Sexual Health Inventory Research Articles

PD41-10 AQUABLATION FOR BPH-RELATED LUTS: FUNCTIONAL AND ENDOSCOPIC RESULTS UP TO TWO YEARS AFTER THE INTERVENTION

PD41-10 AQUABLATION FOR BPH-RELATED LUTS: FUNCTIONAL AND ENDOSCOPIC RESULTS UP TO TWO YEARS AFTER THE INTERVENTION

MP68-16 INTRAOPERATIVE ANGIOGRAPHY OF THE NEUROVASCULAR BUNDLE IMPROVES ANATOMICAL DISSECTION DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: INITIAL CLINICAL EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP68-16 INTRAOPERATIVE ANGIOGRAPHY OF THE NEUROVASCULAR BUNDLE IMPROVES ANATOMICAL DISSECTION DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: INITIAL CLINICAL EXPERIENCE Nordine Amara, Tarek A. L. Youssef, Jordan Massa, Elias Elkhouri, Adel Ait Kaki, Aouad Fidjel, and Belur Patel Nordine AmaraNordine Amara More articles by this author , Tarek A. L. YoussefTarek A. L. Youssef More articles by this author , Jordan MassaJordan Massa More articles by this author , Elias ElkhouriElias Elkhouri More articles by this author , Adel Ait KakiAdel Ait Kaki More articles by this author , Aouad FidjelAouad Fidjel More articles by this author , and Belur PatelBelur Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Based on current knowledge of the surgical anatomy of the prostate we investigated the value of intraoperative angiography of the neurovascular bundle (NVB) using indocyanine green (ICG) and near-infrared fluorescence (ICG-NIRF) during robot-assisted radical prostatectomy (RARP) to provide a better dissection and preservation of the NVB. METHODS: Retrospective, unicentric study of 91 consecutive patients from 2016 to 2021. In patients who met the inclusion criteria (stage T1 and T2 (stage T3 excluded), mild-moderate ED (assessed using the Sexual Health Inventory for Men scores or SHIM Score), prostate specific antigen <10 ng/ml), we used intraoperative ICG-NIRF angiography (using the built-in Firefly fluorescence imaging system). All patients provided signed informed consent for inclusion in our study. We evaluated the proportion (%) of bilateral NVB identified to optimise and facilitate the dissection, as well as any ICG-related complications that occurred (assessed using the Clavien-Dindo classification). All patients were followed up at 3, 6, 9, and 12 months after surgery to evaluate their erectile function using the SHIM score. RESULTS: Ninety-one patients received intraoperative angiography. The NVB was identified in all cases, without difficulties. No ICG-related complications or allergies were observed.There was no significant difference in the SHIM score at 9 months compared with baseline(p=0.331), and erectile dysfunction returned to baseline levels in almost all patients. CONCLUSIONS: Intraoperative, real-time ICG-NIRF angiography is simple, non-invasive, and improves identification of key anatomical landmarks to optimise micropreservation of the NVB during RARP and preserve erectile function. Larger clinical studies should confirm preliminary results. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e959 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nordine Amara More articles by this author Tarek A. L. Youssef More articles by this author Jordan Massa More articles by this author Elias Elkhouri More articles by this author Adel Ait Kaki More articles by this author Aouad Fidjel More articles by this author Belur Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-15 TEMPORARILY IMPLANTED NITINOL DEVICE VERSUS PROSTATIC URETHRAL LIFT FOR MINIMALLY INVASIVE SURGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS: A MATCHING-ADJUSTED INDIRECT COMPARISON

You have accessJournal of UrologyCME1 Apr 2023MP51-15 TEMPORARILY IMPLANTED NITINOL DEVICE VERSUS PROSTATIC URETHRAL LIFT FOR MINIMALLY INVASIVE SURGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS: A MATCHING-ADJUSTED INDIRECT COMPARISON Kenneth M. Kernen, Shalina Omar, Bradley Goodnight, Paul Skodny, Stuart Bruce, and Tiffany M. Yu Kenneth M. KernenKenneth M. Kernen More articles by this author , Shalina OmarShalina Omar More articles by this author , Bradley GoodnightBradley Goodnight More articles by this author , Paul SkodnyPaul Skodny More articles by this author , Stuart BruceStuart Bruce More articles by this author , and Tiffany M. YuTiffany M. Yu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare the safety and efficacy of the temporarily implanted nitinol device (iTind) versus prostatic urethral lift (PUL) for minimally invasive surgical treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. iTind treatment uses a single temporary implant removed after 5-7 days, while PUL uses multiple permanent implants. METHODS: Matching-adjusted indirect comparison (MAIC) was used to account for population differences across seven clinical trials identified by systematic literature review. Individual patient data from two iTind trials and aggregated data from five PUL trials were included. Safety and efficacy outcomes at 12 months post-treatment were compared between the matching-adjusted iTind population and pooled PUL population. RESULTS: iTind patients were significantly less likely than PUL patients to experience treatment-related adverse events (AEs) within three months (25.0% vs 79.8%; p<0.001), including dysuria (17.8% vs 34.7%; p=0.001), hematuria (12.0% vs 25.9%; p=0.002), and pain (9.5% vs 18.7%; p=0.023). Rates of treatment-related AEs from three to 12 months were also significantly lower among iTind than PUL patients (2.6% vs 24.4%; p<0.001). iTind and PUL efficacy outcomes were statistically equivalent on changes from baseline to 12 months on the International Prostate Symptom Score (IPSS, p=0.56), quality of life (QoL, p=0.21), Qmax (p=0.39), post-void residual volume (PVR, p=0.16), and the Sexual Health Inventory for Men (SHIM, p=0.14). CONCLUSIONS: This MAIC found superior safety and reduced risks of early and later treatment-related AEs with iTind versus PUL. The twelve-month efficacy was equivalent on subjective urinary symptoms (IPSS, QoL) and objective urinary symptoms (Qmax, PVR) and preservation of sexual function (SHIM). This study finds that the iTind temporary device provides an improved safety profile with equivalent efficacy compared to PUL permanent implants for patients with benign prostatic hyperplasia with lower urinary tract symptoms. Source of Funding: Financial support for this research was provided by Olympus Corporation of the Americas © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e699 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth M. Kernen More articles by this author Shalina Omar More articles by this author Bradley Goodnight More articles by this author Paul Skodny More articles by this author Stuart Bruce More articles by this author Tiffany M. Yu More articles by this author Expand All Advertisement PDF downloadLoading ...

PD11-12 THE EFFECT OF CLOMIPHENE CITRATE ON PATIENT REPORTED OUTCOME MEASURES

You have accessJournal of UrologyCME1 Apr 2023PD11-12 THE EFFECT OF CLOMIPHENE CITRATE ON PATIENT REPORTED OUTCOME MEASURES Jessica Schardein, Kia Fendereski, Zane Randell, Soren Keihani, Joshua Horns, and James Hotaling Jessica SchardeinJessica Schardein More articles by this author , Kia FendereskiKia Fendereski More articles by this author , Zane RandellZane Randell More articles by this author , Soren KeihaniSoren Keihani More articles by this author , Joshua HornsJoshua Horns More articles by this author , and James HotalingJames Hotaling More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003251.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clomiphene Citrate (CC) is a medication that can be used in hypogonadal men in lieu of testosterone to increase testosterone levels while preserving or improving fertility. Patient reported outcome measures for this medication are limited, especially regarding sexual functioning. Our objective is to assess whether self-reported changes in androgen deficiency symptoms and erectile function are observed along with changes in hormone levels and semen parameters in men taking CC. METHODS: We performed a retrospective review of all patients on CC between 2014 and 2018 for hypogonadism and/or infertility. Patient characteristics including age and body mass index (BMI) along with hormone levels, semen parameters, and self-reported questionnaire scores were obtained. Patients who completed blood work for total testosterone and bioavailable testosterone, a semen analysis, and hypogonadism and erectile function questionnaires including Androgen Deficiency in Aging Male (ADAM) and Sexual Health Inventory for Men (SHIM) before and 3 months after the initiation of CC were included in the analysis. Patients with documented exogenous testosterone, human chorionic gonadotrophin, or anastrozole use were excluded. Changes in baseline and follow-up data were analyzed using paired-sample t-tests. RESULTS: A total of 97 men were identified and included in the analysis. The mean age and body mass index (BMI) were 33.7 ± 6 years and 31.2 ± 7.3 kg/m2, respectively. All patients were followed for at least 3 months. The use of CC significantly increased both mean total and bioavailable testosterone levels by 236.5 ng/dL and 115.6 ng/dL, respectively (p<0.05). Concentration, total progressive motility and morphology all significantly improved as well (p<0.05). Clinical manifestations included a significant improvement in ADAM scores (p=0.025) and no change in SHIM scores (p=0.278). CONCLUSIONS: As more men are placed on CC for hypogonadism and/or infertility, characterizing patient reported outcomes regarding androgen deficiency symptoms and erectile function are important. The medication is able to raise testosterone levels while increasing semen parameters in addition to improving self-reported hypogonadal symptoms and maintaining erectile function scores. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e337 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Schardein More articles by this author Kia Fendereski More articles by this author Zane Randell More articles by this author Soren Keihani More articles by this author Joshua Horns More articles by this author James Hotaling More articles by this author Expand All Advertisement PDF downloadLoading ...

MP74-07 THE EFFECT OF TESTOSTERONE REPLACEMENT THERAPY ON LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyCME1 Apr 2023MP74-07 THE EFFECT OF TESTOSTERONE REPLACEMENT THERAPY ON LOWER URINARY TRACT SYMPTOMS Norichika Ueda, Go Tsujimura, Takahiro Imanaka, Sohei Kuribayashi, Koichi Okada, Kentaro Takezawa, Shinichiro Fukuhara, and Norio Nonomura Norichika UedaNorichika Ueda More articles by this author , Go TsujimuraGo Tsujimura More articles by this author , Takahiro ImanakaTakahiro Imanaka More articles by this author , Sohei KuribayashiSohei Kuribayashi More articles by this author , Koichi OkadaKoichi Okada More articles by this author , Kentaro TakezawaKentaro Takezawa More articles by this author , Shinichiro FukuharaShinichiro Fukuhara More articles by this author , and Norio NonomuraNorio Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both late-onset hypogonadism (LOH) syndrome and lower urinary tract symptoms (LUTS) increase with age and decrease quality of life (QOL). The standard treatment for LOH syndrome is testosterone replacement therapy (TRT). Since the prostate is an androgen-dependent organ, TRT may have some effect on LUTS. However, the effect of TRT on LUTS is not fully understood. The number of patients with both LUTS and LOH syndrome is increasing, therefore it is important to understand the relationship between TRT and LUTS. In this study, we retrospectively examined the effect of TRT on LUTS. METHODS: Ninety-four patients who received TRT for LOH syndrome from May 2017 to August 2022 were evaluated. Three months after the first testosterone administration, Aging males Symptoms rating scale (AMS), Sexual Health Inventory for Men (SHIM), Erection Hardness Score (EHS), International Prostate Symptom Score (IPSS), and IPSS QOL score were assessed. IPSS was also evaluated for the voiding and storage subscores, respectively. RESULTS: TRT improved AMS, SHIM and EHS significantly (all p<0.01). In the evaluation of urinary symptoms, TRT did not improve any of the IPSS total scores, IPSS voiding subscores, IPSS storage subscores, or IPSS QOL scores in the LUTS mild group (IPSS: 8 or less), but in the LUTS moderate-severe group (IPSS: 8-35), TRT significantly improved them all (IPSS total scores: 14.2±0.9 vs 9.8±1.1: p<0.001, IPSS voiding subscores: 8. 0±0.6 vs 5.3±0.8: p<0.001, IPSS storage subscores: 6.3±0.6 vs 4.5±0.5: p=0.003, IPSS QOL scores: 3.9±0.2 vs 3.0±0.3: p=0.002, respectively) (Figure 1). CONCLUSIONS: TRT for LOH patients does not exacerbate LUTS but improves LUTS, especially for moderate or severe LUTS patients. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1071 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Norichika Ueda More articles by this author Go Tsujimura More articles by this author Takahiro Imanaka More articles by this author Sohei Kuribayashi More articles by this author Koichi Okada More articles by this author Kentaro Takezawa More articles by this author Shinichiro Fukuhara More articles by this author Norio Nonomura More articles by this author Expand All Advertisement PDF downloadLoading ...

V10-08 THE USE OF FOCAL IRREVERSIBLE ELECTROPORATION FOR PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023V10-08 THE USE OF FOCAL IRREVERSIBLE ELECTROPORATION FOR PROSTATE CANCER John Torosyan, Amy Cherry, Hasan Abbas, Shima Tayebi, and Abhinav Sidana John TorosyanJohn Torosyan More articles by this author , Amy CherryAmy Cherry More articles by this author , Hasan AbbasHasan Abbas More articles by this author , Shima TayebiShima Tayebi More articles by this author , and Abhinav SidanaAbhinav Sidana More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy of prostate cancer is a treatment strategy that aims to destroy the cancer-containing parts of the prostate while preserving uninvolved prostatic tissue in an attempt to preserve genitourinary function. Irreversible Electroporation (IRE) is a novel ablative modality which utilizes electrical pulses to induce cell apoptosis and can be applied to various malignancies, including prostate cancer. The objective of this video is to discuss the mechanism of action of IRE and describe the components, setup, and operative technique for performing IRE for the focal treatment of prostate cancer. METHODS: IRE is performed under general anesthesia with the patient placed in lithotomy position. Monopolar electrodes are inserted into the prostate under ultrasound guidance and using a brachytherapy grid. The probes are placed 1.5 to 2cm away from one another, and 3-5mm away from the prostatic capsule using cognitive fusion to cover the lesion and 5-10mm margin. After initially estimating voltage configurations, ten test impulses are fired between each probe pair to assess resulting currents. Using test results, final voltages are assigned, and the remaining 80 impulses are fired between each probe pair. RESULTS: This case involves a 74-year-old male with a history of hypertension and hyperlipidemia who presented with an elevated Prostate-Specific Antigen (PSA) of 6.35 and was found to have Gleason 3+4 cancer in the Prostate Imaging Reporting & Data System (PI-RADS) 4 lesion localized in the right mid gland to apex. The patient had a pre-treatment International Prostate Symptom Score (IPSS) of 4-1 and a Sexual Health Inventory for Men (SHIM) of 18 without the use of erectile dysfunction medication. The patient underwent a successful IRE ablation of the lesion along with the margin. The procedure was tolerated well, and the patient was discharged later that day. At his 6-week follow-up, PSA declined to 0.66 and he had an unchanged IPSS/SHIM. CONCLUSIONS: The use of focal therapy in prostate cancer is promising because of its effectiveness paired with minimal procedural side effects. Focal IRE provides a safe and effective way to achieve focal therapy of prostate cancer. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e928 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Torosyan More articles by this author Amy Cherry More articles by this author Hasan Abbas More articles by this author Shima Tayebi More articles by this author Abhinav Sidana More articles by this author Expand All Advertisement PDF downloadLoading ...

Quality of life in patients who underwent robot‐assisted radical prostatectomy compared with those who underwent low‐dose‐rate brachytherapy

To compare the quality of life (QOL) in patients who underwent robot-assisted radical prostatectomy (RARP) or low-dose-rate brachytherapy (LDR-BT) for prostate cancer. We enrolled patients who underwent LDR-BT (LDR-BT alone [n = 540] or LDR-BT plus external beam radiation therapy [n = 428]) and RARP (n = 142). QOL was evaluated using the International Prostate Symptom Score, Expanded Prostate Cancer Index Composite (EPIC), Sexual Health Inventory for Men (SHIM), and 8-item Short Form (SF-8) health survey. The two groups were compared using propensity score matching analysis. At 24 months after treatment, the number of patients with worsened urinary QOL in the urinary domain of EPIC compared with baseline was 78/111 (70%) and 63/137 (46%) in the RARP and LDR-BT groups, respectively (p < 0.001). In the urinary incontinence and function domain, this number was higher in the RARP group versus the LDR-BT group. However, in the urinary irritative/obstructive domain, the number of patients with improved urinary QOL at 24 months compared with baseline was 18/111 (16%) and 9/137 (7%), respectively (p = 0.01). Regarding the SHIM score, sexual domain of EPIC, and mental component summary of SF-8, there were more number of patients with worsened QOL in the RARP group than in the LDR-BT group. In the EPIC bowel domain, the number of patients with worsened QOL was lower in the RARP group versus the LDR-BT group. The differences in QOL observed between patients treated with RARP and LDR-BT could assist in treatment selection for prostate cancer.

The association of leprosy with male fertility and sexual function: a single center study

Introduction and objective Mycobacterium leprae has been identified in the testicular tissue of men with leprosy. We investigated the relationship between leprosy and male infertility and sexual function. Methods Male patients at the Los Angeles County + University of Southern California Medical Center Hansen’s Disease Clinic were surveyed regarding sexual and reproductive history and sexual function via Sexual Health Inventory for Men (SHIM) scores. Survey topics included erectile dysfunction (ED), sexual function, libido, reproductive history before and after leprosy diagnosis, and SHIM scores. SHIM scores were compared with age matched controls without leprosy. Results Forty men with leprosy were interviewed, with a mean age of 53 years. The average age at leprosy diagnosis was 39 years. Thirteen (32.5%) men reported ED, 12 (30%) ejaculatory dysfunction, 6 (15%) impaired libido, and seven (17.5%) primary infertility post-leprosy diagnosis. SHIM scores consistent with mild to severe ED were found in 22/40 (55%) patients and were significantly lower in leprosy patients compared to age matched controls (20/25 versus 23/25, p &lt; 0.001). Lower SHIM scores were also associated with the presence of other neurologic deficits (p = 0.029). Participants with SHIM scores suggestive of ED were no more likely to have had hormone analysis testing done than those with unimpaired SHIM scores. Conclusions Men with leprosy had a range of sexual and reproductive issues. Nearly half reported de novo sexual symptoms, and males with leprosy had lower SHIM scores compared to controls. Men with leprosy should be screened routinely for sexual dysfunction and asked about their reproductive goals.

The Men's Training Cup Keep Training: a masturbation aid improves intravaginal ejaculatory latency time and Erection Hardness Score in patients who are unable to delay ejaculation.

Premature ejaculation (PE) has negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy. In Japan, no oral drugs or devices are approved or used clinically to treat PE. The Men's Training Cup Keep Training (MTCK), a masturbation aid, was developed for PE. MTCK offers 5 grades of tightness and strength. We aimed to investigate the efficacy of the MTCK in patients who are unable to delay ejaculation. Inclusion criteria were 20- to 60-year-old men feeling distressed and frustrated by PE and who had the same sexual partners throughout the study period. Exclusion criteria were neurologic disease and uncontrolled diabetes mellitus, as well as the use of antidepressants, α-blockers, and 5α-reductase inhibitors. The protocol comprised an 8-week training period with the MTCK from level 1 to level 5, with each level used twice before moving to the next level. The main outcome measure was the extension of intravaginal ejaculation latency time (IELT). The secondary outcome measures were score improvements on the Premature Ejaculation Diagnostic Tool, Sexual Health Inventory for Men, Erection Hardness Score, and Difficulty in Performing Sexual Intercourse Questionnaire-5. We enrolled 37 patients, and after 19 patients withdrew, 18 concluded the study without experiencing any adverse events. The mean patient age was 39.9years. Geometric IELT after the 8-week training with the MTCK increased significantly (mean ± SE; 232.10 ± 72.16seconds) vs baseline (103.91 ± 50.61seconds, P = .006). Mean scores on the Premature Ejaculation Diagnostic Tool, Difficulty in Performing Sexual Intercourse Questionnaire-5, and Erection Hardness Score after 8-week training improved significantly vs the baseline values. The mean score on the Sexual Health Inventory for Men did not improve significantly after the 8-week training, but domain 1 did significantly improve after 8weeks of MTCK use. The MTCK may be one possible treatment option for patients who are unable to delay ejaculation. This is the first study to show that the MTCK is effective for patients who are unable to delay ejaculation. A major limitation is that the present study was not strictly limited to an IELT <3minutes. The MTCK may offer benefits not only for delay of ejaculation but also for erectile function.

Low serum zinc concentration is associated with low serum testosterone but not erectile function.

To investigate the relation between serum zinc concentration and several factors, including serum testosterone concentration and the score of questionnaires on sexual function in patients with sexual problems. This study comprised 720 men (age, 46.3 [21-83] years) with some kind of sexual problem. Age, scores of the Sexual Health Inventory for Men and the Erection Hardness Score, and endocrinologic data including serum concentrations of testosterone, prostate-specific antigen, and zinc were included in this study. After serum zinc concentration of the men was classified into 5 groups (<70, 70≤ <80, 80≤ <90, 90≤ <100, ≤100 μg/dl), the relation of each parameter with serum zinc concentration was assessed for a trend analysis. Finally, the relation between serum concentrations of zinc and testosterone as well sexual function evaluated by the scores of the questionnaires was investigated. Only serum testosterone concentration (ptrend=0.028) and serum cortisol concentration (ptrend=0.003) showed a statistically significant relation to serum zinc concentration by trend analysis. Interestingly, trend analysis between serum concentrations of testosterone and zinc still showed a significant association after adjustment for serum cortisol concentration (ptrend=0.032). However, no significant association was found in the relation between serum zinc concentration and the scores of the questionnaires after adjustment for serum concentrations of testosterone and cortisol. We clearly showed that after adjustment for serum cortisol concentration by trend analysis, serum testosterone concentration decreased as serum zinc concentration decreased, although sexual symptoms were not associated with this decrease.

Ultrapreservation in Robotic Assisted Radical Prostatectomy Provides Early Continence Recovery.

We aimed to evaluate oncological and functional results of the ultrapreservation anterior-sparing technique in patients with localized prostate cancer. In this single-center study, patients with low to intermediate risk prostate cancer, who were treated with the ultrapreservation anterior-sparing technique, were included retrospectively. The oncological and functional outcomes were recorded. After the functional and pathological evaluation in the first month, patients' prostate-specific antigen levels were followed, as well as continence and potency status bimonthly for one year. Continence is defined as no leakage and zero pads for security. Patients' potency was evaluated using the Sexual Health Inventory for Men, with ≥ 17 considered potent. A total of 118 patients were included in the study. The pathological stage was pT2 in 78% (n = 92) of patients, with pT3 in 22% (n = 26). Surgical margin positivity occurred in 13.5% (n = 16) of patients. No complications were observed intraoperatively. Continence rates were 25.4% after catheter removal, rising to 88.9% in the first month, 91.5% in the third, 93.2% in the fifth, and 95.7% a year later. Thirty-five (40%) of 86 potent patients were potent in the first postoperative month, 48 patients (55.8%) were potent in the third month, and 58 patients (67.4%) were potent in the twelfth. The total complication rate was 8.4%, with no major complications observed. The ultrapreservation anterior-sparing technique for patients with prostate cancer shows safe, acceptable functional and oncological results in short-term follow-up. However, long-term comparative studies with a larger number of patients are needed.

Predictive factors for efficacy of testosterone replacement therapy for late-onset hypogonadism in Japanese men: a preliminary report.

Although testosterone replacement therapy (TRT) is the first-choice method used worldwide for late-onset hypogonadism (LOH), clinical benefits are not seen in all cases. This study was conducted to determine the predictors of TRT efficacy for LOH. Fifty-six patients who visited our Men's Health Clinic (Kawanishi City Medical Center, Kawanishi and Hyogo Medical University, Nishinomiya, Hyogo, Japan) between November 2003 and June 2021 with data available before and after TRT were enrolled. They were divided into responders (Group 1; n = 45, accounting for 80.4%) and nonresponders (Group 2; n = 11, accounting for 19.6%) based on the clinical response to TRT, including patient satisfaction. Factors noted before TRT included age, body mass index, aging males' symptoms score, sexual health inventory for men, luteinizing hormone, follicular-stimulating hormone, testosterone, free testosterone, prolactin (PRL), estradiol (E2), and testosterone/estradiol (T/E2) ratio in serum. For statistical analysis, a multivariable logistic regression model was used. Univariate analysis revealed PRL (odds ratio [OR]: 0.9624; 95% confidence interval [CI]: 0.9316-0.9943, P < 0.05), E2 (OR: 0.8692; 95% CI: 0.7745-0.9754, P < 0.05), and T/E2 ratio (OR: 1.1312; 95% CI: 1.0106-1.2661, P < 0.05) to be predictive factors. Multivariate analyses showed that T/E2 ratio was an independent predictive factor (OR: 1.1593; 95% CI: 1.0438-1.2875, P < 0.01). The present results suggest that a low value for T/E2 ratio may predict a reduced response to TRT. The T/E2 ratio threshold to predict nonresponders based on receiver-operating characteristics (ROC) curve analysis was shown to be 17.3. Although additional studies with larger number of patients are necessary, we propose the determination of serum E2 level and testosterone level prior to performing TRT.

Can Erectile Dysfunction Severity Predict Major Adverse Cardiovascular Events in Men Undergoing Dialysis? A Prospective Cohort Study.

To evaluate the impact of severe erectile dysfunction (ED) on future major adverse cardiovascular events (MACE) in men on dialysis. This prospective cohort study included 71 men on dialysis. ED was assessed using the Sexual Health Inventory for Men (SHIM). Men were divided into the mild/moderate ED (SHIM score ≥8) and severe ED (SHIM score ≤7) groups. The primary endpoint was MACE-free survival. MACE was a composite of myocardial infarction, cardiovascular death, and stroke. The secondary endpoints were cardiac event-free survival and overall survival (OS). Moreover, the predictive abilities of severe ED for 5-year MACE, 5-year cardiac events, and 5-year overall mortality were evaluated. The median age and follow-up period of the included men were 64 years and 58 months, respectively. The median SHIM score was 4.0; all had a degree of ED, and 64.7% had severe ED. In the background-adjusted multivariable analyses, severe ED was not significantly associated with shorter MACE-free survival (hazard ratio [HR], 1.890; 95% confidence interval [CI], 0.533-6.706; p=0.324), cardiac event-free survival (HR, 2.081; 95% CI, 0.687-6.304; p=0.195), and OS (HR, 0.817; 95% CI, 0.358-1.863; p=0.630). Severe ED did not significantly improve the predictive abilities for 5-year MACE, 5-year cardiac events, and 5-year overall mortality (p=0.110, p=0.101, and p=0.740, respectively). ED severity was not associated with shorter MACE-free survival, cardiac event-free survival, or OS, and ED severity could not improve the predictive abilities for these outcomes in men undergoing dialysis.

The effect of nursing interventions on urinary, bowel and sexual dysfunction among post‐radical prostatectomy patients

AbstractProstate cancer is one of the commonest types of cancer in men worldwide. The primary treatment option for localized prostate cancer is radical prostatectomy. Unfortunately, a considerable proportion of men may experience long‐term post‐surgical sequelae is to determine the effect of nursing interventions on urinary, bowel, and sexual dysfunction among post‐radical prostatectomy patients. A quasi‐experimental (one group, pre‐test–post‐test) research design. We included 30 post‐radical prostatectomy patients in this study. Each patient was interviewed in five sessions. During these sessions, the information about the complications of RP, pelvic floor exercise training and sexual rehabilitation was given. International Consultation on Incontinence Questionnaire‐Urinary Incontinence‐Short Form (ICIQ‐UI‐SF), The Revised Faecal Incontinence Scale (RFIS) and Sexual Health Inventory for Men (SHIM) were used to evaluate the effect of nursing interventions. The study results demonstrate that the incidence of urinary and sexual dysfunction is high among patients post‐radical prostatectomy patients. Fortunately, urinary and sexual dysfunctions were improved post‐implementation of nursing intervention with statistically significant differences (p‐value &lt;0.05). The incidence of faecal incontinence was 16.7% while it was 13.3% post‐nursing implementation with no statistically significant differences. Nursing intervention is effective in the management of urinary incontinence after radical prostatectomy within a short period time while the improvement in sexual dysfunction may need more time.

Evaluation of post-ablation mpMRI as a predictor of residual prostate cancer after focal high intensity focused ultrasound (HIFU) ablation.

To evaluate the performance of multiparametric magnetic resonance imaging (mpMRI) and PSA testing in follow-up after high intensity focused ultrasound (HIFU) focal therapy for localized prostate cancer. A total of 73 men with localized prostate cancer were prospectively enrolled and underwent focal HIFU followed by per-protocol PSA and mpMRI with systematic plus targeted biopsies at 12 months after treatment. We evaluated the association between post-treatment mpMRI and PSA with disease persistence on the post-ablation biopsy. We also assessed post-treatment functional and oncological outcomes. Median age was 69 years (Interquartile Range (IQR): 66-74) and median PSA was 6.9 ng/dL (IQR: 5.3-9.9). Of 19 men with persistent GG ≥ 2 disease, 58% (11 men) had no visible lesions on MRI. In the 14 men with PIRADS 4 or 5 lesions, 7 (50%) had either no cancer or GG 1 cancer at biopsy. Men with false negative mpMRI findings had higher PSA density (0.16 vs. 0.07 ng/mL2, P = 0.01). No change occurred in the mean Sexual Health Inventory for Men (SHIM) survey scores (17.0 at baseline vs. 17.7 post-treatment, P = 0.75) or International Prostate Symptom Score (IPSS) (8.1 at baseline vs. 7.7 at 24 months, P = 0.81) after treatment. Persistent GG ≥ 2 cancer may occur after focal HIFU. mpMRI alone without confirmatory biopsy may be insufficient to rule out residual cancer, especially in patients with higher PSA density. Our study also validates previously published studies demonstrating preservation of urinary and sexual function after HIFU treatment.

Intraoperative angiography of the neurovascular bundle using indocyanine green and near-infrared fluorescence improves anatomical dissection during robot-assisted radical prostatectomy: initial clinical experience.

Landmark artery identification in the neurovascular bundle (NVB) is important for nerve-sparing in radical prostatectomy. We aimed to investigate intraoperative angiography using indocyanine green and near-infrared fluorescence (ICG-NIRF) during robot-assisted radical prostatectomy (RARP) to identify the NVB, visualise vascularisation and haemostasis, and preserve erectile function. Ourretrospective, unicentric study was performed in consecutive localised prostate cancer RARP patients (stage T1/T2, prostate-specific antigen < 10ng/ml) who underwent ICG-NIRF angiography in France (2016-2021). When ready to dissect the NVB, the anaesthesiologist intravenously injected ICG (3ml); the surgeon used alternating standard light or fluorescence to optimise NVB visualisation and facilitate microdissection. Primary outcomes: safety and feasibility of ICG-NIRF. Secondary outcomes: functional erectile dysfunction (Sexual Health Inventory for Men (SHIM)questionnaire) over 9months, proportion of bilateral NVBs identified, ICG-related complications. Standard descriptive statistics were used; t test determined the significance of changes in SHIM scores versus baseline. Ninety-one patients received intraoperative angiography. The NVB was identified in all cases, without difficulties. No ICG-related complications or allergies were observed. There was no significant difference in the SHIM score at 9months compared with baseline (p = 0.331), and erectile dysfunction returned to baseline levels in almost all patients. Intraoperative, real-time ICG-NIRF angiography is simple, non-invasive, and improves identification of key anatomical landmarks to optimise micropreservation of the NVB during RARP and preserve erectile function. Larger clinical studies should confirm preliminary results.

Laparoscopic simple prostatectomy versus robot-assisted simple prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of comparative trials.

Laparoscopic simple prostatectomy (LSP) and robot-assisted simple prostatectomy (RASP) are important approaches for large benign prostatic hyperplasia (BPH), though it is still unclear which is superior. This study aimed to perform a pooled analysis to compare the safety and efficacy profiles of LSP and RASP. We systematically searched the databases of Science, PubMed, Embase, Web of Science, and Cochrane Library database for randomized controlled trials (RCTs) and non-RCTs, comparing LSP to RASP. The principal outcomes included perioperative, functional and complications variables. The results are presented as odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals (CI) of dichotomous and continuous variables. Five comparative trials involving 1928 patients were included. RASP demonstrated a shorter length of hospital stay compared to LSP (WMD 1.20days, 95% CI 0.09, 2.32; p = 0.03). However, there was no difference between the two groups regarding operative time, estimated blood loss, catheterization time and complications. Moreover, RASP had a higher maximum flow rate (Qmax) (WMD -2.15mL/s, 95% CI -3.75, -0.55; p = 0.0009) and comparable international prostate symptom score (IPSS) and sexual health inventory (SHIM) in men with LSP. The results of this study demonstrated that RASP offered comparable efficacy and safety to LSP, while maintaining a superior perioperative and functional profile. However, treatment selection should also be based on the availability and experience of the operator.

Toxicity Outcomes at 18 Months for Cs-131 Low-Dose-Rate Prostate Brachytherapy Compared to I-125 and Pd-103

<h3>Purpose/Objective(s)</h3> Low dose rate prostate brachytherapy is an established component of definitive radiotherapy options for localized prostate cancer. As the utility of LDR brachytherapy (LDRB) has evolved, the focus has shifted to improving the side effect profile while maintaining oncologic outcomes. Most prior efficacy and toxicity data were gathered using I-125 and Pd-103, but due to the shorter half-life and slightly higher average energy of Cs-131, several institutions have adopted its use in an attempt to improve outcomes and decrease toxicity. To report the toxicity outcomes up to 18 months after Cs-131 LDR brachytherapy at our institution, compared to our experience with I-125 and Pd-103. <h3>Materials/Methods</h3> A retrospective review was performed on the first 50 patients treated with Cs-131 LDRB for localized prostate cancer at our institution. Patients receiving either a full or partial implant were included. Prescription doses of 100Gy and 80Gy were utilized, respectively. Patients receiving partial implants generally received 45Gy external beam radiotherapy starting 6-8 weeks after implant. Data regarding AUA prostate symptom score, sexual health inventory for men (SHIM) score, and RTOG GI toxicity score were assessed pretreatment, at 1 month, and at each subsequent follow up. Demographic and clinical data were also collected. The data was compared to cohorts of the last 50 patients treated I-125 and the last 50 patients treated with Pd-103, to standard doses. Descriptive statistics were used to summarize variables. A linear mixed model was used to compare means and to identify variables as prognostic for toxicity (p≤0.05). <h3>Results</h3> The mean AUA scores prior to brachytherapy were similar for patients in all groups (p=1.00), while at 1-month post-treatment, mean AUA score was significantly higher for patients treated with Cs-131 and Pd-103 compared to I-125 (p<0.001). Mean AUA scores were not significantly different at longer follow-up (p>0.50). The need for a catheter post-brachytherapy occurred in 8% of patients and was not associated with type of isotope on multivariate analysis (MVA). Prostate volume, numbers of seeds, and prostate D90% were significant predictors for the need for a catheter on MVA. The use of ADT and the total activity were significant predictors on MVA for a decrease in SHIM score over time. The type of isotope used did not predict for erectile dysfunction (ED) as measured by SHIM score on MVA. Overall rates of GI toxicity were low with only 3 patients developing RTOG grade 2 toxicity or greater without any obvious difference between isotopes. <h3>Conclusion</h3> In patients treated with Cs-131 or Pd-103 LDRB, acute GU side effects peaked higher at 1 month than with I-125, but rapidly decreased to similar levels with longer follow-up. The type of source used did not predict for need for catheterization, ED, or GI toxicity at any time point.

Penile Bulb Dose Predicts Sexual Quality of Life after Prostate SBRT: Secondary Analysis of a Multi-Institutional Trial

<h3>Purpose/Objective(s)</h3> Prostate radiation is associated with erectile dysfunction. Recently, secondary analyses of the CHIPP (19 vs. 20 vs. 37 fractions) and Hypo-RT trials (7 vs. 39 fractions) demonstrated an association between penile bulb (PB) dose and sexual outcomes. Though stereotactic body radiation (SBRT, 4-5 fractions) is increasingly used, minimal data exist regarding dosimetric predictors of sexual function after SBRT. We herein analyze predictors of erectile dysfunction in patients treated with SBRT on a prospective trial. <h3>Materials/Methods</h3> Patients with low or intermediate risk prostate cancer were enrolled on a multi-institutional phase 2 trial from 2007 to 2012. Patients were treated with robotic SBRT to 38 Gy in 4 fractions on consecutive days, without androgen deprivation therapy. The clinical target volume was prostate alone for low-risk patients or prostate+1 cm of proximal seminal vesicles for intermediate-risk patients. Selected dosimetric parameters for PB and neurovascular bundle were prospectively collected. Erectile function was assessed using the Sexual Health Inventory for Men (SHIM) Questionnaire at baseline and after treatment at protocol-specified time points. The SHIM is a patient reported questionnaire scored from 1-30, with lower scores indicating worse erectile function. Linear regression was used to assess factors associated with SHIM score at 2 years. We chose one PB metric (D10%) for use in multivariable analyses given collinearity of dosimetric variables. <h3>Results</h3> 251 patients with PB data were included and received SBRT at 18 institutions. SHIM score was available in 97% and 79% of patients at baseline and 2 years, respectively. Mean SHIM was 14.1 at baseline, declining to 9.8 at 2 years. Median age was 69 years and median PB D10% was 16 Gy. On univariate analysis, higher age, lower baseline SHIM and each PB metric were all significantly associated with worse erectile function (lower SHIM score) at 2 years (Table). On multivariate analysis accounting for age and baseline SHIM, PB D10% remained significantly associated with lower SHIM score at 2 years (Table). In contrast, dose to the neurovascular bundle was not associated with erectile dysfunction (data not shown). Mean SHIM score at 2 years was 11.2 vs. 8.7 in patients with PB D10% below vs. above the median, respectively (t-test p=0.04). <h3>Conclusion</h3> To the authors' knowledge, this is the largest analysis of dosimetric predictors of erectile dysfunction after SBRT. In addition to known factors such as age and baseline function, penile bulb dose appears to correlate with late erectile dysfunction and should be minimized to preserve sexual QOL in patients receiving SBRT. Table: Linear regression analyses of 2-year SHIM score.

Two Year Functional Outcomes Stratified According to Baseline Erectile Function Following Partial Gland Cryo-Ablation

OBJECTIVETo critically evaluate time dependent sexual function following primary partial gland cryo-ablation (PGCA) stratified according to baseline erectile function. METHODSBetween March 2017 and March 2022, all men undergoing primary PGCA by 2 surgeons were enrolled in an IRB approved outcomes registry. All subjects with PIRADS 2-5 lesion concordant with unilateral GGG 1-3 disease, no gross extra-prostatic extension on mpMRI, GGG >1 contralateral to the ROI, or distal apical disease on mpMRI were enrolled. Patients completed the Sexual Health Inventory for Men (SHIM) scale at baseline, 6, and 24 months. Men were stratified by baseline erectile function. Men with SHIM Score < 8 were excluded. Ability to sustain erection (aka “potency”) was defined as a score of 3 or greater on question 2 of the SHIM index. Median SHIM scores and the proportion of men reporting “potency” at baseline, 6, and 24 months was recorded with comparisons between each timepoint. A univariate analysis was used to determine if clinical factors were associated with loss of “potency” at 24 months. RESULTS106 men met the inclusion criteria. There was a statistically significant decrease in the mean SHIM scores for the entire cohort between baseline to 6 months and baseline to 24 months. SHIM scores increased significantly for the total cohort between 6 and 24 months. “Potency” was preserved in 70% at 24 months. CONCLUSIONThose patients most likely to exhibit a decrease in sexual function have moderate ED at baseline. Only baseline ED was shown to predict preservation of “potency”.