bluuebunny/crossref_metadata_2025_split huggingface dataset:
(334) Worldwide Interest in Testosterone Replacement Therapy
Authors: Lumbiganon S , Hammad M , Miller J , Chawareb E , Azad B , Yafi F 
Published: February 2024

Abstract

Introduction
Testosterone therapy has gained popularity in recent decades, with various methods of administration available, such as oral, topical, injection, and implantable routes. As a wider variety of treatment options arise, knowledge regarding the public interest in varying modalities may give providers an insight to patient preferences and assist in the counseling of patients seeking to initiate testosterone replacement therapy.

Objective
To examine public interest in the different methods of testosterone administration across the United States and compare their relative popularity to intramuscular injections.

Methods
Utilizing Google Trends, data pertaining to searches related to diverse testosterone administration methods were collected over a ten-year duration. The categories under analysis encompassed 1) testosterone injections, 2) implanted testosterone, 3) oral testosterone, and 4) topical testosterone. Controlled search terms, including news and weather queries, were employed. Search term trends were quantified in arbitrary units (a.u.) and plotted against the corresponding time period.

Results
Testosterone injection had the highest average search intent from Google Trends during the past 10 years (63.08 +/- 12.7 a.u.), followed by testosterone pills (60.56 +/- 13.4 a.u.), testosterone pellets (53.14 +/- 19.4 a.u.), testosterone patches (51.03 +/- 16.2 a.u.), and lastly testosterone gel (17.29 +/- 21.5 a.u.) A notable upward trend was recorded for all searches, with the highest increase in searches seen for implanted testosterone (m = 0.433), testosterone injections (m = 0.297), oral testosterone (m = 0.222), and lastly topical testosterone (m = 0.050) (Figure 1).

Conclusions
This study provides compelling evidence that all modes of testosterone administration had increasing search trends, most notably implantable testosterone therapies followed by testosterone injections, and oral testosterone, which may be in line with recent FDA approvals since 2019 for newer oral (Jatenzo, Tlando, Kyzatrex) and implantable (ex: Xyosted) options.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma, Clarus Therapeutics, Coloplast.
(341) First-time Orgasm in a Man with Flibanserin Use: A Case Report
Authors: Saffati G , Naeem T , Khera M 
Published: February 2024

Abstract

Introduction
Anorgasmia is a poorly understood phenomenon defined as either a lifelong or an acquired consistent inability to achieve ejaculation. Despite the prevalence of anorgasmia, there is currently no established treatment.

Objective
In this abstract, we present the unique case of a patient with lifelong anorgasmia who was able to achieve his first orgasm with off-label use of flibanserin.

Methods
A 28-year-old male presented to our office with complaints of lifelong anejaculation and anorgasmia, without any signs of erectile dysfunction. He reported good libido and energy levels and denied any urinary symptoms or history of depression. Physical examination revealed normal genital anatomy without lesions. Testicular size was within normal limits, and a palpable varicocele was noted. Hormonal evaluations revealed total testosterone levels of 590 ng/dl and prolactin levels of 12 ng/ml. The baseline International Index of Erectile Function (IIEF) score was 41, with an orgasmic function sub-domain (IIEF-OF) score of 2. The patient had no history of major surgeries. He denied any neurological, infectious, or endocrine cause of anejaculation or anorgasmia. He was not taking medications that could cause these symptoms, except for over-the-counter allergy medications. Upon further questioning, the patient equated orgasm with ejaculation and reported having never experienced any previous orgasms.

Results
The patient was prescribed 150 mg of bupropion daily, which was increased to 300 mg daily after two weeks, in combination with sex therapy. Despite having received four–five sex therapy sessions over three months, the patient reported that this treatment approach was not effective. Subsequently, bupropion was tapered and discontinued. The patient was then started on bremelanotide, administered at a dose of 10 mg/mL, injecting 0.2mL (2 mg) before sexual activity. Although various forms of stimulation were attempted, the patient was unable to achieve orgasm with bremelanotide, and experienced penile pain. Flibanserin was then initiated, and after 28-32 doses over four weeks, the patient achieved his first orgasm. Notably, the patient also experienced nocturia and insomnia after initiating this medication. The follow-up IIEF score marginally improved by two points without any improvement in IIEF-OF.

Conclusions
This case highlights the challenges in managing anorgasmia and anejaculation in a young male patient. A stepwise approach, involving pharmacotherapy and sex therapy, was unsuccessful. However, off-label use of flibanserin ultimately resulted in the patient achieving his first orgasm, albeit with some side effects. Further studies are required to evaluate the efficacy and safety of flibanserin for this indication.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(345) Sexual Health Outcomes After Gender Affirming Metoidioplasty: A Systematic Review
Authors: Dolendo I , Goldstein B , Okamuro K , Peters B , Anger J , Uloko M 
Published: February 2024

Abstract

Introduction
Previous studies have evaluated surgical outcomes and aesthetic results of Genital Gender Affirming Surgery (GGAS) while few studies have examined sexual outcomes after GGAS.

Objective
We sought to systematically review the literature on sexual health outcomes of metoidioplasty in the transmasculine population.

Methods
PubMed, Embase, and Web of Science was used to identify studies through April 29, 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Figure 1 shows search terms, inclusion, and exclusion criteria.

Results
Fourteen papers were included. Findings on arousal/desire ranged from 86% (n=48) reporting desire for sex to 100% (n=1455) reporting no difficulty in arousal. Preserved erogenous sensation and no issues with masturbation was reported in 100% of people across studies (n=1164;1455). Orgasm ability ranged from 66-70% (n=115) who were able to orgasm during sexual activity or masturbation to 100% (n=1455) who had no problems with orgasm. Orgasm satisfaction was found to be 100% (n=48). A study found that 80% (n=15) had challenges with erections, with 83% (n=18) of Erection Hardness Scores were ‘larger but not hard’ or ‘hard but not hard enough for penetration.’ Earlier studies reported 100% of people had an erection (n=1599), and ratings of ‘satisfied’ or ‘partially satisfied’ in 94% (n=145). Across studies, 87-100% were unable to have penetrative sex (87% unable, n=15; 100% unable, n=737). For some, the inability to penetrate was the most dissatisfactory aspect of the metoidioplasty for 39% of patients (n=28).

Conclusions
Current literature on transmasculine people undergoing GGAS shows high ratings of arousal/desire, preservation of erogenous sensation, masturbation, and ability to orgasm following metoidioplasty. Data on the ability and adequacy of erection is less definitive. Overall ratings of sexual health appear high, but inability to have penetrative sex remains a source of persistent dissatisfaction for some. Further studies using surveys validated in transmasculine populations are needed to definitively describe sexual function after GGAS.

Disclosure
No.
(352) High Genital Satisfaction is Associated with Increased Sexual Frequency and Larger Perceived Penile Anatomy
Authors: Choi U , Nicholson R , Cohen A 
Published: February 2024

Abstract

Introduction
Satisfaction with personal genitalia has profound impacts on quality of life and sexual health. Prior studies of men correlated genital dissatisfaction with decreased sexual activity; however, the association between satisfaction and perceptions of “normal” genital anatomy is unknown.

Objective
We aimed to assess the interplay between genital satisfaction, sexual activity, and genital anatomy expectations.

Methods
A 54-item RedCap survey was distributed to volunteers aged ≥18 years through the ResearchMatch database from January to March 2023. Responses were split into: 1) high genital satisfaction (≥7/10 satisfaction rating) and 2) low satisfaction (&lt;7/10). We collected data on perceptions of “normal” genital anatomy and function in addition to sexual function and preferences. Analysis was performed using JMP Pro 16.

Results
649 respondents initiated and 558 respondents completed the survey (86% completion rate). Median genital satisfaction was 7/10. 27.9% of respondents identified as male and 72.1% as female. The mean age was 45.8 years, 83.2% were white, 47.9% married or 25.0% never married, and 75.5% had at least a bachelor’s degree. More low-satisfaction respondents reported perceived “normal” erect penis girth &lt;2 inches (7.8% vs. 3.8%, p=0.04), flaccid penis length &lt;2 inches (11.1% vs. 5.1%, p&lt;0.01) and semen volume &lt;2 mL (5.8% vs. 1.3%, p&lt;0.01). More high-satisfaction respondents believed women had orgasms over half the time (20.8% vs. 13.2%, p=0.02). More high-satisfaction respondents were sexually active (81.1% vs. 71.6%, p&lt;0.01). Of the respondents who were sexually active, high satisfaction was more associated with sexual encounters 1-3 times weekly (44.5% vs. 32.1%, p&lt;0.01).

Conclusions
Genital satisfaction impacts perceptions of male anatomy and female sexual activity. Frequency of sexual activity was higher among high-satisfaction respondents, thus genital satisfaction may be a useful screening tool to determine sexual activity.

Disclosure
No.
(359) Vasectomy Trends in Western NY Following Dobbs v. Jackson Women’s Health Organization
Authors: Greenstein A , Farah G , Vecellio P , Bradin A , Chevli K , Brennan M 
Published: February 2024

Abstract

Introduction
On June 24, 2022, the United States Supreme Court ruled on Dobbs v. Jackson Women’s Health Organization (Dobbs) that the Constitution of the United States does not confer a right to abortion. The court’s decision overruled both Roe v. Wade (1973) and Planned Parenthood v. Casey (1992), giving individual states the full power to regulate any aspect of abortion not protected by federal law.

Objective
Our study aims to identify the difference, if any, in the number of vasectomies performed in Western NY before and after the ruling on Dobbs v. Jackson Women’s Health Organization.

Methods
We performed a retrospective chart review of 2428 patients who had vasectomies in Western New York from August 2021 – March 2023. Leveraging a dataset containing de-identified patient information, we compared the rates of all men undergoing vasectomies in the six-month period before and after the ruling. Vasectomy case information collected by urologists in Buffalo dating back to 1996 was collected and tabulated using Excel. Statistical analyses were performed to compare differences in both the overall change in frequency of vasectomies among all men in the six-month period before and after the court decision, as well as by specific demographic groups. Statistical analyses were performed in R and SAS.

Results
Men with no children had a statistically significant increase (p=0.009) in the number of vasectomies in the six-month period after the Dobbs decision (n=138) compared to before (n=98). Rates of vasectomies pre- and post- Dobbs were organized by age quartiles (&lt;33.20, 33.20-36.65, 36.66-40.59, ≥40.60). In the “No Child” group, men with ages &lt;33.2 (p=0.0137) and ages 33.2-36.65 (p=0.0394) had significant increases in frequency of vasectomy after the court decision.

Conclusions
Our data demonstrates that in the wake of Dobbs v. Jackson Women’s Health Organization (2022), the number of vasectomies among men with no children significantly increased after the court decision. There were significant increases in the number of vasectomies within different age groups of men without children following the decision. Future aims of this study will seek to create statistical models to determine the underlying reasons that influenced the observed change in frequency of vasectomies following the court decision in men without children.

Disclosure
No.
(386) Eight-Dot Extended Corporotomy Versus Conventional Corporotomy for Malleable Penile Prosthesis Implantation
Authors: Ragheb A , Emadeldin M , Abdallah R , Mohamed A , Elmarakby A 
Published: February 2024

Abstract

Introduction
To date, malleable type penile prosthesis implantation (MPPI) remains the more popular in developing countries, owing to its relative economic cost. Despite the simplicity of the procedure, there still may be areas of improvement and refinement to optimize procedure efficiency and accuracy subsequently improving postoperative outcomes while reducing complication risk.

Objective
We aimed to compare between the eight-dot extended corporotomy technique and the conventional corporotomy techniques for MPPI with regards to operative time and postoperative complications.

Methods
We conducted a prospective randomized interventional clinical study on 51 subjects. Patients were randomized into 2 groups: eight-dot group (n=27) and conventional group (n=24). The eight-dot group underwent MPPI using the eight-dot extended corporotomy as previously described (VJPU - Eight-dot Extended Corporotomy: A More Secure, Aesthetic and Time Efficient Technique for Semirigid Penile Prosthesis Implantation, n.d.). The conventional group underwent MPPI using conventional limited corporotomies that were closed via continuous running sutures. We compared between both groups in terms of corporotomy opening to closure time, overall procedure time and perioperative complications. The follow up period was 3 months.

Results
Upon timing in seconds (s), a significant time difference between the 2 groups was demonstrated for suture placement, corporotomy incision and implant placement, corporotomy closure, and total procedure duration. Although patients in the eight-dot group required longer time for suture placement vs the conventional group (486 vs 201 s, respectively, p &lt; 0.001), the durations for the remaining implantation steps as well as the whole procedure were significantly shorter for the former group. Corporotomy opening followed by implant placement took significantly less time for the eight-dot group (1090 s) vs the conventional group (1313 s), p &lt;0.001. Moreover, insertion of implant rods were subjectively easier with no need for aggressive bending owing to the extended corporotomy length. Similarly, corporotomy closure using the 8-dot technique was 10.13 minutes swifter than the conventional group (220 s vs. 828 s, respectively, p &lt; 0.001). The total procedure length was over 8 minutes shorter for the eight-dot group opposed to the conventional group (2527 vs 3027 s, respectively, p &lt; 0.001). In terms of postoperative complications in the form of pain, swelling, hematoma, and infection, there were no significant differences between both groups.

Conclusions
The eight-dot extended corporotomy technique is a safe and time-saving approach compared to the conventional limited corporotomy technique, making the MPPI procedure more efficient. A swifter procedure decreases both patient exposure to anesthesia and device exposure to air which in turn lowers the risk for potential postoperative complications.

Disclosure
No.
(388) Arab Patient and Partner Satisfaction Following Malleable Penile Prosthesis Implantation in the Middle East and North Africa
Authors: Ragheb A , Abdallah M , Abdelbary A , Emadeldin M , Mohamed A , Elmarakby A 
Published: February 2024

Abstract

Introduction
Due to the sensitivity of the topic of penile implants for the treatment of refractory erectile dysfunction (ED) in the Middle East and North Africa region, a scarce body of related research is available.

Objective
We aimed at investigating the levels of patient and partner satisfaction after malleable penile prosthesis implantation among the Arab population and its dynamics during and after the first 6 months of surgery.

Methods
This was a prospective 6-month follow-up study of 120 patients undergoing malleable penile prosthesis implantation at our unit by a single surgeon. Three telephone encounters were conducted for each couple at 1 month, 3 months, and 6 months postoperative (PO). We utilized our validated Arabic version of the Modified Erectile Dysfunction Inventory of Treatment Satisfaction (AM-EDITS). During the 1st first encounter, we inquired about the general patient perioperative experience, starting from preoperative counseling till the first month after surgery. The 2nd and 3rd encounters focused on patient and partner satisfaction after implant utilization.

Results
The average ages of the men and their partners were 54.7±8.4 and 32.9±4.6 years, respectively. Levels of anxiety decreased in over 82% of the men in our study upon receiving proper preoperative counseling. Almost all of the patients were happy (96%) with their early PO days with over 50% of them exceeding their expectations. After 3 months, 82.5% of the men were satisfied, describing their erections to be 80% close to natural. Of the 92.5% satisfied partners at 3 months, nearly 80% were highly satisfied. Over 93% of them reported feeling sexually desirable by their husbands. As opposed to the significant rise in men’s overall satisfaction and AM-EDITS index by 11.6% and 5.2 ± 0.8% (P &lt; 0.001), respectively after 6 months PO, partners demonstrated a 12.4% and 5.9 ± 0.8 decline (P &lt; 0.001), respectively, compared to the 3 months follow up.

Conclusions
Malleable penile implants still represent a good quality of life treatment option for middle to low-income countries. Time has a positive effect on Arab men’s PO satisfaction as opposed to their partners’. The explanation behind these findings should be investigated in further studies. A proper understanding of the dynamics of patient and partner satisfaction over time may be useful for proper perioperative counseling of both parties to ensure their sustainable satisfaction.

Disclosure
No.
(397) Investigating the Psychological Bother and Depression Among Gay Men with Peyronie's Disease
Authors: Novaes LF , Elshafei A , Jenkins L , Terrier J , Taniguchi H , Nascimento B , Carlsson S , Nelson C , Mulhall JP , Flores JM 
Published: February 2024

Abstract

Introduction
I: Peyronie's disease (PD) is associated with psychological bother, including depression and relationship dissatisfaction.

Objective
Our objective is to describe the prevalence of psychosocial issues using validated instruments, comparing gay and non-gay males.

Methods
We included patients diagnosed with PD who completed two validated questionnaires. The questionnaires were the Peyronie's Disease Questionnaire (PDQ) and the Center for Epidemiologic Studies Depression Scale (CES-D). The PDQ has 3 domains that evaluate psychological and physical symptoms, penile pain, and bother signs. Higher PDQ scores indicate a greater negative impact, and a score ≥ 9 on the bother domain indicates significant distress. A CES-D score ≥ 16/60 suggests clinical depression. All gay and non-gay patients were matched, and potential indicators of psychological distress were examined in both populations. Our multivariable analysis (MVA) models included age, sexual orientation, pain, and curvature. Additionally, we collected demographic information and PD-related characteristics.

Results
74 individuals were matched based on age, curvature direction, and curvature degree: 37 gay and 37 non-gay. The median age was 57 (50, 62) years. Gay population characteristics: 60% were partnered; 54% had ≥ 2 comorbidities; median PD duration of 9 (4, 17) months; median curvature of 35 (29, 49) degrees; 66% had penile instability; 57% in a dorsal direction curvature, and 73% were located at the mid-shaft; 18% had multiplanar curvature. The PDQ scores in the gay vs. non-gay population: median score on psychological and physical domain of 10 (7, 18) vs. 11 (5, 16); median score on pain domain was 3 (0, 9) vs. 3 (0, 6), with 43% of the gay population with pain vs. 21% in non-gay; median score on bother domain was 8 (4, 10) vs. 8 (6, 11), with 65% of gay patients with significant bother (score ≥ 9) compared to 51% in non-gay. Regarding the CES-D scores, 38% of individuals in both populations demonstrated meaningful depression (score ≥ 16), with a median score of 12 (4, 19) in the gay population and a median of 12 (5, 23) in non-gay. In the MVA, sexual orientation was not a predictor for bother or depression (Table 1).

Conclusions
More than half of both groups had meaningful bother, and 1 in 3 had clinical depression; however, sexual orientation was not a predictor of bother or depression.

Disclosure
No.
(404) National Trends of Penile Fracture Encounters 2016-2019
Authors: Marte J , Lee J , Ingram J , Han D , Joice G 
Published: February 2024

Abstract

Introduction
Penile Fracture (PF) is an acute urological emergency resulting from the rupture of the tunica albuginea and one or both of the corpus cavernosa. Immediate surgical intervention is crucial in avoiding long-term complications, however the epidemiology and treatment patterns remain understudied, especially with the introduction of the 10th Revision of the International Classification of Diseases (ICD-10).

Objective
To evaluate national trends of PF encounters as well as predictive factors of inpatient admission from the emergency department (ED).

Methods
All patients admitted to the ED for PF between 2016-2019 were extracted from the NEDS using the ICD-10 Diagnosis Code S39.840 and its modifiers. Multivariable logistic regression was performed to identify predictors of this inpatient admission.

Results
Between 2016-2019, there were an estimated 7,091 weighted encounters related to PF in the US with an overall 13% increase in cases (Figure 1). About 20.8% (1,477) of these encounters led to inpatient admission. The average age of a patient presenting with PF was 41 years old. The majority of encounters took place in the South (44.12%) at non-trauma center rural hospitals (63.99%) and involved private insurance holders (44.42%). For those admitted to inpatient service, the average length of stay was 1.44 days, with a maximum of 26 days. The average total charge for patients discharged from the ED was $11,224 USD and those admitted were faced with charges averaging $33,474 USD. Predictors of inpatient admission included an Elixhauser Comorbidity Score &gt; 1, encounters in the Northeast, Midwest, and Western states, and being covered by Medicaid (p &lt; .05).

Conclusions
Penile fractures have seen a small increase in incidence from 2016-2019. Although inpatient admissions are less common, they carry significantly higher costs. Further studies of treatments and regional analysis may be warranted to decrease the amount of inpatient admissions.

Disclosure
No.