bluuebunny/crossref_metadata_2025_split huggingface dataset:
(122) Erectile Hemodynamics Asessment In ED Patients With Self-Diagnosed Post-finasteride syndrome (PFS)
Authors: Deveci S , Sullivan J F , Tal R , Mulhall J P 
Published: May 2023

Abstract

Introduction
Much debate exists regarding the concept of PFS and its etiology. There exists data suggesting abnormal erectile hemodynamic alterations in this population.

Objective
This analysis was performed to define erectile hemodynamics in this population.

Methods
Patients attending the sexual medicine clinic at our institution presenting with (i) new onset ED after commencement of 5-ARI (ii) 5-ARI use specifically for hair loss (iii) with no prior ED history (iv) presenting ≥6 months after cessation of 5-ARI (v) and with at least 3 months use of 5-ARI (finasteride). All completed the IIEF EF domain questionnaire. B-mode assessment was conducted at 15MHz. Duplex ultrasound (PDDU) was conducted using a vasoactive agent-redosing schedule using trimix. On PDDU, a best quality erection (BQE) (equivalent to the best erection obtainable at home without erectogenic medication) was required for inclusion. Redosing was conducted if the patient failed to obtain a BQE up to a maximum of three doses. The criteria for normalcy on DUS included a peak systolic velocity (PSV) &gt;30cms/s and an end-diastolic velocity (EDV) &lt;5 cms/s.

Results
141 men were included in the analysis. Mean patient age was 31±12 (18-42) years. All had used finasteride 1mg. Median vascular risk factor (VRF) number = 1 (0,1). Median duration of 5-ARI exposure = 16 (4, 46) months. Median duration off 5-ARI at first presentation to clinic = 11 (6, 28) months. No patients had ED prior to 5-ARI use. One third developed ED only after cessation of finasteride, at a mean duration off finasteride of 6±3 months. Median IIEF EFD score at presentation = 14 (6,18). Median (range) number of injections needed for BQE sufficiently suitable for DUS measurement was 2 (1, 3). Overall, mean PSV and EDV values were 60±18cm/s and 1.5±1.5 cm/s respectively. 29% required phenylephrine reversal before discharge from clinic.

Conclusions
These data suggest that hemodynamic alterations are not present in men complaining of ED with self-diagnosed PFS.

Disclosure
No
(124) Investigating the Risk Factors of Penile Arterial Insufficiency and Veno-occlusive Dysfunction In Patients with Erectile Dysfunction
Authors: Habous M , Williamson B , Binsaleh S , Muir G , Khattak A 
Published: May 2023

Abstract

Introduction
It was reported that a more generalized peripheral atherosclerotic process is associated with a severer penile arterial insufficiency (PAI), and this in turn was correlated well with decreased blood supply in more important arteries like the coronary and carotid arteries.

Objective
We investigated the risk factors for PAI which is a known cause of erectile dysfunction (ED

Methods
Patients who attended our urology clinic complaining of ED for more than 6 months, were prospectively enrolled in this study in one year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie’s disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile, and glycated haemoglobin (HbA1c). Penile duplex ultrasound study (PDU) was done for all patients after intra-cavernosal injection (ICI) with Alprostadil. peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured after 15 minutes. Statistical analysis was done using SPSS.

Results
A total of 440 patients were enrolled in this analysis. The mean age was 48 (23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r=-0.361, P=0.000) and higher EDV (r=0.174, P=0.001) and both correlations were highly statistically significant. Diabetics had lower PSV (r=-0.318, P=0.000) and higher EDV (r=0.139, P=0.008) which were also highly statistically significant. Hypertensive patients had lower PSV (r=-0.296, P=0.000) which was highly statistically significant. Smokers had lower PSV (r=-0.140, P=0.008) and higher EDV (r=0.178, P=0.001) which were highly statistically significant. Men with larger penises measured skin to tip, had lower EDV (r=-0.119, P=0.024) which was less significant. Interestingly there was neither significant correlation between BMI and PSV (0.16, p=0.745) nor significant correlation between testosterone and PSV (0.029, p=0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD.

Conclusions
Our study highlights key risk factors - Increased age, tobacco consumption, DM and hypertension - are factors that have a statistically significant negative impact on penile haemodynamics. Of these, tobacco consumption, good diabetic control and hypertension are potentially modifiable and should form part of any treatment plan for erectile dysfunction. Other risk factors – increased BMI, low testosterone, PD and penile size – had no statistically significant impact on penile hemodynamics. This allows for targeted advice that can be given to patients who present with this very common problem. Ultimately, good vascular health goes hand in hand with good erectile function.

Disclosure
No
(133) Ambigous Genitalia in a 22 year old woman: A Case Report of Successful Perineoplasty and Clitoroplasty
Authors: Idowu O C , Awolude O , Ifebude J E 
Published: May 2023

Abstract

Introduction
External genitalia are considered to be ambiguous whenever there is difficulty assigning gender to a child based on the appearance of the external genitalia. It is a common presentation of Disorders of Sexual Development (DSD).

Objective
Reported here is the case of a 22year old single undergraduate identified as female who had disorder of sexual development with ambiguous genitalia resulting from congenital adrenal hyperplasia.

Methods
Although the appearance of her genitalia in childhood could not be ascertained, she presented with inability to achieve penetrative vagina intercourse, enlarged clitoris with dissatisfaction and distress about the appearance of her genitals, poor urinary stream and terminal dribbling. On examination she had clitoromegaly with fused labia minora at the midline which formed anterior to the urethral meatus as shown in Fig 1.1. She had acne and hirsutism. Investigations done show hyperandrogenism and were suggestive of congenital adrenal hyperplasia with no salt wasting.

Results
She had successful perineoplasty and clitoroplasty with satisfactory appearance of her genitalia, she has been able to achieve penetrative vagina intercourse with satisfactory sexual function and urinary streams have improved with terminal dribbling resolved.

Conclusions
Disorders of sexual developments though rare may have significant psychosocial effects on its victims and understanding the pathology with surgical intervention as indicated in this case may be helpful to improve the quality of life of the affected persons.

Disclosure
No
(146) Rezum Water Vapor Therapy for Patients with Mild, Moderate, or Severe Lower Urinary Tract Symptoms: A Retrospective Study in a Multiethnic Population
Authors: Babar M , Loloi J , Tang K , Singh S , Ines M , Patel R D , Iqbal N , Ciatto M 
Published: May 2023

Abstract

Introduction
Benign prostatic hyperplasia (BPH) is a common chronic condition that is associated with the development of lower urinary tract symptoms (LUTS). Symptom severity of LUTS secondary to BPH can range from mild, moderate, to severe and can be assessed utilizing the International Prostate Symptom Score (IPSS). The Rezum System (Rezum; Boston Scientific, Marlborough, MA, USA) is a minimally invasive surgical therapy that utilizes convective radiofrequency water vapor thermal energy to ablate obstructive lobes of the prostate, resulting in cell necrosis and improvement in LUTS.

Objective
To evaluate the safety and efficacy of Rezum in patients with mild, moderate, or severe LUTS secondary to BPH.

Methods
A single office, retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017 and 2019. Patients were categorized into three cohorts based on baseline IPSS LUTS severity: mild LUTS (IPSS ≤ 7), moderate LUTS (IPSS 8-19), or severe LUTS (IPSS ≥ 20) cohorts. Outcome measures, including IPSS, quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), alpha blockers and 5-alpha reductase inhibitors usage, and adverse events (AEs) were collected and analyzed at baseline, 1-, 3-, 6-, and/or 12-months postoperatively.

Results
A total of 238 patients were included: 33 with mild LUTS, 109 with moderate LUTS, and 96 with severe LUTS. At 1-month follow-up, the moderate and severe LUTS cohorts saw significant improvements in IPSS (moderate LUTS: -3.0 [-6.0, 1.5], p&lt;0.001; severe LUTS: -10.0 [-16.0, -5.0], p&lt;0.001) and QoL (moderate LUTS: -1.0 [-3.0, 0.0], p&lt;0.001; severe LUTS: -1.0 [-3.0, 0.0], p&lt;0.001) and improvements remained durable up to 12-months (p&lt;0.001). The mild LUTS cohort saw significant worsening in IPSS by 2.0 (0.0, 12.0) at 1-month (p=0.002) but returned to baseline at 3-months (p=0.114). However, the mild LUTS cohort experienced significant improvements in QoL by -0.5 (-3.0, 0.0) at 3-months (p=0.035) and nocturia by 0.0 (-1.0, 0.0) at 6-months (p=0.002), both of which remained durable to 12-months (p&lt;0.05). Most AEs were transient and non-serious, with gross hematuria (66.5%) being most common. There were no significant differences in QoL point reduction, Qmax improvement, PVR reduction, and AE occurrence between the cohorts at 12-months (p&gt;0.05). At 12-months, 80.0%, 87.5%, and 66.0% of the patients in the mild, moderate, and severe LUTS cohorts discontinued their BPH medications, respectively.

Conclusions
Rezum provides rapid and durable relief in LUTS in patients with moderate or severe LUTS and can be offered to patients with mild LUTS who have bothersome nocturia and wish to discontinue their BPH medications.

Disclosure
No
(150) Efficacy of a Novel Collagenase Clostridium Histolyticum Protocol for Peyronie’s Disease Among Prior Non-responders: A Randomized, Controlled, Single-Blinded Study
Authors: Palmer B , Anderson N , Green B , Savage J , Brearton K , Ziegelmann M , Helo S , Kohler T , Trost L 
Published: May 2023

Abstract

Introduction
Limited data currently exist on the role and efficacy of additional series of collagenase clostridium histolyticum (CCH) injections among Peyronie’s disease (PD) men who have previously failed a first series of injections. We have previously reported outcomes of men undergoing a more aggressive protocol for CCH injections. We therefore sought to evaluate results of men who had previously failed CCH injections to determine if they would respond to a repeat course using a more aggressive protocol.

Objective
To evaluate outcomes of a novel, aggressive protocol for CCH injections among men who had previously failed 6-8 CCH injections using a traditional approach.

Methods
A randomized, controlled trial (NCT05108558) is ongoing. All participants had previously failed to achieve ≥20% curvature improvement with 6-8 prior CCH injections. Men are randomized 3:1 to receive either CCH + traction (RestoreX) + sildenafil (treatment) up front or initial observation followed by treatment (controls). Outcomes are subsequently compared between treatment and control groups. Key measures include objective curve improvements, and standardized / non-standardized questionnaires, with assessments obtained at baseline, 6-weeks after completion of CCH (treatment arm), after the no treatment period (controls), and at 1 year.

Results
A total of 11/40 men have been randomized to date, with one having completed four series of CCH injections, three completing one series, and three completing two series. The average age of the cohort is 64.4 years, with a mean PD duration of 28.1 months. Mean baseline curvature was 82.9 degrees (composite curve). The average estimated improvement with prior CCH injections (before enrollment in the current study) was 10%. Preliminary outcomes of men who had completed one series and had a follow-up curve assessment available (n=3) demonstrated an absolute improvement of 28.3 degrees (42%). Of the one patient who completed four full series, the absolute curve improvement was 55 degrees (65%). The overall range of improvement among the four men was 20 to 55 degrees or 31 to 65%, with no patients failing to experience improvements thus far.

Conclusions
Preliminary data suggests that a repeat course of CCH using a previously described more aggressive administration protocol is effective at improving penile curvature in the majority of men. It is unclear if the improvements are due to the difference in administration protocol, or due to the repeat course of CCH alone. Given the very preliminary nature of the current results, additional data, including external validation, are warranted.

Disclosure
Yes, this is sponsored by industry/sponsor: Endo Pharmaceutical

Clarification
Industry funding only - investigator initiated and executed study
(160) An Analysis of the Mis-Diagnosis of Peyronie’s Disease (PD) In Men Referred for the Assessment of Penile Deformity
Authors: Deveci S , Taniguchi H , Torremade J , Ortega Y , Mulhall J P 
Published: May 2023

Abstract

Introduction
PD is diagnosed in the presence of penile deformity combined with a tunical plaque. Clinical experience shows us that some men who believe they have PD actually have congenital penile curvature (CPC), whilst others, especially those with a history of penile trauma, have anxiety about having PD but, in fact, do not.

Objective
This analysis aimed to define the mis-diagnosis rate of men referred for PD evaluation.

Methods
Study population consisted of men who (i) presented to a sexual medicine clinic for the evaluation of penile deformity (ii) and/or the presence of a tunical nodule (iii) underwent comprehensive penile examination by a sexual medicine physician with extensive experience in PD and (iv) underwent penile deformity assessment at the time of penile duplex Doppler ultrasound (PDDU). Demographic and comorbidity data were recorded. Multivariable analysis (MVA) was conducted to define predictors of the absence of PD.

Results
1942 patients met the inclusion criteria. 79% were MD referred (MDR), the remainder were self-referred (SR). Mean age of the entire cohort was 58±28 years (MDR 64±22y, SR 41±11y, p&lt;0.01). Comorbidities: hypertension 24%, diabetes 11%, dyslipidemia 27%, chronic pelvic pain syndrome (CPPS) 6%, history of radical pelvic surgery (RPS) 24%, history of penile trauma 8%. Overall 14% of patients had no PD plaque identified on examination (MDR 12%, SR 21%). For MDR without PD, majority had CPC (9%), 3% had no deformity, while for SR only 6% had CPC, the remaining 15% had no deformity at PDDU. Results of MVA is presented in the Table.

Conclusions
Men referred to a tertiary referral center for the evaluation of PD commonly have no PD. Predictors of no PD include: diagnosis of CPPS, history of penile trauma, young age and absence of RPS.

Disclosure
No
(162) Safety and Feasibility of Platelet-Rich Plasma Injections for Peyronie’s Disease: A Randomized Double-blind Placebo-controlled Cross-over Study
Authors: Zucker I , Molina M , Muthigi A , Ledesma B , Saltzman R , Chu K , Ibrahim E , Masterson T , Ramasamy R 
Published: May 2023

Abstract

Introduction
Peyronie’s Disease (PD) is prevalent in approximately 7.1% of the general population. Current treatment approaches include medical therapy and surgical intervention, and intervention only occurs once the disease process has entered the chronic, stable phase. The only FDA-approved medical therapy involves use of intralesional collagenase clostridium histolyticum injection and surgical interventions include tunica albuginea plication, plaque excision without grafting, or placement of penile prothesis. Autologous platelet rich plasma (PRP) may prove to be a viable treatment for this patient population due to its ability to facilitate tissue repair and wound healing via various growth factors.

Objective
We hypothesized that PRP can be safely utilized in patients with PD, with minimal adverse events.

Methods
We reviewed data for an initial series of men recruited into an ongoing randomized double-blind placebo-controlled cross-over study at the University of Miami from April 2021 to June 2022. Patients received a total of two injections of PRP or placebo directly into the dominant plaque, separated by two weeks. Patients were observed immediately post-injection and assessed with Visual Analogue Pain Scale, and at follow-up for complications and tolerability. Patients are followed three- and six-months post-injection, of which then the patient crosses over into the other treatment / placebo arm. The patient undergoes goniometer measurement with an artificial erection, IIEF-15 and PDQ questionnaire assessment prior to crossover and at the end of the study. ClinicalTrials.gov Identifier: NCT04512287.

Results
We report data from 24 men who completed two injections for Arm 1 (PRP or placebo) and 15 men who completed two injections (PRP or placebo) after cross-over. No post-procedural minor adverse events were seen in any of the men. None of the participants reported adverse effects such as penile bruising, swelling, edema, allergy, penile fracture, or mild pain at injection site. Six men completed 6-month follow-up and no complications were reported. No worsening curvature was observed in men completing pre/post evaluations.

Conclusions
PRP appears to be a safe and feasible treatment modality in patients with PD from our limited data accumulated thus far in our ongoing randomized placebo-controlled trial with PRP for PD. We expect to report efficacy data as soon as it becomes available. Our study is the first study in the USA accruing men with PRP for PD in a clinical trial and believe that safety and efficacy data accumulated from our study will be important for patient counseling.

Disclosure
No
(176) Unconscious Attention to Sexual Stimuli: An Electroencephalography Study Regarding the Role of Neuroticism and Sexual Excitation/Inhibition
Authors: Aguiar S , Carvalho J , Carrito M , Santos I 
Published: May 2023

Abstract

Introduction
Past research has shown that neuroticism is a higher-order vulnerability factor in developing and maintaining emotional disorders and is related to an increased risk of sexual dysfunction. In a recent study, neuroticism was found to impact the automatic attention towards sexual stimuli, but the influence of psychosexual dimensions on such cognitive processes is not fully established.

Objective
Our aim was to study the mediating role of sexual inhibition/excitation propensity in the relationship between neuroticism and automatic attention to sexual stimuli and also to identify the neuroelectric correlates of this process.

Methods
We studied 58 individuals (Mage = 23.63; SD = 0.97), who presented either high or low neuroticism levels in the NEO-Personality Inventory-Revised (NEO PI-R). Participants also completed the Sexual Inhibition/Excitation Scales (SIS/SES) and event-related potentials (ERP) P1, P2 and N2 were recorded during a modified oddball paradigm containing romantic and sexually explicit pictures. Using parallel mediation analyses, we simultaneously tested the mediating role of sexual inhibition/excitation in the relationship between neuroticism and each ERP of interest.

Results
Findings revealed an indirect effect of neuroticism on automatic attention, via SIS1, regardless of the type of stimuli. Such indirect effect was only significant for component N2, with increased amplitudes and earlier latencies in participants with high neuroticism. Effect sizes ranged from medium to large.

Conclusions
These results can be interpreted as a sign of an enhanced emotional response elicited by the exposure to the sexual content. Results also showed that neuroticism predicts sexual inhibition due to threat of performance failure (SIS1), but does not have an effect on sexual excitation (SES) or sexual inhibition due to threat of performance consequences (SIS2). Our findings suggest that automatic attentional mechanisms are closely related to personality and sexual-related domains, and support the relevance of studying non-conscious cognitive phenomena in the context of human sexual behaviour.

Disclosure
No
(207) Risk for Priapism after Intracavernosal Injections and Selected Treatments after Index Priapism Encounters
Authors: Prebay Z , Ebbott D , Li M , Chung P 
Published: May 2023

Abstract

Introduction
Priapism remains a challenging consult for urologists. Proper understanding of the risk of priapism after intracavernosal injections (ICI) and management trends for patients with priapism may help urologists facing this issue.

Objective
To describe rates of priapism and patient demographics after ICI and management trends after a diagnosis of priapism using a global database.

Methods
TriNetX is a collaborative research enterprise which collects real-time data from almost 89 million patients located in 58 healthcare organizations across the globe and analyzes patient data from 20 years back to present (2002-2022). We queried TriNetX for all adult patients receiving ICI or presenting for priapism, using Common Procedural Terminology (CPT) and International Classification of Diseases-10 (ICD-10) codes. The index event was defined as usage of ICI or incidence of priapism. We performed descriptive statistics to describe rates of priapism after ICI within 3 days and between 4 and 90 days after injection and described demographic differences between patients presenting with priapism after ICI and those who did not. We evaluated treatment options for priapism at 1 week, 90 days, 1 year, and 5 years after the initial event. We also described rates of additional priapism episodes within 1 year and 5 years after index priapism encounter. Analyses were run on June 28th, 2022.

Results
There were 26104 usages of ICI and 17545 recorded instances of priapism. Of patients receiving ICI, 4% and 1.6% had priapism at 3 days and between 4 and 90 days, thus most patients presented with priapism near-immediately. Patients presenting with priapism after ICI tended to be younger (46.4 years vs 57.4 years, p&lt;0.01) and had a disproportionate prevalence of mood disorders (20% vs 14%, p&lt;0.01), pain disorders (16% vs 12%, p&lt;0.01) and sickle cell disease (6% vs &lt;1%, p&lt;0.01). They were less likely to have comorbidities such as diabetes (14% vs 22%, p&lt;0.01), hypertension (33% vs 40%, p&lt;0.01) or a history of prostate cancer (13% vs 25%, p&lt;0.01) and less likely to have taken phosphodiesterase 5 inhibitors such as sildenafil (30% vs 35%, p&lt;0.01) or tadalafil (29% vs 38%, p&lt;0.01) in the past. The most common treatment for priapism was irrigation and/or injection of medications (11.3% same day, Table 1). The prevalence of implants for patients experiencing priapism steadily increased throughout the various timepoints, but overall remained low.

Conclusions
Priapism remains an infrequent problem that is difficult to study given the relative rarity of presentation. By utilizing a global data set, we are to describe rates of priapism after ICI and treatments for priapism. For patients prescribed ICI, proper counseling of the risks of priapism is important to reduce damaging long term consequences if the condition does occur.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.