bluuebunny/crossref_metadata_2025_split huggingface dataset:
(259) ARE COST OF LIVING AND AFFORDABILITY CONCERNS CAUSING MORE MEN TO HAVE VASECTOMY WITH NO CHILDREN? A PRE- & POST-PANDEMIC ANALYSIS
Authors: Grober E , Krakowsky Y , Fageeh A 
Published: December 2024

Abstract

Introduction
Most men elect for a vasectomy after the desired number of children in their family unit is complete. Generational lifestyle priorities, cost of living and affordability may also influence the decision and timing of a vasectomy. Following the global pandemic, pressures related to the affordability have meaningfully increased.

Objective
The current initiative investigates the potential impact of post-pandemic lifestyle priorities, cost of living and affordability on decision to have a vasectomy.

Methods
A prospectively maintained database of vasectomy patients of 2 high-volume urologic surgeons was analyzed. Patients were categorized into 2 groups: Group 1 (pre-pandemic) - vasectomy performed between 2018 to 2019 (inclusive); Group 2 (post-pandemic) - vasectomy performed between 2022 to 2024 (inclusive). The groups were compared with respect to patient age, martial/relationship status and the number of children prior to vasectomy. The primary study outcome was the frequency of men undergoing vasectomy with no prior children.

Results
A total of 565 vasectomy patients were analyzed including 152 men in group 1 (pre-pandemic) and 413 men in group 2 (post-pandemic). Table 1. Compares the two groups with respect to patient age, relationship status and the number of children prior to vasectomy. The percentage of men undergoing vasectomy with no previous children was significantly higher (2.7-fold) among men who completed their vasectomy following the pandemic (6% vs. 16%, X2 = 3.9, p = 0.04). The mean number of children among men who underwent vasectomy following the pandemic (1.8 children) was significantly lower compared to mem completing their vasectomy prior to the pandemic (2.1 children).

Conclusions
Following the global pandemic, significantly more men elected for vasectomy with no prior children and the mean number of children among men presenting for vasectomy was lower. Generational lifestyle priorities, cost of living and affordability may have a significant influence on the decision to complete and timing of a vasectomy.

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(262) AN UPDATED PROFILE OF THE VASECTOMY REVERSAL PATIENT
Authors: Kassab J , Oppenheimer A , Huang J , Stocks B , Lipshultz L 
Published: December 2024

Abstract

Introduction
The average age for a vasectomy reversal is reported as 35.2 years in the 1980s and 36.0 in the 1990s.

Objective
We sought to quantify the vasectomy reversal patient profile over the subsequent decades so that urologists may be better informed to counsel patients regarding their current and future fertility options.

Methods
A retrospective chart review was performed on patients undergoing vasectomy reversal from 2010-2023 by a single surgeon. We identified 361 patients. Descriptive statistics were used to obtain demographic data including age at procedure, partner’s age at procedure, time from vasectomy, biologic children prior to vasectomy, indication for procedure, and sperm cryopreservation rates. Independent T-test calculations and one-way ANOVA were used to compare groups using SPSS software.

Results
The average age at time of vasectomy reversal was 42.0 years in the 2010s v. 44.1 years in the 2020s. The average age of the partner at time of vasectomy reversal was 33.2 years in the 2010s v. 33.2 years in the 2020s. The average number of years since vasectomy was 9.69 years and the average age at vasectomy procedure was 32.45 years old in both groups. The average number of biological children born before vasectomy & vasectomy reversal was 2.09 children. 45.7% of vasectomy reversal patients engaged in cryopreservation (sperm banking) at time of their surgery. The most frequently reported cause of seeking a vasectomy reversal was due to a change of marital partner (78.5%). The other main motivations for the surgery were due to a change of mind with their same partner (14.6%), or due to pain or an adverse event related to the original vasectomy procedure (8.23%). The f-ratio of the one-way ANOVA performed on these rates is 13.236 (p-value &lt; .00001).

Conclusions
Our data demonstrate a continued increase in age in our patient cohort at time of vasectomy reversal procedure, exhibiting an average age of 42.0 years old in the 2010s and 44.1 years old in the 2020s. Interestingly, the average age of the partner has remained consistent at 33.2 years old in both time frames studied. It seems that those patients electing vasectomy reversal are getting older with time, perhaps due to advancements in fertility technology or due to an overall shift in family planning ideologies.

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(263) IS THERE STILL A ROLE FOR TESTICULAR FINE NEEDLE ASPIRATION MAPPING IN THE TESTICULAR MICRODISSECTION ERA?
Authors: Joshi P , Schoor R 
Published: December 2024

Abstract

Introduction
Finding sperm in men with non-obstructive azoospermia (NOA) can be challenging. Over the years, reproductive urologists have used a number of different strategies to maximize sperm retrieval rates and the testicular microdissection (mTESE) has been crowned the winner.

Objective
Some urologists perform testicular fine needle aspiration mapping (TFNA mapping) despite the fact that mTESE is the sperm retrieval surgery of choice. Why is this? The present investigation investigated the role of TFNA mapping in the present era.

Methods
We obtained from the “Find an SSMR Doctor” section of the Society for The Study of Male Reproduction (SSMR) email addresses of fellowship-trained male reproductive urologists and sent to them an 8-question survey. We queried the clinician’s attitudes toward TFNA mapping and how, if at all, this procedure fits into their own practices.

Results
Out of 96 surveys sent, we received a total of 32 responses (33% response rate). Of the 32, only 10 had any experience whatsoever with TFNA mappings. 6/10 reported that they currently used TFNA mapping with 4/10 respondents reporting that they used to use it but no longer do. Reasons cited for abandoning mapping included poor results (50%), limited or no access to a laboratory for interpretation (25%), and other (25%). The 6 clinicians that currently used TFNA mapping answered subsequent follow-up questions regarding their usage. If mapping failed to find any sperm at all, then urologists were split 50/50 on either referring for donor sperm or proceeding to mTESE. If mapping found rare sperm only then the majority of respondents proceeded to targeted TESE (75%) as opposed to mTESE (25%). In the event that a mapping resulted in copious amounts of sperm, 75% of clinicians indicated that they would proceed to testicular sperm aspiration as opposed to standard TESE (75% vs 25%). 100% current users of TFNA mapping found that the information gained from the procedure was valuable when counseling patients with non-obstructive azoospermia.

Conclusions
The mTESE is a difficult operation that requires a high level of andrology and embryology support that is simply outside the reach of many urologists that practice male reproductive urology. In contrast, the TFNA mapping is quick and easy to perform. The present study, with all its obvious limitations, demonstrates that some fellowship trained male reproductive urologists utilize TFNA mapping and find it helpful. Urologists that use mapping can avoid mTESE for their patients in certain situations and use the information gained from mapping to guide further management. The survey also indicates that inadequate access to quality laboratories for interpretation is an impediment to TFNA mapping usage.

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(268) PREDICTORS FOR USE OF ADVANCED ERECTILE DYSFUNCTION THERAPY FOLLOWING ROBOTIC ASSISTED RADICAL PROSTATECTOMY
Authors: Oppenheimer A , La T , Huang J , Stocks B , Kadmon D , Lipshultz L 
Published: December 2024

Abstract

Introduction
Despite improvements in nerve-sparing techniques offered by Robotic Assisted Laparoscopic Radical Prostatectomy (RARP), nearly all patients undergoing this procedure will demonstrate some degree of erectile dysfunction (ED) thereafter. Emerging data indicate that older age and pre-surgical hypogonadism correlate with worsened post-surgical erectile dysfunction.

Objective
Herein, we sought to determine real world outcomes of erectile dysfunction therapy as they related to patient age, pre-surgical testosterone level, and testosterone replacement therapy (TRT) at time of RARP.

Methods
We identified patients undergoing RARP by a single surgeon at our institution from 2015-2023. We then collected demographics, pre-surgical total testosterone levels, type of erectile dysfunction therapy (none [No Tx], phosphodiesterase 5 inhibitor [PDE5], or intracavernosal injection [ICI]) and TRT use for each patient. Data were analyzed using GraphPad Prism Software. We performed statistical analysis using One-way ANOVA for comparison of multiple groups followed by Tukey’s post-test. P values less than 0.05 were deemed significant.

Results
We identified a total of 179 patients undergoing RARP (mean age 64 +/- 7 years) who had pre-operative testosterone levels measured (mean testosterone level 396 +/- 299 ng/dL). 74 patients (41%) were found to have untreated hypogonadism. 42 patients (23%) were found to already be receiving testosterone therapy pre-procedurally. Younger patients and those with a higher natural pre-surgical total testosterone level were more likely to proceed with erectile dysfunction therapy (Table 1). Interestingly, while patients on no testosterone therapy were more likely to utilize either no ED therapy or PDE5, those on testosterone therapy were considerably more likely to utilize more invasive ED therapy, namely ICI (Table 2).

Conclusions
Younger age, higher pre-RARP testosterone levels, and Testosterone Replacement Therapy as controlled for by a single surgeon’s operative technique correlate with a patient’s use of erectile dysfunction therapy. Knowledge from this study will aid the urologist in identifying those patients most likely to seek and benefit from post-RARP erectile dysfunction therapy.

Disclosure
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(272) EXPLORING THE IMPACT OF VARICOCELE ON PROSTATE CANCER PATIENTS: A PROPENSITY-SCORE MATCHED ANALYSIS USING GLOBAL REAL-WORLD DATA
Authors: A Moukhtar Hammad M , Miller J , Ahlering T , Yafi FA 
Published: December 2024

Abstract

Introduction
Varicocele is the most common cause of male infertility. Emerging evidence has raised questions about a potential association between infertility and aggressive prostate cancer (PCa).

Objective
Our aim was to investigate whether having a varicocele affects PCa.

Methods
We queried the TriNetX database with access to electronic medical records from 108 partner healthcare organizations worldwide, covering over 129 million patients. We focused on adult males with prostate cancer between 2003 and 2023. Scrotal varices (ICD-10-CM: I86.1) were used to identify varicocele, while prostate cancer patients were identified by ICD-10-CM: C61 codes. We compared the baseline characteristics of PCa patients with and without varicocele, including erectile dysfunction (ED) (ICD-10-CM: N52) and “rising PSA level following PCa treatment” (coded as R97.21). We adjusted for age, BMI, diabetes mellitus, hypertensive diseases, total and free serum/plasma PSA levels, and Gleason score through logistic regression with a 1:1 propensity score matching (PSM). Calculated risk ratios (RR) and Kaplan Meier survival (KM) were calculated after PSM.

Results
Following PSM, 3,809 PCa patients were divided into two groups, with an average age of 66.9 +/- 10.6 years. Of the varicocele group, 50.97% were coded for “elevated PSA levels”, compared to 33.87% in the non-varicocele group, (p = &lt; 0.001). Additionally, 33.89% of the varicocele group experienced ED, compared to 11.84% in the non-varicocele group, (p = &lt; 0.001). Rising PSA level following PCa treatment was observed in 1.60% of the varicocele group, significantly higher than the non-varicocele group at 0.53%, (p = &lt;0.001). Varicocele patients also exhibited a significantly higher rate of PCa screening, biopsy, and ultrasound-guided needle placement. On KM 5-year survival analysis for ED, patients without varicocele had 78.04% survival probability compared to 70.96% for patients with varicocele, (p = &lt; 0.001).

Conclusions
Our study suggests a potential hypothetical association between varicocele and adverse outcomes in prostate cancer patients, including elevated PSA, ED, and rising PSA after PCa treatment. Further research is warranted to understand the clinical implications of this association and determine the usefulness of varicocelectomy on PCa outcomes.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus.
(276) DISRUPTION OF BIOFILM BY LOW INTENSITY SHOCKWAVE THERAPY TO SUCCESSFULLY TREAT AN INFLATABLE PENILE IMPLANT INFECTION: THREE YEAR FOLLOW-UP
Authors: Goldstein I 
Published: December 2024

Abstract

Introduction
Bacterial infection of an inflatable penile implant (IPP) is usually managed by device explantation that is often associated with severe penile fibrosis and decreased length. The decision of device explantation is based on the observation that the infecting bacteria secrete an extracellular biofilm polymer matrix that protect them from systemic intravenous/oral antibiotic therapies. A variety of other infected medical devices, including breast and hip prostheses, and the lines from ventricular assist devices have been successfully treated with low intensity shockwave therapy (LiSWT). To the best of our knowledge, this is the first report of LiSWT successfully treating an infected IPP.

Objective
To report a case of an infected IPP successfully managed using LiSWT combined with systemic antibiotics.

Methods
A 49 year old patient presented 4 weeks post-operatively with an obvious IPP infection: fever (101°F), elevated WBC count (15,400), purulent drainage from a swollen, tender scrotum, and IPP device tenderness. Culture of scrotal drainage prior to antibiotic administration grew serratia marcescens, enterococcus faecalis and citrobacter freundii. He was admitted for broad spectrum IV antibiotics and antifungal agents. Within 6 days, he became afebrile and WBC count normalized (8,000), however his renal and liver function tests became abnormal and he continued to have persistent scrotal drainage/device tenderness. The patient adamantly refused device explanation. He wished to try conservative treatment and was offered LiSWT combined with oral levofloxacin. LiSWT (SoftWave TRT/Urogold 100 MTS, energy flux density 0.13 mJ/mm2, Hz 3.0) was applied to the reservoir, penile shaft and scrotum (600 shocks each) daily for 2 weeks, twice weekly for 2 weeks, and once weekly for 4 weeks.

Results
At 1 week post-LiSWT and systemic antibiotic treatment, the patient remained afebrile with normal WBC count; liver and renal function tests normalized. At 2 weeks, scrotal drainage stopped. At 2.5 weeks, pain/tenderness of IPP components and scrotum stopped. At 3 weeks, inflation/deflation of the IPP occurred without pain. At 5 weeks, intercourse with orgasm was achieved. With greater than 3-year follow-up, he continues to have a fully functional, infection-free IPP.

Conclusions
This obvious IPP infection did not require device explanation. It is hypothesized that LiSWT induced rupture of the biofilm polysaccharide matrix, resulting in bacteria being exposed and thereby enabling systemic antibiotic therapy to access and treat the bacterial infection. LiSWT is a non-invasive, non-operative strategy that has already shown efficacy in treating other medical device infections and may be considered before performing IPP explanation.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Softwave/TRT.
(283) USE OF DECELLULARIZED CADAVERIC DERMAL ALLOGRAFT FOR REVISIONS FOLLOWING GENDER-AFFIRMING GENITAL SURGERY
Authors: Quesada Olarte J , Hale G , Sauer R , Kocjancic E , Acar O 
Published: December 2024

Abstract

Introduction
Gender-affirming vaginoplasty is a complex procedure. Approximately one-third of cases require revisions after penile inversion vaginoplasty (PIV) due to functional and/or cosmetic concerns.

Objective
We aim to describe our experience using a cadaveric decellularized dermal allograft (DDA, DermaPure®;) for PIV revisions.

Methods
We performed a retrospective review of patients who required revision after PIV between October 2020 and October 2023. In our cohort of 19 vaginoplasty revisions, 6 were performed using DDA. We reviewed 5 patients who had adequate follow-up data. Patient characteristics are summarized in Table 1.

Results
The interval between PIV and revision surgery ranged between 3-217 (118.4 mean, SD+/-77.0) weeks. Indications for revisions were neovaginal stenosis, wound dehiscence, or graft loss. Surfaces grafted with DDA were treated with an antiseptic solution. The packing and urinary catheter were removed in 5 days. At this time point, neovaginal self-dilation protocol (TID, 15 minutes/session) was initiated. Signs of graft take and reepithelization were noted two weeks after DDA application in all patients who remained compliant with vaginal dilation at a mean follow-up of 27.2 (SD +/- 12.7) weeks. No allograft-related side effects were encountered. The outcomes of vaginoplasty revision are summarized in Table 2.

Conclusions
Grafting with DDA is a viable option for revisions following PIV and facilitates wound healing and cosmesis with minimal postoperative wound care.

Disclosure
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(284) EVALUATION OF URETHRAL COMPLICATIONS IN A LARGE COHORT FOLLOWING TRANSMASCULINE GENDER AFFIRMATION SURGERY
Authors: Gobbo A , Li VY , Christopher NA , Ralph D , Lee WG 
Published: December 2024

Abstract

Introduction
Currently, literature regarding complications of transmasculine gender affirmation surgery (tGAS) is scarce and based mostly on small retrospective cohorts. The most frequent complications are strictures and fistulas, that frequently require additional surgical procedures to be corrected.

Objective
The purpose of this study is to describe our cohort and identify factors associated with the development of strictures and fistulas at the time of the neophallus construction and join-up stage.

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. Complications from the neophallus construction and join-up stage were extracted and analyzed using Chi-squared test, McNemar 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%). 138 patients experienced at least one complication, with an overall number of 195 complications recorded. Fistulas and strictures accounted for 48.7% and 37.4% of the complications, respectively. There was no association between experiencing fistulas/strictures before and after join-up, although there was a significantly lower incidence after join-up (p = &lt;.001; 31.8% vs 15.7%). Vaginectomy did not significantly decrease the number of fistulas after join-up however, there was a possible trend (4.3% vs 11.5%). Waiting longer between the neophallus construction and the join-up significantly decreased both all-level complications (OR = .93, p = .039) and scrotal/perineal complications (OR = .92, p = .05) after the join-up.

Conclusions
Fistulas and strictures are the most frequent complications in tGAS but are significantly less frequent after the join-up when compared to after the neophallus construction. Vaginectomy does not associate with a lower number of scrotal/perineal fistulas however, our sample may be underpowered. A longer timeframe between the first and second stage proved to be protective against scrotal/perineal complications.

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(286) LEARNING CURVE OF ANTEROLATERAL THIGH FLAP PHALLOPLASTY (ALT) FOR TRANSMASCULINE GENDER AFFIRMATION SURGERY
Authors: Gobbo A , Adasonla K , Christopher NA , Ralph D , Lee WG 
Published: December 2024

Abstract

Introduction
The anterolateral thigh flap phalloplasty (ALTP) offers the advantages of an easily hidden scar, security of vascular supply and improved flexibility in the length of the flap.

Objective
The aim of the study is to define for the first time the surgical learning curve of ALTP.

Methods
To compute the surgical learning curve for ALTP we defined as the surgical outcome measure all complications that occurred after the phalloplasty, excluding complications related to the join-up and erectile device to avoid confounding. 30-day complications, total/partial flap loss, urethral strictures, and urethral fistulas were included. The number of cases performed was used as a proxy for surgical experience. To build the curve we first fitted a multivariable logistic regression model including all clinically significant covariables (case number, flap area, age, presence of urethra, number of vascular pedicles &gt; = 2) and then proceeded with the stepwise backward variable selection to obtain a model with only significant covariables. We then built the surgical learning curve by graphing the marginal predicted complications probability over the number of cases performed, ordered in chronological order, adjusted by the number of vascular pedicles.

Results
From 2009 87 patients underwent ALTP. The median age was 31 (IQR 26-43) and median BMI was 23.5 (21.0-26.0). The cohort had few comorbidities where only 3 patients had diabetes mellitus and none had cardiovascular disease. The median follow up of the cohort was 64 months (43-80). Eighty-one (93%) patients had a pedicled flap, with the remainder requiring free flap transfer. Overall, 31 patients experienced at least one complication as defined previously for the surgical outcome. The multivariable regression model found the case number and the number of vascular pedicles predictors of all complications after the phalloplasty (respectively: OR = .97, p = .003, 95% CI = .95-.99; OR = 4.19, p = .036; 95% CI = 1.09-15.9). More specifically, the probability of complications decreases as more cases are performed and increases when the flap has &gt; = 2 vascular pedicles. The surgical learning curve shows a constant decrease in the adjusted probability of complications from an initial 65% to 10%. Although there was a slight horizontal trend in the last cases, a clear plateau was not reached.

Conclusions
ALTP is a difficult procedure performed only is specialized centers. The learning curve takes several years to accomplish, and we may have not reached its end yet. The relatively low number of cases performed over an extended period may have affected the rendering of the curve.

Disclosure
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