bluuebunny/crossref_metadata_2025_split huggingface dataset:
123 Low Free Testosterone Level as a Predictor of Cardiovascular Events in Japanese Men with Coronary Risk Factors
Authors: Kato Y , Shigehara K , Iijima M , Kawaguchi S , Izumi K , Kadono Y , Namiki M , Mizokami A 
Published: May 2022

ABSTRACT

Introduction
Late-onset hypogonadism is associated with higher mortality largely due to cardiovascular disease (CVD).

Objective
We investigated whether a low plasma free testosterone (FT) level could predict cardiovascular events in middle-aged Japanese men with coronary risk factors.

Methods
We reviewed retrospectively our institutional database of patients with any coronary risk factor (hypertension, diabetes, dyslipidemia, smoking, and obesity) without a previous history of CVD. Serum early morning free testosterone (FT) levels, collected at baseline, were analyzed. Patient age, baseline FT level, and the above coronary risk factor were selected as potential predictors of cardiovascular events. Multivariable time-to-event analysis (Cox proportional hazards), and Kaplan-Meier curve were performed to define impact of the FT level on time of cardiovascular (CV) events.

Results
Four hundred and sixty-six male outpatients (37–89 years old, mean ± SD = 65.1 ± 10.5 years) who had any coronary risk without a previous history of CVD were accumulated. During the mean follow-up period of 84.8 months, a total of 126 CV events occurred. Kaplan–Meier survival analysis by tertile of plasma FT levels revealed that the subjects with the lowest FT tertiles (&lt;6.5 pg/ml) were more likely to develop CV events than those with the highest tertiles (&gt;9.3 pg/ml) (P&lt;0.01 by log-rank test). In multivariate analysis, the subjects with the highest tertiles of plasma FT (&gt;9.3 pg/ml) and those with the second tertiles of plasma FT (6.6–9.2 pg/ml) had significantly lower CV event risk compared to those with the lowest FT tertiles (&lt;6.5 pg/ml) (HR, 0.524; 95% CI, 0.309–0.887, P=0.016 and HR, 0.617; 95% CI, 0.389-0.976, P=0.030, respectively). Furthermore, age, hypertension, duration of diabetes, dyslipedemia and current smoking showed independently significant association with CV events.

Conclusion
In middle-aged Japanese men with some coronary risk factors, lower FT is a predictor for the development of CVDs, independently on any coronary risk factors and age.

Disclosure
Work supported by industry: no.
126 Relationship Between Sexual Function Improvement and Treatment Satisfaction by TRT in LOH Patients
Authors: Chiba K , Sato K , Onishi A , Kaku Y , Ishida T , Okada K , Fujisawa M 
Published: May 2022

ABSTRACT

Introduction
In the treatment of LOH (late-onset hypogonadism) syndrome, TRT (testosterone replacement therapy) is effective for various LOH related symptoms including sexual function. However, among Japanese population, sexual desire is not always strong in elderly men. Even if the patients do not have opportunities of sexual intercourse, TRT may still be beneficial for other symptoms derived from LOH syndrome.

Objectives
To examine patients’ satisfaction by TRT, we examined the relationship between TRT effect on sexual function and whole treatment satisfaction in our patient cohort.

Methods
Patients who have LOH symptoms and low serum free-testosterone (FT) levels were diagnosed as LOH syndrome. FT was diagnosed as “low” when &lt;8.5pg/ml, while diagnosed as “borderline” when 8.5-11.8pg/ml. For TRT, testosterone enanthate 250mg/2-4weeks was given for more than 6 months. SHIM (Sexual Health Inventory for Men) score and our original questionnaire asking whether they are satisfied with the treatment were examined.

Results
Median patients’ age was 54 years (n=95). Before treatment, total testosterone was 4.5±1.8ng/ml and free testosterone was 6.2±2.3pg/ml. The majority of chief complaint before treatment were psychological or somatic symptoms. After treatment, SHIM score showed significant improvement in all questions of 1 to 5, and total SHIM score increased from 6.4 to 9.4. The number of patients who have few opportunities for sexual intercourse (0 point for SHIM Q3.4.5) decreased from 66% to 48% after treatment. Using the questionnaire for patients’ satisfaction, 71% were classified into the effective group. The number of patients who still had few opportunities of sexual intercourse after treatment was 39% in the effective group and 71% in the ineffective group.

Conclusions
From the point of patient satisfaction, TRT for LOH syndrome was effective in 71% of patients. Almost 40 percent of the patients who were satisfied with the treatment answered that there were few opportunities of sexual intercourse even after treatment. The improvement in sexual function may not be always required in a cohort of our patient population.

Disclosure
Work supported by industry: no.
142 Analyzing the Impact of Diabetes on Erectile Function Recovery after Radical Prostatectomy
Authors: Martinez J. Flores , Jenkins L.C. , Benfante N. , Nelson C.J. , Schofield E. , Mulhall J.P. 
Published: May 2022

ABSTRACT

Introduction
Diabetes (DM) is a known risk factor for ED. The impact of DM on erectile function recovery (EFR) after radical prostatectomy (RP) is poorly understood.

Objective
We aimed to assess the impact of DM on the EFR after RP.

Methods
Men who had RP with ≥2 years follow-up constituted the study population. EFR was assessed using International Index of Erectile Function, Erectile Function Domain (EFD) score pre-RP and at 2 years post RP. ADT and radiation therapy before or after RP were exclusions. Demographics, comorbidities, pathological parameters were recorded. We performed univariate and multivariate logistic regression assessments to evaluate predictive factors, including DM, patient age, nerve sparing status (NSS) scored between 1 (preserved) to 4 (resected) for each side, and comorbidity profile, associated with poor EFR post-RP.

Results
2024 men were included. Mean age at RP was 61.3±7.1 years. Median baseline and 2-year EFD scores were 27 (IQR = 19-30), and 13 (IQR = 5-25). 10% had DM with a mean pre-RP hemoglobin A1c of 6.6±1.3%. 44% had hypertension, 51% dyslipidemia, 14.5% obstructive sleep apnea, 5% history of coronary artery disease, 8% were current and 34% former smokers. 38% reported two or more comorbidities pre-RP. Median Gleason sum was 7. Nerves were preserved bilaterally in 77% and unilaterally in 16%. Median NS score was 3 (IQR 2-4). Median EFD scores at 2 years with and without DM were 7 (IQR 3-16), and 14 (IQR 5-25), respectively (p&lt;0.001). At 2 years, in men with and without DM, the proportion with EFD ≥24 was 14% and 32% and EFD ≤10 was 63% and 42% respectively.

Conclusion
In our cohort, DM was a significant predictor of lower EFR at 2 years post-RP.

Disclosure
Work supported by industry: no.
144 Impact of Neoadjuvant Androgen Deprivation Therapy (NADT) on Erectile Function Recovery (EFR) After Radical Prostatectomy (RP)
Authors: Martinez J. Flores , Jenkins L.C. , Benfante N. , Touijer K. , Mulhall J.P. 
Published: May 2022

ABSTRACT

Introduction
NADT has gained increasing recognition in the management of men with high risk disease prior to RP No large study to date has examined EFR in such patients

Objective
we aimed to define such outcomes with this analysis.

Methods
Men who underwent NADT pre-RP with ≥2-year follow-up post-RP constituted the study population. Patients who received ADT post-RP and radiation therapy pre and post-RP were excluded. Demographics, comorbidity, hormone and pathological parameters were recorded. EFR was assessed using the International Index Erectile Function-Erectile Function Domain (EFD) score. Predictors of EFR were analyzed using logistic regression models.

Results
260 men were analyzed. Mean age of 63.6 ± 7.1 years. 11.2% had diabetes, 55% hypertension, 54.2% dyslipidemia, and 16.9% and 5.8% history of sleep apnea and coronary artery disease respectively. Regarding smoking history, 6.9% was current smoker, and 33.1% former smoker. Baseline testosterone was 352.1 ± 225.9 ng/dL, PSA 9.6 ± 8.4 ng/mL, and median EFD score 24 (IQR = 14-30). Median Gleason sum was 7 (IQR = 7-9). 43.4% patients had bilateral nerve sparing status (NSS), and 34% unilateral. 13.1% received NADT. Median duration of NADT was 1 (IQR = 1-3) months. At 2 years post-RP, median EFD was 7 (IQR = 3-22) for men without NADT and 4 (IQR = 2-13) for men with NADT; 8.8% and 21.2% had an EFD score ≥ 24 in men with and without NADT. 73.5% and 55.3% had an EFD score ≤ 10 in men with and without NADT.

Conclusions
Men with NADT had lower EFR at 2 years post-RP, however NADT did not predict EFR in our cohort.

Disclosure
Work supported by industry: no.
151 A Study of Erectile Dysfunction in Men 40 Years of Age or Younger
Authors: Yamagishi M. , Sasaki H. , Ogushi Y. , Niikura A. , Ota T. , Ichimura Y. , Hashimoto Y. , Sugishita H. , Kurokawa I. , Tanifuji S. , Imamura Y. , Shimoyama H. , Ota M. , Ishikawa K. , Hayashi K. , Fukagai T. 
Published: May 2022

ABSTRACT

In recent years, awareness of erectile dysfunction and the demand for treatment have been increasing even among young men. We investigated the status of young patients 40 years of age or younger with erectile dysfunction. The subjects were 208 patients who visited the urology departments of Showa University Fujigaoka Hospital and affiliated hospitals with a chief complaint of erectile dysfunction. The erectile function was assessed with the Sexual Health Inventory for Men (SHIM), diary questions on sexual intercourse from the Sexual Encounter Profile, and the Erection Hardness Score, which measures the hardness of erection. The treatment was monotherapy with sildenafil (25 or 50 mg), vardenafil (10 or 20 mg), or tadalafil (10 or 20 mg) or a combination of multiple phosphodiesterase 5 (PDE5) inhibitors. To investigate the cause, blood tests including free testosterone and the Self-rating Depression Scale questionnaire were conducted, and Pulse Wave Velocity (PWV) was measured. The median age of the patients was 36 years. As for the cause of erectile dysfunction, psychogenic erectile dysfunction was observed in 141 patients, accounting for 67.7% of the patients. However, 82.1% of patients who underwent PWV measurement showed measurements suggestive of organic changes. The efficacy rates of PDE5 inhibitors were 77% for sildenafil, 73% for vardenafil, and 85% for tadalafil. This study showed that psychogenic erectile dysfunction was common in young patients, and that PDE5 inhibitors were effective for them. In addition, the study suggested the presence of organic changes as a risk factor for erectile dysfunction even in young patients.

Disclosure
Work supported by industry: no.
155 Lycium Barbarum Polysaccharides Improves Erectile Function Through Suppression of Inflammation and Apoptosis in Rats with Bilateral Cavernous Nerve Injury
Authors: Wang J. , Song J. , Song G. , Hu P. , Sun T. , Liu K. , Xu W. , Liu J. , Ruan Y. 
Published: May 2022

ABSTRACT

Introduction
Neurogenic erectile dysfunction (NED) responds poorly to phosphodiesterase 5 (PDE5) inhibitors. Lycium barbarum polysaccharide (LBP) has broad-spectrum anti-inflammatory and anti-apoptotic effects, but whether it improves the erectile function of neuropathic ED through the above-mentioned mechanism is unclear.

Objective
We intend to explore the role of LBP in the treatment of NED.

Methods
A rat model of bilateral cavernous nerve injury (BCNI) was constructed by crushing the CN 5 mm distal to the major pelvic ganglion (MPG). Tweety-four BCNI rats were randomly divided into BCNI group, BCNI + LBP-LD (20 mg/kg/day) group and BCNI + LBP-HD (40 mg/kg/day) group, whereas another 8 age-matched rats formed the control group. Erectile function was evaluated by measuring intracavernosal pressure (ICP) and mean arterial pressure (MAP). The penile tissues, and MPG along with CN were collected from each group of rats for subsequent histological and molecular biological analysis. The rat Schwann cell line S16 was used for CCK-8 and wound healing assay, and the Schwann cell (SC) markers S100 and Pmp22, neuroinflammatory indicators IL-1β, TGF-β1, apoptosis-related proteins Caspase-3, Bax, Bcl-2 and nerve growth factor NGF were verified by PCR and WB.

Results
ICP/MAP indicated that the erectile function of rats in the BCNI model group was severely impaired, which was rescued in the BCNI+LBP-LD and BCNI+LBP-HD groups. Rats in the BCNI model group can highly express inflammatory indicators NF-kb, TNF-α and apoptosis-related proteins Bax, Caspase-3. TUNEL confirmed that the level of apoptosis in the penile tissue of BCNI rats increased. The above-mentioned penile inflammation and apoptosis changes can be inhibited by LBP. In addition, both immunofluorescence and WB confirmed that rats in the LBP-LD and LBP-HD groups highly expressed nNOS and down-regulated the expression of TH. In vitro experiments have shown that LBP can promote the proliferation and migration of SC, increase the expression of Pmp22 and NGF, and the inflammation and apoptosis-related proteins were down-regulated.

Conclusion
LBP can relieve the inflammation and apoptosis at the original site of nerve injury by promoting the proliferation and migration of SC, and secretion of NGF, thereby inhibiting the inflammation and apoptosis caused by hypoxia after denervation of penile tissue, and improving penile erection.

Disclosure
Work supported by industry: no.
168 Immediate Salvage with Inflatable Penile Prosthesis in an Infected Field: A Contemporary Multi-Institutional Cohort
Authors: Jiang D. , Barnard J. , Choi E. , Furr J. , Lentz A. , van Renterghem K. , Selph P. , Yafi F.A. 
Published: May 2022

ABSTRACT

Introduction
Contemporary management of inflatable penile prosthesis (IPP) infections involves removal and replacement to minimize corporal fibrosis and penile shortening. Many urologists prefer a malleable prosthesis (MP) followed by staged conversion to IPP, a technique thought to improve outcomes by allowing treatment of the infection while maintaining intracorporeal volume. A staged procedure involves additional surgery with associated risks. Previous studies suggest an 18% infection risk of placing a second device in a non-infected, revision setting, and that infection risk increases with each subsequent procedure.

Objective
Our study aims to delineate whether immediate IPP salvage in an infected field yields similar complication rates to the staged approach.

Methods
Retrospective review at 5 institutions from February 2010 to October 2020 identified patients with IPP infection who underwent IPP salvage. Demographic, laboratory, operative, and microbiology data were collected. Emphasis was placed on the salvage operative technique, duration of antibiotics, and post-salvage complications.

Results
19 patients underwent immediate salvage with IPP in the setting of a suspected infection. Average age at initial implantation was 59.9 years. Median time from initial implant to presentation with infectious symptoms was 2.4 months, and revision was performed a median of 1.5 days after presentation and initiation of antibiotics. Intraoperative complications were rare (5.3%), and post-salvage complications were 21.1%, including 1 cylinder herniation and 3 post salvage infections (15.8%). Only 1 post-salvage infection showed concordance with initial cultures while 1 was discordant and the third showed no growth (Table 1). Fisher's exact test showed diabetes, purulence in the operative field, use of drain, or washout type were not associated with infection post-salvage.

Conclusions
Immediate IPP salvage in the setting of an acutely infected field shows a complication profile not exceeding published data in the staged revision setting. Although staged MP-IPP salvage has been favored by many surgeons, the complication profile may be equivalent to immediate IPP salvage, and the risks of a subsequent operation should be considered.

Disclosure
Work supported by industry: no.
174 Acne, Folliculitis and Post-Operative Infection Rates of Penile Prosthetic Implants
Authors: Choi E. , Barnard J. , Horns J. , Paudel N. , Das R. , Yafi F. , Hotaling J. 
Published: May 2022

ABSTRACT

Introduction and Objective
Acne vulgaris is the inflammation of the pilosebaceous unit due to overgrowth of Propionibacterium acnes while folliculitis is inflammation of the hair follicle commonly due to Staphylococcus aureus. Whether these microbes are pathogenic in urologic procedures is yet to be determined. In this database study, we investigated whether acne or folliculitis were associated with an increased risk of post-surgical infection in men who received a penile prosthetic implant (PPI).

Methods
The IBM MarketScan® Claims dataset was utilized to assess penile prosthesis encounters. Men 18-years and older who received a PPI were included in this study. Acne and folliculitis were analyzed separately as independent variables. Demographic factors that influence infection rates were examined including age, immunosuppressed status, coronary artery disease (CAD), diabetes, smoking status, and spinal cord injury (SCI). (Table 1a-b). A log-rank test of Kaplan-Meier curves determined whether having acne or folliculitis was significantly associated with time to post-operative infection within 6 months. Cox Proportional-Hazard models included covariates deemed most clinically relevant.

Results
Our analysis included 17,031 men who received a PPI. When analyzing men with acne, aside from being younger (59.9 vs 62.4, p&lt;0.001), there were no statistical difference compared to men without (Table 1a). By 6 months, having acne was not associated with increased rates of infection (Figure 1a, Table 2a). Men with folliculitis were found to have significantly higher rates of diabetes, immunocompromised status, and CAD compared to men without (Table 1b). Having folliculitis was not associated with increased rates of infection by 6 months even after adjusting for covariates (Figure 1a, Table 2b).

Conclusions
There appears to be no association between acne and folliculitis and rates of PPI infection. These findings allude to the difficulty in predicting which microorganism within the natural skin flora may be inoculant and which are pathogenic in surgical incisions. Furthermore, infection rates of PPI's may be due to other factors such as intraoperative aseptic techniques and post-operative hygiene.

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).
177 Ejaculation Profiles in Men after Irreversible Electroporation for Prostate Cancer
Authors: Martinez J. Flores , Benfante N. , Chen L. , Ehdaie B. , Mulhall J.P. 
Published: May 2022

ABSTRACT

Introduction
Irreversible Electroporation (IRE) is an evolving strategy for the management of localized prostate cancer. Little data exists on sexual function, in particular ejaculation, in such patients.

Objective
We aimed to report the ejaculatory function in patients undergoing IRE.

Methods
Patients undergoing IRE with ≥1-year follow-up were evaluated. These patients were selected for focal therapy and consented to participate in a prospective registry. Eligibility criteria: Gleason score 3+4, PSA &lt;20, no evidence of extracapsular extension, seminal vesicle invasion or lymph node involvement on standard imaging. The Gleason score 3+4 prostate cancer was allowed up to a maximum of two adjacent sextants within the prostate gland. Concomitant Gleason score 6 was untreated and monitored on active surveillance. They completed the Male Sexual Health Questionnaire ejaculation domain short form (MSHQ-EFD-SF) at 6 weeks, 3 months, 6 months, and 12 months post-IRE. This questionnaire has 4 questions: 3 questions sum scores (range 1-15), where lower scores indicate worse ejaculatory function, and the MSHQ-Bother question score (ranges 0-5), with higher scores indicating higher bother associated with ejaculatory difficulties.
Comorbidities, demographics, and pathology parameters were recorded.

Results
20 men have been evaluated to date with a mean age of 64.3 ± 4.8 years. Baseline testosterone and PSA were 536.3 ± 267.6 ng/dL and 6.2 ± 2.7 ng/mL. Mean prostate volume was 45.6 ± 11.9 cc. Median baseline score of MSHQ-EJD-SF was 13.5 (IQR 10, 14), and post-procedure median scores were 11 at 6 weeks; 12.5 at 3 months; 12 at 6 months; and 11.5 at 12 months (p-value =0.036). Scores for ejaculation strength and seminal volume ejaculated decreased significantly, and bother scores increased significantly between baseline and 1-year post-IRE. The ability to ejaculate during sexual activity did not change over time.

Conclusions
In our cohort of patients with prostate cancer who underwent IRE there was a significant difference in ejaculatory profiles between baseline and 1-year post-IRE.

Disclosure
Work supported by industry: no.
185 Treatment of Intravaginal Ejaculation Disorder Using Ejaculation Aids: A Multicenter Prospective Clinical Trial
Authors: Fukuhara S. , Takezawa K. , Kiuchi H. , Nonomura N. , Iwasa A. , Kobayashi K. , Shirai M. , Tsujimura A. 
Published: May 2022

ABSTRACT

Introduction
Ejaculation disorders, the second most common sexual dysfunction, are often difficult to treat because of the lack of highly effective treatments. The A10 cyclone SA +PLUS (Fig. 1) is a motorized ejaculation aid with adjustable movement and intensity of stimulation. The A10 cyclone SA +PLUS. We hypothesized that the A10 cyclone SA +PLUS would be effective in the treatment of ejaculation disorders.

Objective
To evaluate the efficacy of the A10 cyclone SA +PLUS ejaculation aid in the treatment of intravaginal ejaculation disorder.

Methods
Between August 2020 and May 2021, men from 20 to 60 years of age who visited our hospital with complaints of vaginal ejaculation disorder were included. Patients were treated with masturbation using the A10 cyclone SA +PLUS 1–3 times a week for 8 weeks. A questionnaire was used to assess the ability to achieve vaginal ejaculation before and after the intervention. Sexual function was also assessed using questionnaires such as IIEF, EHS, MSHQ-EjD, CPSIQ-12, and NRS (Numerical Rating Scale) before and after the intervention. The procedures were approved by the Regional Ethics Committee (approval number: 2020-007). All patients provided written informed consent.

Results
Eight patients were included in this study. The median age was 35 years. Three of Eight (38%) patients achieved vaginal ejaculation. Significant improvement was found in IIEF and EH.

Conclusions
Ejaculation aids may be an effective treatment for vaginal ejaculation disorder, for which any drug has not been effective. We plan to conduct further studies to increase the number of patients.

Disclosure
Work supported by industry: no.