bluuebunny/crossref_metadata_2025_split huggingface dataset:
(254) Women in Healthcare: Is Fertility an Issue?
Authors: Parikh N , Alom M , Ahmed M , Robinson M , Mcgriff S , Olive E , Helo S 
Published: May 2023

Abstract

Introduction
Women in healthcare are faced with unique challenges that may increase the risk of infertility including irregular work hours, occupational hazards due to radiation or chemicals, and advanced maternal age.

Objective
We therefore sought to investigate live birth rates of female healthcare workers presenting with infertility compared to their non-healthcare counterparts.

Methods
After obtaining IRB approval, a retrospective review of hospital employees and partners presenting for a fertility evaluation between 2013-2019 was conducted. Patient age, BMI, history of previous live birth, occupation, use of assisted reproductive technology and female fertility factor were recorded. Couples with at least 12 months of follow up from initial presentation as well as a documented semen analysis were included in the study. Normal semen parameters were defined by the World Health Organization 2010 criteria. Logistic regression analysis was conducted to identify factors associated with increased likelihood of live birth.

Results
Of the 934 female partners identified, 445 were healthcare workers and 489 non-healthcare workers. Female age, BMI, smoking status, and history of previous live birth were not statistically significant between groups. No differences in male partner age, BMI, semen parameters and presence of male factor were noted. As an overall group, female age, male age, and abnormal concentration were noted to impact live birth rates (p&lt;0.016). Live birth rates were higher in female health care workers compared to non-healthcare workers, 76.1 vs. 69.6%, respectively, p=0.042. The cohort was then further analyzed to determine if there was a difference in between females holding a Doctor of Medicine (MD) and other medical occupations (91 MDs vs 357 other occupations). Live birth rates, pregnancy complications, and preterm labor were not statistically significant, however MDs were found to have higher rates of use of assisted reproductive technologies (IUI or IVF) and were more likely to be older at time of evaluation (p=0.0015). After controlling for age at delivery, female physicians were still more likely to utilize ARTs, but this was no longer statistically significant (p=0.0806).

Conclusions
In this cohort of hospital employees, female healthcare workers had a higher live birth rate despite no differences in age, BMI, female factor infertility, use of assisted reproductive technology, or male partner factors. However, when the subgroup of female hospital employees was further analyzed, MDs were noted to have higher use of assisted reproductive technologies and older age. This indicates increased difficulty achieving pregnancy, likely a reflection of advanced maternal age. Further research is needed to identify subgroups within the healthcare population that may be at greater risk for infertility.

Disclosure
No
(260) Further Characterizing Treatment Success with Intralesional Collagenase for Peyronie’s Disease
Authors: Mian A , Roshandel R , Alom M , Byrne E , Helo S , Kohler T S , Zieggelmann M J 
Published: May 2023

Abstract

Introduction
Intralesional Collagenase Clostridium histolyticum (CCH) is approved for men with Peyronie’s Disease (PD). Most studies use curve improvement ≥ 20% to define treatment success.

Objective
Here, we sought to further characterize objective and subjective treatment outcomes with CCH.

Methods
We reviewed our prospectively maintained database for all patients who underwent CCH at our institution from 2013 through the present. We specifically identified those who completed four series of CCH (or elected to discontinue prior to completing four series due to satisfactory penile straightening or lack of results) and had available curvature assessment data. Treatment outcomes were broken down by level of curve improvement (0%, 10%, 20%, 30%, and &gt; 40% improvement). Treatment success was also evaluated by improvements in the ability to engage in penetrative sexual intercourse and perceived surgery avoidance. Statistical analyses were performed using JMP Pro 14.1.0 (SAS Institute, Cary, NC).

Results
127 patients had complete data available. The mean age was 57 years (SD 8.4). The mean PD duration was 27 months (SD 59). The mean baseline curvature was 66.1O, and the mean post-treatment curvature was 45.1O (p&lt;0001). The mean curvature improvement was 32% (SD 33). 68% of patients achieved a 20% or greater improvement in penile curvature, including 38% who achieved ≥ 40% improvement. 72% (n=48/67) felt that CCH prevented the need for surgery, and 68% reported CCH restored the ability to penetrate. Stretched flaccid penile length (SPL) increased by ≥ 1 cm in 50% of patients who used concurrent penile traction (PTT) and CCH, including 28% of patients who experienced ≥ 2 cm of length gain. In contrast, only 16% of patients who did not perform concurrent PTT had a ≥ 1 cm increase in SPL (p&lt;0.0001).

Conclusions
CCH may restore the ability to penetrate with intercourse, and most patients feel that CCH prevents the need for surgery. Almost 40% of patients experienced a 40% or greater curvature improvement. However, 13% of patients may go through the entire series with minimal improvement. Concurrent PTT allows for simultaneous penile length gain in some patients. These data are helpful when counseling patients on expected outcomes.

Disclosure
No
(272) Novel Men’s Health Curriculum Increases Fraternity Members’ Knowledge, Confidence, and Willingness to Seek Help for Health Concerns
Authors: Gutierrez W , Gannon M , Scherer A , Pearlman A 
Published: May 2023

Abstract

Introduction
Limited data exist regarding knowledge of male-specific health concerns in young men. We developed a novel men’s health curriculum for undergraduate fraternity members and assessed its impact on knowledge related to, confidence in understanding, and likelihood of seeking help for common men’s health concerns.

Objective
The purpose of this study was to evaluate baseline men’s health knowledge, confidence in understanding men’s health concerns, and likelihood of seeking help for men’s health concerns in a cohort of undergraduate fraternity members and to assess the impact of a novel men’s health curriculum on each of these measures.

Methods
Members of six undergraduate fraternities viewed a 45-minute presentation about men’s health concerns related to sexual health, urinary function, hormones, and fertility. Interested subjects completed pre- and post-presentation surveys evaluating health knowledge, confidence in understanding men’s health concerns, and likelihood of seeking help for men’s health concerns.

Results
189 fraternity members completed at least one of the surveys, of whom 105 completed both pre- and post-presentation surveys. Prior to the presentation, participants answered 57.7% of health knowledge questions correctly. This increased to 88.7% after the presentation (p&lt;0.001). The number of participants who indicated that they are likely to seek help for men’s health concerns also increased from 43.6% to 79.8% (p&lt;0.05) following the presentation. The percentage of participants likely to seek help for concerns about urine stream, erectile dysfunction, low testosterone, and sexually transmitted illness (STI) screening increased by 28.7%, 23.4%, 25.8%, and 12.9% respectively (p&lt;0.05). No changes were observed in participants’ likelihood of seeking help for STI symptoms. Participants’ confidence in their understanding of men’s health concerns and knowing when/where to seek help significantly increased from 2.99 to 4.05 (5-point Likert scale). Confidence, but not health knowledge, correlated with participants’ likelihood of seeking help for health concerns. The strength of this relationship (correlation coefficient) increased from 0.45 to 0.796 (p&lt;0.001) following the presentation.

Conclusions
Our pilot study suggests that a short presentation on common men’s health concerns increases health knowledge, confidence, and likelihood of seeking help for these concerns. Increased self-efficacy (i.e., increased confidence), rather than knowledge, was associated with increased willingness to seek help.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Endo Pharmaceuticals, FirmTech
(280) Second Stage Surgery After Ring Flap Metoidioplasty: Technique and Outcomes
Authors: Sun H , Isali I , Tay K , Mishra K , Sellke N , Gupta S , Chen M 
Published: May 2023

Abstract

Introduction
Metoidioplasty is an option for creation of external male-appearing genitalia in transmasculine individuals. Many individuals report good sensory, functional, and aesthetic outcomes following single-stage metoidioplasty with urethral lengthening and scrotoplasty. However, an average of 12% of patients require a second-stage surgery to improve aesthetic appearance, place testicular implants, address complications, and maximally lengthen the neophallus. These procedures are risky to perform at the time of initial metoidioplasty as this may disrupt the vascular supply to the neoscrotum via the anterior branches of the external pudendal artery. We report outcomes of second-stage ring-flap labial metoidioplasty involving monsplasty, upper labia majora dermatolipectomy, and scrotoplasty with testicular implant insertion.

Objective
Transmasculine individuals who have had metoidioplasty with rotational advancement labia majora flap and (Ghent style) scrotoplasty often desire monsplasty, upper labia majora tissue resection, and testis implant insertion to optimize aesthetics, reduce dysphoria and improve voiding function. We describe our technique and surgical outcomes with dermatolipectomy of the mons pubis (monsplasty) and upper labia majora with simultaneous testis implant insertion.

Methods
We retrospectively reviewed the outcomes of ring flap metoidioplasty patients who underwent second stage surgery involving monsplasty and upper labia majora dermatolipectomy, and testis implant insertion. Monsplasty is performed by excising excess skin and adipose tissue to better expose the penis and lift the genitals. Upper labia majora tissue is subsequently resected, followed by development of pockets into each hemiscrotum inferiorly. Silicone carving implants are then individually sized and inserted to serve as testicular prostheses.

Results
From November 2017 to January 2022, 13 patients underwent second stage metoidioplasty and scrotoplasty with testis implant insertion. Mean follow-up was 22 months. Monsplasty was not desired/necessary in two (15%) patients. Implant malposition occurred in one (7.7%) patient, and one (7.7%) patient was unhappy with the overall aesthetics prompting him to seek a second opinion. To date, no surgical revision was desired nor performed. There were no wound or implant infections, and no scrotal necrosis.

Conclusions
Monsplasty and upper labia majora dermatolipectomy with simultaneous testis implant insertion is a safe and reliable combination of surgeries after metoidioplasty with Ghent style scrotoplasty.

Disclosure
No
(282) Impact of Lichen Sclerosus on Menopausal Women's Sexual Health
Authors: Marino J , Myers A , Pope R 
Published: May 2023

Abstract

Introduction
Lichen sclerosus (LS) is a vulvar dermatosis of unknown origin that affects 1 in 70 women. There is a higher incidence in menopausal women, which may be due to detection bias. LS presents with skin texture changes, hypopigmentation, and scarring. Common symptoms include vulvar burning, pruritus, and dyspareunia.

Objective
This study was to understand the sexual health experience for menopausal women with LS and was part of a larger study on the microbiome and genetics of menopausal women with LS.

Methods
We interviewed 25 women with biopsy proven LS and 5 post-menopausal women who do not have LS or any other vulvar symptoms. This was part of a larger study on the microbiome and genetics of postmenopausal women with LS. We specifically surveyed them regarding the impact their diagnosis had on their sexual health.

Results
The majority (n=10) of the women reported a satisfactory sex life prior to being diagnosed with LS. However, the majority (n=11) of respondents reported that it negatively changed since being diagnosed and most reported their sex life as not being satisfactory (n=8). When asked how their sex life changed women responded with “too uncomfortable at times so hesitant to cause irritation,” “pain, avoidance for intercourse,” “no sex life,” or “no desire no sex.” Unfortunately, the majority (n=10) of the women were not told when they were diagnosed with LS about the possible changes to their sex life. Furthermore, the majority (n=28) were not prescribed medications or had procedures done to improve their sexual health.

Conclusions
Our study revealed that LS had a negative impact on our participants' sexual health and yet the women were not informed of this or given treatment options. We hope this study will call attention to providers to the need for patient education regarding LS' potential negative effects on women's sexual health.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Scynexis
(303) Patient Satisfaction with Oral Testosterone Undecanoate (Jatenzo) in Men with Previous Testosterone Therapy: An Open-Label Single-Center Phase IV Clinical Trial
Authors: Rivero M , Reddy R , Patel M , Muthigi A , Ramasamy R 
Published: May 2023

Abstract

Introduction
Testosterone therapy is available in multiple delivery systems such as gels and injections; however, oral formulations have been unavailable in the United States due to hepatotoxicity and variable bioavailability. Oral formulations of testosterone are convenient, easy to use, and avoid the problems of other forms of testosterone therapy. Jatenzo (testosterone undecanoate) is a novel US FDA-approved oral testosterone capsule that provides a uniform response in patients with testosterone deficiency.

Objective
This study evaluates patient satisfaction with Jatenzo in men with a recent history of alternative testosterone therapy.

Methods
Patients between 18 and 65 years of age with a diagnosis of testosterone deficiency were recruited. Testosterone deficiency was defined as two measurements of serum total testosterone below 300 ng/dL combined with clinical symptoms in accordance with American Urological Association guidelines. Patients were required to have received previous testosterone therapy and completed an adequate washout period prior to starting Jatenzo. The primary outcomes were patient satisfaction, measured by the Treatment Satisfaction Questionnaire for Medication (TSQM-9); and changes in testosterone deficiency symptoms, measured by the quantitative Androgen Deficiency in Aging Males (qADAM) questionnaire at the 3- and 6-month intervals relative to baseline. Serum testosterone, PSA, hematocrit, and estradiol were also evaluated at each time point.

Results
Of the 41 patients recruited into the study, 46% had previously received subdermal pellets, 41% intramuscular injections, 6% transdermal gels, and 7% intranasal gels. Total testosterone levels increased from a baseline after appropriate washout from a mean of 187 ng/dL to 773 ng/dL at 1 month, 434 ng/dL at 3 months, and 397 at 6 months of treatment with Jatenzo. Patient satisfaction with Jatenzo as measured by TSQM-9 improved to 52 and 59.3 at the 3-month and 6-month time points, respectively, relative to 38.5 with previous testosterone therapy. Testosterone deficiency symptoms as measured by qADAM were 34 with Jatenzo and 33.5 with previous testosterone therapy. No significant difference was noted in side effects such as polycythemia or changes in estradiol or PSA.

Conclusions
Jatenzo appears to provide similar patient satisfaction and similar improvement in testosterone deficiency symptoms relative to other forms of testosterone therapy. In addition, Jatenzo increases serum total serum testosterone to reference range (300 – 1000 ng/dL) in &gt;90% of men without a difference in side effect profile.

Disclosure
Yes, this is sponsored by industry/sponsor: Clarus Therapeutics

Clarification
Industry funding only - investigator initiated and executed study
(309) Risk Factors Associated with the Utilization of Xiaflex Injections for Peyronie’s Disease
Authors: Dai M , Patel S , Jin W , Khera M 
Published: May 2023

Abstract

Introduction
Collagenase clostridium histolyticum (CCH), known as Xiaflex (Endo Pharmaceuticals Dublin, Ireland) is the only FDA approved medication for Peyronie’s Disease (PD) in the United States. While Xiaflex has shown efficacy with improvement of curvature by &gt;20% in over half of recipients, patients are hesitant to pursue treatment due to the monetary costs, length of treatment, and perception of injectable therapy.

Objective
The aim of this study is to determine if demographic and clinical factors are associated with clinical decision making to pursue Xiaflex injections for treatment of PD.

Methods
We retrospectively reviewed patients who presented to our institute from 2009 to present with PD. Demographic and clinical parameters were extracted. Independent T-test and Wilcoxon rank sum tests were used to determine correlation between continuous variables and whether Xiaflex was selected. Odds ratios with 95% confidence interval were used to determine association between categorical variables and whether Xiaflex was pursued.

Results
143 patients presented with PD. Of these cases, 24.5% (35) received Xiaflex and 75.5% (108) declined Xiaflex. There was no significant difference in age, months since curvature was first noted, history of erectile dysfunction (ED), ED response to PDE5 inhibitors, history of hypogonadism, lowest total and free testosterone levels documented, history of GU trauma, history of depression or anxiety, hourglass deformity, past urethral instrumentation, SHIM score, plaque volume, maximum plaque diameter on ultrasound, distance of curve apex from coronal sulcus, or history of Dupuytren’s contracture between the treatment and nontreatment group (P&gt;0.05). Subjects who chose treatment had significantly greater predicted curvature and degree of curvature on initial ultrasound at the time therapy was offered compared to those who did not select treatment. Patients who received Xiaflex had an average predicted curvature at presentation of 49.5 degrees (sd = 28.1) and degree of curvature on initial ultrasound of 50.02 degrees (sd=20.0) respectively. Patients who did not receive Xiaflex had an average predicted degree of curvature at presentation of 37 degrees (sd=23.8) and degree of curvature on initial ultrasound of 37.6 (sd=23.0).

Conclusions
Our data suggests that PD patients who chose treatment with Xiaflex had greater penile average curvature compared to those who did not choose treatment. Despite erectile function, comorbidities, and radiographic findings, degree of penile curvature remains a key risk factor for selecting injectable therapy for PD.

Disclosure
No
(310) Nationwide Priapism Emergency Department Encounters in the United States
Authors: Marte J , Brown W , Ha A , Kerr P , Joice G 
Published: May 2023

Abstract

Introduction
There is a lack of understanding of recent trends and costs in emergency department visits and inpatient admissions for priapism. In particular no studies have evaluated nationwide trends in priapism since the roll out of ICD-10CM coding in 2015.

Objective
To determine contemporary national estimates for emergency department visits and inpatient admissions for priapism in the United States from 2016-2019.

Methods
Emergency department (ED) encounters for priapism were analyzed using the Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilization Project (HCUP). Patients presenting to the ED with a diagnosis of priapism were identified by ICD-10-CM codes. Patient demographics, hospital characteristics, patient disposition, and costs were evaluated for each visit. Statistical analysis was performed using established weighting provided by the HCUP 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. Prolonged length of stay was defined as over two days.

Results
Between 2016-2019, there was a weighted total of 78,993 ED visits for priapism nationwide out of an estimated 576,544,259 ED encounters making up 0.014% (p&lt;0.01) of all ED encounters. The average age of a patient diagnosed with priapism was 41 (SEM=0.102). Patients diagnosed with unspecified priapism made up 73.67% (58,197) of encounters, while those diagnosed with drug-induced priapism accounted for 14.34% (11,325) of encounters, and 7.26% (5,738) encounters of priapism were due to disease. The South region had the greatest number of priapism encounters each year accounting for 46.59% (36,800) of all ED visits mostly in metropolitan teaching hospitals hosted 70.53% (55,713). Inpatient admissions occurred in 16.07% (12,696) of ED visits for priapism. Of those admitted, 79.10% (10,043) had a prolonged length of stay with those staying only a day making up 16% (2,031). Inpatient admissions averaged a total charge of $72,668 compared with $3,763 (p&lt;.0001) for patients not admitted. Of the expected primary payers, private insurance covered 32.14% (25,356) of ED visits for priapism with Medicaid covering 30.24% (23,857), Medicare covering 17.50% (13,805), and self-payers covering 14.77% (11,648).

Conclusions
ED visits for priapism remain a frequent and costly event in the United States Healthcare System. Patients requiring inpatient admission leads to a significantly increased cost for the overall encounter. Future studies should examine interventions that can decrease repeated ED visits and inpatient admission for priapism on a regional and national level.

Disclosure
No