bluuebunny/crossref_metadata_2025_split huggingface dataset:
(154) Safety and Efficacy of Platelet-rich Plasma Injection for the Treatment of Erectile Dysfunction; A Randomized Prospective Study
Authors: Ragheb A , Fahmy M , Lotfy A , Elmarakby A 
Published: February 2024

Abstract

Introduction
Platelet-rich plasma (PRP) intracorporeal injection is one of the popular regenerative therapies that has been gaining much interest in recent years as an adjunct or alternative treatment for erectile dysfunction (ED). Nevertheless, scientific evidence to support its clinical efficacy remains controversial.

Objective
The aim of this study was to evaluate the safety and efficacy of PRP injections for the treatment of ED.

Methods
A prospective, randomized, double-blinded, placebo-controlled, interventional clinical study was conducted on 52 subjects. Patients were randomized into two groups: the PRP group (n=26) and the placebo (saline) group (n=26). Each participant received three sessions (at two-week intervals) of PRP or saline injections according to his assigned group. International index of erectile function-5 (IIEF-5) scores and safety-related observations were collected during the 1st, 3rd, and 6th months of follow-up.

Results
The median age and ED duration were statistically comparable for both groups, 52.2 versus 52.5 years and 12.87 versus 11.8, respectively (P = 0.285). With regards to the efficacy of PRP, there were no statistically significant differences between both groups after 1, 3, and 6 months of treatment. After 1 month of treatment, the mean IIEF-5 score for the PRP group was 16.12 ± 1.25 versus 15.99 ± 1.21 for the placebo group (P = 0.683). After 3 months, the IIEF-5 score for the PRP group was 16.44 ± 1.17 compared to 16.31 ± 1.06 for the placebo group (P = 0.653). Also after 6 months, the IIEF-5 score for the PRP group was 16.35 ± 1.45 close to 16.23 ± 1.19 for the placebo group (P = 0.727). No transient hemorrhagic adverse events (hematuria, local petechial bleeding, or ecchymosis) or other side effects were reported during the injection and follow-up period for both groups.

Conclusions
The results of this trial suggest that although the treatment of ED with 3 injections of intracavernosal PRP separated by two-week intervals may be safe, it is not more effective than a placebo injection.

Disclosure
No.
(162) Evaluating the Effectiveness of Testosterone Therapy Combined with PDE5 Inhibitors in Enhancing Erectile Function in Eugonadal Men
Authors: Iacobucci A , Naeem T , Saffati G , Applewhite J , Pierce H , Lipshultz LI , Khera M 
Published: February 2024

Abstract

Introduction
Historically, testosterone therapy (TTh) is not indicated in eugonadal men with erectile dysfunction (ED). Moreover, the 2018 AUA Guidelines state that TTh is not indicated as monotherapy for men suffering from ED but should be considered as combination therapy with PDE5i, as TTh may increase the efficacy of PDE5i therapy.

Objective
We investigated the benefits of providing TTh in combination with PDE5i therapy in marginally eugonadal men to determine its efficacy in improving erectile function.

Methods
A retrospective chart review was performed on men presenting with ED to an academic institution’s Men’s Health Clinic from 2010 to 2022. Objective data was gathered on key variables that affected patient-reported outcomes of ED, including age at presentation and comorbidities, as well as use of TTh and use of oral PDE5i. 177 eugonadal men were selected with the criteria of testosterone levels &gt;300 ng/dL on initial presentation. Results were then statistically analyzed using a two-tailed student’s T test in R and p-values to determine the significance between variables and outcomes in ED.

Results
Out of our cohort of 179 eugonadal men presenting with ED, 42 patients were continued or started on concurrent TTh with oral PDE5i therapy added, and 83 were started on PDE5i monotherapy. Men in the dual-therapy group excluding those already on TTh began with a pre-therapy testosterone mean of 412.3 ng/dL compared to 443.0 ng/dL which was insignificant (p=0.22). There were no significant differences in presenting age (p=0.61) or comorbidities including hypertension (p=0.89) and diabetes (p=0.63) between the two groups. Additionally, there were no significant differences in lab values of HgA1c (p=0.34), cholesterol (p=0.80), triglycerides (p=0.27), or LDL (p=0.89). However, there was a lower initial HDL in the combination group of 45.1 mg/dL compared to 55.8 mg/dL (p = 0.036). Men in the dual-therapy group were more likely to report subjective improvement in ED symptoms compared to men taking PDE5is alone. This was supported by 33/42 (78.6%) of men in the dual therapy group reporting improved erectile function compared to 49/83 (59.0%) of men in the PDE5i only group (p = 0.029).

Conclusions
In conclusion, these results demonstrate that treatment of eugonadal men with concurrent TTh and PDE5i therapy demonstrated a significant improvement in erectile function as compared to PDE5i therapy alone. These findings suggest consideration of testosterone therapy in addition to PDE5i in clinical practice when treating marginally eugonadal men presenting with ED.

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.
(173) Initial Experience with ReSheyP Device for Intraoperative Modeling of Peyronie’s Disease After Placement of a Penile Prosthesis
Authors: Mossack S , Desouky E , Levine L 
Published: February 2024

Abstract

Introduction
Manual modeling to correct penile curvature associated with Peyronie's disease (PD) during penile prosthesis has been a recognized procedure since the 1st publication by Wilson et al in 1992. A key component to optimizing results and minimizing complications (i.e. distal urethral laceration) with manual modeling is proper technique. Manual modeling can be technically challenging as the inflated prosthesis must be maintained bent in the direction opposite to the curvature for up to 60-90 seconds and repeated several times. This can be challenging for the operating surgeon with respect to hand fatigue or even accomplishing the adequate modeling pressure. The purpose of this report is to present initial results with ReSheyP, a device designed to facilitate manual modeling in a more controlled fashion to make it easier to perform and potentially less risky than when done simply by hand. In addition, the device can be used in the postoperative setting to resolve residual curvature.

Objective
We present on 5 men who underwent placement of an inflatable penile prosthesis with manual modeling using the ReSheyP device. Pre- and post-modeling curvature measurement was performed with a goniometer. Men who had severe indentation deformity were excluded from the study.

Methods
A retrospective review was performed on patients who underwent penile prosthesis placement followed by ReSheyP modeling in 2023. During the procedure, the ReSheyP was deployed at least 2-3 times for 60-90 seconds per modeling. Data collection included demographics, pre- and post-operative assessment of penile curvature, adverse events and patient satisfaction with postoperative straightening.

Results
Mean pre-modeling curvature was 62 degrees (range 50-70 degrees) (Table 1). Direction of curvature was dorsal in 3 patients and lateral in 2 patient. The average intraoperative post ReSheyP modeling curvature was 11 degrees and the average change in curvature was 45 degrees. All men reported satisfaction with post-op curve correction. There were no intraoperative or postoperative complications. No patient has felt that further at home modeling was needed. Penile sensation and prosthesis function was uncompromised.

Conclusions
This pilot study using the ReSheyP device for intraoperative modeling to correct penile curvature after penile prosthesis placement suggests that this tool may be an effective procedure for correcting penile curvature in men with PD. Further experience is necessary and longer follow-up will be reported.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(180) Unveiling Consumer Interest and Regional Disparities: Comparative Analysis of Online Search Trends for Penile Aesthetic Procedures
Authors: Hammad MAM , Banton J , Miller J , Yafi FA 
Published: February 2024

Abstract

Introduction
In recent years, the introduction of Penuma, an implantable silicone penile sleeve, offers urologists a tool in the cosmetic enhancement of the penis, specifically for individuals who are concerned regarding the perceived size of their penis, with buried penis, and with mild to moderate penile curvature. With the increasingly widespread adoption of Penuma, it is crucial to understand how public interest in Penuma compares to other related interventions such as hyaluronic acid injections.

Objective
To assess the online search interest over time for Penuma and other penile enhancement terms on a national and regional scale.

Methods
Google Trends data from 2018 to March 2021 were utilized to analyze online traffic for the search terms “Penuma”, “penile implant”, “penile girth”, “HLA injection”, and “penis injection”. Trendlines were generated to assess the changes in search interest over time. The highest search interest locations were identified for each term.

Results
While online searches for Penuma increased between 2018 through 2021, interest in Penuma has since been in decline (Figure 1). While interest in penile implants remained higher than Penuma throughout the study period, Penuma remained a more popular term compared to other cosmetic treatments including penile injections and HLA injections. In terms of regional disparities, the highest search interest for Penuma was observed in San Antonio, TX, while penile girth searches were highest in OKC, OK. Penile implant searches were prominent in Mobile, AL, and Birmingham, AL. Notably, HA injection searches peaked in New York, NY, and penis injection searches were most prevalent in Los Angeles, CA.

Conclusions
This study highlights the dynamics of online search interest of Penuma in relation to other penile enhancement terms. While general interest in penile implants and penile girth surpasses that of Penuma, regional disparities in search patterns are evident. The findings emphasize the need for further research to understand the factors driving these disparities and the implications for consumer decision-making in different regions. Such insights can assist healthcare professionals and policymakers in tailoring educational initiatives and resource allocation to meet the diverse needs and preferences of individuals seeking penile enhancement procedures.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.
(190) Modified Technique for a Mini-Jupette Urethral Sling
Authors: Liaw A , Armitage S , Alexander A 
Published: February 2024

Abstract

Introduction
In this video we present our technique for mini jupette sling (MJS) placement during the placement of an inflatable penile prosthesis (IPP). The technique is initially described by Dr Andrianne, and our technique is modified from the mini-jupette as employed by Dr Yafi.

Objective
MJS could be considered in patients who are experiencing incontinence or climacturia, common complications of radical prostatectomy and prostate cancer treatment.

Methods
The standard dissection and exposure is done using a typical penoscrotal or subcoronal approach. The corporotomies and dilation are done in the typical fashion. However, instead of placing stay sutures on either side of the corporotomies, we only place them on the lateral sides. When the mini jupette is placed it is secured with a running suture, and a loop is tied in the middle and divided to create four free ends, after the start and end of the running suture are completed. These four free ends match up with the four stay sutures placed lateral to the corporotomies. The pairs are tied together once the cylinders are placed, closing the corporotomies and securing the mini-jupette at the same time. The corporotomies are eventually closed by tying the stay sutures across the incision.

Results
This technique allows for a secure sling placement, without bunching of the sling. Since the corporotomies can be tied closed, there is no risk of needle injury to the cylinders

Conclusions
Operative time is not significantly increased when adding this procedure. We have encountered no complications related to the mini-jupette with this method

Disclosure
No.
(197) The Impact of Connective Tissue Disorders on Rates of Penile Fracture and Peyronie’s Disease
Authors: Mandel A , Simhal R , Sholklapper T , Sun K , Poluch M , Wang K , Shah Y , Chung P 
Published: February 2024

Abstract

Introduction
Ehlers Danlos Syndrome (EDS) and collagen-related hypermobility disorders are well known to cause frequent joint dislocations, easy bruising, and poor wound healing. Marfan syndrome is caused by a mutation in the protein fibrillin, a key component of collagen and elastin connective tissue, whose dysfunction causes the marfanoid phenotype. Currently, little is known regarding the impact of connective tissue disorders on men’s sexual health. As a first step in exploring this association, we investigated two physical phenomena that may be impacted by collagen disorders, penile fractures and Peyronie’s disease.

Objective
This study aims to investigate rates of penile fracture and Peyronie’s disease in EDS and Marfan syndrome patients.

Methods
A multi-center, international, electronic health record network (TriNetX) was queried to identify adult male patients with or without EDS between 1993 and 2023 using ICD-10 codes Q79.6, Q79.60, and Q79.62 specific for EDS and EDS related hypermobility syndrome. TriNetX was separately queried for Marfan syndrome using ICD-10 code Q87.4. Incidence and prevalence of penile fractures and Peyronie’s disease were compared between patients with and without the diseases of interest. Penile fractures were identified using ICD-10 codes S39.840, S39.84A, S39.84S, S39.84D. Peyronie’s disease was defined using ICD-10 code N48.6. Odds ratios were generated with 95% confidence intervals. All statistical analyses were conducted within the TriNetX platform.

Results
Data was queried from 82 healthcare organizations to yield 11,937 EDS patients, and from 101 healthcare organizations to yield 13,705 Marfan syndrome patients. 109 healthcare organizations contributed data to yield a control group of 63,790,628 men. Men with EDS had a 25 times higher rate of penile fractures (0.09%) compared to men without EDS (OR 25; 95% CI [13.8-47.8]). Men with Marfan’s syndrome had a 23 times higher rate of penile fractures (0.08%) compared to men without Marfan’s syndrome (OR 23; 95% CI [12.4-43.1]). Men with Marfan’s syndrome also had a significantly higher incidence of Peyronie’s disease compared to men without Marfan’s syndrome (OR 1.9; 95% CI [1.2-3]). The difference in rates of Peyronie’s disease was not significantly higher for men with EDS (OR 1.4; 95% CI [0.8 – 2.5]).

Conclusions
Patients with EDS and Marfan syndrome are at an over 20 times higher risk for penile fracture. These increased risks may be due to EDS’s and Marfan syndrome’s effects on collagen and fibrillin/elastic fibers, respectively, which are significant structural components of the corpora cavernosa. Patients with these syndromes should be aware of this increased risk and further research is needed to establish how to council these patients about taking appropriate precautions.

Disclosure
No.
(200) The Fertility and Childbearing Experiences of US Male Physicians
Authors: Jesse E , Tay K , Sellke N , Rhodes S , Muncey W , Hijaz A , Thirumavalavan N 
Published: February 2024

Abstract

Introduction
Recent attention has been brought to physician fertility in the last decade, most notably amongst female physicians who suffer an increased risk of infertility compared to the general population. Various factors related to a career in medicine play a role, such as a delay in pursuit of childbearing, a demanding work schedule, shift work, and stress associated with the profession. However, risk of infertility in the male physician population has yet to be studied.

Objective
Therefore, we sought to evaluate the experiences and childbearing patterns of a sample of American male physicians with special attention to timing of conception and childbearing, reflections upon professional and personal decision-making, and general knowledge regarding fertility. The primary objective of this study was to determine the incidence of infertility among American male physicians.

Methods
Utilizing a third party to access the American Medical Association (AMA) database, licensed US physicians registered as male and between the ages of 18-65 were identified. Within this cohort, 690 men were randomly selected and contacted via paper mail (340) or email (350) and asked to participate in the survey study. Surveys were administered electronically via REDCap (obtained through a QR code) and included questions regarding the physicians’ demographics, medical specialty, and whether they have attempted to conceive. Those who have attempted to conceive were also surveyed on their work experience at the time of their first attempt at conception and their experience and partner’s experience with fertility and childbearing. Internal Review Board approval was obtained for this study (STUDY 20211036).

Results
Fifty-three men responded to the survey (7.7%). All respondents were cisgender males with cisgender female partners. The majority (94.3%) had attempted to conceive and occurred most during residency (46.0%). The average age when first attempting conception was 31.6 years, and this was most commonly during residency (46.0%) or after training (30.0%). During this time, many (72.0%) were responsible for night shifts, overnight call duties, or both. In addition, as many as 34 men (68.0%) had no access to paid parental leave during this time. Of 50 men who attempted conception, 14 (28.0%) of their partners experienced a miscarriage. Eight men (17.0%) underwent a fertility workup, and 6 underwent infertility treatment(s). Only 4 respondents had insurance partially covering their infertility treatments, while the other two had no insurance coverage.

Conclusions
Male physicians are often exposed to long work hours, nighttime duties, and sparse paid parental leave during the time of their first attempt at conception, most commonly in residency. Our cohort shows a high rate of miscarriage (28.0%) and infertility assessment (16.0%) among this population. Future studies are needed to continue characterizing fertility amongst physicians.

Disclosure
No.
(219) Prevalence of Sexual Incontinence in Men with Stress Urinary Incontinence After Radical Prostatectomy
Authors: Elshafei A , Ljubetic BM , Novaes LF , Benfante N , Cheung F , Sandhu J , Mulhall JP , Flores JM 
Published: February 2024

Abstract

Introduction
Sexual incontinence (SI) includes arousal incontinence and climacturia. SI is under-reported after radical prostatectomy (RP), significantly bothering the patient and the partner.

Objective
This study aimed to evaluate the prevalence of SI based on the SUI severity and identify predictors of SI during the first year after RP.

Methods
This study included men with RP and a follow-up until 1 year post-surgery. Patients who received ADT or radiation therapy either pre or post-RP were excluded. We performed a descriptive assessment of demographics, comorbidities, pre-RP prostate-specific antigen (PSA), Gleason group of the surgical pathology, nerve-sparing status (NSS), and erectile function (EF) based on the IIEF score. SI was defined as the presence or absence of climacturia or arousal incontinence reported by the patient at 3, 6, 9, and 12 months post-RP. SUI was described based on the number of pads used per day. These were categorized as 0 to 1 pad per day (No SUI or mild SUI), 2 pads per day (moderate SUI), and ≥ 3 pads per day (severe SUI) at 3, 6, and 12 months post-RP. We determined the prevalence of SI for each SUI category at each time period. We analyzed predictors of SI using a logistic regression model at 3, 6, 9, and 12 months post-RP. Factors entered into the model included: patient age, number of comorbidities (≥ 3, yes), NSS both resected (yes) and severe SUI (≥ 3 pads per day, yes).

Results
Our study included 2768 men with a median age of 60 (55-66). 11% had diabetes. 27% obstructive sleep apnea, and the median number of comorbidities was 1 (1-2). The median preoperative PSA was 5.6 ng/ml. The median Gleason grade group was 2 (2, 3). 71% had bilateral NSS, 22% unilateral, and 7% had both sides resected. The prevalence of SI was 26%, 24%, 23%, and 27% at 3, 6, 9, and 12 months post-RP, respectively. The prevalence of SI was higher among men with severe SUI compared to men with 0 to 1 pad per day at 6, 9, and 12 months post-RP. At 3 months, men with 0 to 1 pad per day reported 25% SI, vs. men with severe SUI described 28% SI. At 6 months, for men with no SUI/mild SUI, 19% described SI, vs. men with severe SUI, 32% had SI. At 9 months, for men with no SUI/mild SUI, 20% described SI vs. men with severe SUI, 33% had SI. And at 12 months, men with 0 to 1 pad per day reported 23% SI, vs. men with severe SUI described 36% SI. On the logistic regression model, severe SUI ≥ 3 pads/day was the only independent predictor of SI at 6, 9, and 12 months postoperative (Table 1).

Conclusions
Approximately one-quarter of our cohort experienced SI within 12 months after RP. SI was more prevalent among patients with severe SUI, particularly at the 6-month mark and beyond after RP during the first-year post-surgery. Severe SUI significantly predicted SI during the first year following surgery.

Disclosure
No.