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Introduction: Sexual dysfunctions (SD) are a common issue for transgender-identified individuals and may persist despite access to gender-affirming care. Healthcare disparities experienced by transgender and gender-diverse people (TGDP) are often overlooked. Data on the prevalence of SD in TGDP from representative samples are rare, and little is known about the help-seeking behavior and healthcare needs regarding sexual problems in this subgroup compared to the needs of cisgender women (CW) and men (CM). Patient and Public Involvement can improve the quality and impact of research on under-researched topics. Objective: This study aims to investigate the prevalence of SD in TGDP in the German population and to compare sexual health and healthcare needs between TGDP and the groups of CW and CM. Methods: This cross-sectional study used data from an online survey with a sample representative of the German population in terms of gender, age, and federal state. ICD-11 criteria and FSDS-DAO were used to assess sexual health outcomes. Questionnaire items on gender, risk factors for SD, and healthcare needs were developed in collaboration with a culturally and gender-diverse group of eight external co-researchers and advisors following the patient and public involvement methodology. Outcomes were examined by gender group. Participants who reported identification with a gender different from their gender assigned at birth, a non-binary gender, a diagnosis related to gender incongruence, and/or variations of sex development were assigned to the TGDP group. Results: Data from N=4,023 participants (CW: n=1,985, CM: n=1,815, TGDP: n=223) were collected with a mean age of 49.0 years (SD = 16.5). The 6-month prevalence of sexual dysfunction (SD) according to ICD-11 criteria was considerably higher among TGDP (34.4%) compared to CW (16.3%) and CM (16.6%), as reflected in the FSDS-DAO scores of the TGDP subgroup (M = 21.1, SD = 15.3), CW (M = 11.1, SD = 12.4), and CM (M = 12.3, SD = 12.7). The demand for information regarding sexual problems among those experiencing SD was more frequently reported by TGDP (67.5%) than by CW (44.0%) and CM (47.3%), with an odds ratio of 4.3 for TGDP vs. cisgender. Across all gender groups, the most preferred source for information was online research, followed by peer networks (29.0%) and friends (26.5%) in the TGDP group, in contrast to healthcare providers and partners for CW and CM. The most desired dialogue partners among healthcare providers (HCP) were urologists and general practitioners in TGDP (26.4% and 23.9%) and CM (37.3% and 25.4%), and gynecologists (36.0%) and psychotherapists (11.5%) for CW. Among TGDP with SD, 49.9% had undergone therapy for sexual dysfunctions (in CW 10.2%, in CM 15.2%), with psychotherapy (36.0%) being the most frequently reported treatment. The TGDP group showed higher needs for information and help, identifying the lack of services considering individual needs related to culture, gender identity, physical illness, and mental health conditions as the primary barriers to care. Diversity sensitivity training for HCPs, drug developments, improved resources, and 'blended care' solutions that encompass both digital and physical procedures were identified as the most urgent developments to improve care for sexual dysfunctions. Conclusions: The results indicate the alarming extent of the burden of SD for TGDP. Furthermore, the findings emphasize the importance of tailored interventions that acknowledge and address the diverse needs of TGDP. Disclosure: No. [ABSTRACT FROM AUTHOR]

Overactive bladder (OAB) has a significant impact on the quality of life; thus, it requires treatment that can be adhered to over a long period without undue side effects. The current treatment which uses an anticholinergic or β-3 agonist may fail to improve symptoms and has side effects, leading to high discontinuation rates. OnabotulinumtoxinA (OnabotA) detrusor injection has been approved for idiopathic OAB as a second-line treatment with good effectiveness and tolerability. This study used a visual analog scale (VAS) to assess the impact of the type of needle used for OnabotA detrusor injections under local anesthesia on the pain levels after each injection. This study included 68 female patients. We used three different needles with thicknesses ranging from 22 to 27 gauge, lengths between 4 and 5 mm, and different cuts. The sensation of pain was rated at each standardized injection location. Regardless of the needle used, the patients' perceptions of pain at the beginning of the procedure were rated as being less than the subsequent injections. Most pain sensations were rated as low to moderate. The mean pain sensation on the VAS was 2.5 ± 0.3 overall, i.e., for all patients and needles used. Statistically significant differences in pain sensation were rated only at some locations of the bladder (on the back wall and the right side of the bladder). The single needles averaged the following pain scores: 2.8 ± 0.3 for needle A (20 G, 4 mm), 2.1 ± 0.3 for needle B (27 G, 5 mm), and 2.6 ± 0.4 for needle C (20 G, 4 mm, sharp cut 15°). The 27-gauge needle caused significantly less pain, and it had no negative impact due to its length, which was 1 mm longer than the other needles. Thus, the needle thickness was a decisive factor in the patients' perceptions of pain.

Objectives: Carcinoembryonic antigen (CEA) is a cell surface glycoprotein that represents a promising therapeutic target. Serum measurement of shedded CEA can be utilized for monitoring of cancer patients., Material and Methods: To evaluate the potential clinical significance of CEA expression in urothelial bladder neoplasms, CEA was analysed by immunohistochemistry in more than 2500 urothelial bladder carcinomas in a tissue microarray format., Results: CEA staining was largely absent in normal urothelial cells but was observed in 30.4% of urothelial bladder carcinomas including 406 (16.7%) with weak, 140 (5.8%) with moderate, and 192 (7.9%) with strong staining. CEA positivity occurred in 10.9% of 411 pTaG2 low-grade, 32.0% of 178 pTaG2 high-grade, and 43.0% of 93 pTaG3 tumours ( p  < 0.0001). In 1335 pT2-4 carcinomas, CEA positivity (34.1%) was lower than in pTaG3 tumours. Within pT2-4 carcinomas, CEA staining was unrelated to pT, pN, grade, L-status, V-status, overall survival, recurrence free survival, and cancer specific survival ( p  > 0.25)., Conclusion: CEA increases markedly with grade progression in pTa tumours, and expression occurs in a significant fraction of pT2-4 urothelial bladder carcinomas. The high rate of CEA positivity in pT2-4 carcinomas offers the opportunity of using CEA serum measurement for monitoring the clinical course of these cancers. Moreover, CEA positive urothelial carcinomas are candidates for a treatment by targeted anti-CEA drugs., Competing Interests: The rabbit recombinant CEA antibody, clone MSVA‐465R was obtained from MS Validated Antibodies GmbH, Hamburg, Germany (owned by a family member of GS)., (© 2024 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)

Background and Objectives : The acquisition of practical skills at medical school is an important part of the multidimensional education program of future physicians. However, medical schools throughout the world have been slow in incorporating practical skills in their curriculum. Therefore, the aims of the present prospective study were (a) to demonstrate the feasibility of such surgical training, (b) to objectify its benefit in medical education, and (c) to investigate the impact of such training on subsequent career choices. Material and Methods: We introduced a two-day laparoscopy course on the pelvitrainer as part of the curriculum of the gynecological internship of fifth year medical students from 2019 to 2020. The results of the students' training were matched to those of surgeons who completed the same curriculum in a professional postgraduate laparoscopy course from 2017 to 2020 in a comparative study design. Additionally, we performed a questionnaire-based evaluation of the impact of the course on medical education and subsequent career choices directly before and after completing the course. Results: A total of 261 medical students and 206 physicians completed the training program. At baseline, the students performed significantly more poorly than physicians in a median of three of four exercises ( p < 0.001). However, this evened out in the final runs, during which students performed more poorly than physicians only in one exercise and even better than physicians in one. The general integration of surgical training in medical school curricula was rated very low (12.4% on the VAS, IQR 3-16%) despite the high demand for such training. In the survey, the course was deemed very beneficial for medical education (median VAS 80.7%, IQR 73-98%), but did not appear to influence the students' subsequent career preferences. Conclusions: The acquisition of practical surgical skills during medical school is significantly under-represented in many medical faculties. The benefits of such training, as demonstrated in our study, would improve the education of future physicians.

Introduction: Trophoblast cell surface antigen 2 (TROP2; EpCAM2) is a transmembrane glycoprotein which is closely related to EpCAM (EpCAM; EpCAM1). Both proteins share partial overlapping functions in epithelial development and EpCAM expression but have not been comparatively analyzed together in bladder carcinomas. TROP2 constitutes the target for the antibody-drug conjugate Sacituzumab govitecan (SG; TrodelvyTM) which has been approved for treatment of metastatic urothelial carcinoma by the United States Food and Drug administration (FDA) irrespective of its TROP2 expression status., Methods: To evaluate the potential clinical significance of subtle differences in TROP2 and EpCAM expression in urothelial bladder cancer, both proteins were analyzed by multiplex fluorescence immunohistochemistry in combination with a deep-learning based algorithm for automated cell detection on more than 2,700 urothelial bladder carcinomas in a tissue microarray (TMA) format., Results: The staining pattern of TROP2 and EpCAM were highly similar. For both proteins, the staining intensity gradually decreased from pTa G2 low grade (TROP2: 68.8±36.1; EpCAM: 21.5±11.7) to pTa G2 high grade (64.6±38.0; 19.3±12.2) and pTa G3 (52.1±38.7; 16.0±13.0, p<0.001 each). In pT2-4 carcinomas, the average TROP2 and EpCAM staining intensity was intermediate (61.8±40.9; 18.3±12.3). For both proteins, this was significantly lower than in pTa G2 low grade (p<0.001 each) but also higher than in pTa G3 tumors (p=0.022 for TROP2, p=0.071 for EpCAM). Within pT2-4 carcinomas, the TROP2 and EpCAM staining level was unrelated to pT, grade, UICC-category, and overall or tumor-specific patient survival. The ratio TROP2/EpCAM was unrelated to malignant phenotype and patient prognosis., Conclusion: Our data show that TROP2 and EpCAM expression is common and highly interrelated in urothelial neoplasms. Despite of a progressive loss of TROP2/EpCAM during tumor cell dedifferentiation in pTa tumors, the lack of associations with clinicopathological parameters in pT2-4 cancer argues against a major cancer driving role of both proteins for the progression of urothelial neoplasms., Competing Interests: The recombinant EpCAM antibody clone MSVA-326R, the recombinant TROP2 antibody clone MSVA-733R, the recombinant panCK antibody clone MSVA-000R were provided by MS Validated Antibodies GmbH owned by a family member of GS., (Copyright © 2024 Müller, Plage, Elezkurtaj, Mandelkow, Huang, Lurati, Raedler, Debatin, Vettorazzi, Samtleben, Hofbauer, Furlano, Neymeyer, Goranova, Ralla, Weinberger, Horst, Roßner, Schallenberg, Marx, Fisch, Rink, Slojewski, Kaczmarek, Ecke, Hallmann, Koch, Adamini, Lennartz, Minner, Simon, Sauter, Zecha, Schlomm and Bady.)