OBJECTIVE:To explore the differences in symptom patterns and management between individuals with interstitial cystitis/bladder pain syndrome (IC/BPS) who have high vs low self-reported health related quality of life (HRQOL). METHODS:An anonymous 40-question online survey assessed IC/BPS patients' symptoms, triggers, management strategies, and comorbidities. Recruitment was through the Interstitial Cystitis Association's Facebook page. HRQOL was rated on a 0-10 Likert scale, grouping respondents into low-impact (0-3), intermediate (4-6), and high-impact (7-10). Univariate analysis included chi-square, Fisher's exact test, and t tests. RESULTS:Among 451 respondents, 53 (12%) reported low disease impact, while 279 (62%) had high impact. The high-impact group was more frequently triggered by mental health issues (50% vs 32%, P = .016) and exercise (14% vs 4%, P = .040), while the low-impact group was more often triggered by allergies (6% vs 1%, P = .054) and coffee (11% vs 3%, .005). High-impact individuals had higher rates of comorbidities, including pelvic floor dysfunction (39% vs 19%, .005), irritable bowel syndrome (36% vs 21%, P = .029), overactive bladder (30% vs 17%, P = .051), and/or vulvodynia (23% vs 9%, P = .026). CONCLUSION:IC/BPS encompasses a spectrum of disease manifestations. While demographics remain relatively uniform in this IC/BPS population, symptom patterns, comorbidities, and therapeutic choices are correlated with impact on quality of life.

Background Prospective trials have shown similar outcomes with partial nephrectomy (PN) in patients with localized renal cell carcinoma (RCC), and multiple studies suggest increasing the use of the technique. We hypothesize that patients who stem from minority groups, as well as Medicare and Medical, have less access to this specialized procedure and, therefore, have a higher rate of radical nephrectomy (RN). Methods We interrogated the California Office of Statewide Health Planning and Development (OSHPD) database, which collects information from all inpatient admissions, emergency room visits and inpatient/outpatient procedures in the state. All patients undergoing nephrectomy for RCC were identified from 2012 to 2018 using CPT and ICD-9/10 codes to identify patients with RCC undergoing RN and PN. Variables of interest included patient demographics, comorbidities, payor status and type of institution where the surgery was performed. We performed univariate and multivariable analysis to explore associations between patient factors and type of nephrectomy performed. Results In total, 31,093 patients who had undergone a nephrectomy in the study period were identified. Overall, most were 57% male, with a mean age of 58 years. PN and RN were performed in 15,840 (50.9%) and 15,253 (49.1%) patients, respectively. PN rates differed according to race/ ethnicity, as it was performed in 8576 (53.1%) White, 1124 (55.3%) Black, 1286 (46.0%) Asian, 4107 (47.5%) Hispanic and 747 (50.5%) other race patients (P < 0.001). Use of PN also differed among patients based on payor status, with 6800 (56.4%) private, 5,036 (43.9%) Medicare, 1,817 (38.3%) Medical, and 2,187 (77.7%) other insurance patients (P < 0.001). On multivariate analysis controlling for age, gender, comorbidities, and frailty, race was independently associated with the type of nephrectomy, but payor was not. Conclusions Our study confirms that race and payor status may have an influence on the utilization of partial versus status radical nephrectomy, with the highest rate of partial nephrectomies among Black patients and those with private insurance. Although there are multiple potential confounders (e.g., latency of diagnosis and resulting tumor size/complexity), it is possible access to care is a driver of this phenomenon.

Urethral bulking agents (UBA) are a treatment option for patients with stress urinary incontinence and can contain radiopaque material such that misdiagnosis for pelvic pathology occurs. We aim to characterize radiologic interpretation of UBA in patients who had computed tomography of the abdomen and pelvis (CTAP) after UBA. All patients who underwent UBA from January 2011 to March 2024 were identified in the electronic medical record (EMR). Charts were reviewed to identify patients who underwent subsequent CTAP. Radiologic interpretations were reviewed to assess for accuracy in identification of the UBA as well as patient communications regarding imaging results. During the study period, 144 patients underwent injection of UBA. Of those, 31 patients had ≥ 1 CTAP for a total of 61 CTAPs. Average duration of UBA to CTAP was 25.7 months. The UBA was accurately identified in only 15 (24.6

Abstract Introduction In limited studies vibrators have been shown to improve sexual function and improve pelvic floor health; however, there are even less studies on the effect of vibrator use on overall genitourinary and mental health. Objective This study aimed to investigate the effect of regular vibrator use on sexual, genitourinary, and mental health in addition to quality of life. Methods We performed a prospective pilot study of women aged 18 to 99 years recruited from a urogynecology clinic. Study participants were instructed to use a vibrator for five to ten minutes, two to three times a week for three months on their external genitalia. Sexual function, pelvic floor function, mental health, and pelvic examination were assessed at the initial visit and at three months follow-up using validated questionnaires. Results Of the 79 participants enrolled in the study, 53 women (66%) completed the study. The mean age of the participants was 54.7 years (range 19 – 80 years), and the majority of participants were Caucasian (n=59, 74.7%), post-menopausal (n=48, 60.8%), and not receiving systemic (n=63, 79.7%) or local (n=63, 79.7%) hormone therapy. Sexual function significantly improved over time (p =0.002), while the rate of bothersome pelvic organ prolapse symptoms and pain scores significantly decreased (p=0.034 and 0.0008, respectively). Rates of urge urinary incontinence decreased although this was not statistically significant (p=0.059). There was a significant improvement in gross appearance of lichen sclerosus lesions (p=0.025) and in severity of vaginal atrophy (p=0.018). Rates of depression were significantly decreased (p=0.011). Patients who completed the study were more likely to report having partnered sexual activity (p=0.067), and significantly more likely to have vaginal penetration during intercourse (p=0.017). Conclusions Vibrator use was associated with improved sexual, genitourinary, and mental health. Disclosure No.

Abstract Introduction The female sexual response cycle is complex with interconnected domains. Studies have shown that vaginal lubrication is affected by age and hormonal changes; however, the relationship between lubrication and orgasm has not been well described in premenopausal women, women who are postpartum, and postmenopausal women. Objective The objective of this study is to evaluate the relationship between vaginal lubrication and orgasm among premenopausal, postpartum, and postmenopausal women Methods A post-market analysis was performed of all women who had utilized the sexual wellness application Rosy between February 2022 and November 2022. Application users complete the Female Sexual Function Index (FSFI) short form (6-item) upon initial use of the application. We utilized multivariable linear regression models to determine significant effects between lubrication score and orgasm scores score controlling for whether the patient was on birth control, postpartum, or menopausal Results We reviewed a large database of 30,358 women from across the United States. Among these, 2,599 women were menopausal, 2, 011 were premenopausal women, and 795 were postpartum. The mean lubrication scores on FSFI -6 were: menopausal = 1.93, premenopausal = 2.68, postpartum = 2.73. Mean scores for orgasm were 2.2, 2.62, 2.31 respectively. Premenopausal women had higher overall scores on FSFI- 6, with orgasm scores improving with age. Higher scores in lubrication domain had less impact on orgasm domain in pre-menopausal women compared to post-menopausal women (p=0.04). No correlation between improvement in lubrication and orgasm noted among post-partum women when compared to post-menopausal women (p=0.87) Conclusions Lubrication has a higher impact on orgasm among post-menopausal women compared to pre-menopausal women and not correlated with orgasmic function among women in the post-partum period. These findings enhance our knowledge and refine current management of anorgasmia. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Rosy.

Background: It is difficult to assess if the evaluation and treatment of female sexual dysfunction (FSD) has progressed. In 2003, the American Urogynecology Society (AUGS) surveyed members to measure practice patterns for FSD. Our objective was to administer a similar survey to current members of AUGS and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) to evaluate existing practice patterns. Methods: An electronic survey was administered to SUFU and AUGS members. The results were compared to prior survey results from 2003. Results: A total of 187 physicians responded. The majority were female (75%) and at an academic or university-based practice (54%). Twenty percent of current members consider FSD screening to be extremely important versus 9% in 2003 (P=0.002). The most common reason for not screening was time constraints. Current practitioners report not screening because they do not know how/what to ask, whereas in 2003 physicians were more unsure about therapeutic options (P<0.001). In regards to post residency training, 36% were less than satisfied, significantly improved compared from 50% (P<0.001). Females were more likely to screen for FSD (P=0.012) compared to males. Those who were at least "very satisfied" with their training were more likely to screen (P=0.019). 87% of physicians would refer patients to an interactive phone application about FSD. Conclusions: Screening patterns and barriers to treatment of FSD have minimally improved over the last 20 years. Many trainees continue to feel unsatisfied with FSD education. Phone applications about FSD may be a good resource in the future.

It is unknown whether the July Effect (a theory that medical errors and organizational inefficiencies increase during the influx of new surgical residents) exists in urologic robotic-assisted surgery. The aim of this study was to investigate the impact of urology resident training on robotic operative times at the beginning of the academic year. A retrospective chart review was conducted for urologic robotic surgeries performed at a single institution between 2008 and 2019. Univariate and multivariate mix model analyses were performed to determine the association between operative time and patient age, estimated blood loss, case complexity, robotic surgical system (Si or Xi), and time of the academic year. Differences in surgery time and non-surgery time were assessed with/without resident presence. Operative time intervals were included in the analysis. Resident presence correlated with increased surgery time (38.6 min (p < 0.001)) and decreased non-surgery time (4.6 min (p < 0.001)). Surgery time involving residents decreased by 8.7 min after 4 months into the academic year (July–October), and by an additional 5.1 min after the next 4 months (p = 0.027, < 0.001). When compared across case types stratified by complexity, surgery time for cases with residents significantly varied. Cases without residents did not demonstrate such variability. Resident presence was associated with prolonged surgery time, with the largest effect occurring in the first 4 months and shortening later in the year. However, resident presence was associated with significantly reduced non-surgery time. These results help to understand how new trainees impact operating room times.

371 Background: Recently, thymectomy in adults has been linked to a higher incidence of several malignancies (Kooshesh et al NEJM 2023). Accompanying translational studies suggest that depleted T-cell production (both CD4+ and C8+) and decreased clonality may selectively drive the pathogenesis of immunogenic cancers such as RCC. We sought to confirm this finding in a large population-based cohort. Methods: We interrogated the California Office of Statewide Health Planning and Development (OSHPD) database, which collects information from all inpatient admissions, emergency room visits, and inpatient/outpatient procedures in the state. Patients who underwent thymectomy and nephrectomy (specifically for RCC) were identified from Jan 1, 2012, to Dec 31, 2019, using CPT and ICD-9/10 codes. The frequency of nephrectomy following thymectomy was computed. The frequency of both surgical interventions in the general population was derived by comparing their respective incidence in the OSHPD database against age-matched California census data. Chi square test was used to determine differences among groups. Fisher’s exact test was used to determine if the incidence of nephrectomy following thymectomy was different from the incidence of nephrectomy overall. Results: During the study period, 1,969 pts (mean age 56) underwent thymectomy and 31,093 pts (mean age 57) underwent nephrectomy. Relative to patients who underwent thymectomy, a larger proportion of patients undergoing nephrectomy were male (57% vs 45%) and Hispanic (28% vs 18%) (p<0.01)., while a smaller proportion was Asian (7% vs 18%) (p<0.01). Expressed as a percentage of the underlying age-matched population (18,343,792 pts), 0.01% of pts received thymectomy, and 0.17% of pts underwent nephrectomy. A total of 11 pts underwent nephrectomy following thymectomy, suggesting an incidence of 0.56% in this cohort. This was significantly higher than the incidence of nephrectomy in the population at large (P=0.002). The median age of patients who had a nephrectomy for RCC with a prior thymectomy was considerably younger than the general population who underwent a nephrectomy (mean age 52 vs. 57 years). Conclusions: In a large population-based study, we observed a significantly higher rate of nephrectomy for RCC in patients who had received prior thymectomy. These results bolster previous studies done in smaller datasets. Further work is needed to define causality and clarify the mechanism of this association.

INTRODUCTION:Sexual health, an integral component of overall well-being, is frequently compromised by common yet underdiagnosed sexual dysfunctions. Traditional interventions encompass pharmaceutical and psychological treatments. Unconventional therapies, like MDMA, offer hope for sexual dysfunction. This review delves into MDMA's effects on sexual responsiveness and its potential role in treating sexual dysfunction.OBJECTIVES:The purpose of this review is to elucidate effects of MDMA on different domains of the female and male sexual response cycles.METHODS:We conducted a systematic review on the effects of MDMA on each domain of the female and male sexual response cycles. PubMed, MEDLINE, and EMBASE were queried, and results were screened using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms utilized were "MDMA" or "ecstasy" in combination with "desire," "arousal," "lubrication," "orgasm," "pleasure," "libido," "erection," and "ejaculation." Inclusion criteria for this review were MDMA use by study subjects and sexual outcomes in at least 1 domain of the female and/or male sexual response cycles were described and measured. Randomized controlled trials, cohort studies (both prospective and retrospective), surveys, and literature reviews published between January 2000 and June 2022 were included. Case reports and studies that did not address conditions of interest were excluded from analysis. Duplicated search results were screened out. The remaining studies were then read in full text to ensure they met inclusion and exclusion criteria for analysis.RESULTS:We identified 181 studies, of which 6 met criteria for assessment of the female sexual response cycle and 8 met criteria for assessment of the male sexual response cycle. Four of 6 studies reported increased sexual desire with MDMA use among women. Arousal and lubrication were improved with MDMA use in 3 of 4 studies, but they were not affected in 1 randomized control study. In men, 7 studies evaluated the effects of MDMA on desire and/or arousal, 5 studies measured impact on erection, 3 on orgasm, and 2 on ejaculation. Sixty percent of interview-based studies reported increased sexual desire in men, while 40% reported mixed or no effect. Two studies reported impairment of erection, 2 reported mixed effects, and 1 reported fear of erection impairment. In both men and women, all studies evaluating orgasm reported delay in achieving orgasm but increased intensity and pleasure if achieved. Primary outcome measures were variable and largely qualitative.CONCLUSION:Our findings suggest that MDMA generally increases sexual desire and intensifies orgasm when achieved. While producing conflicting evidence on sexual arousal in both sexes, MDMA may impair erectile and ejaculatory function in men.

Abstract Introduction Certain types of masturbation have been shown to affect genital and genitourinary health. However, the full range of health benefits associated with masturbation and its various forms remains inadequately studied. Objective This study aimed to investigate the literature addressing utilization of masturbation for various health conditions among females. Methods We conducted a systematic literature review of PubMed, Embase, and Medline from January 1980 to November 2023, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search incorporated keywords such as “masturbation,” “sexual pleasure,” “benefits of masturbation,” “sexual self-stimulation,” “solo sex,” “onanism,” and “self-pleasure.” Inclusion criteria for the analysis were clinical trials, cohort studies, and reviews with cisgender women over 18 years old as participants, and masturbation utilized as an intervention. Exclusion criteria were case reports, surveys, studies involving men, or those with a history of gender dysphoria. Results A total of 176 studies were initially identified. Only five studies met all inclusion and exclusion criteria. Among these, four were clinical trials, and one was a systematic review. All but one study investigated the role of masturbation in the ability to orgasm with or without a partner. Orgasmic function was noted to be improved among participants in these four studies. One study investigated the endocrine changes associated with orgasm and found a significant elevation in post-orgasmic prolactin, similar to men. Participants in all the studies were cisgender women aged 18 to 55, predominantly heterosexual. The intervention duration ranged from 10 minutes per session to multiple sessions over the course of five weeks, with only one study specifying the mode of masturbation (vibrators). Four of the studies used erotica and pornography as augmentation to masturbation, and a partner was involved in the intervention in two of the studies. Only one study employed formal quantitative methods for outcome assessment. Conclusions Masturbation has primarily been investigated as an intervention for orgasmic dysfunction. There is a significant need for studies examining different types of masturbation and their effects on general and genitourinary health. Disclosure No.

Abstract Introduction The female sexual response cycle is complex with interconnected domains. Studies have shown that vaginal lubrication is affected by age and hormonal changes; however, the relationship between lubrication and orgasm has not been well described in premenopausal women, women who are postpartum, and postmenopausal women. Objective The objective of this study is to evaluate the relationship between vaginal lubrication and orgasm among premenopausal, postpartum, and postmenopausal women. Methods A post-market analysis was performed of all women who had utilized the sexual wellness application Rosy between February 2022 and November 2022. Application users complete the Female Sexual Function Index (FSFI) short form (6-item) upon initial use of the application. We utilized multivariable linear regression models to determine significant effects between lubrication score and orgasm scores score controlling for whether the patient was on birth control, postpartum, or menopausal. Results We reviewed a large database of 30,358 women from across the United States. Among these, 2,599 women were menopausal, 2, 011 were premenopausal women, and 795 were postpartum. The mean lubrication scores on FSFI -6 were: menopausal = 1.93, premenopausal = 2.68, postpartum = 2.73. Mean scores for orgasm were 2.2, 2.62, 2.31 respectively. Premenopausal women had higher overall scores on FSFI- 6, with orgasm scores improving with age. Higher scores in lubrication domain had less impact on orgasm domain in pre-menopausal women compared to post-menopausal women (p=0.04). No correlation between improvement in lubrication and orgasm noted among post-partum women when compared to post-menopausal women (p=0.87). Conclusions Lubrication has a higher impact on orgasm among post-menopausal women compared to pre-menopausal women and not correlated with orgasmic function among women in the post-partum period. These findings enhance our knowledge and refine current management of anorgasmia. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie, Coloplast, Rosy.

Abstract Introduction Sexual, pelvic, and mental health are important and interconnected components of overall health and well-being. As such, the function of one area of health can affect health in general. It has been shown that vibrator use improves sexual function in females. Objective This study aimed to investigate the effect of regular topical vibrator use on sexual, pelvic, and mental health and overall well-being. Methods We performed a prospective pilot study among women aged 18 and 99 years recruited from our urogynecology clinic. Study participants were instructed to use a vibrator for five to ten minutes two to three times a week for three months on their external genitalia with a focus on the duration of application. Demographics, pelvic floor function, and mental health were assessed at the initial and 3- months follow-up appointments using physical exams and validated questionnaires. To determine the effect of vibrator use on pelvic and mental health, statistical analysis was performed with paired t-tests (continuous data) or McNemar’s test (dichotomous data). Results Of 79 women enrolled in the study, 57 (72.2%) women completed the study. The mean age of participants was 54.7 years (range 19 – 80 years), and most were Caucasian (74.7%), menopausal (60.8%), and not on systemic hormone replacement therapy (79.7%) or vaginal estrogen therapy (79.7%). Half (53.2%) of the participants were engaged in partnered sexual activity, and 49.4% used or had used vibrators in the past. Sexual function domains such as arousal (p=0.007), orgasm (p=0.018), and satisfaction (p=0.027) were significantly improved after the completion of the study, as well as genitourinary pain scores (p=0.037). However, symptoms related to pelvic organ prolapse (p=0.59), urinary incontinence (p=0.15), and fecal incontinence (p=0.15) were not significantly improved. Rates of depression significantly decreased (p=0.020), while health-related quality of life significantly improved (p=0.014). Conclusions Vibrator use was associated with improved sexual health, genitourinary pain, and health-related quality of life. Depression was subjectively improved, along with a positive trend in depression scores. Recommendation of regular vibrator use should be considered for certain conditions as it might have a significant influence on women’s well-being. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie, Coloplast.

Abstract Introduction Solo sexual activity is a solo stimulation of one’s genitals and other body areas for sexual pleasure. Treatment methods for Female Sexual Dysfunction (FSD), developed to date are usually assessed in the context of partnered sexual activity. There is a growing need to compare the effect of therapeutic interventions, like vibrators, among women engaged in only solo sexual activity and partnered sexual activity. Objective The aim of this study was to assess the effect of routine vibrator use on sexual health among women engaged in only solo and partnered sexual activity. Methods This was a prospectively pilot study of sexually active women aged 18 and 99 who presented for consultation to our urogynecological clinic with pelvic floor and/or sexual health concerns. Women were offered a bullet vibrator and instructed to use it according to the protocol. Participants’ demographics, health data, sexual practices, frequency of solo and partnered sexual activity, as well as Female Sexual Function Index (FSFI) were assessed at the initial visit and after three months of intervention. We used descriptive statistics and a paired-sample t-test to determine the effect of vibrator use on sexual function. Results Among 61 women enrolled in this study, 60.6% (n=37) were engaged in partnered sexual activity and 39.3% (n=24) were only solo sexually active. Participants were predominantly white (80.3%), with a mean age of 54.7 ± 16.3. There were no significant differences in demographics and pelvic floor disorders (prolapse, urinary incontinence) between the two groups. Vibrator use among women in a solo group did not show significant improvement in sexual response cycle domains (p>0.05). However, the score statistical trend was noted across all the domains. Women engaged in partnered sexual activity had significant improvement in desire (p=0.03), arousal (p=0.03), orgasm (p=0.05), and the total score (p=0.03) with vibrator use. The study completion was higher among women involved in partnered sexual activity 94.6% (n=35) than women who only engaged in solo sexual activity 58.3%(n=14). Conclusions No significant differences in demographics and pelvic health were noted between women engaged in solo sexual activity and women engaged in partnered sexual activity. Vibrator therapy produces significant improvement in desire, arousal, and orgasm domains, as well as total score among women in partnered sexual activities, also more represented in this pilot study. Disclosure No.

In limited studies vibrators have been shown to improve sexual function and pelvic floor health; however, there are even fewer studies on the effect of vibrator use on overall genitourinary and mental health. To investigate the effect of regular vibrator use on sexual, genitourinary, and mental health in addition to quality of life. We performed a prospective pilot study of women aged 18 to 80 years recruited from a urogynecology clinic. Study participants were instructed to use a vibrator according to the protocol. Sexual function, pelvic floor function, mental health, and pelvic examination were assessed at the initial visit and at 3 months’ follow-up using validated questionnaires. Of the 79 participants enrolled in the study, 53 women (66