bluuebunny/crossref_metadata_2025_split huggingface dataset:
(064) The Optilume® Drug Coated Balloon for Recurrent Anterior Urethral Strictures: Robust III Study 3-year Interim Results
Authors: Krug A , Morey A , Coutinho K , Robertson K , D'anna R , Chevli K , Carrier SC , Cantrill C , Ehlert MJ , Te AE , Dann J , Delong JM , Brandes SB , Hagedorn J , Levin R , Schlaifer A , Desouza E , Dimarco D , Erickson B , Elliott S 
Published: February 2024

Abstract

Introduction
The Optilume® Drug Coated Balloon (DCB) is a dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. Outcomes after 3-year follow-up are presented here.

Objective
The ROBUST III study is a randomized controlled trial comparing the Optilume® Drug Coated Balloon (DCB) against direct visual internal urethrotomy (DVIU) or dilation.

Methods
127 subjects were randomized in a 2:1 fashion at 23 sites. Seventy-nine were treated with the DCB and 48 were treated with DVIU or dilation. Follow-up past 1 year was limited to those treated with the DCB. Eligibility criteria included adult males with anterior strictures with ≥2 prior treatments and stricture length ≤3cm. Long-term endpoints included freedom from repeat treatment, International Prostate Symptom Score (IPSS), and peak urinary flow rate (Qmax).

Results
Subjects randomized to receive the DCB had an average of 3.2 prior treatments and average stricture length of 1.6cm (46% ≥2cm), with 8/79 (10.1%) having penile strictures and 9/79 (11.4%) having prior pelvic radiation. IPSS significantly improved from 22.0 at baseline to 11.3 at 3 years. Qmax significantly improved from a baseline of 7.7 mL/sec to 12.2 mL/sec at 3 years. Freedom from repeat intervention for DCB subjects was estimated to be 74%. No late-onset treatment related adverse events were observed.

Conclusions
The Optilume® DCB continues to achieve significant improvements in symptoms, flow, and reintervention rates through 3 years post treatment.

Disclosure
No.
(075) Treating Idiopathic Hematospermia with Oral Tranexamic Acid
Authors: Le B , Shekar A , Lee A , Raheem O 
Published: February 2024

Abstract

Introduction
Hematospermia can be a challenging medical condition to treat for the urologist. While almost universally benign, it causes considerable patient stress and anxiety. There are no standardized treatments and while many cases may resolve on their own the duration can be quite variable. Tranexamic acid (TXA), an antifibrinolytic, has been used to control bleeding in various settings including heavy menstrual bleeding, traumas, and intraoperatively to prevent and control bleeding.

Objective
We sought to investigate the safety and efficacy of tranexamic acid, an oral anti-fibrinolytic for the treatment of idiopathic hematospermia.

Methods
A cohort of patients presenting to urology clinic within the past year for primary complaint of hematospermia without other clear etiology (trauma, radiation, prior surgery, prostatitis) were prescribed TXA 1300 mg BID for 7 days. Patients were followed as part of routine care and resolution of hematospermia and side effects were observed and documented.

Results
Eight patients (median age 42.1 years) met criteria and were treated with the TXA protocol for idiopathic hematospermia. All had immediate resolution at completion of the 7-day course. Two patients had a recurrent episode within follow-up period (Median follow-up of 5.4 months) which resolved with a second treatment course. No adverse events were noted, and all patients were able to tolerate TXA treatment.

Conclusions
TXA appears to be a safe and efficacious treatment for idiopathic hematospermia where often the main goal is to rule out other etiologies and expeditious resolution to relieve patients’ stress and anxiety.

Disclosure
No.
(078) The Effect of Smoking Cessation on Semen Quality
Authors: Ragheb A , Abdelbary A , Massoud A , Mohamed M , Elmarakby A 
Published: February 2024

Abstract

Introduction
Extensive research efforts have always focused on the deleterious effects of smoking on male reproduction by comparing fertility in smokers versus nonsmokers. Nevertheless, studies on the effect of smoking cessation on male fertility remain scarce.

Objective
Our primary aim was to investigate the reversibility of the negative impact of smoking on male fertility. Secondarily, we studied the effect of both time after smoking cessation as well as the smoking index on semen quality improvement.

Methods
Our study included 60 participants who applied to a smoking cessation program. The volunteers started by completing a fertility background questionnaire. Two semen specimens, provided 2 weeks apart, were analyzed according to the WHO guidelines for each candidate on three different occasions. The first was right before smoking cessation followed by the 2nd and 3rd at 3 and 6 months after stopping smoking, respectively. Semen quality was compared between the 3 occasions. The degree of change was correlated with the level of smoking. The nicotine level in urine was used for smoking cessation compliance monitoring during the study.

Results
Comparing semen quality on the 3 different occasions respectively, we detected a significant improvement in semen volume (3.33 ml ± 1.07 vs. 3.88 ml ± 0.80 vs. 4.34 ml ± 0.67, P &lt; 0.001), sperm concentration (14.77 million /ml ± 6.49 vs. 17.71 million /ml ± 6.41 vs. 19.27 million/ml ± 6.46, P &lt; 0.001), total sperm count (49.33 million ± 25.31 vs. 70.16 million ± 30.85 vs. 84.01 million ± 31.00, P &lt; 0.001), progressive motility (20.7% vs. 35.3% vs. 42.28%, P &lt; 0.001), total motility (41.48% vs. 60.33% vs. 67.67%, P &lt; 0.001) and abnormal morphology (69.32% Vs. 50.88% vs. 40.82%, P &lt; 0.001). Improvement in all parameters was positively correlated to time after cessation. Higher smoking indices were related to higher levels of improvement in semen volume, sperm concentration, and total count (areas under the curve of 0.867, 0.852, and 0.863 respectively, P &lt; 0.001 for each).

Conclusions
The negative effect of smoking on semen quality is reversible. Smoking cessation has a time-dependent positive effect on main semen parameters, hence, positive potential for fecundity improvement in men.

Disclosure
No.
(089) Greater Changes in Hematocrit Predict More Frequent Major Adverse Cardiac Events in Men Receiving Testosterone Therapy - A Retrospective Cohort Claims Database Analysis
Authors: Kohn TP , Agrawal P , Ory J , Hare J , Ramasamy R 
Published: February 2024

Abstract

Introduction
While recent studies have shown that Testosterone therapy (TTh)-induced secondary polycythemia, Hematocrit (Hct) &gt; 52%, is an independent risk factor for major adverse cardiac events (MACE) within the first year of treatment, it is not clear whether erythrocytosis – i.e., degree of change in Hct from baseline Hct after starting TTh confers additional risk for MACE.

Objective
The objective of this study is to determine the incidence of MACE associated with the degree of Hct change from baseline in adult men receiving testosterone therapy for hypogonadism.

Methods
To assess whether an increase in Hct after initiating TTh is associated with an increased risk of MACE within 3 and 24 months of initiating TTh, we queried the TriNetX Research network database for men over the age of 18 with Hct values obtained within six months before starting TTh, and who had follow-up Hct measurements within three and 24 months after beginning TTh from 2010 through 2021. Men with and without a subsequent increase in Hct after initiating TTh were propensity matched. MACE was defined as myocardial infarction, stroke, or death.

Results
After matching, 10,291 men who experienced an any increase in Hct after initiating TTh and 6,320 controls who did not were included. Compared to controls who did not have an increase in Hct, the majority of men who had an increase in subsequent Hct had a statistically significant increased risk of major adverse cardiac events with greater change being associated with increase risk of MACE.

Conclusions
We demonstrate that increases in Hct from baseline are associated with increased risk of MACE, compared to men whose Hct remains stable while receiving TTh.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast, Endo Pharmaceuticals, Antares Pharma.
(181) Prior Radiation Therapy is Associated with Increased Risk of Intra-Operative Complications in Patients Undergoing Primary Inflatable Penile Prosthesis Placement: Results from a Large Multi-Institutional Collaborative
Authors: Dalimov Z , Diao L , Chang C , Barham DW , Sadeghi-Nejad H , Hamma MAM , Andrianne R , Sempels M , Hsieh T , Hatzichristodoulou G , Osmonov D , Lentz A , Perito P , Hotaling J , Van Renterghem K , Park SH , Ziegelmann M , Pearce I , Gross  , Yafi FA , Simhan J 
Published: February 2024

Abstract

Introduction
Radiation therapy (RT) can predispose the onset of corporal fibrosis and microvasculopathy. The impact of RT on intra-operative complications is not well described in the literature.

Objective
In this study, we assess intra-operative and post-operative outcomes among patients with or without prior history of RT following primary Inflatable Penile Prosthesis (IPP) implantation.

Methods
We performed a multicenter, retrospective analysis of men undergoing primary IPP placement between January 2015 and December 2022. A total of 3530 patients were identified, of which 3319 had no prior history of RT and 211 patients had history of RT. After 1:1 propensity score matching for all confounding variables, 211 patients with a history of RT were compared to 211 nonradiated patients for intra-operative and post-operative outcomes. Chi-square and Mann-Whitney tests were used for statistical analysis for categorial and continuous variables respectively. For multivariable analysis, we used a forward stepwise model and included significant variables found on pre-operative characteristics of patients. Kaplan-Meier time to event analysis were compared with Mantel-Cox log-rank test.

Results
Patients with history of RT encountered more intra-operative complications (4.3% vs 0.9%, p=0.032); specifically, these men experienced more distal crossover events (1.9% vs 0, p=0.044). On multivariable analysis, history of prior RT (OR 5.29, 95% CI 1.07-26.3, p=0.041) and diabetes mellitus (OR 10.5, 95% CI 2.58-43.5, p=0.01) were associated with increased risk of intra-operative complications. History of obesity (OR 0.11, 95% CI 0.01-0.91, p=0.040) reduced risk of intra-operative complications. There was no significant difference in early or late post-operative non-infectious complications between both groups and there was also no significant difference in risk of post-operative complications within 24 months on Kaplan Meier analysis (log rank p=0.9).

Conclusions
In this large multi-institutional cohort, history of RT is an independent predictor of intra-operative complications but not post-operative complications during primary IPP placement. These findings may help inform patient-specific counseling while guiding surgical planning to prevent untoward morbidity following surgery.

Disclosure
No.
(182) Transurethral Laser Incision of Ejaculatory Duct for Complete Ejaculatory Duct Obstruction
Authors: Madhusoodanan V , Savio L , Muthigi A , White J , Campos L , Shah H , Ramasamy R , Towe M 
Published: February 2024

Abstract

Introduction
It is estimated that approximately 5% of men presenting with infertility suffer from ejaculatory duct obstruction (EDO). Patients suspected to have EDO typically have a palpable vas deferens and normal testicular exam. On semen analysis, low volume and acidic pH should increase suspicion, and transrectal ultrasound is most commonly the first diagnostic modality utilized to confirm the diagnosis when suspecting EDO.

Objective
The objective of this surgical video is to describe the use of holmium laser for the management of ejaculatory duct obstruction (EDO) in the setting of obstructive azoospermia.

Methods
This was a 35 year old male with no significant past medical history who presented with obstructive azoospermia. His partner was a 32 year old female with no significant past medical history, with regular menstrual cycles, and a normal female reproductive evaluation. Semen analysis was significant for low volume (0.5 mL) azoospermia with an acidic pH (6.8). Abdominal and pelvic computerized tomography (CT) scan from 2017 when the patient presented for appendicitis noted an incidental finding of a 9.9 cm prostatic cyst. Thus, a transrectal ultrasound (TRUS) guided aspiration was performed in the ambulatory clinic which demonstrated a large prostatic cyst, with non-motile sperm in the aspirate. The patient was consented for Cystoscopy with transurethral laser incision of ejaculatory ducts. A 22 French (F) cystoscope was used, first for pan-cystourethroscopy, and then to cannulate the right ejaculatory duct with 5F pollack catheter and guide wire. Guide wire and catheter positioning within the cyst was confirmed with fluoroscopy. A 24F resectoscope with a laser bridge working element and 550 micron holmium laser fiber at settings of 1 Joule of energy and 10 hertz frequency to incise the right ejaculatory duct, circumferentially around the wire. The ejaculatory duct was incised and cyst was drained until the ejaculatory duct and thus prostatic cyst could be cannulated and examined with the cystoscope. On examination of the cyst, no vasal openings were identified. Left seminal vesiculography was attempted but unsuccessful due to significant contrast extravasation into the urethra.

Results
The case went well and was uncomplicated. There were no immediate or delayed complications or adverse effects reported by the patient. Post-operative instructions included rest for 1 week, followed by ejaculation every other day for 3 months. Semen analysis and transrectal ultrasound will be performed at 3 months post-operative.

Conclusions
Transurethral laser incision of ejaculatory duct is a safe surgical intervention for management of complete ejaculatory duct obstruction, and is demonstrated successfully in this step-by-step surgical video.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.
(196) Reconstruction of Complex Midline Septal Corporal Defect in a Distal Crossover Penile Implant Cylinder: A Step-by-step Demonstration of Surgical Technique
Authors: Wang C , Barreto Guimaraes PV , Raheem O , Kocjancic E 
Published: February 2024

Abstract

Introduction
Inflatable penile prosthesis (IPP) placement is a common and effective treatment for erectile dysfunction. Around 20,000 procedures are performed annually. Complications can arise after the procedure, with non-infectious complications occurring in approximately 4% of cases. One rare non-infectious complication is complete cylinder crossover, which can happen due to variable windows in the corporal septum.

Objective
This case report presents a complex distal septal defect caused by distal cylinder crossover and its repair using Tutoplast graft.

Methods
The patient, a 59-year-old African American male, had a history of prostate cancer and underwent robotic-assisted laparoscopic prostatectomy in 2018. He received an IPP in September 2020. In 2022, the patient experienced painful leftward penile curvature during erections and incomplete deflation of the penile prosthesis. A physical examination revealed crossover of the right prosthesis cylinder to the left. After a thorough discussion of the risks and benefits, the patient opted for surgical revision and reconstruction of the penile prosthesis. The procedure involved a right corporotomy, septal corporal reconstruction using a 5 × 2 cm Tutoplast graft, and redirection of the uninfected, functioning cylinder into the neocorporal space.

Results
The surgery was successfully completed without any complications, and the IPP functioned well at the end of the procedure. During the 6-week clinic follow-up, the patient reported proper cycling of the device, excellent erectile function, the ability to orgasm, and minimal pain.

Conclusions
In conclusion, our case demonstrates that Tutoplast graft, along with appropriate seating and redirection of the displaced cylinder without replacing the functional hardware, is a viable surgical approach for IPP revision, even in complex cases involving septal defects.

Disclosure
No.
(214) National Trends of Inpatient vs. Outpatient Male Benign Prostate Hyperplasia Procedures: 2016-2019
Authors: Roper W , Marte J , Lee J , Joice G 
Published: February 2024

Abstract

Introduction
Benign prostatic hyperplasia (BPH) is a common condition among aging men, causing urinary symptoms and impacting quality of life. Understanding the trends in BPH treatment procedures is crucial for optimizing patient care. Evaluating the utilization of different treatments, the setting of procedures (inpatient vs. outpatient), and associated costs can provide valuable insights. Identifying patient- and hospital-level factors associated with inpatient treatments can help identify disparities in access to care. Assessing the financial implications of care settings can optimize resource allocation. This research aims to contribute to knowledge by providing comprehensive insights into BPH treatment patterns, patient demographics, and healthcare costs for informed decision-making and improved patient outcomes.

Objective
To evaluate contemporary national trends of BPH treatment procedures among men.

Methods
An analysis of BPH treatment procedures performed from 2016-2019 was conducted utilizing both the National Inpatient Sample (NIS) and the Nationwide Ambulatory Surgery Sample (NASS). BPH treatment procedures were identified by Current Procedural Terminology (CPT) and International Classification of Diseases (10th Revision) Procedure Coding System (ICD-10-PCS) codes. Stratified cluster sampling was used to create weighted national estimates. The primary outcome was the rate of BPH treatments procedures performed in inpatient and outpatient encounters over time. Multivariable logistic regression was used to evaluate patient- and hospital-level factors associated with inpatient BPH treatments.

Results
A total of 811,111 weighted BPH treatment procedures analyzed showed that 45% of procedures were performed inpatient, with the remaining 55% performed outpatient over the course of 2016-2019 (Figure 1). Regional analysis revealed a majority of procedures were performed in the South at 36% and about 40% inpatient and outpatient, respectively (Table 1). The proportion of BPH procedures performed outpatient remained stable at 55% from 2016-2019 (Figure 1). The average age of a treated patient was similar between 66 inpatient and 70 outpatient. Multivariable logistic regression analysis showed an Elixhauser Comorbidity Index greater than 0 as a predictor of inpatient BPH treatment (Table 2). Medicare was the primary payer for both inpatient and outpatient settings at 51% and 60% respectively. Mean total charge for inpatient BPH encounters was $70,061 vs. $22,716 outpatient.

Conclusions
A sizable majority of BPH treatment procedures nationwide appear to be performed in an outpatient setting. Outpatient procedures have a lower total charge compared to inpatient care, which appears to be a contributing factor. Most inpatient procedures are more likely to be performed on patients. Further investigation is warranted to assess how these factors may affect surgical outcomes.

Disclosure
No.
(270) Application of ISSWSH Consensus PGAD/GPD Diagnostic Algorithm to Eight Cases
Authors: Ahrendt H , Pope R , Kingsberg S , Hayek S 
Published: February 2024

Abstract

Introduction
Persistent Genital Arousal Disorder/Genito-Pelvic Dysthesia (PGAD/GPD) is a debilitating, but the mechanism of disease and treatment are poorly understood. To address this gap in knowledge, the ISSWSH consensus statement proposed a diagnostic and treatment algorithm for PGAD/GPD. The algorithm proposes five possible regions of etiologies for the purposes of diagnosis and treatment. These regions include end organ (clitoris, vagina, vulva, etc), pelvis/perineum, spinal cord, cauda equina and brain.

Objective
The purpose of this retrospective case series is to apply the ISSWSH diagnostic and treatment algorithm to nine cases, in order to demonstrate the efficacy of the algorithm, as well as present uniform manner for reviewing PGAD/GPD cases.

Methods
Individuals were identified by the Principal Investigator and colleagues. ISSWSH diagnostic and treatment algorithm was used to note pertinent positives and negatives in history and physical exam, as well as analyze treatment.

Results
Cases of eight patients are reviewed using the algorithm to analyze the treatments and possible etiologies of each patient. Patients presented anywhere from experiencing symptoms for five days to three years. Half of the patients experienced relief of symptoms with treatment of lumbar pathology demonstrated on MRI. Four of the patients found relief with spinal epidural injections performed by a pain medicine physician, two found relief with pelvic floor physical therapy and two found relief with medications including gabapentin and pregabalin.

Conclusions
These cases demonstrate the utility of the ISSWSH consensus algorithm in guiding initial diagnosis and treatment of PGAD/GPD. However, it has limitations due to the multifactorial nature of PGAD/GPD, it is helpful in guiding initial treatment of the disorder. The cases in this series illustrate the importance of MRI in diagnosis of PGAD/GPD etiologies. Fifty percent of the cases in this series included an MRI that revealed lumbar pathologies that could be managed by pain management physician. As shown in these cases, PGAD/GPD can have a significant negative impact on mental health and activities of daily living, therefore it is critical to be systematic and efficient. The steps demonstrated to be most important in these cases include review of recent medication changes, physical examination (with anesthesia testing, if possible), lumbar MRI and referral to pain medicine specialist. The primary limitation of this study is that it is a retrospective chart review and as such, there was no standardization of the work up for each patient and information on each patient was limited to the notes in their charts.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Johnson and Johnson.