bluuebunny/crossref_metadata_2025_split huggingface dataset:
(012) Cannamoms' & the "Postpotum" Stage: Assessment of Cannabis Use and Potential Benefits for Mental Health, Sexual Function & Pleasure, and Parenting Among Postpartum Mothers
Authors: Simpson-Baker D 
Published: May 2023

Abstract

Introduction
Public opinion on cannabis continues to shift as more people emerge from the “green closet” in support of both recreational and medicinal use. ‘Cannamoms,’ a subgroup of cannabis users, represent moms who use cannabis to manage both physical and mental postpartum changes; these moms are attempting to diminish the stigma surrounding cannabis while making the case for how it can be beneficial for postpartum mental health, sex and parenting. For centuries, cannabis has been cited for its multiple benefits, including its anti-depressant and anti-anxiety properties (Zaske, 2018; Stoner, 2017) and its potential to improve sexual health, functioning and pleasure (Kasman et al., 2020; Wiebe & Just, 2019; Testa et al., 2019; Lynn et al., 2019; Sun & Eisenberg, 2017); though multiple studies exist on these topics alone, few have been carried out to investigate how cannabis has the potential to benefit postpartum moms specifically in these areas.

Objective
The purpose of this study is to investigate how cannabis has the potential to be beneficial for moms during the postpartum stage, specifically as it relates to improving mental health, sex and parenting.

Methods
Postpartum moms (participants) were invited to participate in two uncompensated Instagram surveys on May 8, 2021 and May 8, 2022. The survey included 3 poll questions, 4 question & answer sections (Q&A’s) and 1 personal interview. The survey assessed baseline demographics, cannabis use habits and the ways in which participants use cannabis to benefit their mental health, sex lives, and approaches to parenting. A meta-analysis of existing research was also performed to support study findings.

Results
A total of 107 participants between the ages of 18 and 45 were surveyed via Instagram polling, Q&As and personal interviews. Participants reside in the United States and represent multiple racial & ethnic groups (33% Caucasian, 24% Hispanic/Latinx, 25% Black/African American, 1% Native/American Indian, 1% Asian American/Pacific Islander, & 13% Two or more races). 61% of participants endorsed regular use of cannabis, mostly through smoking cannabis flower (46%) or consuming cannabis edibles (36%). Of those participants, 75% agreed that cannabis improves their mental health (including symptoms of depression and anxiety); 89% agreed that cannabis improves their sex lives; and 89% agreed that cannabis improves their approach to parenting.

Conclusions
Cannabis use among postpartum mothers is associated with improved mental health, better sex and better parenting. These results suggest a need for more research on the potential benefits of safe & responsible cannabis use during the postpartum stage.

Disclosure
No
(036) Outcomes of Penile Prosthesis Implantation after Transgender Phalloplasty: A Single Center Study
Authors: Persily J , Mishra K , Lee Y S , Blasdel G , Bluebond-Langner R , Zhao L 
Published: May 2023

Abstract

Introduction
Many transmen chose to pursue penile prosthesis (PP) implantation as a stage of genital gender affirming surgery. The prosthesis facilitates penetrative intercourse, as the neophallus lacks rigid erectile tissue. While PP placement is a well-established and relatively low-risk surgical treatment option for erectile dysfunction is the cis-male population, published series of post-phalloplasty prosthesis placement have demonstrated a higher rate of complications and subsequent explant.

Objective
To demonstrate that an integrated surgical team that participates in all stages of phalloplasty creation can improve penile prosthesis outcomes in transmen.

Methods
We performed a retrospective review of all transmen who underwent PP implantation at our institution from January 2015 through October 2021, yielding a cohort of 44 men. Men who underwent phalloplasty for another reason (trauma, infection, priapism) were excluded. Both malleable (MPP) and inflatable (IPP) prostheses were included in the cohort. Home phalloplasty refers to phalloplasty performed at our institution, and outside phalloplasty at another institution. The surgical technique emphasizes exclusion of urinary flora from the operative field and avoiding excess anchor material to minimize niduses for infection. We analyzed preoperative, operative, and post-operative characteristics, stratified by whether the phalloplasty was performed at our institution. We also performed logistic regression for predictors of explant in the cohort.

Results
Cohort characteristics and outcomes are represented in Table 1. 44 PPs were implanted 28 at our institution, 16 at an outside institution. Average age was 32 and 33 in the cohorts, respectively. IPPs were more commonly implanted than MPP. Notably, operative time was significantly lower if the phalloplasty had been constructed at our institution (p=0.014). 16 men total required explant, 7/28 (25%) in the home phalloplasty group and 9/16 (56.3%) in the outside phalloplasty group. Predictors of explantation are shown in Table 2. Significant predictors included age (p=0.013), smoking (p=0.030), operative time (p=0.007), whether the phalloplasty was performed at our institution (p=0.043), and the number of pre-PP revision surgeries (p=0.047). On multivariate logistic regression including all variables significant on univariate analysis, only age (p=0.032) and operative time (p=0.010) remained significant predictors.

Conclusions
We present a large post-phalloplasty penile prosthesis cohort, demonstrating exceedingly low infection rate and improved explant rate in a cohort of men who all underwent both phalloplasty and prosthesis placement with the same surgical team. Our analysis suggests that phalloplasty characteristics, patient characteristics, and operative time can influence penile prosthesis outcomes.

Disclosure
No
(037) Contemporary Surgical and Functional Outcomes of Anterolateral Thigh Flap for Penile Reconstruction
Authors: Lee W G , Adasonla K , Ralph D , Christopher N 
Published: May 2023

Abstract

Introduction
The radial forearm free flap phalloplasty is the most commonly used flap for penile reconstruction. The anterolateral thigh (ALT) free flap was proposed in 2006 as an alternative due to the twin advantages of a more easily hidden scar and improved flexibility in the length of the flap. A pedicled variant of the ALT flap was proposed the same year thus offering greater security of vascular supply for suitable patients. Previous reports have highlighted higher rates of flap loss and low rates of integrated urethra.

Objective
The aim of the study is to report the contemporary surgical outcomes of ALT phalloplasty. In addition, the functional outcomes of the ALT flap phalloplasty are reported for the first time.

Methods
All patients undergoing ALT flap phalloplasty were included in the study between 2009 and 2021. Data were extracted from a comprehensive prospective database and the medical records. Functional outcomes were assessed by non-validated questionnaire.

Results
Seventy-six patients underwent ALT flap phalloplasty with a mean follow-up of 34 months (SEM ± 3.05). Median age of the patients was 32 (IQR 26 – 46) and body mass index was 24 (SEM ± 0.61). A significant minority had a previous phalloplasty (22%). In addition, 7% of patients had other co-morbidities including diabetes and peripheral vascular disease. Over half of all flaps (n=41) were designed with an integrated urethra and 6.6% (n=5) required free flap transfer. The average length of stay was seven days (SEM ±0.47). Post-surgery, five (6.6%) patients experienced total flap loss, with a further three (3.9%) experiencing partial loss. Urethral complications were common with eleven (26.8%) patients developing fistulae and three (7.3%) developing strictures. Fifty-three (69%) patients completed the functional outcomes questionnaire. Forty-three (81%) were generally satisfied with their phalloplasty, while thirty-four (65%) felt they had a good cosmetic outcome. Twenty-eight (53%) had sensation in at least half of their phallus. Eight (17%) experienced troublesome post-micturition dribbling.

Conclusions
Presented is one of the largest cohort of patients following genital gender affirmation surgery using the ALT flap phalloplasty. Over half of all patients successfully had an integrated urethra (gold standard for urethral reconstruction). Functional outcomes (an important determinant for the choice of a flap) are reported for the first time showing 81% of patients are satisfied despite a challenging cohort with almost a quarter of patients undergoing salvage following previous failed phalloplasty.

Disclosure
No
(077) Testosterone Therapy in Men on Active Surveillance for Prostate Cancer
Authors: Flores J , Salter C A , Benfante N , Jenkins L , Ehdaie B , Laudone V , Eastham J , Mulhall J P 
Published: May 2023

Abstract

Introduction
The role of testosterone therapy (TTH) in men with prostate cancer (PC) is debated, especially in men on active surveillance (AS).

Objective
This study aimed to review our data on TTH in this population.

Methods
The study population consisted of (i) men with PC on active surveillance (ii) with two total T (TT) levels &lt;300 ng/dL (iii) associated with symptoms (iii) performed using LCMS (v) conducted in an early morning fashion who (vi) pursued T therapy (TTH). TTH included exogenous (transdermal, intramuscular) and clomiphene citrate (CC) in the setting of low/low-normal LH levels. T lab work including PSA levels, were checked within 4 weeks of TTH initiation, every three months in the first year and every six months after that. Target TT level was the middle tertile of the normal reference range at our institution. We report on T and PSA levels in this group.

Results
82 patients are included. Mean age = 64 ± 9 years. Median pre-TTH PSA levels were 4.6 [3.4, 6.7] ng/mL. Mean baseline TT levels were 305 ± 145 ng/dL. 19% of these men had a TT level &lt;200 ng/dL. Median Gleason score (GS) was 6 with 90% 3+3, 9% 3+4 and 1% 4+3. Median duration on AS before TTH was 14 [1, 43] months. 45% received transdermal T, 19% intramuscular T and 36% CC. Post-TTH TT = 553 ± 268 ng/dL, PSA = 4.9 [3.2, 9.2] Median duration of TTH at last follow-up was 14 [1, 39] months. Median PSA change per patient was 0.3 [-0.9, 2.6] ng/mL, representing a median of 14 (-24, 70) % change in PSA per patient (p= 0.045). 42% had a decrease in PSA, 58% an increase. In 88% of men who experienced a rise in PSA, the PSA rose ≥10%. 50% of men on TTH who had a PSA level below 4 ng/dL rose above 4. 28% of men experienced a PSA level increase ≥1 ng/mL per year. In 18% of these men, TTH was stopped and definitive PC treatment was instituted. In men with ≤1 ng/mL per year increase in PSA, another 18% opted for definitive PC treatment. The most common reason for this was PSA anxiety.

Conclusions
In men with PC on AS treated with TTH, minimal changes in PSA were seen, with equal numbers of men experiencing a rise and a drop in PSA. About fifth of men ceased AS and proceeded to definitive therapy for their PC.

Disclosure
No
(110) Evaluation of Men Under 35 Who Underwent Penile Implant Surgery
Authors: Suarez-Sarmiento A , Perito P , Ghomeshi A , Mendez L , Suarez-Sarmiento M , Levit B 
Published: May 2023

Abstract

Introduction
Erectile Dysfunction (ED) has become an increasingly common disorder in young adult males. There are multiple etiologies of ED ranging from vascular, neurogenic, and structural causes. Often times, ED presenting in young men is psychiatric in nature as opposed to the other causes that typically present in older patients. ED found in young, healthy men with no history of systemic disease or traumatic injury, can be challenging. Past research has shown that men ages 18-35 typically have normal lab results and are treated with PDE-5 inhibitors. However, our data suggests that patients whose symptoms do not improve following the use of PDE-5 inhibitors may have a vascular etiology of ED.

Objective
Our objective is to determine the prevalence of venous leaks in young adult males who present with ED, but do not respond well to PDE-5 inhibitors.

Methods
Patients who underwent inflatable penile prosthesis (IPP) surgery for the treatment of ED over a 36-month period under the age of 35 who had failed PDE-5 inhibitors were identified from our database retrospectively. All patients completed an IIEF-5 questionnaire and had a penile doppler ultrasound (PDUS) performed preoperatively. PDUS was used to identify and record cavernous arterial flow signals before and after stimulation. Veno-occlusive ED was described as persistent End Diastolic Velocity (EDV) over 5 cm/sec during all phases of erection. The relationships, according to Doppler diagnosis, IIEF-5 score, SHIM scale, and erection score were evaluated as well as surgical outcomes and patient comorbidities.

Results
1,558 patients were evaluated in this series, of whom 32 met inclusion criteria. Patients ages ranged from 18 to 35, with a mean age of 28.4. PDUS determined that 27 (84%) suffered from veno-occlusive disease, while 3 (9%) had arterial insufficiency due to DMI and 2 (7%) had neuropraxia. Of those veno-occlusive disease patients, EDV values ranged from 7.4 to 21.2, with a mean of 13.4, with peak systolic velocity values ranging from 45 to 122cm, with a mean of 97. All patients in this cohort had successful penile prosthesis implantation without complications or need for revision.

Conclusions
Doppler examination does indeed suggest that patients with cavernous venous occlusive dysfunction have moderate to severe leaks. We strongly recommend a baseline PDUS following PDE-5 inhibitor failure due to the significant prevalence of veno-ccclusive disease in this rare patient population. Furthermore, if veno-occlusive disease is identified during PDUS, we encourage frank discussion of penile prosthesis placement with the patient as well as the severity of veno-occlusive disease and its resultant effect of worsening ED.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: coloplast, boston scientific
(126) Long-term Functional Outcomes for Men with Priapism Secondary to Recreational Use of Intracavernosal Injectables: A Multi-center Follo- up Study
Authors: Masterson J M , Li K D , Diaz P , Gurayah A A , Zizzo J , Breyer B N , Ramasamy R , Kim H H , Anger J T 
Published: May 2023

Abstract

Introduction
Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. There is a dearth of studies evaluating long term erectile function after episodes or treatment for priapism.

Objective
We evaluated the functional outcomes of a larger, multi-institutional population of men with priapism due to recreational use of ICIs.

Methods
Men who presented with ischemic priapism due to recreational use of ICIs to Cedars-Sinai Medical Center (Los Angeles, CA), University of California at San Francisco (San Francisco, CA), and Jackson Memorial Hospital (Miami, FL) from January 2010 to December 2018 were contacted via telephone. All participants completed the five-item international index of erectile function (IIEF-5).

Results
A total of 19 men aged 24 – 59 (mean 47.9) were recruited from the 3 sites. Mean follow up was 77.2 months (+/− 27.6). 17 men (89%) were white; the one man was Asian (5.5%) and one man was Hispanic (5.5%). Seven men (37%) had been diagnosed with ED prior to their priapism episode however none of the men had a prescription for ICIs. Four men (21%) required no intervention at all, eleven men (58%) required phenylephrine irrigation alone, four men (21%) required distal shunting. No men required proximal shunting. None of the men had no ED, 31.6% had mild ED, 36.8% had mild-moderate ED, 26.3% had moderate ED, and 5.3% had severe ED. Mean IIEF-5 for the population was 13.4 (+/− 3.9). Strengths of our study included the large population size give the relative rarity of this condition as well as the geographic diversity of our population. Limitations include our low overall recruitment rate and lack of objective measures of erectile function prior to priapism.

Conclusions
Men who suffer ischemic priapism secondary to recreational use of ICIs appear to retain some erectile function following their priapism episode. Nevertheless, 100% report some level of ED. This is likely due a combination of adequate erectile function at baseline and expeditious treatment of priapism in a minimally invasive manner.

Disclosure
No
(128) Complication Rates in Patients Using Intracavernosal Injection Therapy for Erectile Dysfunction With or Without Concurrent Anticoagulant Use—A Single-Center, Retrospective Pilot Study
Authors: Blum K , Mehr J , Green T , Conroy L , Marino V , Kim D , Murphy K P , Murphy L , Panuganti S , Wang R 
Published: May 2023

Abstract

Introduction
Intracavernosal injection therapy (ICI) is an effective intervention used to treat erectile dysfunction (ED). It has been proposed that caution should be exercised when prescribing ICI to patients currently taking anticoagulants (AC) due to the theoretical increased risk of bleeding, however, there is limited literature describing complication rates of actively anticoagulated patients utilizing ICI.

Objective
We sought to determine whether there was a difference in bleeding and other complications in a cohort of patients using ICI therapy with or without concurrent AC use.

Methods
We reviewed our institutional electronic health record and identified 168 patients who were seen in our clinic from January to August 2020 who had either currently or previously utilized ICI therapy for ED treatment. These patients were surveyed regarding their ICI therapy as well as given the Erectile Dysfunction Inventory for Treatment Satisfaction (EDITS) questionnaire. Data from 85 patients was obtained; 43 concurrently using AC during ICI therapy and 42 with no AC use. Documented bleeding events (e.g. bruising, hematoma), complications, and mean EDITS scores were compared between the two groups. Fisher’s exact test for categorical variables and a two-tailed t-test were used with p&lt;0.05 considered to be significant.

Results
There were more absolute bleeding complications in the AC group versus the no AC group, with 3/43 AC patients (7%, 95% CI: 2.4-18.6) and 0/42 no AC patients (0%, 95% CI: 0-8.4) experiencing some type of bleeding complication on ICI. However, there was no statistically significant difference found in overall or stratified documented bleeding events and complications between the two groups.

Conclusions
Findings from a single-center cohort of patients suggest that ICI therapy may be a safe and effective treatment modality for ED in patients with concurrent anticoagulant usage, however, given the higher rate of absolute bleeding events in our AC cohort, future assessment in a higher-powered study is warranted in determining a more accurate estimation of risk or propensity for bleeding complications in patients on AC using ICI therapy.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Run Wang, MD, FACS is a consultant for Boston Scientific and Teleflex.
(142) Proposed Algorithm for Decision Making During Microdissection Testicular Sperm Extraction (m-TESE) in Men with Non-Obstructive Azoospermia (NOA)
Authors: Naber E , Mecca D , Hawksworth D 
Published: May 2023

Abstract

Introduction
Microdissection testicular sperm extraction (m-TESE) is currently proven to yield the highest sperm retrieval rates in men with non-obstructive azoospermia (NOA). Although considered a low-risk procedure in experienced hands, performance of bilateral m-TESE may result in increased complication rate. Several studies examine preoperative factors as candidates for surgical counseling and prediction of m-TESE success, with most suggesting their combination.

Objective
We propose an intra-operative algorithm which may aid with patient counseling and ultimately prediction of success, while minimizing the surgical risks.

Methods
Consecutive records of patients with NOA who underwent m-TESE at our institution between August 2019 and June 2022 were queried retrospectively. Patient demographics, pre-operative workup, intra-operative maneuvers and post-operative follow-up data were analyzed with use of standard statistics.

Results
Records of seventeen men were identified. Average patient age was 38 years (range: 29-46yo). Eight men had prior testis biopsy results available and two others had prior m-TESE performed. Seven men underwent a bilateral m-TESE. Sperm was successfully identified in ten men (58.8%). Eight of these men (80%) underwent a unilateral m-TESE. Men with the successful m-TESE had an average pre-operative FSH level of 10.1 IU/ml (5.4-21.6 IU/ml) and Inhibin B (INHB) level of 90.2 pg/ml (23.3-186.5 pg/ml). The remaining seven men had no sperm identified (41.2%). Two of these men had prior testicular interventions (testis biopsy with SCO, prior unsuccessful m-TESE) and thus underwent a unilateral (28. 6%), while the remaining five underwent a bilateral m-TESE (71.4%). Their FSH and INHB were 16.9 IU/ml (3.6-26.6 IU/ml) and 56.5 pg/ml (6.9-209.5 pg/ml), respectively. A cut-off value of 30pg/ml of INHB and presence of SCO on prior testis biopsy results were used to develop an intra-operative algorithm (Figure 1).

Conclusions
This study proposes a straightforward decision-making process for men with NOA undergoing m-TESE. Systematic use of few predictive factors may improve patient preoperative counseling, decrease surgical times and complication risk. Additional work is necessary to fully examine the validity and applicability of the proposed algorithm.

Disclosure
No
(145) Is LIM-15 an Important Marker in Patients Who Performed Second Micro–testicular Sperm Extraction after Failed First Micro–testicular Sperm Extraction in Men with Nonobstructive Azoospermia?
Authors: Ibis M A , Unal S , Baltaci V , Aydos K , Yaman O 
Published: May 2023

Abstract

Introduction
LIM15, also known as DNA meiotic recombinase 1 (DMC1), is a meiosis-specific recombinase. LIM15 is specifically expressed as a meiotic recombination protein in spermatogenesis.

Objective
Does the LIM15 gene expression value measured in the ejaculate predict the success of the second micro–testicular sperm extraction (mTESE) after the failed first mTESE?

Methods
Data from 111 men who failed the first mTESE and underwent the second mTESE between August 2018 and March 2022 were prospectively collected. LIM15 gene expression level was determined by real-time PCR in the materials from the ejaculate.

Results
Sperm was recovered successfully in 23 out of 111 (20.7%) men with second mTESE. The mean age of men for whom sperm could not be retrieved and men with successful sperm recovery were 34.6 ± 3.5 and 33.7 ± 5.2, respectively. The mean patient age, serum total testosterone and FSH levels, and testicular volume did not show any statistical difference between men with successful sperm recovery and men with failed sperm recovery (Table 1). According to the testicular histology, the sertoli cell-only, maturation arrest, and hypospermatogenesis in men with successful sperm recovery were 26.1%, 65.2%, and 8.7%, and in men for whom sperm could not be retrieved were 0%, 27.3%, and 72.7%. Comparing the groups in terms of testicular histology demonstrated meaningful correlation between sperm retrieval rate (SRR) and testis histology (p&lt;0.001). The LIM15 gene expression level measured in ejaculate significantly correlated with the SRR in mTESE (p = 0.039). As shown in Figure 1, the maximal sensitivity (50%) and specificity (87%) were obtained for the LIM15 gene with a cutoff point of 4.61 and AUC of 0.65.

Conclusions
According to our results, LIM15 measured in the ejaculate before the second mTESE can provide information on sperm retrieval and reduce the potential complications and unnecessary costs associated with assisted reproductive techniques.

Disclosure
No