bluuebunny/crossref_metadata_2025 huggingface dataset:
(266) UNDIAGNOSED CARDIAC RISK FACTORS ARE HIGHLY PREVALENT IN YOUNG MEN PRESENTING WITH INFERTILITY
Authors: Pereira TA , Siddiq A , Arnold PJ , Rust JO , Bernie HL
Published: December 2024

Introduction

Male Fertility is a marker of overall health. The relationship between cardiovascular risk factors (CVR) and male infertility is an emerging area of interest with prior data showing the incidence of developing cardiac disease over time being greater in men with male factor infertility versus the general population.

Objective

Our study sought to determine the prevalence of CVR factors among young men presenting for infertility evaluation at an Andrology Clinic.

Methods

A retrospective review was conducted on all patients (pts) under the age of 45 years who presented to an infertility clinic between March 2023 and May 2024. Patient demographics, smoking status, comorbidities, Lipid panel ([triglycerides (TG), cholesterol (Chol), low-density lipoproteins (LDL), high-density lipoproteins (HDL)]), Body Mass Index (BMI), blood pressure (BP), and a complete hormone panel were collected. The hormone panel included free testosterone (fT), total testosterone (TT), estradiol (E2), sex hormone binding globulin (SHBG), prolactin (P), follicle-stimulating hormone (FSH), luteinizing hormone (LH), Hemoglobin A1c (HgA1c), and hematocrit (Hct). The hormonal panel was collected before 11 AM using LCMS. Individuals with any missing values were not included in the analyses.

Results

442 men with a mean age of 28.03 years [sd 7.02] were included. The mean BMI was 28.04 kg/m2 [sd 7.02]. In this cohort, only 4.4% of patients had a prior diagnosis of Diabetes Mellitus (DM), 9.4% with Hypertension (HTN), and 5.5% with dyslipidemia (DLP). However, among new pts presenting for infertility evaluation without any known comorbidities 22.0% of pts had elevated HbA1c ≥5.7%, 61.78% had HTN (>120/80 mmHg) on two consecutive reads, 31.5% had elevated TG levels (≥150 mg/dL), 35.0% had low HDL levels (<40 mg/dL), and 38.23% of pts had two or more of these risk factors. 36.6% percent of pts were overweight (BMI ≥25 and < 30 kg/m2), 17.6% were obese (BMI ≥30 and < 35 kg/m2), and 11.2% were morbidly obese (BMI ≥35 kg/m2). 26.0% of pts were smokers, and 21.9% had hypogonadism (TT <300 ng/dL). There was no statistically significant difference in the prevalence of these risk factors among different ethnic groups or ages.

Conclusions

Our study revealed a high prevalence of undiagnosed CVR factors in young men presenting for primary infertility evaluation. Our study underscores urologists' pivotal role in evaluating overall men’s health. Assessing BMI, BP measurements, HgA1c, lipid, and hormone panels in this patient population may be useful parameters to identify young infertile men at risk for cardiac disease and lead to earlier detection of undiagnosed CVR factors and early preventative interventions.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific; Coloplast; BK Ultrasound.
(278) THE USE OF IRRISEPT AT THE TIME OF IMPLANTATION OF INFLATABLE PENILE PROSTHESES REDUCES CULTURE POSITIVITY AT THE TIME OF REMOVAL AND REPLACEMENT SURGERY FOR NON-INFECTED IMPLANTS
Authors: Nosé BD , Grimaud L , Sury K , Foreman JR , Lentz AC
Published: December 2024

Introduction

The inflatable penile prosthesis provides durable management for erectile dysfunction with high rates of patient satisfaction; however, the device is still limited by a mechanical lifespan and the risk of infection. Multiple studies have examined the presence of biofilm at the time of revision surgery with reported rates of positivity being as high as 80%. The advent of antiseptic irrigation, notably Irrisept™ (0.05% chlorhexidine gluconate), has potentially introduced a paradigm shift that may alter the rate of culture positivity during revision surgery.

Objective

To evaluate the antibiogram of organisms isolated during penile prosthesis revision surgery before and after the implementation of Irrisept™ irrigation during the device’s original implantation.

Methods

Data was collected using our institution’s prospectively managed database of penile prosthesis surgery. All 845 penile prosthesis cases from the start of Irrisept use in November 2019 to January 2024 were reviewed. Of the 194 removal and replacement cases for non-infectious indications, operative details from the initial implantation and culture data from the time of revision were available for 72 cases. Of these, 22 had undergone original implantation with use of Irrisept irrigation and 50 were performed without Irrisept use at the time of original implantation.

Results

The patient demographics before and after the use of Irrisept were similar, with average ages being 69 and 65 in the pre and post-Irrisept cohorts, respectively. A higher proportion of patients in the pre-Irrisept cohort did have devices with Inhibizone (54% versus 32%) and increased rates of diabetes (36% versus 32%); however, tobacco use was higher in the post-Irrisept™ population (50% versus 38%). Notably, the percent of cases with positive swab cultures at the time of removal and replacement were 9% in the post-Irrisept group compared to 22% in cases where Irrisept™ was not used.

Conclusions

The use of Irrisept™ antiseptic irrigation at the time of implantation is associated with a decreased rate of culture positivity at the time of removal and replacement for non-infected inflatable penile prostheses.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.
(280) NO DIFFERENCE IN PENILE PROSTHESIS COMPLICATION RATE BETWEEN ESRD AND RENAL TRANSPLANT RECIPIENTS: A TRINETX COHORT STUDY
Authors: Ward B , Thompson A , Thirumavalavan N
Published: December 2024

Introduction

Erectile dysfunction (ED) is estimated to have 54-66% prevalence among renal transplant recipients. Patients with end-stage renal disease (ESRD) are known to be at significant risk of perioperative complications. However, in men with ESRD, it is unclear whether penile implantation while on dialysis has a benefit over implantation after transplantation. We utilize a large de-identified database to compare complication rates between patients with ESRD and renal transplant recipients.

Objective

To determine whether there is a difference in penile prosthesis complications between patients dependent on dialysis and patients who have received a kidney transplant.

Methods

Using TriNetX Research Network, we identified patients with history of renal transplant, ESRD, or dialysis-dependent status preceding PPP utilizing ICD-10 and CPT codes. Patients were then grouped into a renal transplant or ESRD/dialysis-dependent status cohort. Penile prosthetic-related complications include infection-related, mechanical, thromboembolism, hemorrhage, pain, stenosis, removal without replacement, removal with replacement, and all complications. Kaplan–Meier analysis was performed on the TriNetX platform to compare occurrence of penile prosthesis complications between cohorts and hazard ratios were calculated.

Results

168 and 196 patients were retrieved with median follow up time of 1265 and 1007 days in renal transplant and on dialysis cohorts, respectively. Significant baseline characteristic differences included American Indian/Alaska Native (p = 0.0005) with <6% and 0% in the renal transplant group and dialysis-dependent group respectively and Hypertensive diseases (p = 0.006) with 96% and 89% in the renal transplant group and dialysis-dependent group respectively. No significant differences in post-PPP complications were observed in hazard ratios including all outcomes (HR 1.216, p = 0.154), infection-related (HR 1.068, p = 0.864), mechanical (HR 0.836, p = 0.513), removal without replacement (HR 1.381, p = 0.7385), and removal with replacement (HR 1.269, p = 0.2235). Less than 10 patients in either group were found to have outcomes including thromboembolism, hemorrhage, pain, and stenosis so these outcomes could not be accurately assessed. Less than 10 patients in the dialysis-dependent group were found to have removal without replacement.

Conclusions

The risk of penile prosthesis complications does not appear to differ between men with previous renal transplant compared to men dependent on dialysis.

Disclosure

No.
(285) DOES A SEPARATE BLOOD SUPPLY TO THE URETHRA DECREASE COMPLICATIONS IN TRANSMASCULINE GENDER AFFIRMATION SURGERY? OUTCOMES OF RADIAL ARTERY URETHROPLASTY IN A LARGE COHORT
Authors: Gobbo A , Li VY , Christopher NA , Ralph D , Lee WG
Published: December 2024

Introduction

Transmasculine gender affirmation surgery (tGAS) is a highly morbid procedure in which the most frequent complications are fistulas and strictures, especially at the phallus level. We hypothesized that the construction of the urethra using the radial artery urethroplasty (RAU) technique, since the urethra is constructed with its own separated blood supply, may lead to an overall lower incidence of complications compared to the integrated phallus urethra construction.

Objective

The purpose of this study is to examine the urethral complication profile after RAU.

Methods

We included patients undergoing tGAS in a three-stage procedure (neophallus-join up-penile prosthesis) between 2014 and 2019 collected from our prospective institutional database. Fistula/stricture occurrence after RAU was recorded and analyzed using the Chi-squared test and univariable logistic regression.

Results

314 individuals with a median follow-up of 4.3y were included. Types of phalloplasty include forearm flap (80.6%), anterolateral thigh flap (7.6%), and abdominal flap with free flap urethroplasty (11.8%). 13% of the patients underwent RAU to construct the urethra or to treat a panurethral stricture following the neophallus construction. 90.2% of the RAU were performed after an abdominal flap. Patients undergoing RAU had a significantly lower number of fistulas/strictures at the phallus level compared to integrated urethras (9.7% vs 39.2%, p = <.001). Logistic regression confirmed RAU as a protective factor (OR = .17, p = .001). A slightly greater number of scrotal or perineal fistulas after the join-up stage were recorded after RAU, however, the finding was not significant (14.6% vs 8.1%, p = .17).

Conclusions

We confirmed the hypothesis that constructing the urethra with a separate vascularization from the phallus assures fewer fistulas/strictures in the phallus, likely because of the better blood supply. We found a non-significant slightly higher incidence of scrotal and perineal fistulas after the join-up stage in individuals who underwent RAU however, larger cohorts are needed to accurately evaluate this aspect.

Disclosure

No.
(294) A CASE OF METAL RING ENTRAPMENT CAUSING PENOSCROTAL STRANGULATION
Authors: Gillan EC , Alwaal A , Popovic A , Ali D
Published: December 2024

Introduction

Penile “tension rings” have been described as early as the 3rd century in Chinese literature as men were described as wrapping goat eyelids around the base of their penis for increased erection potency. There have been other materials used to prevent blood outflow from the penis during an erection such as rubber bands, plastic bottlenecks, rubber bands, silicone rings, and metal rings. Wearing a penile/penoscrotal constriction device for longer than 30 minutes can lead to serious complications such as tissue edema, ischemia, and eventual necrosis. Thus, if unable to remove a constrictive device, emergent medical intervention is required.

Objective

We report a case of an otherwise healthy 56 year-old male who presented to the emergency department with a titanium metal ring around his penis and scrotum for 72 hours.

Methods

We studied the details of patient presentation, our various treatments attempted, and patient outcome at our institution. We additionally performed a literature review on PubMed (keywords: penile ring entrapment, penile ring strangulation, penile ring treatment) to review other treatment options.

Results

A 56 year-old male with a history of HIV who presented to the emergency department with a titanium metal ring around his penis and scrotum for 72 hours (Fig. 1). Patient was afebrile, hemodynamically stable, and with unremarkable labs. Initial attempts at reducing penoscrotal edema by compression to subsequently slide off the ring using mineral oil were unsuccessful. We then attempted the “string pull” technique by sequentially advancing 0 silk sutures over the ring which was also unsuccessful. We then used an orthopedic bone cutter which was also unsuccessful as the titanium material was too strong. Finally, we resorted to using a Dremel circular rotary saw (which provided to the hospital by the local fire department) to cut the titanium metal ring off in the operating room (Fig. 2). The patient did well post-operatively and passed his trial of void before being discharged on post-operative day one. The patient did not follow up in clinic afterwards.

Conclusions

Penile ring entrapment is a true urologic emergency. Treatment aims to remove the ring while protecting underlying tissue. Treatment is based on case severity and what tools a physician may have at their respective hospital. Noninvasive techniques such as edema compression, lubricant use, and the “string pull” method. When these noninvasive techniques fail, various bone/bolt cutters or saws may be used.

Disclosure

No.
(303) EJACULATORY DYSFUNCTION ASSESSMENT USING AN EJACULATION SCORE QUESTIONNAIRE IN A SOUTH FLORIDA COHORT
Authors: Cruz J , Farias A , Defauwes N , Prabhakar P , Martinez D , Caso J
Published: December 2024

Introduction

The field of male sexual health has traditionally placed significant emphasis on aspects like erection and orgasm, leaving ejaculation somewhat overlooked. In response, our pilot study introduces the Ejaculation Score, an ongoing evaluation tool specifically designed to assess the ejaculatory process. Ejaculatory dysfunction is a widespread concern among men, yet it has not received adequate attention.

Objective

To evaluate ejaculatory dysfunction, we developed a comprehensive ejaculation score questionnaire to better understand and address these issues effectively.

Methods

The 11-question self-administered ejaculation score was given to patients in an outpatient clinic setting. The questionnaire response was recorded among all patients presenting to the male sexual health practice in South Florida. Based on the overall scoring, the ejaculation score was scored as mild ejaculatory dysfunction (1-10), moderate ejaculatory dysfunction (11-20), and severe ejaculatory dysfunction (21-29).

Results

A total of 221 patients took the self-administered questionnaire. The mean age of the cohort was 53 years (range 24-83). Out of this, 160 patients completed the questions that contributed to the final score. Based on these scores, 93 (58.1%) patients had mild ejaculatory dysfunction, 60 (37.5%) had moderate ejaculatory dysfunction, 6 (3.8%) patients had severe ejaculatory dysfunction, and one patient did not have any dysfunction.

Conclusions

In conclusion, the Ejaculation Score pilot study marks a significant step forward in the field of male sexual health. By shining a spotlight on the ejaculatory process, this evaluation tool addresses a crucial aspect of male sexual function. With ejaculatory dysfunction being a prevalent concern for men, the development of a comprehensive and reliable assessment tool is paramount in understanding and effectively treating these issues.

Disclosure

No.
(305) MEN WITH PEYRONIE’S DISEASE ARE DIAGNOSED WITH CANCER AT AN EARLIER AGE: GENETICS OR A FOOT IN THE DOOR?
Authors: Kassab J , Oppenheimer A , Huang J , Stocks B , Lipshultz L
Published: December 2024

Introduction

Men with Peyronie’s Disease (PD) are theorized to have an increased cancer risk. PD is characterized by infiltrative growth, proliferation, and decreased apoptosis- pathways shared by malignant neoplastic growth. Thus, one can hypothesize a genetic predisposition toward cancer as heralded by PD pathogenesis.

Objective

To investigate this hypothesis, we identified patients with and without PD over a 28-year period and quantified demographics and cancer incidences.

Methods

We performed a retrospective review of patients cared for by a single urologic provider in Houston, Texas, from 1995 to 2023 and identified those patients with and without PD. These data were sent to the Texas Cancer Registry who identified those patients with a diagnosis of cancer. They returned data including age at diagnosis, cancer anatomic site, and histologic subtype. Data were then studied in detail, and appropriate statistical analyses performed with GraphPad Prism Software.

Results

From 1995-2023 we identified 148 patients with PD and a diagnosis of cancer and 707 patients without PD (controls) and a diagnosis of cancer. Overall, patients with PD were diagnosed at an earlier age across all cancers v. controls (median 59 y v 64 y, p = 0.0008, student’s t-test). The relative frequencies of cancer subtypes were then compared between the PD and control group and log transformed. Overall, we found higher relative frequencies (2-fold difference) of nervous system, ill-defined, intrahepatic bile duct, nasal cavity, oropharynx, and thyroid cancers and lower relative frequencies of kidney, large intestine, and renal pelvis/ureter cancers in the PD group. Regarding histologic subtypes in this cohort, we found higher relative frequencies of bile duct adenocarcinoma, follicular lymphoma, intraductal papillary-mucinous carcinoma, Kaposi sarcoma, and melanoma, and lower relative frequencies of carcinoid, clear cell adenocarcinoma, multiple myeloma, and unspecified neoplasms.

Conclusions

Patients with PD are diagnosed with cancer at an earlier age. Our data aligns with previous work demonstrating higher rates of upper aerodigestive tract and melanoma cancers and lower rates of large intestine and kidney cancers in men with PD. We provide a more detailed and stratified look among histologic cancer subtypes within men with PD. While our data support the genetic similarity hypothesis in which PD and malignant neoplasm share pathologic pathways, it also raises the question of whether PD simply brings patients to the doctor’s office sooner, resulting in increased cancer detection and diagnosis.

Disclosure

No.
(309) WHAT IS THE RIGHT APPROACH FOR PEYRONIE’S DISEASE SURGERY? COMPARING POSTOPERATIVE WOUND COMPLICATIONS BETWEEN VENTRAL AND SUBCORONAL INCISIONS FOR PATIENTS UNDERGOING PENILE STRAIGHTENING SURGERIES
Authors: Seyer A , Sax-Bolder A , Piraino J , Guillen Lozoya A , Ziegelmann M
Published: December 2024

Introduction

Surgical treatment options for Peyronie’s disease (PD) include penile plication, plaque excision with grafting, and penile prosthesis placement with straightening maneuvers. Choice of surgical incision depends on location and severity of curve, concomitant procedures, and surgeon preference.

Objective

To assess risk of wound complications after PD surgery stratified by ventral versus subcoronal incision type.

Methods

A single surgeon retrospective chart review was conducted for all patients undergoing PD tunica albuginea plication (TA) or plaque excision with grafting (PEG) from Aug 2019 to June 2023. Wound complication was classified as any dehiscence or physical examination finding suspicious for infection within 30d of surgery. A Mann–Whitney U Test was used to compare demographic variables and wound complication rate based on ventral and subcoronal approaches.

Results

Of the 161 patients included, 105 underwent TAP and 56 underwent PEG. All patients who underwent PEG had at least one plication suture performed to correct mild residual curvature after grafting. A ventral midline penile incision was used in 81 patients (50%) and subcoronal in 80 patients (50%). Wound complications within 30d of surgery were found in 10 patients (6%), including 8 (10%) with ventral incisions versus only 2 (3%) subcoronal (OR 4.27; 95% CI 0.87-20.79; p = 0.09). There was no significant difference in wound complications between TAP and PEG cohorts. Wound complications included dehiscence requiring repeat closure (n = 1) and superficial wound infection necessitating antibiotic therapy (n = 9). In a subgroup analysis of patients who underwent TAP only, 8 patients (7.6%) with a ventral approach experienced a 30d wound complication compared with 1 patient (3.4%) with a subcoronal approach.

Conclusions

Penile straightening surgeries are associated with a low rate of significant wound infections. While not statistically significant, a ventral incision may have a slightly higher risk than subcoronal for wound complications within the first 30d of surgery. Both ventral and subcoronal incisions can offer excellent exposure and may be considered for patients requiring plication and/or grafting approaches.

Disclosure

No.
(329) GEOGRAPHIC VARIATIONS AND THEIR CORRELATION WITH ERECTILE DYSFUNCTION GOOGLE SEARCHES IN THE UNITED STATES
Authors: Ahmed Z , Hammad MAM , Miller J , Abou Chawareb E , Jenkins L , Yafi FA
Published: December 2024

Introduction

Erectile dysfunction (ED) significantly impacts the well-being and quality of life of millions of men. Understanding geographic patterns and associated factors influencing ED search trends can offer valuable insights for healthcare improvement and advocacy. This study investigates the correlation between Google search trends for ED and various factors across different U.S. states, focusing on healthcare accessibility, demographic characteristics, and socioeconomic status.

Objective

To analyze Google search trends for ED across different states in the United States in correlation with the urologist-to-population ratio, percentage of the population aged 65 and older, median household income, and percentage of state residents with a bachelor's degree or higher.

Methods

Google search trends for ED were collected over a 12-month period between May 2023 and May 2024, with the specific term “erectile dysfunction”. Synonyms such as impotence, sexual dysfunction, erectile difficulty, erection problems, erectile disorder, erection impairment, and erection failure were also included to strengthen the data. The Google search trends provided data for individual states and were ranked on a scale of 1 to 100 to determine ED search popularity. We then analyzed the search volume alongside variables including the urologist-to-population ratio, percentage of the population aged 65 and older, median household income, and percentage of state residents with a bachelor's degree or higher. Pearson correlation coefficients and correlation analyses were conducted to examine the linear relationships between ED search volumes and these factors that create significant geographical variations.

Results

Significant geographic disparities in ED search volumes were identified across U.S. states. Higher ED search volumes were associated with a greater urologist-to-population ratio (r = 0.39, p = 0.0042) and a higher percentage of older adults (r = 0.51, p = 0.0002). No significant correlation was found between median household income and ED search volumes (r = -0.03, p = 0.8704). Similarly, there was no significant correlation between educational attainment and ED search volumes (r = -0.16, p = 0.2581).

Conclusions

The findings highlight the impact of healthcare accessibility and demographic factors on ED search trends. States with better healthcare access and a higher proportion of older adults show increased public interest in ED. These insights can guide targeted healthcare improvements and advocacy efforts. Future research should explore causative factors and potential interventions to address identified disparities.

Disclosure

No.
(331) SOLID ORGAN TRANSPLANTATION IMPROVES SEXUAL DYSFUNCTION IN OLDER MEN AND WOMEN
Authors: Thompson L , Yatsenko T , Riveros C , Muthigi A
Published: December 2024

Introduction

Solid organ transplant recipients experience life-prolonging benefits. While a substantial body of literature addresses the fertility consequences of transplantation, data on the post-transplant sexual function in both male and female recipients is relatively sparse. This study aims to evaluate sexual dysfunction and fertility issues in this patient population and contribute to the existing body of knowledge regarding the long-term quality of life of transplant recipients.

Objective

The primary objective is to assess the prevalence and extent of sexual dysfunction among patients who have undergone solid organ transplantation. This includes various types of sexual dysfunction such as erectile dysfunction, vaginismus, dyspareunia, and other related conditions. Another key objective is to investigate fertility issues in both male and female transplant recipients.

Methods

This study utilized the TriNetX Global Collaborative Network, a federated database containing >140 million anonymized electronic medical records participating healthcare organizations around the world. Using International Classification of Diseases (ICD) codes, adult patients (≥18 years old) who had undergone solid organ (heart, kidney, liver, lung, and pancreas) transplantation were selected. The primary outcome was a composite of sexual dysfunction, including erectile dysfunction, ejaculatory dysfunction, vaginismus, dyspareunia, orgasmic disorder, hypoactive sexual desire disorder, decreased libido, sexual dysfunction not attributable to substance use or a known physiological condition, and vulvar/vaginal atrophy. The secondary outcome was a composite of male/female infertility as defined by ICD codes. Outcomes were defined a priori and reported as absolute risk reduction (ARR), risk ratios (RR) with 95% confidence intervals (CI). The index event was the date of the transplant, and significance was set at P < 0.05.

Results

A total of 81,341 solid organ transplant recipients were identified. The mean age at transplant was 52 ± 14.2 years, 39% of patients were female, 20% were Black, 11% were Hispanic, and 4% were Asian. Mean follow up was 6 years. Most common comorbidities included hypertension (59%), diabetes mellitus (38%), obesity (21%), and depression (21%). Following solid organ transplant, the ARR of sexual dysfunction was 12.5%, with a RR of 0.83, 95% CI 0.79-0.86, P < 0.001. The ARR for infertility after solid organ transplantation was 0.048%, with a RR of 0.86, 95% CI 0.73-1.02, P = 0.09.

Conclusions

This large-scale study highlights significant improvements in sexual health for solid organ transplant recipients, with a significant ARR in sexual dysfunction. Although a reduction in infertility risk was observed, it was not statistically significant. These findings emphasize the importance of considering sexual health in post-transplant care and suggest a need for further research to better understand and address fertility issues in this population.

Disclosure

No.
(333) TRENDS IN PHOSPHODIESTERASE TYPE 5 INHIBITOR PRESCRIPTIONS AND COST: MEDICARE ANALYSIS 2017-2021
Authors: Cahill E , Reddy S , Rotker K , Honig S
Published: December 2024

Introduction

Phosphodiesterase Type 5 (PDE5) inhibitors are the first line treatment for erectile dysfunction. While urologists commonly prescribe these medications, patients may also receive them from their primary care providers. Cost of medication also highly varies depending on insurance, location, and pharmacy type, which may impact prescribing behavior.

Objective

We aimed to examine prescribing patterns and cost of PDE5 inhibitors in the United States over time, specifically comparing urologists to non-urologists.

Methods

The 2017-2021 Medicare Part D Public Use File was used to identify prescribers of PDE5 inhibitor medications including sildenafil, tadalafil, and vardenafil. The number of claims and total annual expenditure for each medication for all prescribers, non-urologists, and urologists were analyzed from 2017 to 2021.

Results

Sildenafil was the most commonly prescribed PDE5 inhibitor each year, comprising 70.6% of claims in 2021 (Table 1). From 2017 to 2021, sildenafil claims increased from 282,809 to 456,709. Tadalafil prescriptions decreased each year, with 278,773 claims in 2017 and 189,303 claims In 2021. Vardenafil was the least prescribed medication each year. Urologists consistently prescribed more tadalafil than sildenafil each year, however there was a trend towards decreased tadalafil and increased sildenafil prescriptions (Fig. 1). Total annual expenditures for all medications steadily decreased from $444 million in 2017 to $143 million in 2021 (Table 2).

Conclusions

There was a rise in overall claims accompanied by a drastic drop in cost for PDE5 inhibitors over the 5 year period in the Medicare Part D database. Specifically, claims for sildenafil increased, while claims for tadalafil decreased. Additionally, claims from non-urologists increased each year, while claims from urologists remained relatively stable. Urologists most commonly prescribed tadalafil while non-urologists most commonly prescribed sildenafil. Vardenafil prescriptions remained low over time. We suspect that usage of these medications increased as a result of decreasing costs. However, online access options, direct to consumer advertising, and patient comfortability with seeking treatment may play a role as well.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Endo Pharma, Fellow, Posterity Health, HIMS, WIN fertility, Haleon.
(335) VENTRAL CORPORAL REINFORCEMENT USING PERICARDIUM ALLOGRAFT (TUTOPLAST®) IN PATIENT UNDERGOING URETHRECTOMY PROCEDURE WITH INFLATABLE PENILE PROSTHESIS IN PLACE
Authors: Leung S , Mahdi M , Wang R
Published: December 2024

Introduction

Radical cystectomy (RC) is the standard treatment for non-metastatic muscle-invasive or high-grade/intravesical therapy refractory bladder cancer. Erectile dysfunction (ED) is a common consequence of RC, with inflatable penile prosthesis (IPP) placement considered as the gold standard for refractory cases. Urethral recurrence post-RC necessitates urethrectomy, which poses challenges for patients with existing IPP.

Objective

The thinning of the ventral tunica albuginea during urethrectomy may increase the risk of corporal disruption and IPP cylinder aneurysm, affecting long-term device functionality. This case introduces a novel surgical technique using Tutoplast graft, a human-derived pericardium allograft, for corporal reinforcement during urethrectomy in the presence of in situ IPP.

Methods

74-year-old male, with history of robotic-assisted RC for bladder cancer in 2015 and IPP placement for refractory ED in 2017, presented for recurrent blood per urethra in 2023. Imaging revealed masses on the penile urethra and bulbar urethra. The patient underwent total urethrectomy and was noted intra-operatively to have significant thinning of the ventral tunica albuginea. To prevent device aneurysm or mechanical failure, Tutoplast graft was used to reinforce the thinned tunica albuginea. Tutoplast was secured to the lateral, superior, and inferior aspects of both corpora. Patient was followed up to 6 months post-operatively.

Results

Final pathology of the urethra showed high-grade papillary urothelial carcinoma with invasion of the corpus spongiosum. The patient recovered well post-operatively, with normal IPP functionality up to the 6 months follow-up period. This case introduces Tutoplast graft as a simple and cost-effective technique to support the ventral tunica albuginea and protect the IPP cylinders during urethrectomy. While Tutoplast has been used in other settings, its application in preventing IPP malfunction post-urethrectomy is a unique contribution.

Conclusions

Corporal reinforcement using Tutoplast graft during urethrectomy in patients with existing IPP is a promising and innovative technique. It presents a viable solution to mitigate the risks of corporal disruption and IPP cylinder aneurysms during urethrectomy. The positive outcome demonstrated in this case report warrants further studies with larger patient populations and longer follow-up periods to assess the long-term outcomes and potential risks associated with this procedure.

Disclosure

No.
(337) PRACTICE PATTERNS AND IMPACT OF PRE-OPERATIVE IMAGING IN PENILE FRACTURE: A RETROSPECTIVE ANALYSIS
Authors: Bahaee J , Bajic P , Parekh N , Lundy S , Vallabhaneni S
Published: December 2024

Introduction

Penile fracture is an uncommon, but potentially devastating urogenital injury characterized by rupture of the tunica albuginea induced by trauma to the erect penis. Immediate repair is associated with a significantly improved prognosis for long-term sexual health. Due to the importance of early surgical intervention, the role of imaging techniques such as ultrasound (US) and magnetic resonance imaging (MRI) in diagnosis is controversial. Typically, the diagnosis of penile fracture is made based on history and physical exam. AUA guidelines recommend imaging as an adjunct study to assist with the diagnosis in equivocal cases. However, there is no clear protocol for the use of supplemental imaging in the literature.

Objective

To report our review of patients who presented to the emergency department with possible penile fracture to 1) examine practice patterns in the use of pre-operative imaging and 2) assess if pre-operative imaging was associated with prolonged time to the operating room (OR).

Methods

Electronic medical record data from a single multi-hospital health system from 2011 to 2022 was reviewed. IRB approval was obtained. The retrospective chart review assessed clinical presentation, physical exam findings, subsequent management, operative details (site of injury), imaging modality and erectile function prior to injury.

Results

A total of 96 patients presented to the emergency department with concern for penile fracture. Three were excluded due to incomplete records. Mean patient age was 47 years. Ten patients (10.8%) underwent MRI and 9 patients (9.7%) underwent penile ultrasound. 71% ultimately underwent surgical intervention. 60% of patients who underwent MRI had findings suggesting penile fracture. 67% of patients who underwent penile ultrasound had findings suggesting penile fracture. Mean time to complete an MRI after it was ordered was 3.85 hours. When comparing the time it took for patients to undergo incision after their initial consultation, we found a notable difference between those who underwent MRI and those who did not (p < .001). On average, patients who had an MRI waited significantly longer-25.09 hours compared to those who did not have imaging, who waited an average of 7.29 hours.

Conclusions

While obtaining imaging can prolong time to OR, imaging did not prevent early repair of penile fracture, which has superior outcomes. Future studies should explore long term outcomes in patients who did vs did not receive pre-operative imaging.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Halozyme, Endo pharmaceuticals, Coloplast.
(338) DISPARITIES IN PRIAPISM CARE: INSIGHTS FROM NSQIP DATABASE
Authors: Langston D , Das R , Horns J , Hotaling J
Published: December 2024

Introduction

Priapism, marked by prolonged penile erection unrelated to sexual arousal, carries risks of tissue damage and permanent erectile dysfunction, mainly in its ischemic subtype. Despite guidelines stressing prompt intervention, disparities in management remain largely unexplored, urging further investigation to enhance patient outcomes and quality of life, driving our objective to analyze Priapism data from the National Surgical Quality Improvement Program (NSQIP) database.

Objective

To examine potential disparities in priapism care using the NSQIP database.

Methods

We conducted a retrospective analysis of priapism cases from 2007-2021 using the NSQIP database, focusing on ischemic and non-ischemic cases identified through ICD-9 and -10 and CPT codes. We assessed how reported race/ethnicity (Black, Hispanic, White) correlated with 30-day complication rates, surgical interventions (shunting), immediate penile prosthesis (PP) placement, and procedural management (penile injection and irrigation), analyzing p-values with Chi-squared tests.

Results

Our cohort of 474 priapism patients, were predominately Whites (43%) and the median age was 44 years. Emergent cases accounted for 51.3%, with corporospongiosal shunt being the most common intervention (57.4%). Patient race did not significantly influence the choice of shunting procedure. For those who underwent procedural intervention, 10.6% underwent irrigation of corpora cavernosa and 3.8% underwent injection of corpora cavernosa. Interestingly, Hispanic males trended lower rates in both categories: irrigation (Hispanic 5.6%, Black 10.8%, White 12.9%, p = 0.235) and injection (Hispanic 0%, Black 4.2%, White 5.0%, p = 0.045).Post-operative complications were observed in 6.7% of cases, with blood transfusion being the most common (4.01%). Reoperation rate was 13.7%, primarily for repeat priapism, leading to a 30-day readmission rate of 7.0%.

Conclusions

Priapism demands swift evaluation and treatment to mitigate discomfort and preserve erectile tissue integrity. Our research suggests a potential link between race and the procedural and surgical approaches to managing priapism, with varying initial management and transfusion rates among racial groups. Future investigations should delve deeper into these racial disparities and investigate potential variations in initial treatment upon presentation to the Emergency Department.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: StreamDx, Inherent Bioscience, Turtle Health, Maimus, Carrot Fertility.
RD21-like proteases: key effector hubs in plant–pathogen interactions
Authors: Huang Jie , van der Hoorn Renier A L
Published: December 2024

Over the past decades, numerous studies have demonstrated that proteases serve as a crucial regulatory mechanism in controlling plant immunity. In this review, we specifically focus on the role of one subfamily of RD21-like papain-like cysteine proteases that carry a C-terminal granulin domain. These proteases share high homology but have been described under very different names in different plant species. We provide a comprehensive overview of the background, endogenous regulation, and subcellular localization of RD21-like proteases in plants. Notably, RD21-like proteases act in immunity against various pathogens and they are targeted by many unrelated pathogen-secreted effectors that inactivate, mislocalize, or degrade RD21-like proteases. We highlight open questions and strategies to use this knowledge to develop innovative approaches for crop protection.
Unlocking the promise of UK health data: considering the case for a charitable GP data trust
Authors: Redhead Caroline A B , Bowden Catherine , Ainsworth John , Burns Nigel , Cunningham James , Holm Søren , Devaney Sarah
Published: December 2024

The UK National Health Service general practice (GP) patient data constitute a rich research resource, but collecting, managing, and sharing patient data present challenges. In May 2021, to address these challenges, substantial changes to the system for processing pseudonymized GP patient data in England were announced. As part of an opt-out process, patient consent to sharing GP data was deemed to have been given. However, when over a million people quickly acted to opt out of the new system, the process was paused, and an engagement exercise commenced, whose aim was to inform a re-designed programme addressing patient concerns. In this article, we present and discuss the findings of the General Practice Data Trust pilot study, which has investigated people’s reasons for opting out of sharing their data, and, looking for practical solutions to their concerns, has discussed with participants the concept of a ‘data trust’ to manage the sharing of patient data. Making a conceptual argument for the use of the (relatively new) charitable incorporated organization as a governance model for a GP data trust, we demonstrate how this could address patients’ concerns and represent a more attractive means of stewarding GP data for research and service planning purposes.
The Unity of Reason
Authors: Zapero David
Published: December 2024

On one possible view of practical reason, that capacity is subject to a standard of correctness determined by independently obtaining facts. This view has recently come under attack, notably in Jeremy Fix’s ‘Intellectual Isolation’. The relevant view, he claims, treats practical reason as a species of theoretical reason and is unable to account for the role that practical reason plays in rational agency. His case relies, however, on a certain conception of theoretical reason: a contemplative conception according to which theoretical reason is practically inert. By embracing that conception, he is led to suppose that exercises of a capacity with an external standard of correctness could not, by themselves, move a subject to act. But the contemplative conception is hardly compulsory. A view according to which practical reason is subject to an external standard need not take the shape, nor involve the corollaries, that Fix, and others, assume it must. Or so I argue.
Tuning and functionalization of logic gates for time resolved programming of bacterial populations
Authors: Bäcker Leonard E , Broux Kevin , Weckx Louise , Khanal Sadhana , Aertsen Abram
Published: December 2024

In order to increase our command over genetically engineered bacterial populations in bioprocessing and therapy, synthetic regulatory circuitry needs to enable the temporal programming of a number of consecutive functional tasks without external interventions. In this context, we have engineered a genetic circuit encoding an autonomous but chemically tunable timer in Escherichia coli, based on the concept of a transcription factor cascade mediated by the cytoplasmic dilution of repressors. As proof-of-concept, we used this circuit to impose a time-resolved two-staged synthetic pathway composed of a production-followed-by-lysis program, via a single input. Moreover, via a recombinase step, this synchronous timer was further engineered into an asynchronous timer in which the generational distance of differentiating daughter cells spawning off from a stem-cell like mother cell becomes a predictable driver and proxy for timer dynamics. Using this asynchronous timer circuit, a temporally defined population heterogeneity can be programmed in bacterial populations.
Structural and kinetic insights into tRNA promoter engagement by yeast general transcription factor TFIIIC
Authors: Seifert-Dávila Wolfram , Chaban Anastasiia , Baudin Florence , Girbig Mathias , Hauptmann Luis , Hoffmann Thomas , Duss Olivier , Eustermann Sebastian , Müller Christoph W
Published: December 2024

Transcription of transfer RNA (tRNA) genes by RNA polymerase (Pol) III requires the general transcription factor IIIC (TFIIIC), which recognizes intragenic A-box and B-box DNA motifs of type II gene promoters. However, the underlying mechanism has remained elusive, in part due to missing structural information for A-box recognition. In this study, we use single-particle cryogenic electron microscopy (cryo-EM) and single-molecule fluorescence resonance energy transfer (smFRET) to reveal structural and real-time kinetic insights into how the 520-kDa yeast TFIIIC complex engages A-box and B-box DNA motifs in the context of a tRNA gene promoter. Cryo-EM structures of τA and τB subcomplexes bound to the A-box and B-box were obtained at 3.7 and 2.5 Å resolution, respectively, while cryo-EM single-particle mapping determined the specific distance and relative orientation of the τA and τB subcomplexes revealing a fully engaged state of TFIIIC. smFRET experiments show that overall recruitment and residence times of TFIIIC on a tRNA gene are primarily governed by B-box recognition, while footprinting experiments suggest a key role of τA and the A-box in TFIIIB and Pol III recruitment following TFIIIC recognition of type II promoters.
High resistance barrier and prophylactic protection in preclinical models of SARS-CoV-2 with two siRNA combination
Authors: Anglero-Rodriguez Yesseinia I , Lempp Florian A , Subramanian Megha , McIninch James , Schlegel Mark K , Bohan Dana , Wong Emily , Brown Christopher R , Foster Donald J , Castoreno Adam B , Nguyen Tuyen , Cuffe Dara , Montiel-Ruiz Martin , Kaiser Hannah , Sahakyan Anna , Spreafico Roberto , Morskaya Svetlana Shulga , Barry Joseph D , Berman Daniel , Zhang Ligang , Lefebvre Stephanie , Kasper Anne , Racie Timothy , Weddle Diann , Mobley Melissa , Wassarman Kelly , Bisbe Anna , Zlatev Ivan , Rogers Arlin , Nechev Lubomir , Dybowski Joseph , Chong Saeho , Nair Jayaprakash , Simon Amy , Sloan Kevin , Hwang Seungmin , Virgin Herbert W , Fitzgerald Kevin , Maier Martin A , Hinkle Gregory , Hebner Christy M , Akinc Akin , Jadhav Vasant
Published: December 2024

RNA interference is a natural antiviral mechanism that could be harnessed to combat SARS-CoV-2 infection by targeting and destroying the viral RNA. We identified potent lipophilic small interfering RNA (siRNA) conjugates targeting highly conserved regions of SARS-CoV-2 outside of the spike-encoding region capable of achieving ≥3-log viral reduction. Serial passaging studies demonstrated that a two-siRNA combination prevented development of resistance compared to a single siRNA approach. Viral resistance to single siRNA treatment occurred due to emergence of point mutations at critical positions required for siRNA-mediated target binding and cleavage, which led to a loss of siRNA efficacy. With a two-siRNA combination, emergence of mutations within the siRNA binding site was abolished. When delivered intranasally, two-siRNA combination protected Syrian hamsters from weight loss and lung pathology by viral infection upon prophylactic administration but not following onset of infection. Together, the data support potential utility of RNAi as a prophylactic approach with high resistance barrier to counteract SARS-CoV-2 emergent variants and complement vaccination. Most importantly, given that the siRNAs can be rapidly developed from a new pathogen sequence, this strategy has implications as a new type of preventive medicine that may protect against future coronavirus pandemics.
Genome-wide mapping of spontaneous DNA replication error-hotspots using mismatch repair proteins in rapidly proliferating Escherichia coli
Authors: Hasenauer Flavia C , Barreto Hugo C , Lotton Chantal , Matic Ivan
Published: December 2024

Fidelity of DNA replication is crucial for the accurate transmission of genetic information across generations, yet errors still occur despite multiple control mechanisms. This study investigated the factors influencing spontaneous replication errors across the Escherichia coli genome. We detected errors using the MutS and MutL mismatch repair proteins in rapidly proliferating mutH-deficient cells, where errors can be detected but not corrected. Our findings reveal that replication error hotspots are non-randomly distributed along the chromosome and are enriched in sequences with distinct features: lower thermal stability facilitating DNA strand separation, mononucleotide repeats prone to DNA polymerase slippage and sequences prone to forming secondary structures like cruciforms and G4 structures, which increase likelihood of DNA polymerase stalling. These hotspots showed enrichment for binding sites of nucleoid-associated proteins, RpoB and GyrA, as well as highly expressed genes, and depletion of GATC sequence. Finally, the enrichment of single-stranded DNA stretches in the hotspot regions establishes a nexus between the formation of secondary structures, transcriptional activity and replication stress. In conclusion, this study provides a comprehensive genome-wide map of replication error hotspots, offering a holistic perspective on the intricate interplay between various mechanisms that can compromise the faithful transmission of genetic information.