bluuebunny/crossref_metadata_2025_split huggingface dataset:
35 Ethnic Underrepresentation in Validation of Female Sexual Dysfunction Questionnaires
Authors: Redmon C , Alzweri L 
Published: April 2022

ABSTRACT

Introduction
Female sexual dysfunction (FSD) is a significant cause of morbidity that affects an estimated 30-50% of women. FSD is characterized by conditions which cause distress in at least one area – desire, arousal, orgasm, or pain – and can be challenging to diagnose depending on the patient-provider relationship and/or individual levels of comfort in having such discussions. Several questionnaires have been developed over the past four decades to assess FSD. This repertoire of tools includes assessments of overall sexual function, quality of life, and specific dysfunctions (i.e., hypoactive sexual desire disorder).

Objective
The purpose of this review is to evaluate the ethnic representation of sample populations used in the studies to validate questionnaires used to assess FSD.

Methods
A literature search was performed to gather information on questionnaires that have been developed to assess FSD. Subsequent searches were targeted to obtain the published studies used to validate each tool. Collective averages from the combined ethnic data were compared to population data from US census data and healthcare workforce reports to evaluate epidemiologic diversity. Ethnicity data from each questionnaire were investigated longitudinally to evaluate trends in representation of these sample populations over the past 40 years.

Results
Nineteen questionnaires were evaluated for ethnic representation based on published validation studies. Each questionnaire was tabulated to include the domain(s) assessed, number of items in each questionnaire, validation sample population size and description, and available ethnicity breakdown for each questionnaire. The average ethnic representation of the questionnaires relative to the US general population and US female health care workforce, respectively, was: Caucasian (78.3% vs. 62.7% and 68.5%), African American (3.3% vs. 13.3% and 8.3%), Hispanic (2.3% vs. 16.0% and 9.6%), American Indian (0.0% vs. 0.8% and 0.3%), Asian (0.6% vs. 6.4% and 6.2%), and Other (0.7% vs. 0.7% and 1.4%).

Conclusions
FSD is a common condition affecting women and causes significant impacts on quality of life. Review of the sample populations used to validate the questionnaires used to evaluate FSD in routine practice shows underrepresentation of ethnic minorities when compared to general population demographics. FSD questionnaire is an important research tool, helps increase health care providers and patients awareness of FSD, in addition, eventually improving access to care for ethnic minority women.

Disclosure
No
57 Pathway Enrichment Analysis of Microarray Data from Human Penis of Diabetic and Peyronie's Patients, in Comparison with Diabetic Rat Erectile Dysfunction Models
Authors: Searl T , Ohlander S , McVary K , Podlasek C 
Published: April 2022

ABSTRACT

Introduction
Erectile dysfunction (ED) is a debilitating medical condition in which current treatments are minimally effective in diabetic patients due to neuropathy of the cavernous nerve, a peripheral nerve that innervates the penis. Loss of innervation causes apoptosis of penile smooth muscle, remodeling of corpora cavernosa (penile erectile tissue) morphology, and ED.

Objective
In this study, microarray and pathway analysis were used to obtain a global understanding of how signaling mechanisms are altered in diabetic patients and animal models as ED develops, in order to identify novel targets for disease management, and points of intervention for clinical therapy development.

Methods
Human corpora cavernosal tissue was obtained from diabetic (n=4) and Peyronie's (control, n=3) patients that were undergoing prosthesis implant to treat ED. Rat tissue was obtained from BB/WOR diabetic (n=5) and diabetes resistant (n=5) rats. RNA was extracted using TRIzol, DNase treated, and purified by Qiagen mini kit. Microarray was performed using the Human Gene 2.0 ST Array. 1) Alterations in patient and diabetic rat pathway signaling were examined using several analytical tools (ShinyGO, Metascape, WebGestalt, STRING) and databases, 2) Strengths/weaknesses of the different pathway analysis tools were compared, and 3) Comparison of human and rat (BB/WOR and Streptozotocin) pathway analysis was performed. Two technical replicates were performed. P value (FDR) &lt; 0.15 was used as threshold for differential expression. FDR&lt;0.05 was considered significant.

Results
Microarray identified 182 differentially expressed protein-coding genes. Pathway analysis revealed similar enrichments with different analytical tools. Down regulated pathways include development, tubular structure, sprouting, cell death, ischemia, angiogenesis, transcription, second messengers, and stem cell differentiation. ED patients, who have diabetes, incur significant loss of normal regulatory processes required for repair and replacement of injured corpora cavernosal tissue. Combined with loss of apoptotic regulatory mechanisms, this results in significant architectural remodeling of the corpora cavernosa, and loss of regenerative capacity in the penis.

Conclusions
Penis from diabetic ED patients lacks capacity for maintenance of corpora cavernosal architecture and regeneration, which are critical points for intervention for therapy development. The analysis of tissue specific gene expression profiles provides a means of understanding drivers of disease and identifying novel pathways for clinical intervention. This first report of microarray and pathway analysis in human corpora cavernosa, is critical for identification of novel pathways pertinent to ED and for validating animal models.

Disclosure
No
62 Changes in Point of Maximal Curvature During Collagenase Clostridium Histolyticum Injections for Peyronie's Disease
Authors: Price T , Burgon H , Green B , Brearton K , Savage J , Ziegelmann M , Kohler T , Helo S , Trost L 
Published: April 2022

ABSTRACT

Introduction
Collagenase Clostridium Histolyticum (CCH) is commonly injected at the point of maximal curvature (POMC) for Peyronie's Disease (PD). However, many providers only evaluate the POMC at baseline and do not reassess during CCH injections. As PD plaques often extend over an extended region, it is currently unknown how much the POMC may change throughout a course of CCH treatment.

Objective
We sought to evaluate for changes in POMC between series among men undergoing CCH injections.

Methods
A prospective database has been maintained of PD men undergoing CCH injections at two institutions. POMC assessments were obtained prior to each series of injections after pharmacologic erection and were measured from the coronal margin to POMC. An analysis was performed comparing changes in POMC throughout the CCH course, including associated baseline demographic and disease characteristics.

Results
A total of 445 men (mean age 55.9, mean PD duration 30.6 months) underwent CCH injections from Jan 2014 through Feb 2021. The mean baseline composite curvature was 63.7° (SD 23.7), and the mean distance to curvature was 3.1 cm. Among men who completed 4 series of CCH injections, the mean improvement was 21° (SD 20.6) or 31.7% (SD 33%). In reviewing changes in POMC, the largest change observed at any point within the CCH series was a median 1 cm (IQR 0.5, 2 cm; range 0, 9.5 cm). Compared to baseline, 58% of men experienced a POMC change of 1 cm or greater, 25% 2 cm or greater, and 12% 3 cm or greater during the course of CCH treatment. Age, duration of PD, and baseline curvature were not associated with changes in POMC, although the POMC itself was associated with extent of changes, with proximal curves more likely to experience more notable changes compared to distal ones (p&lt;0.0001). The total improvement in curve was also variably associated with change in POMC, with those experiencing greater improvements noted to have larger change in POMC (p&lt;0.05 for changes in composite curvature and p=0.07 for percent change from baseline). These findings would suggest significant evolution of the POMC during a course of CCH, particularly among men with mid shaft or proximal curves and among those with greater curve improvements. Findings would support a role for repeat curvature assessments prior to each series of CCH injections.

Conclusions
Based on data from a prospective, two-institution series of PD men undergoing CCH injections, the POMC changes by ≥1 cm in the majority of men. Given the small volume injected with each CCH series, the clinical relevance of these findings and their impact on injector protocols merit further investigation.

Disclosure
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80 Does the Risk of Obstructive Sleep Apnea (OSA) Affect Erectile Function Recovery (EFR) After Radical Prostatectomy (RP)?
Authors: Martinez JM Flores , Salter CA , Ruiz K , Benfante N , Schofield E , Tan M , Laudone V , Mulhall JP 
Published: April 2022

ABSTRACT

Introduction
Obstructive sleep apnea (OSA) affects as many as 7% of adult men in the general population, higher in men with obesity and large neck sizes. OSA is associated with ED. No data to date has assessed EFR after RP in men with OSA.

Objective
The objective of this study was to define EFR rates 2 years post-RP.

Methods
Records of men who underwent RP with 24-month post-RP follow-up were reviewed. ADT and radiation therapy were exclusions. Men completed the OSA screening questionnaire, STOP-BANG (SB) pre-RP. Men were divided into OSA risk groups: high, intermediate, and low. EFR was recorded using IIEF-EFD score, with a score of at least 24 indicating recovery. Univariable and multivariable logistic regression analyses assessed predictors of EFR.

Results
454 men were analyzed. Mean age 62 ± 7 years. Of the studied population,12% had a history of OSA,10% had diabetes,12% were current smokers, and 37% were former smokers. The median STOP-BANG (SB) score was 2. High, intermediate, and low risk of OSA scores were 8%, 41% and 51% respectively. Mean baseline testosterone (T) was 495 ng/dL, PSA 7.4 ng/mL, and EFD score 22. Most men had a Gleason sum of 7 (87%). 73% of patients had bilateral or unilateral neurovascular bundle preservation. At the 2-year follow up, median EFD score in high, intermediate and low OSA risk groups: were 9, 16, and 18 respectively. The low OSA risk group was significantly more likely to recover (OR = 1.6, 1.1 – 2.4) than the moderate/high group. Younger age (OR = 0.92, 0.89 – 0.95), absence of diabetes (OR = 0.31, 0.14 – 0.72), higher baseline T (OR per 100 units = 1.40, 1.04 – 1.89), higher baseline EFD score (OR = 1.16, 1.11 – 1.22), and lower Gleason score (OR = 0.53, 0.34 – 0.82) were also associated with recovery at 2 years.

Conclusions
In our cohort, at 2 years post-RP, increasing OSA risk is associated with poorer EFR in men post-RP.

Disclosure
No
88 Lidocaine Incorporated Alprostadil-phentolamine Urethral Gel for Erectile Dysfunction: Patient Tolerability and Satisfaction
Authors: Pham R , Palasi S , Blum K , Howell S , Beetz J , Santarelli S , Panuganti S , Green T , Wang R 
Published: April 2022

ABSTRACT

Introduction
Localized therapy remains an important tool in the armamentarium against ED in patients who decline surgical intervention. Options include intracavernosal injections (ICI) and intraurethral (IU) therapies. For patients averse to injections, IU can be an option. Discomfort is a common side effect of IU therapies.

Objective
Herein, we assess the use, tolerability and satisfaction of a lidocaine incorporated IU gel treatment including phentolamine and alprostadil.

Methods
In this single-center study, 75 patients were telephonically surveyed following the prescription of IU lidocaine-alprostadil-phentolamine gel for ED. Prior to IU therapy, all patients had ICI incorporated penile Doppler exams as part of their routine ED workup. Each survey consisted of 5 questions from the validated Sexual Health Inventory for Men (SHIM) questionnaire and 4 questions regarding satisfaction with IU therapy. Patients were excluded if they did not fill their IU prescription, did not answer after 3 attempted calls, declined participation, or were non-English speaking. Clinico-demographic factors were analyzed using chi-square, t-tests, and logistic regression to determine associations of treatment satisfaction.

Results
Out of 75 patients, 39 had treatment data available for analysis. Median age of the cohort was 61 years (IQR 56-66). Hypertension and hyperlipidemia were the most common comorbidities within the group at 21 (53.8%) patients and 13 (33.3%) patients, respectively. Surveys were conducted a median 128 days after initial prescription. In total, 15 (38.4%) patients were satisfied with IU treatment. Thirty-seven (94.9%) patients did not report pain with IU gel usage. Prior success with &lt;10 units of ICI alprostadil-papaverine-phentolamine (during penile Doppler or as a previous therapy) was associated with increased treatment satisfaction (p=0.039). Post-treatment SHIM scores were also associated with increased treatment satisfaction (p=0.047). Factors such as age, time since initial insult, hypertension, or hyperlipidemia were not found to influence treatment satisfaction.

Conclusions
IU therapy is an acceptable alternative in patients interested in localized ED therapy who are averse to ICI. Patients who responded to &lt;10 units of ICI was associated with IU treatment satisfaction. IU therapy has a success rate of ∼33%, with the most common adverse event being discomfort. In this study, lidocaine incorporated IU gel offered similar efficacy (38.4%) and is well-tolerated with 94.9% reporting no discomfort.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientic, Coloplast, Neotract
95 Initial Validation of the Radical Prostatectomy Questionnaire (RPQ): A New Patient Reported Outcome (PRO) to Assess Sexual Function following Radical Prostatectomy (RP)
Authors: Nelson C , Flaherty K , Joshi N , Schofield E , Mulhall J 
Published: April 2022

ABSTRACT

Introduction
The only PRO validated for men after RP is Extended Prostate Cancer Index (EPIC). However, EPIC has weaknesses, including the lack of assessment of function in response to ED medication use, inclusion of ejaculation and absence of penile morphology assessment.

Objective
To develop the RPQ to address weaknesses in current PROs that assess sexual function following RP.

Methods
RPQ is a 41-item scale assessing 5 domains: erectile function (EF), sexual desire (SD), orgasm (O), sexual satisfaction (SS), and penile morphology (PM). The EF domain assesses erections in response to no medication, PDE5i, intracavernosal injections (ICI). We used a multi-step process to develop the RPQ including: extensive literature review; development of primary domains; item generation and winnowing; feedback from 8 sexual medicine experts; and cognitive interviewing with 10 patients to verify content, wording, and response format. For validation, post-RP men completed the RPQ and the following PROs: IIEF, EPIC, SEAR, and the PROMISE measures. Participants completed the RPQ again within two weeks. Analyses include internal consistency (Cronbach's alpha), test-retest reliability, and convergent/discriminant validity. Cronbach's alpha and test-retest reliability ≥0.7 were considered acceptable.

Results
Mean age of the 311 men was 62±7. All domains of the RPQ demonstrated strong internal consistency (Cronbach's alpha=0.70-0.98) and test-retest reliability (ICC= 0.82-0.99). There was sound convergent validity for the RPQ EF domains with/without medication demonstrate by correlations with the IIEF Erectile Function Domain (EFD) (r=0.31 to 0.70, p&lt;.05). Discriminate validity was demonstrated for RPQ EF domains with/without medication with moderate correlations with the SEAR and PROMIS scales (r=0.23 to r=0.59, p&lt;.01). There was also sound convergent validity for RPQ SD, O, and SS domains with strong correlations with the PROMIS desire, orgasm, and satisfaction scales (r=0.66 to r=0.77, p&lt;.01), with discriminant validity demonstrating moderate correlations with SEAR Self-Esteem (r=0.38 to r=0.46, p&lt;.01) and Sexual Bother (r=-0.43 to 0.66, p&lt;.01). The RPQ PM domain demonstrated convergent validity with moderate correlations with the IIEF EFD and Orgasm domain (r=-0.20; r=0.33, p&lt;.01, respectively) and discriminant validity with low, non-significant correlation with EPIC Urinary function.

Conclusions
Initial validation of the RPQ supports the reliability and validity of the scale.

Disclosure
No
162 Defining Factors Predictive of Persistent Climacturia After Radical Prostatectomy
Authors: Martinez J. Flores , Benfante N. , Schofield E. , Mulhall J.P. 
Published: April 2022

ABSTRACT

Introduction
Climacturia (Cl) is defined as the involuntary leakage of urine around the time of orgasm. Cl is a common clinical condition after radical prostatectomy (RP). Cl is a barrier to sexual satisfaction. Rates as high as 60% have been reported with little data on the chronology of recovery.

Objective
This study aimed to evaluate the natural history of CI after RP.

Methods
Men who underwent RP and completed a proprietary sexual incontinence questionnaire at 12 and 24 months (±3 months) constituted the study sample. Pre or postop ADT or radiation therapy were exclusions. We assessed demographics, comorbidities, baseline testosterone (T), pre-RP prostate specific antigen (PSA), Gleason group, nerve sparing status (NSS), and the presence of stress urinary incontinence (SUI) post-RP. Primary end-point was Cl rate at 12 and 24 months post-RP. Predictors of Cl were analyzed using a series of logistic regression models. Factors entered into the model included age, diabetes, smoking history, baseline T, baseline PSA, Gleason score sum, and NSS score.

Results
Data on 152 men were analyzed. Mean age 61±8 years. 45% had hypertension, 60% hyperlipidemia, 10% had diabetes, 18% obstructive sleep apnea, 8% were current smoker, and 27% former smokers. Baseline T and PSA were 421±176 ng/dL and 7±6 ng/mL. The median Gleason score was 7, 82% of patients had bilateral NSS, 13% unilateral. Median NSS score was 3 (IQR 2, 4). Cl prevalence at 12 and 24 months post-surgery were 38% and 39%. No patient characteristics were associated with CI at either 12 or 24 months post-RP.

Conclusions
Cl is highly prevalent at 12 months post RP and when present at this juncture appears to be unlikely to recover.

Disclosure
No
168 Extratunical Grafting and Penile Plication for Peyronie's Disease
Authors: Sawyer K. , Leahy S. , Kongnyuy M. , Baumgarten A. , Selph P. 
Published: April 2022

ABSTRACT

Introduction
Extratunical grafting is a surgical option for men with Peyronie's disease who have an hourglass deformity or indentation defect. Rather than necessitating neurovascular bundle elevation and tunical incision, the procedure can be done without mobilization of the bundle. This benefit limits the risk of de novo erectile dysfunction and glans hypoesthesia. Here we present a case of a penile plication combined with extratunical grafting for a man with dorsal curvature and a right sided indentation defect.

Objective
To present a video presentation of extratunical grafting during penile plication for Peyronie's disease

Methods
An artificial erection is done to confirm the location and extent of the penile deformity and curvature. A midline ventral penile incision is made and carried down to the tunica albunigea as is standard for a penile plication. A penile plication is performed with 2-0 polyester suture to correct the dorsal curvature. At the site of the indentation defect, a pericardium allograft is doubly-folded on itself and sewn to the tunica albuginea. The indentation repair is demonstrated, and the surgical site is closed.

Results
The patient reports high satisfaction with the indentation correction and improvement in dorsal curvature with no new erectile dysfunction or hypoesthesia.

Conclusions
Extratunical grafting is a viable, straightforward option for men with Peyronie's disease and indentation defects or an hourglass deformity that can be combined with penile plication to treat symptomatic men.

Disclosure
No
180 A Novel Sacral Erector Spinae Block Reduces Opioid Use After Gender-affirming Vaginoplasty
Authors: Sawyer K. , Ceballos B. , Kukreja P. , Kalagara H. 
Published: April 2022

ABSTRACT

Introduction
Surgeries that affirm a person's gender identity can be the ultimate end to the distress associated with the discordance between one's gender identity and sex assigned at birth. Gender-affirming vaginoplasty (GAV) is increasingly being performed as a critical component of gender transition for individuals assigned male at birth transitioning to female. As GAV becomes offered at more centers around the United States (US), it is important to understand and consider surgical outcomes that are unique to this operation without losing sight of the larger context of surgical care in the US. In this vain, it is known that post-surgery prescriptions for opioids are a catalyst for opioid addiction in nearly 1 in 16 surgery patients; furthermore, individuals with gender dysphoria are twice as likely to abuse prescription opioids. Regional anesthetic blocks have been adopted in many urologic surgeries to reduce opioid consumption both during and after surgery. The sacral erector spinae plane block (ESP) is a novel block that can block the S2-S4 pain levels in addition to some of the lumbar plexus with benefits over a neuraxial/epidural block including being a superficial block, no significant motor weakness, reduced risk of epidural hematoma, and less risk of intraoperative hemodynamic lability.

Objective
We sought to review complications and opioid usage after a novel sacral erector spinae plane block as an adjunct for pain control in the perioperative period in patients undergoing robotic-assisted penile inversion vaginoplasty.

Methods
We reviewed all charts of patients undergoing robotic-assisted penile inversion vaginoplasty or vulvoplasty at our institution. On the morning of surgery, patients were placed in a prone position and administered midazolam and fentanyl for sedation. Median sacral crests and the erector spinae muscle/plane (ESP) were identified using ultrasound guidance, and 0.2% ropivacaine was injected at the S4 and S2 sacral crest.

Results
A total of 13 patients received the ESP block. There were no complications either in the immediate post-block period or after surgery related to the block. Mean opioid consumption in the first 24 hours after surgery, 24-48hr, 48-72hr, 72-96hr, and 96-120 hours after surgery were 29.1, 50.9, 46.0, 36.5, and 38.7 oral morphine equivalents (OMEs), respectively. There was a significantly reduced amount of OME consumption in the 24 hours after surgery compared to the 24-48 hour period (p=0.017).

Conclusions
Sacral erector spinae plane block is a safe and efficacious way to reduce opioid consumption in the postoperative period after gender-affirming robotic-assisted penile inversion vaginoplasty or vulvoplasty.

Disclosure
No