bluuebunny/crossref_metadata_2025_split huggingface dataset:
219 Factors Associated with the Decrease in Orgasm Intensity in Patients Who Underwent to Radical Prostatectomy
Authors: Gamberini P , Nascimento B , Barbosa Neto C , Pedrenho R , Góes P , de Bessa Júnior J , Sphair J , Nahas W , Srougi M 
Published: May 2022

ABSTRACT

Introduction
Orgasmic disorders after radical prostatectomy (RP) surgery have received increasing focus on medical literature, especially the most frequent disorders, to name but a few, climacturia and dysorgasmia. However, changes in orgasm intensity have been reported to non-negligible rates and should be better studied.

Objective
Our study aims at describing the prevalence and predictors of this neglected symptom.

Methods
We performed a retrospective analysis of a prospective maintained database of men after RP with complaints of sexual dysfunction. Patients observed a sexual medicine group of our hospital went throught a supervised visit which included the investigation of orgasmic disorders. Other factors such as erectile dysfunction, hypogonadism symptoms, seric level of testosterone and prolactin, and demographics were also recorded. Finally, these variables were correlated with the decrease in orgasm intensity, seeking to assess the existence of predictive factors for this disorder.

Results
Data from 57 patients were available considering the average age of 67 years old (65,4-68,6 CI, 95%). The decrease in orgasm intensity was reported by 14 patients (24,5%), while climacturia was related to 38 patients (68%) and dysorgasmia to one patient (1,75%). Among patients who experienced decreased orgasm intensity, the average time between the surgery and the search for our service was 27,5 months (15,6-39,4 CI, 95%). After using a logistic regression model adjusted to several variables which include age, time from the last surgery, testosterone and prolactin levels, hypogonadic symptoms, presence of climacturia or dysorgasmia, erectile dysfunction and response to IPDE-5, use of adjuvant radiotherapy or hormonotherapy, it was realized that age was the only factor associated with the lowering of orgasm intensity. The median age was significantly lower in those patients who reported a reduction in orgasm intensity, respectively 62 [59-67] x 68 [64-73] (p &lt;0.01).

Conclusions
Orgasmic disorders after radical prostatectomy surgery have a high incidence and are often neglected. These symptoms have a direct impact on the quality of life and should be actively investigated. Our study showed that age appears to be a relevant factor associated with this condition.

Disclosure
Work supported by industry: no.
240 An Analysis of the Mis-Diagnosis of Peyronie's Disease (PD) in Men Referred for the Assessment of Penile Deformity
Authors: Deveci S , Tanuguchi H , Torremade J , Ortega Y , Mulhall JP 
Published: May 2022

ABSTRACT

Introduction
PD is diagnosed in the presence of penile deformity combined with a tunical plaque. Clinical experience shows us that some men who believe they have PD actually have congenital penile curvature (CPC), whilst others, especially those with a history of penile trauma, have anxiety about having PD but, in fact, do not. This analysis aimed to define the mis-diagnosis rate of men referred for PD evaluation.

Methods
Study population consisted of men who (i) presented to a sexual medicine clinic for the evaluation of penile deformity (ii) and/or the presence of a tunical nodule (iii) underwent comprehensive penile examination by a sexual medicine physician with extensive experience in PD and (iv) underwent penile deformity assessment at the time of penile duplex Doppler ultrasound (PDDU). Demographic and comorbidity data were recorded. Multivariable analysis (MVA) was conducted to define predictors of the absence of PD.

Results
1942 patients met the inclusion criteria. 79% were MD referred (MDR), the remainder were self-referred (SR). Mean age of the entire cohort was 58±28 years (MDR 64±22y, SR 41±11y, p&lt;0.01). Comorbidities: hypertension 24%, diabetes 11%, dyslipidemia 27%, chronic pelvic pain syndrome (CPPS) 6%, history of radical pelvic surgery (RPS) 24%, history of penile trauma 8%. Overall 14% of patients had no PD plaque identified on examination (MDR 12%, SR 21%). For MDR without PD, majority had CPC (9%), 3% had no deformity, while for SR only 6% had CPC, the remaining 15% had no deformity at PDDU. Results of MVA is presented in the Table.

Conclusion
Men referred to a tertiary referral center for the evaluation of PD commonly have no PD. Predictors of no PD include: diagnosis of CPPS, history of penile trauma, young age and absence of RPS.

Disclosure
Work supported by industry: no.
243 Peyronie's Disease in Young Adults: Symptomatic Burden and Clinical Characteristics
Authors: Fallara G , Capogrosso P , Boeri L , Cazzaniga W , Candela L , Schifano N , Costa A , Pozzi E , Belladelli F , Cignoli D , Raffo M , Matloob R , Cornelius J , Ventimiglia E , Mattei A , Montorsi F , Salonia A 
Published: May 2022

ABSTRACT

Introduction
Peyronie's disease is a benign condition involving the tunica albuginea of the corpora cavernosa of the penis.

Objectives
To investigate whether patients’ age has an impact in terms of Peyronie's disease (PD) clinical characteristics at presentation.

Methods
Data from a group of 110 consecutive patients aged &gt;18 and &lt;70 years with PD and seeking first medical attention at a single andrological tertiary-referral centre, with a complete clinical assessment and who completed the IIEF-15 and PDQ questionnaires were included in the study. Descriptive statistics was used to compare categorical and continuous variables, between young (≤45 years) and old (&gt;45 years) patients at presentation. Linear and logistic regression analyses tested the association between age and PDQ subscales (Pain, Bother and Symptoms) or IIEF-erectile function domain scores (IIEF-EF ≤26), after adjusting for Charlson Comorbidity Index (CCI), Body Mass Index (BMI), duration of PD (as self-reported by the patient) and smoking habit. LOWESS curve was used to graphically investigate the association between age and PDQ pain score.

Results
Of 110, 28 (25%) patients were ≤45 years old. Young patients had lower BMI [median (IQR) 24.3 (22.5-25.6) vs. 25.2 (23.7-27.8); p=0.01] and CCI [CCI≥1 in 1 patient (3.6%) vs. 23 (28%); p=0.014) compared to older patients. No differences were found between groups in terms of severity of the penile curvature, PD duration and plaque size. PDQ pain score was 6 (2.8-12.8) for young and 3 (0-8) for older patients (p=0.03). No differences were found in terms of PDQ-symptoms and bother scores, and for IIEF domain scores. At regression analysis, younger age was associated with significant higher PDQ-pain scores at presentation (Coeff 4.45; 95%CI 1.06:7.84; p=0.011). No further associations were observed between age and the other questionnaires. The figure depicts the higher PDQ-pain scores in young compared to older age.

Conclusion
Younger PD patients are at higher risk of complaining penile pain at presentation. No difference in terms of symptoms, PD-associated bother, erectile function and other clinical and morphometric characteristics were found between younger and older patients at first assessment.

Disclosure
Work supported by industry: no.
244 A Systematic Review of Modeling in Peyronie's Disease
Authors: Krishnappa P , Manfredi C , Arcaniolo D , Sinha M , Moncada I 
Published: May 2022

ABSTRACT

Introduction
Penile modeling to correct the penile curvature in Peyronie's disease (PD) may be achieved manually (intra-operatively or post-injection) or by using assisted devices (penile traction, vacuum device or penile prosthesis). To the best of our knowledge this is the first systematic review of the literature comprehensively evaluating penile modeling procedures.

Objective
To evaluate the efficacy, safety and satisfaction associated with penile modeling in patients with PD.

Methods
A PROSPERO registered (CRD42021241729) systematic search in MEDLINE and Cochrane Library was done in accordance with PRISMA. PICO: Studies were deemed eligible if they assessed patients with PD (P) undergoing modeling procedures (I) with or without comparative group(C) evaluating the efficacy, safety or patient satisfaction (O).

Results
A total of 23 studies, involving 1,238 patients were included in the systematic review. The majority (n=13) studied penile traction therapy and the least being manual modeling at home and manual modeling after collagenase injection (1 each). The studies were of low and intermediate quality (mean Newcastle-Ottawa Scale score of 5.7 and mean Jadad score of 3.3) with a mean level of evidence of 3.4. The mean penile curvature at baseline was between 31 and 80.8 degrees. Nine (39.1%) studies found a significant improvement (p&lt;0.05) of penile curvature after penile modeling, ranging between 11.7 and 37.2 degrees. A increase in mean stretched penile length was reported in 7 (30.4%) articles, varying between 0.4 and 1.8 cm. Serious complications such as penile prosthesis malfunctions (3.3%-11.1%) and urethral injuries (2.9%) were only reported for intra-operative manual modeling.

Conclusion
Although individual studies have noted improvement in penile curvature and stretched penile length, specific recommendations regarding penile modeling in PD cannot be provided due to the inability to perform a pooled analysis of the included studies with significant heterogeneity and the absence of standardized methods to report complications and patient satisfaction. Further RCTs with adequate sample size, validated assessment tools and longer follow-up are needed.

Disclosure
Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Boston Scientific).
006 The Effects of a Structured-Exercise Training Program on Erectile Function, Cardiovascular and Respiratory Parameters in Men Following Prostate Cancer Treatment: Preliminary Results from a Randomised, Controlled Clinical Trial in Prostate Cancer Survivorship
Authors: Chung E. , Vear N. , Rhee H. , Skinner T. , Coombes J. 
Published: May 2022

ABSTRACT

Introduction
Prostate cancer (PC) treatments can cause significant cardiovascular and sexual dysfunctions. There is limited data on the effects of structured exercise interventions specifically on the improvements of erectile function (EF) in the context of cardiovascular health and PC survivorship. It is postulated that structured physical exercise programs can result in positive changes in biomarkers of cardiovascular health through cardiovascular remodelling and in turns, will improve penile haemodynamic and EF recovery in PC men with erectile dysfunction (ED).

Objective
To explore the efficacy of structured-exercise training on EF, cardiorespiratory fitness (V̇O2peak), exercise capacity (peak power output; PPO) and vascular health (pulse wave velocity; PWV) in men with ED in the context of PC survivorship.

Methods
Following ethics approval, men who underwent radical prostatectomy and reported mild-to-moderate ED (defined as International Index of Erectile Function (IIEF-5) score of 8 to 21) were recruited and randomised to complete a thrice-weekly 12-week of structured aerobic and resistance high-intensity interval training (HIIT) intervention, or usual care. Changes in EF (based on IIEF-5 scores), V̇O2peak, PPO and PWV were assessed at baseline and 12 weeks follow-up.

Results
Of the 33 patients referred to the study, seven were ineligible due to severe (n=5) or normal (n=2) erectile function, with 12 agreeing to participate and blindly randomise into structured HIIT and usual care groups. Attendance to the 144 scheduled exercise sessions was 100%, with no study-related adverse events. At baseline, 75% of participants had a low V̇O2peak compared to normative data. After 12 weeks, EF (mean improvement in IIEF-5 by 5 points), V̇O2peak (INT=+3.7 mL/kg/min, CON=+0.4 mL/kg/min), absolute PPO (INT=+35 W, CON=+3 W) and PWV (INT=-3.16 m/s, CON=-0.95 m/s) were greater in the intervention group compared with the usual care group.

Conclusions
A 12-week structured HIIT exercise program is feasible, safe and has been shown to improve EF, cardiorespiratory fitness, exercise capacity and vascular health in men with PC.

Disclosure
Work supported by industry: no.
017 Pharmacovigilance Analysis of Reports of Sexual Dysfunction Associated with Finasteride Use: Implications for the Post-Finasteride Syndrome
Authors: Nguyen D. , Herzog P. , Cone E.B. , Labban M. , Zorn K.C. , Chughtai B. , Basaria S. , Elterman D.S. , Trinh Q. , Bhojani N. 
Published: May 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 analyses are presented in Tables 1.

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
Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (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.).
056 Subcutaneous Testosterone Enanthate-Autoinjector: Assessment of its Post-Market Safety and Efficacy Profiles
Authors: Choi E. , Xu P. , El-Khatib F. , Kavoussi P. , Yafi F. 
Published: May 2022

ABSTRACT

Introduction and Objective
A subcutaneous testosterone enanthate-autoinjector (SCTE-AI) was recently approved by the Food and Drug Administration in 2018 for patient-administered weekly testosterone replacement therapy (TRT). This is the largest non-industry sponsored post-market study to evaluate the safety and efficacy profile of SCTE-AI in outpatient urology clinics.

Methods
From January to October 2019, 110 hypogonadal men were treated with SCTE-AI at a two-institutions. Patients were assessed in a pre-therapy visit prior to receiving SCTE-AI and re-assessed at 6-weeks after treatment initiation. Patients with a history of prostate cancer were excluded. Trough serum total testosterone (TT), estradiol, prostate-specific antigen (PSA), and hematocrit (HCT) levels were collected at clinic visits. Therapeutic phlebotomy was recommended for HCT&gt;54%, and treatment was discontinued for significant increases in PSA and for significant treatment-related adverse events. Values from each visit were compared with univariate analysis.

Results
110 patients completed the 6 weeks of observation with a mean age of 40.3 (SD: 10.5). TT significantly rose from 246.6 ng/dL (SD:113.3) pretherapy to 538.4 ng/dL (SD: 209.3) at 6 weeks (p&lt;0.001). Post-therapy, 101/110 (91.8%) of patients had TT&gt;300 ng/dL. No patients had HCT &gt; 54%. 74 patients (70.5%) had PSA increase with only 3 (2.9%) experiencing an increase &gt;1.0 ng/dL. There was a significant increase in mean PSA from 1.07 ng/dL (SD: 0.8) pretherapy to 1.18 ng/dL (SD: 0.9) at 6 weeks (p= 0.01). One patient had immediate treatment cessation following diagnosis of prostate cancer.

Conclusions
This is the largest non-industry sponsored safety and efficacy profile of SCTE-AI application in urology clinics. After 6 weeks of observation, TT levels increased significantly. SCTE-AI is a safe and effective alternative method for TRT.

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).
059 What is a Predictive Factor of the Efficacy of Testosterone Replacement for Late-Onset Hypogonadism?
Authors: Kondoh N. , Togo Y. , Kajio K. , Nagasawa S. , Yamamoto S. 
Published: May 2022

ABSTRACT

Introduction
Testosterone replacement therapy (TRT) is a worldwide first-choice method of treatment for late-onset hypogonadism (LOH). In the diagnosis of LOH in Japan, we use 8.5 pg/mL of serum free-testosterone (FT) level measured by RIA as a lower limit.

Objective
The objective of this study is to determine the predictors of the TRT efficacy for LOH.

Methods
A total of 56 patients who attended our men's health clinic between August 2002 and June 2021 with the data available before and after TRT were enrolled into this study. These patients were divided into responders to TRT (Group 1, n=45, 80%) and non-responders to TRT (Group 2, n=11, 20%) according to clinical response including patient's satisfaction. Evaluated parameters obtained before TRT were following: age, BMI, aging males symptoms scale (AMS), sexual health inventory for men (SHIM), serum luteinizing hormone (LH), follicular stimulating hormone (FSH), testosterone (T), FT, prolactin (PRL), estradiol (E2) and T/E ratio. For statistical analysis, we used a multivariable logistic regression model.

Results
Univariate analysis revealed PRL (OR 0.96; 95% CI 0.93-0.99, P&lt;0.03), E2 (OR 0.87; 95% CI 0.77-0.98, P&lt;0.02), T/E (OR 1.13; 95% CI 1.01-1.27, P&lt;0.04) as predictive factors. Then we carried out multivariate analyses of these factors and determined T/E ratio as an independent predictive factor (OR 1.16; 95% CI 1.04-1.29, P&lt;0.01).

Conclusion
This study suggested that low value of T/E ratio might predict the low response to TRT. Although further study with a larger number of patients is necessary, we propose the measurement of serum E2 level as well as testosterone level before TRT.

Disclosure
Work supported by industry: no.
064 Do Statins Cause Testosterone Deficiency in Men? Systematic Review and Meta Analysis
Authors: Lopes L. Seligra , Glina F. , Spinola e Silva R. , Barros E.A.C. , Biselli B. , Glina S. 
Published: May 2022

ABSTRACT

Introduction
Statins are one of the most prescribed classes of drugs worldwide to treat hypercholesterolemia and dyslipidemia. By lowering the level of cholesterol, the precursor of the steroidogenesis pathway, the use of statin could cause a reduction in testosterone levels. Testosterone is essential in biological functions and its reduction can cause negative effects, such as symptoms of hypogonadism.

Objective
Evaluate whether the continued use of statins causes testosterone deficiency in men.

Methods
Systematic Review with Meta-analysis, performed in Embase, Medline and Cochrane databases, until April 2021; protocol was submitted to PROSPERO. Selection performed by two independent authors with subsequent conference in stages. There were selected comparative studies, prospective cohorts or clinical trials with comparison of testosterone levels before and after the use of statin. Bias analysis were evaluated with Cochrane Tool.

Results
Threre found 717 papers on MedLine, 1352 on Embase and 143 on Cochrane. After removal of duplicates, 833 articles remained. Comparative studies, 10 prospective cohorts and 6 randomized clinical trials were selected for meta-analysis. In the forrest plot with the 16 articles, a reduction in the mean testosterone in patients after the use of statins of 13.61 (95% CI=3.99-23.23, I²=41%, p=0.006) was evidenced, demonstrating statistical significance. In the sub-analysis with the Clinical Trials, a reduction in the mean testosterone levels in patients after the use of statins of 27.45 (95% CI=13.85-41.06, I²=14%, p&lt;0.0001) was evidenced, demonstrating statistical significance. On the other hand, in the sub-analysis of the Prospective Cohorts, an increase in the mean testosterone in patients after the use of statins of 0.25 was evidenced, without statistical significance, of 0.25 (95% CI=-13.87-13.36 I²=38%, p=0.97). A reduction in total testosterone was evaluated in all studies after statin use. However, with the exception of Kannat 2009, all studies showed testosterone levels above the normal level (normal up to 300). In the Kannat study, testosterone levels below this value were already presented before the use of the statin.

Conclusion
Statins cause a decrease in total testosterone, not enough to cause a significant deficiency.

Disclosure
Work supported by industry: no.
Current Trends in Neurosurgical Management of Adult Diffuse Low-Grade Gliomas in Canada
Authors: Fatehi Mostafa , Yefet Leeor S. , Prakash Swetha , Toyota Brian D. , Gooderham Peter A. 
Published: May 2022

ABSTRACT:There is considerable variability in the management of diffuse low-grade gliomas (LGGs). To characterize treatment paradigms, a survey of Canadian neurosurgeons was performed with forty neurosurgeons responding. Their responses show that the management of patients with LGGs has evolved in the past decade and findings from the RTOG9802 trial have been integrated into the practice of Canadian neurosurgeons. Most respondents stated that the patient selection and treatment strategy advocated by the RTOG9802 trial needs further evaluation. Overall, there is a trend toward more aggressive surgical resections, and future investigations will have to more accurately stratify patient risk profiles.