Epididymectomy Is an Effective Treatment for Chronic Epididymal Pain.

INTRODUCTION: Chronic scrotal pain is difficult to manage, and epididymectomy is a treatment option for a subset of men with pain localized to the epididymis. We sought to evaluate the efficacy of epididymectomy at our institution. METHODS: Between 2000 and 2020, 225 men underwent epididymectomy at our institution for pain localized to the epididymis and not part of a greater constellation of pelvic pain or urinary symptoms. Our primary outcome measure was change in pain after epididymectomy, categorized as cured/improved or no change/worsened. Multivariable logistic regression compared the impact of pain duration, and surgical and psychiatric histories on postoperative pain. RESULTS: Patients in both outcome categories-cured/improved and no change/worsened-were similar in age and BMI. Overall, 162 patients (72%) reported cured/improved pain at the last documented follow-up visit. Median follow-up time was 12 (IQR 1-364) weeks. About half of the cohort (n = 117, 52%) had a prior vasectomy, and there was no difference in outcome based on vasectomy history on multivariate analysis (OR 0.625, P = .3). Men with pain duration > 1 year (OR 0.46, P = .03), diagnosed psychiatric conditions (OR 0.44, P = .04), or prior scrotal/inguinal/abdominal surgeries other than vasectomy (OR 0.47, P = .03) had decreased odds of pain relief after epididymectomy. CONCLUSIONS: This 20-year analysis is the largest review of postepididymectomy outcomes reported. Among carefully screened men, 72% had resolution or improvement of scrotal pain. Epididymectomy is most effective for men with < 1 year of focal epididymal pain, with no history of psychiatric conditions or scrotal/inguinal/abdominal surgery other than vasectomy.

Flares and their impact among male urologic chronic pelvic pain syndrome patients: An in-depth qualitative analysis in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network.

INTRODUCTION: There has been a sparse exploration of the lived experience of men with urologic chronic pelvic pain syndrome (UCPPS), and none with the goal of Investigating the experience of "flares" as part of this chronic pain syndrome in men. METHODS: We conducted three focus groups of male UCPPS patients at two sites of the MAPP Research Network (n = 16 total participants) to explore the full spectrum of flares and their impact on men's lives. RESULTS: Flare experiences were common and specific symptom components varied widely. Men reported nonpelvic symptoms (e.g., diarrhea), and variability in symptom intensity (mild to severe), duration (minutes to days), and frequency of flares. Flares episodes, and the threat of flares, were disruptive to their lives, social roles, and relationships. Distinct long-term impacts were reported, such as decreased sexual activity, decreased travel, and potential loss of employment or career. The themes included social isolation and the need for a sense of control and understanding over their unpredictable symptoms. CONCLUSIONS: Given their negative impact, future research with men and UCPPS should focus on approaches to prevent flares, and should consider a multimodal approach to reducing the frequency, severity, and/or duration. Quality of life may be improved by providing men with a sense of control over their symptoms and offering them multimodal treatment options, consistent with the recommendations for further research for women with UCPPS.

Health Seeking in Men: A Concept Analysis.

This article describes the analysis of the concept of health seeking in men. Men have shorter life expectancies and utilize health services less often than women, leading to poor health outcomes, but a gendered basis for health seeking remains poorly defined. Walker and Avant's framework was used to guide this concept analysis. Literature published in English from 1990-2015 was reviewed. Thematic analysis identified attributes, antecedents, and consequences of the concept. Based on the analysis, a contemporary definition for health seeking in men was constructed, rooted in the concept of health. The definition is based on the concept analysis and the defining attributes that were identified. This analysis provides a definition specifically for health seeking in American men, making it more specific and gender-based than the parent concept of "health." This concept analysis provides conceptual clarity that can guide development of a conceptual framework that may be uniquely relevant to providers in urology. Further exploration will uncover specific cultural, social, sexual, and geographic perspectives.

Competencies for the Nurse Practitioner Working with Adult Urology Patients.

The role of the nurse practitioner (NP) has expanded into specialty domains. This document proposes 24 competencies specific to the urology NP, which are also consistent with the recommendations of National Organization of Nurse Practitioner Faculties (NONPF) and compliment the American Urologic Association (AUA) 2014 white paper on the incorporation of advanced practice providers in urology practices. It describes three levels of practice and experience progression for the urology NP working with adult patients, independent of specific clinical setting. These urology-specific competencies supplement and complement the core competencies and population-focused competencies of generalist nurse practitioners.

A historical perspective on the male sexual case history.

The contemporary sexual medicine case history is grounded in the Biopsychosocial Model and its recognition that the past influences one's current interpretation of symptoms. However, the thread of this model can be found throughout the case studies of the early pioneers of sexology. These early investigators began with examinations of homosexual men, slowly moving toward awareness that male sexuality comprises a continuum, while striving to place sexual behavior in a biologic context. Their perspectives served to establish the groundwork for the emerging construct of sexuality and helped shape current methods for identification of sexual function concerns.

Chronic unexplained orchialgia: a concept analysis.

AIMS: To conduct an analysis of the concept of chronic unexplained orchialgia. BACKGROUND: Chronic unexplained orchialgia is a concept unique to men's health; however, clarity is lacking regarding the precise meaning of the key attributes of this important concept. DESIGN: Walker and Avant's framework was used to guide this concept analysis. DATA SOURCES: Literature sources included bibliographic databases. REVIEW METHODS: Literature published in English from January 1970 to December 31, 2012 was reviewed. Thematic analysis identified critical attributes, antecedents and consequences of the concept. RESULTS: Based on the analysis, a contemporary definition for chronic unexplained orchialgia is proposed, rooted in the concept of chronic pain. This definition is based on the concept analysis and the defining attributes that were identified in the literature. Chronic unexplained orchialgia is a subjective negative experience of adult men, perceived as intermittent or continuous pain of variable intensity, present at least three months, localizing to the testis(es) in the absence of objective organic findings and that interferes with quality of life. CONCLUSION: This analysis provides a precise definition for chronic unexplained orchialgia and distinguishes it from other similar terms. This concept analysis provides conceptual clarity that can guide understanding and development of a conceptual framework, middle range theory, or situation-specific theory. Further exploration of this concept is recommended to uncover the influence of social, sexual and cultural factors.

Chronic testicular pain in adult men: an integrative literature review.

Past investigations of chronic testicular pain provide a sparse representation of the men with this condition and lack key details to aid our understanding of this important men's health condition. As a chronic pain syndrome, more research is necessary to understand the phenomenon of chronic testicular pain and the pain experience of these men. This integrative literature review provides a summary of the current state of the science of chronic testicular pain in men, identifies the gaps in our knowledge, and provides recommendations to address this knowledge gap.

A survey evaluating the current role of the nurse practitioner in urology.

The role of the nurse practitioner (NP) continues to expand into the care of specialty populations. This article presents results of a survey that allowed NPs who self-identified as working specifically with people diagnosed with urologic conditions to describe their clinical role. The purpose of identifying NP-specific clinical tasks was to provide evidence to be used in revising the urology specialty certification examination for NPs.

Anejaculation: an electrifying approach.

Anejaculation within the context of a male infertility evaluation can be a distressing condition for patients. A variety of causes for anejaculation have been identified, and although the condition cannot be reversed, in many cases a minimally invasive treatment is feasible, allowing the patient to pursue his desire for children. In most cases, men suffering from anejaculation due to spinal cord injury (SCI) are excellent candidates for ejaculation induction procedures and low-level assisted reproductive techniques. In many SCI men, penile vibratory ejaculation can be performed by the patient himself and home insemination performed as a very low cost alternative. Surgical sperm retrieval and intracytoplasmic sperm injection should be first-line therapy only in non-SCI anejaculatory men.

Evaluation of three penile prosthesis pump designs in a blinded survey of practitioners.

Erectile dysfunction continues to be a problem that can be successfully treated either through medical or surgical management. A cohort of self-identified experts in teaching the operation of penile implants completed a series of questions and tasks associated with three implant pump designs. This study examines the responses and impressions of these expert teachers in regard to three penile prosthesis pump designs. The goal of this project was to establish if one prosthesis pump was superior in the user's ability to correctly identify components in a blinded, scrotal simulation study.

Teaching a patient to successfully operate a penile prosthesis.

Despite the fact that penile prosthesis devices represent the most invasive and least chosen of treatments for erectile function issues, these devices have the highest patient satisfaction rates of all the available treatments. This article will review the process of teaching a patient and his partner how to successfully operate the device.