanoate) is a novel US FDA-approved oral testosterone capsule that provides a uniform response in patients with testosterone deficiency.

Objective

This study evaluates patient satisfaction with Jatenzo in men with a recent history of alternative testosterone therapy.

Methods

Patients between 18 and 65 years of age with a diagnosis of testosterone deficiency were recruited. Testosterone deficiency was defined as two measurements of serum total testosterone below 300 ng/dL combined with clinical symptoms in accordance with American Urological Association guidelines. Patients were required to have received previous testosterone therapy and completed an adequate washout period prior to starting Jatenzo. The primary outcomes were patient satisfaction, measured by the Treatment Satisfaction Questionnaire for Medication (TSQM-9); and changes in testosterone deficiency symptoms, measured by the quantitative Androgen Deficiency in Aging Males (qADAM) questionnaire at the 3- and 6-month intervals relative to baseline. Serum testosterone, PSA, hematocrit, and estradiol were also evaluated at each time point.

Results

Of the 41 patients recruited into the study, 46% had previously received subdermal pellets, 41% intramuscular injections, 6% transdermal gels, and 7% intranasal gels. Total testosterone levels increased from a baseline after appropriate washout from a mean of 187 ng/dL to 773 ng/dL at 1 month, 434 ng/dL at 3 months, and 397 at 6 months of treatment with Jatenzo. Patient satisfaction with Jatenzo as measured by TSQM-9 improved to 52 and 59.3 at the 3-month and 6-month time points, respectively, relative to 38.5 with previous testosterone therapy. Testosterone deficiency symptoms as measured by qADAM were 34 with Jatenzo and 33.5 with previous testosterone therapy. No significant difference was noted in side effects such as polycythemia or changes in estradiol or PSA.

Conclusions

Jatenzo appears to provide similar patient satisfaction and similar improvement in testosterone deficiency symptoms relative to other forms of testosterone therapy. In addition, Jatenzo increases serum total serum testosterone to reference range (300 – 1000 ng/dL) in >90% of men without a difference in side effect profile.

Disclosure

Yes, this is sponsored by industry/sponsor: Clarus Therapeutics

Clarification

Industry funding only - investigator initiated and executed study
(309) Risk Factors Associated with the Utilization of Xiaflex Injections for Peyronie’s Disease
Authors: Dai M , Patel S , Jin W , Khera M
Published: May 2023

Introduction

Collagenase clostridium histolyticum (CCH), known as Xiaflex (Endo Pharmaceuticals Dublin, Ireland) is the only FDA approved medication for Peyronie’s Disease (PD) in the United States. While Xiaflex has shown efficacy with improvement of curvature by >20% in over half of recipients, patients are hesitant to pursue treatment due to the monetary costs, length of treatment, and perception of injectable therapy.

Objective

The aim of this study is to determine if demographic and clinical factors are associated with clinical decision making to pursue Xiaflex injections for treatment of PD.

Methods

We retrospectively reviewed patients who presented to our institute from 2009 to present with PD. Demographic and clinical parameters were extracted. Independent T-test and Wilcoxon rank sum tests were used to determine correlation between continuous variables and whether Xiaflex was selected. Odds ratios with 95% confidence interval were used to determine association between categorical variables and whether Xiaflex was pursued.

Results

143 patients presented with PD. Of these cases, 24.5% (35) received Xiaflex and 75.5% (108) declined Xiaflex. There was no significant difference in age, months since curvature was first noted, history of erectile dysfunction (ED), ED response to PDE5 inhibitors, history of hypogonadism, lowest total and free testosterone levels documented, history of GU trauma, history of depression or anxiety, hourglass deformity, past urethral instrumentation, SHIM score, plaque volume, maximum plaque diameter on ultrasound, distance of curve apex from coronal sulcus, or history of Dupuytren’s contracture between the treatment and nontreatment group (P>0.05). Subjects who chose treatment had significantly greater predicted curvature and degree of curvature on initial ultrasound at the time therapy was offered compared to those who did not select treatment. Patients who received Xiaflex had an average predicted curvature at presentation of 49.5 degrees (sd = 28.1) and degree of curvature on initial ultrasound of 50.02 degrees (sd=20.0) respectively. Patients who did not receive Xiaflex had an average predicted degree of curvature at presentation of 37 degrees (sd=23.8) and degree of curvature on initial ultrasound of 37.6 (sd=23.0).

Conclusions

Our data suggests that PD patients who chose treatment with Xiaflex had greater penile average curvature compared to those who did not choose treatment. Despite erectile function, comorbidities, and radiographic findings, degree of penile curvature remains a key risk factor for selecting injectable therapy for PD.

Disclosure

No