bluuebunny/crossref_metadata_2025_split huggingface dataset:
(159) The Discontinue Rate with Collagenase Clostridium Histolyticum for Peyronie’s Disease in a High-Volume Practice is Unexpectedly High: Identifying Opportunities for Patient Care Improvement
Authors: Lehner K , Byrne E , Rochandel M R , Alom M , Helo S , Kohler T , Ziegelmann M 
Published: May 2023

Abstract

Introduction
Collagenase Clostridium Histolyticum (CCH) is an FDA-approved treatment for Peyronie’s Disease (PD). Based on phase-3 trials, the recommended treatment course consists of 8-injections over the course of roughly 18-20 weeks. While its efficacy has been established, less is known about patient-specific reasons for electing to discontinue CCH injection therapy.

Objective
To evaluate patient-reported factors associated with premature CCH discontinuation.

Methods
We queried a database of all patients (n=406) who underwent CCH at a single institution from 2014-2021. Patients who did not complete the recommended 8 injections were identified, and a detailed review was undertaken to determine causes of discontinuation. Patients were excluded from our analysis for the following reasons: deceased at the time of chart review, declined to participate, or could not be reached in 3 phone calls.

Results
Out of 406 patients who underwent Xiaflex treatment at our single institution, 133 did not complete 8 injections (32.8%). The mean number of CCH injections was 4.42 (SD 1.65). The most common reasons for discontinuing Xiaflex were satisfactory curve reduction (27%), unsatisfactory curve reduction (21%), bothersome side effect (15%), and decision to pursue surgery (12%) [Figure 1]. Other less common reasons included other health concerns, pausing treatments due to the Covid-19 pandemic, high treatment cost, transferring care elsewhere, and lack of awareness that more injections were indicated.

Conclusions
In our single institution study, we find that nearly 1/3 of patients who begin Xiaflex injections will not complete the full recommended treatment course. Understanding the reasons for discontinuation can help providers better stratify patients for Xiaflex treatment versus other modalities. In addition, given previous studies that indicate that 2/3 of men who fail to achieve a 20% curve reduction after their first 4 injections will go on to achieve this curve reduction after their final 4 injections, our data points to the potential impact of improved patient education for the 21% of individuals who discontinue due to unsatisfactory curve reduction (Alom et al 2021).

Disclosure
No
(165) Role of Penile Veno-occlusive Dysfunction in Peyronie’s Disease Patients with Erectile Dysfunction
Authors: Sikka S , Panner Selvam M K , Almajed W , Shalaby H , Hampel G , Greenberg J , Hellstrom W 
Published: May 2023

Abstract

Introduction
The incidence of Peyronie's disease (PD) is 4% in the U.S. male population. Many PD patients also suffer from erectile dysfunction (ED). The etiology of ED incidence in PD men is not known, although veno-occlusive dysfunction (VOD) is often suggested. It is important to appreciate the influence of VOD in PD patients with ED, especially in regard to successful PD treatment.

Objective
The main objective of this study is to assess the penile hemodynamic response to intracavernous injection (ICI) of a vasoactive agent in order to evaluate the incidence of VOD in PD patients with or without ED.

Methods
A total of 333 men, diagnosed either with PD (n=202) or ED (n=68) or both PD and ED (n=63), visiting our Andrology clinic were included in this study. Initial ED was determined by using the International Index of Erectile Function (IIEF) score, whereas patients with penile curvature ≥30° were categorized as having PD. Penile color duplex Doppler ultrasound (CDDU) data was retrospectively collected from these patients, and parameters such as peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were used for analysis. RI (=PSV-EDV/PSV) was calculated, and VOD was confirmed when PSV ≥30 cm/sec, EDV ≥6 cm/sec, and RI &lt;0.8 based on previously published guidelines for standardization of penile CDDU parameters. Statistical analysis was performed using MedCalc statistical software version 20.019 (MedCalc Software bv, Ostend, Belgium).

Results
Table 1 summarizes the CDDU results of all 333 patients. Age of the study subjects was 55.6 ± 11.3 years, with no difference between groups. Incidence of penile VOD was higher in patients with ED without PD (58.8%) or with PD (52.4%) compared to PD alone (44.6%). RI values of PD patients without ED were higher (&gt;0.8) compared to PD patients with ED having VOD (&lt;0.7) (P&lt;0.001).

Conclusions
The current study results indicate that lower RI values suggest a higher incidence of VOD in PD patients. VOD plays an important role in the onset of ED in men with PD. Furthermore, this demonstrates the importance of performing CDDU and diagnosing the presence of VOD in further understanding the pathophysiology of PD.

Disclosure
No
(166) Characteristics of Veterans Suffering Corporeal Rupture after Collagenase Clostridium Histolyticum
Authors: Zucker I , Ghomeshi A , Weber A , Masterson T 
Published: May 2023

Abstract

Introduction
Collagenase clostridium histolyticum is the only guideline and US FDA approved intralesional treatment for Peyronie's disease (PD). The most feared complication is corporeal rupture which occurs in less than 0.5% of treated patients. In the largest clinical trial, only 3 occurred, however this was enough to include a black box warning and recommend patients to abstain from sexual intercourse for 6 weeks. To date, there have been few studies evaluating the timing and causes of fracture after injection.

Objective
To determine the incidence and factors leading to penile fracture in men with PD treated with CCH.

Methods
We queried the VA Informatics and Computing Infrastructure, to identify veterans with a diagnosis of PD by ICD-9 (607.85) or ICD-10 (N48.6) code between 2015-2020. We searched medication codes for CCH and ICD-9 (959.13) and ICD-10 (S39.840) codes for penile fracture to determine which patients had fractures. All patients with penile fracture codes were manually reviewed. Only patients with penile fractures after administration of CCH were included in the study.

Results
In total, 17,647 veterans were diagnosed with PD with 1,541 (8.7%) treated with CCH. In total, 11 patients (0.7%) had penile fracture after treatment with CCH. Table 1 shows patient demographic and clinical information for 11 patients with penile fracture post CCH treatment. Within these 11 patients, the median number of CCH injections was 6 with a median initial curvature of 35°. Fracture occurred at a median of 8 days after CCH injection with all occurring secondary to spontaneous ejections or sexual intercourse. Finally, 6 patients had their fracture repaired with surgery while the remaining were managed conservatively.

Conclusions
The highest risk of penile fracture appears to be within two weeks of the second injection of a CCH cycle. Only one fracture occurred after three weeks, and one occurred after the first injection of a cycle. Our data supports the warning to avoid sexual activity for 4 weeks after CCH injection.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo pharmaceuticals.
(172) TrueNorth Sexual Health and Rehabilitation eTraining (SHAReTraining) in Prostate Cancer: Evaluation of an Online Course for Practitioners
Authors: Matthew A , Robinson J , Mcleod D , Petrella A , Walker L , Wassersug R , Guirguis S , Incze T , Macdonald L , Elterman D 
Published: May 2023

Abstract

Introduction
Sexual dysfunction (SD) is a prevalent and distressing side effect for survivors of prostate cancer (PCa). Unfortunately, many health care practitioners (HCPs) report a lack of training and confidence in addressing the sexual health needs of PCa patients. Consequently, many PCa patients do not receive the comprehensive sexual healthcare needed to manage their SD.

Objective
To address the gap in HCP training, the Movember Foundation funded the development and evaluation of a 12-week, faculty-facilitated, online course designed to train HCPs in the delivery of PCa specific sexual health counselling: the TrueNorth Sexual Health And Rehabilitation eTraining (SHAReTraining). Course content includes, SD assessment and intervention, professional ethics, unique needs of sexual and gender minority populations, and approaches to implementing sexual health programming in a healthcare setting.

Methods
Participants completed a pre-course survey (n=23), a retrospective pre-post survey (n=19), and a 3-month follow-up survey (n=19) to assess retention of relevant outcomes. Outcomes included HCP perceived knowledge and self-efficacy to conduct assessments and provide interventions across a number of relevant physical, functional, psychological, and relational domains of SD in PCa survivors and their partners. Additionally, completed a course satisfaction survey at the conclusion of the course.

Results
Descriptive analysis of the pre-post survey revealed that graduates perceived knowledge of sexual health counselling improved from a mean of 51.12% pre-course to 75.18% post-course across all measured domains. Similarly, graduate ratings of self-efficacy in providing comprehensive care increased from a mean of 56.63% pre-course to 79.73% post-course. The follow-up survey demonstrated participants’ self-efficacy remained high 3-months post-course at 79.75%. Graduate experience taking the course was uniformly positive with a vast majority (94.7%) agreeing that they were satisfied with the course.

Conclusions
For HCPs seeking specialized sexual health care training for PCa patients, the TrueNorth SHAReTraining course is an accessible and effective resource. Graduates of the course have the potential to improve the quality of SD care they provide to their patients.

Disclosure
No
(175) Readability Assessment of Online Men's Health Education Materials from the Sexual Medicine Society of North America, Urology Care Foundation, and European Association of Urology
Authors: Callegari M , Pominville R , Zhou C , Piyevsky B , Jesse E , Prunty M , Loeb A , Thirumavalavan N , Abou Ghayda R 
Published: May 2023

Abstract

Introduction
The use of online health information by patients has gained considerable attention during the last decade. With this attention has come exponential adoption towards online resources. Existing literature has shown that a significant majority of patient education materials (PEM) available online exceed the literacy and comprehension of the audience reading them. The National Institute of Health (NIH) and American Medical Association (AMA) advocate the dissemination of accessible and readable resources targeted towards a fifth to seventh grade reading level. As the rise of mens health and sexual health continues to grow, understanding what resources may currently exist and how they meet or fail to meet patients needs is of growing concern.

Objective
We aimed to evaluate the readability of online patient resources from the Sexual Medicine Society of North America (SMSNA), American Urological Association and European Urological Association websites.

Methods
Content published under the web-section “SMSNA: For Patients - conditions and topics” portal (n=16) were reviewed. Identical topics published online via Urology Care Foundation (ie AUA; n=8) and the European Association of Urology (ie EAU; n=8) were also reviewed. Readability and estimated educational level required for understanding was assessed using validated readability and English language assessment tools including the Flesh Reading Ease score, Flesch Kincade, Gunning Fog, Simple Measure of Gobbledygook (SMOG), Coleman-Liau and Automated Readability index.

Results
SMSNA online patient education materials (PEM), on average, are written at a college sophomore reading level (14th grade). This is 6.5 and 8 grade levels higher than the average U.S. adult and recommended reading levels for PEM, respectively. Comparable AUA and EAU resources were an average of 10th (p&lt;0.05) and 12th (p=0.854) grade reading levels, respectively.

Conclusions
Men’s sexual health PEM’s published online are written at an advanced reading level, most notably the SMSNA compared to equivalent professional sources. This could pose a barrier to patient understanding and impact patients’ engagement and health decision-making. One proposed mitigatory strategy is for PEM to provide improved readability, and appropriate user-friendly language to facilitate easier and inclusive understanding, outreach and educational support.

Disclosure
No
(194) Dyspareunia as a Sign of UTI
Authors: Dominguez-Bali A , Coburn A , Shah P , Hassan Z , Dominguez-Bali C 
Published: May 2023

Abstract

Introduction
Dyspareunia has been defined by the American College of Obstetricians and Gynecologists as pain with sexual intercourse. While dyspareunia has been described as only a part of the symptomatology spectrum of interstitial cystitis, it has never been used as a primary symptom to diagnose uncomplicated or complicated UTIs. Dyspareunia and lower abdominal pain are the most common symptoms followed by dysuria, urodynia, pollakiuria, urgency, nocturia, tenesmus, headache and fever. Increased awareness of the association of dyspareunia with UTI’s will improve the diagnosis of UTIs.

Objective
UTI’s are under-diagnosed in emergency rooms, as clinicians increasingly rely on urinalysis rather than symptomatology. The presence of dyspareunia is rarely inquired during an evaluation of the patient. The objective of this research is to inform clinicians that dyspareunia is a common symptom of urinary tract infections. By increasing awareness of the association between UTI’s and dyspareunia, clinicians will include it in the assessment of a patient, rather than relying solely on a urinalysis. Additionally, our objective is to educate the patient population that dyspareunia is not normal, and it is a medical condition that can be resolved and investigated.

Methods
In 2009-2010, a review of 3,000 charts was conducted to determine the sexual attitudes and behaviors of the female Latin American community in South Florida. Analysis of the data shows a correlation between dyspareunia and urinary tract infections, a finding that has not been described before.

Results
The association between a UTI and dyspareunia was found to be approximately 80% in premenopausal women of reproductive age. In post menopausal women, UTIs are the second most common cause of dyspareunia following vaginal dryness.

Conclusions
This analysis has determined that dyspareunia is a significant aspect of the semiology of a UTI, thus clinicians should be aware of this association in order to accurately diagnose UTIs in patients.

Disclosure
No
(199) Anterolateral Thigh Flap Phalloplasty for Micropenis
Authors: Schirmann A , Ralph D , Christopher N , Lee W G 
Published: May 2023

Abstract

Introduction
Congenital micropenis is defined as a normally formed penis with a stretched penile length less than 2.5 standard deviations below the mean for that man’s age and ethnicity. Micropenis may present as an isolated condition or with other genital or multi-system abnormalities. Penile reconstruction or phalloplasty may be required where topical and systemic hormonal treatment have failed. The most common flap used for phalloplasty is the radial artery forearm free flap phalloplasty. Other alternatives include the anterolateral thigh (ALT), musculocutaneous latissimus dorsi and abdominal flaps.

Objective
The aim of this video is to illustrate the technique for penile reconstruction using a pedicled ALT flap without integrated urethra.

Methods
A 21-year-old man with micropenis and hypospadias from a disorder of sexual differentiation (46XY) presents for penile reconstruction following multiple failed attempts at hypospadias repair. He requested an ALT flap without integrated urethra because he is dependent on a long-term suprapubic catheter due to a hypocontractile bladder. Intraoperative vascular doppler identified 3 perforators from the descending branch of the lateral circumflex iliac artery of the left leg. The flap was designed centred on the perforators with dimensions of 14cm (length), 13cm (width at base) and 12cm (width at tip). The flap was raised carefully and transferred to the recipient groin. The neophallus was constructed and microsurgical anastomosis of the lateral cutaneous of the thigh to one of the dorsal penile nerves with 8/0 nylon was completed. The partially divided left vastus lateralis muscle was re-approximated and the skin edges drawn in and flattened. The left thigh was then resurfaced with a 14/1000 of an inch split-thickness skin graft from the contralateral thigh. All wounds were dressed.

Results
The man had an uneventful post-operative course with careful vascular monitoring, and he was discharged on day 10. He is currently awaiting glans-sculpting and will eventually proceed with insertion of an inflatable erectile device.

Conclusions
Penile reconstruction using an ALT flap can be offered to a well-informed and motivated man with a micropenis following appropriate assessment. As shown, the technique requires careful dissection of the perforator vessels and can usually be transferred as a pedicled flap. Pedicled flaps do not require microvascular anastomosis and therefore have a lower risk of vascular compromise. Further esthetic and functional refinements like the insertion of an erectile device are possible in later stages, if desired.

Disclosure
No
(202) Exploring Erectile Hemodynamics in Men Complaining of Hard-Flaccid Syndrome (HFS)
Authors: Sullivan J , Salter C , Flores J , Ghuring P , Parker M , Mulhall J 
Published: May 2023

Abstract

Introduction
There is increasing awareness of a condition, vernacularly termed HFS, in which men complain of subjective and palpable abnormalities in the flaccid penis (hardness, heaviness) often associated with erectile dysfunction (ED).

Objective
We attempted to define erectile hemodynamic profiles in this population.

Methods
The study population consisted of (i) males ≥18 years of age (ii) who presented with self-diagnosed HFS (iii) who underwent comprehensive history and examination (including genital and lower extremity neurological) and (iv) penile duplex Doppler ultrasound (PDDU). PDDU was performed using redosing of vasodilators. PSV ≥35 cm/s and EDV ≤3 were considered normal. Patients with Peyronie’s disease or a history of intracavernosal injection therapy were excluded.

Results
88 men were analyzed. Mean age was 28 ± 12 years. Median number of vascular comorbidities was zero (0, 1). 66 (75%) had a history of depression or anxiety, 60 of whom had used pharmacotherapy for such at some time and 40 were actively using anxiolytics or anti-depressants at time of evaluation. No patient had a history of neurological conditions and neurological exam was normal in all. Mean duration of symptoms was 14 ± 20 months. Median number of prior physician consultations was 1 (1,4). All complained of impaired erectile function, 50% being incapable of having penetrative sexual relations. 91% had or were using PDE5 inhibitors. On examination all patients had a hypertonic flaccid penis with excellent stretch on traction. At PDDU, median number of penile injections was 2 (1, 3). 50% of men required phenylephrine reversal. All patients had normal PSV with 2/88 having abnormal EDV values, both of whom required reversal. Mean PSV was 45 ± 35 cm/s, mean EDV was 2 ± 11 cm/s. No patient had elevated echogenicity on B-mode scanning.

Conclusions
In this analysis, all men presenting with self-reported HFS had normal hemodynamics and an absence of fibrosis, suggesting the absence of vascular or gross cavernosal smooth muscle structural changes.

Disclosure
No
(205) Erectile Dysfunction is an Independent Risk Factor for Major Adverse Cardiovascular Events
Authors: Mann U , Brar R , Patel P 
Published: May 2023

Abstract

Introduction
Erectile dysfunction (ED) and cardiovascular disease share similar risk profiles which include: aging, hypertension, diabetes, smoking, obesity, and dyslipidemia. Previous literature has suggested ED as a potential harbinger of future cardiovascular disease.

Objective
As such, we sought to investigate the association between ED and major adverse cardiovascular events (MACE) using a large population based database. As a secondary objective, we sought to investigate the relationship of place of residence (rural or urban) in regards to the incidence of MACE.

Methods
A propensity-weighted, retrospective cohort study was conducted by accessing provincial health administrative databases. Eligibility criteria included men 18 years and older, with no prior ED or MACE, who had at least 1 year of provincial health coverage from their index date between June 1st 1996 to March 31st 2018. ED was defined as having at least two ED prescriptions filled within one year (including oral, intraurethral, and/or injection therapies). MACE was defined as myocardial infarction, coronary revascularization procedures, ischemic stroke, or hospitalizations for heart failure. We then classified study groups into ED Urban, ED Rural, No ED Urban and No ED Rural. Multiple logistic regression model that included age categories, socioeconomic status, index year, diabetes, hypertension, dyslipidemia and renal disease was used to determine the propensity score. Stabilized inverse propensity treatment weighting was then applied to the propensity score. A cox proportional hazard model was used to examine our primary outcome of time to a MACE.

Results
The median time to a MACE was 2721, 2620, 2520, and 2438 days in the ED Urban (N=32,138), ED Rural (N=17,821), No ED Rural (N=145,209) and No ED Urban (N=233,073) study groups, respectfully. The ED Rural, ED Urban and No ED Rural study groups had a 54% (Hazard Ratio [HR] 1.54, 95% CI [1.45 – 1.63]), 26% (HR 1.26, 95% CI[1.20 – 1.32]) and 14% (HR 1.14, 95% CI[1.11 – 1.18]) higher risk of a MACE event as compared to the No ED Urban group, in weighted analyses, respectfully. Among individuals with ED, men from a rural setting had a 22% (HR 1.22, 95% CI[1.14 – 1.32]) higher risk of a MACE event, as compared from an urban setting.

Conclusions
Our study demonstrates that men diagnosed with ED had a higher risk of MACE as compared to controls. ED is demonstrated to be an independent risk factor for MACE when controlling for comorbidities. In addition, men residing in rural communities had a higher risk of MACE as compared to other urban counterparts. It is imperative for health care professionals who manage patients with ED to discuss the risk of future cardiovascular disease and identify comorbid conditions to mitigate risk.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.