bluuebunny/crossref_metadata_2025_split huggingface dataset:
(197) PENILE FRACTURE MANAGEMENT AT TRAUMA CENTERS IN THE UNITED STATES
Authors: Furuyama W , Dwyer K , Huang L , Koyama T , Johnsen N 
Published: December 2024

Abstract

Introduction
Current American Urological Association Urotrauma guidelines recommend prompt surgical intervention for patients presenting with acute penile fracture to minimize potential risks of erectile dysfunction and penile curvature. Given its relatively rare occurrence, there have been few large national studies evaluating real-world management of penile fracture.

Objective
To understand if there is variability in intervention for patients presenting with penile fracture associated with patients’ clinical and demographic characteristics and hospital characteristics.

Methods
The Trauma Quality Improvement Program (TQIP) database from 2007 to 2017 was analyzed and patients with diagnosis codes for penile fracture were identified. Patient demographic data and hospital characteristics were analyzed. Multivariable analysis was performed to identify patient and hospital characteristics associated with surgical intervention for penile fracture.

Results
We identified 940 patients presenting with penile fracture. The median age was 39 (quartiles: 31-47). Of the 940 patients, 658 (70%) of patients underwent surgery for penile fracture during index admission. On multivariable regression analysis, hospital teaching status, type of insurance, and concomitant urethral injury diagnosis were significantly associated with the likelihood of intervention.

Conclusions
In this large, retrospective study, most patients underwent guideline-based management. However, several patients did not have surgery at the time of their presentation, which was associated with presenting to a non-teaching hospital, using Medicaid or Medicare insurance, and the absence of urethral injury. TQIP is focused on trauma centers, thus this study may not reflect practice patterns across the United States. Further understanding of nonoperative management may improve adherence to guideline-based care.

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(201) REAL WORLD COMPLICATIONS FOLLOWING BURIED PENIS REPAIR WITH SKIN GRAFTING
Authors: Furuyama W , Dwyer K , Johnsen N 
Published: December 2024

Abstract

Introduction
With rising prevalence of obesity in the United States, adult acquired buried penis (AABP) is an increasingly widespread problem. It impacts sexual function, personal hygiene, urination, self-esteem, and quality of life. As surgery is the cornerstone of definitive management, understanding complication rates in the real world is essential for adequate counseling and setting patient expectations.

Objective
In this study, we sought to describe our experience managing AABP and discuss rates of complications following surgery. We also sought to understand risk factors for complications.

Methods
We performed a single-institution, single-surgeon retrospective study of AABP managed with escutcheonectomy and skin grafting. Complications included wound infection, urinary tract infection, dehiscence, recurrence of AABP, any degree of graft loss, and mortality. We also collected demographic data, including age, comorbidities, and BMI.

Results
We identified 29 cases between February 2020 and March 2024. Of those, 26 patients (90%) had a complication – the most common being wound infection (55%) and partial or complete graft loss (41%). Those with complications following surgery had a higher body mass index than those without complications (46 kg/m2 vs 32 kg/m2, p = 0.017). Two post-operative deaths occurred, both secondary to pulmonary emboli.

Conclusions
While the literature supports high patient satisfaction following surgery for AABP, complications are common. Adequate counseling, vigilant follow-up, and realistic expectations remain critical to the management of AABP. Based on our data and experience, all patients are now sent home on venous thromboembolism prophylaxis and surgical intervention is withheld until the patient’s BMI is less than or equal to 40 kg/m2.

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(203) RISK FACTORS FOR REPEAT EROSION IN RADIATED PATIENTS UNDERGOING REIMPLANTATION OF ARTIFICIAL URINARY SPHINCTER DEVICES
Authors: Gaines T , Ivan S , Loh-Doyle J , Foreman J , Lentz A , Peterson A , Klein R , Myrga J , Rusilko P , Michel J , Matluck N , Cordon B , Mikhail M , Hwang A , Shridharani A , Tryfonyuk L , Martins F , Gonzalez R , Van Der Voort G , Simhan J 
Published: December 2024

Abstract

Introduction
With limited alternatives to achieve continence, radiated patients with prior artificial urinary sphincter (AUS) erosion represent a challenging population at risk for a subsequent erosion event. Though prior analyses have assessed risk factors for the development of subsequent AUS erosion after an initial erosion event, these investigations are often limited by the inclusion of non-radiated erosion patients in the study design.

Objective
We analyze a multi-institutional cohort to identify independent predictors of repeat erosion events in a large series of radiated prostate cancer survivors.

Methods
A multi-institutional, retrospective review was performed of all radiated patients with history of prior AUS erosion. Clinical features, procedural specifics and surgical outcomes were collected for all patients who experienced an erosion event and underwent repeat AUS implantation. Univariate and multivariate logistic regression analyses were performed to identify independent factors predictive of secondary AUS erosion event.

Results
A total of 118 patients with history of pelvic radiation (55% salvage, 32% adjuvant, 13% primary radiation) underwent a second AUS implantation at a median of 6.2 months after a prior AUS erosion event. Median age at time of second AUS implantation was 76.6 years and 35% of patients had a history of low testosterone (low T). The overall rate of second AUS device erosion was 47%. The median time to AUS erosion of the initial device was 22.4 months compared to 14.2 months for the second AUS device (p &lt; 0.01). On univariate analysis, history of radiotherapy in the adjuvant (OR 2.54, CI 1.113-5.432, p = 0.034) and salvage (OR 2.66, CI 1.234-4.345, p = 0.012) settings were associated with increased risk of erosion. Uncorrected (OR 2.43, CI 1.143-6.432, p = 0.032) and corrected (OR 2.22, CI 1.116-6.345, p = 0.041) low T as well as history of urethroplasty (OR 2.23, CI 1.231-4.324, p = 0.08) also conferred additional risk of erosion. On multivariate analysis, independent risk factors for a secondary AUS erosion event in radiated patients included uncorrected low T (OR 2.03, 95% CI 1.435-3.456, p = 0.041), history of urethroplasty (OR 2.14, 95% CI 1.123-4.237, p = 0.045), and salvage radiotherapy (OR 2.23, 95% CI 1.24-5.435, p = 0.026).

Conclusions
Radiated patients with a history of salvage radiotherapy, prior urethroplasty, and uncorrected low T contemplating AUS re-implantation following initial AUS device removal for erosion events are at increased risk of repeat erosion events.

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(206) COMBINED CLOMIPHENE AND HIGH-DOSE ORAL TESTOSTERONE THERAPY IN HYPOGONADAL MEN: A CASE SERIES
Authors: Yoon G , Vo J , Sun AY 
Published: December 2024

Abstract

Introduction
Clomiphene is often used in the treatment of hypogonadal men who wish to preserve endogenous testosterone production, however symptomatic responses are often suboptimal. Exogenous testosterone replacement, while effective, typically suppress the hypothalamic–pituitary-gonadal (HPG) axis. This case series investigates the efficacy of combining clomiphene with high-dose oral testosterone undecanoate (TU) (Kyzatrex, Marius Pharmaceuticals).

Objective
To report the outcomes in a series of patients treated with combined clomiphene and oral TU therapy.

Methods
Three hypogonadal men who initially received clomiphene therapy (50 mg every other day) but did not achieve satisfactory symptomatic improvement despite numerical improvement were identified. Subsequently, they were given oral TU 400 mg once daily with lunch. Subjective symptomatic outcomes, total testosterone (TT), sex hormone binding globulin (SHBG), calculated free testosterone (fT), estradiol, hematocrit (Hct), and HPG axis markers luteinizing hormone (LH) and follicle stimulating hormone (FSH) were monitored at baseline, after 3 months of clomiphene monotherapy, and after 3 additional months of combined clomiphene and oral TU therapy.

Results
The patients had baseline serum testosterone levels of 303, 223, and 230 ng/dL. After 3 months of clomiphene 50 mg QoD, TT rose to 418, 680, and 667 ng/dL respectively, however these patients reported continued symptoms of hypogonadism. After adding 400 mg oral TU once daily for 3 months, TT rose to 1001, 1055, and 1120 ng/dL, and the patients reported significant improvement in symptoms such as erectile dysfunction, fatigue, libido, and exercise tolerance. Both SHBG and Estradiol levels rose with clomiphene monotherapy but subsequently decreased after adding oral TU. Hct was unchanged throughout. FSH and LH levels both rose on clomiphene and subsequently dropped after initiation of oral TU, but remained near baseline, indicating preserved HPG axis function. No significant adverse events were reported.

Conclusions
In these patients for whom clomiphene monotherapy failed to generate a sufficient symptomatic response, the addition of high-dose oral TU therapy (Kyzatrex 400 mg) at a once-daily dosing resulted in substantial symptomatic improvement while maintaining endogenous FSH and LH levels at baseline. These findings suggest a novel approach to hypogonadism management, balancing effective symptom relief with preservation of endogenous testosterone production, with potential downstream ramifications on fertility preservation.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author serves as consultant for Marius Pharmaceuticals, Boston Scientific, Endo Pharmaceuticals.
(210) EXPLORING HERBAL MEDICINE IN TESTOSTERONE TREATMENT: MYTHS AND EFFICACY UNVEILED
Authors: Espinosa G 
Published: December 2024

Abstract

Introduction
Herbal medicine has a long history for its potential benefits in various health domains, including testosterone management. The effectiveness and safety of these natural remedies remain subjects of debate among medical professionals. This presentation aims to provide a comprehensive overview of herbal supplements used in testosterone treatment, addressing common myths and evaluating their efficacy based on current research and clinical experience.

Objective
The primary objective of this presentation is to assess the role of herbal medicine in testosterone treatment critically. I aim to identify evidence-based practices, understand potential drug-herb interactions, and evaluate the integration of these natural remedies with conventional treatments to improve patient outcomes.

Methods
Numerous peer-reviewed articles reviews were conducted, encompassing, clinical trials, and meta-analyses published over the past two decades. The focus was on herbal supplements commonly used for testosterone enhancement, including but not limited to Tribulus terrestris, Fenugreek, and Ashwagandha. Data on efficacy, safety, dosage, and patient-reported outcomes. Additionally, clinical insights on the use of herbal medicines for sexual dysfunction is presented.

Results
In the literature, there are mixed results regarding the efficacy of herbal supplements in testosterone treatment. Some studies demonstrated modest improvements in testosterone levels and related symptoms, while others showed no significant benefits compared to placebo. Safety profiles varied, with some herbs showing potential for adverse interactions with conventional medications. Clinical experience suggests’ using botanicals for testosterone treatment proper use of certain botanicals may show benefit in the right patient population.

Conclusions
Herbal supplements may offer benefits in testosterone treatment for certain patients, but their efficacy and safety are not universally supported by the evidence. Sexual medicine practitioners should approach these remedies with some caution, emphasizing evidence-based practices and considering potential interactions with conventional treatments. Further research is needed to establish standardized guidelines for the use of herbal medicine in testosterone management. This presentation will equip healthcare providers with the knowledge to navigate the complex landscape of herbal supplements, enabling them to offer informed, holistic care to their patients.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: XY Wellness, LLC.
(216) BENIGN PROSTATIC ENLARGEMENT IS ASSOCIATED WITH ERECTILE DYSFUNCTION IN UNITED STATES
Authors: Paulsen O , Son Y , Wu E , Demario V , Patel V , Devincentz D , Mueller T 
Published: December 2024

Abstract

Introduction
Benign Prostatic Hyperplasia (BPH) is common in older men with an approximated prevalence of 70-80% in men greater than 65. BPH has been associated with lower urinary tract symptoms, but its relationship to erectile dysfunction (ED) has not been explored in nearly the same detail, despite both conditions hosting similar risk factors.

Objective
This study aims to determine whether there is an association between BPH and erectile function in the United States.

Methods
A retrospective review was performed using data from the 2003-2004 National Health and Nutrition Examination Survey in patients who were diagnosed with BPH. Erectile function was assessed using a questionnaire “ability to maintain an erection.” Descriptive statistical analysis was performed on patient demographics and a logistic multivariate regression was completed to ascertain if BPH was associated with erectile function.

Results
This cohort comprised 6,089,425 males, with a 12% prevalence of BPH. The majority were aged 40-59 and non-Hispanic white. Age greater than 40 and veteran status were significantly correlated with BPH (p &lt; 0.0001). Married individuals showed a higher BPH prevalence, with 84% diagnosed, but this was not statistically significant. The lowest prevalence was among separated individuals (0.2%). Household income did not correlate significantly with BPH prevalence, though those with incomes over $75,000 had the highest prevalence of 31%. Racial differences in BPH prevalence were not statistically significant; non-Hispanic whites represented 88% of the pool, while Mexican Americans represented only 2%. Educational attainment also did not significantly affect BPH prevalence, but higher rates were noted among college graduates (31%) compared to those with less than 9th-grade education (5%). Erectile dysfunction was significantly more prevalent in individuals with BPH (p &lt; 0.0001), with almost 50% of those with BPH sometimes or never able to hold an erection, compared to approximately 30% without BPH.

Conclusions
BPH is an independent risk factor for erectile dysfunction in the United States. Early recognition and intervention are crucial to maintaining erectile function, especially in the aging population. In our study, we show that there were two-fold odds of erectile dysfunction if benign prostatic enlargement was reported.

Disclosure
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(218) PHYSICIAN AWARENESS AND INDICATIONS OF 5-ALPHA REDUCTASE INHIBITOR USE FOR BENIGN PROSTATIC HYPERPLASIA IN THE PRIMARY CARE SETTING
Authors: Loloi J , Alicea D , Babar M , Shah J , Azhar U , Labagnara K , Salam A , Tang K , Robles J , Maria P 
Published: December 2024

Abstract

Introduction
Primary care physicians (PCPs) commonly prescribe 5-alpha-reductase inhibitors (5-ARIs) for benign prostatic hyperplasia (BPH). 5-ARIs can affect prostate-specific antigen (PSA) kinetics by decreasing PSA levels by approximately half, and therefore delay early detection of prostate cancer (PCa). Our team previously presented preliminary findings revealing a general low level of knowledge regarding the effects of 5-ARIs on PSA kinetics.

Objective
Thus, the objective of this study is to now present further, expanded data investigating PCPs’ level of awareness and indications of 5 ARI use for BPH in the primary care setting.

Methods
An anonymous 14-question survey was emailed to PCPs in the specialties of Family Medicine or Internal Medicine at a diverse, urban academic institution. Questions focused on residency graduation year, patient volume, medical practice characteristics, knowledge of 5-ARIs and their effects on PSA kinetics, role of 5-ARIs in PCa prevention, and indications for prostate biopsy referral.

Results
221 PCPs were emailed. Overall, 85 PCPs responded, yielding a response rate of 38.5%. All PCPs reported to see men &gt;40 years of age and the majority (78.8%) reported to have prescribed 5-ARIs in practice. Approximately 39% of PCPs were not aware of the suppressive effects of 5-ARIs on PSA and 63.5% were not sure or incorrectly answered when asked about calculating the corrected PSA of a patient who is taking 5-ARIs. Furthermore, nearly 80% were not sure or would not refer a patient who is taking 5-ARIs and has an elevated corrected PSA for a prostate biopsy. 63.5% were not sure or believed that 5-ARIs may decrease the risk of high-grade PCa and 49.4% were not sure or believed that 5-ARIs are approved for the prevention of PCa.

Conclusions
Overall, our expanded culmination of data within an academic, urban institution reveals a low level of knowledge amongst PCPs as it relates to the effect of 5 ARIs on PSA kinetics and subsequently the indications for biopsy referral in these patients. Thus, this gap in knowledge may represent an important initiative to work with our primary care colleagues in caring for patients taking 5 ARIs for BPH.

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(224) ROBOTIC UNILATERAL SEMINAL VESICULECTOMY FOR CHRONIC HEMATOSPERMIA
Authors: Alwaal A , Gillan E , Popovic A 
Published: December 2024

Abstract

Introduction
Hematospermia is typically self-limited and warrants no surgical intervention. Chronic hematospermia however can be quite concerning and requires further investigation. We present here an unusual case of chronic hematospermia lasting 5 years in a 22-year-old patient. He had no other symptoms besides painless hematospermia which was present in every ejaculation. Patient had a PMH of depression and congenitally absent left kidney. Physical examination was within normal limits. STI/Urine testing, lab work, and scrotal ultrasound were all normal. Patient was treated with several antibiotic courses which were unsuccessful. After failing conservative medical management, he was successfully treated eventually by robotic unilateral seminal vesiculectomy in the absence of seminal vesicle cyst/tumor.

Objective
Describe a unique cause of chronic hematospermia characterized by blood pooling the left seminal vesicle in the absence of trauma, infection, tumors, and cysts. We also describe a technique in using robotic unilateral seminal vesiculectomy as a form of successful treatment.

Methods
In order to lateralize which SV was causing hematospermia, a pelvic MRI was obtained which revealed a pooling of blood in the left SV with no cysts nor tumors noted. After being counseled on the risks of surgery including erectile and ejaculatory dysfunction, the patient agreed to undergo surgical removal of the left SV. In the OR, the patient was placed supine with 30 degrees of Trendelenburg. The bowels were mobilized cranially and the DaVinci robotic arms were used to mobilize the left SV. The base of the SV duct was ligated with suture and subsequently transected. Bipolar cautery and hemostatic agents were used to achieve hemostasis.

Results
Patient stayed one night in the hospital before being discharged. He re-presented on POD#3 with abdominal pain and was found on CT scan to have a pelvic hematoma which was evacuated via robotic assisted laparoscopic approach. Patient was discharged the next day without further issue. At 6 months follow up, the patient had no symptoms. His hematospernia completely resolved. He had adequate erections with good ejaculate force and volume. Pathology of the left SV revealed chronic inflammation and vascular congestion.

Conclusions
Robotic-assisted laparoscopic unilateral seminal vesiculectomy is a viable treatment option of chronic hematospermia when the etiology of hematospermia can be lateralized to one SV. To our knowledge, this appears to be the first ever case of seminal vesiculectoy for a reason other than SV cyst or SV tumor. Erection and ejaculatory potency are risks of seminal vesiculectomy but these risks can be mitigated with good surgical technique. We suggest that the risk of post-operative pelvic hematoma from seminal vesiculectomy is not higher than that of any other pelvic surgery.

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(227) THE IMPACT OF VACUUM ERECTION DEVICES USE ON PENILE DOPPLER ULTRASOUND READINGS AND INTRACORPOREAL INJECTION DOSAGE IN PATIENTS FOLLOWING PELVIC SURGERIES
Authors: Khalaf Alla K , Mahdi M , Majzoub A , Jacob J , Slovacek H , Wang R 
Published: December 2024

Abstract

Introduction
Vacuum erection devices (VEDs) are widely considered to be integral in penile rehabilitation post-pelvic surgery by enhancing penile blood flow, preserving length, and facilitating erection.

Objective
This study aims to investigate the impact of VED usage on penile Doppler ultrasound (PDU) readings and the subsequent dose adjustments of intracorporeal injection (ICI) therapy in men following pelvic surgery.

Methods
We conducted a retrospective review of our institution's database to identify patients experiencing erectile dysfunction as a result of pelvic surgery. The study involved individuals from a single institution who visited the Sexual Medicine clinic, underwent PDU, utilized Trimix ICI, and had a follow-up for a minimum of one year. Our investigation comprised data gathered from 232 patients meeting these outlined criteria between 2020 and 2023. Patients were categorized into two groups: Group 1 comprising individuals using VED with ICI for a duration of at least 1 year (minimum of at least 3 times per week) & Group 2 without VED. Student T-test was used to compare various numerical variables between both groups.

Results
In general, out of the 232 patients included, 17.2% were diabetic, 51.9% were hypertensive, 24.5% had radiation therapy & 18.5% had Androgen deprivation therapy. B blocker intake was reported in 15.9% of patients. With regards to surgery type, 41.6% underwent bilateral nerve sparing prostatectomy, 25.3% underwent partial nerve sparing while 3.9% had a non-nerve sparing technique. Cystoprostatectomy was observed in 5.2% while the remaining 3.9% had other pelvic surgeries. Results of the patient demographic and clinical parameters along with the PDU readings between both groups are reported in Table 1. Notably, no statistically significant differences were observed between both groups in terms of age, HbA1c, Testosterone levels, PDU readings, or in relation to the alterations in the ICI Trimix dosage.

Conclusions
Our preliminary analysis suggests that the use of vacuum erection devices (VED) in the rehabilitation of patients following pelvic surgery does not significantly impact erectile function as measured by penile Doppler ultrasound (PDU) readings or the requirements for Trimix intracorporeal injections (ICI) in the postoperative period. While advising patients on the use of VED in conjunction with Trimix injections currently lacks robust supporting evidence, it remains a theoretically beneficial approach. Further studies are needed to definitively determine its clinical significance and move beyond the current inconclusive status.

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