bluuebunny/crossref_metadata_2025_split huggingface dataset:
278 Sexual Function after Gender Affirming Phalloplasty
Authors: Boskey E , Jolly D , Ganor O 
Published: May 2022

ABSTRACT

Introduction
Gender-affirming phalloplasty involves the construction of a neophallus using one or more flaps, most often a radial forearm free-flap. Although numerous articles have reported on short-term surgical outcomes of phalloplasty, relatively few studies have followed phalloplasty patient prospectively, starting from before surgery, in order to determine how surgery affects sexual function, including orgasm.

Objective
As part of a prospective, longitudinal study of barriers to and outcomes of masculinizing gender affirming surgery, researchers assessed patients’ sexual function both prior to and after phalloplasty. This represents a sub-analysis of a larger, ongoing research study addressing psychosocial outcomes of gender affirming surgery, including decision regret.

Methods
The population included in this analysis includes 7 patients who had been followed for at least 6 months after phalloplasty – at which time post-operative sexual function was initially assessed. Six of those patients were also assessed at one year about other psychosexual outcomes of surgery. Both of these assessments involved custom instruments developed for this study. All patients included in this analysis has been assessed at least once prior to surgery. The most recent assessment was used for all patients.

Results
Of the included participants, five identified as male and 2 as transgender male. All were White and not Hispanic. All patients who had been assessed for sexual function after phalloplasty reported having been able to experience an orgasm after surgery. Five patients stated that they were satisfied or very satisfied with their sexual sensation during the most recent assessment, and 4 stated they were satisfied with their non-erotic (tactile) sensation. However, only one patients reported being satisfied with being able to urinate as they chose. Despite no patients having undergone penile prosthesis insertion at the time of assessment, one patient reported having been able to engage in sexual penetration with a partner. Of the 6 patients who had completed at least one year of follow-up, all reported their masculine self-image was either slightly or much better. Five reported that their nude appearance was slightly or much better, and all reported an increase in comfort in public locker rooms and showers.

Conclusions
Overall, preliminary longitudinal data suggests that patients who have undergone gender affirming phalloplasty are satisfied with their sexual function, even when they are unsatisfied with their ability to urinate as they choose. These results support previous research showing that orgasmic function can be maintained after gender affirming phalloplasty. Future data will help determine if phalloplasty can improve orgasmic function in the subset of gender affirmation patients who report no history or orgasm prior to surgery.

Disclosure
Work supported by industry: no.
010 Satisfaction Rates of Inflatable Penile Prosthesis in Men Who Have Sex With Men
Authors: La J. , Loeb C. , Chung E. , Gross M. , Hatzichristodoulou G. , Park S.H. , Perito P. , Sarmiento A.S. , van Renterghem K. , Yafi F. 
Published: May 2022

ABSTRACT

Introduction
Men with erectile dysfunction have high patient satisfaction after placement of inflatable penile prostheses (IPP), but the impact on satisfaction and quality of life has never been studied in men who have sex with men (MSM) with erectile dysfunction.

Objective
To assess the satisfaction rates and quality of life of MSM after placement of IPP for erectile dysfunction.

Methods
A multi-institutional, retrospective study enrolled adult men who self-identified as MSM and underwent inflatable penile prosthesis placement with either AMS 700TM LGX, AMS 700TM CX or Coloplast TitanTM models. Two questionnaires were administered at one timepoint post-operatively. The Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) is a 11-item validated questionnaire measured on a 0-100 scale. The Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) is a 16-item questionnaire subcategorized into 4 domains: functional, relational, social, and personal. Fisher's exact test and paired t-test were used to calculate significance with p-values &lt;0.05 considered significant.

Results
Forty-nine MSM were assessed with a median age of 62 years (interquartile range [IQR], 53-69) with median follow-up of 14.2 months (IQR, 8.1-21.9). AMS 700TM LGX, AMS 700TM CX or Coloplast TitanTM IPPs were placed 2, 2 and 45 men, respectively. For the entire cohort, the median EDITS score was 93 (IQR, 91-95) and the median QoLSPP scores each domain were functional 23/25 (IQR, 22-24), relational 17/20 (IQR, 15-18), social 15/15 (12-15), personal 18/20 (IQR, 17-19) with a total of 72/80 (IQR, 68-76).

Conclusions
MSM report high satisfaction rates and quality of life after IPP placement for ED.

Disclosure
Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Coloplast, Boston Scientific/AMS, Urofill, ).
013 Testosterone Positively Regulates Vagina NO-Induced Relaxation: An Experimental Study in Rats
Authors: Comeglio P. , Cipriani S. , Cellai I. , Filippi S. , Maseroli E. , Stasi V. Di , Todisco T. , Fambrini M. , Rastrelli G. , Maggi M. , Vignozzi L. 
Published: May 2022

ABSTRACT

Introduction
Female sexual response is a result of a complex interplay between central and peripheral mechanisms and the nitric oxide (NO)-mediated relaxation of clitoris and distal vagina vascular bed leads to clitoris tumescence and vagina lubrification.

Objective
The aim of this study was to evaluate sex steroids regulation of the relaxant/contractile pathway in vagina, using a validated animal model of ovariectomized (OVX) Sprague-Dawley rats.

Methods
Subgroups of OVX rats were treated with 17β-estradiol (10 mg/kg/die), testosterone (T, 30 mg/kg/week), or testosterone and letrozole (2.5 mg/kg/die) for 6 weeks. The experimental groups were compared with a group of intact rats. In vitro contractility studies were carried out in order to investigate the effect of OVX and in vivo treatments on vaginal smooth muscle activity. RNA from vaginal tissue was analyzed by semi-quantitative RT-PCR.

Results
In vitro contractility studies were performed on noradrenaline pre-contracted distal vaginal strips, isolated from each experimental group. Acetylcholine (Ach; 0.001-10 µM) stimulation induced a concentration-dependent relaxation, which was significantly reduced by NO-synthase inhibitor L-NAME (100 µM) and by guanylate cyclase inhibitor ODQ (1 µM). OVX resulted in a decreased responsiveness to Ach, restored by T supplementation, with or without letrozole, but not by 17β-estradiol. Vaginal strips sensitivity to the NO-donor SNP (1 nM - 100 µM) was higher in OVX than in the control. Vardenafil (100 nM), a PDE5 inhibitor, enhanced SNP effect in OVX+T as well as in control, suggesting that T positively modulates PDE5, as supported by RNA expression analysis.

Conclusions
In vitro contractility studies and mRNA expression analysis highlight the positive regulation of T on Ach- and NO-dependent muscle relaxation by modulating the NO/cGMP/PKG pathways.Our data demonstrate that testosterone improves the NO-mediated vascular smooth muscle vaginal cells relaxation confirming its critical role in maintaining the integrity of muscular relaxant machinery. Our study confirms the decisive role played by androgens, rather than estrogens, in maintaining the functionality and integrity of the vagina. This study might provide support for the use of androgens in the treatment of genitourinary syndrome of menopause (GSM) and/or sexual arousal disorders related to ageing related-hormonal deficiency.

Disclosure
Work supported by industry: no.
015 Testosterone Level in Seminal Vesicle Fluid is a Better Indicator of Sexual Function than Serum Testosterone in Patients with Prostate Cancer
Authors: Kashiwagi E. , Shiota M. , Monji K. , Lee K. , Matsumoto T. , Takeuchi A. , Inokuchi J. , Eto M. 
Published: May 2022

ABSTRACT

Objective
Semen comprises prostatic fluid and seminal vesicle fluid, which makes up the largest proportion. Seminal vesicle fluid contains various factors such as prostaglandin E2 (PGE2), zinc, and testosterone, which play important roles in sperm motility. Although serum testosterone is important in sexual function, many points are unclear regarding correlations between serum testosterone level and erectile function. We hypothesized that testosterone in seminal vesicle fluid may affect sexual function.

Methods
After receiving institutional review board approval, we collected seminal vesicle fluid samples from 132 Japanese patients with localized prostate cancer who underwent robot-assisted prostatectomy at Kyushu University Hospital from May 2017 to August 2020. We examined the relationship between results of the Sexual Health Inventory for Men (SHIM), Erection Hardness Score (EHS), an original questionnaire (presence or absence of sexual desire), and concentrations of testosterone in seminal vesicle fluid as well as serum testosterone level.

Results
Median participant age was 68 (range 51–77) years. Median concentrations were as follows: seminal vesicle testosterone 1.85 (range 0.17–4.32) ng/mL, serum testosterone 4.59 (range 1.75–10.82) ng/mL. When SHIM score was divided into two groups, seminal vesicle testosterone concentration was significantly increased (P=0.001) in participants with SHIM score ≥17; no significant difference was observed in serum testosterone (P=0.716). EHS score was also correlated with seminal vesicle testosterone (P=0.031) but not serum testosterone (P=0.380). Multivariate analysis revealed that seminal vesicle testosterone was significantly correlated with SHIM score (≥17 vs. &lt;17, odds ratio: 2.374, 95% confidence interval: 1.244–4.529, P=0.008). Seminal vesicle testosterone was not correlated with age (R2=0.032) or serum testosterone (R2=0.014).

Conclusions
Testosterone levels in seminal vesicle fluid can reflect sexual function in patients with prostate cancer, suggesting that seminal vesicle testosterone may affect male sexual function.

Disclosure
Work supported by industry: no.
022 Leucine Rich Repeat Containing 8A Anion Channels Modulate Vascular Reactivity in the Pudendal Artery
Authors: Choi H. , Nguyen H. , Priviero F. , Webb R.C. , Lamb F. 
Published: May 2022

ABSTRACT

Introduction
Erectile dysfunction (ED) is characterized by an inability to develop or maintain penile erection during sexual activity. The internal pudendal artery (IPA) is the primary supplier of genital blood flow. Reactive oxygen species (ROS) generation is necessary for intracellular signaling, but excessive ROS production can promote ED. NADPH oxidase (Nox) produces extracellular superoxide (O2 •-) in the vasculature and we have demonstrated that Leucine Rich Repeat Containing 8 (LRRC8)
Volume Regulated Anion Channels (VRACs) physically associate with and regulate Nox1. LRRC8A downregulation or channel inhibition decreases extracellular O2 •- production by Nox1 and dramatically reduces the inflammatory response to tumor necrosis factor alpha.

Objective
We hypothesize that smooth muscle-specific LRRC8A knockout (KO) increases vascular relaxation in IPA.

Methods
The IPAs from male wildtype (WT) and LRRC8A KO (smooth muscle-specific) mice were used in wire myograph studies.

Results
Following phenylephrine (PE, 2x10-6 M)-induced contraction, cumulative relaxation-response curves to acetylcholine (ACh, 10-9 to 3x10-6 M), sodium nitroprusside (SNP, 10-9 to 10-5 M), and a soluble guanylyl cyclase activator (BAY60-2770, 10-9 to 10-6 M) were measured. Endothelium-dependent relaxation to ACh was increased in LRRC8A KO compared to WT (WT LogEC50 -7.3 ± 0.08; LRRC8A KO LogEC50 -7.7 ± 0.12; *p&lt;0.05, n=5). Relaxation to SNP or BAY60-2770 showed no difference between WT and KO. The LRRC8A-targeted VRAC inhibitor, montelukast (10 μM) reduced PE (10-6 M)-induced contractile responses in the IPA (56 % decrease).

Conclusions
These data demonstrate that LRRC8A plays an important role in controlling vascular reactivity that may be associated with ED. We speculate that LRRC8 channels are novel pharmacologic targets. Inhibition of the channels may reduce oxidative stress and improve sexual function.

Disclosure
Work supported by industry: no.
031 The Rigicon Infla10® IPP Implantation via the Penoscrotal and Subcoronal Approaches: The UKSH Experience
Authors: Osmonov D. , Ragheb A. 
Published: May 2022

ABSTRACT

Introduction
Penile implant manufacturers compete to introduce the latest technologies within their devices. They all aim to develop the optimal implant with the best functionality and highest durability. One of the relatively new companies that has recently joined the competition is Rigicon which has lately introduced its new Infla10® inflatable penile prosthesis (IPP). This video was recorded at the University Hospital Campus Kiel, Germany which is one of the first European centers of excellence to implant Rigicon devices.

Objective
The German experience with the new Infla10® penile implant, represented by the Kiel School of Prosthetic Urology, is demonstrated via a step-by-step instructive video of two penile prostheses implantations. While elaborating the steps of the procedures, we highlight the various unique features of the new Infla10® device related to the cylinders, reservoir, and pump.

Methods
We utilized the penoscrotal approach for our first patient and the subcoronal approach for our second. For our first implantation, we chose the high submuscular reservoir location leaving the traditional retropubic reservoir implantation for our second patient.

Results
Both patients demonstrated an eventless surgery and postoperative follow-up period and were satisfied with their implants.

Conclusions
We consider the Infla10® device to be a promising addition to the available devices in the market. The Infla10® implant comprises a number of advanced device technologies that add to both the durability and reliability of the implant.

Disclosure
Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Coloplast).
035 Vaginal Reconstruction: Progress by Perforator Flaps
Authors: Koshima I. , Roh S. 
Published: May 2022

ABSTRACT

Introduction
Gracilis and rectus abdominis myocutaneous flaps have been used for reconstruction of a wide range of vaginal defects, but recently, minimally invasive reconstruction with various perforator flaps has become popular. Vaginal reconstruction for the past 41 years is reported.

Patients Summary
15 cases of vaginal defects were surgically treated. The case was that the age at surgery was 23 to 87 years, with an average of 55 years. The original disease is vesico-vaginal fistula 6 cases, Paget cancer 4 cases, labial1 cancer 1 case, pudendal radiation ulcer associated with lymphedema 1 case, Rokitansky syndrome 1 case, GID (Male to female)1 case, vaginal stenosis 1 case. Flaps for reconstruction are: gracilis musculocutaneous flap 5, superficial circumflex artery perforators (SCIP) flap 4, pudendal artery perforator flap 3, medial femoral perforator Flap 2, scrotal flap 1, gracilis perforator flap 1, free latissimus dorsi musculocutaneous flap 1. Reconstruction using multiple flaps was performed for extremely widespread defects.

Results and Conclusion
Postoperative follow-up was 2weeks to 20 years with an average of 2.5 years. As complications, recurrence of bladder-vaginal fistula occurred in 2 of 6 cases (33%), and partial necrosis of the flap was observed in 1 of 16 cases (6%). For vaginal reconstruction, the surrounding myocutaneous flap or perforator flap can be selected depending on the depth and extent of the defect. Donors can be closed by using combined flaps, especially for a wide range of defects. Irradiated bladder-vaginal fistulas may require a bilateral approach from the bladder and vagina. In the future, reconstructive surgery that considers sexual function will be required for GID as well.

Disclosure
Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Luxanos).
037 Differences in the Gut Microbiome Composition Between Men with Erectile Dysfunction and a Matched Cohort: A Pilot Study
Authors: Osman M.M. , El-Khatib F.M. , Dianatnejad S. , Nguyen J. , Choi E. , Towe M. , Yafi F.A. 
Published: May 2022

ABSTRACT

Introduction
The gut microbiome (GM) plays an important role in human health, ranging from supplying essential nutrients, synthesizing vitamin K, to promoting angiogenesis and enteric nerve function. It has also been recently associated with a variety of chronic health conditions. To date, however, there have been no studies that have attempted to establish any association between the GM and erectile dysfunction (ED).

Objective
To analyze stool samples from patients with ED and compare them to matched controls for differences in their GM.

Methods
We collected stool samples from 37 patients with ED and matched them with 37 controls. All samples were processed by a third-party company, Viome Inc. The samples were analyzed by metatranscriptome sequencing which allows for data to show both the taxonomy of the microbiome and its KEGG orthology (KO). We compared richness, prevalence and expression of the taxa and KOs between the ED and control groups.

Results
There were 224 species (16.85%) with significantly differential prevalence and 135 species (10.31%) with significantly differential expression. There were 565 KOs (10.42%) with significantly differential prevalence and 653 KOs (12.05%) with significantly differential expression. Richness is the number of microbial species detected in a sample. Diversity assesses the abundance and evenness of a species to assess how diverse an individual sample is. The ED group demonstrated significantly lower taxonomic richness and diversity, p= 1.33 x 10^-5 (see figure below).

Conclusions
This is the first study to look at associations between the GM and ED. Patients with ED have significantly lower taxonomic richness and diversity. Further analyses are needed to better understand the implications of these findings and uncover potential targets for early targeted treatment or prevention of ED.

Disclosure
Work supported by industry: yes, by Viome Inc.. A consultant, employee (part time or full time) or shareholder is among the authors (Antares. Clarus. Coloplast. Promescent.).
060 Intramuscular Testosterone Cypionate vs Subcutaneous Testosterone Enanthate: Comparing the Outcomes in Hypogonadal Men
Authors: Choi E. , Xu P. , Loeb C. , El-Khatib F. , Yafi F. , Kavoussi P. 
Published: May 2022

ABSTRACT

Introduction
Intramuscular testosterone cypionate (IM-TC) is the conventional treatment option for hypogonadal men with baseline serum total testosterone (TT) less than 300 ng/dL; however, significant peaks in testosterone cause adverse effects including polycythemia and rise in estradiol (E2). Subcutaneous testosterone enanthate-autoinjectors (SCTE-AI) were designed with a lower testosterone peak-to-trough ratio of 1.8.

Objective
This dual-institutional study compared the TT, hematocrit (HCT), E2, and prostate-specific antigen (PSA) response to treatment with IM-TC versus SCTE-AI.

Methods
263 hypogonadal men were treated with testosterone replacement therapy (TRT) via IM-TC or SCTE-AI. TT, HCT, E2, and PSA levels were obtained at baseline and 6- to 12-weeks post-treatment. Significant differences in baseline and post-treatment levels were identified by univariate analysis. Linear regression models determined whether treatment modality was independently associated with post-TRT levels of TT, HCT, E2, and PSA.

Results
Patients treated with SCTE-AI were significantly younger, had higher baseline TT levels, and lower baseline E2 levels (Table 1). Post-TRT, the SCTE-AI cohort had significantly lower HCT and E2, while TT and PSA levels were not significantly different between the treatment arms. After adjusting for significant differences with linear regression, SCTE-AI was associated with a 14% greater increase in trough TT levels compared to IM-TC (p=0.027) (Table 2a). Furthermore, SCTE-AI was independently associated with 41% and 26.5% lower post-therapy HCT (p&lt;0.001) and E2 (p&lt;0.001) levels, respectively, when compared to IM-TC (Table 2b-c). Neither TRT modality was associated with post-therapy elevation of PSA (p=0.691).
TT: Total Testosterone; HCT: Hematocrit; E2: Estradiol; PSA: prostate-specific antigen

Conclusions
While IM-TC and SCTE-AI provide a significant increase in testosterone, SCTE-AI is associated with lower levels of post-therapy HCT and E2 compared to IM-TC after adjusting for significant covariates. SCTE-AI is an effective testosterone delivery system with a preferable safety profile over IM-TC.

Disclosure
Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome).
069 Prevalence of and Depression, Anxiety and Stress Associated with Premature Ejaculation among the Patients Attended in the Sex Clinic of a Tertiary Level Psychiatric Hospital, Dhaka, Bangladesh
Authors: Nahar S. , Shaheen M.M. , Islam T. , Alim S.A.H. Mostafa , Alam M.F. 
Published: May 2022

ABSTRACT

Introduction
Premature Ejaculation (PE) has been considered as the most common male sexual dysfunction having significant detrimental impact on both men and their partners. But in many cases, it remains undetected and untreated. The relationship between depression, anxiety and stress with PE might be bi-directional. Depression, anxiety and stress may impair male sexual function and couple's sexual relationships. On the other hand, the poor sexual functioning and satisfaction can produce feelings of frustration and anxiety between partners.

Objective
The objective of this study was to determine the proportion of PE and to find out the depression, anxiety and stress associated with PE among the men who perceive themselves as having little control over ejaculation attending in the sex clinic of a tertiary psychiatric hospital.

Methods
This was a cross-sectional study conducted from August 2017 to June 2018, among 280 male patients who perceived themselves as having little control over ejaculation aged from 18 to 60 years and were selected by convenient sampling technique. A semi-structured, self-administered questionnaire containing socio-demographic variables, the Bangla version of the Premature Ejaculation Diagnostic Tool (PEDT), the Bangla version of the short version of Depression Anxiety Stress Scales (DASS 21-BV) were applied to assess their PE and associated depression, anxiety & stress respectively.

Results
It showed that, mean (+ SD) age of the respondents was 38.8 (+8.44) years and 26.4% of the respondents were found to have premature ejaculation. Presence of PE was slightly higher (55.4%) among the older age group (aged 41-60 years) than the younger age group (aged 18-40 years). Chi-square test showed significant association with depression, anxiety and stress with PE (p&lt;0.05 for all comparisons).

Conclusions
This high prevalence and associated psychological factors illustrate the need for promoting awareness regarding PE and for better outcome. During assessment psychological factors should be identified properly and psychosocial management should be emphasized along with pharmacotherapy during management of the PE patients.

Disclosure
Work supported by industry: no.