bluuebunny/crossref_metadata_2025_split huggingface dataset:
(222) Simultaneous Inflatable Penile Prosthesis and Adjustable Male Sling: A Step-by-Step Surgical Technique
Authors: Velasquez DA , Barreto Guimaraes PV , Kocjancic E , Raheem O 
Published: February 2024

Abstract

Introduction
Erectile dysfunction (ED) and urinary incontinence (UI) are common complications following radical prostatectomy (1). At twenty-four months post-surgery, approximately 43% of men experience some degree of ED, while UI affects around 15% of patients between twelve to twenty-four months (2, 3). Notably, nearly 20% of patients experience both ED and UI complications (4). Initial conservative management strategies include the use of PDE-5 inhibitors, intercavernosal injections, or a vacuum erectile device for ED and pelvic floor muscle training for UI (5). However, symptoms that persist or worsen beyond six months can be considered for surgical intervention (6). Surgical options include penile prosthesis implantation for ED and diverse techniques such as the Artificial Urinary Sphincter (AUS) or adjustable male urethral sling, depending on symptom severity, for UI management. Limited evidence suggests that a simultaneous surgical approach addressing both conditions can be a cost-effective and a safe alternative to separate surgeries (7, 8).

Objective
In this context, the objective of this video presentation is to illustrate a detailed, step-by-step technique for the simultaneous implantation of an inflatable penile prosthesis (IPP) and an adjustable male sling (AMS), while also discussing its feasibility, safety, and functional outcomes.

Methods
The combined IPP and AMS surgery is a safe, viable, and cost-effective option for patients who need to address both ED and UI. Rhee (2005) initially described the concurrent placement of a penile prosthesis (PP) and male sling (MS) in a series of four post-prostatectomy patients.

Results
The results demonstrated successful restoration of erections and complete continence in all patients, with no postoperative complications. Our previous systematic review, comparing the outcomes of simultaneous surgical placement of PP and MS versus PP and artificial urethral sphincter (AUS), found no clinically significant differences in outcomes between the two groups (Raheem 2021). Therefore, the simultaneous placement of IPP and AMS should be considered an option for patients, as it shows comparable effectiveness to other concurrent surgical interventions. Dual implantation of PP and male sling have also demonstrated cost savings of approximately $9,000 for patients, further enhancing its advantages in managing both ED and UI (Gorbatiy 2010). Ultimately, a collaborative discussion between patients and their urologist is crucial in determining the most suitable approach for patient individual needs.

Conclusions
The simultaneous surgical placement of an inflatable penile prosthesis (IPP) and adjustable male sling (AMS) presents a favorable and viable solution for managing erectile dysfunction (ED) and urinary incontinence (UI) in patients who exhibit an inadequate response to conservative management following prostatectomy.

Disclosure
No.
(225) Hard-flaccid Syndrome: A Survey of Sexual Medicine Practitioners’ Knowledge and Experience
Authors: Gryzinski G , Moukhtar Hammad M , Alzweri L , Azad B , Barham D , Lumbiganon S , Serefoglu EC , Yafi F 
Published: February 2024

Abstract

Introduction
Hard-flaccid syndrome (HFS) is a condition of male sexual dysfunction (MSD) that has become a relatively new focus in online forums and urologic conferences. It is a poorly understood syndrome characterized by chronic pain, a partially rigid penis while in a flaccid state, and erectile dysfunction. HFS primarily affects men in their second and third decade of life, but its exact pathophysiology remains uncertain, with hypotheses suggesting a combination of physical and psychological factors. Consequently, an evidence-based understanding of HFS is lacking within the sexual medicine community.

Objective
Identify and quantify the current level of understanding of HFS in the sexual medicine academic society.

Methods
A survey was provided to sexual medicine practitioners at the 2023 American Urological Association (AUA) who attended a plenary focusing on sexual medicine. Each survey form included a screening question to determine familiarity with HFS. If they were familiar with HFS, there were multiple additional questions querying experience with HFS in their patients, modalities of diagnosis, preferred therapy options, in addition to others. These answers were then extracted onto a spreadsheet and analyzed.

Results
According to the registration reports from the 2023 AUA conference, there were 37 attendees at the sexual medicine plenary. A total of 36 survey responses were submitted. Of these, 35 were urologists and 1 responder was a mental health professional. Among the respondents, 8 (35%) acquired knowledge about HFS through colleagues, 6 (26%) mentioned medical journals, 4 (17%) mentioned conferences, 4 (17%) mentioned patients, and 1 (5%) stated that they first heard about it from an online pelvic floor therapist. Regarding the diagnostic approach for HFS in their practice, 17 responders considered clinical history, 16 relied on patient self-diagnosis, and 1 utilized imaging, although the specific imaging modality was not specified. Most respondents (74%) indicated that they had seen 1-10 patients with HFS, with 4 and 2 respondents reporting 11-20 and 21-50 patients, respectively. In terms of their beliefs about HFS as a legitimate condition, 12 responders expressed confidence in its existence, while 7 remained uncertain. Most respondents (11) suggested pelvic floor therapy as the optimal approach, with 10 recommending combination therapy.

Conclusions
This analysis highlights the ongoing lack of familiarity with HFS among professionals. This project provides valuable insights into the current understanding of this complex condition. The outcome emphasizes the critical need for continued education and research on HFS to improve diagnostic accuracy, enhance patient care, and develop effective treatment strategies.

Disclosure
No.
(234) How Age and Obesity Influence Erectile Dysfunction: Evaluation Based Upon Penile Color Duplex Doppler Ultrasound
Authors: Sikka S , Panner Selvam MK , Shalaby H , Hellstrom W 
Published: February 2024

Abstract

Introduction
Color duplex Doppler ultrasound (CDDU) is an objective and reliable diagnostic tool for documenting penile hemodynamics. Objective vascular testing provides a physiologic diagnosis of erectile dysfunction (ED) and helps direct appropriate therapy even in this age of ED management including oral drugs. Although age and diabetes are known to be the major etiological factors in development of ED, it is not clear whether obesity as such also plays any role or not.

Objective
The main objective of this study is to retrospectively assess the penile CDDU hemodynamic parameters of obese men with ED in comparison to non-obese ED men in relation to age.

Methods
A total of 271 men including obese and non-obese who were diagnosed with ED visiting our Andrology clinic were included in this study. Initial ED was determined by using the International Index of Erectile Function (IIEF) score. Penile CDDU data was retrospectively collected from these ED patients, and parameters mainly peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were used for analysis. RI (=PSV-EDV/PSV) was calculated, and different types of penile vascular status were established based on our previously published SOP guidelines for standardization of penile CDDU parameters. Statistical analysis was performed using MedCalc statistical software version 22.009 (MedCalc Software bv, Ostend, Belgium).

Results
Our study results revealed that with advancement of age the occurrence of vascular changes in obese men were higher in comparison to non-obese men with ED. Table 1 summarizes the influence of obesity on the prevalence of penile vascular status in different age groups of obese and non-obese men with ED. Surprisingly, higher number of obese men showed non-vascular, venous and mixed vascular components compared to non-obese ED patients. Among these obese groups of all ages, the venous leakage was prevalent than arterial or mixed components.

Conclusions
Our current analysis indicates that besides age, obesity is also one of the major risk factors in altering the penile hemodynamics with increased incidence of veno-occlusive dysfunction (VOD) in ED patients. In addition, this demonstrates the utility of performing CDDU and diagnosing the presence of VOD in further understanding the pathophysiology of obesity associated ED, and an important determining factor in such patient care.

Disclosure
No.
(243) Frenular Delta Excision with Neurectomy of Ventro – Lateral Branches of Penile Dorsal Nerves (Alaa Aglan4 Operation)
Authors: Aglan A 
Published: February 2024

Abstract

Introduction
Neurectomy is one of the surgical options used for treatment of premature ejaculation, variable degrees of neurectomy could be done, aggressive neurectomy may cause severe demenishion in sensations as occurs in cases of perovic technique for penis elongation or in cases of sliding techniques used in treatment of peyronie`s disease also it increases the risk of erectile dysfunction. In our old trials in phalloplasty and penile implantation we were doing neurectomy routinely with few exceptions, the success rate at that time was 78% and some side effects were reported e.g neuroma, numbness, and recurrence. After application of prediction test (spraying local anesthesia procomail at frenular area (temporary excision) and local injection around the chosen nerve/s) the picture has been changed. as we could predict the expected gained time post-surgery. The classic neurectomy is related to neural supply of glans. once we was doing classic Alaa Aglan operation (cutting bulbospongiosus muscles bilaterally plus frenular delta excision) but we found the muscles congenitally absent so we excised part of frenular delta with neurectomy to neural supply to the same area (i.e. ventro – lateral branches of dorsal nerves) the results were satisfactory to the patient. Many patients were afraid of muscles cutting at our early trials, so this operation was the alternative option, dorsal neurectomy could be done with it according to prediction tests in some cases (usually with implants).

Objective
Presentation of new operation for treatment of premature ejaculation (Alaa Aglan4).

Methods
Study was done between 3/12/2011 – 8/2/2017 (5 years following up), 247 patients were operated (after prediction test), partial excision of frenular delta plus neurectomy to ventral branches of RT and LT penile dorsal nerves. Neurectomy was done at middle third of penile shaft before branching. Dissection of proximal part till penis root and retraction of the proximal end and placing it at penis root area (to avoid reunion or recurrence).

Results
Numbness was reported in 13 patients disappeared within 3 months, neuroma was obvious in 7 patients treated by vitamin B injection in 5 patient’s. Re-excision of 2mm of proximal neural end (under local anesthesia) in 3 patients. No recurrence was reported. The dissection of nerves and covering the proximal end with inverted skin graft or silicone cap as a barrier between the nerves ends to prevent reunion and recurrence was done outside this study, but this technique is simple and easy. Erectile dysfunction was not reported in all patients. after 4 months all patients were satisfied by the ejaculation time.

Conclusions
Alaa Aglan4 operation is simple, effective, safe and permanent treatment for premature ejaculation guided by prediction test.

Disclosure
No.
(246) Age Dependent Effect on Contralateral Testicular Compensation Following Testicular Loss
Authors: Nassau D , Deebel N , Kresch E , Loloi J , Bernstein A , Temple D , Kulandavelu S , Arora H , Ramasamy R 
Published: February 2024

Abstract

Introduction
The human testicle is susceptible to loss from events like torsion, trauma, cancer, or cryptorchidism. Most paired organs are known to undergo compensatory hypertrophy following unilateral organ loss. The testicle is physiologically distinct in that it is thought to undergo a period of quiescence in childhood. Previous work has demonstrated testicular hypertrophy occurs if the loss of the contralateral testis occurs before puberty. However, it is unknown if compensatory physiology and growth differs by age of pre-pubertal loss.

Objective
This study aimed to investigate compensatory changes in testicular growth and the hormonal axis following unilateral orchiectomy in a neonatal, pre-pubertal and pubertal/adult murine model.

Methods
C57BL/6 mice were divided into experimental groups: neonatal (days of life 2-4), pre-pubescent (days of life 12-21), and post-pubescent (days of life 42-44) to undergo unilateral orchiectomy. A control group that did not undergo orchiectomy was utilized. Mice were sacrificed at maturity (over 80 days of life), blood samples were drawn, and the remaining testis was removed. Body and testis weight and testicular length in the long axis were measured in blinded fashion. Similarly, testosterone, luteinizing hormone (LH), and Follicle stimulating hormone (FSH) were assessed and expressed as a median and an interquartile range.

Results
Contralateral testes from neonatal and pre-pubertal mice who underwent orchiectomy weighed more (110.5, 12.2 and 103.0, 7.2 mg respectively. Figure 1.) (p &lt; 0.05) than the control mice (91, 11.9 mg, respectively). There was no difference between post-pubertal group and control group. The degree of compensatory hypertrophy was greater in the neonatal group but not the pre-pubertal group when compared to the post-pubertal group. When examining the ratio of testicular weight to body weight, only the neonatal group was significantly higher than that of the control. Differences in FSH and testosterone were not statistically significant between experimental and control arms (p &gt; 0.05). LH was significantly elevated in all experimental groups as compared to the control (p &lt; 0.05).

Conclusions
This is the first study to assess testicular compensatory hypertrophy following contralateral testicular loss using a neonatal mouse survival surgery model. Testicular hypertrophy occurs when unilateral loss occurs prior to puberty, but not in adulthood in mice. Earlier testis loss may contribute to a greater degree of growth. Functionally, the unilateral testis can maintain eugonadal testosterone levels, but higher levels of LH are required following hemicastration to sustain eugonadal testosterone levels. Future studies are warranted to identify testicular transcriptomics in this model to evaluate for candidate genes potentially responsible for this phenotypic change.

Disclosure
No.
(254) Extracorporeal Shock Wave Therapy Combined with Cannabidiol Reduces Prostatic Inflammation by Regulating TLR4-NFκB Signaling Pathway
Authors: Bae WJ , Piao JJ , Kim S , Park S , Kim SW 
Published: February 2024

Abstract

Introduction
Chronic prostatitis is a refractory male disease that has bothered patients and confused urologists for a long time. Recently, extracorporeal shockwave therapy (ESWT), has evolved as a promising treatment approach in several inflammatory disease. Cannabidiol (CBD) is a minor cannabinoid with reported analgesic and anti-inflammatory properties.

Objective
To evaluate the effect of CBD and ESWT in lipopolysaccharide(LPS)-induced prostatic inflammation \

Methods
RWPE-1 cells were randomly divided into five groups: (a) RWPE-1 group (normal control), (b) LPS group (LPS-induced inflammation) and (c) CBD group (LPS-induced RWPE-1 treated with 0.1ug/ml of CBD), (d) ESWT group (LPS-induced RWPE-1 treated with ESWT), (e) CBD+ESWT group (LPS-induced RWPE-1 treated with CBD and ESWT). After administration of treatment, cells were collected for immunocytochemistry and Western blot analysis, respectively.

Results
CBD and ESWT improved the inflammation of LPS-induced RWPE-1 cells, with the most significant improvement in the CBD+ESWT group (p &lt;0.01). Compared with the LPS group, CBD, ESWT decreased cyclooxygenase 2 (COX-2) expression by inhibiting the TLR4-NFκB pathway (p&lt;0.01).

Conclusions
CBD and ESWT reduce inflammation by degrading COX-2 in the microenvironment through the TLR4-NFκB inhibition pathway. ESWT combined with CBD improves inflammation significantly, thus suggesting that the combination treatment may be a potential and promising therapeutic approach for prostatitis.

Disclosure
No.
(257) Is Adderall Effective in the Treatment of Delayed Ejaculation? A Continued Retrospective Analysis
Authors: Johnson A , Dymanus K , Quesada-Olarte J , Levine L 
Published: February 2024

Abstract

Introduction
Numerous treatments have been evaluated for delayed ejaculation (DE), but many are considered sub-optimal and have limited data support. This results in significant patient distress and leads to confusion for providers on the best treatment recommendations for this difficult sexual medicine condition. Preliminary studies have shown as needed low dose Adderall (amphetamine/dextroamphetamine) to provide improvement in symptoms and orgasmic latency time in patients with delayed orgasm or anorgasmia.

Objective
The objective of this study is to retrospectively assess the efficacy of Adderall treatment in men with DE, as well as associated comorbidities. The first phase of this study establishes baseline characteristics of patients that were prescribed Adderall for DE. The second phase of this study includes a survey to assess optimal frequency and dosage based on patient satisfaction and any side-effect profile.

Methods
Patients were identified from an AllScripts query using ICD-10 codes of “Retarded Ejaculation” (N53.11) and “Other ejaculatory dysfunction” (N53.19) and retrospective record review identifying men with DE over 18 years old having been prescribed Adderall. Objective data was collected including biothesiometry results, total testosterone levels, penile prosthesis placement, previous circumcision, and presence of co-morbidities such as erectile dysfunction, diabetes, depression, prostate cancer, smoking and neurologic disorders. Success was defined as subjective reduced time to orgasm per patient report. The second phase of this study includes contacting this study group via survey (RedCAP and phone) to assess the effective dose and side effects of using Adderall for DE.

Results
35 men were treated with Adderall for DE. In total, Adderall was shown to be preliminarily effective in 31% of patients (11/35) with 40% unable to be determined from retrospective review. The majority of patients were started on 5mg Adderall and titrated up to 20mg as needed taken 1-4 hours before sexual activity. Baseline patient characteristics are detailed in Table 1. The average age of patients was 59 years old with 57% of patients over the age of 70 years old. 65% (20/35) patients had abnormal biothesiometry results. There were no adverse events reported.

Conclusions
Low dose Adderall resulted in preliminary improvement in at least 31% of patients with DE. Further patient surveillance is planned, in part to determine if particular patient characteristics may be better for this approach. It is critical to avoid misuse of this drug and larger prospective studies are still needed. This study supports the use of Adderall as another treatment option for this difficult and poorly understood condition.

Disclosure
No.
(274) Sexual Assault Resulting in Hemoperitoneum and Multiple Genital Tract Injuries
Authors: Idowu OC , Ogunkuade MF , Adewumi BA , Olayemi OO 
Published: February 2024

Abstract

Introduction
The sexual experience ought to be pleasant and desirable, this case however demonstrates one of such unusual sexual events with catastrophic ending that may have resulted in fatality but for timely surgical intervention. The first coital experience for women may be associated with discomfort but when it is non-consensual the damaging effect of the trauma is deeper and may last for a lifetime.

Objective
To demonstrate unusual presentation of coital injuries with hemoperitoneum and its management in low resource settings to reduce immediate and long-term effects including death.

Methods
A case report of an 18-year old nulliparous lady with no prior sexual exposure who presented with vagina bleeding of 18hours following non-consensual penetrative sexual intercourse perpetrated by her religious cleric. Bleeding was in excess of 500mLs with associated lower abdominal pain and dizziness. She presented in hypovolaemic shock with severe anemia (hematocrit - 15%). There was ongoing vagina bleeding with mild abdominal distension. No skin injuries.

Results
She had genital tract exploration with findings of a 3cm peri-urethral vaginal laceration and a 6cm longitudinal rent on the posterior upper vagina extending to the cervix. The apex of the vaginal laceration could not be visualized from the vagina, necessitating exploratory laparotomy. Findings at surgery include 1.7L of hemoperitoneum and a transverse laceration on the posterior cervix extending into the lower uterine segment about 5cm long. The lacerations were repaired per vagina and per abdomen respectively with hemostasis secured. She had other supportive care including antibiotics, blood transfusion, analgesics, tetanus prophylaxis, Post-exposure prophylaxis for HIV and Hepatitis B immunoglobulin as well as emergency contraceptives. She was counselled with empathy and referred to the clinical psychologist for mental health support to prevent long term mental health effects. The assailant was arrested by the police and charged to court

Conclusions
Sexual assault may be associated with significant morbidities including unusual presentation such as hemoperitoneum and cervico-uterine laceration even in the absence of obvious skin injuries. Early presentation and appropriate intervention can help limit the adverse outcomes that may be associated as well as long term sequelae.

Disclosure
No.