bluuebunny/crossref_metadata_2025 huggingface dataset:
(323) Injection Pain in Men Using Intracavernosal Injection During Penile Doppler Ultrasound
Authors: Ljubetic BM , Novaes LF , Gonzalez A , Mulhall JP , Flores JM
Published: February 2024

Introduction

Penile Doppler ultrasound (PDUS) is important in assessing erectile dysfunction. Intracavernosal injection (ICI) is utilized to achieve erections during the procedure

Objective

This study aims to examine the needle injection pain and predictors of severe pain in patients using ICI during PDUS.

Methods

The patient population included (i) men with poor response to erectogenic agents or (ii) who need curvature assessment due to Peyronie’s disease (PD), (iii) who underwent PDUS, (iv) using ICI vasoactive agent redosing schedule. We performed a descriptive assessment of demographics and comorbidities. All patients graded anxiety before the PDUS procedure and pain after the first ICI. A visual analog scale (VAS) evaluated the anxiety related to the procedure using a single question: “How anxious are you about your PDUS procedure?” This was measured on a 0 (not at all anxious) to 10 (extremely anxious) Likert scale. 7 or higher was defined as high anxiety, 4 to 6 as moderate anxiety, 1 to 3 as mild anxiety, 0 was no anxiety. A VAS assessed the ICI pain by asking, “How painful was your penile injection?”. This was measured on a 0 (not at all painful) to 10 (extremely painful) Likert scale. 6 or higher was defined as severe pain, 4 and 5 as moderate pain, 1 to 3 as mild pain, and 0 was no pain. Predictors of severe pain were analyzed using a Logistic regression model. Factors entered into the model included: patient age, number of comorbidities, and high anxiety. A p-value ≤0.05 was considered statistically significant.

Results

162 individuals were included. The median age of 65 (59,72) years. 19% had diabetes, 19% reported ≥ 3 comorbidities, 10% had a history of depression, and 11% had a history of anxiety. 72% had prostate cancer, 6%had bladder cancer, 3% had other cancer, and 19% had no cancer history. 35% described PD. The VAS procedure anxiety median was 3 (1, 5), on which 22% reported no anxiety, 35% mild, 25% moderate, and 18% high anxiety. The VAS median pain with the first ICI was 2 (1, 4), on which 9% reported no pain, 61% mild pain, 19% moderate pain, and 11% severe pain. In the MVA, no predictors of severe pain with ICI during PDUS were identified (Table 1).

Conclusions

Pain experienced with ICI during PDUS is low, with most patients reporting no or only mild pain. Only 1/3 of the patients Almost half of the patients reported moderate to high anxiety associated with this procedure; however, high procedure anxiety did not predict severe pain with ICI during PDUS

Disclosure

No.
(329) Exploring the Incidence of Sexual and Reproductive Health Concern in Men with Cystic Fibrosis and CBAVD: An Analysis of a Multi-Institutional Database
Authors: Campbell K , Deebel N , Kohn T , Passarelli R , Ghomeshi A , Samuels R , Velez D , Ramasamy R
Published: February 2024

Introduction

Cystic Fibrosis (CF) is a genetically inherited disease with a highly variable phenotype that results from a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Manifestations of CF include impacts on function of the lungs, liver, pancreas, and reproductive system. While CF is known to be associated with infertility due to congenital bilateral absence of the vas deferens (CBAVD), men with CF also frequently report additional sexual and reproductive health issues, often linked to low testosterone levels.

Objective

In this study we aimed to investigate the prevalence of low testosterone (T) in men with CF and CBAVD, and hypothesized hypothesized that low T would be under-evaluated and under-treated in the CF population compared to CBAVD and the general population.

Methods

We used TrinetX, a multi-institutional insurance claims database, to create a cohort of men over 18 years old with CF or CBAVD. We then queried each cohort to assess how many men had a T level measured, and if hypogonadal (below 300 ng/dL), how many received T therapy (TT).

Results

There were 14,033 men over age 18 years with a diagnosis of CF and 3,439 men over age 18 with a diagnosis of CBAVD in the TriNetX database. Serum T levels were measured in 10.1% of men with CF and 8.9% of men with CBAVD. While mean serum T level in both groups was within the normal range (defined as a total testosterone >300 ng/dL), 32.7% (n=464) of the men with CF and 43% (n=132) of the men with CBAVD were hypogonadal. The majority of men with T<300 ng/dL went on to appropriately receive TT: 59.3% of men with CF and 78% with CBAVD (figure 1).

Conclusions

Our data suggests that hypogonadism is highly prevalent in men with CF and CBAVD. These data suggest that despite a high rate of infertility in men with CF and CBAVD, the majority do not undergo hormonal evaluation. Investigation and appropriate treatment of TD may significantly improve quality of life.

Disclosure

No.
(333) Evaluation and Characterization of Testosterone-Related Mobile Health Applications
Authors: Aguiar J , Halpern J , Hayon S , Brannigan R , Dubin J
Published: February 2024

Introduction

Given the rise of digital health applications and direct-to-consumer (DTC) testosterone platforms, testosterone-related mobile applications (apps) pose significant challenges for both consumers and healthcare professionals.

Objective

The purpose of this study is to investigate trends and characterize the landscape of currently offered testosterone-related mobile health applications.

Methods

A search query of the term “testosterone” was conducted on the Apple app store. A comprehensive analysis of 23 testosterone-related apps was conducted, evaluating them based on categorization, primary service, specific health topics addressed, release years, cost model, user ratings, and evidence base. Apps were also evaluated on an established misinformation index score from one to five, whereby a score of five indicated complete accuracy and one, complete inaccuracy.

Results

Most apps were categorized as Health and Fitness apps, focused on sexual performance optimization, and addressed specific testosterone-related issues. A marked 600% increase in app releases were observed from 2020-22 when compared to prior to 2018. Apps frequently claimed to improve testosterone-related issues, but few cited scientific literature, resulting in a mean misinformation index score of 3.0.

Conclusions

The findings highlight the urgent need for healthcare professionals' active involvement in guiding patients through the digital health landscape. It is crucial to establish guidelines that ensure the provision of accurate, evidence-based information in health apps. Further research should focus on assessing the real-world impact of these apps on patient outcomes and developing strategies to mitigate digital health misinformation risks.

Disclosure

No.
(336) Sperm Retrieval Success During Tese: Prognostic Factors in Non-obstructive Azoospermia Patients
Authors: Vinay J , Nicolas S , Nicolas P , Cristian U
Published: February 2024

Introduction

Male factor is present in 50% of infertile couples. The most severe presentation of male infertility is non-obstructive azoospermia (NOA). In azoospermic patients, testicular sperm extraction (TESE) is frequently performed, followed by assisted reproduction techniques. The successful recovery rates of TESE are variable, and there is little evidence about factors that can predict the success of the technique

Objective

The objective of this study is to analyze the clinical and demographic variables of patients with NOA undergoing TESE, in relation to success or failure in sperm retrieval

Methods

Analytical study that includes all patients with NOA who underwent TESE by the same urologist-andrologist between 2017-2022. Demographic and preoperative clinical variables associated with sperm retrieval (SR) success rates are analyzed and compared. Non-parametric statistics were used with Jamovi 2.3.26 p<0.05 was considered statistically significant

Results

138 patients underwent TESE. 66 patients had a diagnosis of NOA, with a median age of 35 years (IQR 32-39). In 40 patients (60.6%) successful SR was achieved. Among all variables, only FSH and total testicular volume (TTV) presented significant differences between the successful and failed SR groups. The median FSH in patients with successful and failed TESE was 6.88 IU/l (IQR 3.69-13.5) and 16.8 IU/l (IQR 9.25-22.0), respectively (p<0.05). The median VTT in patients with successful and failed TESE was 29 cc (IQR 10-40) and 12 cc (IQR 8-21), respectively (p<0.05). Using univariate analysis for TESE success, VTT ≥28cc and FSH <10 presented Odds Ratios of 5.42 and 5.35, respectively (p<0.05)

Conclusions

In this study of patients with NOA who underwent TESE, only TTV and FSH values were significantly different between patients with successful and failed SR during TESE. Univariate analyses showed that those variables could help the prediction of a positive result of this technique. Considering these variables in the preoperative study of azoospermic men, could help in the preoperative counseling of couples and could influence when choosing the optimal surgical technique for sperm extraction

Disclosure

No.
(337) Microsurgical Varicocelectomy Improves Seminal Parameters in Infertile Men: 10-year Experience in a University Hospital
Authors: Vinay J , Santander D , Gurovich J , Mohr E , Urrutia C , Palma C
Published: February 2024

Introduction

Varicocele is the most common treatable cause of male infertility. Although the exact mechanisms by which varicocele causes infertility have not been fully identified, there is evidence of an improvement in seminal parameters and pregnancy rates after varicocelectomy, especially if the technique is performed with an operating microscope

Objective

This study seeks to compare pre- and post-operative seminal and hormonal parameters of infertile patients undergoing microsurgical varicocelectomy in a local cohort

Methods

Retrospective analytical study of male patients with a diagnosis of infertility and clinical varicocele, who underwent microsurgical varicocelectomy in a University Hospital, between April 2013 - April 2023. Demographic variables, varicocele grade and laterality, reproductive hormone levels, seminal parameters and postoperative complications were collected from the clinical history database. Pre and postoperative seminal parameters and reproductive hormones were compared using non-parametric statisticians were used for data analysis with the Jamovi Software. P<0.05 was considered statistically significant

Results

There were 136 varicocelectomies in the period, 56 patients were excluded due to incomplete data collection and finally 80 patients were analyzed. Median age was 34.5 years (IQR 31-38), with a median infertility duration of 2 years (IQR 1-4). All patents had primary infertility. The median testicular volume was 15 cc (IQR 15-20 cc). 82.5% of varicoceles were Grade ≥2, 70.6% patients presented left varicocele and 28% were bilateral. Of the reproductive hormones, only FSH showed a statistically significant decrease of the pre- and post-operative median values, being 5.8 IU/L (IQR 3.9-8.9) and 2.7 IU/L (IQR 2.5-2.9) (p=0.001), respectively. Median sperm concentration before and after surgery was 7 million/mL (IQR 2-23) and 18 million/mL (IQR 3.3-73.5), respectively (p=0.02). Median preoperative and postoperative sperm progressive motility was 29% (IQR 15-48) and 40% (IQR 27-60), respectively (p=0.004). Seminal volume and normal morphology did not show significative changes after surgery. Only 2 patients (2.5%) presented a grade 1 Clavien-Dindo postoperative complication (mild infection of surgical site)

Conclusions

In this study, infertile patients with a clinical diagnosis of varicocele showed a statistically significant improvement in sperm concentration and progressive motility and a significant decrease in FSH levels after microsurgical varicocelectomy. The reduction of this pituitary hormone may reflect an improvement in testicular spermatogenesis

Disclosure

No.
(338) Impact of Microsurgical Denervation of the Spermatic Cord Treatment of Chronic Scrotal Pain on Men's Sexual Function: A Follow-Up Study for 6 Months After Surgical
Authors: Le Anh T , Mai Ba Tien D , Dang Quang T
Published: February 2024

Introduction

When chronic severe scrotum affects the patient's activities and life in many aspects. Hypothetical study investigating clinical, laboratory characteristics and the influence of Microsurgical Denervation of the Spermatic Cord on male sexual performance.

Objective

The aim of this study was to describe the impact of microsurgical denervation of the spermatic cord treatment of chronic scrotal pain on men's sexual function

Methods

Observation study design. All patients with severe chronic scrotal pain, after excluding other causes, were indicated for surgery at the department of andrology, Binh Dan hospital from January 1, 2022 to November 1, 2022.

Results

There were thirty-one patients with chronic scrotal pain who underwent surgery. Mean age 24.2 ± 4.3 years, duration of pain 2.3 ±1.6 years. Location of pain: scrotum (41.3%), testis-epididymis (47.8%), spermatic cord (24.6%), inguinal (15.1%). Causes of pain: epididymitis (45.3%) accounted for most cases. NRS pain score before surgery 6.8 ± 2.3. There are 13/31 patients with severe pain scale (NRS = 7-10). Quality of life (QOL) in patients with moderate pain (NRS pain scale 1-6) 4.6 ± 4.0 and 6.75 ± 1.1 in patients with severe pain (NRS 7-10). 6%) patients reported pain affecting daily work Patient had small testicle size 43.5%, Varicose veins on ultrasound: 3.4±1.2 mm 51.6% (16/31) patients felt scrotal pain affecting sexual activity Patients with severe scrotal pain with high pain scale (NRS 7-10 points) had an effect on erectile function compared with moderate pain group (NRS 0-6 points) (P<0.05) Indicators “Scrotal pain prevents sexual activity”, “IIEF”, “Decreased libido ADAM questionnaire”, “Stimulating sexual activity pain”, “painful ejaculation” all improved after surgery.

Conclusions

Chronic scrotal pain mostly occurs in young patients with relatively large pain scores. Chronic scrotal pain also contributes to testicular size and endocrine function affecting quality of life. Chronic scrotal pain can greatly affect sexual performance in men. Microsurgical Denervation of the Spermatic Cord improves many aspects of a patient's sexual performance.

Disclosure

No.
(340) The Association Between Varicocele and Premature Ejaculation: Systematic Review
Authors: Mahdi M , Khalafalla K , Arafa M , Elbardisi H , Majzoub A
Published: February 2024

Introduction

Premature ejaculation (PE) is one of the most common sexual disorders that negatively impacts couple’s satisfaction. Varicocele on the other hand is a highly prevalent condition affecting men population. A higher incidence of PE is observed among patients with varicocele, which incited several authors to evaluate the possible correlation between varicocele and PE. Others went beyond that to investigate whether varicocele repair can lead to an improvement in PE.

Objective

To systematically review the literature for all the studies exploring the relationship between PE and varicocele.

Methods

A systemic review was performed utilizing (PRISMA) statement. The PubMed, Google scholar and Scopus databases were used to look for articles published up to June 2023 using the appropriate keywords. Articles reporting an association between the presence of varicocele and PE and exploring changes in ejaculation latency time after varicocele correction were included. Data including study design, sample size, varicocele details, PE diagnostic method, outcome measured and tools used to measure it were collected. The Newcastle-Ottawa scale was used for assessing the quality of the included studies.

Results

A total of eight studies were identified, two of them were retrospective and six were prospective. Intravaginal ejaculation latency time (IELT) was used as a diagnostic tool for PE in 5 studies, Premature Ejaculation Diagnostic Tool (PEDT) in 1 study, Chinese Index of Sexual Function for Premature Ejaculation-5 (CIPE-5) scores in 1 study, and subjective assessment in 2 studies. Two studies looked for the prevalence of PE among patients with and without varicocele. Both studies showed a significantly higher frequency of PE among varicocele patients. Whereas six studies evaluated the improvement in ejaculatory function after varicocelectomy; five of them revealed a statistically significant improvement. Quality check: only one study was of strong quality while the remaining 7 studies were of fair quality.

Conclusions

Limited evidence suggests the presence of positive relation between varicocele and PE. The small number of studies and patients, lack of enough prospective clinical trials, short term follow up, heterogenous study design and absence or diversity in the diagnostic tools used prevent our ability to build strong evidence. For the purpose of supporting the relation and validate it, further prospective studies on a larger number of patients with long-term follow up are needed to reach a solid verdict.

Disclosure

No.
(343) The Psychological, Sexual, and Financial Impact of Infertility on Couples: An Urological Approach
Authors: Jamali M , El Rhaz A , Oukouhou H , Nabil L , El Bahri A , Alami M , Ameur A
Published: February 2024

Introduction

Infertility is a public health issue with socioeconomic and demographic impact. Understanding the psychological, sexual, and financial repercussions on couples is crucial for comprehensive treatment.

Objective

Infertility can evoke complex emotions and disrupt the couple's sexual relationship. The aim of this study is to examine the psychological, sexual, and financial aspects of this condition on infertile couples.

Methods

A retrospective study was conducted on 50 couples undergoing infertility treatment at a military hospital. Data, including medical records, questionnaires, and follow-up information, were collected.

Results

1. Psychological Impact: Infertility represents a failure of the parental project, leading to negative emotions. Women are more likely to report the psychological impact and seek help. Family pressure and potential divorce due to societal expectations were observed. 2. Sexual Impact: Infertility can significantly affect sexual life, causing decreased satisfaction, stress, and anxiety. Communication and emotional intimacy may suffer. Contrary to literature, men reported more sexual disorders due to socio-cultural factors and female partners' discomfort discussing sexuality. 3. Financial Impact: Infertility treatments incur substantial costs, adding to emotional and physical burdens. Financial implications vary by country, and lack of national funding policies lead to debt or abandonment of conception plans. In the study, half of the couples spent over $1000.

Conclusions

Infertility has a significant psychological, sexual, and financial impact on couples. A comprehensive approach involving healthcare practitioners and policymakers is necessary for significant improvement in the well-being of infertile couples.

Disclosure

No.
(361) National Trends of Male Urethroplasty Procedures: 2016-2019
Authors: Han D , Marte J , Lee J , Joice G
Published: February 2024

Introduction

Urethroplasty remains a valuable surgical option in the management of urethral stricture disease. However, current understanding of the patient- and hospital-level factors associated with inpatient versus (vs.) outpatient male urethroplasty is limited on a national scale.

Objective

We therefore sought to evaluate contemporary national trends of urethroplasty procedures among men.

Methods

We performed a retrospective review from 2016 to 2019 of urethroplasty procedures in men utilizing both the National Inpatient Sample and the Nationwide Ambulatory Surgery Sample – the largest publicly available all-payer inpatient and ambulatory databases in the United States. Non-endoscopic urethroplasty procedures were identified by Current Procedural Terminology and International Classification of Diseases (10th Revision) Procedure Coding System codes. Utilizing both inpatient and outpatient encounters, we performed stratified cluster sampling to create weighted national estimates. The primary outcome was the rate of urethroplasty performed in inpatient and outpatient encounters over time. Multivariable logistic regression was used to evaluate patient- and hospital-level factors associated with inpatient urethroplasty.

Results

From 2016 to 2019, there were 28,532 weighted urethroplasty procedures analyzed (37% inpatient vs. 63% outpatient). Over the study period, there was a 27% increase in the total number of annual procedures (n=6270 to n=7980), and the proportion performed outpatient increased from 60% to 68% [Figure]. Mean total charge for inpatient urethroplasty encounters was $84,267 vs. $30,997 outpatient (p<0.0001). Predictors of inpatient urethroplasty included greater Elixhauser Comorbidity Index, use of buccal mucosal graft, non-private insurance status, and Western hospital region (vs. Northeast) (p<0.05) [Table]. Outpatient urethroplasty was associated with higher median income by Zip Code (vs. lowest quartile of median income), Southern hospital region (vs. Northeast), rural or urban non-teaching hospital (vs. urban teaching hospital), and higher urethroplasty case volume hospitals (vs. lowest case volume hospitals) (p<0.05).

Conclusions

An increasing proportion of urethroplasty procedures nationwide appears to be performed on an outpatient basis. Outpatient procedures have lower hospital charges than inpatient encounters – and are associated with higher volume hospitals, not using buccal mucosal graft, private insurance, and less comorbid patients who reside in areas of higher median income. Further investigation is warranted to assess how these factors may affect surgical outcomes.

Disclosure

No.
(362) Stress Urinary Incontinence Rates in Men Undergoing Optilume Balloon Dilation for Radiation-Induced Posterior Urethral Stenosis: A Single Center Experience
Authors: Ceballos B , Shumaker L , Selph JP , Baumgarten A
Published: February 2024

Introduction

While radiation can be a viable treatment option for prostate cancer, development of radiation-induced urethral stenosis occurs in approximately 2% of patients. Optilume, a paclitaxel-coated urethral dilation balloon was FDA approved in 2021 and has shown improved urethral patency and reduced rates of reintervention for anterior urethral strictures relative to standard endoscopic procedures. As the utility of Optilume expands into posterior urethral stenosis, it is important to identify the associated potential complications. Incidence of stress urinary incontinence (SUI) has been reported to be as high as 33% following urethroplasty for patients with radiation-induced urethral stenoses. Rates of SUI following Optilume balloon dilation have yet to be evaluated in this high-risk population.

Objective

To evaluate rates of SUI in patients undergoing Optilume balloon dilation for radiation-induced posterior urethral stenosis.

Methods

From March 2022 to February 2023, select men with radiation-induced posterior urethral stenoses underwent Optilume balloon dilation. Initial evaluation included retrograde urethrogram and/or diagnostic cystoscopy. Dilation was performed with a 30-French Optilume and left inflated for five minutes per standard protocol. A 16-French catheter was inserted and left in place for three to five days. Patients were scheduled for a three-month post-dilation cystoscopy. Pre- and post-dilation continence rates were compared.

Results

A total of 16 men with confirmed radiation-induced posterior urethral stenoses underwent Optilume balloon dilation. Of the 16 patients, 12 patients had documentation regarding their pre- and post-treatment continence status. No patients developed de novo SUI. Baseline pre-treatment SUI was noted in one patient (8.3%) requiring an average of 4 Depends per day. This patient noted no change in his degree of SUI following Optilume dilation and the dilation site was found to be widely patent on his follow up cystoscopy. He is scheduled for artificial urinary sphincter in the near future. Mean follow up was 77 days (range 30-180 days). Repeat intervention was required in three patients (18.8%) for repeat stenosis.

Conclusions

Optilume balloon dilation for radiation-induced posterior urethral stenosis does not appear to lead to de novo SUI in short to intermediate term follow up. Further prospective studies with a larger group of patients and longer follow up duration are warranted in this complex population.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Laborie.
(368) Real World Survey Study to Explore the Effects of Flibanserin in Men with Sexual Dysfunction
Authors: Clavell-Hernandez J , Goldstein I , Rubin R , Tatem A , Gonzalez J , Gumpf K
Published: February 2024

Introduction

Low sexual desire (LSD) is a syndrome of symptoms including diminished sexual interest or desire and absence of sexual thoughts or fantasies. Hypoactive sexual desire disorder (HSDD) is a subtype of persistent LSD associated with marked distress with no known cause. LSD/HSDD in men frequently occurs with other sexual dysfunctions such as erectile dysfunction and delayed orgasms. Flibanserin is a centrally-acting serotonergic medication approved in the United States to treat acquired, generalized HSDD in certain premenopausal women. Improvement in symptoms following the initiation of flibanserin treatment may take up to eight weeks.

Objective

Given the paucity of research available on the off-label use of flibanserin in men, this survey study was conducted to capture general information on the safety and outcomes of flibanserin in men with LSD/HSDD.

Methods

Dispensing data from sexual health clinics were used to identify males older than 18 years prescribed flibanserin between July 1 to December 31, 2022. Invitational emails containing a secure survey link were sent to eligible males. Survey questions captured changes in sexual function and sleep quality during active treatment. Patients not currently on treatment were excluded from the survey after the first question. In addition, 10-minute physician interviews were conducted to capture general safety information and outcomes. Study results are summarized using descriptive statistics.

Results

Thirty-four of 75 eligible males (45%) from 5 centers responded to the survey. The mean age was 55 years (range 30 to 81 years). Among respondents actively taking flibanserin (n=20), 12 selected low sexual desire, and 8 selected difficulties in reaching orgasm as their primary indication. Eleven of 16 respondents (69%) with treatment durations longer than 2 months indicated treatment-related benefits since starting flibanserin (TABLE). For the sleep quality question, 53% reported no change, 31% reported some improvement, and 16% reported worsening sleep. The most common reasons cited by physicians for treatment discontinuation were lack of effect and insomnia, followed by somnolence and fatigue.

Conclusions

Select male patients at sexual health clinics may experience benefits in LSD/HSDD and the ability to reach orgasm following 2 months of flibanserin treatment. Physician interviews suggest flibanserin is well tolerated in men with a safety profile similar to women. It is important to acknowledge survey study limitations when interpreting these findings. These results suggest that more research on the use of flibanserin in men with sexual dysfunctions is warranted.

Disclosure

Yes, this is sponsored by industry/sponsor: Sprout Pharmaceuticals, Inc.

Clarification: Industry initiated, executed and funded study.

Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout Pharmaceuticals, Inc.
(376) High Capability of ChatGPT to Answer Common Patient Questions on Vasectomy Reviewed by Sexual Medicine Specialists
Authors: Reddy S , Harnisch B , Honig S , Rotker K
Published: February 2024

Introduction

Novel technologies utilizing artificial intelligence (AI) have shown their potential to reduce provider workload and improve task efficiency in certain clinical settings. ChatGPT is an AI-powered chatbot which utilizes natural language processing (NLP) technology to provide human-like responses to open-ended questions posed by users. Recent studies have shown ChatGPT’s ability to provide diabetes counseling in lieu of trained educators, and effectively communicate technical research papers in layman’s terms to patients. Vasectomy is a common urologic clinic procedure that can be a source of anxiety for patients, many of whom desire the opportunity for further pre-operative counseling.

Objective

The objective of this preliminary study was to evaluate the ability of ChatGPT to respond to common patient questions on vasectomy encountered by sexual medicine specialists.

Methods

We composed a list of 20 questions commonly asked by patients pertaining to vasectomy. The questions were submitted to ChatGPT Plus with the prompt: “Answer the following questions in 50 words or less”. 3 fellowship-trained sexual medicine specialists then rated the accuracy of ChatGPT’s responses on a scale from 1-5 (1 representing a completely inaccurate response and 5 representing a response in line with what they would recommend to patients). Scores were tabulated and summarized (Table 1). Descriptive statistics were performed. Weighted Cohen’s kappa was calculated to assess for interrater reliability.

Results

Median score across all 20 responses from 3 raters was 4.1 (IQR 1.3). The most common rating was 5, indicating a high level of agreement between ChatGPT’s responses and those of sexual medicine specialists. The lowest score assigned was 2 (indicating poor accuracy), and was received by 6 responses. Weighted Cohen’s kappa was 0.49, implying moderate agreement amongst raters. Overall, ChatGPT was able to provide relatively accurate and concise responses to these common questions.

Conclusions

Our results demonstrate the capability of using ChatGPT as a potentially reliable source of information for patients desiring vasectomy counseling. Given the high clinical volume faced by many vasectomy providers, ChatGPT could possibly improve patient satisfaction and reduce provider burden. Further collection of real-world data is needed to better assess the accuracy and reliability of ChatGPT’s responses. Sexual medicine specialists should be aware of the strengths and limitations of emerging AI technologies as a medium for providing accurate health information to patients.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Fellow, Posterity Health, Coloplast, Hims, Genentech.
(382) Online Trends for Vasectomy Inquiries following Dobbs v. Jackson Women’s Health Organization Supreme Court Decision
Authors: Dolendo I , Leach M , Nguyen V , Uloko M
Published: February 2024

Introduction

On June 24th, 2022, the United States Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization that overturned Roe v. Wade, the constitutional right to abortion access in the U.S. There have been reports of increased interest in vasectomies at individual centers following this Supreme Court ruling, though it is unclear what changes have occurred on the national level.

Objective

We sought to use Google Trends to evaluate online interest in vasectomies in the U.S. in relation to the Dobbs v. Jackson decision.

Methods

We used Google Trends to evaluate the popularity scores (generated as a relative value amongst search terms from 0-100) of the search term “vasectomy” from January 2022 to January 2023. We calculated average rate of change (ROC) of scores for the time periods immediately surrounding the Dobbs V. Jackson court decision on June 24th, 2022 and the decision’s early leak to press on May 2nd, 2022 to determine if there was change in interest in immediate time surrounding these events. We then compared the baseline popularity scores in the 4 months before and after the decision. Additionally, we assessed the top 10 states searching for “vasectomy” and correlated with abortion access following the Dobbs v. Jackson decision.

Results

The national average rate of change of searches for “vasectomy” was significantly higher immediately after the Dobbs v. Jackson decision (0.283 vs. -0.210, p=0.003) (Figure 1). There was not a statistically significantly difference in searches of “vasectomy” after the press leak of the decision (0.001 vs. -0.102, p=0.745) (Figure 1). There was not a statistically significant long-term change in search trends pre- and post- Dobbs v. Jackson decision (p=0.506). Among the 10 states with the highest searches for “vasectomy” after the decision, 7 had abortion bans that went into effect following the Dobbs v. Jackson decision (Table 1).

Conclusions

There were significantly increased Google searches for “vasectomy” following the Dobbs v. Jackson Supreme Court decision to repeal the constitutional right to abortion and most of the states with the highest interest had abortion bans that went into effect following the decision. Urologists should be aware that abortion policies can influence the reproductive interests of their male patients.

Disclosure

No.
(392) Patient Outcomes Following Inflatable Penile Prosthesis Implantation in the Outpatient Setting
Authors: Fidel M , Shah J , Bal D , Patel P
Published: February 2024

Introduction

Inflatable penile prosthesis (IPP) is commonly performed in a hospital or ambulatory setting which involves overnight stay. However, recent literature has demonstrated that IPP surgery is increasingly being performed as same-day procedures in outpatient settings with patients not requiring overnight stay.

Objective

We sought to investigate the rate of complications following day surgery insertion of an IPP. The following was collected within six weeks of their procedure, 1. infection, 2. hospital admission, 3. emergency/urgent care visits, and 4. additional prescription for analgesia.

Methods

A prospective study is being performed since March 2023 of all patients undergoing day surgery insertion of an IPP at Men’s Health Clinic Manitoba (MHC). MHC is an outpatient ambulatory surgical centre. Only patients that are classified as ASA 1 or 2 and suitable for day surgery are deemed eligible for surgery at MHC. Patients are enrolled and consented on the day of the procedure. Patients were prescribed Bactrim BS BID two days prior to surgery along with a Dexedin/Hibiclens wash. Vancomycin and Gentamycin were given pre-operatively. Intraoperative Irricept wash was used during the case for irrigation and implant prep. All procedures involved a three-piece prosthetic device and were performed under spinal anesthesia with an infrapubic approach, with patients discharged with a catheter and a drain. Post-operatively, Gabapentin, Celebrex and Tylenol were given for analgesia.

Results

Currently, 15 patients are enrolled in this study with a mean patient age +/- SD of 64.3 +/- 8.2 years. All procedures were performed successfully with no intra-operative complications. The mean procedure length defined as time from of incision to when the dressing is placed on the surgical wound was 70.7 +/- 19.8 minutes. The mean post-operative duration of stay defined as patient entry into post-operative recovery room to time they leave the clinic was 135.6 +/- 78.8 minutes. Patients were cleared for device after six weeks. Thus far, no patients have required hospital admission or emergency room visits, nor have there been any documented cases of post-operative infection. 20% of the patients have required additional post-operative analgesia (n=3).

Conclusions

This study will aim to evaluate whether outpatient IPP implantation can yield a similar complication risk to those performed in an inpatient hospital setting. If successful, our findings could help increase accessibility and reduce wait times for patients as they could avoid limited hospital operating room use.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(400) Geographic Disparity in Collagenase Clostridium Histolyticum Utilization: A National Population-Based Analysis
Authors: Kaplan-Marans E , Lee J , Martinez M , Shpeen B , Schulman A , Khurgin J
Published: February 2024

Introduction

In 2013, the Food and Drug Administration approved the use of intralesional collagenase clostridium histolyticum for the treatment of Peyronie’s Disease.

Objective

To describe geographic utilization patterns of collagenase clostridium histolyticum.

Methods

The Medicare Provider Utilization and Payment Database was queried for all collagenase clostridium histolyticum injections (Current Procedural Terminology code 54200) performed between 2013 and 2020. The United States Census Bureau estimates for state population by male sex for 2020 were used to calculate the number of injections per male capita. Linear regression was performed with statistical significance set to 95% confidence intervals.

Results

Twenty-two states accounted for a total of 8,576 injections performed on 1,887 men. Five states (Georgia, California, Florida, North Carolina, and Delaware) represented over 50% of the injections per million male capita (figure). There were 28 states with zero injections recorded in the database. The number of injections per year increased from 263 in 2013 to 1,388 in 2020 (y=141.43x + 435.57, R2=0.71, p=0.008). All 8,576 injections were performed in urban vs. rural areas. Urologists and advanced practice providers (APPs) performed 8,309 (97%) and 267 (3%) of these procedures, respectively. The average reimbursement was $80.19 (SD $3.87) for urologists and $67.96 (SD $3.33) for APPs.

Conclusions

In this national population-based database, there was geographic disparity in the use of collagenase clostridium histolyticum for Peyronie’s Disease. Utilization increased fivefold from 2013 to 2020 and was limited to urban centers and less than half the states. APP’s performed a minority of injections.

Disclosure

No.
(402) Peyronie's Disease Treatment- Active Vs. Stable Phase- Retrospective Review of Cases
Authors: Gal J , Marinaro J , Bhambhvani H , Lassiter S , Brant A , Kashanian J
Published: February 2024

Introduction

Peyronie's disease (PD) may be treated with collagenase clostridium histolyticum (CCH) during the stable phase. However, the effectiveness and safety of this treatment during the active phase remain unclear. To address this, we investigated and compared the outcomes of patients receiving treatment in the active phase versus the stable phase of PD.

Objective

To assess the effectiveness and safety of CCH treatment in patients diagnosed with PD during the active phase.

Methods

A retrospective review was conducted on men who underwent at least one cycle of CCH injections for PD with a single fellowship-trained urologist between 2017 and 2023. Active PD was defined as occurring within one year from the onset of symptoms. The severity of penile curvature was measured at the point of maximal curvature and assessed at baseline and after each CCH cycle. In addition to the CCH treatment, patients were prescribed daily phosphodiesterase inhibitors (PDEi) and coenzyme-Q10 (CoQ-10). The treatment response was defined as any improvement in curvature from baseline to the final assessment. The characteristics and outcomes of patients were compared between those with active and stable PD.

Results

Of 107 patients who underwent CCH treatment, 75 were diagnosed with stable PD and 32 with active PD. There were no significant differences observed between the two groups in terms of age (58.1 vs. 57.9 years, p = 0.89), baseline curvature (58.4 vs. 60.5 degrees, p = 0.60), or the number of CCH cycles received (6.6 vs. 6.3 cycles, p = 0.57). Among the active PD patients, 26 (81.2%) experienced an improvement in curvature, which was comparable to the stable PD group (58 (77.3%), p = 0.85). There were no significant differences in the degree of curvature improvement (14.4 vs. 14.0 degrees, p = 0.91) or the percentage of improvement from baseline (22.67% vs. 24.05%, p = 0.86) between the active and stable PD patients. In the subset of patients who showed an improvement in curvature angle, there was no notable distinction in the percentage of improvement from baseline between the stable and active phases (37.4% vs 34.8%, p=0.63). Among the treated patients, we observed two cases of potential penile fractures in the stable phase. All adverse events were conservatively managed.

Conclusions

Patients treated with CCH during the active phase achieved comparable outcomes to those in the stable phase. There were no additional adverse events in the active phase treatment group. These data suggest that early active phase treatment yields similar effectiveness as treatment administered during the stable phase. Treatment during the active phase could be a disease modifier and may change the course of progression.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Endo, Roman Health.
(403) Pilot Study: Fractional CO2 Laser in the Treatment of Chronic Phase Peyronie’s Disease
Authors: Chan J , Alhamam A , Witherspoon L , Rivers J , Flannigan R
Published: February 2024

Introduction

Peyronie’s Disease (PD) is a fibrosing disorder of the penis which may result in penile curvature and deformity of the erect penis. Fractional CO2 laser therapy has been used to remodel severe skin scarring and more recently led to improvements in Dupytren’s contractures.

Objective

We sought to evaluate the safety of Fractional CO2 Laser Therapy in treating Peyronie’s disease. The assessment includes changes in penile curvature, Peyronie’s Disease Questionnaire (PDQ) Symptom bother score, and International Index of Erectile Function (IIEF) scores.

Methods

This pilot study examined the use of fractional CO2 laser therapy with adjuvant topical triamcinolone (10mg/cc) in patients with PD. Each patient underwent three treatment cycles with 6 weeks interval between each treatment. During the interval time period, patients were required to perform at-home penile modeling three times daily. Penile curvature assessments, self-reported questionnaires and any adverse events were collected at baseline, 24 weeks and 52 weeks.

Results

A total of 5 patients were included. The mean baseline curvature was 41.80 ± 10.57 degrees and at 24-week follow-up mean curvature was found to be 34.20 ±18.21 degrees, resulting in an 18.1% reduction in curve (p=0.44). Mean IIEF scores were 55.40 ± 14.26 vs. 61.40 ± 6.58, (p=0.234) at baseline and 24-week follow-up, respectively. Similarly, the IIEF erectile function domain scores were 24.40 ± 4.72 vs. 28.60 ±1.52, (p=0.061) at baseline and 24-week, respectively. PDQ symptom bother average scores were 7.6 vs. 5.4 at baseline and 24-week, respectively. Mild adverse effects such as temporary bruising and penile pain were reported. There were no significant adverse events noted.

Conclusions

Preliminary results, at 24 weeks, suggest that fractionated CO2 laser therapy may serve as a well-tolerated therapy for PD. While this pilot trial was not powered to assess effectiveness, initial results are encouraging. Based upon these findings, a dose escalating phase I clinical trial is warranted to further systematically evaluate the tolerability and utility of Fractional CO2 laser therapy in the treatment of PD.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific. Allergen/Abvie, Galderma, Johnson and Johnson, Leo, MetOptima, Pfizer.
On the role of minor neutrals in determining the characteristic features of the Venus ionosphere at low altitudes
Authors: Ambili K M , Choudhary R K , Tripathi K R
Published: February 2024

Electron density profiles obtained from radio occultation experiments reveal significant ionization occurring at altitudes below 120 km in the Venusian ionosphere. The presence of such ionization remains unexplained when considering only major neutrals and the resulting ion chemistry. In this study, we investigate the role of minor neutrals, including NO, O2, C, Ar, H2, and H, in the lower altitudes of the Venusian ionosphere using a one-dimensional photochemical model and Akatsuki radio science measurements. We derive the density of minor neutrals from the profiles of major neutrals. Our analysis demonstrates that NO+ and O$_2^+$ ions exhibit a notable presence below 140 km. When we incorporate the minor neutrals, electron density increases below 115 km but remains unchanged above this altitude. Specifically, the density of NO+ increases below 125 km, with corresponding reductions in O$_2^+$. The increase in NO+ above 115 km can be attributed to the charge-exchange reaction between O$_2^+$ and NO. However, below 115 km, the photoionization of NO results in a net increase in NO+ and electron density. These findings highlight the significant role played by minor neutrals, particularly below 115 km, in shaping the Venusian ionosphere at low altitudes.
Examining baryonic Faber–Jackson relation in galaxy groups
Authors: Sadhu Pradyumna , Tian Yong
Published: February 2024

We investigate the baryonic Faber–Jackson relation (BFJR), examining the correlation between baryonic mass and velocity dispersion in galaxy groups and clusters. Originally analysed in elliptical galaxies, the BFJR is derivable from the empirical radial acceleration relation (RAR) and MOdified Newtonian Dynamics (MOND), both showcasing a characteristic acceleration scale $\mathrm{g}_\mathrm{\dagger }=1.2\times 10^{-10}\, \mathrm{m}\, \mathrm{s}^{-2}$. Recent interpretations within MOND suggest that galaxy group dynamics can be explained solely by baryonic mass, hinting at a BFJR with g† in these systems. To explore this BFJR, we combined X-ray and optical measurements for 6 galaxy clusters and 13 groups, calculating baryonic masses by combining X-ray gas and stellar mass estimates. Simultaneously, we computed spatially resolved velocity dispersion profiles from membership data using the biweight scale in radial bins. Our results indicate that the BFJR in galaxy groups, using total velocity dispersion, aligns with MOND predictions. Conversely, galaxy clusters exhibit a parallel BFJR with a larger acceleration scale. Analysis using tail velocity dispersion in galaxy groups shows a leftward deviation from the BFJR. Additionally, stacked velocity dispersion profiles reveal two distinct types: declining and flat, based on two parallel BFJRs. The declining profile, if not due to the anisotropy parameters or the incomplete membership, suggests a deviation from standard dark matter (DM) density profiles. We further identify three galaxy groups with unusually low DM fractions.
ProPane: image warping with fire
Authors: Robotham A S G , Tobar R , Bellstedt S , Casura S , Cook R H W , D’Silva J C J , Davies L J , Driver S P , Li J , Garate-Nuñez L P
Published: February 2024

In this paper, we introduce the software package propane, written for the r data analysis language. propane combines the full range of wcslib projections with the C++ image manipulation routines provided by the cimg library. propane offers routines for image warping and combining (including stacking), and various related tasks such as image alignment tweaking and pixel masking. It can stack an effectively unlimited number of target frames using multiple parallel cores, and offers threading for many lower level routines. It has been used for a number of current and upcoming large surveys, and we present a range of its capabilities and features. propane is already available under a permissive open-source LGPL-3 license at github.com/asgr/ProPane (DOI: 10.5281/zenodo.10057053).