OBJECTIVE To examine the association between male factor infertility and the Rural-Urban continuum. MATERIALS AND METHODS Single institution retrospective cohort study using the Utah Population Database, which combines demographic, medical, and residential data for patients residing in Utah and links to the Subfertility Health Assisted Reproduction and Environment database, which houses fertility data from 1998 to 2017. The data was divided by metropolitan (metro-) (large, medium, small) and non-metropolitan (non-metro-) (urban, rural) status, based on United States Department of Agriculture rural-urban continuum codes. RESULTS Non-metro urban/rural males were less likely to be a racial/ethnic minority (92.3% non- Hispanic white vs 86.2%) or use assisted reproductive technology (13.5% vs 18.5%). Multivariate regression controlling for race/ethnicity, age, semen analysis category (oligozoospermic vs normozoospermic), previous successful fertility outcome, and use of assisted reproductive technology, demonstrated complete rurality was associated with decreased likelihood of successful fertility outcome (Hazard Ratio [HR] 0.60, 95% CI 0.41-0.87, n = 49, P = 0.007). Non-metro urban individuals trended towards lower likelihood of successful fertility outcome ([HR] 0.90, 95% CI 0.82-0.98, P = 0.02). Complete rurality was associated with longer time for 50% cohort successful fertility outcome (> 60 months vs approximately 34 months both metro), P = .007. CONCLUSION Across the rural-urban continuum, residing in a metro area was associated with higher rates of racial/ethnically diversity, fertility treatment utilization, and successful fertility outcomes (live births). Given approximately 18% of the United States resides with a rural community (12% in Utah), these findings can provide more informed infertility care. UROLOGY 197: 90-97, 2025. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Abstract Introduction Cancer treatment can affect fertility, but assessing infertility risk accurately remains challenging, leading to inconsistent discussions during cancer care. This study aims to assess semen analysis parameters, the gold standard for male fertility evaluation, in young adult oncology patients undergoing fertility preservation interventions post-treatment for the four most common cancers in this age group: testicular, lymphoma, central nervous system (CNS), and melanoma. Objective To examine the impact of common YA oncologic diagnoses on future fertility. Methods We evaluated semen analysis changes in Adolescent Young Adult (AYA) oncology patients, aged 15-39, who underwent fertility evaluation. Using a statewide patient database linked to the Subfertility Health Assisted Reproduction and Environment (SHARE) databases, we identified patients who had one or more semen analyses before and after diagnosis between 1998-2017. Multivariate analyses tested the influence of time from cancer diagnosis and cancer type on semen parameters (concentration, total sperm count, total motility). Results The cohort included 58 individuals, primarily Non-Hispanic White (94.8%), with testis-related conditions being most common (46.6%), followed by lymphoma (24.1%), CNS disorders (20.7%), and melanoma (8.6%). Mean age at diagnosis was 29 years. Semen parameters showed no significant difference post-diagnosis compared to pre-diagnosis, though concentration and total sperm count trended downward. Sperm concentration was significantly lower in the testis diagnosis group mean 17.3 M/mL, SD 13.2) versus CNS (mean 87.8, SD 79.3, P = 0.04), with a trend toward decrease relative to lymphoma and melanoma. Total motility was significantly lower in the testis diagnosis group (mean 50.4%, SD 26.4) versus CNS (mean 65.5%, SD 19.6, P = 0.02) and a trend toward decreased motility relative to the melanoma group (mean 66.5%, SD 17.8, P = 0.09). Conclusions AYA survivors of testis conditions showed decreased semen health parameters compared to other common cancer diagnoses. Fertility discussions with AYA survivors should consider developmental stage and emotional resilience. Multidisciplinary care teams are crucial for offering optimal fertility advice and care given the limited understanding of cancer treatment impacts on fertility outcomes. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: StreamDx, Inherent Bioscience, Turtle Health, Maimus, Carrot Fertility.

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP13)1 May 2024MP13-08 FERTILITY OUTCOMES ACROSS THE RURAL-URBAN CONTINUUM Devon M. Langston, Kiarad Fendereski, Joshua Halpern, Ijeoma Ika, Kenneth Aston, Elizabeth Ferlic, Ben Emery, Joemy M. Ramsay, Joshua Horns, and James Hotaling Devon M. LangstonDevon M. Langston , Kiarad FendereskiKiarad Fendereski , Joshua HalpernJoshua Halpern , Ijeoma IkaIjeoma Ika , Kenneth AstonKenneth Aston , Elizabeth FerlicElizabeth Ferlic , Ben EmeryBen Emery , Joemy M. RamsayJoemy M. Ramsay , Joshua HornsJoshua Horns , and James HotalingJames Hotaling View All Author Informationhttps://doi.org/10.1097/01.JU.0001008832.14212.d6.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infertility impacts approximately 20% of couples due to male factors alone. The gold standard for assessing male factor infertility (MFI) is a semen analysis (SA) to identify sperm defects that inhibit conception via intercourse. Studies have identified factors influencing male factors including socioeconomic status, but the impact of rurality residence on male factors is underexplored. Our aim was to examine the differences in fertility outcomes among sub-fertile males across the Rural—Urban continuum. METHODS: Our male patient cohort was identified using the Utah Population Database (UPDB), which combines demographic, medical, and residential data for patients residing in Utah. We linked patients to the Subfertility Health Assisted Reproduction and Environment (SHARE) database, which houses fertility data for 13,873 men in our final cohort who underwent semen analysis between 1998-2017. The data was divided by metropolitan (metro-) [large, medium, small], and non-metropolitan (non-metro-) [urban, rural] status, based on United States Department of Agriculture (USDA) rural-urban continuum codes (RUCC). RESULTS: Non-metro urban/rural males were less likely to be racial minority (91.3% non-Hispanic white vs 85.7%), and less likely to use assisted reproductive technology (ART) (13.4% vs 18.5%), intrauterine insemination (IUI) or in vitro fertilization (IVF) (8.0% vs 10.4% and 5.5% vs 8.1%; all comparisons p<0.001). In a multivariate regression controlling for race/ethnicity, age, semen analysis category (oligozoospermic vs normozoospermic), previous successful fertility outcome, and use of ART, completely rural area of residence was significantly associated with decreased likelihood of successful fertility outcome compared to metropolitan individuals (Hazard Ratio [HR] 0.63, 95% CI 0.44–0.91, n=65). Non-metro urban individuals also trended towards lower likelihood of successful fertility outcome ([HR] 0.93, 95% CI 0.85–1.01). Interestingly, completely rural area of residence is associated with longer median time to successful fertility outcome and lower total percent success. CONCLUSIONS: Rural area of residence significantly decreases likelihood of successful fertility outcomes in a statewide patient database of men undergoing semen analysis for fertility assessment. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e213 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Devon M. Langston More articles by this author Kiarad Fendereski More articles by this author Joshua Halpern More articles by this author Ijeoma Ika More articles by this author Kenneth Aston More articles by this author Elizabeth Ferlic More articles by this author Ben Emery More articles by this author Joemy M. Ramsay More articles by this author Joshua Horns More articles by this author James Hotaling More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract Introduction Priapism, marked by prolonged penile erection unrelated to sexual arousal, carries risks of tissue damage and permanent erectile dysfunction, mainly in its ischemic subtype. Despite guidelines stressing prompt intervention, disparities in management remain largely unexplored, urging further investigation to enhance patient outcomes and quality of life, driving our objective to analyze Priapism data from the National Surgical Quality Improvement Program (NSQIP) database. Objective To examine potential disparities in priapism care using the NSQIP database. Methods We conducted a retrospective analysis of priapism cases from 2007-2021 using the NSQIP database, focusing on ischemic and non-ischemic cases identified through ICD-9 and -10 and CPT codes. We assessed how reported race/ethnicity (Black, Hispanic, White) correlated with 30-day complication rates, surgical interventions (shunting), immediate penile prosthesis (PP) placement, and procedural management (penile injection and irrigation), analyzing p-values with Chi-squared tests. Results Our cohort of 474 priapism patients, were predominately Whites (43%) and the median age was 44 years. Emergent cases accounted for 51.3%, with corporospongiosal shunt being the most common intervention (57.4%). Patient race did not significantly influence the choice of shunting procedure. For those who underwent procedural intervention, 10.6% underwent irrigation of corpora cavernosa and 3.8% underwent injection of corpora cavernosa. Interestingly, Hispanic males trended lower rates in both categories: irrigation (Hispanic 5.6%, Black 10.8%, White 12.9%, p = 0.235) and injection (Hispanic 0%, Black 4.2%, White 5.0%, p = 0.045).Post-operative complications were observed in 6.7% of cases, with blood transfusion being the most common (4.01%). Reoperation rate was 13.7%, primarily for repeat priapism, leading to a 30-day readmission rate of 7.0%. Conclusions Priapism demands swift evaluation and treatment to mitigate discomfort and preserve erectile tissue integrity. Our research suggests a potential link between race and the procedural and surgical approaches to managing priapism, with varying initial management and transfusion rates among racial groups. Future investigations should delve deeper into these racial disparities and investigate potential variations in initial treatment upon presentation to the Emergency Department. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: StreamDx, Inherent Bioscience, Turtle Health, Maimus, Carrot Fertility.

ObjectiveTo assess the association between ethnicity and fertility outcomes for men in a statewide cohort.DesignWe linked data from the Utah Population Database (UPDB) and Subfertility Health Assisted Reproduction and Environment (SHARE) database, to comprise a cohort of sub-fertile men who underwent semen analysis (SA) between 1998-2017 in Utah. A multivariable Cox proportional hazard model was constructed to understand the impact of ethnicity on fertility outcomes in our cohort.Results11,363 men were included. 1,039 (9.1%) were Hispanic. 39.7% of men in the lowest socioeconomic status group (SES) were Hispanic (p<0.001). When controlling for demographic and clinical factors, the number of live births was reduced for Hispanic men (HR=0.62 [0.57-0.67], p<0.001). Though fertility treatment (FT) had a positive effect (HR 1.242 [1.085-1.421], p<0.001), in competing risks models, Hispanic men were less likely to use FT (HR=0.633 [0.526-0.762], p<0.001).ConclusionHispanic ethnicity is significantly associated with a lower likelihood of successful fertility outcomes in Utah. Hispanic men had nearly a 40% reduced likelihood of live births when controlling for sociodemographic factors. Our results indicate that, depending on age, Hispanic men have up to approximately 14 fewer live births per 100 men per year, pointing to a significant disparity in fertility outcomes in the state of Utah. Given 15.1% of Utah’s population identifies as Hispanic and 18.7% of the United States population identifies as Hispanic on the 2020 Census, better understanding of the association of ethnicity and fertility outcomes is imperative.

OBJECTIVE To develop and evaluate a mobile phone-based skills assessment tool that measures procedural competency of urology residents learning to perform a common, non-robotic urology procedure as a means of tracking current skillset and improvement over time. METHODS The assessment tool was a Qualtrics survey accessed via a smartphone link that breaks down a vasectomy into 6 critical steps. Level of competency was measured on a scale of '1-novice' to '5-expert.' Nine residents from Post graduate year (PGY)-1 to PGY-5 were evaluated by one instructor after completing a vasectomy (86 single-side cases recorded over a 6-month period). We compared individual trainees to each other, analyzed performance (improvement) over time, and evaluated competency against cohort and program averages. RESULTS As an example, a single resident ('Resident 2,' N = 11 cases) was compared to cohort (PGY, M= 7.5/resident) and program (all residents, M= 7.4/resident). Results indicate similar skillfulness across Step 1 (puncturing and isolation of vas and hand positioning; P > 0.1), but marginally lower competency on Step 2 (opening of vasal sheath to expose/isolate vas; vs. cohort: P = 0.076, vs. residents: P = 0.082). Significantly lower competency on Steps 3-6 (all P < 0.04) suggests targeted teaching could improve cautery technique, fascial interposition, hemostasis, and positioning of stumps. CONCLUSION Our mobile-based skills assessment is a low cost, novel, and efficient assessment that would support current Accreditation Council for Graduate Medical Education (ACGME) goals to increase competency-based residency training. This tool is easily created and accessed, provides real-time feedback to learners, and can be used for individual and group assessment at a single timepoint or longitudinally. UROLOGY 177: 12-20, 2023. (c) 2023 Elsevier Inc. All rights reserved.

Introduction: Fournier's gangrene (FG), is a progressive, necrotizing soft tissue infection of the external genitalia, perineum, and/or anorectal region. How treatment and recovery from FG impacts quality of life related to sexual and general health is poorly characterized. Our purpose is to evaluate the long term impact of FG on overall and sexual quality of life using standardized questionnaires through a multi-institutional observational study. Materials and methods: Multi-institutional retrospective data were collected by standardized questionnaires on patient-reported outcome measures including the Changes in Sexual Functioning Questionnaire (CSFQ) and the Veterans RAND 36 (VR-36) survey of general health-related quality of life. Data were collected via telephone call, email, and certified mail, with a 10% response rate. There was no incentive for patient participation. Results: Thirty-five patients responded to the survey, with 9 female and 26 male patients. All patients in the study underwent surgical debridement between 2007-2018 at three tertiary care centers. Further reconstructions were performed for 57% of respondents. Values for respondents with overall lower sexual function were reduced in all component categories (pleasure, desire/ frequency, desire/interest, arousal/excitement, orgasm/ completion), and trended toward male sex, older age, longer time from initial debridement to reconstruction, and poorer self-reported general health-related quality of life metrics.Conclusion: FG is associated with high morbidity and significant decreases in quality of life across general and sexual functional domains.

The purpose of our study was to examine the differences in demographics, fertility treatment utilization, and fertility outcomes among sub-fertile males across the rural-urban continuum. Our male patient cohort was identified using the Utah Population Database (UPDB), which combines demographic, medical, and residential data for patients residing in Utah. We linked patients to the Subfertility Health Assisted Reproduction and Environment (SHARE) database, which houses fertility data for 13,873 men in our final cohort who underwent semen analysis between 1998-2017. The data was divided by metropolitan (metro-) [large, medium, small], and non-metropolitan (non-metro-) [urban, rural] status, based on United States Department of Agriculture (USDA) rural-urban continuum codes (RUCC). When compared to metro-urban males, non-metro urban/rural males were less likely to be a racial or ethnic minority (91.3% non-Hispanic white vs 85.7%), and less likely to use assisted reproductive technology (ART) (13.4% vs 18.5%): intrauterine insemination (IUI) or in vitro fertilization (IVF) (8.0% vs 10.4% and 5.5% vs 8.1%; all comparisons p<0.001). In a multivariate regression controlling for race/ethnicity, age, semen analysis category (oligozoospermic vs normozoospermic), previous successful fertility outcome, and use of ART, completely rural area of residence was significantly associated with decreased likelihood of successful fertility outcome compared to metropolitan individuals (Hazard Ratio [HR] 0.63, 95% CI 0.44–0.91, n=65). Non-metro urban individuals also trended towards lower likelihood of successful fertility outcome ([HR] 0.93, 95% CI 0.85–1.01). Interestingly, completely rural area of residence is associated with longer time for 50% cohort successful fertility outcome (>60 months vs approximately 34 months both metro). Across the rural-urban continuum in the state of Utah, residing in a large metropolitan area was associated with higher rates of racial/ethnically diverse males, higher rates of fertility treatment utilization, and higher rates of successful fertility outcomes (live births). Future studies should evaluate factors other than ethnicity contributing to these disparities, such as environmental exposure to gonadal toxins.

Background: Emergency general surgery (EGS) patients are more socioeconomically vulnerable than elective counterparts. We hypothesized that a hospital's neighborhood disadvantage is associated with vulnerability of its EGS patients. Materials and methods: Area deprivation index (ADI), a neighborhood-level measure of disadvantage, and key characteristics of 724 hospitals in 14 states were linked to patientlevel data in State Inpatient Databases. Hospital and EGS patient characteristics were compared across hospital ADI quartiles (least disadvantaged [ADI 1-25] "affluent," minimally disadvantaged [ADI 26-50] "min-da", moderately disadvantaged [ADI 51-75] "modda", and most disadvantaged [ADI 76-100] "impoverished") using chi t tests and multivariable regression. Results: Higher disadvantage hospitals are more often nonteaching (affluent = 38.9%, minda = 53.5%, mod-da = 72.1%, and impoverished = 67.6%), nonaffiliated with medical schools (50%, 72.4%, 81.8%, and 78.8%), and in rural areas (3.3%, 9.2%, 31.2%, and 27.9%). EGS patients at higher disadvantage hospitals are more likely to be older (43.9%, 48.6%, 49.1%, and 46.6%), have >3 comorbidities (17.0%, 19.0%, 18.4%, and 19.3%), live in low-income areas (21.4%, 23.6%, 32.2%, and 42.5%), and experience complications (23.2%, 23.7%, 24.0%, and 25.2%). Rates of uninsurance/underinsurance were highest at affluent and impoverished hospitals (18.0, 16.4%, 17.7%, and 19.2%). Higher disadvantage hospitals serve fewer minorities (32.6%, 21.3%, 20.7%, and 24.0%), except in rural areas (2.9%, 6.7%, 6.5%, and 15.5%). In multivariable analyses, the impoverished hospital ADI quartile did not predict odds of serving as a safety-net or predominantly minority-serving hospital. Conclusions: Hospitals in impoverished areas disproportionately serve underserved EGS patient populations but are less likely to have robust resources for EGS care or train future EGS surgeons. These findings have implications for measures to improve equity in EGS outcomes. Published by Elsevier Inc.