bluuebunny/crossref_metadata_2025_split huggingface dataset:
63 Evaluating Different Low-intensity Extracorporeal Shockwave Therapy Intensities in the Treatment of Peyronie's Disease in a Rat Model
Authors: Kim J , Soubra A , Kim H , Greenberg J , Ottaiano N , Morenas R , Chacko B , Wisen W , Fatima N , Dick B , Halat S , Almajed W , Raheem O , Abdel-Mageed A , Hellstrom W 
Published: April 2022

ABSTRACT

Introduction
Low-intensity extracorporeal shockwave therapy (Li-ESWT) is postulated to have physiologic effects including neo-angiogenesis, upregulation of vasoactive endothelial growth factors, nerve recovery, reduction of fibrotic changes, cavernosal tissue remodeling, and reduction in sympathetic tone. To date, randomized clinical trials have failed to demonstrate a change in penile curvature, with mixed results on erectile function, in Peyronie's disease (PD) patients.

Objective
To evaluate the treatment effect of Li-ESWT for amelioration of PD-associated fibrosis and PD-associated erectile dysfunction using a rat model of PD.

Methods
32 adult male Sprague-Dawley rats were divided evenly into four groups: sham (S), control (T), low setting Li-ESWT (TL), and high setting Li-ESWT (TH). Normal saline was injected into the tunica albuginea (TA) of the sham group. Transforming growth factor beta-1 (TGF-B1) was injected into the TA of the remaining groups to induce Peyronies-like fibrosis. After 5 weeks of TGF-B1 induction, treatment with Li-ESWT shockwave (UroGold 100™) was initiated. Treatment was delivered biweekly for 3 weeks (6 total sessions). Device settings were 600 shocks at 3 Hz, at level 6 (0.093 mJ/mm2) for the Low group and at level 12 (0.125 mJ/mm2) for the High group. Two weeks after the end of treatment, erectile function was measured by ratio of intracavernosal pressure (ICP) to mean arterial pressure (MAP). Histological analysis by H&E and Trichrome staining was performed. Western blot analysis of Collagens I (COL1A1), III (COL3A1), elastin, alpha-smooth muscle actin (a-SMA), and TGF-B1 was performed.

Results
There was no significant difference demonstrated in erectile function between T control group and TL and TH groups (P &gt; 0.05). However, there seems to be a trend in decreased amount of fibrosis upon examination of the prepared histologic sections. Animals in the TL and TH groups had decreased COL1A1, COL3A1, elastin, and TGF-B1 expression in the TA compared to the T group. a-SMA expression in the treatment groups was found to be increased compared to both S and T groups.

Conclusions
Our preliminary data shows that Li-ESWT treatments, at different intensities, may decrease fibrosis induced by TGF-B1 TA injections. Additionally, Li-ESWT was not found to have conclusive positive effects on erectile function.

Disclosure
Yes, this is sponsored by industry/sponsor: Sexual Medicine Society of North America

Clarification
Industry funding only - investigator initiated and executed study
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
68 Incidence of Secondary Intervention for Peyronie's Disease after Collagenase Clostridium Histolyticum
Authors: Nackeeran S , Masterson T 
Published: April 2022

ABSTRACT

Introduction
Collagenase clostridium histolyticum (CCH) is the only FDA-approved medical therapy for Peyronie's Disease (PD). It is unknown how many men will elect for surgical correction after CCH treatment. Other surgical options exist, including penile plication, incision and grafting and penile prosthesis. By studying patients within the Veterans Health Administration (VHA), who are all insured and therefore not limited by cost, we aimed to determine the percentage of patients electing additional surgical correction after treatment with CCH.

Objective
To determine the need for secondary surgical correction after CCH

Methods
We queried the VA Informatics and Computing Infrastructure (VINCI), the VHA's national database, to identify veterans with a diagnosis of PD by ICD-9 or ICD-10 code between 2015-2020. We searched medication codes for CCH and surgical CPT codes to determine which patients had the following procedures PD: plaque injection (CPT 54200), penile prosthesis (54400, 54405), penile reconstruction to correct penis angle (54360), or plaque excision (54110, 54111, 54112). Patients with medication codes for CCH and another procedure were assumed to have had surgery after CCH.

Results
In total, 17,647 veterans were diagnosed with PD. Of those, 1295 (7.3%) were treated with CCH. Of those who were treated with CCH, 100 (7.7%) elected for intervention after CCH. Within the group 61 had penile prosthesis, 23 had penile plication, and 32 had plaque excision and grafting (16 combined with IPP).

Conclusions
Approximately 7% veterans who are treated with CCH injection elect secondary surgical correction. This indicates that CCH is an efficacious option for men suffering from PD, and a particularly beneficial choice for those who do not want surgery.

Disclosure
No
71 Adult Patient's Opinions on Surgical Correction of Congenital Penile Curvature
Authors: Ziegelmann M , Winkelman A , Holler J , Breyer B , Herndon A , Villanueva C , Kern N 
Published: April 2022

ABSTRACT

Introduction
Congenital penile curvature is common and presents with varying levels of severity. The curvature may present during infancy or post-pubertal. Historically, treatment has consisted of surgical correction, typically with penile plication or complex grafting procedures. Most pediatric urologists recommend surgical management for penile curvature (PC) based on curvature severity, with previous work identifying ≥ 30° as a common threshold to recommend correction.

Objective
To assess adult patients’ opinions on willingness to consider surgical correction for PC in order to determine if this aligns with pediatric urologists’ opinions.

Methods
In this cross-sectional study, a survey was administered to adult patients and their partners (&gt; 18 years of age) in general adult urology clinics at 3 geographically separate institutions. The survey consisted of unlabeled images of penis models with varying degrees of PC (range 10-90°). Respondents were asked to select the images they would want surgically corrected for themselves or their partners. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to consider correction (p-values &lt; .05 considered significant).

Results
Response rate was 77% (300/388). The majority (80%) of participants chose to surgically correct PC, however 20% chose to not surgically correct any degree of PC. Most participants were male (70%), married (62%), heterosexual (92%), and did not work in healthcare (80%) (Table 1). Among those who endorsed willingness to surgically correct PC, the average threshold for correction was 40.5° (SD 25.3). On univariable analysis, there was a significant difference in willingness to undergo PC correction based on gender, age groups, sexual orientation, and region (Table 1). Male patients were more likely to consider surgery at a lower degree of PC compared to females (36.6° vs 50.6°, p&lt;.001). Those who identified as heterosexual also had a lower threshold for correction compared to those identifying as LGBTQ (39.6° vs 56.4°, p=.015). Midwestern residents endorsed an average threshold for correction of 21.5° compared to other regions varying between 40° to 60° (p&lt;.001). Regionality differences remained true on multivariable analysis when accounting for all demographic features (p&lt;.001).

Conclusions
In surveying adult patients, we identified an average PC threshold of 40° beyond which surgical correction was desired. Females and LGBTQ+ participants had a higher threshold for surgical correction, but when accounting for all demographic factors, only residence in the Midwest US was associated with a lower threshold for correction.

Disclosure
No
94 Anabolic-Androgenic Steroid Use is Associated with Major Depressive Disorder and Suicide Attempt: Analysis of a Multi-National Database
Authors: Nackeeran S , Patel M , Nallakumar D , Deibert C , Ramasamy R 
Published: April 2022

ABSTRACT

Introduction
Anabolic-androgenic steroids (AAS), synthetic derivatives of the male sex hormone testosterone, are often used to enhance athletic performance and physical appearance. Long term use of AAS can be associated with mood destabilizing effects and psychotic behavior. We hypothesized that AAS use is an independent risk factor for mental health disorders. We investigated AAS use and associations with major depressive disorder (MDD), suicide attempt (SA)/intentional self-harm (ISH), and body dysmorphic disorder (BDD) by querying TriNetX, a global health research network that provides data on large cohort of patients from multiple centers across the United States.

Objective
To determine the association between AAS use with MDD, SA/ISH, and BDD.

Methods
To evaluate the psychiatric risk of AAS use two cohorts of adult men, aged 18-50, without history of gender dysphoria (F64, Z87.890) (1) history of documented AAS use, inclusive of testosterone prescriptions (2) history of a visit to a healthcare organization and no history of AAS use. We accounted for confounding variables known to be associated with a risk of mood disorders through propensity score matching by logistic regression for age, race, ethnicity, male hypogonadism (E29.1), history of nicotine dependence (Z87.891), or alcohol-related disorder (F10). We evaluated the association between steroid use and subsequent diagnosis of MDD (F32-33), SA/ISH (T14.91, X71-83, T36-65 and T71 ISH codes), or BDD (F45.22) as a primary outcome through regression analysis with statistical significance assessed at p&lt;.05.

Results
We identified 159,717 cis-men between age 18-50 who used AAS and following propensity score matching for confounding variables, we compared them to an equal-sized cohort of men without AAS use. AAS use was independently associated with all of the psychiatric outcomes that we studied (MDD OR 2.96 95% CI 2.88-3.04 p&lt;.0001, SA/ISH OR 1.37 95% CI 1.25-1.50 p&lt;.0001, BDD OR 5.37 95% CI 2.82-10.21 p&lt;.0001). Strengths of the study include a large sample size, propensity score matching to adjust for confounding variables, and high strength of association. Limitations include lack of information regarding indication for steroid prescription or details regarding severity, duration, withdrawal, or possible steroid abuse.

Conclusions
AAS use appears to be an independent risk factor for MDD, BDD, and/or SA/ISH. Future studies are necessary to elucidate whether a dose-response association exists, withdrawal from AAS plays a role, and if patient selection or preventative measures can mitigate the risk. Men with suicide attempt, BDD, or MDD should be investigated for a history of AAS use. Further, men receiving AAS should be counseled on the possible risk of developing MDD in the future. AAS use can lead to profound and complex psychiatric complications which should be discussed in patient counseling.

Disclosure
No
161 300 Patient Experience with Same Day Surgery for Artificial Urinary Sphincter Insertion - A Safe and Efficient Option
Authors: Dropkin B. , Sanders S. , Kavoussi M. , Shaaban A. , Joice G. , Hudak S. , Lotan Y. , Morey A. 
Published: April 2022

ABSTRACT

Introduction
Prior research has questioned the need for overnight observation (OBS) following artificial urinary sphincter (AUS) surgery.

Objective
We sought to analyze our institutional experience transitioning from OBS to same day surgery (SDS) for AUS surgery.

Methods
We retrospectively reviewed AUS surgeries performed by a single surgeon at our tertiary academic medical center between 08/2013 and 03/2020. Medical records were reviewed for patient demographics, immediate postoperative complications, timing of postoperative discharge, need for readmission, emergency department (ED) visit, outpatient phone call, or non-routine clinic visit within 7 days of discharge, and need for device explant or revision within 90 days of discharge. Patients were grouped based on discharge status: OBS vs. SDS. Catheters were removed prior to discharge (OBS group) or self-removed at home (SDS group) on the morning of postoperative day 1 (POD1). Cost savings associated with SDS were estimated using room and bed charges from a contemporary group of AUS patients (09/2017 through 08/2020). Student's t and Chi-squared tests were used to compare groups.

Results
We identified 528 men who met inclusion criteria. Men in the SDS group (n = 308) were more likely to have undergone a virgin AUS insertion and were slightly younger and healthier (Table). Men in the OBS group (n = 220) were more likely to suffer an immediate postoperative complication and to be readmitted within 90 days of surgery. The groups did not vary with respect to multiple other perioperative outcomes measures. Among patients who underwent AUS surgery between 09/2017 and 08/2020, those with OBS status (n = 39) had mean additional room and bed charges of $ 745 ± 302 vs. none for SDS patients (n = 183).

Conclusions
SDS for AUS insertion is safe, effective, and associated with significant cost savings. Routine overnight observation after AUS insertion appears to be unnecessary.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
165 IPP Cylinder Extrusion. Our Experience and Approach
Authors: Habashy E. , Kohler T. 
Published: April 2022

ABSTRACT

Introduction
The inflatable penile prosthesis (IPP) is a widely accepted surgical treatment for refractory ED. It has the highest satisfaction rates of all ED treatment modalities; however, 7-8% of patients will require reoperations. Mechanical failure, infection, erosion, and extrusion are some of the common indications for reoperations.

Objective
Our video highlights our IPP revision approach that is aimed to lower the risk of future cylinder extrusion/displacement. We also share a rare case of a retained rear tip during device explanation.

Methods
Our video demonstrates our standard technique of obtaining corporal exposure, performing distal corporotomies to explant the cylinders, and utilizing long-acting sutures to prevent future device extrusion. We also demonstrate an encounter with a retained rear tip and our management approach in that scenario.

Results
Our video successfully demonstrates our intraoperative techniques and surgical approach during IPP revision procedures. It also highlights our experience with postoperative cylinder extrusion from 2017-2021.

Conclusions
Our surgical approach during IPP revision using distal corporotomies and long-acting absorbable sutures for corporotomy closure aims to reduce the risk of potential cylinder extrusion. The technique was developed based on our own experience with this complication.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Dr. Kohler is a consultant for Coloplast
166 CT Cavernosography Technique
Authors: Trussler J. , McCullough A. 
Published: April 2022

ABSTRACT

Introduction
Penile anatomy is complex and variable, and not readily assessed with standard ultrasound techniques. Herein we describe the technique and performance of CT cavernosography for the evaluation of penile anatomy in complex cases of Peyronie's disease and erectile dysfunction.

Objective
To describe the procedural steps of CT cavernosography, along with a case report of its use.

Methods
An injection of vasoactive medication is given intracavernosally. A 1cc injection of subcutaneous 1% lidocaine is administered for local analgesia. A 20 gauge angiocatheter is inserted into the corpus cavernosum. 5cc of contrast media is injected via the cannula while the intracavernosal injection takes effect. After 5 minutes, a volume of contrast is injected via the angiocatheter such as to induce a maximal rigidity erection. A CT scan is then obtained. Finally, 2000mcg of phenylephrine is injected via the cannula, and the catheter is removed. A compressive dressing is applied. Images are available for review with the patient within 15 to 20 minutes.

Results
The procedure is well tolerated and provides valuable insight for both the patient and physician with regards to future treatments for Peyronie's disease and erectile dysfunction.

Conclusions
CT cavernosography can be performed easily and readily by the urologist for complex patients who desire further investigation of their condition, or to delineate further anatomic detail prior to undertaking a surgical procedure.

Disclosure
No
204 Growth Factor Concentration Can Vary in Platelet-Rich Plasma from Men with Erectile Dysfunction
Authors: Khodamoradi K , Dullea A , Golan R , Molina Leyba M , Masterson T , Arora H , Ramasamy R 
Published: April 2022

ABSTRACT

Introduction
Erectile Dysfunction (ED) affects 40% of men over 40 and every decade after increases the likelihood by 10% (1). Platelet Rich Plasma (PRP) is a restorative therapy rich in cytokines and growth factors that may reverse the underlying pathology of ED (2). Before PRP can be used effectively in clinic, it is necessary to understand if its components are similar among men with ED.

Objective
To determine whether growth factors vary among PRP of men with ED

Methods
Blood was obtained from three men with ED and one healthy man as a control. The Arthrex Angel system was used to extract their PRP. The sample was immediately stored in ice and kept in -80 C. Bradford assay was ran to ensure equal protein concentrations were used. The Abcam Human Growth Factor Antibody Array kit (ab134002) was used to simultaneously detect 41 human growth factors.

Results
Subject 1 was 43 years old with ED only. Subject 2 was 43 years old with obstructive sleep apnea, hyperlipidemia, and delayed sleep phase syndrome, and BMI 27.1. Subject 3 was 49 years old with hypertension, diabetes mellitus (not on insulin), asthma, high cholesterol, and BMI 32.4.The results of evaluating the 41 growth factor array showed that several growth factors had a fold change greater than 1.5 compared to the control. In PRP of adults with ED, PDGF-AA, PDGF- AB, and PDGF-AB had a greater than 1.5-fold change in at least 2 out of the 3 samples when compared to control. In FGF-6, GM-CSF, NT-3, TGF-α, TGF-β, and TGF-β2, there was a negative fold change of greater than 1.5 in at least 2 out of the 3 samples when compared to control.

Conclusions
Based on these results, the use of PRP as a therapeutic agent may need to be personalized based on individuals' age, comorbidities, or growth factor content. Individuals with underlying comorbidities may need different volumes of PRP. Our future ongoing research is focusing on particular growth factors within PRP that are responsible for improvement in erectile function, thus being able to personalize PRP therapy for me with ED. Citations: 1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61. 2. Liu MC, Chang ML, Wang YC, Chen WH, Wu CC, Yeh SD. Revisiting the Regenerative Therapeutic Advances Towards Erectile Dysfunction. Cells. 2020;9(5). 3. Fang J, Huang X, Han X, Zheng Z, Hu C, Chen T, et al. Endothelial progenitor cells promote viability and nerve regenerative ability of mesenchymal stem cells through PDGF-BB/PDGFR-beta signaling. Aging (Albany NY). 2020;12(1):106-21.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceutical
206 Unexpected Therapeutic Responses in Sexual Function in Women Prescribed Flibanserin for Hypoactive Sexual Desire Disorder
Authors: Goldstein I , Patel S , Donatucci S , Faragasso A , Tojino S 
Published: April 2022

ABSTRACT

Introduction
Flibanserin is a multifunctional serotonin agonist and antagonist for the treatment of acquired, generalized hypoactive sexual desire disorder (HSDD). Flibanserin is approved for use in premenopausal women in the US and in both premenopausal and postmenopausal women ≤60 years old in Canada. A post-hoc analysis of Female Sexual Function Index (FSFI) scores from pivotal trials in premenopausal women with HSDD indicated significant improvements in total and individual domain scores after treatment initiation with flibanserin compared to placebo.

Objective
The purpose of this case report study is to examine the postmarketing database to determine whether improvements in other aspects of sexual function have also been reported by women who were prescribed flibanserin in real world use outside of clinical trials.

Methods
A search was performed in the global safety database to identify postmarketing case reports from August 2015 to March 2021. “Therapeutic response unexpected” was the Medical Dictionary for Regulatory Affairs (MedDRA 23.1) preferred term used in this search strategy. Study results include only case reports with narratives containing verbatim terms relevant to the domains on the FSFI (arousal, lubrication, orgasm, pain, satisfaction), excluding desire as this is an expected response.

Results
Thirty-two postmarketing case reports, including 13 patient testimonials of “therapeutic response unexpected”, were identified during this period. Of these 32 case reports, 12 (38%) contained terms related to unexpected improvements in sexual function. Among the 12 reports of improved sexual function, 10 (83%) included terms related to increases in frequency, intensity, or duration of orgasms, one of which also mentioned improvement in arousal. The remaining 2 cases included 1 report of improvement in lubrication and 1 report of improvement in pain.

Conclusions
These postmarketing case reports are consistent with the post-hoc analyses of the data from the flibanserin clinical trials and provide further support that flibanserin therapy can lead to improvement in multiple aspects of sexual function in addition to sexual desire.

Disclosure
Yes, this is sponsored by industry/sponsor: Sprout Pharmaceuticals

Clarification
Industry initiated, executed and funded study
Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout Pharmaceuticals