bluuebunny/crossref_metadata_2025_split huggingface dataset:
(373) Sexual Health Literacy Confidence Among Urology Resident Physicians
Authors: Horwitz R , Lewis K C , Khooblall P , Haile E , Lundy S D , Bajic P 
Published: May 2023

Abstract

Introduction
Despite the importance of sexual health, physicians may not be adequately equipped to diagnose and treat sexual dysfunction. Topics related to healthy sexual function (pleasure, masturbation, communication, sex toys/tools, and anal sex practices) are largely omitted from medical education. It is vital that urologists are trained to ask detailed questions about sexual health, counsel on healthy sexual habits, and identify and treat sexual dysfunction.

Objective
To determine the level of comfort among urology residents in taking a comprehensive sexual health history, identifying sexual dysfunction, and treating patients of various gender identities and sexual orientations.

Methods
An anonymous electronic survey was distributed to current urology residents in the United States. The survey contained five demographics questions and twenty-three questions tied to sexual health competencies. Participants were asked to provide their education year, current age, medical school location, residency location, and estimated hours of sexual health education during training (excluding STI/STD content). Survey questions targeted previously established sexual education competency domains.

Results
A total of 52 urology residents participated in the study. Participant post-graduate years ranged from 1-6. 61.5% of participants stated they received only 0-3 hours of formal sex education during medical school and 46.3% reported having any formal sex education during urology residency. 80% of participants felt comfortable asking patients about self-erogenous stimulation, but only 27% of responders felt comfortable answering questions about anal stimulation devices, and 35% of responders felt comfortable answering questions about vaginal stimulation devices. Greater than 94% of residents feel “very comfortable” or “somewhat comfortable” with describing male sexual dysfunction and performing physical exam for a man with sexual dysfunction, but only 59% felt the same towards female sexual dysfunction. When describing medicines used for sexual function, 100% of residents are comfortable doing so for men, but only 63% are comfortable doing the same for women. When counseling transgender males or females on sexual practice/therapies/surgeries, only 29% of residents felt comfortable.

Conclusions
There are knowledge gaps in sexual medicine literacy confidence among urology residents surveyed. Lack of a comprehensive sexual health education curriculum during medical training may be affecting patient care. Women and sexual and gender minority (LGBTQ) patients may be at higher risk of being treated by a urologist without comfort in managing their sexual health. Sexual health education optimization during urology residency has the potential to promote improved understanding of the sexual health of women and sexual and gender minorities and improve the evaluation and management of sexual dysfunction in general.

Disclosure
No
(385) The Bulboclitoral Erectile Tissues: A Previously Unacknowledged Organ at Risk During Radiotherapy
Authors: Greenwald L , Reidenberg J S , Downes M , Weiner S , Marshall D 
Published: May 2023

Abstract

Introduction
Loss of sexual function can be a devastating side effect of the radiotherapy techniques used in the treatment of pelvic area tumors. Direct damage to the erectile tissues caused by off-target effects of radiation contributes to this loss of function. Advances in radiation techniques allow for greater tissue sparing, offering the potential to minimize tissue toxicity during treatments for pelvic cancers. In radiation oncology practice, specific attention is given to preserving sexual function in well characterized anatomic areas of male sexual function; however, preservation of clitoral structures involved in sexual function has not been well explored. Incorporating previously unacknowledged sexual structures such as the clitoris and vestibular bulbs (bulboclitoris for short) into radiotherapy treatment planning may improve our ability to preserve the function of these structures, including arousal and orgasm, after pelvic radiotherapy. Such an approach normalizes and affirms sexual pleasure as an important aspect of sexual health in cancer survivorship for women and gender-diverse persons.

Objective
We aim to explore the anatomic and radiologic characteristics of bulboclitoral sexual structures to shed light on their potential therapeutic applications in radiotherapy.

Methods
We evaluated the presence and configuration of the bulboclitoral erectile tissues and their proximity to other organs in a multi-modality study. The morphological characteristics were assessed in human cadaveric specimens using gross anatomic dissection and cross-sectioning as well as cross-sectional imaging using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) (N=3).

Results
We present the CT, MRI, gross cross-sections, and 3D reconstruction of the bulboclitoral sexual structures. The presence and morphology of the female erectile tissues and adjacent structures are consistently demonstrated across modalities to inform anatomic delineation on radiotherapy planning scans.

Conclusions
The bulboclitoral erectile tissues are important structures in the pelvic region that have an essential role in sexual function. Attention to these previously unacknowledged structures has the potential to help improve patient outcomes in radiotherapy. In order to make this step, radiation oncologists can learn about the structures and their functions, and develop and apply advanced techniques to help preserve their integrity. Empowering radiotherapy clinicians with evidence for incorporating the anatomy, physiology and pathophysiology of organ function related to sexual pleasure in female persons with cancer provides an opportunity for tailored clinical decision-making and a more equitable distribution of advanced technologies that may preserve sexual function after cancer treatment.

Disclosure
No
(411) The “Unfolding” Technique for Penile Prosthesis Implantation in Post-priapism Corporeal Fibrosis
Authors: Abdel Rassoul M 
Published: May 2023

Abstract

Introduction
`- In neglected cases of ischemic priapism, there is usually severe corporeal fibrosis that can render penile prosthesis implantation later on extremely difficult. - Although many researchers described different approaches to overcome difficulties during surgery, none of them offered satisfactory results.

Objective
`- to describe a new technique to insert a large sized penile prosthesis in patients suffering from ED after neglected ischemic priapism with resultant severe corporeal fibrosis.

Methods
`- A new surgical technique was done in 15 patients suffering from ED after prolonged ischemic priapism with severe corporeal fibrosis. - Surgery starts by a circumcision incision, complete degloving & delivery of the penis through a midline perineal incision. - The penile urethra is then dissected away from the ventral surface of both corpora cavernosa - A midline ventral incision is done between both corpora cavernosa. This incision is then deepened till it reaches the inner surface of the tunica albuginea. At this point, the scalpel is then rotated 90 degrees to unfold the core of fibrosis into a flat sheet continuous with tunica albuginea. - The process is then repeated on the other side. - The proximal crura are then dilated in the usual manner by metal dilators. The distal part of the corpora are bluntly dilated by the closed blades of scissors. - After inserting the penile prosthesis, both sheets of fibrosis are closed over both prosthetic rods in the midline and the penile urethra is then fixed back to its position. - The penis is then retuned to its normal anatomical site & the skin is closed.

Results
`- Successful surgery was achieved in 13 out of 15 patients (86.7%). - 2 patients developed infection that necessitated surgical removal of the rods. - no incidence of urethral injury, crossover or corporal perforation

Conclusions
`- The new “un-folding” technique is feasible and useful technique in patients with ED after prolonged ischemic priapism - The incidence of complications esp. urethral erosion, crossover and corporal perforation.

Disclosure
No
(423) A Case Series of Successful Off-label Use of Flibanserin
Authors: Trowbridge P , Padhye M , Rubin R 
Published: May 2023

Abstract

Introduction
Flibanserin was the first FDA approved drug for hypoactive sexual desire disorder (HSDD) in premenopausal women, but was initially studied as an antidepressant without concern for age or gender. Flibanserin acts as partial agonist at the serotonin receptor 1A and antagonist at serotonin 2A receptor. The mechanism of action is thought to be due to an increase in dopamine and norepinephrine. Post hoc analysis during the pivotal trials showed improvement not just in desire, but in all domains of the Female Sexual Function Index (FSFI) including orgasm, arousal, lubrication and satisfaction. Off label use of flibanserin therefore is of interest to sexual medicine providers.

Objective
Described here, are four off label uses for flibanserin with successful outcomes in patient’s symptoms and quality of life, including post-orgasmic illness syndrome (POIS), low libido in a eugonadal male, a postmenopausal female with HSDD, and a patient with post-finasteride syndrome (PFS).

Methods
The first case is of a 40-year-old male patient who presented with a 10 year history of acquired POIS, with significantly debilitating symptoms lasting 1 week after orgasm. After trying a number of different multimodal treatment approaches he finally was on a regimen of Bupropion, Lexapro, Silodosin, Ritalin and Tramadol with a reduction in the duration of his symptoms from 1 week to 4 days, without a change in symptom intensity. Patient was then trialed on 200mg gabapentin nightly and 100mg flibanserin nightly, with progressive discontinuation of prior medications. The second patient, is a 77-year-old hypersexual, postmenopausal woman with a significant trauma history, who presented with gradually worsening HSDD despite adequate lubrication on estring, who was started on 100mg flibanserin nightly. Patient 3 is a 51-year-old male who presented with a 1 year history of low libido and mild erectile dysfunction despite normal testosterone levels and minimal improvements with sildenafil, who was trialed on 100mg flibanserin nightly. The fourth case involves a 26-year-old male presenting with PFS symptoms of erectile dysfunction, decreased libido, genital shrinkage, testicular pain, anxiety and brain fog. Patient had some improvement of erections post discontinuation of finasteride, but was only able to achieve full erection with use of tadalafil. Patient was trialed on 2 months of 100mg flibanserin.

Results
All four of these patients experienced significant improvement in their presenting symptoms after starting flibanserin nightly. Patient 1, with POIS, had markedly reduced symptom intensity and reduced duration of POIS from 7 days to 1 day. Patient 2 and 3 regained prior libido and quality of life within 2-3 months. Lastly, patient 4 experienced marked improvement in sleep, brain fog, libido and erectile function.

Conclusions
These cases indicate that flibanserin may be useful to more than premenopausal women and should be studied as a medication with additional pro-sexual affects like bupropion and buspar.

Disclosure
No
(464) Impact of Training on Confronting Discrimination and Harassment by Patients and Peers
Authors: Findlay B , Byrne E , Bearrick E , Alom M , Helo S 
Published: May 2023

Abstract

Introduction
Discrimination and sexual harassment within the workplace have a negative impact on well-being and productivity and are often underreported due to lack of comfortability in confronting the offender.

Objective
We aim to assess the prevalence of these abusive behaviors within a urology department and the impact of a dedicated training session on comfortability reporting/confronting discrimination and harassment.

Methods
Employees within a urology department at a single institution were invited to take a survey regarding discrimination and harassment both before and after a dedicated training session on reporting and confronting these behaviors. Statistical analyses were performed between pre- and post-survey groups, genders, and roles within the department.

Results
A total of 166 employees completed the pre-training survey, while 79 (47.6%) completed the post-training survey. 116 (69.9%) respondents identified as female. Roles within the department included physician (48/166, 28.9%), advanced practice provider (21/166, 12.7%), nurse (42/166, 25.3%), and nonclinical staff (51/166, 30.7%). The training demonstrated a positive impact in respondent comfort level with addressing gender discrimination, where 19/23 (82.6%) people who answered neutral/ disagree/strongly disagree changed their answer to agree/strongly agree compared to 7/56 (12.5%) who changed their answers in the opposite way (p=0.02). More women reported experiencing sexual harassment at least once a year compared to men (38.6% vs. 16.7%, p&lt;0.0001). Patients were the most commonly reported offenders of abusive behaviors towards staff.

Conclusions
Specific training on strategies for addressing abusive behaviors can help employees feel empowered to confront gender discrimination by both patients and their peers.

Disclosure
No
(469) The High Incidence of Female Orgasmic Disorder Secondary to Premature Ejaculation in South Florida
Authors: Dominguez-Bali A , Ramraj C , Dominguez-Bali C 
Published: May 2023

Abstract

Introduction
Premature ejaculation (PE), according to the ISSM Committee, is defined as ejaculation with vaginal penetration that always or nearly always occurs prior to or within about one minute from the beginning of a sexual encounter, together with the inability to retard ejaculation with vaginal penetration. As a result, the personal life of an affected individual may be negatively impacted, with the consequences of distress, bother, frustrations, and/or avoidance of sexual intimacy. However, there are multiple factors to consider and not all sexologists, psychologists, and therapists agree about a clear and complete definition of PE. This, in turn, makes it more difficult to have clear statistics of the incidence, prevalence, and frequency of this disorder. On the other hand, Female Orgasmic Disorder (FOD) is defined as difficulty, delay, or inability for a woman to reach orgasm in a sexual encounter or the reduced frequency and/or intensity of orgasm. While PE and FOD are usually described separately in the medical literature, we have found in both the sexological literature and in practice that women with FOD are frequently the partners of men with PE.

Objective
The objective of this review is to address the increased incidence of FOD secondary to PE in the South Florida Latin-American population, its impact in the sexual function of both male and female partners in their relationship, and the possible reasons for the difference between the Latin-American community and the General population of the United States of America.

Methods
This is a retrospective review of the sexological literature and the statistics we have collected from patients over the last 20 years, in which around 80% of cases of women with FOD are due to PE in their partner.

Results
Nationally speaking, the frequency of FOD secondary to PE has been reported to generally run between 35-50% in reproductive aged women. Throughout the years we have noticed that this frequency is markedly higher in the Latin-American population of South Florida, reaching 79.6% of cases.

Conclusions
We do not have a clear explanation for this important difference between the General population of the United States and the Latin-American population of South Florida, but we know that the Latin-American population in this area is exposed to a great number of stressors. One such set of stressors that may be a contributing to the increased incidence is known as the “Immigrant’s Syndrome,” a set of circumstances which includes sexual dysfunction as one of its components.

Disclosure
No
(471) The Transfacial Fixation of an Ectopic Low Submuscular Reservoir: A Novel Approach to Inflatable Penile Prosthesis Reservoir Placement
Authors: Reddy A , Khera M , Rakic N , Khoei A , Bansal U 
Published: May 2023

Abstract

Introduction
Ectopic reservoir placement has become a more routine practice among high-volume penile prosthesis implanters. In particular, the low submuscular approach has gained considerable popularity given its safe location away from structures of concern such as the iliac vein or bowel, which can frequently be in the proximity of reservoirs placed in the traditional Space of Retzius position in patients with prior pelvic procedures such as a radical prostatectomy. However, the low submuscular approach is not without its own risks, most notably, herniation of the reservoir to an unintended location. In order to maximize the benefits of submuscular reservoir placement and minimize risk for herniation, we describe a novel approach to low submuscular reservoir placement.

Objective
The objective of this study is to present outcomes data on inflatable penile prosthesis patients who underwent low submuscular (LSM) reservoir placement with transfascial fixation (TFF).

Methods
A retrospective review was conducted on patients who underwent an IPP placement using the LSM with TFF technique between June 2019 and March 2022 by a single, high-volume surgeon at a tertiary medical center. Preoperative patient characteristics were collected, and patients then conducted a telephone interview with a modified questionnaire to assess satisfaction with the IPP and reservoir concealment.

Results
A total of 34 patients underwent IPP surgery with low submuscular reservoir placement with TFF of which 29 completed the questionnaire (85.2%). The average age of patients was 68.3 years, and 61.5% of patients had undergone a radical prostatectomy. Overall satisfaction with the penile implant was 4.1 (out of 5). Eight patients (26%) were able to palpate the reservoir, and four patients (15.4%) were able to visualize the reservoir impression below the abdominal skin. However, overall satisfaction with reservoir concealment was 4.6 (out of 5) (Table 1). No surgical revisions were required and there were no surgical complications such as bowel obstruction, herniations, bladder erosion, or vascular injuries.

Conclusions
Low submuscular IPP reservoir placement with TFF is an alternative approach for reservoir placement with a high degree of patient satisfaction, decreased risk for reservoir herniation, and significant ease of placement compared to alternative methods in the literature.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific
(474) Trends and Costs of Ambulatory vs Inpatient Penile Prosthesis Placement
Authors: Brown W , Marte J , Taylor J , Ha A , Kerr P , Joice G 
Published: May 2023

Abstract

Introduction
Current literature is limited in assessing nationwide trends of penile prosthesis (PP) placement in the United States largely due to a lack of data on outpatient PP placement. Particularly no nationwide comparison of ambulatory surgery center (ASC) versus inpatient hospital (IH) PP placement has been published.

Objective
Our objective is to determine the trends of PP placement in ASCs vs IHs utilizing representative nationwide data. Additionally, we examined patient demographics that are associated with the setting for PP placement.

Methods
Inpatient and outpatient encounters for PP placement between 2016 and 2019 were analyzed using data from the Nationwide Inpatient Sample (NIS) and the Nationwide Ambulatory Surgery Sample (NASS) from the Healthcare Cost and Utilization Project (HCUP). These are the largest publicly available inpatient and ambulatory surgery databases available in the United States. PP operations were identified by CPT and ICD-10-PCS codes. Subsequent analysis was performed using the established weighting provided by the HCUP, which utilizes stratified cluster sampling to create national estimates. Comparisons of demographics were performed using t-tests and chi-square tests with a p-value for significance &lt;0.05.

Results
Over the study period, there were 67,722 PP placements in the United States. The percentage placed in ASCs was 93.1%. In 2016, 16,290 PP placements occurred, of which 92.3% were placed in ASCs. Comparatively in 2019, there was a 7.3% increase (17,473) in the number of PP placements, with 94.5% placed in ASCs (p&lt;0.01). Over the study period, 33,008 PP placements were performed in the South (93.8% ASCs), 12,481 in the Midwest (94.6% ASCs), 12,192 in the Northeast (92.4% ASCs), and 10,040 in the West (90.1% ASCs, p&lt;0.01). The average age of patients receiving a PP placement was 64.4 in ASCs compared with 62.5 in IHs (p&lt;0.01). The average cost associated with PP placement in ASCs was $25,935, about half the cost of inpatient settings, which averaged $51,594 (p&lt;0.01). Of all PP implants, the primary payer was medicare for 57.1% (38,660; 93.1% ASCs), medicaid for 4.4% (2980; 86.6% ASCs), private for 33.6% (22,778; 94.3% ASCs), and self-pay for 1.1% (768; 90.9% ASCs, p &lt;0.01).

Conclusions
Our results suggest that the number of PP placements is consistently rising each year, with an increasing majority of PP placements performed in ASCs. The procedure costs roughly half on average when performed in ASCs compared to IHs. Further investigation is needed to compare complication rates and outcomes of PP placements in ASC versus IH.

Disclosure
No