bluuebunny/crossref_metadata_2025 huggingface dataset:
(124) Investigating the Risk Factors of Penile Arterial Insufficiency and Veno-occlusive Dysfunction In Patients with Erectile Dysfunction
Authors: Habous M , Williamson B , Binsaleh S , Muir G , Khattak A
Published: May 2023

Introduction

It was reported that a more generalized peripheral atherosclerotic process is associated with a severer penile arterial insufficiency (PAI), and this in turn was correlated well with decreased blood supply in more important arteries like the coronary and carotid arteries.

Objective

We investigated the risk factors for PAI which is a known cause of erectile dysfunction (ED

Methods

Patients who attended our urology clinic complaining of ED for more than 6 months, were prospectively enrolled in this study in one year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie’s disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile, and glycated haemoglobin (HbA1c). Penile duplex ultrasound study (PDU) was done for all patients after intra-cavernosal injection (ICI) with Alprostadil. peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured after 15 minutes. Statistical analysis was done using SPSS.

Results

A total of 440 patients were enrolled in this analysis. The mean age was 48 (23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r=-0.361, P=0.000) and higher EDV (r=0.174, P=0.001) and both correlations were highly statistically significant. Diabetics had lower PSV (r=-0.318, P=0.000) and higher EDV (r=0.139, P=0.008) which were also highly statistically significant. Hypertensive patients had lower PSV (r=-0.296, P=0.000) which was highly statistically significant. Smokers had lower PSV (r=-0.140, P=0.008) and higher EDV (r=0.178, P=0.001) which were highly statistically significant. Men with larger penises measured skin to tip, had lower EDV (r=-0.119, P=0.024) which was less significant. Interestingly there was neither significant correlation between BMI and PSV (0.16, p=0.745) nor significant correlation between testosterone and PSV (0.029, p=0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD.

Conclusions

Our study highlights key risk factors - Increased age, tobacco consumption, DM and hypertension - are factors that have a statistically significant negative impact on penile haemodynamics. Of these, tobacco consumption, good diabetic control and hypertension are potentially modifiable and should form part of any treatment plan for erectile dysfunction. Other risk factors – increased BMI, low testosterone, PD and penile size – had no statistically significant impact on penile hemodynamics. This allows for targeted advice that can be given to patients who present with this very common problem. Ultimately, good vascular health goes hand in hand with good erectile function.

Disclosure

No
(133) Ambigous Genitalia in a 22 year old woman: A Case Report of Successful Perineoplasty and Clitoroplasty
Authors: Idowu O C , Awolude O , Ifebude J E
Published: May 2023

Introduction

External genitalia are considered to be ambiguous whenever there is difficulty assigning gender to a child based on the appearance of the external genitalia. It is a common presentation of Disorders of Sexual Development (DSD).

Objective

Reported here is the case of a 22year old single undergraduate identified as female who had disorder of sexual development with ambiguous genitalia resulting from congenital adrenal hyperplasia.

Methods

Although the appearance of her genitalia in childhood could not be ascertained, she presented with inability to achieve penetrative vagina intercourse, enlarged clitoris with dissatisfaction and distress about the appearance of her genitals, poor urinary stream and terminal dribbling. On examination she had clitoromegaly with fused labia minora at the midline which formed anterior to the urethral meatus as shown in Fig 1.1. She had acne and hirsutism. Investigations done show hyperandrogenism and were suggestive of congenital adrenal hyperplasia with no salt wasting.

Results

She had successful perineoplasty and clitoroplasty with satisfactory appearance of her genitalia, she has been able to achieve penetrative vagina intercourse with satisfactory sexual function and urinary streams have improved with terminal dribbling resolved.

Conclusions

Disorders of sexual developments though rare may have significant psychosocial effects on its victims and understanding the pathology with surgical intervention as indicated in this case may be helpful to improve the quality of life of the affected persons.

Disclosure

No
(146) Rezum Water Vapor Therapy for Patients with Mild, Moderate, or Severe Lower Urinary Tract Symptoms: A Retrospective Study in a Multiethnic Population
Authors: Babar M , Loloi J , Tang K , Singh S , Ines M , Patel R D , Iqbal N , Ciatto M
Published: May 2023

Introduction

Benign prostatic hyperplasia (BPH) is a common chronic condition that is associated with the development of lower urinary tract symptoms (LUTS). Symptom severity of LUTS secondary to BPH can range from mild, moderate, to severe and can be assessed utilizing the International Prostate Symptom Score (IPSS). The Rezum System (Rezum; Boston Scientific, Marlborough, MA, USA) is a minimally invasive surgical therapy that utilizes convective radiofrequency water vapor thermal energy to ablate obstructive lobes of the prostate, resulting in cell necrosis and improvement in LUTS.

Objective

To evaluate the safety and efficacy of Rezum in patients with mild, moderate, or severe LUTS secondary to BPH.

Methods

A single office, retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017 and 2019. Patients were categorized into three cohorts based on baseline IPSS LUTS severity: mild LUTS (IPSS ≤ 7), moderate LUTS (IPSS 8-19), or severe LUTS (IPSS ≥ 20) cohorts. Outcome measures, including IPSS, quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), alpha blockers and 5-alpha reductase inhibitors usage, and adverse events (AEs) were collected and analyzed at baseline, 1-, 3-, 6-, and/or 12-months postoperatively.

Results

A total of 238 patients were included: 33 with mild LUTS, 109 with moderate LUTS, and 96 with severe LUTS. At 1-month follow-up, the moderate and severe LUTS cohorts saw significant improvements in IPSS (moderate LUTS: -3.0 [-6.0, 1.5], p<0.001; severe LUTS: -10.0 [-16.0, -5.0], p<0.001) and QoL (moderate LUTS: -1.0 [-3.0, 0.0], p<0.001; severe LUTS: -1.0 [-3.0, 0.0], p<0.001) and improvements remained durable up to 12-months (p<0.001). The mild LUTS cohort saw significant worsening in IPSS by 2.0 (0.0, 12.0) at 1-month (p=0.002) but returned to baseline at 3-months (p=0.114). However, the mild LUTS cohort experienced significant improvements in QoL by -0.5 (-3.0, 0.0) at 3-months (p=0.035) and nocturia by 0.0 (-1.0, 0.0) at 6-months (p=0.002), both of which remained durable to 12-months (p<0.05). Most AEs were transient and non-serious, with gross hematuria (66.5%) being most common. There were no significant differences in QoL point reduction, Qmax improvement, PVR reduction, and AE occurrence between the cohorts at 12-months (p>0.05). At 12-months, 80.0%, 87.5%, and 66.0% of the patients in the mild, moderate, and severe LUTS cohorts discontinued their BPH medications, respectively.

Conclusions

Rezum provides rapid and durable relief in LUTS in patients with moderate or severe LUTS and can be offered to patients with mild LUTS who have bothersome nocturia and wish to discontinue their BPH medications.

Disclosure

No
(150) Efficacy of a Novel Collagenase Clostridium Histolyticum Protocol for Peyronie’s Disease Among Prior Non-responders: A Randomized, Controlled, Single-Blinded Study
Authors: Palmer B , Anderson N , Green B , Savage J , Brearton K , Ziegelmann M , Helo S , Kohler T , Trost L
Published: May 2023

Introduction

Limited data currently exist on the role and efficacy of additional series of collagenase clostridium histolyticum (CCH) injections among Peyronie’s disease (PD) men who have previously failed a first series of injections. We have previously reported outcomes of men undergoing a more aggressive protocol for CCH injections. We therefore sought to evaluate results of men who had previously failed CCH injections to determine if they would respond to a repeat course using a more aggressive protocol.

Objective

To evaluate outcomes of a novel, aggressive protocol for CCH injections among men who had previously failed 6-8 CCH injections using a traditional approach.

Methods

A randomized, controlled trial (NCT05108558) is ongoing. All participants had previously failed to achieve ≥20% curvature improvement with 6-8 prior CCH injections. Men are randomized 3:1 to receive either CCH + traction (RestoreX) + sildenafil (treatment) up front or initial observation followed by treatment (controls). Outcomes are subsequently compared between treatment and control groups. Key measures include objective curve improvements, and standardized / non-standardized questionnaires, with assessments obtained at baseline, 6-weeks after completion of CCH (treatment arm), after the no treatment period (controls), and at 1 year.

Results

A total of 11/40 men have been randomized to date, with one having completed four series of CCH injections, three completing one series, and three completing two series. The average age of the cohort is 64.4 years, with a mean PD duration of 28.1 months. Mean baseline curvature was 82.9 degrees (composite curve). The average estimated improvement with prior CCH injections (before enrollment in the current study) was 10%. Preliminary outcomes of men who had completed one series and had a follow-up curve assessment available (n=3) demonstrated an absolute improvement of 28.3 degrees (42%). Of the one patient who completed four full series, the absolute curve improvement was 55 degrees (65%). The overall range of improvement among the four men was 20 to 55 degrees or 31 to 65%, with no patients failing to experience improvements thus far.

Conclusions

Preliminary data suggests that a repeat course of CCH using a previously described more aggressive administration protocol is effective at improving penile curvature in the majority of men. It is unclear if the improvements are due to the difference in administration protocol, or due to the repeat course of CCH alone. Given the very preliminary nature of the current results, additional data, including external validation, are warranted.

Disclosure

Yes, this is sponsored by industry/sponsor: Endo Pharmaceutical

Clarification

Industry funding only - investigator initiated and executed study
(160) An Analysis of the Mis-Diagnosis of Peyronie’s Disease (PD) In Men Referred for the Assessment of Penile Deformity
Authors: Deveci S , Taniguchi H , Torremade J , Ortega Y , Mulhall J P
Published: May 2023

Introduction

PD is diagnosed in the presence of penile deformity combined with a tunical plaque. Clinical experience shows us that some men who believe they have PD actually have congenital penile curvature (CPC), whilst others, especially those with a history of penile trauma, have anxiety about having PD but, in fact, do not.

Objective

This analysis aimed to define the mis-diagnosis rate of men referred for PD evaluation.

Methods

Study population consisted of men who (i) presented to a sexual medicine clinic for the evaluation of penile deformity (ii) and/or the presence of a tunical nodule (iii) underwent comprehensive penile examination by a sexual medicine physician with extensive experience in PD and (iv) underwent penile deformity assessment at the time of penile duplex Doppler ultrasound (PDDU). Demographic and comorbidity data were recorded. Multivariable analysis (MVA) was conducted to define predictors of the absence of PD.

Results

1942 patients met the inclusion criteria. 79% were MD referred (MDR), the remainder were self-referred (SR). Mean age of the entire cohort was 58±28 years (MDR 64±22y, SR 41±11y, p<0.01). Comorbidities: hypertension 24%, diabetes 11%, dyslipidemia 27%, chronic pelvic pain syndrome (CPPS) 6%, history of radical pelvic surgery (RPS) 24%, history of penile trauma 8%. Overall 14% of patients had no PD plaque identified on examination (MDR 12%, SR 21%). For MDR without PD, majority had CPC (9%), 3% had no deformity, while for SR only 6% had CPC, the remaining 15% had no deformity at PDDU. Results of MVA is presented in the Table.

Conclusions

Men referred to a tertiary referral center for the evaluation of PD commonly have no PD. Predictors of no PD include: diagnosis of CPPS, history of penile trauma, young age and absence of RPS.

Disclosure

No
(162) Safety and Feasibility of Platelet-Rich Plasma Injections for Peyronie’s Disease: A Randomized Double-blind Placebo-controlled Cross-over Study
Authors: Zucker I , Molina M , Muthigi A , Ledesma B , Saltzman R , Chu K , Ibrahim E , Masterson T , Ramasamy R
Published: May 2023

Introduction

Peyronie’s Disease (PD) is prevalent in approximately 7.1% of the general population. Current treatment approaches include medical therapy and surgical intervention, and intervention only occurs once the disease process has entered the chronic, stable phase. The only FDA-approved medical therapy involves use of intralesional collagenase clostridium histolyticum injection and surgical interventions include tunica albuginea plication, plaque excision without grafting, or placement of penile prothesis. Autologous platelet rich plasma (PRP) may prove to be a viable treatment for this patient population due to its ability to facilitate tissue repair and wound healing via various growth factors.

Objective

We hypothesized that PRP can be safely utilized in patients with PD, with minimal adverse events.

Methods

We reviewed data for an initial series of men recruited into an ongoing randomized double-blind placebo-controlled cross-over study at the University of Miami from April 2021 to June 2022. Patients received a total of two injections of PRP or placebo directly into the dominant plaque, separated by two weeks. Patients were observed immediately post-injection and assessed with Visual Analogue Pain Scale, and at follow-up for complications and tolerability. Patients are followed three- and six-months post-injection, of which then the patient crosses over into the other treatment / placebo arm. The patient undergoes goniometer measurement with an artificial erection, IIEF-15 and PDQ questionnaire assessment prior to crossover and at the end of the study. ClinicalTrials.gov Identifier: NCT04512287.

Results

We report data from 24 men who completed two injections for Arm 1 (PRP or placebo) and 15 men who completed two injections (PRP or placebo) after cross-over. No post-procedural minor adverse events were seen in any of the men. None of the participants reported adverse effects such as penile bruising, swelling, edema, allergy, penile fracture, or mild pain at injection site. Six men completed 6-month follow-up and no complications were reported. No worsening curvature was observed in men completing pre/post evaluations.

Conclusions

PRP appears to be a safe and feasible treatment modality in patients with PD from our limited data accumulated thus far in our ongoing randomized placebo-controlled trial with PRP for PD. We expect to report efficacy data as soon as it becomes available. Our study is the first study in the USA accruing men with PRP for PD in a clinical trial and believe that safety and efficacy data accumulated from our study will be important for patient counseling.

Disclosure

No
(176) Unconscious Attention to Sexual Stimuli: An Electroencephalography Study Regarding the Role of Neuroticism and Sexual Excitation/Inhibition
Authors: Aguiar S , Carvalho J , Carrito M , Santos I
Published: May 2023

Introduction

Past research has shown that neuroticism is a higher-order vulnerability factor in developing and maintaining emotional disorders and is related to an increased risk of sexual dysfunction. In a recent study, neuroticism was found to impact the automatic attention towards sexual stimuli, but the influence of psychosexual dimensions on such cognitive processes is not fully established.

Objective

Our aim was to study the mediating role of sexual inhibition/excitation propensity in the relationship between neuroticism and automatic attention to sexual stimuli and also to identify the neuroelectric correlates of this process.

Methods

We studied 58 individuals (Mage = 23.63; SD = 0.97), who presented either high or low neuroticism levels in the NEO-Personality Inventory-Revised (NEO PI-R). Participants also completed the Sexual Inhibition/Excitation Scales (SIS/SES) and event-related potentials (ERP) P1, P2 and N2 were recorded during a modified oddball paradigm containing romantic and sexually explicit pictures. Using parallel mediation analyses, we simultaneously tested the mediating role of sexual inhibition/excitation in the relationship between neuroticism and each ERP of interest.

Results

Findings revealed an indirect effect of neuroticism on automatic attention, via SIS1, regardless of the type of stimuli. Such indirect effect was only significant for component N2, with increased amplitudes and earlier latencies in participants with high neuroticism. Effect sizes ranged from medium to large.

Conclusions

These results can be interpreted as a sign of an enhanced emotional response elicited by the exposure to the sexual content. Results also showed that neuroticism predicts sexual inhibition due to threat of performance failure (SIS1), but does not have an effect on sexual excitation (SES) or sexual inhibition due to threat of performance consequences (SIS2). Our findings suggest that automatic attentional mechanisms are closely related to personality and sexual-related domains, and support the relevance of studying non-conscious cognitive phenomena in the context of human sexual behaviour.

Disclosure

No
(207) Risk for Priapism after Intracavernosal Injections and Selected Treatments after Index Priapism Encounters
Authors: Prebay Z , Ebbott D , Li M , Chung P
Published: May 2023

Introduction

Priapism remains a challenging consult for urologists. Proper understanding of the risk of priapism after intracavernosal injections (ICI) and management trends for patients with priapism may help urologists facing this issue.

Objective

To describe rates of priapism and patient demographics after ICI and management trends after a diagnosis of priapism using a global database.

Methods

TriNetX is a collaborative research enterprise which collects real-time data from almost 89 million patients located in 58 healthcare organizations across the globe and analyzes patient data from 20 years back to present (2002-2022). We queried TriNetX for all adult patients receiving ICI or presenting for priapism, using Common Procedural Terminology (CPT) and International Classification of Diseases-10 (ICD-10) codes. The index event was defined as usage of ICI or incidence of priapism. We performed descriptive statistics to describe rates of priapism after ICI within 3 days and between 4 and 90 days after injection and described demographic differences between patients presenting with priapism after ICI and those who did not. We evaluated treatment options for priapism at 1 week, 90 days, 1 year, and 5 years after the initial event. We also described rates of additional priapism episodes within 1 year and 5 years after index priapism encounter. Analyses were run on June 28th, 2022.

Results

There were 26104 usages of ICI and 17545 recorded instances of priapism. Of patients receiving ICI, 4% and 1.6% had priapism at 3 days and between 4 and 90 days, thus most patients presented with priapism near-immediately. Patients presenting with priapism after ICI tended to be younger (46.4 years vs 57.4 years, p<0.01) and had a disproportionate prevalence of mood disorders (20% vs 14%, p<0.01), pain disorders (16% vs 12%, p<0.01) and sickle cell disease (6% vs <1%, p<0.01). They were less likely to have comorbidities such as diabetes (14% vs 22%, p<0.01), hypertension (33% vs 40%, p<0.01) or a history of prostate cancer (13% vs 25%, p<0.01) and less likely to have taken phosphodiesterase 5 inhibitors such as sildenafil (30% vs 35%, p<0.01) or tadalafil (29% vs 38%, p<0.01) in the past. The most common treatment for priapism was irrigation and/or injection of medications (11.3% same day, Table 1). The prevalence of implants for patients experiencing priapism steadily increased throughout the various timepoints, but overall remained low.

Conclusions

Priapism remains an infrequent problem that is difficult to study given the relative rarity of presentation. By utilizing a global data set, we are to describe rates of priapism after ICI and treatments for priapism. For patients prescribed ICI, proper counseling of the risks of priapism is important to reduce damaging long term consequences if the condition does occur.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.
(230) Chronic Unpredictable Stress Impairs Corpus Cavernosum Reactivity in Mice
Authors: Garnto D , Garnto A , Wilczynski S , Crockett A , Arishe O , Dos Anjos Moraes R , Hollis F , Webb C , Priviero F
Published: May 2023

Introduction

Stress is associated with erectile dysfunction (ED), however, it is not clear whether psychological stressors affect the vasculature and the erectile tissue in a manner that could contribute to a vasculogenic erectile dysfunction. A positive correlation between hyperprolactinemia, stress and erectile dysfunction has been demonstrated, and interestingly, prolactin was shown to decrease endothelium nitric oxide and endothelium- dependent vasorelaxation in different vascular beds. In this study, we aimed to evaluate the relaxation of the corpus cavernosum of male and pudendal artery of male and female mice undergoing chronic unpredictable stress (CUS).

Objective

We aimed to test the hypothesis that vascular impairment caused by CUS leads to impaired relaxation of the pudendal artery and corpus cavernosum which may cause erectile dysfunction.

Methods

Male and female C57Bl/6 mice were submitted to 28 days of chronic unpredictable stress (CUS). The pudendal artery and corpus cavernosum were removed and mounted in a myograph to evaluate reactivity. Tissues were kept in physiological salt solution at 37°C, constantly aerated with 95%O2/5%CO2 and concentration-response curves to acetylcholine (ACh; 1 nM – 30 uM) and phenylephrine (PE; 1 nM – 30 uM) were obtained. Using non-linear regression, we obtained the maximal response (Emax) and potency (pEC50) of ACh and PE. Data are expressed as mean ± S.E.M. P<0.05 was considered statistically different.

Results

In the pudendal artery, neither the potency nor the maximal response to ACh was changed by the stress. Contraction to PE was higher in males, compared to females, and there was a trend to be further increased in stressed males. On the other hand, in the corpus cavernosum of stressed males there was a significant decrease in the maximal relaxation induced by acetylcholine (control: 88 ± 4% vs stress: 75 ± 4%, n=7 each group) as well as impaired contraction to PE (control: 1.72 ± 0.17% vs stress: 1.07 ± 0.15%, n= 7 each group). The impaired relaxation might be associated with impaired nitric oxide availability, whereas impaired contraction can be associated with a desensitization of alpha-adrenergic receptors in response to stress.

Conclusions

Our findings demonstrate that stress impairs the reactivity of the corpus cavernosum, which may contribute to the development of erectile dysfunction in stressed males.

Disclosure

No
(253) Comparative Effectiveness in Testosterone Levels and Sperm Parameters of Medical Treatments for Primary Infertility and Testicular Deficiency
Authors: Suarez M C , Narasimman M , Shah K , Ledesma B , Ramasamy R
Published: May 2023

Introduction

The goal of treatment for infertile men with testosterone deficiency is to improve intratesticular androgen levels with the aim of increasing the last step of maturation in spermatogenesis. Medical therapy for male factor infertility remains largely empiric and relies on off-label use of medications known to increase intratesticular testosterone levels, such as selective estrogen receptor modulators (clomiphene citrate and enclomiphene citrate) and gonadotropins (human chorionic gonadotropin). There is scarce data of whether the above-mentioned treatment options offer different success rates in improving testosterone levels and sperm parameters.

Objective

To compare the improvement in total testosterone, intratesticular testosterone, and sperm parameters between patients receiving medical treatment with clomiphene citrate (CC), enclomiphene citrate (ECC), or clomiphene citrate + human chorionic gonadotropin (HCG).

Methods

We conducted a retrospective study from 2018 to 2022 of men with primary infertility, testicular deficiency, and secondary hypogonadism receiving ECC, CC or CC+HCG for at least 3 months. Among the different treatment groups, we assessed baseline and follow-up total testosterone, 17-hydroxyprogesterone (17-OH), semen parameter(s), and demographics. Semen quality improvement was based on assisted reproduction eligibility according to the total motile sperm count (TMSC) value: in-vitro fertilization ( 9 million). Intratesticular testosterone upgrading was based on 17-OH level, with expected values being ≥55 ng/dL. Variables were compared using paired t-test and ANOVA.

Results

A total of 18 men received ECC, 19 received CC and 9 received CC+HCG. Mean age was 41.1±2.28 years in the ECC group, 40.62±1.17 in the CC group, and 45±2.75 in the CC+HCG group (p=0.458). Overall, the mean follow-up was 3.64 ±2.14 months (p=0.242). The 3 treatment groups exhibited a statistically significant increase in total testosterone (table 1), but only the CC and CC+HCG groups had a statistically significant improvement in the level of 17-OH (p 9 million.

Conclusions

Our study showed that ECC, CC and CC+HCG are effective treatment regimens for improving total testosterone without negatively affecting spermatogenesis. Nonetheless, their effects on intratesticular testosterone and sperm parameters varied, suggesting that choosing the best treatment option for improving sperm parameters should be an individualized patient decision.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus, Boston Scientific, Endo Pharmaceuticals and Coloplast.
(261) Response to Intralesional Collagenase Clostridium Histolyticum Therapy in Men with Peyronie’s Disease is Independent of Baseline Testosterone Levels
Authors: Schneider D , O'leary M , Amini E , Miller J , Hassas N , Nguyen J , Barham D , Yafi F
Published: May 2023

Introduction

Testosterone plays an important role in collagen metabolism, TGF-β1 expression, and wound healing, all critical factors in the pathogenesis of Peyronie’s disease (PD). While evidence is mixed, some clinical studies have suggested an association between PD and hypogonadism.

Objective

We seek to investigate whether baseline total serum testosterone (tT) influences response to intralesional collagenase clostridium histolyticum (CCh) for PD.

Methods

A retrospective review of patients undergoing CCh injections was conducted at a single institution. Only patients with available tT levels within one year of initial CCh injection were included. Curvature was assessed after in-office intracavernosal injection of vasodilatory agents or patient-provided photograph. Data was collected on baseline demographic characteristics, hypogonadal status, tT, number of CCh cycles, and pre- and post-treatment degree of curvature. Hypogonadism was defined as a tT <300ng/dL, or a documented diagnosis.

Results

A total of 36 men were included. The mean age was 58.2 years old (SD 10.4) and the mean BMI was 26.8 (SD 3.2). The mean pre-treatment tT was 459.2 ng/dL (SD 144.0), and 14 (39.9%) were hypogonadal. Of hypogonadal men, 5 (35.7%) were receiving hormonal replacement therapy, 4 on testosterone and 1 on clomiphene. Thirty (83.3%) men experienced some degree of erectile dysfunction. The mean pre-treatment curvature was 47.6° (SD 14.2) and the mean post-treatment curvature was 27.8°(SD 10.7), for a mean improvement of 19.9° (40.1%) after an average of 4 cycles (2-8) (Table 1). Baseline tT was not associated with baseline rigidity (β=-0.01; R2=0.02; p=0.41). However, hypogonadal status was significantly associated with more severe curvature, 54.6° among hypogonadal men compared to 43.2° among eugonadal men (p=0.03); however, baseline curvature and tT were not significantly associated (β=-0.03; R2=0.09; p=0.08). On linear regression analysis, tT did not significantly predict improvement in degrees (β=-0.02; R2=0.06; p=0.14; Figure 1) or percent (β=0.0; R2=0.05; p=0.18; Figure 2). Similarly, improvement in neither degrees nor percent differed significantly by hypogonadal status (p=0.14 and p=0.69, respectively). Number of cycles did significantly predict greater improvement in curvature on both univariate and multivariate analyses (β=5.7; R2=0.34; p<0.01).

Conclusions

While hypogonadism is associated with more severe curvature, neither total testosterone nor hypogonadism is associated with degree of improvement after CCh treatment. Men should be offered CCh therapy according to guidelines independent of gonadal status.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Clarus Therapeutics Antares Pharma Acerus.
(273) A Tight Tuck – More Than Meets the Eyes
Authors: Wallace C , Park D , Sapkalova V , King S
Published: May 2023

Introduction

Tucking is a common practice within the transwomen community. One study estimates that 70% of transwomen engage in this non-surgical gender affirming technique. It entails placement of the testes superiorly towards the inguinal canal and the penis inferiorly towards the rectum to conceal a male phenotype and create a female silhouette. By prolonged distortion of the normal anatomical lie of the penis and testes, several genitourinary complications should be expected to result including low sperm quality, genital pain, genitourinary tract infections, lower urinary tract symptoms, and testicular torsion. However, no formal review or survey has been conducted to better inform physicians on how to appropriately incorporate the practice of tucking into formation of a differential diagnoses.

Objective

To assess common genitourinary complications and complaints associated with the practice of tucking.

Methods

We performed a content analysis of posts on Reddit related to tucking and health complaints related to the practice. Reddit is an online forum with various sub-communities known as “subreddits” where anonymous users post and have discussions about a shared interest. In fact, there exist specific forums for the transgender community including r/asktrangender and r/MtF with 142,000 and 161,000 members respectively. A short survey was then created based on common themes of our analysis and posted to the 3 subreddits related to the transgender community with the most members.

Results

Content analysis first demonstrated distrust and displeasure in physicians’ understanding of genitourinary implications of tucking. Whether this reaction is well founded or not, it is true that there is little understanding within the medical community in this area with many physicians likely ignorant to the degree of anatomical distortion tucking entails. Analysis of common complaints revealed themes similar to those expected from review of what literature has been performed. We expect survey results to support our analysis.

Conclusions

Formal study is indicated of the genitourinary complications of tucking for physicians to adequately serve our transfemale patients.

Disclosure

No
(284) A Systematic Review of Loco-sedative Anesthesia for Penile and Scrotal Surgery
Authors: Panchendrabose K , Bal D , Chung D , Sidhom K , Pierce A , Lokeshwar S , Patel P
Published: May 2023

Introduction

The current standard of care for patients undergoing the majority of scrotal and penile procedures is to administer general or spinal anesthesia. The use of general or spinal anesthesia can lead to several complications, long wait times and is not feasible in many rural and remote areas.

Objective

The objective of this study is to perform a systematic review of the characteristics and outcomes of conscious sedation and local anesthesia for penile and scrotal urologic procedures.

Methods

A systematic search was conducted on PubMed, and Scopus databases following PRISMA criteria from inception to August 2021. Articles were included if they were prospective, randomized or non-randomized controlled trials that used local anesthetic or conscious sedation for penile or scrotal interventions. Additionally, included studies provided primary data on the use loco-sedative anesthesia and the efficacy and complications from the procedures.

Results

Nine articles with 4511 patients were included in the study. Procedures examined included vasectomies, adult circumcisions, varicocelectomies, urethrocutaneous fistula repair, microepididymal sperm aspiration and testicular sperm extraction. Of the studies that reported age, the mean patient age was 29.3 years old. The most common anesthetic and analgesic relief was the use of local anesthetic with 1% lidocaine. Only one study used conscious sedation whereas the rest used local anesthetics. However, there was significant heterogeneity in the type of local or conscious sedation method and whether there was a combination was used. 44.4% of the studies used the visual analog scale (VAS) for their primary endpoint. All the studies reported 100% successful procedures with no sedative complications.

Conclusions

Given the high efficacy rates, loco-sedative anesthesia is a promising technique for penile and scrotal urologic interventions. However, the current body of literature has limited data on a wider array of procedures. Further controlled studies examining the use of loco-sedative anesthesia for a larger variety of penile and scrotal interventions are recommended. This review also demonstrates the significant heterogeneity on how sedation may be assessed and the variety of local anesthetics that can be used to substitute for general or spinal anesthesia.

Disclosure

No
(293) Limitations in Reporting and Assessment Tools for Retrograde Ejaculation after Surgical BPH treatment: A Scoping Review
Authors: Khooblall P , Leelani N , Bole R , Lundy S , Bajic P
Published: May 2023

Introduction

Antegrade ejaculation is a fundamental aspect of sexual satisfaction for many individuals, but retrograde ejaculation (RE) occurs in up to 75 % of some surgical treatments of benign prostatic hyperplasia. Unfortunately, clinicians commonly focus only primarily on erection strength, and existing tools inadequately characterize rates and bother associated with RE after BPH treatment.

Objective

This review provides critical appraisal of existing tools used to assess RE and emphasizes the importance of preoperative counseling of this complication prior to surgical BPH treatment.

Methods

A literature review was conducted in June of 2022 using Embase, Medline, and Web of Science to identify relevant manuscripts on “men sexual health”, “men’s sexual health questionnaire (MSHQ), and “retrograde”, “dry”, or “backward” “ejaculate” or “orgasm” from 1946 to June 2022. Eligibility criteria were established by using Population, Intervention, Control, and Outcome (PICO) tool for men with BPH symptoms treated with surgical intervention and developed postoperative RE. Criteria for exclusion were manuscripts in non-English language and studies reporting rates of RE without specifying the criteria used to diagnose the condition.

Results

A literature review was conducted in June of 2022 using Embase, Medline, and Web of Science to identify relevant manuscripts on “men sexual health”, “men’s sexual health questionnaire (MSHQ), and “retrograde”, “dry”, or “backward” “ejaculate” or “orgasm” from 1946 to June 2022. Eligibility criteria were established by using Population, Intervention, Control, and Outcome (PICO) tool for men with BPH symptoms treated with surgical intervention and developed postoperative RE. Criteria for exclusion were manuscripts in non-English language and studies reporting rates of RE without specifying the criteria used to diagnose the condition.

Conclusions

Significant limitations exist in the tools presently available for the reporting of RE related to BPH treatment. With ejaculation playing a very important role in sexual satisfaction for many men, more robust and specific instruments are needed to help with the diagnosis. Through development of such tools, patients will be better counseled and satisfaction with treatments will be improved. Optimized questioning needs to take into consideration both baseline and post-treatment ejaculatory function – including granular specifics on force, volume, sensation, and level of bother rather than general questions on ejaculatory functioning measured on a very broad scale.

Disclosure

No
(300) Impact of Intranasal Testosterone versus Intramuscular Testosterone cypionate on Hematocrit of Hypogonadal Men: Data from an ongoing Phase IV, Open-label, Randomized Clinical Trial.
Authors: Diaz P , Ory J , Loloi J , Bernstein A P , Blachman-Braun R , Rivero M , Muthigi A , Ramasamy R
Published: May 2023

Introduction

The potential increase in hematocrit and subsequent risk of polycythemia has been regarded as one of the most worrisome adverse effects of testosterone therapy (TT). Recent evidence has shown that the modality of delivery and half-life of each formulation may affect the incidence of these side effects. Therefore, we hypothesized that longer-acting intramuscular testosterone would increase hematocrit to a higher degree than the shorter-acting nasal formulations that can more closely mimic normal physiology.

Objective

To compare the effects of Intranasal Testosterone (NT) and Intramuscular Testosterone (TC) on hematocrit and serum testosterone levels in testosterone deficient men over 4 months.

Methods

This Phase IV, randomized, open-label clinical trial was performed on 39 symptomatic, testosterone deficient (TD) men with at least two serum testosterone levels below 300 ng/dL drawn before 10AM. Men were randomized (1:1) to receive either nasal gel three times per day (5.5mg per nostril) and intramuscular TC (200mg) once every two weeks. The primary outcomes were changes in Hematocrit and serum T before and after four months. Secondary outcomes were changes in estradiol (E), PSA and 17-OHP. Data analysis was performed using two-sample and single-sample T tests (Microsoft Excel v.16.60).

Results

A total of 39 men with testosterone deficiency were randomized to receive either NT (n=15) or TC (n=24). The median participant age was 46 years old with a mean serum T of 237.1 ng/dL and hematocrit of 43.3%. Prevalence of participants who screened positive for OSA on STOP-BANG questionnaire for NT and TC group were 67% and 71%, respectively. Compared to their respective baselines, men in both groups saw significantly increased serum testosterone levels (p 52%) after 4 months was 0% in NT group and 4.2% in TC. Those taking TC saw increases in E (p=0.003) and decreases in 17-OHP (p<0.001) at follow-up, where NT saw no changes. Neither regimen significantly impacted PSA at follow-up.

Conclusions

Both Intranasal and Intramuscular testosterone regimens are effective in treating hypogonadal men. However, short-acting nasal T does not appear to impact hematocrit levels especially when compared to testosterone cypionate. Those who are at increased risk of developing polycythemia or want to avoid changes in their E or 17-OHP levels may benefit from short-acting T formulations.

Disclosure

Yes, this is sponsored by industry/sponsor: Acerus 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: Acerus Pharmaceuticals
(302) Changes In Hematocrit Predict More Frequent Major Adverse Cardiac Events In Men Receiving Testosterone Therapy - A Large Claims Database Analysis
Authors: Kohn T P , Ory J , Ramasamy R
Published: May 2023

Introduction

Elevated hematocrit (Hct > 52%) in men receiving testosterone therapy (TTh) has been associated with major adverse cardiac events (MACE), but it remains unclear if the degree of change from baseline Hct after starting TTh confers additional MACE risk.

Objective

The objective of this study is to assess if greater changes in Hct after initiation of TTh for men is associated with greater risk of MACE.

Methods

We compared the occurrence of MACE within 3 and 24 months of initiating TTh in men who did and did not experience an increase in Hct after TTh initiation. We queried the TriNetX Research network database, a health research network of 88 million patients, encompassing healthcare encounters and prescriptions between 2009-2021. Men without unstable angina or heart failure over age 18 were included if their Hct was tested within 1 year prior to initiating TTh and had follow up Hct within 3 and 24 months after beginning TTh. Men with and without increase in Hct after TTh were propensity matched on age, race/ethnicity, hypertension, diabetes, hyperlipidemia, prior myocardial infarction or stroke, and number of hospital/outpatient visits. MACE were defined as myocardial infarction (ICD-10: I21-22), stroke (I60-63), or death.

Results

A total of 11,561 men with an increase in Hct and an equal number of controls were included (average age 49.4 years). When compared to men who received TTh who did not have an increase in Hct, the majority of men with an increase in subsequent Hct a statistically significant increase risk of MACE (Table 1). For example, men with baseline Hct of 44-47% and saw a subsequent increase of Hct to 48-51% were twice as likely to experience MACE (Risk Ratio: 2.07, 95% Confidence Interval 1.13-2.43) when compared to men whose baseline and subsequent Hct was 44-47% after TTh. As the change in Hct from baseline becomes larger, the magnitude of the risk ratio increased.

Conclusions

While absolute Hct is associated with increased risk of MACE after initiating TTh, we demonstrate that increases in Hct from baseline are associated with dose-dependent increased risk of MACE, compared to men with minimal changes to Hct who receive TTh.

Disclosure

No
(305) Impact of Melatonin Supplementation on Testosterone Levels in U.S. Adult Men
Authors: White J , Ramasamy R , Carto C
Published: May 2023

Introduction

Among US adults, the prevalence of melatonin supplement consumption significantly increased in the last two decades across all demographic groups. Despite scant evidence, melatonin is widely used as an over-the-counter sleep aid. Because sleep disorders are associated with testosterone deficiency, we examined the associati.n between melatonin supplementation and serum testosterone levels.

Objective

Evaluate the association between melatonin supplementation and serum testosterone levels in adult males living in the United States.

Methods

The National Health and Nutrition Examination Survey (NHANES) was used to analyze interviews, physical examinations, and laboratory tests. Data from three cycles (2011-2012, 2013-2014, and 2015-2016) was combined (appended) to study the association between melatonin usage and early morning serum total testosterone (TT) levels. Selection criteria included men aged 18 and older; exclusion criteria included the reported use of testosterone, clomiphene, or anastrozole medications or supplements in the past 30 days. Additionally, participants with missing values for age, body mass index (BMI), sleep habits, or EMSTT were excluded from the analysis. Statistical analysis was performed using SPSS v.28. Continuous variables were presented as medians and interquartile ranges [25 - 75]. To determine the association between of low EMSTT (T < 300 ng/dL = low) and clinical variables, demographics characteristics, a multivariable-adjusted logistic regression analysis was performed.

Results

After selection, 7,656 participants were analyzed, of those, the median age was 47 [31 - 63] years old, the median TT level was 389.9 [289 - 513.9] ng/dL, and 27.4% of participants were found to have low TT, and 51 (0.7%) reported melatonin supplementation. Among individuals who reported melatonin intake in the past 30 days, the average intake was approximately 1 mg/day. On multivariable adjusted analysis increase age (OR = 1.019, p < 0.001), and BMI (OR = 1.133, p < 0.001) were associated with increased risk of low TT. However, we did not find an association with low testosterone among men who reported melatonin supplementation (p=0.898) even after analyzing for confounding variables.

Conclusions

These findings suggest that melatonin supplementation within the past 30 days was not associated with low TT levels in a nationally representative sample of men aged 18 and older. Further analyses are needed to highlight the dose-response relationship and examine the potential effects of exposure to supratherapeutic doses and chronic intake.

Disclosure

No
(313) Ethnic and Racial Distribution of Peyronie’s disease in a Hispanic Minority-Minority Community
Authors: Atuluru P , Masterson T
Published: May 2023

Introduction

Peyronie’s disease (PD) is a fibrotic disease of the penile corpora leading to penile curvature. PD is prevalent in up to 9% of males, but the epidemiological and demographic data of PD is not well understood. Prior studies suggest PD primarily impacts older, white, non-Hispanic males; however, this is likely due to population homogeneity in those studies. Our tertiary care center serves a unique, Hispanic minority-majority community that provides us the opportunity to assess sociodemographic and patient characteristics of PD in a heterogeneous population.

Objective

We sought to determine the sociodemographic factors as well as patient characteristics of patients with PD in our community. We hypothesize that PD is more prevalent in Hispanic males than previously reported.

Methods

We retrospectively examined a prospectively collected a database that captured all men presenting with PD from September 2018 to February 2021. At the primary visit, sociodemographic data, patient characteristics and PD disease characters were gathered. To accommodate Miami’s greater percentage of Hispanic and Black population, overall national race/ethnicity breakdowns and national PD incidence in Blacks (3-5%) and Hispanics (2-4%) was used to extrapolate what would be expected in Miami’s Hispanic minority-majority community.

Results

Our analysis included a total of 237 men who were diagnosed with Peyronie’s disease. In our clinic, 138 (58.3%) patients were Hispanic, whereas we only expected 19-36 (8-15%) to be Hispanic based on current data. Further, 26 (10.5%) were black, but we expected 10-17 (4-7%). Sociodemographic details, primary clinical characteristics and expected demographics of PD in Miami are outlined in Table 1.

Conclusions

There is no consensus about the prevalence and demographic distribution of Peyronie’s disease. However, in our diverse community, we showed that a greater number of blacks and Hispanics than expected presented with Pyronine’s disease. This demonstrates that PD is impacting more than the previously reported non-Hispanic, white males. To reduce under-diagnosis and under-treatment, more effort should be made by clinicians to investigate, identify, and properly treat PD in minority communities.

Disclosure

No