bluuebunny/crossref_metadata_2025 huggingface dataset:
(026) Management of Psychosocial and Sexual Complains Among Cancer Patients in the African Context: A Scoping Review
Authors: Esho T , Ramlachan P , Osur J , Magueye Gueye S , Ireri E
Published: May 2023

Introduction

There is a lack of specialized psychosocial and sexual therapies for cancer patients in the African context.

Objective

This paper aims to highlight gaps in capacities of health care providers to address psychosocial and sexual needs of patients suffering from cancer disease, develop and share the proposed algorithm of psychosocial and sexual care management in the African context_

Methods

We conducted a scoping review of literature that highlights the psychosocial and sexual complications associated with cancer disease and its management, especially in the African context. A systematic search of bibliographic databases and websites including BioMed Central, PubMed Central, Taylor and Francis Online, Wiley online Library, EBSCOHOST databases using appropriate keywords on management of cancer in Africa was conducted between 1st January, 2000 to 31st March, 2021, using search words: ‘cancer; cancer treatment; ‘cancer management’; ‘cancer complications’; ‘psychosocial and sexual complications of cancer’. Identified publications were screened against selection criteria following the PRISMA guidelines.

Results

Characteristics or psycho-social and sexual outcomes of cancer were examined and associated management charted in an excel framework with the 6 studies that met the eligibility criteria. There is need to strengthen capacities of health care providers in the African health care system regarding the management of psychosocial and sexual complications associated with cancer disease.

Conclusions

The study proposes a psychosocial and sexual algorithm of care to be utilized by health care providers for the management of psychosexual complications associated with cancer disease. The algorithm can assist and facilitate the integration of psychosocial and sexual cancer programs into existing health care services in primary health-care facilities making it accessible to most patients.

Disclosure

No
(030) Mental Health and Unmet Healthcare Needs of Female Sex Workers in Baltimore, Maryland
Authors: Krishnamoorthi M , Alarcon Basurto S , Sherman S , Tomko C
Published: May 2023

Introduction

Female sex workers (FSW) experience unique mental health and well-being challenges that intersect with their sex work and sexual health. Further, they often experience discrimination and stigma within healthcare settings, leading to delayed or forgone healthcare. Throughout the COVID-19 pandemic, FSW faced unique limitations on their ability to gain financial compensation, which can amplify existing social inequities and morbidities (i.e. poor mental health) among this marginalized population.

Objective

As poor mental health is associated with increased risk of acquiring HIV and other sexually transmitted infections (STI), it is critical to understand the unique mental health strains of FSW in order to improve their engagement in and quality of mental and sexual healthcare.

Methods

Participants were purposively sampled for in-depth qualitative interviews to ensure a diversity of experience from an existing cohort study of COVID-19 testing in Baltimore, Maryland. The semi-structured interview includes questions about aspects of sex work most salient for mental health (and their changes during COVID) including: their relationship with street-based sex work, police interactions, violence, safety, substance use and overdose. Two independent coders conducted a thematic analysis using inductive and deductive codes.

Results

Preliminary results from qualitative interviews (n=14) with FSWs demonstrate a diversity of experience throughout the COVID-19 pandemic and its impact on mental health, self-management practices, stigmatizing and unsafe experiences, and barriers to healthcare. Despite many having a primary care physician, many participants did not report receiving care that was respectful or culturally sensitive to their sex work; participants who did not report having a primary care physician had a harder time seeking care. Multiple FSWs described formal psychiatric diagnoses but often noted that they were not on consistent medication due to financial instability and prescription side-effects. Moreover, self-medication through drugs was a prevalent theme, as barriers to accessing treatment for mental illness required that they find alternate means to address their symptoms. Cultivating self-management strategies (e.g., getting high, writing in a journal, finding a place to release emotions, focusing on work) that serve as alternatives to primary care treatment was common. Themes also included isolation during COVID, and a lack of a strong support system to discuss feelings of stress, depression, and anxiety.

Conclusions

Results show that FSW have a unique constellation of factors that negatively impact their mental health, but often lack access to culturally sensitive and non-stigmatizing care. Healthcare providers must be educated on the healthcare concerns of FSWs and their intersections with the unique social determinants they face.

Disclosure

No
(044) Identifying Challenges Experienced by Transgender Individuals Seeking Urologic Care
Authors: Denisenko A , Bulafka J , Spigner S , Swaminathan V , Stauffer P , Frasso R , Chung P H
Published: May 2023

Introduction

Providers will encounter transgender individuals in their practice, and it is important that they understand the unique challenges that these individuals face.

Objective

We sought to characterize the challenges transfeminine individuals face in seeking urological care through a developed questionnaire.

Methods

IRB approval was obtained to develop (with transgender community feedback) and administer a 58-item questionnaire assessing urinary and sexual health. Participants were recruited from the local community and the Philadelphia Trans Wellness Conference. We assessed the urologic care experiences of participants while comparing vaginoplasty (VP) and non-vaginoplasty (NVP) respondents.

Results

A total 32% of participants (n=17) sought care from a medical provider for GU/sexual symptoms in the past year. 41% of respondents (n=7) who sought medical care saw a urologist, with the majority having seen a urologist based on a referral or recommendation from another physician (n=5, 71%). Among all participants who had been to a urology practice in the past, 57% reported that they experienced a lack of knowledge about transgender health needs from a provider and/or office staff. 14 (26%) participants reported choosing not to see a urologist for one or more of the following reasons: 12 (85.7%) due to fear of being mistreated, disrespected, and/or misgendered, 10 (71.4%) due to discomfort around discussing urinary or sexual function issues as a transgender or gender nonconforming, 3 (21.4%) due to issues with insurance coverage, 3 (21.4%) due to issues with transportation or missing work, and 1 (7.14%) indicated “Other”. With respect to specific patterns of care between VP and NVP participants, we noted that NVP individuals were more likely to seek care for genitourinary issues (p=0.02) than NVP individuals. We also found that a higher proportion of VP compared to NVP individuals (45.5% vs 28.6%) sought general urologic care.

Conclusions

Transfeminine individuals experience a range of socio-economic barriers to urologic care. Participants indicated a reluctance to seek care because of discomfort and fear, and most reported inexperience from staff regarding transgender care. We noted that VP individuals were more likely to seek care from a urologist than NVP individuals, which may reflect a greater familiarity with the medical system. It is important for providers to be aware with these issues and communicate in a compassionate and affirming manner with their transgender patients.

Disclosure

No
(049) Project SEXUS – Baseline Findings from a Nationwide Cohort Study on Sexual Behavior and Health in Denmark
Authors: Graugaard C , Frisch M
Published: May 2023

Introduction

Project SEXUS (www.projectsexus.dk) is a nationwide cohort study on sexual behavior and health in Denmark that was initiated in 2017 by two state research institutions. The aim of this presentation is to introduce the methodology of the study and to present key findings from its baseline data collection.

Objective

The objectives of the Project SEXUS study were 1) to provide a thorough insight into the sexual landscapes of the general Danish population, 2) to shed light on the sexual health of understudied groups such as elderly people, chronically ill individuals and LGBT+ persons and 3) to investigate the interplay between sex lives, lifestyles and general health.

Methods

The cohort was created using a probability-based sampling frame, and the questionnaire comprised more than 600 items, including brief versions of validated measurement instruments such as the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI). Due to strategic filter questions, the median number of items addressed by respondents was 180. Between September 2017 and August 2018, 187,084 Danes aged 15-89 years were invited to participate in the study by filling out an online questionnaire. 64,706 individuals gave complete or almost-complete responses (AAPOR response rate 1: 34.6%). Individual weighting procedures ensured exact national representativeness regarding sex, birth year, region of residence, marital status, cultural background and twin status, and logistic regression analyses provided age-adjusted odds ratios as measures of relative risk at baseline.

Results

Based on complete and validated questionnaire data from 62,675 participants, key findings concerning sexual orientation, needs, experiences, satisfaction and current behaviors will be presented, and various dimensions of sexual health in the Danish population will be discussed. Moreover, topics such as relationship satisfaction, pornography consumption, risky sexual behavior, body contentment and childhood gender non-conformity will be addressed. Further, noteworthy associations between general and sexual lifestyles and health will be emphasized, and main findings regarding general and sexual wellbeing in strata of different sexual and gender identities will be shown.

Conclusions

The presented baseline findings from Project SEXUS provide a detailed account of the sex life situation in contemporary Denmark. Due to its huge size, national representativeness and ability to follow individual cohort members over time through identity-secure linkage with information in national health registers, the study offers internationally unique opportunities for detailed prospective assessments of the complex interplay between sex life, lifestyles and health. This is of obvious relevance to sexologists, sexual health promoters and general health-care providers around the world.

Disclosure

No
(052) The Relationship between Sexual Empowerment and Women's Sexual Pleasure
Authors: Blauenstein L , Reyes M , Cantrick M , Harvey P
Published: May 2023

Introduction

It is debated whether feelings of sexual empowerment are intrinsically derived or whether they are a guise for the positive feelings associated with conforming well to society’s standards. The nexus of sexual empowerment and sexual performance can be examined through the experience of sexual pleasure. The link between sexual empowerment and sexual performance and sexual pleasure has not been explored in depth.

Objective

This study aims to identify the association between sexual pleasure and sexual performance, sexual pleasure and sexual empowerment, and sexual empowerment and sexual performance. The association between sexual empowerment levels and experiences of sexual pleasure with partners among women is investigated.

Methods

Using a purposive convenience sample, data from 1,183 millennials (642 women) from The Pleasure Study (2021-2021) were used, which examined gender and sexual experiences among six gender identity groups. Data on the frequency of orgasm experience, the frequency of orgasm performance, the frequency of sexual pleasure performance, and sexual empowerment were analyzed for this study.

Results

Analyses determined a significant indirect effect of communication about sexual initiation and satisfaction on frequency of experiencing orgasms with partners through frequency of sexual pleasure performance, b = -0.049, 95% CI [-0.099, -0.021]. There was also a significant indirect effect of unwanted sex refusal on frequency of experiencing orgasms with partners through frequency of orgasm performance, b = -0.037, 95% CI [-0.085, -0.022]. Furthermore, there was a significant indirect effect of unwanted sex refusal on frequency of experiencing orgasms with partners through frequency of sexual pleasure performance, b = -0.053, 95% CI [-0.087, -0.022].

Conclusions

This study demonstrates that sexually empowered women perform sexual pleasure less, and this decreased performance of sexual pleasure mediated the association between their sexual empowerment levels and their more frequent orgasm experiences. Higher levels of sexual communication and the ability to refuse unwanted sexual relations predicted performing sexual pleasure less, and decreased performance of sexual pleasure in turn predicted more frequent orgasm experiences. Interestingly, sexual history communication was not associated with decreased performance of sexual pleasure nor more frequent orgasm experiences. Thus, the results suggest that women increase their sexual pleasure with partners when focusing on communicating about their sexual needs and preferences.

Disclosure

No
(062) Testosterone Therapy Improves Mortality after Solid Organ Transplant
Authors: Omil-Lima D , Perez J A , Thompson A , Callegari M , Khera M , Chavin K , Thirumavalavan N
Published: May 2023

Introduction

Low testosterone has been suggested as a contributor to mortality and rejection after solid organ transplant. Whether testosterone therapy specifically improves these outcomes is unknown.

Objective

To determine whether treatment of low testosterone with testosterone therapy is associated with improved rejection or mortality after solid organ transplant using TriNetX, a large deidentified, multi-institutional database.

Methods

We compiled all clinical data from the TriNetX research network, a globally federated health research network (with waiver from Western IRB) that provides de-identified clinical information from 58 heath care organizations, and over 80 million patients located within the United States. We selected male patients (aged ≥ 18) with a history of lung, kidney, liver, heart, or pancreas transplant. We categorized patients into two groups, based on prescription for testosterone therapy. For all patients, we collected clinical information including demographics, comorbidities, laboratory findings, and medication use. Our outcomes of interest were 1-year, 3-year, and all-time mortality, as well as allograft rejection. We evaluated differences in baseline characteristics between testosterone level (Normal T, or Low T), using chi-square or Fisher’s exact test for categorical data (presented as frequencies and percentages), and independent t-test for continuous data. To address potential confounders that could bias our results, we used a propensity score weighted regression (inverse probability of treatment weighting), matched on age, race/ethnicity, comorbid conditions, multiple transplant status, and immunosuppressant use. Multivariable logistic regression was used to model outcome of transplant rejection, on the predictors of testosterone level, testosterone therapy, and their interaction, while a cox regression model was used to determine probability of mortality.

Results

A total of 1,762 men were identified with solid organ transplants. 262 (14.9 %) met criteria for low testosterone and had a history a prescription of testosterone therapy. Baseline characteristics were similar between the two groups (Table 1). After matching for existing patient characteristics, outcomes showed that a prescription for testosterone therapy was associated with improved mortality after organ transplant. The risk of mortality was reduced at 1 year (HR 0.33), 3 years (HR0.57) and for all time mortality (HR 0.61) among patients treated with testosterone therapy. No effect of testosterone treatment was seen with regards to allograft rejection (data not shown).

Conclusions

Testosterone therapy may improve mortality in men with low serum testosterone following solid organ transplant. Further studies are required to determine when and what patients derive most benefit from testosterone therapies, particularly as the result does not appear to be driven by reduced allograft rejection.

Disclosure

No
(064) Pharmacokinetics and Safety Outcomes of Compounded Versus Branded Testosterone Pellets in Men with Testosterone Deficiency: A Single-Center, Open-Label, Randomized Trial
Authors: Kresch E , Fernandes Negris Lima T , Molina M , Reddy R , Patel M , Loloi J , Carto C , Gonzalez D , Ory J , Ramasamy R
Published: May 2023

Introduction

Testosterone deficiency (TD) is a prevalent condition, especially in men ≥ 45 years old, and testosterone therapy (TTh) can improve quality of life in these patients.

Objective

In this abstract, we aim to evaluate the safety profile of compounded subcutaneous testosterone pellets and to compare the pharmacokinetics between compounded and FDA approved testosterone pellets (Testopel®) for TTh.

Methods

This was a prospective, Phase 3, randomized, non-inferiority clinical trial. We enrolled 75 men diagnosed with TD and randomized them 1:1 ratio to Testopel® and a 100mg compounded pellet group. The patients were implanted with their respective treatment: Testopel® (10 pellets of 75mg) or compounded testosterone pellets (8 pellets of 100mg).

Results

After randomization, there were 35 participants enrolled in the Testopel® 75mg arm and 40 participants in E100 arm. Serum T levels were similar between the groups at 2, 4 and 6 months, with most men (82%) dropping below 300 ng/dL by the end of the trial. Adverse events such as elevations in prostate specific antigen, estrogen and hematocrit in each group were similar. Most dropouts were related to persistent TD symptoms and serum T < 300ng/dL, with similar rates between the two groups in the study.

Conclusions

Men treated with Testopel® and compounded pellets had comparable serum testosterone levels and similar adverse events rates. Compounded testosterone pellets can provide an effective choice of long term TTh among men with TD comparable to Testopel®.

Disclosure

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

Clarification

Industry funding only - investigator initiated and executed study.

Any of the authors act as a consultant, employee or shareholder of an industry for: Empower Pharmacy.
(072) What Kind of Specialists Should Know About HRT?
Authors: Dominguez-Bali A , Hassan Z , Shah P , Coburn A , Nani J , Dominguez-Bali C
Published: May 2023

Introduction

Hormone Replacement Therapy (HRT) use has recently been a topic of debate amongst clinicians. The discussion has been most prevalent in the fields of gynecology, urology, and endocrinology. Current research suggests HRT can prevent the development of lethal diseases such as myocardial infarction, osteoporosis, diabetes mellitus, Alzheimer's disease, Parkinson’s disease, and genitourinary syndrome of menopause.

Objective

To raise awareness of HRT as a prophylactic measure to treat a variety of diseases in multiple organ systems, we recommend providing this information across multiple medical specialties to warrant the use of HRT amongst patients. Specialists including obstetricians and gynecologists, urologists, cardiologists, neurologists, dermatologists, psychiatrists, ophthalmologists, orthopedics, wound care specialists, sexologists, sex therapists, psychologists, rheumatologists, immunologists, infectious disease specialists, cosmetic surgeons, endocrinologists, and geriatricians should be aware of the benefits of HRT and how they can incorporate it into patient care.

Methods

Based on our own experience, for more than 40 years and the continued management of postmenopausal women, we have realized the importance that physicians, in specialties other than obstetrics and gynecology must be aware of the use of this therapy in their specific field. For example, approximately 60% of depression diagnoses in perimenopausal years can be treated with greater efficacy with hormone replacement therapy rather than antidepressants prescribed by psychiatrists. These findings have been confirmed in the current literature, however awareness amongst the various specialties is very poor.

Results

HRT plays a significant role in treating silent killers such as myocardial infarction, osteoporosis, diabetes mellitus, Alzheimer’s disease, Parkinson’s disease, and Genitourinary syndrome of menopause.

Conclusions

Previously, the role of HRT was not clearly established. Current data suggests HRT provides many benefits including a reduction in mortality. Through recent research and published literature, the consensus of the benefits and strategies of HRT have been established. However, the use of HRT is currently under-prescribed. This creates an opportunity to bring awareness to clinicians, thereby improving the lives of patients.

Disclosure

No
(074) Association of Androgen Receptor Signaling in Human Corpus Cavernosum with Serum Testosterone Levels
Authors: Khodamoradi K , Dullea A , Golan R , Ory J , Bidhan J , Arora H , Ramasamy R
Published: May 2023

Introduction

Testosterone (T) plays an important role in properly developing and maintaining male reproductive tissues. The normal serum testosterone levels can vary between 300 to 1000 ng/dL or 10.4 to 34.7 nmol/L. However, it is unclear whether androgen receptor signaling can vary based on serum T levels or the half-life of testosterone therapy. What remains unknown is whether there is a uniform serum T level above which androgen receptor signaling within the tissue remains similar (saturation hypothesis).

Objective

We first evaluated whether varying serum levels of T alter androgen receptor (AR) signaling in human penile tissue. Then, we evaluated and compared AR signaling in corpus cavernosum tissue of men treated with short-acting vs. long-acting testosterone. We hypothesized that we would find similar AR signaling in the penile tissue of both eugonadal and hypogonadal men as well as those men receiving short and long-acting testosterone.

Methods

We obtained human corpus cavernosum (hCC) tissue biopsies during penile surgery (for erectile dysfunction) from 14 men. We recorded their serum T levels on week prior to surgery before 10AM. We used western blot to evaluate adrenergic receptor (AR) and VEGF protein levels. Men without erectile dysfunction undergoing penile surgery for Peyronie's disease were used as controls.

Results

The median age of participants was 61 (IQR 12) and the median T level was 325ng/dL (IQR 201.45). The results of western blot showed expression of similar levels of VEGF in hCC samples from men with T >200ng/dL. However, men with serum T levels lower than 200 ng/dL had decreased expression of VEGF and AR.

Conclusions

This finding is significant because it demonstrates that serum testosterone beyond a certain threshold may have a minimal impact on erectile function. If a serum testosterone threshold is identified, this threshold could be a valuable target for future studies on the effects of testosterone on ED. It may alter the treatment threshold for men who have ED as their primary symptom of hypogonadism. This data also suggests the saturation value for penile androgen receptors.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceuticals, Boston Scientific, Coloplast, Endo Pharmaceuticals, Empower Pharmacy, Nestle Health, Olympus, Hims, Inc
(075) Exposing the Unsung Cycle: A Proposed Study to Examine the Connection Between Allopregnanolone and Adverse Mood Effects of Hormonal Contraception
Authors: Schuppe K , Abbe C , Hall B , Prager S
Published: May 2023

Introduction

Allopregnanolone is a GABAnergic neurosteroid. Reduced concentration of allopregnanolone in the cerebrospinal fluid (CSF) and serum are closely associated with several neuropsychiatric conditions, including Alzheimer’s disease, anxiety disorders, premenstrual dysphoric disorder, and postpartum depression. Allopregnanolone is a progesterone metabolite predominantly synthesized in women in the ovaries and prior literature shows the menstrual cycle directly affects serum and CSF allopregnanolone concentrations. We hypothesize that allopregnanolone’s biosynthesis is similarly affected by exogenous hormonal contraceptives. In the United States, 65% of reproductive-aged women use hormonal contraceptives and their discontinuation is commonly attributed to adverse changes in mood; yet, little is understood when it comes to what and how specific components of hormonal contraceptives affect mood and how to manage such effects.

Objective

We aim to review current literature and propose a study to understand the connection between allopregnanolone and the adverse mood effects of hormonal contraceptives in order to improve women’s health.

Methods

We conducted a semi-systematic literature search, using PubMed Central and other databases, compiling peer-reviewed material using keywords including allopregnanolone AND hormonal contraceptives; combined oral contraceptive; progestin; suppression; levonorgestrel, ethinyl estradiol, medroxyprogesterone. All languages of publication were included where reliable translations were available. Studies were excluded if they did not include serum and/or CSF measurements of allopregnanolone.

Results

Rodent studies demonstrated that exogenous hormonal contraceptives reduce both the serum and CSF concentration of allopregnanolone. Human studies analyzing only serum allopregnanolone concentrations showed the same results, but no human studies analyzing CSF allopregnanolone concentrations were identified. Only two human studies have examined serum allopregnanolone levels and mood, and no studies have done so in the context of exogenous hormonal contraceptive use.

Conclusions

While exogenous sex hormones, namely progestins, affect allopregnanolone levels in rodents, their impact on both allopregnanolone levels and mood remains inconclusive and under-researched in humans. We propose a large multi-arm study on humans analyzing CSF and serum allopregnanolone and mood effects following administration of hormonal contraceptives to assess how contraceptives affect allopregnanolone metabolism in connection to adverse mood effects. This research will allow clinicians to better tailor contraceptive selection.

Disclosure

No
(084) Analysis of BMP4 and GREMLIN as targets of SHH signaling and regulators of the collagen axis in the penis.
Authors: Martn S , Deng J , Searl T , Ohlander S , Harrington D , Stupp S , Mcvary K , Podlasek C
Published: May 2023

Introduction

Increased collagen deposition occurs in erectile dysfunction (ED) patients and animal models, and the underlying causes of these fibrotic changes have not been well defined. The Sonic hedgehog (SHH) pathway is critical for the response of the penis to denervation. Decreased SHH in the penis due to cavernous nerve (CN) injury, causes smooth muscle apoptosis and ED. As smooth muscle is lost, increased collagen occurs by a largely unknown mechanism. We have shown that collagen abundance is responsive to SHH signaling in the penis. Microarray analysis identified increased GREMLIN (BMP4 antagonist) in corpora cavernosa of ED patients, and SHH is a regulator of GREMLIN in the limb bud.

Objective

We hypothesize that SHH regulation of collagen occurs through a BMP4/GREMLIN dependent mechanism and will examine BMP4 and GREMLIN signalling in corpora cavernosa of ED patients and a rat prostatectomy model. Study of how collagen induction occurs after prostatectomy would be useful to determine the underlying mechanism of penile remodeling.

Methods

Corpora cavernosal tissue (n=36) from prostatectomy, diabetic and Peyronie’s (control) patients were examined by immunohistochemical and western analysis for BMP-4 and GREMLIN proteins. Localization was determined by dual staining with ACTA2 and CD31. Collagen was quantified by hydroxyproline assay and trichrome stain with Image J analysis. Primary cultures of patient corpora cavernosa were established and treated with BMP4 and GREMLIN proteins, and smooth muscle cell growth was quantified. Sprague dawley rat penis was treated in vivo with SHH protein by peptide amphiphile, 5E1 SHH inhibitor, BMP4 and GREMLIN via Affi-Gel beads. Collagen was quantified.

Results

BMP-4 and GREMLIN were identified in smooth muscle of Peyronie’s, prostatectomy and diabetic ED patients. Western analysis identified increased BMP4 and GREMLIN proteins in prostatectomy and diabetic patients where collagen is increased. Primary culture of corpora cavernosal smooth muscle cells showed an increase in growth with BMP4 and decreased growth with GREMLIN treatment. This trend was more pronounced in cells from hypertension and cardiovascular disease patients. BMP4 and GREMLIN proteins increased 1-2 days after CN injury in a rat prostatectomy model that showed decreasing SHH in the penis. SHH inhibition in the penis increases BMP4, GREMLIN and collagen. SHH treatment of the penis after CN injury in the rat decreases collagen, BMP4 and GREMLIN.

Conclusions

SHH is decreased in corpora cavernosa of prostatectomy and diabetic ED patients while BMP4 and GREMLIN are increased. Decreased SHH increases BMP4 protein and collagen, suggesting a possible mechanism for fibrotic penile remodelling after CN injury. This study is the first step in understanding the mechanism of how SHH regulates collagen abundance in the penis, which is important for clinical translation.

Disclosure

No
(097) A Novel Therapeutic Strategy for Recovery from Cavernous Veno-Occlusive Dysfunction through Chronic Administration of Hepatocyte Growth Factor and a JNK Inhibitor in a Rat Model of Cavernous Nerve Injury
Authors: Lee J , Cho M C , Choi H , Son H , Kim S W
Published: May 2023

Introduction

Structural alterations of penis including cavernosal apoptosis and fibrosis induce venous leakage in the corpus cavernosum or cavernosal veno-occlusive dysfunction, a key pathophysiology of erectile dysfunction (ED) after radical prostatectomy.

Objective

We aimed to determine if JNK inhibition in combination with intracavernosal administration of hepatocyte growth factor (HGF) would completely restore cavernosal veno-occlusive function (CVOF) in a rat model of ED induced by bilateral CN crush injury (CNCI).

Methods

A total of forty-two male Sprague-Dawley rats were randomly assigned to sham control (S), CNCI (I) and CNCI treated with combination of JNK inhibitors and HGF (J+H) for 5 weeks after surgery. All rats in each group were evaluated by dynamic infusion cavernosometry (DIC), caspase-3 activity assay, Masson’s trichrome staining, immunohistochemical staining of α-smooth muscle actin (α-SMA) and immunoblotting at 5 weeks after surgery.

Results

Regarding CVOF, Group I showed a decreased papaverine response, an increased maintenance and drop rates compared to Group S. Group J+H showed significant improvements in the three DIC parameters compared to Group I. There were no differences in papaverine response and drop rate between Group J+H and Group S. Regarding the structural integrity of corpus cavernosum, Group I had an increased caspase-3 activity, decreased SM/collagen ratio, decreased content of SM, decreased protein expression of PECAM-1, and decreased phosphorylation of c-Jun and c-Met. Group J+H had significant alleviation in the histological and molecular derangement compared to Group I. There were no differences in caspase-3 activity, SM content, PECAM-1 protein expression, c-Jun phosphorylation and c-Met phosphorylation between Group J+H and Group S.

Conclusions

Our data indicate that chronic administration of JNK inhibitors and HGF may restore CVOF to the level comparable to sham control level through preservation of structural integrity of the corpus cavernosum. Combination of JNK inhibition and HGF might be a potential therapeutic option for recovering from CVOD.

Disclosure

No
(101) Ultrasonography and Magnetic Resonance Imaging are Accurate for Suspected Penile Fracture
Authors: Lee W G , Von Stempel C , Cayetano A , Mount C , Ralph D
Published: May 2023

Introduction

Penile fracture (PF) is a rare but potentially catastrophic injury due to the risk of erectile dysfunction (ED) and penile curvature in young, sexually active men. The diagnosis is commonly made by clinical examination only but may be inaccurate in 15% of men. Despite this, penile ultrasound (US) and magnetic resonance imaging (MRI) remains poorly utilised.

Objective

This study aims to correlate for the first time imaging suggestive of PF with intraoperative findings as the gold standard comparator in order to calculate the sensitivity and specificity as accurately as possible.

Methods

Retrospective analysis (electronic and paper records) of all men referred for imaging querying penile fracture over ten years at a single centre (January 2010 - December 2020). All men with suspected PF on US and/or MRI were included. Same day MRI was performed in equivocal cases or to further define the extent of injury. Imaging findings were correlated with intraoperative findings.

Results

114 men underwent surgical exploration for PF over 10 years with a median age of 39 years (range 16-74). Pre-existing ED was reported in 9 men and 6 men reported pre-existing Peyronie’s disease. Most men had a pre-operative doppler US (92.6%, n=112) with subsequent MRI in 13 men (11.6%). Two men were surgically explored after MRI only. Table 1 summarises the strong correlation between imaging and intraoperative findings. PF was not identified on US in 8 men (7.1%). MRI upgraded equivocal US findings to PF or showed a greater extent of injury in 76.5% (n=13). All PF were identified on MRI but there was a single false positive where PF was not found on exploration. MRI may have been confounded by Peyronie’s plaque calcification. Urethral injury was identified in 24 men intraoperatively but US only identified 10 with a further 4 identified on subsequent MRI.

Conclusions

Penile US has a high sensitivity and PPV for PF when compared to the gold standard of intraoperative findings. MRI has excellent specificity for both PF and urethral injury and should be considered in equivocal cases. The combination of US and MRI is useful to avoid unnecessary surgery and can characterise complex/atypical injuries to guide choice of incision and surgical planning. Imaging should be routinely offered to all men prior to surgical exploration.

Disclosure

No
(102) Complications of the Penuma Penile Implant for Genital Enhancement
Authors: Barham D , Barnard J , Gelman J
Published: May 2023

Introduction

The Penuma penile implant (PPI) is a subcutaneous silicone implant intended to increase penile length and girth. Only one case report and one case series of four patients have been published on the complications of PPIs.

Objective

To report a single center experience treating complications of the PPI both prior to and after implant removal.

Methods

Patients with a prior history of PPI surgery treated at our center were identified between 2012 and 2022. Demographic data, implant date, complications leading to explant, postoperative course, and functional outcomes were recorded. Our protocol is to wait 6 months after explant prior to scar excision (SE)/revision should disabling capsular contraction develop.

Results

A total of 13 patients were evaluated at our institution. Median age at time of implant was 36 (26-54) years. The median duration of implant was 3 months (range 3 days-33 months). Mean follow-up was 21.6 months. The most common complication leading to explant was distal lateral protrusion of the implant at the coronal margin causing patient and partner discomfort which occurred in 8 patients. Other reasons for explant were skin erosion, infection, decreased sensation, ventral curvature, and penile shortening each occurring in 1 patient. Adverse sensation changes occurred in 2 patients after implant. Following explant 9 (69%) patients developed disabling dorsal curvature, 8 (62%) patients had penile shortening, 3 (23%) had infections, 2 (15%) had de novo sensation changes, 2 (15%) had erectile dysfunction, and 1 (8%) had right lateral curvature. Curvature occurred because of capsule contraction following explant. Of those with disabling curvature, 6 (67%) underwent scar excision (SE), 1 is awaiting scar maturation for SE, 1 more is considering SE for disabling curvature, and 1 has elected not to undergo further surgery. In patients who underwent SE, severe scarring was noted superficial to the neurovascular bundles. All patients who have undergone SE had improvement in curvature and were able to have functional erections.

Conclusions

PPI for cosmetic penile enhancement can be associated with a variety of complications leading to device removal. Subsequent to explant, capsular contraction can result in disabling curvature and penile shortening which can be managed successfully with SE.

Disclosure

No
(103) 3-Piece Inflatable Penile Implant Pump Malfunction: Management using Pump Replacement Alone
Authors: Taniguchi H , Sullivan J , Flores J , Salter C , Bernie H , Jenkins L , Mulhall J
Published: May 2023

Introduction

Expert opinion is that when an implant malfunctions after 2 years it should be replaced in its entirety, despite the fact that reservoir removal is associated with serious potential complications. Furthermore, modern reservoir construction is such that material fracture and leak is rare.

Objective

In this time we reviewed our experience with replacing only the reservoir in patients with malfunctioning 3-piece inflatable implants resulting from pump breakdown.

Methods

The study population consisted of (i) men who had had 3-piece inflatable penile implant surgery (ii) with device malfunction (iii) resulting from pump malfunction (iv) who had all other components functional (v) who underwent pump replacement alone and (vi) had ≥5 years follow-up after device repair (clinic visit, telephone call, letter). Only patients who had undergone a single prior implant operation were included. At the time of the repair, the pump was removed and replaced with a new pump, making sure that both cylinders and reservoir were filled fully intraoperatively and retained all fluid that was instilled. At the postoperative appointment, all patients were retrained in the correct means of device inflation, specially focused on avoidance of pump torqueing.

Results

88 patients had pump tubing blow-out upon delivery of the pump at a mean duration post-primary implant of 9 ± 11 (2-16) years. Mean age 62 ±14 years. All patients had either a Mentor Alpha-1 or a Coloplast Titan devices placed. Tubing disruption was present ≤1cm from pump itself in 66 (75%) or >1cm from the pump in 22 (20%) patients. 25% had a blow out of the pump-reservoir tubing, while 66 (75%) had a tear in the pump-cylinder tubing (46 frayed tubing, 20 compete transection), evenly distributed between right and left-sided tubing. With a mean follow-up of 7±2.5 years, none of the devices had failed again.

Conclusions

In patients with a malfunctioning penile implant with proven pump-only failure, replacing the pump is a viable repair option, thus, circumventing the need for reservoir placement.

Disclosure

No
(106) Concept of Enhanced Recovery Implant Care (ERIC) in Inflatable Penile Prosthesis Surgery: A Double-blind, Randomized, Controlled Trial on Clinical Outcomes and Patient Satisfaction Rate
Authors: Chung E
Published: May 2023

Introduction

ERAS (Enhanced Recovery After Surgery) is considered a standard of care intended to achieve earlier recovery and reduce stress response following surgery. While inflatable penile prosthesis (IPP) surgery is a safe and effective treatment for males with erectile dysfunction, complications such as significant postoperative pain and scrotal hematoma are not uncommon and can result in delayed IPP cycling and lower patient satisfaction rate

Objective

To evaluate the concept of ERIC (Enhanced Recovery Implant Care) on clinical outcomes and patient satisfaction rate following IPP surgery.

Methods

This prospective double-blind, randomised, controlled clinical trial received internal ethics approval and 60 males were randomised to receive “normal care” (NC) vs ERIC pathway which consisted of a strict perioperative regime of intra-operative regional nerve block and device analgesia elution, meticulous haemostatic corporotomy closure and multi-layered scrotal closure as well as postoperative 7 days of fitted scrotal support following IPP surgery. An independent third-party survey with objective measurement of pain score (visual analogue scale, VAS), analgesic requirement (conversion to opioid dose equivalence), time to IPP cycling and overall patient satisfaction rates (on a 5-point scale) were collected and compared on Day 1, 7, 14, 28 and 42 postoperatively.

Results

There was no significant difference in patient demographics between the 2 groups. No intraoperative complication was documented. Males in the ERIC group reported lower VAS scores (p<0.05), less analgesic requirement (p<0.05) and shorter time to IPP cycling (p=0.08). Twelve (40%) patients in NC had a scrotal hematoma (Clavien-Dindo grade 1) compared to 2 (7%) patients in the ERIC group on days 1 and 7 postoperative. The overall patient satisfaction rate (rated 4 or 5) was higher in the ERIC compared to NC groups (93% vs. 70%; p<0.05).

Conclusions

The ERIC pathway appears to improve clinical outcomes and postoperative recovery following IPP surgery in terms of pain score, the analgesic requirement, and time to IPP cycling, as well as the overall patient satisfaction rate.

Disclosure

No
(107) Delayed Closed-Suction Drain Removal Following Inflatable Penile Prosthesis: A Multi-Institutional Experience
Authors: Shumaker L , Zulia N , Kennedy E , Ortiz N , Beilan J , Baumgarten A
Published: May 2023

Introduction

There is a paucity of outcome data for prolonged (>48 hours) closed-suction drains following inflatable penile prosthesis (IPP) placement. Tissue dissection and corporal dilation make scrotal hematomas a potential complication within the first 72 hours following surgery. Maintaining a closed-suction drain represents a method to reduce scrotal hematoma formation and prevent sequela such as infection. However, maintaining a percutaneous tract also represents a feasible pathway for bacterial seeding of a new prosthesis. Given the severe consequences of prosthetic infection, establishing comparable outcomes for delayed drain removal is necessary.

Objective

To evaluate rates of infection, hematoma and device explantation in a multi-institutional cohort of patients undergoing IPP placement with delayed closed-suction drain removal (48-hour duration or greater) and compare observed outcomes to published outcomes in modern IPP cohorts.

Methods

Data was collected retrospectively for 209 patients undergoing virgin IPP placement with delayed closed-suction drain removal. Cases were performed by three surgeons at three high-volume centers between 01/01/2020 and 3/31/2022. R for Statistical Computing was used to generate descriptive statistics (Figure 1) and categorical data visualization (Figure 2). No quantitative statistical analysis was performed regarding infection outcomes as the low observed rate would not accommodate robust quantitative analysis.

Results

Mean drain duration was 66 hours (48 – 312, SD 23). There were 3 device infections (1.4%). Mean patient age was 64.5 years. 84 (40.2%) patients were diabetic, with a mean hemoglobin A1c of 7.2 in these patients. Both penoscrotal and infrapubic approaches were performed (95 versus 114). Reservoir location was either space of Retzius (SOR) or high submuscular (HSM) with the former being more common (164 versus 45). There were 7 (3.3%) post-operative hematomas and 6 patients (2.9%) required device revision for non-infectious causes. Mean follow up interval postoperatively was 170 days (10 – 421 days, SD 78).

Conclusions

Delayed removal of closed-suction drains after virgin IPP is safe. The outcomes for this study cohort are similar to outcomes reported in other modern virgin IPP series where closed-suction drains were not routinely employed. Prospective studies to further characterize how closed-suction drain placement influences hematoma formation, infection rates, and postoperative pain are necessary to definitively establish the role of delayed drain removal following IPP implantation.

Disclosure

No
(122) Erectile Hemodynamics Asessment In ED Patients With Self-Diagnosed Post-finasteride syndrome (PFS)
Authors: Deveci S , Sullivan J F , Tal R , Mulhall J P
Published: May 2023

Introduction

Much debate exists regarding the concept of PFS and its etiology. There exists data suggesting abnormal erectile hemodynamic alterations in this population.

Objective

This analysis was performed to define erectile hemodynamics in this population.

Methods

Patients attending the sexual medicine clinic at our institution presenting with (i) new onset ED after commencement of 5-ARI (ii) 5-ARI use specifically for hair loss (iii) with no prior ED history (iv) presenting ≥6 months after cessation of 5-ARI (v) and with at least 3 months use of 5-ARI (finasteride). All completed the IIEF EF domain questionnaire. B-mode assessment was conducted at 15MHz. Duplex ultrasound (PDDU) was conducted using a vasoactive agent-redosing schedule using trimix. On PDDU, a best quality erection (BQE) (equivalent to the best erection obtainable at home without erectogenic medication) was required for inclusion. Redosing was conducted if the patient failed to obtain a BQE up to a maximum of three doses. The criteria for normalcy on DUS included a peak systolic velocity (PSV) >30cms/s and an end-diastolic velocity (EDV) <5 cms/s.

Results

141 men were included in the analysis. Mean patient age was 31±12 (18-42) years. All had used finasteride 1mg. Median vascular risk factor (VRF) number = 1 (0,1). Median duration of 5-ARI exposure = 16 (4, 46) months. Median duration off 5-ARI at first presentation to clinic = 11 (6, 28) months. No patients had ED prior to 5-ARI use. One third developed ED only after cessation of finasteride, at a mean duration off finasteride of 6±3 months. Median IIEF EFD score at presentation = 14 (6,18). Median (range) number of injections needed for BQE sufficiently suitable for DUS measurement was 2 (1, 3). Overall, mean PSV and EDV values were 60±18cm/s and 1.5±1.5 cm/s respectively. 29% required phenylephrine reversal before discharge from clinic.

Conclusions

These data suggest that hemodynamic alterations are not present in men complaining of ED with self-diagnosed PFS.

Disclosure

No