Purpose: This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines. Materials and Methods: A 39-question survey was developed by senior Global Andrology Forum (GAF) experts to comprehensively cover clinical aspects of RT. This was distributed globally via a secure online Google Form to ED specialists through the GAF website, international professional societies, and social media, the responses were analyzed and presented for frequencies as percentages. Consensus on expert recommendations for RT use was achieved using the Delphi method. Results: Out of 479 respondents from 62 countries, a third reported using RT for ED. The most popular treatment was low-intensity shock wave therapy (54.6%), followed by platelet-rich plasma (24.5%) and their combination (14.7%), with stem cell therapy being the least used (3.7%). The primary indication for RT was the refractory or adverse effects of PDE5 inhibitors, with the best effectiveness reported in middle-aged and mild-to-moderate ED patients. Respondents were confident about its overall safety, with a significant number expressing interest in RT's future use, despite pending guidelines support. Conclusions: This inaugural global survey reveals a growing use of RT in ED treatment, showcasing its diverse clinical applications and potential for future widespread adoption. However, the lack of comprehensive evidence and clear guidelines requires further research to standardize RT practices in ED treatment.

AbstractBackgroundIncreased oxidative stress (OS), resulting from the delicate balance between reactive oxygen species (ROS) production and antioxidant defense, is closely linked to sperm abnormalities and male subfertility. Elevated ROS levels particularly affect sperm quality. The vulnerability of spermatozoa to ROS is due to the absence of DNA repair mechanisms and the high presence of polyunsaturated fatty acids in their membranes.MethodsThis article updates and advances our understanding of the molecular damage caused by OS in spermatozoa, including lipid peroxidation, DNA damage, motility, and functionality. Additionally, the review discusses the challenges in diagnosing OS in semen and recommends accurate and sensitive testing methods. Case studies are utilized to demonstrate the effective management of male infertility caused by OS.Main findingsHighlighting the need to bridge the gap between research and clinical practice, this review suggests strategies for clinicians, such as lifestyle and dietary changes and antioxidant therapies. The review emphasizes lifestyle modifications and personalized care as effective strategies in managing male infertility caused by OS.ConclusionThis review calls for early detection and intervention and interdisciplinary collaboration to improve patient care in male infertility cases related to increased OS.

Abstract Objectives Vasectomy is worldwide considered a cost-effective, definitive and safe method for male contraception and therefore one of the most frequently performed outpatient surgeries. However, repeated spermiogram controls to ascertain azoospermia are generally recommended to guarantee successful operation. This legal necessity, with all its implications, is noted in all signed informed consents basically to avert unjustified medical liability issues. Methods Members of the Austrian Andrological Working Group participate to this nationwide, retrospective data analysis for vasectomy in 2020. The primary aim was to investigate patients adherence/consultations according to the preoperative provided instructions. An anonymous dataset over 610 patients was analyzed. Results The mean patient age of was 41.60 years (SD 6.69), with the youngest male being 25 years old and the oldest male being 68 years old. A documented follow-up appointment for first spermiogram-analysis was scheduled for these patients in 96.89% (n=591), but, only 90.19% (n=533) attended to these appointments by achieving azoospermia in 86.00% (n=436). In 71 cases vital sperm could still be detected in the ejaculate (unknown in 26 cases). A second spermiogram control was scheduled for 87.24% (n=465 patients; unknown in 24 cases) and was attended by 392 patients (84.30% of patients), hereby azoospermia was achieved in 91.33% (n=358; unknown in 2 cases). Complications such as hematoma, edema, or infection were reported in only 25 patients (4.10%). Failure to achieve sperm clearance was age-independent. Conclusions Although being a safe procedure with a low complication rate, post-vasectomy follow-up lacks extensive adherence. Roughly 10% of patients missed the required post-vasectomy controls and this regardless of the informed consent signed by the patient. Due to persisting oligozoospermia in 14% of patients after the first and 9% after the second follow-up visit, patients must be encouraged to attend the previously scheduled follow-up appointments. To guarantee a successful operation and safe contraception follow-up visits are crucial. Conflicts of Interest None

Approximately 10-15% of all couples have an unfulfilled desire to have children, either due to failure to become pregnant or due to recurrent miscarriages. Detectable causes of a fertility disorder are found equally in men and women and in one third of couples both partners are involved. For 5-10% of female patients and 10-20% of male patients genetic causes can be detected with the currently established diagnostic analyses. An etiological clarification enables an informed prognosis and sometimes a specific treatment, which can indicate an increased risk for the occurrence of a fetal disease. A specific genetic clarification is therefore indicated, independent of any possibly planned reproductive medical treatment, in all couples who have been trying unsuccessfully to have a child for more than 1 year and in whom no other explanation for infertility has been identified. The genetic diagnostics of infertility usually include classical karyotyping in both partners to detect the possible presence of gonosomal or balanced structural chromosomal alterations. This is particularly indicated for both partners in the case of recurrent miscarriages. Depending on the hormonal findings, in women an attenuated congenital adrenal hypoplasia should be excluded and a premutation in the fragile X messenger ribonucleoprotein 1 gene (FMR1) should be ruled out if primary ovarian failure is suspected. The genetic diagnostics of men with azoospermia or severe oligospermia include in addition to karyotyping, testing for microdeletions in the azoospermia factor (AZF) regions as well as pathogenic variants in the cystic fibrosis transmembrane conductance regulator (CFTR) gene as a possible cause of obstructive azoospermia, depending on the clinical parameters. Sequence analyses of specific genes can be considered in women and men with hypogonadotropic hypogonadism or men with a suspected monogenic disorder of spermatogenesis. According to the guidelines and national legal regulations, possible consequences as well as the significance for future children should be addressed in the context of genetic counseling before the genetic diagnostics as well as by the detection of a genetic cause of infertility.

Zusammenfassung Etwa 10–15 % aller Paare sind ungewollt kinderlos, entweder durch das fehlende Eintreten einer Schwangerschaft oder durch rezidivierende Aborte. Nachweisbare Ursachen einer Fertilitätsstörung finden sich gleichermaßen bei Männern und bei Frauen, bei einem Drittel sind beide Partner beteiligt. Bei 5–10 % der weiblichen und 10–20 % der männlichen Patienten sind mit den derzeit etablierten diagnostischen Analysen genetische Ursachen erkennbar. Eine ätiologische Abklärung erlaubt eine fundierte Prognose und manchmal eine spezifische Therapie, sie kann auf ein erhöhtes Risiko des Auftretens kindlicher Erkrankungen hinweisen. Eine spezifische genetische Abklärung ist daher unabhängig von einer gegebenenfalls geplanten reproduktionsmedizinischen Behandlung bei allen Paaren indiziert, die länger als ein Jahr vergeblich versuchen, ein Kind zu bekommen, und bei denen keine andere Erklärung für eine Unfruchtbarkeit nachgewiesen wurde. Die genetische Diagnostik der Unfruchtbarkeit umfasst bei beiden Partnern in der Regel eine klassische Karyotypisierung zum Nachweis einer gegebenenfalls vorliegenden gonosomalen oder balancierten strukturellen Chromosomenveränderung. Dies ist insbesondere beim wiederholten Auftreten von Fehlgeburten bei beiden Partnern indiziert. Abhängig von hormonellen Befunden sollte bei Frauen ein attenuiertes adrenogenitales Syndrom bzw. bei Verdacht auf eine primäre Ovarialinsuffizienz eine FMR1 -Prämutation ausgeschlossen werden. Die genetische Diagnostik des Mannes bei Azoospermie oder gegebenenfalls bei schwerer Oligozoospermie umfasst zusätzlich zur Karyotypisierung die Testung auf AZF-Mikrodeletionen ( AZF Azoospermiefaktor) sowie in Abhängigkeit von den klinischen Parametern auf pathogene Varianten im CFTR -Gen als mögliche Ursache einer obstruktiven Azoospermie. Sequenzanalysen spezifischer Gene können bei Frauen und Männern mit hypogonadotropem Hypogonadismus oder bei Verdacht auf eine monogene Spermatogenesestörung in Betracht gezogen werden. Gemäß den Leitlinien und nationalen gesetzlichen Grundlagen sollten vor der genetischen Diagnostik sowie beim Nachweis genetischer Ursachen einer Infertilität mögliche Konsequenzen und die Bedeutung für zukünftige Kinder im Rahmen einer genetischen Beratung besprochen werden.

There is growing public concern that both the SARS-CoV-2 virus infecLon and the corona vaccinaLon could lead to inferLlity or increased miscarriage rates. Especially women and men during reproducLve years raise concerns. We reviewed the current literature on the impact of SARS-CoV-2 infecLon as well as Covid vaccinaLon on female and male ferLlity in animal models and in humans. Method of Study: A systemaLc literature search was performed using the keywords "COVID 19, SARSCoV-2, ferLlity, semen, sperm, oocyte, male ferLlity, female ferLlity, inferLlity" (Pubmed, Embase, Web of Science). Subsequently, original papers from October 2019 to February 2022 were selected and reviewed. Results: With regard to animal models, despite the use of very high vaccine dosages, no negaLve impact on ferLlity, pregnancy outcome, and fetal development was present. In humans, studies to date showed also no negaLve impact on male or female ferLlity aXer Covid-19 vaccinaLon. No virus RNA was detected in human oocytes/follicular fluid in SARS-CoV2-posiLve women; likewise, no differences were found between recovered, vaccinated, and controls with respect to pregnancy or miscarriage rates. Furthermore, vaccinaLon did not affect the live birth rate aXer ART. In infected and sLll infecLous males, no viral RNA was detected in the ejaculate in the majority of cases; however, severe infecLon was associated with low sperm concentraLon and decreased sperm moLlity. Few longLme studies showed a recovery of sperm parameters in the follow up of most cases. Conclusions: Current studies provide no evidence for negaLve effects on male or female ferLlity following Covid vaccinaLon, neither in animals nor in humans. In contrast, adverse effects of a severe SARS-CoV-2 infecLon on male ferLlity was shown and only few longLme follow up studies are currently available. Counseling of young people should therefore take fears and concerns seriously and discuss the current data in a structured manner.

Einleitung Vor allem junge Frauen und Männer mit (zukünftigem) Kinderwunsch äußern die Angst, dass eine Corona Impfung zu einer Infertilität bzw. einer erhöhten Abortrate und negativen Langzeitfolgen für das Kind führen könnte. Ärztliche Kolleg:innen sorgen sich hingegen mehr hinsichtlich der Auswirkungen einer SARS-CoV-2 Infektion auf die Reproduktion.

STUDY QUESTION:When should cystic fibrosis transmembrane conductance regulator (CFTR) mutation analysis be recommended in infertile men based on andrological findings?SUMMARY ANSWER:CFTR mutation analysis is recommended in all men with unexplained azoospermia in the presence of normal gonadotropin levels.WHAT IS KNOWN ALREADY:While 80-97% of men with congenital bilateral absence of the vas deferens (CBAVD) are thought to carry CFTR mutations, there is uncertainty about the spectrum of clinical and andrological abnormalities in infertile men with bilallelic CFTR mutations. This information is relevant for evidence-based recommendations to couples requesting assisted reproduction.STUDY DESIGN, SIZE, DURATION:We studied the andrological findings of patients with two CFTR mutations who were examined in one of the cooperating fertility centres in Germany and Austria. In the period of January till July 2019, the completed and anonymized data sheets of 78 adult male patients were returned to and analysed by the project leader at the Institute of Human Genetics in Innsbruck, Austria.PARTICIPANTS/MATERIALS, SETTING, METHODS:Minimum study entry criteria were the presence of two (biallelic) CFTR mutations and results of at least one semen analysis. Andrological assessments were undertaken by standardized data sheets and compared with normal reference values. Seventy-one patients were eligible for the study (n = 30, 42% from Germany, n = 26, 37% from Austria, n = 15, 21% other nations).MAIN RESULTS AND THE ROLE OF CHANCE:Gonadotropin levels (FSH, LH) were normal, 22% of patients had reduced testosterone values. Mean right testis volume was 23.38 ml (SD 8.77), mean left testis volume was 22.59 ml (SD 8.68) and thereby statistically increased compared to normal (P < 0.01). although the means remained in the reference range of 12-25 ml. Semen analysis revealed azoospermia in 70 of 71 (99%) patients and severe oligozoospermia <0.1 × 106/ml in one patient. Four semen parameters, i.e. ejaculate volume, pH, α-glucosidase and fructose values, were significantly reduced (P < 0.01). Only 18% of patients had a palpatory and sonographically diagnosed CBAVD, while in 31% the diagnosis of CBAVD was uncertain, in 12% patients, the vas deferens was present but hypoplastic, and in 39% the vas deferens was normally present bilaterally. Seminal vesicles were not detectable in 37% and only unilaterally present in 37% of patients. Apart from total testes volume, clinical findings were similar in patients with two confirmed pathogenic CFTR mutations (Group I) compared with patients who carried one pathogenic mutation and one CFTR variant of unknown significance (Group II).LIMITATIONS, REASONS FOR CAUTION:We could not formally confirm the in trans position of genetic variants in most patients as no family members were available for segregation studies. Nonetheless, considering that most mutations in our study have been previously described without other rare variants in cis, and in view of the compatible andrological phenotype, it is reasonable to assume that the biallelic genotypes are correct.WIDER IMPLICATIONS OF THE FINDINGS:Our study reveals that CFTR mutation analysis has a broader indication than just the absence of the vas deferens. We recommend to completely sequence the CFTR gene if there is a suspicion of obstructive azoospermia, and to extend this analysis to all patients with unexplained azoospermia in the presence of normal gonadotropin levels.STUDY FUNDING/COMPETING INTEREST(S):German Research Foundation Clinical Research Unit 'Male Germ Cells: from Genes to Function' (DFG CRU326, grants to F.T.). There are no conflicts of interest to declare.TRIAL REGISTRATION NUMBER:N/A.

Abstract Study question Is impaired sexual functioning correlated to sperm quality in cancer survivors? Summary answer Erectile dysfunction affects 25.0% of cancer survivors, independent of sperm quality. 22.9% of patients show symptoms consistent with a reduced testosterone level. What is known already Gonadotoxic treatment in male cancer patients can end up in reversible or permanent impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction. Study design, size, duration In this prospective single-center study, sexual functioning was assessed in male cancer survivors, who underwent sperm cryopreservation at the Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Austria from 01/2010 to 12/2018. Sexual functioning was assessed between 03–12/2020 via two questionnaires: Aging Male Score (AMS) and International Index of Erectile Function (IEEF-EF). Participants/materials, setting, methods Thirty-five cancer survivors (testicular cancer: n = 16 [45.7%], hematological malignancies: n = 15 [42.9%], others: n = 4 [n = 11.4%]) filled in two questionnaires (AMS and IEEF-EF) during routine follow-up visit at the Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck and the Department of Urology, Medical University Innsbruck, Austria. Moreover, sperm quality was assessed and normozoospermia was defined in accordance with the 2010 WHO criteria (sperm concentration ≥15 million/mL, progressive motility ≥32%, and ≥4% normal morphology). Main results and the role of chance Mean age at sperm cryopreservation and follow-up visit was 25.1±4.2 and 31.9±6.3 years, respectively with a mean follow-up time of 81.4±12.5 months. Rate of erectile dysfunction was low (75.0% no dysfunction, 15.6% low dysfunction, 3.1% low-moderate dysfunction, 3.1% moderate, 3.1% severe dysfunction). Moreover, AMS score indicated no, low, moderate and severe symptoms consistent with a low testosterone level in 77.1%, 8.6%, 2.9%, and 2.9% of patients, respectively. Oligozoospermia was observed in up to 48% of the patients with TM and in only 23% patients with HM. Patients with TM showed significantly reduced sperm count (18.7 × 106/mL [5.3–43.0]) and total sperm count (42.4 × 106/ejaculate [13.3–108.5]) compared to HM (p = 0.03). There was no difference in sexual functioning between patients with HM or TM. Sexual functioning did no correlate with sperm count, progressive motility or morphology. Limitations, reasons for caution Although the study may be limited by its small sample size, it is the first to assess a correlation of sperm quality and sexual dysfunction in cancer survivors. Wider implications of the findings: As every fourth male cancer patient suffers from impaired sexual functioning after gonadotoxic treatment, this important topic should be addressed in clinical and scientific future. Future studies should focus on both, somatic and psychosomatic reasons for sexual dysfunction. Trial registration number none

We aimed to compare the sperm quality in different cancer types and benign diseases before gonadotoxic treatment, and assess the usage rate of cryopreserved sperm for assisted reproductive treatment (ART). This retrospective study was conducted at two university clinics between January 2008 and July 2018. A total of 545 patients suffering from cancer or benign diseases were included in the study. The pretreatment sperm analyses were based on the World Health Organization (WHO) guidelines. Patients with testicular malignancy (TM) showed a significantly lower sperm count (median [interquartile range]: 18.7 × 106 [5.3 × 106–43.0 × 106] ml−1; P = 0.03) as well as total sperm count (42.4 × 106 [13.3 × 106–108.5 × 106] per ejaculate; P = 0.007) compared to other malignant and benign diseases. In addition, patients with nonseminomatous TM showed the lowest sperm count (14.3 × 106 [6.0 × 106–29.9 × 106] ml−1, vs seminomas: 16.5 × 106 [4.6 × 106–20.3 × 106] ml−1; P = 0.001). With reference to the WHO 2010 guidelines, approximately 48.0% of the patients with TM and 23.0% with hematological malignancies (HM) had oligozoospermia. During the observation period, only 29 patients (5.3%) used their frozen sperms for 48 ART cycles, resulting in 15 clinical pregnancies and 10 live births. The sperm quality varies with the type of underlying disease, with TM and HM patients showing the lowest sperm counts. Due to the observed low usage rate of cryopreserved sperm, further patient interviews and sperm analyses should be included in the routine oncologic protocols to avoid unnecessary storage expenses. However, sperm banking is worth the effort as it provides hope for men who cannot reproduce naturally after gonadotoxic treatment.

Gel disintegration via compression is a possible approach for the reversal of the occlusion of male vasa deferentia (VD) by hydrogels. κ -carrageenan (KC) hydrogels can be used for such an application. To determine the required forces for in-vessel compressive disintegration, a gel-tube model, preparing KC gels in different tubes, is studied. These gels are of alternating biopolymer (1-3% by mass) and potassium (100-300 mM) concentration. Gel-filled tubes are uniaxially compressed at two different compression speeds (1 and 0.3 mm s-1 ). Breakage compression strains are cross studied by shear breaking gel measurements using dynamic mechanical analysis. The measurements showed good agreement. Gel structure disintegration occurred below (62 ± 8) % strain. During compression, three stages of gel disintegration are present. Gel-tube wall detachment, gel rupture, and gel expulsion. The force required for gel disintegration and tube deformation can be added arithmetically. From the modulus of a human aortae model, it is estimated that average human pinch forces are insufficient to disintegrate 2% and 3% by mass KC hydrogels in VD by massage. The compressive disintegration would require a compression device while evading tissue damage.

Infertilität besteht, wenn trotz regelmäßigen, ungeschützten Geschlechtsverkehrs nach 12 Monaten keine Schwangerschaft eingetreten ist. Die Ursachen für eine ungewollte Kinderlosigkeit liegen zu etwa gleichen Teilen mit je bis zu je 40 % bei Mann und Frau. In den übrigen Fällen finden sich bei beiden Partnern Faktoren, die die Fertilität beeinträchtigen können. Der Mann sollte daher gleichzeitig mit seiner Partnerin abgeklärt werden. Ziel der andrologischen Diagnostik ist es, behandelbare Ursachen frühzeitig zu erkennen und – wenn möglich – zu behandeln. Gleichzeit kann durch eine rechtzeitige Untersuchung des Mannes eine Verzögerung von Methoden der assistierten Reproduktion verhindert werden. Die intrazytoplasmatische Spermieninjektion erfolgt mehrheitlich aus andrologischer Indikation. Eine andrologische Diagnostik vor Ablauf der 12 Monate kann notwendig werden, wenn die Partnerin über 35 Jahre alt ist oder Faktoren beim Mann vorliegen, die auf eine eingeschränkte Fertilität hindeuten.

OBJECTIVE: We aim to assess the risk of infection during urologic surgeries. Therefore possible hazards in tissue, blood, urine and aerosolized particles generated during surgery, are evaluated. Understanding the risk, recommendations for clinical practice are provided. MATERIALS AND METHODS: Review of available literature on urological and other surgical procedures in patients with virus infections such as HPV, HIV and hepatitis B and current publications on COVID-19. RESULTS: Several possible pathways for viral transmission appear in the literature. Recent groups detected SARS-CoV-2 in the urine and faeces, even after negative pharyngeal swabs. In addition, viral RNA can be detected in the blood and several tissues. During surgery, viral particles are released, aerosole-borne and present a certain risk for transmission and infection. However, there is currently no evidence on the exact risk for infection by the substances mentioned above. It remains unclear whether or not viral particles in the urine, blood or faeces are infectious. CONCLUSIONS: Whether SARS-CoV-2 can be transmitted by aerosols remains controversial. In any case, standard surgical masks offer inadequate protection from SARS-CoV-2. Full PPE including at least FFP-2 masks and safety goggles should be used. Aerosolized particles might remain for a longer time in the operation theatre and contaminate other surfaces, like floors or computer input devices. Therefore scrupulous hygiene and disinfection of surfaces must be carried out. To prevent aerosolization during laparoscopic interventions, the pneumoperitoneum should be evacuated with suction devices. The use of virus proof HEPA filters is recommended. Local separation of anesthesia/intubation and operation theatre can reduce the danger of viral transmission. Lumbar anaesthesia should be considered especially in endourology. Based on current knowledge, COVID-19 is no contraindication for acute urological surgery. If possible however, as european guideline committees recommend, non-emergency urological interventions should be postponed until negative SARS-CoV-2 tests become available.

Die COVID-19 („coronavirus disease 2019“) stellt Gesundheitssysteme weltweit vor eine große Herausforderung. Mit steigenden Infektionsraten geraten auch Urologen wegen eines Infektionsrisikos mit SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) bei operativen Eingriffen in den Fokus. Hierdurch entsteht die Notwendigkeit über das Coronavirus sinnvolle und umsetzbare Handlungsempfehlungen zu erstellen. Es wurde eine umfassende Einschätzung des Infektionsrisikos mit SARS-CoV‑2 bei urologischen Eingriffen erstellt. Auf Basis der Datenlage sowie aktueller Empfehlungen nationaler und internationaler Richtlinien soll einerseits das Infektionsrisiko im Umgang mit humanen Geweben und Stoffen beurteilt und andererseits notwendige hygienische Maßnahmen beleuchtet werden. Letztlich sollen hieraus Handlungsempfehlungen und zu treffende Schutzmaßnahmen für die urologische Praxis abgeleitet und erklärt werden. In PubMed, bioRxiv und medRxiv sowie den Datenbanken der WHO und des RKI wurde eine Literatursuche über SARS-CoV‑2 und das chirurgische Prozedere bei infizierten Patienten durchgeführt. Der Zeitraum der Literatursuche war bis 21.04.2020. Auf Basis der recherchierten Daten können generelle und spezifische Handlungsempfehlungen für die urologische Praxis abgeleitet werden. Zwar bleibt unklar, ob SARS-CoV‑2 letztlich über die entstehenden Aerosole übertragen wird, aber allgemeine Schutzempfehlungen bieten gerade bei chirurgischen Eingriffen in Zeiten der SARS-CoV-2-Pandemie vermutlich keinen suffizienten Schutz und sollten sorgfältig überdacht werden. Entscheidend dürfte hierbei ein konsequenter Einsatz von FFP-2-Masken, Schutzbrillen und Vollkörperanzug sein. Um eine Kontaminationsbelastung von Luft und Oberflächen einzudämmen, sollen komplexe Filtersysteme (HEPA), der Einsatz von zumindest begrenzt viruziden Oberflächendesinfektionsmitteln und intraoperative Absaugvorrichtungen Verwendung finden. Eine Fokussierung auf wenige, aber optimierte eigens hierfür bereitgestellte COVID-OPs ist nicht zuletzt unter dem Gesichtspunkt der Ressourcenschonung sinnvoll. Unter Einhaltung der entsprechenden Handlungsmaßnahmen kann ein für Urologen und medizinisches Personal sicheres Arbeitsumfeld geschaffen werden. Daher sehen die Autoren nach derzeitigem Wissensstand keine Kontraindikation für dringliche und Notfalleingriffe, vorausgesetzt entsprechende Vorsichtsmaßnahmen in ihrer Schutzwirkung werden eingehalten.

To assess the risk of viral infection during urological surgeries due to the possible hazards in tissue, blood, urine and aerosolised particles generated during surgery, and thus to understand the risks and make recommendations for clinical practice. We reviewed the available literature on urological and other surgical procedures in patients with virus infections, such as human papillomavirus, human immunodeficiency virus and hepatitis B, and current publications on coronavirus disease 2019 (COVID-19). Several possible pathways for viral transmission appear in the literature. Recently, groups have detected severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the urine and faeces, even after negative pharyngeal swabs. In addition, viral RNA can be detected in the blood and several tissues. During surgery, viral particles are released, aerosol-borne and present a certain risk of transmission and infection. However, there is currently no evidence on the exact risk of infection from the agents mentioned above. It remains unclear whether or not viral particles in the urine, blood or faeces are infectious. Whether SARS-CoV-2 can be transmitted by aerosols remains controversial. Irrespective of this, standard surgical masks offer inadequate protection from SARS-CoV-2. Full personal protective equipment, including at least filtering facepiece-2 masks and safety goggles should be used. Aerosolised particles might remain for a long time in the operating theatre and contaminate other surfaces, e.g. floors or computer input devices. Therefore, scrupulous hygiene and disinfection of surfaces must be carried out. To prevent aerosolisation during laparoscopic interventions, the pneumoperitoneum should be evacuated with suction devices. The use of virus-proof high-efficiency particulate air filters is recommended. Local separation of anaesthesia/intubation and the operating theatre can reduce the danger of viral transmission. Lumbar anaesthesia should be considered especially in endourology. Based on current knowledge, COVID-19 is not a contraindication for acute urological surgery. However, if possible, as European guideline committees recommend, non-emergency urological interventions should be postponed until negative SARS-CoV-2 tests become available.

Intralesional injection of collagenase clostridium histolyticum has been recommended as a non-operative therapy for Peyronie’s disease (PD). Two randomized, placebo-controlled, double-blind studies (IMPRESS I&II) have shown a decrease of curvature by 34%; however, high adverse events rates (AER) of 84.2% are associated with this treatment. Aim of our study was to clarify whether the AE could be reduced by performing intraoperative ultrasound. Patient collective involved 23 men (58.17 years (SD: 7.97), of which 22 without the need for SKAT in ED. 70% received “full-dose” Xiapex (0.9 mg vs. 0.58 mg). Case history, penile ultrasound and erect penis photography were obtained prior to treatment to document the degree of deviation. Significantly calcified plaques were excluded. To detect plaques in mm range during operation, we used high-frequency, ultrasound-guided, intralesional injection in real-time and injection of CCH with a 27 G-needle was performed after guided localization of the plaque. Following the procedure, penis-remodeling as endorsed by the manufacturer was performed. In addition, we used a penile stretching device after seven days. In total, 65 guided CCH injections were given to the collective of 23 patients.

According to recent studies, in the major developed countries, the market for genitourinary drugs is rapidly increasing with an estimated compound annual growth rate of over 3% over the last 5 year...