bluuebunny/crossref_metadata_2025_split huggingface dataset:
(47) MAJORITY OF ERECTILE DYSFUNCTION PATIENTS WOULD HAVE PREFERRED EARLIER IMPLANTATION OF THEIR PENILE PROSTHESIS: VALIDATION OF THE RECENTLY CHANGED EAU GUIDELINES
Authors: Dr. Andries Van Huele , Dr. Jonas Mennes , Prof. Eric Chung , Prof. Koenraad Van Renterghem ,   Accepted in the “International Journal of Impotence Research - Nature” with the same title
Published: July 2023

Abstract

Objectives
Until 2019, the European Association of Urology (EAU) guidelines recommended the implantation of a penile prosthesis as a third-line therapy, which has since then changed to "if other treatments fail or depending on the patient's preference", thus a more patient oriented approach. The primary endpoint of this study was to assess whether patients with a penile prosthesis and their partner would have preferred earlier implantation. Secondary endpoints were how much earlier and why patient and partner wanted earlier implantation, satisfaction of patient and partner and if patient and partner would have recommended the intervention.

Methods
We selected patients operated between April 2013 and December 2019. Inclusion criteria were a virgin implantation of an inflatable penile prosthesis (IPP) and a signed informed consent with agreement for a telephonic interview. Exclusion criteria were combined implants and follow-up less than one year. This resulted in a series of 155 patients and 65 partners. Telephonic interview was conducted in a structured manner. Further data were collected retrospectively.

Results
The preference for earlier implantation was reported in 59.4% of patients and 46.2% of partners. Of them, respectively 53.2% and 46.6% would have wanted the prosthesis more than five years earlier. Satisfaction was seen in 83.2% of patients and 73.8% of partners. Respectively 82.6% and 78.4% of patients and partners would recommend the procedure.

Conclusions
The majority of erectile dysfunction patients would have preferred earlier implantation of their IPP. Our results indicate that a more patient-oriented approach with good counseling is desirable and that the “three-level” concept must be abandoned.

Conflicts of Interest
The authors declare no competing interests.
(46) VASECTOMY: PREVALENCE AND SEX LIFE
Authors: Prof. Kathleen Herkommer , Matthias Jahnen , Anna Rechberger , Stefan Schiele , Dr. Christian Leiber-Caspers , Helga Schulwitz , Prof. Juergen E Gschwend 
Published: July 2023

Abstract

Objectives
Although vasectomy is a very safe and effective contraceptive procedure with few side effects, men often fear that this procedure could have a negative impact on their sex life. The aim of this study was to assess the prevalence of vasectomy among middle-aged men in Germany and to investigate possible associations between a previous vasectomy and factors of sex life.

Methods
Data on sociodemographics, sexual activity, and satisfaction with sex life from heterosexual men of the Bavarian Men's Health-Study were analyzed. Validated questionnaires, such as the International Index of Erectile Function (IIEF-6), the Erection-Hardness-Score and the Sexual-Complaints-Screener for Men were used to record the presence of the following sexual dysfunctions: Erectile dysfunction, premature ejaculation, and low libido.

Results
The analysis included 2,330 men with a mean age of 50.4 ± 0.8 years. Vasectomy was performed in 12.6% (n=294) on average 9.2 ± 5.8 years ago. 88.2% had a steady partner (with vasectomy 95.9%, without vasectomy 87.1%; p&lt;0.001) and 73.3% had children (with vasectomy 86.7%, without vasectomy 71.4%; p&lt;0.001). 80.8% were satisfied with their sex life (with vasectomy 85.6%, without vasectomy 80.1%; p=0.027).
Erectile dysfunction was recorded in 13.5% of vasectomized men (without vasectomy 20.5%; p=0.005), premature ejaculation in 6.7% (without vasectomy 5.1%; p=0.289) and low libido in 4.8% (without vasectomy: 7.0%; p=0.159). In multiple logistic regression vasectomy was associated with a lower risk of erectile function (OR 0.61; 95%CI 0.42-0.89), there was no association with premature ejaculation (OR 1.49; 95%CI 0.86-2.59) and low libido (OR 0.66; 95%CI 0.36-1.18) respectively.

Conclusions
The results of this study can allay patients’ fears about vasectomy. Vasectomy represents a safe contraceptive method with no evidence of negative impact on men's sexual function, sexual frequency or satisfaction with sex life.

Conflicts of Interest
none
(51) DO WOMEN WISH TO TALK ABOUT SEX?
Authors: Joanna Ghigo 
Published: July 2023

Abstract

Objectives
Our study aims at establishing the prevalence of sexual dysfunction in women attending gynecology clinics, and explore women’s preferences about the routine introduction of sexual function questions in general gynecological consultations.

Methods
120 Caucasian women referred to gynaecology outpatients were identified and invited to complete an anonymous questionnaire. Written consent was sought.
Questions about frequency of sexual activity, dysparunia, problems with desire, arousal, orgasm and affect on Quality of Life were included. Participants were asked whether they agreed to the gynaecologist asking questions related to sexual function during their consultation, and whether they felt comfortable with their answers being recorded in their hospital notes.

Results
108 participants completed the questionnaires. Respondents were divided in 2 groups: a premenopausal group aged less than 50 years - 62 patients (57%) and a postmenopausal group aged over 50 years -46 (43%).
55 (89%) premenopausal patients reported regular sexual activity, compared to 32 (69%) postmenopausal patients. 26 (42%) premenopausal patients reported sexual dysfunction, with pain (65%) and problems with orgasm (33%) being most frequent whilst postmenopausal patients complained of vaginal dryness (85%), pain (70%) and difficulty in arousal (68%).
70 % of all respondents were favourable to the gynaecologist asking sexual function questions. A statistically significant difference between the two groups was noted.(p=0.033). Only 25 (23%) respondents agreed to this information be kept in their hospital notes.
Overall, women were more likely to discuss sexual dysfunction if they were affected. Being asked questions by the gynaecologist made women feel that it ‘normalized the issue.’ Postmenopausal women expressed some reluctance; possibly due to their decreased interest in sexual activity but also their more conservative values.

Conclusions
Our study confirms that women would like to be asked sexual dysfunction questions during their gynaecological consultation in a sensitive manner.

Conflicts of Interest
I have no conflict of interest.
(94) A COGNITIVE BEHAVIORAL INTERVENTION FOR FEMALE SEXUAL AROUSAL DISORDERS USING A VIBRATING DEVICE
Authors: Dr. Jesús E Rodríguez , Lucrecia Martínez , Natalia Bonachera 
Published: July 2023

Abstract

Objectives
We will investigate the safety and preliminary evidence of the effectiveness of a new Cognitive Behavioral Therapy (CBT) in combination with a vibrating device for the treatment of Female Sexual Arousal Disorders (FSAD).

Methods
A one-group pretest-posttest multicenter design was used. Main outcome measure was assessed using the Female Sexual Function Index (FSFI). A total of 16 patients aged between 19 and 48 years of age (mean = 28.12 years, standard deviation (SD) = 1.92) met criteria and were instructed in the use of a small, portable vibration device over 12 weeks. The inclusion criteria were: Premenopausal women between 18 and 50 years of age who were diagnosed with FSAD and were in a stable monogamous relationship with a male or female partner. Exclusion criteria were: If they were pregnant or nursing or were diagnosed with or being treated for depression, anxiety, psychosis, bipolar disorder, or substance abuse within 6 months before screening. The CBT consists of three educational sessions to provide patients with greater knowledge, awareness, and control of the excitation reflex using a bendable vibration prior to sexual intercourse called Crescendo®.

Results
There was a significant improvement score in domain of FSFI Arousal (mean pre = 1.31 (SD) = 0.41, mean post = 2.27 (SD) = 0.55, Wilcoxon test pre vs. post p-value = 0.02) and Lubrication (mean pre = 1.23 (SD) = 0.41, mean post = 2.38 (SD) = 0.60, Wilcoxon test pre vs. post p-value = 0.02).

Conclusions
In this study, CBT in combination with a vibrating device is a potential treatment for sexual arousal difficulties. It was associated with a significantly increased from baseline in Arousal and Lubrication domain score of the FSFI, with no adverse effects related to the treatment. Future studies with, larger group of patients, with larger follow-up and group control are needed.

Conflicts of Interest
The authors declare that they have no known competing financial interests.
(44) SHAEER'S CAVERNOTOME: THE FIRST CORING / GRINDING CAVERNOTOME
Authors: Prof. Osama Shaeer , Prof. Kamal Shaeer 
Published: July 2023

Abstract

Objectives
Fibrosis of the corpora cavernosa follows removal of an infected implant or protracted / recurrent priapism. Penile prosthesis implantation in cases with fibrosis is both difficult and risky. Complications include perforation and/or failure. Shaeer’s Cavernotome (patent application number PCT/EG2021/050003) is a coring / grinding cavernotome that relies on rotational movement without force instead of forward stabbing notorious for complications.

Methods
Eighteen patients with severe corporal scarring were operated upon. Surgery is performed through a peno-scrotal incision with urethral catheter in place. Two cm long core of fibrous tissue is excised with scalpel, excavating the corporotomies. Shaeer’s Cavernotome (ShC) is lodged-in against the fibrous tissue. Rotational coring is performed proximally and distally with the penis on stretch. ShC doubles as a sizer. Following coring, penile prosthesis implantation proceeds.

Results
Dilation of the corpora cavernosa was successful up to either girth 11 or 13 Hegar with a single pass, in 17 out of 18 patients. Average coring time was 8 minutes ±3.2. No perforations or infections were encountered

Conclusions
Shaeer’s Cavernotome facilitates excavation of scarred corporal bodies without forward stabbing, thereby decreasing the difficulty and risk.

Conflicts of Interest
Author is the inventor of the instrument.
(93) SURGICAL OUTCOMES OF URETHRAL LENGTHENING IN THE CONTEXT OF GENITAL GENDER-CONFIRMING SURGERY IN TRANSGENDER MEN
Authors: Marco Falcone , Mirko Preto , Ilaria Ferro , Cirigliano Lorenzo , Peretti Federica , Plamadeala Natalia , Ceruti Carlo , Gontero Paolo 
Published: July 2023

Abstract

Objectives
Our study aim is to analyze the surgical and functional outcomes after urethral reconstruction in consecutive series of transgender men who underwent genital gender-confirming surgery.

Methods
A retrospective monocentric cohort study was conducted. From 2015 to 2022, patients who underwent urethral lengthening in the context of GGCS were enrolled.
Surgical outcomes and postoperative complications were reported. Three questionnaires were administered to evaluate patients’ urinary function (CCO-EPIC, ICIQ-SF) and patients’ psychological well-being (BDI - scale of depression). A 6-item ad hoc created questionnaire was administered to inquire patients’ reported outcomes.

Results
31 patients were included in the study. 11 underwent metoidioplasty (Group A), while 20 underwent phalloplasty with different techniques (Group B). The descriptive characteristics between the two groups were comparable, except for the BMI resulting greater in Group B (p-value 0.012). Average follow-up was 18 months (±18SD). Mean operative time was 160 minutes (±43 SD). No significant intraoperative complications occurred. Early postoperative complication rate resulted significantly higher for group B (83.3% p-value 0.034). The most frequent complication, urethral fistula, healed in all cases after prolonged catheterization. Overall 9.6% of patients needed a surgical revision to address urethral complications. CCO-EPIC and ICIQ-SF administered preoperatively and 1-year after surgery showed worsening in urinary function (p-value = 0.04 and p-value = 0.02 respectively), BDI score showed a significant improvement in postoperative settings (p-value= 0.02). 82 % of the patients after 1-year follow-up were satisfied with the procedure and 81 % declared that surgery had a positive impact on their quality of life. The main limitations of the study are the limited follow-up, the non-randomized nature of the study and the small number of patients.

Conclusions
Urethral reconstruction in the context of GGCS is a challenging reconstructive surgery burdened by high incidence of postoperative complications. Despite that, it may contribute to improve the psychological well-being of transgender men.

Conflicts of Interest
This study is free from commercial influence or bias and the authors had no conflict of interest.
(243) PERCEPTION OF HEALTHCARE FOR TRANSGENDER PEOPLE IN CROATIA
Authors: Iva Zegura , Priv-Doz. Andrea Jambrosic Sakoman , Karlo Dalić 
Published: July 2023

Abstract

Objectives
No systemic care under specific gender clinics for transgender people exists in Croatia. There is a National list of experts in the health care of transgender people which did not expand since its establishment in 2015 with new competent professionals. The main focus of the study was to find out how experts and NGOs perceive the existing level of healthcare for transgender people.

Methods
The online study is conducted in 2021 on a sample of experts from the National list of experts in healthcare for transgender people and two main NGOs that are dealing with transgender rights. The results are analyzed mainly using the qualitative methodology and to a lesser extent quantitative methodology. The thematic analysis was performed by two independent researchers.

Results
The analysis has shown three main themes: 1) Positive aspects of healthcare for transgender people; 2) Negative aspects of healthcare for transgender people; 3) Improvements in the healthcare of transgender people. Perceived positive aspects are: the existence of care options for trans people within the health care system; achieved progress in the implementation of Standards of care; availability of information regarding health care. Perceived negative aspects are a lack of competent professionals; geographically centralized health care; experts working in different hospitals; no systematic education for new professionals. Proposed improvements relate to establishing a professional association of experts for transgender health, education of new experts, decentralization of health care, and standardization of procedures of assessment and treatment within each profession.

Conclusions
Obligatory systematic education regarding the health care of trans people is necessary on graduate and postgraduate levels as well as establishing standardized procedures in diagnostic assessment of trans people for each profession included in interdisciplinary teams. A new round of discussion between professionals, transgender NGOs, and stakeholders should be made in order to remove existing barriers to complete and affirmative health care for transgender people in Croatia.

Conflicts of Interest
The authors declare no conflict of interest.
(187) MAX AND AVERAGE FLOW RATE ARE CORRELATED WITH SEVERITY OF ERECTILE DYSFUNCTION
Authors: Dr. Mohamad Habous , Dr. Simone Giona , Prof. Saleh Binsaleh , Prof. Anthony Mundy 
Published: July 2023

Abstract

Objectives
Numerous cross-sectional epidemiological studies have reported a clear and clinically significant association between lower urinary tract symptoms (LUTSs) and erectile dysfunction (ED) in aging men worldwide.
We aimed to investigate the severity of ED symptoms with flow rate specifically.

Methods
All patients came to our urology clinic, complaining of LUTSs for at least 3 months were prospectively included in this study, in one year. Complete medical history including international index of erectile function (IIEF-5) and international prostate symptom score (IPSS) questionnaires, physical examination and comorbidity profile were collected. Patients were stratified according to IIEF-5 score into 4 groups: no or mild ED, mild to moderate ED, moderate ED and sever ED. Standard uroflowmetry test was done, and prostate size was calculated through transrectal ultrasound (TRUS). Patients with middle lobe, urethral stricture and previous lower urinary tract surgery were excluded from the study. Database was done with Microsoft Excel and statistical analysis was done by SPSS software.

Results
166 patients had complete data and were included in this analysis. The mean age was 57,and 26% were diabetic. When running Kruskal-Wallis Test it, showed that there is a statistical difference between the groups, the lower is the IIEF score (sever ED), the lower is the max flow (P&lt;0.049) and the average flow (P&lt;0.025). There was an inverse correlation between max flow rate and Prostate volume, the bigger is the prostate the lower tend to be the max flow (p&lt;0.000), and same for average flow (P&lt;0.001). There was a slight but significant (P&lt;0.006) increase in severity of ED with the increase in prostate volume. The older were the patients the worse is the ED and the worse the flow rate (p&lt;0.000). The flow rate was nor correlated neither with dyslipidemia nor with BMI

Conclusions
Flow rate is correlated with severity of ED symptoms and prostate volume.

Conflicts of Interest
None
(245) FLACCID PENILE COLOUR-DOPPLER ULTRASOUND REPRESENTS A BETTER MARKER OF SYSTEMIC CARDIOVASCULAR STATUS THAN CAROTID COLOUR-DOPPLER ULTRASOUND
Authors: Prof. Francesco Lotti , Dr. Sarah Cipriani , Dr. Beatrice Gasperetti , Dr. Carolina Baraddi , Dr. Viviana Ciambrone , Prof. Mario Maggi 
Published: July 2023

Abstract

Objectives
To assess the correlations between flaccid penile colour-Doppler ultrasound (fPCDU) parameters, carotid colour-Doppler ultrasound (CCDU) parameters and history of major adverse cardiovascular events (MACE) in men with erectile dysfunction (ED).

Methods
A consecutive series of 269 men (55.3±11.6 years) complaining of ED were evaluated with fPCDU (assessing cavernosal artery peak systolic velocity [CAPSV] and acceleration [CAA]) and CCDU (evaluating intima-media thickness [IMT], the presence of atherosclerotic plaques [AP] at the origin of the internal carotid artery [ICA], and the ratio between ICA-PSV and common carotid artery-PSV [ICA/CCA-PSV ratio], the latter widely used to extimate hemodynamic abnormalities at the ICA level). In addition, the history of MACE of the patients was collected.

Results
At fPCDU, the mean CAPSV was 13.9±4.2 cm/s, the mean CAA was 1.92±0.66 m/s2. At CCDU, the mean IMT was 0.8±0.3 cm/s, 37% of men had ICA-AP and the median ICA/CCA-PSV ratio was 0.7 [0.6-0.8]. Overall, 7.9% of men had a history of MACE (3.7% acute myocardial infarction, 2.4% NSTEMI, 0.7% stroke, 1.1% peripheral arterial thrombosis). At fPCDU, mean CAPSV was positively associated with mean CAA (p&lt;0.0001). At CCDU, mean IMT was positively associated with mean ICA/CCA-PSV ratio (p&lt;0.001). Both mean CAPSV and CAA were negatively associated with mean IMT and ICA/CCA-PSV ratio, respectively (all p &lt; 0.001). Men with ICA-AP showed lower CAPSV and CAA than those without (both p &lt;0.001). Men with a history of MACE showed lower penile CAPSV and CAA (both p&lt;0.05), but no difference in IMT, ICA-AP or ICA/CCA-PSV ratio compared to those without. Al data were confirmed after adjusting for age.

Conclusions
Although fPCDU and CCDU blood flow parameters are associated, subjects with MACE history show worse fPCDU, but not CCDU, blood flow parameters, than those without MACE history. Hence, fPCDU represent a better marker of a worse systemic cardiovascular status respect to CCDU.

Conflicts of Interest
No
(79) SURGICAL AND FUNCTIONAL OUTCOMES OF PENILE PROSTHESIS IMPLANTATION IN MEN WITH NEUROLOGICAL CONDITIONS
Authors: Marco Falcone , Paolo Capogrosso , Lorenzo Cirigliano , Mirko Preto , Massimiliano Timpano , Federica Peretti , Ilaria Ferro , Nicolò Schifano , Carlo Ceruti , Edoardo Pescatori , Enrico Caraceni , Fulvio Colombo , Maurizio Carrino , Carlo Bettocchi , Antonio Vitarelli , Matteo Paradiso , Federico Dehò , Tommaso Cai , Franco Giorgio , Alessandro Palmieri , Prof. Paolo Gontero 
Published: July 2023

Abstract

Objectives
Pharmacological treatment for erectile dysfunction (ED) is not always effective in patients with neurological disease; as such, penile prosthesis implant (PPI) can be a valid treatment option. We investigated outcomes of PPI in neurological patients using the Italian multi-institutional national registry of penile prostheses (INSIST-ED)

Methods
INSIST-ED registry, relating to patients implanted from 2014 to 2021, was analyzed. All data were prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a data-manager. We selected patients with neurological disease undergoing PPI for ED. Follow-up was scheduled at 3,6 and 12 months, then annually. We evaluated postoperative complications and functional outcomes through validated questionnaires (IIEF and EDITS). A non-validated questionnaire was administered to evaluate patient’satisfaction.

Results
33 patients were included with a median age of 52 (IQR: 44.75-55.25). Peno-scrotal approach for PPI was performed in most cases (90.9%) while infra-pubic was used in 3 cases (9.1%). An inflatable and a malleabel device was implanted in 30 (90.9 %) and 3 cases (9.1 %), respectively. Median follow-up was 83 months (IQR: 67-99.5). Intraoperative complications occurred in one case (3%). Early postoperative complications (&lt;90 days) were observed in 4 cases (12.1%): 3 peno-scrotal hematoma (Clavien-Dindo G1), 1 device infection requiring prosthesis explant (Clavien-Dindo G3a). At the last follow-up, 29 prostheses (87.9%) were still in place and well-functioning. Mechanical failure of inflatable PP occurred in 3 cases (9.1%). Median IIEF before surgery was 32 (IQR 30.25-36). At the last follow-up, IIEF was 61.5 (IQR 60.25-64.25), and median EDITS was 45.5 (IQR 39-46.75). Overall, 29 patients (87.9%) affirmed to be fully satisfied with the PPI.

Conclusions
Although PPI in the neurological population has been historically limited by the evidence of common complications and infections, our study showed that PPI represents a safe and effective procedure to treat ED in neurological patients.

Conflicts of Interest
The Authors have no conflict of interest.