Urologic Health Research Articles

P-581: Incidence and clinical correlates of ejaculatory dysfunction in the general urology population

Ejaculatory complaints (ECs), such as painful, retrograde, diminished ejaculation or anejaculation, are issues often overlooked in the male sexual health evaluation. Population studies in older patients (>50years) have shown ECs to be quite prevalent when specifically screened for and to be independently associated with the presence of lower tract urinary symptoms (LUTS) as measured by such studies as the IPSS. The purpose of this study was to evaluate the prevalence of ECs in a younger urology population and evaluate their relationship to patient demographic and urologic health variables. Prospective patient questionnaire. From the period of time between March 2005 and September 2005, male patients in a combined male infertility/general urology clinic were asked to participate in a voluntary, IRB-approved study. Patients were given a packet of questionnaires which were anonymous and mailed back to the clinic after completion. Questionnaires included a basic demographic and medical history questionnaire, the IPSS, and the IIEF-5 (the first 5 questions of the IIEF). Ejaculatory symptoms were measured by using the ejaculatory domain of the Male Sexual Health Questionnaire (MSHQ-EjD) which consists of 7 questions rated from 1 to 6, in which a higher score indicates more severe ECs (range 7-41). Sixty male patients completed and mailed back the questionnaires. Average age of the patients was 45 years (range 20-77). The mean MSHQ-EjD score for the entire group was 14.1. Only one patient out of 60 had no ejaculatory complaints at all. On univariate statistical analysis, history of BPH diagnosis, history of erectile dysfunction (ED) diagnosis, and IIEF-5, were all significantly correlated (p<0.05) with higher (worse) MSHQ-EjD scores. Factors not found to be statistically correlated included race, BMI, educational status, smoking, IPSS, and prior vasectomy. On multivariate analysis the only factor which was found to be independently predictive of ejaculatory symptoms was the IIEF-5. The mean IIEF-5 score was 19.4 (range 0-25), and mean IPSS score was 7.7 (0-27). Ejaculatory complaints are a common finding in the middle age male urology population. On multivariate analysis, IIEF-5 scores were found to significantly predict more severe ejaculatory complaints. As opposed to earlier studies in older men, the IPSS was not found in this study to correlate with the presence of ejaculatory problems.

Results of a Men??s Urological Health Screening Program at Lockheed Martin Aeronautical Systems

Men are less likely to use preventive services than women, perhaps because of a perceived lack of timely access to healthcare. This paper reports the results of the Men’s Health Screening Program offered by Lockheed Martin Aeronautical Systems in Marietta, Georgia, USA. Volunteer male employees were screened at the work site for prostate cancer, benign prostatic hyperplasia (BPH), and erectile dysfunction (ED). Prostate-specific antigen (PSA) tests and digital rectal examination (DRE) were used to detect prostate cancer. DRE and a urologic health questionnaire were used to detect BPH. An erectile dysfunction questionnaire was used to screen for ED. Of the 4877 eligible male employees, 317 (6.5%) participated in the medical screening program. Two were found to have prostate cancer, one of whom had a previous diagnosis of prostate cancer. Using the results from both a urologic health questionnaire and the DRE test, 46 men were found to have BPH; however, only 30 noted a prior diagnosis of BPH. 273 men completed the ED questionnaire; 22–44 of the ED respondents reported frequent difficulties with one or more aspects of the sexual experience, but only 13 had sought prior treatment. 300 participants completed a short satisfaction survey, and 40 of these respondents were randomly selected for analysis. Of these 40 respondents, 60% said the program was either ‘good’ or ‘great’, and 95% agreed that the program had a beneficial impact on their ability to work. Some unmet need for care was noted. To address this, disease management professionals can help employers bring preventive care to the work site, at little or no cost to the employee, with benefits accruing to employers and employees alike.

Critical role of the reproductive urologist in men’s preventive health care.

Objective: Preventive medicine has taken an important role in medical care in the past 10 years. Men’s health issues in older men such as prostate cancer and erectile dysfunction has become more openly discussed and treated. Although men are more educated about the importance of health maintenance and healthy lifestyle practice, men, especially young men, continue to be reluctant to subject themselves to routine health screening. Reproductive urologists who evaluate young men may have a critical role in facilitating access to preventive health measures. The purpose of this study is to evaluate the current status of access to health care of a male infertility population regarding both urologic health and general health issues.

Urethral syndromes in children.

1. Walid Farhat, MD* 2. Gordon McLorie, MD* 1. 2. *Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Objectives After completing this article, readers should be able to: 1. Describe the evaluation of a child suspected of having urethritis. 2. Delineate the screening tests that have the highest yield for urethritis in young children. 3. List components of a behavioral modification approach to treating dysfunctional voiding. 4. Compare and contrast physical findings in gonococcal and nongonococcal urethritis. Inflammation of the urethra (urethritis) may be due to infection, trauma, allergy, foreign body, or an undetermined factor. Certain characteristics distinguish urethritis in the pediatric population from that in adults. First, urethritis in adults and adolescents has an infectious etiology and always is the result of sexual contact; infectious urethritis in the pediatric age group is uncommon, except in sexually active adolescents or children who have been sexually abused by an adult who has the disease. Second, the variability and nonspecificity of a variety of noninfectious urethral pathologies may mimic infectious urethritis in children. Children who have urethritis may present with irritative voiding symptoms, such as dysuria, urgency, or frequency; possible urethral discharge; initial hematuria; or blood spotting on the underwear. Patients suspected of having urethritis are evaluated with a detailed history, physical examination, urethral smear, or urine culture. In girls, examination may show evidence of vaginitis, which is a common cause of dysuria after urinary tract infection, labial adhesions, or even sexual abuse; in males, results of the examination frequently are inconclusive. In infants, young children, and sexually inactive adolescents, screening tests that have the highest yield include urinalysis and abdominal ultrasonography (US); uroflow is reserved for toilet-trained children. The urine should be examined for evidence of infection or hematuria. Abdominal US can diagnose a variety of abnormalities, including bladder stone or inflammation, ureterocele, foreign body, or tumor. Uroflow is a noninvasive urodynamics test that assesses the ability to initiate voiding on command, quantitates …

Older men's concerns about their urological health: a qualitative study.

While there has been widespread recent interest in men's health issues, and prostate cancer in particular, there have been few studies to determine which issues are important from the viewpoint of men themselves. This study was undertaken to identify genitourinary issues of concern to older men. A series of 19 focus groups involved 137 men and 14 women from a broad demographic background. Men expressed consistent concern about urinary symptoms, prostate cancer and sexual function. They revealed misunderstanding and a desire for more information about all issues. Urinary symptoms had a high impact on quality of life that could be made worse by environmental constraints such as working conditions and availability of toilets. Prostate cancer was a concern in all groups, even those at low risk, and men believed that screening for prostate cancer should be offered. Men believed sexuality was not recognised as an issue of concern to older people. Potential barriers to health action included stoicism, not talking about health issues and poor relationships with doctors. The study suggests a substantial need for community and professional education and for health promotion focused on preventable morbidity.

EPIDEMIOLOGY OF URINARY SYMPTOMS IN THE GERIATRIC POPULATION

As the US population ages, there is a growing need for information about the urologic health problems facing older adults. In conjunction with findings from clinical studies and basic research on biological mechanisms, the epidemiologic approach offers insights on the prevalence, etiology, and impact of these geriatric conditions. This information can provide the basis for planning health care services and intervention programs. The authors discuss trends associated with population aging and the challenges posed by the epidemiologic study of older adults. Also reviewed are current findings on the prevalence, incidence, and correlates of urinary incontinence and other common urologic symptoms.

Unification of urologic health care in Germany

I t is well known that standards in health care differ widely among developed countries of North America and Europe and in Japan in contrast to cbuntries in other parts of the world. Although this dilemma has been brought to our attention almost daily for many years, only recently have urologic initiatives focused on this increasing humanitarian problem. The issue is addressed more often at strategic planning conferences of the American Urological Association (AUA), European Association of Urology (EAU), Societe Internationale d’Urologie (SIU), and by many national urologic societies, particularly as a reaction to the dramatic political changes in eastern Europe and the subsequent need to deal with healthcare problems. The resulting activities of the various societies are examples of subsidarity, which is a basic sociologic principle meaning that we all have the responsibility to provide support and that we should not wait for political solutions for the many existing problems. Within a short period of time, many programs for support have been developed to pursue specific goals. They have one aspect in common: to increase and eventually adjust urologic health care on a global basis. Programs are now available to improve theoretical knowledge for those colleagues in the world who do not have the opportunity to receive a high standard of continuous postgraduate urologic education; other programs try to provide practical assistance or to provide financial and technical support. All these programs are necessary and certainly not competitive alternatives. Despite the fact that the different approaches are undoubtedly effective, it remains unclear in which sequence and to which extent the described concepts should be applied to be most effective. The principle of subsidarity has been the basis of many activities aimed at adjusting urologic health care within the unification process of the western and eastern part of Germany. Knowledge collected in this context may