bluuebunny/crossref_metadata_2025_split huggingface dataset:
(028) Intracavernosal Injection of Platelet-Rich Plasma for the Treatment of Erectile Dysfunction: A Meta-Analysis of Randomized Placebo-Controlled Trials
Authors: Atmoko W , Savira M 
Published: March 2024

Abstract

Introduction
Erectile dysfunction (ED) affects 3 to 76.5% of men globally. Appropriate treatments for ED patients are vital to ensure their quality of life. However, the present conservative ED treatments cannot reverse the underlying pathology and often lead to discontinuation due to the lack of efficacy. Regenerative therapies, including platelet-rich plasma (PRP), have been gaining increasing interest for the last few years. Preclinical studies suggest that growth factors in PRP may be beneficial in ED. With the increasing evidence of PRP, a meta-analysis has yet to be conducted to determine its efficacy and safety compared to a placebo.

Objective
To systematically evaluate PRP's efficacy and safety for treating ED based on randomized placebo-controlled trials (RCTs) results.

Methods
A comprehensive search on PubMed, Scopus, and EMBASE databases was conducted on June 2023 to find relevant articles following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. RCTs in English evaluating PRP's efficacy and safety in treating ED were included. The primary outcomes were the International Index of Erectile Function-Erectile Function (IIEF-EF) score at 1-, 3-, and 6-months post-treatment. The secondary analysis includes the proportion of patients who met the minimal clinically important difference (MCID) of IIEF-EF score, IIEF score for sexual satisfaction and overall satisfaction, peak systolic velocity (PSV) in the cavernousal artery, and the complication rate after treatment. Quality of included studies was assessed using JADAD Score and Cochrane RoB2 tools. Meta-analysis with a random or fixed effects model based on the heterogeneity was performed using Revman 5.4.

Results
From 183 articles in initial research, three RCTs with low risk of bias were reviewed. We included 103 patients in the PRP group and 106 in the placebo group. The baseline of the evaluated score from both groups was comparable despite variable PRP protocol being used. The pooled analysis showed that PRP is associated with higher IIEF-EF scores at 1, 3, and 6 months follow up compared to placebo with a mean difference (MD) of 2.85 (95% CI, 1.68 – 4.03, p: &lt;0.00001), 2.81 (95% CI, 1.57 – 4.05, p: &lt;0.00001), 3.11 (95% CI, 1.96 – 4.27, p: &lt;0.00001). Similarly, the proportion of patients who met MCID and PSV at follow-up also favoured the PRP group. On contrary, the IIEF score for sexual satisfaction and overall satisfaction domain, as well as VAS score post-injection were comparable between groups. No significant adverse event was reported in any study during follow-up.

Conclusions
The present meta-analysis suggests that PRP is effective and tolerable as a restorative therapy for managing ED patients compared to a placebo. Nevertheless, additional RCTs with more robust data from larger sample sizes and longer-term follow-ups are required to corroborate the findings.

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(038) Development of a Vaginal Dilator and Home Insemination Device for Cis-And Transgender People, Based on Actual Pelvic Anatomy
Authors: Sandhu S , Mallavarapu S , Stelmar J , Garcia M 
Published: March 2024

Abstract

Introduction
Genital gender-affirming surgery (gGAS) is a rapidly evolving surgical field. Specific to feminizing gGAS, one surgical option pertains to vaginoplasty with creation of a neovaginal canal. Given this canal is commonly lined with skin, peritoneum, or colon, women who undergo these procedures as part of their gender affirmation must commit to life-long self-dilation and douching to maintain canal patency and hygiene. Current commercially available dilators and douches are designed for cisgender anatomy, and are either straight, or, have an abrupt upward curve at the tip, inconsistent with neovaginal canal anatomy, which also lacks the elasticity of a cisgender woman’s vagina, making it sensitive to dilator shape, and douche nozzle length. In addition, many LGBTQ+ individuals with a uterus seek pregnancy without a male sexual partner, but few devices exist which cater to this specific population.

Objective
1) To design a vaginal dilator which more accurately reflects pelvic and vaginal canal anatomy, 2) Design a novel dilator which combines dilation, douching, and depth measurement functions, and 3) Modify our new dilator-douche device for use with semen for home insemination by both cis- and transgender women, and, transgender men seeking to become pregnant.

Methods
A radio-opaque catheter was placed into the neovaginal canal of 12 transgender women who underwent vaginoplasty with canal creation. C-Arm fluoroscopy delineated canal curvature based on the catheter. In addition, gynecologic texts and instruments were examined to ascertain the shape of a cisgender woman’s vaginal canal. Based on these findings, a novel dilator was designed and 3-D printed.

Results
A smooth “S-shape” was found in the vaginal canal of both cis- and transgender women, consistent with the shape of cervical dilators. In cisgender women, the vaginal vault, which is elastic, is closer to the introitus than that of transgender women. The cervix is typically anteriorly located between 0.5 to 4cm proximal to the posterior fornix. Our vaginal dilators (Figure 1a) (five, each 8–12cm circumference) and insemination device (Figure 1b-c) (9cm circumference) reflect the same smooth S-shaped design. Our dilators have depth markings, side-wall grooves to allow air and liquid to pass, and, can be fitted with a douche-bulb to maintain hygiene. Our insemination device can accommodate a 10cc syringe and has a recessed anterior wall 0.5–4cm from the tip to deposit semen around the cervix for conception.

Conclusions
The design improvements shown with respect to this dilator-douche device should make dilation and douching more comfortable, improve hygiene, and, decrease the incidence of granulation tissue. Our inseminator offers a private, at-home means of achieving fertilization for both cisgender and transgender individuals. (U.S. Patent 11638808; Neovaginal and vaginal health devices)

Disclosure
No.
(040) Anterolateral Thigh Flap Phalloplasty: Outcomes Following Genital Gender Affirmation Surgery
Authors: Adasonla K , Christopher N , Ralph D , Lee W G 
Published: March 2024

Abstract

Introduction
Genital gender affirmation surgery (gGAS) is a key part of the management of patients with gender dysphoria. The anterolateral thigh (ALT) free flap was proposed as an alternative to the more common radial forearm free flap (RFFP) phalloplasty due to the twin advantages of a more easily hidden scar and improved flexibility in the length of the flap. A pedicled variant of the ALT flap offers greater security of vascular supply for suitable patients, and if suitable and desired the flap can be formed with an integrated urethra, facilitating voiding while standing.

Objective
The aim of the study is to report the contemporary surgical and functional outcomes of ALT phalloplasty.

Methods
All individuals undergoing ALT flap phalloplasty for genital gender affirmation surgery (GAS) between 2009 and 2023 nationwide were included. Individuals were managed in accordance with the World Professional Association for Transgender Health (WPATH) Standards of Care version 7. Data were extracted from a prospectively collected single surgeon database and medical records. Functional outcomes were assessed by non-validated questionnaire. Statistical analysis included Mann-Whitney, chi-squared, Fisher’s exact and unpaired T tests.

Results
Surgical outcomes: A total of 87 patients were included in the study. More than half (45, 51.7%) had an integrated urethra. The median length of stay following surgery was six days (IQR 6-7). Eleven patients (12.6%) had a 30-day Clavien-Dindo 3b complication or greater. Three patients (3.4%) experienced total flap loss. A further three patients (3.4%) had partial flap loss. Three patients (3.4%) required a salvage phalloplasty later. Thirteen patients (out of 42, 31.0%) without an integrated urethra went onto have a free flap urethroplasty. Functional outcomes: Thirty-nine individuals (44.8%) completed the patient reported outcomes questionnaire. Most patients (77%) were generally satisfied with their phalloplasty. More than half (56%) with an erectile device used their phallus for penetrative intercourse, while one in five reported experiencing orgasm using their phallus alone. Following urethral lengthening, all respondents were able to void standing. There was no significant difference in mean satisfaction scores for those with an integrated urethra compared to those without (4.18/5 vs 3.82/5, p=.45), as well as between those with or without an erectile device, respectively (3.78/5 vs 4.10/5, p=.26).

Conclusions
This study is one of the largest single centre cohorts of ALT flap phalloplasty reported to date. It further supports the use of the ALT flap as one of the main genital GAS options for transmen. Over half of the patients studied had an integrated urethra, the gold standard for urethral lengthening. Patient reported functional outcomes were promising, with similar scores regardless of urethral lengthening or erectile device insertion.

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No.
(058) Evaluation of Pathway Expression Following Down-Regulation of NELL1, a Potential Gene of Interest in Peyronie’s Disease
Authors: Christensen B , Tulona R , Weston J , Stover J , Bowles R , Pastuszak A 
Published: March 2024

Abstract

Introduction
Peyronie’s Disease (PD) is a superficial fibrosing disorder characterized by inelastic fibrous plaques within the tunica albuginea. We previously performed high-resolution array comparative genomic hybridization analysis of genomic DNA from men with both PD and Dupuytren’s Disease (DD), yielding candidate genes, including NELL1, with potential involvement in these conditions. NELL1 is a secreted growth factor that enhances osteoblastic differentiation and chondrogenesis and may contribute to calcification and inflammation in fibrotic plaques via its interaction with bone morphogenetic protein (BMP) within the TGF-β signaling pathway. Here, we report on pathway analysis following up- and down-regulation of NELL1 using CRISPR modification in an in vitro setting.

Objective
This study aimed to investigate the influence of NELL1 modification on downstream gene regulation, focusing on pathways that were significantly regulated following NELL1 down-regulation.

Methods
For down-regulation of NELL1, gRNAs were delivered to HEK293 cells with a nuclease deficient (d) dCas9-KRAB system adapted from Streptococcus pyogenes. Gene regulation was assessed using qRT-PCR.

Results
For down-regulation of NELL1, PCR analysis confirmed a 95% reduction in expression. Non-target vectors did not change NELL1 expression levels. RNA sequencing results found over 5,000 differentially expressed genes between, with significant changes in multiple pathways, including the HIF-1α pathway, which promotes keloid development by activating the TGF-β/Smad pathways. Additionally, we identified pathways related to ECM-receptor interaction, inflammation, apoptosis, and cell cycle regulation that are mediated by TGF-β/Smad signaling, which plays a crucial role in fibrosis. Our analysis also demonstrated upregulation of the PI3K-Akt pathway, which is involved in regulating type I collagen expression in response to TGF-β1. These results highlight the significance of NELL1 in fibrotic regulation and suggest its potential involvement in the development of PD.

Conclusions
We have created guides for and successfully down-regulated the expression of NELL1, a gene of interest in Peyronie’s disease. We have also demonstrated, through RNA sequencing, that changes in NELL1 lead to large changes in gene and pathway expression. The identified modified pathways, including HIF-1α-mediated, TGF-β/Smad and PI3K-Akt, provide valuable insights into the potential molecular mechanisms underlying NELL1's role in regulation of fibrosis, and further investigation of these pathways may reveal potential therapeutic targets for fibrosis-related disorders.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Contraline, Techfields Inc, Alto Neurosciences, Curebase.
(092) Mental and Sexual Health Outcomes Associated with Female Genital Mutilation/Cutting in Africa: A Systematic Narrative Synthesis
Authors: Esho T , Kumar M 
Published: March 2024

Abstract

Introduction
There are gaps in evidence regarding mental and sexual outcomes and associated interventions for women with Female Genital Mutilation/Cutting (FGM/C) living in Africa.

Objective
This study's objective was to collate evidence on mental and sexual health outcomes associated with female genital mutilation/cutting in Sub-Saharan Africa

Methods
The study employed a scoping review and narrative synthesis approach and conducted a systematic search of bibliographic databases and websites was performed using appropriate keywords and studies published in English from January 1, 2010 to March 25, 2022. 25 studies were retrieved and reported mental and sexual health complications associated with FGM/C.

Results
Most studies, n = 13 studies reported on sexual health outcomes including sexual pain, orgasm and sexual desire problems at sexual arousal and difficulties in lubrication. Mental health outcomes were reported in four studies including depression which was most prominent followed by somatisation and anxiety, Post Traumatic Stress Disorder (PTSD) and sleep disorder. Studies did not highlight combined mental and sexual health interventions.

Conclusions
The findings of this narrative synthesis reveal the need to prioritise provision of mental and sexual health care services for women with FGM/C. The study recommends strengthening of health systems in Africa through awareness building, training and capacity building of primary health and specialist health workers in offering mental and sexual health care to women with FGM/C.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Amref International University and Aga Khan University Hospital.
(113) Investigating the Prevalence of Erectile Dysfunction in Patients with Non-Alcoholic Fatty Liver and Its Relationship with the Severity of Fatty Liver
Authors: Abdoly M , Taqinejad S 
Published: March 2024

Abstract

Introduction
Today, the relationship between erectile dysfunction in men and the pathogenesis process in the field of metabolic syndrome is of interest. Non-alcoholic fatty liver disease is one of the diseases related to metabolic syndrome, which has a high prevalence. This study was conducted with the aim of evaluating the prevalence of erectile dysfunction in men with non-alcoholic fatty liver disease and investigating the relationship between its severity and the grading of liver complications.

Objective
In this research, the frequency of erectile dysfunction and decreased libido and sexual satisfaction in patients with non-alcoholic fatty liver disease have been investigated and compared with the control group. Also, the relationship between the severity of sexual dysfunction and fatty liver grading has been investigated.

Methods
In this study, 1200 patients with non-alcoholic fatty liver disease were randomly selected and participated in this study between 2019 and 2022. In order to investigate sexual disorders, the standard male sexual performance questionnaire was used along with the demographic questionnaire.

Results
The results of this study showed that the indicators of male sexual dysfunction in patients with non-alcoholic fatty liver have a high prevalence (44.5%). Also, the severity of erectile dysfunction has a significant relationship with the severity of non-alcoholic fatty liver disease (pv=0.002).

Conclusions
A holistic view of the health category requires that in the treatment of medical disorders, the effective factors and consequences of the disorder should be considered. Paying attention to the diagnosis and treatment of sexual disorders in the treatment process will be one of the most important aspects of the patient's health; Because erectile dysfunction in men, apart from the effect on sexual relations, will have destructive consequences on their psychological indicators and quality of life. On the other hand, it is possible to improve the quality of patients' health by modifying the lifestyle and interdisciplinary cooperation.

Disclosure
No.
(127) Is Artificial Intelligence Ready to Help Urologists?
Authors: Van De Walle G , Morgantini L , Donaldson H , Smith J , Mima M 
Published: March 2024

Abstract

Introduction
ChatGPT is a language model developed by OpenAI. It's a variant of the GPT (Generative Pretrained Transformer) architecture, a transformer-based neural network used for natural language processing tasks. The model has been trained on a massive corpus of text data and can generate human-like responses to topics and questions. ChatGPT can be used for chatbots, conversation agents, and language translation. The integration of AI into urology has the potential to improve patient outcomes, increase efficiency, and reduce costs, ultimately leading to a better healthcare experience for patients.

Objective
The objective of this study is to assess the current state of artificial intelligence (AI) when it comes to urologic problems and to determine whether it is sufficiently developed and prepared to provide useful assistance to urologists in their clinical practice. This study aims to assess the accuracy, reliability, and potential benefits of one AI language model (ChatGPT) in efficiently answering common patient questions, providing patients with accurate educational information, minimizing patient harm, and guiding patients towards appropriate management. By exhibiting ChatGPT's capabilities and limitations in the context of urology, the study aims to demonstrate how AI can be helpful in everyday urological practices.

Methods
ChatGPT (chat.openai.com) was presented with typical clinical scenarios and patient questions.

Results
AI wrote the introduction answering “What is ChatGPT?” and “How can AI help urologists?”. For the conclusion, AI was prompted with “Is artificial intelligence ready to help urologists?”. Figures summarize the answers to common patient questions given by ChatGPT.

Conclusions
The use of AI in the field of urology is still in its early stages and more research is needed to determine its full potential. However, there have already been some promising developments and successful applications. For example, AI algorithms have been used to accurately diagnose prostate cancer, predict patient outcomes, and improve surgical planning. While AI has the potential to revolutionize the field of urology, it is important to note that AI is not a substitute for human expertise and judgment. AI algorithms can provide valuable insights and assistance, but the ultimate decision making and treatment planning should still be done by experienced urologists. Additionally, it is important to ensure that AI systems are developed and used in a way that respects patient privacy and data security, and that the outcomes of AI-assisted decision making are transparent and explainable. In summary, AI has the potential to greatly benefit the field of urology. Still, it is important to approach its use with caution and continue evaluating its impact as more research is conducted.

Disclosure
No.
(146) Sex Education and Pattern of Sexual Behavior among Adolescents in a Sub-Urban High School
Authors: Idowu O C , Adedeji O , Oyerogba O P , Osundara O 
Published: March 2024

Abstract

Introduction
Adolescence being the transition from childhood to adulthood may be associated with risky sexual behavior with consequences that may last a lifetime. Sex education for teenagers to encourage safe sexual practices is necessary to build a society of adults with healthy sexual lifestyle. The details of the source of information, level of knowledge and actual sexual practices among these adolescents will inform the approach to supplying adequate information.

Objective
The objective of the study is to demonstrate the level of knowledge of adolescents about safe sexual practices, contraceptives and their pattern of behavior.

Methods
Data regarding knowledge and sexual behavior was obtained from adolescents in a Sub-Urban high school with the aid of pre-tested self-administered questionnaire. The data was imputed and analyzed with the IBM SPSS software.

Results
A total of 107 adolescents aged 13 to 19years (mean - 16.078years) with average weight of 47.931Kg; 53(49.5%) were males and 54(50.5%) were females. About half (51.4%) practice Christianity and 48.6% practice Islamic religion and majority (96.3%) were in their penultimate class in high school. Majority of respondents (87.7%) reported having formal sex education, the commonest source of sex education was school in 76.9%, other sources of information were parents (11.0%), friends and peers (8.7%), mass media (4.4%) and siblings (2.2%). The quality of knowledge of these adolescents may be poor, as many as 25% of respondents think that casual sex does not predispose to infections and only 21.8% had any knowledge of modern contraceptives. Nearly one-quarter (23.36%) of respondents have commenced sexual activities with the mean age at coitarche being 12.38±2.38years; majority in this category (92%) being males. The commonest form of sexual practice is peno-vagina intercourse which is seen in 21.7% of respondents, 13.3% practice masturbation, 5.8% of respondents have had homosexual activities, 6.7% practice oral sex and 1.9% practice peno-anal sex. Among the sexually active respondents, 72% have had multiple sexual partners, 32% practice casual sex. Majority (92%) have used male condoms before but only 32% of sexually active respondents regularly use condoms. Majority (98%) of sexually naïve were contented with their status and 13% of sexually active respondents wished they had delayed sexual activities.

Conclusions
Although, intervention at adolescence with sex and reproductive health services offers the opportunity to form societies with healthy sexual lifestyle, the level of knowledge of sex education among adolescents in Sub-Urban communities remain poor yet a significant proportion of these Adolescents have commenced sexual activities with some practicing risky sexual behavior.

Disclosure
No.