bluuebunny/crossref_metadata_2025_split huggingface dataset:
(134) Development of a Multidisciplinary Step-Care Management Algorithm and Surgical Outcomes of PGAD/GPD Patients with Tarlov Cyst-Induced Sacral Radiculopathy
Authors: Goldstein I , Kim C , Komisaruk B , Kim N , Goldstein S , Yee A 
Published: May 2023

Abstract

Introduction
Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD) is characterized by persistent, unwanted genital arousal and/or other genito-pelvic dysesthesia, including burning, itch, pain in the clitoris/penis, mons pubis, vulva/scrotum, vagina, urethra, perineal region, bladder, and/or rectum. Patients with PGAD/GPD are significantly bothered/distressed and catastrophization and suicidal ideation are common. In 2012 Komisaruk reported that PGAD/GPD could be mediated by Tarlov cyst-induced sacral radiculopathy. In 2016 we developed a multidisciplinary step-care management algorithm with specialists in sexual medicine, spine surgery, sex therapy, physical therapy, and neurophysiology to diagnose Tarlov cyst-induced sacral radiculopathy.

Objective
To utilize a novel multidisciplinary step-care management algorithm to identify PGAD/GPD patients with Tarlov cyst-induced sacral radiculopathy who could benefit from Tarlov cyst spine surgery, and to evaluate the long-term safety and efficacy of the surgery.

Methods
Clinical data were collected on PGAD/GPD patients who underwent Tarlov cyst spine surgery between 2016 and 2020 with at least 1-year follow-up. The management algorithm used to identify and treat Tarlov cyst-induced sacral radiculopathy involves: detailed psychosocial assessment and medical history; non-invasive assessments for sacral radiculopathy; targeted diagnostic caudal epidural injection that results in temporary clinically significant reduction of PGAD/GPD symptoms; and surgical intervention with Tarlov cyst spine surgery. Treatment outcome was based on the validated patient global impression of improvement (PGI-I) measured at intervals post-operatively.

Results
Ten patients (8 women, 2 men), mean age 40 years (range 19 - 66), met inclusion criteria. Patients were discharged the same day or following morning post-operatively. No serious complications occurred. Follow-up was &gt;12 months (range 13 - 22 months). Seven (70%) patients reported post-operative clinical improvement on PGI-I at last follow up: two patients reported “very much better”, three patients reported “much better” and two patients reported “little better”. Two patients had no improvement. Only one patient was much worse, however we believed that the PGI-I score of 6 reflected the worsening of the PGAD/GPD condition and not a specific result of the surgical procedure.

Conclusions
Distressing PGAD/GPD symptoms can be caused by Tarlov cyst-induced sacral radiculopathy. This case series with long-term follow-up demonstrates that spine surgery effectively treats PGAD/GPD patients with Tarlov cyst-induced sacral radiculopathy established by a multidisciplinary step-care management algorithm. Imbricating the Tarlov cyst using minimally invasive spine surgery techniques was associated with clinical improvement in 70% of these select patients.

Disclosure
No
(139) Intraoperative Glanspexy During Complex Repair of Peyronie’s Disease
Authors: Mossack S , Roadman D , Levine L 
Published: May 2023

Abstract

Introduction
Peyronie’s disease (PD) is a disorder marked by the formation of a fibrous plaque in the tunica albuginea often causing a penile deformity. Surgical correction remains the gold standard of treatment for PD. The choice of procedure depends on various factors including erectile function, degree of penile curvature, hinge effect, and patient preference. We have found that men undergoing surgical correction of PD had intraoperative identification of a glans tilt or floppy glans, which was not recognized preoperatively.

Objective
Our aim was to analyze a large PD database to review the results after a glanspexy was performed in men undergoing partial plaque excision and grafting (PEG), tunica albuginea plication (TAP) or inflatable penile prosthesis (IPP) with straightening maneuvers.

Methods
A retrospective analysis was performed on all patients who presented with PD and were subsequently treated with a surgical procedure that included a glanspexy from 2016-2021. Demographics, comorbidities, erectile function (ED), PD characteristics, physical exam, penile duplex ultrasound findings, and surgical outcomes were obtained. Patients were tracked longitudinally, and subsequent interventions and outcomes were collected. All glanspexies were performed using the same surgical technique, where the glans was secured over the tips of the corpora cavernosa using several 4-0 Monocryl sutures between the glans and the tunica albuginea contralateral to the tilt through a subcoronal incision.

Results
A total of 97 glanspexies were performed in conjunction with an operation for PD. IPP with glanspexy (49.5%) was the most common procedure performed followed by PEG with glanspexy (36.1%) and TAP with glanspexy (14.4%). Post-operatively, there were no patient complaints or physician identification of irregularities pertaining to glans position or sensitivity. 6 patients required a reoperation after their initial PD procedure, however, none of the indications were related to the glanspexy portion of the procedure. There was one patient who sustained partial glans necrosis following complex reconstruction including extensive plaque incision with grafting, IPP and glanspexy.

Conclusions
Glanspexy using 4-0 Monocryl suture on a TF needle appears to be a safe, easy and effective technique for the treatment of a glans tilt or floppy glans identified during the surgical management of PD.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(157) Advanced Practice Providers Deliver Equivalent Outcomes with CCH Injection for Peyronie’s Disease
Authors: Carlson S , Tentis E , Nelson K , Reza Roshandel M , Alom M , Helo S , Tobias K , Matthew Z 
Published: May 2023

Abstract

Introduction
Independently performed procedures by well-trained advanced practice providers (APP) facilitate access to specialized care. We sought to compare outcomes between physicians and APPs with intralesional collagenase clostridium histolyticum (CCH).

Objective
Compare outcomes of CCH injections based on injection provider. Outcomes included curvature improvement and adverse events.

Methods
Men receiving CCH between 2014-2021 at our institution by four physicians and four APPs were included in an IRB-approved database. CCH was delivered as a series of 8 injections per protocol. Patient demographics, procedural-related adverse events, and curvature changes were recorded. The “APP-ratio” is defined as percentage of total injections administered by an APP per patient.

Results
After excluding patients who did not complete the entire CCH course or return for final assessment, 150/406 patients were analyzed. Mean baseline penile curvature was 66.2° (SD 23). Mean absolute and percent improvements in curvature were 21.7° (SD 18) and 33% (SD 27). The mean APP ratio was 69%, and 133 patients (89%) had at least 25% of their injections performed by an APP. There was no significant difference (p=0.65, p=0.39) in absolute or relative curvature improvement based on the APP-ratio [Figure 1]. There was also no difference in adverse events (pain, swelling, and hematoma).

Conclusions
In our high-volume CCH practice, APPs achieve the same outcomes and safety compared to physicians. Greater training efforts expand access to care for patients with PD.

Disclosure
No
(179) Incidence of Fertility Preservation Procedures in Prepubertal and Pubertal Individuals with Cancer
Authors: White J , Ory J , Ramasamy R 
Published: May 2023

Abstract

Introduction
Fertility Preservation (FP) for children and adolescents with cancer is underutilized. In prepubertal individuals, ovarian and testicular tissue can be frozen; however, this is still considered largely experimental.

Objective
Identify trends of FP in prepubertal individuals in the United States.

Methods
We performed a retrospective study of prepubertal children with cancer identified through the Pediatric Health Information System from 2011 to 2020. Children who underwent a testicular or ovarian biopsy were included. Any patients with testicular or ovarian malignancy, or other diagnoses which may have required a gonadal biopsy were excluded.

Results
A total of 418 boys under 13 and 333 girls under 12 who underwent a gonadal biopsy were identified. There was a total of 66929 new cancer diagnoses in girls and 86001 new cancer diagnoses in boys during this time. The most common cancer diagnosis was hematologic in both boys (50.96%) and girls (36.64%). A concurrent procedure at time of gonadal biopsy was performed in 84% of boys and 62% of girls, with line insertion being the most common. The only predictive variable of receiving a gonadal biopsy was increasing year. Overall, only 0.04% of children had a gonadal biopsy for FP during this time period.

Conclusions
Gonadal biopsy rates have increased in prepubertal children with cancer, presumably for FP. While recent international guidelines support FP in this group, our findings highlight the need to establish protocols and tracking for FP procedures in the US.

Disclosure
No
(209) Sexual Knowledge, Attitude and Practices in Women Attending OBG Out Patient Department and Its Effect on Sexual Dysfunctions
Authors: Mishra B , Sujatha M S , Rao S T S 
Published: May 2023

Abstract

Introduction
In India, despite significant advances in the prevention and treatment of sexual dysfunctions, the majority of these have focused on male sexual dysfunction disorders. There is still a paucity of literature that adequately explains the relationship between sexual knowledge and attitudes of women and female sexual dysfunctions. Furthermore, physiological events such as pregnancy, childbirth, breastfeeding, menopause, and ageing have a significant impact on sexual well-being, particularly when co-morbid psychiatric illnesses are present. The prevalence of these interactions and their relationship with female sexual dysfunctions are being explored which have consequences in the prevention and treatment of female sexual dysfunctions

Objective
1. To assess sexual health knowledge and attitudes regarding sexual practices in women attending Obstetrics and Gynecology Out Patient Department. 2. To assess presence and extent of sexual dysfunctions in these women 3. To evaluate for presence of co-morbid psychiatric conditions

Methods
Hospital based cross-sectional study with a sample size of 220 women in the category of pregnant, nulliparous and perimenopause/ menopause/ post menopause with age range from 18 to 65 years. Pregnancy carrying high risk and women nearing term were excluded from the study. After a detailed history regarding their socio-economic data, each of them were handed out questionnaires. The SKAQ-II (Sexual knowledge and attitude questionnaire), which was standardized using Indian population assessed their sexual knowledge and attitude, the Female Sexual Functioning Index scale (FSFI) evaluated sexual dysfunction and the presence of psychiatric comorbidities was assessed with the M.I.N.I PLUS scale.

Results
93% of the women had an adequate amount of knowledge regarding sexual practice and 83.2% had liberal attitude. Level of sexual knowledge and attitude was positively correlated with presence of sexual dysfunction, with the prevalence of latter being 65.5% with 63% of pregnant women having sexual dysfunction and 77.8% of menopausal women having sexual dysfunction. Rural women had lower levels of sexual knowledge and conservative attitude towards sexual practice, leading to more sexual problems. Around one-fourth of women reported psychiatric morbidities with majority suffering from depression.

Conclusions
Women with greater sexual knowledge and a liberal mindset towards sexual practices tend to have lower levels of sexual dysfunction. Rural women tended to have lower levels of sexual knowledge and poor attitude towards sexual practice. There was no association found between religious attitudes. Most dysfunctions were reported by the menopausal age group. Sexual issues were more common in the domains of desire, lubrication, orgasm and pain. A positive correlation was noted between sexual dysfunction and kind of housing, leading to lack of intimacy being an important contributing factor.

Disclosure
No
(238) TikTok as a Source of Information Regarding Premature Ejaculation: a Qualitative Assessment
Authors: Bernstein A , Loloi J , Babar M , Zhu M , Winokur N , Wysocki M , Labagnara K , Cohen S 
Published: May 2023

Abstract

Introduction
Patients are increasingly looking to social media platforms for sources of medical information. TikTok is one of the newest social media platforms primarily geared towards younger audiences.

Objective
This study aimed to evaluate the quality of information regarding premature ejaculation (PE) on TikTok.

Methods
The term “premature ejaculation” was searched on TikTok in May 2022. The first 40 top videos that met inclusion criteria were included. Videos were sorted as reliable or unreliable based on accuracy of video content by three reviewers. Relevant user metrics were collected for each video, including: number of likes, shares, followers of user, video length, source of upload and speaker type. Quality of information was numerically evaluated using Patient Education Materials Assessment Tool (PEMAT) and 5-point modified DISCERN validated tools with mean scores obtained from the three reviewers.

Results
Eight videos were categorized as reliable and 32 videos were categorized as unreliable. Mean number of “likes” per video was higher in the reliable versus unreliable group (1,238 vs. 126, p &lt; 0.018). Accounts posting reliable videos had higher mean number of followers versus unreliable (55,050 vs. 12,042, p = 0.025). The majority of unreliable videos (75%) were posted by self-identified patients or individual users versus 12.5% of reliable videos. 62.5% of reliable videos were posted by individual physicians or physician groups, versus 6.3% of unreliable videos. Few overall videos mentioned indications for PE treatment, types of treatment, or value of psychological intervention (12.5%, 15%, 22.5% and 5.0% respectively.) Video length and number of shares did not differ between groups. Reliable videos had a higher DISCERN (2.7 vs. 0, p &lt; 0.001) and PEMAT (73.0 v. 45.1, p &lt; 0.001).

Conclusions
Quality of information regarding premature ejaculation on TikTok is low with a significant percentage of videos on this topic fraught with inaccurate information. Given TikTok’s prominence as a social media platform primarily geared towards younger audiences, we emphasize a need for improvement in the quality of information available regarding premature ejaculation and its management.

Disclosure
No
(268) Does Medical School Prepare Doctors to Treat Sexual Health?
Authors: Kenya S , Young B , Carrasquillo O 
Published: May 2023

Abstract

Introduction
Sexual function is a normative process warranting the equal attention of preventive and treatment services throughout the lifespan. Despite growing recognition of the value of human sexuality in clinical settings, there is no standardized sexual wellness curriculum universally administered in medical schools. Accordingly, many current and future physicians feel underprepared when taking care of patients’ sexual health needs.

Objective
Assess and strengthen sexual health knowledge among medical students in Miami.

Methods
In February 2020 and March 2021, medical students at a large university in South Florida requested a brief sexual health workshop to enhance their knowledge in this domain of patient care. The workshop provided an introductory overview of the physiology of sexual pleasure and functioning. The curriculum was developed and taught by an associate professor of medicine who directs the university’s sexual wellness consortium and is formally certified as a clinical sexologist. Prior to the workshop, a brief survey was conducted to understand medical students’ experience with sexuality education and identify gaps in training. Post workshop another survey was administered evaluating content as well as instructor proficiency.

Results
Among 62 participants who completed a pre-workshop survey, less than 30% reported being trained to query patients on sexual dysfunction, and just 8% were trained to assess sexual satisfaction. In the post workshop survey, 95% of participants believed the workshop increased their knowledge of sexual functioning and its physiologic markers and nearly all would also recommend the session to other students.

Conclusions
Increased sexual health training in medical schools has the potential to better prepare future physicians to serve patients’ diverse sexual health needs and improve patient outcomes.

Disclosure
No
(296) Variations in the Retail Price of Human Chorionic Gonadotropin in the United States
Authors: Miller J , O'leary M , Schneider D , Loeb C , Jenkins L , Yafi F 
Published: May 2023

Abstract

Introduction
Urine-derived human chorionic gonadotropin (HCG) remains a popular treatment for hypogonadotropic hypogonadism and induction of spermatogenesis or puberty in select patients. Shortages in both brand name and generic HCG, and the resulting increases in prices, have raised barriers in the treatment of patients.

Objective
To determine the variations in the price of HCG therapy within the U.S. and the potential for the undue financial burden on patients receiving HCG therapy.

Methods
Using the GoodRx website, prices of generic HCG, Pregnyl, and Novarel (10,000-unit vial) with and without coupons were recorded. Prices were collected from the most popular retail pharmacies in each state’s most populous zip code. The lowest and highest retail prices were noted for each brand by state and pharmacy.

Results
The mean highest retail prices for generic HCG, Pregnyl, and Novarel were $546.42 ± $64.95, $170.28 ± $76.82, and $387, respectively. The mean lowest retail prices of generic HCG, Pregnyl, and Novarel were $289.68, $113.88 ± $1.29, and $307.31 ± $2.00, respectively. The mean difference between the highest and lowest prices available within the same zip code for generic HCG, Pregnyl, and Novarel were $256.74 ± $64.95, $54.40 ± $76.65, and $79.69 ± $2.00, respectively (Figure 1).

Conclusions
Differences between the highest and lowest prices available for HCG therapy within a set zip code reached $462 per vial, demonstrating the potential for the undue financial burden on patients receiving HCG therapy. Significant changes in the cost of HCG therapy were seen within zip codes as a result of pricing differences between brands and pharmacies. Despite this, there was no significant variation in the lowest price available for generic HCG therapy between states. Given these price variations, providers must be aware of pricing patterns and be able to assist patients as they navigate the financials of these treatments.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma; Clarus Therapeutics; Cynosure; Promescent; Sprout; Viome.
(321) Long-Term Evaluation of Sperm Parameters Following COVID-19 mRNA Vaccination
Authors: Diaz P , Dullea A , Patel M , Blachman-Braun R , Reddy R , Khodamoradi K , Ibrahim E , Bidhan J , Ramasamy R 
Published: May 2023

Abstract

Introduction
Despite the demonstrated safety of COVID-19 mRNA vaccines, potential impact on fertility remains a major concern for vaccine hesitancy.

Objective
We conducted a single-center prospective study to investigate the long-term impact of COVID-19 vaccination on sperm parameters of healthy men. We hypothesized that COVID-19 vaccination (and booster doses) would not negatively impact sperm parameters in the long-term.

Methods
Twelve healthy male volunteers between the ages of 18-50 years old with pre-vaccination semen analyses completed follow-up analyses between September 2021 - March 2022. Participants were required to provide documentation demonstrating at least two mRNA vaccine doses after a minimum of 9 months prior to the first vaccine. Semen analyses evaluated volume, sperm concentration, total motility, and TMSC. The number of days abstinent prior to sample collection was documented during the visit. The primary outcome was median change in the total motile sperm count at least 9 months following fully vaccinated COVID-19 status. Individuals who admitted a history of infertility or previous azoospermia were excluded from study participation. After calculating data distribution on normality test, medians, and interquartile ranges (IQRs) were reported for all variables. The Wilcoxon rank sum test was used to compare pre- and post-vaccination semen parameters. A 2-tailed P &lt; .05 was considered statistically significant.

Results
A total of 12 men volunteered in our study (median age 26 [25 - 30] years. Subjects provided follow-up semen samples at a median of 10.5 months following the second vaccine dose. There were no significant changes in any semen parameters between baseline, 3 months, and 10 months following vaccination. Baseline samples demonstrated median sperm concentrations and TMSC of 29.5 million/cc [9.3 – 49] and 31 million [4-51.3], respectively (Table 1). At follow-up, sperm concentration and TMSC were 43 [20.5 – 63.5] (p=0.050) and 43.5 [8.5 – 102.8] (p=0.407), respectively. Of note, there were no significant changes in semen volume nor total motility (%) for participants at follow-up. Two of the men had semen analyses demonstrating oligospermia at baseline. Of these two men, one was found to be normospermic at follow up from 8 to 25 million/mL, and the other remained oligospermic.

Conclusions
COVID-19 mRNA vaccines and booster doses do not appear to negatively impact the semen parameters of healthy males even 10 months following vaccination. Our study and future studies should add to the growing body of the evidence on the long-term safety of vaccines and potentially decrease vaccine hesitancy.

Disclosure
No