bluuebunny/crossref_metadata_2025_split huggingface dataset:
(410) Multiple Slit Incisions with Tachosil® Grafting for Treatment of Peyronie’s Disease and ED
Authors: Ragheb A , Osmonov D 
Published: May 2023

Abstract

Introduction
Plaque incision or partial excision with collagen fleece grafting and IPP implantation is a well-established treatment for severe penile curvatures associated with ED. Nevertheless, multiple plaque incisions combined with Tachosil® grafting may have added advantages.

Objective
We demonstrate step-by-step the treatment of a case of severe ED with an over 60 degree dorsal curvature mainly on the left side and an hour glass indentation on the right side of the penile shaft. We highlight the advantages of multiple plaque incisions and Tachosil® grafting combined with IPP implantation for these specific cases.

Methods
After IPP implantation via the penoscrotal approach, the neurovascular bundle was mobilized. For the left sided curvature we underwent multiple deep transverse slits starting from and around the point of maximum curvature using a low energy cutting current (20 to 30 Watts). Our transverse incisions were complimented with the modeling technique. For the right sided waist formation we underwent longitudinal slits. The area of incisions was covered by a Tachosil® graft.

Results
The multiple horizontal incisions led to a vertical release thus straightening of the curved penile shaft. Longitudinal slits led to a horizontal release, therefore expanding and obliterating of the waist formation.

Conclusions
The multiple slit technique together with Tachosil® grafting may have added advantages compared to the conventional plaque incision/excision utilizing the same graft. The smaller defects created by the multiple tunical incisions may avoid potential cylinder protrusion, facilitate better sealing of the collagen fleece, lower the incidence of hematoma and/or infections and allow complimentary modeling of the penis. Moreover, complex deformities may also be treated simultaneously with success.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.
(428) Complex Treatment of Venous Leak with Embolisation and Autological Stem Cells Injections
Authors: Knigavko O 
Published: May 2023

Abstract

Introduction
The venous leakage is one of the most often reason of erectile dysfunction (ED) in young and middle age men. The main reason of veno-occlusive ED (VOED) is the insufficiency venous obstruction in corpora cavernosa under tunica albuginea that is why all types of veno-occlusive operations have particular and short term effect up to renovation of venous leakage in half year. Conservative treatment of VOED with PDE-5 has a low effectiveness. Evermore young patients deny Penile prosthesis implantation for psychological reason.

Objective
We want to stimulate growth of endothelial valves under tunica albuginea with injections autological mesenchymal stem cells (ASC) and autological VEGF (Vascular endothelial growth factor) and combine it with veno-occlusive surgeries (embolization and/or ligation).

Methods
On the basis of Andrology deratment in 2012-2022 we treated 184 patients with VOED. The average patient age is 36.1 +4.1 years. Patients with prostatitis or depression/anxiety were excluded from the investigation or treated previously. We embolizated deep dorsal and Santorini plexus veins for patients with distal form of VOED–47 patients -Group 1. We ligated deep dorsal and penile veins for proximal form of VOED – 68 patients – Group 2. And we made both methods together for 71 patients –Group 3 with combination of proximal and distal leak. Patients with only surgical methods created subgroup A – 106 men. For improving of veno-occlusive mechanism for 78 patients (subgroup B) we injected to each corpus cavernosa 1 mln of autological stem cells 5 times (2 times before and 3 times after surgery) each 1.5-2 months and we performed 15 microinjections of VEGF each 10 days. Then we compared short (2 months) and long term (10 months) results.

Results
The efficacy of surgical treatment according to subjective data (questionnaires on IIEF-5) in 2 months was almost equal (16.7+3.1 and 16.9+3.0), but in 10 months significantly higher in SubGroup B (14.3+3.2 and 19.7+3.4). According to Ultrasound and Cavernosography in 10 months adding microinjections ASC and VEGF to surgery significantly improves Erectile function (absence of venous leakage) 56.4% - subgroup A and 87.4% - subgroup B.

Conclusions
Half year injections of autological stem cells and VEGF improve of veno-occlusive mechanism and increases effectiveness and long term result of veno-occlusive operations for treatment of VOED. This method can be offer as second line therapy of ED for young patients with venous leak.

Disclosure
No
(444) Long-term Outcomes of Inflatable Penile Prosthesis in a VA Practice
Authors: Sax-Bolder A , Van der Voort G , Makedon A , Shahinyan G , Morrison J , Lloyd G 
Published: May 2023

Abstract

Introduction
Inflatable penile prostheses have favorable short-term results for men with refractory erectile dysfunction, but few studies have evaluated the long-term outcomes, including in a VA population.

Objective
This study aims to evaluate the outcomes and satisfaction rates using the novel validated survey, the Satisfaction Survey for Inflatable Penile Implant (SSIPI) of a long-term single-center VA practice.

Methods
Chart reviews were completed as a Quality Improvement project. All patients who underwent a primary inflatable penile prosthesis implantation from 1993-2021 were included. Demographics and data were collected; SSIPI was administered to men who could be reached. Statistical analyses were performed.

Results
114 men were identified, 82 alive and 32 deceased. In the cohort we contacted, mean age at time of surgery was 62.6 years old and mean follow-up 78.2 months (5-234 months). Average SSIPI scores were 64.5/80 (26-80). Smokers were less satisfied with length of penis vs. non-smokers (SSIPI#8 = 2.89 vs 3.93, p=0.032). Men with diabetes were more likely to express regret about undergoing IPP surgery compared to men without (SSIPI#4 = 4.05 vs 4.38, p=0.0029). Men with an ASA score of 2 or less had higher total SSIPI scores compared to ASA score of 3+ (70.36 vs. 61.13, p=0.046).

Conclusions
Long-term satisfaction with IPP in a veteran population appears favorable. However, a significant number of these men still score poorly on SSIPI and/or have complications. The utility of this novel assessment instrument appears excellent. Men with smoking, diabetes, and higher overall comorbidities may find fewer positive results.

Disclosure
No
(450) Max And Average Flow Rate Are Correlated With Severity Of Erectile Dysfunction On Men With Symptomatic Benign Prostatic Hyperplasia
Authors: Habous M , Giona S , Binsaleh S , Almannie R , Ralph D , Bittocchi C 
Published: May 2023

Abstract

Introduction
Numerous cross-sectional epidemiological studies have reported a clear and clinically significant association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging men worldwide.

Objective
We aimed to investigate the severity of ED symptoms with flow rate specifically

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

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

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

Disclosure
No
(452) Glans Necrosis is Not a Risk for Simple Inflatable Penile Prosthesis Insertion Performed via Subcoronal Incision
Authors: Park S H , Wilson S 
Published: May 2023

Abstract

Introduction
Some studies have questioned subcoronal incision via IPP as a risk factor for glans ischemia or necrosis. We analyzed the largest ever reported series of IPP via subcoronal incision.

Objective
To report complications related with subcoronal incision for IPP placement

Methods
We studied 898 men who had subcoronal IPP placement from 5/2015-3/2022 by single surgeon. 817 were first-time patients under local anesthesia, with 81 revisions under spinal anesthesia including 707 circumcised and 181 uncircumcised subjects. Most (76%) uncircumcised men underwent coincident circumcision; the remainder refused. Implants were Coloplast Titan (489) and AMS 700 (329) in 329 (36.6%) diabetics and 38 (4%) Peyronie’s. We report postoperative occurrence of device infections and glans/penile skin problems.

Results
Mean follow up was 47.3 months (3-81 months). Modeling (64%) and corporal relaxing incisions (36%) straightened the Peyronie’s patients. Transient distal penile skin edema which resolved within 2 to 4 months was noted in 673 cases (74.9%). Edema developed in 68.3% previously circumcised patients, 100% of concomitant circumcised patients and 96.2% of patients who had refused circumcision. One previously circumcised patient experienced prolonged edema of 7 months. Five previously circumcised patients (0.5%) developed partial distal penile skin necrosis on the proximal side of the subcoronal incision (Figure-1) with all but one healing without grafting. The other patient sustained necrotic wound dehiscence which led to device infection and removal. There were zero cases of glans ischemia or necrosis. Only 2 patients became infected (0.2%).

Conclusions
Subcoronal incision for simple IPP placement or revision is not an independent risk factor for glans ischemia or necrosis. Most postoperative patients do experience transient distal penile skin edema without glans involvement which heals without sequelae regardless of circumcision status. Very rarely (0.5%) penile skin loss may occur.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, International Medical Devices, Rigicon, Uramix.
(454) Variations in Practice Patterns of Xiaflex Providers Throughout the United States
Authors: Parikh N , Sischka M , Ungerer G , Ziegelmann M 
Published: May 2023

Abstract

Introduction
Intralesional Collagenase Clostridium Histolyticum (CCH; Xiaflex; Endo Pharmaceuticals, Dublin, Ireland) is the only FDA-approved intralesional therapy to treat bothersome penile curvature in men with Peyronie’s Disease (PD). Clinicians who administer CCH must be certified through a risk evaluation and management strategy (REMS) program. However, provider availability is highly dependent on geography and many patients must travel great distances to undergo evaluation and treatment with CCH by an experienced injector.

Objective
The goal of the current study is to describe the landscape of certified CCH injectors with respect to location and clinical background/training.

Methods
Patients are currently able to use an online “locate a specialist” tool through Endo Pharmaceuticals to identify clinicians in their local geographic area who are certified to administer CCH. Using this tool, a list of all providers who offer CCH injections was compiled throughout the continental United States. Pertinent information that was gathered included geographic location, type of provider or level of training [Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Physician Assistant (PA), Nurse Practitioner (NP), and Registered Nurse (RN)], and gender of providers. This information was compared to state population data (United State Census Bureau) to determine per capita coverage.

Results
A total of 1947 Xiaflex providers were identified: 1749 Doctors of Medicine (MD; 90%), 115 Doctor of Osteopathic Medicine (DO; 6%), 60 Physician Assistants (PA; 3%), 21 Nurse Practitioners (NP; 1%), and 1 Registered Nurse (RN; 0.05%). Out of the 1947 providers, only 95 (4.9%) were women. Most women administering Xiaflex were MDs (73%), followed by PAs (12%), NP and DOs (7%), and RN (1%). Xiaflex providers were available in all states except for Hawaii and Alaska. Providers were distributed throughout the United States with the average provider per capita ratio of 230,240. Wyoming, Washington D.C., Rhode Island, and Georgia had the best provider per capita at &lt;10,000 while New Mexico had the worst provider per capita ratio at 2,117,522.

Conclusions
Our results show significant variation in certified CCH injector availability for patients across the United States. &lt; 5% of all certified clinicians are female and 4% were advanced practice providers. Further work is needed to characterize and remedy gender disparities amongst providers, and ensure greater access for patients who desire an FDA-approved non-surgical treatment for their PD-associated curvature.

Disclosure
No
(459) Healthy Effects of Sex
Authors: Dominguez-Bali A , Santana R , Basta J , Belizaire J , Dominguez-Bali C 
Published: May 2023

Abstract

Introduction
Traditionally, sex has been thought of as a function predominantly exercised for reproductive purposes. Likely, religion and culture have both failed to promote a healthy appreciation for the pleasure that sex can provide. Due to the heavy focus on the reproductive utility of sex, society has perpetuated the misconception that increased age reduces libido. As such, the health benefits of sex, particularly in older adults, has been largely ignored as an integral part of preventative medicine. Furthermore, recent studies in the field of neuroendocrinology have demonstrated an increase in the number of receptors for estrogen, progesterone, and testosterone in different tissues of our body, especially in vital organs as brain, heart, bone, and muscle.

Objective
To spread awareness on the importance of maintaining a healthy amount of sexual activity in order to decrease adverse health outcomes.

Methods
In this study, we review the literature extensively and use the sexual histories of patients in our office to assess the beneficial health outcomes.

Results
We present evidence associating increased sexual activity with decreased risk of many disease states. Populations with higher frequency of arousal and orgasms showed reduced rates of breast cancer, prostate cancer, obesity, vaginal atrophy, dyspareunia, dysmenorrhea, dysfunctional uterine bleeding, recurrent urinary tract infections, urinary stress incontinence, fecal incontinence, genitourinary symptoms of menopause, abnormal false pap smears, vulvar, labial, and vaginal obliteration, and cardiovascular disease.

Conclusions
Our findings suggest that increased sexual activity is an important factor for the maintenance of general good health. These findings indicate decline in sexual activity, desire or function, particularly in older patients, as potential risk factors for adverse health outcomes. Promotion of healthy sexual behaviors have been strongly linked to sexual ability at advanced ages, with studies since 1948 showing that over 80% of women with orgasmic dysfunction do not masturbate, while over 80% of women who regularly achieve orgasm do not have trouble masturbating. Sexual literacy and comfort are key factors that may promote healthy sexual activity during adulthood. As such, masturbation should be promoted in adolescent and young adults as part of routine sexual education. Furthermore, standard medical practice should encourage regular sexual activity, with or without a partner.

Disclosure
No
(465) Effect of Anticancer Agents on Erectile Function in Juvenile Rats
Authors: Kataoka T , Hotta Y , Sanagawa A , Hibi Y , Kimura K 
Published: May 2023

Abstract

Introduction
Several cancer chemotherapeutic agents are administered to patients with cancer worldwide. Our previous report on the analysis of the US Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) database revealed that five anticancer agents (melphalan; L-PAM, methotrexate; MTX, vincristine; VCR, docetaxel; DTX, and doxorubicin; DOX) were proven risk factors for erectile dysfunction (ED). Furthermore, administering these anticancer agents to sexually mature rats reduced their erectile function.

Objective
To investigate the effect of anticancer agents on erectile function in juvenile rats.

Methods
Four-week-old male Wistar ST rats were divided into Control, L-PAM, MTX, VCR, DTX, and DOX treatment groups. L-PAM (3 mg/kg, intravenous, i.v.) and MTX (20 mg/kg, intraperitoneal, i.p.) were injected on day 1. VCR (0.1 mg/kg, i.v.), DTX (5 mg/kg, i.v.), DOX (3 mg/kg, i.v.), and saline (Control, i.v.) were injected on days 1, 8, 15, and 22, respectively. Erectile function was measured following one-, two-, and four-week treatment periods. In the Control, VCR, DTX, and DOX groups, erectile function was also evaluated after four weeks of treatment and a subsequent 4, 8, and 12-week rest period without any treatments. Furthermore, erectile function was evaluated by measuring intracavernous pressure (ICP) and mean arterial pressure (MAP) after electrical stimulation of the cavernous nerve.

Results
After a one-week observation period, the ICP/MAP ratio in the L-PAM group (0.39±0.08) decreased significantly compared to that in the Control group (0.60±0.03) (P&lt;0.01); however, no change was observed in the MTX group (0.59±0.06). The ICP/MAP ratio in the L-PAM group at week 4 (0.66±0.05) increased significantly compared to that at week 1. However, after the four-week observation period, the ICP/MAP ratio in the VCR (0.46±0.04), DTX (0.28±0.01), and DOX (0.38±0.03) groups was significantly decreased compared to that in the Control group (0.66±0.05) (P&lt;0.05). The ICP/MAP ratio in the VCR (0.55±0.05) group after a 12-week rest was decreased compared to that in the Control group (0.68±0.03) (P=0.06). Furthermore, these ratios in the DTX (0.26±0.02) and DOX (0.36±0.02) groups significantly decreased compared to that in the Control group (P&lt;0.01).

Conclusions
In conclusion, ICP measurements revealed that the four anticancer drugs (L-PAM, VCR, DTX, and DOX) significantly reduced erectile function in juvenile rats. Furthermore, in the VCR, DTX, and DOX groups, the erectile function of rats remained compromised 12 weeks post-drug administration. Notably, VCR and DOX are general-purpose anticancer agents for treating leukemia in children, underscoring the requirement for long-term monitoring of the erectile function in cancer survivors. Thus, monitoring the dose and the possibility of recovery after administering anticancer agents is vital, especially considering the risk of developing ED as a side effect.

Disclosure
No
(468) Hypersexuality with SSRI Medication
Authors: Dominguez-Bali A , Harvey A , Farag M , Dominguez-Bali C 
Published: May 2023

Abstract

Introduction
Hyposexuality is a well-defined and prevalent side effect of individuals prescribed SSRI medication. However, hypersexuality has never been found in patients taking SSRI and antitypical antidepressant medications. We present two new case reports to the scanty literature found up to now in this area. This condition needs to be differentiated from the hyperactive arousal disorder already described in the sexological literature. This demands further study. With several documented reports of these side effects, failure to examine and develop therapy options for our patients would be a disservice.

Objective
The objective of this care report is to educate both patients and medical providers of this side effect as well as further investigation to include the pharmacological mechanism involved.

Methods
Two patients presented to the office complaining of hypersexuality. These patients were then followed for four months before completing analysis.

Results
Of the two patients presenting on the drug regimen specified, both experienced hypersexuality.

Conclusions
This case study illustrates that the use of Bupropion and Fluoxetine/Sertraline concomitantly can cause hypersexuality in perimenopausal women. This is an area that needs to be studied more to conclude the mechanism of action.

Disclosure
No
(470) Malleable Penile Implant Rod Diameter Predicts Complications And Patient Satisfaction
Authors: Habous M , Aziz M , Ralph D , Mulhall J 
Published: May 2023

Abstract

Introduction
One of the most common complaints after malleable prosthesis implantation (MPI) is thinning of the penis and decreasing girth. Some surgeons try to insert the largest diameter they can to improve patient satisfaction

Objective
To investigate if malleable rod diameter (MRD) has an impact on outcome and patient satisfaction

Methods
Consecutive malleable prosthesis implanation (MPI) was assessed in a high volume center over one year. The same preoperative, intraoperative, and postoperative protocols were used for all patients and one brand of the malleable device was used only. We recorded MRD and length for all patients. All patients had data on comorbidities including glycated hemoglobin (HbA1c) and clinical Peyronie’s disease (PD). Revision cases and those who lost for follow up were excluded from the study. We also excluded patients operated on by low volume surgeons. All complications, minor (edema, ecchymosis, pain), and major (infection and erosion) were recorded. After 1-year, patients were assessed and given a Likert scale from 1-5 where 1 is dissatisfied and 5 is most satisfied with their MPI. We stratified patients according to MRD into two groups: group A for diameter 9.5 and 11 mm and group B for 13 mm.

Results
183 patients had full data and filled the questionnaire after 1 year follow up. All patients had Coloplast, Genesis penile implants. Major complications rate (infection, erosion, and removal) was significantly higher in group B 11% versus 1.2% in group A (P=0.016). At 4 weeks postoperative visit, 90 % of group A showed no complications versus 60 % only in group B that was statistically significant (p=0.0003). Satisfaction rate was more in patients in group A (88.6%) compared to patients in group B (75.7%)but this did not reach to be statistically significant (P=0.0519). See Table 1.

Conclusions
Larger diameter of malleable penile implants are not always associated with higher patient satisfaction as there are other predictors like postoperative complications and concealement. The best implant size for a certain patient is the best fitting, neither the oversize nor the undersize.

Disclosure
No