The relationship between male genitourinary conditions and sleep disorders has previously only been reported in single-institution studies with small cohorts. Our objective was to assess the association of erectile dysfunction (ED) and testosterone deficiency with various sleep disorders using a large claims database. The TriNetX Diamond database was queried in June 2022. In men aged 40–70 years, insomnia, sleep apnea, and circadian rhythm sleep disorder were each independently assessed to determine the association with ED and testosterone deficiency and then followed by propensity score matching performed for age, hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, tobacco usage, and obesity. Testosterone deficiency was more likely to be found in men diagnosed with sleep apnea (odds ratio (OR) 1.66 [95% confidence interval (CI) 1.65–1.67]), insomnia (OR 1.74 [95% CI 1.73–1.76]), and circadian rhythm dysfunction (OR 2.63 [95% CI 2.54–2.73]) compared to matched controls. ED was more likely to be found in men diagnosed with sleep apnea (OR 1.02 [95% CI 1.01–1.03]), insomnia (OR 1.30 [95% CI 1.30–1.31]), and circadian rhythm dysfunction (OR 1.54 [95% CI 1.49–1.59]) compared to matched controls. Our results emphasize the negative impact of poor sleep on diseases of the male genitourinary system by identifying these relationships in the largest cohort in the U.S. reported to date.

You have accessJournal of UrologyPediatrics IV (MP55)1 May 2024MP55-13 CONTEMPORARY MANAGEMENT AND OUTCOMES OF PEDIATRIC PATIENTS WITH LOW-GRADE VS. HIGH-GRADE RENAL TRAUMA Logan Galansky, Andrew T. Gabrielson, Corey Able, and Chad Crigger Logan GalanskyLogan Galansky , Andrew T. GabrielsonAndrew T. Gabrielson , Corey AbleCorey Able , and Chad CriggerChad Crigger View All Author Informationhttps://doi.org/10.1097/01.JU.0001008616.01808.0f.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the last decade, management of renal trauma has shifted to favor observation for high-grade renal trauma (HGRT) in hemodynamically stable children. We hypothesized that there has been a decrease in surgical intervention for pediatric HGRT compared to historical rates, but that HGRT continues to be managed with more aggressive intervention than low-grade renal trauma (LGRT). METHODS: A retrospective cohort study was conducted using the TriNetX database between 2012-2023. Patients<20 years old presenting with renal trauma were queried. We used AAST grading to categorize injuries as either LGRT (I-III) or HGRT (IV-V). We analyzed evaluation and management strategies after index trauma event, including initial and subsequent surveillance imaging modality, interventions within one week of trauma, and long-term sequela outcomes from 1 month to 5 years. RESULTS: A total of 1,997 renal trauma patients were identified (526 HGRT, 1,471 LGRT). Abdominal/retroperitoneal ultrasound and multi-phase CT were used at similar rates during the index trauma between groups, but those with HGRT were more likely to have additional imaging with abdominal/pelvic plain films. The most common management strategy in both groups was observation (95% vs. 84%, p<0.01), but those with HGRT were more likely to require transfusion (37% vs. 26%, p<0.01), embolization (6% vs. 3%, p<0.01), exploratory laparotomy (6% vs. 3%, p<0.01), and/or nephrectomy (4% vs. 0%, p<0.01). For surveillance, most patients were followed with renal ultrasound. There was no difference in rates of subsequent hypertension (11% vs. 10%, p=0.5), CKD (4% vs. 3%, p=0.2), need for renal replacement therapy (1% vs. 0.5%, p=0.4), depression (4% vs. 3%, p=0.9), or anxiety (9% vs. 8%, p=0.7). CONCLUSIONS: Historically, pediatric HGRT management included surgical intervention in as high as 36% of patients. In this contemporary cohort, we observed much lower utilization of surgical interventions for HGRT, with observation as the most common current management strategy. Although LGRT was managed almost exclusively with observation, we observed similar rates of subsequent hypertension, CKD, and psychological sequela among patients with LGRT and HGRT, suggesting that even LGRT warrants continued follow-up and psychological support. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e921 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Logan Galansky More articles by this author Andrew T. Gabrielson More articles by this author Corey Able More articles by this author Chad Crigger More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyPediatrics II (MP21)1 May 2024MP21-20 NATIONAL POSTOPERATIVE OPIOID PRESCRIBING RATES FOLLOWING PEDIATRIC UROLOGY PROCEDURES BEFORE AND AFTER THE 2018 AMERICAN ACADEMY OF PEDIATRICS CHALLENGE TO REDUCE OPIOID PRESCRIBING: A CLAIMS DATABASE ANALYSIS Corey A. Able, Courtney Stewart, Andrew Gabrielson, Tyler Overholt, Steven Banner, Kelli Gilliam, Aditya Srinivasan, Nora Haney, Taylor P. Kohn, Chad Crigger, and Jonathan Gerber Corey A. AbleCorey A. Able , Courtney StewartCourtney Stewart , Andrew GabrielsonAndrew Gabrielson , Tyler OverholtTyler Overholt , Steven BannerSteven Banner , Kelli GilliamKelli Gilliam , Aditya SrinivasanAditya Srinivasan , Nora HaneyNora Haney , Taylor P. KohnTaylor P. Kohn , Chad CriggerChad Crigger , and Jonathan GerberJonathan Gerber View All Author Informationhttps://doi.org/10.1097/01.JU.0001008844.84871.17.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In 2018, the American Academy of Pediatrics challenged physicians to reduce opioid prescribing to pediatric patients. In this study, we evaluate the overall rates and trends of pediatric urology opioid prescriptions. METHODS: We queried the TriNetX Research database and included children under age 18 who underwent circumcision, hydrocelectomy, inguinal hernia repair, orchiopexy, hypospadias repair, pyeloplasty, or ureteral reimplantation who received an oral opioid prescription within five days of surgery. Patients were excluded if they had any concomitant surgery. The primary analysis evaluated the total rate of opioid prescriptions (number of patients prescribed opioids/number of procedures) using 3 month intervals from January 2010 to December 2022. Secondary analysis was performed by procedure, race (White, Black, Hispanic), age (0 to 5, 6 to 10, 11 to 18), and United States region (West, Midwest, South, Northeast). An interrupted time series linear regression analysis was used to assess trends before and after the challenge. Statistical significance was set at p<0.05. RESULTS: A total of 77,823 pediatric cases were identified, 25,617 (32.92%) of which received an opioid prescription. Figure 1 displays the rate of pediatric urology opioid prescriptions over time. In December 2022, 24.4% of patients received an opioid prescription. Opioids were prescribed for 29.8% of circumcisions, 39.6% of hypospadias repairs, 25.8% of hydrocelectomies, 42.7% of pyeloplasties, and 42.8% of ureteral reimplants. Table 1 displays the trends before and after the challenge for each cohort. CONCLUSIONS: We conclude that prescription rates remain high but have steadily decreased since the AAP statement. Additionally, the racial and age prescription disparities warrant further evaluation. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e338 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Corey A. Able More articles by this author Courtney Stewart More articles by this author Andrew Gabrielson More articles by this author Tyler Overholt More articles by this author Steven Banner More articles by this author Kelli Gilliam More articles by this author Aditya Srinivasan More articles by this author Nora Haney More articles by this author Taylor P. Kohn More articles by this author Chad Crigger More articles by this author Jonathan Gerber More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To evaluate trends in opioid prescribing rates following pediatric urologic surgery.METHODS:We queried the TriNetX Research database for patients under age 18 who underwent one of seven common pediatric urology procedures. We identified the proportion of patients that received an oral opioid prescription within 5days of surgery. The primary analysis evaluated the trend in postoperative opioid prescriptions using 3-month intervals from January 2010 to December 2022. We performed an interrupted time series analysis assessing trends in opioid prescribing patterns both before and after the American Academy of Pediatrics challenge.RESULTS:Of the 81,644 pediatric urology procedures, 29,595 (36.2%) received a postoperative opioid prescription, including 29.8% of circumcisions, 25.8% of hydrocelectomies, 39.6% of hypospadias repairs, 42.7% of pyeloplasties, 42.8% of ureteral reimplants. For all procedures we observed rising rates of opioid prescribing, increasing by 0.9% per 3-month interval prior to the challenge statement release from 2010 to 2018. We observed an overall significant decrease in opioid prescribing by 2.2% per 3-month interval following the challenge statement release. Additionally, since 2018, there was a significant decrease in opioid prescribing in all of the race, ethnicity, and age cohorts.CONCLUSION:Opioid prescribing following pediatric urology procedures has sharply decreased following the 2018 American Academy of Pediatrics challenge statement which underscores the value of cross-specialty quality improvement initiatives. Nonetheless, opioid prescribing remains high with potential racial or age disparities that warrant further investigation.

Background: This study aims to compare perioperative morbidity and drainage tube dependence following open radical cystectomy (ORC) with ileal conduit (IC) or cutaneous ureterostomy (CU) for bladder cancer. Methods: A single-center, retrospective cohort study of patients undergoing ORC with IC or CU urinary diversion between 2020 and 2023 was carried out. The 90-day perioperative morbidity, as per Clavien–Dindo (C.D.) complication rates (Minor C.D. I–II, Major C.D. III–V), and urinary drainage tube dependence (ureteral stent or nephrostomy tube) after tube-free trial were assessed. Results: The study included 56 patients (IC: 26, CU: 30) with a 14-month median follow-up. At 90 days after IC or CU, the frequencies of any, minor, and major C.D. complications were similar (any—69% vs. 77%; minor—61% vs. 73%; major—46% vs. 30%, respectively, p > 0.2). Tube-free trial was performed in 86% of patients with similar rates of tube replacement (19% IC vs. 32% CU, p = 0.34) and tube-free survival at 12 months was assessed (76% IC vs. 70% CU, p = 0.31). Conclusions: Compared to the ORC+IC, ORC+CU has similar rates of both 90-day perioperative complications and 12-month tube-free dependence. CU should be offered to select patients as an alternative to IC urinary diversion after RC.

Semaglutide was approved in June 2021 for weight loss in non-diabetic, obese patients. While package inserts include sexual dysfunction as a side effect, no study has assessed the degree of this risk. The objective of our study is to assess the risk of developing erectile dysfunction after semaglutide is prescribed for weight loss in obese, non-diabetic men. The TriNetX Research database was used to identify men without a diagnosis of diabetes ages 18 to 50 with BMI > 30 who were prescribed semaglutide after June 1st, 2021. Men were excluded if they had a prior erectile dysfunction diagnosis, any phosphodiesterase-5 inhibitors prescription, intracavernosal injections, penile prosthesis placement, history of testosterone deficiency, testosterone prescription, pelvic radiation, radical prostatectomy, pulmonary hypertension, or were deceased. We further restricted our cohort to non-diabetic, obese men by excluding men with a prior diabetes mellitus diagnosis, a hemoglobin A1c > 6.5%, or having ever received insulin or metformin. Men were then stratified into cohorts of those that did and did not receive a semaglutide prescription. The primary outcome was the risk of new ED diagnosis and/or new prescription of phosphodiesterase type 5 inhibitors at least one month after prescription of semaglutide. The secondary outcome was risk of testosterone deficiency diagnosis. Risk was reported using risk ratios with 95% confidence intervals (95% CI). 3,094 non-diabetic, obese men ages 18-50 who received a prescription of semaglutide were identified and subsequently matched to an equal number cohort of non-diabetic, obese men who never received a prescription of semaglutide. After matching, average age at index prescription for non-diabetic, obese men was 37.8 +/- 7.8 and average BMI at index prescription was 38.6 +/- 5.6. Non-diabetic men prescribed semaglutide were significantly more likely to develop erectile dysfunction and/or were prescribed phosphodiesterase type 5 inhibitors (1.47% vs 0.32%; RR: 4.5; 95% CI [2.3, 9.0]) and testosterone deficiency (1.53% vs 0.80%; RR: 1.9; 95% CI [1.2, 3.1]) when compared to the control cohort of non-diabetic men who never received a semaglutide prescription.

We investigated the prevalence, incidence, and rates of pharmacological treatment of delayed ejaculation using the TriNetX Diamond Network. We included all men evaluated in the inpatient, outpatient, and emergency settings. Prevalence was determined by comparing the number of men diagnosed with delayed ejaculation to the entire population. Incidence was determined by comparing the number of men diagnosed with delayed ejaculation without a prior diagnosis to the overall population without a prior diagnosis. Rates of pharmacologic treatment were calculated by comparing the number of men who received a prescription to the total number of men with delayed ejaculation. Trends in prevalence and incidence were compared using six-month intervals, while trends in pharmacologic treatment were compared using one-year intervals. A total of 23,164 adult males were diagnosed with delayed ejaculation from 2013 to 2019. During the final six-month interval (July to December 2019), 2,747 of 16,496,744 men received a delayed ejaculation diagnosis, and 1,375 of 16,488,270 men without a prior diagnosis were diagnosed with delayed ejaculation. In 2019, only 916 of 4,733 (19.4%) men diagnosed with delayed ejaculation received any prescription, with the most common being testosterone (9.5%), bupropion (6.6%), and buspirone (2.3%). Prevalence, incidence and pharmacologic treatment all had increasing trends.

Pharmacovigilance databases are important for tracking rare adverse events associated with medications. Approximately 51 new drugs are approved each year by the United States Federal Drug Agency and rare adverse events may be too infrequent to be detected in pre-approval clinical trials, thus the importance of these ongoing pharmacovigilance databases. Using the Federal Drug Agency pharmacovigilance databases, Schifano et al. found trazadone, olanzapine, and tadalafil had a higher risk of causing priapism compared to other medications within this database. We attempted to validate these findings using a large US claims database to assess the frequency of priapism diagnosis within 6 months of prescribing medications identified by Schifano et al. (trazodone, quetiapine, risperidone, olanzapine, aripiprazole, tadalafil, sertraline, sildenafil, methylphenidate, alprostadil, and clozapine). On propensity-matched retrospective cohort analysis with 3.4 million men exposed to the drugs of interest with 3.4 million propensity-matched controls. We find that trazadone and tadalafil were associated with increased risk of priapism – risk ratio [RR] 1.73, 95% Confidence Interval [CI] 1.28–2.34 and (RR: 3.00, 95% CI 2.19–4.11), respectively. Sildenafil was also found to be associated with increased risk of priapism diagnosis (RR: 1.77, 95% CI 1.37–2.29). The antipsychotic quetiapine, a second-generation antipsychotic like olanzapine, had the greatest association with a diagnosis of priapism (RR 3.50, 95% CI 1.93–6.34). Some analyses were unable to be performed, such as for alprostadil and olanzapine, as low number of patients having received a prescription for these medications resulted in a propensity-matched control group that was too small to accurately assess the risk ratio for the incidence of priapism. We confirm the findings of Schifano et al. describing the increased risk of priapism associated with prescriptions of trazadone, tadalafil, sildenafil, and second-generation antipsychotics.

BACKGROUND:The effects of bariatric surgery on testosterone levels in men with obesity and hypogonadism have not been thoroughly explored yet. OBJECTIVES:To investigate the possible effects of bariatric surgery on T levels in obese hypogonadal men by comparing T levels before and after surgery using a comprehensive claims database. MATERIALS AND METHODS:The TriNetX US Collaborative Network database was used to identify men ages 18-80 who underwent a bariatric procedure and had a serum T value of < 350 ng/dL prior to surgery. Men who received testosterone therapy before/or after surgery were excluded. We conducted a retrospective self-matched cohort analysis to examine the difference in serum T levels before and after bariatric surgery. A sub-analysis was carried out to explore differences between men who reached eugonadal status or maintained low T levels following surgery. Descriptive statistics detailed sociodemographic and clinical characteristics, with continuous and categorical data compared using unpaired t-tests and chi-square analysis, respectively. Changes in T levels and body mass index (BMI) before and after surgery were compared using an unpaired t-test with a < 0.05 set for significance. All analyses were conducted using the TriNetX platform which utilizes both Python and R software. RESULTS:The study analyzed 69 hypogonadal men who underwent bariatric surgery and had T levels assessed before and after the procedure. The mean (standard deviation) pre-surgery serum T level was 208 ± 79 ng/dL, which post-surgery increased to 371 ± 164 ng/dL, marking an average increase of 163 ± 164 ng/dL. Likewise, the mean (standard deviation) body mass index decreased from 42.9 ± 9.0 to 38.8 ± 5.7 kg/m2. Post-surgery, 45% (31 men) achieved eugonadal status, while 55% (38 men) continued to have low T levels. A comparison between the post-surgery eugonadal cohort and the persistent low T cohort revealed that the former had higher pre-surgery serum T levels (235 ± 71 ng/dL vs. 184 ± 80.4 ng/dL, p = 0.007), a higher pre-surgery body mass index (45.5 ± 4.5 kg/m2 vs. 41.1 ± 11.5 kg/m2, p = 0.041), and a significantly greater reduction in body mass index post-surgery (7.3 ± 7.2 kg/m2 vs. 2.0 ± 12.8 kg/m2, p = 0.04). Notably, the increase in T was significantly higher in the eugonadal cohort compared to the persistent low testosterone cohort (257 ± 143 ng/dL vs. 95 ± 178 ng/dL, p < 0.0001). CONCLUSION:This study provides evidence of bariatric surgery's positive effect on serum T levels in obese men with baseline low T. Almost one out of two men with low T reached normal T levels after bariatric surgery. As the most comprehensive study to date, it validates and substantiates previous work suggesting that weight loss can improve T levels physiologically.

No study has yet assessed the risk of developing erectile dysfunction (ED) after a diagnosis of long COVID, defined by the Centers for Disease Control and Prevention as the persistence or presence of new symptoms at least 4 weeks after initial SARS-CoV-2 infection, when compared to those diagnosed with acute COVID or cases in which more severe treatment is required. To assess these risks, we queried the TriNetX COVID-19 Research Network from December 1st 2020 through June 2023. Men aged ≥ 18 diagnosed with long COVID were compared to those diagnosed with acute COVID and analyses were performed to compare men who were/were not hospitalized within 1 month of acute COVID diagnosis and men who did/did not need vasopressors. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). After propensity score matching, the long and acute COVID cohorts included 2839 men with an average age of 54.5±16.7 and 55.1±17.1 years respectively (p = 0.21). Men with long COVID were more likely to develop ED or be prescribed PDE5i (3.63%) when compared to men with only acute COVID infections (2.61%) [RR 1.39; 95% CI 1.04, 1.87]. There was no statistically significant risk of developing ED or being prescribed PDE5i for individuals who received vasopressors [RR 0.92; 95% CI 0.77,1.10] or were hospitalized [RR 0.93; 95% CI 0.82,1.06].

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Pelvic Organ Prolapse and Reconstructive Surgery (Including Non-trauma Related Fistula and Urethral Diverticulum) (PD24)1 May 2024PD24-07 PERSISTENT OPIOID USE DISORDER FOLLOWING UROGYNECOLOGICAL PROCEDURES: AN ANALYSIS USING A CLAIMS DATABASE Brian Liao, Corey Able, Kevin Vu, and Bilal Farhan Brian LiaoBrian Liao , Corey AbleCorey Able , Kevin VuKevin Vu , and Bilal FarhanBilal Farhan View All Author Informationhttps://doi.org/10.1097/01.JU.0001008840.07763.8d.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic organ prolapse (POP) and urinary incontinence affect over 40% of women globally. Surgical interventions like POP repair and urethral sling are common treatments. We aim to investigate the link between perioperative opioid use and the development of persistent opioid use disorder (POUD). METHODS: Using the TriNetX Research database (2009-2023), we studied adult women (≥18 years) undergoing sling surgery or POP repair. Exclusions included diagnoses of dyspareunia, vulvodynia, interstitial cystitis, concurrent hysterectomy, prior opioid use, or additional surgeries within 9 months post-procedure. Propensity-score matching was performed for demographic factors and comorbidities including anxiety, depression, tobacco and alcohol use. Perioperative opioid use was defined as opioid prescription within 5 days post-procedure. POUD was defined as opioid prescription 3-9 months post-surgery. Cohorts were stratified based on sling only, POP repair only, or combined procedure. Rates of POUD were compared between cohorts receiving perioperative opioids and those not. Relative risk (RR) with 95% confidence intervals were calculated. RESULTS: After matching, 2,442 urethral slings, 2,939 POP repairs, and 1,542 combined sling and POP repair cases were compared to an equal number of matched controls. Perioperative opioid use increased POUD risk in urethral sling (RR 3.0, CI [1.7 – 5.4]), POP repair (RR 3.2, CI [1.8 – 5.8]), and combined procedures (RR 2.5, CI [1.2 – 5.2]). POUD rates in women with perioperative opioid usage were 1.8% for slings, 1.5% for POP repair, and 1.6% for combined surgery. Refer to Table 1 for postoperative opioid use rates and demographic characteristics. CONCLUSIONS: Our study reveals a significant risk of POUD when opioids are prescribed within five days of POP repair and sling surgery. These findings underscore the long-term health consequences of early postoperative opioid prescriptions. Further research is crucial to develop opioid-sparing pain management strategies for urogynecological procedures. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e533 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Brian Liao More articles by this author Corey Able More articles by this author Kevin Vu More articles by this author Bilal Farhan More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD37)1 May 2024PD37-04 THE EFFECT OF ADOLESCENT CHEMOTHERAPY ON RISK OF FUTURE TESTOSTERONE DEFICIENCY IN YOUNG ADULTS—A CLAIMS DATABASE ANALYSIS Courtney A. Stewart, Steven Banner, Pranjal Agrawal, Mark Alshak, Corey Able, Aurora Grutman, Andrew Gabrielson, Nora Haney, and Taylor Kohn Courtney A. StewartCourtney A. Stewart , Steven BannerSteven Banner , Pranjal AgrawalPranjal Agrawal , Mark AlshakMark Alshak , Corey AbleCorey Able , Aurora GrutmanAurora Grutman , Andrew GabrielsonAndrew Gabrielson , Nora HaneyNora Haney , and Taylor KohnTaylor Kohn View All Author Informationhttps://doi.org/10.1097/01.JU.0001009464.98066.03.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Male adolescents with cancer requiring chemotherapy have been shown to be at risk of future infertility due to the negative impact of chemotherapy on spermatogenesis, however, the risk of future testosterone deficiency has not been as well-established as studies have been limited by small sample sizes.Our objective was to assess the association of adolescent chemotherapy with testosterone deficiency and erectile dysfunction (ED) using a large national claims database. METHODS: Searching the TriNetX Research network from 2010 through July 2023, our study cohort included males age ≤35-years who were diagnosed with a neoplasm and treated with chemotherapy at or before the age 18 years. Patients receiving chemotherapy after the age of 18-years or with a history of testicular cancer were excluded. Our control cohort included males age ≤35-years with no history of neoplasm or chemotherapy. Both cohorts excluded men with mortality, Klinefelter's Disease, undescended testicles, orchiectomy, usage of anabolic steroids, personal history of irradiation, or history of isotretinoin use. Propensity score matching was performed for multiple covariates (Table 1). Study outcomes were risk of developing testosterone deficiency or erectile dysfunction. RESULTS: 1,417 men with a history of chemotherapy were compared to propensity-score matched controls. The average age of initiation of chemotherapy was 15.0±2.8 and the average age at follow-up was 24.6±4.1. Overall, 2.4 % of men with a history of adolescent chemotherapy were diagnosed with testosterone deficiency or had a total testosterone value<300. This was significantly higher than in controls (0.75%) (RR 3.2, 95% CI [1.6 – 6.2]). When assessing 232 men receiving alkylating chemotherapeutic agents with an equal number of matched controls, rates of testosterone deficiency was 4.3% versus 0.86% in controls (RR 5.0, 95% CI [1.11 – 22.6]).Rates of ED diagnosis or new prescriptions for PDE5i were not statistically different between the two cohorts (0.9% in men with a history of adolescent chemotherapy versus 1.5% in those without a history of chemotherapy) (RR 0.59, 95% CI [0.30 – 1.17]). CONCLUSIONS: These results demonstrate that men with a history of adolescent chemotherapy were at higher risk of future testosterone deficiency in their early adulthood years. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e800 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Courtney A. Stewart More articles by this author Steven Banner More articles by this author Pranjal Agrawal More articles by this author Mark Alshak More articles by this author Corey Able More articles by this author Aurora Grutman More articles by this author Andrew Gabrielson More articles by this author Nora Haney More articles by this author Taylor Kohn More articles by this author Expand All Advertisement PDF downloadLoading ...

It is unknown if the risk of erectile dysfunction (ED) following Coronavirus-19 (COVID-19) infection is virus-specific. Our study assessed the risk of ED in COVID-19 patients as compared to patients with other common viral infections. The TriNetX COVID-19 Research Network was queried. We examined cohorts of men aged ≥18 years infected with: COVID-19, influenza, respiratory syncytial virus, enterovirus, acute viral hepatitis, mononucleosis, and herpes zoster. Men were included if they had at least one outpatient follow-up visit within 18 months and excluded if they had one of the other viruses of interest or a prior ED diagnosis or treatment, prostatectomy, pelvis radiation, or chronic hepatitis infection. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). COVID-19 positive men were less likely to develop ED or have a PDE5i prescription than men with infected with herpes zoster [Relative Risk (RR): 0.37, 95% Confidence Interval (CI) 0.27–0.49] and more likely to develop ED or have a PDE5i prescription than men with no acute viral illness (RR: 1.33, 95% CI 1.25–1.42). In this national propensity-matched cohort study comparing post-infection ED risk and PDE5i prescriptions, we found that COVID-19 was no more likely to result in a diagnosis of ED or prescription of PDE5i when compared to all acute viral illnesses except herpes zoster, which was more likely to result in a diagnosis of ED or prescription of PDE5i when compared to COVID-19. These findings suggest an inflammatory etiology (perhaps due to cytokine release, endothelial dysfunction, or blunted hormone signaling) behind any acute infection can result in a heightened ED risk; however, further studies are required to investigate the connection between other viral infections and ED.

You have accessJournal of UrologyCME1 Apr 2023MP61-10 URINARY FUNCTIONAL OUTCOMES OF RADICAL PROSTATECTOMY VS. RADIATION THERAPY FOR PROSTATE CANCER FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Alex Piroozi, Austen Slade, RJ Caras, T. Max Shelton, Udit Vyas, Katrina Collins, Omar Ishaq, Mohamed Elsaqa, Corey Able, Ronald Boris, Marawan M. El tayeb, Marcelino Rivera, and James Lingeman Alex PirooziAlex Piroozi More articles by this author , Austen SladeAusten Slade More articles by this author , RJ CarasRJ Caras More articles by this author , T. Max SheltonT. Max Shelton More articles by this author , Udit VyasUdit Vyas More articles by this author , Katrina CollinsKatrina Collins More articles by this author , Omar IshaqOmar Ishaq More articles by this author , Mohamed ElsaqaMohamed Elsaqa More articles by this author , Corey AbleCorey Able More articles by this author , Ronald BorisRonald Boris More articles by this author , Marawan M. El tayebMarawan M. El tayeb More articles by this author , Marcelino RiveraMarcelino Rivera More articles by this author , and James LingemanJames Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is a well-documented finding in Holmium Laser Enucleation of the Prostate (HoLEP); however, there is little data on the outcomes of patients who underwent HoLEP followed by definitive therapy for subsequent prostate cancer diagnosis. We sought to compare the urinary functional outcomes after undergoing radical prostatectomy or external beam radiation for prostate cancer following HoLEP. METHODS: All patients from 2010 to 2021 at Indiana University and Baylor Scott and White Hospitals who underwent radiation or prostatectomy for treatment of prostate cancer after HoLEP were included. We performed a retrospective analysis of their urinary function with greater than 1-year post-treatment American Urological Association Symptom Index (AUA), Quality of Life (QOL), and incontinence follow up. Incontinence was defined as patient reported leakage of any urine. RESULTS: There were 33 radical prostatectomy and 36 radiation patients who met the inclusion criteria. There was no statistical significance between the mean AUA scores of greater than 1-year post-prostatectomy patients (7.69) and post-radiation patients (8.08) (p=0.8175). Similarly, there was no statistical significance between the QOL scores of greater than 1-year post-prostatectomy patients (1.96) and post-radiation patients (2.00) (p=0.9175). There is a statistically significant decrease in complaints of incontinence in greater than 1-year post-radiation patients (28%) compared to post-prostatectomy patients (73.3%) (p=0.0017). There was also a significant difference between mean age of the prostatectomy group (66.4 years) and the radiation group (75.3 years) (p<0.001). There was no significant difference in BMI, pre-HoLEP prostate size, pre-HoLEP AUA score, or pre-HoLEP QOL score between the groups. CONCLUSIONS: Radical prostatectomy and radiation provide similar AUA and QOL symptom scores for prostate cancer patients who previously underwent HoLEP, with radiation associated with decreased incidence of incontinence. Patients specifically concerned with the risk of incontinence following prostate cancer treatment may consider the increased risk from a prostatectomy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e856 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Piroozi More articles by this author Austen Slade More articles by this author RJ Caras More articles by this author T. Max Shelton More articles by this author Udit Vyas More articles by this author Katrina Collins More articles by this author Omar Ishaq More articles by this author Mohamed Elsaqa More articles by this author Corey Able More articles by this author Ronald Boris More articles by this author Marawan M. El tayeb More articles by this author Marcelino Rivera More articles by this author James Lingeman More articles by this author Expand All Advertisement PDF downloadLoading ...

Objective To assess the role of influential figures within social media (SoMe) in driving future citations. Methods All original articles published in the Journal of Urology and European Urology in 2018 were identified. For each article, number of mentions on any SoMe platform, article's Twitter reach, and total citations were collected. Article characteristics such as type of study, article topic, and open access status were identified. Total academic research output was obtained for first and last authors of included articles. Influential SoMe figures were defined as users that tweeted about included articles and had over 2000 followers. For these accounts, we collected total followers, total tweets, engagement statistics, verification status, and academic characteristics such as total citations and total prior publications. The impact of SoMe, article, and academic characteristics on future citations was assessed using panel data regression analysis. Results We identified 394 articles with 8895 total citations and 460 SoMe influencers. On panel data regression modeling, tweets about a specific article were associated with future citations (0.17 citations per tweet about an article, P < .001). SoMe influencer characteristics were not associated with increased citations (P > .05). The following non-SoMe-associated characteristics were predictive of future citations (P < .001): study type (prospective studies received 12.9 more citations than cross-sectional studies), open access status (4.3 citations more if open access, P < .001), and previously well-published first and last authors. Conclusion While SoMe posts are associated with increased visibility and higher future citation rates, SoMe influencers do not appear to drive these outcomes. Instead, high quality and accessibility were more predictive of future citability.

OBJECTIVE To assess the risk of persistent opioid use following various urologic procedures in adolescents and young adults.MATERIALS AND METHODS The TriNetX LLC Diamond Network was queried for patients aged 13-21 years who underwent pyeloplasty, hypospadias repair, inguinal hernia repair, inguinal orchiopexy, hydrocelectomy, or circumcision. Cohorts of patients prescribed and not prescribed postoperative opioids were created and propensity-matched for age, race/ethnicity, psychiatric diagnoses, and preoperative pain diagnoses. The primary outcome was new persistent opioid use, defined as new opioid use 3-9 months after index procedure without another surgery requiring anesthesia during the post-operative timeframe.RESULTS Of 32,789 patients identified, 66.0% received a postoperative opioid prescription. After pro-pensity score matching for each procedure, 18,416 patients were included: 197 for pyeloplasty, 469 for hypospadias repair, 1818 for inguinal hernia repair, 2664 for inguinal orchiopexy, 534 for hydrocelectomy, and 3526 for circumcision. Overall, 0.41% of patients who did not receive postoperative opioids developed new persistent opioid use, whereas 1.69% of patients who re-ceived postoperative opioids developed new persistent opioid use (P < .05). Patients prescribed postoperative opioids had statistically higher odds of developing new persistent opioid use for hypospadias repair (RR: 17.0; 95% CI: 2.27-127.2), inguinal orchiopexy (RR: 3.46; 95% CI: 1.87-6.4), inguinal hernia repair (RR: 2.18; 95% CI: 1.07-4.44), and circumcision (RR: 4.83; 95% CI: 2.60-8.98).CONCLUSION The use of postoperative opioids after urological procedures in adolescents and young adults is associated with a significant risk of developing new persistent opioid use. UROLOGY 182: 211-217, 2023.(c) 2023 Elsevier Inc. All rights reserved.

To characterize U.S. vasectomy rates in men undergoing clinical evaluation before and after the reversal of Roe v. Wade and investigate the impact of demographic and geographic variables. Dobbs vs. Jackson Supreme Court ruling: a stimulant of male reproductive responsibilityFertility and SterilityVol. 120Issue 1PreviewThe Dobbs vs. Jackson decision in June 2022 caused an overnight halt on abortion care in many states in the United States and changed the scope of reproductive care in women’s health. A leaked draft 2 months prior fueled speculation leading up to the decision, which predicted the pending reversal ruling would have a major impact on obstetric and gynecology provider training, female reproductive care, and women’s wellbeing (1). However, an immediate influence was also seen in men’s reproductive health, with countless reports of increased vasectomy internet searches within the first month after the reversal (2). Full-Text PDF

Our objective was to analyze the rates of erectile dysfunction and Peyronie’s disease following a penile fracture using a large, multi-institutional claims database. Inclusion criteria included men ages 15 or older with a diagnosis of penile fracture and any office visit within 5 years of the penile fracture. Exclusion criteria included prior erectile dysfunction, prescription of erectile aids, or penile prosthesis placement. Our primary outcome was the diagnosis of erectile dysfunction or prescription of phosphodiesterase-5 inhibitors within 5 years. A secondary analysis assessed rates of Peyronie’s disease following penile fracture. 1242 men were identified with penile fracture and subsequently matched to men without penile fracture, resulting in equal cohorts of 1227 men. Men with a history of penile fracture were more likely to receive a diagnosis of erectile dysfunction or require phosphodiesterase-5 inhibitors (RR 3.18, 95% CI: 2.30–4.40). Men who did not undergo immediate repair had higher rates of erectile dysfunction or treatment (RR: 1.84, 95% CI: 1.22–2.78). Men over the age of 45 years who had a penile fracture were more likely to develop erectile dysfunction or treatment compared to men under 45 years (RR: 1.65, 95% CI: 1.14–2.39). Rates of Peyronie’s disease were higher in men with a history of penile fracture (5.8% vs 0%, p < 0.0001). Rates of Peyronie’s disease were lower if immediate repair of the fracture was performed (RR: 0.20, 95% CI: 0.10–0.41). Men over the age of 45 years with penile fracture were more likely to develop Peyronie’s Disease within 5 years compared to men under the age of 45 years penile fracture (RR: 3.72, 95% CI: 1.94–7.16). Penile fracture increases the risk of both erectile dysfunction and Peyronie’s disease, especially those treated with conservative measures or over the age of 45 years compared to patients under 45 years with a penile fracture.