bluuebunny/crossref_metadata_2025_split huggingface dataset:
(210) Clitoral Blood Flow After Use of Gel Containing L-Arginine and L-Citrulline
Authors: Marashi A , Lovie K 
Published: May 2023

Abstract

Introduction
L-arginine and its precursor, l-citrulline, are two amino acids involved in the production of nitric oxide (NO); as a result, they increase blood flow and have been used to treat male sexual dysfunction (Alatas and Yagci, 2004). Some lubricants and gels contain l-arginine and are applied directly to the genital area to increase blood flow. Although these products have been evaluated subjectively through patient reports of increased warmth, arousal, and orgasm, to our knowledge, they have not been evaluated quantitatively in women. Moreover, the effect of gels combining both l-arginine and l-citrulline have not been reported in the medical literature.

Objective
To evaluate whether a topical gel containing l-arginine and l-citrulline increases blood flow to the clitoris.

Methods
Sonography of the clitoris was performed on a healthy 32-year-old volunteer before and after applying the gel externally to the vulva. The “before” scans were obtained using a neutral ultrasound gel (without l-arginine or l-citrulline). This allowed us to verify that the observations were due to the active ingredients of the gel, and not from massage associated with its application. Control images without gel could not be obtained, since acquisition of ultrasound images requires ultrasound gel in order to reduce acoustic impedance. The scans were obtained with a Philips Lumify™ ultrasound (Koninklijke Philips N.V., Amsterdam, Netherlands) with a L12-4 linear array transducer (4-12 MHz). Clitoral blood flow was assessed qualitatively (color Doppler images), as well as quantitatively (peak systolic velocity, end diastolic velocity, and resistive index of the deep artery of the clitoris).

Results
Blood flow to the clitoris increased after application of the gel containing l-arginine and l-citrulline at both evaluated time points. The maximum PSV of the deep artery of the clitoris also increased from 6.2 cm/s (before), to 8.6 cm/s (5 minutes) and 13.9 cm/s (15 minutes). The maximum EDV of the deep artery of the clitoris increased from 1.4 cm/s (before), to 1.7 cm/s (5 minutes) and 9.5 cm/s (15 minutes). The RI was 0.8 before and at 5 minutes. After 15 minutes, the RI decreased to 0.3, explained by a disproportional increase in EDV compared to PSV.

Conclusions
The results of this pilot study suggest that clitoral blood flow increases with the use of a gel containing l-arginine and l-citrulline. These findings can help clinicians inform patients with female sexual dysfunction. Difficulty achieving clitoral stimulation is a major cause of sexual dysfunction. Clinicians can use these findings to counsel patients about using gels to increase clitoral blood flow.

Disclosure
No
(224) Icilin, a TRPM8 Agonist, Induces Relaxation and Reduces Sensitivity to Phenylephrine in Pudendal Artery from Control and Diabetic Mice
Authors: Dos Anjos Moraes R , A  Araujo F , Arishe O , L  C  de Jesus R , B  Da Silva L , Priviero F , Webb C , F  Silva D 
Published: May 2023

Abstract

Introduction
Diabetes mellitus (DM) is a chronic metabolic disease with epidemiological relevance worldwide. One of the most common and most underestimated complications of diabetes is erectile dysfunction (ED). It is estimated that approximately 35-90% of diabetic men present ED as an early complication. Previous studies have shown that TRPM8 activation triggers relaxation of pudendal artery with increased sensitivity in the hypertensive rats. However, despite the correlation between ED and diabetes, research on the role of TRPM8 channels in the vasculature responsible for sexual function in diabetic condition still needs to be elucidated.

Objective
In this way, the aim of this study was to investigate TRPM8 channels in arteries vital to erection of the penis. We hypothesized that TRPM8 activation would induce relaxation and reduce sensitivity to alpha-adrenergic stimulation in pudendal arteries from diabetic mice.

Methods
Male control and db/db mice were euthanized, and the internal pudendal arteries were mounted on DMT wire myographs for the measurement of isometric force.

Results
Cumulative administration of icilin (10-8 to 10-4M), a TRPM8 agonist, induced endothelium-dependent and endothelium-independent relaxation in pre-contracted rings with phenylephrine (Phe,1μM). Relaxant effect induced by icilin was similar between pudendal arteries from db/db (Emax: 56.31 +/− 1.90%, n=5) and control (Emax:46.57 +/− 4.45%, n=5) mice. Diabetes increased the contractility of the pudendal artery in response to phenylephrine in concentration of 3x10-6M (99.40 +/− 4.65%, n=4) compared to control (85.44 +/− 2.36%, n=4). Interestingly, pre-incubation with icilin (10-4M) decreased the potency of the contraction induced by phenylephrine (10-9 to 3x10-5M) compared to untreated rings in both diabetic (pD2: 6.39 +/− 0.07 vs 6.67 +/− 0.05, n=4) and control (pD2: 6.43 +/− 0.09 vs 6.82 +/− 0.05, n=4) animals. In the pudendal artery, diabetes decreased the sensitivity to acetylcholine compared to control (pD2: 7.17 +/− 0.06 vs 7.42 +/− 0.03, n=4). However, the relaxation induced by acetylcholine (10-9 to 3x10-5M) was not changed by pre-incubation with icilin.

Conclusions
Icilin is able to promote relaxation with the same magnitude in pudendal arteries from diabetic and control mice. Increased responses to phenylephrine in pudendal artery may contribute to the development of ED. In addition, pre-incubation with icilin reduced sensitivity to phenylephrine, suggesting that the icilin could be a helpful treatment for ED.

Disclosure
No
(225) Rabbits Provide a Viable Model for Preclinical Penile Implant Studies
Authors: Chung P , Liu J , Machado P , Shah Y , Simhal R , Wang K , Wessner C , Isguven S , Delaney L , Hickok N , Forsberg F 
Published: May 2023

Abstract

Introduction
Inflatable penile implants (IPP) are the mainstay treatment for refractory erectile dysfunction (ED), but device infection is common and confers significant morbidity. Besides the addition of antibiotic and hydrophilic coatings, improvements targeting this complication are lacking. Preclinical in vivo studies to study methods of decreasing biofilm and mitigating infection sequelae are hindered by the lack of animal models containing functional IPPs. Previously, IPP fragments have been subcutaneously placed to study antimicrobial strategies, but the placement of complete, functioning IPP cylinders has not been demonstrated.

Objective
This biocompatibility study aimed to demonstrate the feasibility of placing and inflating IPPs in rabbits, with the goal of developing a viable model to study penile implant infections.

Methods
This study utilized 2 cadaveric and 2 live male New Zealand White rabbits. Experimental protocols were approved by IACUC (21-08-418). Cadaveric rabbits were utilized to evaluate surgical technique and ultrasound parameters prior to in vivo study. Following anesthesia and surgical site preparation, functioning IPPs were placed into the rabbits’ flanks. Upon dissection down to the plane between the panniculus carnosus and underlying muscle fascia, a subcutaneous pouch was developed to accommodate the implant. Following implantation, unrestricted ambulation was permitted, and the rabbits were observed daily for activity and recovery. Wounds were inspected daily for drainage, erythema, warmth, and swelling. Inflation-deflation cycling was performed following a 3-day post-implantation recovery period and evaluated via ultrasound. Surveillance was conducted for 14 days, after which the animals were euthanized.

Results
A single cylinder 14 cm implant without rear tip extender was successfully placed into each rabbit. IPP cycling mimicking the inflation protocol was successfully completed without tissue damage or harm to the animals. All IPP components were successfully visualized via ultrasound, which demonstrated the superficial position of the implant (Figure 1). Over a 14-day observation period, no concerns were identified, and signals of pain or distress, including gait disturbance, hypoactivity, restlessness, weight loss, dehydration, or reduced eating/drinking, were not observed, indicating the biocompatibility of functioning penile implants in the back of rabbits.

Conclusions
Preclinical in vivo models are the primary representative way to investigate IPP infection. This rabbit model may serve as an effective tool for the evaluation of novel infection prevention strategies following penile prosthesis implantation for ED.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: PHC: Boston Scientific and Coloplast.
(226) Mito-Q, a Mitochondrial-targeted Antioxidant, Partially Improves Relaxation of the Corpus Cavernosum in Aged Diabetic Mice
Authors: Priviero F , Garnto A , Garnto D , Dos Anjos Moraes R , Webb C 
Published: May 2023

Abstract

Introduction
Erectile dysfunction is associated with increased contraction and decreased relaxation of the corpus cavernosum (CC). Excessive reactive oxygen species produced by mitochondria play a key role in aging- and diabetes-induced erectile dysfunction. Erectile dysfunction is associated with increased contraction and decreased relaxation of the corpus cavernosum. Mitochondrial deterioration is part of normal physiological aging, and it plays a role in the pathogenesis of age-related disorders by producing reactive oxygen species (ROS). It is also known that excessive ROS produced by mitochondria plays a key role in aging- and diabetes-induced erectile dysfunction.

Objective
We aimed to test the hypothesis that in vitro inhibition of mitochondrial oxidative stress improves the reactivity of the CC.

Methods
To test this hypothesis, the CC of young (3 to 4-month-old) and old (10 to 14-month-old) male lean and diabetic (dbdb-/-) mice were mounted in myographs. Concentration-response curves to acetylcholine (ACh 1 nM – 30 uM) and relaxation induced by electrical field stimulation (EFS – 1, 2, 4, 8 and 16 Hz) were obtained. All curves were repeated after 30 minutes of incubation with the antioxidant Mito-Q (100 nM).

Results
Results: Relaxation to ACh was significantly reduced in the CC of diabetic mice (Lean: 87 ± 8% vs dbdb-/-: 60 ± 6%). Similarly, aged lean mice presented impaired relaxation to ACh (Lean old: 54 ± 6%) while old diabetic mice displayed a further decrease in the relaxing response to ACh (35 ± 6%). After 30 minutes of incubation with Mito-Q, the relaxation produced by ACh was improved in the CC of the aged lean mice (62 ± 3%) and aged diabetic mice (44 ± 1%). Relaxing responses to EFS were significantly decreased in obese and aged mice compared to the lean young animals. However, no improvement in the relaxing response to EFS was seen after incubation with Mito-Q.

Conclusions
Impairment in the endothelium-dependent relaxation of the CC induced by aging and diabetes is associated with increased production of mitochondrial reactive oxygen species. The use of the mitochondrial-targeted antioxidant Mito-Q improved at least in part the relaxation of the CC in both aged and diabetic mice.

Disclosure
No
(239) Readability Assessment of Online Educational Information on Premature Ejaculation
Authors: Lee J , Khurgin J 
Published: May 2023

Abstract

Introduction
Approximately one-third of US adults have trouble reading and acting on health-related information. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that patient education materials should not exceed a sixth-grade reading level. Given the difficulty in defining premature ejaculation (PE) and the lack of a US Food and Drug Administration (FDA) - approved drug therapy, many patients may seek information about PE through online resources. We sought to assess the readability and quality of online educational information on PE in light of these standards.

Objective
To assess the quality and readability of available online educational information on premature ejaculation using a Google search.

Methods
The search term “premature ejaculation” was queried on Google and the first 100 web pages were assessed. Duplicate websites, scientific publications, sub-pages of identical websites, or websites with paywalls were excluded from the analysis. Readability was assessed by three validated indices: the Flesch-Kincaid grade level (FKG), the Simple Measure of Gobbledygook (SMOG), and the Coleman-Liau Index (CLI). The quality of websites was assessed using the DISCERN instrument and the presence of Health on the Net (HON) code certification.

Results
After applying the exclusion criteria, a total of 43 websites were included in the data analysis. There were 15/43 (36.6%) web pages with HON code certification. On average, patient education materials about PE were written at a grade level of 12.2 (range 8.1-17.9). The mean DISCERN score for all web pages was 48.9 out of 80, which is considered “fair” quality. Web pages with HON code certification had a higher mean DISCERN score of 51.7 versus 47.3, which was not found to be significantly different (P=0.19).

Conclusions
Most of the online educational information on PE is of mediocre quality. In addition, the average web page on PE is written at a senior high school level, exceeding the recommended readability standards set by the AMA and NIH. It is imperative to place an emphasis on improving the quality and readability of online health information on PE to optimize patients’ abilities to make informed decisions.

Disclosure
No
(241) Shaeer’s Cavernotome: A New Cavernotome to Facilitate Penile Prosthesis Implantation into Scarred Corporal Bodies
Authors: Shaeer O 
Published: May 2023

Abstract

Introduction
Penile prosthesis implantation into scarred corporal bodies is one of the most challenging prosthetic urology procedures, with high risks of corporal perforation, urethral laceration & lack of success. Objective: We introduce a novel Cavernotome (patent application number PCT/EG2021/050003) which cuts the channel as it is passed forward. The instrument relies on controlled coring rather than forward stabbing, with resected tissue accumulated into the hollow core.

Objective
We introduce a novel Cavernotome (patent application number PCT/EG2021/050003) which cuts the channel as it is passed forward. The instrument relies on controlled coring rather than forward stabbing, with resected tissue accumulated into the hollow core.

Methods
After ethical committee approval, we utilized the cavernotome in 18 patients with severe corporal fibrosis. Scarring was due to penile prosthesis removal after infection in twelve patients, and neglected ischemic priapism in six. Surgical Procedure: Surgery is performed through a peno-scrotal incision with urethral catheter placed for identification. Corporotomies are 2-5 cm long depending on the implant to be used. A 2cm core of fibrous tissue is excised with scalpel or electrosurgical pencil. The appropriate size for Shaeer’s Cavernotome (ShC) is determined according to the maximum that fits in the fore mentioned excavated space, mostly size 11 Hegar. ShC is advanced proximally and distally in a screwing / coring motion, rather than the customary oscillating or forward thrusting motion. To prevent inadvertent direction, the stretched corpus is held between the thumb and index fingers of the non-dominant hand ahead of the tip. ShC doubles as a sizer with a ruler marked on the shaft. Following coring, the excavated corpora and crura are dilated with minimal resistance using Hegar or Brook’s dilators. Penile prosthesis implantation proceeds in the usual fashion. The surgical technique is available at VJPU: https://www.vjpu-issm.info/videos/peer-reviewed/1-penile-prosthesis-malleable-inflatable-penile-prosthesis-ipp/1-a-first-time-implant/item/198-shaeer-s-cavernotome

Results
Prosthesis implantation was successful in 17 out of 18 patients. In one patient, coring was not possible. the corpora were thinned out and calcified. Size 6 ShC could not be introduced. Corporal reconstruction was performed. Average coring time was 8 minutes. Dilation to 13mm Hegar in 12 patients, and 11mm in 5. The implant used was Rigicon Rigi10® (n=12), Rigicon Infla10® (n=2) and Coloplast Genesis® (n=3). No perforations or infections in the 17 successful implantations.

Conclusions
Shaeer’s Cavernotome is a new instrument that, in its initial study by the inventor, facilitates penile prosthesis implantation into scarred corporal bodies.

Disclosure
No
(243) Irrisept Washout at the Time of Revision Surgery Decreases Tissue Culture Positivity: Single Center Experience
Authors: Fuselier A , Griggs R , Henry G , Chung P , Karpman E 
Published: May 2023

Abstract

Introduction
The presence of biofilm, which resist eradication, at the implant site during inflatable penile (IPP) replacement surgery for infectious or non-infectious reasons appears to increase infection rates. Irrigation at the time of salvage rescue surgery has been shown to work in patients with clinically infected IPPs. Similarly, washout at the time of non-infectious revision surgery has been shown to lower subsequent infection rates. Positive cultures confirm bacterial presence on IPPs in both the clinically infected and uninfected settings. 0.05% chlorhexidine gluconate in sterile water (Irrisept, Irrimax Corporation, Lawrenceville, GA) has been shown to reduce biofilm in the orthopedic literature.

Objective
We investigated capsule tissue cultures before and after dilute chlorhexidine irrigation in a series of patients who underwent revision surgery.

Methods
A total of 31 patients with indwelling IPPs underwent revision surgery for both infectious and noninfectious reasons between May 2021 and March 2022. A section of capsule tissue surrounding the pump was sent for culture / gram staining. After implant removal, we performed a washout of all implant spaces with 0.05% chlorhexidine gluconate irrigation (2 bottles of 450mL each). A second tissue culture was obtained post washout. No other additional antibiotic solutions were utilized for irrigation. All patients received clindamycin, gentamicin, and fluconazole for intravenous prophylaxis.

Results
Of the 31 patients (4 with infection, 27 had noninfectious etiologies), 4 (13%) had evidence of positive bacterial presence prior to washout. All 31 (100%) of these patients had negative cultures after dilute chlorhexidine washout.

Conclusions
Early results of revision washout with 0.05% chlorhexidine gluconate solution appears to decrease the bacterial load and potentially sterilize the implant capsule at revision surgery of inflatable penile prostheses for both infectious and noninfectious reasons.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Signati, Endo, Pfizer, Irrimax, Procept.
(245) Outcomes of Penile Reconstruction for Salvage of Penile Gangrene
Authors: Lee W G , Assiri H , Reid T , Christopher N , Ralph D 
Published: May 2023

Abstract

Introduction
The most catastrophic complication of penile implant surgery results in either total/partial loss of the penis to such an extent that salvage penile reconstruction or phalloplasty is required. Penile gangrene (or necrosis) is rare and is associated with several patient factors (smoking, diabetes) and surgical factors (sliding technique, revision or a subcoronal incision). Irreversible ischemia with tissue loss will ensue if the prosthesis is not removed immediately. Nevertheless, subsequent corporal fibrosis and penile length loss may preclude an adequate functional penile length. In this situation, total penile reconstruction would be the only option to restore the ability for sexual intercourse and to void while standing.

Objective
The aim of this series is to assess the risk factors that predispose a select group of patients that require phalloplasty following penile gangrene and their surgical and functional outcomes following reconstruction.

Methods
All patients following phalloplasty for penile necrosis were identified from a comprehensive prospective database. Potential risk factors for penile necrosis were identified and the type and outcomes of reconstruction summarized. Functional outcomes were assessed by non-validated questionnaire.

Results
Thirteen patients with a median age of 57 years (range 27-68 years) required phalloplasty following penile necrosis with no incidence of flap loss. Reasons for erectile dysfunction were diabetes (37.5%), Peyronie’s disease (31%) and pelvic trauma (25%). The most common identifiable risk factors was diabetes (60%), followed by smoking (53%), adjunctive procedures like sliding technique or grafting (40%), revision surgery (27%) and infection with delayed explantation (27%). All patients had more than one risk factor for penile necrosis. Penile reconstruction was achieved with the radial artery forearm free flap (62%) and the anterolateral thigh flap (38%). All flaps were designed with an integrated urethra requiring anastomotic urethroplasty. Urethral complications occurred in 46.2% of men (fistulae and strictures) requiring surgical repair (Clavien 3b) while 2 had partial skin graft loss from the donor arm that improved with dressings and antibiotics (Clavien 2). Following phalloplasty, all responders had sensation (46% could orgasm with the neophallus) and 86% were able to void while standing. Most men were satisfied with the esthetic outcome (92%). The questionnaire response rate was 67%.

Conclusions
Penile necrosis following penile prosthesis insertion is rare and occurs in the presence of risk factors, particularly diabetes and smoking. Penile prosthesis surgery should be considered carefully in this cohort of patients especially for revision surgery or where adjunctive procedures are planned. Infection requires immediate explant of the device. Phalloplasty has good surgical and functional outcomes should reconstruction be required although there is a significant risk of surgical complications.

Disclosure
No