Eligible Men Research Articles

Relations of Knowledge with Perceptions of Eligible Men About Vasectomy in Angsau Primary Health Care, Tanah Laut, South Kalimantan

Background: Indonesia’s Maternal Mortality Rate (MMR) in 2015 was still high around 305 over 100.000 population. South Kalimantan MMR’s in 2018 increase to 108 over 100.000 population. If not handled properly the increasing of MMR, it will not achieve the SDG's by 2030. The high MMR is caused by the large number of pregnancies and deliveries in Indonesia. One of the ways to prevent it, is by reducing the number of pregnancies and one of the most effective way is through the Family Planning (FP) program. Vasectomy is a method of operative contraception in men. Public perception of vasectomy is a complicated operation, so vasectomy is not an option. Aim: Knowing the relations between knowledge and perceptions of eligible men on vasectomy Method: This research is an analytical survey with a cross sectional approach. The number of subjects used as many as 80 respondents who meet the feasibility of being included in this study. The chi-square test with a significance level of p<0.05 was used for statistical analysis. Knowledge is considered good if it has a total score of more than 76 percent, and it is considered poor if it is less than equal to 76 percent. Positive perception if the respondent's mean score is less than the T score, and to be negative perception if the respondent's mean score is more than the T score. Results: A total of 108 respondents were included in this study. There are 89 respondents or 82% who have good knowledge and 19 respondents or 18% who have bad knowledge about vasectomy. Negative perceptions were owned by 81 respondents or 75% while positive perceptions were only found in 27 respondents or 25%. Chi-square analysis showed that there was a significant relation between poor knowledge and negative perceptions with p<0.05. Conclusion: Poor knowledge of vasectomy is associated with negative perceptions. This study shows lack of public knowledge about vasectomy, causing a negative stigma about vasectomy.

Outcomes of Screening for Prostate Cancer Among Men Who Use Statins

Prostate-specific antigen (PSA) screening for prostate cancer has resulted in a slight reduction in prostate cancer mortality but also a concomitant overdiagnosis of low-risk tumors. Prostate-specific antigen levels are affected by use of cholesterol-lowering statin drugs, but the association of statin use with PSA screening performance is unknown. To investigate whether statin use was associated with outcomes of a randomized PSA-based prostate cancer screening intervention. This post hoc subgroup analysis of a cohort from a population-based randomized clinical trial used data from the population-based Finnish Randomized Study of Prostate Cancer Screening, which randomized men to PSA screening or routine care from March 1, 1996, to December 31, 1999, with follow-up continuing until December 31, 2015. The population included all men aged 55 to 67 years at baseline and residing in the Tampere or Helsinki districts of Finland. Information on statin purchases from 1996 to 2009 was obtained from a national prescription registry. Eligible men were identified from the population registry of Finland. Prevalent prostate cancer cases at baseline were excluded. Data were analyzed from January 1, 2019 to March 31, 2021. Three invitations for PSA screening at 4-year intervals from 1996 to 2007 vs routine care. Risk for prostate cancer overall, high-risk disease, and prostate cancer mortality in the screening group vs the control group as an intention-to-treat analysis. The analysis was stratified by statin use. The study comprised 78 606 men (median age, 59 years [range, 55-67 years]) with statin purchase data available. Although PSA screening was associated with increased prostate cancer incidence among statin nonusers (screening vs control, 11.2 vs 8.6 per 1000 person-years); rate ratio [RR], 1.31; 95% CI, 1.24-1.38), no similar increase in incidence was observed among statin users (6.9 vs 5.9 per 1000 person-years; RR, 1.02; 95% CI, 0.95-1.10; P < .001 for interaction). Incidence of low-risk (Gleason score 6) and localized tumors was lower among statin users, whereas detection of tumors with a Gleason score of 8 to 10 was similar. Screening was associated with a lower incidence of metastatic tumors regardless of statin use. In this post hoc subgroup analysis of a cohort from a population-based randomized clinical trial, PSA screening among statin users was associated with a decreased incidence of advanced prostate cancer that was similar among statin nonusers, but with less increase in detection of low-grade localized tumors in statin users than in nonusers. These findings suggest that statin use does not materially compromise benefits of PSA-based screening.

Sexual Function in Men Living With a Fontan Circulation.

Introduction: It is unknown if the Fontan circulation has an impact on sexual health in men. This study assessed self-reported sexual health and fertility in men with a Fontan circulation.Aims: In this prospective, cross-sectional study, Australian men ≥18 years enrolled in the Fontan Registry of Australia and New Zealand were invited to complete the International Index of Erectile Function (IIEF), alongside questions assessing fertility. These data were compared to historical, age-matched controls.Results: Of 227 eligible men, 54 completed the survey; of those 37 were sexually active and included in the final analysis. Mean age was 28 ± 3 years, age at Fontan was 5 ± 3 years. Fontan type was extra-cardiac conduit in 15 (41%), lateral tunnel in 12 (32%), and atriopulmonary connection (APC) in 10 (27%). Ventricular function was normal in 24 (83%), and all were New York Heart Association Class I (23 patients, 79%) and II (six patients, 21%). Nine participants (24%) had erectile dysfunction (IIEF-EF score ≤25). The severity was mild (IIEF 22–24) in six (16%), mild–moderate (IIEF 17–21) in two (5%), and moderate (IIEF 11–16) in one (3%). Baseline characteristics and current medication usage were similar in those with and without erectile dysfunction. Compared with historical control values, erectile function was not significantly impaired in the Fontan population (p =0.76). Men with a Fontan circulation had decreased levels of sexual desire and overall satisfaction (p < 0.001). There was no correlation between the presence of erectile dysfunction and any assessed parameter. Eleven (30%) of the cohort reported a pregnancy with a prior partner.Conclusion: In our cohort, overall erectile function was comparable between men with a Fontan circulation and historical controls, however sexual desire and overall satisfaction were reduced. There was no correlation between study parameters and the presence of erectile dysfunction. The proportion of the cohort who had a prior pregnancy was congruent with population data.

Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 4: Transperineal Magnetic Resonance–Ultrasound Fusion Guided Biopsy Using Local Anesthesia

BackgroundTransperineal magnetic resonance imaging–transrectal ultrasound fusion guided biopsy (MFGB) is an increasingly popular technique due to increasing rates of biopsy-related infections. However, its widespread implementation has been hampered by the supposed necessity of epidural or general anesthesia. ObjectiveTo demonstrate the technique, feasibility, and results of transperineal MFGB under local anesthesia, in an ambulatory setting without the administration of prophylactic antibiotics. Design, setting, and participantsThis single-center study enrolled consecutive biopsy-naïve men with a clinical suspicion of prostate cancer into a prospective database between November 2015 and November 2020. Men with Prostate Imaging Reporting and Data System (PI-RADS) version 2 scores 3–5 underwent transperineal MFGB. Surgical procedureTransperineal MFGB was performed in an ambulatory setting under local anesthesia by a single operator. MeasurementsProcedure-associated adverse events were recorded. Patient discomfort during both the local anesthesia and the biopsy procedure was determined using a visual analogic scale (0–10). Detection rates of grade group (GG) ≥2 prostate cancer and the proportion of men with GG 1 cancer were assessed. Results and limitationsA total of 1097 eligible men underwent transperineal MFGB. The complication rate was 0.73% (8/1097); complications comprised five (0.46%) urinary tract infections including one hospitalization and three (0.27%) urinary retentions. In 735 men, the median pain scores were 2 (interquartile range [IQR] 2–3) for the local anesthesia procedure and 1 (IQR 0-2) for the biopsy. Prostate cancer was detected in 84% (926/1097) of men; 66% (723/1097) had GG ≥2 and 19% (203/1097) GG 1. ConclusionsTransperineal MFGB can safely be performed as an outpatient procedure under local anesthesia in an ambulatory setting. The detection rate of clinically significant prostate cancer is high, and biopsy is well tolerated. Although no antibiotic prophylaxis was used, the rate of infectious complications is practicably negligible. Patient summaryThis article shows how tissue samples (biopsies) can accurately be obtained from suspicious regions seen on prostate magnetic resonance imaging via needles inserted in the perineum (skin between the scrotum and the anus) in men with suspected prostate cancer. This technique appears to be very well tolerated under local anesthesia and has a lower risk of infection without antibiotic prophylaxis than the more common biopsy route through the rectum, with antibiotics.

Human Papillomavirus Vaccine Course Completion Among Gay and Bisexual Men Who Have Sex With Men From a Time-Limited HPV Vaccination Catch-Up Program in Victoria, Australia

Background: To examine completion of the human papillomavirus (HPV) vaccination 3-dose regimen and factors associated with completion among men who have sex with men (MSM) aged ≤ 26 years participating in a time-limited HPV catch-up vaccination program in Victoria, Australia.Methods: MSM who received their first dose of HPV vaccine at Melbourne Sexual Health Centre in 2017 were followed until October 2019. Vaccination completion was defined as those who received three doses. Multivariable logistic regression was performed to examine factors associated with vaccine completion.Results: 931 of 1,947 (47.8%) eligible men received at least one dose of HPV vaccine, 750 (38.5%) received two and 590 (30.3%) received three doses. The median time to receiving the second and third dose was 2.8 (IQR = 2.1–4.8) and 7.2 (IQR = 6.3–10.7) months, respectively. Gay men had higher odds of receiving three doses compared to bisexual men (aOR = 2.17; 95%CI: 1.16–4.04). Compared with HIV-negative MSM not taking PrEP, HIV-positive MSM were more like to complete vaccination (aOR = 3.92, 95%CI: 1.62–9.47) but no difference was found compared to HIV-negative men taking PrEP (aOR = 1.55; 95%CI: 0.95–2.53).Conclusion: Less than one-third of men aged ≤ 26 years completed the three doses of HPV vaccine. Further studies are needed to understand the barriers of men not completing the vaccine.

Comparison of Communication Channels for Large-Scale Type 2 Diabetes Risk Screening and Intervention Recruitment: Empirical Study.

BackgroundClinical trials have shown that type 2 diabetes (T2D) is preventable through lifestyle interventions targeting high-risk people. Nevertheless, large-scale implementation of risk identification followed by preventive interventions has proven to be challenging. Specifically, recruitment of participants into preventive interventions is an important but often overlooked part of the intervention.ObjectiveThis study aims to compare the reach and yield of different communication channels to engage people at increased risk of T2D to fill in a digital screening questionnaire, with emphasis on reaching those at most risk. The participants expressing their willingness to participate is the final step in the risk screening test, and we aim to determine which channels had the most participants reach this step.MethodsWe established a stepwise web-based T2D risk screening tool with automated feedback according to the T2D risk level and, for those who were eligible, an invitation to participate in the StopDia prevention intervention study conducted in a primary health care setting. The risk estimate was based on the Finnish Diabetes Risk Score; history of repeatedly measured high blood glucose concentration; or, among women, previous gestational diabetes. We used several channels to invite people to the StopDia web-based screening tool, and respondents were classified into 11 categories based on the channel through which they reported having learned about StopDia. The demographics of respondents reached via different communication channels were compared using variance analysis. Logistic regression was used to study the respondents’ likelihood of progressing through risk screening steps.ResultsA total of 33,399 persons started filling the StopDia screening tool. Of these, 86.13% (28,768/33,399) completed the test and named at least one communication channel as the source of information about StopDia. Altogether, 26,167 persons filled in sufficient information to obtain risk estimates. Of them, 53.22% (13,925/26,167) were at increased risk, 30.06% (7866/26,167) were men, and 39.77% (10,136/25,485) had low or middle education levels. Most frequently mentioned channels were workplace (n=6817), social media or the internet (n=6712), and newspapers (n=4784). The proportion of individuals at increased risk was highest among those reached via community pharmacies (415/608, 68.3%) and health care (1631/2535, 64.33%). The communication channel reaching the largest percentage of interested and eligible men (1353/3979, 34%) was relatives or friends. Health care (578/1069, 54.07%) and radio or television (225/487, 46.2%) accounted for the largest proportion of people with lower education.ConclusionsCommunication channels reaching a large number of people, such as social media and newspapers, were the most effective channels for identifying at-risk people. Personalized approaches increased the engagement of men and less-educated people. Community pharmacies and health care services reached people with a particularly high T2D risk. Thus, communication and recruitment channels should be selected and modified based on the intended target group.International Registered Report Identifier (IRRID)RR2-10.1186/s12889-019-6574-y

MP15-15 WHO ARE THE PATIENTS WHO BENEFIT THE MOST FROM EXTENDED PELVIC LYMPH NODE DISSECTION IN LOCALIZED PROSTATE CANCER? IDENTIFICATION OF THE OPTIMAL CANDIDATES TO BE INCLUDED IN A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-15 WHO ARE THE PATIENTS WHO BENEFIT THE MOST FROM EXTENDED PELVIC LYMPH NODE DISSECTION IN LOCALIZED PROSTATE CANCER? IDENTIFICATION OF THE OPTIMAL CANDIDATES TO BE INCLUDED IN A RANDOMIZED CONTROLLED TRIAL Giorgio Gandaglia, Giuseppe Rosiello, Simone Scuderi, Nicola Fossati, Armando Stabile, Andrea Necchi, Vito Cucchiara, Riccardo Leni, Donato Cannoletta, Andrea Gallina, Emanuele Zaffuto, Marco Moschini, Andrea Salonia, Federico Dehò, Francesco Montorsi, and Alberto Briganti Giorgio GandagliaGiorgio Gandaglia More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Armando StabileArmando Stabile More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Riccardo LeniRiccardo Leni More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Federico DehòFederico Dehò More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A Phase III RCT (NCT01812902) failed to show a benefit of limited vs extended pelvic lymph node dissection (ePLND) in intermediate and high-risk prostate cancer (PCa) patients undergoing RP. We aimed at assessing the generalizability of this trial and the outcomes of ePLND according to different selection criteria to identify the candidate for inclusion in a RCT METHODS: 3,421 PCa patients treated with RP and PLND were included. We identified men who fulfilled the NCT01812902 criteria for inclusion. Kaplan-Meier analyses assessed time to biochemical recurrence (BCR). An interaction test assessed whether the impact of the number of nodes removed on BCR-free survival varied according to the risk of lymph node invasion (LNI) according to different risk strata calculated with the Briganti nomogram RESULTS: The criteria proposed by the NCT01812902 trial would have resulted in 1,076 (72.7%) and 405 (27.3%) eligible intermediate- and high-risk patients. The number of nodes removed was 18 (vs. 17 in the ePLND group of the trial) and the rate of LNI was 15.6% (vs. 17%). If the 5% Briganti nomogram cut-off to select PLND candidates had been used, only 758 (51.2%) patients would have been included in the trial with a rate of LNI of 27.3% and a 55% 5-year BCR-free survival (n=171), lower than 67.5% (n=228) corresponding to intermediate and high risk patients. The impact of the PLND extent (i.e., number of nodes removed) on BCR varied according to the risk of LNI according to the Briganti nomogram (p=0.04 by interaction test). A more extensive PLND was associated with a decreased BCR if the risk of LNI was between 10-20% but not in men with a lower or higher risk (Figure). The use of this range of the estimated risk of LNI for patient selection would have resulted in only 258 (34%) eligible men CONCLUSIONS: The use of a 5% Briganti nomogram cut-off as eligibility criteria for a RCT would have resulted into the inclusion of only 50% of intermediate and high-risk patients. The NCT01812902 trial cannot be generalized to patients selected for PLND according to guidelines. A more extended PLND was beneficial in men with a 10-20% LNI risk, who should theoretically be considered for the inclusion in RCTs Source of Funding: © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e269-e269 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giorgio Gandaglia More articles by this author Giuseppe Rosiello More articles by this author Simone Scuderi More articles by this author Nicola Fossati More articles by this author Armando Stabile More articles by this author Andrea Necchi More articles by this author Vito Cucchiara More articles by this author Riccardo Leni More articles by this author Donato Cannoletta More articles by this author Andrea Gallina More articles by this author Emanuele Zaffuto More articles by this author Marco Moschini More articles by this author Andrea Salonia More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Loading ...

PD11-05 PRELIMINARY RESULTS OF BASELINE CORTICAL NEURAL ACTIVITY IN MEN WITH BENIGN PROSTATIC HYPERPLASIA AND BLADDER OUTLET OBSTRUCTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research & Pathophysiology (PD11)1 Sep 2021PD11-05 PRELIMINARY RESULTS OF BASELINE CORTICAL NEURAL ACTIVITY IN MEN WITH BENIGN PROSTATIC HYPERPLASIA AND BLADDER OUTLET OBSTRUCTION Ricardo Gonzalez, Logan Hubbard, Khue Tran, Natalia Hernandez, Christof Karmonik, Shi Zhaoyue, and Rose Khavari Ricardo GonzalezRicardo Gonzalez More articles by this author , Logan HubbardLogan Hubbard More articles by this author , Khue TranKhue Tran More articles by this author , Natalia HernandezNatalia Hernandez More articles by this author , Christof KarmonikChristof Karmonik More articles by this author , Shi ZhaoyueShi Zhaoyue More articles by this author , and Rose KhavariRose Khavari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001986.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) affects the entire micturition cycle including filling/storage phases, creating bothersome lower urinary tract symptoms (LUTS). Chronic bladder outlet obstruction (BOO) remodels the entire lower urinary tract including the detrusor, connective tissue and local neural network; yet the extent to which it alters the central nervous system (CNS) in BPH is unknown. This study explores brain activation patterns on fMRI in men with BPH and BOO. METHODS: Men age ≥45 who failed conservative BPH therapy planning to undergo BOO procedures were recruited. Eligible men underwent concurrent fMRI-urodynamics (UDS) examination, their bladder was filled until a strong desire to void was signaled. Subjects were asked to hold for 30 seconds, before receiving permission to void while concurrent UDS was performed. After voiding/attempt to void, the bladder was drained and the cycle was repeated up to four times. fMRI images were obtained via a T1W 3 Tesla MRI. Significant activated voxels (p <0.05) were identified at strong urge to void and voiding initiation/attempt to void. RESULTS: Seven men with baseline demographics are represented in table 1. At strong urge to void, there was activation in the right inferior frontal gyrus (IFG) (p <0.05), fig 1a. Deactivation was seen bilaterally in thalamus, middle frontal gyrus, insula and parahippocampal gyrus, and in left middle/superior temporal gyrus (p <0.05). At voiding initiation activation was seen in the left angular gyrus/superior temporal gyrus, and the IFG, fig 1b. Only four of seven patients were able to void supine during fMRI scan. CONCLUSIONS: This is the first study evaluating cortical activity in men with BPH and BOO. At full urge there was significant activation of the IFG, consistent with data from Harvie et al showing its significance during the voiding phase. However, there were important deactivations including bilateral thalamus, insula, and IFG during initiation and voiding attempts previously shown to be important regions in normal micturition in healthy adults. Further studies should evaluate whether deactivation in these regions reflect the inability to void of multiple subjects and/or represent neuroplastic changes of supraspinal micturition control in response to chronic BOO in men with BPH. Source of Funding: This study is supported by Pilot project funding through University of Pittsburgh O’Brien Cooperative Research Center program U54DK112079. Dr. Khavari is partially supported by K23DK118209, by National Institute of Heath, NIDDK and by Houston Methodist Clinician Scientist Award © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e199-e199 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ricardo Gonzalez More articles by this author Logan Hubbard More articles by this author Khue Tran More articles by this author Natalia Hernandez More articles by this author Christof Karmonik More articles by this author Shi Zhaoyue More articles by this author Rose Khavari More articles by this author Expand All Advertisement Loading ...

Post-incarceration outcomes for individuals who continued methadone treatment while in Connecticut jails, 2014–2018

PurposeTo assess post-release outcomes associated with continuation of methadone treatment in correctional centers. MethodsThis case-control study of the post-incarceration impact of pilot methadone programs operating in jails in New Haven and Bridgeport, Connecticut, USA was conducted in 2014−18. The study compared non-fatal overdose, fatal overdose, reincarceration, and resumption of methadone in the community experienced by 1564 eligible men, 660 (42.2 %) of whom continued treatment while incarcerated. ResultsContinuation of methadone was associated with a significant decrease in non-fatal overdose (OR:0.55; 95 % CI: 0.36, 0.85) and a greater likelihood of resuming methadone treatment in the community post-release (OR:2.56; 95 % CI: 2.07, 3.16). Time to resumption of methadone was shortened by treatment while time to non-fatal overdose was increased. Treatment while incarcerated resulted in a modest but not significant decrease in fatal overdoses and no difference in reincarceration between those who did and did not receive methadone. However, resumption of methadone after release did significantly reduce fatal overdoses (OR = 0.26, 95 % CI: 0.11, 0.62, p = 0.002). Conclusion and relevanceImprovements in post-release outcomes of non-fatal overdose and treatment reengagement emphasize the benefits of continuing medication-based treatment for opioid use disorder within the criminal justice system for those receiving it prior to being incarcerated.

Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection

Determination of optimal treatment durations for common infectious diseases is an important strategy to preserve antibiotic effectiveness. To determine whether 7 days of treatment is noninferior to 14 days when using ciprofloxacin or trimethoprim/sulfamethoxazole to treat urinary tract infection (UTI) in afebrile men. Randomized, double-blind, placebo-controlled noninferiority trial of afebrile men with presumed symptomatic UTI treated with ciprofloxacin or trimethoprim/sulfamethoxazole at 2 US Veterans Affairs medical centers (enrollment, April 2014 through December 2019; final follow-up, January 28, 2020). Of 1058 eligible men, 272 were randomized. Participants continued the antibiotic prescribed by their treating clinician for 7 days of treatment and were randomized to receive continued antibiotic therapy (n = 136) or placebo (n = 136) for days 8 to 14 of treatment. The prespecified primary outcome was resolution of UTI symptoms by 14 days after completion of active antibiotic treatment. A noninferiority margin of 10% was selected. The as-treated population (participants who took ≥26 of 28 doses and missed no more than 2 consecutive doses) was used for the primary analysis, and a secondary analysis included all patients as randomized, regardless of treatment adherence. Secondary outcomes included recurrence of UTI symptoms and/or adverse events within 28 days of stopping study medication. Among 272 patients (median [interquartile range] age, 69 [62-73] years) who were randomized, 100% completed the trial and 254 (93.4%) were included in the primary as-treated analysis. Symptom resolution occurred in 122/131 (93.1%) participants in the 7-day group vs 111/123 (90.2%) in the 14-day group (difference, 2.9% [1-sided 97.5% CI, -5.2% to ∞]), meeting the noninferiority criterion. In the secondary as-randomized analysis, symptom resolution occurred in 125/136 (91.9%) participants in the 7-day group vs 123/136 (90.4%) in the 14-day group (difference, 1.5% [1-sided 97.5% CI, -5.8% to ∞]) Recurrence of UTI symptoms occurred in 13/131 (9.9%) participants in the 7-day group vs 15/123 (12.9%) in the 14-day group (difference, -3.0% [95% CI, -10.8% to 6.2%]; P = .70). Adverse events occurred in 28/136 (20.6%) participants in the 7-day group vs 33/136 (24.3%) in the 14-day group. Among afebrile men with suspected UTI, treatment with ciprofloxacin or trimethoprim/sulfamethoxazole for 7 days was noninferior to 14 days of treatment with regard to resolution of UTI symptoms by 14 days after antibiotic therapy. The findings support the use of a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole as an alternative to a 14-day course for treatment of afebrile men with UTI. ClinicalTrials.gov identifier: NCT01994538.

Effect of Berberine on Cardiovascular Disease Risk Factors: A Mechanistic Randomized Controlled Trial.

Cardiovascular disease (CVD) is a major contributor to the global burden of disease. Berberine, a long-standing, widely used, traditional Chinese medicine, is thought to have beneficial effects on CVD risk factors and in women with polycystic ovary syndrome. The mechanisms and effects, specifically in men, possibly via testosterone, have not been examined previously. To assess the effect of berberine on CVD risk factors and any potential pathway via testosterone in men, we conducted a randomized, double-blind, placebo-controlled, parallel trial in Hong Kong. In total, 84 eligible Chinese men with hyperlipidemia were randomized to berberine (500 mg orally, twice a day) or placebo for 12 weeks. CVD risk factors (lipids, thromboxane A2, blood pressure, body mass index and waist–hip ratio) and testosterone were assessed at baseline, and 8 and 12 weeks after intervention. We compared changes in CVD risk factors and testosterone after 12 weeks of intervention using analysis of variance, and after 8 and 12 weeks using generalized estimating equations (GEE). Of the 84 men randomized, 80 men completed the trial. Men randomized to berberine had larger reductions in total cholesterol (−0.39 mmol/L, 95% confidence interval (CI) −0.70 to −0.08) and high-density lipoprotein cholesterol (−0.07 mmol/L, 95% CI −0.13 to −0.01) after 12 weeks. Considering changes after 8 and 12 weeks together, berberine lowered total cholesterol and possibly low-density lipoprotein-cholesterol (LDL-c), and possibly increased testosterone. Changes in triglycerides, thromboxane A2, blood pressure, body mass index and waist–hip ratio after the intervention did not differ between the berberine and placebo groups. No serious adverse event was reported. Berberine is a promising treatment for lowering cholesterol. Berberine did not lower testosterone but instead may increase testosterone in men, suggesting sex-specific effects of berberine. Exploring other pathways and assessing sex differences would be worthwhile, with relevance to drug repositioning and healthcare.

Nurse-led telephone notification of a prostate cancer diagnosis: Prospective analysis of men's preferences for and experiences of a same-day assessment and diagnostic clinic.

The 'One Stop Prostate Clinic' (OSPC) was a same-day prostate cancer assessment and/or diagnostic clinic. Preferences and experiences of men who received initial telephone notification of their prostate biopsy results (cancer or benign) by the OSPC Clinical Nurse (CN) are reported. Prospective mixed methods study using survey instrument and thematic analysis of OSPC preferences and experiences. One thousand men attended the OSPC between August 2011 and November 2017, 876 underwent prostate biopsies; 790/876 (90%) men consented to telephone notification of biopsy results, 5/876 (1%) declined and 79/876 (9%) were ineligible/not contacted. 220/403 men (55%) returned the OSPC questionnaire; 135/220 (61%) men received a cancer diagnosis, 119/132 (90%) would choose this method again and 7/132 (5.5%) would not and 6/132 (4.5%) were unsure; 94/135 (70%) reported no disadvantages with this notification method. Overall satisfaction rate with the OSPC was 96% (209/218) men. Initial telephone notification of prostate biopsy results by the OSPC CN was preferred by the vast majority of eligible men. Many men with a cancer diagnosis did not experience any disadvantages. This method of results delivery can be incorporated by other tumour groups.

Progression on active surveillance for prostate cancer in Black men: a systematic review and meta-analysis.

Several studies evaluated prostate cancer (PCa) outcomes in Black men on active surveillance (AS); most studies contained few Black men and results were conflicting. We performed a systematic review and meta-analyze of race and outcomes on AS. A systematic search was performed for articles of men with Grade Group 1 or 2 (GG1 or GG2) PCa on AS. All studies required race-specific comparative progression data. Progression to treatment, PSA, or biopsy progression were considered and relative risk (RR) estimates of Black men progressing were extracted and pooled using random-effects models. Differences by study-level characteristics were evaluated using subgroup and a cumulative meta-analysis by time. In total, 12 studies were included (3137 Black and 12,206 non-Black men); eight prospective (27%, n = 4210) and four retrospectives (73%, n = 11,133) cohorts. The overall RR of progression for Black men was 1.62 (95%CI, 1.21-2.17), I2 = 64% (95% CI, 32-80%), (χ2 = 30.23; P = 0.001; τ2 = 0.16). Black men with GG1 PCa alone had a higher pooled progression: RR = 1.81 (95% CI, 1.23-2.68). Including only studies with clinical progression (excluding progression to treatment), potentiated results: RR = 1.82 (95%CI, 1.27-2.60). However, a cumulative meta-analysis demonstrated decreasing pooled effect over time, with contemporary studies after 2019 showing a tempered effect (RR: 1.29, 95% CI: 1.20-1.39). Many studies attribute racial disparity in PCa to delayed presentation of disease, however, AS is unique since all AS eligible men have a low grade and stage PCa. Our findings suggest Black men may have an increased risk of progression during AS, but the association is not so strong that Black men should be discouraged from undergoing AS. Indeed, contemporary evidence suggests stricter inclusion, better confirmatory testing or better access to care may temper these findings. Importantly, these results utilize self-reported race, a social construct that has many limitations.

Cohort profile: the Men and Parenting Pathways (MAPP) Study: a longitudinal Australian cohort study of men’s mental health and well-being at the normative age for first-time fatherhood

PurposeThe Men and Parenting Pathways (MAPP) Study is a prospective investigation of men’s mental health and well-being across the normative age for transitioning to fatherhood. This includes trajectories and outcomes...

PROState Pathway Embedded Comparative Trial: The IP3-PROSPECT study

IntroductionThe traditional double blind RCT is the ‘gold standard’ trial design. For a variety of reasons, these designs often fail to accrue enough participants to conclude. This is particularly challenging in localized prostate cancer. The cohort multiple randomised controlled trial (cmRCT) trial design may represent an alternative approach to delivering robust comparative data in prostate cancer. Patients and methodsIP3-PROSPECT is a cmRCT designed to test multiple prostate cancer interventions from eligible men in one cohort. Key to the design is two points of consent. First, at point of consent one, men referred for prostate cancer investigations are invited to join the cohort. They may then be randomly invited at a later date to consider an intervention at point of consent two. In the pilot phase we will test the acceptability and feasibility of developing the cohort. ResultsAcceptability and feasibility of the study will be measured by a combination of quantitative and qualitative methods. The primary outcome measure is the rate of consent to inclusion to the IP3-PROSPECT cohort. Secondary outcome measures include the completeness of data collection at sites and return rates of patient questionnaires. We will also interview patients and healthcare professionals to explore their thoughts on the implementation, practicality and efficiency of IP3-PROSPECT. ConclusionThe IP3-PROSPECT study will evaluate the cmRCT design in prostate cancer. Initially we will pilot the design, assessing for acceptability and feasibility. The cmRCT is an innovative design that offers potential for building a modern comparative evidence base for prostate cancer.

Perceived barriers to the adoption of active surveillance in low-risk prostate cancer: a qualitative analysis of community and academic urologists

BackgroundClinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists’ recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting.MethodsWe conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for intervention.ResultsCommunity and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient’s ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation.ConclusionsDespite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.

ADVANCE integrated group intervention to address both substance use and intimate partner abuse perpetration by men in substance use treatment: a feasibility randomised controlled trial

BackgroundSubstance use is a risk factor for intimate partner abuse (IPA) perpetration. Delivering perpetrator interventions concurrently with substance use treatment shows promise.MethodsThe feasibility of conducting an efficacy and cost-effectiveness trial of the ADVANCE 16-week intervention to reduce IPA by men in substance use treatment was explored. A multicentre, parallel group individually randomised controlled feasibility trial and formative evaluation was conducted. Over three temporal cycles, 104 men who had perpetrated IPA towards a female (ex) partner in the past year were randomly allocated to receive the ADVANCE intervention + substance use treatment as usual (TAU) (n = 54) or TAU only (n = 50) and assessed 16-weeks post-randomisation. Participants’ (ex) partners were offered support and 27 provided outcome data. Thirty-one staff and 12 men who attended the intervention participated in focus groups or interviews that were analysed using the framework approach. Pre-specified criteria assessed the feasibility of progression to a definitive trial: 1) ≥ 60% of eligible male participants recruited; 2) intervention acceptable to staff and male participants; 3) ≥ 70% of participants followed-up and 4) levels of substance use and 5) IPA perpetrated by men in the intervention arm did not increase from average baseline level at 16-weeks post-randomisation.Results70.7% (104/147) of eligible men were recruited. The formative evaluation confirmed the intervention’s acceptability. Therapeutic alliance and session satisfaction were rated highly. The overall median rate of intervention session attendance (of 14 compulsory sessions) was 28.6% (range 14.3–64.3% by the third cycle). 49.0% (51/104) of men and 63.0% (17/27) of their (ex) partners were followed-up 16-weeks post-randomisation. This increased to 100% of men and women by cycle three. At follow-up, neither substance use nor IPA perpetration had worsened for men in the intervention arm.ConclusionsIt was feasible to deliver the ADVANCE intervention in substance use treatment services, although it proved difficult to collect data from female (ex)partners. While some progression criteria were met, others were not, although improvements were demonstrated by the third cycle. Lessons learned will be implemented into the study design for a definitive trial of the ADVANCE intervention.Trial registrationISRCTN79435190 prospectively registered 22nd May 2018.

An integrated multicomponent care model for men affected by prostate cancer: A feasibility study of TrueNTH Australia.

ObjectiveTo evaluate the feasibility of implementing an integrated multicomponent survivorship care model for men affected by prostate cancer.MethodsUsing a single arm prospective cohort study design, men with prostate cancer were recruited from two regional public hospitals in Australia for a 6‐months program that provided information and decision support, exercise and nutrition management, specialised clinical support, and practical support through localised and central care coordination. Carers of the men were also invited to the program. Data were collected from multiple sources to evaluate: (1) recruitment capability and participant characteristics; (2) appropriateness and feasibility of delivering the specific intervention components using an electronic care management tool; and (3) suitability of data collection procedures and proposed outcome measures.ResultsOf the 105 eligible men, 51 (consent rate 49%) participated in the program. Of the 31 carers nominated by the men, 13 consented (consent rate 42%). All carers and 50 (98%) men completed the program. Most (92%) men were newly diagnosed with localised prostate cancer. All men attended initial screening and assessment for supportive care needs; a total of 838 episodes of contact/consultation were made by the intervention team either in person (9%) or remotely (91%). The intervention was implemented as proposed with no adverse events. The proposed outcome measures and evaluation procedures were found to be appropriate.ConclusionsOur results support the feasibility of implementing this integrated multicomponent care model for men affected by prostate cancer.

Patient-Reported Outcomes After Genital Gender-Affirming Surgery With Versus Without Urethral Lengthening in Transgender Men

In our institution, genital Gender-Affirming Surgery (gGAS;phalloplasty or metoidioplasty) in transgender men is offered with or without Urethral Lengthening (UL). The aim of this cross-sectional and retrospective study was to assess the effect of gGAS with or without UL on several Patient-Reported Outcomes (PROs), and to identify predictors of overall patient satisfaction at follow-up. A self-constructed Patient-Reported Outcome Measure (PROM) was sent to transgender men who were ≥1 year after gGAS. The survey comprises 25 questions divided into 5 domains: type of surgery, satisfaction with the appearance and functionality, quality of life, feelings of masculinity, and sexuality. Answers to the survey were compared between groups, and a linear regression analysis was conducted to identify predictors of overall patient satisfaction. Of 154 eligible transgender men, the PROM was sent to 118 (77%) willing to participate, and 102 (66%) completed the survey. The majority previously underwent phalloplasty (n=74;73%) compared to metoidioplasty (n=28;27%). Urethral Lengthening was performed in 56/102 (55%) participants, 51/74 (69%) in phalloplasty, 5/28 (18%) in metoidioplasty. The mean number of complications and reoperations was significantly higher in the UL group (2.7vs1 and 1.6vs0.4 respectively, both P < .001). Most participants were satisfied to very satisfied with life (75%), the appearance (66%), voiding (59%), the effect of surgery on masculinity (82%), and confirmed that the end surgical result matched their expectations (61%), independently of UL. Lowest scores in satisfaction were observed for the sexual functioning of the neophallus, with 34% satisfied to very satisfied participants. Both satisfaction with the appearance of the neophallus (P < .001) and with voiding (P=.02) were positive predictors of overall patient satisfaction at follow-up, in contrast to the complication and reoperation rate postoperatively (P=.48 and P=.95 respectively). Transgender men choosing for gGAS with or without UL can be adequately informed on PROs regarding type of surgery, satisfaction with the appearance and functionality, quality of life, feelings of masculinity, and sexuality. Study strengths comprise the relatively large cohort, long duration of follow-up, completeness of the data, and innovativeness of the studied outcomes. Limitations are the cross-sectional and retrospective design, possible participation bias and non-validated survey. No significant differences in several PROs were observed between participants who chose gGAS with or without UL in this retrospective study. Additionally, according to this study, satisfaction with the appearance of the neophallus and with voiding were positive predictors of overall patient satisfaction at follow-up. de Rooij FPW, van de Grift TC, Veerman H, etal. Patient-Reported Outcomes After Genital Gender-Affirming Surgery With Versus Without Urethral Lengthening in Transgender Men. J Sex Med 2020;18:974-981.

"It really proves to us that we are still valuable": Qualitative research to inform a safer conception intervention for men living with HIV in South Africa.

Many men living with HIV want to have children. Opportunities to reduce periconception HIV transmission include antiretroviral therapy as prevention, pre-exposure prophylaxis, limiting condomless sex to peak fertility, and sperm processing. Whether men have knowledge of or want to adopt these strategies remains unknown. We conducted focus group discussions (FGDs) with men accessing HIV care in South Africa in 2014 to inform a safer conception intervention for men. Eligible men were 25-45 years old, living with HIV, not yet accessing treatment, and wanting to have a child with an HIV-negative or unknown serostatus female partner (referred to as the "desired pregnancy partner"). FGDs explored motivations for having a healthy baby, feasibility of a clinic-based safer conception intervention, and acceptability of safer conception strategies. Data were analyzed using thematic analysis. Twelve participants from three FGDs had a median age of 37 (range 23-45) years, reported a median of 2 (range 1-4) sexual partners, and 1 (range 1-3) desired pregnancy partner(s). A third (N = 4) had disclosed HIV-serostatus to the pregnancy partner. Emergent themes included opportunities for and challenges to engaging men in safer conception services. Opportunities included enthusiasm for a clinic-based safer conception intervention and acceptance of some safer conception strategies. Challenges included poor understanding of safer conception strategies, unfamiliarity with risk reduction [versus "safe" (condoms) and "unsafe" (condomless) sex], mixed acceptability of safer conception strategies, and concerns about disclosing HIV-serostatus to a partner. Men living with HIV expressed interest in safer conception and willingness to attend clinic programs. Imprecise prevention counseling messages make it difficult for men to conceptualize risk reduction. Effective safer conception programs should embrace clear language, e.g. undetectable = untransmittable (U = U), and support multiple approaches to serostatus disclosure to pregnancy partners.