bluuebunny/crossref_metadata_2025_split huggingface dataset:
(258) Trends in Prevalence, Incidence and Pharmacological Prescriptions for Premature and Delayed Ejaculation – A Claims Database Analysis
Authors: Liao B , Banner S , Vodnala S , Able C , Vu K , Sonstein J , Alzweri L , Kohn T 
Published: February 2024

Abstract

Introduction
Premature (PE) and delayed (DE) ejaculation are common male sexual dysfunction disorders. Despite a community-reported prevalence of approximately 30% for PE and 5% for DE, the clinical prevalence, incidence, and rates of pharmacological prescriptions for both disorders remain under-investigated in the literature.

Objective
Our objective is to assess the trends in prevalence, incidence, and pharmacological treatment of PE and DE using a large claims database.

Methods
The TriNetX Research database, a large insurance claims database, was queried to identify all adult (≥18 years) males that were evaluated from January 2012 through December 2022. The number of men diagnosed with PE (ICD-10 F52.4) and DE (F52.32 and N53.11) was compared to the total number of men evaluated using six-month intervals (January-June, July-December) to calculate percent prevalence and incidence. A chi-squared test of linear trends was performed for prevalence and incidence. Rates of prescribed treatments were calculated comparing the number of men receiving the treatment to the total number of men with the assessed disorder using six-month intervals for PE and one-year intervals for DE.

Results
A total of 17,647 adult males with a diagnosis of PE and 6,304 adult males with a diagnosis of DE were identified from January 2012 to December 2022. The prevalence and incidence for both disorders are found in Figure 1. The chi-square test for trends showed a significant increasing trend in the prevalence of PE (χ2 = 303.44, p-value = &lt;0.0001) and DE (χ2 = 314.14, p-value = &lt;0.0001) and incidence of PE (χ2 = 6.40, p-value = 0.0114) and DE (χ2 = 187.43, p-value = &lt;0.0001). In the final period, 63.5% males with PE and 33.4% males with DE received at least one medication of the investigated therapies. The most common medications prescribed to men with PE were phosphodiesterase-5 inhibitors (25.7%), paroxetine (17.4%), topical anesthetics (13.4%), and sertraline (12.2%). The most common medications prescribed to men with DE were testosterone (11.7%), bupropion (12.2%), and cabergoline (10.0%). The prescription rates of all of the investigated medications for PE and DE are shown in Figures 2 and 3, respectively.

Conclusions
In this large US claims database analysis, premature and delayed ejaculation are overall diagnosed at low but increasing rates. Furthermore, the rates of pharmacological prescriptions for PE remains relatively low, despite pharmacotherapy being recommended as first-line options under the current guidelines. Additional research is necessary to investigate the long-term efficacy of individual medications for both PE and DE.

Disclosure
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(267) The Prevalence of Conditions Involving Aberrant Mast Cell Activity in Patients with Neuroproliferative Vestibulodynia
Authors: Goldstein S , Goldstein I , Kim NN , Drian A , Dempsey T , Mueller J , Yee A 
Published: February 2024

Abstract

Introduction
Neuroproliferative vestibulodynia (NPV) is a provoked vestibular pain, shown to be associated with excess immunohistochemical staining for CD117 and PGP9.5, consistent with mast cells and nerves, respectively. It is hypothesized that NPV occurs in genetically predisposed patients in whom mast cells accumulate in the vestibular sub-epithelial stroma where they release various cytokines/growth factors that stimulate the growth of nerves, causing severe allodynia and hyperalgesia throughout the entire vestibule.

Objective
To assess, in our patient cohort with histopathologically confirmed diagnosis of NPV, the prevalence of concomitant conditions involving aberrant mast cell activity.

Methods
Medical records from people with vulvas who underwent vestibulectomy between June 1, 2019 and December 31, 2022 were retrospectively reviewed. This research protocol was IRB-exempt. Histories from these patients, all of whom had histopathologically confirmed NPV after observing &gt; 8 immunopositive CD117 stained cells per high-power field in the sub-epithelial stroma, were reviewed. The prevalence was noted for the presence of concomitant conditions where aberrant mast cell activity has been reported to play a critical role in symptomatology. The focus was on the following eight conditions: asthma, chronic sinusitis, endometriosis, food allergy/intolerance, interstitial cystitis, irritable bowel syndrome, migraine, and postural orthostatic tachycardia syndrome.

Results
A total of 65 NPV patients were included in this chart review. While 24 (37%) reported none, 41 (63%) had at least one other concomitant condition involving aberrant mast cell activity. A total of 25 (38%), 10 (15%), 4 (6%) and 2 (3%) had one, two, three and five other conditions, respectively, involving aberrant mast cell activity. The most common such condition was migraine (n=14; 22%), followed by endometriosis (n=12; 19%), food allergy/intolerance (n=11; 17%), interstitial cystitis (n=10; 15%), irritable bowel syndrome (n=8; 12%), asthma (n=7; 11%), chronic sinusitis (n=5; 8%) and postural orthostatic tachycardia syndrome (n=2; 3%). There was no correlation between the number of concomitant conditions with aberrant mast cell activity reported and the density of CD117-immunopositive staining in the overall cohort of patients with NPV or within the subgroups of those with either lifelong or acquired NPV.

Conclusions
Patients with histopathologically confirmed NPV have a high prevalence of concomitant conditions associated with aberrant mast cell activity. While more studies are needed, NPV is likely part of a broader systemic collection of conditions associated with aberrant mast cell activity. This finding is relevant in terms of future diagnostic and treatment options for patients with NPV.

Disclosure
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(290) Impact of Neoadjuvant Relugolix on Patient-Reported Sexual Function and Bother
Authors: Gallagher L , Wells M , Hsueh J , Danner M , Zwart A , Ayoob M , Yung T , Simpson T , Kumar D , Leger P , Dawson N , Suy S , Rubin R , Collins S 
Published: February 2024

Abstract

Introduction
Relugolix is an oral GnRH receptor antagonist used in combination with radiation therapy in the treatment of unfavorable prostate cancer. It has been shown to achieve rapid and profound testosterone suppression (total testosterone &lt;20 ng/dL) without the need for bothersome injections. Such low testosterone levels may impact sexual functioning and perceptions.

Objective
Given the potential benefits of Relugolix over other androgen deprivation therapies (ADTs), this prospective study sought to assess neoadjuvant Relugolix-induced sexual dysfunction prior to the initiation of stereotactic body radiation therapy (SBRT).

Methods
Prospective, patient-reported data was collected from a male cohort diagnosed with localized prostate cancer and subsequently treated with neoadjuvant Relugolix and SBRT. Relugolix was initiated at least 2 months prior to SBRT. Sexual function and bother were assessed via the sexual domain of the validated Expanded Prostate Index Composite (EPIC-26) survey which includes five function questions (erections and orgasm) and one overall bother question. Individual scores ranged from 0-100 with higher scores reflecting improved function/less bother. EPIC-26 was collected for each patient at pre-Relugolix baseline and one hour prior to SBRT initiation. Individual items were evaluated for statistical significance (paired t-test, p &lt; 0.05) and clinical significance by minimally important difference (MID, +/- 0.5 SD from baseline score).

Results
Between July 2021 and January 2023, 49 patients with localized prostate cancer were treated with neoadjuvant Relugolix (4-6 months) and SBRT (36.25-40 Gy in 5 fractions) at Georgetown University Hospital per institutional protocol IRB 12-1775. The median age was 73 years. 27% of patients were black and 26.1% were obese (BMI ≥30 kg/m2). Patients initiated Relugolix at a median of 3.6 months prior to SBRT. 82% of patients had intermediate risk disease. All individual EPIC sexual function scores declined in a similar manner following neoadjuvant Relugolix therapy. These declines were both statistically and clinically significant. There was no statistically or clinically significant change in the EPIC sexual overall bother score.

Conclusions
In concordance with known side effects of ADT, neoadjuvant Relugolix was associated with a significant decline in self-reported sexual function. However, patients indicated only a minimal and non-significant increase in bother. Relugolix was well-tolerated as patients on Relugolix did not subjectively find their sexual dysfunction troublesome. Future investigations should compare outcomes while on Relugolix directly to GnRH agonist-induced sexual dysfunction.

Disclosure
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(305) Contemporary Therapies in Oncofertility: Identifying the Common Consults
Authors: Mallory C , Lorduy S , Staley L , Ligon J , Halpern J , Potts S , Campbell K 
Published: February 2024

Abstract

Introduction
Fertility inquiries among chemotherapy, immunotherapy, and targeted therapy regimens are increasing in volume and heterogeneity of referrals. There is limited research highlighting the prevalence of contemporary oncologic therapies seen by urologists and patient-specific fertility concerns.

Objective
This study seeks to identify the most common contemporary chemotherapy, immunotherapy, and targeted therapy regimens referred to urology for oncofertility inquiries and concerns.

Methods
We performed a retrospective single institutional review of all oncologic agents referred to the department of pediatric hematology oncology for fertility evaluation over the past five years (April, 2018- April, 2023). These included both frontline and salvage treatments. Agents were defined as contemporary if drug approval was received by the Food and Drug Administration 2006 or later.

Results
We identified 75 patients who underwent 28 unique contemporary agents ranging across 16 different drug classes referred for fertility evaluation (Figure 1). The majority of agents referred were used by 1-2 patients. The most common agents for oncofertility consultation included the monoclonal antibody Brentruximab (9), immune checkpoint inhibitor pembrolizumab (8), and T-cell engager Bilinotumomab (8). The most common agents included immune checkpoint inhibitors (16), monoclonal antibodies (16), and tyrosine kinase inhibitors (15).

Conclusions
There is significant variability and diversity among modern oncologic agents among patients referred for oncofertility evaluation, demonstrating the need for provider familiarity and future research in the oncofertility space.

Disclosure
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(310) Severe Delayed Skin Reaction to Antiseptic Irrigation Solution Managed with Pinch Skin Grafting After Inflatable Penile Prosthesis Surgery: A Case Report
Authors: Freudenburg E , Yafi F , Hammad M 
Published: February 2024

Abstract

Introduction
Inflatable penile prosthesis (IPP) surgery is a common procedure for treating erectile dysfunction, and skin preparation with antiseptic solutions is a standard practice to reduce infection risk. However, some antiseptic solutions, such as chlorhexidine-based Irrisept, have been associated with severe skin reactions. Several studies have reported cases of contact dermatitis, blistering, and chemical burns following the use of chlorhexidine-based antiseptic solutions before surgery.

Objective
This case report aims to highlight the potential risk of severe skin reactions when using Irrisept and other chlorhexidine antiseptic solutions during penile prosthesis surgery. It also explores the novel technique of pinch skin autografting used to salvage the implant and achieve successful wound healing after delayed skin necrosis.

Methods
61-year-old male with a history of prostate cancer and erectile dysfunction who underwent insertion of an IPP.

Results
The patient's penile shaft developed blisters 3 weeks post-implantation, which progressed to full-thickness necrosis despite conservative treatment. The distribution and location of the reaction led to the hypothesis that it was caused by the chlorhexidine-based Irrisept antiseptic. The antiseptic solution used copiously throughout the case and 10CC was injected under pressure into the drain which also may explain the reaction observed. The patient underwent wound debridement and was treated with pinch skin autografts from the bilateral thighs. The autografts resulted in 95% epithelialization with excellent cosmetic outcomes with no other complications. To the best of our knowledge, this is the first reported case of Irrisept-induced delayed skin necrosis and the use of pinch skin grafting to salvage the implant after penile prosthesis surgery.

Conclusions
Skin reactions to Irrisept antiseptic solution during penile prosthesis surgery are rare but can be severe. Surgeons should be cautious and consider alternative skin preparation methods in patients with a history of skin allergies or sensitivities. This case also highlights the potential of pinch skin autografting as a salvage technique for post-IPP skin reactions. A multidisciplinary approach involving reconstructive burn surgeons and specialty wound care teams may be beneficial in optimizing outcomes in such cases.

Disclosure
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(314) Combing Penile Venous Stripping and Bilateral Varicocelectomy Benefit Patients with Erectile Dysfunction Secondary to Prostatectomy
Authors: Hsu G , Chueh J 
Published: February 2024

Abstract

Introduction
Albeit present human penile anatomy has remained unchanged for three thousand centuries and extensive study has been conducted on anatomical architecture and male potency reconstructive strategies for many centuries, it might not above be sustainable.

Objective
Given only evidence can speak volumes, and practice is the criterion for testing truth, we sought to report an innovative circumferential approach for fulfilling penile erection restoration and morphology reconstruction on an ambulatory basis microsurgical in recent years

Methods
From October 2013 to October 2020, 33 men aged 21–59 underwent penile venous stripping (PVS) and corporoplasty via a circumferential approach on an ambulatory basis. The abridged five-item version of the International Index of Erectile Function (IIEF-5), erection hardness scales (EHS), and cavernosography were used for assessment, as required. The PVS entails stripping one deep dorsal vein and two cavernosal veins after every specific emissary vein is microscopically ligated closest to the outer tunica, whereas the para-arterial veins are segmentally ligated. Subsequently, a tunic corporoplasty is conducted before and after artificial erection with autologous venous wall bi-layered patches, whereby a water-tight running suture is undertaken for the inner layer and interrupted for the second layer for idealizing penile morphology using 6-0 nylon.

Results
The average follow-up period was 5.1±1.3 years, and the surgery time was 5.2±1. 4 hours, respectively. The radiopacity was unexceptionally enhanced postoperatively. There was a significant difference (P&lt;0.01) between the preoperative (9.8±2.7) vs. Postoperative IIEF-5 scores (20.7±2.3). The EHS improved on at least one scale. The penile shape (&lt;10°) was deemed reported in 93.9% (31/33) patients.

Conclusions
This combination of physiologically penile venous stripping and an anatomy-based corporoplasty is ideally suited to the simultaneous restoration of penile erectile function and morphological reconstruction via a circumferential approach.

Disclosure
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(318) Factors Influencing Compliance with Trimix, an Intracavernosal Injection for Erectile Dysfunction: A Retrospective Analysis
Authors: Best J , Ledesma B , White J , Molina M , Ramasamy R 
Published: February 2024

Abstract

Introduction
Trimix, an intracavernosal injection therapy, is an effective treatment for erectile dysfunction. However, patient compliance with Trimix use is crucial for treatment success, and factors influencing compliance are not well understood.

Objective
This retrospective analysis aimed to identify factors that influence compliance with Trimix therapy among patients with erectile dysfunction. Additionally, the study aimed to investigate the impact of comorbidities, specifically diabetes and prostate cancer, on the duration of Trimix treatment.

Methods
Patient data from pharmacy records between 2017 and 2022 was analyzed. Custom Python code was used to calculate the duration of Trimix use based on the first and last prescription refill events. A comprehensive chart review was conducted to collect additional patient-related data, including demographics and comorbidities. Cox Proportional Hazards Regression models were employed to assess the effects of predictor variables on the duration of Trimix use. Simple linear regression was used to compare the presence of diabetes, prostate cancer, or both on time spent on Trimix treatment.

Results
The analysis included a total of 4,072 patients. Age was identified as a significant predictor of Trimix therapy discontinuation, with every additional year of age associated with an increased hazard ratio of 1.007 (p &lt; 0.001). Preferred language also emerged as a significant predictor, with patients preferring Spanish exhibiting a higher hazard ratio of 1.163 compared to patients preferring English (p = 0.004). In terms of comorbidities, the presence of prostate cancer significantly differed from other organic causes of erectile dysfunction on time spent on Trimix treatment (p = 0.002), resulting in 80 fewer days of Trimix treatment.

Conclusions
This retrospective analysis revealed that age and preferred language are important factors influencing compliance with Trimix therapy. Older patients and those preferring Spanish were more likely to discontinue Trimix treatment. Additionally, the presence of prostate cancer significantly impacted the duration of Trimix treatment. These findings emphasize the need for age-specific counseling, language-concordant interventions, and tailored approaches to address comorbidities such as prostate cancer. Understanding these factors is vital for optimizing treatment adherence and efficacy in patients with erectile dysfunction.

Disclosure
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(346) Simultaneous Bladder Drainage via Suprapubic and Urethral Catheters: Which Drains More Completely and Why?
Authors: Naser-Tavakolian A , Sandhu S , Masterson J , Dallmer J , Bresee C , Zaliznyak M , Zhao H , Garcia M 
Published: February 2024

Abstract

Introduction
Reconstructive urologists often place both a urethral and suprapubic catheter intraoperatively to prevent extravasation of undrained urine across anastomosis sutures. As no consensus exists on which catheter drains the bladder more completely, many surgeons leave one catheter to gravity drainage and cap the other postoperatively.

Objective
We sought to identify differences in catheter urine outflow during dual bladder drainage with suprapubic and urethral catheters in postoperative urology patients.

Methods
Urine output (UOP) from transgender men who underwent Stage II Phalloplasty with urethral lengthening was retrospectively reviewed. Both 16 French urethral and suprapubic catheters were placed to gravity drainage postoperatively. UOP from each catheter was recorded separately, twice daily. Mixed model regression modeling tested for differences in urine output by time of day (day/night) and activity status (Bedrest: Postop Day 0-2, Ambulatory: Postop Day 3+).

Results
The aggregate number of 12-hour shift UOP observations was 250 (125 for urethral and 125 for suprapubic catheters) across 14 inpatients. Suprapubic catheters had a mean 410 ml higher output than urethral catheters per 12-hour shift (p=0.002; 95% CI: 185, 636 ml). During daytime, suprapubic catheters demonstrated higher UOP than urethral catheters per 12-hour shift (Estimated Difference: 464 ml; p=0.002; 95% CI: 211, 718 ml). During nighttime, a similar phenomenon was observed (Estimated Difference: 356 ml; p=0.009; 95% CI: 104, 606 ml). When comparing mean UOP from each catheter during the Bedrest Phase, suprapubic catheters averaged an estimated 295 ml higher UOP compared to urethral catheters per 12-hour shift with a trend toward statistical significance (p=0.052; 95% CI -3, 594 ml). During the Ambulatory Phase, mean suprapubic catheter UOP was an estimated 472 ml higher than urethral catheters per 12-hour shift (p=0.009; 95% CI 142, 802 ml) (Table 1).

Conclusions
Simultaneous bladder drainage with urethral and suprapubic catheters shows greater drainage from the suprapubic catheter (35% vs 65%). The difference in urinary drainage is likely explained by the suprapubic catheter tip and drainage inlet residing in a more gravity-dependent location, within the funnel-shaped bladder neck (Figure 1). When using two catheters, both can be placed to gravity to maximize bladder drainage as the suprapubic catheter can drain residual urine not adequately drained by the urethral catheter.

Disclosure
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(366) Potential Effectiveness of Focused Vibration Treatment for Psychogenic Erectile Dysfunction: A Case Series
Authors: Rodriguez JE , Dadian R , García A , Valverde J 
Published: February 2024

Abstract

Introduction
The current non-pharmacological treatment of psychogenic erectile dysfunction (pED) is based on cognitive-behavioral interventions that often involve the participation of the partner, such as desensitization procedures, sensory focusing, and couples counseling. However, it is important to note that in many cases, patients may not have a stable partner or their partner cannot participate in the treatment. The application of local mechanical vibration has shown promising results in increasing skin blood flow and nitric oxide production in healthy young adults. The relaxation of smooth muscle in the penis initiates and maintains an erection. The local release of nitric oxide from autonomic dilator nerves and vascular endothelium is crucial in initiating and sustaining this process. Technological advances have allowed the design of vibrating devices that men can use during sexual encounters.

Objective
To determine if the on-demand use of a focused vibration device can increase blood flow and promote relaxation of erectile tissue to improve erectile function in patients with pED.

Methods
Seven sexually active men diagnosed with pED based on criteria for Erectile Disorder from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and without a stable partner, were instructed to use a vibrating device called TENUTO II during their sexual encounters for duration of 8 weeks. This device generates focal vibrations on the penis and the perineal area in intervals of 10 seconds of vibration followed by 10 seconds of pause, with a frequency of 50Hz and an amplitude of 2mm. The five-item Spanish version of the International Index of Erectile Function (IIEF-5) questionnaire was used to assess symptoms before and after the procedure and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used for evaluating satisfaction with treatment.

Results
After the using the device, all patients enrolled with a mean age of 36.1 years (range 28-45) experienced an improvement in erectile function, mean IIEF-5 score pretreatment was 11(range 5–13) mean posttreatment IIEF score was 20 (range 18-27). No adverse effects were reported during the treatment.

Conclusions
This case series suggests that use of an on-demand focused vibration device could be a potentially effective and safe therapeutic option for men with pED. However, further studies with a larger number of participants and a more rigorous research design are needed to confirm these preliminary findings.

Disclosure
Yes, this is sponsored by industry/sponsor: MysteryVibe.
Clarification: Industry funding only - investigator initiated and executed study.
Any of the authors act as a consultant, employee or shareholder of an industry for: Mysteryvibe.