bluuebunny/crossref_metadata_2025_split huggingface dataset:
(162) IT’S TIME TO THINK GREEN: COULD WE REDUCE SEXUAL MEDICINE SURGERY’S CARBON FOOTPRINT?
Authors: Mass Lindenbaum M , Ljubetic BM , Harlamova D , Miller A , Bole R , Bajic P 
Published: December 2024

Abstract

Introduction
Efforts to reduce carbon footprints have been increasing in recent years as concern about the environmental impact of healthcare grows.

Objective
This preliminary study aims to quantify the carbon footprint associated with waste produced in sexual medicine surgeries.

Methods
In the months of May and June 2024, the type, practice location (hospital or surgery center), and total amount of waste in each procedure were recorded. Procedures included inflatable penile prosthesis implantation, malleable prosthesis implantation, and plaque excision and grafting. The waste in the trash bag was weighed by the attending surgeon using a luggage scale. We also recorded the amount of waste sent to recycling and the amount produced by the anesthesia team as separate measurements. In our center, the waste produced in the surgical setting is eliminated by high-temperature incineration. The carbon footprint was calculated by subtracting the amount of recycled waste reported per procedure and then using an emission factor of 0.949 (0.949 Kg. of carbon dioxide emissions (CO2e) for every Kg. of waste incinerated).

Results
The waste produced in 4 different types of sexual medicine surgeries was recorded during this period. The total weight was 100.1 lbs, with an average of 16.68 (+/- 3.79) lbs. The average weight produced by the anesthesia team was 2.92 (+/- 1.78) lb. The average weight of waste that went to recycling was 1.32 (+/- 0.55). The weights broken down by procedure and the carbon footprints are shown in Table 1.

Conclusions
Quantifying the extent of waste production in surgical procedures is crucial. A better understanding of the carbon footprint of sexual medicine practice is essential to working towards mitigation strategies. This study opens up opportunities for further investigation into the environmental impact of elective surgery and developing strategies for carbon emission reduction.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.
(163) VIABILITY OF TARGETED SCREENING FOR STAPHYLOCOCCUS AUREUS AND MRSA AS A SUBSTITUTE FOR UNIVERSAL PREOPERATIVE INFLATABLE PENILE PROSTHESIS NASAL SCREENING
Authors: Alvermann T , Atwater BL , Gross MS 
Published: December 2024

Abstract

Introduction
Staphylococcus aureus (SA) and Methicillin-resistant Staphylococcus aureus (MRSA) are significant and preventable sources of inflatable penile prosthesis (IPP) infection. SA and MRSA nasal carriers have increased risk of healthcare-related infections. Screening and prompt decolonization for nasal carriers of SA in the hospital setting has been shown to reduce postoperative SA hospital-associated surgical-site infections.

Objective
We determined if known epidemiologic risk factors for SA and MRSA were prevalent in our IPP patients who tested positive for SA or MRSA at their preoperative visit. Our hypothesis was that these determinants would help identify at-risk patients to better target preoperative SA and MRSA screening in the future.

Methods
This is a retrospective IRB-approved analysis of 62 asymptomatic patients who screened positive for either SA (n = 56) or MRSA (n = 6) via nasal culture prior to undergoing IPP placement at two hospitals in our practice. These two groups were evaluated separately to compare the presence of risk factors present for SA and MRSA prior to nasal screening. Known risk factors for SA include: intravenous drug use, diabetes, recent hospitalization within 30 days, immunocompromised status, healthcare employment, hemodialysis, HIV positive status, and prior prosthetic implant placement. Known risk factors for MRSA patients include: intravenous drug use, living in a correctional facility, residential home, or shelter, occupation as a veterinarian, recent influenza-like illness and/or severe pneumonia, concurrent skin/soft tissue infection, and history of MRSA. We examined the presence of these risk factors in patients who screened positive for nasal colonization to determine if they could have undergone targeted nasal screening.

Results
Our data are shown in Table 1. We found that the most common indicator for SA colonization in our population was diabetes in 16 of 56 patients (28.6%). We found the most common MRSA-specific risk factor was a history of MRSA in 1 of 6 patients (16.7%). No patient in this prescreened and pretreated cohort subsequently had IPP infection.

Conclusions
No known risk factor for SA and MRSA colonization was found to be widely prevalent in our SA and MRSA patient cohorts. Targeting screening based on known epidemiologic risk factors for SA and MRSA would not have been a useful substitute for universal preoperative nasal screening in our population. Universal preoperative nasal SA and MRSA screening and treatment may be a useful tool to potentially diminish postoperative IPP surgical-site infections.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, MenMD.
(164) AN UPTICK IN IPP INFECTIONS WITH 0.05% CHLORHEXIDINE GLUCONATE
Authors: Bonakdar Hashemi M , Guillen Lozoya A , Ziegelmann M , Kohler T , Helo S 
Published: December 2024

Abstract

Introduction
The optimal irrigation solution with inflatable penile prosthesis (IPP) remains controversial.

Objective
We sought to determine the impact of the type of fluid used for dipping and irrigation (D&I) on the risk of IPP infections.

Methods
This is a retrospective, consecutive cohort study that includes individuals who underwent initial Coloplast IPP insertion or revision between January 2021 and May 2024. Cases done from January 2021 to August 2022 (20 months) underwent Rifampin/Gentamycin for dipping and Vancomycin/Gentamycin for irrigation (Group 1), whereas those from October 2022 to May 2024 (20 months) utilized 0.05% chlorhexidine gluconate for both D & I (Group 2). Surgeon, operative time, age, diabetes mellitus (DM), perioperative level of HbA1C, history of acute urinary retention (AUR), positive urine culture, and oral antibiotic (AB) regimen at discharge were obtained. The rate of infection between the two study groups and the association of risk factors with developing infection were explored by t-test and chi-square analysis for continuous and discrete variables, respectively. P-value less than 0.05 was considered statistically significant.

Results
In comparison of two study groups, infection rate was significantly higher in group 2 at 2.5% (8/314) than group 1 which did not have any infection (0/280) (P = 0.008). There was no significant association between the study group and operative time (P = 0.45), DM (P = 0.29), HbA1C level (P = 0.20) and AUR (P = 0.87) or surgeon (Table 1). Notably, two clinical infections were from non-virulent organisms (Streptococcus Constellatus & Staphylococcus Lugdunensis). Two of three patients undergoing malleable salvage failed. Since no infection was observed in group1, infection risk predictors were only analyzed in group 2. The patients in group 2 were stratified based on their diabetes mellitus (DM) status, and analyses were conducted to investigate the effect of a positive DM history on the risk of infection. The results indicated that having DM significantly increased the risk of infection, with 75% (6/8) of patients with DM developing an infection compared to 26% (78/306) of those without DM (P = 0.006) (Table 2). Notably, three of eight infections occurred in patients discharged on Augmentin or cefdinir secondary to drug interaction warning (our typical post op prophylaxis is Bactrim or ciprofloxacin).

Conclusions
Type of antiseptic fluid for D&I and DM were associated with IPP infection following surgery in our patient cohort.

Disclosure
No.
(165) NOVEL INSIGHTS ON PERIOPERATIVE ANTIMICROBIAL PROPHYLAXIS PATTERNS FOR INFLATABLE PENILE PROSTHESIS: FINDINGS FROM A LARGE MULTINATIONAL COLLABORATIVE
Authors: Hammad MAM , Azad B , Gross MS , Swerdloff D , Miller J , Abou Chawareb E , Andrianne R , Burnett AL , Gross K , Hatzichristodoulou G , Lentz A , Osmonov D , Jones A , Modgil V , Perito P , Hotaling JM , Park SH , Pearce I , Sadeghi-Nejad H , Sempels M , Suarez-Sarmiento Jr. A , Van Renterghem K , Warner JN , Ziegelmann M , Hsieh TC , Jenkins L , Jones J , Simhan J , Yafi FA ,   on behalf of the PUMP (Prosthetic Urology Multi-institutional Partnership) collaborators, Barham DW 
Published: December 2024

Abstract

Introduction
Inflatable penile prosthesis (IPP) surgery is a well-established treatment for erectile dysfunction (ED). There is little information in the literature regarding the utilization of perioperative antimicrobial prophylaxis in primary and revision IPP surgeries.

Objective
We investigated the patterns of perioperative antimicrobial prophylaxis among a large multinational cohort of primary and revision IPP surgeries.

Methods
We conducted a retrospective analysis of 5,400 patients (4,187 primary IPP patients and 849 revision IPP patients) from our Prosthetic Urology Multi-Institutional Partnership (PUMP) institutions. Usage data for intravenous (IV), preoperative oral, and postoperative oral antimicrobials were analyzed. We specifically assessed patient profiles, antimicrobial selection, and antimicrobial duration. Multivariate statistical analyses were conducted to identify significant variations between primary and revision surgeries.

Results
For patients undergoing primary IPP placement, 81.9% received IV antibiotics for &lt;24 hours whereas 18.1% received IV antibiotics for &gt;24 hours. Preoperative oral antimicrobials were used in 59.4% of patients and 99.4% received postoperative oral antimicrobials. The overall infection rate for primary implants was 2%. Notably, quinolone administration shows a higher postoperative infection rate (11.4%) compared to gentamicin (1.9%), cephalosporin (0%), and vancomycin (1.0%). Multivariable regression analysis identifies factors such as a history of infection, diabetes, and priapism as predictors for postoperative infections. Furthermore, the study finds that perioperative antifungal use is associated with a decreased risk of infection.

Conclusions
This study provides valuable insights into the patterns of perioperative antimicrobial prophylaxis. Duration, type, and route of antibiotics given preoperatively or postoperatively do not affect postoperative infection rates among high volume prosthetic urologists. Giving IV antibiotics for more than 24 hours does not affect postoperative infection. Perioperative antifungals are a protective factor.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus.
(167) INFLATABLE PENILE PROSTHESIS INFECTION IN DIABETIC PATIENTS ON SODIUM-GLUCOSE TRANSPORT PROTEIN 2 INHIBITORS
Authors: Wahlstedt E , Schardein J , Horns JJ , Vichare V , Das R , Hotaling J , Gross K 
Published: December 2024

Abstract

Introduction
Infections following inflatable penile prosthesis (IPP) placement occur in 1-3% of patients, with increased rates among diabetic patients. Attempts to predict infections using markers like glycosylated hemoglobin, glucose levels, and insulin dependence have yielded inconclusive results. Sodium-glucose transport protein 2 inhibitors (SGLT2i) are among the most commonly prescribed medications in diabetic patients and are associated with possibly increased rates of urinary tract and genital infections. The relationship between SGLT2i and IPP infections in diabetic patients has not yet been explored.

Objective
Our objective is to identify if diabetic patients taking SGLT2i are at increased risk of an IPP infection.

Methods
We performed a retrospective review of all diabetic men who underwent IPP placement utilizing MarketScan insurance claims database between 2011-2021. Patients with a diagnosis of diabetes whose medication use we were unable to identify were excluded. Demographic data, including age, smoking status and obesity were obtained. All cases of IPP infection requiring device removal were identified based on ICD-9/10 and CPT codes. Multivariate model outputs were performed to assess the likelihood of IPP infection in diabetic patients on SGLT2i as well as based on demographics.

Results
A total of 2,383 privately insured diabetic patients who underwent IPP placement were identified. The mean age of the cohort was 61 years (55-66 years), with 18.9% identified as smokers and 61.0% classified as obese. Among these patients, 883 (31.1%) were using a SGLT2i or combination medication. Over a mean follow-up period of 25 months (10-49 months), there were 82 (2.9%) documented cases of infections requiring IPP removal, which included 28 (3.2%) patients on SGLT2i and 54 (2.8%) patients on other medications. SGLT2i use was associated with a nonsignificant increase in the HR [1.26 (p = 0.39)], while smoking and obesity were both associated with significantly increased HRs [2.20 (p &lt; 0.01) and 2.024 (p = 0.02), respectively].

Conclusions
These results suggest that preoperative counseling and lifestyle changes, particularly smoking cessation and weight loss, are important to potentially decrease the risk of IPP infections in diabetic patients. Tobacco screening and treatment, nutritional assessments, and guided weight loss plans should be integrated into preoperative management strategies prior to IPP surgery. SLGT2i may be continued perioperatively to ensure appropriate glycemic control as these medications have not been found to be associated with a significantly increased risk of postoperative infections.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Paterna bio, firmtech, Turtle health, maximus, carrot, inherent bio.
(171) A NOVEL PLACEMENT OF INFLATABLE PENILE PROSTHESIS PUMP IN THE MONS FAT
Authors: Lai L , Sessine M , O Hollaren K , Liaw A 
Published: December 2024

Abstract

Introduction
The utility of an inflatable penile prosthesis (IPP) can be highly influenced by good positioning of the IPP pump. Traditionally, the IPP pump is placed in the dependent portion of the scrotum. However, manipulation of the IPP pump placed in the scrotum can be difficult for some men with a large pannus or unhelpful body habitus. While some have advocated for mons fat excision with simultaneous placement of IPP, we chose to leverage patient anatomy by placing IPP pumps in the mons fat pad such that the IPP pump can be easily accessible.

Objective
To evaluate the feasibility and outcome of placing IPP pumps in the mons fat pad of obese patients.

Methods
A right groin incision next to the mons pubis was made and a subcutaneous pocket in the mons fat pad was developed using blunt dissection. The pump was placed in the subcutaneous pocket and secured with permanent suture. The tubing was tunneled to the penoscrotal incision and connected as per the traditional approach.

Results
A total of three patients have undergone IPP pump placement in the mons fat pad (Fig. 1). One patient had a de novo IPP placement and two patients had an IPP revision due to difficulty reaching the pump within the scrotum. At a follow-up of 6-24 months, the pump remained easily accessible by the patients and the IPP remained functional (Fig. 2). None had developed prosthetic infection or erosion.

Conclusions
Placing the IPP pump in the mons fat pad is safe and reproducible. This novel placement of the IPP pump in the mons fat pad represents an alternative option for patients whose anatomy may hinder the control of IPP pumps placed in the scrotum. Further research is needed to understand long-term outcomes.

Disclosure
No.
(181) MODIFIED LOCAL AND REGIONAL PUDENDAL NERVE BLOCK AT TIME OF PENILE PROSTHESIS INSERTION
Authors: Kalidoss S , Fenton D , Velasquez D , Washington S , Suarez-Sarmiento A , Perito P , Raheem O 
Published: December 2024

Abstract

Introduction
The Insertion of penile prosthesis can be associated with significant post operative pain often requires significant narcotics use in patients. Several post operative pain regimens have been adapted to reduce pain in the post operative period for penile prosthesis.

Objective
IIn this video, we demonstrated a step-by-step technique using modifications of several local anesthetics use at time of penile prosthesis surgery including regional pudendal nerve blocks.

Methods
IIn this video, we demonstrated a step-by-step technique using modifications of several local anesthetics use at time of penile prosthesis surgery including regional pudendal nerve blocks.

Results
These local and regional anesthetics techniques can be used by urologists to improve post operative pain level in patients receiving penile prosthesis and improve overall outcomes.

Conclusions
These local and regional anesthetics techniques can be used by urologists to improve post operative pain level in patients receiving penile prosthesis and improve overall outcomes.

Disclosure
No.
(185) MORPHOLOGICAL ANALYSIS OF TRANSGENDER TUNICA ALBUGINEA
Authors: Colombo A , Deng J , Kocjancic E , Acar O , Ohlander S , Harrington D , Mcvary K , Podlasek C 
Published: December 2024

Abstract

Introduction
The tunica albuginea plays a critical role in the biomechanics and physiology of the penis, as the main bearer of mechanical forces, especially during erection. Collagen fibers represent a key element of the tunica albuginea strength, however the collagen composition of the tunica remains poorly understood despite its critical role in disease development (erectile dysfunction and Peyronie's).

Objective
In this study, analysis of tunica morphology was performed on tissue from transgender patients, in order to identify the types of collagen/collagen composition of the tunica.

Methods
Transgender tunica tissue (n = 18) was obtained from patients undergoing penectomy surgery for gender reassignment. Immunohistochemical (IHC) analysis for collagen 1-2, -3 and -4, and trichrome stain were performed to characterize the collagen subtypes and abundance. Primary cell cultures were established from transgender tunica and cultures were characterized with IHC analysis for P4HB (fibroblast), alpha-ACTIN (smooth muscle), CD31 (endothelium) and nNOS (neurons). Tunica cell growth was quantified in response to Sonic hedgehog (SHH) pathway signaling.

Results
Trichrome stain identified the undulating structure of the tunica, which predominantly contained collagen fibers, and rare smooth muscle cells, in contrast to the corpora cavernosa which contained abundant collagen and smooth muscle. IHC analysis identified collagen 1, 2 and 4 in the tunica, but collagen 3 was not observed.

Conclusions
Characterization of tunica morphology in healthy patients is important to understand the mechanophysiology of the tunica. This morphological analysis identified the collagen subtypes present in patient tunica tissue and is a first step in understanding how diseases of the tunica develop. Comprehension of how collagen remodeling occurs would be useful for development of novel treatments for Peyronie’s disease.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Uronext LLC.
(187) T LYMPHOCYTES IN HUMAN SEMEN: INSIGHTS INTO IMMUNE TOLERANCE OF SPERMATOGENESIS
Authors: Stocks B , Oppenheimer A , Huang J , Lipshultz L 
Published: December 2024

Abstract

Introduction
Emerging preclinical work has demonstrated the requisite role of the adaptive immune system in maintaining tolerance toward “foreign” spermatozoa. As seen in animal models, breaks in this system directly causes male factor infertility. Depletion of tolerogenic T lymphocytes induces severe autoimmune orchitis, immune cell infiltration, and reduced sperm number and motility.

Objective
There exists no investigation of the adaptive regulatory immune system in the context of human male fertility. We interrogated our seminal fluid cryobank which consists of 1700 patient samples to study this highly relevant question in male fertility.

Methods
We identified 15 semen samples with increased round cells on semen analysis. Patient samples were thawed, fixed and permeabilized, and stained with the nuclear fluorescent stain DAPI. This differentiates DAPI dim spermatozoa [haploid] from DAPI bright leukocytes [diploid]. Cells were then stained with fluorescently conjugated antibodies (CD45, CD3, CD4, CD25 and Foxp3) to identify leukocytes and specifically, tolerogenic CD4 T Regulatory Cells (CD4 Tregs). Multiparameter flow cytometric analysis was performed (BD LSRFortessa) and data analyzed using GraphPad Prism Software.

Results
CD45 positive leukocytes as identified by flow cytometry ranged in frequency from 0.003% to 2.93% +/- 0.88% and correlated positively with WBC counts on semen analyses. We were able to reliably identify Foxp3+ CD4 Tregs in semen samples. Increased frequencies of CD4 Tregs were observed in patients with higher seminal fluid WBC counts. Interestingly, CD4 Treg frequencies were inversely correlated with sperm density and motility [p &lt; 0.05 linear regression].

Conclusions
We describe the first report of tolerogenic T lymphocytes studied in human semen. We reliably identified and documented increased frequencies of CD4 Tregs in patients with lower sperm density and motility. CD4 Tregs expand in inflammatory conditions to quell ongoing autoimmunity. Overall, we hypothesize that inadequate control of autoreactive anti-sperm lymphocytes by tolerogenic CD4 Tregs leads to poor sperm quality. Further mechanistic investigation of this paradigm remains highly warranted.

Disclosure
No.