bluuebunny/crossref_metadata_2025_split huggingface dataset:
84 Evaluating the Impact of Time Between Radical Prostatectomy (RP) and Adjuvant Radiation Therapy (RT) on Erectile Function Recovery (EFR)
Authors: Flores Martinez J , Benfante N , Schofield E , Mulhall JP 
Published: April 2022

ABSTRACT

Introduction
RT post-RP in men with PSA recurrence improves survival. It is also associated with a higher rate of urinary incontinence and erectile dysfunction (ED).

Objective
We attempted to evaluate if the time period between RP and adjuvant RT predicts EFR outcomes.

Methods
Men who received RT post-RP with ≥2 years post-RT follow-up were analyzed. ADT and RT pre-RP were exclusions. Demographics, comorbidities and pathological parameters and IIEF erectile function domain (EFD) scores were recorded. We report median EFD scores and factors correlated with EFR ≥24 months post-RT. Factors included: patient age, comorbidities, smoking status, baseline pre-RP and pre-RT Testosterone (T), prostate specific antigen (PSA), baseline EFD score, Nerve-Vascular bundle (NVB) status, and time between RP and RT.

Results
126 men were included. Mean age at RP was 63 ± 7 years. Mean pre-RP T was 390 ± 222 ng/dL, PSA, 10.2 ± 10.4 ng/mL and median EFD score were 27 (IQR = 20-30). Median pre-RT T was 376.9 ± 187 ng/dL, PSA 0.25 ± 0.33 ng/mL, and median EFD score was 9 (IQR = 3-20). 54% of patients had bilateral NVB preservation, and 29.5% unilateral. 71% received ADT with their RT, the median duration of ADT exposure was 4.5 (IQR = 3-8.5) months. Median time between RP and RT was 14.9 months (IQR = 8.5-28.6) months; 41% had ≤1 year between RP and RT. 2 years post RT, median EFD was 9.5 (IQR = 3-22). 22% had a score ≥24. EFD score at follow-up was correlated with age at RP (r=-0.32, p&lt;.001), and pre-RT EFD score (r=0.56, p&lt;.001). Time between RP and RT did not correlate with EFD score at follow up (r=0.08, p=0.39).

Conclusions
In our prostate cancer patients cohort post-RP/RT, EFR is lower; almost 4 of 5 patients will have some ED degree at two years post-RT. The period time between RP and RT is not correlated with EFR post-RT.

Disclosure
No
156 Where to Draw the Line: Understanding Preferences in Mucosal Collar Length After Circumcision
Authors: Callegari M. , Muncey W. , Kim T. , Rhodes S. , Woo L. , Hannick J. 
Published: April 2022

ABSTRACT

Introduction
Male circumcision is a polarizing and omni prevalent procedure within the United States (U.S.). Little understanding exists regarding patient preferences for circumcision appearance.

Objective
To illicit how mucosal collar length may be perceived in terms of overall cosmesis and desirability amongst adults.

Methods
A questionnaire using REDCap was created and distributed through Amazon Mechanical Turk. Respondents provided demographic information and circumcision status before being challenged with artistic representations of circumcised penises with increasing lengths of mucosal collar. Participants were asked to select the most and least aesthetically pleasing image as well as rate the “importance of appearance” from 0 to 100. Responses were analyzed with ordinal regression models.

Results
Preference for shorter mucosal collars were seen in respondents with a postgraduate education (P = 0.013) and no religious affiliation (P = 0.034). In contrast, participants reporting a religious affiliation preferred longer mucosal collars (P = 0.034). Circumcised males rated appearance as being more important (P = 0.001) in contrast to uncircumcised males who did not (P = 0.001). Women were neutral (P = 0.199). Black or African American participants valued circumcision appearance more (P = 0.020) than Caucasian participants (P = 0.021).

Conclusions
Preferences regarding mucosal collar length appear to be influenced by education and religion. Overall, our study did not observe a predominant preference for mucosal collar length following circumcision. With this in mind, surgeons should engage patients preoperatively in discussions regarding preferences and desired cosmetic outcomes.

Disclosure
No
158 Artificial Urinary Sphincter Reverses Weight Gain Associated with Post-Prostatectomy Incontinence
Authors: Bhanvadia R. , Dropkin B. , Wolfe A. , Diao L. , Sanders S. , Joice G. , Roehrborn C. , Hudak S. , Morey A. 
Published: April 2022

ABSTRACT

Introduction
Post-prostatectomy stress urinary incontinence (PPI) is associated with decreased physical activity, a known risk factor for weight gain and negative health outcomes. The relationships of PPI severity and its surgical correction to body mass index (BMI) are unknown.

Objective
We sought to examine the association between urinary incontinence severity and BMI changes before and after artificial urinary sphincter (AUS) insertion.

Methods
We performed a single-institution, retrospective review of 1513 AUS and inflatable penile prosthesis (IPP) insertion cases performed between 2008 and 2020. Inclusion criteria included a history of radical prostatectomy (RP) and complete data on PPI and BMI. The IPP cohort served as a surgical control. PPI severity was assessed by pads per day (PPD). BMI data were reviewed at the following three time points: (a) at RP, (b) at urologic prosthetic surgery (UPS), and (c) 12 months post-UPS. Multivariable linear regression assessed the associations between (a) PPI severity and BMI change from RP to UPS and (b) AUS insertion and BMI change 12 months post-UPS.

Results
We identified 250 men (187 AUS and 63 IPP) who met selection criteria. Men in the AUS group had a mean BMI increase between RP and UPS of + 1.0 kg/m2 versus - 0.6 kg/m2 in the IPP group (p &lt; 0.01, duration 26.0 ± 21.8 months). Higher PPD use was associated with greater BMI gain after RP (Figure 1A, p = 0.03). On multivariable analysis, higher PPD use at the time of UPS was positively associated with BMI gain (Rho coeff. 0.50 kg/m2, p &lt; 0.01), independent of RT and ADT. AUS insertion was independently associated with a decrease in BMI of -2.83 kg/m2 12 months post-UPS (p = 0.02) on multivariable analysis. Magnitude of incontinence improvement after AUS insertion was associated with greater BMI reduction at 12 months (Figure 1B, p = 0.04).

Conclusions
PPI is associated with weight gain, and its correction via AUS insertion is associated with weight loss. Because severe PPI is a potential risk factor for weight gain and subsequent negative health outcomes, timely anti-incontinence surgery is prudent for prostate cancer survivorship care.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
167 New Bipolar Radiofrequency Sealing Tool for Transdermal Vasectomy in the Rabbit Model: A Paradigm Shift in Vasectomy Technique?
Authors: Henry G. , Griggs R. , Hakky T. 
Published: April 2022

ABSTRACT

Introduction
Bipolar Radiofrequency (RF) sealing tools have been shown to be successful in the treatment of many areas in the human body. RF has been utilized in the sealing of larger blood vessels and in nerve pain ablation in humans, showing good results for years. Urology has used RF ablation percutaneously for treating renal tumors for years.

Objective
We evaluate the utilization of a new bipolar RF sealing tool for transdermal vasectomy in the rabbit model.

Methods
Two groups of 5 male New Zealand white rabbits were given IV sedation and local anesthetic and subsequent transdermal bilateral vasectomy using a high lateral scrotal approach. We isolated the vas with a novel insulated clamp, fitting the U-shaped electrode of the sealing tool (Figure 1) around the clamp. In Group 1 (n=5), the device was set at 60 watts for 20 seconds. In the second group (n=5), the size of the U-shaped tool jaw was reduced and the device was set at 40 and 60 watts using impedance sensing to automatically shut off energy at a predetermined level. Wound healing, complications, survival, postmortem biopsies, and histology were evaluated. A doe rabbit was used with semen collections & semen analyses preformed on all male rabbits.

Results
We sacrificed 4 of the 5 (80%) of Group 1 rabbits due to poor wound healing due to excessive thermal damage. All 5/5 (100%) of Group 2 rabbits had good tissue healing and survived the procedure. At about 5 seconds of sealing, the impedance sensing automatically shut off power to the device in all Group 2 procedures. All rabbits had a negative semen analysis and on histology had occluded vas deferens. In bench top testing, we found that a 5 second interval is optimal for vas ligation. (Figure 1) Bench top testing revealed that thin short jaws created lower nearby tissue temperature (50 degree Celsius) than wide long jaws (77 degree Celsius).

Conclusions
Transdermal bipolar radiofrequency sealing successfully occludes the vas deferens in rabbit vasectomy. The jaw size and sealing time using an impedance alarm system appear to be important for wound healing. This novel technique may decrease vasectomy time and morbidity. Further studies are needed before its application in humans.

Disclosure
Yes, this is sponsored by industry/sponsor: Signati
Clarification: Industry initiated, executed and funded study
Any of the authors act as a consultant, employee or shareholder of an industry for: Signati
172 Racial Trends in Peyronie's Disease Treatments: Analysis of the Veterans Health Administration
Authors: Nackeeran S. , Masterson T. 
Published: April 2022

ABSTRACT

Introduction
Racial disparities are known to affect urologic care. Settings such as the Veterans Affairs (VA) health system, where access to care is more equitable, have noted reductions in racial disparities for certain diseases. Previous studies of Peyronie's Disease (PD) have investigated responses to treatment by race, but not treatment rates themselves. Frequently, racial disparities in healthcare are attributed to differences in income or decreased insurance rates among people of color. For this reason, we aimed to investigate racial disparities in PD treatments by evaluating the VA Informatics and Computing Infrastructure (VINCI), which contains data from the VA. As veterans are insured and able to obtain treatment for PD through the VHA, this population allows us to study the effects of race on treatment rates when insurance does not serve as a barrier.

Objective
To evaluate the treatment rates for Peyronie's Disease within the VA by race in order to determine whether racial disparities exist when insurance access is equitable.

Methods
We queried VINCI to obtain data for a cohort of men that have a recorded diagnosis of PD by ICD-9 or ICD-10 code between 2015-2020. We then used the following CPT codes to identify which patients had procedures known to be therapeutic for PD: plaque injection (CPT 54200), penile prosthesis (54400, 54405), penile reconstruction to correct penis angle (54360), or plaque excision (54110, 54111, 54112). We evaluated treatment rates among patients with race/ethnicity information recorded. We reported results as frequencies and used the chi-square test to evaluate significant differences in treatment rates when comparing racial groups to Whites, with statistical significance reported at p&lt;.05.

Results
We obtained data for 17,022 patients with diagnoses of PD. Within the total population of patients diagnosed with PD, 71.4% were White (Non-Hispanic), 25.4% were Black, 5.8% were Hispanic or Latino, 0.3% were Asian or Pacific Islander (API), and 1.6% were Native American (NA), and 5.4% were unknown. Among this cohort, 13.6% of all patients, 13.6% of Whites, 14.3% of Blacks (p=0.2985), 13.5% of Hispanics (p=0.9205), 9.1% of API (p=0.3319), 16.7% of NA (p=0.1406), and 9.6% of unknown (p=0.0041) were treated.

Conclusions
Within the VHA population, which is not limited by access to health insurance, all patients with recorded race information were treated at similar rates for PD to Whites. Only those without racial information recorded were treated at a significantly lower rate. This study demonstrates the potential for equitable insurance and access to healthcare to reduce racial disparities. Further investigation is required to evaluate whether these treatment patterns are similar within the general population.

Disclosure
No
186 Does Medicaid Cover Male Urethral Sling Surgery? A State-by-State Analysis
Authors: Loeb C. , Barnard J. , Yafi F. , Schneider D. 
Published: April 2022

ABSTRACT

Introduction
Male suburethral slings are one treatment option for stress urinary incontinence (SUI) due to intrinsic sphincter deficiency post-prostatectomy in appropriately selected patients. Some studies report up to 55% social continence, and 23% of respondents reduced use of pads by greater than 50%. Male slings may be preferred in men with limited manual dexterity who have difficulty manipulating an artificial urinary sphincter, or in men with more mild SUI, particularly if there is no history of prior radiation. Existing literature regarding insurance coverage and physician reimbursement overwhelmingly focuses on Medicare and commercial plans, leaving a knowledge gap with respect to the Medicaid population which may contribute to inequitable utilization of this treatment modality for SUI.

Objective
To quantify Medicaid coverage for placement and revision of male suburethral slings for correction of male SUI by state.

Methods
State Medicaid websites were utilized to access publicly available physician fee schedules. Individual search queries were performed for CPT codes 53440 and 53442, which represent sling operation for correction of male urinary incontinence and removal or revision of sling for male urinary incontinence, respectively. Data were recorded for each device, including the coverage status and physician fees.

Results
Medicaid physician fee schedules were accessible for 49 out of 50 US states. All 49 of these states reported coverage for placement of a male urethral sling, and 48 states reported coverage for removal or revision of a male urethral sling. Means and range of physician reimbursement for each procedure were $834.26 ($198.00-$5,237.35) for placement of a male urethral sling (53440) and $616.88 ($104.27-$2,288.93) for removal or revision of a male urethral sling (53442).

Conclusions
Male suburethral sling placement and revision for SUI in the Medicaid population are covered by nearly all states as confirmed by publicly available data. Knowledge of Medicaid coverage for SUI related surgery may result in improvement in the utilization of this treatment option for male SUI and may improve quality of life in the Medicaid cancer survivorship population.

Disclosure
No
189 Anal Sex Practices and Rectal Erogenous Zones: An Anatomic Questionnaire Based Study
Authors: Walton A. , Stelmar J , Carter E. , Duralde E. , Isaacson D. , Zaliznyak M. , Garcia M. 
Published: April 2022

ABSTRACT

Introduction
There is a lack of research that explores the prevalence, pleasure, and erogenous zones associated with anal sex.

Objective
To report the results of a cross-sectional study questionnaire that queries receptive anal intercourse (RAI) (e.g., when a partner inserts any part of themselves, like a penis, finger, tongue, or toy into their anus).

Methods
We used an anonymous online survey platform (Qualtrics), to query respondents’ experiences with RAI. Respondents who reported a history of ever engaging in RAI were asked questions about their ability to orgasm from RAI. These respondents were further shown anatomic illustrations of the rectum divided into four quadrants and were asked to designate regions they found “pleasurable when touched during sex.” Respondent demographics were collected and used to analyze data by gender identity, age, and sexuality. Chi-squared tests were used to evaluate the statistical differences between cisgender men (CM) and cisgender women (CW). Statistically significant differences existed where P&lt;0.05.

Results
A total of 489 CM (mean age ± SD, 46.3 ± 17.5 years) and 501 CW (48.1 ± 16 years) completed the survey. Comparative analysis revealed CW were significantly more likely to endorse ever engaging in RAI, as compared to CM (34% vs 24%, p=0.00181). By different age groups: middle-aged CW [40-59 yo] were significantly more likely to endorse RAI (and older [&gt;60yo] CM were significantly less likely; 41% vs. 20% respectively, p=0.00122). By sexuality: bisexual CM (73%), homosexual CM (40%), and homosexual CW (41%) were significantly more likely to report engaging in RAI while heterosexual CM (18%) were significantly less likely to endorse it (p&lt;0.00001). By ability to orgasm: CM were significantly more likely to endorse achieving orgasm from RAI alone, as compared to CW (38.5% vs 18.6% respectively, p&lt;0.001). By erogenous zone location: the superficial aspects of the rectum were more frequently selected by CM and CW as sites of pleasure when touched during RAI, as compared to the deep aspects (39% vs 14.6%). Also, respondents more frequently selected the anterior aspects of the rectum over the posterior aspects (36.6% vs 28.3%).

Conclusions
Our findings show that anal sex is practiced by many adults, across age, gender and sexual identity categories. Universally, both more CM and CW report pleasure from the superficial areas of the rectum. These findings may prove useful in elucidating the practice of RAI to improve patient sexual satisfaction.

Disclosure
No
196 IIEF-EF Improvements are more Pronounced with Nutraceuticals Compared to Placebo Medications: A Systematic Review and Meta-analysis
Authors: Arthur M. , Feustel P. , Welliver C. 
Published: April 2022

ABSTRACT

Introduction
Nutraceuticals are pharmacological alternatives to conventional medications that have been used to treat a variety of ailments or conditions however frequently these compounds are used without rigorous assessment of safety and efficacy.

Objective
Our goal was to assess the placebo and nutraceutical effect on erectile function as measured by the change in baseline international index of erectile function-erectile function (IIEF-EF) score.

Methods
The search terms ‘(erectile dysfunction OR erectile function OR sexual dysfunction) AND (placebo OR sham)’ were queried via Pubmed. For inclusion in analysis, studies had to be blinded, placebo controlled, and use the IIEF-EF to measure outcomes. Studies were excluded if data was missing, articles could not be retrieved, or if protocol was ambiguous or unblinded. Data was then extracted and analyzed via meta-analysis. Differences between groups were considered statistically significant if p&lt;0.05.

Results
A total of 12 studies were identified that utilized a natural medication (“nutraceutical”) and placebo (“placebo”) control group with 602 patients receiving nutraceutical and 559 patients receiving placebo in total. A variety of different compounds were tested. While improvements in IIEF-EF were more pronounced in the nutraceutical group (16.6 increasing to 20.6, p=0.0008) the placebo control group also demonstrated a statistically significant increase (17.0 to 18.4, p=0.0021).

Conclusions
Studies demonstrate an increase in subjective measures of erectile function both in placebo and nutraceutical groups. Nutraceuticals did have a more pronounced effect despite not containing active drug compounds. The mechanism of response to placebo for erectile function is unclear however the increases in both nutraceutical and placebo group points towards a contributory psychological effect of the medications.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Compensated Reviewer for Oakstone Publishing, Medscape
199 A Free Listing Assessment of Sexual Function and Relationships for Penile Prosthesis and Intracavernosal Injection Therapy for Erectile Dysfunction
Authors: Berry K. , Salib A. , Tidwell T. , Chung P. 
Published: April 2022

ABSTRACT

Introduction
Most erectile dysfunction (ED) studies focus predominantly on sexual function leaving self-esteem and relationships understudied. Free listing is a technique for gathering data about a specific topic by asking participants to list items that relate to the topic. We evaluated free listing responses of patients undergoing treatment with penile prosthesis (PP) and intracavernosal injection (ICI).

Objective
To compare free listing responses about sexual function and relationships between patients treated with penile prosthesis (PP) and intracavernosal injection (ICI).

Methods
IRB-approval was obtained to interview patients by phone who underwent ED treatment by a single surgeon. Participants were asked to give three one-word responses to questions about sexual function and relationships. Responses with like terms were grouped together to avoid redundancy in reporting results. All words reported at least four times were included.

Results
Fifty patients (25 PP, 25 ICI) agreed to be interviewed for this study. For Q1 (What are some words that describe how your current sexual function makes you feel?) responses for PP included positive (n=13), content (n=12), confident (n=5), dependable (n=5), nervous (n=4), nonfunctional (n=4), and unsatisfied (n=4), while responses for ICI were positive (n=9), content (n=6), excited (n=4), fine (n=4), and nonfunctional (n=4). For Q2 (what are some words that come to mind that describe your ability to have sex by yourself or with others?) responses for PP included positive (n=7), unsatisfied (n=5), dependable (n=5), and confident (n=4), while the responses for ICI were nonfunctional (n=5), dependable (n=5), and positive (n=4). For Q3 (what are some words that describe your intimate relationships with others?) the responses for PP included positive (n=7) and content (n=7), while responses for ICI were positive (n=9), content (n=8), and love (n=8).

Conclusions
PP and ICI patients reported predominantly positive statements but did report psychosocial concerns despite undergoing ED treatment. Further discussion into patient expectations both before and after treatment may help to improve patient satisfaction and self-perception.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific