Cocaine-related ischemic priapism. Systematic review and presentation of a single center series

INTRODUCTION

Ischemic priapism is a medical emergency that, if not treated, could lead to permanent erectile dysfunction. The association between cocaine and priapism is well-known; however, data on patient characteristics, treatment, and outcomes is missing. This work aimed to answer the research question: What are the characteristics, management strategies, and erectile prognosis of patients consuming cocaine and presenting with priapism?

METHODS

We conducted a systematic review according to PRISMA guidelines and described our case series.

RESULTS

Eight studies were selected for qualitative synthesis, presenting information on ten patients. In our case series, we showed information regarding four patients. From the systematic review, the mean presentation time was 42.6 h, and the mean number of procedures to solve priapism was 2,4; in our case series was 42.75 h and 2, respectively.

CONCLUSION

Cocaine-related priapism might present with a delayed diagnosis, need more procedures to be managed, and have a worse prognosis. More extensive and prospective studies are required.

Analysis of the effects of different surgical approaches on corporotomy localization in inflatable penile implant surgery performed by expert implant surgeons

Inflatable penile prostheses may be a solution for patients with erectile dysfunction. To our knowledge, no data exist regarding the effect of different surgical approaches used during implantation on the site of the corporotomy. The main purpose of this multicentre study was to investigate the influence of different surgical approaches on the corporotomy site.Data were collected from six expert implant surgeons. Surgical notes were searched for the incision site, proximal, distal and total corporal length measurement, total cylinder length, length of rear tip extenders, surgery time, type of implant, and reservoir placement. The association between the proximal/distal corporal length and the recorded covariates was examined using a linear mixed model.A total of 1757 patients who underwent virgin prosthesis implantation were included in the analysis. Analysis of proximal/distal measurements was performed on 1709 patients. The proximal/distal ratio had a mean of 0.8 ± 0.3 in penoscrotal incisions (n = 391), 0.7 ± 0.2 in infrapubic incisions (n = 832) and 0.7 ± 0.2 in subcoronal (n = 486) incisions. We observed no significant differences in proximal/distal measurements between the highest-volume surgeons.We could not draw a firm conclusion about the difference in corporotomy site between different surgical approaches, but we found no significant difference between the highest-volume surgeons using different techniques.

P–128 Audit of testicular sperm in assisted conception for non-azoospermic infertile couples

Study question

What live birth rate do we see when we use testicular sperm in ART for non-azoospermic couples after at least one previous failed cycle?

Summary answer

In our cohort of couples 24% had a live birth using testicular sperm and therefore was not higher than national average ART rates.

What is known already

There is increased interest in using testicular sperm in assisted reproduction technology (ART) to improve outcomes after previous failed cycles. Mehta et al. reported results of a 50% live birth rate using testicular sperm in the first cycle for couples with oligospermia and a history of failed cycles with ejaculated sperm. We aim to audit our results in a similar population of couples.

Study design, size, duration

St Peters Andrology Centre in London, United Kingdom completed 128 surgical testicular sperm retrievals reviewed between the two-year period of 2018–2019. We conducted a retrospective audit of their paper-based records to identify those couples with injectable sperm on their semen analysis and who had previous cycles attempts using ejaculated sperm.

Participants/materials, setting, methods

We identified 27 couples who underwent testicular sperm extraction despite having an ejaculated semen analysis with injectable sperm and at least one previous failed cycle. A systematic review of their paper and electronic medical record was conducted to assess live birth rates and fertilization rates from ART.

Main results and the role of chance

Couples had an average male age of 41 (range 31–60) and an average female age of 38 (range 30–45). The men had an average serum testosterone of 15 nmol/L (range 8–35 nmol/L) and an average serum FSH of 8.9 IU/L (range 1.7–30 IU/L). 59% (n = 17) of men had a DNA fragmentation index completed with an average score of 41% (range 31%–51[Y1]%). In the women the mean serum anti-Müllerian hormone (AMH) was 15.8 pmol/l (range 1–64 pmol/l). With ejaculated sperm the fertilization rate was 59% (95% CI [27%, 59%]) and blastocyst conversion rate was 43% (95% CI [50%, 69%]). There was no statistical significance with testicular sperm where the fertilization rate was 58% (95% CI [51%, 65%]) and blastocyst conversion rate was 54% (95% CI [40%, 67%]). Overall, there were 7 clinical pregnancies in this population of couples. Of these clinical pregnancies, 2 miscarried and 5 progressed to a live birth. This audit yielded a live birth rate per cycle of 15% and a live birth rate per couple of 24%.

Limitations, reasons for caution

Limitations of the study are low number of patients and absence of a control group.

Wider implications of the findings: We recommend caution and further analysis going forward using testicular sperm in ART where ejaculated sperm in available.

Trial registration number

Not applicable

P–028 Single centre retrospective analysis of endocrine stimulation therapy prior to microsurgical testicular sperm retrieval (mTESE) in men with hypogonadism and non-obstructive azoospermia (NOA)

Study question

What is the role of endocrine stimulation therapy prior to mTESE in men with hypogonadism and non obstructive azoospermia (NOA)?

Summary answer

In hypogonadal men there is a positive correlation between change of serum Testosterone (ΔT) before and after stimulation, and a successful mTESE.

What is known already

NOA is the most common cause of azoospermia and it is often associated with hypogonadism and testicular failure. It is common practice for endocrine stimulation therapies such as gonadotropines or selective estrogens receptor modulators to be used prior mTESE; however there is currently paucity of data regarding their efficacy.

Study design, size, duration

Retrospective analysis on infertile men with hypogonadism (defined as T < 12nmol/L) and NOA who underwent mTESE with or without prior endocrine stimulation therapy (clomiphene or human chorionic gonadotropin). Retrospective data from 2015–2020, total number of patient: 71; stimulated group (N:40) vs unstimulated group (N:31).

Participants/materials, setting, methods

Retrospective study on infertile men who underwent mTESE with or without prior endocrine stimulation therapy. Hypogonadism was defined as serum testosterone (T) level <12nm/L. We recorded demographic data, cause of testicular failure, previous testosterone therapy, duration and type of endocrine stimulation, pre-and post-stimulation hormone levels(T, FSH, LH), pre-operative hormone levels, successful sperm retrieval rate (at least 1 vial of viable sperm), average Johnsen score and total number of vials of sperm retrieved.

Main results and the role of chance

One-hundred-sixty-eight men underwent mTESE out of which 59 men received endocrine stimulation therapy for NOA between 2015–2020. Among them, we selected men with hypogonadism defined as serum T < 12nmol/L which comprised 43% of the entire patient cohort. The hypogonadal group included 71 men, 28/71 had Klinefelter syndrome and 40/71 received endocrine stimulation for 13.9±9.2 months.

Testosterone levels significantly increased after endocrine stimulation (6.3±3.3nm/L vs 11.7±7.4nm/L) with mean change in serum testosterone (ΔT) of 5.7 nm/L (–5.5–23.3, N35). In the stimulated group, pre-operative serum T levels were significantly higher (11.7±7.4 vs 7.8±3.0 p:0.007) as compared to unstimulated men but the success rate of mTESE did not differ significantly (16/40–40%) vs 13/31–42%). Men with Klinefelter syndrome demonstrated significant differences with regards to age, lower T levels, higher FSH and LH levels, lower Johnsen score and success rates compared to other causes of NOA. Comparing men who had successful mTESE vs unsuccessful mTESE - higher T and lower FSH and LH seemed to correlate with successful sperm retrieval. Among men who received endocrine stimulation therapy the ΔT before and after stimulation seemed to correlate with successful sperm retrieval (AUC:0.701, SE:0.089, p:0.043). In the stimulated group a ΔT>3.5nm/L showed a significant association with successful mTESE(p:0.041).

Limitations, reasons for caution

Retrospective study limitations.

Wider implications of the findings: Our study shows a significant improvement of serum T following endocrine stimulation therapy. Overall, in hypogonadal men, the hormonal stimulation seems not to be related to a higher success rate of mTESE but our data do suggest a positive correlation between ΔT before and after stimulation, and a successful mTESE.

Trial registration number

Not applicable

THU0540 A PHASE 2B STUDY OF INTRAVENOUSLY (IV) ADMINISTERED TC 99M TILMANOCEPT TO DETERMINE DIFFERENTIAL UPTAKE, REPRODUCIBILITY OVER TIME AND IMAGE STABILITY IN HEALTHY SUBJECTS AND IN PATIENTS WITH RHEUMATOID ARTHRITIS (RA) ON STABLE TREATMENT

Background:

At present, there are no reliable noninvasive means to directly monitor disease activity in RA patients. Activated macrophages are a critical component of the inflammatory etiology of RA due to their role in prolonged RA joint inflammation and destruction through the release of pro-inflammatory cytokines and chemokines. Tc 99m tilmanocept is a radiopharmaceutical imaging agent that binds with high affinity to the macrophage mannose receptor CD206 that resides on activated macrophages. Previous clinical trials demonstrated safety and tolerability of Tc 99m tilmanocept, as well as a determination of optimal clinical dose and timeframe for RA imaging.

Objectives:

The current phase 2b study aims to evaluate reproducibility and stability of imaging and will assess quantitative Tc 99m tilmanocept uptake cut points that reliably enable discrimination between joints of healthy people and RA patients.

Methods:

The analysis cohort contained 18 healthy controls (HC) clinically free of inflammatory joint disease and 12 subjects with clinically diagnosed RA who are on stable anti-inflammatory and/or anti-rheumatic therapy. Each subject received a 150-mcg dose of tilmanocept radiolabeled with 10 mCi of Tc 99m in a 3mL IV injection. Injection was followed by planar imaging at 60 and 180 minutes for both HC and RA subjects on study Day 0 and repeated in RA subjects on Day 8. Images were quantitatively assessed to detect localization within synovial spaces of bilateral hands and wrists by determining average pixel intensity in each region of interest relative to average pixel intensity in a joint-specific reference region.

Results:

Data obtained from the interim analysis support the hypothesis that Tc 99m tilmanocept imaging can provide robust quantitative imaging in HC and RA subjects. Repeat images within and between days demonstrate root mean squared differences that are approximately 10% or less of the observed localization of Tc 99m tilmanocept. Qualitatively, images of HC indicated no disease-related site-specific localization, whereas localization is present in RA subjects at levels expected given the difference in macrophage number and density in different pathotypes of RA. Notably, images from patients with active RA exhibit the same localization patterns on images taken in a test-retest fashion on the same day as well as in subjects with images acquired on Day 0 and Day 8 (see Figure 1). These results show low imaging readout variability, enabling reliable quantification of joints with RA-involved macrophage-mediated inflammation. Analysis of the HC and RA images was used to determine initial quantitative “cut-points” to differentiate between joints with and without the inflammation typically seen in RA.

Figure 1.

Tilmanocept consistently localizes in areas of macrophage-driven inflammation, demonstrating low variability. RA patients exhibit reproducible localization over a 1-week period. Typical of healthy subjects, no evidence of inflammation-related Tc 99m tilmanocept uptake was observed in the healthy control. Images on the right show same patient imaged on 2 different days.

Conclusion:

Tc 99m tilmanocept imaging of the joints in healthy subjects as well as in patients with active RA under stable treatment is reproducible and stable over time. The results confirmed that the signal in joints of healthy subjects and RA patients can be quantified and used to establish cut points to distinguish inflamed and non-inflamed joints on a joint-by-joint basis. These results provide the foundation for a noninvasive, objective method to monitor activity in macrophage-driven inflammation in joints of patients with RA.

Disclosure of Interests:

Ayah Hussein Employee of: Currently employed by Navidea Biopharmaceuticals, David Ralph Consultant of: Previous consultant for Navidea Biopharmaceuticals, Employee of: Currently employed by Navidea Biopharmaceuticals, Beth Potter Employee of: Currently employed by Navidea Biopharmaceuticals, Bonnie Abbruzzese Employee of: Currently employed by Navidea Biopharmaceuticals, Rachael Hershey Employee of: Currently employed by Navidea Biopharmaceuticals, Katherine Repp Employee of: Previously employed by Navidea Biopharmaceuticals, Haya Shakhtra Employee of: Currently employed by Navidea Biopharmaceuticals, Mehak Goel Employee of: Currently employed by Navidea Biopharmaceuticals, Madison Palmer Employee of: Currently employed by Navidea Biopharmaceuticals, Allison Kissling Employee of: Previously employed by Navidea Biopharmaceuticals, Carley Hartings Employee of: Previously employed by Navidea Biopharmaceuticals, Michael Blue Employee of: Currently employed by Navidea Biopharmaceuticals, Michael Rosol Employee of: Currently employed by Navidea Biopharmaceuticals

The management of the acute ischemic priapism: A state of the art review

OBJECTIVE

To review the current literature on early penile prosthesis implantation in patients with refractory ischemic priapism (IP).

ACQUISITION OF EVIDENCE

A systematic search for the terms "penile prosthesis", "priapism", "impotence", "fibrosis", "downsized prosthesis cylinders", and "patient satisfaction" has been carried out in PubMed, EMBASE, Cochrane, SCOPUS and Science Citation Index databases.

SYNTHESIS OF EVIDENCE

Cavernosal tissue damage in IP is time related. Conservative measures and aspiration with or without intracorporeal instillation of α-adrenergic agonists are usually successful in the early stages. Shunt surgery in patients remains debatable, as the lack of response to aspiration and instillation of α-adrenergic agonists indicates that irreversible changes in the cavernosal smooth muscle are likely to have already occurred. Immediate penile prosthesis implantation in patients with refractory IP settles the priapic episode, maintains the long term rigidity necessary to engage in penetrative sexual intercourse and prevents the otherwise inevitable penile shortening. Although complication rates after penile prosthesis implantation in acute priapism are higher than in virgin cases, they are still lower than after implantation in patients with severe corporal fibrosis due to chronic priapism. Regardless of the complication rates, penile prosthesis implantation in refractory IP should be preferred as it allows the preservation of penile length, which is one of the main factors influencing postoperative patient's satisfaction following surgery.

Measurements of the [Formula: see text] production cross section in lepton+jets final states in pp collisions at 8 [Formula: see text] and ratio of 8 to 7 [Formula: see text] cross sections

A measurement of the top quark pair production ([Formula: see text]) cross section in proton-proton collisions at the centre-of-mass energy of 8[Formula: see text] is presented using data collected with the CMS detector at the LHC, corresponding to an integrated luminosity of 19.6[Formula: see text]. This analysis is performed in the [Formula: see text] decay channels with one isolated, high transverse momentum electron or muon and at least four jets, at least one of which is required to be identified as originating from hadronization of a b quark. The calibration of the jet energy scale and the efficiency of b jet identification are determined from data. The measured [Formula: see text] cross section is [Formula: see text]. This measurement is compared with an analysis of 7[Formula: see text] data, corresponding to an integrated luminosity of 5.0[Formula: see text], to determine the ratio of 8[Formula: see text] to 7[Formula: see text] cross sections, which is found to be [Formula: see text]. The measurements are in agreement with QCD predictions up to next-to-next-to-leading order.

Search for direct pair production of supersymmetric top quarks decaying to all-hadronic final states in pp collisions at [Formula: see text]

Results are reported from a search for the pair production of top squarks, the supersymmetric partners of top quarks, in final states with jets and missing transverse momentum. The data sample used in this search was collected by the CMS detector and corresponds to an integrated luminosity of 18.9[Formula: see text] of proton-proton collisions at a centre-of-mass energy of 8[Formula: see text] produced by the LHC. The search features novel background suppression and prediction methods, including a dedicated top quark pair reconstruction algorithm. The data are found to be in agreement with the predicted backgrounds. Exclusion limits are set in simplified supersymmetry models with the top squark decaying to jets and an undetected neutralino, either through a top quark or through a bottom quark and chargino. Models with the top squark decaying via a top quark are excluded for top squark masses up to 755[Formula: see text] in the case of neutralino masses below 200[Formula: see text]. For decays via a chargino, top squark masses up to 620[Formula: see text] are excluded, depending on the masses of the chargino and neutralino.

Measurement of the [Formula: see text] cross section in pp collisions at [Formula: see text] TeVand limits on anomalous gauge couplings

A measurement of the W boson pair production cross section in proton-proton collisions at [Formula: see text] TeV is presented. The data collected with the CMS detector at the LHC correspond to an integrated luminosity of 19.4[Formula: see text]. The [Formula: see text] candidates are selected from events with two charged leptons, electrons or muons, and large missing transverse energy. The measured [Formula: see text] cross section is [Formula: see text], consistent with the standard model prediction. The [Formula: see text] cross sections are also measured in two different fiducial phase space regions. The normalized differential cross section is measured as a function of kinematic variables of the final-state charged leptons and compared with several perturbative QCD predictions. Limits on anomalous gauge couplings associated with dimension-six operators are also given in the framework of an effective field theory. The corresponding 95 % confidence level intervals are [Formula: see text], [Formula: see text], [Formula: see text], in the HISZ basis.

Measurement of [Formula: see text] production with additional jet activity, including [Formula: see text] quark jets, in the dilepton decay channel using pp collisions at [Formula: see text]

Jet multiplicity distributions in top quark pair ([Formula: see text]) events are measured in pp collisions at a centre-of-mass energy of 8 TeV with the CMS detector at the LHC using a data set corresponding to an integrated luminosity of 19.7[Formula: see text]. The measurement is performed in the dilepton decay channels ([Formula: see text], [Formula: see text], and [Formula: see text]). The absolute and normalized differential cross sections for [Formula: see text] production are measured as a function of the jet multiplicity in the event for different jet transverse momentum thresholds and the kinematic properties of the leading additional jets. The differential [Formula: see text] and [Formula: see text] cross sections are presented for the first time as a function of the kinematic properties of the leading additional [Formula: see text] jets. Furthermore, the fraction of events without additional jets above a threshold is measured as a function of the transverse momenta of the leading additional jets and the scalar sum of the transverse momenta of all additional jets. The data are compared and found to be consistent with predictions from several perturbative quantum chromodynamics event generators and a next-to-leading order calculation.