Helo, Sevann

ABSTRACT Introduction Covid-19 has helped drive all forms of medicine away from traditional brick and mortar medical interactions. Given the availability of online services to obtain treatments for ED, we developed a website to facilitate patient education, triage and men's health appointment scheduling. Objective We sought to assess characteristics of men who utilized a novel website to treat their ED. Methods We report on 50 patients who ultimately booked and attended appointments (video or in person) for erectile dysfunction. Patients found our website through our institution's main informational ED pages or through youtube links from our men's health video playlist library. Patients create an institutional account and are then asked a series of MD created questions designed to streamline patient triage and complete the majority of chart documentation ahead of the appointment. Patients are then sent videos relevant to their condition and future appointment options. Results 2300 users investigated the ED portion of the website with 1.8% of patients ultimately following through with an appointment. 13% of patients who explored the ED portion of the site created a user account that allows a questionnaire to be taken. 90% of men who began the ED questionnaire completed with a mean time of 11 minutes. 52% of men offered an appointment based on their responses completed the patient scheduling form. 71% of traffic was on mobile devices with 29% on desktop/tablet. Site use by time of day is shown in figure 1. Mean age of patients was 53. 92% of patients had ED that occurred > 6 months. Mean SHIM score was 8.2 (IQR 4-12). 80% of participants had both desire and opportunity for sexual activity, 20% did not meet both criteria and thus SHIM scores were less valid for these men. Of the users 28% had never tried pde5s, 32% had partial success with pde5s, 24% could not tolerate or afford pde5s and 42% had unsatisfactory results with pde5s. PDE5 naïve patients were seen by an internal medicine MD specializing in men's health, 10 were seen by surgeons as they requested IPPs and the rest were seen by a combination of men's health APPS and urology attendings for second line treatments and penile doppler. Interestingly, 66% of men were interested in undergoing penile doppler to better understand the etiology of their ED. Hypertension (40%) and diabetes (22%) were the most common medical comorbidities. 36% of the cohort had a strong family history of cardiac disease. Conclusions Men with ED can be effectively triaged through a website application. Most men with pde5 refractory ED wish to pursue penile doppler. The majority of patients seen had watched educational video material ahead of time, facilitating a more sophisticated and streamlined patient interaction. Disclosure No

ABSTRACT Introduction Women in healthcare are faced with unique challenges that may increase their risk of infertility including irregular work hours, occupational hazards due to radiation or chemicals, and advanced maternal age. Objective We sought to investigate live birth rates of female healthcare workers presenting with infertility compared to their non-healthcare counterparts. Methods After obtaining IRB approval, a retrospective review of all hospital employees (and their partners) presenting for a fertility evaluation between 2013-2019 was conducted. Patient age, BMI, history of previous live birth, occupation, use of assisted reproductive technology and female fertility factor were recorded. Couples with at least 12 months of follow up from initial presentation as well as a documented semen analysis were included in the study. Normal semen parameters were defined by the World Health Organization 2010 criteria. Logistic regression analysis was conducted to identify factors associated with increased likelihood of live birth. Results Of the 934 female partners identified, 445 were healthcare workers and 489 non-healthcare workers. Female age, female BMI, smoking status, and history of previous live birth were not statistically significant between groups. No differences in male partner age, male BMI, semen parameters and presence of male factor were noted. Live birth rate was greater in female health care workers compared to non-healthcare workers, 76.1 vs. 69.6%, respectively, p=0.042. Conclusions In this cohort of hospital employees, female healthcare workers had a higher live birth rate despite no differences in age, BMI, rate of female factor infertility, use of assisted reproductive technology, or male partner factors. While no differences in fertility were noted for female health care workers in this study, further research is needed to identify subgroups within the healthcare population that may be at greater risk for infertility. Disclosure No

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<0.05 for all). The only statistically significant increase occurred Oct 2020, a 16% change compared to Oct 2019 (p<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<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<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<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

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<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<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 No