bluuebunny/crossref_metadata_2025_split huggingface dataset:
(081) Comparing the Contributions of Nitric Oxide and Estrogen to Methamphetamine-Induced Alterations of Vaginal Blood Flow in Rats
Authors: Mott M , Goeders N 
Published: May 2023

Abstract

Introduction
Vaginal dryness is a frequent complaint, especially in post-menopausal women. The physiology underlying the production of vaginal lubrication in response to arousing stimuli is established; however, no current pharmacological agents successfully target mechanisms utilizing this physiology. Previous research from our lab has demonstrated that female methamphetamine (meth) users experience the production of excessive vaginal lubrication immediately following an intravenous injection of methamphetamine, and we have recapitulated this in an anesthetized rodent model. We have also found that this vaginal lubrication, as well as vaginal blood flow increased by meth, are heavily nitric oxide dependent.

Objective
The purpose of the current study is to determine if increased vaginal blood flow correlates with increased vaginal lubrication in response to meth, and to determine if alterations in this blood flow are dependent upon nitric oxide, estrogen, or both.

Methods
Adult female Wistar rats were implanted with chronic indwelling jugular catheters and allowed at least one week to recover from surgery. Rats anesthetized with isoflurane gas were intravenously infused with meth or saline via the implanted catheter. Vaginal blood flow, measured using a Periflux System 5000 and a small laser probe inserted 5-10 mm into the vaginal canal, was continuously recorded before and for at least twenty minutes following drug administration. After establishing meth-induced alterations in vaginal blood flow, rats were pre-treated with L-NG-Nitro arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor or fulvestrant, an estrogen receptor antagonist, followed by meth administration using the same procedure for measuring blood flow to determine the contribution of nitric oxide and estrogen.

Results
Meth immediately increases vaginal blood flow, followed by a decrease in perfusion, which is characteristic of a drug that induces such profound sympathetic activation. L-NAME reduced meth-induced increases in vaginal blood flow, and we predict that fulvestrant will be less effective.

Conclusions
Nitric oxide and estrogen are molecules critical to the production of vaginal lubrication. Nitric oxide, important for the vasodilation cascade leading to the production of vaginal transudate, contributes to meth-induced increases in vaginal blood flow and vaginal lubrication. Estrogen signaling likely contributes to meth-induced increases in vaginal blood flow, and thus, vaginal lubrication, but not as substantially as nitric oxide, making nitric oxide a better potential target for those suffering from vaginal dryness.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Embera NeuroTherapeutics & JanOne, both affiliations unrelated to current research
(109) Transdermally Powered, MRI Conditional Pump-in-Reservoir Implant Inflator System: Preclinical Studies
Authors: Burnett A , Horowitz M , Newman M , Newman H , DuComb W 
Published: May 2023

Abstract

Introduction
Inflatable medical implants have been used in the treatment of erectile dysfunction and both urinary and fecal incontinence. However, commercially available devices have required manual operation, which present difficulty in their use for patients lacking strength and dexterity to use such pumps. In women with urinary incontinence, anatomical constraints limit the use of manually operable inflatable devices.

Objective
The aim of this study was to conduct preclinical testing of a wirelessly powered inflatable medical implant system consisting of a medical provider software application, a patient external controller, and a magnetic resonance imaging (MRI)-conditional nonferrous pump-in-reservoir implant system.

Methods
An inflatable medical implant system was designed and tested. Serial prototypes designs included a nonferrous, reservoir-submerged package containing electronic motor and pump with piezoelectric valves, and an external controller resembling a TV remote. The implant system was evaluated after being connected to commercially available penile prosthetic cylinders. Power settings were tested at various thresholds; testing requirements considered to be clinically applicable were set as fluid transfer of 60 ml of normal saline at 25 psi within 45 seconds. The effectiveness of power transmission across the human abdominal wall was tested using an interface of a steak slab placed between the external controller and the implant system.

Results
Device testing at 24 and 36 volts determined that the latter was more efficient and afforded a smaller motor and pump package. Full penile cylinder inflation was recorded at 23 seconds. Effective power transmission was demonstrated across steak slabs.

Conclusions
A nonferrous pump-in-reservoir medical implant inflator system for penile prostheses is legitimate. It offers an improvement over manually operated inflatable devices, and because it eliminates a manual pump component there is feasibility of constructing a modified device for fluid transfer of urethral cuffs for treating urinary incontinence in men and women. The pump package within the reservoir is advantageous as a heatsinking feature that may limit implant overheating. Finally, the device design without ferrous components affords MRI compatibility.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Novartis
(117) Should Men Eat More Plants? A Systematic Review of the Literature on the Effect of Plant-Based Diets on Men’s Health in Urology
Authors: Feiertag N , Tawfik M , Loloi J , Patel R D , Green B , Zhu M , Klyde D , Small A C , Watts K 
Published: May 2023

Abstract

Introduction
There is considerable evidence describing the benefits of a plant-based diet and cardiovascular and metabolic disease. Emerging studies have evaluated the association between plant-based diets and urologic conditions affecting men’s health.

Objective
We performed a systematic review of the literature on the potential role plant-based diets may play in the following men’s health topics: prostate cancer (PCa), erectile dysfunction (ED), and benign prostatic hyperplasia (BPH).

Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system (PRISMA) criteria were followed to search PubMed and Medline databases for the following search terms: “Diet [Mesh]” OR “Diet Therapy [Mesh]” AND “Prostatic Hyperplasia [Mesh]” OR “Prostatic Neoplasm [Mesh]” OR “Erectile Dysfunction [Mesh]”. Articles in English published from 1989 to 2022 using human participants were analyzed. Data were summarized and bias assessment of the literature performed.

Results
Initial literature search yielded 345 articles. We excluded 121 articles based on title and abstracts not being pertinent to the study. The remaining 224 articles were screened for relevance resulting in 23 articles that met inclusion criteria. Ultimately, 12 PCa articles, 4 BPH articles, 5 ED articles, and 2 articles related to both BPH and ED were reviewed.

Conclusions
Several studies support the protective nature of plant-based diets in PCa, ED, and BPH patients. The use of plant-based diets for PCa had the greatest amount of literature supporting positive benefits, with reasonable data from large registry trials supporting the protective effects of a plant-based diet on incident prostate cancer. Strength of association between plant-based diets and condition were variable, and no studies reported a non-association or harmful effects of plant-based diets. Most trials are limited to observational and cohort studies which rely on patient-reported evaluations of diet, limiting the generalizability of most findings. Currently, there is a lack of evidence to guide urologists and men definitively toward plant-based diets for prevention and/or treatment of PCa, ED, or BPH, and thus further studies may be helpful to evaluate this relationship, particularly in the setting of a rising public consumer interest in these diets.

Disclosure
No
(140) Penile Length and Girth Restoration in Mb Peyronie: Less Invasive Approach for Complex Composite Graft Corporplasty and Implantation of Inflatable Penile Prosthesis
Authors: Stanojevic N , Ruffo A 
Published: May 2023

Abstract

Introduction
Peyronie's disease (PD) is a fibrotic disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, narrowing and shortening, which eventually compromise sexual function.

Objective
The presented technique is a less invasive approach that gives few complications, has a natural cosmetic outcome with preserved preputium, and high patient satisfaction.

Methods
In the period between December 2017 and May 2022, 65pts aged 33y to 78y underwent complex corporoplasty with inflatable penile prosthesis implantation. Mean penile curvature was 70 o (60 o -95 o ). Average penile shortening was 3.2cm (1 - 5.5cm), and girth narrowing 2.5cm (0 - 4cm). The surgical approach was thru penos-crotal incision, followed by direct dissection of NVB from tunica albuginea, penile eversion, composite corporoplasty (for transversal grafting 0.5mm thick porcine dermal graft, and for longitudinal graft composite semi-resorbable soft mash), and 3-piece inflatable penile prosthesis implantation. Postoperative vacuum drainage and compressive dressing were left in place for one week.

Results
Follow-up was 2-58 months (mean 21). Penile shape (corrected curvature, length and girth) was restored in all patients. In the first 4 weeks postoperatively 12pts had mild scrotal oedema; 8pts developed mild scrotal haematoma; 7pts developed penile skin oedema; 5pts had a transitory loss of sensitivity. All patients 5 weeks postoperatively started with sexual intercourse. All patients 12 weeks after surgery reported satisfactory aesthetical and functional results with no visible scaring related to surgery. Five pts (12-23 months after surgery) had prosthesis malfunction that needed reimplantation of the prosthesis.

Conclusions
Penile eversion thru peno-scrotal incision with preserving the prepuce for complex reconstructive surgery of PD is safe and gives the natural aesthetic appearance and good functional result with low complication rate. The high satisfaction rate for the patients is the most important aspect of this surgical method.

Disclosure
No
(151) Development of a New Peyronie’s Disease Self-Assessment Screening App
Authors: Tayi R , Broderick G A , Rosen G , Khera M , Hu Y , Sajan A 
Published: May 2023

Abstract

Introduction
Peyronie’s disease (PD) is a connective tissue disorder associated with the formation of fibrotic plaques in the tunica albuginea, leading to penile curvature. PD is underdiagnosed, and this may be related to the reluctance of some men to seek consultation with a health care provider (HCP).

Objective
The aim was to develop an English-language digital application (app) to increase PD awareness, give men concerned about penile curvature a self-screening tool, and provide a link for locating HCPs with expertise in PD.

Methods
The Peyronie’s Disease Self-Assessment App is Android- and iOS-compatible. It was developed as a self-assessment tool for screening purposes only. It is not intended to diagnose, treat, cure, or prevent any medical condition, disease, or health problem and should not be considered a replacement for a consultation with a physician. The app provides instructional videos on general features and how to perform a penile scanning procedure.

Results
The PD Self-Assessment App includes a questionnaire related to penile curvature, penetration difficulty, degree of bother for partner, and impact on sexual activity. An innovative feature of the app is a live scanning technology, which uses the phone’s camera to detect the contours of the penis from multiple angles and applies an algorithm that determines the degree of curvature. The resulting image is a 3D penile simulation in the app, which allows the user to mark the location of any “lumps.” The app will also produce a 2D outline to determine the maximum curvature. External links are provided to a PD education website and to locate an HCP. The patient can share both the questionnaire responses and penile curvature simulation with his HCP via the user’s native email. This tool has password protection features and encrypts sensitive data. The scan images are representations of the penis, not photographs. Images are stored in the app library and are not stored in the user’s photo gallery. To enhance security, all data are erased when the app is uninstalled. The app is adaptable and scalable as needed for future updates.

Conclusions
The PD Self-Assessment App will help improve patient knowledge of the condition, document penile deformity, and facilitate consultation with an HCP. For men with PD, the app will help ease their journey with PD. The app will assist HCPs with evaluation and diagnosis. Sequential documentation of penile curvature during medical treatment, during mechanical traction protocols, or following surgery will provide an evidence basis for tracking long-term outcomes in PD.

Disclosure
Yes, this is sponsored by industry/sponsor: Endo Pharmaceuticals Inc.

Clarification
Industry initiated, executed and funded study
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals Inc.
(204) Predictors of Non-Prescription PDE-5 Inhibitor Use in Adult Men - Results of a Community-Based Survey
Authors: Cabo J , Johnsen N 
Published: May 2023

Abstract

Introduction
PDE-5 inhibitors have long been the mainstay of medical management for erectile dysfunction but do carry the risk for potentially significant side effects, particularly when combined with other medications. The increased availability of these medicines from sources outside of a physician’s office may present risks to patients due to incomplete counseling or medication reconciliation and may also expose individuals to counterfeit medication. Prior work has shown PDE-5i inhibitors obtained online are frequently counterfeit with inaccurate dosing of the active ingredient. Factors associated with non-prescription PDE-5 inhibitor use remain incompletely characterized.

Objective
We sought to characterize associations of demographic variables, sexual function, and sexual orientation with PDE-5i obtained from non-prescription means.

Methods
Males 18 years and older were recruited through a national registry of volunteers (Research Match) to participate in an online survey. We assessed PDE-5 inhibitor use and the source of this medication within the last year. Validated scores for erectile function (IIEF-5) and ejaculatory function (PEDT) were obtained in addition to demographic data and sexual partner information. Univariable and multivariable logistic regression was performed to identify associations with obtaining PDE-5 inhibitors from a non-prescription source.

Results
Of the 1033 men who completed the survey, 348 reported using PDE-5 inhibitors in the past year (Table 1). Of this cohort, 88 (25.1%) reported obtaining PDE-5 inhibitors from an online source, purchase from non-pharmacy source, or obtained from family or friends. Men obtaining PDE-5i outside a physician’s office tended to be younger (median age 51.5 vs. 62, p&lt;0.001) than those obtaining it with a standard prescription. Sexual function characteristics including IIEF and PEDT scores were similar between groups. Men who have sex with men (MSM) were nearly twice as likely to have obtained PDE-5i from a non-prescription or online source (37.3 vs. 22.5%, P=0.018). Married men were less likely than single men to purchase PDE-5i from a nonprescription source (22.3 vs. 35.9%, P=0.017On multivariable analysis, only younger age was associated with increased odds of obtaining PDE-5i from an online or non-prescription source (OR 0.97, 0.95-0.98, P&lt;0.001; Table 2).

Conclusions
In this large, community-based study of adult men, we found that a quarter of PDE-5i users had obtained medication from either an online source or from family or friends. Furthermore, we found that younger men and men who have sex with men were more likely to obtain these medicines from alternative sources. While these medicines are typically well tolerated, medication obtained from unreliable sources is more likely to be counterfeit and may place individuals at higher risk for adverse events.

Disclosure
No
(216) Insufficient Medical School Sexual Health Curriculum Leads to Inadequately Prepared Trainees
Authors: Kemble J , Köhler T , Helo S , Warner J N , Ziegelmann M 
Published: May 2023

Abstract

Introduction
Sexual Health Curriculum (SHC) in medical schools has been insufficiently training medical students for many years. While most medical schools report teaching a SHC, many medical students and residents report being inadequately trained in sexual health. This has led to infrequent physician screening for sexual problems due to insufficient knowledge and a lack of training about sexual function and dysfunction.

Objective
To investigate the current body of literature for changes in SHC in medicals schools in the last 20 years, and to identify any discrepancies between SHC taught in medical school and resident and medical student comfort in treating Sexual Health Dysfunction.

Methods
A literature review was conducted in PubMed on “sexual health education in medical school”, and of 16,962 results 37 relevant papers published in the U.S. and Europe were identified and analyzed.

Results
In 2003 86% of medical schools reported teaching over 3 hours of SHC, but by 2021 only 65% of students and 50% of PGY 4/5 Urology residents recalled a dedicated SHC in medical school. Consistently 50% of medical students are unsatisfied with their SHC, 52% are rarely or never evaluated on their sexual history taking skills, and 7% report not learning about human sexuality at all. Most German medical students believe that sexual health courses should be mandatory. Medical students have overall positive attitudes towards sexual and gender minority populations but lack adequate knowledge, especially about transgender and intersex health. Only 55% of 3rd/4th year OBGYN residents reported feeling comfortable in performing a targeted sexual dysfunction exam, and 66% of residents in Family Med, IM, OBGYN, and Psych had no previous educational experience in sexual problem management.

Conclusions
Sexual health curriculum in medical schools has not significantly improved in the last 20 years, leading to students and residents inadequately prepared to treat sexual health dysfunctions. The adoption of previously proposed SHC competencies for medical schools should be strongly considered.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
(242) Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery: Trends after Publication of the AUA Best Practice Statement
Authors: Brant A , Lewicki P , Punjani N , Kang C , Marinaro J , Thirumavalavan N , Halpern J , Shoag J , Kashanian J 
Published: May 2023

Abstract

Introduction
In April 2008, the American Urological Association (AUA) released a Best Practice Statement on antimicrobial use in urologic surgery, in which the combination of an aminoglycoside with either vancomycin or a 1st/2nd generation cephalosporin was recommended as the preferred antimicrobial regimen for inflatable penile prosthesis (IPP) implantation. This recommendation has come under scrutiny due to weak evidence supporting these combinations.

Objective
To assess changes in antibiotic prophylaxis for IPP surgery following publication of the AUA Best Practice Statement in April 2008.

Methods
The Premier Healthcare Database, an all-payer dataset that captures approximately 20% of hospital discharges in the United States, was queried for IPP surgeries from January 2000 to March 2020. The primary outcome was administration of an AUA-adherent antimicrobial regimen and secondary outcome was 90-day explant. Piecewise linear regression was used to compare antimicrobial trends before vs. after guideline publication. Multivariable logistic regression models were constructed for primary and secondary outcomes.

Results
A total of 26,574 patients who underwent IPP surgery were identified, of whom 17,754 (67%) received AUA-adherent antibiotics. After guideline publication, there was a 42% relative increase in AUA-adherent regimen usage, with an increase in the usage trend on piecewise linear regression (from 0.1% to 0.8% of encounters per quarter, R2=0.75, p&lt;0.001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0% of encounters per quarter, R2=0.84, p&lt;0.001) and vancomycin (0.1% to 0.7%, R2=0.77, p&lt;0.001). On multivariable regression, odds of AUA-adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54 – 1.80, p&lt;0.001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07 – 2.35, p&lt;0.01). The risk of 90-day IPP explant was not associated with adherence to an AUA-recommended regimen (OR: 0.94, 95% CI: 0.75 – 1.18, p=0.6).

Conclusions
Publication of the AUA Best Practice Statement on Antimicrobial Prophylaxis was associated with a subsequent increase in the usage of AUA-recommended antibiotic regimens, with gentamicin and vancomycin being the most frequently used combination. No association was observed between AUA-adherent regimens and risk of 90-day explant. These findings suggest that the AUA Best Practice Statement, among other relevant communications on antimicrobial use at the time, led to significant changes in prophylactic antibiotic choice in IPP surgery, despite the absence of level-1 evidence regarding a superior choice.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Roman Health.