bluuebunny/crossref_metadata_2025_split huggingface dataset:
17 To Drain or Not To Drain an Inflatable Penile Prosthesis Implantation? A Multi-institutional Experience Tracking Scrotal Hematoma and Infection Occurrence
Authors: Osmonov D , Ragheb A , Romero-Otero J , Bettocchi C , van Renterghem K , Jünemann K , Wilson S 
Published: April 2022

ABSTRACT

Introduction
Although the placement of a drain after inflatable penile prosthesis (IPP) implantation has become a current recommendation by many surgeons, some institutions still disagree believing drainage to be a potential source of infection.

Objective
We hereby present our data to defy this belief and to add to the body of evidence supporting postoperative (PO) drainage. Furthermore, we attempt to define the optimal duration of drainage.

Methods
Our subjects underwent IPP implantation by four European high volume surgeons. All implantations were performed via the penoscrotal access. Only virgin cases were included. We divided our patients into 3 groups: Group 1: no-drain (n=60), Group 2: 24-hour drain (n=60) and Group 3: 72-hour drain (n=60). All patients received similar perioperative antibiotics according to clinical guidelines. Surgical outcomes such as presence or absence of PO scrotal hematoma and infection were evaluated and compared between the 3 groups. We defined hematoma as a scrotal swelling correlated with evidence of scrotal free floating fluid on ultrasound examination. The ultrasound was done after 24 hours and on the 3rd and 10th PO days. Overall PO follow up was for 80 days.

Results
There were no significant differences in age, BMI, operative time, medical comorbidities among our study groups. The patients from Group 3 developed significantly less hematoma compared to Groups 1 and 2. The exact distribution of hematoma incidence was greatest in Group 1: n=12 (20%, p=0.005) followed by Group 2: n=8 (13.3%, p=0.05) and least in Group 3: n=1 (1.7%, p=0.002). Four patients in the no-drain group (6.7% p=0.005) developed IPP associated infection requiring device removal. All four had a hematoma prior to the infection. Groups 2 and 3 were infection-free.

Conclusions
Prolonged drainage up to 72 hours after virgin IPP implantation significantly reduces hematoma rates without the increased risk of drain-associated infections. Moreover, we believe that the development of a scrotal hematoma, by itself, may be a potential cause for surgical site infection.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
19 Evaluation of Gram Positive and Gram Negative Bacteria in a Novel In Vitro Biofilm Model of Penile Prosthesis
Authors: Narasimman M , Chu K , Plano G , Ory J , Bartra S Schesser , Ramasamy R 
Published: April 2022

ABSTRACT

Introduction
Infection is the most feared complication of inflatable penile prosthesis (IPP), often necessitating complete removal. Late infection after IPP insertion is thought to be due to the slow formation of a biofilm. Understanding and preventing biofilm formation would be a breakthrough in preventing IPP infections.

Objective
We aimed to develop an in vitro model to compare formation and growth of biofilms on penile implants by bacteria commonly associated with infection.

Methods
Sterile IPPs (Coloplast Titan) were cut into rings and incubated with S. epidermidis, S. aureus, P. aeruginosa, or K. pneumoniae cultures in tryptic soy broth (TSB) for a 4 h attachment period, and then in only TSB for 120 h. We utilized a published and validated method to measure biofilm mass. Rings were then dipped in deionized water to wash off additional bacteria and either fixed with ethanol (EtOH) or not treated further (no fix). Fixing was employed to preserve biofilm on the rings that otherwise may have been lost during crystal violet staining. Biofilm formation was measured with a spectrophotometer (OD570) after crystal violet staining.

Results
All bacteria formed substantial biofilm on implant rings as measured by OD570. As expected, the gram-negative bacteria, P. aeruginosa and K. pneumoniae produced significantly more biofilm than the gram-positive S. epidermidis and S. aureus. Interestingly, P. aeruginosa formed the most biofilm by at least a factor of 6 in both testing conditions. The ethanol fixing condition produced more consistent results for the crystal violet assay.

Conclusions
Our novel in vitro model of biofilm formation of penile implants can be used in future studies to evaluate the effect of different antibiotic dips and anti-infective capacity of pre-coated implants against different bacteria. Our findings suggest gram-negative bacteria form faster and a greater quantity of biofilm on penile implants as compared to gram-positives. P. aeruginosa displayed the strongest predilection to form biofilm on implants compared to all other bacteria studied, and could be investigated as a specific target to reduce delayed post-operative IPP infections.

Disclosure
Yes, this is sponsored by industry/sponsor: Coloplast

Clarification
Industry funding only - investigator initiated and executed study
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific
30 Testosterone (T) Recovery Profiles After Short-Term Androgen Deprivation Therapy (ADT)
Authors: Flores Martinez J , Nascimento B , Benfante N , Schofield E , Mulhall JP 
Published: April 2022

ABSTRACT

Introduction
ADT plays a major role in several scenarios for men with prostate cancer. T recovery after ADT cessation may be incomplete with 10% of men estimated to suffer persistent castrate levels after long-term ADT.

Objective
The objective of this study was to evaluate T recovery after short courses of ADT.

Methods
Study population included men treated with ≤6 months of ADT in association with radiation therapy (RT). Early morning T levels were collected at baseline and periodically after ADT cessation. T recovery after ADT cessation was analyzed in 2 ways: improvement to non-castrate level (T ≥50 ng/dL), and recovery to normal (T ≥ 300 ng/dL). Recovery rates and median survival time were estimated using Kaplan-Meier statistics and predictors analyzed using Cox proportional hazard ratios.

Results
88 men with a mean age of 68 ± 8 years at time of ADT were analyzed. Median duration of ADT was 3.1 months; 56% had an ADT duration between 1-3 months and 44% between 4-6 months. Mean pre-ADT T level was 390 ± 158 ng/dL. After cessation of ADT, median time to non- castrate levels was 9.3 (IQR = 6.3 – 18.5) months and 15.8 (IQR = 8.3 - 33.8) ‘months for recovery to T ≥300 ng/dL. Higher baseline T levels (T &gt; 400 ng/dL) was associated with a faster recovery to normal T level (HR = 1.80, 95% CI = 1.09 – 2.95), but not to non-castrate level. Neither age &gt; 65 years, prevalent diabetes, nor ADT duration of 4-6 months vs ≤ 3 months were significantly associated with a slower T recovery.

Conclusions
Most of our patients remained with low T levels one year after the cessation of ADT. Higher baseline T was associated with faster T recovery to normal (T ≥ 300 ng/dL).

Disclosure
No
31 Systematic Evaluation of YouTube Content on Testosterone Therapy: The Proliferation of Bro-Science
Authors: Huang Z , Ruan H , Jeong R , Zhou E , Cohen T , Kim J , Berg W 
Published: April 2022

ABSTRACT

Introduction
There has been a marked increase in commercial advertising and prescriptions for testosterone therapy over the last two decades. Patients are increasingly turning to the internet and social media as their initial source for medical information.

Objective
We sought to investigate the quality of information for testosterone therapy on YouTube.

Methods
A YouTube search was performed using the keyword ‘testosterone therapy’. The top 150 most viewed videos were then assessed for inclusion criteria. Videos were evaluated using the DISCERN consumer health evaluation technique and scored via the Patient Education Materials Assessment Tool (PEMAT) by five reviewers. Videos that exceeded twenty minutes in duration, were non-English, were duplicated, consisted of unrelated content, or were presentations intended for medical professionals only, were excluded.

Results
A total of 88 videos met inclusion criteria with a cumulative total of 14,282,476 views. Median video length was 9 minutes (range 1-20). Sixty-eight percent (n=60) of videos were produced by individual YouTubers with no medical background. Twenty-three percent of videos featured a physician with only 7% featuring a urologist. Median DISCERN quality score was 2 (1-5) with 76% of videos rated as moderate to poor quality (DISCERN ≤3). Videos featuring a physician had better content quality compared to videos that did not (DISCERN 3.5 vs 2, p&lt;0.01). Median PEMAT understandability and actionability scores were 81 (31-100) and 50 (0-100) respectively. Forty-five percent of videos included the YouTubers’ personal experiences of undergoing testosterone therapy. Eight (9%) videos discussed testosterone therapy in females. Forty-three percent of videos discussed side effects of testosterone therapy; however, only 10 % (n=9) mentioned infertility as a negative effect. Seventeen percent (n=15) of videos contained potentially misleading information with a total of 3,537,609 views.

Conclusions
Less than a quarter of the most popular videos on YouTube discussing testosterone therapy featured a physician. Less than half of them discussed side effects of testosterone therapy with only ten percent mentioning infertility. With the increasing role of the internet and social media in patient medical decision making, a stronger physician presence on YouTube and other platforms can help deliver more accurate and accessible information to the public.

Disclosure
No
41 Sexual Activities and Fear-related Reasons for Avoiding Sexual Activities in Early Pregnancy: A Cross-sectional Study
Authors: Phan CT , Tran DC , Hoang BL , Tran KT , Pham TTT , Thi H Dao , Van T Ngo , Viet A Bui 
Published: April 2022

ABSTRACT

Introduction
Several studies have reported women's worry that sexual intercourse may harm the course of pregnancy

Objective
To assess if fears about harming the pregnancy are associated with avoidance of sexual intercourse during pregnancy

Methods
A cross-sectional study was conducted on 250 Vietnamese pregnant women in the first or second trimester who visited our hospital for antenatal care. Sexual function was measured by the Female Sexual Function Index (FSFI) questionnaire. The types of fears that were explored in the study included preterm labor, premature rupture of membranes, bleeding, infection, and fetus harm, and were measured by modified questions from the Reasons For Not Engaging in Sexual Activity During Pregnancy (RFNS) questionnaire. Using the total fear score, pregnant women were categorized into low, moderate, and high fear. Main Outcome Measures: Not having sexual intercourse during the past 4 weeks

Results
Seventy-two (28.8%) pregnant women had no sexual intercourse for the past 4 weeks. All types of fear were common among pregnant women, the more important fears were infection and harming the fetus. On multivariable regression analysis, the prevalence of not having sexual intercourse was higher in both women who had moderate (adjusted prevalence ratio (PR) = 2.84, 95%CI 1.42–5.67) and high fear (adjusted PR = 4.39, 95%CI 2.28–8.44)

Conclusions
Avoidance of sexual intercourse was common among Vietnamese pregnant women and was associated with the fears about harming the pregnancy. This can be a target in the health education programs for pregnancy couples

Disclosure
No
64 Development of a Machine Learning Algorithm for at Home Curvature Assessment
Authors: Witherspoon L , Soltani R , Gleave J , Hach F , Flannigan R 
Published: April 2022

ABSTRACT

Introduction
Peyronie's disease prevalence estimates suggest that 11-15% of men suffer from this disease, although only 1% seek evaluation. When patients do seek help, tools for penile curvature assessment are lacking. This represents a barrier for both patient engagement with a health care provider, and for proper assessment by their treating clinician.

Objective
We set out to develop a tool for patient and clinician led assessment of Peyronie's disease using a neural network system capable of plaque assessment of photographic images.

Methods
Men underdoing penile curvature assessment in a sexual medicine clinic were recruited to enroll in this study. Images were taken of the erect penis from the left, right and top sides using an Apple iPad™. Model training was conducted with a residual neural network (ResNet), a neural network-based framework used for image recognition, to identify male genitals. To assess basic curvature a mathematical formulation was created to calculate the penile curvature after fitting linear lines from genital tip to curvature point and from curvature point to the base of the penis. To validate the algorithms performance two urologic surgeons with extensive experience performing curvature assessments were asked to use the labelling software Rectlabel™ to place linear lines identifying the penile curvature on the same photographs used to train the model.

Results
Initial training of the image analysis model has allowed for identification of the presence of a curvature of a penis, with ongoing training for curvature quantification (Figure 1). We have trained the model to remove background images, isolating the genitals (Figure 1) to aid in patient privacy. When assessing the models ability to measure penile curvature the algorithm calculated the curvature with a median difference of 7.7 degrees between model and physician assessment across the photographic library.

Conclusions
This study presents an algorithm capable of performing accurate curvature assessment based on photographic images. With demonstration of curvature assessment via photographic images this will allow patients to perform an initial curvature assessment at home, improving motivation for patients to seek help. Furthermore, this technology can augment clinician led curvature assessment, providing an objective and easy means for documenting disease severity.

Disclosure
No
65 Standardizing Sonographic Descriptors of Peyronie's Plaques
Authors: Baird B , Haehn D , Broderick G 
Published: April 2022

ABSTRACT

Introduction
Peyronie's Disease (PD) is characterized by a fibrous scar of the tunica albuginea. PD is typically imaged with 2D ultrasound. We propose a classification system of these ultrasound findings in the evaluation of PD.

Objective
The purpose of this study is to establish a functional, reproducible sonographic classification system for evaluating PD and to examine the relationship between PD grading and curvature, duration of PD, and vascular erectile status.

Methods
In our study, 395 patients with PD underwent intracavernous injection with an erectile agent (ICI) followed by Color Doppler Duplex Ultrasound (CDDU). All CDDU studies were performed by a single examiner and all PD grading was done by two independent reviewers using saved images. CCDU findings including peak systolic velocities (PSV) and resistive indices (RIs) were recorded. PD grades of 2D images were classified into three grades: Grade 1 acoustic shadowing without calcification; Grade 2 focal microcalcifications of the tunica, pillars, or septal fibers; Grade 3 confluent calcification of the dorsal, septal, ventral tunica albuginea.

Results
There were 250 patients classified with Grade 1 (63%) sonographic changes, 75 with Grade 2 (19%), and 70 with Grade 3 (18%). Neither median age nor body mass index (BMI) of the cohorts were significantly different: Grade 1 (59.3 yr), Grade 2 (59 yr) and Grade 3 (60.3 yr), p = 0.711; BMI 27.6, 28.2, 27.7, p = 0.813. Medical risk factors for erectile dysfunction, including hypertension, heart disease, diabetes mellitus, hyperlipidemia, smoking history, and history of prostate surgery were not statistically different for the three cohorts. Most patients had previously used PDE5-Inhibitors (293/395). History and or physical findings of Dupuytren's palmar contracture was noted in 30/395 (7.6%) of men. The median duration of PD was not significantly different in the three cohorts (12, 12, 14 months p = 0.639). Neither CDDU diagnoses (Table 1) nor curvature varied by sonographic grades (Table 2).

Conclusions
The scar resulting from PD seals together the outer longitudinal and inner circular layers of the tunica albuginea causing deformity of the erect shaft. PD plaques are usually palpable and associated with focal thickening of the tunica. On 2D ultrasound, the typical appearance is an acoustic shadow. Most of our patients presented with Grade I acoustic shadowing and no calcifications 250/395 (63%); on the other hand, 19% had acoustic plaque shadowing and additional findings of focal tunica or deep microcalcifications and 18% had confluent calcification of the dorsal, septal or ventral tunica. We propose a unique and reproducible classification system. This grading system based on grayscale ultrasound of Peyronie's plaques may serve as a paradigm for diagnosis, didactics and integrated research.

Disclosure
No
74 Does Treating a Penile Plaque with Collagenase Clostridium Histolyticum Lead to Changes in Vascular Characteristics?
Authors: Soubra A , Greenberg JW , Kim J , Natale C , Pincus J , Ottaiano N , Nguyen HMT , Almajed W , Sikka S , Hellstrom WJ 
Published: April 2022

ABSTRACT

Introduction
Peyronie's Disease (PD) is a localized disease of the Tunica albuginea (TA) characterized by the formation of fibrotic plaque. Patients with PD present with erectile dysfunction (ED) up to 32% of the time. We have presented in previous studies that the most common etiology of ED in this population is vascular leak characterized by elevated end-diastolic velocity (EDV) on penile duplex doppler ultrasound (PDDU). It is postulated that the change in the architecture of the TA could be the cause of this venous leak; however, this is not definitive. XIAFLEX, which is a collagenase clostridium histolyticum, has been used in clinical practice since 2013 to dissolve the abnormal deposition of collagen type I and III, which is the predominant type in the fibrotic plaque.

Objective
In this study, we explore if there is a change in mean EDV and rate of vascular leak measured on PDDU before and after receiving four cycles of XIAFLEX in patients treated for Peyronie's disease.

Methods
All patients presenting to our institution with chief complaints suggestive of PD undergo PDDU as part of the initial evaluation. Patients who are eligible and choose to get Xiaflex underwent four cycles of treatment, each consisting of two injections 24-72 hours apart. They then undergo another PDDU 8 weeks after completing the last cycle to assess response to treatment. Peak systolic velocity, EDV, resistive index, curve degree, and direction are usually recorded during the test at 0, 5, 10, 15, and 20 min after injection of a vasoactive agent. The lowest value recorded of EDV at times 10, 15 or 20 min at the time of maximal tumescence/rigidity was chosen for the analysis.

Results
We identified 223 patients with PD who underwent XIAFLEX treatment with 148 completing all 4 cycles at our center between 2016 and 2020. All patients had complete data available for analysis. 87% of patients showing improvement of equal to or more than 15 degrees after four cycles of treatment. The mean EDV at the initial PDDU was 26.7, while the mean EDV at the follow-up study was 13.9 (image 1). The rate of the non-vascular PDDU findings increased after XIAFLEX treatment with initial study containing 38% as compared to 48% on follow up (p-value: 0.044).

Conclusions
The mean EDV and the rate of the venous leak seem to decrease with the treatment of XIALFEX for Peyronies disease. Whether this is related to change in the architecture of the plaque or improved erectile function in general due to psychological and various factors in the patient who experience improvement in the curve is to be further explored.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
151 Factors that Drive Patient Satisfaction in Early Recovery Period After Minimally Invasive Surgical Therapy (MIST) for BPH: a Sub-Analysis of PUL and Rezum
Authors: Schiff W. , Tutrone R. 
Published: April 2022

ABSTRACT

Introduction
As utilization of MISTs for the treatment of BPH increases, physicians and patients should seek to understand not only long-term symptom outcomes, but also factors that may drive high satisfaction during the recovery period.

Objective
This new sub-analysis evaluates factors that may influence satisfaction in the early recovery period after undergoing Rezum Water Vapor Therapy (Rezum) or UroLift Prostatic Urethral Lift (PUL).

Methods
Within 2 months post-procedure, 30 PUL and 23 Rezum patients completed a questionnaire detailing their experience. Highly Satisfied patients achieved a pooled score of ≥3 on two questions on the subject of satisfaction (satisfaction with the effect of the procedure on urinary symptoms; satisfaction with speed and ease of recovery). For each question, a score of &lt;0 = dissatisfaction and a score of +2 = high satisfaction. Outcomes were compared between all Highly Satisfied vs. all Dissatisfied patients, and between PUL vs. Rezum patients.

Results
Highly Satisfied patients in the early recovery period after either procedure reported significantly better absolute IPSS (8.0 vs. 24.3, p&lt;0.0001) and QoL (1.0 vs. 4.6, p&lt;0.0001) compared to Dissatisfied patients. Catheter duration was shorter for Highly Satisfied patients (1.9d) compared to Dissatisfied patients (5.6d, p=0.02). Highly Satisfied patients experienced lower rates of interference by their urinary symptoms with activities related to sports, entertainment, and community, and experienced less impact of recovery on work (p-value = 0.002). Within this early recovery timeframe, outcomes associated with increased satisfaction (IPSS, QoL, catheter duration, interference by urinary symptoms with sports, entertainment, and community activities) were better for PUL vs. Rezum patients (respective p-values: 0.001, 0.04, &lt;0.001, 0.007, 0.01, 0.04).

Conclusions
Better absolute IPSS and QoL scores, less interference by urinary symptoms, and shorter duration of catheterization in the early recovery period appear to be factors which correspond to satisfaction in this population of MIST patients; these factors demonstrate superior outcomes for PUL patients compared to Rezum.

Disclosure
No