bluuebunny/crossref_metadata_2025_split huggingface dataset:
(231) SOLID ORGAN TRANSPLANT IS NOT ASSOCIATED WITH INCREASED COMPLICATION RATES AFTER PENILE PROSTHESIS: A TRINETX STUDY
Authors: Ward B , Thompson A , Thirumavalavan N 
Published: December 2024

Abstract

Introduction
Erectile dysfunction (ED) has increased prevalence among solid organ transplant (SOT) recipients than the general population. Penile prosthesis placement (PPP) allows efficacious treatment, though with concern for increased complications in this population. Here we utilize a large de-identified database to compare complication rates between men who received PPP after SOT and immunosuppression.

Objective
To determine whether risk of solid organ transplant is associated with an increased risk of penile prosthesis-related complications.

Methods
Using TriNetX Research Network, we identified men aged ≥18 who underwent PPP and SOT (kidney, lung, heart, liver, intestine, pancreas). Men were grouped into cohorts: patients with PPP excluding transplant status (control), and those with an IPP after SOT. 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 the occurrence of penile prosthesis complications between cohorts and hazard ratios were calculated.

Results
12282 patients were included in the control group and 253 patients were included in the solid organ transplant group. Multiple significant differences were observed in baseline comorbidities including Black or African American race (20% control vs 36% SOT, p &lt; 0.0001), White race (57% vs 38%, p &lt; 0.0001), Hypertensive disorders (52% vs 96%, p &lt; 0.0001), cerebrovascular diseases (7% vs 19%, p &lt; 0.0001), atherosclerosis (5% vs 21%, p &lt; 0.0001), diabetes mellitus (31% vs 79%, p &lt; 0.0001), overweight and obesity (20% vs 44%, p &lt; 0.0001), nicotine dependence (11% vs 23%, p &lt; 0.0001), malignant neoplasms of male genital organs (27% vs 16%, p0.0001), and major depressive disorder (3% vs 8%, p = 0.0002). No statistically significant differences in post-PPP complications were observed in comparison between control and SOT groups including infection-related (HR = 0.56, p = 0.832), mechanical (HR = 0.738,p = 0.95), removal without replacement (HR = 1.033, p = 0.22), removal with replacement (HR = 0.659, p = 0.661) (see Table 2). Thromboembolism, hemorrhage, pain, and stenosis outcomes all had less than 10 instances in the SOT group and could thus not be accurately assessed.

Conclusions
SOT status itself does not appear be associated with an increased risk of penile prosthesis-related complications when compared to a control population despite increased prevalence of multiple comorbid conditions.

Disclosure
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(241) BEYOND STRAIGHTENING: LONG-TERM SATISFACTION WITH A MODIFIED TUNICA ALBUGINEA PLICATION TECHNIQUE
Authors: Desouky E , Katz DO , Feldman-Schultz O , Levine LA 
Published: December 2024

Abstract

Introduction
The Tunica Albuginea Plication (TAP) procedure is a corrective surgery for penile curvature, addressing both congenital (chordee) and acquired (Peyronie’s disease(PD)) deformity. Like any surgical intervention, TAP carries potential side effects including penile shortening, palpable stitches/nodules, changes in penile sensation, incomplete correction of curvature, and potential impacts on sexual function. The modification of the Duckett-Baskin procedure, employs a minimal number of permanent sutures per case (1-3), can mitigate problems associated with the use of only permanent sutures without a higher recurrence rate. While the primary aim of TAP is to achieve a functional straightening of the penis (curvature &lt;20 degrees), there's limited data available regarding patient perspectives and long-term satisfaction.

Objective
This study aims to evaluate patient satisfaction over the long term following the modified TAP procedure.

Methods
We collected data of patients who underwent TAP between 2019 and 2023. An 8-question survey was conducted via telephone. Satisfaction levels were graded from 1 (very disappointed) to 5 (very satisfied). Survey questions encompassed aspects such as penile length, residual curvature, penile sensation, palpable sutures, pain, erectile function, ability to engage in penetrative sex, and overall sexual satisfaction.

Results
A total of 233 patients underwent TAP, aged 15-77 years, with a follow-up period ranging from 11 to 71 months. So far, 91 patients have completed the survey (72 with PD & 19 with Chordee). Penile length emerged as a primary concern for 12% of PD patients who were dissatisfied with their length following the procedure, while none of the chordee patients expressed such concern. Dissatisfaction with palpable nodules or sutures was reported by only 2%, and dissatisfaction with residual or recurrent curvature was reported by 8%. 96% were satisfied with penile sensation. Pain/discomfort was reported as very satisfying by 99% of respondents. Erectile function was satisfactory for 94% of the cohort, with 93% reporting overall sexual satisfaction as satisfactory and very satisfactory.

Conclusions
Overall, patients perceive the long-term outcomes of our modified TAP procedure positively. Dissatisfaction primarily centered around penile length, with lesser concerns about penile sensation, indicating the necessity for increased attention to these known side effects, particularly in addressing the impact on penile length, potentially associated with PD itself.

Disclosure
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(242) THE IMPACT OF ENVIRONMENTAL FACTORS AND CHRONIC MEDICAL CONDITIONS ON SEMEN PARAMETERS: A TEN-YEAR LONGITUDINAL ANALYSIS
Authors: Venishetty S , Scott M , Rodriguez A , Lundy S 
Published: December 2024

Abstract

Introduction
The environmental and chronic medical conditions including metabolic risk factors appear to continue to negatively impact the semen qualities in men worldwide including United States. Poor semen parameters is often used as marker for underlying men’s health and can be associated with increased morbidities and overall mortality.

Objective
In this large longitudinal analysis, we aim to evaluate the correlations between variable risk factors and medical conditions and semen analysis in adult men at a large reproductive urology center.

Methods
In this ten-year retrospective chart review, male patients ≥18 of age with documented semen analyses were included. Data collected included the patients’ demographics, comorbid medical conditions recreational alcohol, tobacco or marijuana use. Semen analysis as per WHO 10th reference included sperm concentration, count and motility. Data analyzed using multivariate and univariate linear regression and logistic regression.

Results
A total of 2,322 patients were included in the study. White and black non-Hispanic men had higher rates of oligospermia and/or azoospermia compared with Asian men (p &lt; 0.001) and had higher body mass index (BMI) (p = 0.019). Among the comorbidities, type 2 diabetes (p = 0.046), hypertension (p = 0.014), anemia (p = 0.001), chronic kidney disease (p = 0.013), and heart failure (p = 0.001) were associated with higher rates of oligospermia and/or azoospermia. Among recreational use, tobacco and marijuana use were associated with oligospermia. (p = 0.043) (Table 1).

Conclusions
In our study, environmental and metabolic risk factors and conditions appear to be significantly associated with reduced semen qualities particularly sperm concentration, count and motility. This analysis underpins this critical association between men’s health marker ie, semen analysis and underlying environmental and chronic medical conditions in men at-risk. Future studies are warranted to further exploit these association and provide appropriate medical counseling and treatment.

Disclosure
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(243) DELAY OF CARE NEGATIVELY IMPACTS FEMALE PARTNERS OF PATIENTS WITH MALE FACTOR INFERTILITY
Authors: Kassab J , Garcia Keeme-sayre A , Oppenheimer A , Huang J , Stocks B , Lipshultz L 
Published: December 2024

Abstract

Introduction
Approximately half of couples with infertility will be found to have a male factor. However, historical data has revealed that infertility is preferentially attributed to the female partner. This often-wrong assumption may cause female partners to undergo invasive and expensive procedures and treatments when the couple’s lack of fertility is ultimately due to male-related factors.

Objective
We aimed to quantify the impact of delayed urologic care for male-factor infertility.

Methods
An electronic survey was delivered through REDCap to patients who were evaluated in our clinic for male-factor infertility from January 2023 to June 2024. The survey assessed each couple’s reproductive care quantitatively and qualitatively prior to seeking urologic services at our institution. Descriptive statistics were employed to analyze the data.

Results
A total of 121 couples completed the anonymous survey. 35.5% of the couples reported experiencing early focused female gynecologic care and 13.3% sought out reproductive endocrinology and female fertility counseling prior to seeing a urologist for male infertility evaluation. Of those who first sought other specialties before investigating the possibility of male-related infertility, respondents stated that they spent a range of 2 months to 6 years on solely female reproductive care. Additionally, 51.5% considered their treatments invasive and costly. Almost half (48.7%) of all respondents wish they sought out urologic care sooner.

Conclusions
Delayed urologic care for male-related factors can result in significant premature costs, both financially and in time invested, and in invasive treatments for female partners, who are often presumed to be the primary cause of infertility. These findings highlight the need for early and equitable evaluation of both partners in infertility cases to optimize patient care and minimize unnecessary procedures. Further, the results indicate patients who did not seek urologic care earlier regretted not doing so. This delay underscores the significance of better patient education and awareness regarding male-factor infertility.

Disclosure
No.
(244) MEDICAID COVERAGE OF INFERTILITY TREATMENTS
Authors: Popovic A , Gillan E , Jain K , Alwaal A 
Published: December 2024

Abstract

Introduction
Infertility is experienced by 15% of couples, with up to 50% of cases related to male factors. Unfortunately, infertility treatments are expensive and infrequently covered by insurance, burdening patients and deterring access to care. However, Medicaid patients are even less likely to pursue treatments. Of 92 million Medicaid enrollees, 31 million are between the ages of 18 to 44, prime age for fertility intervention. However, transparency of Medicaid coverage of fertility interventions is low.

Objective
In this study, we evaluated Medicaid coverage status and physician reimbursement for the most common infertility-related interventions.

Methods
Physician fee schedules were accessed through state Medicaid websites for the year 2023. The fee schedules were searched for current procedural terminology (CPT) codes used for male infertility interventions. The Medicaid physician fee index was accessed for each state and linear regression analysis was performed to assess if state reimbursements were attributable to a tendency for that state to reimburse more for Medicaid services.

Results
Of the 50 US states analyzed, 49 publish accessible physician fee schedules. Tennessee requires patient claim data to be submitted before releasing fee schedules. No states offered reimbursement for microscopic testicular extraction of sperm thus requiring alternatives for coding, or the use of out-of-pocket billing. Certain procedures were covered by every state, such as testis biopsy, while others were rarely covered, such as vasovasostomy (table 1). Reimbursement patterns for several CPTs significantly varied based on the state physician fee index, although these were typically weak correlations (table 2).

Conclusions
Discrepancies in state coverage and reimbursement for fertility procedures is evident. Some of the discrepancies can be explained by state fee indexes, however the absence of clear methodology behind a state’s decision to cover fertility procedures and physician reimbursement rates both contribute to overall lack of transparency within Medicaid. This lack of transparency may be partially responsible for underutilization of infertility treatments in Medicaid patients.

Disclosure
No.
(252) INDUCING BUSINESS OR IMPROVING PRACTICE? AN ANALYSIS OF EXISTING STEM CELL TRAINING PROGRAMS FOR PHYSICIANS
Authors: Ellythy L , Addani M , Master Z 
Published: December 2024

Abstract

Introduction
Most US businesses offering unproven stem cell interventions (SCIs) are run by physicians, many of whom operate outside their scope of training. To date, little effort has been made to educate practicing physicians about SCIs. To circumvent the need, several businesses have begun advertising training opportunities for physicians.

Objective
To understand the current training landscape for physicians, we undertook a systematic content analysis of stem cell courses advertised on the internet.

Methods
We conducted Google searches using keywords and included onsite, online, and hybrid training programs targeting physicians or other clinicians. We systematically examined all information and identified 14 courses (6 onsite, 4 online, and 4 hybrid) offered by 11 different organizations. Courses ranged from single-day workshops to year-long programs with an average cost of $4,919 and ranged from $500 to $22,000.

Results
Nine courses listed a practicum component and ten courses listed 63 affiliated clinics, companies, and non-profit institutions. Eight organizations included learner testimonials as text and/or video with most authored by physicians and all expressed a positive tone. We analyzed marketing language used by training organizations that 6 of 14 explicitly mentioned offering assistance in marketing and/or revenue growth to learners. We also examined the backgrounds of physician faculty among organizations. Of the 7 businesses which listed faculty, a total of 172 faculty were found ranging from 4 to 71 individuals. Among the 172 faculty, 121 were physicians where we were able to determine whether they provided unproven, questionable or proven treatments within their practice. The majority of physician faculty (66%) were associated with unproven treatments, 21% offered proven treatments, and 13% offered questionable treatments. Nearly half the faculty (48%) provided 3-5 unproven therapies, 35% provided 1-2 unproven therapies, and 17% provided 6 or more unproven therapies.

Conclusions
Our results indicate that current pedagogical offerings for physicians interested in SCIs are likely to offer questionable training that is not rooted in evidence. Physicians interested in SCIs should seek training from nationally accredited organizations. The scientific community should invest in physician training surrounding SCIs.

Disclosure
No.
(255) “WHAT PUSHED IT FOR ME WAS THE OVERTURNING OF ROE V. WADE”: ASSESSING THE PATIENT-REPORTED INFLUENCE OF SOCIOPOLITICAL ISSUES ON POST-DOBBS VASECTOMY DECISIONS
Authors: Cheng L , White K , Mcnally K , Wecht A , Jarlenski M , Hwang K 
Published: December 2024

Abstract

Introduction
Following the June 2022 US Supreme Court decision on Dobbs v Jackson Women’s Health Organization overturning the federal constitutional right to abortion recognized since Roe, high levels of vasectomy interest and confusion regarding male reproductive healthcare options have persisted despite no direct impact to male contraception. To the best of our knowledge, the patient-reported influence of sociopolitical issues on male patients’ vasectomy decisions has not been studied.

Objective
Our objective was to characterize the impact of sociopolitical issues, including the Dobbs reversal of the right to abortion recognized since 1973, on male patients’ vasectomy decisions and timing.

Methods
Patients of a men's reproductive health outpatient clinic within a large academic healthcare system in Southwestern Pennslyvania who had initiated a vasectomy consult from July 2022 – February 2024 were eligible to participate in a survey questionnaire. Patients were called retrospectively or approach prospectively in-person. Demographics, factors influencing vasectomy, and general economic and political interest data were collected via modified Likert and short free-text answers. Chi-square, logistic regression, Mann–Whitney U, and Kruskal-Wallis tests were performed as indicated.

Results
311 patients completed the survey. Mean age of patients was 37 years of age (range: 21, 61); 11.7% (n = 30) were under 30 at time of appointment. Median number of biological children was two (IQR: 1, 3); 19.6% (n = 50) had no biological children. Patients spent on average 2.9 years (range: 0, 33) considering a vasectomy prior to deciding. Regarding factors influencing vasectomy, 31.3% (n = 80) of participants indicated sociopolitical issues as very influential in deciding to undergo a vasectomy, with 17 participants writing in the “reversal of Roe v Wade” or “abortion legislature” in response to a free-text question asking what prompted their vasectomy decision. Men with no children were seven times more likely than men with to cite sociopolitical issues as influencing their vasectomy (sociopolitical: OR = 7.3, p &lt; 0.001). When asked how Roe would influence access to male reproductive healthcare options in their home state, 21.9% (n = 56) answered Roe would limit or prevent access to the listed options (ie, hormone replacement therapy, IVF, vasectomy, or sperm cryopreservation).

Conclusions
While recent sociopolitical and legislative issues may not directly impact male patients’ reproductive healthcare, our results demonstrate the influence broader events have on male patients’ contraceptive decisions and reproductive healthcare understanding. Furthermore, clinicians may need to proactively address uncertainty and confusion around the impact of reproductive healthcare legislature on male patients’ reproductive healthcare options.

Disclosure
No.
(257) TURNING TO TIKTOK: PRECONCEIVED NOTIONS AMONG PATIENTS ABOUT VASECTOMIES
Authors: Cheng L , Wang V , Hwang K 
Published: December 2024

Abstract

Introduction
TikTok, a short-form video social media platform, is used by hundreds of millions daily to share experiences and learn new information. Millennials (born between 1981 to 1996) have indicated increased trust in healthcare information accessed over TikTok; a recent study demonstrated one in five surveyed went to TikTok for health information before a physician. As vasectomy interest rises, awareness and understanding of the most commonly available information is critical for physicians to better aid patients.

Objective
Explore the reach, content, and quality of vasectomy-related TikTok content created in 2022 before and after the reversal of Roe v. Wade.

Methods
Using a proprietary TikTok application program interface (API) program, we queried the 100 most-viewed vasectomy-related videos created across two time periods in 2022: January 24–June 23 and June 24–December 23. We segmented our time periods to best represent the increase of reproductive healthcare content created following the June 24th, 2022 Dobbs v Jackson Women’s Health decision overturning Roe v. Wade (hereafter, Roe). Videos in a language other than English, lacking textual or verbal content, or deemed unrelated to vasectomies were excluded. Included videos were categorized by two raters as primarily educational, experiential, or entertainment in purpose, as well as positive, neutral, or negative tone.

Results
158 videos met inclusion criteria. Since their creation, these videos garnered more than 137.5 million views, 20.7 million likes, and 1.25 million shares. Mentions of reproductive rights increased more than 300% in videos created after Roe compared to those created before (n = 25 vs n = 7, respectively). The two raters’ Cohen’s kappa on tone and purpose categorization agreement were 0.85 (95% CI: 0.81, 0.89) and 0.91 (95% CI: 0.87, 0.94). Videos were overwhelmingly neutral to positive in vasectomy portrayal, with only 3.2% (n = 5) videos categorized as negative in tone. 22 videos (13.9%) were categorized as educational in purpose, 73 (46.2%) as entertainment, and 63 (39.9%) as experiential. Among educational videos, only seven videos were created by a board-certified MD, and only two were created by urologists.

Conclusions
Patients are increasingly turning to social media for healthcare information. Given the dearth of educational videos on social media about vasectomies and men’s reproductive health, we urge physicians to be aware of, and even actively engage in creating, this informational presence.

Disclosure
No.
(258) VASECTOMY ON TIKTOK: AN ANALYSIS OF THE TOP 50 VIDEOS
Authors: Cahill E , Reddy S , Rotker K , Honig S 
Published: December 2024

Abstract

Introduction
Vasectomy is a safe and effective procedure for men desiring permanent sterility. Recent research has shown a trend towards rising vasectomy volume since the Dobbs decision, especially in men under age 30. Social media is commonly used by patients seeking information prior to proceeding with surgical procedures.

Objective
We aimed to analyze videos discussing vasectomy on TikTok, with specific attention to the type of user, video content, and video engagement (ie, likes, comments, and views).

Methods
TikTok was queried for “vasectomy” and the top 50 results were analyzed. Video information collected included source of video (physician v. non-physician user), likes, comments, views, followers, and video length. Videos were further analyzed for specific content including discussion of procedure itself, permanence, failure, need for post-vasectomy semen analysis (PVSA), and reversal.

Results
50 TikTok videos were reviewed by one physician. Of the videos reviewed, 41 (82%) were created by non-physicians and 9 (18%) were created by physicians. Of the physician users, four (44.4%) were urologists. Between these two groups (table 1), videos from non-physician creators had significantly more views, likes, and comments whereas physician users had significantly more followers. Physician users were significantly more likely to discuss permanence of procedure, possible failure and need for PVSA, whereas non-physician users were significantly more likely to discuss side effects/post-procedure experience.

Conclusions
TikTok users are more likely to view and engage with non-physician user posts discussing their vasectomy experience. Physician users are more likely to mention the risks of the procedure including intent of permanence, possibility of failure, and need for PVSA. Social media is a common way for patients to obtain information about procedures. Due to 23 times more views of non-physician created videos, vasectomists should continue to counsel patients regarding the risks, benefits and alternatives of a vasectomy prior to proceeding.

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.