We performed a randomized-control trial to assess the impact of a video-based educational platform (VEP) on the pre-consult knowledge and post-consult satisfaction of patients presenting for vasectomy consultation. Between December 2022-2023, 39 patients were randomized on an alternating basis to receive either access to a VEP before their vasectomy consult (n = 18) or an in-person consult only (n = 21)(standard of care [SOC]). The VEP was created in partnership with EngagedMD, and consisted of 6 videos (total of 7 min) with mandatory checkpoint questions. A 10-question assessment was given prior to the start of the vasectomy consultation, and custom Likert-scale surveys were given after the consultation. Age, level of education, and marital status were not statistically different between the groups. The VEP group scored higher on the baseline knowledge assessment compared to the SOC group (90% vs 60%, p = <0.001). 100% of patients agreed the VEP helped educate them on the risks and benefits of vasectomy. 94.1% of patients endorsed that the VEP enhanced their ability to converse with the medical team. Compared to the SOC group, the VEP group had higher median composite survey scores regarding comfort with procedure decision-making, clinical expectations, and overall care satisfaction (34 vs 31, p = 0.004).

We sought to characterize the prevalence of sexual dysfunction and barriers to treatment among male physicians. Between June and December 2022, male physicians were invited to complete a questionnaire regarding sexual function. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT). In totla, 235 responses were included in the final analysis. The mean age of respondents was 36.3 ± 7.4 years (range 23–72). 27 (11.5%) reported having seen a doctor for sexual health. Of these 27, 40.7% saw a physician for erectile dysfunction, 29.6% for low libido, 22.2% for premature ejaculation, 7.4% for delayed ejaculation, and 33.3% for other concerns. An additional 29 (12.3%) considered establishing care for sexual issues but didn’t, mostly due to being too busy. 46 (19.6%) respondents reported having taken medication to improve erectile function. Therefore, in a cohort of young male physicians, 23.8% had seen or considered seeing a doctor for sexual health concerns, and nearly 1 in 5 had taken medication for erectile dysfunction. Male physicians appear to be at higher risk for sexual dysfunction than the general population and face significant and unique barriers in access to care for sexual dysfunction.

OBJECTIVE:To compare the prevalence of abnormal hormone parameters among men with and without oligospermia to determine the value of universal hormonal screening during initial fertility evaluation. MATERIALS AND METHODS:We retrospectively evaluated men who underwent semen analysis and hormonal evaluation (morning testosterone [T] and follicle-stimulating hormone [FSH]) between January 2002 and May 2021. Sperm concentration was dichotomized at 15 million/mL according to World Health Organization (WHO) criteria. We compared median and interquartile range (IQR) T and FSH levels according to sperm concentration using Kruskal-Wallis test. Differences in prevalence of low testosterone (<300 ng/dL) and abnormal FSH (>7.6mIU/mL) were determined using chi-square test. RESULTS:1164 men had a morning serum T. There was no difference in median T among men with normal vs abnormal sperm concentration (316 ng/dL, IQR 250-399 vs 316 ng/dL, IQR 253-419; P = .52). FSH was measured in 1261 men. Median FSH was higher among men with sperm concentration <15 million/mL (6.0IU/mL, IQR 3.9-10.7 vs 3.8IU/mL, IQR 2.7-5.7; P < .001). Among men with ≥15 million/mL concentration, 44.1% were found to have low T (P = .874) and 10.8% had an FSH ≥7.6 mIU/mL (P < .001). Among men with ≥15 million/mL sperm concentration who underwent both T and FSH evaluation, 43.6% had at least 1 hormonal abnormality. CONCLUSION:Almost half of men with normal sperm concentration had low T. As low T may have long-term implications for both fertility and overall health, providers should consider universal T screening in men presenting for fertility evaluation.

OBJECTIVE To determine whether health-conscious men are more likely to be concerned about infertility and self-initiate semen analysis at a laboratory/clinic or through a direct-to-consumer at-home product without a health care provider recommendation. METHODS Cross-sectional survey conducted online via ResearchMatch.org between November 2019 and January 2020. Men age 18 and older without children (n = 634) were included for analysis. Outcomes were likelihood of self-initiating a semen analysis, prevalence of infertility concern. RESULTS Of the 634 participants, 186 expressed concern about infertility but only 29% were likely to discuss these concerns with a health care provider. More men would self-initiate a semen analysis using an at-home product than through a traditional laboratory/clinic (14.2% vs 10.4%, P = .04). Odds of self-initiating a traditional semen analysis were higher for men concerned about low testosterone (odds ratio [OR] 2.30, 95% confidence interval [CI] 1.12-4.74, P = .023) and infertility (OR 3.91, 95% CI 2.14-7.15, P G.001). Self-initiating an at-home semen analysis was associated with concern for low testosterone and infertility as well as middle age (age 40-59: OR 3.02, 95% CI 1.16-7.88, P = .024) and fitness tracker use (OR: 1.95, 95% CI 1.12-3.39, P = .018). CONCLUSION Many men were unlikely to discuss infertility concerns with a health care provider. Middle aged men and those who used fitness trackers were more likely to self-initiate fertility evaluation through at-home semen analysis. Concern about low serum testosterone was pervasive and strongly associated with concern for being infertile and self-initiating a semen analysis of any kind. (C) 2021 Elsevier Inc.

You have accessJournal of UrologyCME1 May 2022PD20-05 HIGH PREVALENCE OF HORMONAL ABNORMALITIES IN MEN WITHOUT OLIGOSPERMIA Matthew Hudnall, Bailey Goyette, Minh Pham, Jeremy Lai, Justin Dubin, Richard Fantus, James Wren, Nelson Bennett, Robert Brannigan, and Joshua Halpern Matthew HudnallMatthew Hudnall More articles by this author , Bailey GoyetteBailey Goyette More articles by this author , Minh PhamMinh Pham More articles by this author , Jeremy LaiJeremy Lai More articles by this author , Justin DubinJustin Dubin More articles by this author , Richard FantusRichard Fantus More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , Robert BranniganRobert Brannigan More articles by this author , and Joshua HalpernJoshua Halpern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002558.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Newly updated male infertility guidelines from the American Urological Association recommend against universal hormone evaluation with measured levels of follicle stimulating hormone (FSH) and testosterone (T) in men with normal semen parameters due to prior limited data suggesting a low prevalence of abnormalities in this cohort. We sought to compare the prevalence of abnormal hormone parameters among men with and without sperm concentration abnormalities to determine the value of universal hormonal screening during fertility evaluation. METHODS: We retrospectively evaluated all men who underwent semen analysis (SA) and hormonal evaluation (morning serum T, FSH) at a large, integrated academic healthcare system between January 2002 and May 2021. Men were excluded if they had a prescription for T-modulating medications prior to index SA or if semen parameters were missing. Sperm concentration was dichotomized at 15 million/mL according to World Health Organization (WHO) criteria. Men with hormonal evaluation >1 year following index SA were excluded. We compared median and interquartile range (IQR) T and FSH levels according to sperm concentration using Kruskal-Wallis test. Differences in prevalence of low testosterone (<300 ng/dL) and abnormal FSH (>7.6 mIU/mL) were determined using Chi-square test. RESULTS: A total of 1,164 men had a morning serum T. There was no difference in median T among men with normal vs abnormal sperm concentration (316 ng/dL, interquartile range [IQR] 250-399 vs 316 ng/dL, IQR [253-419]; p=0.515). FSH level was measured in 1,261 men. Median FSH was higher among men with sperm concentration <15 million/mL (6 IU/mL, IQR 3.85-10.7 vs 3.8 IU/mL, IQR 2.7-5.7; p <0.001). Among men with ≥15 million/mL concentration, 44.1% were found to have low T (p=0.874) and 10.8% had an FSH ≥7.6 mIU/mL (p <0.001) (Table 1). Among men with ≥15 million/mL sperm concentration who underwent both T and FSH evaluation, 43.6% had at least 1 hormonal abnormality (Table 2). CONCLUSIONS: A large percentage of men with normal semen analysis had low T, challenging prior literature. As low T may have long-term implications for both fertility and overall health, providers should consider universal T screening in men presenting for fertility evaluation. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e357 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Hudnall More articles by this author Bailey Goyette More articles by this author Minh Pham More articles by this author Jeremy Lai More articles by this author Justin Dubin More articles by this author Richard Fantus More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Robert Brannigan More articles by this author Joshua Halpern More articles by this author Expand All Advertisement PDF DownloadLoading ...

This cross-sectional study examines whether direct-to-consumer platforms provide guideline-concordant care regarding testosterone therapy.

Purpose of review The COVID-19 pandemic has led to devastating health outcomes across the world. Initially thought to primarily affect the respiratory system, there is now clear and abundant evidence that COVID-19 can impact upon the male genitourinary system and overall men's health. In this review article, we explore the potential mechanisms by which COVID-19 specifically affects men and we review the literature examining the adverse effects of the disease on men's health Recent findings Studies suggest that men are at higher risk for severe COVID-19 infection and death. COVID-19 infection has a negative impact on men's health including worsening semen parameters, potentially lower testosterone levels, and an increased risk of erectile dysfunction. Summary COVID-19 is a highly pathogenic virus that exerts adverse effects upon the male genitourinary system in myriad ways. The COVID-19 infection can impact serum testosterone, fertility, sexual function, and mental health. Fortunately, the COVID-19 vaccine is safe and effective in preventing COVID-19 infection and many of these sequelae.

The SSIPI has demonstrated robust psychometric properties.

The relationship between testosterone and premature mortality has caused recent controversy. While previous studies have demonstrated mixed results, this is partly because of variable patient populations, different testosterone thresholds, and the use of antiquated techniques to measure serum testosterone. Using the National Health and Nutrition Examination Survey we analyzed a cohort representative of men in the USA to explore the relationship between serum testosterone and premature mortality using contemporary guidelines and testosterone measurements. We found that men with low testosterone (<300 ng/dl) were at higher risk (odds ratio 2.07, 95% confidence interval 1.30-3.32; p < 0.01) of premature death compared to men with normal testosterone. Furthermore, men with low testosterone were also more likely to have treatable comorbid conditions that were independently predictive of premature mortality. Both testosterone and these comorbid conditions are also modulated by lifestyle modifications, rendering this an important therapeutic approach in men with either or both conditions. Patient summary: We explored the relationship between testosterone levels and premature death in a large US population. We found that low testosterone is associated with both premature death and related disease processes such as obesity, both of which can be initially treated with diet and exercise. (C) 2021 Published by Elsevier B.V. on behalf of European Association of Urology.

You have accessJournal of UrologyAUA ANNUAL MEETING PROGRAM ABSTRACTS 20201 Apr 2020AUA ANNUAL MEETING PROGRAM ABSTRACTS 2020: ACCREDITATION, DISCLAIMER AND COPYRIGHT View All Author Informationhttps://doi.org/10.1097/01.JU.0000611464.00945.6fAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail ACCREDITATION STATEMENT: The American Urological Association Education and Research, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American Urological Association Education and Research, Inc. takes responsibility for the content, quality and scientific integrity of the CME Activity. DISCLAIMER The statements and opinions contained in the articles of The Journal of Urology® are solely those of the individual authors and contributors and not of the American Urological Association Education and Research, Inc. (AUAER). The content of this publication may contain discussion of off-label uses of some of the agents mentioned. Please consult the prescribing information for full disclosure of approved uses. To the extent permissible under applicable laws, no responsibility is assumed by the AUAER for any injury and/ or damage to persons or property as a result of any actual or alleged libelous statements, infringement of intellectual property or privacy rights, or products liability, whether resulting from negligence or otherwise, or from any use of operation of any ideas, instructions, procedures, products or methods contained in the material therein. The abstracts are being reprinted without editorial review. COPYRIGHT AND PERMISSIONS:The Journal of Urology® including supplements is the Official Journal of the American Urological Association Education and Research, Inc. and is published monthly by Wolters Kluwer Health Inc. The American Urological Association grants the Publisher full and exclusive publishing and distribution rights, worldwide, for both print and electronic media. Therefore no portions of the work(s) can be reproduced without written consent from the Publisher. Permissions and photocopying: For permission and/ or rights to use content for which the copyright holder is Wolters Kluwer or the society we have partnered with the Copyright Clearance Center to provide permissions for our products through their RightsLink service, please go to the journal's website and after clicking on the relevant article, click on the Get Content & Permissions link under the Article Tools box that appears on the right side of the page. For questions about the Rightslink service, e-mail [email protected]com or call 877-622-5543 (U.S. Only) or 978-777-9929. Permissions FAQs and information on authors permission requests are available at https://shop.lww.com/journal-permission. For additional permission inquiries, please contact [email protected]com. Copyright © 2020 by the American Urological Association Education and Research, Inc. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To determine the proportion of men presenting for fertility evaluation who reported having an established primary care physician (PCP). DESIGN:Retrospective, observational study. SETTING:Academic health center. PATIENTS:All men presenting for initial male factor infertility consultation with a single reproductive urologist between 2002 and 2018. INTERVENTIONS:Men were asked to provide the name of their PCP at the time of initial visit. MAIN OUTCOME MEASURES:Descriptive statistics characterized the proportion of men with a PCP at the time of evaluation and associations between PCP status and clinical characteristics. RESULTS:Among 4,127 men presenting for initial fertility consultation, 844 (20.5%) reported having an established PCP, 480 (11.6%) reported no PCP, and 2,803 (67.9%) did not have data available. Among 1,302 men who had a prior primary care visit within our healthcare system, 414 (31.8%) had been seen within 1 year before their fertility evaluation. Men with an established PCP were slightly older than those without a PCP, with higher body mass index, and lower systolic blood pressure. Hormonal profiles were similar across groups, but men with an established PCP had a significantly higher total motile sperm count than those without a PCP, median 53 (interquartile range, 11-109) versus 35 (interquartile range, 8-98). CONCLUSIONS:More than one third of men presenting for fertility evaluation did not have an established PCP. Reproductive urologists are uniquely positioned to facilitate the critical relationship between young men and PCPs, which should be a key component of the male fertility treatment paradigm.

OBJECTIVES To evaluate the extent to which erectile dysfunction (ED) is managed by urologists versus non-urologists. We sought to characterize the epidemiology, diagnosis, and outpatient treatment of ED using a nationally representative cohort. METHODS We examined all male patient visits between 2006 and 2016 in the National Ambulatory Medical Care Survey, a survey designed to provide a nationally representative estimate of ambulatory visits in the United States. Distribution of ED diagnoses among physician specialties was determined. Demographic, clinical, and treatment characteristics of men with ED seeing urologists versus non-urologists were compared using chi-squared tests. RESULTS Among the 170,499 patient visits analyzed, 1.2% were associated with a diagnosis of ED, which translated into 3,409,244 weighted visits annually. Visits for ED were predominantly seen by urologists (58.0%) and family practitioners (26.2%). Men visiting non-urologists for ED were more likely to be younger than 65 (77.4% vs 52.9%, P < .05). Men seeing urologists for ED more frequently had an active cancer diagnosis (24.2% vs 2.8%, P < .05). Non-urologists more readily ordered or reordered phosphodiesterase-5 inhibitors for men with ED (66.62% vs 50.77%, P < .05). Advanced therapies such as intracavernosal injections and intra-urethral agents were almost exclusively ordered by urologists compared to non-urologists (2.72% vs 0.25%, P < .05). CONCLUSION Almost half of all ED visits were seen by non-urologist providers, who were much less likely than urologists to order advanced pharmacologic therapies. This difference in prescribing patterns presents an opportunity for interdisciplinary collaboration and education to ensure that all patients seeking treatment for ED are receiving guideline-based care. Published by Elsevier Inc.

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP26)1 Apr 2020MP26-08 GEOGRAPHIC DISTRIBUTION AND CHARACTERISTICS OF REPRODUCTIVE UROLOGISTS IN THE UNITED STATES Arighno Das*, Anne Darves-Bornoz, Tejas Joshi, Mary Kate Keeter, James Wren, Nelson Bennett, Robert Brannigan, and Joshua Halpern Arighno Das*Arighno Das* More articles by this author , Anne Darves-BornozAnne Darves-Bornoz More articles by this author , Tejas JoshiTejas Joshi More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , Robert BranniganRobert Brannigan More articles by this author , and Joshua HalpernJoshua Halpern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000865.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While male factor infertility is present in up to half of infertile couples, studies have demonstrated that many male partners do not undergo evaluation by a reproductive urologist. We examined the geographic distribution of reproductive urologists relative to population density throughout the United States to determine whether restricted access to reproductive urologists could contribute to underutilization of male fertility evaluation. METHODS: We compiled a database of reproductive urologists using the Society for the Study of Male Reproduction (SSMR) membership directory and targeted Google searches, as these are the primary means through which patients can find a provider online. All practice locations and the male fertility procedures offered by each provider were recorded. Population data was abstracted from US Census Data (2010) and the American Community Survey 5-year estimates (2017). RESULTS: 255 reproductive urologists were identified of whom 131 (51%) were registered in the SSMR membership directory. Among all providers, 165 (65%) completed a fellowship in male infertility, andrology, and/or microsurgery. Fellowship-trained providers were more likely to mention sperm extraction, varicocelectomy, or vasectomy reversal on their website compared to non-fellowship trained providers (all p < 0.001) and more likely to practice exclusively at an academic medical center (p < 0.001). Among 3220 counties in the US, only 195 (6.1%) had a practicing reproductive urologist. Counties with a male infertility provider were more populous, had younger residents, higher mean household income and higher rate of college education (all p < 0.001). There was a dearth of reproductive urologists in rural areas (population < 50,000) with 2206 (99%) rural counties lacking a reproductive urologist. CONCLUSIONS: There are a small number of fellowship-trained reproductive urologists in the United States, and the majority of counties do not have a local reproductive urologist, regardless of fellowship training. These factors may contribute to the low rates of male partner evaluation, suggesting a potential role for telemedicine or other novel approaches to improve patient access. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e403-e403 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arighno Das* More articles by this author Anne Darves-Bornoz More articles by this author Tejas Joshi More articles by this author Mary Kate Keeter More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Robert Brannigan More articles by this author Joshua Halpern More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP26)1 Apr 2020MP26-05 PREVALENCE OF CLINICALLY APPARENT PROLACTINOMAS IN THE SUBFERTILE MALE Anne Darves-Bornoz*, Mehul Patel, Mary Kate Keeter, James Wren, Nelson Bennett, Joshua Halpern, and Robert Brannigan Anne Darves-Bornoz*Anne Darves-Bornoz* More articles by this author , Mehul PatelMehul Patel More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , Joshua HalpernJoshua Halpern More articles by this author , and Robert BranniganRobert Brannigan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000865.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The physiologic role of prolactin in men remains unclear. However, excessive serum concentrations of prolactin can lead to clinical sequelae such as infertility and hypogonadism. Using population-based studies, the prevalence of prolactinoma in the general male population is estimated at 1:100,000 (0.0001%). Although a well-established cause of male infertility, the prevalence of prolactinoma within this subgroup has not been evaluated. METHODS: We retrospectively examined all men presenting for initial male fertility consultation at a tertiary care center with a single reproductive urologist between 1999 and 2018. Men with a prolactin level collected at this encounter were analyzed with descriptive statistics to determine incidence of hyperprolactinemia and resulting clinical significance. RESULTS: Among 4116 men presenting for initial fertility consultation, 3102 had a serum prolactin level measured. 65 men (2.1%) had a prolactin level greater than or equal to 18 ng/mL. Of the 65 men with an initial elevated prolactin level, 21 (32.3%) were evaluated by an endocrinologist and 21 (32.3%) underwent a brain MRI. 11/65 (17%) were diagnosed with a pituitary adenoma, of which 8 were microadenomas (<10 mm on MRI) and 3 were macroadenomas (>10mm). 8 of the 11 men with a prolactinoma were treated with cabergoline. The overall prevalence of a clinically apparent prolactinoma in our cohort was 11:3102 (0.35%). CONCLUSIONS: This is the largest known study to evaluate the prevalence of prolactinomas among a population of subfertile males. We found a 350-fold increased prevalence of prolactinoma among our cohort when compared to the general male population. Despite a low absolute prevalence, prolactinoma remains an important source of morbidity and potential etiology for subfertility, and clinicians should continue to include this condition in the differential diagnosis of male subfertility. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e401-e402 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anne Darves-Bornoz* More articles by this author Mehul Patel More articles by this author Mary Kate Keeter More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Joshua Halpern More articles by this author Robert Brannigan More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To describe trends in the characteristics of urologic surgeons performing vasectomy over time.METHODS:We performed a retrospective, cross-sectional study examining surgeon characteristics for case logs from the American Board of Urology between 2004 and 2013. We used generalized estimating equations with a log link and negative binomial distribution to examine demographic differences (gender, rural location, and surgeon volume) in the number of vasectomies surgeons performed over time.RESULTS:Between 2004 and 2013, 5316 urologists had case logs collected within the 7-month certification window. The majority of these surgeons self-identified as general urologists (82.8%), and a small proportion identified as andrology and infertility specialists (1.7%). Across all years, the median number of vasectomies performed per certifying surgeon during the study period was 14 (interquartile range 6-26). The majority of vasectomies were performed by high-volume surgeons (≥ 26 vasectomies) ranging from 49.2% to 66.9% annually, whereas the proportion performed by low-volume (≤ 5 vasectomies) surgeons ranged from 3.3% to 6.6% annually. Male surgeons performed vasectomies 2.20 times more frequently than female surgeons (95% confidence interval 1.93-2.49; P <.0001) across the study period with no evidence to suggest this gap changed over time (gender-year interaction 1.01 [95% confidence interval: 0.97-1.06; p = .576]).CONCLUSION:While the majority of urologists performing vasectomy identify as general urologists, there appears to be a focus on vasectomy practice among a small number of high-volume surgeons. Furthermore, while the number of female surgeons performing vasectomies increased, a gender gap persists in the proportion of vasectomies performed by females.

Recent data have suggested that short-term NSAID use induces a state of compensated hypogonadism. Our aim was to investigate the association between chronic, regular NSAID use and compensated hypogonadism in a large, nationally representative cohort, the US National Health and Nutrition Examination Survey (NHANES) database. Men 20-80 years who answered the analgesic use questionnaire and underwent hormonal testing were included. Multivariable regression was utilised to determine the relationship between NSAID use and serum testosterone (T), anti-Mullerian hormone (AMH) and T:AMH ratio. Among 3,749 men, 505 (13.5%) reported regular NSAID use and 3,244 (86.5%) did not. Regular users had lower T (440.7 ± 27.0 vs. 557.0 ± 24.9 ng/dl, p = .005) and albumin (43.8 ± 0.2 vs. 45.1 ± 0.1, p < .001) compared to nonregular users. On multivariable analysis, only active smoking was significantly associated with T, AMH and T:AMH ratio (p < .001, p = .036 and p = .005 respectively). Regular NSAID use was not associated with T, AMH or T:AMH ratio (p = .523, p = .974, and p = .872 respectively). In this nationally representative sample of US men, regular and chronic NSAID use was not associated with alterations in T or compensated hypogonadism. These data should reassure patients and clinicians regarding the safety of NSAID use with respect to the risk of alteration in the hypothalamic-pituitary-gonadal axis.

Background The purpose of this study is to evaluate the prognostic factors for sperm retrieval and determine if Y chromosome deletion is associated with deleterious effects. Whether Y chromosome deletion determines the sperm retrieval rate in non-mosaic Klinefelter patients has not yet been addressed. Methods We retrospectively collected medical records of azoospermic patients from Sep 2009 to Dec 2018, and enrolled 66 non-mosaic 47, XXY patients who were receiving mTESE. The predictive values of patients age, serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, prolactin, estradiol and Y chromosome deletion were assessed for successful sperm recovery. Results Testicular sperm recovery was successful in 24 (36.4%) of 66 men. The mean age (36.0 vs. 36.6 years), and levels of FSH (30.0 vs 36.9 IU/L), LH (17.7 vs 21.9 IU/L), testosterone (2.4 vs. 2.1 ng/ml), prolactin (9.1 vs. 8.8 ng/ml), and estradiol (19.4 vs. 22.3 pg/ml) did not show any significant difference when comparing patients with and without successful sperm retrieval. Partial deletion of azoospermic factor c (AZFc) was noted in 5 (20.8%) of 24 patients with successful sperm retrieval, including three b2/b3 and two gr/gr deletion cases, whereas 4 (9.5%) of 42 patients with unsuccessful sperm retrieval were noted to have AZFc partial deletion (one b2/b3 , one sY1206 and two gr/gr deletion), though the difference was not statistically significant (p=0.27) Conclusion According to present results, age and AZFc partial deletion status should not be a deterrent for azoospermic males with non-mosaic Klinefelter syndrome to undergo mTESE.

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD25)1 Apr 2020PD25-08 ONLINE ACCESS TO MALE INFERTILITY CARE: THE CHALLENGE OF FINDING A REPRODUCTIVE UROLOGIST Arighno Das*, Anne Darves-Bornoz, Mary Kate Keeter, James Wren, Nelson Bennett, Robert Brannigan, and Joshua Halpern Arighno Das*Arighno Das* More articles by this author , Anne Darves-BornozAnne Darves-Bornoz More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , Robert BranniganRobert Brannigan More articles by this author , and Joshua HalpernJoshua Halpern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000882.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients increasingly utilize the internet as a primary source of health information. As many subfertile couples do not undergo male partner evaluation by a reproductive urologist, we hypothesized that internet search and referral patterns may contribute to underutilization of reproductive urological evaluation. We examined internet search results to understand the information available to couples searching for a male infertility provider. METHODS: The phrase “male infertility specialist ” was searched in Google (Incognito mode) for all 50 states. The first ten results (i.e. first page) of each search were evaluated for provider type (urology vs obstetrics and gynecology [OBGYN]), level of training (fellowship vs none), male fertility information provided and procedures offered. Websites that were purely informational without any listed providers were excluded. We compared search position rank (1-10) across provider types to determine the likelihood of finding an urologist vs OBGYN. RESULTS: 421 individual results were identified of whom 232 (55.1%) were OBGYN providers, whereas only 160 (38.0%) results led to a fellowship-trained reproductive urologist. On average, urology providers were ranked higher than OBGYN providers (4.8±3.0 vs 5.5±2.8, p=0.01). Geographic differences in the search results were noted, with a significant association found between state population and percent of results that were urology-related (Spearman’s correlation, p<0.001). Among 232 OBGYN providers, 136 unique practices were identified. The majority of websites for these practices did not mention varicocele repair (86, 63.2%), vasectomy reversal (104, 76.5%), or sperm extraction (70, 51.5%). Among 66 OBGYN websites that did mention sperm extraction, 20 (30.3%) performed sperm extraction in-house, 23 (34.8%) referred to an urologist, and 22 (33.3%) did not specify who performed the procedure CONCLUSIONS: When searching the internet for a male infertility specialist, the majority of results identified OBGYN physicians. Furthermore, a large proportion of OBGYN websites lacked information on important male fertility treatments, and most did not appear to offer these treatments. These data indicate a need for a more robust online presence to optimize online access for subfertile couples. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e541-e541 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arighno Das* More articles by this author Anne Darves-Bornoz More articles by this author Mary Kate Keeter More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Robert Brannigan More articles by this author Joshua Halpern More articles by this author Expand All Advertisement PDF downloadLoading ...

To determine the relationship between popular diets and erectile function we queried the National Health and Nutrition Examination Survey, a cross-sectional dataset, between 2001 and 2004. All men aged 18–85 who answered the prostate and dietary questionnaires were included. Diets were categorized as Mediterranean, low-fat, low-carbohydrate, or nonrestrictive. Multivariable models were created to determine the relationship between erectile function and each diet. Among 4027 men, 649 (16.1%) met criteria for a low-fat diet, 1085 (26.9%) for a Mediterranean diet, and 0 (0%) for a low-carbohydrate diet. 1999 men (49.6%) had some degree of erectile dysfunction. Men with nonrestrictive diets were more likely to endorse normal erectile function compared with those adhering to the Mediterranean or low-fat diets (both p < 0.05) on univariable analysis. Multivariable analysis controlling for age, comorbidities, activity level, and body mass index showed no differences in erectile function among men adhering to a low-fat, Mediterranean diet, or nonrestrictive diet. There was no association between specific diets and erectile function. While additional prospective research is required to corroborate these findings, these data support the notion that individualized diets should be tailored toward goals of weight loss and reduction of comorbidity.

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP26)1 Apr 2020MP26-06 REFERRAL PATTERNS AND PATIENT CHARACTERISTICS OF MEN UNDERGOING FERTILITY EVALUATION: WHERE DO OUR PATIENTS COME FROM? Tejas Joshi*, Anne Darves-Bornoz, Mary Kate Keeter, James Wren, Nelson Bennett, Robert Brannigan, and Joshua Halpern Tejas Joshi*Tejas Joshi* More articles by this author , Anne Darves-BornozAnne Darves-Bornoz More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , Robert BranniganRobert Brannigan More articles by this author , and Joshua HalpernJoshua Halpern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000865.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are limited data on the proportion of infertile couples referred to a reproductive urologist and which physicians are most likely to refer these couples for male partner evaluation. We sought to describe referral patterns and differences in patient characteristics according to referral source. METHODS: We retrospectively reviewed data on men presenting for new fertility evaluation over 17 years at a tertiary care center. We characterized patients as self-referred or referred from primary care / family practice (PCP), general obstetrics and gynecology (OBGYN), reproductive endocrinology (REI), general urology, or other physicians. Patient characteristics were compared across groups, including the proportion of men with severe oligospermia (sperm concentration < 5 million/mL). RESULTS: Among 4041 men, 2137 (52.9%) were referred by physicians, 908 (22.5%) self-referred, and 996 (24.6%) reported no referral. Physician referrals were most commonly from PCP (62.2%) followed by REI (16.8%), general OBGYN (11.3%), other specialists (5.8%), and urologists (3.8%). Groups were largely similar in terms of age, race, body mass index, and hormone levels. Severe oligospermia was present in a higher proportion of men referred by REI or self-referred versus PCPs (37.6% and 32.8% vs 20.8%, both p<0.01). When controlling for age, race, and hormone levels, men referred by PCP had significantly higher total motile sperm counts (TMSC) than other specialties, and those referred by REI had significantly lower TMSCs than those referred by PCPs and self-referred. CONCLUSIONS: A minority of male fertility patients were referred by REI, whereas most patients were referred by PCPs or self-referred. Furthermore, REI patients were more likely to be severely oligospermic than men referred by other providers. These data suggest that REI may have more restrictive criteria when referring male partners for evaluation, which presents an opportunity for interdisciplinary education, outreach, and collaboration to increase patient access. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e402-e402 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tejas Joshi* More articles by this author Anne Darves-Bornoz More articles by this author Mary Kate Keeter More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Robert Brannigan More articles by this author Joshua Halpern More articles by this author Expand All Advertisement PDF downloadLoading ...