bluuebunny/crossref_metadata_2025 huggingface dataset:
(183) MACROPHAGE-DERIVED TLR9 ACTIVATION ON INFLAMMATION, VASCULAR AND ERECTILE DYSFUNCTION: PERSPECTIVES FOR TREATING COMPLICATIONS ASSOCIATED WITH OBESITY AND DIABETES
Authors: Tomazini Goncalves T , Vieira Dos Santos C , Rodrigues Dos Passos R , Dos Anjos Moraes R , Atube K , S Carneiro F , Clinton Webb R , Michael Gower R , Priviero F
Published: December 2024

Introduction

Obesity represents a significant risk factor for various ailments like type 2 diabetes and cardiovascular conditions, alongside complications such as sexual dysfunction, which is linked to inflammation even in the absence of cardiovascular problems. Recently our group described that inhibiting TNF-α production in macrophage-specific-TLR9-mutant mice subjected to a high-fat diet prevented sexual dysfunction, underscoring the involvement of macrophage-derived TLR9 activation on the etiology of obesity-induced ED. The augmented adipose tissue levels in obesity result in increased macrophage levels, indicating that modulation of the inflammatory response of these macrophages could serve as an alternative therapeutic approach for sexual dysfunction.

Objective

This investigation tested the hypothesis that TLR9 activation through the agonist ODN2395 will increase the pro-inflammatory cytokine profile in macrophages, and in turn, these cytokines negatively alter vascular reactivity and corpus cavernosum functionality in mice.

Methods

The cytokine profile secreted by macrophages was evaluated by culturing mouse bone marrow-derived macrophages (BMDM) incubated with 1uM of ODN2395. After 24 hours of incubation, the supernatant was collected for Elisa analysis. To address vascular and cavernosal reactivity, the pudendal artery and corpus cavernosum were harvested from C57BL/6 J mice and incubated with ODN2395, in the presence or the absence of BMDM. After 24 hours of incubation, dose–response curves were generated for acetylcholine and phenylephrine.

Results

Stimulation of BMDM with ODN2395 led to a dose-dependent increase in TNF-α, IL-6 and IL-10, with the highest concentration (1uM) elevating the expression of inflammatory proteins derived from macrophages. In the pudendal artery, there was an enhancement in the maximal contractile response to phenylephrine in the presence of ODN2395 (VHC 8.114 +/- 0.71 vs ODN 12.515 +/-1.228; Mφ 10.113 +/- 0.674 vs Mφ + ODN 13.983 +/- 0.916), while no impact was observed on vascular relaxation. Within the corpus cavernosum, there was a tendency towards an increased maximal contractile response to phenylephrine following incubation with ODN2395, yet no effect was noted on acetylcholine-induced relaxation. Incubation with BMDM did not affect pudendal artery or cavernosal reactivity.

Conclusions

These findings indicate that macrophage-derived TLR9 activation by ODN2395 induces cytokine release from macrophages, however, vascular and cavernosal reactivity were impaired by ODN2395 independent of macrophages, suggesting that tissue activation of TLR9 may also play a role in the pathophysiology of ED.

Disclosure

No.
(193) HOW MUCH OF THE GENITAL AREA CAN PEOPLE ACTUALLY SEE DIRECTLY WITH THEIR OWN EYES? AN ASSESSMENT OF GENITAL VISUAL FIELDS IMPORTANT FOR CISGENDER AND TRANSGENDER PEOPLE
Authors: Lin J , Dadashian E , Sandhu S , Mallavarapu S , Smith S , Garcia M
Published: December 2024

Introduction

The genitals are an area which can be predisposed to the development of a variety of lesions. Many conditions such as infections, genital pain and wound care require patients to assess their genitalia. Urologic, Gynaecologic, and other surgeons who operate on the genital area, as well as Primary Care Physicians assume that patients can see this area clearly to monitor this area for changes. However, no literature to date assesses how much of the genital area is commonly visible.

Objective

We aimed to: 1) Query both individuals with natal birth anatomy and transgender individuals post-gender-affirming surgery the extent of genital visibility on their own bodies without the aid of a mirror or camera, and: 2) Query whether patient age and BMI predict visibility in genital sub-fields.

Methods

195 individuals completed an anonymous survey (82 cisgender women; 89 cisgender men; and 12 transgender women; 12 transgender men) for this study. No subjects had visual or physical deficits. Each was shown an anatomic illustration with genital anatomy subdivided into various subfields (Fig. 1a, b). Subjects identified each field they are able to see with their own eyes, on their body, without the aid of a camera or mirror. Age, and BMI were recorded. Logistic regression was performed for visibility based upon age and BMI.

Results

Average visibility decreased more posteriorly on the visual field for all genders. A majority of men were able to see to the level of their scrotum, and visibility precipitously decreased posterior to the clitoris for women. For cisgender women, 44-91% could not see their vulva below their clitoris. For cisgender men, 23-82% could not see below their scrotum. With increasing BMI, visibility significantly decreased starting at the penile glans for men. Interestingly, BMI was not a significant predictor of field-visibility for women (Fig. 1c, d).

Conclusions

Visibility of the genital area is limited posterior to the clitoris among women and posterior to the lower half of the scrotum among men respectively. BMI is only noted to be significant in cisgender men. This is the first study to describe how much of the genital area is directly visible to patients.

Disclosure

No.
(204) INITIATING HIGH-DOSE ORAL TESTOSTERONE UNDECANOATE THERAPY IN HYPOGONADAL MEN: SAFETY, EFFICACY, AND PATIENT SATISFACTION
Authors: Vo J , Yoon G , Sun AY
Published: December 2024

Introduction

Hypogonadism in men is commonly treated with testosterone replacement therapy. Kyzatrex (Marius Pharmaceuticals), a novel oral testosterone undecanoate (TU) formulation, is conventionally initiated at a dose of 200 mg BID. However, many patients attain greater symptomatic benefit at higher doses. In our practice we often initiate therapy at a starting dose of 400 mg BID. This retrospective chart review examines the outcomes of initiating therapy at 400 mg BID.

Objective

Retrospectively report the safety, efficacy, patient satisfaction, and adherence of starting hypogonadal men on oral TU at the maximum available dose of 400 mg BID.

Methods

This retrospective, single-center chart review included hypogonadal men treated with oral TU at 400 mg BID from August 2023 to April 2024. Medical records were reviewed for baseline and follow-up levels of serum total testosterone (TT), sex hormone binding globin (SHBG), calculated free testosterone (fT), Estradiol, Hematocrit (Hct), follicle stimulating hormone (FSH), and luteinizing hormone (LH). Satisfaction was subjectively recorded in the medical record and adherence was measured by prescription refill records.

Results

A total of 27 patients met the inclusion criteria and had complete data. At a mean follow up time of 6 months, patients demonstrated a significant increase in TT (263 to 798 ng/dL), drop in SHBG (32.4 to 17.83 nmol/L), and increase in calculated fT (7.24 to 26.74 ng/dL). FSH and LH, while lower, were maintained at non-zero levels (FSH from 5.7 to 2.9 mIU/mL and LH from 3.3 to 1.9 mIU/mL). Estradiol modestly increased (20.5 to 24.7 pg/mL) while hematocrit did not significantly increase (44.9% to 47.4%). No patients reported testicular atrophy or were initiated on aromatase inhibitors. One patient had a hematocrit rise above 52% (53.2%) and was reduced to 300 mg BID. Patient reported side effects were rare with 2 patients (7.4%) reporting transient GI upset. Subjective patient satisfaction was high, with 26/27 (96%) of patients reporting improvement in symptoms and continuing on therapy. One patient opted to convert to testosterone cypionate injections instead.

Conclusions

Initiating oral TU therapy with Kyzatrex at 400 mg BID is safe and effective in achieving therapeutic serum testosterone levels. The high dose was well-tolerated and resulted in substantial symptom improvement, high patient satisfaction, and adherence. These findings support considering a higher starting dose for hypogonadal men considering oral TU therapy.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author serves as consultant for Marius Pharmaceuticals, Boston Scientific, Endo Pharmaceuticals.
(207) THE LANDSCAPE OF TESTOSTERONE REPLACEMENT THERAPY RESEARCH: A BIBLIOMETRIC AND PUBLIC ATTENTION ANALYSIS
Authors: Manafi E , Furtado T , Mills N , Eleswarapu S , Mills J , Andino J
Published: December 2024

Introduction

Testosterone Replacement Therapy (TRT) is a pivotal treatment for men with hypogonadism, aiming to alleviate symptoms of testosterone deficiency. Given the debates over TRT’s safety, particularly concerning prostate cancer and cardiovascular risks, it is crucial to understand the most influential research at both the academic setting as well as what lay audiences are being exposed to.

Objective

This bibliometric analysis aims to identify and analyze the most cited and impactful literature on TRT using two distinct metrics: Web of Science (WoS) citations and Altmetric Attention Scores (AAS), a metric that captures the online visibility of academic work.

Methods

A comprehensive literature search was performed using WoS and Altmetric Explorer with the keyword "testosterone replacement therapy." Two urology researchers screened the top 1000 papers from both databases to identify the top 100 relevant papers. Data extraction included citations, authorship, publication journals, language, study design, country, year of publication, and specific TRT topics. Altmetric scores were calculated based on a weighted algorithm considering various types of attention, such as news and social media mentions.

Results

From WoS, the highest cited paper was “The Decline of Androgen Levels in Elderly Men and its Clinical and Therapeutic Implications” (Kaufman and Vermeulen, 2005), with 786 citations. The median and mean citations for the top 100 papers were 145.5 and 195.2, respectively. The most frequent journal was the Journal of Clinical Endocrinology & Metabolism (JCEM), contributing 17 papers and 4350 citations. Most papers were in English and affiliated with institutions in the United States (47%), followed by Europe (29%). Studies focused on treatment dominated (61%), with evaluation (34%) and comorbidities (5%) following. From Altmetric Explorer, the median and mean Dimension citations were 52 and 94.96, respectively. The most frequent journal was also JCEM, and all papers were in English, primarily from the United States. The paper “Effects of Testosterone Treatment in Older Men” by Synder et al. (2016) possessed the highest Altmetric Score of 1691, with 660 Dimension citations. The most recent top paper, “Cardiovascular Safety of Testosterone-Replacement Therapy” (Lincoff et al., 2023), ranked second with Altmetric Score of 1217 and 61 Dimension citations.

Conclusions

While WoS citations reveal the historical foundations and established research trends for evaluation and management of testosterone deficiency, Altmetric scores offer insights into current public and academic interest, particularly around cardiovascular concerns. This dual bibliometric approach provides a detailed understanding of influential TRT literature which shaped its history and current clinical concerns across specialties – from urology to endocrinology and primary care.

Disclosure

No.
(208) SOCIAL MEDIA, BODY DYSMORPHIA AND RESISTANCE TRAINING: THE EMERGING WAVE OF ANABOLIC ANDROGENIC STEROIDS IN MEN
Authors: Guillen A , Bonakdarhashemi M , Pinkhasov A , Helo S , Kohler T , Ziegelmann M
Published: December 2024

Introduction

Resistance training by recreational sportspeople in fitness settings has become increasingly popular worldwide, moreover an increasing landscape of social media (SM) influencers in bodybuilding have arisen since 2021, specially on short-duration videos (clips). Some Image enhancer drug users, including anabolic androgenic steroids (AAS) are known to mistrust medical health professionals and seek out information and advice from online sources.

Objective

we aimed to quantitatively assess the quality of social media videos as an information source for AAS usage in the general population.

Methods

A search was performed on the most popular short-clips social media platforms in the US (TikTok, YouTube) with the most searched terms for AAS. The first 50 results with any search term listed by relevance were selected in each platform. Video features (views, likes, subscribers) and video sources were collected. Each video included in the study was assessed using DISCERN score to quantify the source quality.

Results

A total of 100 videos were included and analyzed. Most videos (84%) were from non-health professionals (influencers/clip source/podcasts), only 7% of the videos came from a health educator/physician. Most videos were rated as “very poor” (85%) and “poor” (7%) According to the DISCERN classification, there was a statistically significant difference (p < 0.001) by both content creator type, and platform with the highest scores among physicians [37 (33-41)] and YouTube [19(17.7-30.2]. [Fig].

Conclusions

Image-centric social media use is positively associated with the use of AAS. Despite the increasing number of information, the overall quality was poor. The misleading, inaccurate and incomplete information may pose a health risk to the viewers. Further efforts in health policies are strongly encouraged to assess this problem.

Disclosure

No.
(209) TIKTOK FOR LOW T: THE CURRENT LANDSCAPE OF TESTOSTERONE REPLACEMENT THERAPY MISINFORMATION AND SUPPLEMENTATION ON A POPULAR VIDEO PLATFORM
Authors: Cheng L , Huang S , Hwang K
Published: December 2024

Introduction

Due to challenges diagnosing young men with “low T” secondary to non-specific presenting symptoms, patients have turned towards self-managed forms of treatment obtained from non-medical resources like TikTok without proper risk of future side-effects.

Objective

Understand the current landscape of symptomatic hypogonadism (i.e., “low T”) content and treatment options on TikTok, the fast-growing social media platform in popularity.

Methods

Using a proprietary TikTok application program interface (API) program, we queried the most-viewed TRT-related videos based on associated hashtag created from October 2022 – 2023. Videos in a language other than English, lacking textual or verbal content, or deemed unrelated to TRT were excluded. Included videos were subsequently analyzed by two independent reviewers based on the AUA Testosterone Deficiency Guidelines (AUA-TDG).

Results

Of 562 videos, 50 videos by 22 unique creators met inclusion criteria; since their creation, these videos garnered more than 15 million views, almost 1 million likes, and 35 K shares. While 36% of these videos mentioned TRT would improve erectile function, lean body mass, and/or depressive symptoms (AUA-TDG 14,) only four mentioned inconclusive evidence around TRT improving cognitive function (AUA-TDG 15) or encouraging lifestyle modification prior to starting TRT (AUA-TDG 21). No videos analyzed mentioned the long-term impact of exogenous testosterone on future fertility (AUA-TDG 16). Of the 22 unique creators, only one was an MD trained in family medicine. Most videos (72%, n = 36) were made by companies advertising their supplement.

Conclusions

Patients are increasingly turning towards non-medical institutions for low T information and supplementation. By the time patients seek medical care, it may be due to improperly advised negative side effects. Given the lack of educational, non-commercial videos about TRT benefits and risks on popular content platforms like TikTok, we urge physicians to actively engage in creating accurate and holistic content to reach patients currently consuming healthcare disinformation.

Disclosure

No.
(212) INVESTIGATING THE ROLE OF ALCAM AS A GENE OF INTEREST IN ERECTILE DYSFUNCTION
Authors: Christensen B , Pastuszak A , Hotaling J , Wessells H
Published: December 2024

Introduction

Erectile Dysfunction (ED) is a common and psychologically damaging condition, impacting 20% of all men and 33% of men over age 50, increasing at 10% per additional decade of age, and costing billions of dollars per year to treat. Since the introduction of PDE5 inhibitors (PDE5i) in 1998, no novel therapies for ED have been introduced, despite substantial research to understand ED molecular mechanisms. Identification of genes associated with ED would provide a deeper understanding of underlying mechanisms and could provide targets for additional therapies. We previously identified Activated Leukocyte Cell Adhesion Molecule (ALCAM) as a candidate ED gene in men with diabetes. In order to understand the potential role of ALCAM in ED development, we have created lentiviral gRNA vectors for the up- and down-regulation of ALCAM in an in vitro setting. Subsequent to up- and down-regulation of ALCAM, we will perform PCR in order to identify changes in down-stream regulation of genes and pathways that may be implicated in ED progression.

Objective

To determine the down-stream influence of ALCAM regulation on genes and pathways that may be implicated in ED progression.

Methods

For down-regulation of ALCAM, gRNAs were delivered to fibroblasts with a nuclease deficient (d) dCas9-KRAB system adapted from Streptococcus pyogenes. For upregulation, gRNAs were delivered to fibroblasts expressing the dCas9-VPR system adapted from Streptococcus pyogenes. Gene regulation via these systems was assessed using qRT-PCR. RNA sequencing and analysis will be performed by the High-Throughput Genomics and Bioinformatic Analysis core at the University of Utah.

Results

Final values for vector efficiency for up- and down-regulation of ALCAM are pending. Final vectors used will be chosen from four potential vectors each for up- and down-regulation. RNA sequencing will be performed pending final modification of cells with chosen vectors, though results from similar studies suggest that differential gene expression will range from 5,000-10,000 differentially regulated genes which will then be evaluated with pathway analysis.

Conclusions

Previous studies by our group have identified ALCAM as a potential gene of interest in the regulation of ED. Analysis of down-stream regulation of genes and pathways implicated in ED progression following regulation of ALCAM will shed additional light on the potential role of ALCAM in ED pathogenesis.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Paterna, Contraline.
(213) MICROSURGICAL DEVELOPMENT IN FRESH CADAVER - A NEW ERA FOR SURGICAL LEARNING
Authors: Campos LR , Oliveira KM , Savio LF , Kulumbu KM , Campos ME , Reis AB
Published: December 2024

Introduction

Microsurgical skills are indispensable for good patient outcomes and a successful surgeon career in male reproductive medicine. The development of these surgical skills is a long hard-earned process with hours of practice and dedication. The learning curve in acquiring microsurgical skills defines the need for training outside the operating room and training models are becoming a crucial step in the progress of the apprentice towards performing live operations. Several surgical simulation techniques are available offering different degrees of realism. One of these techniques is based on learning through fresh cadaver models providing visual and tactile learning closer to real-life anatomy. In this fresh frozenncadaver model, following our preservation protocol, the viability of all the structures of the male reproductive system allowed for microsurgery training with vasovasostomy and other local surgical treatments, with the appearance of a conventional operating room with a genuine patient.

Objective

Describe the most realistic and innovative simulation model of these applicable educational tools for urological microsurgery using a fresh frozen cadaver.

Methods

Microsurgical training was performed with 3 microsurgically qualified urologists and 3 trainees in a fresh frozen cadaver. A step-by-step of vasovasostomy surgery and other procedures were performed in the simulation model, from the physical examination to the last stitch in the skin.

Results

All the reproductive system structures in the fresh frozen cadaver were presented in the same way as in a live patient (Fig. A and B). The texture, the consistency of the anatomic tissues and even the coloring were preserved, enabling urologists in training to perform vasectomy reversals on the model, realistically simulating conventional surgery (Fig. C and D).

Conclusions

The training of vasectomy reversal on the fresh frozen cadaver, stored at low temperatures and treated with cryopreservatives and antimicrobials provides more realistic learning. The preservation of the cadaver gives it a great physical similarity to a live patient. It also allows the surgeon in training to maintain all the surgery times, from the skin incision to the final suture. A new tool has emerged with strong real-life characteristics for training urologists in microsurgery.

Disclosure

No.
(228) PARTNER SATISFACTION AFTER PENILE PROSTHESIS PLACEMENT IN PATIENTS WITH ERECTILE DYSFUNCTION
Authors: Dumbrava M , Guillen A , Pinkhasov A , Ziegelmann M , Kohler T , Helo S
Published: December 2024

Introduction

Penile prosthesis (PP) implantation is associated with high patient satisfaction and improved sexual quality of life in medically refractory erectile dysfunction (ED). Despite the current surgical advances and patients’ satisfactions after PP implantation, there has been paucity of data on reported partner satisfaction. We aimed to evaluate changes in partner satisfaction after PP placement.

Objective

We aimed to evaluate changes in partner satisfaction after PP placement.

Methods

We initiated a registry of patients undergoing surgery for placement of a PP. After consent, Perioperative study assessments and follow-ups were conducted. After surgery, patients were directed to fulfill a survey at 6 months and 12 months. Patients who fulfilled both items were included in the analysis.

Results

A total of 304 patients had a PP placement, of these 101 completed the survey. At 6 months, 62 patients (61.4%) reported a moderate to high partner’ satisfaction, and this positive response was sustained at 12-months (82.3%). 73.3% of partner’s reported no-pain after 6 months and this increased to 79.7% after 12 months. 67.3% of partners stated they would recommend the procedure to a friend or family at 6-months. This increased significantly to 84.8% at 12-months (p = 0.012).

Conclusions

Penile prosthesis placement is associated with high partner satisfaction rates, with a sustained positive perception over time when comparing 6 and 12-month follow-up outcomes. Further study is warranted to assess partner satisfaction after penile prosthesis implantation.

Disclosure

Yes, this is sponsored by industry/sponsor: COLOPLAST.

Clarification: Industry funding only - investigator initiated and executed study.
(230) EXPLORING HOW BMI SHAPES THE SUCCESS OF INFLATABLE PENILE PROSTHESIS SURGERY: MULTI-CENTER STUDY INSIGHTS
Authors: A Moukhtar Hammad M , Gross MS , Miller J , Abou Chawareb E , Andrianne R , Burnett AL , Amini E , Gross K , Hatzichristodoulou G , Lentz A , Osmonov D , Modgil V , Perito P , Hotaling JM , Park SH , Pearce I , Sadeghi-Nejad H , Sempels M , Suarez-Sarmiento Jr. A , Van Renterghem K , Warner JN , Ziegelmann M , Hsieh TC , Azad B , Karthikeyan H , Jenkins L , Jones J , Simhan J , Yafi FA ,   on behalf of the PUMP (Prosthetic Urology Multi-institutional Partnership) collaborators, Barham DW
Published: December 2024

Introduction

Obesity, defined as an elevated Body Mass Index (BMI) >30, is a prevalent public health concern with far-reaching implications for various medical procedures and outcomes. In the context of inflatable penile prosthesis placement (IPP), where patient well-being and surgical success are of paramount importance, the impact of obesity on postoperative and intraoperative complications warrants thorough investigation.

Objective

We aimed to investigate the impact of BMI on both postoperative and intraoperative complications in an international, multi-institutional cohort of patients who underwent IPP placement.

Methods

We performed a retrospective chart review of 4,398 cases. These cases were divided into two distinct groups based on BMI: less than 30 (n = 2,260) and greater than or equal to 30 (n = 2,138). The study assessed various surgical factors as well as complications, including overall complications, corporal scarring, incontinence, intraoperative complications, proximal perforation, distal perforation, proximal crossover, distal crossover, and urethral injury.

Results

Our analysis revealed that there were no statistically significant differences in intraoperative or postoperative complications between the two BMI categories. Notably, proximal corporal measurement was significantly higher for >30 BMI group with 1858 (86.9%) compared to 1919 (84.9%) for <30 BMI group, (p = < 0.001). The incidence rates for overall complications (30.2% vs. 28.7%; p = 0.164), corporal scarring (18.2% vs. 16.7%; p = 0.36), incontinence (3.53% vs. 3.13%; p = 0.076), intraoperative complications (1.94% vs. 1.68%; p = 0.253), and specific complications all exhibited no significant differences. Similarly, post-operative complications, including both non-infectious (6.99% vs. 6.22%; p = 0.215) and infectious (2.61% vs. 1.87%; p = 0.165) complications, did not significantly vary between BMI categories.

Conclusions

Our findings indicate that BMI does not exert a statistically significant influence on postoperative and intraoperative complications in the context of high-volume prosthetic urology. In the absence of any other differences between patients of differing BMIs, the IPP industry may need to consider device specific alterations with pump tubing length in obese patients.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus.
(232) AGGRESSIVE REHABILITATION POST-IPP EXCHANGE: WE BLEW A GASKET
Authors: Calopedos R , Suarez-Sarmiento A , Perito P
Published: December 2024

Introduction

In our center, the majority of men undergoing virgin IPP are engaging in sexual activity from 14-21 days post-operatively. Our standard protocol in these patients is to leave cylinders completely deflated post-operatively without compressive dressing or foley catheter. A 10Fr Jackson Pratt closed suction drain is left for 48-72 hours. At 10-14 days patients are taught to cycle their device. In November 2023, we implemented an accelerated rehab to coitus algorithm for patients undergoing simple device exchanges as well. We interrogated the effect of this protocol change in IPP exchanges over a 6-month period.

Objective

To interrogate an accelerated post-IPP rehab protocol in simple exchange cases.

Methods

This is a retrospective review of virgin IPP insertions and exchange cases that occurred between November 2023 and May 2024. Inclusion criteria were uninfected revision cases for existing device malfunction for which all components were exchanged. In the month of November, post-op protocols were identical for virgin and exchange cases, except that two closed-suction drains were used in the latter. Data on post-operative course, complications and time to sexual activity were collected. Of note, post-exchange rehabilitation protocol was modified in December 2023. Following identification of 2 complications, all exchange cases were advised to leave device completely deflated for 6 weeks.

Results

In this 6-month period, there were 156 virgin IPP insertions. Of these men, 85% had engaged in sexual activity from 14-21 days post-operatively. All 156 remain without complication until the end of June 2024. There were 40 device exchanges in this period, all of which were successfully exchanged via infrapubic incision to Coloplast Titan IPP irrespective of the primary surgical approach or device. 6 exchanges occurred in November 2023 when the accelerated rehabilitation protocol was instituted. Of these 6 cases, 2 (33%) developed proximal cylinder herniation through the corporotomy site within 2 weeks of initiating sexual activity. This was the first exchange for both men. Neither patient, aged 58 and 70 years, have medical conditions that would impair normal healing. For the subsequent 34 exchanges, who did not activate their IPP for 6 weeks, there were no cylinder herniations. All 34 men were able to successfully cycle their device at 6 weeks without de-novo deformity.

Conclusions

While an accelerated rehabilitation protocol is safe for virgin cases, we observe that a longer duration of time is required for healing following non-virgin cases. Even in the absence of systemic factors or localised infection, the corporal tunica appears to behave differently following initial intervention and requires longer for corporal integrity to re-establish.

Disclosure

No.
(251) WHICH PATIENTS CHOOSE SHOCKWAVE THERAPY? AN ANALYSIS OF PATIENT DIRECTED UTILIZATION OF LISWT AT AN ACADEMIC INSTITUTION
Authors: Hartman-Kenzler J , Griffin S , Mishra A , Berg W
Published: December 2024

Introduction

Low-intensity shockwave therapy (LiSWT) is an increasingly popular treatment for mild to moderate erectile dysfunction (ED). While considered investigational, a wide range of patients are progressively seeking and obtaining LiSWT in a variety of settings overseen by a wide range of providers in various medical and non-medical settings.

Objective

Assess which patients are more likely to elect for LiSWT when administered and overseen by fellowship trained sexual medicine providers in an academic medical setting.

Methods

Retrospective review of consecutive patients suspected of having arterial insufficiency predominant ED presenting for diagnostic Duplex Doppler ultrasound of the penis with intention to undergo LiSWT. Patient demographics, comorbidities, baseline, in-treatment, and post treatment sexual health inventory for men (SHIM) score, prior ED treatments, and insurance status was collected. Patients who elected to undergo LiSWT were compared to those who did not. Patients were specifically counseled on expected outcomes based on prior published efficacy data for baseline SHIM score and ED severity based on peak systolic velocity. All patients who utilized LiSWT underwent a standard protocol using the Storz Duolith SD1 with 6 consecutive weekly sessions of 3,000 shocks per session at 0.25 mJ/mm2 at 6 Hz divided between the penile shaft and crura.

Results

100 consecutive patients with vasculogenic ED received a diagnostic Duplex Doppler ultrasound in the office. Of these patients, 22 elected to undergo LiSWT. Patients who elected to have LiSWT were older compared those who did not (58 versus 52 years old, p < 0.05). There was no statistically significant difference in ethnicity, baseline SHIM score, maximum arterial blood flow on doppler US, or insurance type/status. The most commonly cited barrier to pursuing treatment was cost compared to expected outcomes. Baseline mean PSV in the LiSWT cohort was 37.5 cm/s versus 42.9 cm/s in the non LiSWT group. 100% of patients in either group had prior PDE5i exposure.

Conclusions

In an academic practice with fellowship trained sexual medicine urologists, there does not appear to any significant differences patients who decide to undergo LiSWT. Many patients choose to pursue LiSWT despite low normal PSV or mild arterial insufficiency ED. Despite extensive counseling, most patients appear eager for non-invasive treatment alternatives to PDE5i, even with a lack of definitive evidence in efficacy. The biggest barrier to treatment remains cost for many patients.

Disclosure

No.
(253) REGENERATIVE THERAPIES FOR ERECTILE DYSFUNCTION: A SYSTEMATIC REVIEW, BAYESIAN NETWORK META-ANALYSIS, AND META-REGRESSION
Authors: Hinojosa-Gonzalez D , Saffati G , Orozco Rendon D , La T , Kronstedt S , Muthigi A , Khera M
Published: December 2024

Introduction

Current guidelines advocate a shared decision-making process approach to erectile dysfunction (ED) management. There is growing interest in regenerative therapies such as stem cell therapy (SCT), platelet-rich plasma (PRP) injections, and low-intensity shockwave therapy (LiSWT) for ED. However, comparative data on the efficacy of these modalities are limited.

Objective

This systematic review and network meta-analysis aims to compare SCT, PRP injections, and LiSWT for managing ED and quantify their impact on the International Index of Erectile Function (IIEF).

Methods

In January 2024, a systematic search of online databases was performed to identify randomized clinical trials related to SCT, PRP and LiSWT for ED. Eligible articles reported outcomes using the IIEF score. Data was inputted into Review Manager 5.4 for pairwise meta-analysis. Data was then used to build a network in R Studio. These networks were used to model 200,000 Markov Chains via MonteCarlo sampling. The results are expressed as mean difference (MD) with 95% credible intervals (CrI). Meta-regression was used to determine coefficient of change and adjust for PDE5is use.

Results

A total of 17 studies involving 1,020 patients were analyzed. PRP with LiSWT led to the greatest increase in IIEF at a MD vs control of 8.2 IIEF [95% CrI 3.8, 13.0], followed by LiSWT alone with a MD vs control of 3.4 IIEF [95% CrI 2.1, 4.9], these findings are summarized in Fig. 1A. When stratifying interventions by dose, PRP with LiSWT led to the greatest increase in IIEF at a MD vs control of 10.0 IIEF [95% CrI 5.0, 16.0], followed by LiSWT 0.15 mJ/mm2 MD vs control of 5.7 IIEF [95% CrI 2.9, 8.6]. SCT showed no significant difference in IIEF scores, these findings are summarized in Fig. 1B. Meta-regression adjusting for the administration of PDE5 inhibitors yielded non-significant results.

Conclusions

Our findings underscored the effectiveness of LiSWT, PRP, and their combination as promising interventions for ED, with limited efficacy for SCT at this time.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast, Halozyme Investor: Sprout.
(264) A SYSTEMATIC REVIEW OF SEXUAL HEALTH OUTCOMES THROUGHOUT THE LIFE COURSE OF INDIVIDUALS WITH SPINA BIFIDA
Authors: Kohli P , Do C , Au M , Lavoie C , Soohoo M , Olais J , Vasquez E
Published: December 2024

Introduction

Spina bifida (SB) is a congenital neural tube defect which can lead to various downstream neurological impairments including sexual function and fertility. As modern medicine has led to longer lifespans, existing literature has established that sexual health related information and outcomes are imperative in the SB population, yet this topic remains largely understudied. The primary aim of this study is to systematically review sexual health-related outcomes regarding sexual activity, sexual education, and sexual dysfunction in SB patients. This study will allow us to identify the barriers that exist for SB patients regarding their sexual health and function.

Objective

Our objective was to identify sexual health outcomes throughout the life course of Spina Bifida patients.

Methods

A systematic review was conducted following the PRISMA guidelines. We conducted a systematic search search of PubMed, Scopus, and Cochrane Central databases using key terms for spina bifida, sexual health and function, and age. Three individuals independently reviewed articles for eligibility. Studies that did not contain quantitative results for sexual activity, sexual function, or sex education were excluded.

Results

In our final review, 22 studies met the inclusion criteria including 1984 patients, (females = 981, males = 1022). Ages ranged from 12-73. Females were mentioned in 16/22 publications. Mean age for first sexual intercourse ranged from 13.2–35.5 across studies which assessed this metric. 42.1% of patients engaged in solo or partnered activity. 33.8% of male patients experienced erectile dysfunction. 58% and 48% of patients experienced urinary or fecal incontinence, respectively. 5 studies assessed desire in male patients, all found that SB male patients have similar desire to age-match controls. 2 studies assessed desire in female patients. 7 manuscripts cited similar themes regarding the need for increased spina bifida specific sexual education resources.

Conclusions

Current literature, though limited, shows that individuals with spina bifida often do not receive adequate levels of sex education during adolescence. Despite this, many adults with spina bifida have relationships and engage in sexual activity. Sexual health outcomes are largely affected by sexual dysfunction and incontinence, while desire remains similar to their non SB-counterparts. Moving forward, guidelines related to addressing SB specific sexual health education and resources would be beneficial.

Disclosure

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(265) BARRIERS TO FERTILITY PRESERVATION: THE ROLE OF HEALTH POLICY, COST, AND ACCESS TO SPECIALIZED CARE
Authors: Thompson L , Huang E , Shandley L , Kobashi K , Muthigi A
Published: December 2024

Introduction

Iatrogenic infertility, arising from necessary medical interventions such as gonadotoxic chemotherapy, radiation therapy, certain surgeries, biologic treatments for autoimmune conditions, and hormone therapy, presents significant reproductive challenges. Fertility preservation techniques-including the cryopreservation of embryos, oocytes, ovarian tissue, sperm, or testicular tissue-provide critical options for patients seeking to maintain their reproductive potential. Despite growing awareness and increased referrals for individuals at risk, numerous barriers impede access to fertility preservation services.

Objective

This study aims to identify and analyze the obstacles that patients face in accessing fertility preservation services in the context of iatrogenic infertility.

Methods

A comprehensive literature review was conducted using PubMed, with a focus on the terms “iatrogenic infertility,” “fertility preservation,” and “health policy.” Relevant articles were systematically reviewed and categorized by three reviewers to ensure thoroughness and accuracy in identifying key barriers.

Results

Key barriers to fertility preservation identified include prohibitive costs, limited access to specialized care, and inconsistent insurance coverage. The financial burden for fertility preservation ranges from $2,500 to $20,000 for initial processing and storage, with significant variability based on state and insurance policy. Additional challenges include a lack of standardized guidelines to inform policymaking, difficulties in policy implementation at the state level, and insufficient coverage in public insurance programs, including Medicaid.

Conclusions

The lack of attention to fertility preservation before fertility-compromising treatments can significantly impact patients' well-being and quality of life. Urologists and other healthcare providers can play a crucial role in improving patient care through advocacy, policy initiatives, and clinical practices. Future directions include advocating for policy changes at multiple levels, increasing access to specialized fertility care, and leveraging technological advancements to reduce costs.

Disclosure

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(267) SPERM EXTRACTION IN MEN INTERESTED IN FERTILITY AFTER RADICAL PROSTATECTOMY
Authors: Mulhall J , Deveci S , Flores J
Published: December 2024

Introduction

Radical prostatectomy (RP) is associated with permanent failure to ejaculate. It is estimated that up to 40% of men after RP do not remember being told they will never ejaculate postoperatively and very few have heard of sperm banking prior to RP. Clinical experience has demonstrated that some men regret not banking sperm pre-RP and present for a discussion regarding sperm extraction.

Objective

To review our experience with sperm extraction in men post-RP.

Methods

We review our experience at a specialist andrology practice regarding post-RP sperm extraction over the past two decades. The study population included men who (i) were post-RP (ii) requested future fertility (iii) with available pre-sperm extraction FSH levels (iv) and partners with documented fertility potential (normal FSH/AMH levels). All patients underwent attempted vasal sperm aspiration (VA). If this was of poor quality - azoospermia, low motility (<5%) - microsurgical epididymal sperm aspiration (MESA) was attempted and when no sperm/poor motility was found, testis tissue extraction (TESE) was performed.

Results

A total of 16 sperm extractions have been performed over this time period. Median patient age 48 (44, 62) years, partner age 36 (32, 41) years. Baseline median testicular volume on clinical examination 16 (14, 18) mls; total early morning testosterone level 480 (340, 690) ng/dl, FSH 4.5 (2, 8) mU/ml. All patients had successful vasal fluid retrieval, 12/16 (75%) had good quality specimens on microscopy, median sperm concentration of 32 M/ml, forward motility rate of 20%. Three had very low concentration (<5/HPF on intraoperative microscopy) or motility (<5%). All of these men underwent attempted MESA, with again low motility rates. These three and the single patient with azoospermia on VA underwent TESE and all had sperm found. The median number of vials across all patients/forms of sperm extraction was 8 (4, 16).

Conclusions

Sperm extraction is a viable option for men requesting reproductive assistance after RP, with vasal aspiration being successful in the vast majority of these patients, especially in men with normal baseline FSH levels. Counseling patients about failure to ejaculate and the option of sperm banking should be considered prior to RP.

Disclosure

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(270) IMPACT OF TRAINING ON CONFRONTING DISCRIMINATION AND HARASSMENT BY PATIENTS AND PEERS
Authors: Guillen A , Findlay B , Bearrick E , Ziegelmann M , Kohler T , Sevann H
Published: December 2024

Introduction

Discrimination and sexual harassment within the workplace have a negative impact on well-being and productivity and are often underreported due to lack of comfortability in confronting the offender.

Objective

We aim to assess the prevalence of these abusive behaviors within a urology department and the impact of a dedicated training session on comfortability reporting/confronting discrimination and harassment.

Methods

Employees within a urology department at a single institution were invited to take a survey regarding discrimination and harassment both before and after a dedicated training session on reporting and confronting these behaviors. Statistical analyses were performed between pre- and post-survey groups, genders, and roles within the department.

Results

A total of 77 participants were included, 52 (67.5%) identified as female. Roles within the department included physician (25; 32.5%), advanced practice provider (11; 14.3%), nurse (20; 26%), and nonclinical staff (21, 27.2%). More women reported experiencing sexual harassment at least once a year compared to men (38.6% vs. 16.7%, p < 0.001). Patients were the most commonly reported offenders of abusive behaviors towards staff (p < 0.05) Fig. 1.A. The training demonstrated a positive impact in respondent comfort level with addressing gender discrimination (14.3% increase in comfort; p = 0.043) Fig. 1.B.

Conclusions

Specific training on strategies for addressing abusive behaviors can help employees feel empowered to confront gender discrimination by both patients and their peers.

Disclosure

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(271) CHARACTERIZING TESTOSTERONE PROFILES IN MEN WITH TESTIS CANCER PRIOR TO RADICAL ORCHIECTOMY
Authors: Flores Martinez J , Ljubetic BM , Liso N , Mulhall JP
Published: December 2024

Introduction

Testis cancer (TC) is one of the most common cancers in young men.

Objective

We aimed to evaluate testosterone (T) levels in men with TC prior to undergoing radical orchiectomy (RO).

Methods

Men treated with RO for TC who had total T (TT; LCMS) and free T (FT; equilibrium dialysis) levels done before surgery were analyzed. Men with a history of prior chemotherapy, radiation therapy, prior RO were excluded. Patient demographics, hormone levels, ultrasound-measured testis volume TC markers and pathology were recorded. Low T was defined as TT <300 ng/dL, high T as TT >950 ng/dL. Univariable analysis was used to explore pre-RO predictors associated with low and high T. Parameters explored included: patient age, testis volume, number of comorbidities, estradiol, LH, FSH, HCG levels.

Results

83 men met study criteria. Median age 34 (29, 41) years. 2% of the patients reported ≥3 comorbidities, 2% had diabetes, 16% had sleep apnea, and 35% smokers. Median baseline TT level was 454 (320, 715) ng/dL, free T 18 (13, 39) ng/dL, LH 2.8 (1, 8) mU/mL, FSH 6 (1, 19) mU/mL, and estradiol levels 24 (19, 51) pg/mL. 22% had low T, and 10% had high T. TC markers, the median of beta-HCG, alpha-fetoprotein, and lactate dehydrogenase were 2 (0.5-8.6) mIU/mL, 2.8 (2.1-4.7) ng/mL, and 175 (157-224) U/L, respectively. Median testis volume was 18 (13, 31) mls. TC pathology: 75% had seminoma, 21% embryonal carcinoma, 18% Yolk sac tumor, 15% teratoma, 2% choriocarcinoma. 23% had 2 or more tumors. Based on univariable analysis, older age, and lower testicular volume were associated with low T levels. Higher levels of HCG was the only predictor of high T levels.

Conclusions

About a 1/5 of the men with TC had low T before RO, while the prevalence of high T was almost 1 in 10. Important predictors of both were identified. Older age and lower testicular volume were associated with low T and higher levels of beta-HCG were associated with high T in men with TC before RO.

Disclosure

No.