bluuebunny/crossref_metadata_2025_split huggingface dataset:
173 Penile Implants in Japan
Authors: Nagao K. , Nakajima K. 
Published: May 2022

ABSTRACT

Introduction
In Japan, APSSM's founding president Shirai developed a silicon single rod that is inserted into the outside corpora in 1971. In the 1990s penile prostheses started to be sold in Japan. However, sales stopped in 2007. Since then, it has been up to doctors to order them individually.

Objective
we performed 141penile prothesis surgeries between 1992 and 2019.9. Age is 25-81 years average 62 ± 8 years old. the causes of ED are Diabetes 57 cases, arteriosclerosis (hypertension) 24 cases, failure of prosthesis surgery 17 cases, intrapelvic surgery (prostate ca, bladder Ca, rectal Ca) 16 cases, brain disease (bleeding, infarction, Parkinson, meningitis) 12 cases, Renal failure 7 cases, Peyronie ’s disease 5 cases, priapism 2 cases, wrong masturbation habit 1 case. Diabetes was the most common cause. Diagnosis is vasculogenic and neurogenic 88 cases, vasculogenic 54 cases, vasculogenic and curvature 3 cases, neurogenic 6 cases.

Methods
Anesthesia method is local anesthesia (penile block) 128 cases, general anesthesia 13 cases. Penile prostheses were AMS 700CXM 6 cases, Titan OTR narrow base (Coloplast) 2 case, hydroflex 1 case, AMS Dura II 26 cases, AMS 600 17 cases, Genesis (Coloplast) 84 cases, Koken (Japan) 5 cases. We have used AMS since 1992, The sale of penile protheses in Japan was halted in 2007. Since 2008, Our University doctors have been ordering Coloplast prostheses Implanted penile prosthesis size is 11-19.5cm length average 15.9cm, median 16cm. The diameter is Dura II 1cm (26 cases), AMS 600 0.95cm (15 cases) 1.15cm (2 cases), Genesis 1.1cm (28 cases), Genesis 0.95cm (56 cases). Day surgeries are popular therefore 94% of patients prefer a non-inflatable prosthesis. We devised a single-implant procedure and performed surgery for the following indications:1. Narrow cavernosum because of congenital abnomarity or re-operations. 2. Small penis. 3. Uncontrolled diabetes. 4. ED caused by corporal veno-occlusive dysfunction (CVOD) in a young man. 5. Patient preference for a warm erect penis (with a PDE5 inhibitor). Single implant surgery has a high satisfaction rate of 98% with no complications, but there are still many enlargement operations and use of PDE5 inhibitors.

Results
Intercourse was possible 137 cases (97.0%) and impossible 4 cases (3.0%). Ejaculation was possible 100cases (77%), impossible 32 cases (24%) (prostate or rectal surgery, retrograde ejaculation due to DM). Complication rate is 7.8%, exposure of one side prosthesis to urethra 2.8%, exposure of one side prosthesis to skin 0.7%, Exposure of tube (AMS700CXM) 0.7%, persistent pain 2.1%, infection 1.4%. Satisfaction rate is 95.0%

Conclusions
The penile prosthesis is still considered to be the surgical gold standard for treatment of ED. All other available treatments for ED should be compared with the results of penile prosthesis surgery. In Japan, 95% of day surgeries use non-inflatable prostheses.

Disclosure
Work supported by industry: no.
180 The Efficacy of Amoxapine for Ejaculatory Dysfunction
Authors: Watanabe A. , Kitamura H. 
Published: May 2022

ABSTRACT

Introduction
Amoxapine, as a tricyclic antidepressant, inhibits noradrenalin reuptake and is often used in the treatment for retrograde ejaculation in Japan.

Objective
To evaluate the efficacy of amoxapine for ejaculatory disorder in our hospital, retrospectively.

Methods
Seventeen men (age 38.4 ± 5.2 y) complaining with infertility or decrease of ejaculated semen volume who received amoxapine (25-75 mg/day) for retrograde ejaculation or emission less were included. The changes of semen analysis parameters before and after amoxapine therapy were examined. When the semen volume increased after therapy, it was considered to be effective. Wilcoxson signed-ranks test was used for statistical analysis. P &lt; 0.05 was considered to be significant. This study was approved by the ethical committee of Toyama university hospital.

Results
It was diagnosed retrograde ejaculation in 15 patients (complete type 3, partial type 12 cases), and emission less in two patients. The causes of ejaculatory disorders were diabetes mellitus in 4 patients, urethral trauma in 1 patient, antidepressants in 1 patient, anti-androgenetic alopecia drugs in 1 patient, sigmoidectomy for dolichocolon and proctopexy for rectal prolapse in 1 patient, and unknown cause in 9 patients. The average value of BMI in patients was 25.0 ± 4.18. Each patient had normal level of the total testosterone in blood. The average score of International Index of Erectile Function score and Erection hardness score before treatment showed 49.8 ± 17.9, 3.13 ± 0.62, respectively. The efficacy rate of amoxapine was 78.6%. Before and after amoxapine therapy, semen volume increased significantly from 0.29 ± 0.31 ml to 1.23 ± 1.56 ml, sperm concentration did from 19.5 ± 34.7 × 106/ml to 99.3 ± 172.7 × 106/ml, and total sperm count did from 7.83 ± 14.0 × 106 to 94.8 ± 149.7 × 106, respectively. By the amoxapine therapy, the antegrade ejaculated sperm count ratio* significantly increased from 28.1 ± 37.6 to 65.7 ± 40.1%. The average duration of amoxapine therapy was 13.0 ± 20.6 months and the maximum duration was 80 months. No side effects were observed. Of all patients, 15 patients would hope to have baby. There were 3 spontaneous pregnancies and 2 pregnancies due to assisted reproductive technology. All 5 pregnancies resulted in delivery.

Conclusions
It was suggested that amoxapine is an effective drug for ejaculatory disorder and might not only increase ejaculation volume but also improve sperm concentration and total sperm count.
*(total sperm counts in ejaculated semen / (total sperm counts in ejaculated semen + total sperm counts in urine after orgasm)) × 100%

Disclosure
Work supported by industry: no.
221 Incidence of Climacturia in Men with Sexual Dysfunction after Radical Prostatectomy
Authors: Gamberini P , Ribeiro H , Sayao R , Pedrenho R , Barbosa Neto C , Goes P , Nascimento B , de Bessa Júnior J , Nahas W , Srougi M , Amoedo F 
Published: May 2022

ABSTRACT

Introduction
Many series report the incidence of climacturia after radical prostatectomy (RP) as greater than 50%, and yet it is remarkable the short space for its discussion, which remains largely unrecognized and unaddressed.

Objective
Our aim was to describe the incidence and characterize climacturia in patients with erectile dysfunction (ED) after RP.

Methods
We performed a retrospective analysis of a prospectively maintained database of men after RP with complaints of ED not responsive to oral therapy. Patients seen in the sexual medicine group of our institution underwent a structured visit which included the investigation of the presence of climacturia and a detailed characterization (frequency, intensity, discomfort). Other factors such as the presence of stress urinary incontinence (SUI) and demographics were also recorded. Finally, patients were asked if they were counseled of this possible side effect of RP.

Results
Data from 56 patients were available, with a mean age of 66 years. Climacturia was reported by 37 patients (66,07%). Of these, 62,2% reported to occur rarely or occasionally, while 37,8% reported to occur frequently. In terms of the amount of urinary leakage, the vast majority (79%) reported leakage in small amounts, with only 8 patient (21%) reporting leakage in moderate volume. In general, 28,6% reported that climacturia generated significant discomfort, and only 10,5% recalled being warned preoperatively. Among patients with climacturia, 19,35% had SUI.

Conclusions
Our analysis supports a high incidence of climacturia, with perceived negative impact on approximately half of patients and with almost 90% of them not being aware of this possible complication. This preliminary analysis is one of the first on sexual urinary incontinence in Brazil and highlights the importance of its recognition and better patient counseling.

Disclosure
Work supported by industry: no.
222 Determinants of Female Orgasm in Medical Students from Southern Brazil
Authors: Castralli H , Tronco G , Salatino L , Motta G , Zancan M 
Published: May 2022

ABSTRACT

Introduction
The female orgasm is understood as a physiological experience within a psychosocial context. As such, inter and intrapersonal factors can cause orgasmic inconsistency. Since women not only achieve orgasm at substantially lower rates than men, but also fake orgasms more often than these, it is important to identify determinants of orgasm in this population.

Objective
To analyze the factors associated with female orgasm among medical students in southern Brazil.

Method
Cross-sectional study developed with young female adults that answered an online survey with 34 questions covering sociodemographic, behavioral and sexuality aspects. The validated Portuguese version of the Female Sexual Function Index questionnaire (FSFI-6) was applied, which is composed of six questions scored from 0 to 5, addressing the main sexual domains: desire, arousal, lubrication, orgasm, satisfaction and pain. A total FSFI-6 score ≤ 19 was considered a positive screening for female sexual dysfunction. The practice of physical activity was divided in not practice, practice 1 or 2 times, 3 or 5 times and 6 or more times. We used the Kruskall-Wallis statistical test for quantitative analysis.

Results
Of the 169 participants, 96.4% (n=163) were sexually active. The analysis of the FSFI-6 revealed a statistically significant association between the worst medians in the orgasm parameter and the variables: lack of physical activity (p=0.01), single marital status (p=&lt;0.001), use of oral contraceptives (p=0.012) and condom (p=0.003) as contraceptive methods. In contrast, in this study, no association was observed between orgasm and sexual orientation, consumption of alcohol, tobacco or illicit drugs.

Conclusion
The findings reinforce the hypothesis that female orgasm is determined by several factors, some of them modifiable, and its recognition is relevant in the approach to sexual dysfunctions in women.

Disclosure
Work supported by industry: no.
230 Relationship Between Self- Image of Penile Size and Erectile Function in Japanese Men
Authors: Suetomi T , Ichioka D , Iimura T , Kojo K , Ikeda A , Kimura T , Kawahara T , Hoshi A , Kandori S , Negoro H , Nishiyama H 
Published: May 2022

ABSTRACT

Background
Many studies on penile size have been conducted in other countries, but very few in Japan. Furthermore, there are no reports about men's self-image of penile size or the effect of self-image on erectile function.

Objectives
We investigated penile size in male urology outpatients and examined the difference between subjective and objective penile size and the relationship between self-image and erectile function.

Materials and Methods
186 patients who visited our clinic between April 2007 and March 2015 with the chief complaint of late-onset hypogonadism symptoms were enrolled. Patients were asked to complete a questionnaire that included their self-assessed flaccid and erect penile length, self-image of their penile size, SHIM (Sexual Health Inventory for Men) score, and time to ejaculation. All objective penile measurements including stretched length and circumference were performed by the same physician (s).

Results
The mean self-assessed flaccid and erect penile lengths were 6.8 cm and 12.5 cm, respectively. The mean objectively measured flaccid and stretched penile lengths were 8.3 cm and 12.6 cm, respectively. Most of the patients (71.0%) rated their penis as normal, 27.9% as small, and only 1.1% as large. 28.5% of the patients described their penis as short, and 17.2% as thin. The mean SHIM score of patients who rated their penis as small (7.9) was significantly lower than that of patients who rated their penis as normal (10.5) (p&lt;0.05). The mean time to ejaculation of all patients was 8.7 minutes, and that of the patients with premature ejaculation was 4.6 minutes. Fewer cases (8.6%) desired treatment for penile length, compared to those desiring treatment for ED (31.7%) or premature ejaculation (18.3%).

Conclusion
Compared with reports from other countries, a high percentage of Japanese patients are dissatisfied with their penile size, and these patients may have a lower self-esteem with respect to their erectile function.

Disclosure
Work supported by industry: no.
232 The Outcome of Gracilis Muscle Flap Wrapping Around the Neourethra-Native Urethral Anastomosis after Radial Forearm Free Flap Phalloplasty on the Incidence of Fistula Formation
Authors: Elsayed A , Shorbagi G El , Abdel-Rassoul M , Ghoneimy M El , Hamid M Abdel , Fayad A , Rahman S Abdel 
Published: May 2022

ABSTRACT

Introduction
The radial artery-based free-flap phalloplasty (RFFP) is accompanied by high rates of fistula formation and urological complications. We thought to investigate the impact of pedicled gracilis muscle flap wrapping around the urethral anastomosis on the occurrence of fistula at the neourethra-native urethral junction.

Materials and Methods
Prospective study was conducted at the urology department of Cairo University Hospitals. Patients presenting with micropenis (stretched penile length ≤7 cm) underwent RFFP. The RFF was harvested from the non-dominant forearm after ensuring of good collateral supply to the hand. All patients underwent RFFP with pedicled gracilis muscle flap wrapping. Under microscopic guidance, the radial artery was anastomosed with the inferior epigastric artery, the cephalic vein with the great saphenous vein and the medial and the lateral ante-brachial nerves with the ilioinguinal nerve and the dorsal penile nerve, respectively. Data were reviewed for demographics and perioperative outcomes.

Results
Nineteen patients were included in the study with a median follow up of 11 months (3, 22). Median age of 26 yrs (16, 43), hospital stay was 7 days (7, 30) and. Indications for RFFP were: micropenis (40%), post-surgery crippled penis (25%), amputated penis (20%), aphallia (5%), epispadias (5%) and gender dysphoria (5%). Median ischemia time was 88 mins (60, 120), ebl was 600 cc (300, 2000) and operative time 11 hrs (8, 14). Intraoperative complications were a case of transection of the radial artery during graft harvesting, failure to tubularize the graft and significant blood loss during vaginectomy. Overall success rate was 70%. 5 cases had a complete success, only one case had a fistula at the neo-uretheral native urethral anastomosis, one patient had a distal fistula and another patient had a ring stricture at site of anastomosis. 8 cases were complicated by complete disruption of the urethra. 6 cases were complicated by total graft loss (2 cases due to arterial causes and 4 cases due to venous congestion).
No donor site morbidity was noted. During follow up patients reported shortness in the mean length of the phallus was 2.1cms. All patients reported recovery of both general and erogenous sensations in the neo-phallus. The recovery of the general sensation (tactile stimulation and two-point discriminations) ranged between 2 to 4 weeks post-operatively while recovery of the erogenous sensation occurred between 8 to 16 weeks.

Conclusion
The use of pedicled garcilis flap during RFFP resulted in a fistulae rate of 20%.

Disclosure
Work supported by industry: no.
237 Gender Differences in Internet Use for Sexual Purposes in Individuals Aged 55 Years and Over
Authors: Oliveira M , Scanavino M 
Published: May 2022

ABSTRACT

Introduction
Surveys indicate gender differences in the general population in the use and frequency of the internet and in the use of applications for the expression of sexuality online, with the majority of users being male. Despite several studies already carried out regarding the gender difference in the expression of sexuality online, there is a lack of scientific studies seeking to identify the influence of gender in individuals aged 55 years and over in the expression of sexuality

Objective
The aim of this descriptive study is to compare the distribution the internet use for sexual purposes behavior among the male and female gender in individuals aged 55 years and over.

Methods
119 (66.39%] female and 33,61% male) participated in this research, conducted through an online survey in Brazil, aged 55 years or more. The instruments that were applied in the online survey include the Sociodemographic Questionnaire, Internet Use, General Technical Interest and Protocol Online Sexual Behaviour and Satisfaction. Statistical analyzes were performed using Stata software.

Results
Regarding sociodemographic variables, no statistically significant differences were identified in relation to education and marital status by gender, and a greater number of participants of both genders with a complete postgraduate degree (51.26%) and married (48.74%) were registered. On the other hand, with regard to age, there were statistically significant differences (p value=0.040) in relation to gender, with the sample of men (M=63.47%, SD=4.66) older than women (M=61.65%, SD=5.13) Similarities were identified in the results by gender of participants aged 55 and over in this study regarding interest in new technologies (91.60% of participants are interested in new technologies), internet usage (96.64% of the sample uses it daily) and frequency of use of social networks (47.06% use up to three hours a day), dating sites (91.60% do not use it), online games (97.48% of the sample does not use it) and applications/chats (45.38 % of the sample use between one to three hours a day) for the expression of sexuality. Regarding the frequency of use of pornographic sites, there was a significant difference (p&lt;0.001) by gender with the sample of men (65%) using sites with explicit content compared to women (11.39%).

Conclusions
In the present study, it was identified that the significant differences between genders only occurred in relation to the age of the sample, with men older than women and in relation to the consumption of pornography, with men using pornographic websites for sexual purposes in a greater proportion compared to the women's group. Through this research with individuals aged 55 years or more, it was found that the differences between genders are less significant than expected with regard to the frequency of internet use and behavior for sexual purposes on the Internet.

Disclosure
Work supported by industry: no.
239 Improved Peyronie's Disease Curvature Outcomes Using a More Aggressive Collagenase Technique
Authors: Tyler A , Green B , Savage J , Brearton K , Burgon H , Trost L 
Published: May 2022

ABSTRACT

Introduction
Since the FDA approval of Collagenase Clostridium Histolyticum (CCH) for the treatment of Peyronie's Disease (PD), several investigators have reported outcomes of CCH, with improvements ranging from approximately 15-30%. More recently, we reported improved results (49% mean improvement) when CCH was combined with RestoreX penile traction therapy (RxPTT). Since then, we have made additional modifications to create a more aggressive injection / traction protocol to further optimize outcomes.

Objective
To report outcomes of a more aggressive CCH injection / traction protocol in men with PD.

Methods
A prospective database has been maintained of all individuals undergoing CCH injections since 2014. Our CCH injection protocol has evolved from the one described in the IMPRESS trials to a more aggressive use of injections and manual and mechanical traction. Currently, the protocol consists of injecting 0.9 mg of CCH in 0.7 ml of saline into approximately 15-20 sites around the point of maximal curvature (pharmacologically-induced erection performed with the first injection of each series). Injections are only performed on subsequent days (not 2-3 days apart), and very aggressive (i.e. 10-15 lbs of force) modeling is performed with the 2nd injection. Patients are counseled to begin RestoreX traction at 24-48 hours after the 2nd injection for 30-60 minutes daily, and to continue aggressive manual modeling for at least the first week post injection. Penile wraps are applied for 5 days post injection. A descriptive analysis was subsequently performed to review outcomes.

Results
A total of 320 men underwent at least 1 series of CCH and had baseline and follow-up curve assessment data available. Mean age was 55.8 (SD 10.4), with a mean PD duration of 27.8 months (SD 53) and a median baseline composite curvature of 64 degrees (IQR 45-80). Curvature improvements (most recent minus baseline) improved over time, correlating with increased injection experience and implementation of more aggressive traction protocols: 2014-2020 (20 degrees, 29% improvement) vs 2020-mid 2021 (27.8 degrees, 50%, p&lt;0.001). When men were stratified by those who either completed 8 injections or indicated that they were satisfied with outcomes (n=147), median results were more pronounced: 2014-2017 (29% improvement), 2018 (38%), 2019 (47%), 2020-mid 2021 (59%), p&lt;0.01.

Conclusions
Progressive implementation of a more aggressive CCH injection protocol has resulted in improved curvature outcomes. Given the specialized nature of technique modifications described, these results would argue for a center-of-excellence model for CCH administration to achieve optimal outcomes.

Disclosure
Work supported by industry: no.
254 A Study on Knowledge, Attitude and Practices of Andrological Problems Among Male Patients at a Public Tertiary Care Hospital in Western India
Authors: Hegde A 
Published: May 2022

ABSTRACT

Introduction
Patients with andrological problems especially in developing countries do not readily seek treatment with health care professionals. Various barriers to treatment exist including cultural taboos associated with these problems. This has been an unexplored area among Indian patients especially in the public healthcare domain. Public health care set ups in India deal with a huge volume of patients and many set ups do not have dedicated andrology services to handle such patients.

Objectives
To evaluate the knowledge, attitudes and practices related to andrological problems among the out-patient population, an observational questionnaire survey was administered.

Methods
A cross sectional questionnaire survey was conducted on 400 andrology OPD patients over one year. They were given a questionaire that asked basic questions about demographics, sexual habits, education and income level. Subsequent questions assessed the knowledge, attitudes, practices and help seeking behaviour about andrological problems. On follow up, questionnaire recorded the same details along with satisfaction with the andology services.

Results
The mean age of the 400 men was 46.4 years; 73% were &lt;50-years-old and 74% had a low income, 60% had low education. The mean time between noticing a symptom and first hospital visit was 5.3 months. Of the 400 respondents, peer groups (30%) and internet (26%) were most frequently consulted sources for information about ED initially. Older patients preferred consulting with physicians. Side effects of treatment were the greatest concern, especially for older patients. More than 95% of the respondents were satisfied with the andrology services and hospital environment. All patients felt a confidential environment in a dedicated OPD helped them.

Conclusion
Patients frequently consult their peer groups and the internet for information about andrology issues. We believe there should be more awareness about men's health issues and the options available for treatment. Dedicated andrology services among others, go a long way in bridging the gap.

Disclosure
Work supported by industry: no.