bluuebunny/crossref_metadata_2025_split huggingface dataset:
(316) Age Is Not a Number When It Comes to Penile Prosthesis Implantation. A Mini–Case Series
Authors: Slovacek H , Khalafalla K , Wang R 
Published: February 2024

Abstract

Introduction
Given the overall aging of the population, erectile dysfunction has become an increasingly relevant issue among the elderly. When elective surgery is offered, the patient's age is often taken into consideration as a potential limiting factor. Moreover, the importance of addressing the quality of life and sexual satisfaction of older men tends to be overlooked in the management of erectile dysfunction.

Objective
The aim of this study is to investigate the safety of implanting penile prostheses (PP) in patients aged 90 years and older, as well as the potential complications associated with this age group.

Methods
The database of patients was screened between the years 2003 and 2023, to identify patients at least 90 years and older who underwent the implantation of penile prosthesis by a single surgeon at two large volume centers. We collected demographic information for the patients, including their past medical and surgical history, medication list, anesthesia peri-operative assessment and recommendations, details of the surgical procedure, intra-operative and postoperative recovery period, as well as clinic follow-up.

Results
Between 2003 and 2023, a total of 2000 men underwent PP surgery at the two centers. Out of the total number of patients, only two were 90 years or older at the time of implantation. One patient was a first timer, while the other had two previous PP surgeries over the span of 15 years for mechanical failure reasons. Both surgeries were performed using different device types, without any intra-operative or postoperative complications. At their three and six months follow up visits, both patients demonstrated the ability to cycle the implant smoothly, reported satisfactory penetrative intercourse with their partners, and improved sexual intimacy through Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. They were followed for a total of 1 year with no long-term negative effects.

Conclusions
Despite reporting only two cases in this specific cohort, it demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED. Maintaining satisfactory sexual activity in this age group is vital and achievable through inflatable penile prosthesis (IPP) insertion. There are several complex factors that must be considered prior to operating on an older patient due to medical co-morbidities and age. However, with proper patient selection, pre-operative counseling and optimization, this operation can be effectively performed in patients who are at least 90 years old. Simply, age is not a limitation to undergo penile implant.

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(319) Evaluating the Racial Distribution of Clinical Trial Participants for Drugs Leading to FDA Approval of Novel Biologics for the Treatment of Hypoactive Sexual Desire Disorder (HSDD)
Authors: Matthew-Onabanjo A , Bjurlin M , Rogers M 
Published: February 2024

Abstract

Introduction
Hypoactive sexual desire disorder (HSDD) is defined as a persistent deficiency or absence of sexual desire or sexual fantasies that result in significant personal distress and relationship difficulties. It is considered one of the most prevalent diseases impacting the sexual function of women. Prior studies suggest that the prevalence of HSDD ranges between 8%-20%. Recently, two novel drugs gained FDA approval for the treatment of HSDD. This includes both Addyi and Vyleesi. Although multiple reports suggest that HSDD is more prevalent in white women, HSDD still impacts minority women.

Objective
Our study aim was to determine the distribution of race and ethnicity among trial participants leading to FDA approval of novel drugs for HSDD.

Methods
A retrospective review of FDA Center for Drug Evaluation and Research Drug Trials Snapshot (DTS) was conducted utilizing the DTS FDA website (https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshots). The DTS highlights who participated in the clinical trials that supported the FDA approval of a drug that is novel. This includes new molecular entities or original biologic products. DTS was searched for drugs created for the treatment of HSDD and clinical trial enrollment data was stratified by race and ethnicity.

Results
A total of 2 clinical trials were identified that led to the FDA approval of 2 novel drugs for HSDD including Addyi (flibanserin) and Vyleesi (bremelanotide injection) Trials for Addyi included 2743 participants of which 89% were white, 8% Black, 1% Asian, 8% Hispanic, &lt;1% American Indian/Alaska Native, &lt;1% Native Hawaiian/Pacific Islander, 2% unknown. Trials for Vyleesi approval had 1067 participants of which 86% were white, 12% Black, 1% Asian, 8.5% Hispanic, &lt;1% American Indian/Alaska Native, 1% unknown. Limitations include the unknown race category which included both not reported, multiracial, and true unknowns in some trials.

Conclusions
Participants in clinical trials leading to FDA approval of novel drugs for HSDD are overwhelmingly white in spite of the fact that other women including minorities are impacted by this disorder. Although white women are more likely to report low sexual desire, studies likely underestimate the the impact on minority women. Involving stakeholders who represent the needs and interests of underrepresented populations in the design and implementation of clinical trials of novel agents may be a strategy to increase diversity, equity, and inclusion among drugs designed to impact low sexual desire and treatment of HSDD.

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(322) Predictors of Erection Reversal After Penile Doppler Ultrasound
Authors: Ljubetic BM , Novaes LF , Gonzalez A , Mulhall JP , Flores JM 
Published: February 2024

Abstract

Introduction
Erection hardness (EH) is a physiologic response graded subjectively on the Erection Hardness Grading Scale during penile Doppler ultrasound (PDUS).

Objective
This study aims to gather data on the reversal rate following persistent EH sufficient for penetration or higher after PDUS and identify associated predictors.

Methods
The study population consisted of (i) men with poor response to PDE5i and ICI or (ii) who need curvature assessment due to Peyronie’s disease (PD), (iii) and underwent penile duplex Doppler ultrasound (PDUS), (iv) using a vasoactive agent redosing schedule were included and reviewed retrospectively. Patients with incomplete data were excluded. We performed a descriptive assessment of demographics and comorbidities, including a history of cancer, PD, depression, or anxiety. EH was evaluated by a sexual medicine-trained physician for each case and reported before and 30 minutes after PDUS. EH was assessed on a scale between 0 (no erection) to 10 (erection hard as a rock), with 6 being good enough for penetration. We also described the number of injections, the dose, and PDUS hemodynamic parameters, including peak systolic velocity (PSV) and end-diastolic velocity (EDV). Arterial insufficiency (AI) diagnosis was made with PSV values ≤25 cm/sec bilaterally and corpora veno-occlusive dysfunction (CVOD) with EDV values ≥5 cm/sec bilaterally. We also reported a reversal procedure rate performed due to persistent erection after PDUS, and predictors were assessed. Factors entered into the model included: patient age, EH for PDUS (8 or greater), and dose of vasoactive agent used (Table 1). A p-value ≤0.05 was considered statistically significant.

Results
2439 individuals were included. The median age of 59 (50,67) years. 12% had diabetes, 13% reported ≥ 3 comorbidities, 44% had prostate cancer, 17% had a history of depression, and 14% had a history of anxiety. 44% described PD. The vasoactive agent used for PDUS was Trimix 86% and 14% others. The median dose used was 20 (10, 50), and the median of injections applied was 2 (1, 2). The EH median was 8 (6, 9) for PDUS, and 65% had an EH of 8 or greater. The PDUS diagnosis was normal in 62% of the patients; 8% had AI, 29% had CVOD, and 1% had AI+CVOD. The reversal procedure rate was 41%. In the MVA, significant predictors of erection reversal were higher vasoactive agent dose used, age 50 years or younger, and EH 8 or greater for PDUS (Table 1).

Conclusions
Erection reversal in our redosing PDUS was highly prevalent; predictors of reversal were younger age, greater EH for PDUS, and higher vasoactive agent dose.

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(323) Injection Pain in Men Using Intracavernosal Injection During Penile Doppler Ultrasound
Authors: Ljubetic BM , Novaes LF , Gonzalez A , Mulhall JP , Flores JM 
Published: February 2024

Abstract

Introduction
Penile Doppler ultrasound (PDUS) is important in assessing erectile dysfunction. Intracavernosal injection (ICI) is utilized to achieve erections during the procedure

Objective
This study aims to examine the needle injection pain and predictors of severe pain in patients using ICI during PDUS.

Methods
The patient population included (i) men with poor response to erectogenic agents or (ii) who need curvature assessment due to Peyronie’s disease (PD), (iii) who underwent PDUS, (iv) using ICI vasoactive agent redosing schedule. We performed a descriptive assessment of demographics and comorbidities. All patients graded anxiety before the PDUS procedure and pain after the first ICI. A visual analog scale (VAS) evaluated the anxiety related to the procedure using a single question: “How anxious are you about your PDUS procedure?” This was measured on a 0 (not at all anxious) to 10 (extremely anxious) Likert scale. 7 or higher was defined as high anxiety, 4 to 6 as moderate anxiety, 1 to 3 as mild anxiety, 0 was no anxiety. A VAS assessed the ICI pain by asking, “How painful was your penile injection?”. This was measured on a 0 (not at all painful) to 10 (extremely painful) Likert scale. 6 or higher was defined as severe pain, 4 and 5 as moderate pain, 1 to 3 as mild pain, and 0 was no pain. Predictors of severe pain were analyzed using a Logistic regression model. Factors entered into the model included: patient age, number of comorbidities, and high anxiety. A p-value ≤0.05 was considered statistically significant.

Results
162 individuals were included. The median age of 65 (59,72) years. 19% had diabetes, 19% reported ≥ 3 comorbidities, 10% had a history of depression, and 11% had a history of anxiety. 72% had prostate cancer, 6%had bladder cancer, 3% had other cancer, and 19% had no cancer history. 35% described PD. The VAS procedure anxiety median was 3 (1, 5), on which 22% reported no anxiety, 35% mild, 25% moderate, and 18% high anxiety. The VAS median pain with the first ICI was 2 (1, 4), on which 9% reported no pain, 61% mild pain, 19% moderate pain, and 11% severe pain. In the MVA, no predictors of severe pain with ICI during PDUS were identified (Table 1).

Conclusions
Pain experienced with ICI during PDUS is low, with most patients reporting no or only mild pain. Only 1/3 of the patients Almost half of the patients reported moderate to high anxiety associated with this procedure; however, high procedure anxiety did not predict severe pain with ICI during PDUS

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(329) Exploring the Incidence of Sexual and Reproductive Health Concern in Men with Cystic Fibrosis and CBAVD: An Analysis of a Multi-Institutional Database
Authors: Campbell K , Deebel N , Kohn T , Passarelli R , Ghomeshi A , Samuels R , Velez D , Ramasamy R 
Published: February 2024

Abstract

Introduction
Cystic Fibrosis (CF) is a genetically inherited disease with a highly variable phenotype that results from a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Manifestations of CF include impacts on function of the lungs, liver, pancreas, and reproductive system. While CF is known to be associated with infertility due to congenital bilateral absence of the vas deferens (CBAVD), men with CF also frequently report additional sexual and reproductive health issues, often linked to low testosterone levels.

Objective
In this study we aimed to investigate the prevalence of low testosterone (T) in men with CF and CBAVD, and hypothesized hypothesized that low T would be under-evaluated and under-treated in the CF population compared to CBAVD and the general population.

Methods
We used TrinetX, a multi-institutional insurance claims database, to create a cohort of men over 18 years old with CF or CBAVD. We then queried each cohort to assess how many men had a T level measured, and if hypogonadal (below 300 ng/dL), how many received T therapy (TT).

Results
There were 14,033 men over age 18 years with a diagnosis of CF and 3,439 men over age 18 with a diagnosis of CBAVD in the TriNetX database. Serum T levels were measured in 10.1% of men with CF and 8.9% of men with CBAVD. While mean serum T level in both groups was within the normal range (defined as a total testosterone &gt;300 ng/dL), 32.7% (n=464) of the men with CF and 43% (n=132) of the men with CBAVD were hypogonadal. The majority of men with T&lt;300 ng/dL went on to appropriately receive TT: 59.3% of men with CF and 78% with CBAVD (figure 1).

Conclusions
Our data suggests that hypogonadism is highly prevalent in men with CF and CBAVD. These data suggest that despite a high rate of infertility in men with CF and CBAVD, the majority do not undergo hormonal evaluation. Investigation and appropriate treatment of TD may significantly improve quality of life.

Disclosure
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(333) Evaluation and Characterization of Testosterone-Related Mobile Health Applications
Authors: Aguiar J , Halpern J , Hayon S , Brannigan R , Dubin J 
Published: February 2024

Abstract

Introduction
Given the rise of digital health applications and direct-to-consumer (DTC) testosterone platforms, testosterone-related mobile applications (apps) pose significant challenges for both consumers and healthcare professionals.

Objective
The purpose of this study is to investigate trends and characterize the landscape of currently offered testosterone-related mobile health applications.

Methods
A search query of the term “testosterone” was conducted on the Apple app store. A comprehensive analysis of 23 testosterone-related apps was conducted, evaluating them based on categorization, primary service, specific health topics addressed, release years, cost model, user ratings, and evidence base. Apps were also evaluated on an established misinformation index score from one to five, whereby a score of five indicated complete accuracy and one, complete inaccuracy.

Results
Most apps were categorized as Health and Fitness apps, focused on sexual performance optimization, and addressed specific testosterone-related issues. A marked 600% increase in app releases were observed from 2020-22 when compared to prior to 2018. Apps frequently claimed to improve testosterone-related issues, but few cited scientific literature, resulting in a mean misinformation index score of 3.0.

Conclusions
The findings highlight the urgent need for healthcare professionals' active involvement in guiding patients through the digital health landscape. It is crucial to establish guidelines that ensure the provision of accurate, evidence-based information in health apps. Further research should focus on assessing the real-world impact of these apps on patient outcomes and developing strategies to mitigate digital health misinformation risks.

Disclosure
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(336) Sperm Retrieval Success During Tese: Prognostic Factors in Non-obstructive Azoospermia Patients
Authors: Vinay J , Nicolas S , Nicolas P , Cristian U 
Published: February 2024

Abstract

Introduction
Male factor is present in 50% of infertile couples. The most severe presentation of male infertility is non-obstructive azoospermia (NOA). In azoospermic patients, testicular sperm extraction (TESE) is frequently performed, followed by assisted reproduction techniques. The successful recovery rates of TESE are variable, and there is little evidence about factors that can predict the success of the technique

Objective
The objective of this study is to analyze the clinical and demographic variables of patients with NOA undergoing TESE, in relation to success or failure in sperm retrieval

Methods
Analytical study that includes all patients with NOA who underwent TESE by the same urologist-andrologist between 2017-2022. Demographic and preoperative clinical variables associated with sperm retrieval (SR) success rates are analyzed and compared. Non-parametric statistics were used with Jamovi 2.3.26 p&lt;0.05 was considered statistically significant

Results
138 patients underwent TESE. 66 patients had a diagnosis of NOA, with a median age of 35 years (IQR 32-39). In 40 patients (60.6%) successful SR was achieved. Among all variables, only FSH and total testicular volume (TTV) presented significant differences between the successful and failed SR groups. The median FSH in patients with successful and failed TESE was 6.88 IU/l (IQR 3.69-13.5) and 16.8 IU/l (IQR 9.25-22.0), respectively (p&lt;0.05). The median VTT in patients with successful and failed TESE was 29 cc (IQR 10-40) and 12 cc (IQR 8-21), respectively (p&lt;0.05). Using univariate analysis for TESE success, VTT ≥28cc and FSH &lt;10 presented Odds Ratios of 5.42 and 5.35, respectively (p&lt;0.05)

Conclusions
In this study of patients with NOA who underwent TESE, only TTV and FSH values were significantly different between patients with successful and failed SR during TESE. Univariate analyses showed that those variables could help the prediction of a positive result of this technique. Considering these variables in the preoperative study of azoospermic men, could help in the preoperative counseling of couples and could influence when choosing the optimal surgical technique for sperm extraction

Disclosure
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(337) Microsurgical Varicocelectomy Improves Seminal Parameters in Infertile Men: 10-year Experience in a University Hospital
Authors: Vinay J , Santander D , Gurovich J , Mohr E , Urrutia C , Palma C 
Published: February 2024

Abstract

Introduction
Varicocele is the most common treatable cause of male infertility. Although the exact mechanisms by which varicocele causes infertility have not been fully identified, there is evidence of an improvement in seminal parameters and pregnancy rates after varicocelectomy, especially if the technique is performed with an operating microscope

Objective
This study seeks to compare pre- and post-operative seminal and hormonal parameters of infertile patients undergoing microsurgical varicocelectomy in a local cohort

Methods
Retrospective analytical study of male patients with a diagnosis of infertility and clinical varicocele, who underwent microsurgical varicocelectomy in a University Hospital, between April 2013 - April 2023. Demographic variables, varicocele grade and laterality, reproductive hormone levels, seminal parameters and postoperative complications were collected from the clinical history database. Pre and postoperative seminal parameters and reproductive hormones were compared using non-parametric statisticians were used for data analysis with the Jamovi Software. P&lt;0.05 was considered statistically significant

Results
There were 136 varicocelectomies in the period, 56 patients were excluded due to incomplete data collection and finally 80 patients were analyzed. Median age was 34.5 years (IQR 31-38), with a median infertility duration of 2 years (IQR 1-4). All patents had primary infertility. The median testicular volume was 15 cc (IQR 15-20 cc). 82.5% of varicoceles were Grade ≥2, 70.6% patients presented left varicocele and 28% were bilateral. Of the reproductive hormones, only FSH showed a statistically significant decrease of the pre- and post-operative median values, being 5.8 IU/L (IQR 3.9-8.9) and 2.7 IU/L (IQR 2.5-2.9) (p=0.001), respectively. Median sperm concentration before and after surgery was 7 million/mL (IQR 2-23) and 18 million/mL (IQR 3.3-73.5), respectively (p=0.02). Median preoperative and postoperative sperm progressive motility was 29% (IQR 15-48) and 40% (IQR 27-60), respectively (p=0.004). Seminal volume and normal morphology did not show significative changes after surgery. Only 2 patients (2.5%) presented a grade 1 Clavien-Dindo postoperative complication (mild infection of surgical site)

Conclusions
In this study, infertile patients with a clinical diagnosis of varicocele showed a statistically significant improvement in sperm concentration and progressive motility and a significant decrease in FSH levels after microsurgical varicocelectomy. The reduction of this pituitary hormone may reflect an improvement in testicular spermatogenesis

Disclosure
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(338) Impact of Microsurgical Denervation of the Spermatic Cord Treatment of Chronic Scrotal Pain on Men's Sexual Function: A Follow-Up Study for 6 Months After Surgical
Authors: Le Anh T , Mai Ba Tien D , Dang Quang T 
Published: February 2024

Abstract

Introduction
When chronic severe scrotum affects the patient's activities and life in many aspects. Hypothetical study investigating clinical, laboratory characteristics and the influence of Microsurgical Denervation of the Spermatic Cord on male sexual performance.

Objective
The aim of this study was to describe the impact of microsurgical denervation of the spermatic cord treatment of chronic scrotal pain on men's sexual function

Methods
Observation study design. All patients with severe chronic scrotal pain, after excluding other causes, were indicated for surgery at the department of andrology, Binh Dan hospital from January 1, 2022 to November 1, 2022.

Results
There were thirty-one patients with chronic scrotal pain who underwent surgery. Mean age 24.2 ± 4.3 years, duration of pain 2.3 ±1.6 years. Location of pain: scrotum (41.3%), testis-epididymis (47.8%), spermatic cord (24.6%), inguinal (15.1%). Causes of pain: epididymitis (45.3%) accounted for most cases. NRS pain score before surgery 6.8 ± 2.3. There are 13/31 patients with severe pain scale (NRS = 7-10). Quality of life (QOL) in patients with moderate pain (NRS pain scale 1-6) 4.6 ± 4.0 and 6.75 ± 1.1 in patients with severe pain (NRS 7-10). 6%) patients reported pain affecting daily work Patient had small testicle size 43.5%, Varicose veins on ultrasound: 3.4±1.2 mm 51.6% (16/31) patients felt scrotal pain affecting sexual activity Patients with severe scrotal pain with high pain scale (NRS 7-10 points) had an effect on erectile function compared with moderate pain group (NRS 0-6 points) (P&lt;0.05) Indicators “Scrotal pain prevents sexual activity”, “IIEF”, “Decreased libido ADAM questionnaire”, “Stimulating sexual activity pain”, “painful ejaculation” all improved after surgery.

Conclusions
Chronic scrotal pain mostly occurs in young patients with relatively large pain scores. Chronic scrotal pain also contributes to testicular size and endocrine function affecting quality of life. Chronic scrotal pain can greatly affect sexual performance in men. Microsurgical Denervation of the Spermatic Cord improves many aspects of a patient's sexual performance.

Disclosure
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