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the application of fertility preservation, initially intended for oncological patients prior to gonadotoxic treatment, has extended in recent years to transgender and gender-nonconforming individuals undergoing therapy for gender compatibility.to examine semen quality and survival in transgender women pursuing semen cryopreservation in the presence or absence of gender affirming hormonal medication.in this retrospective cohort study, we reviewed data of 74 consecutive transgender women presenting for semen cryopreservation at a single center between 2000-2019. Semen parameters before and after cryopreservation were compared to a control group composed of 100 consecutive sperm bank donor candidates. A subgroup analysis of subjects who had used gender-affirming hormonal treatment was also performed.Compared to the control group, transgender women had lower total sperm count (144.0 vs. 54.5 million, respectively, p0.001), lower sperm motility percentage (65.0 vs. 51.0%, respectively, p0.001) and lower total motile sperm count (94.0 vs. 27.0 million, respectively, p0.001). Values were further decreased in transgender women who had received hormonal treatment before sperm cryopreservation. Post-thawing motility rate remained lower in the transgender group compared to the control group (20.0 vs. 45.0%, respectively, p0.001), and the total motile count remained lower as well (2.7 vs. 9.0 million, respectively, p0.001). Following sperm cryopreservation, the post-thaw decreases in total motile sperm count were higher in the transgender group compared with the control group (91.5 vs. 90.0%). Further subdivision in the transgender group showed that the decrease in total motile sperm count was lower for transgender women who did not use gender-affirming hormonal treatment compared to those who did (-89.7% vs. -92.6%, respectively, p0.01).Sperm parameters in transgender women are poor compared to candidates for sperm donation representing the general population. Specimens collected after discontinuation of gender-affirming hormone treatments were further impaired. Moreover, post-thawing sperm total motile count, motility, and overall sperm survival were reduced in transgender women. This article is protected by copyright. All rights reserved.

Objectives To present a flexible protocol of vaginal pessaries for older women with significant pelvic organ prolapse (POP). Design A prospective cohort study of 140 consecutive older women (aged ≥65 years) with significant POP treated with individually fitted vaginal pessaries. After initial insertion, each patient was invited for a first evaluation after 1 month and subsequent follow-ups at increasing intervals of 1 month. During each examination, the pessary was removed and the vagina was inspected for infection, bleeding, or erosions. All patients were advised to use a vaginal estrogen cream twice a week. Setting The study was conducted during 2020 in the urogynecology clinic of a tertiary medical center. Participants The study cohort included 140 consecutive older women with significant and symptomatic POP treated with vaginal pessaries. Main outcome Primary outcomes included time intervals between follow-up visits, pessary-associated complications, need to change the pessary, need to remove the pessary temporarily, and whether the patients eventually underwent POP surgery. Results The mean age of the patients at the time of pessary fitting was 76.7 ± 9.2 years (range 65-100 years). Mean interval between follow-up examinations was 3.3 ± 1.1 months (range 1-6 months). Most patients (83.6%) used a ring pessary with support, but only a small number of patients were able to maintain the pessary by themselves. Of the 140 patients, five (3.6%) patients only eventually underwent POP surgery, and in 11 (7.9%) patients, the vaginal pessary had to be removed for 2-4 weeks because of significant vaginal discharge or superficial erosions. Additionally, 12 (8.6%) patients developed stress urinary incontinence following pessary insertion. Conclusions Customized management with vaginal pessary for symptomatic POP in older women is effective and safe, and is a suitable therapeutic alternative for older women who are unable or unwilling to undergo reconstructive pelvic surgery.

Aim To investigate the effect of bariatric surgery on male lower urinary tract symptoms (LUTS) and sexual function. Methods Fifty-five consecutive obese men who underwent a laparoscopic sleeve gastrectomy were prospectively enrolled. Two validated questionnaires, the International Prostate Symptoms Score (IPSS) and the International Index of Erectile Function (IIEF) were used to assess LUTS and sexual function, before and 3 months after surgery. Fifty-three men (mean age 39 ± 12.5 years) completed all pre and postoperative questionnaires. Mean body mass index (BMI) before and 3 months after surgery was 42.8 ± 5.3 and 31.3 ± 5.4 kg/m2; respectively. Results Preoperatively, 41 (77%) men (mean age 40 ± 12.9, mean BMI 42.2 ± 5 kg/m2) had some degree of LUTS and 39 (74%) men (mean age 40.7 ± 12.4, mean BMI 42.8 ± 5.6 kg/m2) were sexually active. Postoperatively, the total IPSS score decreased significantly (5.5 ± 4.4 vs. 2.7 ± 2.6; P