bluuebunny/crossref_metadata_2025_split huggingface dataset:
(276) Self-Performed Bilateral Testicle Amputation for Gender Affirmation
Authors: Waldoch B , Melin I , Dietrich P , Guise A 
Published: February 2024

Abstract

Introduction
Genital gender-affirming care is an essential aspect of care for individuals with gender dysphoria. Bilateral orchiectomy is performed for both hormonal control and for gender identity physical transition. The time and financial costs required to access such procedures can be prohibitive, leading to pursuit of morbid gender affirmation outside of healthcare systems. While genital self-mutilation is rare, up to 32% of cases have been found to involve self-castration. Management of this varies but in severe cases prompt surgical repair is imperative. We present a case report of a non-binary patient who underwent self-amputation of both testicles, with subsequent primary closure of the perineum.

Objective
A 34-year-old non-binary individual with autism spectrum disorder and gender dysphoria presented with uncontrolled bleeding after self-amputating both testicles (Photo 1). This was done with use of a zip tie around the scrotal base, application of lidocaine cream to the scrotum, and a sterilized kitchen knife. The patient performed this to eliminate the physical and psychological effects of testosterone, and cited lack of access to care as a motivating factor.

Methods
Psychiatry consultation confirmed decision-making capacity without acute severe mental illness, and no substance abuse was involved. Sperm cryopreservation was discussed with the patient but was declined. While awaiting capacity assessment, measurements of the testicular arteries and vas deferens were obtained to assess the possibility of reanastomosis, which was deemed technically feasible.

Results
After the patient was deemed decisional they were taken to the operating room for vascular control and planned primary closure and possible skin grafting. Cystoscopy confirmed no concomitant urethral injury. Intraoperatively the bilateral spermatic cords were tied off to achieve hemostasis. Skin closure was able to be performed primarily with a favorable result (Photo 2).

Conclusions
We present a unique case of a non-binary individual with gender dysphoria who underwent successful self-amputation of both testicles. This case highlights the significant barriers faced by individuals seeking gender affirmation procedures and the lengths to which patients may go to conform with their gender identity. Our case also highlights important management steps, including sperm cryopreservation, decisional capacity evaluation, and reattachment versus primary closure with or without skin grafting. The patient's decision to pursue self-amputation underscores the urgent need for improved access to gender-affirming procedures and mental health support for individuals with gender dysphoria.

Disclosure
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(280) Innovative Team Approach to Sexual Health Counseling; Partnership of Urology, Infectious Disease and Pelvic Floor Therapy to Increase Access to Care
Authors: Jackson C , Hakky T , Tims-Cook Z , Frank L 
Published: February 2024

Abstract

Introduction
Despite the prevalence and availability of HIV (Pre-exposure Prophylaxis i.e., PrEP), the number of new AIDS diagnoses continues to outpace treatment and prevention. Stigma, discrimination, lack of access continue to remain significant barriers in the prevention of new HIV infections, especially amongst vulnerable groups (i.e. LGBTQ, women, and minorities). We present a novel strategy to address a comprehensive approach to sexual health medicine through the partnership of Urology, Infectious Disease, and Pelvic Floor therapy.

Objective
Men who have sex with men (M2M) who either currently use or have an interests in use of pre-exposure prophylaxis (PrEP) continue to face barriers with respect to access to care, stigma, and or availability of effective partnerships to address and offer culturally competent care. The objective of this study is to assess attitudes and barriers to conventional and novel PrEP offerings as well as to present an innovative team approach between Urology, Infectious Disease (ID) Medicine and Pelvic Floor Therapy to offer a comprehensive multidisciplinary approach to treatment and care.

Methods
We enrolled 6 candidates (M2M) into our PrEP clinic which offers the Apretude (Cabotegivir 600 mg/3mL) injections. We conducted interviews, focused groups, and provided questionnaires to detail their experiences, beliefs, attitudes, barriers, and considerations for therapy.

Results
First, the preliminary results and findings of our study has shown that the needs, considerations, and beliefs of M2M is more varied, nuanced, and divergent with need to characterize, understand, and offer more specific culturally competent care in Sexual Health Medicine with respect to PrEP. Second, M2M designation does not exclude men from having sex with the opposite gender. These man preferred injectable PrEP option. Third, the partnership of Urology, Infectious Disease and Pelvic Floor Therapy reduced barriers, increased access to care, and decreased stigma as M2M felt more comfortable in the Urological setting.

Conclusions
M2M patients stated hesitancy, increased stigma and “shame” in going to ID for sexual health. Additionally, for M2M who have sexual partners of the opposite sex this would further increase stigma. Urology practices are accustomed to having discussions surrounding men’s sexual health with reduced stigma. The combination of Infectious Disease has presented an innovative partnership to discuss, prevent, and treat sexuallly transmited infections amongst M2M.

Disclosure
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(282) Longitudinal Impact of Inflatable Penile Prostheses on Patients’ Body Image and Sexual Satisfaction
Authors: Kassab J , Saffati G , Naeem T , Khera M , Lipshultz L 
Published: February 2024

Abstract

Introduction
Inflatable penile prostheses (IPP) are used in a multitude of urologic disorders including Peyronie’s disease and medication-refractory erectile dysfunction. The IPP procedure is performed by inserting a penile pump to help generate and maintain penile erections.

Objective
To analyze self-perceptions and body dysmorphia of patients who have had an IPP placement.

Methods
An electronic survey was delivered through REDCap to patients who had undergone an IPP placement and who were identified using diagnosis codes associated with the procedure within the 06/01/2007 - 09/01/2022 observation interval. The survey asked each patient about their comfort with their penis’s appearance and usage in sexual settings, with answer choices corresponding to a five-point Likert-Scale in addition to a free-form response section. T-tests were utilized to compare mean respondent scores before and after IPP placement using SPSS software.

Results
436 surveys were sent out, and 69 responses were received (15.83%). When asked about comfort with their penis’s appearance, the respondents had a slight, non-significant increase after IPP (T-value = -0.771, p = .221). In response to inquiring about the patient’s ease using their penis in sexual relationships, patients reported an increase due to their IPP placement (T-value = -3.00, p = .0016). When reverse coded, patients demonstrated a great decrease in concern about their penis in social situations after the IPP procedure (T-value = -3.88, p = .00008). The total score of all questions before and after IPP placement increased by an average of 15.1% (T-value = -3.21, p = .00082). 44.78% of respondents noted a positive change in how the IPP changed how they view themselves and their body; 40.30% noted neutral change and 14.93% noted a negative change. In response to how the IPP has affected sexual and romantic relations, 68.66% reported a positive difference after IPP, 16.42% were neutral, and 14.93% reported a negative difference.

Conclusions
Our data demonstrate that IPPs have a stronger impact on sexual function, as opposed to body image; however, the vast majority of patients felt a positive or neutral change of how they view themselves and their bodies post-IPP. These findings support the continued use of IPPs in patients who are non-responsive to previous erectile dysfunction treatments.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Larry Lipshultz: AbbVie (Consultant) American Medical Systems/Boston Scientific (Speaker) Augmenta LLC (Stockholder) Aytu BioScience (Consultant) Contraline, Inc. (Consultant) Endo Pharmaceuticals (Consultant/Speaker) Inherent Biosciences (Advisor) Lipocine (Consultant); Mohit Khera: Consultant- AbbVie, Halozyme, Clarus, Metuchen, Acerus, Boston Scientific, Coloplast, Endo.
(298) AUA vs AI: An Inquiry into Testosterone Guidelines
Authors: Katlowitz Y , Khurgin J , Leelani N 
Published: February 2024

Abstract

Introduction
ChatGPT is an artificial intelligence with an accessible user interface that allows for conversational input. It uses deep learning, a subset of machine learning based on artificial neural networks, to “speak” to the user. Patients and clinicians alike have been querying ChatGPT with medical questions, and recent publications have shown that the validity of responses vary. Limited information is available pertaining to ChatGPT’s capacity to accurately discuss testosterone management and deficiency. It is imperative for the medical community to be aware of potentially accurate or inaccurate information sources. This project is designed to assess ChatGPT’s clinical competency compared to the American Urologic Association (“AUA”) guidelines regarding the evaluation and management of testosterone deficiency.

Objective
To assess the competency of ChatGPT to answer general and clinical questions related to testosterone deficiency and replacement compared to the AUA guidelines.

Methods
The AUA guidelines for evaluation and management of testosterone deficiency include 31 main points. Each point was prompted to ChatGPT in the form of a question, accompanied by requests for validation of information, providing further information, or clinical next-step recommendations. The answers were then sorted into 3 categories all relative to the AUA guidelines, being accurate and complete, (AC), accurate but incomplete (AI), and incorrect or misleading (IM).

Results
Of the 31 guideline-based questions queried, 22/31 (71%) were AC, 4/31 (13%) were AI, and 5/31 (16%) were IM. The highest number of AI answers pertained to treatment related queries. The highest number of IM answers pertained to counseling, particularly on commonly contested topics, such as the relationship between testosterone and prostate cancer or cardiovascular health.

Conclusions
When queried about the evaluation and management of testosterone deficiency, ChatGPT offered complete and accurate answers in 71% of cases. It had increased accuracy of even up to 100% when answering regarding firmly established or more binary topics, such as diagnosis requirements or recommended adjunct testing. As such, patients and providers may consider using ChatGPT as an ancillary resource for uncomplicated or firmly established testosterone related queries. However, it did much more poorly when discussing more contested topics such as testosterone’s relationship to prostate cancer, or when approaching elements of medicine that require a more personalized human touch, such as counseling. While ChatGPT may be helpful in the base or binary matters, interpersonal and patient specific matters are best handled by experts in the field.

Disclosure
No.
(325) A Descriptive Analysis of Digital Resources for Educating Sickle Cell Patients About Priapism
Authors: Thorogood SL , Flores JM , Mulhall JP 
Published: February 2024

Abstract

Introduction
Men with sickle cell disease (SCD, HbSS or HbSC hemoglobinopathy) are at increased risk of priapism via increased cell surface adhesion molecule expression and blunted vasodilatory responses to nitric oxide. Previous studies have suggested that priapism knowledge is poor among men with SCD; however, studies have yet to characterize public-facing priapism educational resources.

Objective
To describe key features of online educational resources targeted to priapism patients with SCD in the US.

Methods
In March 2023, we searched the following keywords and terms using the Google search engine and search features within Facebook, YouTube, and TikTok: “painful erection”, “priapism”, “priapism patient education”, “priapism for patients”, and “priapism sickle cell patient”. Searches were performed via a computer located in Manhattan, New York and in the English language only.

Results
Google search results differed considerably when searching “painful erection” versus “priapism” and are depicted in Table 1: the former directed users to telehealth commercial websites while the latter directed users to websites hosted by healthcare and professional organizations and medical reference sites which primarily discussed etiology and need for prompt diagnosis of the condition. YouTube search results overwhelmingly focus on discussion of diagnosis, pathophysiology, and management of priapism, and most of these appear designed for a medical or medically-literate audience; however, when querying for “priapism sickle cell patient”, users are directed to patient testimonial or documentary style videos. The results of a Facebook pages search seemed intended for student education and associated with low quality media material. An equivalent search performed on Tik Tok yields videos with noticeably different characteristics, namely: starring and created by “younger” urologists and hematologists, depicting a diverse cohort of providers and patients, written/spoken in Spanish and Portuguese, informal dialogue, increased use of Q&A format. Compared to YouTube videos, TikTok posts were more recent, received more views, and were associated with more comments.

Conclusions
Our exploratory search for priapism educational resources revealed differences in content, tone, and format between online sites and mobile platforms. Based on view and comment statistics, it appears as though mobile platforms such as TikTok have an increasing role in disseminating knowledge about priapism. However, it remains unclear as to whether individual modalities are well-suited to deliver information in a specific disease phase (e.g. preventative, acute, or chronic). Importantly, the impact of word-of-mouth and private provider-to-patient interactions cannot be estimated by this methodology.

Disclosure
No.
(331) A Novel Epidemiological Approach to Geographically Mapping Selective Androgen Modulator Receptors (SARMs) in the United States Through Google Trends
Authors: Hammad MAM , Khan A , Yafi FA , Barham DW 
Published: February 2024

Abstract

Introduction
Selective androgen receptor modulators (SARMs) are a class of compounds known for their ability to exert agonistic and/or antagonistic effects on androgen receptors. Although there are currently no U.S. Food and Drug Agency-approved indications for SARMs, investigators are exploring the potential uses for these compounds.

Objective
This study aims to comprehensively assess the level of public interest in SARMs over the past ten years.

Methods
Google Trends data spanning the past decade was meticulously analyzed to evaluate the public interest in specific SARMs, (Ostarine, LGD-4033, GSK2881078, PF-06260414, AC-262,356), in comparison to testosterone replacement therapy and androgen replacement therapy. As benchmarks, control search terms, such as “news," "weather," "sports," "Google," "Netflix," and "Facebook" were employed.

Results
The 10 geographical areas with the highest SARM search rate were military instillations or towns surrounding military instillations. Within these areas, the search interest accounted for a median of 4.5% of the control search interest, while the areas displaying the greatest interest reached a substantial 12%. It is noteworthy that even in the presence of an awareness campaign against the use of unapproved supplements (such as SARMs) by the Department of Defense, SARM use steadily increased in close proximity to these identified areas. In contrast, metropolitan areas unrelated to military installations accounted for less than 1% of the control search interest. Search interest for “Testosterone” was 6% nationally, however, in areas associated with high SARM interest, search interest was 6.8%.

Conclusions
Our results suggest there is a higher rate of internet searches for SARMs at or near military instillations compared to other geographic regions. Since these medications are not FDA approved and still undergoing clinical investigation, the side effect profiles are not well understood potentially leading to adverse events. Further work is needed to understand if this increased interest translates to use of SARMs among our service members.

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.
(342) Glans Augmentation and Glans – Bulbospongiousus Reflex
Authors: Aglan A 
Published: February 2024

Abstract

Introduction
The creation of a barrier at the level of glans by the bulking agents blocking accessibility and inhibiting the tactile stimuli to reach the dorsal nerve of penis (branch of pudendal nerve) receptors is the theory behind the effect of hyaluronic acid in the field of premature ejaculation. Clinically there is a doubt about that as filler injection in frenular delta (most sensitive area in penis) and in G-spot at female accelerates time of ejaculation, some cases with history of failed dorsal neurectomy my response to hyaluronic acid injection, filler or fat injection in penis shaft doesn’t improve ejaculation time, in the opposite side implants like Elist`s implant (pneuoma) or other solid inner condoms improves premature ejaculations. The cause is that the hard implant masks pressure on the corona thus inhibits glans – bulbospongiosus reflex which delays the second phase of ejaculation, ring application at coronal sulcus delays ejaculation for the same reason, filler or fat is not solid and doesn’t resist pressure and compressed due to pressure. In glans area compression is not possible due to tight space at glans mucosa.

Objective
Explanation why glans augmentation by filler delays ejaculation.

Methods
Seven patients with history of previous glans penis augmentation (hyaluronic acid) with good response (12-14 months ago) instead of re-injection, Alaa Aglan operation was done, cutting of bulbospongiosus muscles bilaterally plus frenular delta excision 4 months post-operative all patients were injected by hyaluronic acid at glans.

Results
All patients were satisfied by the operation, 3 months post-operative the gained time was calculated for each patient (by himself) then hyaluronic acid injection was done. No change in time was reported in all patients and they reported that it was still the same time gained after surgery despite all patients reported satisfactory results after previous injection one year ago.

Conclusions
Inhibition of glans – bulbospongiosus reflex is the main cause to delay ejaculation after glans augmentation.

Disclosure
No.
(374) Comparing the Species Richness in Infectious versus Mechanical Failure Cases in Secondary Penile Prostheses Surgeries
Authors: Henry G , Henry C , Hollenbach S , Phillips C , Diaz N , Chung P 
Published: February 2024

Abstract

Introduction
Inflatable penile prosthesis (IPP) is a third-line treatment for treating erectile dysfunction in men. However, complications in the prostheses can cause the patient to undergo secondary penile prostheses (PP) surgery. Infection is a feared complication of IPP surgery and has a higher risk at secondary surgery. Next-generation sequencing (NGS) compares DNA to identify species and report relative abundances. NGS is an established method of microbial detection and identification in Orthopedics, Otolaryngology, wound care, and infectious disease. In prosthetic urology, NGS has been shown to provide better and more acute information than traditional cultures.

Objective
This study aims to identify species richness (i.e., number of species occurring in a sample) in penile prostheses that needed revision surgery in comparison between infectious etiology and mechanical failure cases. We hypothesize that, during secondary surgery, mechanical failure IPPs will display a greater species richness than infectious caused.

Methods
This study comprised 126 patients from 2 different centers that underwent revision PP surgery for either infectious or non-infectious issues. Upon entering the pump space (wiped pump/tubing/capsule) during surgery, 2 swabs specimens were collected and sent to the institutional laboratory for routine culture and the other to MicrogenDx for NGS testing. During the specimen evaluation, the species richness of each specimen was recorded and sorted based on the reason for revision PP surgery. ANOVA was used to test effects of ethnicity, age, diabetes status, implant duration, and year of implant removal.

Results
The demographics of the 126 patients consisted of a median age of 69 (1st quartile= 61, 3rd quartile= 76), of which 84 were White, 41 were African American, and 1 was of unknown ethnicity. 104 patients (83%) needed revision PP surgery due to mechanical failure causes, and 22 patients (17%) needed revision PP surgery due to infectious causes. From the data collected and analyzed, patients who needed revision PP surgery due to mechanical failure showed a larger species richness in the collected biofilm than patients who needed surgery due to infectious reasons (Figure 1; p= 0.04).

Conclusions
NGS has been shown to accurately represent the characteristics of biofilm present in secondary PP surgery, supported by similar results in Ortho and ENT literature. When the PP was clinically infected, NGS identified less species richness in biofilm from revision PP surgery than non-infectious PP biofilm which is consistent with infections being caused by a few key pathogens per case.

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