bluuebunny/crossref_metadata_2025_split huggingface dataset:
(311) Socioeconomic Risk-Adjustment with Area Deprivation Index (ADI) Predicts Delays to Urethroplasty for Patients with Urethral Stricture Disease
Authors: Watkins E , Koch G , Ayangbesan A , Gambrah H , Bhalla R , Cabo J , Hill S , Johnsen N 
Published: May 2023

Abstract

Introduction
Treatment of urethral stricture disease with multiple repeated endoscopic procedures has been shown to be both ineffective and costly. While a number of patient and provider factors are known to be associated with likelihood of undergoing multiple endoscopic, little is known about non-clinical factors that can impact care.

Objective
As social inequalities such as living in a disadvantaged neighborhood are known to be associated with poorer overall health, worse health outcomes, and decreased quality of care, the aim of this study was to assess whether neighborhood deprivation is associated with delays to definitive care for urethral stricture disease.

Methods
This study identified patients treated by a single surgeon with urethroplasty between 9/4/2019 and 12/29/2021. Patients with a previous history of urethroplasty, under the age of 18, and those with insufficient follow-up data were excluded from the study. Area deprivation index (ADI) is a composite comprised of 17 factors describing income, education, employment and housing quality based on subject 9-digit ZIP code and obtained from the University of Wisconsin School of Medicine and Public Health Neighborhood Atlas. Scores are normalized to a percentile from 0 to 100, with higher numbers representing higher levels of disadvantage. Patient addresses were geocoded and assigned a national ADI rank based on residential census block group. For the present study, ADI rank was sub-grouped into least disadvantaged (lower 50%) and most disadvantaged (upper 50%). Multivariate logistic regression was performed to assess impact of ADI score on likelihood of receiving multiple endoscopic procedures prior to urethroplasty. Final model was assessed for multicollinearity and goodness of fit via Hosmer-Lemeshow goodness-of-fit test.

Results
104 patients were included in the final analysis. 44% of patients had undergone multiple prior endoscopic procedures. Patients who had undergone ≥2 endoscopic procedures tended to be older, have higher ADI scores, and were more likely to be white. Median time to urethroplasty was significantly higher in those who had undergone multiple prior endoscopic procedures (88 mos vs 12 mos, p&lt;0.001). On multivariate analysis adjusting for age, ADI classification, and insurance status, patients in the more disadvantaged group were significantly more likely to have undergone multiple endoscopic procedures prior to urethroplasty (OR 2.79), as were older patients (OR 1.04).

Conclusions
Neighborhood disadvantage as assessed by the ADI provides an alternative methodology to identify disparities in health services utilization in patients with urethral stricture disease. These findings highlight needs to increase provision of urologic resources and care to disadvantaged communities.

Disclosure
No
(327) The Masturbatory Premature Ejaculation Diagnostic Tool (MPEDT): A Novel Psychometric Tool to Evaluate Premature Ejaculation During Masturbation
Authors: Xi Y , Zhang H , Colonnello E , Limoncin E , Jannini E , Zhang Y 
Published: May 2023

Abstract

Introduction
Premature ejaculation (PE) is a highly prevalent male sexual dysfunction. Its current definition, together with the most used diagnostic tools, does not include non-vaginal sexual intercourse such as anal sex, self-masturbation and/or partnered-masturbation, and other forms of sexual stimulation. However, diagnostic psychometry currently available is exclusively evaluating PE in the vaginal coitus.

Objective
To validate a new tool, the Masturbatory Premature Ejaculation Diagnostic Tool (MPEDT), by assessing the control over ejaculation and its psychological effects during self-masturbation, rather than heterosexual vaginal intercourse.

Methods
We studied 135 male patients aging from 18 to 40 years seeking medical care for PE in the Infertility and Sexual Medicine Department from June to September 2020. All the participants were asked to fill the PEDT and MPEDT questionnaires to estimate the PE symptoms during, respectively, intercourse and self-masturbation. The reliability/validity, the factor analysis of the tool, and the diagnostic sensitivity/specificity of MPEDT were calculated.

Results
The overall Cronbach alpha was 0.884. In our adjusted model, both RMSEA (Root Mean Square Error of Approximation) and SRMR (Standardized Root Mean Square Residual) were lower than 0.08, while Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), Non-Normed Fit Index (NNFI), and Comparative Fit Index (CFI) were higher than 0.9. The area under the ROC curve (AUC) is 0.943±0.015. The results suggest MPEDT points being ≤5 as “normal”, ≥7 as “PE during self-masturbation” and 6 as “suspected PE”, with the sensitivity of 91.9% and specificity of 88.1%.

Conclusions
An efficient diagnostic psychometric tool is needed for the individuals who, based on the impaired control over ejaculation during self-masturbation, may also suffer from PE during partnered intercourse. MPEDT is able to evaluate the existence of PE symptoms not necessarily during heterosexual intercourse but rather during self-masturbation, possibly aiding to the diagnosis, as well as planning and follow-up of a prompt therapeutical strategy. MPEDT could be considered a new, objective and reliable diagnostic tool for the evaluation of the existence of PE symptoms.

Disclosure
No
(334) Robotic Transabdominal Vasovasostomy Following Laparoscopic Vasectomy: A Case Series
Authors: Lundy S , Sabanegh E , Kaouk J , Krishnan J , Parekh N 
Published: May 2023

Abstract

Introduction
A small subset of men undergoing laparoscopic hernia repair will request concomitant vasectomy, which is typically performed via resection of a segment of the intra-abdominal vas deferens near the inguinal ring. Some of these men will ultimately desire vasectomy reversal to restore fertility or alleviate post-vasectomy pain syndrome. Traditional scrotal or inguinal microsurgical techniques are clearly not feasible in this situation, and open surgical repair carries significant morbidity. The use of a robotic approach may offer an attractive alternative to improve visualization and facilitate a patent intra-abdominal anastomosis.

Objective
To demonstrate technical feasibility and report institutional outcomes of robotic-assisted laparoscopic transabdominal vasectomy repair

Methods
IRB approval was obtained. A retrospective chart review of our institutional experience with this operation was performed. Preoperative, operative, and postoperative data was collected.

Results
Three cases were identified with a mean patient age of 43 and mean interval of 6 years (range 3-10 years) between vasectomy and reversal attempt. Two men desired restoration of fertility, and one man desired reversal for testicular pain. All patients had previously fathered children, and mean partner age was 30 years. Port placement was similar to standard W-configuration used for robotic prostatectomy. Mean operative time was 319 minutes and estimated blood loss was 27mL. Two men required a modified Prentiss maneuver to re-route the vas deferens to obtain additional length. Indocyanine green was used in one case to confirm vasal perfusion. Bilateral vasovasostomy was completed in all cases with either a modified one-layer anastomosis using 8-0 nylon or a two-layer anastomosis using 10-0 and 9-0 nylon. Both men undergoing fertility restoration had return of sperm in the ejaculate with a mean concentration of 62 million sperm/mL, and the solitary patient with pain had subjective resolution of his pain.

Conclusions
Robotic transabdominal vasectomy reversal is technically challenging but feasible with an experienced team including a robotic surgeon and andrologist. Outcomes appear to be satisfactory. This technique may be considered for men who have undergone abdominal vasectomy and desire restoration of fertility or treatment of post-vasectomy pain syndrome.

Disclosure
No
(338) Factors Associated with Sexual Inactivity in Patients Diagnosed with Benign Prostatic Hyperplasia
Authors: Vasquez A 
Published: May 2023

Abstract

Introduction
Benign prostatic hyperplasia is a common pathology in patients over 40 years of age, with an important role in male sexual health due to its association with sexual dysfunction, with an elevated proportion of patients with sexual inactivity.

Objective
The objective of this study is to evaluate the factors associated with sexual activity in patients over 40 years of age with a diagnosis of benign prostatic hyperplasia

Methods
A retrospective cross-sectional study of 331 patients with a confirmed diagnosis of benign prostatic hyperplasia between January 2021 and November 2021. Both sociodemographic and clinical data were evaluated to associate them to the IIEF questionnaire15

Results
Of the 331 patients diagnosed with BPH, 68.5% had erectile dysfunction: severe ED 119 (36%) moderate ED 14.2%, Mild/moderate ED 10.6% andMild in 7.9%. Of the 226 patients with ED, only 50 patients (22.1%) treated their erectile dysfunction. In addition, 33.2% had low sexual desire and the overall prevalence of sexual inactivity in more than 1 month was 43%. Sexual inactivity was classified: in 1-3 months: 29, 5%, 3-6 months 15.4%, 12% more than 6 months and 42.9% more than 12 months. The independent predictors related variables of sexual inactivity were: age over 60 years (PR 1.5), not having a sexual partner (PR 3.2), IEEF-15 (Erectile dysfunction RP 9.2) dissatisfaction with the partner (PR 4.9), low sexual desire (PR 2.9), and lack of confidence (PR 2.5), Severity of IPSS (RP 1.7) and urethral catheter carrier (RP 2.4)

Conclusions
Sexual inactivity is common in patients diagnosed with BPH and is associated with age and sexual desire. Independently lack of confidence, erectile dysfunction, not having a sexual partner or dissatisfaction with the partner. Of the specific variables related to prostatic hyperplasia, the only ones related were being a carrier of urethral catheter and IPSS severity, the latter associated with decreased sexual frequency and erectile dysfunction. Cardiovascular risk factors had no independent association unlike what was found in other studies.

Disclosure
No
(340) Sexual Dysfunction in Women with Sickle Cell Disease
Authors: Siva C , Ribeiro A P , Contreras J C , Oliveira A C , Andrade T , Nascimento B , Tiraboschi R , Miranda E , Bessa Junior J 
Published: May 2023

Abstract

Introduction
Sickle cell disease (SCD) is a genetic hemoglobinopathy with clinical and epidemiological relevance. Its clinical manifestations directly affect the quality of life of affected individuals. There is a gap in the literature regarding the approach to aspects related to the sexual and reproductive health of people with sickle cell disease, especially in the female population, given that most of the available studies evaluated men. The aim of this study was to assess the sexual health of adult women with SCD.

Objective
The aim of this study was to assess the sexual health of adult women with SCD.

Methods
We prospectively evaluated 29 women with SCD with a median age 34 (26.5 - 40). Nineteen women had HbSS and 10 HbSC hemoglobinopathies. Quantitative data on sociodemographic, biological, and clinical characteristics were collected. Sexual dysfunction was assessed using the Female Sexual Function Index (FSFI).

Results
The median age at diagnosis was 9(1-22) years old, the median age at menarche was 14(13-15) years, and the onset of sexual life occurred on average at 19(16-20) years. Sexual activity was reported by 75.8%. Of the sexually active patients, 40.9% had impaired sexual function (the FSFI total score &lt; 26.55). The Median, FSFI score was 23.5 (1-32.5). The median scores of each domain are detailed in fig 1.The most prevalent sexual dysfunction was hypoactive desire, reported by 72.7% of women.

Conclusions
Sexual function is tremendously affected by SCD in most women. They present a significant decrease in overall satisfaction with sexual life and markedly reduced sexual desire and orgasmic function.

Disclosure
No
(344) The Surgical Outcome of Buried Penis Surgery
Authors: Megson M , Ralph D 
Published: May 2023

Abstract

Introduction
Buried penis is a condition where the penis retracts and becomes hidden beneath the skin. It has a significant impact on quality of life of the patient and can present with a variety of symptom including lower urinary tract symptoms and erectile dysfunction. Whilst there are several causes, obesity is the most common in adults.

Objective
The aim of this study is to assess the variety of different operations performed with patient and surgeon satisfaction rates.

Methods
This is a retrospective study on patients with a buried penis operated on between 2010 and 2020. Data retrieved included presenting complaints, previous surgery, co-morbidities, surgical details and patient and surgeon satisfaction rates with cosmesis.

Results
A total of 141 patients were recruited with buried penis (median age 54, range 20-80). The presenting complaints were inability to void standing n = 30, erectile dysfunction n = 18, small penis n = 94. Aetiological factors included diabetes n=47, vascular disease n=62, penile cancer surgery n= 3 and BXO n= 13. The BMI was recorded in 44 patients (range 23-52) with 7 being morbidly obese (BMI &gt;40). 47 patients had only a weight was recoded with a median of 114kg (range 68-169kgs). A total of 96 (68%) patients had had previous surgery prior to referral and in particular circumcision in 49 patients. The operations performed on the 141 patients were circumcision n=40, scrotoplasty n=35, V-Y plasty n=11, skin grafting n=34, suprapubic fat pad excision n=77, abdominoplasty n=25, malleable penile prosthesis n=7, inflatable prostheses n=7 and division of suspensory ligament n=24. The post-operative length of stay was median 3 days (range 0-52 days) but for abdominoplasty and grafting this was a median of 5 days (range 1-52 days). There were 27 complications (19%); infections (n=15), dehiscence (n=5), haematomas (n=2) The mean follow up was 506 days (range 0-4313 days) with a surgical satisfaction rate of 87% and patient satisfaction of 79%. Of note the highest dissatisfaction occurred in patients having circumcision or suprapubic fat pad removal.

Conclusions
Buried penis is a complex condition with patients likely requiring a combination of surgical techniques. Circumcision alone usually does not treat the problem and may make things worse. A prolonged hospital stay with significant wound complications may occur but the majority of patients are happy with the final outcome.

Disclosure
No
(346) Long Term Experience with AMS-700 CXR™ Prosthesis in High-Risk Patients with Corporal Fibrosis
Authors: Cook G , Nealon S , Badkhshan S , Sanders S , Langford B , Vandyke M , Morey A 
Published: May 2023

Abstract

Introduction
Although commonly utilized for high-risk patients with corporal fibrosis, outcome data for narrow inflatable penile prosthesis (IPP) cylinders are relatively sparse.

Objective
The objective of this study is to assess the outcomes of a cohort of patients who underwent IPP placement with the AMS-700 CXR™ (CXR) cylinders at our tertiary referral center.

Methods
We retrospectively reviewed our institutional IPP database for patients who underwent CXR cylinder implantation between 2007 and 2021. Indications, clinical factors, and surgical outcomes were documented for all patients. Kaplan-Meier survival analysis was performed to illustrate implant survival. Patient satisfaction was assessed with a phone survey in which patients provided feedback on penile length, girth, rigidity, and overall satisfaction with the CXR implant.

Results
Among 1149 IPP surgeries reviewed during the study interval, 49 (4%) underwent CXR implantation with a mean (SD) age of 64 years (±11). Indications for CXR implantation included history of infected IPP (30/49, 62%), ischemic priapism 8/49 (16%), and idiopathic fibrosis (11/49, 22%). Postoperative complications occurred in 6/49 (12%) patients including infection 3/49 (6%), cylinder herniation 2/49 (4%), and glans necrosis 1/49 (2%). Discordant intraoperative corporal measurements were common (13/49, 27%), as were discordant rear tip extender lengths (16/49, 33%). The explantation and revision rates were 3/49 (6%) and 4/49 (8%), respectively. Forty percent (19/48) of patients were available for phone survey response (Figure). A total of 47% (9/19) of patients were dissatisfied with their implant, primarily due to perceived loss of penile length (12/19, 63%) and girth (10/19, 53%). Five (5/9, 55%) of these patients had a history of IPP explantation. Fifty-three percent (10/19) of those surveyed are still satisfied with their implant with 58% (11/19) pleased with the rigidity the CXR implant provides.

Conclusions
Narrow based inflatable penile implants have acceptable long-term survival. Cylinder lengths are often discordant in corporal fibrosis patients. Despite use in a high-risk group, patient satisfaction remains acceptable, although many complain of perceived loss of penile length and girth.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.
(349) Risk Factors for Revision of Inflatable Penile Prosthesis among an Ethnically Diverse Urban Population
Authors: Aalami Harandi A , Labagnara K , Zhu M , Salami A , Babar M , Loloi J , Maria P 
Published: May 2023

Abstract

Introduction
Inflatable Penile Prosthesis (IPP) is an increasingly popular surgical treatment for refractory erectile dysfunction. However, there is a feared complication of infection or need for revision surgery. While the risk, treatment, and prevention of infections following IPP placement has been studied, few studies have reported on the risk factors for revision of implant, particularly among a diverse urban population with high rates of comorbid conditions.

Objective
To identify risk factors for revision surgery after primary IPP implantation among an ethnically diverse urban population with high rates of comorbid conditions. Furthermore, to aid informed consent of patients with refractory erectile dysfunction considering IPP surgery.

Methods
This study was a retrospective review of patients receiving IPP implantation surgery at a large urban hospital between January 2015 and December 2021. The primary outcome was revision or removal of IPP due to infection, device malfunction, or other. Patient characteristics, implant characteristics, intraoperative factors, and 30-day outcomes were compared between groups via Chi-squared, student’s t-test, or Mann-Whitney U test. A multivariate cox regression survival analysis was used to identify risk factors for revision surgery. A Kaplan-Meier survival curve was calculated for identified risk factors.

Results
A total of 489 patients received IPP implantation within the study period with 50 (10.2%) requiring revision surgery. Twenty-two (44.0%) patients had removal or revision of IPP due to infection, 19 (38.0%) due to device malfunctions, and 9 (18.0%) due to other reasons. The average time to revision surgery was 8.7 +/− 2.03 months. History of smoking was identified as a risk factor for revision surgery (p&lt;.01), with 23% of active smokers and 13% of former smokers requiring revision surgery. Active smokers had a 3-fold higher risk of requiring revision surgery (OR: 3.23 [0.35-1.32], p&lt;.01). The use of Arista hemostatic agent, as opposed to Surgicel or Evicel, resulted in a more than 50% reduction in the risk of revision surgery (p&lt;.01). However, this finding fell out of our model when adjusted for smoking status (p=.072). Other characteristics such as age, BMI, race, comorbid conditions, length of surgery, implant size, use of surgical drain, and 30-day outcomes were not associated with risk of revision surgery.

Conclusions
There is a mounting body of evidence associating history of smoking with revision surgery and infection following IPP implantation surgery. Patients with active smoking history should be counseled on the up to 3-fold increased risk of requiring revision surgery. Additionally, further studies should assess the use of hemostatic agents such as Arista in reducing risk of revision surgery.

Disclosure
No
(360) Low-Intensity Shockwave Therapy (LiSWT) Appears to Show Improvement in Erectile Function at 1 Month Compared to SHAM in Men with Erectile Dysfunction
Authors: Ballantyne C , Ali M , Ratcliffe S , Mallawaarachchi I , Ostad B , Beano H , Krzastek S , Bryk D , Clements M , Kennady E , Gray M , Rapp D , Ortiz N , Smith R 
Published: May 2023

Abstract

Introduction
Restorative therapies such as Low-intensity Shockwave Lithotripsy (LiSWT) for erectile dysfunction (ED) have generated substantial interest. Despite growing popularity, a paucity of data exists to confirm efficacy in reversing underlying pathophysiologies of ED.

Objective
We evaluated the efficacy of the Storz® Duolith™ to determine whether active versus sham treatment is superior for treatment of ED.

Methods
We performed a two-arm stratified, single-blinded, randomized controlled clinical trial. Inclusion/exclusion criteria are listed in table 1. A total of 31 patients were enrolled, with 15 randomized to the sham group and 16 to the treatment group. Patients underwent LiSWT with the Duolith™ device delivered twice weekly for 3 weeks, comprising 3000 shockwaves at 0.1 mJ/mm2 delivered to the distal penis, base of penis, and crura. Outcomes included absolute change in IIEF/SHIM score and change in EHS score. Changes in SHIM scores were compared between the treatment arms using Student’s t-test, while changes in EHS scores were compared using Wilcoxon rank-sum test.

Results
Demographic and baseline clinical characteristics were similar between arms. At one-month post-treatment, SHIM scores improved by 3.4 points in the LiSWT arm while no improvement was seen in the sham arm (-3.4 vs. 0.7, p=0.014). This corresponded to a 42.1% improvement in the LiSWT arm and a 0.1% decline in the sham arm. No significant differences were observed in EHS change scores between treatment arms. No adverse outcomes were reported.

Conclusions
The present interim analysis shows improvement in SHIM scores in men undergoing LiSWT for ED. Additional recruitment and follow-up is in ongoing to further demonstrate efficacy and sustainability of LiSWT in the treatment of ED.

Disclosure
No