bluuebunny/crossref_metadata_2025_split huggingface dataset:
(253) REGENERATIVE THERAPIES FOR ERECTILE DYSFUNCTION: A SYSTEMATIC REVIEW, BAYESIAN NETWORK META-ANALYSIS, AND META-REGRESSION
Authors: Hinojosa-Gonzalez D , Saffati G , Orozco Rendon D , La T , Kronstedt S , Muthigi A , Khera M 
Published: December 2024

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

Disclosure
No.
(271) CHARACTERIZING TESTOSTERONE PROFILES IN MEN WITH TESTIS CANCER PRIOR TO RADICAL ORCHIECTOMY
Authors: Flores Martinez J , Ljubetic BM , Liso N , Mulhall JP 
Published: December 2024

Abstract

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

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

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

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

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

Disclosure
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(289) SAFETY AND EFFICACY ASSESSMENT OF THE VERTICA® - A RADIO FREQUENCY DEVICE FOR THE TREATMENT OF ERECTILE DYSFUNCTION (ED)
Authors: Abou Chawareb E , Lumbiganon S , Hammad MA , Raheem OA , Reisman Y , Gruenwald I , Lischinsky D , Yafi FA 
Published: December 2024

Abstract

Introduction
The VERTICA® is a hand-held, home use device, designed to treat 'mild to moderate' and moderate erectile dysfunction (ED) using radiofrequency (RF) electrodes. These electrodes deliver sequential RF energy to the penile area, with additional electrodes on a pad applied to the perineal area to also cover the penile crus. We hypothesize that 1) RF energy raises penile temperature, enhancing erectile response, and 2) RF energy posits a direct structural and biochemical impact on tunical and corporal tissue, improving the tunical veno-occlusive mechanism.

Objective
The purpose of the current study is to evaluate the safety and efficacy of the VERTICA® investigational device for treatment of ED.

Methods
This study is a pivotal, prospective, randomized, controlled, double-blind clinical trial. Around 100, in our center 33 adult, heterosexual, and sexually active males (≥22 years) with mild to moderate and mild organic ED (IIEF EF score 11-21) will be enrolled and randomized 1:1 for Active or Sham VERTICA® treatment. Patients are instructed to use the device 3 times a week for 4 weeks (12 treatments), twice a week for an additional 4 weeks (8 treatments) and then 1-2 times a week for another 4 months. Every treatment comprises a 15-minute session involving ring electrodes, followed by an additional 15-minute session incorporating both ring and pad electrodes. Compliance and treatment data is monitored using a smartphone app. Subjects are instructed to attempt sexual activity weekly or 6 times a month, logging events in the Sexual Encounter Profile (SEP) form. Monthly follow-up assessments at months 1, 2, 3, and 6 include evaluating the efficacy of the treatment using the IIEF-EF, SEP, EHS, EDITS, and SHIM questionnaires. Enhancements in ED will be measured by comparing the scores of these questionnaires within both groups and, for every individual, before and after completing the study.

Results
A pilot study with 28 subjects demonstrated the device's safety and efficacy, with no serious adverse events reported in 144 treatment sessions.

Conclusions
In conclusion, the VERTICA® investigational device shows promise in the treatment of mild to moderate erectile dysfunction (ED) based on the pilot study and the ongoing pivotal clinical trial. If the results of this trial are promising, the VERTICA® device could offer a novel and effective treatment option for men with mild to moderate ED, potentially improving their quality of life and sexual health.

Disclosure
Yes, this is sponsored by industry/sponsor: Ohhmed.
Clarification: Industry funding only - investigator initiated and executed study.
Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout.
(295) EARLY PLACEMENT OF INFLATABLE PENILE PROSTHESIS FOLLOWING PENOSCROTAL DECOMPRESSION
Authors: Tabei SS , Raheem O 
Published: December 2024

Abstract

Introduction
Ischemic priapism is the most common form of priapism which accounts for up to 95% of the cases. Prolonged ischemic priapism is associated with a higher risk of corpus spongiosum fibrosis and the development of erectile dysfunction. Studies have shown that treatment of ischemic priapism under 12 hours has an excellent prognosis and may prevent erectile dysfunction in 100% of cases. On the other end of the spectrum, ischemic priapism &gt;36 hours may lead to permanent loss of erectile function in virtually all cases.

Objective
One of the newer procedures applied in cases of refractory priapism is the penoscrotal decompression approach which is technically similar to the inflatable penile prosthesis insertion technique. In cases of failed distal shunting, this procedure has proven to be useful in small-scale studies. In this method, a penoscrotal incision is made followed by corporotomy and and corporal dilation. It is suggested that penoscrotal decompression may be favorable to early IPP placement from an economical standpoint.

Methods
In our experience, a 42-year-old individual presented with a prolonged episode of ischemic priapism for approximately 36 hours which did not achieve detumescence by conservative management. A shared decision was made to proceed with penoscrotal decompression. However, the patient was unable to achieve detumescence after the procedure. We decided to insert a three-piece IPP approximately 48 hours after the penoscrotal decompression procedure. A separate inguinal counter-incision was made for reservoir placement according to the established protocols for IPP placement.

Results
Penoscrotal decompression may not always provide favorable outcomes and maintaining erectile function by IPP implantation may be considered afterwards.

Conclusions
The insertion of the prosthesis following penoscrotal decompression is more challenging than the normal setting as the primary priapism leads to more blood clot formation and intracavernosal adhesion and fibrosis.

Disclosure
No.
(296) SALVAGE VAGINOPLASTY WITH SINGLE-PORT ROBOT ASSISTED TUBULARIZED URACHUS PERITONEAL HINGE FLAP: TECHNIQUE HIGHLIGHTS, OUTCOMES, AND AN EVIDENCE-BASED PROPOSAL FOR HOW AND WHEN TO USE (AND NOT USE!) PERITONEUM WITH VAGINOPLASTY
Authors: Shiang A , Sandhu S , Smith S , Mallavarapu S , Stelmar J , Yuan N , Gupta A , Kim H , Garcia M 
Published: December 2024

Abstract

Introduction
Currently, only two published gender-affirming vaginoplasty techniques describe using peritoneal tissue to contribute to the neovaginal canal: The modified Davydov technique, first described by Zhao et al (2019), and the Tubularized Urachus-Peritoneal Hinge Flap, described by Garcia et al (2022). Today, many providers use the Davydov technique at the time of primary vaginoplasty, while other providers argue that use of peritoneum is not necessary at the time of primary vaginoplasty. We use peritoneum (urachus-flap) only for salvage surgery.

Objective
We report urachus hinge-flap technical innovations, and clinical outcomes at 1.5-years postoperatively. We also review the literature to determine whether there is evidence to support using peritoneum at time of primary vaginoplasty.

Methods
We review our single-port robot-assisted urachus hinge flap technique to augment neovaginal depth following primary vaginoplasty. We also review technical innovations to maximize neovaginal depth with primary vaginoplasty using only penile and scrotal skin. We present our literature review, and posit a theory that explains why, regardless of PV technique, mean neovaginal depth is 11-13 cm in all series.

Results
Our mean neovaginal depth after salvage urachus hinge flap technique is 12.5 cm (range 11-14.2) at 409 days post-op, comparable to the Davydov technique. With primary vaginoplasty using only penile and scrotal skin, our mean depth is 12.5 cm, which is comparable to other series (Fig. 1). We use video to show how, with the Davydov technique, rectum and bowel are pulled deep into the pelvis post-op, which increases risk of bowel injury at time of salvage surgery with intestine (URL: https://youtu.be/z3pQrNY-A5I).

Conclusions
By the techniques described herein, we are able to achieve comparable vaginal depth as other groups that use the “pull-through” technique. We suggest that peritoneum is only rarely necessary at primary vaginoplasty, and should be reserved for use as a salvage surgery if needed. The urachus flap is a safer alternative to the Davydov technique if and when PV fails and salvage intestinal vaginoplasty must be undertaken.

Disclosure
No.
(299) EJACULATORY INSIGHT OF A SOUTH FLORIDA COHORT USING A MODIFIED EJACULATION SCORE QUESTIONNAIRE
Authors: Farias A , Cruz J , Defauwes N , Prabhakar P , Martinez D , Caso J 
Published: December 2024

Abstract

Introduction
Elements like erection and orgasm have been the main focus regarding male sexual health, overshadowing ejaculation in the comprehension and study of male sexual function.

Objective
We modified an ejaculation score questionnaire to assess the ejaculatory process and identify ejaculatory dysfunction. In addition to the questions to score and evaluate ejaculatory dysfunction, we included questions to apprehend the patient’s perspective of an ideal ejaculation.

Methods
At a male sexual health outpatient clinic in South Florida, patients were given an 11-question self-administered ejaculation score. These patients were not seeking care for ejaculatory disorders. Elements such as force, consistency, volume, and the significance of these factors were incorporated into the questionnaire to understand the patient’s perception of an ideal ejaculation. In addition, we explored whether having difficulties with ejaculation was bothersome and the importance of ejaculation for sexual satisfaction. All the responses were recorded and analyzed for further evaluation.

Results
Of the 221 patients who finished the self-administered questionnaire, those who particularly responded to the questions about their perception of ejaculation were evaluated. A substantial majority, 70% (126/180), preferred “Strong (Shoots out)” as their ideal force of ejaculation. A considerable 62.2% (107/172) favored a “Moderate (½ a shot glass)” amount regarding the ideal volume of semen expelled. Similarly, 54.4% (93/171) considered “Thin/thick, chunky” as an ideal consistency. Furthermore, 47.9% (79/165) of participants experiencing difficulties with ejaculation answered “A lot” when asked if it was a bother. Finally, a significant 81.2% (138/170) of respondents expressed the notable importance of ejaculation to the male sexual orgasm.

Conclusions
This ongoing pilot investigation gained valuable insights into the perceptions of ejaculation. This study can be a foundation for healthcare providers to improve patient-centered care by recognizing and addressing individual preferences and concerns. Thus, it provides enhanced support for patients so they can attain healthy and gratifying sexual experiences, thus improving their quality of life.

Disclosure
No.