Potential primary prevention of Peyronie's disease post prostatectomy?-retrospective analysis of peri-operative multi-modal penile rehabilitation.

The surgical management of prostate cancer through radical prostatectomy has the potential to impact patients' sexual function, including erectile dysfunction and Peyronie's disease (PD). Historical data suggests the incidence of PD in post-prostatectomy patients is higher than in the general population at 15.9%. Our study objective was to measure the rate of the development of PD among patients that receive penile rehabilitation (PR) regimen prior to and immediately after radical prostatectomy. In this study, we retrospectively reviewed the charts of 581 patients who were diagnosed with prostate cancer, treated with radical prostatectomy, and engaged in a PR program. Patients with the diagnosis of PD prior to prostatectomy were excluded from this study. The PR program consists of daily tadalafil, L-citrulline, and weekly vacuum erectile device with the option of intracavernosal injections if patients fail to respond to the regular regimen. We found the incidence of PD to be 2.9%, suggesting that PR regimens programs may be associated with a reduced incidence of PD in post-prostatectomy patients. Ten (out of 17) patients were diagnosed with PD after 2 years of follow up. The return of erections was not statistically different among patients who developed PD and the rest of the patients. Prospective, multi-institutional trials will be required to elucidate whether PR can prevent the development of PD in this patient population.

Access to male sexual and reproductive health services in publicly funded California clinics in 2018.

OBJECTIVES: To characterize the sexual and reproductive health (SRH) services available to men from publicly funded family planning clinics in California. STUDY DESIGN: We conducted a cross-sectional telephone survey in 2018 to compare the accessibility of SRH services for male clients at Planned Parenthood clinics in California to those visiting a random sample of 200 other publicly funded family planning clinics, selected from a California Department of Health Care Services list of 773 that had served at least 15 male clients in the prior year. A representative at each clinic answered questions about provision of 20 clinical services. We examined differences in individual service provision by clinic affiliation using χ2 tests. RESULTS: Only one-third (773/2348) of publicly funded clinics in California served more than 15 male clients each year, with rural clinics less likely than urban counties to do so. We were able to contact 62 of 107 Planned parenthood clinics and 81 of the 200 other publicly-funded family planning clinics that we attempted to reach. Most (95%) offered HIV and STI screening; 65% offered vasectomy consultation, but only 5% provided vasectomy services. Planned Parenthood clinics were more likely than other publicly funded clinics to provide condom demonstrations, emergency contraception, STI testing, HPV vaccination, penile/testicular exams, and infertility testing (p < 0.05 for all comparisons). CONCLUSIONS: Male family planning services are less frequently offered by rural clinics and by publicly funded clinics in California that are not affiliated with Planned Parenthood. IMPLICATIONS: Men's underutilization of family planning may be partially explained by a lack of access to clinical services.