bluuebunny/crossref_metadata_2025 huggingface dataset:
Variability of bile bacterial profiles and drug resistance in patients with choledocholithiasis combined with biliary tract infection: a retrospective study
Authors: Zhang Hang , Cong Yuchen , Cao Lichao , Xue Kuijin , Qi Peng , Mao Qingdong , Xie Cong , Meng Yushan , Cao Bin
Published: February 2024

Background

Biliary tract infection is a common complication of choledocholithiasis. This study aimed to analyse the distribution of pathogenic bacteria in bile cultures from patients with choledocholithiasis combined with biliary tract infection to guide clinical application of antimicrobials and reduce the emergence of drug resistance.

Methods

A total of 880 patients were enrolled in this retrospective study from 30 March 2017 to 31 August 2022 at the Affiliated Hospital of Qingdao University in China. Bile specimens were extracted for microbiological culture under aseptic conditions using endoscopic retrograde cholangiopancreatography. Bacterial culture, strain identification, and antimicrobial susceptibility testing were conducted according to the standard protocol. Baseline data were retrieved from patient files.

Results

Overall, 90.34% (795/880) of bile samples showed positive microbiological results and 37.50% (330/880) demonstrated polymicrobial infections. Among the 795 bile specimens with positive culture results, 1,216 pathogenic bacteria were detected, with gram-negative bacilli accounting for 56.33%, gram-positive cocci for 41.86%, and fungi for 1.81%. The predominant gram-negative bacilli in the bile cultures were Escherichia coli (30.43%) and Klebsiella pneumoniae (13.98%), whereas the main gram-positive cocci were Enterococcus faecium (14.04%) and E. casseliflavus (4.28%). The annual trend analysis revealed a gradual decrease in the proportion of gram-negative bacilli and a gradual increase in the proportion of gram-positive cocci, with a concomitant decrease in the dominance of E. coli. Both E. faecium and E. coli showed high resistance to conventional antibiotics but high sensitivity to piperacillin/tazobactam, carbapenems, amikacin, and vancomycin.

Conclusions

A significant change has occurred in the bile bacterial spectrum in patients with choledocholithiasis and biliary tract infection. The incidence of gram-positive cocci infections has increased annually, while that of gram-negative bacilli and E. coli infections has decreased. Antibiotic administration should be tailored based on the local bacterial profile.
Optimization of ON-grid hybrid PV/wind system for a cement factory in Kuwait using HOMER pro software
Authors: Al-Odat Mohammad , Al-Hasan Mohammed , Obeidat Firas , Chamkha Ali J
Published: February 2024

The reliance on a single energy source leads to many problems, i.e. cost and unsustainable operation. Hybrid renewable energy systems (include more than one energy source) has been effectively shown as a feasible choice to overcome these problems. The main purpose of this research is to carry out a techno-economic optimization to minimize the size of the system with lower cost and higher reliability. This proposed ON-grid hybrid PV/wind energy system is designed to supply the electrical power of a cement factory in Kuwait. To achieve this purpose, the Hybrid Optimization of Electric Energy (HOMER Pro) software was utilized to carry out the optimization process. The results of this study show that the cost of electricity energy generated by the hybrid PV/wind energy system is equal to $0.082/kWh which is much lower when compared to the conventional fuel power plants in Kuwait which is approximately $0.12/kWh.
Changes in bacterial communities during rice cultivation remove phenolic constraints on peatland carbon preservation
Authors: Qin Lei , Tian Wei , Freeman Chris , Jia Zhongjun , Yin Xiaolei , Gao Chuanyu , Zou Yuanchun , Jiang Ming
Published: February 2024

Northern peatlands contain ~30% of terrestrial carbon (C) stores, but in recent decades, 14% to 20% of the stored C has been lost because of conversion of the peatland to cropland. Microorganisms are widely acknowledged as primary decomposers, but the keystone taxa within the bacterial community regulating C loss from cultivated peatlands remain largely unknown. In this study, we investigated the bacterial taxa driving peat C mineralization during rice cultivation. Cultivation significantly decreased concentrations of soil organic C, dissolved organic C (DOC), carbohydrates, and phenolics but increased C mineralization rate (CMR). Consistent with the classic theory that phenolic inhibition creates a “latch” that reduces peat C decomposition, phenolics were highly negatively correlated with CMR in cultivated peatlands, indicating that elimination of inhibitory phenolics can accelerate soil C mineralization. Bacterial communities were significantly different following peatland cultivation, and co-occurrence diagnosis analysis revealed substantial changes in network clusters of closely connected nodes (modules) and bacterial keystone taxa. Specifically, in cultivated peatlands, bacterial modules were significantly negatively correlated with phenolics, carbohydrates, and DOC. While keystone taxa Xanthomonadales, Arthrobacter, and Bacteroidetes_vadinHA17 can regulate bacterial modules and promote carbon mineralization. Those observations indicated that changes in bacterial modules can promote phenolic decomposition and eliminate phenolic inhibition of labile C decomposition, thus accelerating soil organic C loss during rice cultivation. Overall, the study provides deeper insights into microbe-driven peat C loss during rice cultivation and highlights the crucial role of keystone bacterial taxa in the removal of phenolic constraints on peat C preservation.
(002) An Update to The Safety of VE Therapy for Genitourinary Syndrome of Menopause in Women with a History of Breast Cancer – A Claims Database Analysis
Authors: Agrawal P , Singh S , Able C , Dumas K , Kohn J , Kohn T , Clifton M
Published: February 2024

Introduction

Systemic therapies for breast cancer (BC) may result in genitourinary syndrome of menopause (GSM) in up to 70% of postmenopausal breast cancer survivors. Though systemic estrogen therapy is usually avoided in these patients, vaginal estrogen (VE) therapy may be prescribed to treat GSM symptoms. However, we recently demonstrated, few eligible patients with GSM and a history of breast cancer are prescribed VE.

Objective

To assess the recurrence rates of breast cancer in women diagnosed with GSM with a history of breast cancer by VE therapy status using a large US claims database.

Methods

A US health research network was queried. Our cohort consisted of females diagnosed with BC within five years prior to the initial GSM diagnosis. Patients with active disease within three months prior to diagnosis of GSM were excluded. Recurrence was defined as mastectomy, radiation, chemotherapy, or secondary malignancy within three months to five years after initiating VE therapy for GSM. The study cohort included those with ≥3 VE prescriptions. The control cohort included women with BC without any VE prescriptions after GSM diagnosis. Propensity matching was performed. A sub-analysis evaluating the effect of concurrent aromatase inhibitor (AI) use with VE was also conducted with concurrent AI use defined as ≥3 AI prescriptions.

Results

We identified 42,113 females with a diagnosis of GSM following BC diagnosis with any ER status; 5.0% received VE. Of the initial cohort, 10,584 patients had ER+ BC; 3.9% of this group received VE. Risk of BC recurrence was comparable between those who received VE and those who did not in both the any-ER (RR 1.03, 95% CI [0.91-1.18]) and ER+ status (RR 0.94, 95% CI [0.77-1.15]) analyses. BC recurrence-free survival was comparable between those who received VE and those who did not in both the any-ER (HR 0.98, 95% CI [0.85 – 1.14]) and ER+ status (HR 0.88, 95% CI [0.69 – 1.12]) analysis. A sub-analysis comparing concurrent VE and AI prescriptions to those with VE-only was performed. Risk of BC recurrence was significantly higher among those who received AI+VE versus VE-only in both the any-ER (RR 5, 95% CI [3.05 – 8.19]) and ER+ status (RR 2.64, 95% CI [1.55 – 4.47]) analysis (Table 1). Significant differences in BC recurrence-free survival were observed between the AI+VE and VE-only groups in both the any-ER (HR 9.88, 95% CI [5.50 – 17.73]) and ER+ status (HR 4.82, 95% CI [2.36 – 9.84]) analysis. (Figure 1). No mortality event was observed at five- or ten-year follow-up in either analysis.

Conclusions

We found similar BC recurrence risk between BC survivors with and without prescriptions of VE. An increased risk of BC recurrence was seen with concurrent AI and VE use. These results suggest that VE therapy in select patients with GSM is safe.

Disclosure

No.
(008) Update on Female Sexual Dysfunction Training in Urology Residencies: Are We Making Progress?
Authors: Brink S , Nguyen J , Implicito C , Ullah N , Shin D
Published: February 2024

Introduction

As urologists and sexual medicine specialists, we are the experts in treating sexual health issues. Female sexual dysfunction (FSD) receives considerably less attention than male sexual dysfunction (MSD). The AUA Core Curriculum includes lessons on FSD and MSD, and thus urology residencies should be providing education on both.

Objective

We sought to evaluate all AUA accredited urology residency program websites in order to determine the availability of FSD and MSD information. Our group conducted a preliminary study on this subject in 2017 and now wish to see how this information has changed over time.

Methods

Program websites of accredited U.S. urology residencies listed on the AUA website were analyzed. Two independent reviewers each collected information from the websites of the 147 residency programs. Information on FSD and MSD content, curricula, subspecialists on faculty, and program directors (PDs) were recorded, as well as the minimum number of clicks required to reach each topic. Data was stratified by AUA section. Chi-square analysis was performed to compare the proportion of programs with FSD and MSD content.

Results

In 2023, 132 (89.8%) program websites included MSD content with a median of 1 click required to access that content, compared to 74 (58.2%) programs in 2017 when 2.5 clicks were required (p<0.01). In 2023, 43 (29.3%) program websites included FSD content with a median of 2 clicks, compared to 12 (9.4%) in 2017 with the number of clicks remaining at 2 (p<0.01). In 2023, all AUA sections are represented by programs containing both MSD and FSD content, although there are significantly fewer programs with FSD (43) compared to MSD content (132) across all sections (p <0.01). However, this is an improvement from 2017 when the Northeastern, Mid-Atlantic, and Southeastern sections contained no program websites with FSD content. Curricula with FSD is lacking; only 4 programs (2.7%) specifically include FSD, compared to MSD being included in 39 (26.5%) program’s curricula (p<0.01). 127 (86.4%) residencies have MSD subspecialists on faculty compared to only 29 (19.7%) with FSD subspecialists on faculty (p <0.01). Interestingly, 15% of PDs (22/147) are FPMRS subspecialists compared to 8% (12/147) who are Andrology or Sexual Medicine subspecialists. Neither PD subspecialty of FPRMS vs Andrology/Sexual Medicine nor PD gender predicted FSD content.

Conclusions

More urology residency program websites are including FSD and MSD content, although the number with MSD content has increased to a greater degree compared to the number with FSD content. MSD content is becoming more available, now requiring fewer clicks to access than FSD content. While increasing, FSD content still remains lower than MSD content in all analyzed domains. Although the gap is closing, the opportunity to increase FSD education still exists within urology residency programs.

Disclosure

No.
(021) ChatGPT's Ability to Assess Quality and Readability of Online Medical Information
Authors: Golan R , Ripps SJ , Raghuram R , Loloi J , Bernstein A , Connelly ZM , Golan NS , Ramasamy R
Published: February 2024

Introduction

Health literacy plays a crucial role in enabling patients to understand and effectively use medical information. As technology rapidly advances, the significance of health literacy becomes even more pronounced, particularly in comprehending complex medical information. Artificial Intelligence (AI) platforms have garnered significant attention for their remarkable ability to generate automated responses to a wide range of prompts. However, their capacity to assess the quality and readability of provided text remains uncertain. Given the growing prominence of AI web assistant tools, we hypothesized that integrating these tools into patients' web searches could enhance the retrieval of accurate medical information.

Objective

To evaluate the proficiency of Conversational Generative Pre-Trained Transformer (ChatGPT) in assessing readability, and utilizing the DISCERN tool to assess quality of online content regarding shock wave therapy for erectile dysfunction.

Methods

Websites were generated using a Google search of “shock wave therapy for erectile dysfunction” with location filters disabled. Readability was analyzed using the Readable software (Readable.com, Horsham, United Kingdom). Quality was assessed independently by three reviewers using the DISCERN tool. The same plain text files collected were inputted into ChatGPT to determine whether it produced comparable metrics for readability and quality.

Results

The study results revealed a notable disparity between ChatGPT's readability assessment and that obtained from a reliable tool, Readable.com (p<0.05). This indicates a lack of alignment between ChatGPT's algorithm and that of established tools, such as Readable.com. Similarly, the DISCERN score generated by ChatGPT differed significantly from the scores generated manually by human evaluators (p<0.05), suggesting that ChatGPT may not be capable of accurately identifying poor-quality information sources regarding shock wave therapy as a treatment for erectile dysfunction.

Conclusions

ChatGPT’s evaluation of the quality and readability of online text regarding shockwave therapy for erectile dysfunction differs from that of human raters and trusted tools. ChatGPT's current capabilities were not sufficient for reliably assessing the quality and readability of textual content. Further research is needed to elucidate the role of AI in the objective evaluation of online medical content in other fields. Continued development in AI and incorporation of tools such as DISCERN into AI software may enhance the way patients navigate the web in search of high-quality medical content in the future.

Disclosure

No.
(034) Lifetime Receptive Anal Intercourse Exposure Influences Pelvic Sensations During Sex
Authors: Gaither T , Siapno A , Kianian R , Vincent N , Williams K , Piquerias E , Russell M , Litwin M
Published: February 2024

Introduction

Despite the negative societal stigma on receptive anal intercourse (RAI), this behavior has a positive influence on individuals’ sexual and relationship health. No large studies have previously looked at the sensations experienced during RAI, especially their association with lifelong exposure.

Objective

This study aims to quantify commonly reported pelvic sensations during RAI and determine whether their presentation changes with increasing experience to RAI.

Methods

An internet survey was conducted on sensations felt during RAI among people with prostates (i.e. cis men and trans women) from July 2022-January 2023. The survey content was developed based on a mixed-methods qualitative study and inquired about demographic and sexual histories as well as sensations (pleasure, pain, urinary, and bowel) experienced during RAI. We used descriptive statistics to describe demographic and sexual histories. All data was stratified by lifetime exposure to RAI. The primary outcomes assessed included both the quantification of the primary sensations experience during RAI and associated bother.

Results

975 participants completed the survey. Nine percent reported less than 10 experiences with RAI, 26% reported 11-50 RAI experiences, 32% reported 51-200 experiences, 16% reported 201-500 experiences, and 18% reported >500 experiences. As the number of experiences with RAI increased (from <10 exposures to >500 exposures), the reported frequency of pleasurable sensation and satisfaction with pleasure at the level of anus increased from 41% to 92% (p<0.0001), whereas severe pain and symptoms of bowel urgency decreased from 39% to 13% and from 21% to 6% respectively (p<0.0001). Urinary urgency sensation did not differ by lifetime RAI experience.

Conclusions

Lifetime exposure to RAI is positively associated with pleasure and is negatively associated with pain and bowel urgency. Pelvic sensations experienced during RAI appear to be dependent on lifetime RAI exposure history regardless of age. Lifetime RAI exposure can be readily assessed and correlates not only with pelvic sensation but also many other aspects of sexual health. These results imply that the etiology of dissatisfaction with pleasure or anodyspareunia during RAI may be distinct by lifetime RAI exposure status. This is the first study assessing pelvic sensations experienced during RAI among a large sample of individuals. This is a cross-sectional study, and we cannot conclude how pelvic sensations change overtime among individuals. Internet based participants may not be representative of clinical populations.

Disclosure

No.
(038) Health-Related Quality of Life after Gender-Affirming Pelvic Surgery: A Systematic Review and Meta-Analysis
Authors: Uloko M , Dolendo I , Goldstein B , Okamuro K , Anger J
Published: February 2024

Introduction

Various validated questionnaires have been designed to evaluate sexual dysfunction as it relates to specific phases of the sexual response cycle, which include desire, arousal, orgasm, and resolution. Although there is a breadth of data on the surgical and aesthetic outcomes of patients who have undergone gender-affirming pelvic surgery (GAPS), there are limited data on sexual outcomes as they relate to the sexual response cycle after GAPS. Questionnaires are a crucial tool for research and clinical assessment of sexual dysfunction. However, many of the validated questionnaires for sexual dysfunction were not created for use in transgender patients after GAPS. To date, there is not a validated questionnaire specifically for patients who have undergone GAPS.

Objective

We sought to review the most commonly used sexual function questionnaires and assess their inclusivity as it relates to transgender patients who have undergone GAPS.

Methods

A PubMed and PsycINFO search was carried out using the keywords: “Validated questionnaires” AND “sexual dysfunction” OR “arousal” OR “desire” OR “libido” OR “satisfaction” OR “quality of life”. We then reviewed the most commonly used validated sexual dysfunction questionnaires and graded them on the metrics of medical applicability of patients who had undergone vaginoplasty, metoidioplasty, or phalloplasty, affirming language, and inclusion of identities beyond fully binary transgender people. The validated questionaries were reviewed by a comprehensive sexual health expert and a gender-affirming surgeon.

Results

Of the 13 questionnaires reviewed, only 5 met all metrics for inclusiveness. 4/13 of the validated questionnaires used exclusionary gendered language (female vs male), 6/13 were not physiologically applicable to patients who had undergone GAS (vaginal lubrication, ejaculation etc) and 2/13 assumed heterosexual orientation.

Conclusions

The current clinical and research tools used to define sexual dysfunction are not inclusive of people who have undergone gender-affirming surgery. Validated questionnaires are needed to optimally assess the sexual outcomes of patients who have undergone GAS.

Disclosure

No.
(056) Cross-sectional Analysis of the Vas Deferens and Its Associated Blood Supply
Authors: Narasimman M , Kim M , Varnum A , Qureshi F , Zhang G , Loloi J , Goldstein M , Kryvenko O , Ramasamy R
Published: February 2024

Introduction

In performing both vasectomy and vasectomy reversal, a precise understanding of the local anatomy and blood supply of the vas deferens and associated structures is essential. However, the exact importance and contribution of the perivasal versus intramural vessels in perfusion to the vas deferens has not been investigated. This may be clinically relevant as the perivasal blood supply may be prone to compromise with bipolar electrocautery during the vasectomy reversal, potentially resulting in a poor blood supply to the anastomosis which can detrimentally affect outcomes.

Objective

To highlight the importance and contributions of the perivasal and intramural vessels in the blood supply to the vas deferens

Methods

92 consecutive bilateral vas deferens specimens from 46 patients undergoing first time vasectomy were examined. H&E slides were reviewed by a senior genitourinary pathologist to describe architectural and growth pattern of the small arteries. Intramural (arterioles in the muscular coat of a vas deferens) and perivasal (those located in the vas adventitia immediately juxtaposed to the organ) arterioles were counted microscopically. Clinical data, including patient age and ethnicity, were obtained by reviewing medical charts.

Results

The average number of perivasal arteries surrounding the bilateral vas deferens in each patient was 15 ± 4 whereas the number of intramural arteries was 4.5 ± 3. There was no linear trend between the age of our patients or the number of intramural or perivasal arteries. Five patients (11%) had less than 2 total intramural arteries.

Conclusions

Our study found significantly more perivasal arteries than intramural arteries in vas deferens samples. Interestingly, this association did not seen to vary with patient age. To our knowledge, this represents the first study to demonstrate this anatomical relationship and suggests there may be greater reliance on perivasal arteries for overall vas deferens perfusion, thus emphasizing the importance of prioritizing the preservation of the perivasal blood supply during vasectomy. This may be particularly relevant should a future reversal be considered. Future directions may include examining specimens of patients undergoing vasectomy reversal and evaluating the relevant vasculature and procedure outcome/success.

Disclosure

No.
(064) The Optilume® Drug Coated Balloon for Recurrent Anterior Urethral Strictures: Robust III Study 3-year Interim Results
Authors: Krug A , Morey A , Coutinho K , Robertson K , D'anna R , Chevli K , Carrier SC , Cantrill C , Ehlert MJ , Te AE , Dann J , Delong JM , Brandes SB , Hagedorn J , Levin R , Schlaifer A , Desouza E , Dimarco D , Erickson B , Elliott S
Published: February 2024

Introduction

The Optilume® Drug Coated Balloon (DCB) is a dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. Outcomes after 3-year follow-up are presented here.

Objective

The ROBUST III study is a randomized controlled trial comparing the Optilume® Drug Coated Balloon (DCB) against direct visual internal urethrotomy (DVIU) or dilation.

Methods

127 subjects were randomized in a 2:1 fashion at 23 sites. Seventy-nine were treated with the DCB and 48 were treated with DVIU or dilation. Follow-up past 1 year was limited to those treated with the DCB. Eligibility criteria included adult males with anterior strictures with ≥2 prior treatments and stricture length ≤3cm. Long-term endpoints included freedom from repeat treatment, International Prostate Symptom Score (IPSS), and peak urinary flow rate (Qmax).

Results

Subjects randomized to receive the DCB had an average of 3.2 prior treatments and average stricture length of 1.6cm (46% ≥2cm), with 8/79 (10.1%) having penile strictures and 9/79 (11.4%) having prior pelvic radiation. IPSS significantly improved from 22.0 at baseline to 11.3 at 3 years. Qmax significantly improved from a baseline of 7.7 mL/sec to 12.2 mL/sec at 3 years. Freedom from repeat intervention for DCB subjects was estimated to be 74%. No late-onset treatment related adverse events were observed.

Conclusions

The Optilume® DCB continues to achieve significant improvements in symptoms, flow, and reintervention rates through 3 years post treatment.

Disclosure

No.
(075) Treating Idiopathic Hematospermia with Oral Tranexamic Acid
Authors: Le B , Shekar A , Lee A , Raheem O
Published: February 2024

Introduction

Hematospermia can be a challenging medical condition to treat for the urologist. While almost universally benign, it causes considerable patient stress and anxiety. There are no standardized treatments and while many cases may resolve on their own the duration can be quite variable. Tranexamic acid (TXA), an antifibrinolytic, has been used to control bleeding in various settings including heavy menstrual bleeding, traumas, and intraoperatively to prevent and control bleeding.

Objective

We sought to investigate the safety and efficacy of tranexamic acid, an oral anti-fibrinolytic for the treatment of idiopathic hematospermia.

Methods

A cohort of patients presenting to urology clinic within the past year for primary complaint of hematospermia without other clear etiology (trauma, radiation, prior surgery, prostatitis) were prescribed TXA 1300 mg BID for 7 days. Patients were followed as part of routine care and resolution of hematospermia and side effects were observed and documented.

Results

Eight patients (median age 42.1 years) met criteria and were treated with the TXA protocol for idiopathic hematospermia. All had immediate resolution at completion of the 7-day course. Two patients had a recurrent episode within follow-up period (Median follow-up of 5.4 months) which resolved with a second treatment course. No adverse events were noted, and all patients were able to tolerate TXA treatment.

Conclusions

TXA appears to be a safe and efficacious treatment for idiopathic hematospermia where often the main goal is to rule out other etiologies and expeditious resolution to relieve patients’ stress and anxiety.

Disclosure

No.
(078) The Effect of Smoking Cessation on Semen Quality
Authors: Ragheb A , Abdelbary A , Massoud A , Mohamed M , Elmarakby A
Published: February 2024

Introduction

Extensive research efforts have always focused on the deleterious effects of smoking on male reproduction by comparing fertility in smokers versus nonsmokers. Nevertheless, studies on the effect of smoking cessation on male fertility remain scarce.

Objective

Our primary aim was to investigate the reversibility of the negative impact of smoking on male fertility. Secondarily, we studied the effect of both time after smoking cessation as well as the smoking index on semen quality improvement.

Methods

Our study included 60 participants who applied to a smoking cessation program. The volunteers started by completing a fertility background questionnaire. Two semen specimens, provided 2 weeks apart, were analyzed according to the WHO guidelines for each candidate on three different occasions. The first was right before smoking cessation followed by the 2nd and 3rd at 3 and 6 months after stopping smoking, respectively. Semen quality was compared between the 3 occasions. The degree of change was correlated with the level of smoking. The nicotine level in urine was used for smoking cessation compliance monitoring during the study.

Results

Comparing semen quality on the 3 different occasions respectively, we detected a significant improvement in semen volume (3.33 ml ± 1.07 vs. 3.88 ml ± 0.80 vs. 4.34 ml ± 0.67, P < 0.001), sperm concentration (14.77 million /ml ± 6.49 vs. 17.71 million /ml ± 6.41 vs. 19.27 million/ml ± 6.46, P < 0.001), total sperm count (49.33 million ± 25.31 vs. 70.16 million ± 30.85 vs. 84.01 million ± 31.00, P < 0.001), progressive motility (20.7% vs. 35.3% vs. 42.28%, P < 0.001), total motility (41.48% vs. 60.33% vs. 67.67%, P < 0.001) and abnormal morphology (69.32% Vs. 50.88% vs. 40.82%, P < 0.001). Improvement in all parameters was positively correlated to time after cessation. Higher smoking indices were related to higher levels of improvement in semen volume, sperm concentration, and total count (areas under the curve of 0.867, 0.852, and 0.863 respectively, P < 0.001 for each).

Conclusions

The negative effect of smoking on semen quality is reversible. Smoking cessation has a time-dependent positive effect on main semen parameters, hence, positive potential for fecundity improvement in men.

Disclosure

No.
(089) Greater Changes in Hematocrit Predict More Frequent Major Adverse Cardiac Events in Men Receiving Testosterone Therapy - A Retrospective Cohort Claims Database Analysis
Authors: Kohn TP , Agrawal P , Ory J , Hare J , Ramasamy R
Published: February 2024

Introduction

While recent studies have shown that Testosterone therapy (TTh)-induced secondary polycythemia, Hematocrit (Hct) > 52%, is an independent risk factor for major adverse cardiac events (MACE) within the first year of treatment, it is not clear whether erythrocytosis – i.e., degree of change in Hct from baseline Hct after starting TTh confers additional risk for MACE.

Objective

The objective of this study is to determine the incidence of MACE associated with the degree of Hct change from baseline in adult men receiving testosterone therapy for hypogonadism.

Methods

To assess whether an increase in Hct after initiating TTh is associated with an increased risk of MACE within 3 and 24 months of initiating TTh, we queried the TriNetX Research network database for men over the age of 18 with Hct values obtained within six months before starting TTh, and who had follow-up Hct measurements within three and 24 months after beginning TTh from 2010 through 2021. Men with and without a subsequent increase in Hct after initiating TTh were propensity matched. MACE was defined as myocardial infarction, stroke, or death.

Results

After matching, 10,291 men who experienced an any increase in Hct after initiating TTh and 6,320 controls who did not were included. Compared to controls who did not have an increase in Hct, the majority of men who had an increase in subsequent Hct had a statistically significant increased risk of major adverse cardiac events with greater change being associated with increase risk of MACE.

Conclusions

We demonstrate that increases in Hct from baseline are associated with increased risk of MACE, compared to men whose Hct remains stable while receiving TTh.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast, Endo Pharmaceuticals, Antares Pharma.
(181) Prior Radiation Therapy is Associated with Increased Risk of Intra-Operative Complications in Patients Undergoing Primary Inflatable Penile Prosthesis Placement: Results from a Large Multi-Institutional Collaborative
Authors: Dalimov Z , Diao L , Chang C , Barham DW , Sadeghi-Nejad H , Hamma MAM , Andrianne R , Sempels M , Hsieh T , Hatzichristodoulou G , Osmonov D , Lentz A , Perito P , Hotaling J , Van Renterghem K , Park SH , Ziegelmann M , Pearce I , Gross  , Yafi FA , Simhan J
Published: February 2024

Introduction

Radiation therapy (RT) can predispose the onset of corporal fibrosis and microvasculopathy. The impact of RT on intra-operative complications is not well described in the literature.

Objective

In this study, we assess intra-operative and post-operative outcomes among patients with or without prior history of RT following primary Inflatable Penile Prosthesis (IPP) implantation.

Methods

We performed a multicenter, retrospective analysis of men undergoing primary IPP placement between January 2015 and December 2022. A total of 3530 patients were identified, of which 3319 had no prior history of RT and 211 patients had history of RT. After 1:1 propensity score matching for all confounding variables, 211 patients with a history of RT were compared to 211 nonradiated patients for intra-operative and post-operative outcomes. Chi-square and Mann-Whitney tests were used for statistical analysis for categorial and continuous variables respectively. For multivariable analysis, we used a forward stepwise model and included significant variables found on pre-operative characteristics of patients. Kaplan-Meier time to event analysis were compared with Mantel-Cox log-rank test.

Results

Patients with history of RT encountered more intra-operative complications (4.3% vs 0.9%, p=0.032); specifically, these men experienced more distal crossover events (1.9% vs 0, p=0.044). On multivariable analysis, history of prior RT (OR 5.29, 95% CI 1.07-26.3, p=0.041) and diabetes mellitus (OR 10.5, 95% CI 2.58-43.5, p=0.01) were associated with increased risk of intra-operative complications. History of obesity (OR 0.11, 95% CI 0.01-0.91, p=0.040) reduced risk of intra-operative complications. There was no significant difference in early or late post-operative non-infectious complications between both groups and there was also no significant difference in risk of post-operative complications within 24 months on Kaplan Meier analysis (log rank p=0.9).

Conclusions

In this large multi-institutional cohort, history of RT is an independent predictor of intra-operative complications but not post-operative complications during primary IPP placement. These findings may help inform patient-specific counseling while guiding surgical planning to prevent untoward morbidity following surgery.

Disclosure

No.
(182) Transurethral Laser Incision of Ejaculatory Duct for Complete Ejaculatory Duct Obstruction
Authors: Madhusoodanan V , Savio L , Muthigi A , White J , Campos L , Shah H , Ramasamy R , Towe M
Published: February 2024

Introduction

It is estimated that approximately 5% of men presenting with infertility suffer from ejaculatory duct obstruction (EDO). Patients suspected to have EDO typically have a palpable vas deferens and normal testicular exam. On semen analysis, low volume and acidic pH should increase suspicion, and transrectal ultrasound is most commonly the first diagnostic modality utilized to confirm the diagnosis when suspecting EDO.

Objective

The objective of this surgical video is to describe the use of holmium laser for the management of ejaculatory duct obstruction (EDO) in the setting of obstructive azoospermia.

Methods

This was a 35 year old male with no significant past medical history who presented with obstructive azoospermia. His partner was a 32 year old female with no significant past medical history, with regular menstrual cycles, and a normal female reproductive evaluation. Semen analysis was significant for low volume (0.5 mL) azoospermia with an acidic pH (6.8). Abdominal and pelvic computerized tomography (CT) scan from 2017 when the patient presented for appendicitis noted an incidental finding of a 9.9 cm prostatic cyst. Thus, a transrectal ultrasound (TRUS) guided aspiration was performed in the ambulatory clinic which demonstrated a large prostatic cyst, with non-motile sperm in the aspirate. The patient was consented for Cystoscopy with transurethral laser incision of ejaculatory ducts. A 22 French (F) cystoscope was used, first for pan-cystourethroscopy, and then to cannulate the right ejaculatory duct with 5F pollack catheter and guide wire. Guide wire and catheter positioning within the cyst was confirmed with fluoroscopy. A 24F resectoscope with a laser bridge working element and 550 micron holmium laser fiber at settings of 1 Joule of energy and 10 hertz frequency to incise the right ejaculatory duct, circumferentially around the wire. The ejaculatory duct was incised and cyst was drained until the ejaculatory duct and thus prostatic cyst could be cannulated and examined with the cystoscope. On examination of the cyst, no vasal openings were identified. Left seminal vesiculography was attempted but unsuccessful due to significant contrast extravasation into the urethra.

Results

The case went well and was uncomplicated. There were no immediate or delayed complications or adverse effects reported by the patient. Post-operative instructions included rest for 1 week, followed by ejaculation every other day for 3 months. Semen analysis and transrectal ultrasound will be performed at 3 months post-operative.

Conclusions

Transurethral laser incision of ejaculatory duct is a safe surgical intervention for management of complete ejaculatory duct obstruction, and is demonstrated successfully in this step-by-step surgical video.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.
(196) Reconstruction of Complex Midline Septal Corporal Defect in a Distal Crossover Penile Implant Cylinder: A Step-by-step Demonstration of Surgical Technique
Authors: Wang C , Barreto Guimaraes PV , Raheem O , Kocjancic E
Published: February 2024

Introduction

Inflatable penile prosthesis (IPP) placement is a common and effective treatment for erectile dysfunction. Around 20,000 procedures are performed annually. Complications can arise after the procedure, with non-infectious complications occurring in approximately 4% of cases. One rare non-infectious complication is complete cylinder crossover, which can happen due to variable windows in the corporal septum.

Objective

This case report presents a complex distal septal defect caused by distal cylinder crossover and its repair using Tutoplast graft.

Methods

The patient, a 59-year-old African American male, had a history of prostate cancer and underwent robotic-assisted laparoscopic prostatectomy in 2018. He received an IPP in September 2020. In 2022, the patient experienced painful leftward penile curvature during erections and incomplete deflation of the penile prosthesis. A physical examination revealed crossover of the right prosthesis cylinder to the left. After a thorough discussion of the risks and benefits, the patient opted for surgical revision and reconstruction of the penile prosthesis. The procedure involved a right corporotomy, septal corporal reconstruction using a 5 × 2 cm Tutoplast graft, and redirection of the uninfected, functioning cylinder into the neocorporal space.

Results

The surgery was successfully completed without any complications, and the IPP functioned well at the end of the procedure. During the 6-week clinic follow-up, the patient reported proper cycling of the device, excellent erectile function, the ability to orgasm, and minimal pain.

Conclusions

In conclusion, our case demonstrates that Tutoplast graft, along with appropriate seating and redirection of the displaced cylinder without replacing the functional hardware, is a viable surgical approach for IPP revision, even in complex cases involving septal defects.

Disclosure

No.
(214) National Trends of Inpatient vs. Outpatient Male Benign Prostate Hyperplasia Procedures: 2016-2019
Authors: Roper W , Marte J , Lee J , Joice G
Published: February 2024

Introduction

Benign prostatic hyperplasia (BPH) is a common condition among aging men, causing urinary symptoms and impacting quality of life. Understanding the trends in BPH treatment procedures is crucial for optimizing patient care. Evaluating the utilization of different treatments, the setting of procedures (inpatient vs. outpatient), and associated costs can provide valuable insights. Identifying patient- and hospital-level factors associated with inpatient treatments can help identify disparities in access to care. Assessing the financial implications of care settings can optimize resource allocation. This research aims to contribute to knowledge by providing comprehensive insights into BPH treatment patterns, patient demographics, and healthcare costs for informed decision-making and improved patient outcomes.

Objective

To evaluate contemporary national trends of BPH treatment procedures among men.

Methods

An analysis of BPH treatment procedures performed from 2016-2019 was conducted utilizing both the National Inpatient Sample (NIS) and the Nationwide Ambulatory Surgery Sample (NASS). BPH treatment procedures were identified by Current Procedural Terminology (CPT) and International Classification of Diseases (10th Revision) Procedure Coding System (ICD-10-PCS) codes. Stratified cluster sampling was used to create weighted national estimates. The primary outcome was the rate of BPH treatments procedures performed in inpatient and outpatient encounters over time. Multivariable logistic regression was used to evaluate patient- and hospital-level factors associated with inpatient BPH treatments.

Results

A total of 811,111 weighted BPH treatment procedures analyzed showed that 45% of procedures were performed inpatient, with the remaining 55% performed outpatient over the course of 2016-2019 (Figure 1). Regional analysis revealed a majority of procedures were performed in the South at 36% and about 40% inpatient and outpatient, respectively (Table 1). The proportion of BPH procedures performed outpatient remained stable at 55% from 2016-2019 (Figure 1). The average age of a treated patient was similar between 66 inpatient and 70 outpatient. Multivariable logistic regression analysis showed an Elixhauser Comorbidity Index greater than 0 as a predictor of inpatient BPH treatment (Table 2). Medicare was the primary payer for both inpatient and outpatient settings at 51% and 60% respectively. Mean total charge for inpatient BPH encounters was $70,061 vs. $22,716 outpatient.

Conclusions

A sizable majority of BPH treatment procedures nationwide appear to be performed in an outpatient setting. Outpatient procedures have a lower total charge compared to inpatient care, which appears to be a contributing factor. Most inpatient procedures are more likely to be performed on patients. Further investigation is warranted to assess how these factors may affect surgical outcomes.

Disclosure

No.
(270) Application of ISSWSH Consensus PGAD/GPD Diagnostic Algorithm to Eight Cases
Authors: Ahrendt H , Pope R , Kingsberg S , Hayek S
Published: February 2024

Introduction

Persistent Genital Arousal Disorder/Genito-Pelvic Dysthesia (PGAD/GPD) is a debilitating, but the mechanism of disease and treatment are poorly understood. To address this gap in knowledge, the ISSWSH consensus statement proposed a diagnostic and treatment algorithm for PGAD/GPD. The algorithm proposes five possible regions of etiologies for the purposes of diagnosis and treatment. These regions include end organ (clitoris, vagina, vulva, etc), pelvis/perineum, spinal cord, cauda equina and brain.

Objective

The purpose of this retrospective case series is to apply the ISSWSH diagnostic and treatment algorithm to nine cases, in order to demonstrate the efficacy of the algorithm, as well as present uniform manner for reviewing PGAD/GPD cases.

Methods

Individuals were identified by the Principal Investigator and colleagues. ISSWSH diagnostic and treatment algorithm was used to note pertinent positives and negatives in history and physical exam, as well as analyze treatment.

Results

Cases of eight patients are reviewed using the algorithm to analyze the treatments and possible etiologies of each patient. Patients presented anywhere from experiencing symptoms for five days to three years. Half of the patients experienced relief of symptoms with treatment of lumbar pathology demonstrated on MRI. Four of the patients found relief with spinal epidural injections performed by a pain medicine physician, two found relief with pelvic floor physical therapy and two found relief with medications including gabapentin and pregabalin.

Conclusions

These cases demonstrate the utility of the ISSWSH consensus algorithm in guiding initial diagnosis and treatment of PGAD/GPD. However, it has limitations due to the multifactorial nature of PGAD/GPD, it is helpful in guiding initial treatment of the disorder. The cases in this series illustrate the importance of MRI in diagnosis of PGAD/GPD etiologies. Fifty percent of the cases in this series included an MRI that revealed lumbar pathologies that could be managed by pain management physician. As shown in these cases, PGAD/GPD can have a significant negative impact on mental health and activities of daily living, therefore it is critical to be systematic and efficient. The steps demonstrated to be most important in these cases include review of recent medication changes, physical examination (with anesthesia testing, if possible), lumbar MRI and referral to pain medicine specialist. The primary limitation of this study is that it is a retrospective chart review and as such, there was no standardization of the work up for each patient and information on each patient was limited to the notes in their charts.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Johnson and Johnson.
(276) Self-Performed Bilateral Testicle Amputation for Gender Affirmation
Authors: Waldoch B , Melin I , Dietrich P , Guise A
Published: February 2024

Introduction

Genital gender-affirming care is an essential aspect of care for individuals with gender dysphoria. Bilateral orchiectomy is performed for both hormonal control and for gender identity physical transition. The time and financial costs required to access such procedures can be prohibitive, leading to pursuit of morbid gender affirmation outside of healthcare systems. While genital self-mutilation is rare, up to 32% of cases have been found to involve self-castration. Management of this varies but in severe cases prompt surgical repair is imperative. We present a case report of a non-binary patient who underwent self-amputation of both testicles, with subsequent primary closure of the perineum.

Objective

A 34-year-old non-binary individual with autism spectrum disorder and gender dysphoria presented with uncontrolled bleeding after self-amputating both testicles (Photo 1). This was done with use of a zip tie around the scrotal base, application of lidocaine cream to the scrotum, and a sterilized kitchen knife. The patient performed this to eliminate the physical and psychological effects of testosterone, and cited lack of access to care as a motivating factor.

Methods

Psychiatry consultation confirmed decision-making capacity without acute severe mental illness, and no substance abuse was involved. Sperm cryopreservation was discussed with the patient but was declined. While awaiting capacity assessment, measurements of the testicular arteries and vas deferens were obtained to assess the possibility of reanastomosis, which was deemed technically feasible.

Results

After the patient was deemed decisional they were taken to the operating room for vascular control and planned primary closure and possible skin grafting. Cystoscopy confirmed no concomitant urethral injury. Intraoperatively the bilateral spermatic cords were tied off to achieve hemostasis. Skin closure was able to be performed primarily with a favorable result (Photo 2).

Conclusions

We present a unique case of a non-binary individual with gender dysphoria who underwent successful self-amputation of both testicles. This case highlights the significant barriers faced by individuals seeking gender affirmation procedures and the lengths to which patients may go to conform with their gender identity. Our case also highlights important management steps, including sperm cryopreservation, decisional capacity evaluation, and reattachment versus primary closure with or without skin grafting. The patient's decision to pursue self-amputation underscores the urgent need for improved access to gender-affirming procedures and mental health support for individuals with gender dysphoria.

Disclosure

No.