Increased Risk of Hypogonadal Symptoms in Shift Workers With Shift Work Sleep Disorder.

OBJECTIVE: To examine the association between shift work sleep disorder (SWSD), a primary circadian rhythm disorder characterized by excessive day-time sleepiness associated with shift work, and hypogonadal symptoms in shift workers. METHODS: Men presenting to an andrology clinic between July 2014 and June 2017 completed questionnaires assessing shift work schedule, SWSD risk, and hypogonadal symptoms ([quantitative] Androgen Deficiency in the Aging Male [qADAM, ADAM]). The impact of nonstandard shift work and SWSD on responses to qADAM and ADAM was assessed using ANOVA and linear regression. RESULTS: About 24.1% (619/2571) of men worked nonstandard shifts. Of those, 196 (31.7%) were considered to have SWSD. Controlling for age, comorbidities, and testosterone (T) levels, nonstandard shift workers had qADAM scores 1.12 points lower than day-time workers (P <.01). Subgroup analysis of nonstandard shift workers showed that those with SWSD had qADAM scores 5.47 points lower than men without SWSD (P <.01). In this same subgroup analysis, SWSD was independently associated with lower T levels (mean decrease 100.4 ng/dL, P <.01) when controlling for age, comorbidities, and prior T supplementation. CONCLUSION: Nonstandard shift workers with SWSD have even worse hypogonadal symptoms and lower T levels than day-time workers and nonstandard shift workers without SWSD. This suggests that poor sleep habits, as identified by SWSD, may contribute to the more severe hypogonadal symptoms seen in nonstandard shift workers.

Sexual dysfunction and infertility in the male spina bifida patient.

Spina bifida is a congenital neural tube defect with many neurological implications, as well as decreased sexual function and infertility. Few studies have directly investigated infertility in men with spina bifida. Infertility in this special patient population is primarily the result of spermatogenic defects and/or failure of sperm transport due to erectile or ejaculatory dysfunction. The severity of sexual and reproductive dysfunction seems to correlate with higher level of spina cord lesion and presence of hydrocephalus. Phosphodiesterase 5 inhibitors (PDE5is) have been shown to be effective for erectile dysfunction in some men with spina bifida. Surgical sperm retrieval from the genitourinary tract and rectal probe electroejaculation can serve as methods for collecting sperm from those with ejaculatory dysfunction or retrograde ejaculation. Assisted reproductive technology such as intracytoplasmic sperm injection allows isolated sperm from men with infertility to achieve fertilization. Since most spina bifida patients are surviving into adolescence and adulthood due to improved medical and surgical advancements, it is paramount for healthcare professionals to address issues related their sexual and reproductive function.

Variability in penile duplex ultrasound international practice patterns, technique, and interpretation: an anonymous survey of ISSM members.

Penile duplex ultrasound (PDU), combined with pharmacologic stimulation of erection, is the gold standard for the evaluation of multiple penile conditions. A 30-question electronic survey was distributed to members of the International Society for Sexual Medicine (ISSM). The survey assessed the variability in current PDU practice patterns, technique, and interpretation. Chi-square test was used to determine the association between categorical variables. Approximately 9.5% of all 1996 current ISSM members completed the survey. Almost 80% of members surveyed reported using PDU, with more North American practitioners utilizing PDU than their European counterparts (94% vs 69%, p < 0.01). Approximately 62% of PDU studies were performed by a urologist and more than 76% were interpreted by a urologist. Although almost 90% of practitioners reported using their own protocol, extreme variation in the technique existed among respondents. Over ten different pharmacologic mixtures were used to generate erections, and 17% of respondents did not repeat dosing for insufficient erection. Urologists personally performing PDU were more likely to assess the cavernosal artery flow using recommended techniques with the probe at the proximal penile shaft (73% vs 40%) and at a 60-degree angle or less (68% vs 36%) compared with non-urologists (p < 0.01). Large differences in PDU diagnostic thresholds were apparent. Only 38% of respondents defined arterial insufficiency with a peak systolic velocity < 25 cm/s, while 53% of respondents defined venous occlusive disease with an end diastolic velocity > 5 cm/s. This is the first study to assess the variability in the PDU protocol and practice patterns, and to pinpoint areas of improvement. As in other surveys, recall bias, generalizability, and response rate (9.5%) are inherent limitations to this study. Although most respondents report utilizing a standardized PDU protocol, widespread variation exists among practitioners in terms of both technique and interpretation, limiting accurate diagnosis and appropriate treatment of penile conditions.

Male Infertility Diagnosis and Treatment in the Era of In Vitro Fertilization and Intracytoplasmic Sperm Injection.

As assisted reproductive technologies use increases, the evaluation of male factor infertility has often become overlooked. However, male evaluation remains critically important, with benefits seen in overall health, as well as in natural and assisted pregnancy and birth rates. A comprehensive assessment of the male partner should be offered to all couples seeking infertility care.

Objective Assessments of Peyronie's Disease.

INTRODUCTION: Penile deformity is the most obvious manifestation of Peyronie's disease (PD) and key to determining the optimal method of treatment. Other aspects of PD to consider include plaque size, location, and density; amount of calcification; erection quality; disease progression; and penile anatomy. Few standards exist for the objective assessment of these parameters. AIM: To describe current options and new trends in the objective evaluation of PD with a focus on penile curvature and imaging modalities. METHODS: A literature review was performed through PubMed from 1990 to 2017 regarding objective parameters in PD, including imaging modalities, measurements of deformity, and serum markers. Non-English-language articles were excluded. MAIN OUTCOME MEASURES: We sought to assess various objective measurements obtained in patients with PD and to evaluate their usefulness in the evaluation, treatment, and counseling of patients with PD. RESULTS: Measurement of penile curvature is most accurately performed with in-office goniometric angle measurement of a pharmacologically induced erection. However, new methods of assessing penile curvature using 3-dimensional photography and smartphone and tablet applications can aid clinicians in describing and treating PD. Ultrasound and ultrasound adjuncts provide excellent plaque characterization and assessment of penile vasculature, which can be useful for treatment planning and research. Presence of inflammation can be evaluated using magnetic resonance imaging or nuclear scintigraphy. CONCLUSION: Current guidelines only recommend obtaining measurements of penile length and penile curvature in the erect state. However, many other options exist for the objective evaluation of PD. These options can have a role in treatment decision making and help standardize results in PD research. Chen JY, Hockenberry MS, Lipshultz LI. Objective Assessments of Peyronie's Disease. Sex Med Rev 2018;6:438-445.

A novel use of near-infrared fluorescence imaging during robotic surgery without contrast agents.

We describe a novel use of near-infrared fluorescence (NIRF) imaging without contrast agents, like indocyanine green, to identify otherwise obscured intraluminal areas of interest during robot-assisted laparoscopic (RAL) surgery marked by the white light (WL) of endoscopic instruments. By filtering light wavelengths below near-infrared, NIRF imaging causes the WL of the endoscopes to illuminate green while allowing simultaneous vision of the surrounding tissues. With this visualization, intraoperative ureteroscopy was used to identify the extent of a ureteral stricture in a patient undergoing RAL partial ureterectomy. Cystoscopy was used to identify bladder diverticula and tumor locations in three patients undergoing RAL partial cystectomy with or without diverticulectomy and the ureteral orifice in another patient undergoing RAL nephroureterectomy. This technique enabled more precise identification of important areas and successful completion of RAL surgery in these five patients, which serves as proof of concept for broader applications in RAL surgery.

Smoking knowledge assessment and cessation trends in patients with bladder cancer presenting to a tertiary referral center.

OBJECTIVE: To determine the knowledge level of patients with bladder cancer (BC) regarding smoking risks. We also sought to determine the role of their urologists in initiating smoking cessation at the diagnosis. Smoking is the leading risk factor for BC in industrialized nations. However, little information is available regarding patients' knowledge of the risks of smoking and the role of their urologists in initiating smoking cessation at diagnosis. METHODS: A smoking knowledge and cessation questionnaire was administered to 71 patients referred to the Johns Hopkins Hospital for BC from April 2008 to June 2009. The questionnaire captured data on demographics, BC history, smoking status and history, risk factor knowledge, and cessation patterns. RESULTS: The mean age of the cohort was 65.1 years (range 42-86) and 72% were men. At the referral, all 71 patients (100%) knew smoking was a risk factor for lung cancer compared with 61 (86%) who knew it was for BC. Only 36 patients (51%) knew smoking was the leading risk factor for BC. Of the 17 patients (24%) who were smokers at their BC diagnosis, 12 (71%) were counseled by their referring urologist to quit smoking; however, the significant majority (76%) was not offered any specific intervention. CONCLUSION: The association between smoking and BC was not as well known as that of lung cancer in our cohort of patients. Most current smokers were advised to stop smoking by their primary urologist; however, few were offered any intervention to aid in cessation. Urologists should assume a more active role both in educating patients regarding smoking's link to BC and in initiating smoking cessation.