bluuebunny/crossref_metadata_2025_split huggingface dataset:
(446) Synchronous Surgical Management of Erectile Dysfunction and Stress Urinary Incontinence: A Systematic Review and Meta-analysis of Reoperation Rates
Authors: Pyrgidis N , Barham D W , Hammad M A M , Sokolakis I , Hatzichristodoulou G , Lentz A C , Simhan J , Yafi F A , Gross M S 
Published: May 2023

Abstract

Introduction
The efficacy, safety, and postoperative outcomes of synchronous surgery for concomitant erectile dysfunction (ED) and stress urinary incontinence (SUI) remain unclear.

Objective
We performed a systematic review and meta-analysis to evaluate the available synchronous surgical approaches for concomitant ED and SUI and to assess the reoperation rates compared to asynchronous surgery and surgery only for ED or SUI.

Methods
We searched PubMed, Cochrane Library, and Embase databases until June 2022 for relevant studies. Based on data availability, we performed a meta-analysis of odds ratios (ORs) comparing reoperation rates after synchronous surgery in patients with concomitant ED and SUI versus asynchronous surgery, as well as surgery solely for ED or SUI (PROSPERO: CRD42022326941).

Results
We included 18 studies in the systematic review (16,517 patients) and 5 in the meta-analysis. Comparing synchronous implantation of penile prosthesis and artificial urinary sphincter (AUS) versus asynchronous surgery, no statistically significant differences were observed in the reoperation rates [OR:0.98, 95% confidence interval (CI): 0.52-1.84, I2:0%). Comparing synchronous implantation of both penile prosthesis and AUS versus implantation of only a penile prosthesis or an AUS, combined surgery was associated with higher reoperation rates (OR:2.02, 95%CI: 1.29-3.16, I2:36% and OR:1.7, 95%CI: 1.25-2.32, I2:0%, respectively). Synchronous surgery led to high satisfaction rates and significant improvement in ED and SUI. Evidence for the combination of penile prosthesis with a male sling or the ProACT device is low, but data suggests it may be safe and effective. The synchronous placement of a Mini-Jupette sling and penile prosthesis represents a promising treatment modality for the correction of ED and mild SUI and/or climacturia.

Conclusions
Synchronous penile prosthesis and AUS implantation appears safe and effective in patients with severe ED and SUI. Further high-quality studies are mandatory to strengthen the current scarce evidence for synchronous surgery in patients with ED and SUI.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Cynosure, Coloplast, Clarus Therapeutics, Antares Pharma, Acerus
(451) Human Rights and Sexual Health to Reproductive Health, A Research Project on Massive Open One line Courses (MOOCs)
Authors: Ward S , Troussier T , Choucroun D , Brival M , Gerbase A 
Published: May 2023

Abstract

Introduction
Faced with alarming and persistent reproductive health indicators, the raise in refusal of oral contraception by young people and the decline in access to abortion in some developed countries, United states more precisely, UNESCO Chair is creating a mini MOOC in the MOOC Rights, sexual health in Educations, "What sexual health and human rights bring to reproductive health?

Objective
To raise awareness and advance knowledge, empower citizens and their practice in the area of human rights in relation to reproductive health. This includes a variety of aspirations: the protection of young people from sexual violence, infertility; the fight against gender inequality, incest, sexual mutilation, sexual exploitation, unsafe abortion.

Methods
This mini MOOC is composed of 6 mini modules with different formats: • What are the contributions of sexual health to reproductive health? • What are the contributions of human rights to reproductive health? • The desire for a child • Contraception, historical abortion and current issues • Reduction of unwanted pregnancies? • The role of man in reproductive health, a challenge for achieving the 2030 SDGs This mini-MOOC is blended-learning approach, at opening sessions of the MOOC, learners register on a social network (WhatsApp, Fb….) and create private groups to discuss and exchange regularly different materials (testimonies, useful links, files…). This learning technique, which mixes a top down and a horizontal approach, aims at creating a community of learners, a strong group entity that can positively impact public opinion to thrive change.

Results
Past MOOCs results 2021, 93% of learners were satisfied and would recommend UNESCOs’ MOOC. We have had more than 40,000 learners in total in only two years (2019-2021). More than one thousand members of our community on Facebook dedicated to the MOOC and more than one thousand participants of contests/polls and quizess on social media.

Conclusions
What we want to do with ISSM is create an intercultural MOOC available in English and/or more your local languages (Spanish?), that promotes reproductive health and human rights and reflects both our values and vision. A process of co-creation taking into account intercultural diversity as well as the United Nations human rights framework and the Sustainable Development Goals (SDGs)

Disclosure
No
(453) Seasonal Variation in Serum Testosterone Levels
Authors: Miller D , Weber A , Dullea A , Ramasamy R 
Published: May 2023

Abstract

Introduction
Variation in testosterone levels by season and month have been reported, however results have been inconsistent across studies. Large series are conflicting with reported peaks in June, October, December, and January. Testosterone levels in most of these studies nadir in the spring. The etiology for the variability remains unknown but is likely multifactorial including sunlight exposure, sleep duration, and outdoor temperature.

Objective
To determine if there is seasonal variability in testosterone levels in a large cohort of men and if this variability may be clinically relevant.

Methods
Using a single institutional database, testosterone levels were obtained for men ages 18-99 from 2010-2021 who had at least 2 testosterone levels drawn within a 2-year period. Patients who were currently or previously on exogenous testosterone, testosterone stimulating medications, testosterone suppressing medications, and aromatase inhibitors were excluded from the study. Climate data including mean monthly temperature for Miami-Dade County, FL was obtained from the PRISM Climate Group. Minutes of daylight on the fifteenth day of each month was applied as the representative daylight duration for each month.

Results
There were 3,377 total patients included in the study, there were 9495 total testosterone levels measured with all patients having 2 or more levels. The mean age was 58.8 years old. In the winter the mean testosterone level in the was 422 ng/dl (Figure 1.), the average time of daylight was 682 minutes, and the average temperature was 68 F. In the spring the mean testosterone level was 412 ng/dl, the average time of daylight was 801 minutes, and the average temperature was 78.4 F. In the summer the mean testosterone level was 416 ng/dl, the average time of daylight was 780 minutes, and the average temperature was 83.6 F. In the fall the mean testosterone level in the fall was 417ng/dl, the average time of daylight was 661 minutes, and the average temperature was 75.3 F.

Conclusions
Our findings suggest seasonal variability in testosterone levels with the highest testosterone levels in the winter, the lowest levels in the spring and a steady increase in testosterone levels in the summer and fall. However, this variation is minor and not likely to be clinically relevant.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceuticals Consultant, Grant Recipient Boston Scientific Consultant, Grant Recipient Coloplas tConsultant, Grant Recipient Endo Pharmaceuticals Consultant, Grant Recipient Empower Pharmacy Grant Recipient Nestle Health Consultant Olympus Grant Recipient Hims, Inc Advisory Board.
(455) The Modern Eunuch: A Historical Review of Voluntary Castration and Modern Perspective On the Practice
Authors: Anglin C , Baas W 
Published: May 2023

Abstract

Introduction
Voluntary castration in men has existed for several centuries with popularity in many different cultures. The practice is still prevalent today in the Western world with varying reasoning for why men still seek the identity of a Eunuch.

Objective
We aim to explore the natural history of voluntary castration including examination of its presence in different cultures, associated societal roles, and the methodology and historical reasoning behind the practice. We also examine roles and reasoning in contemporary society with investigation of how and by who this service is provided.

Methods
We reviewed both historical literature of voluntary castration as well as more updated literature including recent questionnaires, surveys, and internet forums regarding the practice.

Results
Eunuchs have occupied many important historical roles in many different societies and the practice of voluntary castration has continued to be prevalent to this day. There are many different inspirations as to why modern Eunuchs continue this practice. We explore the written evidence of these roles while also focusing on contemporary voluntary castration, what roles Eunuchs fulfill or desire in modern society, and motivations for doing so.

Conclusions
In this historical review, we explore written evidence of the roles Eunuchs traditionally held in historical societies while also focusing on contemporary inspirations for the practice, which continues to be a prevalent interest among some men.

Disclosure
No
(457) Comparing Longevity and Need for Revision Between 2- and 3-piece Inflatable Penile Prostheses
Authors: Berk B , Ernandez J , Gu C , Kathrins M 
Published: May 2023

Abstract

Introduction
The management of pharmacotherapy-refractory erectile dysfunction includes placement of an inflatable penile prosthesis (IPP). Although invasive, placement of an IPP is considered a safe procedure with high patient satisfaction rates. Broadly, these devices have two different inflation mechanisms: a two-piece (2p) device consisting of a pump and inflation cylinders, and a three-piece (3p) device, which incorporates a low-pressure reservoir. The relative difference in concealability has long been considered a major factor in patient decision-making. However, the difference in durability and subsequent need for revision amongst the two types of devices have not yet been explored.

Objective
To investigate differences in longevity and need for revision in patients with 2p and 3p IPPs.

Methods
After receiving institutional review board approval, a retrospective chart review was performed on all patients that underwent IPP revision or exchange for mechanical failure from 2001 to 2021 at our institution. Only patients who underwent revision of the initial device placed were included in the analysis. Men with retired IPP models or who underwent salvage protocol for infected prosthetics were excluded. Baseline characteristics, including history of diabetes or cardiovascular disease, smoking history, prior radical prostatectomy and/or pelvic radiation, and prior incontinence surgery were recorded. Cox proportional hazard models adjusted for age were developed comparing time to revision between 2p and 3p devices. Baseline characteristics were compared with descriptive statistics. Statistical significance was defined as p &lt; 0.05.

Results
A total of 64 men underwent IPP exchange or revision during the study period, including 38 and 26 men undergoing revision of 2p and 3p devices, respectively. Baseline characteristics are included in Table 1. The median number of days until first revision was 2,695 for 2p IPP compared to 2,101 for 3p IPP (p = 0.27). On unadjusted proportional hazard analysis, there was a significant longevity benefit for 2p IPP compared to all 3p devices [HR: 1.80 95% CI (1.09, 3.00), p = 0.02]. When controlled for patient age, 2p IPPs continued to have a significant longevity benefit compared to 3p devices [HR 1.87 95% CI (1.13, 3.09), p = 0.02].

Conclusions
Amongst our institutional cohort, 2p IPPs have significantly longer durability compared to 3p devices. These findings may be used to counsel patients who are deciding between different devices for management of their erectile dysfunction.

Disclosure
No
(467) Outcomes Of Penile Implant Surgery In The Elderly Patient
Authors: Habous M , Almannie R , Binsaleh S , Ralph D , Bittocchi C , Mulhall J 
Published: May 2023

Abstract

Introduction
Penile prosthesis implantation (PPI) is a highly effective therapy for erectile dysfunction (ED) with high satisfaction rates reported.

Objective
We aimed to investigate if age has an impact on the outcome and complications of PPI, and to compare the outcomes of PPI in elderly men compared to men of younger age.

Methods
The data analyzed in this study based on a huge multicenter prospective study of patients who underwent PPI at our centers between 2010 to 2015.The data included patient’s demographics, comorbidities, preoperative data, type of implant used, postoperative adverse events (early and late) and overall satisfaction. Patients were stratified according to age into two groups: group I less than 70 years, and group 2 equal or more than 70 years. Satisfaction was measured using a 5-point Likert scale, given to patients 1 year postoperatively, scored from 0-5 where 0 is dissatisfied and 5 is most satisfied.

Results
913 patients were included in this analysis, 814 in group 1 and 99 in group 2. Comorbidity profile and smoking habits were similar between groups, but hypertension was more frequent in group 2 (p less than 0.001). Preoperative glycated hemoglobin (HBA1c) was similar in both groups (8% and 7.8% respectively, p = 0.18).75% had a malleable implant group 1 and 83% group 2 (p = 0.21). The remaining had an inflatable implant placed. There was no difference in early, or late complications between the two groups (p = 0.11). Furthermore, there was no difference in the satisfaction between the two groups (p=0.13)

Conclusions
Penile implant surgery is effective with high satisfaction rate independent of age. It seems to be that age has no impact on increasing complication rate.

Disclosure
No
(473) Simultaneous Multidisciplinary Gender Affirming Surgery during COVID-19: Improving Access to Care for Military Patients
Authors: Luther R , Salter C , Hohman M , Teixeira J , Sabino J , Llewellyn C 
Published: May 2023

Abstract

Introduction
Access to surgical care for the transgender population has been a persistent challenge. Frequently cited barriers include long waiting lists, strict insurance prior authorization protocols, surgeon scarcity, financial cost, and social stigma. These issues have been magnified throughout the COVID-19 pandemic response, as the diversion of resources has led to the postponement of surgeries deemed “routine” or “non-essential.” Many medical societies and healthcare organizations have classified gender-affirming surgery (GAS) as such despite the World Professional Association for Transgender Health (WPATH) defining surgical care for gender dysphoric individuals as medical necessity. Unfortunately, delays in care for this population contribute to prolonged mental health distress. Another important barrier to access centers on the issue of surgical timing. Many patients cannot afford to postpone school and work obligations to undergo multiple surgeries each with long recovery times. Furthermore, staffing shortages nationwide have limited operating room (OR) availability. To respond to these issues, our center organized a multidisciplinary collaboration among various surgical subspecialties to perform simultaneous GASs (e.g., top and bottom surgeries). In this way, the patient can undergo multiple GASs in a single procedure, thus limiting anesthesia exposure, expediting postoperative recovery, improving patient satisfaction and maximizing limited healthcare resources.

Objective
To describe a multidisciplinary model for GAS involving simultaneous top and bottom surgery to improve access to care for the transgender population in a resource-limited environment.

Methods
Case report describing successful multidisciplinary surgical management of a transgender female desiring multiple simultaneous GAS.

Results
Patient is a 24-year-old active duty transgender female who met WPATH criteria for top and bottom surgery. She desired numerous procedures including simple orchiectomy, breast implants and facial feminization. Given our limited OR availability during COVID-19, the decision was made to perform all of these surgeries under the same anesthetic. She underwent breast augmentation and fat harvesting with plastic surgery, which was immediately followed by simultaneous simple orchiectomy by urology and facial feminizing surgery with otolaryngology. Total operative time was 8.3 hours. Patient was discharged on post-op day 1 and had an uneventful recovery without surgical or anesthetic complications.

Conclusions
Simultaneous GAS is an effective approach to improve access to care during the COVID-19 pandemic. A single anesthetic enables the patients to achieve their surgical goals sooner and to lessen their overall recovery time compared to staged procedures.

Disclosure
No
(475) Comparison of Female Sexual Function Index in Premenopausal Women and Postmenopausal Women
Authors: Kong M K , Cho J , Bai S 
Published: May 2023

Abstract

Introduction
Menopause is known to have a significant impact on mental health, women's quality of life, and sexuality.

Objective
The purpose of this study is to evaluate the impact of menopause on sexual function in women. The associations of sexual function with demographic and clinical variables were evaluated.

Methods
We performed a retrospective study comparing the relationship between female sexual function index and menopause in premenopausal women and postmenopausal women. Patients with a diagnosis of benign gynecologic disease who admitted for gynecological surgery at our institution from January 2009 to December 2012 were evaluated. Total 349 women were enrolled in this study and complete the Female Sexual Function Index (FSFI) questionnaires. Risk factors for female sexual function were examined using logistic regression models. Patients were separated into two groups: premenopausal women (group 1), postmenopausal woman (group 2). Women with prior gynecologic surgery were excluded. Continuous variables was compared using the two sample t-test, while non-continuous variables using the Chi-squared test.

Results
The mean age of the premenopausal women group was 41.7 years, and the average age of the postmenopausal women group was 58.8 years. There was no difference in parity, body weight, height, BMI, disease incidence, and smoking rate between the two groups. Comparing the female sexual function between the two groups, there was a significant relationship between menopause and female sexual function; Desires disorder (p value=0.00), Arousal disorder (p value=0.002), Lubrication disorder (p value=0.003), Orgasm disorder (p value=0.019), Satisfaction disorder (p value=0.002), Pain (p value=0.001), Total FSFI (Premenopausal women; 20.3/postmenopausal women; 15.3, p value=0.001). The result of the FSFI study between the two groups, the postmenopausal women group showed a significant decrease compared to the premenopausal women in all areas.

Conclusions
Female sexual dysfunction (FSD) is a complex disorder which has an impact on women regardless of their age and race, and related to a variety of biological, psychological, and social determinants. Sexuality impact quality of life through effects on the emotional and psychological health of a woman. Consequently, clinicians who take care of women appreciate when they may be vulnerable to sexual dysfunction. The menopausal transition, a time characterized by hormonal, physiologic, and social changes, is often associated with sexual dysfunction. As postmenopausal woman population is increasing, the further study will be needed in a larger subgroup of women with long-term follow up period.

Disclosure
No
(479) Diabetic ED Treatment by Treating Psychosocial Factors
Authors: Nasim M A F , Farooq U 
Published: May 2023

Abstract

Introduction
ED is either predominantly psychogenic or predominantly organic. Psychosocial factor prevalence in diabetic ED varies in different cultures and societies. Psychosocial factor is quite prevalent in Pakistan for e.g in Pakistani national language (Urdu) ED is named ‘NAMARDI’ meaning that ‘he is not a man’, so ED has a lot of psychosocial effect on a patient and treatment of this factor is significant in restoring normal sexual functions

Objective
The aim of this study is to find the outcome by treating psychosocial factors in diabetic ED patients by sex therapy, counselling and psychotropic drugs supported by good glycemic control and methyl cobalamin.

Methods
74 patients of diabetic ED were treated at Nasim Fertility Centre during Sep 2020 - Jan 2021 Aging from 42 years to 62 years. Duration of diabetes was from 3 to 24 years. Diagnostic work up included detailed medical and sexual history. HbA1c, testosterone and prolactin level were documented. These patients were treated on weekly basis for 10 weeks by sex therapy and counselling. Minimum effective doses of SSRI’s, benzodiazepines, yohimbine and I/M Testosterone were also prescribed. PDE-5 Inh were also prescribed as per requirement. Patients were also advised a healthy change in lifestyle, good glycemic control and regular sexual activity.

Results
Patients were divided in three groups depending upon the presenting complaints A- 36 out of 74 patients had presenting complaint of less erection and less time. By treatment mentioned above, normal sexual functions were restored in 30 patients (83%) and 6 patients (17%) needed PDE- 5 inh. B- 16 out of 74 patients had presenting complaint of using PDE-5 inh which was becoming less effective. By treatment mentioned above in 11 patients (69%) natural sexual functions were restored and 5 patients (31%) they had to use PDE-5 inh in less dose with better effects C- 22 out of 74 patients had presenting complaint that PDE-5 inh has become non effective. In 6 patients (27%) normal sexual functions were restored, in 12 patients (55%) PDE -5 inh became effective and in 4 patients (18%) PDE-5 inh was still non effective so they were advised I/D inj or vacuum constriction device.

Conclusions
Psychosocial factors in diabetic ED is quite prevalent in Pakistani society and treating this psychosocial factor helps to restore natural normal sexual response or improve the efficacy of PDE-5 inh in less dose.

Disclosure
No