bluuebunny/crossref_metadata_2025_split huggingface dataset:
(087) Testosterone Replacement Therapy in Men on Active Surveillance for Prostate Cancer: Using a Novel Database to Examine Disease Progression
Authors: Applewhite JP , Saffati G , Naeem T , Chaput MB , Patel S , Lipshultz LI , Khera M 
Published: February 2024

Abstract

Introduction
Traditionally, the use of testosterone replacement therapy (TRT) in hypogonadal men on active surveillance (AS) with prostate cancer (PC) has been controversial, and for many providers, contraindicated. However, studies suggesting a need to revisit the association between TRT and prostate cancer progression have contributed to a recent paradigm shift in this approach. More studies are needed to analyze this relationship, especially due to the psychosocial and biological consequences of testosterone deficiency.

Objective
We aim to examine the effects of TRT on PC progression in hypogonadal men on active surveillance.

Methods
In this retrospective chart review, data from men diagnosed with hypogonadism and PC at a single hospital system between 2009 to 2022 were compiled into a database. Inclusion criteria for this specific study included men who underwent TRT while being on AS protocol for PC. Men receiving prior treatment for PC such as prostatectomy or radiation therapy were excluded. For each patient, PSA and total testosterone (TT) levels were recorded at 12 and 6 months prior to TRT, at the onset of TRT, and 3, 6, and 12 months following TRT initiation. One-way ANOVA was used to analyze variance in mean PSA and TT. Mean TT levels pre-TRT and post-TRT were calculated and analyzed for a significant difference. Progression to PC treatment was noted for each patient.

Results
30 men meet the study criteria. The table below demonstrates the mean PSA and TT levels at each time interval. There was a significant variation in mean TT (P=0.0031) while there was no significant difference in mean PSA levels (P=0.3003) throughout the 2-year study period. Mean TT before initiation of TRT was 297.97 ng/dL, and mean TT after TRT was 716.15 ng/dL. There was an increase in mean TT after starting TRT (P=0.00072). One patient (3.3%) eventually underwent radiation therapy for PC five years after initiating TRT.

Conclusions
In hypogonadal men on AS for PC, no significant change in PSA level was observed after initiating TRT, despite an increase in testosterone. As we grow the database, we aim to increase the power of this study. Our findings contribute to the mounting evidence demonstrating TRT may be a viable option for hypogonadal men on AS.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(096) Use of GLP-1 Agonists Associated with Diagnosis of Hypogonadism in Large Retrospective Cohort
Authors: Crisostomo-Wynne T , Santamaria A , Holt S , Hehemann M 
Published: February 2024

Abstract

Introduction
Glucagon-like peptide receptor agonist (GLP-1a) medications are a novel treatment for type 2 diabetes mellitus (DM), receiving US FDA approval for this indication in 2017. The use of these medications is increasing rapidly for both diabetes and weight loss, and FDA approval was granted for treatment of obesity in 2021. There is evidence that these medications have a direct effect on the hypothalamic-pituitary-gonadal (HPG) axis in animal studies and mixed findings in small human studies. The effects on the HPG axis in humans with long-term use has not been described.

Objective
To determine if there is a correlation between use of GLP-1a medications and subsequent diagnosis of hypogonadism in men.

Methods
The Marketscan Research database was queried for men who received a prescription for any GLP-1a medication from 2017 to 2020. The length of time on the medication was then compared to subsequent diagnosis of hypogonadism for up to one year after initiation of treatment. Men with a preexisting diagnosis of hypogonadism were excluded.

Results
The initial query yielded 116,704 patients receiving a prescription for GLP-1a medication. Of these, 26,668 received the prescription for at least 1 year. Of those with prescription duration &gt;1 year, 1,075 (4.0%) men had a new diagnosis of hypogonadism within the next year following GLP1a initiation. The mean age of men was similar between those with and without hypogonadism (50.33 vs 50.26, p = 0.8). Using point-biserial correlation, the length of time on the medication was compared with a new diagnosis of hypogonadism. There was a weak but significant correlation between the time on the medication and new diagnosis of hypogonadism (rpb = -0.015, p = 0.015)

Conclusions
This large cohort of patients shows a significant correlation between the length of time taking GLP-1a and the subsequent development of hypogonadism within one year of initiating treatment. Along with prior research, this study raises concerns about the use of GLP1a medication and possible long term effects its use.

Disclosure
No.
(141) Surgical Outcomes of Infrapubic Insertion of the Inflatable Penile Prosthesis in 175 Transmen After Phalloplasty
Authors: Chen M , Patel D , Hotaling J , Sun H , Gupta S , Hsieh T , Goodwin I , Watt A , Lin W , Safa B 
Published: February 2024

Abstract

Introduction
Historically, inflatable penile prostheses (IPP) insertion in a neophallus has an estimated 40-50% surgical revision rate.

Objective
To review the surgical outcomes of a single center’s experience with the infrapubic approach to insertion of the IPP after phalloplasty in transmen.

Methods
The infrapubic prosthesis insertion after phalloplasty (IPIP) technique involves a horizontal incision anterior to the pubic symphysis, which allows dissection of the neophallus channel, the Space of Retzius, and the scrotal pocket. Surgical outcomes using the Titan (Coloplast, Minneapolis, MN) IPP by a single surgeon (MLC) were analyzed between October 2017 and June 2023. Complications were reviewed and categorized into erosions, infections, device malposition and malfunction, and less common events like necrosis and urinary tract injury.

Results
The IPIP technique was performed on 175 phalloplasty patients by a single surgeon (MLC): 156 patients had a prior RF phalloplasty, and 19 had a prior ALT phalloplasty. The mean followup was 32.8 months. Surgical revision was required in 35 patients (20%). There were 10 pump erosions through the neoscrotum, 1 glans erosion, 9 infections, 6 pump malpositions in the neoscrotum, 6 cylinder malposition in the neophallus, 3 mechanical malfunctions with broken tubing, 2 urethral injuries, 2 bladder injuries, and 1 glans necrosis. There were no instances of implant detachment from the pubic bone anchor site, osteomyelitis, nor total phallus loss.

Conclusions
Data for the IPIP technique using the commercially available Coloplast Titan IPP suggest a reduction in neophallus prosthetic surgical revision rates compared to previous reports. Longer term studies with patient reported outcomes are required for further evaluation.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.
(150) Erectile Dysfunction and Peyronie’s Disease Diagnosis Rates After Penile Fracture – A Retrospective Claims Database Cohort Analysis
Authors: Physicians M , Maremanda A , Kohn T , Able C , Burnett A 
Published: February 2024

Abstract

Introduction
Penile fracture (PF) is a rare urologic emergency, with an estimated incidence of 500-600 PFs per year in the United States. Delays in surgical repair increase the risk of developing erectile dysfunction (ED) and Peyronie’s disease (PD).

Objective
Our objective was to analyze the rates of ED and PD following a PF using a large, multi-institutional claims database.

Methods
We conducted a cohort analysis utilizing the TriNetX Research database. The inclusion criteria included men ages 15 or older with a diagnosis of PF and any office visit within 5 years of the PF. Our exclusion criteria included any prior ED diagnosis, prescription of erectile aids, or penile prosthesis placement. Our primary outcome was the diagnosis of ED or prescription of erectile-aid dosing of phosphodiesterase-5 inhibitors (PDE5i) within five years. A secondary analysis was used to assess rates of PD following a PF. Subgroup analyses were performed for age and the impact of initial repair. Propensity-matching was performed to compare men with and without PF by calculating risk ratios (RR).

Results
1,242 men were identified with a diagnosis of PF and subsequently matched to men without a PF, resulting in equal cohorts of 1,227 men. Men with a history of PF were more likely to receive a diagnosis of ED or require PDE5i (RR 3.18, 95% CI 2.30-4.40). Men over the age of 45 years who had a PF were more likely to develop ED or require ED treatment compared to men under 45 years (RR: 1.65, 95% CI 1.14-2.39). Men who did not undergo immediate repair had higher rates of ED diagnoses or treatment (RR: 1.84, 95% CI 1.22-2.78). Rates of PD diagnoses were significantly higher in men with a history of PF (5.8% vs 0%, p-value&lt;0.0001). Rates of PD were significantly lower if immediate repair of the fracture was performed (RR: 0.20, 95% CI 0.10-0.41). Men over the age of 45 years with a history of a penile fracture were more likely to develop Peyronie’s Disease within 5 years compared to men under the age of 45 years with a history of penile fracture (RR: 3.73, 95% CI 1.94-7.16).

Conclusions
We found that a PF increases the risk of both ED and PD, especially for those treated with conservative measures or over the age of 45 years. Consequently, it is essential to follow up with these patients in the long term and survey potential adverse side effects relating to sexual function that may arise.

Disclosure
No.
(168) Downgrading Surgical Recommendations After Intralesional Injections of Collagenase Clostridium Histolyticum in Peyronie’s Disease Patients
Authors: Hata L , Horodyski L , Metro M 
Published: February 2024

Abstract

Introduction
After patients undergo intralesional injections of collagenase clostridium histolyticum (CCH) as a primary treatment for Peyronie’s disease (PD), they may have residual curvature and may opt for secondary treatment with surgery. On the other hand, the initial severity of curvature may be best addressed by plaque incision and grafting (PIG), but the surgeon may offer CCH with the intent that post-CCH curvature can be treated with a penile plication (PP) rather than a PIG.

Objective
Our study investigated the group of PD patients who had their surgical recommendations downgraded from a plaque incision and grafting (PIG) to penile plication (PP), a less complicated procedure, after receiving CCH.

Methods
Our retrospective, single institution chart review included patients from 2016 to 2022 who underwent surgery to treat PD. We then looked at patients who underwent CCH then PP, and compared those who were initially recommended PIG before CCH to those who were initially recommended PP. Functional penile length was also evaluated as the length of the erect penis, from the base of the pubis to the tip of the glans, in a straight line while disregarding any curvature.

Results
Our study included 53 men who underwent surgery for treatment of PD, with mean age 56.0 (SD 11.3) at presentation. Of the 24 patients who underwent CCH, their pre-CCH and post-CCH surgery recommendations were: PP then PP in 5 patients (21%), PIG then PP in 11 (46%), PIG then PIG in 8 (33%) (Figure 1). The PIG then PP recommended group had a pre-CCH primary curvature range of 30 to 64 degrees, and post-CCH range of 16 to 46 degrees (Table 1). These patients had no significant difference in operative duration, difficulty, functional penile length, or complications (Table 2). The PIG then PP recommended group had 5 patients (46%) who reported functional residual curves that were manage conservatively, which was not significantly different from the PP then PP recommended group (0 patients, 0%, p=0.08).

Conclusions
Intralesional injections of CCH helped to downgrade surgical recommendations from the more drastic PIG to the simpler PP in a subset of PD patients, without compromising operative difficulty or postoperative outcomes. This finding is encouraging given that PP can be performed in a shorter operative time, by less experienced surgeons, and with lower risk of postoperative sensation and erectile issues.

Disclosure
No.
(198) Gaps in Patient Representation for Peyronie’s Disease Clinical Trials
Authors: Leelani N , Shumaker A , Khooblall P , Bole R , Lundy SD , Bajic P 
Published: February 2024

Abstract

Introduction
Recent studies have highlighted the lack of generalizability of clinical trials with respect to patient race and ethnicity for urologic diseases due to inadequate recruitment and reporting of racial and ethnic minority populations in clinical trials. To date, there have been no studies examining the diversity of patients with Peyronie’s disease recruited to clinical trials.

Objective
The objective of this study was to identify disparities in representation of patients in PD clinical trials relating to race and ethnicity.

Methods
A systematic electronic search of the published English literature was performed to identify clinical trials involving PD. The search was performed using the Medline/Pubmed, Ovid, and Embase databases. After articles were identified, they were screened based on their title and abstract. Articles were included if they were in English, relevant to Peyronie’s disease and specified clinical trial in the title or abstract. Exclusion criteria were articles about congenital penile curvature, systematic reviews, pooled analysis, and articles not in the English language.

Results
Of the 48 articles included in the analysis, 10 of them reported race, ethnicity, or sexual orientation. All 10 studies reported enrollment of Caucasian men, with Caucasian men making up 98.0% of the enrolled population across these 10 studies. Enrollment of African-American men were was reported in six of the 10 studies and constituted 2.6% of the enrollees. Enrollment of Asian men were was reported in three studies and comprised of 0.7% of the patients in those studies. Enrollment of American Indian/Native American men were was reported in a single study and made up 0.2% of patients enrolled in that study. Hispanic ethnicity was the only ethnicity reported and was available in five studies with of 4.0% of men reported as Hispanic across those studies. Only two studies reported the sexual orientation of patients. Five of the 10 studies that reported race enrolled patients exclusively from the United States. A pooled analysis from these 5 studies revealed that Caucasian men were significantly overrepresented and all other racial and ethnic groups were significantly underrepresented (p &lt; .05).

Conclusions
In conclusion there is a lack of representation of multiple racial and ethnic minorities with PD along with the over-representation of Caucasian men. Aside from the lack of reporting of racial and ethnic information, there was a dearth of information on sexual orientation of men in these clinical trials.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.
(223) Using Aglan Flap in Peyronie`s Surgery
Authors: Aglan A 
Published: February 2024

Abstract

Introduction
Surgical therapy is indicated if: 1- Deviation compromises or makes sex practice impossible. 2- Conservative treatment has failed. 3- Disease duration is at least 12 months. 4- The stable phase is at least 6 months. When deviation is greater than 60 degrees many centers prefer a grafting procedure to avoid penile shortening, grafting procedures leads to potential lengthening of the concave side of the deviation. The resulting tunical defect may be filled using an auto graft .e.g. detubulerized saphenous vein, fascia-lata, buccal mucosa, allograft e.g human pericardial tissues and human fibrinogen and thrombin coated onto equine collagen sponge, or xenografts e.g bovine pericardial and bovine intestinal submucosal tissues. Currently there is no consensus on the most suitable graft material for penile graft, many surgeons used synthetic grafts e.g self-adhesive collagen fleece, we were used the elastic wall of silicone caps with penile implants as a cover to the defects during implantation with peyronie`s previously. Synthetic grafts has the risk of infection, sensory loss, altered glans sensation, recurrent curvature due to graft contraction and length loss. So synthetic grafts should be avoided. Penile plication is simple and minimally invasive but invariably may results in penile length loss and may in fact worsen the existing hour-glass or hinge effect.

Objective
Presentation of new method to cover defects in peyronie`s diseases.

Methods
Methods two patients were operated, excision of the plaque was done, dissection of caval tissues in subtunical plane, elevation of Aglan caval flap, penile implantation (maliable), covering of the implant by the flap and suturing, second layer of the nearby tissues was added. The dissection could be done up to 360 degrees.

Results
Follow up for six months was done, both patients have no complications initial decrease in sensation was reported, improved within 3 months completely, the flap is safe, very vascular could be based at any point. It is natural, economic with minimal side effects if compared with synthetic grafts. Obvious nerves at area of excision should be retracted away if possible for maintenance of sensation. It could be used to cover defects with peyronie`s or other tunical defects with implantation.

Conclusions
Aglan flap is safe, economic, simple and effective method for covering tunical defects in peyronie`s disease.

Disclosure
No.
(248) Evaluation of Androgen Receptor Signaling and Saturation in Erectile Dysfunction
Authors: Khodamoradi K , Campbell K , Codrington J , Varnum A , Arora H , Ramasamy R 
Published: February 2024

Abstract

Introduction
Testosterone (T) is a steroid hormone responsible for the development and maintenance of male secondary sex characteristics. T exerts this physiologic function throughout by binding to the androgen receptor (AR). It is unclear how AR function varies as a function of serum T.

Objective
We hypothesized that there is a saturation value for the AR above which excess serum T does not lead to increased binding or downstream signaling. This study evaluated whether varied serum T levels were associated with AR signaling in the penile tissue of men with erectile dysfunction (ED).

Methods
The mean age of participants was 61 (IQR 8.5) years. The mean serum T level was 300.2 (IQR 231.3). The results of the western blot showed that HO and PDE-5 signaling was decreased in men with serum T less than 200 ng/dL compared to those with serum T above 200, while AR and iNOS expression was decreased in men with serum T less than 300 ng/dL compared to those with serum T above 300.

Results
Within a wide range of serum T values, AR signaling was similar in penile tissue above 200-300 ng/dL. These findings provide a possible explanation for why PDE5 inhibitors are most effective in men with serum testosterone levels greater than 200 ng/dL, as our western blot results indicate that PDE-5 signaling is diminished in men with lower serum testosterone levels. This suggests that maintaining eugonadal levels of serum androgens is essential for optimal functioning of PDE-5 inhibitors.

Conclusions
Our findings suggest that there is a limit to the effect of serum testosterone levels on AR signaling, as the downstream activity appears to plateau beyond a certain point of receptor activation.

Disclosure
No.
(251) Exogenous Leptin Treatment Augments Testicular T-cell Secretion and Function Differentially in Context to BMI in Murine Models
Authors: Arora H , Khodamorad K 
Published: February 2024

Abstract

Introduction
In previous research, we explored the effects of exogenous Leptin treatment on modulating the immune landscape within the testicular microenvironment (TME). We found that within the TME, it is the CD8+ T cells which were enriched upon Leptin treatment. However, our earlier study did not took into account the impact of variations in BMI which could potentially confound the effects of Leptin on T cells and on TME as a whole.

Objective
To investigate the impact of Leptin on a complete testicular immune microenvironment.

Methods
We used 6-week-old C57BL6 mice (n=30), grouped into three, with first group subjected to regular diet, second to Lean fat and third to high fat inducing diet. Once the mice reached the desired weights, they were exposed to two different concentrations of Leptin, 10 and 100 mg/ml, for seven days. After the treatment period, the animals were humanely euthanized, and their blood and testes were collected. Blood samples underwent a CBC differential profile analysis using a Hemavet Mascot Multispecies Hematology System Counter 1500R. Testes samples were subjected to comprehensive immunophenotyping, allowing us to assess the impact of Leptin treatment on various immune cell types within the testes.

Results
In mice with regular BMI, Leptin at a low dose (10 mg/ml) showed increased, but not significant, levels of serum testosterone (13.20 + 0.37 ng/dl), while LH and FSH levels significantly (p&lt;0.05) increased. In contrast, animals receiving 100 mg/ml Leptin showed no significant changes in hormone levels. CBC profiling indicated that lymphocytes and platelets were significantly influenced, specifically upon low doses of Leptin. Comprehensive immunophenotyping revealed a significant increase in CD4+ (helper T cells) and CD8+ (cytotoxic T lymphocytes) cell numbers in animals treated with low doses of Leptin, a pattern not observed with high doses. These results were in contrast to the mice which represented lean and obese conditions.

Conclusions
This study uncovers previously unexplored aspects of how exogenous Leptin treatments can modulate the immune microenvironment within the testis, potentially impacting testosterone production. Future research will investigate the relationship between changes in immune cell types, increased T cell numbers, and their influence on Leydig stem cell differentiation into adult Leydig cells.

Disclosure
No.