Comparison of the gut microbiome composition between men with erectile dysfunction and a matched cohort: a pilot study.

BACKGROUND: To-date there have been minimal studies to investigate an association between the gut microbiome and erectile dysfunction. There have been many inflammatory diseases linked to gut microbiome dysbiosis; such as cardiovascular disease and metabolic syndrome. These same inflammatory diseases have been heavily linked to erectile dysfunction. Given the correlations between both conditions and cardiovascular disease and the metabolic syndrome, we believe that it is worthwhile to investigate a link between the two. OBJECTIVE: To investigate the potential association between the gut microbiome and erectile dysfunction. METHODS: Stool samples were collected from 28 participants with erectile dysfunction and 32 age-matched controls. Metatranscriptome sequencing was used to analyze the samples. RESULTS: No significant differences were found in the gut microbiome characteristics, including Kyoto Encyclopedia of Genes and Genomes richness (p = 0.117), Kyoto Encyclopedia of Genes and Genomes diversity (p = 0.323), species richness (p = 0.364), and species diversity (p = 0.300), between the erectile dysfunction and control groups. DISCUSSION: The association of gut microbiome dysbiosis and pro-inflammatory conditions has been well studied and further literature continues to add to this evidence. Our main limitation for this study was our small-sample size due to recruitment issues. We believe that a study with a larger population size may find an association between the gut microbiome and erectile dysfunction. CONCLUSIONS: The results of this study do not support a significant association between the gut microbiome and erectile dysfunction. Further research is needed to fully understand the relationship between these two conditions.

Comparative assessment of outcomes and adverse effects using two different intramuscular testosterone therapy regimens: 100 mg IM weekly or 200 mg IM biweekly.

This study aimed to compare the change in levels of several laboratory values and the development of adverse events using two commonly used intramuscular testosterone therapy regimens. Men were included if they were 18 years or older and received one of the following testosterone therapy regimens: 100 mg intramuscular once weekly or 200 mg intramuscular once every other week. Primary outcomes were relative changes in total testosterone, free testosterone, estradiol, prostate-specific antigen, and hematocrit at 6 months after initiation of testosterone therapy. Secondary outcomes were any significant rises in estradiol, hematocrit, prostate-specific antigen, and any other treatment-related adverse events requiring cessation of testosterone therapy. A total of 263 men were enrolled. In a subanalysis of men who had a baseline hematocrit below 54% before intramuscular testosterone therapy initiation, we found the following: men who received 100 mg weekly injections were significantly less likely to have hematocrit levels rising above 54% (1/102 (1%) vs. 4/51 (8%); p = 0.023). No significant differences were recorded in the increase in total testosterone, free testosterone, prostate-specific antigen, and estradiol levels between both groups. A higher average serum testosterone over the dosing interval seen with the 200 mg regimen appears to be associated with a higher risk of erythrocytosis.

Immediate preoperative blood glucose and hemoglobin a1c levels are not predictive of postoperative infections in diabetic men undergoing penile prosthesis placement.

Defining the risks associated with diabetes mellitus in patients undergoing penile prosthesis implantation remains controversial. Our study aims to assess whether preoperative hemoglobin a1c and preoperative blood glucose levels are associated with an increased risk for postoperative infection in diabetic men. We performed a retrospective review of 932 diabetic patients undergoing primary penile prosthesis implantation from 18 high-volume penile prosthesis implantation surgeons throughout the United States, Germany, Belgium, and South Korea. Preoperative hemoglobin a1c and blood glucose levels within 6 h of surgery were collected and assessed in univariate and multivariate models for correlation with postoperative infection, revision, and explantation rates. The primary outcome is postoperative infection and the secondary outcomes are postoperative revision and explantation. In all, 875 patients were included in the final analysis. There were no associations between preoperative blood glucose levels or hemoglobin a1c levels and postoperative infection rates; p = 0.220 and p = 0.598, respectively. On multivariate analysis, a history of diabetes-related complications was a significant predictor of higher revision rates (p = 0.034), but was nonsignificant for infection or explantation rates. We conclude preoperative blood glucose levels and hemoglobin a1c levels are not associated with an increased risk for postoperative infection, revision, or explantation in diabetic men undergoing penile prosthesis implantation.

Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis.

BACKGROUND: Modern-day penile prostheses use infection retardant coating to decrease rates of postoperative infection, subsequently reducing explantation and revision rates as well. The Coloplast Titan models are dipped into antimicrobial solutions right before implantation, and the components used for dipping can be tailored toward the patient. AIM: To compare infection, explantation, and revision rates among different dipping solutions used before implantation for patients with diabetes receiving a Coloplast Titan implant. METHODS: We systematically reviewed 932 patients with diabetes receiving a primary penile implant across 18 different centers from the period April 2003 to August 2018. Of those patients, 473 received a Coloplast device, whereas 459 received an AMS device. Data regarding the type of antimicrobial solution used before implantation were recorded for 468 patients receiving a Coloplast Titan, including whether or not they suffered a postoperative infection and if they underwent explantation and/or revision. Outcome rates were compared using Fisher's exact and Pearson's chi-square tests, and logistic regression modeling was performed to account for covariates. OUTCOMES: The main outcome measures of this study were postoperative infection, explantation, and revision rates. RESULTS: Of the total 932 patients reviewed, 33 suffered a postoperative infection. Of 468 patients receiving Coloplast implants, there was a 3.4% infection rate. The most commonly used antibiotic combination before dipping was vancomycin + gentamicin (59.0%). There was a significantly lower rate of postoperative infection, explantation, and revision when vancomycin + gentamicin was used than those associated with the use of all other dipping solutions ([1.4% vs 6.4%; P = .004], [1.1% vs 8.3%; P < .001], and [2.5% vs 12.5; P < .001], respectively). After adjusting for age, body mass index, preoperative blood glucose level, and hemoglobin A1c, the use of other dips was an independent predictor of postoperative infection (odds ratio: 0.191; P = .049). The inclusion of rifampin in the dipping solution trended toward being a significant risk factor for infection (P = .057). Including antifungals in the dipping solution did not affect infection (P = .414), explantation (P = .421), or revision (P = .328) rates. CLINICAL IMPLICATIONS: Vancomycin + gentamicin was the most efficacious combination of antibiotics used for dipping in terms of preventing postoperative infection and subsequent explantation and revision. STRENGTHS AND LIMITATIONS: Data were sampled across multiple institutions providing a large sample that may be more representative of the population of interest. A key limitation of the study was its retrospective nature, which prevented us from controlling certain variables. CONCLUSION: The use of rifampin did not provide the same type of protection, possibly representing a shift in resistance patterns of common bacteria responsible for device infection. Towe M, Huynh LM, Osman MM, et al. Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis. J Sex Med 2020;17:2077-2083.

Organic Diet and Intermittent Fasting are Associated With Improved Erectile Function.

OBJECTIVE: To explore associations between dietary habits and erectile dysfunction (ED) in a cohort of patients presenting to a high-volume men's health clinic. MATERIALS AND METHODS: All patients presenting to a high-volume men's health clinic between July 2018 and May 2019 were evaluated for their dietary habits and screened with the International Index of Erectile Function-5 (IIEF-5) and Androgen Deficiency in Aging Males (ADAM). The primary outcome measure was the impact of dietary habits on ED, defined as IIEF-5 <22. Stepwise logistic regressions were used to control for patient characteristics and relevant comorbidities. RESULTS: Two hundred seventy-one patients were included. Primary reasons for visit were ED (110, 40.6%), hypogonadism (39, 14.4%), benign prostatic hyperplasia/lower urinary tract symptoms (80, 29.5%), and Peyronie's Disease (30, 11.1%). 176 (64.9%) followed no diet, while 11 (4.1%), 11 (4.1%), 8 (2.9%), and 11 (4.1%) were whole food only, low-carb/keto, vegetarian/pescatarian, and low-fat, respectively. Additionally, 105 (38.7%) reported organic foods consumption, while 51 (18.8%) had no processed food consumption, and 77 (28.4%) performed intermittent fasting. Patients reporting ED were more likely to be over the age of 65, had higher body mass index, more comorbidities, and less likely to report an organic diet or intermittent fasting. There were no correlations between diet and ADAM score. In adjusted analysis, patients reporting organic diet or intermittent fasting were significantly less likely to have ED. CONCLUSION: This is the first study suggesting organic diet and intermittent fasting to be protective against ED. These results are hypothesis-generating and warrant further exploration.

A Multicenter Investigation Examining American Urological Association Recommended Antibiotic Prophylaxis vs Nonstandard Prophylaxis in Preventing Device Infections in Penile Prosthesis Surgery in Diabetic Patients.

PURPOSE: American Urological Association (AUA) antibiotic prophylaxis recommendations may be insufficient for covering organisms commonly found in penile prosthesis infections. In this study we assess the difference between AUA recommended antibiotic prophylaxis and nonstandard prophylaxis in preventing device infections in penile prosthesis surgery performed in diabetic patients. MATERIALS AND METHODS: A multicenter, retrospective cohort study of diabetic patients undergoing primary penile prosthesis surgery was performed between April 2003 and August 2018. Eighteen institutions from the United States, Europe and Korea contributed. The association between antibiotic prophylaxis type and postoperative penile prosthesis infections, device explantations and revision surgeries was assessed. RESULTS: Standard AUA antibiotic prophylaxis was followed in 48.6% (391) of cases while nonstandard prophylaxis was used in 51.4% (413). Common nonstandard antibiotic prophylaxis included vancomycin-gentamycin-fluoroquinolone, clindamycin-fluoroquinolone, and vancomycin-fluoroquinolone among other combinations. Patients who received AUA prophylaxis had significantly more postoperative device infections (5.6% vs 1.9%, p <0.01) and explantations (8.3% vs 2.0%, p <0.001) compared to those who received nonstandard prophylaxis. Patients who received AUA prophylaxis had significantly higher odds of a postoperative device infection (OR 2.8, 95% CI 1.1-7.3) and explantation (OR 3.6, 95% CI 1.4-9.1) compared to those who received nonstandard prophylaxis. CONCLUSIONS: Diabetic men with erectile dysfunction who received standard AUA prophylaxis for penile prosthesis surgery had significantly greater odds of experiencing a postoperative device infection and device explantation compared to patients who received nonstandard prophylaxis. Our study provides a strong rationale for a prospective investigation to establish the most appropriate prophylaxis strategy in penile prosthesis surgery.

Treatment-related Outcomes for Patients With Atypical Peyronie's Disease Using Xiaflex Injections.

OBJECTIVE: To evaluate the efficacy and safety of collagenase Clostridium histolyticum (CCH) for the management of penile deformities in patients presenting with different categories of atypical Peyronie's disease (PD). METHODS: We conducted a retrospective review of charts of patients who presented to a men's health clinic with atypical PD between October 2016 and June 2019. We included patients in the stable phase of the disease, had completed a penile duplex Doppler ultrasound before any intervention, and proceeded with CCH treatment. Gathered data included patient demographics, treatment details, outcomes, and complications. Outcomes collected were both quantitative (curvature assessments) and qualitative using the symptom bother domain (last 6 questions; Q10 to Q15) of the Peyronie's Disease Questionnaire. RESULTS: Twenty-one men with stable PD underwent CCH inject therapy after penile duplex Doppler ultrasound. The mean number of injections was 8.4 (standard deviation [SD] = 3.3), and the mean follow-up was 20.5 months (SD = 5.9). The overall mean change in penile curvature was -19.2° ± 8.3°, which corresponded to a -39% ± 13% improvement in curvature (P = .0079). In men who presented with an indentation or hourglass deformity, 11 of 17 (64%) were satisfied and reported subjective improvement in narrowing/indentation after receiving CCH injections. The average composite symptom bother domain of the Peyronie's Disease Questionnaire decreased by 6.7 (P = .0029). CONCLUSION: Our results suggest that CCH appears to be safe and provide significant clinical improvements in men presenting with atypical PD.

Risk profiling in patients undergoing penile prosthesis implantation.

Penile prosthesis implantation is the gold standard of surgical therapy for patients with medication-refractory erectile dysfunction. However, this umbrella definition includes significant heterogeneity and associated risk profiles that should be candidly discussed and addressed perioperatively. Factors associated with operative success and patient satisfaction are often surgery specific; however, risk profiling via patient selection, preoperative optimization, proper device selection, and intraoperative consideration are highly correlated. Some examples of common risk profiles include comorbidity(ies) such as cardiovascular disease, diabetes mellitus, prior abdominal surgery, Peyronie's disease, and psychological risk factors. Similarly, integration of surgeon- and patient-amenable characteristics is key to decreasing risk of infection, complication, and need for revision. Finally, patient risk profiling provides a unique context for proper device selection and evidence-based intraoperative considerations.

Synthesis, characterization of silica gel phases-chemically immobilized-4-aminoantipyrene and applications in the solid phase extraction, preconcentration and potentiometric studies.

Two new 4-aminoantipyrene chemically-immobilized silica gel phases: ii (N,N-donor) and iii (N,O-donor), were synthesized and characterized by IR and surface coverage determination. The latter was accomplished by thermal desorption and metal probe methods, giving 0.300 and 0.312 mmol g(-1) for ii and 0.220 and 0.250 mmol g(-1) for iii. Moreover, potentiometric titration provided a surface coverage of 0.323 mmol g(-1) for ii. The metal capacity values in mmol g(-1) of ii, iii and the active silica gel phase i for a series of di- and trivalent metal ions were determined at pH 1.0 - 6.7. Phase i showed the lowest values, while ii and iii reflected higher affinity toward most of the metal ions. The highest values were 0.300 for Hg(II)-ii and 0.220 mmol g(-1) for Cd(II)-iii. Distribution coefficients (log Kd) were in the range of 3.57 - 4.76 for ii and 2.32 - 3.46 for iii, thus confirming certain selectivity characters of the solid extractors. The application of the phases as solid extractors and preconcentrators for some heavy metal ions is presented. Good percentage extraction and removal of 94 - 98 +/- 4 - 6% of the spiked 1.000 microg ml(-1) of Hg(II), Cd(II), Pb(II), Cu(II) and Zn(II) and good percentage recovery of 94 - 99 +/- 3 - 6% of 50 ng ml(-1) of these ions from tap water samples were obtained. Stability constants of H(I) and Cu(II) with ii for the two-phase mixture at 25 degrees C and I = 0.1 (KCI) were determined potentiometrically. The pKa of ii are 5.6 and 8.4, while the log K values for CuHL and CuL (L = ii) are 6.3 and 5.8, respectively, leading to the determination of several analytical data for Cu(II)-ii.