bluuebunny/crossref_metadata_2025_split huggingface dataset:
(340) The Association Between Varicocele and Premature Ejaculation: Systematic Review
Authors: Mahdi M , Khalafalla K , Arafa M , Elbardisi H , Majzoub A 
Published: February 2024

Abstract

Introduction
Premature ejaculation (PE) is one of the most common sexual disorders that negatively impacts couple’s satisfaction. Varicocele on the other hand is a highly prevalent condition affecting men population. A higher incidence of PE is observed among patients with varicocele, which incited several authors to evaluate the possible correlation between varicocele and PE. Others went beyond that to investigate whether varicocele repair can lead to an improvement in PE.

Objective
To systematically review the literature for all the studies exploring the relationship between PE and varicocele.

Methods
A systemic review was performed utilizing (PRISMA) statement. The PubMed, Google scholar and Scopus databases were used to look for articles published up to June 2023 using the appropriate keywords. Articles reporting an association between the presence of varicocele and PE and exploring changes in ejaculation latency time after varicocele correction were included. Data including study design, sample size, varicocele details, PE diagnostic method, outcome measured and tools used to measure it were collected. The Newcastle-Ottawa scale was used for assessing the quality of the included studies.

Results
A total of eight studies were identified, two of them were retrospective and six were prospective. Intravaginal ejaculation latency time (IELT) was used as a diagnostic tool for PE in 5 studies, Premature Ejaculation Diagnostic Tool (PEDT) in 1 study, Chinese Index of Sexual Function for Premature Ejaculation-5 (CIPE-5) scores in 1 study, and subjective assessment in 2 studies. Two studies looked for the prevalence of PE among patients with and without varicocele. Both studies showed a significantly higher frequency of PE among varicocele patients. Whereas six studies evaluated the improvement in ejaculatory function after varicocelectomy; five of them revealed a statistically significant improvement. Quality check: only one study was of strong quality while the remaining 7 studies were of fair quality.

Conclusions
Limited evidence suggests the presence of positive relation between varicocele and PE. The small number of studies and patients, lack of enough prospective clinical trials, short term follow up, heterogenous study design and absence or diversity in the diagnostic tools used prevent our ability to build strong evidence. For the purpose of supporting the relation and validate it, further prospective studies on a larger number of patients with long-term follow up are needed to reach a solid verdict.

Disclosure
No.
(343) The Psychological, Sexual, and Financial Impact of Infertility on Couples: An Urological Approach
Authors: Jamali M , El Rhaz A , Oukouhou H , Nabil L , El Bahri A , Alami M , Ameur A 
Published: February 2024

Abstract

Introduction
Infertility is a public health issue with socioeconomic and demographic impact. Understanding the psychological, sexual, and financial repercussions on couples is crucial for comprehensive treatment.

Objective
Infertility can evoke complex emotions and disrupt the couple's sexual relationship. The aim of this study is to examine the psychological, sexual, and financial aspects of this condition on infertile couples.

Methods
A retrospective study was conducted on 50 couples undergoing infertility treatment at a military hospital. Data, including medical records, questionnaires, and follow-up information, were collected.

Results
1. Psychological Impact: Infertility represents a failure of the parental project, leading to negative emotions. Women are more likely to report the psychological impact and seek help. Family pressure and potential divorce due to societal expectations were observed. 2. Sexual Impact: Infertility can significantly affect sexual life, causing decreased satisfaction, stress, and anxiety. Communication and emotional intimacy may suffer. Contrary to literature, men reported more sexual disorders due to socio-cultural factors and female partners' discomfort discussing sexuality. 3. Financial Impact: Infertility treatments incur substantial costs, adding to emotional and physical burdens. Financial implications vary by country, and lack of national funding policies lead to debt or abandonment of conception plans. In the study, half of the couples spent over $1000.

Conclusions
Infertility has a significant psychological, sexual, and financial impact on couples. A comprehensive approach involving healthcare practitioners and policymakers is necessary for significant improvement in the well-being of infertile couples.

Disclosure
No.
(361) National Trends of Male Urethroplasty Procedures: 2016-2019
Authors: Han D , Marte J , Lee J , Joice G 
Published: February 2024

Abstract

Introduction
Urethroplasty remains a valuable surgical option in the management of urethral stricture disease. However, current understanding of the patient- and hospital-level factors associated with inpatient versus (vs.) outpatient male urethroplasty is limited on a national scale.

Objective
We therefore sought to evaluate contemporary national trends of urethroplasty procedures among men.

Methods
We performed a retrospective review from 2016 to 2019 of urethroplasty procedures in men utilizing both the National Inpatient Sample and the Nationwide Ambulatory Surgery Sample – the largest publicly available all-payer inpatient and ambulatory databases in the United States. Non-endoscopic urethroplasty procedures were identified by Current Procedural Terminology and International Classification of Diseases (10th Revision) Procedure Coding System codes. Utilizing both inpatient and outpatient encounters, we performed stratified cluster sampling to create weighted national estimates. The primary outcome was the rate of urethroplasty performed in inpatient and outpatient encounters over time. Multivariable logistic regression was used to evaluate patient- and hospital-level factors associated with inpatient urethroplasty.

Results
From 2016 to 2019, there were 28,532 weighted urethroplasty procedures analyzed (37% inpatient vs. 63% outpatient). Over the study period, there was a 27% increase in the total number of annual procedures (n=6270 to n=7980), and the proportion performed outpatient increased from 60% to 68% [Figure]. Mean total charge for inpatient urethroplasty encounters was $84,267 vs. $30,997 outpatient (p&lt;0.0001). Predictors of inpatient urethroplasty included greater Elixhauser Comorbidity Index, use of buccal mucosal graft, non-private insurance status, and Western hospital region (vs. Northeast) (p&lt;0.05) [Table]. Outpatient urethroplasty was associated with higher median income by Zip Code (vs. lowest quartile of median income), Southern hospital region (vs. Northeast), rural or urban non-teaching hospital (vs. urban teaching hospital), and higher urethroplasty case volume hospitals (vs. lowest case volume hospitals) (p&lt;0.05).

Conclusions
An increasing proportion of urethroplasty procedures nationwide appears to be performed on an outpatient basis. Outpatient procedures have lower hospital charges than inpatient encounters – and are associated with higher volume hospitals, not using buccal mucosal graft, private insurance, and less comorbid patients who reside in areas of higher median income. Further investigation is warranted to assess how these factors may affect surgical outcomes.

Disclosure
No.
(362) Stress Urinary Incontinence Rates in Men Undergoing Optilume Balloon Dilation for Radiation-Induced Posterior Urethral Stenosis: A Single Center Experience
Authors: Ceballos B , Shumaker L , Selph JP , Baumgarten A 
Published: February 2024

Abstract

Introduction
While radiation can be a viable treatment option for prostate cancer, development of radiation-induced urethral stenosis occurs in approximately 2% of patients. Optilume, a paclitaxel-coated urethral dilation balloon was FDA approved in 2021 and has shown improved urethral patency and reduced rates of reintervention for anterior urethral strictures relative to standard endoscopic procedures. As the utility of Optilume expands into posterior urethral stenosis, it is important to identify the associated potential complications. Incidence of stress urinary incontinence (SUI) has been reported to be as high as 33% following urethroplasty for patients with radiation-induced urethral stenoses. Rates of SUI following Optilume balloon dilation have yet to be evaluated in this high-risk population.

Objective
To evaluate rates of SUI in patients undergoing Optilume balloon dilation for radiation-induced posterior urethral stenosis.

Methods
From March 2022 to February 2023, select men with radiation-induced posterior urethral stenoses underwent Optilume balloon dilation. Initial evaluation included retrograde urethrogram and/or diagnostic cystoscopy. Dilation was performed with a 30-French Optilume and left inflated for five minutes per standard protocol. A 16-French catheter was inserted and left in place for three to five days. Patients were scheduled for a three-month post-dilation cystoscopy. Pre- and post-dilation continence rates were compared.

Results
A total of 16 men with confirmed radiation-induced posterior urethral stenoses underwent Optilume balloon dilation. Of the 16 patients, 12 patients had documentation regarding their pre- and post-treatment continence status. No patients developed de novo SUI. Baseline pre-treatment SUI was noted in one patient (8.3%) requiring an average of 4 Depends per day. This patient noted no change in his degree of SUI following Optilume dilation and the dilation site was found to be widely patent on his follow up cystoscopy. He is scheduled for artificial urinary sphincter in the near future. Mean follow up was 77 days (range 30-180 days). Repeat intervention was required in three patients (18.8%) for repeat stenosis.

Conclusions
Optilume balloon dilation for radiation-induced posterior urethral stenosis does not appear to lead to de novo SUI in short to intermediate term follow up. Further prospective studies with a larger group of patients and longer follow up duration are warranted in this complex population.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Laborie.
(368) Real World Survey Study to Explore the Effects of Flibanserin in Men with Sexual Dysfunction
Authors: Clavell-Hernandez J , Goldstein I , Rubin R , Tatem A , Gonzalez J , Gumpf K 
Published: February 2024

Abstract

Introduction
Low sexual desire (LSD) is a syndrome of symptoms including diminished sexual interest or desire and absence of sexual thoughts or fantasies. Hypoactive sexual desire disorder (HSDD) is a subtype of persistent LSD associated with marked distress with no known cause. LSD/HSDD in men frequently occurs with other sexual dysfunctions such as erectile dysfunction and delayed orgasms. Flibanserin is a centrally-acting serotonergic medication approved in the United States to treat acquired, generalized HSDD in certain premenopausal women. Improvement in symptoms following the initiation of flibanserin treatment may take up to eight weeks.

Objective
Given the paucity of research available on the off-label use of flibanserin in men, this survey study was conducted to capture general information on the safety and outcomes of flibanserin in men with LSD/HSDD.

Methods
Dispensing data from sexual health clinics were used to identify males older than 18 years prescribed flibanserin between July 1 to December 31, 2022. Invitational emails containing a secure survey link were sent to eligible males. Survey questions captured changes in sexual function and sleep quality during active treatment. Patients not currently on treatment were excluded from the survey after the first question. In addition, 10-minute physician interviews were conducted to capture general safety information and outcomes. Study results are summarized using descriptive statistics.

Results
Thirty-four of 75 eligible males (45%) from 5 centers responded to the survey. The mean age was 55 years (range 30 to 81 years). Among respondents actively taking flibanserin (n=20), 12 selected low sexual desire, and 8 selected difficulties in reaching orgasm as their primary indication. Eleven of 16 respondents (69%) with treatment durations longer than 2 months indicated treatment-related benefits since starting flibanserin (TABLE). For the sleep quality question, 53% reported no change, 31% reported some improvement, and 16% reported worsening sleep. The most common reasons cited by physicians for treatment discontinuation were lack of effect and insomnia, followed by somnolence and fatigue.

Conclusions
Select male patients at sexual health clinics may experience benefits in LSD/HSDD and the ability to reach orgasm following 2 months of flibanserin treatment. Physician interviews suggest flibanserin is well tolerated in men with a safety profile similar to women. It is important to acknowledge survey study limitations when interpreting these findings. These results suggest that more research on the use of flibanserin in men with sexual dysfunctions is warranted.

Disclosure
Yes, this is sponsored by industry/sponsor: Sprout Pharmaceuticals, Inc.
Clarification: Industry initiated, executed and funded study.
Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout Pharmaceuticals, Inc.
(376) High Capability of ChatGPT to Answer Common Patient Questions on Vasectomy Reviewed by Sexual Medicine Specialists
Authors: Reddy S , Harnisch B , Honig S , Rotker K 
Published: February 2024

Abstract

Introduction
Novel technologies utilizing artificial intelligence (AI) have shown their potential to reduce provider workload and improve task efficiency in certain clinical settings. ChatGPT is an AI-powered chatbot which utilizes natural language processing (NLP) technology to provide human-like responses to open-ended questions posed by users. Recent studies have shown ChatGPT’s ability to provide diabetes counseling in lieu of trained educators, and effectively communicate technical research papers in layman’s terms to patients. Vasectomy is a common urologic clinic procedure that can be a source of anxiety for patients, many of whom desire the opportunity for further pre-operative counseling.

Objective
The objective of this preliminary study was to evaluate the ability of ChatGPT to respond to common patient questions on vasectomy encountered by sexual medicine specialists.

Methods
We composed a list of 20 questions commonly asked by patients pertaining to vasectomy. The questions were submitted to ChatGPT Plus with the prompt: “Answer the following questions in 50 words or less”. 3 fellowship-trained sexual medicine specialists then rated the accuracy of ChatGPT’s responses on a scale from 1-5 (1 representing a completely inaccurate response and 5 representing a response in line with what they would recommend to patients). Scores were tabulated and summarized (Table 1). Descriptive statistics were performed. Weighted Cohen’s kappa was calculated to assess for interrater reliability.

Results
Median score across all 20 responses from 3 raters was 4.1 (IQR 1.3). The most common rating was 5, indicating a high level of agreement between ChatGPT’s responses and those of sexual medicine specialists. The lowest score assigned was 2 (indicating poor accuracy), and was received by 6 responses. Weighted Cohen’s kappa was 0.49, implying moderate agreement amongst raters. Overall, ChatGPT was able to provide relatively accurate and concise responses to these common questions.

Conclusions
Our results demonstrate the capability of using ChatGPT as a potentially reliable source of information for patients desiring vasectomy counseling. Given the high clinical volume faced by many vasectomy providers, ChatGPT could possibly improve patient satisfaction and reduce provider burden. Further collection of real-world data is needed to better assess the accuracy and reliability of ChatGPT’s responses. Sexual medicine specialists should be aware of the strengths and limitations of emerging AI technologies as a medium for providing accurate health information to patients.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Fellow, Posterity Health, Coloplast, Hims, Genentech.
(382) Online Trends for Vasectomy Inquiries following Dobbs v. Jackson Women’s Health Organization Supreme Court Decision
Authors: Dolendo I , Leach M , Nguyen V , Uloko M 
Published: February 2024

Abstract

Introduction
On June 24th, 2022, the United States Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization that overturned Roe v. Wade, the constitutional right to abortion access in the U.S. There have been reports of increased interest in vasectomies at individual centers following this Supreme Court ruling, though it is unclear what changes have occurred on the national level.

Objective
We sought to use Google Trends to evaluate online interest in vasectomies in the U.S. in relation to the Dobbs v. Jackson decision.

Methods
We used Google Trends to evaluate the popularity scores (generated as a relative value amongst search terms from 0-100) of the search term “vasectomy” from January 2022 to January 2023. We calculated average rate of change (ROC) of scores for the time periods immediately surrounding the Dobbs V. Jackson court decision on June 24th, 2022 and the decision’s early leak to press on May 2nd, 2022 to determine if there was change in interest in immediate time surrounding these events. We then compared the baseline popularity scores in the 4 months before and after the decision. Additionally, we assessed the top 10 states searching for “vasectomy” and correlated with abortion access following the Dobbs v. Jackson decision.

Results
The national average rate of change of searches for “vasectomy” was significantly higher immediately after the Dobbs v. Jackson decision (0.283 vs. -0.210, p=0.003) (Figure 1). There was not a statistically significantly difference in searches of “vasectomy” after the press leak of the decision (0.001 vs. -0.102, p=0.745) (Figure 1). There was not a statistically significant long-term change in search trends pre- and post- Dobbs v. Jackson decision (p=0.506). Among the 10 states with the highest searches for “vasectomy” after the decision, 7 had abortion bans that went into effect following the Dobbs v. Jackson decision (Table 1).

Conclusions
There were significantly increased Google searches for “vasectomy” following the Dobbs v. Jackson Supreme Court decision to repeal the constitutional right to abortion and most of the states with the highest interest had abortion bans that went into effect following the decision. Urologists should be aware that abortion policies can influence the reproductive interests of their male patients.

Disclosure
No.
(392) Patient Outcomes Following Inflatable Penile Prosthesis Implantation in the Outpatient Setting
Authors: Fidel M , Shah J , Bal D , Patel P 
Published: February 2024

Abstract

Introduction
Inflatable penile prosthesis (IPP) is commonly performed in a hospital or ambulatory setting which involves overnight stay. However, recent literature has demonstrated that IPP surgery is increasingly being performed as same-day procedures in outpatient settings with patients not requiring overnight stay.

Objective
We sought to investigate the rate of complications following day surgery insertion of an IPP. The following was collected within six weeks of their procedure, 1. infection, 2. hospital admission, 3. emergency/urgent care visits, and 4. additional prescription for analgesia.

Methods
A prospective study is being performed since March 2023 of all patients undergoing day surgery insertion of an IPP at Men’s Health Clinic Manitoba (MHC). MHC is an outpatient ambulatory surgical centre. Only patients that are classified as ASA 1 or 2 and suitable for day surgery are deemed eligible for surgery at MHC. Patients are enrolled and consented on the day of the procedure. Patients were prescribed Bactrim BS BID two days prior to surgery along with a Dexedin/Hibiclens wash. Vancomycin and Gentamycin were given pre-operatively. Intraoperative Irricept wash was used during the case for irrigation and implant prep. All procedures involved a three-piece prosthetic device and were performed under spinal anesthesia with an infrapubic approach, with patients discharged with a catheter and a drain. Post-operatively, Gabapentin, Celebrex and Tylenol were given for analgesia.

Results
Currently, 15 patients are enrolled in this study with a mean patient age +/- SD of 64.3 +/- 8.2 years. All procedures were performed successfully with no intra-operative complications. The mean procedure length defined as time from of incision to when the dressing is placed on the surgical wound was 70.7 +/- 19.8 minutes. The mean post-operative duration of stay defined as patient entry into post-operative recovery room to time they leave the clinic was 135.6 +/- 78.8 minutes. Patients were cleared for device after six weeks. Thus far, no patients have required hospital admission or emergency room visits, nor have there been any documented cases of post-operative infection. 20% of the patients have required additional post-operative analgesia (n=3).

Conclusions
This study will aim to evaluate whether outpatient IPP implantation can yield a similar complication risk to those performed in an inpatient hospital setting. If successful, our findings could help increase accessibility and reduce wait times for patients as they could avoid limited hospital operating room use.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(400) Geographic Disparity in Collagenase Clostridium Histolyticum Utilization: A National Population-Based Analysis
Authors: Kaplan-Marans E , Lee J , Martinez M , Shpeen B , Schulman A , Khurgin J 
Published: February 2024

Abstract

Introduction
In 2013, the Food and Drug Administration approved the use of intralesional collagenase clostridium histolyticum for the treatment of Peyronie’s Disease.

Objective
To describe geographic utilization patterns of collagenase clostridium histolyticum.

Methods
The Medicare Provider Utilization and Payment Database was queried for all collagenase clostridium histolyticum injections (Current Procedural Terminology code 54200) performed between 2013 and 2020. The United States Census Bureau estimates for state population by male sex for 2020 were used to calculate the number of injections per male capita. Linear regression was performed with statistical significance set to 95% confidence intervals.

Results
Twenty-two states accounted for a total of 8,576 injections performed on 1,887 men. Five states (Georgia, California, Florida, North Carolina, and Delaware) represented over 50% of the injections per million male capita (figure). There were 28 states with zero injections recorded in the database. The number of injections per year increased from 263 in 2013 to 1,388 in 2020 (y=141.43x + 435.57, R2=0.71, p=0.008). All 8,576 injections were performed in urban vs. rural areas. Urologists and advanced practice providers (APPs) performed 8,309 (97%) and 267 (3%) of these procedures, respectively. The average reimbursement was $80.19 (SD $3.87) for urologists and $67.96 (SD $3.33) for APPs.

Conclusions
In this national population-based database, there was geographic disparity in the use of collagenase clostridium histolyticum for Peyronie’s Disease. Utilization increased fivefold from 2013 to 2020 and was limited to urban centers and less than half the states. APP’s performed a minority of injections.

Disclosure
No.