bluuebunny/crossref_metadata_2025_split huggingface dataset:
(081) EXTERNAL SCATTERED RADIATION FROM PROSTATE CARCINOMA THERAPY AFFECTS BOTH GERM AND SOMATIC HUMAN TESTICULAR CELLS
Authors: Caldeira- Brant A , Martello R , Campos L , Reis AB , Samesima ET , Reis FM , Orwig KE , Chiarini-Garcia H 
Published: December 2024

Abstract

Introduction
Prostate cancer (PC) is the leading cancer type among men. While external radiation therapy (RT) is commonly utilized and successful in eradicating prostate cancer cells, its scattered radiation can potentially harm male fertility. There is limited understanding of how scattered radiation from RT impacts both germ and somatic cells in the testis of men with prostate cancer.

Objective
This study aims to evaluate the germ and Sertoli cells of adult men diagnosed with PC and who underwent RT.

Methods
Five men, aged between 60 and 78, who were fertile and diagnosed with prostate cancer (PC), underwent total external radiation therapy with doses ranging from 64 to 72 Gy for 32 to 40 days. They were later castrated between 15 and 24 months after treatment due to cancer recurrence. Additionally, testes were collected from five other patients, aged between 48 and 62, with advanced PC who had not undergone any prior treatment before castration, serving as the control group (NoT). Analysis of sex hormone levels, along with histological and immunohistochemistry (IHC) examinations, was conducted.

Results
Despite similar testosterone serum levels, FSH and LH were augmented in the RT group (Fig. 1). While 100% of NoT seminiferous tubules presented VASA+ germ cells, only 9% of RT tubules had them, with 70% and 21% showing Sertoli cell (SOX9+) only and fibrotic phenotypes, respectively (Fig. 2). Regarding germ cells, types Adark, Apale and B spermatogonia, and preleptotene spermatocytes were lower in RT (Fig. 3A), which was confirmed by MAGEA-4 spermatogonial immunostaining (Fig. 3B). In terms of undifferentiated spermatogonia, despite being reduced in the RT group (Fig. 4A), UTF1+ cells presented higher mitotic activity after IHC for MCM7 (Fig. 4B). 85% of MAGEA-4+ spermatogonia were undergoing apoptosis (CASPASE3+) in RT patients, whereas only 1% were found in NoT (Fig. 5). Concerning SOX9+ Sertoli cells, their number was not only lower in the RT group (Fig. 6A), but also showed increased apoptosis (Fig. 6B) and proliferation (Fig. 6C). Claudin-11 immunostaining revealed the presence of a blood-testis barrier protein in RT Sertoli cells, despite being more evenly organized in NoT patients (Fig. 7). Υ-H2AX immunostaining revealed DNA damage in both somatic and germ cells of RT patients.

Conclusions
The scattered radiation from radiation therapy disrupts the process of spermatogenesis in adult men by impacting both germ and Sertoli cells. Additionally, these cells notably decreased in RT patients compared to NoT patients. Surprisingly, it was also observed that Sertolli cell proliferation and apoptosis, as well as DNA damage, occurred even 2 years post-irradiation. In addition, the blood-testis barrier was severely affected in post-irradiation patients. Future studies should be conducted to investigate Sertolli’s cell proliferation.

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(082) EFFICACY OF EMLA CREAM FOR OFFICE-BASED ANDROLOGY PROCEDURE UNDER LOCAL ANESTHETIC: A RANDOMIZED CONTROLLED STUDY
Authors: Chung D , Bal D , Morra M , Shah J , Fidel M , Dhillon H , Nayak J , Patel P 
Published: December 2024

Abstract

Introduction
There has been an increasing number of office base urology procedure performed under local anesthesia (LA), although it can be associated with needle phobia and pain. EMLA (Eutectic Mixture of Local Anesthetic) is a topical anesthetic cream that is used in office-based urology procedures. However, its use in more involved/invasive andrology and male-infertility procedures such as hydrocelectomy, spermatocelectomy, and others remain poorly studied.

Objective
We hypothesized that pre-application of EMLA cream in office-based andrology and male-infertility procedures may provide better pain control and overall experience for patients.

Methods
A double-blinded randomized controlled trial was conducted for patients undergoing scrotal andrology surgeries under LA. Power calculation was performed with an estimated sample size of 72. Participants were randomly assigned in a 1:1 ratio to topical EMLA + LA vs LA alone. In the post-operative recovery area, patient will be asked to complete a VAS questionnaire rating pain with LA administration and pain with procedure. Analysis comparing VAS pain scores of both groups was performed using the independent sample t-test method.

Results
72 patients were included in our analysis, with 36 in the control and 36 in the intervention arm. For patient pain with administration of LA, the control arm reported an average VAS pain score of 4.31, compared to 3.72 in the intervention arm (p = 0.319). For patient pain with procedure, patients in the control arm reported a median VAS pain score of 3.47 compared to 3.03 (p = 0.432) in the intervention arm. Overall, 86% (62/72) of patients reported that they would either be “very likely” (4/5) or “highly likely” (5/5) to undergo future procedures under local anesthetic.

Conclusions
Performing scrotal surgeries under LA appears to be well tolerated and feasible option. Pre-application of EMLA cream does not appear to significantly patient reported outcomes.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(088) TRENDS IN VARICOCELE SURVEILLANCE AND SURGICAL INTERVENTION IN CHILDREN AND ADOLESCENTS
Authors: Sweeney I , Chang J , Wiseman B , Merheb S , Sharadin C , Demarco R , Campbell K 
Published: December 2024

Abstract

Introduction
Varicocelectomy is often recommended in the setting of abnormal semen analyses, testicular atrophy, or associated testicular discomfort. Managing varicoceles in the adolescent populations is less clear because of the unknown impact on fertility. Expert consensus recommends adolescent patients diagnosed with varicocele undergo further evaluation to assess testicular growth. Varicocele surveillance trends including prevalence, length of follow-up, and indications for intervention are underreported. We report our experience with varicocele surveillance and the triggers for surgical intervention in the pediatric population at our institution.

Objective
We aim to characterize the selection of adolescent patients with varicocele participating in surveillance and the triggers for proceeding to varicocelectomy.

Methods
A single institutional retrospective review of electronic medical records from a tertiary referral center was performed. We evaluated pediatric patients ≤18 years old diagnosed with varicocele from 5/1/1993 to 5/31/2023. Varicocele diagnosis was identified using ICD 9 and 10 codes. Surveillance was defined as having at least one additional encounter for varicocele evaluation following the initial diagnosis. Testicular volumes were obtained by scrotal ultrasound and clinical assessment.

Results
96% of patients (380 of 395) had no varicocelectomy. 209 (53%) patients participated in surveillance. 9 of these patients eventually had a varicocelectomy. Indications for surgery in patients being surveilled included testicular pain (n = 4), testicular volume difference (n = 3 with a median testicular volume difference of 2.7 mL), and 2 patients with no reported indication. 186 (47%) patients had no surveillance period, 6 of which had a varicocelectomy. Indications for surgery in these patients included testicular pain (n = 2), testicular volume difference (n = 3 with a median testicular volume difference of 2.4 mL), and bilateral testicular hypotrophy (n = 1) with a total testicular volume of 10 mL. The median age at diagnosis was 15.05 years in the surveillance group and 15.5 years in the non-surveillance group.

Conclusions
Following diagnosis, only half of children and adolescent patients participated in surveillance of their varicocele. Rates of boys proceeding to varicocelectomy were very low and did not differ between patients seen at the primary visit and those who were followed for their varicocele. Our findings highlight the importance of maximizing patient counseling about varicoceles at diagnosis. Surveillance of young males with varicoceles requires patient, guardian, and provider education to counsel patients who may not otherwise undergo evaluation until infertility is encountered.

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(097) IMPACT OF PROSTATE CANCER ON SEXUAL QUALITY OF LIFE FOR FEMALE PARTNERS OF PATIENTS
Authors: Loeb S , Gupta N , Wittmann D , Nelson CJ , Salter CA , Rivera A , Byrne N , Sanchez Nolasco T , Zebib L , Garrett L , Schofield E , Mulhall J 
Published: December 2024

Abstract

Introduction
Prostate cancer diagnosis and treatment can have a significant impact on sexual quality of life for patients and their partners. We developed and validated a new instrument, the Sexual Concerns In Partners of Patients with Prostate cancer (SCIPPP-F), to measure sexual quality of life among female partners of patients with prostate cancer.

Objective
To examine scores on the SCIPPP-F questionnaire in 200 female partners from across the U.S. and factors associated with worse scores.

Methods
The SCIPPP-F survey includes 19 questions in 7 domains: 1) distress/satisfaction, 2) loss of connection as a couple, 3) active communication, 4) discomfort with communication, 5) frustration with sexual counseling, 6) expansion of sexual repertoire, and 7) non-penetrative sexual activity. All questions have 5 response choices (not at all, a little bit, somewhat, quite a bit, very much). Descriptive statistics were used to examine the distribution of survey responses, and the Mann–Whitney U test was used to compare median scores between subgroups of partners based on demographics and relationship characteristics.

Results
Results of the survey are shown in the table. More than half of partners (53%) felt their sex life is quite a bit or very much worse since the prostate cancer diagnosis and/or treatment, and 35% were not at all satisfied with their current sex life. Loss of intimacy was a common complaint. Additionally, approximately 1/3 of partners were at least somewhat uncomfortable talking to their partner about sexual problems and frustrated/angry about the lack of information they received about sexual health from clinicians, with 51 partners (26%) reporting that they were not at all prepared for sexual side effects. Notably, the majority of partners were at least somewhat comfortable trying new ways to achieve intercourse and at least somewhat satisfied with hugging, kissing, and other intimate activities rather than intercourse. There were no significant differences in median overall SCIPPP-F scores based on partners’ marital status, relationship length (&gt;30 vs &lt; =30 years), or menopausal status; however, there was a trend toward lower (better) SCIPPP-F scores among non-white partners (p = 0.07).

Conclusions
These results identify multiple actionable gaps in sexual quality of life for female partners of patients with prostate cancer, including a need for more comprehensive sexual counseling prior to treatment and interventions to improve sexual quality of life, such as individual/couples counseling and/or sex therapy. Funding acknowledgement: Department of Defense.

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(100) DEPRESSION IN MEN UNDERGOING FERTILITY TESTING IS NEGATIVELY ASSOCIATED WITH SEXUAL FUNCTION
Authors: Seyer A , Nolte D , Kenfield S , Belarmino A , Civello D , Smith J , Helo S 
Published: December 2024

Abstract

Introduction
Depression is a common mental health disorder affecting men of reproductive age. Depression or depressive symptoms may impact a variety of health factors, including sexual function. Trying to conceive may contribute to additional stress and negative emotions for the couple.

Objective
To determine the rate of sexual dysfunction in men with depression who are undergoing fertility testing.

Methods
A review was performed of a prospectively maintained database of men utilizing a mail-in semen analysis test system developed by Fellow Health, Inc. Men ≥18 years were included if they consented to participate in research and completed survey questionnaires on both their quality of life and sexual function. Depression level (normal, mild, moderate, or severe) was derived via the short-form depression assessment developed by the Patient Reported Outcomes Measurement Information System (PROMIS). The sexual function survey assessed libido, orgasmic and ejaculatory dysfunction, intercourse frequency, Erection Hardness Score, and IIEF-5 score. Descriptive statistics were reported and chi-squared tests were used to determine statistical significance at the 0.05 alpha level.

Results
Of the 2125 men included, 15.2% reported mild depression and 12.8% moderate or severe depression. The presence of depression was negatively associated with libido, with 11.2% of men with normal levels of depression reporting terrible or poor libido compared to 18.7% with mild depression and 22.2% with moderate or severe depression, p &lt; 0.001. Compared to men without depression, those with moderate or severe depression were nearly twice as likely to report ejaculatory dysfunction (17.2% vs. 29.7%) and three times as likely to report orgasmic dysfunction (3.9% vs. 13.0%), p &lt; 0.001 for all. Severity of depression was also predictive of an erection sufficient for penetration: whereas 96.8% of those with normal levels of depression reported an erection sufficient for penetration, the same could be said for only 94.5% of those with mild depression and 92.5% of those with moderate or severe depression (p &lt; 0.001). Only 53.1% of men with moderate or severe depression had an IIEF-5 score greater than 21 (i.e., “No signs of ED”), compared to 60.9% with mild depression and 75.8% without depression, p &lt; 0.001. Importantly, men with moderate to severe depression were more than twice as likely to report intercourse frequency less than once weekly (18.0%) as opposed to men without depression (7.4%), p &lt; 0.001.

Conclusions
The presence of depression in men undergoing fertility testing is negatively associated with libido, ejaculatory, orgasmic, and erectile function.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Fellow Health.
(107) IDENTIFYING PREDICTORS OF LOW TESTOSTERONE LEVELS IN MEN WITH TESTICULAR CANCER AFTER RADICAL ORCHIECTOMY
Authors: Flores Martinez J , Ljubetic BM , Liso N , Mulhall JP 
Published: December 2024

Abstract

Introduction
It is well known that there is a risk of low testosterone (T) after radical orchiectomy (RO) in men with testicular cancer (TC).

Objective
We aimed to identify predictors of low T levels in men after RO for TC.

Methods
Men treated with RO for TC who had a total testosterone (T) level measured before surgery and within 12 months after RO were included. Men with chemotherapy after surgery, a history of T replacement, and men with synchronous or metachronous bilateral TC were excluded. Additional parameters of interest included patient demographics, and testis ultrasound (TUS) factors: volume of non-cancerous testis, number of tumors, tumor laterality, presence of microcalcifications, TC markers, and TC pathology. LCMS was used to measure total T. Low T was defined as a total T level &lt; 300 ng/dL. A significant difference between pre and post-RO was any increase/decrease ≥100 ng/dL. Multivariable analysis (MVA) explored predictive factors associated with low T in this population.

Results
120 men were included. The median age was 34 (28, 38) years. Median baseline total T levels were 467 (324, 699) ng/dL. 22% had low T prior to surgery. Median beta-HCG, alpha-fetoprotein, and lactate dehydrogenase were 2.3 (0.8, 24) mIU/mL, 3.7 (2.4, 13.5) ng/mL, 191 (164, 242) U/L. TUS: median testis volume 15 (11, 21) cc. 43% had right RO, 57% left RO, 72% had a single mass, 28% ≥2 masses. 43% of the TUS showed microcalcifications. 81% had seminoma, 38% embryonal carcinoma, 29% Yolk sac tumor, 26% teratoma, 3% choriocarcinoma, and 3% other findings. Median total T levels after surgery were 457 (306, 636) ng/dL. Median time T levels measured after RO was 6 (3, 12) months. 23% had low T postop. 13% of individuals who did not exhibit low T prior to RO subsequently developed low T, 54% of those initially presenting with low T continuing to experience this condition post-surgery, while 46% of the low T before surgery cases resolved after RO. Median change in T levels pre vs post-RO was –20 (-159, 180) ng/dL. Post-surgery, total T levels increased significantly in 29% and decreased significantly in 33%. On MVA, only pre-RO low T was a predictor of low T after surgery in men with TC. (Table).

Conclusions
Around a quarter of men have low T before and after RO in men with TC, and pre-RO low T is a significant predictor of low T after surgery.

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(108) SERUM TESTOSTERONE LEVEL AS A PREDICTOR OF BIOCHEMICAL RECURRENCE IN MEN WITH PROSTATE CANCER
Authors: Mulhall J , Liso N , Elshafei A , Flores J 
Published: December 2024

Abstract

Introduction
The literature has engaged in a discussion regarding the potential connection between total testosterone (TT) levels and biochemical recurrence (BCR) in individuals diagnosed with prostate cancer (PC).

Objective
We herein explore the relationship between preoperative TT levels and the BCR rates in these men.

Methods
We retrospectively reviewed the records of 1599 men with PC treated by RP. We excluded men who had androgen deprivation therapy (ADT) prior to RP or within 3 months after RP from the study. Morning TT levels measured by LCMS within 3 months of RP with low TT defined as &lt;300 ng/dl. BCR defined by two consecutive postoperative prostate specific antigen (PSA) levels of ≥0.1. Univariate analysis (UVA) was used to examine predictors of BCR. Variables included in the analysis were age, comorbid conditions pretreatment PSA, clinical T stage, biopsy GG, peri-operative TT, and adverse pathological features at RP (extracapsular extension (ECE), seminal vesical invasion (SVI), positive surgical margins (PSM), lymph node invasion (LNI)). Multivariable analysis (MVA) was conducted using those factors found to be significant on UVA.

Results
1599 men analyzed. Median age 63 (57, 68) years, median follow up of 62 (18115) months. Pre-RP PSA 6 (4,9) ng/ml, TT 447 (343, 575) ng/dl. Median GGG 2 (2, 3). 57% had ECE, 12% SVI, 22% PSM, 14% LNI. BCR occurred in 26% of men with a median time of 28 (5.7, 66.6) months. On MVA, higher biopsy GGG, clinical stage ≥T2b, higher pre-RP PSA, and adverse pathological features at RP were independent predictors of BCR, while peri-operative TT (≤300 ng/dl) was not associated with BCR. (Table) Additionally, we did not identify any association between extremely low TT levels (≤200 ng/dl) and BCR.

Conclusions
TT was not associated with biochemical recurrence in men after RP.

Disclosure
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(113) WHY DO NEOURETHRAL STRICTURES COMMONLY OCCUR AT THE PROXIMAL NEOURETHRA? A NOVEL THEORY, AND SIGNIFICANT REDUCTION IN STRICTURE INCIDENCE AFTER INITIATING USE OF A NEW POST-SURGERY DEVICE
Authors: Lin J , Sandhu S , Mallavarapu S , Smith S , Ray E , Garcia M 
Published: December 2024

Abstract

Introduction
Transgender men (TM) seeking phalloplasty must choose between phalloplasty with- (P + UL) and without urethral lengthening (P-UL). Those seeking P + UL must be counselled about the risks of neourethral strictures (NUS) and urethrocutaneous fistulae (UCF), whose incidence is reported at 25-63% and 22-75%, respectively. A decision-making tool to aid in surgical decision-making has not been described. Because tissue ischemia commonly causes NUS and UCF, strategies must be implemented to prevent this.

Objective
1) Develop a decision-making tool comparing P + UL/P-UL. 2) Evaluate what proportion of our TM choose P + UL/P-UL before and after implementation of our decision-making tool. 3) Develop a means to reduce neourethral ischemia postoperatively. 4) Evaluate NUS and UCF requiring surgical repair after P + UL, before and after initiating our “Manny Pack” protocol.

Methods
Single-center, retrospective, chart review of all patients undergoing phalloplasty from July/2017–May/2024. Subjects were divided based on urethral lengthening status before and after implementing our decision-making tool (comparison-table of each option’s pro’s/con’s). We report the incidence of NUS and UCF before and after initiation of our “Manny-pack” to support the neophallus for 3-months postoperatively.

Results
67 patients underwent phalloplasty over ~6-years. 35/67(51.6%) patients underwent P + UL. After initiation of our decision-making tool, the proportion of TM choosing P + UL decreased significantly from 30/49(61.2%) to 5/18(27.8%) (p = 0.009). Our incidence of NUS and UCF was 3/32 (9.4%) and 7/32 (21.9%), respectively. After initiation of our “Manny-pack” (Fig. 1) protocol, the incidence of NUS and UCF requiring surgical intervention decreased to zero (0%).

Conclusions
Debut of our decision-making tool significantly increased the proportion of TM who chose lower-risk P-UL. Our “Manny Pack” supports the neophallus and proximal neourethra for 3-months after surgery with privacy, and promotes normal activity (Fig. 1). This is the first report to propose that supporting the phallus reduces kinking of the proximal neourethra, causing ischemia exactly where NUS typically occur. (Figure 2) The significantly decreased incidence of NUS and UCF requiring surgery that we observed supports this theory.

Disclosure
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