Pubic Hair Grooming and Sexually Transmitted Infections: A Clinic-Based Cross-Sectional Survey.

BACKGROUND: Pubic hair grooming has been correlated with a self-reported history of sexually transmitted infections (STIs). We examined this relationship further in a cross-sectional survey of patients attending an urban STI clinic in San Francisco in 2018. METHODS: Pubic hair grooming practices and detailed sexual histories were obtained. Sexually transmitted infections were confirmed via laboratory diagnosis or physical examination by a licensed provider. RESULTS: A total of 314 individuals completed the survey. The median age of participants was 31 years. In total, there were 247 (80%) men, 58 (19%) women, and 5 (2%) transgender participants. Of the 247 men, 177 (72%) identified as gay or bisexual. Twenty-five (82%) of 314 patients reported pubic hair grooming within the past 3 months. Seventy-eight (25%) patients were diagnosed with a new STI during their visit. There were no significant associations between reporting any anal or genital grooming and being diagnosed with an STI. However, anal groomers were 3 times as likely to be diagnosed with a rectal STI after adjustment (adjusted odds ratio, 3.0; 95% confidence interval, 1.2-7.5) compared with genital only groomers and nongroomers. Participants who report removing all of their pubic hair more than 6 times within the past year had higher prevalence of genital STIs (33.3%, 6-10 times; 28.6%, >10 times) compared with participants who never groom all of their pubic hair (15.3%, P = 0.01). CONCLUSIONS: We found no association between recent grooming and genital STIs. Anal grooming was associated with rectal STIs in gay and bisexual men.

Stability of a 17-Gene Genomic Prostate Score in Serial Testing of Men on Active Surveillance for Early Stage Prostate Cancer.

PURPOSE: Genomic testing may improve risk stratification in men with prostate cancer managed by active surveillance. We aimed to characterize the stability and usefulness of serial genomic test scores in men undergoing serial biopsies during active surveillance. MATERIALS AND METHODS: We compiled clinical and disease characteristics of men on active surveillance using an institutional Urologic Outcomes Database. We included patients initially diagnosed with Gleason 3 + 3 prostate cancer who elected active surveillance and received 2, 17-gene GPS (Genomic Prostate Score) results. We examined the association of GPS results and Gleason grade reclassification (Gleason 3 + 4 or greater) with definitive treatment using multivariable Cox proportional hazards regression models. RESULTS: We identified 111 men who underwent serial genomic testing. There were 49 grade reclassification events (44%) at a median followup of 64 months. The mean ± SD GPS change between the first and second biopsies was 2.1 ± 10.3. The GPS at first biopsy (per 5 units HR 1.04, 95% CI 1.00-1.07, p=0.03) was associated with an upgrade at second biopsy, although the second GPS was not (HR 1.02, 95% CI 0.99-1.05, p=0.13). The first and second GPSs (HR 1.09, 95% CI 1.04-1.14 and HR 1.09, 95% CI 1.04-1.14, each p <0.01) were associated with active treatment. CONCLUSIONS: The GPS undergoes small changes with time. Absolute GPS results at the first and second biopsies were associated with Gleason upgrading and transition from active surveillance to active treatment.

Trends in Complementary and Alternative Medicine Use among Patients with Prostate Cancer.

PURPOSE: We explored the prevalence and trends of self-reported complementary and alternative medicine use among patients with prostate cancer using CaPSURE™ (Cancer of the Prostate Strategic Urologic Research Endeavor). MATERIALS AND METHODS: A total of 7,989 CaPSURE participants completed questionnaires between 1996 and 2016 on the use of nearly 70 complementary and alternative medicine types. Participants were defined as users if they indicated that they had ever used complementary and alternative medicines. To evaluate trends among 7,696 patients with newly diagnosed prostate cancer we considered complementary and alternative medicine use within 24 months of diagnosis and calculated the percent change in complementary and alternative medicine use between groups defined by the year of diagnosis. RESULTS: Of patients with prostate cancer 56% reported complementary and alternative medicine use on at least 1 questionnaire. Multivitamin and omega-3 fatty acid use was common at 40% and 24% of patients, respectively. Compared to nonusers greater proportions of complementary and alternative medicine users were college educated, had a higher household income and lived in the West and Midwest. Median prostate specific antigen at diagnosis was 5.8 (IQR 4.4-8.4) and 6.2 ng/ml (IQR 4.7-10.1) among users and nonusers, respectively (p <0.01). Between those diagnosed in 1996 to 2000 and 2011 to 2016, complementary and alternative medicine use increased 128% from 24% to 54%. When comparing participants diagnosed in 2006 to 2010 with those diagnosed in 2011 to 2016, a 108% increase was seen in supplemental vitamin D use and a -48% decrease was seen in supplemental vitamin E use. CONCLUSIONS: Many patients with prostate cancer reported complementary and alternative medicine use. Multivitamins and omega-3 fatty acids were commonly ingested and vitamin D use increased dramatically from 2006 to 2010 compared to 2011 to 2016. These data can guide clinical discussions and decision making such as nutritionist referral and help prioritize future research.

The association of bicycle-related genital numbness and Sexual Health Inventory for Men (SHIM) score: results from a large, multinational, cross-sectional study.

OBJECTIVE: To assess the association of genital numbness and erectile dysfunction in male cyclists. SUBJECTS AND METHODS: Cyclists were recruited through Facebook advertisements and outreach to sporting clubs. This is a secondary analysis of a larger epidemiological population-based study that examined sexual and urinary wellness in athletes. We queried cycling habits and erectile function using Sexual Health Inventory for Men (SHIM). RESULTS: A total of 2 774 male cyclists were included in the analysis. Amongst cyclists, there was a statistically significant increase in the trend of genital numbness presence with more years of cycling (P = 0.002), more frequent weekly cycling (P < 0.001), and longer cycling distance at each ride (P < 0.001). Less frequent use of padded shorts (odds ratio [OR] 0.14, P < 0.001) and lower handlebar (OR 0.49, P < 0.001) were associated with numbness, but body mass index (BMI) (OR 1.1, P = 0.33) and age (OR 1.2, P = 0.15) were not. In a multivariate logistic regression model, after adjusting for age, BMI, and lifetime miles (calculated by average daily cycling mileage × cycling days/week × cycling years.), there were no statistically significant differences in mean SHIM score between cyclists with and cyclists without numbness (20.3 vs 20.2, P = 0.83). However, interestingly, the subset of cyclists who reported numbness in the buttock reported statistically significantly worse SHIM scores (20.3 vs 18.4, P < 0.001). This association was not present in cyclists who reported numbness in the scrotum, penis, or perineum and remained significant after adjusting for overall biking intensity. CONCLUSION: Cyclists report genital numbness in proportion with biking intensity but numbness is not associated with worse sexual function in this cohort.

Sex differences and subclinical retinal injury in pediatric-onset MS.

OBJECTIVE: To assess retinal ganglion cell (RGC) injury and sex differences in axon loss in pediatric multiple sclerosis (MS). METHODS: This is a cross-sectional evaluation of consecutive pediatric MS subjects and controls. Eyes with acute optic neuritis (ON) within 6 months of visit were excluded. Spectral domain optical coherence tomography (OCT) included peripapillary ring and macular scans with post-acquisition segmentation of retinal layers using automated software (Heidelberg v1.8.6.0). Generalized estimating equations (GEEs) measured associations of sex, history of ON, disease duration, and age with OCT outcomes. RESULTS: In all, 53 MS subjects (100 eyes, median disease duration = 1.0 years, interquartile range (IQR) = 0.3, 2.5) were compared to 19 control subjects (38 eyes). Eyes with history of ON showed reduced retinal nerve fiber layer (RNFL: -26.8 µm, 95% confidence interval (CI) = -38.9, -14.8, p < 0.001) and 26% lower ganglion cell layer (GCL) volumes (-0.12 mm3, 95% CI = -0.16, -0.072, p < 0.001) compared to control eyes. Non-ON MS eyes had lower temporal RNFL (-11.9 µm, 95% CI = -18.6, -5.3, p < 0.001) and GCL volumes (-0.036 mm3, 95% CI = -0.06, -0.011, p = 0.004) than control eyes. In MS eyes, males versus females had lower global RNFL (-9.4 µm, 95% CI = -17.4, -1.33, p = 0.022) and in ON eyes had lower temporal quadrant RNFL (-9.6 µm, 95% CI = -15.1, -4.15, p = 0.001). CONCLUSION: Subclinical retinal injury occurs in pediatric-onset MS patients without a history of ON. As in adult-onset MS, substantial GCL thinning is present in eyes with prior ON. Finally, greater retinal axonal injury occurs in boys compared to girls.

Delayed gangrenous penile necrosis following prolonged utilization of penile constriction ring.

Penile strangulation secondary to utilization of a constrictive ring is a rare urologic emergency that requires urgent decompression to prevent prolonged vascular obstruction resulting in necrosis and gangrene. Current literature is mainly comprised of case presentations that focus on management in the acute setting via removal of the ring. Herein, we describe surgical management of a patient who presents in delayed fashion after self-removal of the constrictive ring. We discuss our penectomy-sparing technique of debridement and split thickness skin graft.

Thematic analysis of the psycho-sexual symptoms in patients with Peyronie's disease present on online forums.

Peyronie's disease (PD) is a fibrotic disorder of the tunica albuginea that may result in penile deformity, pain, a palpable plaque, and erectile dysfunction. In order to understand the psycho-sexual impacts of PD on patients and their partners, we selected three online forums containing the largest number of threads on PD. Threads focusing on the psycho-sexual impacts posted from January 1, 2011 to January 1, 2021 were compiled, and thematic analysis was performed on Dedoose. There were 277 unique posters, including 225 patients and 52 partners. Eighty-four categories and five themes were developed including information and social support, physical symptoms, psycho-sexual symptoms, treatment and effect, and impacts on partners and relationship. Emotional distress including depressed mood (n = 75, 33.3%) and feelings of isolation (n = 41, 18.2%) was prevalent. Partners developed sexual dysfunction including sexual dissatisfaction (n = 11, 21.2%) and dyspareunia (n = 4, 7.7%). Relationships experienced disruption (n = 14, 5.1%) or termination (n = 10, 3.6%). Posters received psychological treatment including psychotherapy (n = 20, 8.9%) and antidepressants (n = 17, 7.6%). Of these, 12 reported improvement and 11 stated no improvement. On these forums, psychological burden affecting individuals with PD and their partners is reported. Few seek help from a psychologist or therapist, and psychological distress may persist even after successful PD treatment. Further research is needed to identify strategies for effective psychological management.

Placement of Resonance Stent for Malignant or Benign Ureteral Obstruction.

The aim of this article is to illustrate a step-by-step guide to placement of Resonance® metallic ureteral stent (Cook Medical, Bloomington, IN) for management of malignant or benign ureteral obstruction. In this article, the steps of operating room setup, patient positioning, gaining access to the upper urinary tract, and endoscopic and fluoroscopic placement of a Resonance ureteral stent are described.

Risk Factors for Sexual Pain Among Physically Active Women.

INTRODUCTION: Sexual pain is common among women but little is known about associations with exercise and physical activity. AIM: To determine the prevalence of sexual pain among physically active women and to evaluate cycling and other potential risk factors. METHODS: This is a secondary data analysis of a study on the urinary and sexual wellness of physically active women recruited through sporting clubs and targeted social media advertising. We used multivariable logistic regression to assess the role of cycling and exercise in reporting any, frequent, or severe sexual pain, controlling for demographic, relationship, and health risk factors. MAIN OUTCOME MEASURE: Sexual pain, including frequency and severity, was measured using the Female Sexual Function Index. RESULTS: A total of 2,039 women were included, with 1,097 (54%) reporting any level of sexual pain, 364 (18%) experiencing frequent pain, and 378 (19%) reporting severe pain. Less than 5% of women reported diabetes or hypertension, and the cohort had a median body mass index of 23.3 (interquartile range 21.4-25.7). Increasing age and body mass index were protective against any sexual pain, as was cycling (odds ratio [OR] 0.73 [95% CI 0.59-0.90]). Participants who reported being "moderately satisfied" (OR 0.53 [95% CI 0.31-0.91]) or "very satisfied" (OR 0.33 [95% CI 0.19-0.56]) with their emotional closeness to a sexual partner had decreased odds of any sexual pain. CONCLUSION: Experiencing any sexual pain is common in physically active women, with a prevalence of over 50%; however, weekly energy expenditure from exercise was not associated with sexual pain. Cycling participation and higher levels of emotional closeness and intimacy were associated with less pain. Patients between the ages of 18 and 30 years who were normal or underweight incurred the highest risk of sexual pain. Fergus KB, Cohen AJ, Cedars BE, et al. Risk Factors for Sexual Pain Among Physically Active Women. Sex Med 2020;8:501-509.

An electronic registry to improve adherence to active surveillance monitoring among men with prostate cancer at a safety-net hospital: protocol for a pilot study.

BACKGROUND: The evidence-based practice of active surveillance to monitor men with favorable-risk prostate cancer in lieu of initial definitive treatment is becoming more common. However, there are barriers to effective implementation, particularly in low-resource settings. Our goal is to assess the efficacy and feasibility of a health information technology registry for men on active surveillance at a safety-net hospital to ensure patients receive guideline-recommended care. METHODS: We developed an electronic registry for urology clinic staff to monitor men on active surveillance. The health information technology tool was developed using the Systems Engineering Initiative for Patient Safety model and iteratively tailored to the needs of the clinic by engaging providers in a co-design process. We will enroll all men at Zuckerberg San Francisco General Hospital and Trauma Center who choose active surveillance as a treatment strategy. The primary outcomes to be assessed during this non-randomized, pragmatic evaluation are number of days delayed beyond recommended date of follow-up testing, the proportion of men who are lost to follow-up, the cancer stage at active treatment, and the feasibility and acceptability of the clinic-wide intervention with clinic staff. Secondary outcomes include appointment adherence within 30 days of the scheduled date. DISCUSSION: Use of a customized electronic approach for monitoring men on active surveillance could improve patient outcomes. It may help reduce the number of men lost to follow-up and improve adherence to timely follow-up testing. Evaluating the adoption and efficacy of a customized registry in a safety-net setting may also demonstrate feasibility for implementation in diverse clinical contexts. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03553732, An Electronic Registry to Improve Adherence to Active Surveillance Monitoring at a Safety-net Hospital. Registered 11 June 2018.

Attributes of Society of Genitourinary Reconstructive Surgeons Fellows and Early Career Trajectory of the Recent Graduates.

INTRODUCTION: We identified the attributes that the Society of Genitourinary Reconstructive Surgeons (GURS) fellowship directors prioritize in applicants. The secondary objective was to study the early career trajectory of recent GURS fellowship graduates. METHODS: GURS fellowship directors and fellows from 2014 to 2018 were surveyed electronically using Qualtrics® software. We asked fellowship directors to rate 12 items for their importance in match selection on a Likert scale. Fellows were prompted for details of practice size, case mix and research time. We assessed research productivity based on published articles on PubMed® and Google Scholar™. Findings were summarized with descriptive statistics and continuous variables were reported as median with interquartile range. RESULTS: Fellowship directors (90% response rate) rated subjective personal qualities as more important compared to more objective measures and achievements. Personality (5, 5-5), overall interview performance (5, 4-5) and letters of recommendation (5, 4-5) were most important. About 4 papers were published during fellowship per fellow. However, research productivity did not persist during early career. Upon graduation the majority of graduates were the only reconstructionist at their practice, with approximately 40% of their operative time dedicated to such cases. While we identified a variety of practice settings, an academic career focusing on urethroplasty and male incontinence was the most common. CONCLUSIONS: Our data provide potential applicants with a better understanding of how to optimize their candidacy and what to expect in their early careers.

Qualitative Analysis of the Content Found in Online Discussion Boards for Urethral Stricture Disease and Urethroplasty.

OBJECTIVE: To describe the patient experience and chief concerns with urethroplasty to improve physician understanding and patient education. Online discussion boards allow patients with urethral stricture disease (USD) to connect with other USD patients. It is unknown how men use these web resources and what information is available about urethroplasty. METHODS: Three online forums featuring urethroplasty were identified by Google search. Thematic analysis categorized the content of posts using manually applied codes, with inter-rater reliability and descriptive statistics generated by Dedoose (Los Angeles, CA). RESULTS: A total of 140 unique posters contributed 553 posts to the forums. Posts were categorized as information support (n = 651), issues posturethroplasty (n = 470), own experience preurethroplasty (n = 336), feelings towards other posters (n = 312), what to expect posturethroplasty (n = 265), feelings after urethroplasty (n = 228), and considerations before urethroplasty (n = 134). Experience navigating the healthcare system with USD (n = 141) and weak urine stream (n = 70) were the most frequent preurethroplasty complaints. Postoperative pain (n = 164) was the most frequent issue. Patients expressed more positivity (n = 126) and satisfaction (n = 120) than negativity (n = 33) with urethroplasty. CONCLUSION: Patients participated in online discussions to share experiences with USD and urethroplasty, receive emotional support, and find answers. Men were more often satisfied than not with their urethroplasty outcomes, with 88% of postoperative feelings coded as positive or satisfied compared to negative. This study provides physicians with insight into the experiences of patients and how to best educate them.

Feasibility, Acceptability, and Behavioral Outcomes from a Technology-enhanced Behavioral Change Intervention (Prostate 8): A Pilot Randomized Controlled Trial in Men with Prostate Cancer.

BACKGROUND: Increasing evidence suggests that lifestyle factors may decrease the risk of prostate cancer progression. Lifestyle guidelines and tools may support lifestyle modification after diagnosis. OBJECTIVE: To determine the feasibility and acceptability of a digital lifestyle intervention among men with prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: A 12-wk pilot randomized controlled trial among 76 men with clinical stage T1-T3a prostate cancer. Eligibility included Internet access, no contraindications to aerobic exercise, and engaging in four or fewer of eight targeted behaviors at baseline. INTERVENTION: Website, Fitbit One, and text messaging to facilitate adoption of eight behaviors: vigorous activity, smoking cessation, and six diet improvements. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Our primary outcomes were feasibility and acceptability based on recruitment and user data, and surveys, respectively. Secondarily, we evaluated the change in eight lifestyle behaviors, and also objective physical activity. Each factor was assigned one point, for an overall "P8 score" (range 0-8). Analysis of covariance (ANCOVA) was conducted. Exploratory outcomes included quality of life, anthropometrics, and circulating biomarkers after 12wk, and behaviors after 1yr. RESULTS AND LIMITATIONS: At baseline, men in both arms met a median of three targeted behaviors. Sixty-four men (n=32 per arm) completed the study; 88% completed 12-wk assessments (intervention, 94%; control, 82%). Intervention participants wore their Fitbits a median of 82d (interquartile range [IQR]: 72-83), replied to a median of 71% of text messages (IQR: 57-89%), and visited the website a median of 3d (IQR: 2-5) over 12wk. Median (IQR) absolute changes in the P8 score from baseline to 12wk were 2 (1, 3) for the intervention and 0 (-1, 1) for the control arm. The estimated mean score of the intervention arm was 1.5 (95% confidence interval: 0.7, 2.3) higher than that of the control arm at 12wk (ANCOVA p<0.001). Changes were driven by diet rather than exercise. Limitations include self-reported diet and exercise data. CONCLUSIONS: Overall, in this novel pilot trial, the intervention was feasible and acceptable to men with prostate cancer. Next steps include improving the intervention to better meet individuals' needs and focusing on increasing physical activity in men not meeting nationally recommended physical activity levels. PATIENT SUMMARY: Tailored print materials combined with technology integration, including the use of a website, text messaging, and physical activity trackers, helped men with prostate cancer adopt healthy lifestyle habits, in particular recommended dietary changes, in the Prostate 8 pilot trial.