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To examine the association between selective serotonin reuptake inhibitor (SSRI) use and semen quality.We performed a retrospective review of all men undergoing semen analysis (SA) for fertility evaluation from 2002-2020 at a single academic medical center. Men were excluded if they had prior exposure to spermatotoxic medications, clomiphene citrate, gonadotropins, selective estrogen receptor modulators, or medical conditions known to impact male fertility. SSRI exposure was defined by an outpatient prescription within 90 days prior to any semen test. Differences between men with and without SSRI exposure were assessed with Wilcoxon rank sum for continuous variables and chi-squared testing for proportions. Univariable and multivariable linear regression models were fit to evaluate the relationship between SSRI use and individual semen parameters, controlling for age at the time of the semen analysis and non-SSRI drug use.A total of 8861 men were identified, of whom 153 men (1.7%) were exposed to SSRIs prior to SA. Median age was 35 years (interquartile range: 32-39) and was similar between groups (P = .999). Non-SSRI medication use was significantly higher in men taking SSRIs (78.4% vs 23.3%,.001). On univariable and multivariable analyses, SSRI exposure was not associated with differences in semen volume, sperm concentration, motility, total motile sperm count, or normal morphology.In adult men undergoing fertility evaluation, SSRI exposure was not associated with impaired semen parameters. These data may help inform reproductive counseling and medical decision-making regarding SSRI use in men seeking paternity.

Objective To determine prevalence of hyperprolactinemia and prolactinoma among men presenting for initial fertility evaluation. Methods We performed a retrospective review of men presenting for initial fertility evaluation at a tertiary care, academic health system between 1999 and 2018. Men with measured prolactin levels were analyzed to determine prevalence of hyperprolactinemia and prolactinoma. We compared clinical characteristics of men with and without hyperprolactinemia. Univariable and multivariable analysis were used to determine factors associated with hyperprolactinemia. We assessed effects of hyperprolactinemia and prolactinoma on testosterone levels, semen parameters and pregnancy outcomes after treatment. Results 3,101 men had serum prolactin level measured. 65 (2.1%) had hyperprolactinemia. Patients with hyperprolactinemia had lower testosterone (median 280 ng/dL vs. 313 ng/dL, p=0.038) and lower total motile sperm count (TMSC) (median 7.0 million vs. 34.7 million, p=0.001) compared to men without hyperprolactinemia. 43.1% of men with hyperprolactinemia had oligospermia versus 21.5% of men without hyperprolactinemia (p 0.05). Of the 65 men with hyperprolactinemia, 11 (17%) were diagnosed with a prolactinoma, resulting in an overall prevalence of 11 in 3,101 (0.35%). Conclusion The overall prevalence of prolactinoma in our cohort of men undergoing fertility evaluation was 35-fold higher than the prevalence in the general male population.

Objective To characterize the epidemiology of male factor infertility and identify which types of providers are treating infertile men in the United States. Materials and methods The National Ambulatory Medical Care Survey was queried between 2006 and 2016 for all ambulatory care visits. Men with a diagnosis of infertility were identified by international classification of disease coding. Comorbidities, demographic and visit information were abstracted from the patients’ medical record by a combination of trained surveyors and physicians. The survey data was weighted to create nationally representative estimates, and a combination of Chi-squared and Student's t-tests were utilized to determine significance. Result(s) Among the 8.7 billion patient visits between 2006 and 2016, there were 3,422,000 male encounters with a diagnosis of male factor infertility. The most common provider type for male factor infertility encounters was urology (42.12%) followed by primary care (39.79%), gynecology (7.05%) and all other provider types (11.01%). A significant number of men seen for infertility had comorbidities such as cancer (115,000 men, 3.36%) diabetes (267,000 men, 7.81%), depression (301,000 men, 8.8%), and active tobacco use (857,000 men, 30.3%). Conclusion In a nationally representative sample, more than 50% of ambulatory care visits for male factor infertility were not seen by urologists. These men also had a significant number of comorbidities for a relatively young cohort, emphasizing the importance of multidisciplinary care for men with a diagnosis of infertility.

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 (

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 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.

Objectives To characterize 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 (ABU) between 2004 and 2013. We used generalized estimating equations (GEE) 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, 5,316 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 [IQR] 6-26). The majority of vasectomies were performed by high-volume surgeons (≥ 26 vasectomies) ranging from 49.2%-66.9% annually, whereas the proportion performed by low-volume (≤ 5 vasectomies) surgeons ranged from 3.3%-6.6% annually. Male surgeons performed vasectomies 2.20 times more frequently than female surgeons (95% confidence interval [CI] 1.93-2.49; p Conclusions 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.

OBJECTIVE To compare the efficacy of men's and women's cancer awareness campaigns using internet relative search volume (RSV) as a surrogate for public interest. METHODS We utilized Google Trends to determine the RSV for “breast cancer,” “prostate cancer,” and “testicular cancer” from 2010 to 2017. Baseline annual RSV for each cancer was calculated as the median annual RSV, exclusive of the awareness month period. RSV was then determined for each cancer-specific awareness month and compared to baseline. The primary outcome was 2-fold rise in RSV above baseline. RESULTS Breast Cancer Awareness Month led to a significant increase in cancer-specific RSV in October each year during the study period (mean increase 180.1%). In contrast, none of the men's cancer awareness campaigns led to a significant increase in cancer-specific RSV in any year during the study period. RSV for prostate cancer increased by 2.4% and 4.1% in September and November, respectively. RSV for testicular cancer increased by 9.3% and 6.2% in April and November, respectively. CONCLUSION Men's cancer awareness campaigns did not increase cancer-specific RSV, whereas Breast Cancer Awareness Month consistently increased RSV. While additional metrics are needed to evaluate the efficacy of public health campaigns, the current data suggest the need for new approaches to generate public interest in male-specific malignancies.

Sexual dysfunction affects both men and women and is responsible for 1 in 5 visits to urologist and/or gynecologists. It is important that treating providers use a logical and methodical approach to the diagnosis and treatment of this disorder. Behavioral therapy, coupled with oral medications, are very successful in treating erectile dysfunction. Complex and invasive therapies are used for more severe cases of sexual dysfunction and are best deployed by specialists.

Objective To report on an early adopter series of collagenase Clostridium histolyticum (CCh) for Peyronie's disease (PD). Postapproval studies of CCh have been anticipated after recent Food and Drug Administration authorization of its use for men with PD as definitive and durable nonsurgical interventions have been long desired. Materials and Methods From May 2014 to October 2015, a database consisting of PD patients with >30° of penile curvature received CCh from a single provider at a single institution. Objective penile curvature measurements and deformity directions were assessed pre- and posttreatment. Using the validated Peyronie's Disease Questionnaire (PDQ), changes in subjective symptoms of intercourse ability, penile pain, and bother were also noted. Results We followed 49 unique PD patients treated with CCh. Mean follow-up was 183 days with a median of 6 injections over 3 cycles performed per patient. The mean pretreatment penile curvature was 49.3 degrees. Curvature was reduced by 15.4 degrees (32.4%, P P P P = .89). Five notable bleeding events (10.2%) were noted, including 1 penile fracture requiring operative exploration. Conclusion CCh use for PD yielded improvements in penile curvature, subjective intercourse, and bother symptoms. Further postanalysis studies of greater follow-up are needed to assess long-term durability, efficacy, and safety.

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. Patient(s) All men presenting for initial male factor infertility consultation with a single reproductive urologist between 2002 and 2018. Intervention(s) Men were asked to provide the name of their PCP at the time of initial visit. Main Outcome Measure(s) Descriptive statistics characterized the proportion of men with a PCP at the time of evaluation and associations between PCP status and clinical characteristics. Result(s) 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). Conclusion(s) 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 define the impact of intralesional verapamil injection therapy on penile deformity in men with Peyronie’s disease. Methods Patients underwent a total of 6 intralesional injections of verapamil. Penile deformity was assessed at baseline and 3 months after the last intralesional injection of verapamil during penile erection after the administration of intracavernosal medication. Measurement was recorded using a goniometer at maximum penile rigidity. Endpoints included change in magnitude of curvature, stretched penile length, penetration ability, and resolution of pain. Results Ninety-four consecutive patients met all inclusion criteria. Mean (± standard deviation) patient age and duration of Peyronie’s disease at time of baseline deformity assessment were 44 ± 18 years and 5.2 ± 2.7 months, respectively. At baseline 86% had dorsal and 14% lateral curvature. The mean curvature and stretched flaccid length were 50° ± 28° and 12.6 ± 3.1 cm, respectively. At the follow-up evaluation, patients were 5.2 ± 1.8 months after their last ILV injection and were 11.7 ± 4.2 months after the onset of Peyronie’s disease. Eighteen percent of patients had improvement of curvature, 60% were unchanged, and 22% worsened. Pain resolved in 100% of patients. Conclusions In response to intralesional verapamil, a minority of men experienced improvement in penile deformity; however, the majority of patients had stabilization of their deformity. This information may permit clinicians to give realistic expectations to patients considering intralesional verapamil therapy.

An updated method for obtaining purified]glucosylgalactosyl hydroxylysine (Glc-Gal-Hyl) is presented. Marine sponge is subjected to alkaline hydrolysis followed by ion-exchange chromatography and gel filtration. Identification is confirmed by consecutive mild acid hydrolysis of the extract to produce galactosyl hydroxylysine (Gal-Hyl) and hydroxylysine (Hyl). High-performance liquid chromatography (HPLC) with a sodium acetate-acetonitrile-buffer and dabsyl chloride as the derivatizing agent demonstrated the purity of the extract and its hydrolyzates. Glc-Gal-Hyl is not commercially available but this easy and efficient method can provide large amounts of it for collagen metabolism studies.