bluuebunny/crossref_metadata_2025_split huggingface dataset:
(230) Chronic Unpredictable Stress Impairs Corpus Cavernosum Reactivity in Mice
Authors: Garnto D , Garnto A , Wilczynski S , Crockett A , Arishe O , Dos Anjos Moraes R , Hollis F , Webb C , Priviero F 
Published: May 2023

Abstract

Introduction
Stress is associated with erectile dysfunction (ED), however, it is not clear whether psychological stressors affect the vasculature and the erectile tissue in a manner that could contribute to a vasculogenic erectile dysfunction. A positive correlation between hyperprolactinemia, stress and erectile dysfunction has been demonstrated, and interestingly, prolactin was shown to decrease endothelium nitric oxide and endothelium- dependent vasorelaxation in different vascular beds. In this study, we aimed to evaluate the relaxation of the corpus cavernosum of male and pudendal artery of male and female mice undergoing chronic unpredictable stress (CUS).

Objective
We aimed to test the hypothesis that vascular impairment caused by CUS leads to impaired relaxation of the pudendal artery and corpus cavernosum which may cause erectile dysfunction.

Methods
Male and female C57Bl/6 mice were submitted to 28 days of chronic unpredictable stress (CUS). The pudendal artery and corpus cavernosum were removed and mounted in a myograph to evaluate reactivity. Tissues were kept in physiological salt solution at 37°C, constantly aerated with 95%O2/5%CO2 and concentration-response curves to acetylcholine (ACh; 1 nM – 30 uM) and phenylephrine (PE; 1 nM – 30 uM) were obtained. Using non-linear regression, we obtained the maximal response (Emax) and potency (pEC50) of ACh and PE. Data are expressed as mean ± S.E.M. P&lt;0.05 was considered statistically different.

Results
In the pudendal artery, neither the potency nor the maximal response to ACh was changed by the stress. Contraction to PE was higher in males, compared to females, and there was a trend to be further increased in stressed males. On the other hand, in the corpus cavernosum of stressed males there was a significant decrease in the maximal relaxation induced by acetylcholine (control: 88 ± 4% vs stress: 75 ± 4%, n=7 each group) as well as impaired contraction to PE (control: 1.72 ± 0.17% vs stress: 1.07 ± 0.15%, n= 7 each group). The impaired relaxation might be associated with impaired nitric oxide availability, whereas impaired contraction can be associated with a desensitization of alpha-adrenergic receptors in response to stress.

Conclusions
Our findings demonstrate that stress impairs the reactivity of the corpus cavernosum, which may contribute to the development of erectile dysfunction in stressed males.

Disclosure
No
(253) Comparative Effectiveness in Testosterone Levels and Sperm Parameters of Medical Treatments for Primary Infertility and Testicular Deficiency
Authors: Suarez M C , Narasimman M , Shah K , Ledesma B , Ramasamy R 
Published: May 2023

Abstract

Introduction
The goal of treatment for infertile men with testosterone deficiency is to improve intratesticular androgen levels with the aim of increasing the last step of maturation in spermatogenesis. Medical therapy for male factor infertility remains largely empiric and relies on off-label use of medications known to increase intratesticular testosterone levels, such as selective estrogen receptor modulators (clomiphene citrate and enclomiphene citrate) and gonadotropins (human chorionic gonadotropin). There is scarce data of whether the above-mentioned treatment options offer different success rates in improving testosterone levels and sperm parameters.

Objective
To compare the improvement in total testosterone, intratesticular testosterone, and sperm parameters between patients receiving medical treatment with clomiphene citrate (CC), enclomiphene citrate (ECC), or clomiphene citrate + human chorionic gonadotropin (HCG).

Methods
We conducted a retrospective study from 2018 to 2022 of men with primary infertility, testicular deficiency, and secondary hypogonadism receiving ECC, CC or CC+HCG for at least 3 months. Among the different treatment groups, we assessed baseline and follow-up total testosterone, 17-hydroxyprogesterone (17-OH), semen parameter(s), and demographics. Semen quality improvement was based on assisted reproduction eligibility according to the total motile sperm count (TMSC) value: in-vitro fertilization ( 9 million). Intratesticular testosterone upgrading was based on 17-OH level, with expected values being ≥55 ng/dL. Variables were compared using paired t-test and ANOVA.

Results
A total of 18 men received ECC, 19 received CC and 9 received CC+HCG. Mean age was 41.1±2.28 years in the ECC group, 40.62±1.17 in the CC group, and 45±2.75 in the CC+HCG group (p=0.458). Overall, the mean follow-up was 3.64 ±2.14 months (p=0.242). The 3 treatment groups exhibited a statistically significant increase in total testosterone (table 1), but only the CC and CC+HCG groups had a statistically significant improvement in the level of 17-OH (p 9 million.

Conclusions
Our study showed that ECC, CC and CC+HCG are effective treatment regimens for improving total testosterone without negatively affecting spermatogenesis. Nonetheless, their effects on intratesticular testosterone and sperm parameters varied, suggesting that choosing the best treatment option for improving sperm parameters should be an individualized patient decision.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus, Boston Scientific, Endo Pharmaceuticals and Coloplast.
(261) Response to Intralesional Collagenase Clostridium Histolyticum Therapy in Men with Peyronie’s Disease is Independent of Baseline Testosterone Levels
Authors: Schneider D , O'leary M , Amini E , Miller J , Hassas N , Nguyen J , Barham D , Yafi F 
Published: May 2023

Abstract

Introduction
Testosterone plays an important role in collagen metabolism, TGF-β1 expression, and wound healing, all critical factors in the pathogenesis of Peyronie’s disease (PD). While evidence is mixed, some clinical studies have suggested an association between PD and hypogonadism.

Objective
We seek to investigate whether baseline total serum testosterone (tT) influences response to intralesional collagenase clostridium histolyticum (CCh) for PD.

Methods
A retrospective review of patients undergoing CCh injections was conducted at a single institution. Only patients with available tT levels within one year of initial CCh injection were included. Curvature was assessed after in-office intracavernosal injection of vasodilatory agents or patient-provided photograph. Data was collected on baseline demographic characteristics, hypogonadal status, tT, number of CCh cycles, and pre- and post-treatment degree of curvature. Hypogonadism was defined as a tT &lt;300ng/dL, or a documented diagnosis.

Results
A total of 36 men were included. The mean age was 58.2 years old (SD 10.4) and the mean BMI was 26.8 (SD 3.2). The mean pre-treatment tT was 459.2 ng/dL (SD 144.0), and 14 (39.9%) were hypogonadal. Of hypogonadal men, 5 (35.7%) were receiving hormonal replacement therapy, 4 on testosterone and 1 on clomiphene. Thirty (83.3%) men experienced some degree of erectile dysfunction. The mean pre-treatment curvature was 47.6° (SD 14.2) and the mean post-treatment curvature was 27.8°(SD 10.7), for a mean improvement of 19.9° (40.1%) after an average of 4 cycles (2-8) (Table 1). Baseline tT was not associated with baseline rigidity (β=-0.01; R2=0.02; p=0.41). However, hypogonadal status was significantly associated with more severe curvature, 54.6° among hypogonadal men compared to 43.2° among eugonadal men (p=0.03); however, baseline curvature and tT were not significantly associated (β=-0.03; R2=0.09; p=0.08). On linear regression analysis, tT did not significantly predict improvement in degrees (β=-0.02; R2=0.06; p=0.14; Figure 1) or percent (β=0.0; R2=0.05; p=0.18; Figure 2). Similarly, improvement in neither degrees nor percent differed significantly by hypogonadal status (p=0.14 and p=0.69, respectively). Number of cycles did significantly predict greater improvement in curvature on both univariate and multivariate analyses (β=5.7; R2=0.34; p&lt;0.01).

Conclusions
While hypogonadism is associated with more severe curvature, neither total testosterone nor hypogonadism is associated with degree of improvement after CCh treatment. Men should be offered CCh therapy according to guidelines independent of gonadal status.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Clarus Therapeutics Antares Pharma Acerus.
(273) A Tight Tuck – More Than Meets the Eyes
Authors: Wallace C , Park D , Sapkalova V , King S 
Published: May 2023

Abstract

Introduction
Tucking is a common practice within the transwomen community. One study estimates that 70% of transwomen engage in this non-surgical gender affirming technique. It entails placement of the testes superiorly towards the inguinal canal and the penis inferiorly towards the rectum to conceal a male phenotype and create a female silhouette. By prolonged distortion of the normal anatomical lie of the penis and testes, several genitourinary complications should be expected to result including low sperm quality, genital pain, genitourinary tract infections, lower urinary tract symptoms, and testicular torsion. However, no formal review or survey has been conducted to better inform physicians on how to appropriately incorporate the practice of tucking into formation of a differential diagnoses.

Objective
To assess common genitourinary complications and complaints associated with the practice of tucking.

Methods
We performed a content analysis of posts on Reddit related to tucking and health complaints related to the practice. Reddit is an online forum with various sub-communities known as “subreddits” where anonymous users post and have discussions about a shared interest. In fact, there exist specific forums for the transgender community including r/asktrangender and r/MtF with 142,000 and 161,000 members respectively. A short survey was then created based on common themes of our analysis and posted to the 3 subreddits related to the transgender community with the most members.

Results
Content analysis first demonstrated distrust and displeasure in physicians’ understanding of genitourinary implications of tucking. Whether this reaction is well founded or not, it is true that there is little understanding within the medical community in this area with many physicians likely ignorant to the degree of anatomical distortion tucking entails. Analysis of common complaints revealed themes similar to those expected from review of what literature has been performed. We expect survey results to support our analysis.

Conclusions
Formal study is indicated of the genitourinary complications of tucking for physicians to adequately serve our transfemale patients.

Disclosure
No
(284) A Systematic Review of Loco-sedative Anesthesia for Penile and Scrotal Surgery
Authors: Panchendrabose K , Bal D , Chung D , Sidhom K , Pierce A , Lokeshwar S , Patel P 
Published: May 2023

Abstract

Introduction
The current standard of care for patients undergoing the majority of scrotal and penile procedures is to administer general or spinal anesthesia. The use of general or spinal anesthesia can lead to several complications, long wait times and is not feasible in many rural and remote areas.

Objective
The objective of this study is to perform a systematic review of the characteristics and outcomes of conscious sedation and local anesthesia for penile and scrotal urologic procedures.

Methods
A systematic search was conducted on PubMed, and Scopus databases following PRISMA criteria from inception to August 2021. Articles were included if they were prospective, randomized or non-randomized controlled trials that used local anesthetic or conscious sedation for penile or scrotal interventions. Additionally, included studies provided primary data on the use loco-sedative anesthesia and the efficacy and complications from the procedures.

Results
Nine articles with 4511 patients were included in the study. Procedures examined included vasectomies, adult circumcisions, varicocelectomies, urethrocutaneous fistula repair, microepididymal sperm aspiration and testicular sperm extraction. Of the studies that reported age, the mean patient age was 29.3 years old. The most common anesthetic and analgesic relief was the use of local anesthetic with 1% lidocaine. Only one study used conscious sedation whereas the rest used local anesthetics. However, there was significant heterogeneity in the type of local or conscious sedation method and whether there was a combination was used. 44.4% of the studies used the visual analog scale (VAS) for their primary endpoint. All the studies reported 100% successful procedures with no sedative complications.

Conclusions
Given the high efficacy rates, loco-sedative anesthesia is a promising technique for penile and scrotal urologic interventions. However, the current body of literature has limited data on a wider array of procedures. Further controlled studies examining the use of loco-sedative anesthesia for a larger variety of penile and scrotal interventions are recommended. This review also demonstrates the significant heterogeneity on how sedation may be assessed and the variety of local anesthetics that can be used to substitute for general or spinal anesthesia.

Disclosure
No
(293) Limitations in Reporting and Assessment Tools for Retrograde Ejaculation after Surgical BPH treatment: A Scoping Review
Authors: Khooblall P , Leelani N , Bole R , Lundy S , Bajic P 
Published: May 2023

Abstract

Introduction
Antegrade ejaculation is a fundamental aspect of sexual satisfaction for many individuals, but retrograde ejaculation (RE) occurs in up to 75 % of some surgical treatments of benign prostatic hyperplasia. Unfortunately, clinicians commonly focus only primarily on erection strength, and existing tools inadequately characterize rates and bother associated with RE after BPH treatment.

Objective
This review provides critical appraisal of existing tools used to assess RE and emphasizes the importance of preoperative counseling of this complication prior to surgical BPH treatment.

Methods
A literature review was conducted in June of 2022 using Embase, Medline, and Web of Science to identify relevant manuscripts on “men sexual health”, “men’s sexual health questionnaire (MSHQ), and “retrograde”, “dry”, or “backward” “ejaculate” or “orgasm” from 1946 to June 2022. Eligibility criteria were established by using Population, Intervention, Control, and Outcome (PICO) tool for men with BPH symptoms treated with surgical intervention and developed postoperative RE. Criteria for exclusion were manuscripts in non-English language and studies reporting rates of RE without specifying the criteria used to diagnose the condition.

Results
A literature review was conducted in June of 2022 using Embase, Medline, and Web of Science to identify relevant manuscripts on “men sexual health”, “men’s sexual health questionnaire (MSHQ), and “retrograde”, “dry”, or “backward” “ejaculate” or “orgasm” from 1946 to June 2022. Eligibility criteria were established by using Population, Intervention, Control, and Outcome (PICO) tool for men with BPH symptoms treated with surgical intervention and developed postoperative RE. Criteria for exclusion were manuscripts in non-English language and studies reporting rates of RE without specifying the criteria used to diagnose the condition.

Conclusions
Significant limitations exist in the tools presently available for the reporting of RE related to BPH treatment. With ejaculation playing a very important role in sexual satisfaction for many men, more robust and specific instruments are needed to help with the diagnosis. Through development of such tools, patients will be better counseled and satisfaction with treatments will be improved. Optimized questioning needs to take into consideration both baseline and post-treatment ejaculatory function – including granular specifics on force, volume, sensation, and level of bother rather than general questions on ejaculatory functioning measured on a very broad scale.

Disclosure
No
(300) Impact of Intranasal Testosterone versus Intramuscular Testosterone cypionate on Hematocrit of Hypogonadal Men: Data from an ongoing Phase IV, Open-label, Randomized Clinical Trial.
Authors: Diaz P , Ory J , Loloi J , Bernstein A P , Blachman-Braun R , Rivero M , Muthigi A , Ramasamy R 
Published: May 2023

Abstract

Introduction
The potential increase in hematocrit and subsequent risk of polycythemia has been regarded as one of the most worrisome adverse effects of testosterone therapy (TT). Recent evidence has shown that the modality of delivery and half-life of each formulation may affect the incidence of these side effects. Therefore, we hypothesized that longer-acting intramuscular testosterone would increase hematocrit to a higher degree than the shorter-acting nasal formulations that can more closely mimic normal physiology.

Objective
To compare the effects of Intranasal Testosterone (NT) and Intramuscular Testosterone (TC) on hematocrit and serum testosterone levels in testosterone deficient men over 4 months.

Methods
This Phase IV, randomized, open-label clinical trial was performed on 39 symptomatic, testosterone deficient (TD) men with at least two serum testosterone levels below 300 ng/dL drawn before 10AM. Men were randomized (1:1) to receive either nasal gel three times per day (5.5mg per nostril) and intramuscular TC (200mg) once every two weeks. The primary outcomes were changes in Hematocrit and serum T before and after four months. Secondary outcomes were changes in estradiol (E), PSA and 17-OHP. Data analysis was performed using two-sample and single-sample T tests (Microsoft Excel v.16.60).

Results
A total of 39 men with testosterone deficiency were randomized to receive either NT (n=15) or TC (n=24). The median participant age was 46 years old with a mean serum T of 237.1 ng/dL and hematocrit of 43.3%. Prevalence of participants who screened positive for OSA on STOP-BANG questionnaire for NT and TC group were 67% and 71%, respectively. Compared to their respective baselines, men in both groups saw significantly increased serum testosterone levels (p 52%) after 4 months was 0% in NT group and 4.2% in TC. Those taking TC saw increases in E (p=0.003) and decreases in 17-OHP (p&lt;0.001) at follow-up, where NT saw no changes. Neither regimen significantly impacted PSA at follow-up.

Conclusions
Both Intranasal and Intramuscular testosterone regimens are effective in treating hypogonadal men. However, short-acting nasal T does not appear to impact hematocrit levels especially when compared to testosterone cypionate. Those who are at increased risk of developing polycythemia or want to avoid changes in their E or 17-OHP levels may benefit from short-acting T formulations.

Disclosure
Yes, this is sponsored by industry/sponsor: Acerus Pharmaceuticals

Clarification
Industry funding only - investigator initiated and executed study
Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceuticals
(302) Changes In Hematocrit Predict More Frequent Major Adverse Cardiac Events In Men Receiving Testosterone Therapy - A Large Claims Database Analysis
Authors: Kohn T P , Ory J , Ramasamy R 
Published: May 2023

Abstract

Introduction
Elevated hematocrit (Hct &gt; 52%) in men receiving testosterone therapy (TTh) has been associated with major adverse cardiac events (MACE), but it remains unclear if the degree of change from baseline Hct after starting TTh confers additional MACE risk.

Objective
The objective of this study is to assess if greater changes in Hct after initiation of TTh for men is associated with greater risk of MACE.

Methods
We compared the occurrence of MACE within 3 and 24 months of initiating TTh in men who did and did not experience an increase in Hct after TTh initiation. We queried the TriNetX Research network database, a health research network of 88 million patients, encompassing healthcare encounters and prescriptions between 2009-2021. Men without unstable angina or heart failure over age 18 were included if their Hct was tested within 1 year prior to initiating TTh and had follow up Hct within 3 and 24 months after beginning TTh. Men with and without increase in Hct after TTh were propensity matched on age, race/ethnicity, hypertension, diabetes, hyperlipidemia, prior myocardial infarction or stroke, and number of hospital/outpatient visits. MACE were defined as myocardial infarction (ICD-10: I21-22), stroke (I60-63), or death.

Results
A total of 11,561 men with an increase in Hct and an equal number of controls were included (average age 49.4 years). When compared to men who received TTh who did not have an increase in Hct, the majority of men with an increase in subsequent Hct a statistically significant increase risk of MACE (Table 1). For example, men with baseline Hct of 44-47% and saw a subsequent increase of Hct to 48-51% were twice as likely to experience MACE (Risk Ratio: 2.07, 95% Confidence Interval 1.13-2.43) when compared to men whose baseline and subsequent Hct was 44-47% after TTh. As the change in Hct from baseline becomes larger, the magnitude of the risk ratio increased.

Conclusions
While absolute Hct is associated with increased risk of MACE after initiating TTh, we demonstrate that increases in Hct from baseline are associated with dose-dependent increased risk of MACE, compared to men with minimal changes to Hct who receive TTh.

Disclosure
No