To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG). We i... more To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG). We identified men with completed staged penile urethroplasty with OMG from the Trauma and Urologic Reconstruction Network of Surgeons database between January 1, 2010 and May 1, 2014. Our primary outcome was change in total Sexual Health Inventory for Men (SHIM) and total Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) Short Form at baseline vs after the second stage of the procedure. Second, we assessed subjective changes in penile curvature, length, and sensation. Thirty-three patients were included with a mean age of 45 years and mean body mass index of 27.6 kg/m(2). Urethral strictures arose from failed hypospadias repair in 52% and lichen sclerosus in 27%. Fifty-two percent of patients reported a previous urethroplasty. The median follow-up time between the second stage procedure and postoperative questionnaires was 6.3 months (interquartile range: 3.5-13.3). There was no significant change in the total SHIM (Δ0.64, 95% confidence interval [CI]: -3.00∼1.72) and MSHQ-EjD (Δ1.55, 95% CI: -1.53∼4.63) scores preoperatively vs postoperatively. In addition, 32% reported improved and 52% no change in satisfaction with sexual intercourse (SHIM Q5). Forty percent of patients reported reduced and 45% no change in bother with ejaculation after surgery (MSHQ-EjD Q4). Men reported new penile curvature (23%), loss of penile length (55%), and altered penile sensitivity (45%) after surgery. Patients undergoing staged penile urethroplasty with OMG are likely to have minimal changes in erectile and ejaculatory function postoperatively, although many may experience new penile curvature, reduced penile length, and/or reduced penile sensitivity.
To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in pa... more To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy in our Veterans Affairs population. Between June 1, 2013, and June 1, 2014, we implemented an antimicrobial prophylaxis protocol using rectal swab cultures on selective media containing ciprofloxacin for all men scheduled for TRUS-guided prostate biopsy. Data from 2759 patients from Jan 1, 2006 to May 31, 2013, before protocol implementation served as historical controls. Patients with fluoroquinolone (FQ)-susceptible organisms received FQ monotherapy, while those with FQ-resistant organisms received targeted prophylaxis. Our objective was to compare the rate of infectious complications 30 days after prostate biopsy before and after implementation of our antimicrobial protocol. One hundred and sixty-seven patients received rectal swab cultures using our protocol. Seventeen (14 %) patients had FQ-resistant positive cultures. Patients with positive FQ-resistant culture results were more likely to have had a history of previous prostate biopsy and a positive urine culture in the last 12 months (p = 0.032, p = 0.018, respectively). The average annual infectious complication rate within 30 days of biopsy was reduced from 2.8 to 0.6 % before and after implementation of our antimicrobial prophylaxis protocol using rectal swab cultures, although this difference was not statistically significant (p = 0.13). An antimicrobial prophylaxis protocol using rectal culture swabs is a viable option for prevention of TRUS-guided prostate biopsy infectious complications. After implementation of an antimicrobial prophylaxis protocol, we observed a nonsignificant decrease in the rate of post-biopsy infectious complications when compared to historical controls.
To evaluate the utility of routine hormone evaluation in all men presenting for infertility by un... more To evaluate the utility of routine hormone evaluation in all men presenting for infertility by understanding the relationship between sperm concentration and hypoandrogenism. We performed a retrospective cross-sectional study between September 2013 and May 2014 at a tertiary referral center in Utah. Ninety-four men presenting for infertility consecutively between the ages of 18 and 55 years were identified. Our primary outcome was rate of hypoandrogenism among infertile men defined as the baseline total serum testosterone levels <300 ng/dL or bioavailable testosterone (BAT) levels <155 ng/dL. Secondary outcomes included association of normospermia, oligozoospermia, or azoospermia with biochemical or clinical hypoandrogenism. Thirty-nine men (41%) had a total serum testosterone level of <300 ng/dL, and 41 men (43%) had a BAT level <155 ng/dL. Biochemical and symptomatic hypoandrogenism was common; 17 men (18%) had a total testosterone level <300 ng/dL and ≥3 positive Androgen Deficiency in Aging Male (ADAM) responses, and 18 men (19%) had a BAT level of <155 ng/dL and ≥3 positive ADAM responses. Sperm concentration (normospermia, oligozoospermia, and azoospermia) was not associated with biochemical hypoandrogenism (total testosterone…
American journal of physiology. Cell physiology, Jan 15, 2014
Partial bladder outlet obstruction (pBOO)-induced remodeling of bladder detrusor smooth muscle (D... more Partial bladder outlet obstruction (pBOO)-induced remodeling of bladder detrusor smooth muscle (DSM) is associated with the modulation of cell signals regulating contraction. We analyzed the DSM from obstructed murine urinary bladders for the temporal regulation of RhoA GTPase and Rho-activated kinase (ROCK), which are linked to Ca(2+) sensitization. In addition, the effects of equibiaxial cell stretch, a condition thought to be associated with pBOO-induced bladder wall smooth muscle hypertrophy and voiding frequency, on the expression of RhoA, ROCK, and C-kinase-activated protein phosphatase I inhibitor (CPI-17) were investigated. DSM from 1-, 3-, 7-, and 14-day obstructed male mice bladders and benign prostatic hyperplasia (BPH)-induced obstructed human bladders revealed overexpression of RhoA and ROCK-β at the mRNA and protein levels compared with control. Primary human bladder myocytes seeded onto type I collagen-coated elastic silicone membranes were subjected to cyclic equibia...
To identify differences in demographic and socioeconomic factors between men seeking infertility ... more To identify differences in demographic and socioeconomic factors between men seeking infertility evaluation and those undergoing vasectomy, in order to address disparities in access to these services. Data from Cycle 6-Cycle 7 (2002, 2006-2008) of the National Survey of Family Growth (NSFG) was reviewed; the NSFG is a multi-stage probability survey designed to capture a nationally representative sample of households with men and women 15 to 45-years-old in America. Variables analyzed included age, body mass index, self-reported health, alcohol use, race, religious affiliation, marital status, number of offspring, educational attainment, income level, insurance status, and metropolitan home designation. Our primary outcome was correlation of these demographic and socioeconomic factors with evaluation for male infertility or vasectomy. Of the 11,067 men identified through the NSFG, 466 (4.2%) men sought infertility evaluation representing 2,187,455 men nationally and 326 (2.9%) had a vasectomy representing 1,510,386 men nationally. Those seeking infertility evaluation were more likely to be younger and have fewer children (p=0.001, 0.001) and less likely to be currently married (78% vs. 74%, p=0.010) or ever married (89% vs. 97%, p=0.002). Men undergoing a vasectomy were more likely to be Caucasian (86% vs. 70%, p=0.001). Men seeking infertility evaluation were more likely to have a college or graduate degree compared to men undergoing a vasectomy (68% vs. 64%, p=0.015). There was no difference between the 2 groups for all other variables. While differences in demographic characteristics such as age, offspring number, and marital status were identified, measures of health, socioeconomic status, religion, and insurance were similar between men utilizing vasectomy and seeking infertility services. These factors help characterize utilization of male reproductive health services in the United States and may help address disparities in access to these services and improve public health strategies.
To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG). We i... more To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG). We identified men with completed staged penile urethroplasty with OMG from the Trauma and Urologic Reconstruction Network of Surgeons database between January 1, 2010 and May 1, 2014. Our primary outcome was change in total Sexual Health Inventory for Men (SHIM) and total Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) Short Form at baseline vs after the second stage of the procedure. Second, we assessed subjective changes in penile curvature, length, and sensation. Thirty-three patients were included with a mean age of 45 years and mean body mass index of 27.6 kg/m(2). Urethral strictures arose from failed hypospadias repair in 52% and lichen sclerosus in 27%. Fifty-two percent of patients reported a previous urethroplasty. The median follow-up time between the second stage procedure and postoperative questionnaires was 6.3 months (interquartile range: 3.5-13.3). There was no significant change in the total SHIM (Δ0.64, 95% confidence interval [CI]: -3.00∼1.72) and MSHQ-EjD (Δ1.55, 95% CI: -1.53∼4.63) scores preoperatively vs postoperatively. In addition, 32% reported improved and 52% no change in satisfaction with sexual intercourse (SHIM Q5). Forty percent of patients reported reduced and 45% no change in bother with ejaculation after surgery (MSHQ-EjD Q4). Men reported new penile curvature (23%), loss of penile length (55%), and altered penile sensitivity (45%) after surgery. Patients undergoing staged penile urethroplasty with OMG are likely to have minimal changes in erectile and ejaculatory function postoperatively, although many may experience new penile curvature, reduced penile length, and/or reduced penile sensitivity.
To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in pa... more To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy in our Veterans Affairs population. Between June 1, 2013, and June 1, 2014, we implemented an antimicrobial prophylaxis protocol using rectal swab cultures on selective media containing ciprofloxacin for all men scheduled for TRUS-guided prostate biopsy. Data from 2759 patients from Jan 1, 2006 to May 31, 2013, before protocol implementation served as historical controls. Patients with fluoroquinolone (FQ)-susceptible organisms received FQ monotherapy, while those with FQ-resistant organisms received targeted prophylaxis. Our objective was to compare the rate of infectious complications 30 days after prostate biopsy before and after implementation of our antimicrobial protocol. One hundred and sixty-seven patients received rectal swab cultures using our protocol. Seventeen (14 %) patients had FQ-resistant positive cultures. Patients with positive FQ-resistant culture results were more likely to have had a history of previous prostate biopsy and a positive urine culture in the last 12 months (p = 0.032, p = 0.018, respectively). The average annual infectious complication rate within 30 days of biopsy was reduced from 2.8 to 0.6 % before and after implementation of our antimicrobial prophylaxis protocol using rectal swab cultures, although this difference was not statistically significant (p = 0.13). An antimicrobial prophylaxis protocol using rectal culture swabs is a viable option for prevention of TRUS-guided prostate biopsy infectious complications. After implementation of an antimicrobial prophylaxis protocol, we observed a nonsignificant decrease in the rate of post-biopsy infectious complications when compared to historical controls.
To evaluate the utility of routine hormone evaluation in all men presenting for infertility by un... more To evaluate the utility of routine hormone evaluation in all men presenting for infertility by understanding the relationship between sperm concentration and hypoandrogenism. We performed a retrospective cross-sectional study between September 2013 and May 2014 at a tertiary referral center in Utah. Ninety-four men presenting for infertility consecutively between the ages of 18 and 55 years were identified. Our primary outcome was rate of hypoandrogenism among infertile men defined as the baseline total serum testosterone levels <300 ng/dL or bioavailable testosterone (BAT) levels <155 ng/dL. Secondary outcomes included association of normospermia, oligozoospermia, or azoospermia with biochemical or clinical hypoandrogenism. Thirty-nine men (41%) had a total serum testosterone level of <300 ng/dL, and 41 men (43%) had a BAT level <155 ng/dL. Biochemical and symptomatic hypoandrogenism was common; 17 men (18%) had a total testosterone level <300 ng/dL and ≥3 positive Androgen Deficiency in Aging Male (ADAM) responses, and 18 men (19%) had a BAT level of <155 ng/dL and ≥3 positive ADAM responses. Sperm concentration (normospermia, oligozoospermia, and azoospermia) was not associated with biochemical hypoandrogenism (total testosterone…
American journal of physiology. Cell physiology, Jan 15, 2014
Partial bladder outlet obstruction (pBOO)-induced remodeling of bladder detrusor smooth muscle (D... more Partial bladder outlet obstruction (pBOO)-induced remodeling of bladder detrusor smooth muscle (DSM) is associated with the modulation of cell signals regulating contraction. We analyzed the DSM from obstructed murine urinary bladders for the temporal regulation of RhoA GTPase and Rho-activated kinase (ROCK), which are linked to Ca(2+) sensitization. In addition, the effects of equibiaxial cell stretch, a condition thought to be associated with pBOO-induced bladder wall smooth muscle hypertrophy and voiding frequency, on the expression of RhoA, ROCK, and C-kinase-activated protein phosphatase I inhibitor (CPI-17) were investigated. DSM from 1-, 3-, 7-, and 14-day obstructed male mice bladders and benign prostatic hyperplasia (BPH)-induced obstructed human bladders revealed overexpression of RhoA and ROCK-β at the mRNA and protein levels compared with control. Primary human bladder myocytes seeded onto type I collagen-coated elastic silicone membranes were subjected to cyclic equibia...
To identify differences in demographic and socioeconomic factors between men seeking infertility ... more To identify differences in demographic and socioeconomic factors between men seeking infertility evaluation and those undergoing vasectomy, in order to address disparities in access to these services. Data from Cycle 6-Cycle 7 (2002, 2006-2008) of the National Survey of Family Growth (NSFG) was reviewed; the NSFG is a multi-stage probability survey designed to capture a nationally representative sample of households with men and women 15 to 45-years-old in America. Variables analyzed included age, body mass index, self-reported health, alcohol use, race, religious affiliation, marital status, number of offspring, educational attainment, income level, insurance status, and metropolitan home designation. Our primary outcome was correlation of these demographic and socioeconomic factors with evaluation for male infertility or vasectomy. Of the 11,067 men identified through the NSFG, 466 (4.2%) men sought infertility evaluation representing 2,187,455 men nationally and 326 (2.9%) had a vasectomy representing 1,510,386 men nationally. Those seeking infertility evaluation were more likely to be younger and have fewer children (p=0.001, 0.001) and less likely to be currently married (78% vs. 74%, p=0.010) or ever married (89% vs. 97%, p=0.002). Men undergoing a vasectomy were more likely to be Caucasian (86% vs. 70%, p=0.001). Men seeking infertility evaluation were more likely to have a college or graduate degree compared to men undergoing a vasectomy (68% vs. 64%, p=0.015). There was no difference between the 2 groups for all other variables. While differences in demographic characteristics such as age, offspring number, and marital status were identified, measures of health, socioeconomic status, religion, and insurance were similar between men utilizing vasectomy and seeking infertility services. These factors help characterize utilization of male reproductive health services in the United States and may help address disparities in access to these services and improve public health strategies.
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