bluuebunny/crossref_metadata_2025_split huggingface dataset:
(477) Ablation Vaginectomy is a Safe and Effective Technique in Transmasculine Gender Affirmation Surgery
Authors: Lee W G , Schirmann A , Ralph D , Christopher N 
Published: May 2023

Abstract

Introduction
Genital gender affirmation surgery ameliorates gender incongruence with the aim to align an individual’s genital appearance more closely to their experienced gender identity. Vaginectomy is commonly requested because it allows closure of the vaginal vault resulting in a masculine appearance to the perineum. Vaginectomy also allows a more appealing sac-like scrotoplasty and may reduce the risk of urethral complications. Transvaginal, laparoscopic (often combined with transvaginal) and robotically assisted approaches have been described. The transvaginal approach involves the excision of vaginal mucosa but blood loss may be significant and there is a risk of injury to adjacent organs like the bladder or rectum. Alternatively, the vaginal mucosa can be obliterated by high power electrocautery without excision. This technique has not been formally described in the literature before.

Objective
Pilot study to describe the technique for ablation vaginectomy (AV) and to assess the safety and efficacy of AV compared to traditional transvaginal excision vaginectomy (EV).

Methods
Retrospective review of a comprehensive prospective database and supplemented by medical records of transgender and non-binary persons requesting vaginectomy for gender affirmation surgery. AV was performed using high power electrocautery while EV was by a transvaginal approach. Follow-up was 30 days post-surgery. Data were reported as mean (standard error) unless specified otherwise.

Results
A hundred and thirty-seven patients were included in the study (62 following AV, 75 following EV). The median age (interquartile range) of both cohorts were similar [AV, 38 years (29-48); EV 37.7 years (31.5-43)]. Patients who underwent AV had a higher BMI but despite this, they had a lower intra-operative blood loss (99.8 ± 12.7mL vs 646.7 ± 63.4mL) and post-operative drain loss (90.9 ± 11.6mL vs 242.8 ± 23.6mL). More patients following EV required a transfusion (n=11) of 2.34 ± 0.5 units of packed red cells. Six patients had an intraoperative complication during EV (none for AV). Two patients had a recognised urethral perforation (one combined with a bladder injury) and 3 others had a bladder injury. All were repaired at the time. Complication rates after 30 days were similar although there was a trend for higher complications following EV (24% vs 11.3%, p=0.06). These were all related to bleeding and haematoma formation with 3.4% (AV cohort) and 8% (EV cohort) Clavien-Dindo grade 3b complications.

Conclusions
AV may be a feasible and safe approach when requested for gender affirmation surgery. Further prospective data with longer follow-up are required.

Disclosure
No
(498) Take it or Leave it? Comparison Between Drain and Retain Versus Reservoir Recycling in Inflatable Penile Prothesis Revision
Authors: Amini A , Nealon S , Badkhshan S , Sanders S , Langford B , Vandyke M , Morey A 
Published: May 2023

Abstract

Introduction
There are three strategies for managing an implanted urologic reservoir during inflatable penile prothesis (IPP) revision. The original reservoir can be removed, deactivated and left in place (drain and retain), or validated and reconnected to an IPP system (reservoir recycling). Although complete removal of a reservoir would prevent the potential complications of a retained device, the formation of a surrounding fibrotic capsule leads to complete removal being less popular among providers compared to drain and retain or reservoir recycling. We sought to evaluate the long-term complications and efficacy of these approaches.

Objective
To compare the efficacy and safety of the drain and retain and reservoir recycle approaches to IPP revision against the gold standard of full device replacement.

Methods
We performed a retrospective chart review of our large, single-surgeon tertiary referral center penile prosthesis database between 2007-2022 to identify all individuals with a retained or recycled reservoir. Only those who had undergone appropriate follow-up and had complete documentation about reservoir handling were included in the study. Reservoir-related complications, mechanical failures, and device infections were compared between the retained, recycled, and full replacement groups using a chi-square test. Mean follow-up duration, time to revision, and operative time were assessed using a Student’s T-test.

Results
There were 140 patients who met inclusion criteria with 48 retained reservoirs, 30 recycled reservoirs, and 62 full replacements. The average age of a reservoir when it was recycled was 4.3 years. Retained and recycled reservoir groups had similar mean follow-up duration, time to revision, and intraoperative time when compared to the full replacement group (Table). Most reservoirs (91% of retained, 90% of recycled, 90% of full replacement) were implanted using the high submuscular technique. Our institution’s virgin IPP implant infection rate was 2.6%. When compared to the full replacement group, infection, mechanical failure, and revision rates were similar for both the retained and recycled reservoir groups (Table and Figure). There was only one verified post-revision reservoir leakage from a recycled reservoir, but no instances of reservoir herniation or reservoir-related bowel complications between the three groups.

Conclusions
There was no difference in reservoir-related complications, mechanical failure, or infections when comparing the drain and retain or reservoir recycle groups to the full replacement group. Reservoir drain and retain and recycling are both safe and effective management options in IPP revision surgery.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.
(502) Arista™ Hemostat Associated with Decreased Odds of Infection and Reoperation Following Inflatable Penile Prosthesis Surgery in a Diverse, Multiethnic Academic Center
Authors: Patel R , Labagnara K , Loloi J , Babar M , Harandi A , Zhu M , Salami A , Davila J , Maria P 
Published: May 2023

Abstract

Introduction
Using hemostatic agents to manage intraoperative bleeding or assist in surgical closures is well established practice. Currently, several hemostatic agents such as Arista™, Surgiflo®, and Surgicel® are available for surgeon use when placing inflatable penile prosthesis (IPP). However, the effect of these agents on postoperative infection remains to be seen. Thus, we conducted a study to compare postoperative infection and reoperation rates of Arista™ to other hemostatic agents.

Objective
Primary objective was to determine if use of Arista™, when compared to other hemostatic agents, was associated with decreased rates of infection and reoperation in patients from a diverse, multiethnic population undergoing a primary IPP implantation.

Methods
A single institution retrospective study of patients who underwent IPP implantation between December 2015 and February 2022 from a single surgeon was conducted. Patients were sorted into groups based on use of intraoperative hemostatic agents. Demographic data, intra- and peri-operative patient characteristics, reoperation, and post-operative infection information was extracted from electronic medical records.

Results
A total of 434 patients undergoing primary IPP (95.4% Coloplast and 4.6% AMS devices) met inclusion criteria; of which, 158 (36.4%) received Arista™ and 276 (63.6%) received other hemostats such as Surgiflo®, and Surgicel®. There was no significant difference between age, race, preferred language, BMI, or smoking status between the Arista™ and other hemostat groups. Cardiovascular disease (CVD) and diabetes were prevalent in 76.7% and 56.3% of our sample, respectively. A vast majority (84%) of CVD patients had concomitant diabetes. Median Operative time was significantly shorter in the other hemostat group compared to the Arista™ group (62 minutes vs. 75, P &lt;0.001). There was no significant difference in post-operative instances of urinary retention, emergency department visits, or readmission between the two hemostat groups. Multivariable model controlling for age and CVD (Table 1) revealed that Arista™ was associated with significantly decreased odds of postoperative infection and reoperation when compared to other hemostats (OR = 0.36; 95% CI (0.14 – 0.97), P=0.04). Conversely, active smoking were associated with significantly higher odds (OR = 3.92; 95% CI (1.39 – 11.04), P=0.01).

Conclusions
Our retrospective study indicates that use of Arista™, regardless of patient CVD status, may lead to decreased infections and subsequent reoperations. Prospective randomized control trials should be pursued to adequately assess the benefits of Arista™ compared to other hemostatic agents.

Disclosure
No
(504) Subinguinal Microsurgical Cremasteric Muscle Division for Painful Retractile Testis: Single Center Experience
Authors: Abello A , Carrasquillo R J 
Published: May 2023

Abstract

Introduction
Cremasteric muscle division or release is a procedure performed in patients with chronic orchialgia associated with hyperactive cremaster muscle reflex who do not respond to medical therapy. This condition was first described in the literature by Dr. Thomas in 1927 and the first procedures releasing or removing cremaster muscle were first described in the 1930s. Nowadays, cremasteric muscle division is usually performed with a surgical microscope to improve accuracy and avoid injury of cord structures. However, data about outcomes of this procedure are sparse. To our knowledge, the only series of cases was reported by Dr. Kavoussi in 2019 who reported resolution of retraction in 100% of the patients that had this procedure and resolution of orchialgia in 92% of them.

Objective
Our main objective was to describe and evaluate outcomes of microsurgical cremasteric muscle division in a men’s health practice in Boston, MA and to determine if prior results described in the literature are similar to our current experience.

Methods
We performed a retrospective review of cases performed in our institution between 2018-2022 and recorded different outcomes including post-operative pain, post-operative physical exam, ED visits and complications.

Results
We performed a total of 4 cremasteric muscle divisions for unilateral retractile testis in 3 and bilateral retractile testis in 1 of the patients. All of the cases had retraction of the testis with reproducible findings on preop physical exam, and all of them endorsed pain and discomfort associated with retraction. The patient age ranged 21 to 56. All cases were performed using a surgical microscope. After a median follow-up of 52 days, 100% of the patients had improvement in the position of the testicle with no further episodes of retraction, and 75% (3/4) had complete resolution of pain. Regarding complications, only 1 patient had an episode of mild epididymitis that improved with a short course of NSAIDS and there were no visits to the emergency department or other complications.

Conclusions
Our experience is similar to prior case series reported in the literature showing resolution of testicular retraction in all the patients that had microsurgical cremasteric muscle release and resolution of pain in the majority of the cohort with a low rate of post-operative complications. Future multicenter studies with a larger sample size should be performed to confirm these results, compare outcomes to other more conventional approaches such as scrotal orchiopexy, and to explore preoperative characteristics associated failure to resolve pain. In addition, future studies should assess differences in outcomes in procedures using surgical microscope compared to the traditional open approach.

Disclosure
No
(520) The Use of Gracilis Muscle Flap in Radial Forearm Free Flap Phalloplasty to Decrease Urethral Fistula Rate: Initial Outcome
Authors: Abdel Rassoul M , El-Shorbagy G , El-Ghoneimy M , El-Sayed A , Fayad A , Abdel-Rahman S , Abdel-Hamid M 
Published: May 2023

Abstract

Introduction
`- Chang and Hwang, in 1984, described the technique of Radial Forearm Free Flap Phalloplasty (RFFFP). It is now considered to be the standard surgery for phallic reconstruction. Urethral fistula is the most common complication reported in RFFFP and may reach up to 60-70%. Most commonly, the fistula site is at the anastomosis between the native urethra and the neo-urethra.

Objective
`- to study the impact of gracilis muscle flap wrapping around the native urethra/neo-urethral anastomosis on decreasing the fistula rate.

Methods
`- A prospective study was conducted at our urology department, from January 2018 till December 2020. - Patients presenting with a micropenis (Stretched penile length &lt;7 cm) underwent RFFFP with gracilis muscle flap wrapping. - The free-flap was harvested from the non-dominant forearm. Under microscopic guidance, the radial artery was anastomosed with the inferior epigastric artery, the cephalic vein with the great saphenous vein, and the medial and lateral antecubital nerves with the ilio-inguinal and the dorsal penile nerves respectively. - A pedicled gracilis muscle flap was then wrapped around the neo-urethera/native urethral anastomosis to assess its possible role in decreasing the postoperative urinary fistula rate.

Results
`- Nineteen patients were included in the study with a median age of 26 years (16 - 43) and a BMI of 24 (22-25). The median hospital stay of 14 days (14 - 21) and the median follow-up was 11 months (4 - 13). The median cold ischemia time was 90 mins (70 - 100), estimated blood loss was 500 cc (400 - 500) and operative time was 11 hrs (10 - 12). - A viable phallus was achieved in 13 patients (overall free flap survival 68.4%). - Of the successfully viable phallus cases, 8 cases (42.1%) were complicated by complete disruption of the urethra and the remaining five cases (26.3%) had complete urethral tube. - One case of them developed a fistula at the neo-urethera/native urethral anastomosis, one case had a distal fistula and one case had a ring stricture at the site of anastomosis. - The gracilis muscle flap prevented urethral fistula formation in 4 out of 5 cases (80%) with complete urethral tube.

Conclusions
`- The use of pedicled garcilis muscle flap wrapping around the neo-urethra/native urethral anastomosis during RFFP might be helpful in reducing the urinary fistulae rates at this site. However, larger comparative studies are needed.

Disclosure
No
(522) Possible Role of the Sex Script in the Orgasm Gap Between Genders: How Sodomy is an Egalitarian Practice
Authors: Choucroun D 
Published: May 2023

Abstract

Introduction
The orgasm gap between genders is found in scientific and generalist literature: men, of all sexual orientations, report reaching orgasm during nearly 90% of sexual intercourses, while heterosexual women only achieve orgasm during 65% of intercourse.

Objective
We want to demonstrate that the sexual script of penis/vagina penetration is anatomically less satisfactory than anal penetration, and carries risks for women: unwanted pregnancy, iatrogenic risks of contraception We want to highlight, that in terms of gender, this script is unequal, while during sodomy, role can be exchanged, with the help of a dildo, the man can discover his passivity, and no longuer submit to the erection's performance.

Methods
Literature review: -we introduced the words “orgasm gap” on PubMed for the last five years -press articles

Results
We have found only four survey about the orgasm gender gap on PubMed When the women can't achieve orgasm, they are generally advised clitoral stimulation During the consultation we hear the women say: I do not feel anything during vaginal penetration, indeed the vaginal mucosa is weakly innervated, and vagina does not have sphincters, which decreases the sensation after childbirth. Conversely the anal region and the rectal mucosa are strongly innervated.

Conclusions
Sodomy requires learning as sport or music. This learning can cause unpleasant sensations, but when the technique is acquired, as for sport or music, the pleasure is deep intense and continuous. We do not stop sport or music because of aches and pains of the beginner. Sodomy is egalitarian, that can be practiced by all genders, bringing intense pleasure, too often reserved for initiates, and therefore we can say that sodomy is sacred, leaving to the laymen the few orgasmic tremors obtained painfully by external stimulation of the penis or the clitoris.

Disclosure
No
(533) Penile Venous Stripping for Treating Patients with Erectile Dysfunction Secondary to a Minimally Invasive Prostatectomy
Authors: Hsu G , Chang Y , Chang C 
Published: May 2023

Abstract

Introduction
A minimally invasive prostatectomy becomes a treatment of choice in patients with operable prostate cancer. However, it is not uncommon to encounter patients with erectile dysfunction (ED) secondary to this procedure.

Objective
Although there are many ED treatment strategies, we want to report a physiological penile venous stripping surgery to those patients whose ED was secondary to prostatectomy and refractory to all medical treatments in the recent decade.

Methods
From 2012 to 2021, 15 consecutive patients, aged 62 to 79, sustained erectile dysfunction (ED) following a minimally invasive prostatectomy for treating prostate cancer. Meanwhile, their ED was refractory to contemporary varied treatment strategies, including one 70-year-old patient non-responsive to 800 mg sildenafil. All patients received dual cavernosography in which the penile venous anatomy was shown by a pilot cavernosograpy, PGE-1 test in-between, and a veno-occlusive dysfunction (VOD) was documented by pharmaco-cavernosography. Eventually, they underwent a physiologically penile venous stripping surgery (PVSS) for erection restoration from VOD. The ambulatory basis was unexceptionally conducted under acupuncture-assisted local anesthesia. PVSS begins with a circumferential approach, followed by degloving those tissues superficial to the Colles' fascia until the penile base. Next, it entailed stripping a deep dorsal vein and two cavernosal veins while fixing every emissary's vein with 6-0 nylon closest to the outer tunica. In contrast, the two pairs of para-arterial veins were only segmentally ligated. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and corporeal radio-opacity assessed erection restoration. Additionally, the erection hardness scale (EHS) confirmed improvement.

Results
The prostatectomy was performed in laparoscopic (n=7) and Da Vinci surgical system (n=8) elsewhere. The average follow-up period was 5.3±0.4 years. It was unexceptionally pronounced on the radiopacity of the corpora cavernosa to the femoral cortex, denoting the intracorporeal retention established in the corpora cavernosa after PVSS. It was statistically significant between the preoperative and postoperative IIEF-5 scores (5.9±1.8 vs. 11.8±2.6, P&lt;0.01). The EHS improved at least one scale. Surprisingly, two patients reported gratifying outcomes although they were committed to Parkinsonism. Overall, just 42.9% (9/21) of patients reported unaided sex. The remaining patients required medication aid every five men depending on 20 mg sildenafil and 5 mg vardenafil, respectively. Eventually, four resorted to malleable penile implants, which firmly declined preoperatively.

Conclusions
PVSS is beneficial in managing some groups of males whose ED is secondary to a minimally invasive prostatectomy, although the sample size is limited.

Disclosure
No
(539) Preventive Effects of Pterorhachis Zenkeri Harm (Meliaceae) in Testosterone Propionate-induced Benign Prostatic Hypertrophy in Wistar Rat
Authors: Watcho P , Bonsou Fozin G R 
Published: May 2023

Abstract

Introduction
Benign prostatic hypertrophy (BPH) is an androgen-dependent and age-related disease which significantly affects the patient’s life. BPH can lead to a number of symptoms for patients commonly referred to as lower urinary tract symptoms including obstructive and irritative disorders as well as complications such as renal failure and sexual disorders. In addition, medical health care remains problematic due to therapeutic limits such as the cost, the accessibility and the side effects.

Objective
The aim of the present study was to assess the preventive effects of the aqueous (62 mg/kg) and methanolic (10 mg/kg) extracts from Pterorhachis zenkeri (P. zenkeri) on testosterone propionate-induced benign prostatic hypertrophy in rats.

Methods
Adult Wistar rats were randomly partitioned into groups of 5 rats each and treated with one of the following: distilled water (10ml/kg)/soja oil (1 ml/kg), testosterone (10 mg/kg), aqueous extract (62 mg/kg), methanolic extract (10 mg/kg), testosterone plus bicalutamide (5 mg/kg) plus aqueous extract (62 mg/kg), testosterone plus bicalutamide plus methanol extract (10 mg/kg) during 2 or 4 weeks. At the end of the treatment periods, body and prostate related weight, biochemical, histological, histo-morphometrical and oxidative stress parameters were comparatively measured.

Results
Testosterone propionate induced a significant (p&lt;0.001) increase in the size and relative weight of ventral prostate, plasmatic level of prostate specific antigen (PSA), length of prostate epithelial cells and prostate structural damages. Additionally, the levels of prostatic dihydrotestosterone and, plasmatic nitrogen monoxide and malondialdehyde were increased whereas the activity of superoxide dismutase was decreased. Administration or co-administrations of P. zenkeri extracts with bicalutamide time-dependently prevented the above-mentioned damages through its anti-androgenic and anti-oxidant properties.

Conclusions
The bioactive compounds present in P. zenkeri extracts could justify the reported findings. Present results therefore suggest that P. zenkeri could be a good candidate in the management of BPH.

Disclosure
No