bluuebunny/crossref_metadata_2025_split huggingface dataset:
(213) Sexual Dysfunction in Young Women with Recurrent Urinary Tract Infections
Authors: Schulz A E , Axler E , Loloi J , Abraham N 
Published: May 2023

Abstract

Introduction
Sexual intercourse is the risk factor most commonly associated with recurrent UTI in young women. Few studies have analyzed how rUTIs subsequently impact women’s sexual health and function

Objective
To investigate whether young women with rUTIs experience sexual dysfunction.

Methods
This is a prospective study with preliminary data collection from May – June 2022. A survey was posted on five subreddits, r/Healthyhooha, r/Interstitialcystitis, r/CUTI, r/WomensHealth and r/badwomensanatomy, which included questions on demographics, rUTI history and the 13-question Female Sexual Distress Scale-Revised (FSDS-R). Women were asked to answer the questionnaire in terms of their rUTI frequency and severity, with a scale from 0 (never) to 4 (always). Women between 18 – 35 years, not currently pregnant, and had UTIs at least every 3-4 months were included in the analysis. A score ≥ 11 indicated female sexual dysfunction (FSD). Severity of FSD was categorized as: mild (11 – 20), mild-moderate (21 – 30), moderate (31 – 40) and severe (≥41).

Results
One hundred fifty-one women completed the survey with 120 included in the analysis (79.5%). The average age was 27±4.9 years, majority self-identified as white (85.7%), and over half had a comorbidity (57.5%), with the most common being irritable bowel syndrome (33.3%) and autoimmune illnesses (23.2%). Half of women (50%) experienced UTIs every 3-4 months, 36.7% every month, and 13.3% every week. Women had rUTIs for an average of 9.2±8.4 years. Over half of women (59.2%) had a complication from their rUTIs, with 43% having pyelonephritis and 26.6% urosepsis. In the FSDS-r, frustration about sexual problems received the highest average score (2.9), with 42.5% of women reporting frequently and 30% reporting always feeling frustrated. Guilt over sexual problems had the second highest average score (2.7), with 35% of women frequently and 29.2% always feeling guilty. More than a third of women (40.8%) responded that they frequently avoid sex due to sexual distress. We found 111 (92.5%) participants qualified as having FSD, with an average FSDS-r score of 31.9±12.3. In terms of FSD severity, 10.8% had mild, 28% mild-moderate, 33.2% moderate and 28% severe. There was no significant difference between ethnicity, comorbidities, complications, and UTI frequency with worsening FSD score.

Conclusions
Many young women experience rUTIs. In our study, over 90% of young women with rUTIs qualified as having FSD measured by the FSDS-R. Our findings highlight the importance of screening women who experience rUTIs for sexual dysfunction to potentially improve their sexual health and quality of life.

Disclosure
No
(214) Female bmg Urethroplasty and 2nd Degree Vaginal Tear Repair
Authors: Stanojevic N , Ruffo A 
Published: May 2023

Abstract

Introduction
Pregnancy and childbirth bring biological, psychological, and social changes which may influence women's health.

Objective
Second degree tears are the most common type of tear. A female urethral stricture is a less common condition. Buccal mucosa graft (BMG) is widely used tissue for urethral stricture repair.

Methods
We present a 38-year old female who suffered a 9-year long history of urethral stricture disease and dyspareunia after two vaginal child births. The patient (pt) had urethral injury and 2nd degree tear in vaginal wall and pelvic muscle. Despite repeated attempts of urethral dilations, the stricture and the obstructive complaints persisted. Additionally, lack of sexual arousal and painful intercourses, affected the patient’s quality of life. The pt was treated with a dorsal onlay urethroplasty using a buccal mucosa graft, excision of vaginal wall scar, pelvic floor muscle repair, and repair of vaginal opening The surgery was carried out with a suprameatal approach. A semicircular incision was performed and the urethra was dissected from the ventral aspect of the clitoris with a sharp and blunt dissection up to the proximal part of stricture. Then, a dorsal sagittal incision is performed over the stricture and the BMG is sutured dorsally for the edges and quilted with 4.0 polyglactin sutures. A 16Fr Foley catheter was left in place for two weeks. Then, we performed hydrodissection of posterior vaginal wall, scar excision from episiotomy and 2nd degree tear, approximation of levator ani muscle, vaginal wall and opening repair.

Results
Two weeks after surgery the patient urinates without strain and with no post voiding residual urine. Uroflow 6 weeks after surgery showed Qmax of 28ml/sec and urethra was easily passable for 20Fr Nelaton catheter. Eight weeks after surgery the patient reported having a normal sexual life without pain and lack of sexual satisfaction

Conclusions
Female dorsal onlay urethroplasty and vaginal wall tear repair are feasible and give great functional and aesthetical results

Disclosure
No
(217) “Vagina” is Not a Bad Word: Historical and Contemporary Censorship of the Word “Vagina”
Authors: Popat S , Horwitz R , Eilber K , Lee U 
Published: May 2023

Abstract

Introduction
The first recorded use of the word “vagina” was in 1680. It is the only contemporary anatomic term for the female reproductive canal and has no anatomically accurate substitute. For the last 350 years, use of the word has been intentionally avoided in media, print, and society in general.

Objective
We sought to characterize instances of “vagina” censorship to better understand perceptions and behaviors surrounding the word “vagina.”

Methods
An internet and relevant database (PubMed, Academic OneFile, Proquest, Health Business Elite, etc.) search was conducted for “vagina, “censor,” and related wildcard terms. Search results were filtered by three independent reviewers for relevance. Related articles were summarized and reviewed for common themes.

Results
Examples of censorship of the word “vagina” were compiled in Table 1, and several themes were identified: (1) Policies surrounding censorship are unclear. Affected parties typically receive generic responses – for instance, that content “does not comply” with standards. Censoring parties oftentimes will not explicitly identify language or elements of concern. (2) Policies appear highly variable. In advertisements for similar products on the same social media platforms, some companies successfully use the word “vagina” while others are barred, highlighting puzzling inconsistencies. (3) Another related theme that emerges is differing standards between references to male and female genitalia. For example, “penis” and associated references were often allowed by the same television shows that mandated censorship or omission of “vagina.” (4) Objections often call the use of “vagina” overtly sexual, profane, or unprofessional. However, “vagina” refers to an anatomical term for which there is no suitable, biologically accurate alternative. Censorship of the word forces inaccurate, over-generalized, ambiguous references to female genitalia.

Conclusions
The word “vagina” is censored across multiple platforms: print, film and television, social media, politics, education, and more. It has been censored for centuries and continues to be today. This erects barriers to care for women. Patients increasingly turn to the internet and other media platforms as accessible sources of high-quality health information about their bodies. Pervasive censorship of the word “vagina” perpetuates a culture of ignorance and shame about women’s bodies. Until we normalize the term “vagina,” we cannot make progress on women’s pelvic health.

Disclosure
No
(223) Sexual Therapy: Patient-reported Barriers to Care
Authors: Jefferson F , Ziegelmann M , Vencill J , Helo S , Kohler T , Collins C S 
Published: May 2023

Abstract

Introduction
Sexual therapy for male sexual dysfunction has been used to help patients address a variety of sexual dysfunction-related conditions. While this intervention is frequently recommended for patients by male sexual health experts, the rate of adherence to the recommended therapy and associated factors is unknown.

Objective
To understand factors leading to completion of sex therapy consultations and barriers that prevent it.

Methods
A survey was developed by experts in the management of male sexual dysfunction and sex therapy at our institution. The survey included questions focusing on the decision to pursue sex therapy (or not), barriers or facilitating factors, patient perceptions regarding the referral, and treatment success. A retrospective chart review was performed to identify those patients who were referred for sexual therapy after undergoing evaluation for male sexual dysfunction at an academic Men’s Health urology clinic from 2017 - present. The survey was mailed out to these patients, and respondent survey data was compiled to evaluate survey responses.

Results
To date, 23 patients completed the survey (20% response rate). Sixty-five percent of survey respondents were ≥ 50 years of age, 87% were straight, and 71% were married. Reasons for sex therapy referral were frequently multi-factorial and included erectile dysfunction (65%, n=15), low libido (43%, n=10), ejaculatory dysfunction (39%, n=9), performance anxiety (30%, n=7), relationship problems (30%, n-7), and genital pain (14%, n=3). Seventy-eight percent of patients (n=18) felt that sex therapy consultation was a reasonable part of their treatment plans. Six (26%) patients did not attend their recommended sex therapy consultations. Reported barriers included sense of shame (n=2), embarrassment (n=2), scheduling conflicts (n=1), lack of anticipated benefits (n=1), and feeling dismissed by the referring provider (n=2). Those who attended sex therapy frequently reported the perception that referral made sense based on their symptoms (n=10, 59%) and/or a feeling of desperation to “do anything do get better” (n=11, 65%). Seventy-eight percent of patients who attended sex therapy found it helpful and would recommend it to a friend with a similar concern.

Conclusions
The majority of male patients who are referred to sexual therapy feel it is beneficial. However, one in four men choose not to pursue this line of treatment despite recommendations from their treating physicians. Future work is needed to address barriers to pursuing sex therapy.

Disclosure
No
(231) Endogenous Vasoactive Peptides in the Control of Human Penile Erectile Tissue: Is There a Significance of the Neuropeptide Y (NPY)?
Authors: Maerker V , Ueckert S , Becker A , Bannowsky A , Kuczyk M 
Published: May 2023

Abstract

Introduction
Aside from the neurotransmitters of the sympathetic adrenergic system, vasoconstrictor peptides may also play a role in mediating the constant tone of the erectile tissue during penile flaccidity and in returning the erect penis to the flaccid state. Neuropeptide Y (NPY) is present in high concentrations in the male genital tract. The peptide has been shown to induce contraction of isolated human penile tissue (corpus cavernosum, penile arteries) and potentiate its response to noradrenaline.

Objective
The purpose of our study was to measure in the cavernous and systemic blood of healthy male volunteers the course of NPY through different stages of sexual arousal.

Methods
Whole blood was drawn from the corpus cavernosum and the cubital vein of 15 healthy male volunteers during penile flaccidity (Fl), tumescence (Tu), rigidity (Ri) and detumescence (Det). Penile tumescence and erection were induced by applying audiovisual and tactile stimulation. Plasma levels of NPY (given in pmol/L) were determined by means of an enzyme-linked immunoassay (ELISA, IBL GmbH, Hamburg, Germany).

Results
NPY significantly decreased in the cavernous blood with the beginning of sexual arousal, when the flaccid penis became tumescent and finally rigid (Fl: 88.8 ± 35.8, Tu: 62.4 ± 22.7, Ri: 62.3 ± 19.7). In the phase of detumescence, only a slight increase was noted (64.8 ± 23). In the systemic circulation, no pronounced alterations in the concentration of NPY were registered through the different penile stages (Fl: 64.4 ± 27, Tu: 65.8 ± 19, Ri: 59.6-25, Det: 67.6 ± 29.3).

Conclusions
Our findings are in favor of the hypothesis that NPY could contribute to the maintenance of the resting state of cavernous smooth muscle. It remains to be elucidated whether the peptide may play a role in the pathophysiology of erectile dysfunction.

Disclosure
No
(248) Utility of Fine-needle Vasography in Men with Obstructive Azoospermia
Authors: Mian A , Huang E , Starke N , Trost L , Helo S 
Published: May 2023

Abstract

Introduction
Obstructive azoospermia accounts for up to 14% of patients presenting for fertility evaluation. Fine-needle vasography (FNV) is a diagnostic procedure that can be performed to identify an obstruction proximal to the ejaculatory duct. Compared to traditional vasography, FNV utilizes a less-invasive method to perform imaging of the vas deferens and distal ejaculatory structures. Herein we report our experience performing FNV in a series of patients with suspected complete or near-complete obstruction.

Objective
To report our experience using FNV to identify a site of obstruction and determine candidacy for reconstructive procedures in patients presenting with suspected obstructive azoospermia or cryptozoospermia.

Methods
We report a multi-Institutional case series of patients with suspected complete or partial obstructive azoospermia. Patients that were included had azoospermia or severe oligoasthenospermia, presence of palpable vasa, testicles ≥12 ml, and FSH &lt;7.6 IU/L. All patients underwent testicular biopsy prior to or at the time of FNV to confirm spermatogenesis. Fine-needle vasography was performed using a 25F angiocatheter, with radio-opaque dye visualized under fluoroscopy. Descriptive statistics are reported as median and interquartile range (IQR).

Results
A total of 16 patients underwent vasography between 2014 and 2022 with three surgeons. Twelve patients presented with azoospermia, and four with severe oligoasthenospermia. Median age at vasography was 35.0 (IQR 17) years. Median pre-vasography semen parameters were sperm concentration 0 million/mL (IQR 0.3), sperm motility 0% (IQR 1), semen volume 2.5 mL (IQR 2.5), and semen pH 8.0 (0.7). Median total testosterone was 445 ng/dL (IQR 433), and FSH 4.5 IU/L (IQR 3.6). Half of patients had a history of inguinal hernia repair, unilateral in two and bilateral in six cases. History of genitourinary infection was present in six (35.3%) patients. A total of 7 (44%) men were found to have distal obstruction on FNV, while 8 (50%) were offered epididymovasal reconstruction. Of the seven patients diagnosed with obstruction/atresia of the vas deferens within the inguinal canal and/or pelvis, only two were related to prior inguinal hernia repair. Of the eight men with prior inguinal hernia repairs, two were confirmed to have an obstruction at the level of the inguinal canal. Of the six patients with a history of genitourinary infection, four had an obstruction at the level of the epididymis (with normal FNV), while two had atresia of the vas deferens in the pelvis.

Conclusions
Fine-needle vasography is an effective, minimally-invasive way to identify the site of complete or partial obstruction in patients presenting with suspected obstructive azoospermia or severe oligoasthenospermia. It additionally permits identification of men who are candidates for epididymovasostomy reconstruction and helps to differentiate between ejaculatory duct obstruction and other causes of blockage.

Disclosure
No
(257) Ultrasound Classification System for Peyronie's Disease
Authors: Baird B , Haehn D , Gibbs E , Wajswol E , Anderson A , Alexander L , Broderick G 
Published: May 2023

Abstract

Introduction
Peyronie’s Disease (PD) is characterized by a fibrous scar of the tunica albuginea. PD is typically imaged with 2D ultrasound. We propose a classification system of these ultrasound findings in the evaluation of PD.

Objective
The purpose of this study is to establish a functional sonographic classification system for evaluating PD and to examine the relationship between PD grading and curvature, duration of PD, and vascular erectile status.

Methods
In our study, 395 patients with PD underwent intracavernosal injection with an erectile agent (ICI) followed by Color Doppler Duplex Ultrasound (CDDU). All CDDU studies were performed by a single examiner and all PD grading was done by two independent reviewers using saved images. Ultrasound findings including peak systolic velocities (PSV) and resistive indices (RIs) were recorded. PD grades of 2D images were classified into three grades: Grade 1 acoustic shadowing without calcification; Grade 2 focal microcalcifications of the tunica, pillars, or septal fibers; Grade 3 confluent calcification of the dorsal, septal, ventral tunica albuginea.

Results
There were 250 patients classified with Grade 1 (63%) sonographic changes, 75 with Grade 2 (19%), and 70 with Grade 3 (18%). All groups had similar median ages and body mass index (BMI): Grade 1 (59.3 yr), Grade 2 (59 yr) and Grade 3 (60.3 yr), p = 0.711; BMI 27.6, 28.2, 27.7, p = 0.813. Additionally, medical and surgical risk factors for erectile dysfunction were similar across the three groups; these included hypertension, heart disease, diabetes mellitus, hyperlipidemia, smoking history, and history of prostate surgery. Most patients had previously used PDE5-Inhibitors (293/395). History and/or physical findings of Dupuytren’s palmar contracture was noted in 30/395 (7.6%) of men. The median duration of PD was not significantly different across the three groups (12, 12, 14 months p = 0.639). Neither CDDU diagnoses (Table 1) nor curvature varied by sonographic grades (Table 2).

Conclusions
The scar resulting from PD seals together the outer longitudinal and inner circular layers of the tunica albuginea causing deformity of the erect shaft. PD plaques are usually palpable and associated with focal thickening of the tunica. On 2D ultrasound, the typical appearance is an acoustic shadow. Most of our patients presented with Grade I acoustic shadowing and no calcifications 250/395 (63%). On the other hand, 19% had acoustic plaque shadowing and additional findings of focal tunica or deep microcalcifications and 18% had confluent calcification of the dorsal, septal or ventral tunica. We propose a unique and reproducible classification system for Peyronie's Disease. This grading system is based on grayscale ultrasound of Peyronie’s plaques may serve the purpose of diagnostic evaluation, didactic teaching and integrated research.

Disclosure
No
(258) Agatston Calcium Score Assessment of Plaque Calcification in Peyronie’s Disease
Authors: Baird B , Gibbs E , Wajswol E , Geldmaker L , Haehn D , Alexander L , Broderick G 
Published: May 2023

Abstract

Introduction
Peyronie’s disease (PD) is characterized by penile pain, penile deformation and curvature, sexual dysfunction, and psychological implications. Fibrosis and plaque formation are often part of PD pathophysiology. Calcified plaques can alter treatment planning. Penile ultrasound with Doppler (PUS) is used to exclude erectile dysfunction and identify plaques. However, plaque extent and distribution can be obscured by acoustic shadowing, limiting complete plaque characterization. Non-contrast pelvis computed tomography (CT) provides a noninvasive method to identify plaques in 3 dimensions and quantify plaque Ca burden.

Objective
Our objective was to utilize Agatston Ca scoring measure Ca burden in patients with Peyronie's disease.

Methods
A retrospective database from 1/1/2017 and 6/30/2021 identified 25 men with calcified plaques on CT after PUS performed by a single urologist. Two abdominal radiologists reviewed CTs in consensus to measure calcified plaque size and distribution on Visage PACS. Semiautomated Agatston Ca scoring values were obtained with Syngo.via. Total Ca volume (mm3), total Ca score were correlated with hourglass deformity on clinical exam, plaque complexity on CT (&gt;2 discrete calcified plaques, circumferential corpus cavernosum involvement, septal involvement), and surgical management using descriptive statistics and t-test.

Results
Mean Ca volume was 1417 mm3 (range 1.4-5425.7, standard deviation (SD) 1570); mean Ca score was 1691 (range 1.6-6048; SD 1862) with significantly higher Ca volume in patients with complex plaques (265 mm3 vs 472 mm3, p&lt;0.05), and significantly longer plaque dimension for longest plaque dimension measured by CT vs US (31 vs 23, p&lt;0.05). There was no significant difference in Ca volume for nonsurgical vs surgical (1791 vs 893, p=0.06) or for no hourglass vs hourglass deformity (1173 vs 1904, p=0.19).

Conclusions
CT scan and calcium scoring are useful tools in the assessment of PD. Semiautomated Ca scoring may help noninvasively identify complex calcified penile plaques to guide medical and surgical therapy for Peyronie’s disease.

Disclosure
No
(259) Computed Tomography for Evaluation of Complex Calcified Peyronie's Disease
Authors: Baird B , Gibbs E , Wajswol E , Haehn D , Geldmaker L , Alexander L , Broderick G 
Published: May 2023

Abstract

Introduction
The presence and extent of penile calcifications is an important factor in disease management of Peyronie’s Disease (PD). Calcified plaques may necessitate plaque excision and grafting (E&G) in addition to other therapies or surgeries. PD pathology such as corporal septal involvement, multifocal calcifications, and circumferential corporal calcification can be difficult to assess on color doppler ultrasound (CDDU) due to device limitations. Computed tomography (CT) can be utilized for further characterization of PD.

Objective
The objective of our study was to review patients who underwent CT imaging for characterization of their Peyronie's Disease.

Methods
Twenty-three patients with a diagnosis of PD were retrospectively evaluated between 2017 and 2021. Patients underwent CDDU examination with artificial erection and were evaluated based on erectile function, plaque dimension, hourglass deformity, plaque septal involvement, and suspected calcification status. Patients with CDDU examination suggestive of calcification or significant complexity underwent non-contrast CT scan for 3-dimensional evaluation of the plaque prior to surgical discussion. CT complexity was defined as concern for multifocal calcified plaques (&gt;2), partial/complete circumferential corpus cavernosum involvement, or septal involvement.

Results
All 23 patients had concerning findings on initial examination for calcified plaque which led to their CT evaluation; 9 of 23 (39.1%) patients had exam findings with hourglass deformity. On CT evaluation, calcification was confirmed in 22 of 23 patients (95.7%). Plaque dimensions on CT scan ranged from 0.4 x 0.2 x 0.5 cm to 4.0 x 2.0 x1.7 cm. Many of these measurements were approximations due to circumferential calcified plaque. A classic “gull-wing” appearance was noted in 6 of 23 (26%) patients; 12 of 23 (52.2%) of patients had septal involvement on CT; 8 of 23 patients (34.8%) had significant multifocal disease; 8 of 23 patients (34.8%) decided to proceed with surgical correction via E&G (n = 3), IPP with E&G (n =1), or via IPP with manual remodeling via Wilson technique (n = 4).

Conclusions
Non-contrast penile CT scan identifies calcification well in patients with Peyronie's Disease. CT allows for increased accuracy of surgical planning especially when evaluating for multifocal disease, circumferential plaque and/or septal involvement. These elements are critical for for providing accurate surgical recommendations and preoperative discussions.

Disclosure
No