bluuebunny/crossref_metadata_2025_split huggingface dataset:
154 Post-Phalloplasty Urinary Function Test: A Novel Outcome Instrument to Capture Urinary Dysfunction and Quality of Life after Phalloplasty
Authors: Liu J. , Eisenbeis L. , Preston S. , Burnett A. , DiCarlo H. , O'Brien Coon D. 
Published: April 2022

ABSTRACT

Introduction
Due to rapidly growing demand for gender affirmation surgery, the number of phalloplasties performed has increased dramatically. Existing research focuses largely on surgical complications and in transmen there is no widely accepted post phalloplasty specific urinary questionnaire.

Objective
The objective of this study is to present a novel patient-reported outcome instrument – the Post-Phalloplasty Urinary Function Test (PPUFT) – and protocol to measure post-void urethral volume (PVUR) and preliminary results.

Methods
We conducted a cross-sectional pilot study in a cohort of 15 adult transmen who had undergone phalloplasty with urethral lengthening surgery between 2018 and 2021 by a single center. Patients had stable urinary function via the neophallus at time of survey. Patients filled out the PPUFT and were asked to record their PVUR as per our protocol.

Results
The average PPUFT score was 8.86 out of 40 and the average quality of life (QOL) score was 2.6. Post void dribbling constituted the major complaint and on average comprised 63% of the reported PPUFT score. Average PVUR was 2.16 ml (range 0.5-5.6 ml). There was a positive correlation between higher PPUFT and worse reported quality of life (p=0.01; R2=0.39).

Conclusions
Current questionnaires accepted in cis-male urology have limitations for accurately capturing urinary dysfunction in this specific patient group, especially post-void symptoms from the unique anatomy of a flap-based neo-urethra. The combination of PPUFT and PVUR measurement offers potential for quantifying urinary function and quality of life in patients who undergo phalloplasty. Future studies will validate these instruments.

Disclosure
No
169 Red Sky in Morning: A Case of Concurrent Hematospermia and Anorgasmia
Authors: Yee A. , Tennenbaum D. , Rabinowitz D. , Khurgin J. 
Published: April 2022

ABSTRACT

Introduction
Hematospermia, or blood in the ejaculate, usually follows a benign course. However, it can be a source of considerable anxiety in patients. Similarly anorgasmia, or the inability to achieve orgasm despite adequate sexual stimulation may cause significant psychological distress. These rare conditions pose unique challenges for diagnosis and treatment and have distinct considerations when they occur together.

Objective
We present a case of concurrent hematospermia and anorgasmia with the diagnostic and treatment procedures for both. We report that simultaneous cystoscopy, electroejaculation (EEJ), transurethral resection of ejaculatory ducts (TURED), and seminal vesiculography is safe and effective as a diagnostic and treatment modality.

Methods
Medical history, physical exam, laboratory analyses of blood, urine, and semen were performed. A cystoscopic video of the prostatic urethra was recorded while performing EEJ, in order to observe hematospermia under direct vision. A TURED was then performed to evaluate the ejaculatory ducts and to facilitate seminal vesiculography.

Results
A healthy 36 year old man reported avoidance of all sexual activity after a few episodes of hematospermia due to extreme fear. He continued to note bloody discharge on occasion in the morning, attributing this to bloody nocturnal emissions. Despite normal erectile function, he adamantly avoided all sexual activity including masturbation. Prior STI workup, cystoscopy, urinalysis, urine and semen cultures were all negative. Prior treatments with finasteride, NSAIDs, and antibiotics failed to reduce the frequency of hematospermia, and he had minimal improvement in libido with cabergoline and buproprion. Concurrent urethroscopy and EEJ revealed initial hematospermia from bilateral ejaculatory ducts with normal, white emission after several seconds. A TURED and direct seminal vesiculography revealed hypoplastic seminal vesicles bilaterally. The patient tolerated the procedure well and had resolution of hematospermia post-operatively. He reports improvement in libido and willingness to attempt sexual activity.

Conclusions
Despite a usually benign clinical course, hematospermia can provoke great anxiety in patients to the point of avoidance of sexual activity. We propose a causal relationship between hematospermia and our patient's sexual dysfunction and anorgasmia, as the patient reports renewed interest in sex after his hematospermia resolved post-operatively. A thorough evaluation to rule out more serious pathology and to address the patient's anxiety included simultaneous cystoscopy, EEJ, TURED, and seminal vesiculography. This was both safe and effective in diagnosis and treatment of concurrent hematospermia and anorgasmia, and is the first video demonstration of simultaneous cystoscopy and EEJ reported in the literature to our knowledge.

Disclosure
No
195 Utility of Novel Mapping Biopsy for Improvement of Extramammary Paget Disease Outcomes: A Case Series
Authors: Zurlo R. , Li R. , Mosiello G. , Spiess P. 
Published: April 2022

ABSTRACT

Introduction
Extramammary Paget's Disease (EMPD) is a rare neoplasm typically found in the genital and perianal region. It typically presents as a pruritic, painful rash and is often mistaken for a fungal infection before biopsy is taken. Staging and biopsy technique have not yet been standardized given the cancer's rarity, leading to a recurrence rate ranging from 21-61% recurrence upon literature review.

Objective
To analyze outcomes of EMPD patients receiving mapping biopsy prior to tumor excision

Methods
Retrospective chart review was conducted of 19 EMPD patients treated with biopsy and/or surgery by co-author at our institution from 2013 to 2021. We extracted patient demographic data, length of follow-up time, percent positive biopsy sites, margin status, recurrence status, and other pertinent disease characteristics.

Results
Within our 19 total patients, median age at diagnosis was 72 with a range between 62 and 88. The majority of patients had a prior history of cancer (13/19), with the most common type being skin cancer (12) followed by prostate cancer (4). No patients were diagnosed with secondary malignancy during mandatory EMPD workup of cystoscopy and colonoscopy before WLE. The majority of patients had not been treated for EMPD prior to presenting to Moffitt (16/19). Of the 16 patients receiving novel mapping biopsy, 8/16 had at least one positive core biopsy site, with a mean of 7% positivity of the total core sites (4/60). Mapping biopsy positive sites helped shape perimeters for wide local excision (WLE) of tumor for patients opting for surgical treatment. Margins of WLE were positive for 11/17 patients. Calculating the length of follow-up time after WLE revealed a median of 6 months, with a range from 0 to 74 months and a mean of 14. No patients received postoperative radiation. One patient did receive topical 5-FU, but use was discontinued after several days due to irritation. Only 1 episode of recurrence was reported during this period of follow-up.

Conclusions
Our novel mapping biopsy technique is an effective way to delineate surgical margins before WLE. Margin positivity is not an accurate indicator of the likelihood of recurrence for EMPD patients, as only 1/17 saw recurrence post-WLE despite 11/17 with positive margins.

Disclosure
No
198 Pre- and Post-injection Pain in Patient's Undergoing First Intracavernosal Injection
Authors: Baird B. , Ericson C. , Broderick G. 
Published: April 2022

ABSTRACT

Introduction
Intracavernosal injections (ICI) are a well-established treatment option with great success rates for men with erectile dysfunction. Unfortunately, the anticipation of pain with injections remains a significant barrier to the use of ICI.

Objective
This study aims to utilize a standardized verbal pain scale to examine the perception of pre- and post-injection pain in men who are undergoing their first injection with an intracavernosal erectile agent. Thus, inclusion criteria required no previous penile injection of any type, including but not limited to erectile medications and collagenase.

Methods
We determined a prospective pre-post observational study would be best to examine men undergoing their first ICI. Men who had no previous history of intracavernosal injection of any kind were asked to predict the pain associated with their first ICI with a score of zero to ten. Patients then received a 10 microgram (mcg) injection of prostaglandin E1 (PGE1). Immediately after they received their injection, they were asked to rate the pain they perceived with the injection on the same scale (0-10). The same physician administered pre- and post-injection scales in a standardized fashion.

Results
A total of 17 of men were asked to rate their pain as discussed in the Methods Section. The average age of men sampled was 61.8 years of age. On review of history, 64.7% of men were found to have used some type of PDE-5 inhibitor before visiting our clinic. The majority of men we saw had erectile dysfunction (70.6%) and/or Peyronie's Disease (58.8%). The average pre-injection prediction pain score was 5.29 +/- 1.90; the average post-injection perceived pain score was 1.21 +/- 0.81. Thus, there was an average decrease of over 4 points in predicted pain versus perceived pain. A two-sample t-test was performed; in addition, a Wilcoxson Signed Rank Test was performed. Both of these tests showed statistical significance in the difference between pre- and post-injection pain scores (p &lt;0.001).

Conclusions
We found that patients who are undergoing ICI for their first time have a significantly higher prediction of pain versus perception of pain after the injection. We have utilized this data in our clinic to explain to patients that while the majority of patients predict high pain scores associated with injection, the vast majority of patients report very minimal pain associated with the injection. Patients can be more open-minded to ICI therapy which could help aid them with their erectile status; this can particularly be helpful in patients who want to avoid surgery and in patients who are not good surgical candidates.

Disclosure
No
203 Successful Treatment of Hard Flaccid Syndrome: A case report
Authors: Nico E , Rubin R , Trosch L 
Published: April 2022

ABSTRACT

Introduction
Hard flaccid syndrome (HFS) is a chronic, painful condition cited in several patient online forums but poorly defined in literature. Gul and Towe were the first to report on cases of HFS with symptoms including a semi-rigid penis in the flaccid state, erectile dysfunction, penile sensory changes of numbness and coldness, and incomplete voiding. These symptoms have a rapid onset, typically following a traumatic event during sexual intercourse or masturbation. The leading hypothesis regarding the pathophysiology of HFS involves physical or psychological stress which injures the pelvic floor neurovasculature leading to prolonged contraction of the pelvic floor muscles and subsequent pelvic floor dysfunction. Though there is no standardized treatment for HFS, patients have been treated, largely unsuccessfully, with analgesics for the neuropathic pain, phosphodiesterase 5 inhibitors for the erectile dysfunction, and pelvic floor relaxation exercises for the overactive pelvic floor muscles.

Objective
We present a case of a patient diagnosed and successfully treated for HFS.

Methods
A 16-year-old male patient presented to the emergency room with penile and testicular pain and numbness after masturbation and other associated HFS symptoms. Laboratory and imaging tests were normal. He underwent a circumcision for phimosis which did not relieve his symptoms. His symptoms persisted for several months until seeking a sexual medicine trained urologist. The patient was referred to pelvic floor physical therapy and through a series of exercises targeting abdominal and gluteal muscles he became symptom free.

Results
We found that specialized pelvic floor physical therapy can relieve the overactive pelvic floor and entrapped penile neurovasculature, supporting and supplementing the leading theory on the pathophysiology of HFS. The patient, like many of the others cited in forums and case reports, also had an inciting traumatic stressor, masturbation, for his HFS. This physical trauma to the pelvic neurovasculature partially explains the contraction of pelvic and penile musculature and resultant erectile and ejaculatory dysfunction; however, it does not provide a full picture of the pathophysiology of HFS. In this case study, physical activity level, social factors, changes in muscle strength and coordination, and postural changes may have all played a role in the development of this chronic condition.

Conclusions
HFS is a rare condition that requires further research. A multidisciplinary approach including individualized pelvic floor physical therapy that addresses impairments beyond the pelvic floor may be a key in treatment.

Disclosure
No
217 Health Care Provider Knowledge and Attitudes about Erectile Dysfunction and Penile Implants
Authors: Roshandel MR , Ziegelmann MJ , Helo S , Köhler TS , Collins CS 
Published: April 2022

ABSTRACT

Introduction
Erectile dysfunction (ED) stems from a variety of etiologies and often requires a multidisciplinary approach to optimize patient care.

Objective
We sought to assess attitudes and confidence regarding the treatment of erectile dysfunction across different provider types.

Methods
Anonymous, email-based survey of physicians and advanced practice providers in the disciplines of urology, internal medicine, and family medicine. Responses were recorded using a five-point Likert scale. Descriptive statistical analysis of survey response data was performed.

Results
With 76 providers on this ongoing survey including 31 internists, 24 family physicians, and 21 urologists, 88% of providers believed there to be good options for erectile dysfunction after failing pills. Figure 1 shows attitudes of the modalities of “good” options and confidence in the ability to counsel about these options. Regarding if most patients report willingness to consider surgical intervention for ED when counseled about it an equal portion of providers had positive, neutral, and negative feedback. Figure 2 lists other specific attitudes and opinions about penile prosthesis (IPP) implants. Moreover, 78% emphasized the necessity of a multidisciplinary team-based approach to ED patients. However, only 30% of the participants were in agreement with referrals to specialists in sexual health including urologists.

Conclusions
This survey indicates a knowledge gap and low comfort level in 2nd and 3rd line ED treatments. Focused education on penile implant outcomes appears particularly helpful.

Disclosure
No
222 Pharmacovigilance Analysis of Reports of Sexual Dysfunction Associated with Finasteride Use: Implications for the Post-Finasteride Syndrome
Authors: Nguyen D , Herzog P , Cone EB , Labban M , Zorn KC , Chughtai B , Basaria S , Elterman DS , Trinh Q , Bhojani N 
Published: April 2022

ABSTRACT

Introduction
Finasteride, a 5α-reductase inhibitor, is used in the management of androgenetic alopecia and benign prostatic hyperplasia (BPH). There is growing attention to the post-finasteride syndrome, a constellation of adverse events associated with finasteride use which include sexual dysfunction.

Objective
To investigate reports of sexual dysfunction associated with finasteride.

Methods
We conducted a pharmacovigilance study using VigiBase, the World Health Organization's international database of individual case safety reports. We used the reporting odds ratio (ROR). Sensitivity analyses stratified by indication (BPH and alopecia) and age (&lt;45 and ≥45); compared finasteride signals to those of drugs with different mechanisms but similar indications (minoxidil for alopecia and tamsulosin for BPH); compared finasteride to a drug with a similar mechanism of action (dutasteride); and compared reports of sexual dysfunction before and after 2012.

Results
We identified 7700 sexual dysfunction reports associated with finasteride. There was a disproportionality signal for sexual dysfunction associated with finasteride (ROR 50.3, 95% confidence interval (CI) 49.0-51.6). Patients under 45 (ROR 56.4, 95% CI 53.1-59.9) and alopecia patients (ROR 64.9, 95% CI 62.7-67.2) drove the signal. All sensitivity analyses met the threshold of signal significance. Results of primary and sensitivity analyses are presented in Tables 1 and 2.

Conclusions
We detected disproportional signals of sexual dysfunction linked with finasteride use. Despite sexual dysfunction being more prevalent in older BPH patients, we detected larger signals of sexual dysfunction in young alopecia patients. Sensitivity analyses suggest that reports of sexual dysfunction linked with finasteride use may be confounded by indication and by stimulated reporting. However, confounding alone is unlikely to account for the totality of the signal observed in young patients with alopecia.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: QDT reports personal fees from Astellas, Bayer, Janssen, Insightec, and Intuitive Surgical, outside the submitted work. NB, DSE, and KCZ reports consulting fees from Procept Robotics, Olympus, and BSC. BC reports consulting fees from BSC, Olympus, Meditate, Ferring, and Urovant.
226 Is Testosterone Really Your Sex Hormone: Sexual practices as Defined by Testosterone Concentration
Authors: Campbell K , Velazquez O , Sullivan J , Lipshultz L 
Published: April 2022

ABSTRACT

Introduction
Testosterone has long been thought of as the male sexual hormone. Individuals with elevated levels of testosterone have been portrayed to have increased sexual promiscuity. It is not unimaginable that these theories would become prevalent at the opposite end of the spectrum and demonstrable with muted sexual practices seen with lower levels of testosterone.

Objective
This study evaluates sexual encounter tendencies of individuals based on testosterone level as well as by race.

Methods
The National Center for Health Statistics (NHANES) was searched from 2011 to 2016 for males over the age of 18 with available serum testosterone levels. All participants were grouped by age and further subdivided by race. Average testosterone values in increments of 100ng/dL were plotted against different age groups per race. The average age of the first sexual encounter and average number of total lifetime female sexual partners were plotted against testosterone per race. Men who self-identified as “homosexual” were not examined due to the limited sample size. Additionally, men with greater than 500 sexual lifetime partners were excluded as not reflective of the general population.

Results
A total of 3,179 participants were identified and evaluated. Average testosterone levels showed a decreasing trend with age below 50-year-olds (&lt;20 = 490.70, 20-29 = 478.78, 30-39 = 407.03, 40-49 = 401.59; p&lt; 0.0001). Substratification revealed an increase in testosterone in men &gt; 50 (423.16, p&lt; 0.0001). Testosterone stratified by race showed no difference (p &lt; 0.0001). The age of first sexual encounters did not change when stratified among testosterone ranges (average = 17.27, p = 0.008353). When substratified by race, Asian men reported their first sexual encounter at an older age (22.03, p = &lt; 0.0001). The average number of total lifetime sexual partners was 14.50 and did not change when stratified among all testosterone values (p&lt; 0.368). Substratification revealed a significant difference only between testosterone levels in the 200-300ng/dl vs 400-500ng/dl (13.00 vs 15.50, p = &lt;0.0001)

Conclusions
The number of lifetime sexual partners and earlier age of sexual activity were not found to have a consistent correlation with testosterone values. When examined by race, Asian men were noted to have their first sexual encounter at an older age.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Abbie, American Medical Systems, Augmenta LLC, Clarus Therapeutics, Endo Pharmaceuticals, Lipocine, Vault Health
230 Boston Scientific vs. Coloplast: A Prospective Analysis of a Single High-volume Surgeon's Inflatable Penile Prosthesis Experience
Authors: Lopez J , Bansal U , Brunner R , Luna E , Khera M , Gheiler E 
Published: April 2022

ABSTRACT

Introduction
Surgical implantation of a penile prosthesis may be offered to patients with erectile dysfunction (ED) as primary treatment or after failed therapy. The two FDA approved three-piece inflatable penile prostheses (IPPs) on the market, the AMS (American Medical Systems) 700TM series (Boston Scientific, Massachusetts) and the Coloplast Titan® (Coloplast, Minnesota), differ in their overall design and anti-microbial coating. However, little is known as to whether these differences have an impact on risk of infection or revision.

Objective
To compare the likelihood of infection and short-term revision in IPP placements performed by a single high-volume surgeon when using Boston Scientific's AMS 700TM series versus Coloplast Titan® implants.

Methods
We performed a prospective analysis of a single IPP surgeon's experience with AMS 700TM and Titan® at two private hospitals between January 2017 and December 2019. The surgeon alternated the implants every other week for comparison. Data was collected on patient demographics, implant characteristics, case duration, and complications.

Results
A total of 542 patients (mean age 69.2 years) underwent 548 IPP implantations during the two-year period. Of the 548 cases, 303 (55.3%) implantations were performed using Boston Scientific AMS 700TM while 245 (44.7%) were with Coloplast Titan®. Only one (0.18%) case was complicated by post-operative infection despite drain placement for three days in all 548 cases. This infection occurred in a Coloplast Titan® placed as a revision for SST deformity. Seven (1.3%) cases ultimately required revision by the time of review. Although five of the seven cases requiring revision were done using AMS 700TM implants, this did not amount to a statistically significant increase in risk compared to Titan® (p=0.39). First revisions of AMS 700TM were noted to be done earlier than Titan® on average (225 days vs. 450 days postoperatively, p=0.42). Overall, the most common reason for revision was tube fracture (n=3). Diabetes, case time, performing hospital, reservoir type, and reservoir location were not significant prognostic factors for revision (p&gt;0.05).

Conclusions
Risk of infection or short-term revision is not impacted by whether the IPP is manufactured by Coloplast or Boston Scientific. A high-volume IPP surgeon has a significantly decreased risk of infection and revision compared to those currently published in the literature.

Disclosure
No