bluuebunny/crossref_metadata_2025_split huggingface dataset:
(158) Antihypertensive Medications and Erectile Dysfunction: Is this Association Accurate?
Authors: Visingardi J , Paul Feustel P , De EJ , Inouye B , Welliver C 
Published: February 2024

Abstract

Introduction
The association between erectile dysfunction (ED) and antihypertensive medications (AM) has been previously described with varying results in small or single center data sets. Utilizing large post marketing surveillance databases allows one to study drug side effects across patients in a much larger and more diverse sample size.

Objective
Our study sought to investigate AMs and their medication classes to determine the incidence of ED. Our hypothesis was that thiazide diuretics and beta blockers would have significantly higher rates of reported ED than other AM classes due to the classic association with these medications and ED.

Methods
We utilized the US government Medical Expenditure Panel Survey maintained by the Agency for Healthcare Research and Quality to determine the total number of patients on each medication each year. The total number of ED adverse events reported per year per medication was accessed via the Food and Drug Administration’s adverse event reporting database (FAERS). Date ranges were 2013 to 2020. We reviewed all substantive outpatient AMs and compared them to one another as well as across the class with regards to reported ED rates.

Results
We found that a higher incidence of ED adverse events were reported with ramipril and bisoprolol -15 events per 100,000 patients and 34.1 events per 100,000 patients, respectively. Interestingly fewer adverse events (0.4 events per 100,000 patients) were reported for lisinopril. We did recognize differences among AM classes via Kruskal-Wallis analysis however the structure of our study was not able to distinguish which class was different in rates of ED as a result of the large number of drugs included. Reported ED rates increased over the study period with 2020 having the most ED reports. However, most medications reported fewer than 100 adverse events over an 8-year time period with many medications having tens of millions of patients taking them a year.

Conclusions
Higher rates of reported ED were seen with ramipril and bisoprolol and lower rates found with lisinopril than in other AMs. Differences among medication classes were not identified. The infrequent reporting of ED with AMs questions the existing dogma that AMs cause ED and further consideration should be given to the causality of this association.

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No.
(165) Assessing Artificial Intelligence Quality in the Evaluation and Treatment of Erectile Dysfunction
Authors: Pathuri M , Marciano O , Barrtero Guimaraes P , Kocjancic E , Raheem O 
Published: February 2024

Abstract

Introduction
Since November 2022, Artificial Intelligence (AI) chatbots have grown in popularity including in urologic conditions. However, their accuracy and quality has not been evaluated systematically. In this study, we sought to assess the accuracy and quality of AI chatbots in the management of Erectile Dysfunction (ED).

Objective
We aim to evaluate the accuracy and quality of open-source language models in fielding common clinical questions pertaining to ED compared to board certified urologists.

Methods
Two AI open-source language models, ChatGPT and Google Bard, were fielded 15 standard questions related to ED some of which included causes, risk factors and treatment options of ED. Two board certified urologists were given the same questions on a standard survey. A third blinded board-certified urologist served as a grader using the AUA guidelines for ED on a Likert scale to assess the accuracy, robustness, and bias of each response. Urologist and AI responses were graded and aggregated using Likert scales.

Results
Overall AI responses were significantly more accurate (p&lt;0.01), robust (p&lt;0.01), and unbiased (p&lt;0.01). Additionally, Google Bard had the highest scores all around followed by ChatGPT. The urologists’ responses were approximately 38% lower compared to the AI responses.

Conclusions
This study suggests that AI responses were superior compared to urologists in the areas of accuracy, robustness, and bias pertaining to the management of ED. Albeit, the chatbots have promising role in urologic conditions including ED, its widespread clinical use and adoption warrants further evaluation in the context of clinical decision making and enhancing patient care.

Disclosure
No.
(170) Satisfaction with Penile Prosthesis Implantation among Patients with Peyronie’s Disease Using a Contemporary Questionnaire
Authors: Leelani N , Hua V , Shumaker A , Bole R , Lundy SD , Bajic P 
Published: February 2024

Abstract

Introduction
The Satisfaction Survey for Inflatable Penile Implants (SSIPI) is a recently validated 16-question survey used to quantitatively measure patient outcomes after penile prosthetic surgery. The survey consists of four subdomain scores representing the appearance, pain, satisfaction, and function of the penile implant. Since its validation, there have been limited studies examining its use in patients with Peyronie’s disease (PD).

Objective
The objective of this study is to explore the use of the SSIPI in men with Peyronie’s Disease and to determine if any factors predict patient-perceived postoperative outcomes.

Methods
Preoperative, intraoperative, and postoperative data for patients with PD undergoing implantation of an inflatable penile prosthesis (IPP) by a single surgeon at a tertiary care institution was retrospectively collected into a secure database. Only those patients with at least one completed SSIPI postoperatively were included in the analysis. For those patients with multiple completed SSIPI’s, only the most recently completed one was used. Linear regression and Fischer’s exact test were used to determine if there were any significant relationships between variables and the SSIPI scores.

Results
There were a total of 44 men with PD who underwent surgery for an IPP. 31 of them were Caucasian, 11 were African-American, and one each were Hispanic and American Indian/Native American. Median time between surgery and completion of the SSIPI at a follow-up visit was 291 days (IQR 107.75-403.50). 35 men received a Coloplast Titan and 9 received an AMS 700 CX. There was no significant difference in the overall SSIPI score and any of the subdomains between men who received different types of implants or between men of different races. All four subdomains were significantly negatively correlated with the residual curvature which was measured intraoperatively after the IPP was implanted and any adjunctive straightening techniques were used (Fig 1a-d). The appearance domain was also significantly negatively correlated with the preoperative total testosterone indicating that men with a lower total testosterone level were more satisfied with the appearance of their penis. (p &lt; 0.05, R2 = 0.32). Interestingly, those men who underwent manual modeling (n=36) had a significantly lower score in the appearance domain (p &lt; 0.05).

Conclusions
Post-operative residual curvature in men with PD undergoing implantation of an IPP is a predictor of satisfaction with the IPP. The role of preoperative testosterone and intraoperative manual modeling in how men with PD perceive the appearance of their penis postoperatively requires further investigation.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.
(174) Use of Penuma® for Correction of Residual Deformity following Previous Treatment of Peyronie’s disease: Case Series
Authors: Desouky E , Elist J , Levine L 
Published: February 2024

Abstract

Introduction
Over the years, numerous treatment approaches have been explored for Peyronie's disease (PD) including non-surgical and surgical options. Nevertheless, the current options are largely insufficient in effectively correcting residual penile deformities after treatment.

Objective
To evaluate the efficacy of utilizing the subcutaneous silicone penile prosthesis (Penuma®) as a treatment modality for correcting residual penile deformity, including curvature and indentation, and providing penile girth enhancement post-PD treatment.

Methods
This is a two center case series of three patients who had previously undergone various treatments for PD. Detailed data about these patients were collected including their demographics, PD characteristics, previous treatments, and outcomes (see table). These patients previously had different treatments including non-surgical i.e. Xiaflex® and/or surgical options i.e. plication procedure. The placement of Penuma® subcutaneous silicone penile prosthesis was performed in a standardized manner across all cases. Follow-up evaluations were conducted to assess the effectiveness of the procedure and any associated complications.

Results
The main findings of the study revealed successful correction of residual penile deformity (curvature, indentation, narrowing) as well as significant improvement in penile girth in all three cases following the placement of the Penuma® subcutaneous silicone penile prosthesis. The procedure resulted in improved sexual function and satisfactory aesthetic outcomes as reported by patients. No major complications were observed during the follow-up period.

Conclusions
Our case series demonstrates the potential effectiveness and benefits of using Penuma® to correct residual penile deformity and to provide penile girth enhancement in patients post-PD treatment. At this time, we would consider offering Penuma® implantation when residual curvature is less than 30 degrees and indentation does not cause any instability or hinge-effect during penetrative sexual activity. Further research and larger case studies are warranted to validate these findings and assess long-term outcomes and patient-reported satisfaction.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: IMD.
(204) National Trends in the Treatment of Fournier’s Gangrene: 2016-2019
Authors: Su I , Marte J , Lee J , Han D , Kurtzman J , Joice G 
Published: February 2024

Abstract

Introduction
Fournier’s gangrene (FG) is a surgical emergency with significant inpatient mortality and long-term morbidity. Population-based databases such as the National Inpatient Sample (NIS) are valuable tools in investigating rare conditions, yet no recent studies have looked at trends and outcomes of FG at a national level. An increasing burden of this disease may be placed on large academic centers due to regional demographics and hospital transfer to these centers for specialized expertise.

Objective
To evaluate national trends in the management of FG to identify predictive factors of in-hospital mortality or inter-hospital transfer.

Methods
All patients hospitalized with FG between 2016-2019 were extracted from the NIS using the International Classification of Diseases (10th Revision) Diagnosis Code N49.3. Stratified cluster sampling was used to create weighted national estimates. The primary combined outcome was the proportion of patients who died during hospitalization or required inter-hospital transfer. Multivariable logistic regression was performed to identify predictors of this outcome.

Results
Between 2016 and 2019, there were an estimated 21,715 inpatients treated for FG in the US. There was an 8.5% increase in the patients treated yearly over the study period. The average age was 45.8 years, the average length of stay was 10.8 days, and the average total charge of hospitalization was $127,140. Overall, 4.3% of patients died during hospitalization and 7.2% were transferred to another short-term hospital facility. The region with the highest prevalence was the South (44.8%) and most admissions were to urban teaching hospitals (72.6%). Significant predictors of the combined outcome of in-hospital mortality or inter-hospital transfer included older age, non-private insurance, and greater Elixhauser Comorbidity Index (p&lt;0.05). Protective factors included medium/high volume hospital, urban setting (vs. rural), Midwest/Southern region (vs. Northeast), and 2nd or 3rd cost tertile (vs. 1st tertile) (p&lt;0.05) [Table].

Conclusions
We highlight an association of poor outcomes from FG with non-private insurance in older adults with more comorbidities. We also noted an increased burden of FG patients at large, urban teaching facilities due to regional demographics and inter-hospital transfer. Further work needs to be done to determine how inter-hospital transfer and potential delays in life-saving surgical debridement affect outcomes in FG.

Disclosure
No.
(206) Novel Observations about Epididymal Cysts Found in a Cohort of Michigan Men
Authors: Dong Y , Arenas M , Cedona K , Armitage S , Liaw A , Steinhardt G 
Published: February 2024

Abstract

Introduction
Epididymal cysts (EC) are an incidental finding on scrotal ultrasounds (SUS), with an anecdotal prevalence from 5-20% with peaks at age 2 and in puberty. A recent survey at a children’s hospital in Michigan found that up to 35% of boys 15 or older had ECs. While adult men often demonstrate EC, comparatively few papers characterize the prevalence of ECs in adults. It is presumed that ECs most commonly develop during their 20s-40s but no clear prevalence by age has been established in the general adult population.

Objective
This present research will investigate within the same geographic region the prevalence of ECs in adult men.

Methods
A retrospective review was conducted for men 18-years-of-age and older who underwent a Michigan hospital-based SUS between 2010 – 2015. Patients without EC and EC patients were compared using two-sample t test, associations between age and presence of ECs were evaluated by chi-square test, and associations between age and TTV were evaluated by one-way ANOVA and Pearson’s correlation coefficient.

Results
357 out of 801 men (44.6%) were found to have sonographic evidence of ECs. When separated into age groups, the prevalence of ECs significantly increased (p=0.041) with increasing age. In men with only ECs, their TTV did not significantly decrease with age (r = 0.06, p=0.684), unlike men without EC (r = 0.18, p=0.028).

Conclusions
This geographic cohort of men have the highest prevalence of ECs reported in the global literature. Two novel observations are that ECs frequency increases with age and TTV is preserved with age in men with ECs. TTV correlates significantly with FSH, LH, testosterone, and sperm health – further investigation should examine how preserved TTV may correlate with these values. Future studies should also examine the link between endocrine disrupting compound exposure and development of ECs.

Disclosure
No.
(213) Assessing Primary Care Physicians Awareness of 5-Alpha Reductase Inhibitors for Men with Benign Prostatic Hyperplasia
Authors: Babar M , Loloi J , Azhar U , Labagnara K , Salami A , Tang K , Robles J , Maria P 
Published: February 2024

Abstract

Introduction
Primary care physicians (PCPs) commonly prescribe 5-alpha-reductase inhibitors (5-ARIs) for the management of benign prostatic hyperplasia (BPH). 5-ARIs can affect prostate-specific antigen (PSA) kinetics by decreasing PSA levels by approximately half, and therefore delay the early detection of prostate cancer (PCa).

Objective
To determine PCPs’ level of awareness and indications for urology referral in patients treated with 5-ARIs.

Methods
After IRB approval, an anonymous survey was emailed to affiliated PCPs at an academic urban institution. Questions focused on residency graduation year, patient volume, knowledge of 5-ARIs and their effects on PSA, role of 5-ARIs in PCa prevention, and indications for prostate biopsy referral. PCPs were stratified by residency graduation year before or after 2010, or medical specialty of Family Medicine or Internal Medicine. Survey responses were summarized with descriptive statistics and responses between groups (residency graduation year or medical specialty) were compared using Chi-squared test.

Results
A total of 182 PCPs were emailed, of which 30 responded (16.5% response rate). Thirteen PCPs (43.3%) graduated residency before 2010 and 17 (56.7%) after 2010. Sixteen PCPs (53.3%) were Family Medicine physicians and 14 (46.7%) were Internists. The majority of PCPs reported that every 6 months, they saw at least one patient with BPH (96.7%), ordered at least one PSA test (86.7%), and referred at least one patient for a prostate biopsy (56.7%). Forty percent of PCPs were not aware of the suppressive effects of 5-ARIs on PSA, 70.0% would not refer a patient for a prostate biopsy who is taking 5-ARIs and has an elevated corrected PSA, 70.0% were not sure or thought that 5-ARIs may decrease the risk of high-grade PCa, and 43.3% were not sure or thought that 5-ARIs are approved for the prevention of PCa. There were no significant differences in the knowledge of 5-ARIs and their effects on PSA, role of 5-ARIs in PCa prevention, or indications for prostate biopsy referral between PCPs who graduated residency before 2010 and after 2010, or between PCPs who were Family Medicine physicians and Internists (p&gt;0.05 for all).

Conclusions
There is a general lack of awareness amongst PCPs on the knowledge of 5-ARIs and indications for biopsy referral in patients treated with 5-ARIs. An educational opportunity exists to optimize usage of 5-ARIs and avoid delaying PCa detection.

Disclosure
No.
(215) Penuma® Penile Implant Adverse Events in the Manufacturer and User Facility Device Experience (MAUDE) Database
Authors: Martinez Rivera M , West M , Kaplan-Marans E , Lee J , Katlowitz Y , Jivanji D , Khurgin J 
Published: February 2024

Abstract

Introduction
Penuma® is an FDA-approved penile implant intended to increase flaccid penile length and girth for improved cosmesis. It is the only FDA-approved product of its kind, with reportedly thousands of implants since 2004. There is a paucity of data on the adverse events related to this procedure.

Objective
To describe and characterize adverse events related to Penuma® using a national database.

Methods
The Manufacturer and User Facility Device Experience (MAUDE) database, a voluntary-reported database of medical device complications with data since 1991, was queried. The MAUDE adverse event classification system, a validated classification system, was used as a standardized tool to classify adverse events based on severity. All adverse events related to Penuma® were identified and quantified.

Results
42 reports of adverse events related to Penuma® were identified (Figure 1). Of these, 35 patients were reported to undergo device removal most commonly due to infection (n=8) or protrusion (n=8). (Table 1). The most commonly reported adverse event was deformity/disfigurement (n=27), of which 18 cases reported loss of penile length. Other adverse events included: pain (n=16), infection (n=12), decreased sensitivity (n=10), scar tissue (n=9), erectile dysfunction (n=8), seroma (n=7), and erosion (n=6).

Conclusions
To our knowledge, this is the first study to systematically characterize publicly reported adverse events occurring with Penuma® implantation, using the MAUDE database. Further research is warranted to delineate the incidence of adverse events related to Penuma®.

Disclosure
No.
(218) Bladder Outlet Procedures Performed in Patients with a Penile Prosthesis Do Not Increase Device Complication Rates
Authors: Reddy A , Yu B , Saffeti G , Song J , Dai M , Park B , Applewhite J , Khera M 
Published: February 2024

Abstract

Introduction
At present, minimal evidence exists in the literature regarding the management of benign prostatic hyperplasia (BPH) in patients with a penile prosthesis. While it is considered prudent to address BPH prior to penile prosthesis placement, no formal guidelines exist on this topic and in many instances, patients develop lower urinary tract symptoms secondary to BPH after prosthesis placement. Thus, understanding how to safely manage BPH in this patient population is key to optimal outcomes.

Objective
The aim of this study was to understand if patients with a penile prosthesis who subsequently underwent bladder outlet procedures (BOP) had an increased risk of prosthesis complications compared to those patients who underwent BOP prior to their penile prosthesis placement.

Methods
An Institutional Review Board approved retrospective chart review of all penile prosthesis patients with concomitant BPH from 2008-2023 was undertaken. Men who underwent a BOP before and after penile prosthesis placement were identified and separately analyzed for patient demographics, type of outlet procedure performed, type of prosthesis placed, and complications following penile prosthesis surgery. Complications were defined as any device infections, device malfunctions, or the need for any sort of operative interventions including explant. Statistical analysis was then conducted to identify significant differences between these two cohorts.

Results
A total of 424 patients with a history of penile prosthesis and BPH were identified. Of this group, a total of 61 patients were found to have undergone a BOP. Specifically, 28 patients were found to have undergone a BOP following their penile prosthesis placement, and 33 were found to have undergone a BOP prior to their penile prosthesis placement. Amongst the two cohorts, there were no statistically significant differences in age, race, prostate volume, hemoglobin A1c levels, type of outlet procedure performed, and history of hypertension, hyperlipidemia, radiation therapy, or smoking. Importantly, there was no statistically significant difference in complication rates between the two cohorts (P=0.910).

Conclusions
To our knowledge, this study is the largest ever analysis of penile prosthesis patients who underwent bladder outlet procedures. From this data, it seems that patients who undergo BOP after penile prosthesis surgery are not at increased risk for complications compared to those patients who undergo a BOP prior to penile prosthesis surgery. Given that this is a retrospective chart review of a multi-center, high-volume implant practice, further randomized controlled trials will be necessary to confirm these findings.

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