bluuebunny/crossref_metadata_2025_split huggingface dataset:
(119) Impact of Ethnicity on Clinical Outcomes of Intralesional CCH in Peyronie's Disease Patients Across Kaiser Permanente Southern California Database
Authors: Okene M , Hsieh T , Mirheydar H 
Published: February 2024

Abstract

Introduction
Intralesional CCH injection is an effective treatment for Peyronie’s disease (PD) that utilizes collagenolytic enzymes to break down collagen plaque, thus reducing the penile deformity. The IMPRESS I and II clinical trials demonstrated efficacy of CCH in a predominant Caucasian population of men (95.8%). Little is known about treatment efficacy in the non-Caucasian population.

Objective
Using Kaiser Permanente’s ethnically diverse database, we sought to study the impact of race on CCH treatment outcomes.

Methods
This study examined the efficacy of intralesional CCH injection in a large healthcare system over 15 years. We defined treatment efficacy as percent change in penile curvature abnormality from baseline after a maximum of 4 treatment cycles. Impact of comorbidities on CCH efficacy was also examined. Patients with ventral curvature or initial curvature &lt;30 ̊ or &gt;90 ̊ were excluded from analysis. Standard statistical analysis was performed.

Results
112 patients underwent CCH therapy and were included in this analysis. 46.4% of men completed all 4 cycles. Among men who received CCH, 66.1% were Caucasian, 22.3% Hispanic, and 9.8% African American. For co-morbidities, 87.5.% of men were not diabetic, while 22.3% of men had erectile dysfunction. The mean baseline pre-injection penile curvature was 51.63 degrees (range was 32-87 degrees). Caucasian men had the largest treatment response to CCH (45.6% decrease in penile curvature) compared to African American men (43.7%) and Hispanic men (40.5%), p = 0.9554. Non-diabetic men had a larger treatment response to CCH (44.9% decrease in curvature versus 39.3% in diabetics, p = 0.4726). Younger Men (age 18-44) also experienced a greater treatment response compared to other age groups (57.9% reduction in curvature, p = 0.171). There was a significant difference in number of cycles completed across different ethnicities (p = 0.0220). Hispanic men were significantly less likely to complete all 4 cycles of CCH compared to Caucasian and African American men (p=0.0004). Only 28.2% of Hispanic men completed all 4 treatment cycles. 48% of Hispanic patients report the need of language interpretation services during health appointments.

Conclusions
This is the largest post-market analysis of CCH treatment outcomes in a racially diverse PD population. Caucasian men had a greater treatment response after CCH injection possibly due to higher rate of completing all 4 treatment cycles. Nondiabetic men and younger men (aged 18 to 44) also had a greater treatment response after CCH injection. Hispanic men were significantly less likely to complete 4 cycles of injection therapy; possible explanations include language barriers. Future study is needed to determine if patient resources prepared in Spanish can improve treatment outcomes in Hispanic men with PD, and reduce these health care disparities observed in our study.

Disclosure
No.
(131) Predictors of Success with Early Antibiotic Therapy for Penile Implant Infection: Patients from a Prospective Randomized Study Comparing DNA Sequencing versus Traditional Cultures
Authors: Henry G , Stuart A , Chung P , Diaz N , Lentz A , Natale R , Perito P 
Published: February 2024

Abstract

Introduction
Traditional culture is the current standard-of-care to determine therapeutic antibiotics for patients suffering from penile prosthesis (PP) infections. However, approximately 30% to 50% of PPs removed for infection are culture negative. Next-generation sequencing (NGS) of DNA has proven to be beneficial in its thorough analysis of biofilm composition. However, there are no existing clinical measures for identifying presenting characteristics of patients of successful or failed antibiotic treatments.

Objective
The purpose of this early dataset is to identify patient characteristics predicting success or failure with early antibiotic therapy in the setting of penile implant infection.

Methods
Upon institutional review board approval, adult men undergoing treatment for mild to moderate clinical (non-systemic) PP infection are enrolled after providing informed consent. Enrollees are randomized into one of two analytic arms – traditional culture or NGS. Traditional culture and NGS samples are collected upon clinical presentation prior to initiation of antibiotics. Patients are started on set empiric antibiotics and randomized to traditional culture or NGS. Patients follow up within ten days of antibiotic initiation and at six months complete a safety and compliance questionnaire which assesses symptoms, device function, and patient satisfaction.

Results
Of the 8 patients enrolled in the study, 4 eventually underwent device explantation due to worsening infection within 7 days of initiating empiric antibiotic treatment. The other 4 patients went on to the next step in the protocol. In evaluating these 2 groups: if there was penile shaft tenderness (2/4) this required PP removal prior to 7 days; while if there was no penile tenderness, the patient ended up with the device surviving at least 10 days. Patients on the NGS arm included those that survived the entire 6-month period. Currently, there are 11 active sites already participating; more patients and more centers are being enrolled in the study.

Conclusions
Penile shaft tenderness was a more common presentation in patients who failed early antibiotic treatment for penile implant infection. Recruitment of additional patients to this prospective, randomized controlled trial will help to identify additional favorable presentations of penile implant infection in addition to comparing the utility and outcomes of NGS and culture.

Disclosure
Yes, this is sponsored by industry/sponsor: Microgen Dx.
Clarification: Industry initiated, executed and funded study.
Any of the authors act as a consultant, employee or shareholder of an industry for: Microgen Dx.
(144) Contemporary Trends in Testicular Prosthesis Placement: An Analysis Of U.S. Claims Data
Authors: Seranio N , Muncey W , Cox S , Glover F , Belladelli F , Del Giudice F , Li S , Zhang C , Eisenberg M 
Published: February 2024

Abstract

Introduction
Testicular prosthesis placement (TPP) is a procedure associated with high patient satisfaction that improves body image and quality of life following orchiectomy. However little information exists regarding contemporary TPP as placement for metastatic prostate cancer has fallen out of favor and gender affirming surgery is on the rise.

Objective
This study sought to describe current trends in TPP in the United States.

Methods
Using the IBM® MarketScan® Research Databases (DOI 10.57761/ray7-1g16) we performed a retrospective analysis from 2007 to 2021 and identified 1,059 adult men who had undergone placement of a testicular prosthesis based on ICD-9 codes.

Results
The median age of TPP was 34 (IQR 23-44; range 18-80). At least 433 (35.5%) men were married. A total of 536 (43.8%) men had orchiectomy concurrently at the time of TPP. Just under half of the cases prescribed antibiotics postoperatively (44.9%). The five most common indications at the time of TPP were malignancy (54.7%), gender dysphoria (10.4%), cryptorchidism (9.6%), atrophy/hypofunction (6.6%), and testicular torsion (3.9%). A total of 46 (3.8%) of men underwent subsequent removal of their prosthesis. A diagnosis of gender dysphoria was associated with prosthesis removal (odds ratio (OR) 4.51, 95% CI 2.10-9.86). No significant associations were seen for other indications, Charlson Comorbidity Index scores, post-operative antibiotic use, tobacco use, psychiatric diagnoses, or prior pain diagnoses. Rates of testicular prosthesis placement for a diagnosis of gender dysphoria are rapidly increasing while placement for prostate cancer is increasingly rare.

Conclusions
Among the studied population the primary indication for testicular prosthesis placement is for testicular cancer, contradicting the findings of earlier series. We also show that TPP for gender dysphoria is increasingly common. Additionally, we report rates of explanation and complications related to prosthesis that are higher than what is described in the literature.

Disclosure
No.
(145) Utilization of Crowdfunding for Genital Gender Affirmation Surgery
Authors: Sun H , Pei E , Rhodes S , Mishra K , Gupta S 
Published: February 2024

Abstract

Introduction
Though the incidence of gender-affirming surgery (GAS) is increasing within the United States (US), many transgender and gender diverse individuals are denied insurance coverage for these procedures. Some turn to crowdfunding for financial assistance.

Objective
We aimed to determine characteristics of fundraisers for genital GAS within the US and factors associated with greater funding.

Methods
GoFundMe is the largest individual crowdfunding platform in the US and was queried in January 2023 using search terms related to genital GAS such as “bottom surgery”, “gender affirming surgery”, and “transgender surgery”. Duplicate, outside the US, non-English, and non-relevant campaigns were excluded. For each campaign, organizer’s state, fundraising goal, amount raised, number of donors, and campaign description were retrieved. Generalized additive models were created to determine the relationship of predictors with achieving full funding. An additional Bayesian estimation approach model was created to determine the relationship of predictors with overall campaign progress.

Results
From 4,921 viewable campaigns, 1,497 met inclusion criteria for analysis. All states were represented with the greatest number in California (n = 155, 10.4%). The median amount raised was $195 (IQR 0-2,270) of a goal of $12,000 (IQR 5,000-30,000); 87 (5.8%) campaigns were fully funded, while 555 (37.1%) had no funding. Three-quarters of campaigns were less than one-third funded. Of 1,315 campaigns where transition type was indicated, 76.6% (n = 1,007) were for FGS and 22.7% (n=298) were for MGS. Though the average marginal effect of increasing the goal was to decrease funding progress (FGS -0.329, 95% CI -0.445 to -0.0248, MGS -0.589, 95% CI -1.071 to -0.347), an increase in funding progress was seen with increasing the goal from $1,000 to $10,000 for FGS. The average marginal effect of increasing word count was +0.26 (95% CI 0.18 to 0.36) with the greatest effect between 100 to 500 words. The average marginal effect of increasing campaign age on progress was +0.35 (95% CI 0.27 to 0.47), with the greatest effect between 500 to 1000 days.

Conclusions
Crowdfunding is an attractive option for TGD individuals who need financial support for genital GAS and related expenses, but the majority of individual fundraisers on GoFundMe will only raise one-third or less of their goal. Specific windows of funding goal, word count, and campaign age are associated with greater odds of campaign progress. Such information can be used to counsel patients who are seeking financial assistance for genital GAS.

Disclosure
No.
(155) Transcutaneous Electrical Neural Stimulation Improves Overall Satisfaction in Patients with Erectile Dysfunction
Authors: Saffati G , Naeem T , Orozco-Rendon D , Kaaki B , Khera M 
Published: February 2024

Abstract

Introduction
Transcutaneous electrical neural stimulation (TENS) therapy has demonstrated the potential to augment peripheral blood flow towards the musculature, thereby enhancing oxygen supply to the working muscles. Erectile dysfunction (ED) is a pathological condition characterized by compromised blood flow to the penis. In theory, TENS therapy can enhance penile blood circulation and alleviate the symptoms associated with ED.

Objective
Therefore, we aimed to assess the effects of penile TENS therapy on reducing ED symptoms and improving erectile function (EF).

Methods
We conducted a pilot cohort trial following approval from the Institutional Review Board (IRB), in which we enrolled patients presenting with clinical ED at our clinic. The TENS therapy intervention comprised ten sessions lasting 20 min each, administered over a period of 5 weeks. Two TENS patches were used, with one patch positioned at the base of the penis and the second patch placed on the perineum. The intensity of TENS therapy was determined using a scale ranging from 0 to 10, with the patients selecting the maximum intensity that they could tolerate without experiencing pain. Baseline and post-therapy questionnaires were administered using the International Index of Erectile Function (IIEF) as the primary outcome measure. A paired t-test was conducted to assess the results, which are presented as the mean difference (MD) along with a 95% confidence interval.

Results
Ten patients, all of whom were already receiving oral PDE5i medications ED were enrolled. However, specific drugs, dosages, and regimens were not standardized across patients, although they maintained the same treatment regimen throughout the study period. The mean baseline total testosterone level was at 527.9 ng/dL. On average, the intensity of TENS therapy administered to the patients was 6.58. A statistically significant improvement in the IIEF total score was seen with an MD of 5.6 (95% CI:0.35, 10.85; p = 0.03). Additionally, a statistically significant difference was observed in the IIEF overall satisfaction domain, with an MD of 1.20 (95% CI:0.14, 2.26; p = 0.03). However, no significant differences were found in IIEF erectile function, desire, orgasm, and intercourse satisfaction subdomain scores. Furthermore, none of the patients reported any adverse effects associated with TENS therapy.

Conclusions
These findings suggest that TENS therapy has the potential to improve the overall satisfaction of patients with ED. Further research with larger sample sizes and randomized controlled trials are warranted to validate these initial findings and to elucidate the full potential of TENS therapy in ED management.

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.
(160) Improving Symptoms in Young Men with Erectile Dysfunction: Testosterone Therapy With or Without PDE5 Inhibitors
Authors: Song J , Saffati G , Naeem T , Biles B , Pierce H , Lipshultz LI , Khera M 
Published: February 2024

Abstract

Introduction
While erectile dysfunction (ED) in young men has traditionally been viewed as primarily psychogenic in etiology, a growing body of evidence supports a higher prevalence of organic etiology.

Objective
The aim of this study was to further characterize the etiology and treatment outcomes of ED in men under 40 years at a single institution.

Methods
A retrospective chart review of men presenting with ED from 2010-2022 was undertaken. Men initially presenting under the age of 40 years were included and analyzed for hypogonadism, ED etiology, and treatment outcomes.

Results
Of our cohort, a total of 74 men under the age of 40 years presented with complaint of ED (mean age 31.6 years). Twenty-three (31.1%) men were eugonadal without organic etiology of ED. Of these men, 22 (95.7%) were started on phosphodiesterase-5 inhibitors (PDE5i) and one (4.3%) reported symptom resolution without treatment. The remaining 51 (68.9%) men presented with ED of likely organic origin. Forty-two (82.4%) of these men were hypogonadal and were started on testosterone, human chorionic gonadotropin, clomid and/or a PDE5i. Of those who followed up, 32 (91.9%) men reported improvement in symptoms after therapy. The organic etiologies of ED in the nine (17.6%) eugonadal men included history of urologic surgery (4), Peyronie’s disease (2), prior genitourinary trauma (1), spinal cord tumor (1), and prolactinoma (1). Within this group, four (44.4%) progressed to intra-cavernosal injection, two (22.2%) improved with PDE5i, and three (33.3%) were lost to follow-up.

Conclusions
It appears that the majority of young patients who present with ED are hypogonadal. Treating this population of men with medication to raise natural testosterone with or without the addition of a PDE5i has been shown to improve their symptoms. Young eugonadal men with no discernable organic etiology of ED respond well to oral PDE5i alone but tended to not follow-up, suggesting possible ED resolution without a need for prolonged treatment. In all, clinicians should check serum testosterone levels and conduct a thorough urological history to identify potential organic etiologies of ED in younger men before assuming a psychogenic basis.

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.
(179) Does Climate Impact IPP Infection Risk? Assessment of Temperature and Dew Point on IPP Infections
Authors: Barham D , Pyrgidis N , Amini E , Hammad M , Miller J , Andrianne R , Sadeghi-Nejad H , Gross K , Hatzicrhistodoulou G , Hotaling J , Hsieh T , Lentz A , Modgil V , Osmonov D , Park SH , Yafi F , Perito P , Simhan J , Van Renterghem K , Gross M 
Published: February 2024

Abstract

Introduction
Variations in climate have been associated with greater risk of surgical site infections, urinary tract infections, and changes in the skin microbiome. Although the pathogenic organisms for inflatable penile prosthesis (IPP) infections are commonly skin flora, limited data exists on the impact of climate on IPP infections.

Objective
We sought to evaluate the impact of climate on the pathogenic organisms of IPP infections in a large international, multicenter cohort.

Methods
We performed a multi-institutional, retrospective study of patients undergoing IPP surgery. We then evaluated whether the month or season, during which surgery was performed, affected device infections. Additionally, we assessed the effect of temperature, dew point, and humidity on the microorganisms involved in implant infections. Infections were classified as Gram positive, Gram negative, or mixed (including a combination of Gram positive, Gram negative, and/or fungi). A univariate logistic regression analysis was undertaken.

Results
A total of 5289 patients with a mean age of 62.2 ± 10.8 years received IPP placement. A total of 103 (1.9%) infections were recorded. Overall, 38 (36.9%) infections were caused by Gram positive bacteria. An increase in temperature was associated with a higher risk of infection with Gram positive bacteria (OR: 1.03, 95% CI: 1 to 1.07, p=0.035). Infections were more frequent as temperature increased with 74.7% of infections occurring when mean ambient temperature was greater than 55□F. No statistically significant differences were recorded in terms of season (p=0.19) and month (p=0.29).

Conclusions
Higher temperature is associated with greater risk of Gram positive infections These findings may help surgeons tailor antibiotic prophylaxis based on local climate especially when temperatures are over 55□F. Our findings should prompt further studies regarding the impact of climate on infection prevention to further improve IPP outcomes.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: consultant Coloplast, Cynosure, Antares Pharma, Clarus Pharmaceuticals, Acerus Pharma, Boston Scientific.
(183) Radial Artery Free Flap Urethroplasty
Authors: Sun H , An C , Mishra K , Khouri J , Gupta S 
Published: February 2024

Abstract

Introduction
Urethroplasty is an essential component of gender-affirming phalloplasty for transgender individuals who desire the ability to stand to void through a neophallus.

Objective
We demonstrate the creation of a neourethra using a radial artery free flap for transmasculine individuals with an existing neophallus using live surgical footage.

Methods
The patient was a 36 year old transmasculine individual who had undergone abdominal phalloplasty 6 months prior, and desired the ability to stand to void. Two teams may simultaneously work; one will harvest a radial forearm flap from the non-dominant upper extremity following a preoperative Allen's test. The flap is tubularized over a catheter. The other team will open the existing neophallus and groin site to prepare the flap recipient site. Following microvascular anastomosis, a micro-Doppler is used to confirm perfusion. The donor site is covered with a skin graft and negative pressure wound dressing.

Results
The patient had an uneventful recovery after 48 hours of bedrest with head of bed maintained at 30 degrees, and scheduled flap checks. They were discharged on postoperative day 5 after removal of the negative pressure forearm dressing. He has recovered well and has satisfactory orthotopic voiding on follow-up visits.

Conclusions
This technique of radial artery flap urethroplasty is a safe and effective option for patients who desire a neourethra with their neophallus.

Disclosure
No.
(184) Gender-Affirming Abdominal Phalloplasty
Authors: Sun H , An C , Mishra K , Khouri J , Gupta S 
Published: February 2024

Abstract

Introduction
Phalloplasty can alleviate gender dysphoria in transgender individuals. Various techniques exist and selection of phalloplasty technique depends on patient preference, body habitus, and surgeon experience.

Objective
We demonstrate the creation of a neophallus using a pedicled abdominal flap using live surgical footage.

Methods
The patient was a 19 year old transmasculine individual who had been on gender-affirming hormone therapy for 3 years and desired a neophallus to align external appearance with his gender identity. The flap is designed using a fasciocutaneous flap based off the inferior epigastric and superficial circumflex iliac vessels, with innervation from the ilioinguinal nerve. Perfusion is assessed using fluorescence imaging prior to tubularization. Rotational flaps are used to cover the abdominal wound.

Results
The patient had an uneventful recovery after 48 hours of bedrest and was discharged on post-operative day 4 without complications. He has recovered well without any complications at 6 months postoperatively. Patients may elect to undergo next staged phalloplasty procedures with or without urethroplasty at least 6 months afterwards.

Conclusions
A pedicled abdominal flap phalloplasty is a safe and effective option for patients desiring a more easily concealed scar and fewer complications compared to alternative techniques.

Disclosure
No.