bluuebunny/crossref_metadata_2025_split huggingface dataset:
(245) Surveying the Genomic Landscape of Peyronie's Disease: A Study of 22 Cases
Authors: Machado B , Oliveira A 
Published: February 2024

Abstract

Introduction
Since its description in 1743 by François de la Peyronie, penile fibromatosis continues to present an elusive pathogenesis. One of its distinguishing characteristics is the excessive proliferation of fibrogenic myofibroblasts, resulting in the formation of dense fibrous plaques that disrupt the normal cytoarchitecture of the tunica albuginea, giving rise to penile abnormalities. The possible clonal nature of the disease has been investigated by many studies and some have identified occasional karyotypic abnormalities, most commonly involving chromosomes 7, 8, 17, 18, X and Y (Mulhal JP et al 2004).

Objective
This study aimed to comprehensively analyze the genomic landscape of Peyronie's disease in a significant number of cases using a whole genome copy number variation assay (CNV). The objective was to identify any recurrent chromosomal gains or losses that could shed light on the pathogenesis of this disease, including the potential identification of an underlying clonal process.

Methods
Thirty-nine surgical specimens were retrospectively examined from men diagnosed with Peyronie's disease, collected between 1992 and 2022 (median age: 56 years, range: 17-73). The study was conducted under the approval of the Institutional Review Board (IRB # 22-006924). Tissue samples were fixed in 10% buffered formalin, embedded in paraffin, and subsequently subjected to histologic review and DNA analysis. DNA extraction followed standard protocols. Among the samples, 22 contained high-quality material suitable for CNV array analysis using the OncoScan SNV array, which encompassed approximately 900 genes/loci with a resolution of 50-125 kb. Additionally, the array included a somatic mutation panel targeting nine cancer-related genes.

Results
No significant loss or gain of chromosomal material was identified in the twenty-two cases analyzed. However, the somatic mutation panel revealed potential unconfirmed DNA mutations in NRAS, EGFR, and TP53. Ongoing studies are being conducted to confirm these mutations.

Conclusions
The etiology and pathogenesis of Peyronie's disease remain unresolved, presenting a challenging area of research. However, the findings of this study provide evidence that major recurrent losses or gains of chromosomal material are unlikely to play a significant role in the pathogenesis of this disease. While shedding light on this aspect, it is crucial to acknowledge that further research is necessary to confirm and expand upon these initial observations.

Disclosure
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(272) Botulinum Toxin Injection in Vulva and Vagina: Evidence from a Literature Systematic Review
Authors: Benalla A 
Published: February 2024

Abstract

Introduction
Vaginismus, vulvodynia and chronic pelvic pain are a group of pain syndromes that may have, in addition to pain, other types of symptoms. Often no specific etiology can be identified, and the choice of treatment is complicated. Although several treatment methods have been proposed, evidence-based therapies are limited. Therapies can be classified in medical, surgical and interventional treatment. Interventional therapy contemplates injection therapy with botulinum toxin, proposed in 1997

Objective
To evaluate the BoNT injection in the comprehensive care of vaginismus, vulvodynia and chronic pelvic pain and to enhance the impact on the sexual arousal.

Methods
1108 patients, Randomized Controlled Trials (RCT) were 7. The Retrospective Studies Without a control group were 4, With a control group: 1. Besides, the Prospective Studies Without a control group were, . 2 patients were With a control group. The BoNT Dosage Range was: Minimum: 12 UI Maximum: 500 UI Types of BoNT Products: Botox® (onabotulinumtoxinA): 14 Xeomin® (incobotulinumtoxinA): 3 Dysport® (abobotulinumtoxinA): 3 Unspecified BoNT Product: 1 EMG-Guided Injection: 5 I used as BoNT Administration Techniques, the Digital Palpation: 12, the unspecified Injection Procedure: 4. My methods were 17 patients in Intramuscular Injection, 3 patients with Vaginal Submucosal Plane, and one patient with Subcutaneous Injection.

Results
For Vaginismus, Significant improvement in sexual and orgasmic dysfunction Successful intercourse Reduction of vaginal muscle resistance Improved sexual function (evaluated by Female Sexual Function Index) Pain reduction and improved quality of life (Short-Form Health Survey) BoNT reduced muscular hyperactivity. Both BoNT and placebo improved sexual pain, function, and distress for patients with vulvodynia, Significant improvement in pain 4, improved quality of life 2 and increase of sexual activity due to the reduced pelvic hypertonicity. Other Study Results: Significant improvement in pelvic pain [22, 23, 31, 32] Reduction of vaginal pressure [32] Improvement in quality of life, sexual activity, and reduced pelvic floor muscles myoelectrical activity [31]

Conclusions
Different endpoints and different methods of analysis. Different types of participants. Various techniques and timing. Adverse events. For this reason, even though BoNT seems a promising treatment, a clear standardization in clinical guidelines is still lacking. A clear standardization is needed for practical guidelines. Future perspectives should address reproducible protocols for BoNT administration.

Disclosure
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(286) Gender Disparities Exist in the Surgical Management of Peyronie's Disease and Urologic Prosthetics: An Evaluation of American Board of Urology (ABU) Surgical Case Logs
Authors: Bui K , Hochberg A , Schneider AC , Chung PH 
Published: February 2024

Abstract

Introduction
Urology has been predominantly male-dominated, although recent trends indicate increased female representation among urology residents, physicians and advanced-practitioner providers. While progress has been made, gender disparities persist due to societal perceptions and biases. The goal of this study was to investigate whether a provider gender gap exists in the field of reconstructive urology using American Board of Urology (ABU) case logs.

Objective
To examine case volume characteristics for provider gender disparities in Peyronie’s disease and urologic prosthetic surgery.

Methods
Retrospective review of surgical case log data from 2003 to 2023 of certified urologists was performed for 11 Current Procedural Terminology (CPT) codes for the surgical management of Peyronie’s disease (penile plication CPT 54360, plaque excision/incision with grafting CPT 54111, 54112), male urethral sling or artificial urinary sphincter (CPT 53440, 53445), and placement of penile implant (CPT 54400, 54401, 54405). Inclusion criteria included male patients who were 18 years old or older. Data collected included patient and surgeon demographics, surgical procedure, and surgeon fellowship training status. Cases were analyzed using descriptive statistics and regression testing.

Results
From 2003 to 2023, a total 2,852 urologists performed 15,171 Peyronie’s disease and urologic prosthetic surgical procedures. Among these procedures, 1,910 (13%) Peyronie’s disease, 8,940 (59%) penile implant, and 4,321 (28%) incontinence procedures were identified. Out of the total practicing urologists, 2,626 were male and 226 were female; the distribution of cases revealed 5 cases performed per male surgeon and 4 cases per female surgeon. Over two decades, there was a significant positive trend in the proportion of cases performed by female surgeons (p &lt; 0.001). 169 (6%) surgeons completed fellowships in Andrology or Male Reconstruction, and performed 2,129 (14%) of total procedures. Across surgeons with Andrology or Male Reconstruction fellowship-training, there were 13 cases performed per male surgeon and 7 cases per female surgeon.

Conclusions
Our study confirms underrepresentation of female surgeons in the field of Peyronie's disease and prosthetic urology. Although there is a trend of increasing female representation over time, further research can be done to identify barriers to gender equality in the field.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.
(292) Underneath the White Coat: Testosterone Deficiency in Male Resident Physicians
Authors: Krishingner G , Mallory C , Moy L , Campbell K 
Published: February 2024

Abstract

Introduction
Resident physicians are a vulnerable population often subjected to long working hours, atypical sleep schedules, and high stress working environments. These conditions have been associated with hypogonadism in other populations, but hypogonadism has been inadequately studied in this unique population. Symptoms of hypogonadism have a high degree of overlap with conditions such as burnout and depression, both of which have been well-established in this population.

Objective
This study aims to examine the prevalence of hypogonadism among male resident physicians, a demographic susceptible to conditions contributing to hormone deficiencies due to their demanding work environment.

Methods
This is a prospective study to evaluate male physicians in medical training who voluntarily participated in wellness screening at our institution. Following approval by the Institutional Review Board, residents at a high-volume tertiary referral center were contacted via e-mail regarding participation in men’s health screening. Baseline demographics were obtained including age, specialty, and post-graduation year (PGY). Participants were asked to complete the Androgen Deficiency in the Aging Male (ADAM) and 36-Item Short Form Health Survey (SF-36) questionnaires in additional to obtaining lab work: BMP, CBC, Lipid panel, thyroid panel, testosterone, FSH, LSH, and estradiol. Survey questionnaire data was obtained through Research Electronic Data Capture (RedCAP).

Results
Out of 651 male residents and fellows contacted, 27 residents responded (4.1%) with 66.7% (18/27) completing surveys and 33.3% (6/18) undergoing lab tests. Two-thirds (4/6) of these participants had total testosterone levels &lt;400ng/dl and two participants met serum criteria for hypogonadism. Half (9/18) of participants scored positively in their ADAM responses. 44.4% (8/18) reported their health as worse compared to a year prior (Table 1).

Conclusions
The preliminary findings suggest a significant prevalence of hypogonadism symptoms among male resident physicians. Given the severe impact of hypogonadism on overall health and work productivity, implementing wellness screening among this population could lead to earlier detection and management. However, additional research is required, especially considering the low response rate of this study.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Tolmar Pharmaceuticals.
(295) Characterizing Testosterone Transference Risk Among Men Undergoing Evaluation for Low Testosterone
Authors: Thorogood SL , Novaes LF , Mulhall JP , Flores JM 
Published: February 2024

Abstract

Introduction
Pre-pubertal exposure to exogenous testosterone (T) is known to cause virilization and precocious puberty (PP). Thus, the AUA and the US Food and Drug Administration have warned of the risk of transference associated with T gels/creams. Yet, little is known about the testosterone transference risk (TTFR) profiles of men undergoing evaluation for low T.

Objective
We aimed to identify the prevalence of TTFR in men undergoing evaluation for low T.

Methods
This retrospective analysis included all men with TTFR documented during evaluation for low T at our institution. Total/free T were measured using LCMS/equilibrium dialysis in an early morning fashion. Patients were asked for frequency of contact with at least one child ≤ 12 years old. TTFR was deemed as high if the patient reported a frequency of contact ≥1/month with a pre-pubertal child; all other patients were classified as having low TTFR. Demographic, comorbidities and hormone profile at the time of TTFR assessment were analyzed.

Results
118 men had TTFR documented. Median age was 62 (48, 70) years; 20% were ≤ 40 years, 27% were 41-60 years, 53% were ≥ 61 years. Median number of comorbidities was 2 (0, 2); 36% of men had two or more comorbidities. 17% had diabetes. 97% of men had a history of cancer: prostate 57%, testis 22%, bladder 4%, hematologic 8%, pituitary neoplasm 2%. Median T level was 220 (170, 310) ng/dL, free T 6.6 (5.3, 10.7) ng/dL, estradiol 14 (11, 19) pg/mL, luteinizing hormone 4.3 (2.5, 8.9) IU/L, hemoglobin A1c 5.6 (5.3, 6.1)%, and hematocrit 43 (40, 45)%. Regarding TTFR, 53% of men were classified as high-risk for T transference based on the a priori definition utilized. In the overwhelming majority of instances, high TTFR was associated with family contact (children and grandchildren). Patient occupation (pediatrician, counselor) was the second most cited reason for high TTFR.

Conclusions
Among men being evaluated for low T, more than half had a high TTFR. These findings suggest that the TTFR assessment prior to start T therapy is critical, that high TTFR is highly prevalent, and that TTFR should be documented and discussed with the patients during T therapy counseling.

Disclosure
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(320) Erectile Dysfunction and Men’s Health Websites: How diverse is our Racial, Ethnic, and Sexual Orientation Representation?
Authors: Channa L , Reynolds E , Staff I , Mclaughlin T , Pinto K , Olivo Valentin L , Bieniek J 
Published: February 2024

Abstract

Introduction
Images featured in patient educational materials can enhance comprehension of medical conditions, particularly those associated with sensitive issues like erectile dysfunction (ED). Past research indicates that minority men are often underrepresented in online urological content and thus may not relate to the material.

Objective
The present study aims to evaluate the representation of racial, ethnic, and sexual orientation diversity in ED and men’s health content on reputable urology program websites.

Methods
Websites of the top urology departments from U.S. News & World Reports 2022 rankings were reviewed as sources of high quality content. All subpages were reviewed to identify ED and men’s health sites with extraction of photo and video imagery depicting human subjects. A three-person review team interpreted race, ethnicity, and sexual orientation categorically. Race was also interpreted using a numeric scale, Fitzpatrick skin rating, and median ratings classified as white (1-3) or non-white (4-6). Consensus ratings were summarized descriptively. Spearman’s rank correlation was used to measure inter-rater reliability of Fitzpatrick ratings and MedCalc’s z-test used to compare diversity proportions to national rates from census data.

Results
The top 50 ranked urology program websites were reviewed. Seven programs did not have any patient-facing ED or men’s health web pages. Nearly half of programs with sites did not contain any human images (n=19/43, 44%). A total of 113 images were collected and reviewed. Race in the 102 (90.3%) interpretable images included 6 (5.9%) Asian, 16 (15.7%) black, 75 (73.5%) white, and 5 (4.9%) other men. Latino men were represented in 3/70 (4.3%) images. Utilizing Fitzpatrick ratings, 94 (83.2%) subjects were classified as white and 19 (16.8%) non-white. Most images [67 (59.3%)] demonstrated a man without a partner which precluded sexual orientation evaluation. Of those pictured with a partner, 25 (92.6%) were interpreted as heterosexual and 2 (7.4%) as same sex. Between reviewer correlation coefficients for Fitzpatrick ratings ranged from 0.66-0.69. Table 1 compares interpreted image data to population benchmarks from United States census data.

Conclusions
Limited imagery on academic urology ED websites continues to underrepresent some groups, namely Latinos. Although men in same sex relationships were depicted, the absolute number of such images was low. Conscious effort to improve diversity in online men’s health, and namely ED, content is needed.

Disclosure
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(324) History of Priapism Treatment in the 20th Century
Authors: Kulkarni A , Ikedionwu I , Singh A , Penukonda S , Bloom D , Raheem O 
Published: February 2024

Abstract

Introduction
Priapism, defined as a prolonged erection in the absence of sexual arousal, leads to decreased quality of life, physical health, and increased erectile dysfunction. The modern priapism treatments of vasoconstriction and cavernous aspiration stem from strides made throughout the last century.

Objective
As a result, we seek to chronicle the history of priapism treatment throughout the 20th century.

Methods
We reviewed over two dozen academic articles and medical textbooks from 1872 to 1990 with relevant information on priapism treatment.

Results
In the 19th century, treatment of priapism solely involved symptomatic management with morphine and medicinal leeches. In 1928, Dr. Robert McKay and Dr. John Colston discovered that a thrombotic condition is sufficient to sustain an erection and that removing clots from the penis is sufficient to alleviate the erection. They recommended the newly-discovered anticoagulant heparin as a potential remedy. Dr. Rita Franklin then established in 1940 a positive association between testosterone propionate levels and priapism in eunuchoid men. Priapism therapies improved exponentially beginning in the late 1950s. Dr. H. Stephen Brody conducted the first successful penile aspiration in 1957 by aspirating blood from the base of each corpus cavernosum in a hypotensive patient. This groundbreaking procedure is conducted to this day for patients who do not respond effectively to medication management. Nine years after Dr. Brody’s study in 1966, Dr. Robert Garrett and Dr. Donald Rhamy reported penile flaccidity and sexual satisfaction in five patients who underwent a corpus-saphenous shunt to improve venous drainage. In 1997, Dr. Pierre Bondil and colleagues conducted a novel experiment demonstrating the efficacy of vasoconstrictive alpha agonist agents in decreasing penile blood flow to decrease erections and preserve erectile function.

Conclusions
The last one hundred years has shown significant innovation in the treatment of priapism. Some of the major developments in the first half of the 20th century included the use of heparin and the establishment of a relationship between testosterone and priapism. The second half of the 20th included treatment still in use today, such as carvenoglandular shunts and vasoconstrictive agents. Therapies from the 20th century will continue to play a vital role in the treatment and research of priapism management.

Disclosure
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(330) Testosterone Replacement Therapy in Hypogonadism: A Single Center Longitudinal Analysis of Treatment Patterns and Clinical Outcomes
Authors: Iacobucci A , Naeem T , Saffati G , Gadiwalla Q , Mody-Bailey N , Green C , Lipshultz LI , Khera M 
Published: February 2024

Abstract

Introduction
Male hypogonadism impacts the production of hormone production, which plays a key role in masculine growth. It has also been shown to impair certain male reproductive functions or delay development.

Objective
The goal of this study is to describe the characteristics and treatment outcomes for patients with a diagnosis of Hypogonadism (HG) presenting to an academic urology center.

Methods
An IRB was approved to conduct a longitudinal study on the outcomes of male hypogonadism at a high-volume tertiary referral center. Men diagnosed with hypogonadism were identified by ICD 10 code (E 29.1). Clinical, demographic, laboratory, and testosterone replacement therapy and outcomes were extracted from the EMR.

Results
This retrospective study included 537 patients with a median age of presentation of 52 years (IQR: 42-68). At the initial visit, 66% presented with low libido, 65% with erectile dysfunction (ED), and 6% with depression. On initial hormonal evaluation, median (IQR) measurements for testosterone, free testosterone, and estradiol were 294 (217.5-417), 6.1 (4.45-8.0), and 4 (2-17) respectively. 227 (56.5%) patients elected to begin Testosterone Replacement Therapy (TRT). Of these, five treatment types of TRT were observed: 114 (53%) patients elected for intramuscular TRT, 25 (12%) utilized a pellet implant, 74 (34%) utilized topical treatment TRT, 3 (1.4%) used pellet and topical, and 1 (0.5%) used topical and intramuscular. Following TRT, 143 (79%) patients endorsed an improvement in ED, 175 (84%) reported improved libido, 176 (84%) reported increased energy levels, and 88 (59%) showed improvement in muscle mass. Follow-up labs measuring testosterone, free testosterone, and estradiol demonstrated medians of 486 (IQR: 296.5-802.8), 15.3 (IQR: 6.9-88.7), and 16.45 (IQR: 3-28.85) respectively. Adverse events while on TRT were 32 (15%) polycythemia, 3 (1.4%) VTE’s, and 3 (1.4%) MI.

Conclusions
Sexual dysfunction is a prominent symptom encountered by men with hypogonadism. However, only 56.5% of hypogonadal men pursue TRT, with intramuscular injections being the most commonly prescribed formulation. In our longitudinal cohort, we report that polycythemia and cardiovascular events are uncommon sequela after TRT. Further randomized control trials are warranted to better understand cardiovascular events' association with TRT.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(332) Predictors of being at High Risk for Obstructive Sleep Apnea in Men Presenting for Low Testosterone Evaluation
Authors: Novaes LF , Salter C , Tan M , Flores JM , Mulhall JP 
Published: February 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is a common condition and is more common in men with obesity and low testosterone (T). In men with OSA, T therapy is associated with the development of polycythemia (POLY). It has been shown that men with OSA have a higher risk of POLY with T therapy.

Objective
We aimed to identify the predictors of being at high risk for OSA in men presenting for low T assessment.

Methods
The study population included men undergoing low T assessment who completed the OSA risk assessment questionnaire, the STOP-BANG (SB). SB contains 8 questions: STOP (Snoring, Tiredness, Observed apnea during sleeping and high blood Pressure); BANG (BMI ≥ 35, Age ≥ 50, Neck circumference ≥ 17 inches, Gender). Each question is scored as yes (1) or no (0) and is scored 0-8. Using this score, patients are categorized as low risk of OSA (score 0-2), intermediate risk (score 3-4), or high risk (score ≥ 5 or ≥ 3 plus a BMI ≥ 35 or a neck circumference ≥ 17 inches). We also measured total T and free T levels, hematocrit (HCT), and recorded BMI and demographics. Multivariable analysis (MVA) was performed to define predictors of having a high risk of OSA. Parameters in the model included: age, comorbidities (hypertension, diabetes, dyslipidemia, coronary arterial disease), total T, HCT, and BMI. Receiver operating characteristic (ROC) analysis was performed to identify a BMI cut-off point associated with high risk OSA.

Results
321 men were analyzed. Median age was 64 (56, 69) years. Median SB score was 4 (3, 5), 55% were high risk, 25% moderate risk, and 19% low risk. 46% had 2 ≥ comorbidities. 57% had T levels ≤300 ng/dL. Median total and free T were 281 (222, 373) and 7.5 (5.4, 10) ng/dL and median LH was 3.7 (2.2, 6.7). Median HCT was 44% (41, 46). 33% had HCT ≥ 45%, and 4% had HCT &gt; 50%. Median BMI was 29 (26, 33) kg/m2 and 42% had obesity (BMI ≥ 30 kg/m2). On MVA, BMI and ≥2 comorbidities predicted high risk for OSA. ROC analysis showed cut-off point BMI ≥ 27 kg/m2 is associated with high risk for OSA by SB (sensitivity=0.8; specificity=0.6; AUC=0.77; p&lt;0.001). For men with BMI ≥27 kg/m2, the rate of high risk OSA was 71%, versus 29% rate of high risk in men with BMI &lt;27 kg/m2.

Conclusions
BMI ≥ 27 kg/m2 or higher and the presence of 2 or more comorbidities are the main predictors of high risk OSA.

Disclosure
No.