bluuebunny/crossref_metadata_2025_split huggingface dataset:
(024) Cognitive Behavioral Therapy for Compulsive Sexual Behavior Disorder
Authors: Kolomanska A 
Published: May 2023

Abstract

Introduction
Cognitive Behavioral Therapy (CBT) is often used in the treatment for Compulsive Sexual Behavior Disorder (CSBD). However, no review of the evidence on the clinical efficacy of CBT for CSBD has been conducted. Compulsive Sexual Behavior Disorder (CSBD) is characterized by a lack of control over sexual impulses, thought, phantasies and urges and may have serious negative consequences of a person well-being, families, and functioning in work and education (Kraus et al., 2018). The prevalence of CSBD in the general population ranges from 3% to 6% (Derbyshire & Grant, 2015) with a near 4:1 ratio of male to female (Kuzma & Black, 2008). Due to the negative consequences of CSBD people often seek professional help.

Objective
To provide a systematic review of published studies on the efficacy of CBT for Compulsive Sexual Behavior Disorder.

Methods
The material for the analysis was obtained by searching 4 internet databases: Scopus, PubMed, ResearchGate and the Cochrane Library. Articles describing Cognitive Behavioral Therapy and their efficiency in reducing symptoms of CSBD were required. The search in the selected databased using the keywords identified in 203 records. Screening of abstract excluded 174 records and 29 records were assessed for eligibility. Four studies fulfilled the criteria for eligibility and were included in the study (see table 1). The selection process and reasons for exclusion of studies are shown in the Prisma flowchart (see Figure 1).

Results
4 original research articles were included to the review (Hallberg et al., 2017; Hallberg et al., 2019; Hallberg et al., 2020; Nwokeoma et al., 2019). Articles were devoted to the analysis of the efficiency of Cognitive Behavioral Therapy in reducing symptoms of hypersexual behavior. Studies show that CBT led to a significant reduction in hypersexual as well as symptoms of CSBD. Both RCT and non-controlled studies showed decrease in symptoms of CSBD after CBT. RCTs showed significant intermediate effects between treatment groups and control groups. Means (s.d.) on pre- and post-treatment scores of selected measures from included RCTs are shown in table (see table 2). Result indicate that CBT is a promising treatment for CSBD. However, studies included in the current review suffer from several methodological bias.

Conclusions
CBT show promise as treatment of CSBD. However, future studies should evaluate the treatment program with a larger sample in randomized controlled procedures and investigate the long-term effects; include women and comprise dismantling analysis of the constituting interventions.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Clinic for Sexology and Psychotherapy
(040) Is it Hard Enough? Higher Axial Force is Necessary for Penetrative Anal Intercourse
Authors: Miller J , Loeb C , La J , El Khatib F , Yafi F 
Published: May 2023

Abstract

Introduction
Inflatable penile prosthesis (IPP) remains the gold standard for surgical management of erectile dysfunction. Device buckling and malfunction represent a problem leading to patient dissatisfaction and high cost of care. While prior data suggests that the force needed for vaginal penetration (6.0 – 14.1 N) is typically below that at which prostheses begin to buckle (8.2 – 10.5 N), no data exists detailing the force needed for penetrative anal intercourse.

Objective
To evaluate the safety of IPP use with anal intercourse, especially for the population of men who have sex with men, we aim to determine the maximal axial loading force associated with anal penetration.

Methods
A hand-held force sensor device attached to a silicone rod with a length and girth representative of the average male phallus in the United States was inserted into the anal canal of six participants. The maximal axial loading force during penetration to a depth of six inches was recorded for a total of five measurements per participant. Participants then completed a survey eliciting demographic information and past experience with receptive anal intercourse.

Results
The average maximal force recorded across all participants was 30.3 N (16.1 – 51.7 N) [Figure 1]. By participant, average maximal forces ranged between 21.1 N – 49.4 N. All participants identified as homosexual men and had engaged in anal receptive intercourse within the past year. Participants who engaged in receptive anal intercourse more than once per month were with lesser average maximal forces (25.7 N) than those who less frequently engaged in receptive anal intercourse (42.0 N).

Conclusions
The average maximal force recorded during anal penetration exceeded the historically reported force required for vaginal penetration by a factor of 3.2 times, and that at which IPP buckling has been noted by a factor of 2.9 to 3.7 times [Table 1]. While the axial force required for anal penetration was lesser in those who more frequently engaged in receptive anal intercourse, this force still exceeded that at which IPP buckling can be seen. This study, while limited by sample size, highlights the necessity for further research investigating the efficacy and satisfaction associated with IPP implantation in those who engage in penetrative anal intercourse.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma; Clarus Therapeutics; Coloplast; Cynosure; Promescent; Sprout; Viome.
(137) Surgical Outcomes at a Single Institution of Infrapubic insertion of Malleable Penile Prosthesis in Transmen after Phalloplasty
Authors: Sun H , Isali I , Mishra K , Callegari M , Sellke N , Tay K , Gupta S , Chen M 
Published: May 2023

Abstract

Introduction
Penile reconstruction has allowed transmasculine individuals to attain the aesthetic appearance of male genitalia, however a penile prosthesis is needed to achieve the ridigity and bulk for penetration. High complication rates have been reported with penile prosthesis placement after phalloplasty, with the rate of reoperation exceeding 40% following both inflatable penile prosthesis (IPP) and malleable penile prosthesis (MPP). We describe the experience of a single surgeon with the infrapubic approach for MPP placement after phalloplasty.

Objective
To review the surgical outcomes of the infrapubic approach to the insertion of the MPP after phalloplasty in transgender men.

Methods
The infrapubic prosthesis insertion after phalloplasty technique involves a horizontal incision anterior to the pubic symphysis, which allows dissection of the neophallus channel and the anchor site on the pubic symphysis. Surgical outcomes using the Spectra (Boston Scientific, Marlborough, MA) and Genesis (Coloplast, Minneapolis, MN) MPP were analyzed between October 2017 and May 2022. Complications were reviewed and categorized into erosions, infections, device malposition and malfunction, and less common events like necrosis.

Results
The infrapubic MPP technique was performed on 40 patients by a single surgeon; 35 patients had a prior radial forearm free flap (RFFF) phalloplasty, and 5 had a prior anterolateral thigh flap (ALT) phalloplasty. Of the 30 patients who have continued to follow-up, mean follow-up was 34.9 months. Complications were not mutually exclusive, with 7 implant detachments from the anchor site, 3 malpositions, 2 with pain/activity limitation, and 1 infection. Surgical revision was required in 12 patients (40.0%). There were no neophallus erosions, flap loss, seromas, nor urethral injuries. More complications occurred with the Spectra MPP (9/17 or 52.9%) compared to the Genesis MPP (3/13 or 23.1%).

Conclusions
Infrapubic MPP insertion in transmen after phalloplasty is associated with high prosthetic surgical revision rates. Fewer complications were identified in the Genesis cohort. Longer term studies with patient reported outcome measures are required for further evaluation.

Disclosure
No
(155) Peyronie's Disease in Young Adults: Symptomatic Burden and Clinical Characteristics
Authors: Fallara G , Capogrosso P , Boeri L , Cazzaniga W , Candela L , Schifano N , Costa A , Pozzi E , Belladelli F , Cignoli D , Lanzaro F , Bertini A , Raffo M , Matloob R , Cornelius J , Ventimiglia E , Abbate C , Mattei A , Montorsi F , Salonia A 
Published: May 2023

Abstract

Introduction
Peyronie's disease is a common yet poorly understood condition occurring in teenagers as well as in men in their late 70s.

Objective
The aim of the study is to investigate whether patients’ age has an impact in terms of Peyronie’s disease (PD) clinical characteristics at presentation.

Methods
Data from a group of 125 consecutive patients aged &gt;18 and with PD and seeking first medical attention at a single andrological tertiary-referral centre, with a complete clinical assessment and who completed the IIEF-15 and PDQ questionnaires were included in the study. Descriptive statistics was used to compare categorical and continuous variables, between young (≤45 years) and old (&gt;45 years) patients at presentation. Linear and logistic regression analyses tested the association between age and PDQ subscales (Pain, Bother and Symptoms) or IIEF-erectile function domain scores (IIEF-EF ≤26), after adjusting for Charlson Comorbidity Index (CCI), Body Mass Index (BMI), duration of PD (as self-reported by the patient), smoking habit and penile curvature. LOWESS curve was used to graphically investigate the association between age and PDQ pain score.

Results
Of 125, 33 (26%) patients were ≤45 years old. Young patients had lower BMI [median (IQR) 23.6 (21.4-25.1) vs. 25.5 (23.7-27.8); p=0.01] and CCI [CCI≥1 in 1 patient (3%) vs. 25 (27%); p=0.007) compared to older patients. No differences were found between groups in terms of PD duration and plaque size, however curvature was lower among younger patients (20° [15-50] vs 47 [40-75]; p=0.045). PDQ pain score was 6 (2.0-10.0) for younger and 3 (0-8) for older patients (p=0.049). No differences were found in terms of PDQ-symptoms and bother scores, and for IIEF domain scores. At multivariable regression analysis, younger age was associated with significant higher PDQ-pain scores at presentation (Coeff 4.39; 95%CI 2.64:6.16; p&lt;0.011). No further associations were observed between age and the other questionnaires. The figure depicts the higher PDQ-pain scores in young compared to older age.

Conclusions
Younger PD patients are at higher risk of complaining penile pain at presentation despite having a lower penile curvature. No difference in terms of symptoms, PD-associated bother, erectile function and other clinical and morphometric characteristics were found between younger and older patients at first assessment.

Disclosure
No
(164) Real-World Practice in Peyronie’s Disease Management: Results from a National Survey of Urologists
Authors: Brant A , Basourakos S , Lewicki P , Kang C , Marinaro J , Punjani N , Kashanian J 
Published: May 2023

Abstract

Introduction
There are many treatment options for men with Peyronie's disease, some which have been shown in randomized controlled trials to be more effective than placebo in reducing curvature and plaque size and others which do not have strong evidence of efficacy for use. It is unclear which of the many Peyronie's disease treatment choices are preferred by practicing urologists.

Objective
To survey practicing urologists on their preferred methods for diagnosing and treating Peyronie's disease.

Methods
A 34-item survey was distributed via REDCap to urologists in all American Urological Association (AUA) sections. Questions elicited demographic information as well as practices in diagnosis and treatment of Peyronie’s disease. Comparisons were made with Pearson’s chi-squared test.

Results
A total of 145 respondents completed the survey, of whom 19% were fellowship trained in andrology/sexual medicine, 36% practiced in an academic setting, and 50% had at least 20 years in practice. Only 60% of respondents reporting performing in-office curvature assessment prior to commencing intralesional injection or surgical treatment, with higher prevalence in andrology/sexual medicine fellowship-trained vs. non-fellowship trained urologists (85% vs. 54%, p=0.003). The most popular treatment modalities were collagenase clostridium histolyticum (CCH) (61% of respondents), phosphodiesterase-5 (PDE-5) inhibitors (54%), and penile traction (53%). Twenty-one percent of respondents reported currently using a treatment that is explicitly discouraged by the AUA guidelines (extracorporeal shockwave therapy for curvature, L-carnitine, omega-3 fatty acids, procarbazine, tamoxifen, or vitamin E).

Conclusions
We found reported use of a variety of Peyronie's disease treatments, despite poor evidence of efficacy for several of these therapies. PDE-5 inhibitors, penile traction, and CCH were among the most popular non-surgical treatments, with a significant proportion of urologists reporting “off-label” use of CCH. Efforts are needed to identify optimal regimens for Peyronie's disease treatment and to better educate urologists on the up-to-date evidence and guidelines in Peyronie's disease management.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Roman Health
(177) Female Sexual Dysfunction: Can it be Addressed During Infertility Treatment?
Authors: Schaub A , Dubinskaya A , Pisarska M , Eilber K 
Published: May 2023

Abstract

Introduction
Female sexual dysfunction (FSD) is a highly prevalent and distressing condition in the general population. Women undergoing fertility treatments are at even higher risk of developing sexual dysfunction due to sexual activity being perceived as an obligation to conceive versus for pleasure, stress of whether the current act of intercourse will result in conception, and a sense of sexual activity as being part of a demanding medical treatment regimen.

Objective
The purpose of this review is to investigate currently used interventions and/or treatments of FSD in the settings of infertility treatment.

Methods
We conducted a systematic review on the current approaches to treat FSD while undergoing fertility treatments. PubMed, PMC and Google Scholar were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria for this review were female subjects undergoing infertility treatment, sexual health was described and measured, interventions were performed or recommended to the subjects with measured outcomes, and the manuscript was written in English between January 2000 to June 2022. Case reports and studies that did not address conditions of interest were excluded from analysis.

Results
Queries identified 2,341 studies of which title and summary were screened. Fourteen articles met inclusion criteria and underwent full text review. Although multiple studies described an association between infertility and different types of FSD, no study described outcomes for FSD interventions in the infertility setting.

Conclusions
There is a complete lack of FSD treatment options for infertility patients. Clinicians treating infertility patients should consider discussing FSD and its treatment options in this population.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie, Coloplast, Sprout Pharmaceuticals.
(178) Prospective Urology Resident Exposure to Genital Gender Affirming Surgery
Authors: De Rosa P , Pearlman A 
Published: May 2023

Abstract

Introduction
Genital gender affirming surgery (GGAS) is a component of transgender and gender expansive healthcare. Transgender health has been increasingly covered in undergraduate medical school curricula, however the prevalence of education on GGAS is not well known. We sought to learn about urology applicants’ exposure to GGAS.

Objective
To investigate prospective urology resident exposure to GGAS and impact on residency applications.

Methods
An online Redcap survey was distributed via Twitter in Spring 2022. Recent or prospective urology residency applicants were invited to participate. The survey collected demographic data and assessed level of exposure to GGAS in medical school and perceived importance of GGAS training in choice of urology residency program.

Results
42 respondents completed the survey. 21.4% (9) of respondents identified as a member of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA) community. 73.8% (31) identified as White. 59.5% (25) reported experience with LGBTQ health. 59.5% (25) reported no clinical or didactic exposure to GGAS. 57.1% (24) reported training in GGAS was “moderately important” to “extremely important” in their selection of residency programs. Didactic exposure to GGAS was weakly associated with importance of GGAS training (LR 0.335, p = 0.03). LGBTQIA respondents were more likely to have greater didactic exposure to GGAS (LR 7.776, p = 0.021).

Conclusions
The majority of respondents had no clinical or didactic exposure to GGAS in medical school. Over half of respondents indicated that GGAS was an important factor in residency program selection. Our findings emphasize the importance of GGAS training as part of comprehensive urology graduate medical education.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(189) Sexual Abuse and Vesico-Sphincter Dysfunction
Authors: Jamali M , Boukhlifi Y , Melang Mvomo A , Mohammed A , Ameur A 
Published: May 2023

Abstract

Introduction
Even though urologists know that there may be an association between sexual abuse and urinary disorders, finding sexual abuse (SA) is often not part of their standardized questioning.

Objective
Evaluate the incidence of sexual abuse (SA) in women with vesico-sphincter dysfunction, to understand the cause-and-effect relationship in order to adapt their management.

Methods
A multi-parametric, cross-sectional study was conducted by a female doctor looking for sexual assault, the latter interviewed 214 women (42 years, extremes 19-75 years), followed by specialists between January 2017 and December 2019. All patients were evaluated by voiding schedule, MHU score (a measure of urinary disability), bladder fibroscopy, and urodynamic workup and spinal MRI to exclude neurological injury. The results are presented in Tables 1 and 2.

Results
The possible recollection of a memory of sexual abuse leads to a categorical refusal of the urogynecological clinical examination or an attitude of opposition during a urodynamic or proctological examination. No correlation between the painfulness of this memory and the seriousness of what induced it has been demonstrated; sometimes a simple examination may have been experienced as aggression. The observation of a "frozen" perimeter, which does not contract with the effort of restraint and does not relax with the push or the request for relaxation, will draw our attention even more to the fact that it is a hypertonic perimeter.

Conclusions
Sexual assaults are very frequent and their management is multidisciplinary due to the physical, psychological, or psychosomatic consequences. They concern men as well as women, regardless of the socio-economic context, and this has been shown in all epidemiological studies. This proves the strong causal link between LUTS and sexual abuse.

Disclosure
No
(198) How to Use VSI HoloMedicine for Beginners: Imaging and Surgical Instrument’s Sharing
Authors: Hakky T , Carrion R , Simhan J , Shridharani A , Steinhorst B , Henry M , Henry G 
Published: May 2023

Abstract

Introduction
Extended Reality-Assisted Surgery (XRAS) is a novel technology that superimposes a computer-generated image in the physicians’ visual field to integrate common elements of the surgical process in advanced detail. Although XRAS has already been utilized by several medical disciplines, many face challenges with implementation and perceive integration between the hardware and software for XRAS to be quite burdensome. Nevertheless, the present group has successfully reported XRAS in complex penile implant revision surgery. In order to help reduce the learning curve, we present this introductory video demonstrating how users may sign into the software for XRAS, download patient imaging, demonstrate imaging to other doctors, and employ surgical tools “live” with other colleagues.

Objective
Video for beginners to XRAS to learn how to sign onto VSI HoloMedicine®, download patient imaging, demonstrate the imaging to other doctors and usage of surgical tools and penile implants ‘live” with other surgeons.

Methods
The hardware utilized for XRAS was XR Microsoft HoloLens (Microsoft, Redmond, WA, USA) while VSI HoloMedicine (XX, Dusseldorf, Germany) was the software program. Raw data from CT scans were downloaded onto VSI HoloMedicine. Local Wi-FI was used for connecting different surgeons remotely to discuss patient care decision-making and surgical tool usage.

Results
Signing onto VSI HoloMedicine and downloading patient imaging is detailed. Two (2) de-identified patient’s imaging was shown to surgeon colleagues for discussion and clinical assistance in making patient care decisions. Surgical tool and penile implant components were demonstrated while connected to another surgeon.

Conclusions
With proper instructions as shown on this video, getting on and connecting with other surgeons through XRAS can be straightforward. Here, we demonstrate how to download patient imaging, show the imaging details in-depth and how surgical tools and penile implants can be successfully implemented during XRAS.

Disclosure
Yes, this is sponsored by industry/sponsor: Coloplast

Clarification
Industry funding only - investigator initiated and executed study
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.
(208) Coital Positions and Clitoral Blood Flow: A Biomechanical and Sonographic Analysis
Authors: Marashi A , Lovie K 
Published: May 2023

Abstract

Introduction
The purported benefits of various coital positions are described in numerous magazines, books, and public forums. However, there is little scientific research that evaluates the association between different coital positions and the ability to produce female orgasm.

Objective
To create biomechanical models of five coital positions, and evaluate the degree of contact and forces against the clitoris. To evaluate clitoral blood flow before and after engaging in these positions.

Methods
Biomechanical models were rendered of a male and female pelvis in the following coital positions: face-to-face/female above, sitting/face-to-face, face-to-face/male above (with and without pillow), and kneeling/rear entry. The thrusting force and gravitational force were estimated for the pelvis(es) providing the main forces. The areas of contact between the pelvises were identified and highlighted. Sonography of the clitoris was performed before and after a healthy volunteer couple engaged in each position, using a Philips Lumify™ ultrasound (Koninklijke Philips N.V., Amsterdam, Netherlands) with a L12-4 linear array transducer (4-12 MHz).

Results
The biomechanical models for each position, with the exception of kneeling/rear entry, reveal a large amount of contact with the clitoris. Clitoral blood flow increased after engaging in each position except for kneeling/rear entry. Positions in which the gravitational force of the thrusting partner was in the same direction of (and thereby augmenting) the thrusting force resulted in intense clitoral blood flow (face-to-face/female above, and face-to-face/male above). Augmenting the face-to-face/male above position with a pillow generated a component of the male pelvic gravitational force in the direction of the clitoris; this resulted in more blood flow to all components of the cavernous body.

Conclusions
From a biomechanical perspective, different coital positions vary in their potential to stimulate the clitoris. These positions lead to variable increases in clitoral blood flow, concordant with our biomechanical models.

Disclosure
No