bluuebunny/crossref_metadata_2025_split huggingface dataset:
26 Testosterone (T) Challenge in Men Post-Radical Prostatectomy (RP) with Profoundly Low Testosterone
Authors: Flores Martinez J , Mulhall JP , Deveci S , Matsushita K , Torremade J , Salter CA 
Published: April 2022

ABSTRACT

Introduction
Prostate specific antigen is the primary marker of prostate cancer recurrence. PSA secretion is T dependent with T levels below saturation point associated with sub-optimal PSA production. Men with an undetectable PSA level after RP with very low T levels might have an artificially low PSA level.

Objective
We aimed to evaluate the effects of raising T level in such men.

Methods
Study population consisted of (i) men post-RP (ii) with undetectable PSA level (iii) total T levels &lt;200 ng/dl (two levels, LCMS) who (iv) underwent in-office intramuscular injection of 100mg of T cypionate (v) had a PSA level checked 5 days later, and if undetectable every month after that, 3 months later then every 6 months and (vi) follow-up of at least 24 months on T therapy.

Results
22 men have been challenged thus far. Mean age 62±18 years. Mean preoperative PSA 6.2. Mean post-RP TT value 140± 35 ng/dL 2.2. Median Gleason sum 7. 23% had GS ≥8. Mean post-RP, pre-challenge T value 140± 35 ng/dL. Mean time post-RP to challenge was 7± 9 months. Mean TT value 5 days after IMT challenge 640± 220 ng/dL, all with TT levels above 400. 5/22 has a PSA elevation, 2 immediately after IMT challenge (PSA values 0.07, 0.08). All other men started T therapy immediately and had PSA elevation at 9, 14 and 22 months after commencing T therapy (PSA values 0.08, 0.12, 0.11). All patients with PSA elevation had continued rise in PSA and had detectable disease on imaging. All men with PSA recurrence had either GS 7 with unfavorable pathology (2) or GS ≥8 (3).

Conclusions
This T challenge approach permits the early detection of prostate cancer recurrence permitting early intervention. About 10% of such men had a PSA rise immediately after T challenge.

Disclosure
No
36 The Impact of Social Determinants of Health on Female Sexual Function
Authors: Davila J , Tellechea L , Zuo S , Leegant A , Fazzari M , Abraham N 
Published: April 2022

ABSTRACT

Introduction
Social Determinants of Health (SDOH) like economic stability, education, neighborhood & environment, and social and community context, may significantly impact overall health and drive health disparities.

Objective
Our aim was to evaluate the association between female sexual function and SDOH.

Methods
We conducted a cross-sectional study of women 18 and older presenting to outpatient female pelvic medicine and reconstructive surgery (FPMRS) clinics at Montefiore Medical Center (Bronx, NY) from November 2018 to November 2019. The Female Sexual Function Index (FSFI-6) was administered to screen for female sexual dysfunction (FSD) and The Accountable Health Communities Health-Related Social Needs Screening Tool to evaluate unmet social needs. Ordinal logistic regression models were used to examine the association between FSD (defined as FSFI-6 score 19 or less for FSD and FSFI-6 &gt;20 as no FSD) and each social need item, while adjusting for potential confounders.

Results
89 women were included in the analysis, with mean age 55.7 years (SD=13.5) and mean BMI 32 (SD=8.4). 4.5% were White, 38.2% Black, 48.3% Hispanic, and 9% did not identify a race or ethnicity. FSD was associated with women who spoke a language other than English or wanted more schooling/training, whereas women who were searching for employment were less likely to have FSD. However, needing family or community support for completion of their activities of daily living (AOR=4.27, 95% CI:(1.05, 17.38), p = .04) was the only social need statistically significantly associated with FSD after adjusting for age, race, BMI, parity and previous pelvic surgery in ordinal logistic regression analysis.

Conclusions
Family or community support is a social need that was associated with FSD in our diverse, urban cohort. Further exploration with patient interviews may reveal social and cultural beliefs that explain this association. Urologists should consider screening for SDOH to better serve patients with FSD.

Disclosure
No
39 Onset of Flibanserin Treatment Effect in Postmenopausal Women Assessed by Subdomain Scores of the Female Sexual Function Index (FSFI)
Authors: Simon J , Shapiro M , Larkin L , Kim N , Patel S , Kingsberg S 
Published: April 2022

ABSTRACT

Introduction
Flibanserin, a treatment for acquired, generalized hypoactive sexual desire disorder (HSDD), is approved in the US for use in certain premenopausal women and in Canada for use in both premenopausal and naturally postmenopausal women ≤60 years of age. Improvement in symptoms following initiation of flibanserin may take several weeks to emerge and it is important to set realistic expectations of treatment onset.

Objective
The primary objective of this analysis was to evaluate the onset of flibanserin's treatment effect in naturally postmenopausal women with HSDD across the 6 subdomains of the FSFI.

Methods
A post-hoc analysis was conducted using FSFI data from a randomized, controlled, double-blind trial of flibanserin in naturally postmenopausal women with HSDD that included 895 postmenopausal women (flibanserin, n=432; placebo, n=463) who had at least one on-treatment efficacy assessment. The FSFI is a validated, 19-item self-report questionnaire comprising 6 subdomains of sexual functioning: desire, arousal, lubrication, orgasm, satisfaction, and pain. Each subdomain has a maximum score of 6 and higher scores indicate better sexual functioning. For each subdomain, change from baseline at each assessment visit (4, 8, 16, and 24 weeks) was calculated as the least squares mean difference. Comparisons between flibanserin and placebo groups were performed using analysis of covariance.

Results
Postmenopausal patients treated with flibanserin had significantly greater sexual desire and arousal scores than those treated with placebo at Week 4 and at every assessment timepoint thereafter (see figure). By Week 8, patients in the flibanserin group had significantly higher scores for all FSFI subdomains compared to the placebo group. This treatment effect was maintained at Week 24 for all subdomains except for pain.

Conclusions
Results from this post-hoc analysis indicates that postmenopausal women treated with flibanserin experienced improved sexual function compared to those treated with placebo with regard to sexual desire, arousal, lubrication, orgasm and satisfaction. This improvement was maintained over the entire course of treatment. These findings are consistent with those from a previous FSFI post-hoc analysis of clinical trial data from premenopausal women and suggest that flibanserin treatment of postmenopausal women was associated with improvement of multiple aspects of sexual function in addition to sexual desire.

Disclosure
Yes, this is sponsored by industry/sponsor: Sprout Pharmaceuticals, Inc.

Clarification
Industry initiated, executed and funded study
Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout Pharmaceuticals, Inc.
40 Female Genitalia in Pornography: The Source of Labiaplasty Trends?
Authors: Dubinskaya A , Dallas K , Eilber K , Scott V , Anger J 
Published: April 2022

ABSTRACT

Introduction
Trends in appearance of female genitalia has been influenced by social media, entertainment industry, and even politics. Cosmetic labiaplasty has increased by 39% over the last decade. Wide availability and accessibility of pornography is another source where women and men learn about the anticipated normal appearance of the genitals.

Objective
The purpose of this review is to evaluate the current trends in appearance of female genitalia based on the most viewed pornography videos. We hypothesized that pornography may influence such trends in labiaplasty.

Methods
After panel of experts agreed on definitions and classifications of the different genital parts and beautification trends, we reviewed videos from the category “most viewed videos” on the most popular free pornography websites. We analyzed common representations of female genital appearance, including hair grooming (completely shaved, trimmed, natural), hyperpigmentation (natural with hyperpigmented perianal and labial skin vs. bleached with equal hyperpigmentation throughout), appearance of labia majora (thickness, length), appearance of labia minora (presence and length compared to the labia majora), clitoral hood appearance (status post clitoral hood reduction), and width of the genital hiatus.

Results
We reviewed the 25 most viewed videos from the five most popular free pornography websites. Among females and males, complete shaving of the pubic hair was the most common pattern, 56% (14) and 52% (13) respectively, followed by the trimmed pubic hair equally among both genders 40% (10). Only 8% of videos demonstrated labia majora resembling pre-pubertal (surgically enhanced) appearance. 44% of women had labia minora larger than labia majora, 36% had them at equal length, and 16% showed no labia minora and were consistent with labiaplasty. 92% of videos demonstrated a normal appearing clitoral hood with no signs of surgical reduction. Bleaching or removal of natural hyperpigmentation was noted in 20% of videos. Wide genital hiatus consistent with vaginal delivery was identified in 16% of videos. No signs of pelvic organ prolapse, piercings, or other abnormalities were noted.

Conclusions
We found that the most popular pornography videos had a range of genital appearances, disproving our hypothesis that labiaplasty and bleaching are commonly seen in pornography. However, pornography likely has influenced trends in hair removal. The most viewed videos on the most popular pornography sites may nonetheless create expectations for both genders on the genital appearance of a partner.

Disclosure
No
66 Novel 3D MRI Fusion Penile Imaging Modality for Peyronie's Disease: A Pilot Study
Authors: Pincus J , Lerner M , Sanekommu G , Ottaiano N , Raheem O 
Published: April 2022

ABSTRACT

Introduction
Penile imaging for Peyronie's disease (PD) can be challenging. Traditional cross-sectional imaging modalities such as computerized tomography (CT) or magnetic resonance imaging (MRI) can delineate and characterize pathological penile anomalies; however, limitation in imaging interpretations do exist. Optimal imaging of the penis aids in surgical planning and patient counseling.

Objective
In this study, we aim to utilize a novel three-dimensional (3D) MRI fusion penile imaging modality for men undergoing surgical reconstruction for PD.

Methods
Men with PD, palpable plaques, and deformed corpora were included in this study. We obtained preoperative cross-sectional MRI penile images and Sexual Health Inventory for Men Questionnaire (SHIM) scores on all included patients. We fused MRI images with Ceevra (Ceevra, Inc., San Francisco, CA, USA) 3D imaging software to develop detailed imaging aiding surgical reconstruction. 3D models were used for preoperative patient counseling and surgical planning as well as intraoperatively.

Results
A total of six patients were included, 3 African American men and 3 White men. The mean age was 65 and mean BMI was 35. There was no difference in preoperative SHIM scores (4 severe and 2 mild erectile dysfunction). Preoperative MRI images were fused with Ceevra software to develop detailed 3D models of corporal plaques and its related structures. The 3D models were easily accessible to surgeons during preoperative clinic visits and at time of reconstruction (Figure 1).

Conclusions
In this study, 3D MRI fusion penile imaging for PD has emerged as a potential preoperative advanced imaging modality useful for preoperative counseling and planning, especially in complex PD cases. Further evaluation is prerequisite to evaluate its potential role in aiding intraoperative decision making.

Disclosure
No
67 Postoperative Progress of Modified Grid Incision and Sealing with Collagen Fleece for Treatment of Peyronie's Disease
Authors: Ahn S , Moon DG , Cho S , Lee H , Han DE , Lee DH 
Published: April 2022

ABSTRACT

Introduction
Recently, there have been reports on partial plaque excision and grafting with collagen fleece technique regarding long term efficacy. However, there is still concern regarding complete regeneration of tunical defect from collagen fleece graft in terms of regenerative medicine. Previously, we introduced a less invasive modified technique by multiple grid incisions of Peyronie's plaque to minimize weakness of regenerated tunica from the collagen fleece graft and consequent veno-occlusive erectile dysfunction.

Objective
To assess the efficacy of Modified Grid Incision of plaque and sealing with Collagen Fleece through post-operative progress of 31 patients with prospective follow-up study.

Methods
From Aug 2018, 31 patients with stable Peyronie's disease (PD) were included. Surgical technique was composed 3 major steps; 1) dissection of the neurovascular bundle or urethra according to the location of plaque, 2) multiple deep grid plaque incisions for complete correction of curvature and deformity and 3) sealing with collagen fleece (TachoSil®) without suturing. Prospectively, we assessed the stretched penile length (SPL), totally straightness, penile sono, erectile function preoperatively and 6, 12, 24, 36 months postoperatively. This study was approved by the Institutional Review Board of the Korea University Hospital.

Results
Mean patient age was 58.5 years (range: 46–75). The mean curvature was 45.95 (15-90) degrees, 8 with hinge and 7with hourglass deformity. Inflatable penile prosthesis (IPP) was inserted in 4 patients and postoperative 30 months in a patient for poor erectile function. Mean follow-up was 15 months (6-36). Daily massage softened the hard thickening of penis gradually from 3 months until 2 year. On follow-up sonography, subcutaneous thickening gradually decreased to near normal at 1 year and the breakage of tunica by grid incision reunited at postoperative 10-12 months. All patients achieved totally straightness. All patients gained preoperative length after 1.6 year. 96% of patients satisfied in GAQ at 1 year. Minor skin problem was occurred in three patients of IPP. Subcutaneous bulging hematoma was occurred in 2 patients but subsided within 3 months. In postoperative erectile function of 27 patients without IPP, spontaneous hard erection was recovered in 10 and the rest are satisfied with PED5 inhibitors.

Conclusions
Our prospective progress reports with technical modification of various plaque incisions shows that one can achieve a sufficient surgical effect without making defect of tunica albuginea. Precise understanding of the postoperative progressions are necessary for physician's confidence and encouraging the patients for successful clinical outcomes.

Disclosure
No
69 Xiaflex® Treatment for Peyronie's Disease May Improve Penile Curvature Degree With No Effect on the Loss on Penile Length in Post-marketing Analysis
Authors: Greenberg JW , Soubra A , Kim J , Pincus J , Ottaiano N , Natale C , Nguyen HMT , Tannenbaum J , Sandberg ML , Almajed W , Sikka S , Hellstrom WJ 
Published: April 2022

ABSTRACT

Introduction
One of the main complaints of patients with Peyronie's Disease (PD), besides the curvature, is penile shrinkage. Both deformities result in significant distress to the patient and his partner. XIAFLEX has been developed to treat Peyronie's plaques with substantial improvement of the curvature in the IMPRESS TRIAL.

Objective
In this study, we perform a post-marketing analysis to see if there is any significant improvement of stretched penile length, erect penile length and erect circumference in patients who respond to XIAFLEX compared to patients who do not.

Methods
Consecutive patients treated with XIAFLEX for dorsal plaque and penile curvature above 30 degrees in the absence of hourglass deformity were included in this study. Penile curvature was assessed using a goniometer after induction of artificial erection using alprostadil, before treatment, and eight weeks after the end of the 4th cycle. Stretched and erectile length, as well as erectile circumference, were measured at the same setting. Based on the results of the IMPRESS trial, we decided that any improvement over 15 degrees was deemed a positive response (given our initial measurements were in increments of 5 degrees).

Results
148 patients with PD and penile curvature above 30 degrees elected and completed 4 cycles of non-surgical intervention were included in this study. In this cohort, 129 (87%) of patients had improvement over 15 degrees after completing eight total injections of Xiaflex. The average penile curvature at the beginning of the study was 61.4 degrees, while stretched penile, erected penile length, and erected circumference were 13.9 cm, 13.3 cm, and 11.8 cm respectively. The figure shows no significant change in neither the erect nor the stretched penile length in patients who responded to the injections. However, there was a significant decrease in the erect circumference in the majority of patients from an average of 11.8cm to 9.3cm.

Conclusions
There appears to be no significant regain of the penile length in which patients often complain about losing due to Peyronie's disease in those who respond to Xiaflex injections. The study finding suggests that the erect circumference might decrease, not necessarily due to the injection itself but due to the disease or recovery process.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
89 Are There Differences in Stretched Flaccid Penile Length Versus Erectile Penile Length in Men with Erectile Dysfunction?
Authors: Flores Martinez J , Salter CA , Benfante N , Schofield E , Mulhall JP 
Published: April 2022

ABSTRACT

Introduction
Penile length measurement is an important tool in various clinical scenarios in andrology. It has been suggested that stretched flaccid penile length (SFPL) is an excellent surrogate for erect penile length (EPL).

Objective
We aimed to evaluate if the SFPL accurately reflects EPL.

Methods
Men with (i) Erectile Dysfunction (ED) without penile curvature (ii) undergoing penile duplex doppler ultrasound (DDUS) (iii) with a rigid erection were analyzed. SFPL and EPL were measured dorsally from the pubic symphysis to the coronal sulcus. Significant discrepancy was defined as a difference ≥1cm between the two measurements. We collected demographic and comorbidity data.

Results
64 men were analyzed with a mean age of 59.4 ± 13.4 years. 37.5% of the patients reported 2 or more comorbidities, 11% had diabetes, 19% obstructive sleep apnea, 29% were current or former smokers, 54% had radical pelvic surgery, and 44% pelvic radiation. Mean SFPL was 10.8 ± 1.9 cm and mean EPL was 11.8 ± 1.8 cm, (p&lt;0.001). 83% had EPL&gt;SFPL. 47% of men had a significant discrepancy between the two measurements. No predictors of discrepancy were identified.

Conclusions
In our cohort of men with ED assessed during DDUS, there was a statistically significant difference between SFPL and EPL measurements. In almost half of the cases EPL was significantly longer than SFPL. SFPL is not a reasonable surrogate for erect penile length

Disclosure
No
90 A Comparison of the Psychosocial Impact of Penile Prosthesis and Intracavernosal Injection Therapy for Erectile Dysfunction Using the Self-Esteem and Relationship (SEAR) Questionnaire
Authors: Tidwell T , Andrew Salib A , Berry K , Chung P 
Published: April 2022

ABSTRACT

Introduction
The few studies that do compare penile prostheses (PP) and intracavernosal injections (ICI) focus predominantly on sexual function leaving self-esteem and relationships understudied. The Self-Esteem and Relationship (SEAR) questionnaire was developed to provide a reliable tool to assess psychosocial variables of ED treatments. We hypothesized that patients with PP would have higher SEAR scores compared to patients treated with ICI.

Objective
To compare psychosocial variables of PP and ICI treatments using the SEAR questionnaire.

Methods
IRB-approval was obtained to interview patients by phone who underwent ED treatment by a single surgeon. SEAR questionnaire results were calculated according to the previously described formula and individual questions and domains were compared using T-test statistics.

Results
Fifty patients (25 PP, 25 ICI) agreed to be interviewed for this study. Prostate cancer (n=21, 45%) and vascular disease (n=7, 14%) were the leading cause of ED in our cohort. PI patients on average suffered from ED for a longer period than patients on ICI (5.6 vs 2.7 years, p=0.005). There were no differences in age or marital status. PP patients reported numerically higher total SEAR scores than PP patients (63 vs 53, p=0.12). PI patients reported higher sexual relationships domain scores than ICI patients (64 vs 46, p=0.04), especially in “I felt confident that during sex my erection would last long enough” (p=0.004), “I was satisfied with my sexual performance” (p=0.05), and “I felt confident about performing sexually” (p=0.02). There were no statistical differences in the confidence domain (p=0.89) or self-esteem (p=0.68) and overall relationship (p=0.80) sub-domains.

Conclusions
PP patients reported higher sexual relationship domain scores than ICI patients, while confidence, self-esteem, and overall relationships were similar. Regular use of the SEAR questionnaire may help to identify areas of post-treatment psychosocial needs in ED patients that may benefit from support groups or discussion with a counselor.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific