Introduction: Men seeking treatment for sexual dysfunction can experience embarrassment as a result of stigma. This research manuscript presents the findings of a survey conducted to investigate the influence of humor on prospective patients' preferences when selecting a specialist to address erectile dysfunction (ED). Methods: The respondents were presented with five pairs of mock urology business cards: one professional and one humorous. A questionnaire was designed and distributed via an online survey platform. Descriptive statistics and Fisher's exact test were performed using the Statistical Package for Social Sciences (SPSS) software version 29 (IBM SPSS Statistics, Armonk, NY) to evaluate age and race associations with card preference. Results: Among the 997 participants, an average of 66.1% (a median of 71.2%) preferred professional cards. Humorous card selection rates ranged from 5.2% to 38.4% compared to 54.0% to 78.1% for professional cards. A statistically significant relationship between age and professional card choice existed in all except the fifth set of cards (p = 0.001, 0.001, 0.001, 0.001, and 0.054). The relationship between race or ethnicity and business card preference was not reported due to an imbalance in demographics, with most participants identifying as Caucasian. Discussion: A humor -centric approach may not resonate with all individuals seeking treatment for sensitive conditions such as ED. Limitations include the subjectivity of humor, the use of an online survey platform, and the hypothetical nature of this study. Real patients experiencing ED may face stigma and respond to humor differently. Conclusion: This study provides insights into patient preference for professionalism over humor from their urologist but leaves room for the exploration of humor in medical contexts. Future studies could examine the impacts of humor on patient choices in real -world healthcare settings.

We evaluated depression-related health care resource utilization and antidepressant prescription medication utilization among commercially insured men in the United States who underwent inflatable penile prosthesis (IPP) implantation between January 1, 2007 and December 31, 2020, and who received a depression diagnosis in the year preceding the IPP procedure. A total of 11,177 patients received an IPP during the index period, 808 of whom were diagnosed with depression. A statistically significant reduction in overall depression-related health care visits occurred from pre- to post-IPP, decreasing from 4.9 to 3.8, p < .001. In addition, there was a significant reduction in depression-related inpatient visits (0.07 vs. 0.03, p = .02) and office visits (4.25 vs. 3.29, p < .001) from pre- to post-IPP. Of the 678 men who received an antidepressant medication within 1 year prior to their IPP date, 15% stopped antidepressant medication use entirely post-IPP. Among patients with continued antidepressant medication use post-IPP ( n = 574), there was a significant decrease in the number of prescriptions (7.55 vs. 8.09, p < .0001) and refills (7.52 vs. 8.11, p = .0015), with a higher likelihood of discontinuation (17.6% vs. 10.5%, p < .0001) and a lower proportion of days covered (0.79 vs. 0.83, p = .0004) post-IPP compared with pre-IPP. In conclusion, IPP was associated with reduced depression-related health care utilization and antidepressant medication use among recipients. This suggests potential mental health benefits for IPP recipients beyond restoration of erectile function. Comprehensive insurance coverage for IPP, especially for men with depression, may be beneficial to both patients and insurers.

Introduction: We investigate and analyze the available information regarding on-call patterns among urologists in the US. Methods: The AUA Workforce Workgroup collaborated with the AUA Data Team to analyze information from the 2022 AUA Census. Extracted data were analyzed to identify variability across gender, subspecialty, hours worked per week, AUA section, salary, and practice setting. We used chi 2 tests to compare the groups with respect to each factor and defined statistical significance as a P value less than .05. Results: There were significant differences by gender and several other on-call factors including being required to take call to maintain hospital privileges (reported by 76% of female urologists vs 67% of male urologists; P = .026), getting paid for weekend call (28% of females vs 38% of males; P = .030), and making over $500 per day when taking weekend call (18% of females vs 32% of males; P < .001). Other differences existed between AUA sections in percentage of physicians receiving over $500 for weekday or weekend calls (P < .001). Lastly, practice setting differed in likelihood of being paid over $500 for weekday call (44% reported by private practice urologists, 7% reported by academic urologists, 14% reported by institutional urologists; P < .001). Conclusions: These results underscore the substantial variability in on-call responsibilities and structure within the AUA workforce. Further research and regular participation in future censuses are recommended to continue to characterize these trends.

Aim: To assess the content and quality of YouTube videos related to cerebral palsy to provide insights into the online video resources available for individuals affected by cerebral palsy and suggest strategies for improvement. Methods: YouTube videos were analyzed based on interaction parameters, content characteristics/category, and video source. Video reliability and quality were assessed using the Journal of American Medical Association benchmark, Global Quality Scale, and cerebral palsy-specific score. Statistical analyses examined associations between video characteristics and reliability/quality scores. Results: The average video ( n = 48) length was 6.8 min, with 29 informational and 19 experiential videos. The mean Journal of American Medical Association score was 2.0, indicating moderate reliability. The Global Quality Scale suggested good quality content (average: 3.5), but only 14% were rated as good via cerebral palsy-specific score. Higher views were associated with higher Journal of American Medical Association score and cerebral palsy-specific score ( p = 0.002 and p = 0.006), and nonphysician medical expert videos had lower Journal of American Medical Association scores than academic videos ( p = 0.042). Video content was not significantly associated with either score. Conclusion: YouTube provides moderate to good quality information on cerebral palsy. Critical evaluation of video sources and content is essential. Findings can guide strategies to enhance the quality of cerebral palsy-related YouTube content, benefiting individuals with cerebral palsy, health care providers, and caregivers.

Rubin H. Flocks, MD is one of the most distinguished academic physicians whose contributions to the urologic community should not go unnoticed. Through his unmatchable work ethic and desire to inspire his residents and medical students, Flocks had a never-ending desire to serve his patients. He has co-authored multiple textbooks and has published more than 150 research articles. Additionally, Flocks held various leadership positions, including president of the American Urological Association (1969) and secretary and president of the American Board of Urology (1963-1968).

Background While large language models show potential as beneficial tools in medicine, their reliability, especially in the realm of obstetrics and gynecology (OB-GYN), is not fully comprehended. This study seeks to measure and contrast the performance of ChatGPT and HuggingChat in addressing OB-GYN-related medical examination questions, offering insights into their effectiveness in this specialized field. Methods ChatGPT and HuggingChat were subjected to two standardized multiple-choice question banks: Test 1, developed by the National Board of Medical Examiners (NBME), and Test 2, gathered from the Association of Professors of Gynecology & Obstetrics (APGO) Web-Based Interactive Self-Evaluation (uWISE). Responses were analyzed and compared for correctness. Results The two-proportion z-test revealed no statistically significant difference in performance between ChatGPT and HuggingChat on both medical examinations. For Test 1, ChatGPT scored 90%, while HuggingChat scored 85% (p = 0.6). For Test 2, ChatGPT correctly answered 70% of questions, while HuggingChat correctly answered 62% of questions (p = 0.4). Conclusion Awareness of the strengths and weaknesses of artificial intelligence allows for the proper and effective use of its knowledge. Our findings indicate that there is no statistically significant difference in performance between ChatGPT and HuggingChat in addressing medical inquiries. Nonetheless, both platforms demonstrate considerable promise for applications within the medical domain.

Abstract Introduction Inflatable penile prosthesis (IPP) is widely considered medically necessary and a definitive treatment to restore erectile function, yet employer benefit exclusion and lack of insurer coverage of IPP implantation among non-Medicare men may limit their access to the treatment that can negatively impact quality of life. While previous research examined the impact of penile implants among men with depressive symptoms, limited evidence is available to quantify the impact of IPP on depression-related healthcare utilization including emergency department, inpatient, outpatient, and office visits among this patient population. Objective To evaluate the real-world healthcare utilization associated with depression among men undergoing IPP in a US commercial population. Methods A retrospective claims-based analysis was conducted using the 85% Merative™ MarketScan® commercial database to identify men aged ≥18 undergoing IPP (CPT 54405) between 2007 and 2020. Male patients were included if they had at least one claim of depression as a primary diagnosis one-year pre-index IPP and did not have any IPP during this period. Patients were required to have one-year continuous enrollment pre- and post-index IPP. Healthcare utilization associated with a primary diagnosis of depression including number of emergency department visits, inpatient visits, outpatient visits, office visits, and total healthcare visits were measured one-year pre- and post-index IPP. The total healthcare visits included all sites of service for depression. A paired t-test was conducted to evaluate the differences pre- and post-index IPP among patients using the Instant Health Data software (Panalgo, Boston MA, USA) and R, version 3.2.1 (R Foundation for Statistical Computing, Vienna, Austria). Results Among 11,177 patients identified with an IPP during the index period, 808 patients had depression. Average age was 55.26 (±6.83) and average Charlson comorbidity score was 1.63 (±1.67). A statistically significant reduction in the mean number of total healthcare visits, inpatient visits, and office visits were observed pre- and post-index IPP. The mean number of total healthcare visits in the pre-IPP period was 4.88 ± 7.71 compared to 3.82 ± 8.48 in the post-index IPP period (P<0.0001). Among these, the mean number of inpatient visits in the pre-index IPP period was 0.07 ±0.57 compared to 0.03 ±0.22 in the post-index IPP period (P=0.02) and the mean number of office visits in the pre-index IPP period was 4.25 ±7.17 compared to 3.29 ±7.84 in the post-index IPP period (P<0.0001). Conclusions The study provides evidence highlighting the benefits of IPP in alleviating the healthcare resource utilization associated with depression among men undergoing an IPP. For these benefits to be fully realized, it is critical to ensure comprehensive coverage of medically necessary IPP among commercially insured patients with depression. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Abstract Introduction The time to conception is an essential factor that influences reproductive outcomes, and understanding its variance aids in appropriate family planning. Factors such as Body Mass Index (BMI), polycystic ovarian syndrome (PCOS), and maternal age significantly impact time to conception. Our study explores these factors in the light of the perceived increase in conception time over the last decade. Existing data show a decrease in births per woman worldwide over several decades; however, there is a lack evidence to prove if this trend is due to fertility or volition. Our goal was to observe whether or not a true increase in time to conception exists. Objective The study aimed to discern whether time to conception has increased over the past decade compared to the previous decade. The secondary aim was to explore the relationship between conception time and several variables, including BMI, PCOS, maternal age, and lifestyle habits. Methods We employed Amazon Mechanical Turk (MTurk) to conduct an online survey of 12 questions. The study population consisted of pregnant women from the year 2000 onwards. The survey assessed a range of factors: maternal and paternal age, pregnancy year, physical activity levels, tobacco and alcohol use, BMI, race/ethnicity, certain aspects of medical history, months to conception, and total number of gestations. Univariable logistic regression models were employed to assess the correlation between these factors and conception time. Results The results from 852 respondents showed no significant differences in time to conception when comparing individuals who became pregnant post-2012 versus pre-2012. However, several factors significantly influenced conception time. Mothers who exercised more than 150 minutes per week or had endometriosis, history of pelvic inflammatory disease (PID), or PCOS were 1.4, 1.7, 1.7, and 2.4 times more likely, respectively, to have longer times to conception (>= 6 months) (p < 0.05). Additionally, paternal factors such as undergoing chemotherapy, having testicular cancer, or varicocele were associated with 1.7, 1.6, and 3.5 times longer conception times, respectively (p < 0.05). Conclusions Although there was no apparent increase in time to conception over the past decade, several factors were significantly associated with extended conception time. These include maternal factors like physical activity, endometriosis, PID, and PCOS, as well as paternal factors like undergoing chemotherapy, having testicular cancer or varicocele. The current guidelines recommend a twelve-month period of attempting conception before pursuing fertility assessment. This study implies that a reevaluation of these guidelines may be warranted. It is plausible that women with one or more of these risk factors should be advised to seek medical attention earlier than twelve months, or even prior to attempting conception. Understanding these relationships provides valuable insights for family planning and infertility treatment, underscoring the importance of comprehensive health and lifestyle evaluation in couples planning to conceive. Future studies should focus on developing targeted interventions to optimize these factors and potentially reduce conception time. Disclosure No.

Bibliometric analyses serve to identify influential articles that have shaped medical practice and fostered new research ideas. Over the past decade, research in andrology has witnessed exponential growth, with an increasing number of academic publications, collaborations, and research innovations. However, there is a lack of literature that has identified the top-cited andrology articles. We conducted a bibliometric analysis to identify the top 1000 citations in andrology journals, with a focus on the top funding agencies, authors, institutions, countries/regions, and journals. To perform this analysis, we identified the top-cited articles in andrology journals as indexed in the Web of Science Core Collection. From 2013 through 2022, we found a total of 9827 articles published in andrology journals. The top publishers included “Andrology,” the “Asian Journal of Andrology,” and “Andrologia.” The top affiliations contributing to research include the Cleveland Clinic Foundation (269 publications), Egyptian Knowledge Bank (EKB) (265), and Shanghai Jiao Tong University (202). Funding was primarily provided by notable agencies such as the National Natural Science Foundation of China (905 grants), United States Department of Health Human Services (321), and National Institutes of Health (NIH USA) (317). The present bibliometric analysis highlights andrology research from 2013 through 2022, offering key insights into leading contributors, influential authors, prominent funding sources, and major trends in the field.

Purpose:Our goal was to explore the current trends in burnout, career choice regret, and well-being needs among urology residents and fellows, with specific emphasis on identifying key factors associated with burnout.Materials and Methods:The AUA Workforce Workgroup collaborated with the AUA Data Team to analyze data from the 2021 AUA Census, comprising a total of 243 residents and fellows. Key demographics, benefits and resources, career choice and debt, and burnout levels were analyzed, focusing on variables like gender, PGY (postgraduate year) level, debt burden, and personal health appointments.Results:Overall, 48% of residents and 33% of fellows met criteria for professional burnout, with a higher incidence among PGY-2 residents (70%). Depersonalization was particularly notable, with 74% of residents reporting medium to high levels. Burnout was significantly associated with difficulty attending personal health appointments (52% vs 34%) and lack of access to on-call rooms (54% vs 36%). In contrast, having children during residency was associated with lower burnout levels (30.8% vs 49.1%). Meal plans were ranked as the most desired benefit (32%), followed by ability to attend health appointments during work hours (17%) and paid family leave (16%). Educational debt over $150,000 was carried by 53% of residents and 48% of fellows. Interestingly, burnout rates showed no statistically significant difference in response rates across genders, relationship status, amount of educational debt, presence of paid maternity or paternity leave, and type of childcare arrangements.Conclusions:Burnout remains a significant issue among urology trainees, with a complex interplay of factors like lack of personal time and provision of call rooms. The alarming rates of depersonalization and exhaustion highlight the urgency of implementing targeted interventions. Enhanced support systems, improved access to health care appointments, provision of call rooms, and debt management programs are recommended to alleviate the growing problem of professional burnout in the field of urology.

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes II (MP57)1 May 2024MP57-20 ANTIDEPRESSANT MEDICATION USE AMONG COMMERCIALLY INSURED MEN WITH DEPRESSION UNDERGOING INFLATABLE PROSTHESIS IMPLANTATION Roei Golan, Young Shin, Alysha M. McGovern, Rutugandha Paranjpe, Sirikan Rojanasarot, Taylor Kohn, Francis Petrella, Sirpi Nackeeran, and Ranjith Ramasamy Roei GolanRoei Golan , Young ShinYoung Shin , Alysha M. McGovernAlysha M. McGovern , Rutugandha ParanjpeRutugandha Paranjpe , Sirikan RojanasarotSirikan Rojanasarot , Taylor KohnTaylor Kohn , Francis PetrellaFrancis Petrella , Sirpi NackeeranSirpi Nackeeran , and Ranjith RamasamyRanjith Ramasamy View All Author Informationhttps://doi.org/10.1097/01.JU.0001009420.83948.eb.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Depression often occurs alongside sexual dysfunction in men and can greatly reduce quality of life. Previous research shows inflatable penile prosthesis (IPP) implantation may improve depressive symptoms for these patients, suggesting benefits beyond erectile restoration. However, there is limited data on how IPP affects use of antidepressant medications for depression. This study aimed to investigate the impact of IPP placement on antidepressant prescription patterns in commercially insured American men diagnosed with depression. METHODS: A retrospective claims database analysis was conducted using the Merative™ MarketScan® commercial claims database to identify men aged 18+ with a depression diagnosis who underwent IPP implantation (Current Procedural Terminology [CPT®] code 54405) between 01/01/2007 and 12/31/2021 post-depression diagnosis. Included patients were required to have at least 1 year of continuous enrollment pre-IPP and post-IPP and to have received an antidepressant prescription prior to their IPP date. Antidepressant utilization was assessed based on proportion days covered (PDC) (a measure of consistent use of a medication), number of prescriptions and refills, and discontinuation (defined as a gap of ≥90 days between refills) pre- and post-IPP. A paired t-test was performed to assess the differences before and after IPP implantation. RESULTS: A total of 678 men diagnosed with depression who underwent IPP were identified with an average age of 55.8±6.4 and Charlson Comorbidity Score of 1.6±1.6 pre-IPP. Of these patients, 104 (15%) had no antidepressant prescriptions in the post-IPP follow-up period, representing a complete stop of treatment. For the 574 men with antidepressant prescriptions following IPP (Table 1), the number of antidepressant prescriptions and refills decreased significantly from post-implantation. Patients were also significantly more likely to discontinue their antidepressant treatment and had lower PDC post-IPP versus pre-IPP. CONCLUSIONS: The study found a significant decline in antidepressant utilization post-IPP implantation, emphasizing IPP's potential role in not only addressing erectile function but also influencing mental health outcomes. Further research may evaluate the causative factors and implications of these findings on patient care and treatment approaches. Source of Funding: This study was supported by Boston Scientific. RR is a practicing urologist at University of Miami and discloses financial interest with Boston Scientific (consultant, grant recipient). RP and SR are employees of Boston Scientific. YS is a graduate student at the University of Cincinnati and is not a Boston Scientific employee; however, she is working on a Global Health Economics and Market Access project with Boston Scientific.Supported by NIDDK grants R01 DK130991, UE5 DK137308, and Clinician Scientist Development Grant from American Cancer Society to RR © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e946 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Roei Golan More articles by this author Young Shin More articles by this author Alysha M. McGovern More articles by this author Rutugandha Paranjpe More articles by this author Sirikan Rojanasarot More articles by this author Taylor Kohn More articles by this author Francis Petrella More articles by this author Sirpi Nackeeran More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract Introduction Testosterone (T) plays an important role in properly developing and maintaining male reproductive tissues. The normal serum testosterone levels can vary between 300 to 1000 ng/dL or 10.4 to 34.7 nmol/L. However, it is unclear whether androgen receptor signaling can vary based on serum T levels or the half-life of testosterone therapy. What remains unknown is whether there is a uniform serum T level above which androgen receptor signaling within the tissue remains similar (saturation hypothesis). Objective We first evaluated whether varying serum levels of T alter androgen receptor (AR) signaling in human penile tissue. Then, we evaluated and compared AR signaling in corpus cavernosum tissue of men treated with short-acting vs. long-acting testosterone. We hypothesized that we would find similar AR signaling in the penile tissue of both eugonadal and hypogonadal men as well as those men receiving short and long-acting testosterone. Methods We obtained human corpus cavernosum (hCC) tissue biopsies during penile surgery (for erectile dysfunction) from 14 men. We recorded their serum T levels on week prior to surgery before 10AM. We used western blot to evaluate adrenergic receptor (AR) and VEGF protein levels. Men without erectile dysfunction undergoing penile surgery for Peyronie's disease were used as controls. Results The median age of participants was 61 (IQR 12) and the median T level was 325ng/dL (IQR 201.45). The results of western blot showed expression of similar levels of VEGF in hCC samples from men with T >200ng/dL. However, men with serum T levels lower than 200 ng/dL had decreased expression of VEGF and AR. Conclusions This finding is significant because it demonstrates that serum testosterone beyond a certain threshold may have a minimal impact on erectile function. If a serum testosterone threshold is identified, this threshold could be a valuable target for future studies on the effects of testosterone on ED. It may alter the treatment threshold for men who have ED as their primary symptom of hypogonadism. This data also suggests the saturation value for penile androgen receptors. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceuticals, Boston Scientific, Coloplast, Endo Pharmaceuticals, Empower Pharmacy, Nestle Health, Olympus, Hims, Inc

Given the lack of regulatory approval for restorative therapies for the treatment of erectile dysfunction, we hypothesized that clinical trials would vary in methodology and endpoint measurements. Our objective was to analyze methodological approaches and outcome measures of clinical trials evaluating restorative therapies for erectile dysfunction. Data was extracted from clinicaltrials.gov on trials which contained the keywords "erectile dysfunction". We evaluated trials initiated between 2004 and 2021 which listed a restorative therapy intervention. We identified 95 trials investigating energy-based/shockwave therapies (60/95), stem cell therapies (25/95), platelet-based therapies (6/95), and others (4/95). Only 41.1% of the trials evaluated safety. The most common efficacy endpoint was International Index of Erectile Function and Sexual Health Inventory for Men, and only 29.5% utilized penile Doppler. Thirty (31.6%) trials had been completed yet only 3 (3.2%) have published results. We found substantial heterogeneity in methodological approach in the trials. Subjective measures of erectile function were commonly reported, but definitions of inclusion criteria and objective outcome measures were inconsistent. These results provide a basis for the design of future clinical trials to improve the quality of trial data and aid in the development of standardized criteria for erectile dysfunction clinical trials.

No AccessJournal of UrologyEditorials1 Jun 2023Peer Review: A Process Primed for Quality Improvement? Roei Golan, Rohit Reddy, Nicholas A. Deebel, Ranjith Ramasamy, and Andrew M. Harris Roei GolanRoei Golan *Correspondence: Department of Urology, University of Kentucky Medical Center, 800 Rose Street, MS 283, Lexington, KY 40536-0298 telephone: 859-257-3533; E-mail Address: [email protected] https://orcid.org/0000-0002-7214-3073 Florida State University College of Medicine, Tallahassee, Florida , Rohit ReddyRohit Reddy Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida , Nicholas A. DeebelNicholas A. Deebel Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina , Ranjith RamasamyRanjith Ramasamy Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida , and Andrew M. HarrisAndrew M. Harris Department of Urology, University of Kentucky Medical Center, Lexington, Kentucky Veterans Health Administration, Lexington, Kentucky View All Author Informationhttps://doi.org/10.1097/JU.0000000000003460AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Peer Review: A Process Primed for Quality Improvement?." The Journal of Urology, 209(6), pp. 1069–1070 REFERENCES 1. . Should peer reviewers be paid to review academic papers?. Lancet. 2022; 399(10335):1601. Crossref, Medline, Google Scholar 2. . The ups and downs of peer review. Adv Physiol Educ. 2007; 31(2):145-152. Crossref, Medline, Google Scholar 3. . Motivations for performing scholarly prepublication peer review: a scoping review. Account Res. 2021; 28(5):297-329. Crossref, Medline, Google Scholar 4. . Artificial intelligence in academic writing: a paradigm-shifting technological advance. Nat Rev Urol. 2023. doi. 10.1038/s41585-023-00746-x. Crossref, Medline, Google Scholar Support: This work was supported by NIH Grant R01 DK130991 and Clinician Scientist Development Grant from the ACS to RR. Conflict of Interest: AMH: BD Inc. The remaining Authors have no conflicts of interest to disclose. Ethics Statement: This study was deemed exempt from Institutional Review Board review. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 6June 2023Page: 1069-1070 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Metrics Author Information Roei Golan Florida State University College of Medicine, Tallahassee, Florida *Correspondence: Department of Urology, University of Kentucky Medical Center, 800 Rose Street, MS 283, Lexington, KY 40536-0298 telephone: 859-257-3533; E-mail Address: [email protected] More articles by this author Rohit Reddy Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida More articles by this author Nicholas A. Deebel Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina More articles by this author Ranjith Ramasamy Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida More articles by this author Andrew M. Harris Department of Urology, University of Kentucky Medical Center, Lexington, Kentucky Veterans Health Administration, Lexington, Kentucky More articles by this author Expand All Support: This work was supported by NIH Grant R01 DK130991 and Clinician Scientist Development Grant from the ACS to RR. Conflict of Interest: AMH: BD Inc. The remaining Authors have no conflicts of interest to disclose. Ethics Statement: This study was deemed exempt from Institutional Review Board review. Advertisement PDF downloadLoading ...

Background: Testosterone (T) plays an important role in male reproductive function and tissue development. Normal serum T levels vary between 300 and 1000 ng/dl. It is not known, however, if varying serum T levels alter androgen receptor (AR) signaling in tissue.Objective: To measure AR signaling levels in human corpus cavernosal tissue in males with different serum T levels.Design, setting, and participants: Participants were selected from a group of males undergoing surgical management for erectile dysfunction (ED; penile prosthesis place-ment). T levels were measured 1 week before surgery and a sample of corpus cavernosal tissue was procured during surgery. The tissue was homogenized, measured for protein concentration, and used for western blot analysis. VEGF was selected as an AR marker and actin was used for protein normalization.Outcome measurements and statistical analysis: VEGF and actin expression levels were analyzed using western blot analysis and ImageJ was used for quantification of antibody expression.Results and limitations: AR signaling was measured in terms of VEGF expression. Above a T level of 200 ng/dl, there was no significant difference found in VEGF expression. Only one patient had a T level less than 200 ng/dl, limiting the generalizability of these results. In addition, all patients had a history of ED, and controls (patients without ED) were not included in the study.Conclusions: Above a serum T level of 200 ng/dl, there was no significant difference in AR signaling. This finding suggests that there could be a saturation level present in corpus cavernosal tissue that is approximately 200 ng/dl.Patient summary: Serum testosterone levels above a certain threshold may not be nec-essary for biological functions. Instead, it is most likely that there is an approximate serum testosterone level that fully saturates tissue androgen receptors and results in peak function in men.(c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Aboard his grandfather's vessel while in the North Sea, Ferdinand Charles Valentine (Fig. 1) was born on March 22, 1851. Valentine's birth was registered in the town of Leer of the East Frisian region of Germany. Valentine's dad was a banker, and his family moved to United States when Valentine was an infant. His mom's maiden name was Van Biema, a Dutch surname.1Ferdinand C. Valentine Medalists. Vol 2023. The New York Section of American Urological Association; 2014.Google Scholar Valentine graduated in 1876 from McDowell Medical School in St. Louis, which was later known as the Missouri Medical College and became absorbed into the Washington University School of Medicine in St. Louis.2Ferdinand C. Valentine Medal. Vol 2023. Virtual Museum: The British Association of Urological Surgeons; 2023.Google Scholar, 3Origins and History of the Washington University School of Medicine. Vol 2023. Washington University School of Medicine Bernard Becker Medical Library.Google Scholar At first, he was drawn to become an ophthalmologist, learning from Prof. Charles E. Michel from Missouri Medical College and Prof. Jacob Herman Knapp from New York, who are associated with electrolysis and their eponymous Knapp striae, respectively.1Ferdinand C. Valentine Medalists. Vol 2023. The New York Section of American Urological Association; 2014.Google Scholar, 4Ferdinand C. Valentine, MD (1851-1909). Vol 2023. The William P. Didusch Center for Urologic History; 2023.Google Scholar, 5Tripathy K, Quint JM. Angioid Streaks. StatPearls; 2023.Google Scholar, 6Wagner R.F. Brysk H. Tyring S.K. Revisiting the Michel/Green controversy of 1879: was Carron du Villards the first to use probe/needle electrolysis for permanent hair destruction?.Int J Dermatol. 1997; 36: 947-951Crossref PubMed Scopus (4) Google Scholar, 7Wilson JW. JOSEPH NASH McDOWELL, M.D. The Register of the Kentucky Historical Society. 1967;65:324-340.Google Scholar Later, he traveled to Central America, where Valentine served as the Surgeon General of the Army of Honduras.4Ferdinand C. Valentine, MD (1851-1909). Vol 2023. The William P. Didusch Center for Urologic History; 2023.Google Scholar During his 9 years with the Army of Honduras, his interest in urological diseases burgeoned.1Ferdinand C. Valentine Medalists. Vol 2023. The New York Section of American Urological Association; 2014.Google Scholar Thereafter, he went back to the United States to do general practice for a couple of years.4Ferdinand C. Valentine, MD (1851-1909). Vol 2023. The William P. Didusch Center for Urologic History; 2023.Google Scholar Following this, Valentine studied genitourinary diseases and urologic surgery in Europe.4Ferdinand C. Valentine, MD (1851-1909). Vol 2023. The William P. Didusch Center for Urologic History; 2023.Google Scholar Valentine authored numerous urology articles and books such as The Irrigation Treatment of Gonorrhea Its Local Complications and Sequelae (1900), 600 Medical Don'ts; or, The Physician's Utility Enhanced (1887), Aids to Cytoscopic Practice (1903), The Prevention of Venereal Diseases (1906), and more.8Valentine F. The Irrigation Treatment of Gonorrhea. William Wood and Company, 1900Google Scholar, 9Valentine F. 600 Medical Dont's; or, The Physician's Utility Enhanced. G.W. Dillingham, 1887Google Scholar He wrote his book The Irrigation Treatment of Gonorrhea8Valentine F. The Irrigation Treatment of Gonorrhea. William Wood and Company, 1900Google Scholar to share his research on gonorrhea with general practitioners, whom he commends in his dedication:The demands upon [the general practitioner's] waking and sleeping hours are usually so great…The General Practitioner… conscientiously exercises [their] power to benefit mankind. In both these books as well as several news articles, he illustrates schematics of instruments he envisions such as an urethral and intravesical irrigator and improved urethroscopy instrument.4Ferdinand C. Valentine, MD (1851-1909). Vol 2023. The William P. Didusch Center for Urologic History; 2023.Google Scholar, 8Valentine F. The Irrigation Treatment of Gonorrhea. William Wood and Company, 1900Google Scholar Valentine was a member of several distinguished medical associations: the Medico-legal Society, the Association Francaise d′Urologie, the American Association for the Advancement of Science, the Societe Belge d′Urologie, Faculties of Medicine of the Republics of Guatemala and Honduras, the Deutsche Gesselschaft fur Urologie, and the American Medical Association.1Ferdinand C. Valentine Medalists. Vol 2023. The New York Section of American Urological Association; 2014.Google Scholar, 9Valentine F. 600 Medical Dont's; or, The Physician's Utility Enhanced. G.W. Dillingham, 1887Google Scholar Stateside, Valentine worked as a professor of genito-urinary diseases in the New York School of Clinical Medicine, was a genitourinary surgeon at the West Side German Dispensary, and served as a genito-urinary consultant to both the Metropolitan Hospital and Dispensary and the United Hebrew Charities.8Valentine F. The Irrigation Treatment of Gonorrhea. William Wood and Company, 1900Google Scholar In 1900, Valentine and other genitourinary surgeons formed the New York Genito-Urinary Society.10William P. Didusch Center for Urologic History Permanent Exhibits. Vol 2023. The William P. Didusch Center for Urologic History; 2023.Google Scholar On February 22, 1902, alongside Ramon Guieteras, William Otis, A.B. Mabie, and others, Ferdinand C. Valentine voted to dissolve the New York Genito-Urinary Society and founded the American Urological Association (AUA).10William P. Didusch Center for Urologic History Permanent Exhibits. Vol 2023. The William P. Didusch Center for Urologic History; 2023.Google Scholar Valentine was elected as the first secretary during the first AUA meeting, and he also served as the third president from 1905 to 1906.10William P. Didusch Center for Urologic History Permanent Exhibits. Vol 2023. The William P. Didusch Center for Urologic History; 2023.Google Scholar, 11Past Presidents. Vol 2023. American Urological Association.Google Scholar The first official records of the AUA were held by Valentine in his office, which was in New York City.10William P. Didusch Center for Urologic History Permanent Exhibits. Vol 2023. The William P. Didusch Center for Urologic History; 2023.Google Scholar The New York section of the AUA awarded the first Ferdinand C. Valentine medal (Fig. 2) in 1962 to Nobel Prize in Physiology or Medicine winner Dr Charles B. Huggins1Ferdinand C. Valentine Medalists. Vol 2023. The New York Section of American Urological Association; 2014.Google Scholar as a testament to the services provided by Valentine during his tenure with the AUA. Later, Alfred Jost, who discovered the anti-Müllerian hormone, received the medal in 1973. More recently, Dr Tom Lue at University of California San Francisco received the medal in 2013 after elucidating the mechanism of an erection and developing the first animal model to analyze Peyronie's disease. Valentine passed away on December 13, 1909, in his home located in Belle Harbor, Long Island.1Ferdinand C. Valentine Medalists. Vol 2023. The New York Section of American Urological Association; 2014.Google Scholar Valentine left a reverberating impact on the field of urology. In honor of Valentine, the New York Academy of Medicine (NYAM) established the Ferdinand C. Valentine Medical Student Research Grants in Urology.12The Ferdinand C. Valentine Medical Student Research Grants in Urology. Vol 2023. New York Academy of Medicine.Google Scholar Awardees are M.D. candidates who are either currently attending a medical school in New York or would conduct clinical or basic science urological research at a New York institution for 10-12 weeks during the summer and carries with it a generous stipend.12The Ferdinand C. Valentine Medical Student Research Grants in Urology. Vol 2023. New York Academy of Medicine.Google Scholar Moreover, the NYAM also awards the Ferdinand C. Valentine Fellowship Award for Research in Urology, which was established in 1963.13The Ferdinand C. Valentine Fellowship Award for Research in Urology. Vol 2023. New York Academy of Medicine.Google Scholar A $50,000 1-year fellowship award is given annually to 1-4 selected grant recipients, who have completed urology residency training.13The Ferdinand C. Valentine Fellowship Award for Research in Urology. Vol 2023. New York Academy of Medicine.Google Scholar Furthermore, the NY section of AUA conducts Ferdinand C. Valentine Resident Essay meetings for urology residents. In addition to his research contributions, Valentine, a dedicated professor and mentor, trained urologists who paved the way for where the field is now. His legacy carries on, and his passion for medicine and caring for patients is highlighted in the conclusion he wrote in 600 medical don'ts; or, The physician's utility enhanced9Valentine F. 600 Medical Dont's; or, The Physician's Utility Enhanced. G.W. Dillingham, 1887Google Scholar:Meanwhile, if a single pain be spared, if a life, even that of the lowliest in the world, be saved in consequence of what this little book contains, the author's labors will not have been vain. Overall, Valentine was an esteemed genito-urinary surgeon, linguist, eloquent writer, passionate researcher, and an AUA founding member. Urologists and those on the path to joining this field should learn from Valentine's life and tremendous contributions to the field. By studying his passion for the field of urology, they may apply what they learn to advance the field of urology, become better at their craft, and most importantly, provide the best care for their patients. The authors have no conflict of interest to declare.

Abstract Introduction Platelet Rich Plasma (PRP) is a novel restorative therapy rich in growth factors and cytokines used to target the underlying causes of erectile dysfunction (ED). It is not known, however, if the composition of growth factors in PRP varies between men. Objective This study aimed to evaluate PRP growth factor variability among men with ED. Methods Whole blood was collected from sixteen men, eight participants with at least a six-month history of ED. The others were the control group, including seven men with Peyronie’s Disease (PD) and one healthy man without sexual dysfunction. PRP was extracted from whole blood using the Arthrex Angel system. A Human Growth Factor Antibody Array for 41 proteins was performed. Using all 16 samples, quantitative detection of GM-CSF, VEGF, and TGF-β were validated by western blot. Results From the growth factor array, two growth factors - Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) and Transforming Growth Factor-beta (TGF-β) - were identified as having a 1.5-fold decrease between the participants and the control. In addition to the shortlisted growth factors, VEGF was selected because androgens can upregulate VEGF production. Other than a weak negative correlation between VEGF expression and age, we found no correlation between growth factor expression for GM-CSF or TGF-β and age, BMI, or comorbidities. Conclusions PRP growth factor concentration appears to vary among men with ED. Depending on individual growth factor concentration, PRP treatment for ED may need to be personalized for patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceuticals, Boston Scientific, Coloplast, Endo Pharmaceuticals, Empower Pharmacy, Nestle Health, Olympus, Hims, Inc.