bluuebunny/crossref_metadata_2025_split huggingface dataset:
(362) Testosterone Replacement Therapy for Management of Cachexia: A Review of Current Literature
Authors: Hou S , Singh A , Dhindsa S , Hsieh T M , Raheem O A 
Published: May 2023

Abstract

Introduction
Cachexia is a progressively debilitating loss of skeletal muscle often seen in late-stage chronic medical diseases, such as cancer, HIV/AIDS, chronic obstructive pulmonary disease (COPD), and liver cirrhosis. Cachexia contributes to mortality and morbidity with reduced quality-of-life (QoL) and disease treatment options, and can be associated with adult-onset hypogonadism (AOH), which is commonly treated with testosterone replacement therapy (TRT) in men.

Objective
This comprehensive review highlights the current literature on TRT for management of patients with chronic disease-associated cachexia, with an emphasis on clinical outcomes and side effects. Specifically, we identify and highlight relevant primary literature and reviews published since 2000 on TRT for management of patients with cancer, COPD, HIV/AIDS, and liver cirrhosis.

Methods
A comprehensive PubMed literature review was performed to identify articles published between 2000-2021 on TRT and cachexia-related chronic medical diseases (cancer, COPD, HIV/AIDS, and liver cirrhosis) to highlight the use of TRT for management of AOH in male patients with cachexia. The list of studies generated by the initial search was screened to identify eligible studies. Inclusion criteria included primary literature with clinical outcome measures related to changes in lean body mass, muscle mass, body composition, QoL, fatigue scores, and/or exercise scores, in addition to relevant meta-analyses.

Results
12 studies were included in our review out of 653 initial search results (Table 1). In three studies of TRT in cancer patients, there were mixed results on the effects of TRT on QoL assessment. Across three studies of TRT in COPD patients, there was consistent improvement in exercise capacity and disease condition with TRT. Across four studies of TRT in HIV-infected men, TRT resulted in notable improvement in body weight, muscle mass, function, and QoL. Lastly, in two studies of TRT in patients with cirrhosis, testosterone therapy improved muscle strength and body composition across both cohorts.

Conclusions
Based on recent studies, there is robust data for the clinical benefits of TRT for the management of certain subgroups of cachexic patients, specifically those with COPD, HIV, and liver cirrhosis. Because of mixed results in cancer cachexia patients, further investigation of its long-term efficacy is warranted, in addition to hormonal therapy for female cachexic patients.

Disclosure
No
(368) Stuttering Priapism: A Rare Manifestation of Underlying Malignancy
Authors: Lyons C , Crain D 
Published: May 2023

Abstract

Introduction
First described by Peacock in 1938, malignant priapism (MP) is defined as persistent erection in the absence of sexual stimulation or other triggering factors. The proposed mechanism is due to neoplastic invasion of cavernous sinuses and venous system resulting in poor outflow and painful penile engorgement. Though rare, MP due to penile tumors has been described in cases of hematologic malignancies, primary penile neoplasms, local invasion from urologic primary tumors including prostate and bladder cancer, and penile metastasis from other primary sources.

Objective
Here we describe a case of metastatic epithelioid sarcoma that presented with recurrent priapism.

Methods
An otherwise healthy 43 year old male presented with two weeks of intermittent priapism. Initially thought to be traumatic in nature, the patient was managed conservatively with penile irrigation and phenylephrine. Though the patient achieved some improvement in his pain, full detumescence was never achieved. Approximately one month later the patient elected for placement of an inflatable penile prosthesis (IPP) due to persistent incomplete detumescence. At the time of surgery, extensive corporal induration was noted bilaterally. Upon entry into the corpora, copious purulent material was expressed from the tissues and the decision was made to abort the case. Prior to closure, several representative biopsies were collected.

Results
Blood gas performed at initial presentation was consistent with low flow priapism. Doppler studies showed intact arterial blood flow to the penis bilaterally and pelvic MRI was negative for penile injury though asymmetric enhancement of the corpora was noted incidentally. Surgical pathology revealed an unclassified malignancy and increased proliferation concerning for metastasis. A PET scan was performed which was consistent with widely metastatic disease with mets to the liver, lung, bone, muscles, adrenal glands, brain, and penis. Percutaneous biopsy of an abdominal mass confirmed the diagnosis of epithelioid sarcoma. Despite palliative chemotherapy and radiation the patient succumbed to his cancer just two months after diagnosis.

Conclusions
Epithelioid sarcoma is a rare soft tissue neoplasm primarily affecting young adult males and representing less than 1% of soft tissue sarcomas. Even rarer is the incidence of metastatic penile tumors, with fewer than 500 cases reported in the literature since 1850. A literature review by Lin YH et al based on reports from 2006 to 2011 suggested that the true incidence of penile metastasis may be higher given that 12% of penile metastasis may be asymptomatic and discovered only at autopsy. To our knowledge, this is the first case of widely metastatic epithelioid sarcoma presenting with priapism secondary to penile metastasis.

Disclosure
No
(370) The Prevalence and Genotype Distribution of Human Papillomaviruses among Men in Korea
Authors: Ahn S , Moon D , Hwang W , Cho S , Lee H , Park H 
Published: May 2023

Abstract

Introduction
Human papillomavirus (HPV) prevalence and genotype distribution are different between various nations and regions. Additionally, previous studies have mainly focused on HPV infection in women and epidemiological studies of HPV infection in men have been rarely reported. The lack of information on the HPV genotype distribution of men in each individual country or region raises questions about the effectiveness of the current 9-valent vaccination.

Objective
Therefore, we aimed to investigate the HPV infection status in men in Korea to establish vaccine-based HPV prevention strategies.

Methods
Between January 2014 to June 2022, samples of 44,065 men, who were volunteered for testing or recommended to be tested by a clinician, were tested for the HPV detection and genotyping. Samples were collected from the coronal sulcus, glans penis, shaft, and scrotum. HPV detection and typing was conducted using the Anyplex™ II HPV 28 Detection system, which detects 19 high-risk (HR) HPVs and 9 low-risk (LR) HPVs.

Results
Overall HPV prevalence was 59.7%, and overall prevalence of HR and LR HPVs were 30.6% and 50.1%, respectively. The most prevalent genotypes of HR were 16 (5.2%), 53 (4.6%), 51 (4.2%), 52 (3.8%), 58 (3.7%), 39(3.6%) and 66(3.4%). Overall HPV prevalence was not associated with age. However, the prevalence of HR HPVs in teens (34.1%) and 20s (33.8%) were significantly higher than in other age groups. Of the 26,299 men with HR HPV infection, 9259 (35.2%) had a genotype that could not prevented by the 9-valent vaccine.

Conclusions
In this study, men aged under 30 years show high prevalence of HR HPVs. A significant number of infections of genotypes that were not prevented by 9-valent vaccine were observed. Based on this, it is considered necessary to evaluate the usefulness of developing HPV vaccination for men.

Disclosure
No
(371) Testosterone Levels after Lung Transplant: An Analysis of the TriNetX Research Network
Authors: Omil-Lima D , Jaime Abraham Perez J A , Thompson A , Jesse E , Khera M , Chavin K , Thirumavalavan N 
Published: May 2023

Abstract

Introduction
Men with end stage organ dysfunction or failure are more likely to have low testosterone. In the case of men with heart and kidney failure, improvement in testosterone levels are seen after successful transplantation. Limited data exists regarding the natural course of serum testosterone after lung transplant.

Objective
To report incidence of low testosterone in men prior to lung transplant and to determine changes in testosterone levels after transplantation.

Methods
We compiled all clinical data from the TriNetX research network, a globally federated health research network (with waiver from Western IRB) that provides de-identified clinical information from 58 heath care organizations, and over 80 million patients located within the United States. We selected male patients (aged ≥ 18) with a history of lung transplant and testosterone levels recorded before and after transplantation. All men who had a recorded prescription for testosterone therapy were excluded. For all patients, we collected clinical information including demographics, comorbidities, laboratory findings, and medication use. Patients were stratified by testosterone levels and grouped into those who had low serum testosterone versus those with normal levels, with a cut-off point of 300 ng/dL. Patient characteristics were compared using descriptive statistics. Propensity score matching was performed between the two groups to normalize differences in pre-operative characteristics. Mean serum testosterone levels before and after transplantation was compared using a paired T test to determine change in serum testosterone levels after successful transplantation.

Results
A total of 37 men were identified with history of lung transplant, and testosterone levels recorded before and after transplant. Average serum testosterone level in the year prior to lung transplantation was 301.57 +/− 163.25. After transplantation, average serum testosterone was 332.37 +/− 200.92, for a mean difference of 30.80 (p = 0.4815). Prior to transplantation, 24 (65%) men met criteria for low serum testosterone. After transplantation 17 (46%) men demonstrated serum testosterone less than 300 ng/dl. Among men with low serum testosterone, average testosterone levels in the year prior to lung transplantation was 203.29 +/− 66.57, and was 332.37 +/− 200.92 after transplantation (p = 0.0057).

Conclusions
Among men with low serum testosterone receiving lung transplant, transplantation was associated with rescue of low testosterone levels. Further research incorporating a larger cohort is required to determine which patients recover endocrine function after lung transplant and whether etiology of chronic lung disease results in different outcomes after transplantation with regards to serum androgen level and function.

Disclosure
No
(400) Robotic-Assisted Intra-Abdominal Vasovasostomy
Authors: Mikesell C , Lundy S , Krishnan J , Parekh N 
Published: May 2023

Abstract

Introduction
Microscopic-assisted vasovasostomy is a well described procedure used to manage obstructive azoospermia. Intra-abdominal obstructive azoospermia poses a challenge and various techniques have been described, including both open and minimally invasive approaches. The wide-spread adoption of robotics within urology has led to multiple reports of robotic-assisted vasovasostomy, which offers a feasible solution for this challenging problem.

Objective
We describe our technique for robotic-assisted intra-abdominal vasovasostomy in a patient with intra-abdominal obstructive azoospermia.

Methods
A 52 y/o male with past surgical history of right laparoscopic inguinal hernia repair with mesh and concurrent bilateral laparoscopic vasectomy presented to our institution with desire for fertility. He elected to proceed with robotic-assisted intra-abdominal vasovasostomy.

Results
We present and describe our technique for robotic-assisted intra-abdominal vasovasostomy. Post-operative semen analysis confirmed the presence of motile sperm.

Conclusions
We conclude that robotic-assisted intra-abdominal vasovasostomy is a feasible approach to intra-abdominal vasal obstruction. This can be a technically challenging procedure, particularly in the setting of previous laparoscopic inguinal hernia repair with mesh.

Disclosure
No
(402) Analysis of Peyronie’s Disease Injection Techniques
Authors: Masterson T , Lesdesma B , Khodamoradi K , Ziegelmann M 
Published: May 2023

Abstract

Introduction
Collagenase clostridium histolyticum (CCH) is the only food and drug administration (FDA) approved intralesional medication for Peyronies Disease (PD). The manufacture instructions recommend a single injection into the plaque at the point of maximal curvature. However, a 2019 survey of the Sexual Medicine Society of North America (SMSNA) found that physicians were utilizing many different injection techniques. It is unknown if one technique is superior.

Objective
To assess delivery of medication into PD plaques using an invitro model.

Methods
We obtained PD plaques from men undergoing plaque excision and grafting. Plaques were stored at -80C until ready for use in the lab. We injected the plaques with 0.25ml of Eosin Y, 5 wt. 5% solution in water because this solution is visibly red and similar to the density of CCH. We assess how the dye spread through the plaque in four different injection techniques: single injection, single injection with slow pull back, multiple site injection and lateral injection. All injections were video recorded in real time.

Results
Dye was retained inside the plaques will all injection techniques, however in all conditions, a significant amount of dye leaked out of the plaques. Multiple injection technique appeared to have the least about of dye leak out of the plaque.

Conclusions
In all conditions, dye leaked out of the plaques, however the multiple injection technique appears to have deliver the greatest amount

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
(403) Artificial Urinary Sphincter Implantation for Severe Post-Prostatectomy Incontinence in Setting of Salvage Radiotherapy and Prior Inflatable Penile Prosthesis
Authors: Hou S , Cooper C A , Sloan M J , Raheem O A 
Published: May 2023

Abstract

Introduction
Artificial urinary sphincter (AUS) implantation is one of the most common treatment options for individuals with severe stress urinary incontinence (SUI), which is a common complication after radical prostatectomy (RP). The modern AUS consists of a urethral cuff, pump, and reservoir, which serves as a replacement for the native incompetent sphincter. There are various surgical approaches for AUS insertion, including transperineal, transscrotal, and abdominal approaches.

Objective
This video covers the surgical technique for the implantation of an AUS for management of SUI. Notably, this patient underwent RP followed by salvage radiotherapy (XRT) for biochemical recurrence of prostate cancer and had prior inflatable penile prosthesis (IPP) placement.

Methods
A standard step-by-step surgical technique for placement of an AUS through a perineal incision and additional counter incision to allow for high submuscular placement of the pressure-regulating balloon is demonstrated in this unique case of a patient with prior IPP placement and salvage XRT.

Results
We highlight a meticulous dissection around the urethra in a case that had a challenging urethral dissection secondary to prior radiotherapy and a prior IPP in the proximal corpora. The AUS pump was successfully placed in the subdartos pouch of the scrotum on the contralateral side to avoid the patient’s prior IPP pump. At the conclusion, a flexible cystourethroscopy showed adequate AUS cuff coaptation and cycling.

Conclusions
This video covers the step-by-step technique for insertion of an AUS with a transperineal approach in the unique context of a patient with prior IPP placement and XRT. Preoperative counseling, evaluation, and careful intraoperative dissection of key parts of the procedure are critical for successful placement of the AUS, especially in patients who are at high-risk for complications, such as in this case.

Disclosure
No
(406) The “Kiel Knots” Technique for the Treatment of Congenital and Acquired Penile Curvature
Authors: Ragheb A , Osmonov D 
Published: May 2023

Abstract

Introduction
Penile curvature is not only a cosmetic issue, but can also cause severe organic and psychological problems in the affected patients. It can negatively affect the quality of the person’s sexual life or even ruin a relationship. There are many surgical techniques for correction ranging from the least invasive as plication to more invasive as incision or excision and grafting.

Objective
We propose a surgical technique for the correction of both congenital and acquired penile curvatures. Our technique is based on modifying and combining the 16-dot and the Essed-Schroeder plication techniques by burying the knots in shallow troughs of the incised tunica albuginea. We entitle this modification as the “Kiel Knots”. In this video, we demonstrate step-by-step the Kiel Knots technique for the correction of a case of dorsal acquired curvature with good erectile function via the subcoronal approach.

Methods
A circumcising incision is made and the penis is degloved. Buck’s fascia is then incised exposing the tunica albuginea opposite the curvature. Eight dots 5mm apart are marked bilaterally on the tunica albuginea with the point of maximum curvature in the center and a 5 mm superficial incision along the marks is made without cutting into the corpus cavernosum. Instead of plicating with one suture for 4 dots, our modification entails utilizing a separate suture for every two dots with the knot being buried in the shallow trough we created by the scalpel.

Results
Our average operative time is an hour. An average loss of penile length of 0.5-1cm has been reported in 30% of our patients. All our patients preserved their erectile function. 90% of our patients remained without recurrence of curvature after 2 years of surgery. None of our patients reported problems with their suture knots.

Conclusions
The Kiel Knots technique achieves penile straightening with minimal loss of length and no erectile dysfunction. We believe that our technique combines the best of Lue’s 16 dot together with the Essed-Schroeder plication techniques while avoiding the downsides of both approaches.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.
(407) Buried Penis in Morbidly Obese Patient: Surgical Technique of Fat Pad Excision, Malleable Penile Prosthesis Insertion and Penile Split Skin Graft
Authors: Chiriaco G , Satchi M , Lee W G , Ralph D 
Published: May 2023

Abstract

Introduction
Buried penis has a significant impact on quality of life affecting voiding and sexual function. Central and suprapubic deposition of adipose tissue related to obesity is a common cause.

Objective
This video shows the surgical approach of a complex case of buried penis managed with a suprapubic fat pad excision and simultaneous malleable penile prosthesis insertion.

Methods
We present a case of buried penis in a morbidly obese patient (BMI:43) with a history of two previous gastric bypass surgery and an apronectomy. affecting micturition and sexual function. A skin incision is made with a transverse incision at the level of the anterior superior iliac spine and a curvilinear inferior border. The apex of the inferior border should be approximately 2 finger breadth above the level of the penopubic junction. The incision is extended down to the rectus sheath and the spermatic cords at the lateral boundaries and the penile shaft at the midline are exposed. A malleable implant is inserted using the infrapubic approach and a split skin graft harvested to replace the unhealthy penile shaft skin. The dermis of the skin edges are secured to the rectus sheath with 0/0 vicryl sutures and the wound is closed in layers.

Results
Post-operative recovery was complicated by partial necrosis of the skin graft. At 3 months, the patient was able to stand to void and engage in sexual intercourse at 6 months.

Conclusions
The prevalence of obesity is increasing and in men, the presence of a suprapubic fat bad can result in a buried penis and affect voiding and sexual function. Although weight loss should be advised in the first instance, this may often not be enough. A combination of a suprapubic fat pad excision with malleable penile implantation and spit skin graft is a treatment option that can be considered.

Disclosure
No
(408) THALIA Technique Fixation of the IPP Reservoir
Authors: Wen L , Kemble J , Byrne E , Warner J N , Helo S , Ziegelmann M , Köhler T 
Published: May 2023

Abstract

Introduction
Inflatable penile prosthesis reservoir herniation or migration may occur with space of Retzius or submuscular placement. The dangers of high submuscular placement include bowel or bladder perforation (from blind instrument passage) and or bowel herniation (from unintentional peritoneal placement and stretching of small opening with reservoir filling). Even under direct vision submuscular placement, reservoirs can ultimately reside into the scrotum, retroperitoneum, and lateral abdominal wall. The Tubing, Hitch And Lasso, Intussusception Anchor (THALIA) technique was recently developed to prevent reservoir migration with placement either submuscularly or in the space of Retzius, but video of this technique has not been previously published.

Objective
To visually demonstrate the proper surgical technique of THALIA during IPP reservoir placement.

Methods
An IPP surgical candidate at high risk of complications should reservoir migration occur was identified. Video of THALIA technique performed during IPP surgery was recorded using an in-light overhead camera and a GoPro aseptically positioned on the lead surgeon.

Results
Successful demonstration of THALIA technique during IPP placement.

Conclusions
THALIA technique is a feasible option to aid prevention of penile implant reservoir herniation.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
(409) Low Transfascial Fixation of the IPP Reservoir
Authors: Kemble J , Wen L , Byrne E , Khera M , Warner J N , Helo S , Ziegelmann M , Köhler T 
Published: May 2023

Abstract

Introduction
Inflatable penile prosthesis reservoir herniation or migration may occur with space of Retzius or submuscular placement. The dangers of high submuscular placement include bowel or bladder perforation (from blind instrument passage) and or bowel herniation (from unintentional peritoneal placement and stretching of small opening with reservoir filling). Even under direct vision submuscular placement, reservoirs can ultimately reside into the scrotum, retroperitoneum, and lateral abdominal wall. The Transfascial Fixation (TFF) technique was recently developed to prevent reservoir migration with placement either submuscularly or in the space of Retzius, but video of this technique has not been previously published.

Objective
To visually demonstrate the proper surgical technique of TFF during IPP reservoir placement.

Methods
An IPP surgical candidate at high risk of complications should reservoir migration occur was identified. Video of TFF technique performed during IPP surgery was recorded using an in-light overhead camera and a GoPro aseptically positioned on the lead surgeon.

Results
Successful demonstration of TFF technique during IPP placement.

Conclusions
TFF technique is a feasible option to aid prevention of penile implant reservoir herniation.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Metuchen Pharmaceuticals, Acerus Pharmaceuticals, Endo Pharmaceuticals, AbbVie Inc.