bluuebunny/crossref_metadata_2025_split huggingface dataset:
72 Eight injections of Collagenase Clostridium Histolyticum May Be Effective in Calcified Plaques
Authors: Masterson T , Ranier Q , Hauser N , Kava B , Ramasamy R 
Published: April 2022

ABSTRACT

Introduction
Peyronie's disease (PD) is the result of abnormal tissue healing in the tunica albuginea resulting in an inelastic plaque. In some instances, plaques will calcify. Several studies question the efficacy of Collagenase Clostridium Histolyticum (CCH) in calcified plaques leading to a belief that calcification is associated with failure of medical treatment and an increased risk of surgical intervention. Our objective is to measure changes in curvature before and after treatment of calcified plaques with CCH.

Objective
To determine change in curvature of calcified plaques treated with 8 injections of CCH

Methods
We prospectively evaluated PD plaques using ultrasound in all men presenting with PD starting November, 2018. Plaques were evaluated in the flaccid state and curvature was measured after the injection of intracavernosal Trimix using goniometer. We utilized a standardized system of plaque typing: type 1: thickening of the tunica albuginea without acoustic shadowing, type 2: a moderately calcified plaque with a typical ultrasound shadow, type 3: a severely calcified plaque complete acoustic shadowing. We measured pre and post CCH curvature 6 months after all eight injections using he standard manufacturer protocol. All patients were instructed on home modeling. Paired T-t was used to compare pre and post measurements. Results presented as means± standard deviations.

Results
We identified 19 men with calcified PD who completed all 8 injections of CCH. Mean age and curvature were 61±7 years and 55±22 degrees. Of the 19 men, 7 had type 3 plaques and 12 had type 2 plaques. There were no differences in patient age however there was a difference in baseline curvature between type 2 and 3 plaques (55±17 vs 75±17 degrees p&lt;0.05). Curvature improved by an average of 25±20 degrees p&lt;0.05. Interestingly, as a group, type 3 plaques improved by 37±23 degrees compared to 18±15 degrees for Type 2, however this difference was not significant

Conclusions
In our small cohort, 8 injections of CCH appear to be an effective therapy for men with calcified PD plaques. Interestingly, CCH remained effective even in severely calcified PD. A larger study including a comparison of non-calcified PD is needed.

Disclosure
Yes, this is sponsored by industry/sponsor: ISR from Endo Pharmaceuticals

Clarification
Industry funding only - investigator initiated and executed study
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
79 Outcomes of Collagenase Clostridium Histolyticum in Men with Congenital Penile Curvature
Authors: Burgon H , Tyler A , Green B , Savage J , Brearton K , Granberg C , Ziegelmann M , Kohler T , Helo S , Trost L 
Published: April 2022

ABSTRACT

Introduction
Congenital penile curvature is a relatively uncommon condition characterized by penile angulation. Similar to Peyronie's Disease (PD), this condition has historically been managed with various surgical techniques. Given the efficacy of Collagenase Clostridium Histolyticum (CCH) in men with PD, our team has elected to treat men with CPD with CCH injections.

Objective
To describe outcomes of CPD men treated with CCH injections and to compare against a traditional PD cohort.

Methods
A prospective database has been maintained of all men undergoing CCH injections by our team since Jan 2014. The specific CCH administration protocol has been modified over time and currently includes combined use of RestoreX traction therapy, sildenafil, 0.9 mg of CCH diluted into 0.7 ml, injections performed at the point of maximal curvature, and aggressive manual modeling. Curvatures were measured in two planes (dorsal and lateral), with the combined measure reported as a composite. Outcomes were reported based on the most recent curvature assessment obtained minus baseline. Men were included if they received at least one series of CCH injections and had at least one baseline and follow-up curvature assessment available.

Results
A total of 272 men comprised the current cohort, with 23 exhibiting CPD and 249 PD. Mean age was higher in PD men (57.4 vs 38.4, p&lt;0.0001), and mean PD duration was 18 months in PD men. Median baseline curvature was non-statistically higher in PD (65 vs 55 degrees, p=0.06). Baseline curvature directions for PD and CPD, respectively were: dorsal (82% vs 35%, p&lt;0.0001), lateral (58% vs 78%, p&lt;0.05), ventral (11% vs 35%, p&lt;0.01). Following treatment with CCH, median curvature improvement was similar between cohorts, with 20 degrees (IQR 5, 35) for PD and 20 degrees (IQR 5, 30) for CPD, p=0.62. Percentage improvement from baseline was non-statistically higher in PD men (33% vs 29%, p=0.99).

Conclusions
Treatment of CPD men with CCH is a viable therapeutic option and provides similar benefits to those observed in men with PD.

Disclosure
No
81 Assessing Online Symptom Checker Accuracy in Diagnosing Men's Health Conditions
Authors: Patel R , Swanton A , Gross M 
Published: April 2022

ABSTRACT

Introduction
Many medical sites offer algorithm-based tools where patients can enter symptoms to receive potential diagnoses. The efficacy of these online symptom checkers (OSCs) in properly diagnosing male sexual health issues has not been explored.

Objective
We analyzed the accuracy of the four most commonly used OSCs in diagnosing erectile dysfunction (ED), scrotal pain (SP), Peyronie's disease (PD), and low testosterone (LT).

Methods
One-hundred and sixty artificial vignettes were created by de-identifying recent initial outpatient consults presenting to discuss ED (40), SP (40), PD (40), and LT (40). ED and PD were selected for assessment because they were straightforward diagnosis. In contrast, SP and LT was selected because of varied etiologies and clinical presentations. The vignettes were entered into the 4 most frequently used OSCs as determined by web traffic analysis tools. The top 4 OSCs in order of use are WebMD (WMD), MedicineNet (MN), Everyday Health (EH) and Sutter Health (SH). The top 5 conditions listed in the OSC differential diagnosis were recorded and scored. If less than 5 conditions were offered, the available conditions were recorded and scored. The primary outcome was the accuracy of primary (Top 1) condition listed. The secondary outcome was frequency of the correct diagnosis appearing in the Top 3, or 5 of the suggested conditions.

Results
WMD did not offer the correct diagnosis for any ED or PD regardless of the number of conditions included from the differential vignettes (Table 1). However, WMD did successfully diagnose SP and LT in 22.5% and 95% of patients, respectively. Comparatively, EH was only able to diagnose SP 20% of the time, and failed to diagnose ED, PD, or LT on all occasions. MN successfully diagnosed ED, PD, SP, and LT in 100%, 98%, 27.5%, and 0% of patients, respectively. On average, MN was the most accurate OSC when including Top 1 (48.25%), Top 3 (53.88%), and Top 5 (56%) suggested conditions. Lastly, SH saw the largest overall improvement in accuracy when using the Top 5 suggested conditions compared to Top 1 (50% vs. 18%). SH correctly diagnosed ED, SP, and LT in 100%, 20%, and 80% of patients, respectively. The OSCs were most accurate diagnosing ED and least accurate diagnosing SP when using the Top 1 (37.5% vs. 6.88%), Top 3 (47.5% vs. 17.5%) and Top 5 (50% vs. 24.5%) of the suggested conditions.

Conclusions
WebMD, which receives nearly five times the web traffic of the next leading online symptom checker, and Everyday Health were both incapable of diagnosing ED and PD in this series. Only MedicineNet offered diagnoses for PD. All OSCs were routinely poor at suggesting precise diagnoses for scrotal pain, even when including 5 potential options in the differential. LT was only diagnosed by WMD and SH. Patients should be cautioned regarding the accuracy of OSCs.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
91 Impact of Neoadjuvant Androgen Deprivation Therapy (NADT) on Erectile Function Recovery (EFR) after Radical Prostatectomy (RP)
Authors: Flores Martinez J , Jenkins LC , Benfante N , Touijer K , Mulhall JP 
Published: April 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
No
99 Comparison of Sexual Concerns Between Patients with Prostate Cancer and Their Partners
Authors: Loeb S , Salter C , Nelson CJ , Mulhall JP , Byrne N , Sanchez Nolasco T , Ness M , Gupta N , Cassidy C , Crisostomo-Wynne T , Li R , Wittmann D 
Published: April 2022

ABSTRACT

Introduction
Prostate cancer diagnosis and treatment have a significant impact on sexual function and quality of life. Although prostate cancer is often called a “couples disease,” there is limited research on the needs of partners who are affected by the patient's sexual dysfunction.

Objective
The objective of our study was to compare the sexual health concerns and unmet needs of patients with prostate cancer and partners using real-world data from an online prostate cancer community.

Methods
We performed a mixed-methods analysis of data from the Inspire UsTOO Prostate Cancer Online Support & Discussion Community. This online health community about prostate cancer has more than 30,000 members, including both patients and partners. Through a data use agreement, we obtained anonymized text from public postings to the Sexual Health & Intimacy Forum on this community. Quantitative and qualitative data were examined from a random sample of 10% of the posts by women about sexual health (n=66), and were compared to an equal number of randomly selected posts by men.

Results
Among 6193 posts about sexual health and intimacy in prostate cancer, 661 (11%) were by female contributors. Of posts with cancer treatment details, surgery was the most common treatment discussed followed by hormonal therapy. Erectile dysfunction was the most common sexual complaint for both men and women. Posts by women were most likely to discuss problems with communication, relationship conflict, their partner's loss of libido, and the importance of intimacy. Common themes of the posts included coping with a “new normal” in their relationship, lack of access to and expense of erectile aids, and insufficient information and support from clinicians surrounding sexual recovery. A greater proportion of female posts conveyed emotion compared to male posts. The most common positive emotions were satisfaction and hope; while the most common negative emotions were frustration and loss of familiar sexual interaction. Although many posts discussed a variety of medical and surgical therapies for sexual recovery, very few discussed counseling or other psychosocial treatments.

Conclusions
Patients with prostate cancer and their partners experience a wide range of sexual health issues related to prostate cancer diagnosis and treatment. Online communities are widely used to give and receive peer-to-peer advice and support during sexual recovery. These findings highlight an unmet need for more extensive education and support surrounding sexual health for couples during the prostate cancer journey.

Disclosure
No
155 Requirement of Mental-health Referral Letters for Staged and Revision Genital Gender-Affirming Surgeries:  An Unsanctioned Barrier to Care
Authors: Yuan N. , Chung T. , Ray E. , Sioni C. , Jimenez A. , Garcia M. 
Published: April 2022

ABSTRACT

Introduction
The World Professional Association for Transgender Health (WPATH) recommends referral letters from two mental-health providers within one year of gender-affirming genital surgery (gGAS) to ensure patient readiness before primary surgeries. Many U.S. health-insurance plans will not authorize second- and third-stage surgeries or revision surgeries without two referral letters. Such requirements are not supported by WPATH guidelines.

Objective
This study investigates insurance requirements for referral letters and their negative impact on care.

Methods
We retrospectively reviewed all gGAS cases over a 4-year period at our tertiary care medical center. Referral-letter requirements for insurance authorization were documented. The nation's largest insurance companies, including commercial, state-, and federally funded plans, were contacted to confirm requirements. We prospectively recorded time needed to complete insurance authorization for a patient subset. WPATH publications were reviewed.

Results
Nearly all reviewed U.S. health-insurance plans required annually updated referral letters for each gGAS procedure, including staged and revision surgeries. No updated letters changed clinical management. Referral-letter requirements delayed care. WPATH states that letters should not be needed for staged surgeries. Some plans required letters even for initial surgical consultation, a practice not supported by WPATH.

Conclusions
Insurance companies’ requirements for referral letters impede care and contradict WPATH guidelines. We advocate that referral letters should not be required for surgical consultations or for staged or revision surgeries after a patient has already had first-stage primary gGAS. Universal referral-letter requirements for secondary surgeries provide minimal clinical value, delay care, increase costs, and exacerbate gender dysphoria by invalidating gender transition. As with all procedures, surgeons themselves should be responsible for assessing patients’ surgical readiness. Significant changes in mental-health status or social situation should prompt surgeons to seek reassessment. WPATH recommendations regarding referral letters should be clarified and consolidated into a single document.

Disclosure
No
170 Uncontrolled Diabetes Mellitus is associated with Complications of Peyronie's Disease
Authors: Karakus S. , Burnett A.L. , Joseph C. , Dai X. , Hawksworth D. 
Published: April 2022

ABSTRACT

Introduction
Peyronie's disease (PD) is a connective tissue disorder of the penis characterized by an abnormality in the collagen structure of the penile tunica albuginea resulting in plaque formation and penile deformity. The prevalence of PD is estimated to be 3.2-8.9% overall and as high as 20.3% in men with diabetes mellitus (DM). However, the impact of the severity of DM on PD complications is unclear.

Objective
We aimed to investigate the association between uncontrolled DM and PD complications.

Methods
We performed a retrospective study of patients with PD and DM presenting to our institution between December 2015 and June 2020. Clinical history, PD complications, erectile status, and clinical parameters of DM were analyzed. Penile deformities were determined by physical exam, photographs, and penile Doppler ultrasound. HbA1c level greater than 7% at the time indicated uncontrolled DM.

Results
A total of 119 patients were evaluated. HbA1C levels were documented in 68 patients (median level of 7.2%). Thirty-six patients (36/68, 52.9%) had an HbA1c level &gt;7% (uncontrolled DM). Data collection parameters have been shown in Table 1. Regression analysis indicated a significant association between the degree of penile curvature and status of uncontrolled DM after adjustment for age, body mass index, presence of hypertension, hyperlipidemia, and cardiovascular disease, and smoking status (B=13 degrees, 95% CI=1-25 degrees, p=0.04). An increase in HbA1c level after the initial diagnosis of PD positively correlated with a formation of penile plaque (rho=0.34, p=0.04).

Conclusions
Our study suggested that uncontrolled DM and a further increase in HbA1c levels after the PD diagnosis significantly impact the severity of PD. Revealing mechanisms behind this will help us develop better management strategies in diabetic PD patients.

Disclosure
No
174 Sub-Coronal Inflatable Penile Prosthesis Placement: Patient Satisfaction and Outcomes
Authors: Feng C. , Langbo W. , Anderson L. , Cao D. , Bajic P. , Amarasekera C. , Levine L. 
Published: April 2022

ABSTRACT

Introduction
Placement of an inflatable penile prosthesis (IPP) is a common surgical treatment of multiple disorders of male sexual function, including erectile dysfunction (ED) and Peyronie's disease (PD). The infra-pubic and peno-scrotal approaches have classically been favored for IPP placement since the first description of IPP placement in 1973 given reliably good outcomes. A sub-coronal incision was then described in 2016 for the implantation of a multicomponent IPP. The benefits of a sub-coronal approach to IPP placement includes exposure and access to the entire pendulous penis back to the mid bulb to allow for additional reconstructive procedures, such as plaque incision and grafting for Peyronie's disease, which previously would require an additional incision.

Objective
Although the sub-coronal approach has been described to be operatively feasible with advantageous operating times, the aim of this project is to report outcomes of the sub-coronal approach, such as patient satisfaction, rate of revision, infection, and wound complications.

Methods
A retrospective chart review from 5/11/2012 to 12/28/2020 was conducted on IPP placements performed at a single, tertiary-care institution to identify patients with IPPs placed via a sub-coronal approach. Data was collected at most recent follow-up date to determine outcomes measures such as satisfaction and complication rates.

Results
Forty-six patients had IPPs placed through a sub-coronal incision. Mean time to follow-up was 9.81 months (0.46-45.6 months). Of these patients, 22 (47.8%) explicitly expressed satisfaction with the procedure at follow-up. Four (8.7%) had wound complications. Additionally, only one (2.2%) experienced a post-operative prosthetic infection. Revision was performed in 3 IPPs (6.5%). One revision was performed to primarily release prothesis tubing that had become adherent to the left base of penile shaft, which was causing patient discomfort. The same revision served additional cosmetic purpose to reduce redundant skin along the patient's circumcision line. The other two revisions were performed for prosthesis malfunctions: one prosthesis acquired “buckling” leading to a ventral curvature requiring release of scar contraction, and the other prosthesis developed a proximal aneurysm requiring removal and replacement.

Conclusions
The sub-coronal approach for placement of an IPP is a promising alternative to the infra-pubic and peno-scrotal incisions with high patient satisfaction, low complication, and low revision rates.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
177 Differences in Patient Characteristics and Surgical Outcomes in Inpatient vs Outpatient Surgery for Peyronie's Disease: Contemporary Data from the National Surgical Quality Improvement Program Database
Authors: Raheem T.M. , Fustok J. , Voznesensky I. , Pandit A. , Machado B. , Payakachat N. , Davis R. , Benson C. , Raheem O. 
Published: April 2022

ABSTRACT

Introduction
Peyronie's disease (PD) is a fibrotic condition of the tunical layer of corporal penis that can cause deformity, erectile dysfunction, and reduced quality of life in men. Surgical therapy remains an integral treatment of the condition in severe cases. However, there is a paucity of data describing trends in surgical practices.

Objective
To characterize the differences between inpatient (IP) and outpatient (OP) practice patterns for PD surgery. We utilized the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach.

Methods
NSQIP database was queried for men undergoing PD surgery between 2005-2019. Patients were classified as either OP (&lt;24 hours) or IP(&gt;24 hours). Baseline demographics, operating time, and complications were compared between the two groups. Multivariate logistic regression evaluated factors associated with discharge times and 30-day complications.

Results
A total of 924 patients were identified and classified as IP in 157 and OP in 767 patients. Operative time was shorter in OP (89 minutes) compared to IP (126 minutes, p&lt;0.001). A statistically significant difference was noted in comorbidities favoring IP surgery between the groups including chronic obstructive pulmonary disease, anemia, and pre-operative dyspnea. The 30-day complication rates between both groups differed notably for any complication (9.6% IP, 1.6% OP, p&lt; 0.001), any readmission (3.8% IP, 0.7% OP, p 0.005) superficial incisional surgical site infection (5.1% IP, 0.7% IP, p&lt; 0.001), and unplanned intubation (1.3% IP, 0 % OP, p 0.029).

Conclusions
Surgical treatment for PD is increasingly utilized as an OP procedure. Patients with shorter operative times and fewer comorbidities appear to be the best suited candidates OP procedures. Beginning in 2015, trends began to shift toward OP procedures. In the era of increasing hospital costs, a shift toward OP surgery for PD has been rising.

Disclosure
No