Preoperative Testosterone Research Articles

8314 Masculinizing Hormone Therapy and Gynecological Neoplasm: a Single Institution Cohort

Abstract Disclosure: S. Korpaisarn: None. T. Ngaothepphurktharam: None. Y. Tingthanatikul: None. Background: Gynecological neoplasm/malignancy is one of the concerned areas among transgender men on masculinizing hormone therapy (MHT). Long-term MHT and gynecological neoplasm/malignancy remain unclear. Methods: A retrospective cohort chart review was done on all transgender men (TM) who underwent hysterectomy with or without oophorectomy between January 2014 and October 2022. Intraoperative findings and pathological results of genital organs, including the cervix, endometrium, myometrium, and fallopian tubes, were extracted. The pathological results were classified as benign, precancerous, and malignant. Descriptive statistical analysis was used to demonstrate the prevalence of gynecological neoplasm and malignancy. Results: A total of 30 TM underwent hysterectomy with oophorectomy. Twenty-eight (93%) had bilateral oophorectomy, and 7% had unilateral oophorectomy due to gynecological conditions. The mean age when TM underwent surgery was 32.1 ± 5.1 years, and the mean age of gender-affirming hormone initiation was 28.7± 5.1 years. The median duration of MHT before gynecological surgery was 32 months (IQR 22-59). Most TM (73%) used testosterone enanthate, 17% testosterone undecanoate, and 2 transgender men did not start MHT before genital surgery. All TM who used GHT became amenorrheic before surgery. The median preoperative testosterone level was 561.5 ng/dL (IQR 776-1189). Intraoperative findings revealed that most TM (86.7%) had unremarkable uterus size, and 13% showed enlarged uterus size. In the latter, all were from myoma uteri. Most intraoperative findings of ovaries showed 93% unremarkable. One TM had intraoperative polycystic ovarian morphology, and one showed a unilateral ovarian cyst. Cervical pathological reports showed unremarkable results in 67%. Five TM (17%) had chronic cervical inflammation. There was 1 TM (3%) who showed low-grade squamous intraepithelial lesion (LSIL) with squamous metaplasia. Regarding endometrial pathology, the mean endometrial thickness was 0.13 ± 0.08 cm. Most endometrial reports (66%) were in a proliferative phase, 27% were in an atrophic or inactive endometrium, and 7% were in the secretory phase. Regarding pathological reports of ovaries, 80% had cystic ovaries. None of the TM showed precancerous or malignant conditions of endometrium, ovaries, and fallopian tubes. PAP smear was available in 27 TM; all were negative for intraepithelial lesions or malignancy. Conclusion: Among a cohort of TM who received MHT for 32 months, there is no evidence of precancerous or malignant pathology of the endometrium, ovaries, and fallopian tubes. Most of them had thin endometrium with cystic ovaries. One TM showed LSIL with squamous metaplasia of the cervix. Healthcare providers should follow local gynecological cancer screening guidelines developed for cisgender women in their clinical practice. Presentation: 6/2/2024

Central precocious puberty should be taken seriously in children with Leydig cell tumors of the testis after surgical treatment: a tertiary center experience.

Central precocious puberty secondary to Leydig cell tumors is rare in children. We retrospectively analyzed the mid- to long-term follow-up data of patients with Leydig cell tumors. The clinical data of 12 consecutive patients who were treated at Beijing Children's Hospital, Capital Medical University (Beijing, China), between January 2016 and October 2023 were retrospectively reviewed. Clinical evaluations, including physical examination, hormone examination, serum tumor marker analysis, abdominal and scrotal ultrasound, chest X-ray, and bone age measurement, were conducted before surgery and at follow-up time points. Surgical approaches were selected according to the individual conditions. Patients with an abnormal hormonal status and suspected of having central precocious puberty were referred to endocrinologists to confirm the diagnosis. Subsequently, gonadotropin-releasing hormone analog therapy was proposed. The mean patient age was 81.3 (range: 40-140) months at the time of the operation. Ten patients had peripheral precocious puberty at admission. All patients had elevated preoperative testosterone levels, whereas tumor marker levels were normal. Testis-sparing surgery was performed in eleven patients, and radical orchiectomy was performed in one patient. The follow-up duration (mean ± standard deviation) was 36.2 ± 25.3 months. Five patients had central precocious puberty, with a mean duration of 3.4 (range: 1-6) months postoperatively. Three patients were receiving gonadotropin-releasing hormone analog therapy, and good suppression of puberty was observed. No risk factors were found for secondary central precocious puberty. There was a high prevalence of central precocious puberty secondary to Leydig cell tumors in our study. Gonadotropin-releasing hormone analog therapy has satisfactory treatment effects. Larger sample sizes and long-term follow-up are needed in future studies.

Age-related impairment in testosterone elevation after anterior fibromuscular stroma preserved enucleation.

This study aims to evaluate the impact of anterior fibromuscular stroma preserved enucleation (AFSPE) of the prostate on serum testosterone levels in patients with benign prostatic obstruction (BPO) and to explore age-related differences in postoperative testosterone elevation. In a retrospective analysis, 304 patients from a pool of 560 who underwent AFSPE at Linkou Chang Gung Memorial Hospital between January 2018 and December 2021 were evaluated. Patients were stratified based on preoperative testosterone levels into low (<3.5 ng/mL) and normal (≥3.5 ng/mL) groups. Serum testosterone levels were measured preoperatively, at 1.5 and 3-6 months postoperatively. Age and other demographic data were analyzed as potential factors influencing testosterone changes. The low-testosterone group (n = 90) showed significant testosterone increases, from an average of 2.61 ng/mL preoperatively to 3.3 ng/mL at 1.5 months and 3.59 ng/mL at 3-6 months postoperatively (p < 0.0001). The normal-testosterone group (n = 214) maintained stable testosterone levels at 1.5 months but exhibited a significant rise to 6.06 ng/mL by 3-6 months (p = 0.0079). Older age was inversely associated with postoperative testosterone elevation in both groups. Improvements in nocturia were notable in both groups. AFSPE of the prostate significantly elevates serum testosterone levels in men with BPO, particularly benefiting those initially with low levels. Age is a crucial factor influencing postoperative testosterone changes, indicating that younger patients may benefit more from this intervention. AFSPE offers a promising approach for improving hormonal health in BPO patients, alongside alleviating urinary symptoms.

O-263 The risk of hypogonadism after microdissection testicular sperm extraction (micro TESE) in non-obstructive azoospermia (NOA) patients with various etiologies

Abstract Study question What is the risk factor of hypogonadism after micro TESE in NOA patients? Summary answer Klinefelter syndrome (KS), past history of cryptorchidism, preoperative testicular volume &amp;lt;8 ml or testosterone &amp;lt;287 ng/dL are significant risk factors of hypogonadism after micro TESE. What is known already Micro TESE combined with intracytoplasmic sperm injection (ICSI) is currently standard procedure to treat infertility in cases of NOA. Although many studies have reported the effectiveness of the treatment concerning about sperm retrieval rates (SRR) and the live birth rates, data on safety, especially on the risk of hypogonadism, are limited. Most previous studies, including our past study, regarding the risk of hypogonadism after TESE have been limited to relatively few in number of patients and the investigations only of the changes of mean serum testosterone levels. Study design, size, duration This study retrospectively investigated 535 NOA patients including 336 cases of unexplained NOA, 91 KS, 16 other chromosomal abnormalities, 31 azoospermia factor (AZF)c deletions, 31 past history of cryptorchidism, and 30 post anticancer chemotherapy, who had undergone micro TESE at our institution from September 2013 to August 2018. All of them had been examined serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels before and at least once in 1-3 months after micro TESE. Participants/materials, setting, methods In this study, hypogonadism was defined as total testosterone &amp;lt;250 ng/dL, which is established by the Japanese Society of Men’s Health as diagnostic criteria for late onset hypogonadism syndrome, and/or starting testosterone replacement therapy (TRT). We assessed risk factors of hypogonadism after micro TESE using indicators such as age, preoperative testicular volume and testosterone levels, past medical history, unilateral or bilateral, first time or not micro TESE. Main results and the role of chance In total of 535 men, FSH and LH after micro TESE significantly increased vs baseline (26.2 vs 29.9 IU/L, 9.6 vs 12.8 IU/L, respectively). On the other hand, testosterone levels significantly decreased after surgery (351.2 vs 297.5 ng/dL). Although postoperative hypogonadism was found in 42% (227/535), many of whom were cases of KS or preoperative testosterone levels &amp;lt;250 ng/dL. Sixteen men with KS, 3 men with unexplained NOA, and 2 men with past history of cryptorchidism started TRT because they complained clinical symptoms after micro TESE. Of the 21 men who started TRT, only 5 had new-onset low testosterone levels after micro TESE. According to the assessment of any association of various indicators and low postoperative total testosterone levels using multiple logistic regression analysis, significant risk factors of hypogonadism early after micro TESE were cases of KS (OR 11.4, 95% CI 4.4-29.9), preoperative testosterone levels &amp;lt;287 ng/dL (OR 7.5, 95% CI 4.7-12.0), preoperative testicular volume &amp;lt;8 ml (OR 3.9, 95% CI 2.3-6.4), past history of cryptorchidism (OR 2.9, 95% CI 1.1-7.8). Limitations, reasons for caution Most examinations of postoperative hormone levels were performed in short-term period after micro TESE, so we could only assess the risk of postoperative hypogonadism in a short time course in this cohort study. Wider implications of the findings The strength of the current study is that the risk factors of hypogonadism after micro TESE was assessed in a large population of NOA men with various etiologies. The results of this study provide useful clinical information about the risk of postoperative hypogonadism for NOA patients considering micro TESE. Trial registration number not applicable

Commentary on: Long-Term Effects of Pre-Operative Testosterone and Dihydrotestosterone on Glans Width in Boys With Hypospadias

Commentary on: Long-Term Effects of Pre-Operative Testosterone and Dihydrotestosterone on Glans Width in Boys With Hypospadias

Long-term Effects of Pre-operative Testosterone and Dihydrotestosterone on Glans Width in Boys With Hypospadias

BackgroundSmall glans width is a risk factor for urethroplasty complications. This study aimed to assess and compare short- and long-term effects of two pre-operative topical androgen treatment protocols on maximum glans width. Furthermore, to evaluate post-operative complications when surgery was delayed >3 months following hormonal treatment completion. MethodsTopical 2.5% dihydrotestosterone (February 2016–July 2018) and 5% testosterone (August 2018–December 2022) treatment protocols, completed >3 months before surgery, were offered to all children with proximal hypospadias and small glans width requiring urethroplasty. Serial glans width measurements were collected prospectively pre- and post-androgen treatment. Demographic data and complications were collected retrospectively. ResultsA significant increase in mean glans width was observed following both dihydrotestosterone (6.1 mm [95% CI 4.3–7.9 mm] pre-dihydrotestosterone to 14.9 mm [13.2–16.6 mm, p < 0.0001] post-dihydrotestosterone in 11 children) and testosterone (10.5 mm [9.9–11.1 mm] pre-testosterone to 14.6 mm [13.7–15.5 mm, p < 0.0001] post-testosterone in 32 children). Serial post-treatment measurements showed no loss of gained width >1 year after treatment completion. Mean increase in glans width from pre-treatment measurement at 0–3 months, 4–12 months and >12 months following treatment was 7 mm (95% CI 3.8–10.2), 9 mm (7.2–10.8) and 10 mm (7.3–12.7) post-dihydrotestosterone and 4.4 mm (95% CI 3.4–5.4 mm), 4.3 mm (3.5–5.2) and 5.1 mm (4–6.2) post-testosterone respectively. Complications were noted in 4/22 patients who received topical androgen prior to initial hypospadias surgery and had completed all surgical stages. ConclusionsBoth treatment protocols produced a significant, sustained increase in glans width. Delaying hypospadias surgery for >3 months following androgen application may circumvent androgen induced vascularity and poor wound healing. Level of EvidenceLevel IV. Type of StudyTreatment study.

Effect of Pre-operative Parenteral Testosterone on Penile Dimensions and Vascularity in Proximal Hypospadias: A Prospective Observational Study.

Severe or proximal hypospadias is associated with inadequate local tissue and small phallus size. Pre-operative androgens have been used to increase phallus size, but there are very few studies on its role in proximal hypospadias. This study aimed to assess the effects of pre-operative intramuscular (IM) testosterone on proximal penile hypospadias in terms of penile morphology and tissue characteristics of penile skin. This prospective observational study was conducted on 27 patients of proximal hypospadias over a period from June 2017 to July 2018. The patients were sequentially enrolled into two groups: Group A and Group B. Group A patients received IM testosterone before surgery, whereas Group B patients were operated without pre-operative testosterone. Outcomes were analysed in terms of change in penile dimensions and effect on vascularity of penile skin. Pre-operative IM testosterone in Group A caused a significant increase in stretched penile length from a mean of 3.058 cm (±0.691) to 3.9 cm (±0.875) ( P = 0.002), penile circumference from a mean of 4.142 cm (±0.772) to 4.667 cm (±1.174) ( P = 0.029) and glans width from a mean of 1.225 cm (±0.245) to 1.750 cm (±0.571) ( P = 0.002). There was higher microvessel density in the preputial skin of Group A (mean: 12.212 [±4.745] blood vessels/high-power field [HPF]) compared to Group B (8.867 [±3.258] blood vessels/HPF) ( P = 0.043). Pre-operative testosterone in proximal hypospadias causes significant changes in penile dimensions and tissue characteristics. Improvement in penile dimensions leads to ease in operability and better tissue handling. However, more studies with large sample size are required to establish the beneficial effects of pre-operative hormone stimulation on urethroplasty.

(170) Satisfaction with Penile Prosthesis Implantation among Patients with Peyronie’s Disease Using a Contemporary Questionnaire

Abstract Introduction The Satisfaction Survey for Inflatable Penile Implants (SSIPI) is a recently validated 16-question survey used to quantitatively measure patient outcomes after penile prosthetic surgery. The survey consists of four subdomain scores representing the appearance, pain, satisfaction, and function of the penile implant. Since its validation, there have been limited studies examining its use in patients with Peyronie’s disease (PD). Objective The objective of this study is to explore the use of the SSIPI in men with Peyronie’s Disease and to determine if any factors predict patient-perceived postoperative outcomes. Methods Preoperative, intraoperative, and postoperative data for patients with PD undergoing implantation of an inflatable penile prosthesis (IPP) by a single surgeon at a tertiary care institution was retrospectively collected into a secure database. Only those patients with at least one completed SSIPI postoperatively were included in the analysis. For those patients with multiple completed SSIPI’s, only the most recently completed one was used. Linear regression and Fischer’s exact test were used to determine if there were any significant relationships between variables and the SSIPI scores. Results There were a total of 44 men with PD who underwent surgery for an IPP. 31 of them were Caucasian, 11 were African-American, and one each were Hispanic and American Indian/Native American. Median time between surgery and completion of the SSIPI at a follow-up visit was 291 days (IQR 107.75-403.50). 35 men received a Coloplast Titan and 9 received an AMS 700 CX. There was no significant difference in the overall SSIPI score and any of the subdomains between men who received different types of implants or between men of different races. All four subdomains were significantly negatively correlated with the residual curvature which was measured intraoperatively after the IPP was implanted and any adjunctive straightening techniques were used (Fig 1a-d). The appearance domain was also significantly negatively correlated with the preoperative total testosterone indicating that men with a lower total testosterone level were more satisfied with the appearance of their penis. (p &amp;lt; 0.05, R2 = 0.32). Interestingly, those men who underwent manual modeling (n=36) had a significantly lower score in the appearance domain (p &amp;lt; 0.05). Conclusions Post-operative residual curvature in men with PD undergoing implantation of an IPP is a predictor of satisfaction with the IPP. The role of preoperative testosterone and intraoperative manual modeling in how men with PD perceive the appearance of their penis postoperatively requires further investigation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.

Impact of the preoperative hormone therapy duration on the satisfaction of transgender men after chest masculinization surgery

Introduction Chest masculinization is currently the most commonly performed gender-affirming surgery. It is often preceded by testosterone replacement therapy, whose duration is not agreed upon before surgery. Our study evaluates the postoperative satisfaction of transgender men who have undergone chest masculinization surgery according to their preoperative hormonal treatment duration. Material and methods We conducted a single-center prospective study conducted from 2021 to 2022. All transgender men older than 18 years who had chest masculinization surgery were included. Demographic data, medical history, operative data, and duration of preoperative hormone therapy were collected. Participants completed the BREAST-Q© and BODY-Q© questionnaires pre- and postoperatively. Results Forty-six patients were included, with a median age of 21 years (18–45 years). The median preoperative testosterone duration was 596 days (186–4479 days). A significant improvement was found in BREAST-Q© (psychosocial, sexual and physical well-being; satisfaction with chest) and BODY-Q© (satisfaction with chest and nipples) parameters (p < 0.01). There was no significant correlation between preoperative hormone therapy time and chest satisfaction of BREAST-Q© (ρ = 0.069; R2 = 0.002; p = 0.647) and BODY-Q© (ρ = –0.114; R2 = 0.007; p = 0.450). Conclusion All patients in our study were exposed to exogenous testosterone for at least six months. Our study suggests that satisfaction remains unchanged with a longer duration of usage, indicating that an extended period of hormone impregnation may not be necessary before performing chest masculinization surgery in transgender men. Furthermore, the findings confirm a significantly high post-operative satisfaction rate among participants, emphasizing the positive impact of this type of surgery.

Bilateral Subcapsular Orchidectomy as Surgical Castration: A Reasonable Aesthetic Alternative to Bilateral Total Orchidectomy in Patients with Metastatic Hormone-sensitive Prostate Cancer

Background: The study highlights the historical significance of bilateral orchidectomy as the traditional 'gold standard' for surgical androgen deprivation in treating advanced prostate cancer. The study presented aims to compare total orchidectomy and subcapsular orchidectomy, considering factors such as androgen ablation, disease progression control, and patient satisfaction. Objective: This study aims to compare the effectiveness and patient satisfaction of bilateral subcapsular orchidectomy and bilateral total orchidectomy treatment in managing hormone-sensitive metastatic prostate cancer. Methods and materials: In this prospective study of 18 months at North East Medical College Hospital, 40 participants with Metastatic Carcinoma of Prostate underwent bilateral orchidectomy, among them 20 subcapsular and 20 total orchidectomy. The research focused on evaluating the impact of these treatments on serum testosterone levels, serum PSA levels, employing as outpatient procedures and a 3-month follow-up, utilizing a satisfaction scoring scale. Data, including age, Gleason Grade Group, PSA, and testosterone levels at diagnosis &amp; at 3-month follow-up were recorded and analyzed using IBM SPSS-21 software. Result: The study compared Bilateral Subcapsular Orchidectomy and Bilateral Simple Orchidectomy for Hormone-Sensitive Metastatic Carcinoma of Prostate in 40 patients. The highest frequency was in the 71-75 age group (30%), with a mean age of 66.67 ± 2.21 years. Gleason grade group 3 dominated (40%), followed by 2 (25%). Pre-operative PSA levels were 31.14±1.27 ng/ml for Subcapsular and 35.21±1.70 ng/ml for Total Orchidectomy, decreasing post-operatively to 8.25±0.41 ng/ml and 7.32±0.80 ng/ml, respectively. Pre-operative testosterone levels were 513.21±3.01 ng/dl for Subcapsular and 498.40±2.10 ng/dl for Total Orchidectomy, decreasing post-operatively to 21.14±2.84 ng/dl and 16.90±1.08 ng/dl, respectively, with non-significant p-values. Surgery related Satisfaction scores in the Follow-Up phase were significantly higher for Subcapsular Orchidectomy, 2.91±0.31 comparing with Total Orchidectomy, 2.05±0.45. The results emphasize better patient satisfaction after subcapsular orchidectomy, while maintaining similar cancer control in the form of PSA and testosterone level changes. Conclusion: In conclusion, our study advocates for the reconsideration of bilateral subcapsular orchidectomy as a preferred method for surgical androgen ablation in metastatic prostatic carcinoma, offering comparable efficacy to traditional total orchidectomy approach while prioritizing patient satisfaction and psychological well-being. This suggests a potential paradigm shift in the landscape of cost-effective androgen deprivation therapy within the urological field.

A Prior History of Cryptozoospermia Is Associated with a Significantly Higher Chance of a Successful Microdissection Testicular Sperm Extraction Compared to Non-Obstructive Azoospermia

Background: Our study sought to evaluate the rates of successful sperm retrieval following microdissection testicular sperm extraction (mTESE) in patients with a prior history of cryptozoospermia, compared to patients with non-obstructive azoospermia (NOA). Methods: A retrospective chart analysis evaluating all mTESE procedures was performed from January 2004 to August 2018. Inclusion criteria involved all males &gt;18 years of age with a diagnosis of cryptozoospermia and/or NOA that underwent a mTESE. The patient’s genetic profile, hormonal profile, semen analysis, testicular volumes, pathology and comorbidities were analyzed. Results: We identified 40 patients with cryptozoospermia and 221 patients with NOA. Successful mTESE occurred in 34/40 (85%) cryptozoospermic males compared to 104/221 (48%) NOA males (p &lt; 0.001). In univariate and multivariate analyses, patients with cryptozoospermia were more likely to undergo a successful mTESE than patients with NOA (OR 5.56 [1.79–17.29], p = 0.003; OR 5.41 [1.94–15.08], p = 0.0013), respectively. Factors that were associated with a statistically significant lower chance of successful mTESE included Sertoli-cell only pathology, pre-operative testosterone &lt; 300 ng/dL and FSH &gt; 7.6 mIU/mL. Conclusion: Despite patients with a history of cryptozoospermia having a significantly higher chance of a successful sperm retrieval than patients with NOA, couples should be counselled on the possibility of an unsuccessful sperm extraction, in order to optimize the pre-operative IVF planning and to manage operative expectations.

Effect of supplemental testosterone use on shoulder arthroplasty infection rates

BackgroundSupplemental testosterone use among patients undergoing shoulder arthroplasty can increase the Cutibacterium acnes load on the skin. Although higher C acnes loads on the skin are associated with higher amounts of bacteria in deep tissues, it is unknown whether preoperative testosterone use increases the risk of shoulder prosthetic joint infection. Therefore, the purpose of this study was to determine if there is a temporal relationship between testosterone use and the risk of prosthetic joint infection after shoulder arthroplasty. MethodsThe PearlDiver database was queried to identify a cohort of patients who underwent shoulder arthroplasty (hemiarthroplasty, anatomic or reverse total shoulder arthroplasty) with a minimum 2-year follow-up. Current Procedural Terminology and International Classification of Diseases codes were used to compare the demographics and comorbidities of patients with (n = 2285) and without testosterone use (n = 41,712). Patients with testosterone use were further stratified by the duration between last testosterone use and surgery. Prosthetic joint infection rates were compared between those with and without testosterone use. ResultsThe overall prevalence of testosterone use was 3.4%. Patients who used testosterone within 6 months prior to shoulder arthroplasty had a significantly higher rate of prosthetic joint infection at 3.4% compared to those without use at 2.4% [odds ratio (OR) = 1.44 (95% confidence interval (CI): 1.03-2.01), P = .042]. However, patients who used testosterone between 6 and 12 months before surgery did not have a significantly higher rate of infection. On multivariate analysis, only younger age [OR = 0.98 (95% CI: 0.97-0.99), P < .001] and diabetes [OR = 1.26 (95% CI: 1.10-1.44), P < .001] were independent risk factors for the development of an infection. ConclusionTestosterone use within 6 months of shoulder arthroplasty may be associated with higher rates of prosthesis joint infection. However, patients who were taking testosterone but stopped before surgery did not have a higher rate of infection compared to those who never used the medication. Surgeons should actively screen patients for testosterone use. A referral to the patient’s endocrinologist to discuss the risks and benefits of testosterone cessation prior to shoulder arthroplasty may also be warranted.

Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty? Reply.

Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty? Reply.

Editorial Comment.

No AccessJournal of UrologyPediatric Article31 May 2023Editorial CommentThis article comments on the following:Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty? Rafael Tua-Caraccia and Jonathan C. Routh Rafael Tua-CaracciaRafael Tua-Caraccia Department of Urology, Duke University School of Medicine, Durham, North Carolina More articles by this author and Jonathan C. RouthJonathan C. Routh Department of Urology, Duke University School of Medicine, Durham, North Carolina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003548.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. REFERENCES 1. Does preoperative testosterone administration decrease complications in distal hypospadias repair with urethroplasty?J Urol. 2023; 210(2):000. Google Scholar 2. EAU Guidelines on Paediatric Urology. 2023 Update. Accessed May 11, 2023. https://uroweb.org/guidelines/paediatric-urology Google Scholar Submitted March 6, 2023; accepted May 4, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology17 May 2023Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty? Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael Tua-Caraccia Department of Urology, Duke University School of Medicine, Durham, North Carolina More articles by this author Jonathan C. Routh Department of Urology, Duke University School of Medicine, Durham, North Carolina More articles by this author Expand All Submitted March 6, 2023; accepted May 4, 2023; published 000. Advertisement PDF downloadLoading ...

Editorial Comment.

No AccessJournal of UrologyPediatric Article31 May 2023Editorial CommentThis article comments on the following:Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty? Siam Oottamasathien Siam OottamasathienSiam Oottamasathien Department of Surgery, Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003548.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. REFERENCE 1. Does preoperative testosterone administration decrease complications in distal hypospadias repair with urethroplasty?J Urol. 2023; 210(2):000 Google Scholar Submitted March 6, 2023; accepted May 4, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology17 May 2023Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty? Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Siam Oottamasathien Department of Surgery, Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts More articles by this author Expand All Submitted March 6, 2023; accepted May 4, 2023; published 000. Advertisement PDF downloadLoading ...

Reply by Authors.

No AccessJournal of UrologyPediatric Article31 May 2023Reply by Authors Karl F. Godlewski, Sameer Mittal, Nathan Hyacinthe, Katherine Fischer, John Weaver, Jason Van Batavia, Dana Weiss, Arun Srinivasan, Aseem Shukla, Stephen Zderic, Thomas Kolon, Mark Zaontz, and Christopher Long Karl F. GodlewskiKarl F. Godlewski *Correspondence: Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19123 telephone: 215-590-4690; E-mail Address: [email protected] Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Sameer MittalSameer Mittal Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Nathan HyacintheNathan Hyacinthe Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Katherine FischerKatherine Fischer Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , John WeaverJohn Weaver Rainbow Babies and Children’s Hospital, Cleveland, Ohio More articles by this author , Jason Van BataviaJason Van Batavia Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Dana WeissDana Weiss Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Arun SrinivasanArun Srinivasan Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Aseem ShuklaAseem Shukla Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Stephen ZdericStephen Zderic Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Thomas KolonThomas Kolon Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Mark ZaontzMark Zaontz Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , and Christopher LongChristopher Long Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003548.03AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Reply by Authors." The Journal of Urology, Publish Ahead of Print, pp. REFERENCE 1. Does preoperative testosterone administration decrease complications in distal hypospadias repair with urethroplasty?J Urol. 2023; 210(2):000. Google Scholar Submitted March 6, 2023; accepted May 4, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karl F. Godlewski Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania *Correspondence: Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19123 telephone: 215-590-4690; E-mail Address: [email protected] More articles by this author Sameer Mittal Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Nathan Hyacinthe Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Katherine Fischer Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author John Weaver Rainbow Babies and Children’s Hospital, Cleveland, Ohio More articles by this author Jason Van Batavia Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Dana Weiss Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Arun Srinivasan Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Aseem Shukla Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Stephen Zderic Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Thomas Kolon Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Mark Zaontz Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Christopher Long Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Expand All Submitted March 6, 2023; accepted May 4, 2023; published 000. Advertisement PDF downloadLoading ...

Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty?

Testosterone administration prior to hypospadias repair is common practice among pediatric urologists; however, its impact on surgical outcomes remains controversial. We hypothesize that testosterone administration prior to distal hypospadias repair with urethroplasty significantly decreases postoperative complications. We queried our hypospadias database for primary distal hypospadias repairs with urethroplasty from 2015 to 2021. Patients undergoing repair without urethroplasty were excluded. We collected information on patient age, procedure type, testosterone administration status, initial visit and intraoperative glans width, urethroplasty length, and postoperative complications. To determine the role of testosterone administration on incidence of complications, a logistic regression adjusting for initial visit glans width, urethroplasty length, and age was performed. A total of 368 patients underwent distal hypospadias repair with urethroplasty. One hundred thirty-three patients received testosterone and 235 did not. Initial visit glans width was significantly larger in the no-testosterone vs testosterone group (14.5 mm vs 13.1 mm, P = .001). Testosterone patients had significantly larger glans width at the time of surgery (17.1 mm vs 14.6 mm [no-testosterone group], P = .001). On multivariable logistic regression analysis after controlling for age at surgery, preoperative glans width, testosterone status, and urethroplasty length, testosterone administration did show significant association with reduced odds of postoperative complications (OR 0.4, P = .039). This retrospective review of patients shows that on multivariable analysis there is significant association between testosterone administration and decreased incidence of complications in patients undergoing distal hypospadias repair with urethroplasty. Future studies on testosterone administration should focus on specific cohorts of patients with hypospadias as benefits of testosterone may be more evident in some subgroups than others.

V10-11 TIPS AND TRICKS FOR TESTIS SPARING SURGICAL TECHNIQUE

You have accessJournal of UrologyCME1 Apr 2023V10-11 TIPS AND TRICKS FOR TESTIS SPARING SURGICAL TECHNIQUE Silvia Altomare, Gabriele Tulone, Cristina Minasola, Arjan Bishqemi, Antonio La Rocca, Rosa Giaimo, Nicola Pavan, and Alchiede Simonato Silvia AltomareSilvia Altomare More articles by this author , Gabriele TuloneGabriele Tulone More articles by this author , Cristina MinasolaCristina Minasola More articles by this author , Arjan BishqemiArjan Bishqemi More articles by this author , Antonio La RoccaAntonio La Rocca More articles by this author , Rosa GiaimoRosa Giaimo More articles by this author , Nicola PavanNicola Pavan More articles by this author , and Alchiede SimonatoAlchiede Simonato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testis sparing surgery is now a well known surgical technique for small testicular masses. The candidate are patients with normal pre operative testosterone (if fertility preservation is required), small masses (under 2 cm, or not more then 1/3 of the testicular volume), normal value of serum markers for testicular cancer (bHCG, aFP, LDH), testicular masses in monorchid patients and in case of bilateral tumors. METHODS: We conducted a retrospective study including the period from February 2021 to August 2022. Our cohort of patients is composed by 4 patients with small testicular masses who underwent testis sparing surgery. The mean age was 36 years (27-57). BMI was >25 in 50% of patients. One patient reported cryptorchidism history. One patient referred anabolic steroids abuse in the past. None of them had previous history of testicular cancer. A testicular lamp was palpable in 2 patients. The mean lesion size was 0,7 cm (0,5-1,1). 2 patients presented with testicular pain, while two others patient had incidental diagnosis during routinary assessment for infertility and hypogonadotropic hypogonadism. For each patient US scan, tumor markers serum level, were performed. Tumor markers were within the normal limits in 100% of patients. RESULTS: The frozen sections assessment detected correctly benign tumors in 3 out of 4 patients: Adenomatoid tumor 2 (50%), Leydig cell tumor 1 (25%). A single malignant case was correctly identified as seminomatous proliferation in 1 patient; subsequently orchiectomy was performed, histologic examination confirmed Seminoma tumor plus Granulosa Cell Neoplasia In Situ (GCNIS). No one of the four patients developed post-op complications. Each patient is still in a follow-up program that includes periodic imaging surveys and clinical examinations. CONCLUSIONS: Testis sparing surgery is safe and effective in selected patients for small, benign masses and in the setting of bilateral disease or tumor in a solitary testis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e929 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Silvia Altomare More articles by this author Gabriele Tulone More articles by this author Cristina Minasola More articles by this author Arjan Bishqemi More articles by this author Antonio La Rocca More articles by this author Rosa Giaimo More articles by this author Nicola Pavan More articles by this author Alchiede Simonato More articles by this author Expand All Advertisement PDF downloadLoading ...

The ovaries of transgender men indicate effects of high dose testosterone on the primordial and early growing follicle pool.

Androgens are essential in normal ovarian function and follicle health but hyperandrogenism, as seen in polycystic ovary syndrome, is associated with disordered follicle development. There are few data on the effect of long-term exposure to high levels of testosterone as found in transgender men receiving gender-affirming endocrine therapy. In this study, we investigate the effect of testosterone on the development, morphological health and DNA damage and repair capacity of human ovarian follicles in vivo and their survival in vitro. Whole ovaries were obtained from transgender men (mean age: 27.6 ± 1.7 years; range 20-34 years, n = 8) at oophorectomy taking pre-operative testosterone therapy. This was compared to cortical biopsies from age-matched healthy women obtained at caesarean section (mean age: 31.8±1.5 years; range= 25-35 years, n=8). Cortical tissues were dissected into fragments and either immediately fixed for histological analysis or cultured for 6 days and subsequently fixed. Follicle classification and morphological health were evaluated from histological sections stained with H&E and expression of γH2AX as a marker of DNA damage by IHC. In uncultured tissue, testosterone exposure was associated with reduced follicle growth activation, poor follicle health and increased DNA damage. After 6 days of culture, there was enhanced follicle activation compared to control with further deterioration in morphological health and increased DNA damage. These data indicate that high circulating concentrations of testosterone have effects on the primordial and small-growing follicles of the ovary. These results may have implications for transgender men receiving gender-affirming therapy prior to considering pregnancy or fertility preservation measures.

Effects of bariatric surgery on testosterone level and sexual function in men with obesity: A retrospective study.

Bariatric surgeries induce well-documented weight loss and resolve obesity comorbidities. Sexual function is one of the aspects of life quality and may benefit from surgery. Few studies have revealed the impact of bariatric surgeries on sexual function in Chinese men with obesity. This is a retrospective cohort study of patients undergoing bariatric surgery [laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB)]. Data were collected between September 2017 and February 2022. The International Index of Erectile Function (IIEF) questionnaire was used to evaluate erectile function, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction. Sex hormones and other blood tests were evaluated before and at least 1 year after the surgery. Fifty-nine Chinese male patients completed the IIEF questionnaire. The multivariate logistic regression analysis revealed that body mass index (BMI) was the single independent risk factor of the severity of erectile dysfunction (ED). Preoperative testosterone levels had negative correlations with BMI and waist circumference. Thirty-seven patients completed the postoperative questionnaire with a mean follow-up of 23.2 months. BMI and waist circumference were negatively correlated with testosterone levels. BMI was an independent risk factor for the severity of ED. LSG and LRYGB led to positive and sustained improvement in sexual function of men with obesity. The two procedures had a comparable effect, more subjects being needed. Sex hormone levels also could be reversible. However, more weight loss did not predict a positive change in sexual function. A greater BMI loss might predict a greater increase in testosterone.