bluuebunny/crossref_metadata_2025_split huggingface dataset:
(192) The Perceptibility Difference between Glans Penis and Penile Shaft in Primary Premature Ejaculation
Authors: Jiang T , Wei L , Zheng L , Jiang H , Tang Q , Wang K , Liu W 
Published: May 2023

Abstract

Introduction
The penis is a vital perceptor that transmits perceived signals to ejaculation-related centers. The penis consists of the glans and the shaft, and histology and innervation differ considerably. Does this difference affect their perceptibility?

Objective
This paper aims to investigate whether perceived signals are different using the glans penis or penile shaft as the perceptor zone and whether hypersensitivity of the penis is the whole or the part.

Methods
Through somatosensory evoked potentials, thresholds, latencies, and amplitudes were recorded in 290 cases of primary premature ejaculation, using the penis and penile shaft as the perceptor areas, respectively.

Results
(1) Thresholds, latency, and amplitude of the glans penis and penile shaft in patients were significant differences (P&lt; 0.05) (2) The latency of the glans penis or penile shaft was shorter than average (hypersensitivity) in 141 cases (48.62%), of which 50 cases (35.5%) were sensitive to both the glans and shaft of the penis, 14 cases (9.93%) were sensitive to the glans only and 77 cases (54.6%) were sensitive to the shaft only. (P &lt;0.05)

Conclusions
There are differences in the signals perceived with the glans penis and the penile shaft as the perceptive zone. Penile hypersensitivity does not necessarily mean that the whole penis is hypersensitive. We classify the penile hypersensitivity into three categories: the glans, the shaft, or the whole penile hypersensitivity, and we put forward the new penis high sensitivity zone concept.

Disclosure
No
(220) Penile Enhancement Supplements: The Only Thing Getting Bigger is Demand & False Hope
Authors: Roshandel R , Koo K , Kohler T S 
Published: May 2023

Abstract

Introduction
Penile dysmorphophobia is common, with up to 20% of men reporting dissatisfaction with their genital size. The global market for Sexual Enhancement Supplements is estimated at $300 Million in the year 2020 and is projected to reach $608 Million by 2027 in the US alone. Evidence for efficacy is minimal, and purported claims are hyperbolic.

Objective
We sought to assess penile elongation internet offerings, quantify cost, ingredients, and risk and investigate scientific literature of product ingredients when available.

Methods
Three online marketplaces (Amazon, Google market, and Walmart) were queried for dietary supplements available without a prescription to improve penile size. Product labels were reviewed to compile penile size-related claims and active ingredients. The one-course (60-day) cost of treatment and consumer star rating were assessed. MEDLINE, Web of Science, and Google Scholar were queried with labeled ingredients to assess the scientific evidence from published and lay sources.

Results
A total of 84 dietary supplements claimed either increased penile length, girth, enhanced sexual performance, or a combination thereof. Of these 84 products, 90 ingredients were listed. The Mean 60-day cost was $52 (range of $12–$222). The median score by consumers in the markets with a possibility of star rating was 3.5 (range 2.4-4.2) with obvious repetitive and self-promotional tactics. Unsurprisingly, no scientific evidence supporting change in penile size was found for any products in our search. Actual described physiologic activity from active ingredients included were described as antidepressant, lipid and glucose lowering/metabolizing, blood pressure effecting, anti-inflammatory, renally protective, cognitive function effecting, antioxidant, and several ingredients weakly enhancing erectile activity. Renal failure, warnings against long-term use, heart problems, neuropathy, blood pressure effects, fertility toxicity, bleeding, liver disease, and numerous interactions with diabetes, blood thinning, immunosuppressant, and PDE5 medications were found for the ingredients.

Conclusions
Dietary supplements claiming to enhance penile size contained ingredients with conflicting or no scientific evidence to support their claims. Several ingredients were dangerous. Clinician awareness of these sham “solutions” and their continued mass consumption highlight the magnitude of misinformation, unrealistic expectations, shame, and enhancement desperation regarding penile size in the male public psyche.

Disclosure
No
(264) Reasons of Discontinuation from Collagenase Clostridium histolyticum treatments in Peyronie’s Disease
Authors: Atuluru P , Masterson T 
Published: May 2023

Abstract

Introduction
Peyronie’s disease is an acquired fibrotic condition that impacts quality of life and sexual function. Intralesional Collagenase Clostridium histolyticum (CCH) is the only FDA approved medication to correct curvature. The treatment consists of 8 injections over 26 weeks and previous studies indicate that greater improvement is associated with a greater number of injections; however, reasons for early discontinuation are not well studied.

Objective
We aimed to understand the reasons for early discontinuation of CCH treatment in a major academic system.

Methods
We retrospectively reviewed charts of PD patients from October 2018 to October 2020 who underwent CCH treatment. Complete treatment consists of four cycles of two injections, each separated by approximately 5-6 weeks, for a total of 8 injections. Treatment completion was defined as receiving 8 injections or stopping because curvature decreased to &lt;15 degrees. Patients who did not complete 8 injections were contacted and surveyed about reasons for discontinuation. Data was gathered and analyzed on Microsoft Excel.

Results
A total of 73 patients elected for CCH. Only 43 (58.9%) completed all 8 injections and another 5 (6.8%) stopped due to treatment satisfaction, for a total of 48 (66%) reaching endpoint. There was no significant difference in age, duration of symptoms or Peyronie’s Disease Questionnaire scores between patients who completed treatment and those who didn’t (Table 1). Similar number of patients dropped out in the first half and second half of treatment. Out of the 30 (41.1%) of patients who discontinued therapy before 8 injections, 4 (13.3%) wanted to try another treatment, 6 (20%) experienced side effects, 3 (10%) had insurance issues, 5 (16.7%) was satisfied after a few injections, 4 (13.3%) was disappointed in treatment and 8 (26.7%) were unable to be contacted to return to the hospital (Table 2).

Conclusions
We found that shifts in financial/insurance status and onset of adverse events, such as an autoimmune flair, were predictive of dropouts in our cohort. Most of the patients who wanted to attempt another treatment did so with the same surgeon but wanted a faster solution. Further, in our cohort, difficulty contacting patients was the biggest reason of discontinuation; this is likely skewed due to the COVID19 pandemic as patients relocated or underwent fewer elective treatments and procedures. To reduce CCH discontinuation, we propose that counseling should focus on potential adverse events, speed of change and financial assistance.

Disclosure
No
(265) Socioeconomic Factors Affecting Patient Engagement with Sensitive Urologic Social Media Content
Authors: Leelani N , Bole R , Lundy S D , Bajic P , Hyatt D 
Published: May 2023

Abstract

Introduction
As the use of social media becomes more prevalent within healthcare practices, it is important to understand how patients may engage with social media posts by their physicians. The conditions addressed within the field of urology are often particularly sensitive in nature, particularly within the realm of sexual medicine. Therefore, patients might be less likely to engage with social media posts from their urologists based on their own comfort levels and privacy concerns. A previous study evaluating this interaction determined the likelihood to engage varied based on age and gender. However, social media engagement patterns in sensitive topics based on socioeconomic background have not been previously evaluated.

Objective
This study aims to determine the likelihood of patients in a community urology practice to engage with sensitive social media posts by their urologist according to socioeconomic factors. The likelihood to engage actively (defined as commenting or sharing) versus passively (defined as liking a post) on two different topics within the scope of urology was determined. The two topics used were erectile dysfunction (ED)/urinary incontinence and kidney stone prevention.

Methods
Participants completed a survey that included basic demographic questions as well as questions determining their potential likelihood to engage on the different topics using a visual analog 5-point Likert scale. Responses on the Likert scale were given a value of one (very unlikely) to five (very likely), and a two-tailed Mann-Whitney U test with an α of 0.05 was used to determine the significance of differences in responses. For analysis of the Likert scale responses, only those respondents who had social media accounts were included.

Results
The final sample consisted of 293 responses with a 93.0% response rate. Of respondents, 65.7% had a social media account. Of those respondents that had a social media account, 50.5% had an annual income under $50,000. There was no significant difference in the likelihood to follow their urologist on social media for those with an annual income under $50,000 in comparison to those over $50,000. When looking at the overall likelihood of engagement, those with an annual income of less than $50,000 were more likely to actively engage compared to those making over $50,000 (p-value = 0.02. When stratifying by topic, those making less than $50,000 were more likely to actively engage on the topic of ED/urinary incontinence than those making more than $50,000 (p-value = 0.02).

Conclusions
Patient education via social media is an effective tool for urology practices to engage with patients. Engagement with this content is greater among lower-income patients. Further investigation is needed to determine whether increased engagement with online content translates to improved health outcomes.

Disclosure
No
(274) Sexual Behaviors and Social Barriers to Access Public Health of Brazilian Transgender Men
Authors: Leônidas G , Carneiro G , Peixoto R , Britto D , Neto J , Frota I 
Published: May 2023

Abstract

Introduction
There is a need of information about transgender individuals and their health needs. This work has as object of study sexual behaviors and social barriers to access health of transgender men. There is a need for information about transgender men and their health needs. Globally, transgender people face discrimination and social exclusion. Available data indicate numerous healthcare inequities between trans and cisgender (non-trans) people.

Objective
The aim of this study was to evaluate transgender men at a public university hospital linked to brazilian´s public healthcare, analyzing sexual practices and barriers to access affirmative care.

Methods
The medical records of seventeen patients (range 18-42 of age) followed between 2016 and 2018, were used to collect data retrospectively and descriptively with quantitative and qualitative approach. Through a structured interview, there was a focus on data concerning difficulties to reach healthcare and medical inequities.

Results
It was noticed that transgender men face social barriers to health access, such as insistent non-respect of the use of the social name, the lack of knowledge of health demands by health professionals and the barriers imposed by family and/or spouse. The sexual practices performed by these men, who proved to be widely diverse and changing, are mostly penetrative (70,58%), and such practices may be passive and / or active. It was also observed variable sexual orientation among the patients, although most of them (88,23%) maintain a relationship with a cisgender woman. Gynecological follow-up was also the subject of discussion in this study, and despite the fact that 23,52% of patients had gynecological complaints, 29,41% had never done a gynecological consultation, being the resistance to do gynecological exams very commun. Only 28,57% of the patients had not yet started hormone therapy, and they declared that they would like to start this process. The majority of transgender men have also the need of body change.

Conclusions
Therefore, it is necessary to develop strategies in public and universal health that are effective to provide transgender men with their need to body change or hormone therapy, as well as to guide them to the gynecological examination. Additionally, health care providers need to guarantee proper and free of prejudice assistance.

Disclosure
No
(275) Health Care Disparities in the Transgender Population
Authors: Parikh N , Gargollo P , Granberg C 
Published: May 2023

Abstract

Introduction
The transgender population has largely been marginalized by society, causing inequities in health care delivery. The dearth of provider knowledge on transgender health issues further exacerbates these disparities.

Objective
A survey of the transgender population was conducted to help call attention to the often-overlooked aspect of care: fertility preservation prior to hormone therapy or gender affirmation surgery.

Methods
A survey of 65 transgender individuals was conducted, with participants recruited through Reddit transgender groups and local transgender associations, to assess their knowledge regarding fertility preservation and their experience with healthcare providers. Results were compiled and analysis was performed.

Results
Out of the 65 individuals who responded to the survey, approximately 88% were between the ages of 18 and 39. Seventy-four percent were assigned male gender at birth and 26% female. Sixty-two percent of individuals identified as female, 20% as male, and 18% as gender non-conforming. Only 35% of individuals had ever been cared for in a multidisciplinary transgender clinic. Interestingly, while 100% of surveyed individuals were aware that fertility would be irreversibly lost after hormonal or surgical affirmation surgery and 43% believed this to be an important issue, only 46% had any health care providers discuss fertility preservation options with them.

Conclusions
Hormonal therapy and gender affirming procedures affect the long-term reproductive potential of transgender individuals. While oncofertility is a prominent area of discussion, transgender care is still lagging. With an increase in medical and surgical therapy in younger individuals, health care providers must discuss fertility preservation options prior to affirmation therapy.

Disclosure
No
(276) Sexual Health of Transfeminine Individuals: A Chance to Educate Medical Providers
Authors: Denisenko A , Bulafka J , Spigner S , Swaminathan V , Stauffer P , Shumaker A , Frasso R , Chung P H 
Published: May 2023

Abstract

Introduction
Providers may be unfamiliar with the sexual health needs of transgender patients. This hinders chances to provide comprehensive care, as many patients require prompting to discuss sensitive sexual issues. To increase awareness of these issues, we developed a questionnaire which assessed the sexual health of transfeminine individuals.

Objective
We sought to describe the sexual experiences and preferences of transfeminine individuals, and to categorize sexual health needs in this population.

Methods
IRB approval was obtained to develop (with transgender community feedback) a questionnaire assessing urinary and sexual health. Sexual preferences, symptoms, and quality of life (QOL) responses were compared among vaginoplasty (VP) and non-vaginoplasty (NVP) groups. NVP respondents were evaluated based on the International Index of Erectile Function (IIEF) categories: erectile function (EF), orgasmic function (OF), and sexual desire (SD).

Results
53 transfeminine individuals (11 vaginoplasty, 10 orchiectomy, 32 no procedure) with mean age of 40 years (range 21-80) participated. Sexual QOL was similar for both groups (Table 1). There was an association between self-reported sexual activity and VP/NVP status, where a higher proportion of NVP respondents reported sexual activity with others and penetrative anal sex (p&lt;0.05). Among NVP respondents, 38 (90.4%) of whom were undergoing hormone therapy, 23 (55%) indicated penile function was important to them. NVP IIEF EF, OF, and SD categories mean scores were 13.3, 5.8, and 5.6, respectively, compared to 25.8, 9.8, and 7.0 from the cis-gender controls in the initial IIEF study. 5 (11.9%) individuals used oral medications for erectile assistance, while 1 (2.3%) had a prosthesis.

Conclusions
When comparing VP and NVP respondents, we found similarities in sexual QOL while noticing differences in sexual preference, highlighting the diversity of this population. While many NVP respondents reported importance of penile function and presence of erectile dysfunction, only a minority were on treatment. This highlights an opportunity for providers to discuss sexual health with transfeminine patients and offer appropriate treatments.

Disclosure
No
(279) Total Phalloplasty with Latissimus Dorsi Myocutaneous Flap. Our Italian Experience
Authors: Stanojevic N , Ruffo A 
Published: May 2023

Abstract

Introduction
Total phalloplasty (TP) is used for the creation of a penis in female to male sex reassignment surgery (FTM SRS).

Objective
We focused our work on free flap transfer technique using latissimus dorsi myocutaneous flap (MLDF) in order to create a neophallus that allows safe performance of urethroplasty and two cylinders prosthesis implantation.

Methods
Five patient underwent surgery. A necessary precondition for this technique was the normal body mass index. The donor site was prepared preoperatively by skin massage at least one month before surgery to enable easier donor site closure. The first surgical step includes removal of female genitalia (transvaginal hysterectomy, adnexectomy, colpocleisis), proximal urethroplasty, perineoplasty, the formation of external male genitalia (scrotoplasty, free flap transfer phalloplasty), and 1st stage distal urethroplasty. The second stage includes distal tubularizing urethroplasty, glans plasty, and testicular prosthesis implantation. In the third stage implantation of a 2-cylinder penile prosthesis is performed through the infrapubic approach. The time between stages was 6-9 months.

Results
The five pts underwent just the first two stages. Penile length varies from 12-18cm and penile girth from 11-16cm. One partial flap loss occurred. Penile urethral stricture developed in 3 pts; 1 pt developed proximal urethral diverticulum. Donor site healed satisfactorily in three pts, two of them required additional scar correction.

Conclusions
This surgery is a high-risk, complex staged procedure, but with a satisfactory functional and esthetic outcome

Disclosure
No
(291) Long-term Assessment of the Safety and Efficacy of the Mini-Jupette Sling: 5-year Follow-up of the Original Series
Authors: Hammad M A M , Barham D W , Osmonov D , Hatzichristodoulou G , Van Renterghem K , Andrianne R , Park S H , Kohler T S , Hellstrom W J G , Jenkins L , Yafi F A 
Published: May 2023

Abstract

Introduction
Climacturia has been reported in up to 64% of patients following radical prostatectomy (RP). In 2017, a prospective multicenter, multinational, investigational pilot study was conducted examining outcomes using a novel surgical technique, the Mini-Jupette sling, for the management of men with post-RP erectile dysfunction (ED) and climacturia and/or minimal stress urinary incontinence (SUI). We sought to report the 5-year outcomes from this original cohort.

Objective
To assess long-term safety and efficacy of the mini-jupette sling in the treatment of ED and concomitant mild SUI and/or climacturia

Methods
We identified patients who were enrolled in the previous multicenter study with post-RP ED and climacturia and/or mild SUI (2 ppd) and underwent IPP insertion with simultaneous placement of a Mini-Jupette sling. Data including current ppd, improvement in climacturia, complications, need for revision of IPP or additional urinary incontinence surgery, and date of most recent follow-up were collected.

Results
Of the original 38 patients, 5 have since died and 10 were lost to follow-up with 23/38 (61%) patients available for evaluation of long-term outcomes. The average follow-up time was 59 months (SD= 8.8) with a mean age of 69 years (SD= 6.8). Most patients (n=21, 91%) had subjective improvement of SUI and climacturia. One patient with persistent bothersome incontinence underwent artificial urinary sphincter (AUS) placement in 2018 with no complications, while the other is still considering a repeat procedure due to minor but persistent SUI. The mean ppd decreased from 1.4 preoperatively to 0.3 at a mean 5 years of follow-up. Most patients reported satisfaction in their urinary symptoms with 91% and 73% reporting improvement in SUI and climacturia respectively, compared to 86% and 93% respectively in the original series. One (4.3%) patient had an IPP revision for pump malfunction. There were no device infections reported.

Conclusions
The Mini-Jupette sling appears to be a safe and effective procedure with durable improvements in SUI and climacturia at 5 years of follow-up.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus, Intuitive Surgical, Fidalis, Hims & Hers Health Inc
(306) U-shaped Curvilinear Relationship Between the Prevalence of Testosterone Deficiency and Low-density Lipoprotein Cholesterol (LDL) Levels in Nonstatin Users
Authors: Lee J H 
Published: May 2023

Abstract

Introduction
Contradictory data have been reported about the association between testosterone levels and the levels of low-density lipoprotein cholesterol (LDL).

Objective
The aim of this study was to elucidate the association between testosterone and LDL levels.

Methods
A cross-sectional study was conducted that included 7,268 men who had participated in a health examination. Men who took agents that influence serum lipid profiles within the previous 6 months were excluded. A full metabolic work-up and serum testosterone level checks were performed. The main outcome measures included the testosterone level and testosterone deficiency (TD) prevalence of each decile of LDL and their polynomial trendlines and the odds ratio (OR) of TD according to the LDL level.

Results
The polynomial trendline suggests an inverted U-shaped curvilinear relationship between LDL and testosterone levels (figure 1) and a U-shaped curvilinear relationship between LDL levels and the prevalence of TD (figure 2). The adjusted ORs of TD in men in the lowest and highest deciles were significantly higher than those of men in the 10th – 90th deciles of LDL (90th LDL, OR for TD: 1.277, 95% CI: 1.006–1.621), which reinforces the U-shaped curvilinear relationship between LDL levels and the prevalence of TD.

Conclusions
There was a U-shaped curvilinear relationship between LDL levels and the prevalence of TD. Both low LDL and high LDL levels were significantly and independently associated with TD. Care should be taken to screen for TD in men with low LDL levels or high LDL levels. Further study to elucidate the effect of extremely lowering LDL levels on TD is needed.

Disclosure
No