RESUMEN
PURPOSE: The use of antioxidants is common practice in the management of infertile patients. However, there are no established guidelines by professional societies on antioxidant use for male infertility. MATERIALS AND METHODS: Using an online survey, this study aimed to evaluate the practice pattern of reproductive specialists to determine the clinical utility of oxidative stress (OS) testing and antioxidant prescriptions to treat male infertility. RESULTS: Responses from 1,327 participants representing 6 continents, showed the largest participant representation being from Asia (46.8%). The majority of participants were attending physicians (59.6%), with 61.3% having more than 10 years of experience in the field of male infertility. Approximately two-thirds of clinicians (65.7%) participated in this survey did not order any diagnostic tests for OS. Sperm DNA fragmentation was the most common infertility test beyond a semen analysis that was prescribed to study oxidative stress-related dysfunctions (53.4%). OS was mainly tested in the presence of lifestyle risk factors (24.6%) or sperm abnormalities (16.3%). Interestingly, antioxidants were prescribed by 85.6% of clinicians, for a duration of 3 (43.7%) or 3-6 months (38.6%). A large variety of antioxidants and dietary supplements were prescribed, and scientific evidence were mostly considered to be modest to support their clinical use. Results were not influenced by the physician's age, geographic origin, experience or training in male infertility. CONCLUSIONS: This study is the largest online survey performed to date on this topic and demonstrates 1) a worldwide understanding of the importance of this therapeutic option, and 2) a widely prevalent use of antioxidants to treat male infertility. Finally, the necessity of evidence-based clinical practice guidelines from professional societies is highlighted.
RESUMEN
INTRODUCTION: Photoselective vaporization of the prostate (PVP) with the greenlight laser has become a popular alternative to the standard transurethral resection of the prostate for patients with benign prostatic hyperplasia (BPH). Our initial results of postoperative erectile function are presented. AIM: To prospectively evaluate the postoperative erectile function of the first 105 consecutive patients undergoing PVP at Texas A&M Health Sciences Center, Scott & White Memorial Hospital, using the Sexual Health Inventory for Men (SHIM) questionnaire. METHODS: Institutional Review Board approved this case series of 105 consecutive patients who underwent PVP. The men were divided into three groups depending on their preoperative bladder management: Group N-catheter free (N = 86), Group Y-indwelling catheters (N = 8), and Group clean intermittent catheterization (CIC)-performing clean intermittent catheterization (N = 11). MAIN OUTCOME MEASURES: SHIM scores were obtained and compared preoperatively and at 12-month follow-up visit. RESULTS: The mean age of the 86 patients in group N, who did not require an indwelling catheter or CIC preoperatively, was 71.8 years. Their mean preoperative SHIM score was 10.7, and was 10.4 postoperatively. The mean age of the eight patients who were in group Y, who did require an indwelling catheter preoperatively, was 76.8. Their mean preoperative SHIM score was 10.5, and improved to 23 postoperatively. The mean age of the 11 patients in group CIC, who performed CIC preoperatively, was 71.8 years. Their mean preoperative SHIM score was 6.0, and was 5.8 postoperatively. CONCLUSIONS: Sexual function was maintained by patients who underwent PVP for obstructive BPH and who were catheter free or required CIC preoperatively, and was improved for men who had indwelling catheters preoperatively. There was no statistically significant difference between preoperative and postoperative sexual function after PVP for men with either mild or no erectile dysfunction preoperatively.