bluuebunny/crossref_metadata_2025_split huggingface dataset:
(047) Practice Patterns for Inflatable Penile Prosthesis Revisions Within a Large Fully Integrated Healthcare System
Authors: Krug A , Ye N , Lee J , Abdelsayed G 
Published: February 2024

Abstract

Introduction
Revision Inflatable Penile Prosthesis (IPP) surgery is considered to be more surgically complex than virgin IPP implantation. Not all implanters perform revision surgery. Moreover, there is a paucity of data on the practice patterns of implanters regarding revision surgery. We aimed to evaluate the practice patterns of revision vs virgin inflatable penile prosthesis implantation within a large fully integrated healthcare system.

Objective
We aimed to evaluate the practice patterns of revision vs virgin inflatable penile prosthesis implantation within a large fully integrated healthcare system.

Methods
After Institutional Review Board approval, we reviewed the Kaiser Permanente Southern California (KPSC) database for all IPPs implanted within a 10 year period (2009-2019) at 15 medical centers. Patients undergoing virgin and revision penile prosthetic surgery were identified using CPT codes. Preoperative patient characteristics, intra-operative and postoperative outcomes were obtained via retrospective chart review. Univariate and multi-variate logistic regressions were performed.

Results
Between 2009 and 2019, 1,093 IPP surgeries were performed at KPSC, 115 of which were revision cases (10.5%). A total of 66 surgeons performed at least 1 IPP surgery (median=5 IPPs/surgeon, Range 1-160). Yet, revision IPPs were performed by only 32 surgeons, of which 4 surgeons were responsible for 61 of the revisions (p&lt;0.05). When compared to virgin cases, revision cases had a longer median operative time (121 mins vs 96 mins, p &lt;0.001), were more likely to be a penoscrotal approach (OR 3.17, p&lt;0.05), have an ectopic reservoir placement (63.5% vs 35.7%, p&lt;0.001), and significantly less likely to have a concurrent procedure done (OR 0.21, p&lt;0.05) all based on multivariable logistic regression analysis. Nevertheless, device infection rates were not significantly different (revision 2.6% vs virgin 4.5%, p=0.43). There was no difference in intra-operative complications between revision and virgin cases (2.6% vs 1.4%, P=0.5). Median follow up was 4.1 years.

Conclusions
To our knowledge, this is one the largest series of revision IPPs done at multiple centers among more than 30 surgeons with long term follow up. Our data suggests that most IPP revisions are done by a select few implanters. Despite longer operative times, device infection rates were less than virgin cases, though not statistically significant. Within our large fully integrated healthcare system, in the hands of high-volume revision implanters, device infection and intraoperative complications rates remain quite low. These findings could help implanters counsel future patients regarding revision IPP surgery.

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(051) Safety of Novel Hyaluronic Acid Dermal Filler Injections for Penile Girth Enhancement
Authors: Pearlman A , Gumpf K , Moore W , Clavell J , Kansal J , Milhouse F , Tatem A 
Published: February 2024

Abstract

Introduction
Limited data exist regarding safety of penile girth enhancement treatments. Reported options for girth enhancement include injections of autologous fat, liquid silicone, hyaluronic acid (HA), or polymethyl-methacrylate, grafting with dermal fat, porcine dermal acellular matrix, or acellular collagen matrix, and surgical placement of a silicone implant.

Objective
The purpose of our study was to retrospectively evaluate safety in a cohort of men undergoing penile girth enhancement with HA dermal filler at a single site by reporting on post-procedure complications.

Methods
We performed a retrospective review of men who underwent penile girth enhancement with HA dermal filler from August 2020 through April 2023.

Results
471 men underwent penile girth enhancement with HA dermal filler. Two patients experienced injection site infections related to non-compliance post treatment with infection resolution after completing a course of oral antibiotic. One patient reported urinary tract infection symptoms shortly after HA dermal filler procedure and subsequently underwent additional filler injections without recurrence of urinary symptoms. One patient underwent reversal with hyaluronidase after his initial treatment. Three patients developed granulomas which were completely resolved with a single treatment of hyaluronidase. All three of these patients underwent additional HA injections without granuloma formation. Three patients experienced priapism treated without long term sequelae when intracavernosal injection (ICI) therapy was used for tumescence at time of filler injection. Once ICI was no longer used, no patients reported priapism. No patients reported erectile dysfunction or loss of sensitivity.

Conclusions
Our study suggests that injection of HA dermal filler may be a safe option for men interested in penile girth enhancement. While rare complications may occur, our research suggests they are easily treatable in the outpatient setting without long term sequelae.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: PhalloFill.
(052) Penile Length Enhancement with Suspensory Ligament Release, Corporal Advancement, and Periosteal Stabilization
Authors: Cook B , Rubin J , Brennan M 
Published: February 2024

Abstract

Introduction
Penile shortening is a common complaint with multiple etiologies. To date, safe and efficacious options have been limited. Release of the penile suspensory ligament has been described for penile augmentation with a reported increase in penile length, However, a simple release of the suspensory ligament sacrifices the stability of the erect penis. We propose a novel technique of dividing the penile suspensory ligament while simultaneously advancing the corporal bodies and maintaining penile stability with periosteal anchoring of the corpora to the pubic symphysis.

Objective
We demonstrate a method to increase penile length by releasing the suspensory ligament while simultaneously performing corporal body advancement and anchoring of the corpora to the periosteum of the pubic symphysis.

Methods
An IRB protocol was submitted to the State University of New York at Buffalo IRB committee. The project was found to be IRB-exempt. A test procedure was performed on a male cadaver. A 3cm transverse infrapubic incision was made one fingerbreadth superior to the dorsal aspect of the penis. Scarpa’s fascia and the fundoform ligament were dissected to expose the suspensory ligament and dorsal phallus. Stretched penile length was measured. The suspensory ligament of the penis was released and the corporal bodies were advanced. A 2-0 Ethibond suture was placed through the periosteum of the inferior aspect of the pubic symphysis and tunica albuginea bilaterally in an intervascular manner. Stretched length was again measured with an increase of approximately four centimeters observed.

Results
In our cadaveric model, simultaneous penile suspensory ligament with corporal advancement and reattachment resulted in a four-centimeter increase in stretched penile length.

Conclusions
Simply releasing the suspensory ligament may lead to penile instability, scar tissue formation, and retraction of gained penile length. In this cadaveric model, we demonstrate suspensory ligament release with stabilization of the phallus is viable and may offer a method to increase stretched penile length.

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(055) LRRC8A-VRAC Controls Superoxide Anion Flux in Diabetic Vasculogenic Erectile Dysfunction
Authors: Vieira Dos Santos C , Rodrigues Dos Passos Jr. R , Choi H , Panja S , Wilczynski S , Lamb F , Facholi Bomfim G , Webb RC , Priviero F 
Published: February 2024

Abstract

Introduction
Erectile dysfunction (ED) may be an early marker for cardiovascular diseases, and it is often associated with an hypercontractility of the corpus cavernosum (CC) as a consequence of increased reactive oxygen species (ROS), which favors the flaccid state of the penis. Leucine Rich Repeat Containing 8 (LRRC8A) Volume Regulated Anion Channels (VRACs) regulates Nox1 and modulates the extracellular production of superoxide anion (O2•-). Downregulation of LRRC8A is associated with decreased production of O2•- and we have demonstrated improved relaxation and reduced contraction of the pudendal artery in LRRC8A knockout mice.

Objective
We hypothesized that the role of LRRC8A in contractile responses to phenylephrine (PE) and electrical field stimulation (EFS) in the CC of diabetic mice would be exaggerated compared to that in normal mice.

Methods
To test this hypothesis, the CC of diabetic (dbdb-/-) mice was mounted in a myograph, and contraction elicited by PE or EFS was performed in the presence of apocynin (non-selective NOX inhibitor), GKT137831 (NOX1/4 inhibitor) and montelukast (LRRC8A inhibitor). In LRRC8A KO dbdb-/- mice, contractions to PE and EFS were obtained in the absence or in the presence of GKT137831.

Results
In the CC, the maximal contraction to PE was increased in diabetic animals, and in the presence of 3 mM of apocynin, the contractile response was markedly diminished in both control and diabetic mice. The LRRC8A inhibitor, montelukast, significantly reduced PE-induced contraction of the CC reaching maximal contraction of 69 + 7% and 65 + 10% in the control and diabetic group, respectively, compared to the contraction in the absence of the inhibitor. In the presence of the Nox1/Nox4 inhibitor, GKT137831, the contraction elicited by PE was reduced only in the diabetic group (68 + 9% of the maximal contraction), whereas in the control group this reduction was not significant (82 + 14% of the PE-maximal contraction). In the LRRC8A KO dbdb-/- mice, the contraction to EFS was similar to dbdb-/-, however, GKT137831 reduced the contraction to EFS with lesser magnitude of inhibition in the LRRC8A KO dbdb-/- mice (35% of inhibition) compared to dbdb-/- mice (50% of inhibition), suggesting that the participation of O2•- in the contractile response was reduced by the lack of functional LRRC8A.

Conclusions
LRRC8A modulates the contractile response of the CC induced by α-adrenergic stimulation and in diabetes, this may be associated with O2•- production, which plays a role in the development of ED. Inhibition of LRRC8A may be a therapeutic target to prevent hypercontractility of arteries and CC in vasculogenic ED.

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(060) Evaluation of the Mechanical Properties of the Human Tunica Albuginea
Authors: Colombo A , Chuang E , Kandabarow A , Mckenna K , Le B , Mcvary K 
Published: February 2024

Abstract

Introduction
The penis is in its essence a biomechanical implement and the Tunica Albuginea is the main load-bearing tissue during erection and its biomechanical properties are critical to understanding the penile physiology and the expansion of corpora cavernosa. There is surprisingly a paucity of data surrounding the biomechanical properties of the (TA) in literature.

Objective
We previously quantified the Young’s modulus and ultimate tensile strength (UTS) of TA in primates and we now compare these values with human TA tissue.

Methods
Strips of TA were dissected from patients undergoing penectomy in both longitudinal and circumferential orientations. We measured the thickness, the width and the length of every sample in three different locations for statistical purposes and we generated stress-strain curves via mechanical extensometry using an Instron machine. From this curve the Young’s modulus (a measure of stiffness) and ultimate tensile strength were calculated. Comparisons between human and baboon values were performed with a t-test.

Results
Six samples from 3 penes produced a mean Young’s modulus of 8.1 MPa (SD 1.7) longitudinally (n=3) and 10.3 MPa (SD 3.1) circumferentially (n=4). The mean ultimate tensile strength was 1.8 MPa (SD 0.6) longitudinally and 1.7 MPa (SD 0.1 MPa) circumferentially. These values show that human tunica albuginea has a stiffness between cartilage and cancellous bone. In comparison with baboons (Papio anubis), human samples had a lower Young’s modulus longitudinally (8.1 vs 34.0, p &lt;0.01) but not circumferentially (10.3 vs 11.7, p=0.32). Additionally, the human samples had a lower maximum stress longitudinally (1.8 vs 4.3, p=0.01) but not circumferentially (1.7 vs 2.0, p=0.29). These data show that baboon TA is stiffer and stronger longitudinally than human TA.

Conclusions
These measures of fresh human TA show some variation between human and primate models and support the need for fresh human tissue measurements to characterize the mechanical properties of the penis. These data will be critical in developing in silico models that can be used to investigate mechanical disease states of the penis and predict tissue/prosthesis interactions.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Uronext.
(069) Markers of Neovascularization and Neurogenesis May Change After Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction
Authors: Matthew A , Coffey S , Nguyen T , Sapao P , Klausner A , Smith R , Teves M , Krzastek S 
Published: February 2024

Abstract

Introduction
Low-intensity extracorporeal shockwave therapy (LiESWT) is thought to treat erectile dysfunction (ED) but the mechanism remains elusive. It is believed that LiESWT may work by stimulating neovascularization and nerve regeneration as demonstrated in animal models by histologically increased angiogenesis-related growth factors and neuronal factors including vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), neuronal NOS (nNOS) and brain derived-neurotropic factor (BDNF). Given its prolific use, a thorough understanding of the mechanism of action of this therapy at a cellular level is critical prior to recommendation of this therapy on a larger scale.

Objective
Objective data post LiESWT is sparse. In this study, we aimed to determine whether markers for neovascularization and nerve regeneration can be detected in the serum of penile tissue in men following LiESWT treatment. We hypothesized that LiESWT results in appreciable increases in vascular and neuronal factors post therapy.

Methods
Patients were prospectively enrolled in a clinical trial of LiESWT for ED. Patients received 12 bi-weekly LiESWT treatments of 0.2mJ/mm2 at 5Hz, 1500 shocks delivered per treatment, with follow up at 1-2 weeks, 4-6 weeks, 3 months and 6 months post-treatment. Cavernosal penile blood samples were obtained prior to treatment and at each visit post-treatment. The concentrations of eNOS, nNOS, VEGF, and BDNF in penile plasma samples were measured using Enzyme-Linked Immunosorbent Assay (ELISA) with specific commercial kits, following the protocols provided by the manufacturer.

Results
Twenty-five patients completed all five study visits. Mean patient age was 63. Mean baseline IIEF-EF score prior to treatment was 14.24 (±1.21). At the time of data analysis, plasma samples from 9 men were analyzed for BDNF, eNOS, and nNOS levels using the ELISA assay, and samples from all 25 men were analyzed for VEGF. BDNF levels demonstrated a sustained decrease after the first treatment (P = 0.0001, Figure 1A). Levels of eNOS were noted to trend upward, but no significant changes in eNOS, nNOS or VEGF levels were noted.

Conclusions
To our knowledge, this is the first study in human tissues to attempt to quantify objective measures of neurogenesis and neovascularization in penile tissue following LiESWT for ED. Though our N is small, our results suggest that LiESWT may decrease BDNF levels after initial LiESWT treatment while VEGF, eNOS and nNOS levels remain unchanged. The clinical significance of these findings is currently unknown, as our findings are not consistent with histological studies in animals which demonstrate upregulation of these markers in penile tissues. However, we believe this represents a promising first step in attempting to understand the effect of LiESWT at a tissue level in men undergoing LiESWT.

Disclosure
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(077) Development of a Vaginal Dilator and Home Insemination Device for Cis-And Transgender People, Based on Actual Pelvic Anatomy
Authors: Sandhu S , Mallavarapu S , Garcia M 
Published: February 2024

Abstract

Introduction
Genital gender-affirming surgery (gGAS) is a rapidly evolving surgical field. Specific to feminizing gGAS, one surgical option pertains to vaginoplasty with creation of a neovaginal canal. Given this canal is commonly lined with skin, peritoneum, or colon, women who undergo these procedures as part of their gender affirmation must commit to life-long self-dilation and douching to maintain canal patency and hygiene. Current commercially available dilators and douches are designed for cisgender anatomy, and are either straight, or, have an abrupt upward curve at the tip, inconsistent with neovaginal canal anatomy, which also lacks the elasticity of a cisgender woman’s vagina, making it sensitive to dilator shape, and douche nozzle length. In addition, many LGBTQ+ individuals with a uterus seek pregnancy without a male sexual partner, but few devices exist which cater to this specific population.

Objective
1) To design a vaginal dilator which more accurately reflects pelvic and vaginal canal anatomy, 2) Design a novel dilator which combines dilation, douching, and depth measurement functions, and 3) Modify our new dilator-douche device for use with semen for home insemination by both cis- and transgender women, and, transgender men seeking to become pregnant.

Methods
A radio-opaque catheter was placed into the neovaginal canal of 12 transgender women who underwent vaginoplasty with canal creation. C-Arm fluoroscopy delineated canal curvature based on the catheter. In addition, gynecologic texts and instruments were examined to ascertain the shape of a cisgender woman’s vaginal canal. Based on these findings, a novel dilator was designed and 3-D printed.

Results
A smooth “S-shape” was found in the vaginal canal of both cis- and transgender women, consistent with the shape of cervical dilators. In cisgender women, the vaginal vault, which is elastic, is closer to the introitus than that of transgender women. The cervix is typically anteriorly located between 0.5 to 4cm proximal to the posterior fornix. Our vaginal dilators (Figure 1a) (five, each 8-12cm circumference) and insemination device (Figure 1b-c) (9cm circumference) reflect the same smooth S-shaped design. Our dilators have depth markings, side-wall grooves to allow air and liquid to pass, and, can be fitted with a douche-bulb to maintain hygiene. Our insemination device can accommodate a 10cc syringe and has a recessed anterior wall 0.5-4cm from the tip to deposit semen around the cervix for conception.

Conclusions
The design improvements shown with respect to this dilator-douche device should make dilation and douching more comfortable, improve hygiene, and, decrease the incidence of granulation tissue. Our inseminator offers a private, at-home means of achieving fertilization for both cisgender and transgender individuals. (U.S. Patent 11638808; Neovaginal and vaginal health devices)

Disclosure
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(101) Erogenous Zones of the Head and Neck: A Comparison Study Between Cisgender Men and Women
Authors: Stelmar J , Zaliznyak M , Isaacson D , Duralde E , Gaither T , Topp K , Sandhu S , Mallavarapu S , Smith S , Garcia M 
Published: February 2024

Abstract

Introduction
Erogenous zones (EZ) of the body elicit feelings of sexual arousal in response to tactile stimulation. While previous studies have defined general whole-body maps and detailed maps of the genitalia, there is limited data that defines extragenital structures and compares findings between cisgender men (CM) and cisgender women (CW).

Objective
This study aims to describe EZs of the head and neck, and to describe differences in EZs that exist between CM and CW.

Methods
A total of 403 CM and 451 CW (mean age 47.2 ± 16.8 and 48.9 ± 15.5y respectively, p&gt;0.05) were recruited and administered an anonymous, online questionnaire via Qualtrics. Standardized anatomic illustrations with 11 predefined areas of the head and neck were presented to respondents, who were instructed to select which structure(s) bring them pleasure when touched during sex. For each EZ selected, the respondent was asked to rate its importance to their sexual pleasure on a 10-point Likert scale, from “1-not at all important” to “10-extremely important.” Differences in frequency of selection and importance ratings were analyzed via Qualtrics Stats iQ software using Fisher’s exact test and t-tests, with p&gt;0.05 indicating statistical significance.

Results
Of the 11 head and neck EZs, the tongue, neck, ear, and lips were the most frequently selected structures (Figure 1). A comparison between CM and CW revealed that CM were significantly more likely to indicate erogeneity of the tongue (51.4% vs 41.3%, p&lt;0.05) and nose (5.2% vs 2.0%, p&lt;0.02). CW were more likely to indicate the posterior neck as erogenous (40.1% vs 30.3%, p&lt;0.01). Statistically significant differences in ratings revealed that CM were more likely to indicate higher levels of importance to sexual pleasure of the cheek (6.3 ± x vs. 5.1 ±, p&lt;0.03) and forehead (5.3 vs. 2.8, p&lt;0.001).

Conclusions
EZs of the head and neck were centralized around the mouth, neck, and ears. CM were more likely to select structures around the mouth while CW selected the anterior and posterior neck. While some statistically significant differences were found in EZs between CM and CW, the majority of similarly selected and rated EZs indicate a pattern of comparable overall distributions of extragenital EZs. Findings from this study highlight the presence of extragenital erogeneity, and the importance of prioritizing the preservation of tactile sensation in head and neck surgeries (or communicating these risks to patients during preop consultations). These EZ maps may furthermore be used in future studies to compare pre- versus postoperative changes in erogenous sensation amongst patients who undergo head and neck surgery.

Disclosure
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(114) Mathematical Model for Peyronie's Disease
Authors: Machado B , Marsh J 
Published: February 2024

Abstract

Introduction
Peyronie's disease may affect up to 20% of men worldwide. After the curvature, penile length loss is the most common complaint. The severity of the curve angle is associated to with penile length and volume loss.

Objective
Create a theoretical mathematical formula to help clinicians and patients to estimate the penile length and volume loss in patients with Peyronie's Disease.

Methods
Applying Euclidean Trigonometric principles an geometric axioms a mathematical formula was created. Inserting measurements that are commonly retrieved from patients with Peyronie's disease, i.e., Penile girth, length, and curvature angle in the formula, a 2-d dimensional triangle is created. Applying the torus equation the arc length and angular deviation is found and the the penis volume and lenght loss can be calculated.

Results
A mathematical formula to evaluate the penile volume and length loss was created accounting for the deviations in the penile geometry occuring in patients with monoplanar and multiplanar Peyronie’s disease deviations.

Conclusions
This formula provides a mathematically accurate method to predict potential loss of penile length and volume in patients with monoplane or multiplanar Peyronie's disease. The model can be an additional tool for advising patients between shortening or lengthening procedures and help physicians and patients set expectations for results after surgical procedures.

Disclosure
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