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Background: Testicular microlithiasis is the presence of small calcifications in the testicular parenchyma. The association between testicular microlithiasis and germ cell neoplasia in situ, a precursor to testicular cancer, is still unclear. Objectives: To determine the incidence of germ cell neoplasia in situ in men with testicular microlithiasis and evaluate the indication for testicular biopsy according to risk factors in the form of male infertility/reduced semen quality, testicular atrophy, and history of cryptorchidism. Materials and methods: This retrospective case series included all patients diagnosed with testicular microlithiasis who underwent testicular biopsies at three hospitals in Denmark between 2007 and 2021. The medical records of 167 patients were reviewed, and data on patient demographics, testicular microlithiasis characteristics, risk factors, histological findings, and treatments were collected. The main outcome measure was the incidence of germ cell neoplasia in situ in relation to each risk factor. The data were analyzed using descriptive statistics. Logistic regression was used to examine the odds ratio of germ cell neoplasia in situ in patients with testicular microlithiasis and testicular atrophy. Results: Germ cell neoplasia in situ was found in 13 out of 167 patients (7.8% [95% confidence interval: 4.3, 13.2]). Eleven of these had testicular atrophy resulting in a significantly higher incidence in this group than other risk factors (odds ratio 9.36 [95% confidence interval: 2.41, 61.88]; p = 0.004). Discussion: The study comprises the largest cohort to date of men who have undergone testicular biopsies because of testicular microlithiasis and additional risk factors. Limitations include its retrospective design, and relatively low absolute numbers of patients with germ cell neoplasia in situ on biopsies. Conclusion: This study found that men with testicular microlithiasis and testicular atrophy are at an increased risk of germ cell neoplasia in situ. Additionally, our results indicate that biopsies should be considered in men with a combination of subfertility and bilateral testicular microlithiasis. Our findings do not support testicular biopsies for men with testicular microlithiasis and other risk factors. [ABSTRACT FROM AUTHOR]

Objective: To explore how the use of the ProPep® Nerve Monitoring System (ProPep Surgical, Austin, TX, USA) for intraoperative specific sparing of the pudendal nerve fibres influences postoperative functional outcomes after unilateral nerve‐sparing (UNS) or non‐nerve‐sparing (NNS) robot‐assisted radical prostatectomy (RARP). Patients and methods: We randomised 100 men undergoing UNS or NNS RARP to ProPep nerve monitoring during RARP (intervention) or standard of care RARP (control). Functional outcomes were assessed at 3, 6, and 12 months using the International Consultation on Incontinence Questionnaire Short Form (ICIQ‐SF), the International Prostate Symptom Score, the Danish Prostate Symptom Score, the International Index of Erectile Function, the Erection Hardness Scale, and 24‐h pad tests. The primary outcome was the difference in ICIQ‐SF score between the groups at 12 months. Secondary outcomes included differences in the remaining outcome measures and continence rates at all time points. Continence was defined as the use of no pads and the answer 'Never' to the question: 'How often do you experience urinary incontinence?' or a urine loss of <8 g on the 24‐h pad test. Results: A total of 82 patients were included in the per‐protocol analysis at 12 months with 41 in each group. At 12 months the mean ICIQ‐SF scores were 5.37 (95% confidence interval [CI] 3.71–7.03) and 5.66 (95% CI 4.05–7.27) for the intervention and control groups, respectively (P = 0.8). There were no statistically significant differences in any of the remaining outcomes. However, the continence rate was higher in the intervention group at 6 months (63% vs 44%, P = 0.09). Conclusions: Intraoperative nerve monitoring did not result in better functional outcomes following UNS or NNS RARP. Larger studies are needed to explore if ProPep can reduce the time to continence after RARP. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the oncological and perioperative outcomes from a large, single‐centre, robot‐assisted radical cystectomy (RARC) cohort performed with intracorporeal urinary diversion (ICUD). Patients and Methods: Patients who underwent RARC because of bladder cancer or recurrent carcinoma in situ from June 2009 until August 2020 at Herlev and Gentofte Hospital were prospectively and consecutively included. Kaplan–Meier survival analysis was used to estimate recurrence‐free survival (RFS), cancer‐specific survival (CSS) and overall survival (OS). A Cox proportional hazards model was used to identify individual predictors of outcomes. Multiple logistic regression analysis was used to identify predictors of high‐grade complications (Clavien–Dindo Grade ≥III). Results: A total of 542 patients were included. The median (interquartile range) follow‐up was 5.3 (2.73–8.06) years. In all, 78 patients (14%) were converted to open surgery; 15 (3%) during cystectomy and 63 patients (12%) were converted from ICUD to extracorporeal urinary diversion. The 5‐year RFS, CSS and OS rates were 63% (95% confidence interval [CI] 59%–68%), 75% (95% CI 72%–80%) and 67% (95% CI 63%–72%), respectively. Pathological non‐organ‐confined disease (tumour stage >T2 or positive lymph nodes) predicted poorer RFS, CSS and OS. Reconstruction with a neobladder (20% of cases) compared to an ileal conduit was the only predictor of high‐grade complications (odds ratio 2.54, 95% CI 1.46–4.43; P < 0.001). Conclusion: A RARC with ICUD is feasible as a standard surgical procedure for bladder cancer with only a few patients converted to open surgery. In our hands reconstruction with a neobladder was a strong predictor for high‐grade complications. [ABSTRACT FROM AUTHOR]

Summary: In the present study, we aimed to evaluate the association between asexual trait, erectile dysfunction (ED) and porn addiction in a community sample of young men. Between August 2019 and October 2019, a total of 559 young male adults were subjected to an online survey sponsored by social networks with the aim of assessing their sexual habits. The following questionnaires were administered: The International Index of Erectile Function (IIEF‐5), Masturbation Erection index (MEI), Pornography Craving Questionnaire (PCQ) and Asexuality Identification Scale (AIS). The overall rate of ED according to IIEF‐5 was 26.0% (165/478), the rate of ED according to MEI was 16.9% (81/478) and the rate ED in patients with AIS ≥23 indicating asexual trait was 10.0% (48/478). We found that IIEF‐5 was positively associated with MEI (b = 0.32; p <.01) and negatively with AIS (b = −0.36; p <.01) and MEI was negatively associated with AIS (b = −0.36; p <.01). We found that MEI (odds ratio [OR]: 0.86; p <.01) and IIEF‐5 (OR: 0.89; p <.01) were inversely associated with asexual trait. The presence of asexual trait can hide a greater risk of finding ED both in intercourse or masturbation. These results should be taken into consideration during the general assessment of the patient with sexual problems. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate patient‐reported outcomes of Collagenase Clostridium Histolyticum (CCHi) for Peyronie's Disease. Patients treated with 2–4 cycles of CCHi between 01/2016 and 08/2018 were asked to fill out the "bother domain" of the Peyronie's Disease Questionnaire (PDQ) at scheduled appointments for injections. CCHi cycles involved two injections (0.58 mg) separated by 48–72 hr. During the study, 34 patients were treated, seven patients were excluded due to incomplete baseline values. Mean (standard deviation) PDQ bother domain baseline score was 11.1 (2.6). ANOVA demonstrated statistically significant effects of injections (p <.001) with a decrease in PDQ bother domain scores 6 weeks after the 1st cycle (9.9 [3.3], p =.013), 6 weeks after the 2nd cycle (8.2 [4.0], p =.009) and 6 weeks after the 3rd cycle (6.5 [3.6], p <.001). After 2–4 cycles of CCHi treatment, patients reported changes in penile curvature as "Worse" (0), "No Change" (2), "Little decrease" (10), Decrease (10) and "Significant decrease" (4). After completion of CCHi treatment, 82% of patients still reported that vaginal intercourse was difficult or impossible. Patients with Peyronie's Disease undergoing CCHi treatment reported statistically significant decreases in PDQ bother domain scores. However, most patients still report difficulty with intercourse after treatment. [ABSTRACT FROM AUTHOR]

"Case of the Month" from Herlev and Gentofte Hospital, Denmark: metastatic prostate cancer in a man with late-onset hypogonadism following testosterone-replacement therapy An SP 18 sp F-sodium fluoride positron emission tomography (PET)/CT (NaF-PET/CT) showed bone metastases in the spine and pelvis. Abbreviations ADT androgen-deprivation therapy LOH late-onset hypogonadism NaF-PET/CT 18 F-sodium fluoride positron PET/CT PET positron emission tomography TRT testosterone-replacement therapy Introduction When symptomatic testosterone deficiency develops in adult men in the absence of a specific disease process, it is termed late-onset hypogonadism (LOH). [Extracted from the article]

Objectives: To compare the metabolic changes between men with advanced prostate cancer commenced on a gonadotropin‐releasing hormone (GnRH) agonist and those treated with orchiectomy. Patients and Methods: Fifty‐eight hormone‐naive men with advanced prostate cancer were randomly assigned (1:1) to either subcapsular orchiectomy or triptorelin 22.5 mg/24 week depot injections. The participants were followed for 48 weeks, with study visits at baseline, 12, 24 and 48 weeks. The primary endpoint was changes in fasting plasma glucose. Secondary endpoints included changes in body composition (i.e. weight, fat mass, visceral adipose tissue [VAT], subcutaneous adipose tissue [SAT], lean body mass [LBM] and android/gynoid fat [AG] ratio) assessed with dual X‐ray absorptiometry, serum lipid profiles, and insulin resistance evaluated during an oral glucose tolerance test. Linear mixed models were used to analyse the between‐group differences. Results: No treatment differences in the changes in fasting plasma glucose (0.2 mmol/L, 95% confidence interval [CI] −0.1, 0.4; P = 0.32) were observed. The orchiectomy group experienced greater increases in total fat mass (+2.06 kg, 95% CI 0.55, 3.56), SAT (+133 cm3, 95% CI 22, 243) and weight (+3.30 kg, 95% CI 0.74, 5.87) at 48 weeks than did the triptorelin group (all P < 0.05), with the increases in fat mass being moderately correlated with increases in insulin resistance (P < 0.001). No differences in changed VAT, LBM or AG ratio were observed between the groups. The pooled analyses, combining data from both groups, showed androgen deprivation therapy (ADT) to significantly increase fat mass, SAT, VAT, serum cholesterols (total, high‐density lipoprotein and low‐density lipoprotein) and all measures of insulin resistance over time, while LBM decreased as compared with baseline values (all P < 0.05). These changes were apparent after only 12–24 weeks of ADT. Conclusions: Androgen deprivation therapy leads to adverse changes in body composition and increased insulin resistance and serum cholesterols, with changes already observed after only 12–24 weeks of treatment. This study further demonstrates that orchiectomy causes greater increases in fat accumulation compared with GnRH agonists and that these increases are associated with an increase in insulin resistance. [ABSTRACT FROM AUTHOR]

Objectives: To compare the metabolic changes between men with advanced prostate cancer commenced on a gonadotropin‐releasing hormone (GnRH) agonist and those treated with orchiectomy. Patients and Methods: Fifty‐eight hormone‐naive men with advanced prostate cancer were randomly assigned (1:1) to either subcapsular orchiectomy or triptorelin 22.5 mg/24 week depot injections. The participants were followed for 48 weeks, with study visits at baseline, 12, 24 and 48 weeks. The primary endpoint was changes in fasting plasma glucose. Secondary endpoints included changes in body composition (i.e. weight, fat mass, visceral adipose tissue [VAT], subcutaneous adipose tissue [SAT], lean body mass [LBM] and android/gynoid fat [AG] ratio) assessed with dual X‐ray absorptiometry, serum lipid profiles, and insulin resistance evaluated during an oral glucose tolerance test. Linear mixed models were used to analyse the between‐group differences. Results: No treatment differences in the changes in fasting plasma glucose (0.2 mmol/L, 95% confidence interval [CI] −0.1, 0.4; P = 0.32) were observed. The orchiectomy group experienced greater increases in total fat mass (+2.06 kg, 95% CI 0.55, 3.56), SAT (+133 cm3, 95% CI 22, 243) and weight (+3.30 kg, 95% CI 0.74, 5.87) at 48 weeks than did the triptorelin group (all P < 0.05), with the increases in fat mass being moderately correlated with increases in insulin resistance (P < 0.001). No differences in changed VAT, LBM or AG ratio were observed between the groups. The pooled analyses, combining data from both groups, showed androgen deprivation therapy (ADT) to significantly increase fat mass, SAT, VAT, serum cholesterols (total, high‐density lipoprotein and low‐density lipoprotein) and all measures of insulin resistance over time, while LBM decreased as compared with baseline values (all P < 0.05). These changes were apparent after only 12–24 weeks of ADT. Conclusions: Androgen deprivation therapy leads to adverse changes in body composition and increased insulin resistance and serum cholesterols, with changes already observed after only 12–24 weeks of treatment. This study further demonstrates that orchiectomy causes greater increases in fat accumulation compared with GnRH agonists and that these increases are associated with an increase in insulin resistance. [ABSTRACT FROM AUTHOR]

Aims To examine penile vibratory stimulation (PVS) in the treatment of post-prostatectomy urinary incontinence (UI). Methods Patients with post-prostatectomy UI were included in a 12-week trial. A 24-hr pad test and a 72-hr voiding diary were collected at baseline. Participants were randomized to receive PVS for the first 6 weeks (group 1) or for the final 6 weeks (group 2) of the study. The primary outcome was the difference in leakage between groups 1 and 2 at 6 weeks as measured by changes in the pad test. The trial was registered at (NCT01540656). Results Data from 31 men were available for analyses. The difference in the change on the pad test between the groups did not reach statistical significance at 6 weeks ( P = 0.13) while the change in incontinence episodes between groups approached statistical significance ( P = 0.052). However, there was a median reduction of −33 g ( P = 0.021) on the pad test and a median reduction in daily incontinence episodes of −1 ( P = 0.023) in group 1 at 6 weeks. At 12 weeks, group 2 had a median decrease on the pad test of −8 g ( P = 0.10) and no change in incontinence episodes. A pooled analysis showed a decline on the pad test of −13.5 g ( P = 0.004) after PVS. Small improvements were seen in subjective symptom scores and 58% stated to be satisfied with PVS. Self-limiting side effects were experienced by 15% of patients. Conclusions PVS is feasible in the treatment of post-prostatectomy UI. Larger trials are needed to document the clinical efficacy. Neurourol. Urodynam. 34:117-122, 2015. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective To examine the effect of penile vibratory stimulation ( PVS) in the preservation and restoration of erectile function and urinary continence in conjunction with nerve-sparing radical prostatectomy ( RP)., Patients and Methods The present study was conducted between July 2010 and March 2013 as a randomized prospective trial at two university hospitals. Eligible participants were continent men with an International Index of Erectile Function-5 ( IIEF-5) score of at least 18, scheduled to undergo nerve-sparing RP., Patients were randomized to a PVS group or a control group. Patients in the PVS group were instructed in using a PVS device ( FERTI CARE® vibrator)., Stimulation was performed at the frenulum once daily by the patients in their own homes for at least 1 week before surgery. After catheter removal, daily PVS was re-initiated for a period of 6 weeks., Participants were evaluated at 3, 6 and 12 months after surgery with the IIEF-5 questionnaire and questions regarding urinary bother. Patients using up to one pad daily for security reasons only were considered continent. The study was registered at ( NCT01067261)., Results Data from 68 patients were available for analyses (30 patients randomized to PVS and 38 patients randomized to the control group)., The IIEF-5 score was highest in the PVS group at all time points after surgery with a median score of 18 vs 7.5 in the control group at 12 months ( P = 0.09), but the difference only reached borderline significance., At 12 months, 16/30 (53%) patients in the PVS group had reached an IIEF-5 score of at least 18, while this was the case for 12/38 (32%) patients in the control group ( P = 0.07)., There were no significant differences in the proportions of continent patients between groups at 3, 6 or 12 months. At 12 months 90% of the PVS patients were continent, while 94.7% of the control patients were continent ( P = 0.46)., Conclusion The present study did not document a significant effect of PVS. However, the method proved to be acceptable for most patients and there was a trend towards better erectile function with PVS. More studies are needed to explore this possible effect further. [ABSTRACT FROM AUTHOR]

The pathophysiology of erectile dysfunction after radical prostatectomy ( RP) is believed to include neuropraxia, which leads to temporarily reduced oxygenation and subsequent structural changes in penile tissue. This results in veno-occlusive dysfunction, therefore, penile rehabilitation programmes focus on tissue oxygenation. Animal studies support the use of phosphodiesterase type 5 inhibitors ( PDE5Is) after cavernous nerve damage but results from human studies are contradictory. The largest study to date found no long-term effect of either daily or on-demand PDE5I administration after RP compared with placebo. The effects of prostaglandin and vacuum erection devices are questionable and high-quality studies are lacking. Better documentation for current penile rehabilitation and/or better rehabilitation protocols are needed. One must be careful not to repeat the statement that penile rehabilitation improves erectile function after RP so many times that it becomes a truth even without the proper scientific backing. [ABSTRACT FROM AUTHOR]

Objective Patients and Methods Results Conclusion To investigate the association between pre‐ and postoperative magnetic resonance imaging (MRI) measurements of the membranous urethra and the prostate volume and continence following robot‐assisted radical prostatectomy (RARP).From December 2018 to June 2022, 100 continent patients undergoing unilateral nerve‐sparing or non‐nerve‐sparing RARP were included in this cohort study. Bi‐parametric MRI scans were performed before and 12 months after RARP and measurements included the membranous urethral length (MUL) measured in cm (mMUL) and in the number of image slices (sMUL; 3 mm/slice), the membranous urethral diameter (MUD), and the prostate volume. Urinary function was evaluated by the International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐UI SF) and continence, defined as the use of zero pads and the answer ‘never’ to the ICIQ‐UI SF question regarding incontinence frequency or <8 g urine‐loss per 24 h. Regression with robust variance estimates was used to analyse the association between measurements and outcomes.At 12 months, continence and MRI data were available for 82 patients. The continence rate was 63% and the median (interquartile range) ICIQ‐UI SF score was 4 (0–9). Both preoperative MUL measurements were associated with continence at 12 months. Every extra 5 mm of MUL increased the likelihood of being continent by 13 percentage points (P = 0.03) and every additional slice of sMUL increased it by 6 percentage points (P = 0.05). Both postoperative MUL measurements were associated with better continence and lower ICIQ‐UI SF scores (P < 0.01). A larger prostate volume was associated with urinary incontinence at 12 months, with a small effect size. The MUD was not associated with continence.Preoperative mMUL and sMUL are associated with continence at 12 months after RARP. The sMUL may be a useful measurement when only the axial plane is available, and the slice gap is known. Postoperative MUL measurements are strongly associated with continence, while MUD and prostate volume hold minimal prognostic value. [ABSTRACT FROM AUTHOR]

This article presents a case study of a patient with diabetes who developed a fungal infection in the urinary tract while taking a specific medication. The medication, called an SGLT-2 inhibitor, has been linked to an increased risk of urinary tract infections and genital yeast infections. The article emphasizes the need for more research to understand the connection between fungal infections and the use of SGLT-2 inhibitors in diabetic patients. The text is a correspondence from a researcher at Copenhagen University Hospital and is published by BJU International. [Extracted from the article]