bluuebunny/crossref_metadata_2025_split huggingface dataset:
202 Impact of COVID-19 Pandemic in Online Interest in Erectile Dysfunction
Authors: Bearrick E , Ziegelmann M , Kohler T , Helo S 
Published: April 2022

ABSTRACT

Introduction
The COVID-19 pandemic has had a significant impact on global health. During uncertain times, priorities amongst patients shifted as many faced health concerns, economic uncertainty, and isolation. Access to general medical care during 2020 was challenging for many Americans who spent the year in quarantine. Without access to care, we hypothesize that patients were less likely to search for treatment options for a non-emergent condition like erectile dysfunction.

Objective
Herein, we aim to report on Google search trends observed in the pre COVID and post COVID era.

Methods
Google Trends was analyzed using search terms related to erectile dysfunction between June 2018 and June 2021. The search volume index (SVI), a relative measure of search volume on Google, was obtained for the following terms: erectile dysfunction, viagra, trimix, penile pump, and penile implant. Student t test was used to compare changes in mean SVI for each month compared to the same month one year prior.

Results
Compared to one year prior, the search for erectile dysfunction remained relatively stable over time with the exception of three months (9% decline Mar 2020, 38% increase Jan 2021, 8% increase Jun 2021). When compared to the preceding year, searches for Viagra declined during 9/37 (24%) months analyzed including Mar-Jun 2020, which coincided with the early part of the COVID-19 pandemic (p&lt;0.05 for all). The only statistically significant increase occurred Oct 2020, a 16% change compared to Oct 2019 (p&lt;0.05). In contrast, search for trimix did not change significantly over time except for an increase of 62% Mar 2021 and 60% Apr 2021 (p&lt;0.05 for all). Search for the term penile pump did not change over time except for a 16 and 10% decline early during the pandemic, Feb and Mar 2020, respectively (p&lt;0.05 for all). Lastly, search for penile implant declined 37% Mar 2020 and 32% Apr 2020 compared to 2019, and increased by 67% May 2021 compared to May 2020 (p&lt;0.05 for all).

Conclusions
COVID-19 represented a major global health crisis, raising concerns and uncertainties for many. Erectile dysfunction remained a constant source of online interest. Despite limited access to medical care for elective conditions, only a few isolated increases in Google SVI were noted, most of which occurred during 2021 compared to 2020. This may be a reflection of the general public's lack of familiarity with treatments other than phosphodiesterase-5 inhibitors.

Disclosure
No
218 Evaluating the Relationship Among Erectile Dysfunction, Prostate Cancer Treatment Type and Inflatable Penile Prosthesis (IPP) Implantation
Authors: Shah T , Shen C , Jain K , Schasefer E , Zhou S , Fried D , Helmer D , Sadeghi-Nejad H 
Published: April 2022

ABSTRACT

Introduction
Sexual health problems affect approximately 60% of male cancer survivors in the U.S. Erectile dysfunction (ED) is the most common sexual health condition men seek professional help for after cancer treatment with some studies reporting ED rates as high as 85% in these men. Inflatable penile prosthesis (IPP) implantation is a safe and highly effective form of ED treatment for patients who fail or cannot tolerate medical therapies. A 2011 study suggested that IPPs are under-utilized by urologists, as less than 1% of men with prostate cancer and ED received IPP following radical prostatectomy or external beam radiation.

Objective
To better characterize the utilization of IPP treatment, we examined the relationships between ED, prostate cancer treatment type and IPP implantation in a national cohort.

Methods
We performed a retrospective review of older SEER-Medicare patients who were diagnosed with local/regional prostate cancer between 2006 and 2011 and treated with surgery or radiation for it, with and without ED. Using ICD9/CPT/HCPCS codes we created a cohort of patients who has receipt of surgery or radiation within 3 months of cancer diagnosis as well as diagnosed ED within 5-years after undergoing treatment. Chi-square/Wilcoxon tests were used to detect significant differences between the surgical and radiation treatment groups for ED rates and use of IPP among those with ED.

Results
Of the 31,854 patients in our cohort, 10,475 (32.9%) received surgery and 21,152 (66.4%) received radiation only. Overall, ED was significantly more common for surgical (65.2%) than for radiation patients (33.8%, p&lt;.001). For the subset of 14,121 patients with ED (overall IPP use=2.5%), IPP implantation was significantly more frequent for surgical patients (n=6,976, IPP use= 3.6%) than for radiation patients (n=7,145, IPP use=1.4%, p&lt;.001).

Conclusions
Shockingly few (2.5%) prostate cancer patients with ED received IPP, with only 1.4% of radiation patients undergoing IPP vs. 3.6% of RALP patients. IPP under-utilization may be due to greater clinical focus on cancer treatment rather than quality-of-life issues. Discrepancies in ED rates between radiation and surgery may also be partially explained by lack of follow-up standardization and highly variable sexual dysfunction reporting, especially in the radiation literature. These findings highlight the importance of thorough counseling about all treatment options including penile prosthesis surgery for prostate cancer patients with ED.

Disclosure
No
221 Impact of Environmental and Socioeconomic Factors on Semen Quality in the United States
Authors: Rabinowitz M , Bowring MG , Kohn T , Levy J , Herati A 
Published: April 2022

ABSTRACT

Introduction
It has been stated that sperm counts worldwide have declined by as much as 50% since 1973, with increasing environmental pollutants cited as one of many possible root causes. Recent theories challenge the validity of these contentious claims, such as the sperm count bioavailability (SCB) hypothesis, which asserts that global sperm health remains highly heterogenous across bodies, ecologies, and even time periods. Specifically, the impact of ecological factors on sperm health in the United States remains grossly understudied.

Objective
To examine the effect of environmental and socioeconomic factors, such as air quality, rurality, median income, and poverty rates, on sperm quality in the United States.

Methods
An ecological study was conducted using a nation-wide sample obtained from Dadi Kit, a company which produces at-home sperm testing kits, containing the zip code, age, and semen analyses for all subjects consenting to research. Subjects were linked via zip code to national, geographical databases on Air Quality Index (Environmental Protection Agency), rurality (Federal Office of Rural Health Policy), median household income (Census Bureau), and poverty rates (Census Bureau). Comparative analyses were conducted on Stata (College Station, TX). Linear regression models adjusted for age were used to analyze associations of sperm concentration (millions/mL of semen), motility (%), and semen volume (mL) with each exposure variable.

Results
A total of 1,343 male subjects with a median age of 32 (interquartile range [IQR]: 28-38) were included, representing 1,035 unique zip codes and 306 United States counties. Median values of sperm concentration, motility, and semen volume were 126.8 million/mL (IQR: 64.2-226.5 million/mL), 25.9% (IQR: 15.7-38%), and 2.2 mL (IQR: 1.4-3.6 mL), respectively. As illustrated in Table 1, air quality index, median household income, and poverty rates were not significantly correlated with any of the three semen parameters measured. A significant negative correlation between rurality and sperm motility was observed (P=.04), yet no association was observed with sperm concentration or semen volume.

Conclusions
Our study found no apparent link between air quality, median income, or poverty rates and any of the semen parameters measured in our nation-wide sample, while rurality was negatively associated with sperm motility only. Further longitudinal studies at the individual level are needed to dismiss a link between socioeconomic factors and sperm quality in the United States.

Disclosure
Yes, this is sponsored by industry/sponsor: Dadi Kit

Clarification
No industry support in study design or execution
Any of the authors act as a consultant, employee or shareholder of an industry for: Dadi Kit
227 The Clinical Significance of Imperfection: Do Asymmetry or Occult Curvature Matter in Penile Prosthesis Placement?
Authors: Bole R , Ahmed M , Gopalakrishna A , Ziegelmann M , Kohler T , Helo S 
Published: April 2022

ABSTRACT

Introduction
Patient satisfaction after inflatable penile prosthesis (IPP) placement has been linked to preexisting curvature. Intraoperative findings such as curvature on artificial erection (AE) or asymmetric corporal measurements (ACM) are incompletely characterized in terms of impact on IPP outcome.

Objective
We sought to evaluate the clinical utility of AE and the significance of ACM during IPP surgery.

Methods
A single institution retrospective review of patients undergoing primary IPP placement between 7/2019-9/2020 was performed. Patient characteristics and intraoperative measurements were compared. Threshold for statistical significance was p≤0.05.

Results
A total of 130 patients underwent primary placement of penile prosthesis. Median age was 67 years (IQR 13). Comorbidities included prostatectomy in 33.8%, and known Peyronie's disease in 21.5%. Of the 27.7% (n=36) of patients who underwent intraoperative AE, 63.9% (n=23) had visible curvature. Of the patients with visible curvature, 70% (n=16) had a preoperative diagnosis of Peyronie's disease and 56.3% (n=9) underwent straightening procedures compared to 28.6% (n=2) of the 30% (n=7) with no known curvature. Incision and grafting was most frequently performed (6/11)- with a minority undergoing plication (2/11). Of the 72.3% (n=94) who did not undergo AE, only 2.1% (n=2) required additional measures for curvature correction. Median corporal measurement was 21 (IQR 2) bilaterally and median cylinder size 20 cm (IQR 4) bilaterally with 1cm rear tip extenders. Of the 18.5% (24/130) of patients with ACM, asymmetry was as follows: 20.8% (5/24) had less than 1 cm, 70.8% (17/24) had 1 to &lt;2 cm, and 8.3% (2/24) had 2 cm or greater. Of these patients 87.5% (21/24) underwent placement of an asymmetric device, only 5% (1/21) of which had residual curvature less than 30 degrees. Despite ACMs, 12.5% (3/24) of patients had a symmetric device placed, one of which had residual curvature. Only 2 patients underwent straightening procedures including plication and incision/grafting.

Conclusions
Intraoperative AE is effective at revealing occult penile curvature at time of IPP placement, however most men with newly detected curvature do not require additional straightening measures. We also found that 1 in 5 patients undergoing IPP had ACM but this did not correspond to residual curvature following IPP or requirement for adjunct straightening. These findings may provide reassurance to urologists who do not routinely perform AE or those who encounter ACM during corporal dilation

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast
228 Reservoir Distance from Critical Pelvic Structures: Radiographic Comparison of High Submuscular and Space of Retzius Inflatable Penile Prosthesis Placement Techniques
Authors: Kavoussi M , Cook G , Nordeck S , Dropkin B , Joice G , Sanders S , Pruitt J , Hudak S , Morey A 
Published: April 2022

ABSTRACT

Introduction
Inflatable penile prosthesis (IPP) reservoir placement into the High Submuscular space (HSM) has been proposed as a strategy to prevent injury to organs adjacent to the Space of Retzius (SOR). SOR reservoir proximity to critical pelvic structures (CPS) has been previously established in a cadaver study.

Objective
We sought to evaluate reservoir distance from CPS for SOR and HSM placements using cross-sectional imaging obtained following IPP insertion.

Methods
We retrospectively reviewed our institutional database and identified men who underwent IPP insertion between 2007 and 2020. Men who underwent subsequent cross-sectional abdominopelvic imaging following IPP insertion until October 2020 were included in this study. Two radiologists blinded to IPP surgical technique evaluated reservoir position to determine (a) mass effect on the bladder and iliac vessels and (b) the shortest distance between each of these structures and the reservoir. Men were grouped based on reservoir placement technique (SOR vs. HSM) as documented in the operative notes. Variables were analyzed using chi-squared, fisher's exact, and student's T-tests as indicated.

Results
Among 1010 IPP cases performed during the study interval, 139 (13.7%) met our inclusion criteria with imaging obtained an average of 827 (± 785) days after IPP insertion. Oncologic follow-up (46%) was the most common indication for imaging. Compared with SOR reservoirs (n = 32), HSM reservoirs (n =107) were significantly less likely to induce a mass effect on the bladder (72 vs. 9%) or iliac vessels (34 vs. 4%) and were located roughly 5x further from the bladder (10 ± 22 vs. 49 ± 36 mm) and iliac vessels (5 ± 9 vs. 23 ± 26 mm, Table 1).

Conclusions
This study radiographically confirms that IPP reservoirs are located significantly further away from CPS following HSM placement compared to SOR placement. These findings suggest a potential patient safety benefit via avoidance of bladder and iliac vessel-related IPP reservoir complications.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
229 Global Trends in Prevalence, Treatments, and Costs of Penile Prosthesis for Erectile Dysfunction in Men
Authors: Kohn TP , Nguyen HMT , Rajanahally S , Hellstrom W , Hsieh T , Raheem OA 
Published: April 2022

ABSTRACT

Introduction
Penile prosthesis is a durable and effective treatment for erectile dysfunction (ED). Even as other treatment options for ED have been brought to market, penile prosthetic surgery remains a mainstay for urologists treating ED. No systematic study has yet summarized the global trends in penile prosthetic surgery.

Objective
To systematically review studies of trends in penile prosthetic surgery to determine global movements in implantation rates, malleable vs inflatable prosthetic surgery, inpatient vs outpatient implantation surgery, the proportion of men with ED undergoing penile prosthetic surgery, and prosthetic cost.

Methods
A systematic review of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov was performed for studies assessing trends in penile prosthetic surgeries and costs associated with penile prosthetic device and inclusive surgical costs.

Results
Twenty-seven studies were identified during the systematic review, comprising 447,204 penile prosthetic surgeries reported from 1988 to 2019. Trend analysis demonstrates that rates of penile prosthetic surgery dramatically declined in the late 1980s and early1990s but has demonstrated modest growth since the mid-2000s. Outpatient inflatable penile prosthetic surgery has strongly trended upward. Penile prostheses device costs have matched the rate of inflation, but inclusive surgical cost has radically outpaced inflation. Growth has mainly been seen in the United States, with a more modest global growth.

Conclusions
Penile prosthesis remains a viable option for the treatment of ED. Trends such as outpatient surgery and inflatable penile prosthesis placement may be driving the recent steady growth of penile prosthetic surgeries but surging inclusive surgical cost may present a barrier for some patients without insurance coverage.

Disclosure
No
231 Radiographic Assessment of Inflatable Penile Prosthesis Reservoir Location Variability in Contemporary Practice
Authors: Kavoussi M , Cook G , Nordeck S , Dropkin B , Joice G , Sanders S , Pruitt J , Hudak S , Morey A 
Published: April 2022

ABSTRACT

Introduction
Inflatable penile prosthesis (IPP) reservoirs are typically placed into the Space of Retzius (SOR), High Submuscular Space (HSM), or alternative locations via a transinguinal (TI) approach or a lower abdominal counter incision (CI). A cadaver study showed variability in reservoir location after TI-HSM placement (JSM: 2016 Sep;13(9):1425-1431).

Objective
We sought to evaluate reservoir location using cross-sectional imaging following contemporary IPP insertion.

Methods
We retrospectively reviewed our institutional database and identified men who underwent virgin penoscrotal IPP insertion from 2007 to 2019. We then identified those men who subsequently underwent cross-sectional imaging prior to October 2019. Radiologists blinded to reservoir placement technique evaluated cross-sectional imaging and categorized each reservoir location in relation to the abdominal wall musculature, transversalis fascia, and peritoneum. Statistical analysis was performed using Chi-squared and Fisher's exact tests.

Results
Among 561 men who underwent virgin IPP insertion during the 12 year study period, 114 had cross-sectional imaging subsequently obtained: 29 TI-SOR, 80 TI-HSM, and 5 CI-HSM (Table). TI-HSM reservoirs were more likely than TI-SOR to be located anterior to the transversalis fascia (14 vs. 48%, p=0.001). TI-HSM reservoirs were less likely than TI-SOR to be located in the preperitoneal space (62 vs. 18%, p&lt;0.001). Rates of retroperitoneal reservoir location were similar between the TI-HSM and TI-SOR groups. Among all 561 patients (131 TI-SOR, 405 TI-HSM, and 25 CI-HSM), rates of reservoir-related complications requiring operative intervention were similar between groups (5 vs. 2 vs. 0%, p = 0.24).

Conclusions
Roughly half of the TI-HSM reservoirs in this series appeared to be located posterior to the transversalis fascia on cross-sectional imaging. Although preperitoneal and retroperitoneal locations were common in both groups, reservoir related complications were rare.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
238 A Novel Algorithm for Peyronie's Management At the Time of Penile Prosthesis to Maximize Length Without Elevation of the Neurovascular Bundle
Authors: Balzano F , Miran A , Warner J 
Published: April 2022

ABSTRACT

Introduction
Peyronie's disease (PD) is a fibrous transformation of the tunica albuginea within the corpora cavernosa causing curvature of the penis while erect. This can not only be painful but can also cause narrowing, shortening, an hourglass deformity and problems with penetrative intercourse.

Objective
There are many means of management of Peyronie's disease at the time of penile implant. Modelling is a commonly used approach but leaves the penis without increased length. Multi-incisional techniques enhance length restoration, but risk significant vascular and neurologic compromise. Herein, we present our experience with a novel algorithm to approach Peyronie's disease with an effort to enhance and restore length without elevation of the neurovascular bundle.

Methods
A retrospective review was performed of an institutional review board approved database. Patients treated for Peyronie's disease and erectile dysfunction with penile implant from 8/16/18 to 8/20/2020 were evaluated.

Results
In our cohort of 33 patients there is an average of 1.9 cm average stretch difference in stretch penile length. There was a 2.15 cm difference in the cohort subset that utilized the Brock technique. We had no loss of sensation or glans ischemia. There was one patient with autoinflation. All patient had less than 10 degrees of residual curvature.

Conclusions
In conclusion with the proposed algorithm we are able to safely maximize length restoration without elevation of the neurovascular bundle. We do require more patients with longer follow-up however to ensure the safety of this algorithm.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Olympus
107 Outcomes for Chronic Pelvic and Genital Pain Using Through an Interdisciplinary Pain Rehabilitation Program
Authors: Roshandel R , Ziegelmann M , Betcher H , Helo S , Collins CS , Kacel E , Gilliam W 
Published: April 2022

ABSTRACT

Introduction
Chronic pelvic and/or genital pain is a disabling condition and commonly associated with poor quality of life, impaired sexual function and decreased productivity.

Objective
To examine treatment outcomes among a cohort of patients diagnosed with refractory pelvic and/or genital pain enrolled in a 3-week interdisciplinary pain rehabilitation program (IPRP).

Methods
A series of with-in subjects ANOVAs (corrected for multiple comparisons) were used to evaluate the effectiveness of IPRP on self-report (pain severity, interference, depressive symptoms, quality of life) and observer-rated outcome (5 minute walk) among 15 treated patients receiving care at the Mayo Clinic IPRP between 2016-2018.

Results
Fifteen patients (5 male, 10 female) were identified. Mean age was 47.0 (range: 24-78) and primary diagnoses were pelvic pain (n=13) and penile pain (n=2). Significant within-subject effects were detected for all self-report outcomes and the 5-minute walk test (see table 1). Six patients were on opioid therapy (MME = 49mg), and all but one successfully tapered off opioids. In the remaining patient, daily MME decreased from 150 mg to 30 mg.

Conclusions
Intensive outpatient IPRP significantly improves quality of life for patients with treatment-refractory chronic pelvic and/or genital pain. These results support multi-disciplinary treatment paradigms for refractory urogenital pain.

Disclosure
No