Helo, Sevann

Abstract Background Erectile dysfunction (ED) is a known precursor and sequela of cardiovascular disease (CVD), with ED severity predicting CVD severity. Aim This study aimed to evaluate the utility of ceramide levels in patients with ED. Methods We initiated ceramide testing in all patients with ED. We retrospectively analyzed ceramide levels from electronic records and stratified by severity of symptoms using the erectile function domain of the International Index of Erectile Function (IIEF). Outcomes The study aimed to determine whether abnormal ceramide levels were associated with ED severity and increased cardiovascular risk. Results Three hundred and fifty-four patients were reviewed, of whom 253 (71.5%) had moderate or higher ED. A statistically significant difference in abnormal ceramide values was found in patients with moderate to severe symptoms, and the odds of getting an abnormal ceramide test were increased based on the IIEF scoring alone (odds ratio [OR] 2.3 [1.04-5.12]; P-value = .034). Clinical Implications Serum ceramide testing could be beneficial in identifying cardiovascular risk in men with ED, potentially prompting cardiac referrals and lifestyle modifications. Strengths and Limitations The strengths of this study include a large sample size and the use of a well-established scale, while the limitations include the retrospective nature of the study and the need for further research to validate the findings. Conclusion Patients undergoing management for ED may benefit from serum ceramide testing and subsequent cardiac referral.

Abstract Background Chlorhexidine gluconate (CHG) (0.05%) has recently been suggested as a dip and irrigation solution at time of inflatable penile prosthesis (IPP) surgery. Aim This study evaluated infection rates before and after implementing CHG protocol while investigating concurrent risk factors contributing to post operative infections. Methods A retrospective, consecutive cohort study was performed that included patients who underwent insertion of a Coloplast Titan IPP including both virgin and revision cases between 2021 and 2024. Cases performed from January 2021 to August 2022 utilized rifampin/gentamicin for dip and vancomycin/gentamicin for irrigation (ABX), whereas those from October 2022 to May 2024 utilized CHG for both dip and irrigation. Perioperative risk factors including dip and irrigation solution used at time of surgery were compared between groups. Outcomes We defined the incidence of postoperative infection and risk factors associated with infection in each group. Results The incidence of infection was significantly higher in the 0.05% CHG group (13/377) compared to the ABX group (0/320) (P < .001). When analyzed separately by subgroup, virgin cases treated with CHG for dip and irrigation demonstrated a significantly higher infection rate (7/315) compared to those in the ABX group (0/280) (P = .012). Similarly, in revision cases, the CHG group also exhibited a significantly higher infection rate (0/40) than the ABX group (6/62) (P = .043). Univariable analysis of the CHG cohort identified three significant risk factors for infection: diabetes mellitus (DM), extended operative time (OP), and revision surgery (P = .003, .001, and < .001, respectively). Multivariable regression analysis revealed that patients with DM had a 5.7-fold increased risk of infection (OR: 5.70, P = .004), while those undergoing revision surgery faced a 5.3-fold higher risk (OR: 5.26, P = .004). Additionally, each minute increase in OP was associated with a 1% higher infection risk (OR: 1.01 per minute, P = .007). These associations remained significant after adjusting for all variables in the model. Clinical Implications Prosthetic surgeons should be cautious about adopting 0.05% CHG for both dip and irrigation in the absence of strong clinical evidence demonstrating its non-inferiority to antibiotic solutions. Strengths and Limitations This is the first clinical study reporting infection rates after IPP surgery using 0.05% CHG for both dip and irrigation. While retrospective and non-randomized, we present a relatively large sample size of patients. Conclusions Our findings identify four risk factors for penile prosthesis infection: usage of the 0.05% CHG solution for dip and irrigation solution of Coloplast hydrophilic-coated devices, DM, revision surgery, and extended OP.

Abstract Introduction Penile prosthesis (PP) implantation is associated with high patient satisfaction in patients with medically refractory erectile dysfunction (ED). There remains a paucity in the literature regarding the temporal evolution of patient following PP surgery. Objective We sought to evaluate mechanical-associated outcomes in our Penile prosthesis (PP) cohort. Methods We analyzed our prospective penile registry that includes patient-completed surveys regarding device outcomes administered at 6 and 12-months after PP placement. We specifically examined the questions: “Have you had another [prosthesis] surgery since your first operation?”; and, “Does the device ever inflate or deflate on its own, if Yes how bothersome is this for you on a scale of 1-10 (1- very bothersome, 10 no bother)?”. Chart review was performed to identify pertinent variables including reservoir location (retropubic vs submuscular) and need for prosthesis revision for survey respondents. Results A total of 304 patients were enrolled in the registry. Of these, 101 completed the 6-month assessment and 79 completed the 1-year survey. The vast majority of PP were Coloplast (91.4%) utilizing the “classic” pump. Mean chart review follow up was approximately 3 years. One device was explanted for implant infection. No additional operations were reported for mechanical failure. Auto-inflation (AI) was reported in 38 patients at 6 months and 21 patients at 12 months. AI was most common in patients with submuscular reservoir placement (75.9% of those who reported AI at 6 months and 50% at 12 months respectively). The relative risk of developing AI was doubled in patients with a submuscular reservoir [2.2 (1.05-3.44); p < 0.001)]. Degree of bother had a reported median of 5 (3.75-9) at 6 months and became less bothersome after 12-months year with a reported median of 7 (5-9) (p = 0.230) [Fig. 1]. Conclusions Early Penile prosthesis mechanical failure requiring revision surgery did not occur in our cohort but patient-reported auto-inflation was identified more frequently than previously reported. Further study is warranted, but patients may benefit from pre-operative counseling regarding the incidence of auto-inflation. Disclosure Yes, this is sponsored by industry/sponsor: Coloplast. Clarification: Industry funding only - investigator initiated and executed study.

Abstract Introduction Penile prosthesis (PP) implantation is associated with high patient satisfaction and improved sexual quality of life in medically refractory erectile dysfunction (ED). Despite the current surgical advances and patients’ satisfactions after PP implantation, there has been paucity of data on reported partner satisfaction. We aimed to evaluate changes in partner satisfaction after PP placement. Objective We aimed to evaluate changes in partner satisfaction after PP placement. Methods We initiated a registry of patients undergoing surgery for placement of a PP. After consent, Perioperative study assessments and follow-ups were conducted. After surgery, patients were directed to fulfill a survey at 6 months and 12 months. Patients who fulfilled both items were included in the analysis. Results A total of 304 patients had a PP placement, of these 101 completed the survey. At 6 months, 62 patients (61.4%) reported a moderate to high partner’ satisfaction, and this positive response was sustained at 12-months (82.3%). 73.3% of partner’s reported no-pain after 6 months and this increased to 79.7% after 12 months. 67.3% of partners stated they would recommend the procedure to a friend or family at 6-months. This increased significantly to 84.8% at 12-months (p = 0.012). Conclusions Penile prosthesis placement is associated with high partner satisfaction rates, with a sustained positive perception over time when comparing 6 and 12-month follow-up outcomes. Further study is warranted to assess partner satisfaction after penile prosthesis implantation. Disclosure Yes, this is sponsored by industry/sponsor: COLOPLAST. Clarification: Industry funding only - investigator initiated and executed study.

Abstract Introduction Male masturbation is a scarcely discussed topic in male sexual health. In the context of trying to conceive, male masturbation may impact overall sexual function and ultimately fertility outcomes. Objective To evaluate the relationship between masturbation frequency and sexual function amongst men undergoing fertility testing. Methods We performed a review of a prospectively maintained database of men utilizing a mail-in semen analysis test system developed by Fellow Health, Inc. Men ≥18 years were included if they consented to participate in research and completed survey questionnaires on both their quality of life and sexual function. Men reported their typical weekly masturbation frequency (0, 1-2, 3-4, 5-6, or ≥ 7 times per week) as part of the sexual function questionnaire. Descriptive statistics were reported and chi-squared tests were used to determine statistical significance at the 0.05 alpha level. Results Of the 2,034 men included, most reported masturbating one to two times per week (41.2%). Nearly one-fourth (21.6%) reported never masturbating, and only 14.2% reported a frequency of more than four times per week. Mean semen volume did not differ significantly by masturbation frequency (p = 0.07). Of note, patients were instructed to abstain from ejaculation for 48 hours prior to sample collection. Men who reported masturbating most frequently (≥7 times per week) were least likely to report ejaculatory dysfunction (12.0% vs. 21.0% for all others combined; p = 0.04), but most likely to report orgasmic dysfunction (12.0% vs. 5.7% for all others combined; p = 0.02). Interestingly, men who reported masturbating most often (≥7 times per week) were both most likely to report having sex less than once per week and most likely to report having sex ≥7 times per week when compared to other strata of masturbation frequency. Conclusions Those with higher masturbation frequency also had better ejaculatory function, but worse orgasmic function. Men who masturbate most frequently (>7 times per week) were most likely to report having sex less than one time per week and also most likely to report having sex >7 times per week, which may be reflective of differences in libido in this group. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Fellow Health.

Abstract Introduction Resistance training by recreational sportspeople in fitness settings has become increasingly popular worldwide, moreover an increasing landscape of social media (SM) influencers in bodybuilding have arisen since 2021, specially on short-duration videos (clips). Some Image enhancer drug users, including anabolic androgenic steroids (AAS) are known to mistrust medical health professionals and seek out information and advice from online sources. Objective we aimed to quantitatively assess the quality of social media videos as an information source for AAS usage in the general population. Methods A search was performed on the most popular short-clips social media platforms in the US (TikTok, YouTube) with the most searched terms for AAS. The first 50 results with any search term listed by relevance were selected in each platform. Video features (views, likes, subscribers) and video sources were collected. Each video included in the study was assessed using DISCERN score to quantify the source quality. Results A total of 100 videos were included and analyzed. Most videos (84%) were from non-health professionals (influencers/clip source/podcasts), only 7% of the videos came from a health educator/physician. Most videos were rated as “very poor” (85%) and “poor” (7%) According to the DISCERN classification, there was a statistically significant difference (p < 0.001) by both content creator type, and platform with the highest scores among physicians [37 (33-41)] and YouTube [19(17.7-30.2]. [Fig]. Conclusions Image-centric social media use is positively associated with the use of AAS. Despite the increasing number of information, the overall quality was poor. The misleading, inaccurate and incomplete information may pose a health risk to the viewers. Further efforts in health policies are strongly encouraged to assess this problem. Disclosure No.

Abstract Introduction Limited data currently exist on the role and efficacy of additional series of collagenase clostridium histolyticum (CCH) injections among Peyronie’s disease (PD) men who have previously failed a first series of injections. We sought to evaluate outcomes of a novel protocol for CCH injections among men who had previously failed 6-8 CCH injections using a traditional approach. Objective To evaluate whether additional rounds of CCH using a novel protocol in men previously unresponsive results in greater curve improvements. Methods A randomized, controlled trial (NCT05108558) is ongoing. All participants previously failed to achieve ≥20% curvature improvement with 6-8 prior CCH injections. Men were randomized 3:1 to receive either CCH + traction (RestoreX) + sildenafil (treatment) up front or initial observation followed by treatment (controls). Outcomes were compared between treatment and control groups. Key measures included objective curve improvements and standardized/non-standardized questionnaires, with assessments obtained at baseline, 6-weeks after completion of CCH (treatment arm), after the no treatment period (controls), and at 1 year. Results A total of 38/40 men have been randomized to date, with 22 having fully completed treatment. Mean age was 57 years, with a median PD duration of 22 months. Median composite baseline curvature was 65 degrees, with 40% having hourglass or indentation deformities, 8% calcification, median baseline IIEF-EFD 20, and 58% able to have penetrative intercourse. Median estimated improvement with the prior CCH series was 0% (IQR 0, 18.8), and the median number of prior injections was 8. The majority of men were dissatisfied with their prior series of CCH (58% vs 35% satisfied, 8% neutral). Of the 22 men who had completed the study protocol, 50% required 1 series, 14% 2 series, 29% 3 series, and 7% 4 series. Compared to the no treatment arm, treated men experienced significantly greater improvements (median 60 degrees vs 0, p = 0.01). IIEF-EFD was non-statistically higher in treated men (0 vs -5, p = 0.17). 92% of men reported a subjective major improvement in curvature, with the median subjectively estimated improvement 90%. 42% reported improved sensitivity (58% no change), while 63% reported improved or no change in erectile function, with 9% unsure, and 27% worse. Post-treatment, 92% of men were very satisfied with CCH as a treatment and 8% neutral. Conclusions Repeating CCH using a novel protocol after an initially unsuccessful course of CCH achieves significant improvements in curvature and patient satisfaction. Additional data, including external validation, are warranted. Disclosure Yes, this is sponsored by industry/sponsor: 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: PathRight Medical.

Abstract Introduction Undergoing fertility testing can be a stressful event in a couple's life. This can impact multiple aspects of life, including sex. Objective To evaluate the relationship between stress and sexual function in men undergoing fertility testing. Methods We performed a review of a prospectively maintained database of men utilizing a mail-in semen analysis test system developed by Fellow Health, Inc. Those included consented to participate in research, were 18 or older, and completed survey questionnaires on both their quality of life and sexual function. Stress level (low, moderate, or high stress) was determined using the validated Perceived Stress Scale (PSS) 10-question survey. The sexual function survey assessed libido, orgasmic and ejaculatory dysfunction, intercourse frequency, Erection Hardness Score, and IIEF-5 score. Descriptive statistics were reported and chi-squared and t-tests were used to determine statistical significance at the 0.05 alpha level. Results A total of 2077 men undergoing fertility testing were included in this study. 50.2% reported moderate stress levels and 2.6% reported high stress levels. Those with low stress were older than those with moderate or high stress (average 35.4 vs. 34.3 and 34.0 years, respectively; p < 0.01). Men with high stress levels were more likely to report a “poor” or “terrible” libido (31.4%) compared to those with moderate or low stress, 17.2% and 9.5%, respectively (p < 0.01). Stress was highly associated with weekly intercourse frequency (p < 0.01): among men with high levels of stress, 25.5% reported having sex less than once a week compared to 6.0% of men with low stress. Likewise, no highly stressed men reported having sex more than six times per week compared to 2.8% of men with low stress. Whereas 80.4% of men with low stress were evaluated to have “No signs of ED” by the IIEF-5, the same was true for only 62.3% of moderately stressed men and 56.0% of highly stressed men (p < 0.01). Conclusions More than half of men undergoing fertility testing report increased levels of stress, which is negatively associated with libido and erectile function. In men seeking fertility evaluation, lifestyle factors such as stress levels should be assessed to identify patients who may benefit from stress management strategies. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Fellow Health.