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The Peyronie’s Disease Questionnaire (PDQ) is a 15-question self-reported questionnaire that evaluates the severity and physical and psychosexual issues of Peyronie’s disease (PD) symptoms in three scales: “psychological and physical symptoms,” “penile pain,” and “symptom bother.” Previous studies validated the PDQ US version and confirmed its test–retest reliability and responsiveness. The aim is to translate and validate the Spanish version of the PDQ to be used in the clinical practice and in PD research studies in Spain. A non-interventional, observational study with 160 PD patients was conducted. Patients included from four healthcare centers in Spain and completed the PDQ in two study visits separated for a period of 4–7 days from March 2018 to June 2019. Patients received no type of treatment or intervention. Different statistical tests were applied to the data in order to validate the structural and construct of the PDQ, as well as its internal reliability, temporal stability reliability, reliability between observers, and test–retest reliability. Cronbach’s alpha over 0.9 showed good internal consistency. We found an ICC agreement of 0.82 (test–retest) for the three scales of the Spanish version of the PDQ, which demonstrates good reliability. When comparing Visit 1 and Visit 2 questionnaires mean scores, the PDQ showed non-significant differences, as expected because no intervention or treatment was administered to the patients between visits. Translation and validation of the PDQ for the Spanish population makes available a valid, useful, and reliable tool to properly evaluate quality of life of men suffering PD.

Background A xenograft consisting of equine collagen coated with human fibrinogen and thrombin (TachoSil; Baxter, CA) has recently been introduced in grafting procedures for Peyronie’s disease (PD). Aim To describe the results of a multicenter prospective registry on patients with PD undergoing plaque incision or and grafting (PIG) or plaque excision and grafting (PEG) with collagen fleece TachoSil, to evaluate the efficacy and safety of this procedure. Methods A prospective non-controlled multicenter study of patients with PD was performed between May 2016 and March 2018. Patients from 10 centers with stable PD for at least 3 months, difficulties in sexual intercourse, normal erectile function with or without pharmacological treatment, curvature >45°, and/or penile shortening and/or complex deformities were included. All patients underwent PIG/PEG with collagen fleece TachoSil. Outcomes The main outcome measure of this study were penile curvature correction (intraoperative), penile shortening (intraoperative), erectile function with the 5-item version of the International Index of Erectile Function (IIEF-5) and the Erection Hardness Score, subjective patient outcomes with non-validated questionnaires, and complications. Results A total of 52 patients were enrolled in the study. The mean (SD) preoperative penile curvature was 72.8° (17.0). PIG was the preferred technique (80.8%). Intraoperatively, complete curvature correction was achieved in 92.3%, and no significant penile shortening was recorded in 80.8% of subjects. Subjective penile shortening was reported in 83.3% of patients at 6 months. No objective measurement of penile curvature and length was recorded during follow-up. No statistically significant difference from the baseline was found in IIEF-5 and Erection Hardness Score at 3 or at 6 months, although 16.7% of men experienced a worsening of IIEF-5 scores and 14.3% required de novo phosphodiesterase type 5 inhibitor use. 6 months after surgery, 78.5% of men were satisfied with intervention. Swelling and ecchymosis/hematoma were the most common perioperative complications (40.4%). 2 cases (3.8%) of wound infection were recorded. At 6 months, 35.7% of patients reported mild penile hypesthesia. Clinical implications Our results confirm the high success rate of grafting with TachoSil, and the surgeon perceived low percentage of penile shortening. Strength & Limitations This is the first multicentre study on patients with PD undergoing grafting with TachoSil without concomitant placement of penile prosthesis. The main limitations are the short follow-up and the relatively small sample size. Conclusion Grafting with TachoSil after PIG/PEG in patients with PD is an effective and safe procedure. Among the main advantages of this technique, there are ease of use of the graft and reduced operative time.

We aimed to evaluate ten-year outcomes of penile prosthesis (PP) implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection (EPI). We identified 549 men who underwent 576 PP placements between 2008 and 2018. Univariate and multivariate analyses were used to identify potential predictors of EPI. An EPI predictive nomogram was developed. Thirty-five (6.1%) cases of EPI were recorded with an explant rate of 3.1%. In terms of satisfaction, 82.0% of the patients defined themselves as "satisfied," while partner's satisfaction was 88.3%. Diabetes (P = 0.012), longer operative time (P = 0.032), and reinterventions (P = 0.048) were associated with EPI risk, while postoperative ciprofloxacin was inversely associated with EPI (P = 0.014). Rifampin/gentamicin-coated 3-piece inflatable PP (r/g-c 3IPP) showed a higher EPI risk (P = 0.019). Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients, redo surgeries, or when a r/g-c 3IPP was used (all P < 0.03). We showed that diabetes, longer operative time, and secondary surgeries were the risk factors for EPI. Postoperative ciprofloxacin was associated with a reduced risk of EPI, while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant. After further validation, the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.

The Peyronie's Disease Questionnaire (PDQ) is a 15-question self-reported questionnaire that evaluates the severity and physical and psychosexual issues of Peyronie's disease (PD) symptoms in three scales: "psychological and physical symptoms," "penile pain," and "symptom bother." Previous studies validated the PDQ US version and confirmed its test-retest reliability and responsiveness. The aim is to translate and validate the Spanish version of the PDQ to be used in the clinical practice and in PD research studies in Spain. A non-interventional, observational study with 160 PD patients was conducted. Patients included from four healthcare centers in Spain and completed the PDQ in two study visits separated for a period of 4-7 days from March 2018 to June 2019. Patients received no type of treatment or intervention. Different statistical tests were applied to the data in order to validate the structural and construct of the PDQ, as well as its internal reliability, temporal stability reliability, reliability between observers, and test-retest reliability. Cronbach's alpha over 0.9 showed good internal consistency. We found an ICC agreement of 0.82 (test-retest) for the three scales of the Spanish version of the PDQ, which demonstrates good reliability. When comparing Visit 1 and Visit 2 questionnaires mean scores, the PDQ showed non-significant differences, as expected because no intervention or treatment was administered to the patients between visits. Translation and validation of the PDQ for the Spanish population makes available a valid, useful, and reliable tool to properly evaluate quality of life of men suffering PD.

Introduction and objectives: Adult patients with Klinefelter syndrome (KS) may present with testicular volume loss and a decrease in circulating testosterone (T) levels. However, the actual rate of hypogonadism in adult KS men is unknown. We aimed to (a) assess the prevalence of different forms of hypogonadism in a cohort of KS patients with non-obstructive azoospermia (NOA); and (b) investigate potential preoperative predictor of positive sperm retrieval (SR) at surgery in the same cohort of men. Methods: Complete data from 103 KS men with NOA who underwent testicular sperm extraction (TESE) between 2008 and 2019 at five centers were analyzed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients were categorized into four groups of hypogonadism as follows: eugonadism [normal total T (tT) (≥3.03ng/mL) and normal luteinizing hormone (LH) (≤9.4 mUI/mL)], secondary hypogonadism [low tT (≤3.03ng/mL) and low/normal LH (≤9.4 mUI/mL)], primary hypogonadism [low tT (≤3.03ng/mL) and elevated LH (≥9.4 mUI/mL)], and compensated hypogonadism [normal tT (≥3.03ng/mL) and elevated LH (≥9.4 mUI/mL)]. Descriptive statistics tested the association between clinical characteristics and laboratory values among the four groups. Results: Median (IQR) patients age was 32 (24, 37) years. Baseline follicle-stimulating hormone and tT levels were 29.5 (19.9, 40.9) mUI/mL and 3.8 (2.5, 11.0) ng/mL, respectively. Eugonadism, primary hypogonadism, and compensated hypogonadism were found in 16 (15.6%), 34 (33.0%), and 53 (51.4%) men, respectively. No patients had secondary hypogonadism. Positive SR rate at TESE was 21.4% (22 patients); of 22, 15 (68.2%) patients underwent assisted reproductive technology and five (22.7%) ended in live birth children. Patients’ age, BMI, CCI, FSH levels, and positive SR rates were comparable among hypogonadism groups. No preoperative parameters were associated with positive SR at logistic regressions analysis. Conclusions: Findings from this cross-sectional study showed that 15.6% of adult KS men have normal tT values at presentation in the real-life setting. Most KS patients presented with either compensated or primary hypogonadism. Sperm retrieval rates were not associated with different forms of hypogonadism.

Background A recent meta-analysis (Human Reproduction Update 23, 2017 and 265) reported positive sperm retrieval rates (SRR) in 50% of patients with Klinefelter syndrome (KS) undergoing testicular sperm extraction (TESE). However, these results do not reflect the rates of SR that we observe in clinical practice. We assessed the rate and potential predictors of SR in Klinefelter patients in the real-life setting. Materials and Methods We reviewed clinical data of 103 KS men who underwent TESE between 08/2008 and 03/2019 at five tertiary referral Andrology centers. Patients underwent testis ultrasound, hormonal evaluation, and genetic testing. All patients were azoospermic based on the 2010 WHO reference criteria. Conventional TESE (cTESE) or microsurgical TESE (mTESE) was performed based on the surgeon's preference. We used descriptive statistics and logistic regression models to describe the whole cohort. Results Median (IQR) patient's age was 32 (24-37) years. Baseline serum FSH and total testosterone levels were 29.5 (19.9-40.9) mUI/mL and 3.8 (2.5-11.0) ng/mL, respectively. Conventional TESE and mTESE were performed in 38 (36.5%) and 65 (63.5%) men, respectively. The sperm retrieval rate was 21.4% (22/103 men). Fifteen patients used spermatozoa for ICSI and five ended in live birth children. Patients with positive SR were similar to those with a negative TESE in terms of clinical, hormonal, and procedural parameters (all P > .05). Logistic regression analyses confirmed the lack of association between clinical, hormonal, and procedural parameters with SR outcome. Discussion Given the conflicting results in the literature regarding SRR in KS, patients should be carefully counseled regarding TESE outcomes based on data from published literature and local results. Conclusions In the real-life setting, we observed a lower SRR (21.4%) than that reported in meta-analyses in our cohort of KS patients. No associations between clinical, hormonal, and procedural variables with TESE success were found.

Most widespread three-component penile prosthesis models are 700CX™ and Titan ® . Our purpose is to assess patient and partner satisfaction after the first implant. This is a multicenter, retrospective, nonrandomized study in which all patients who met the inclusion criteria between 2009 and 2013 were included. In total, 248 patients agreed to participate. To evaluate patient satisfaction, a validated but modified 11-question questionnaire was completed (EDITS); and a nonvalidated two-item questionnaire was given to the partner. Statistical analysis used an ordinal logistic regression model. Two hundred and forty-eight patients (194 with 700CX™ vs 54 with Titan®) and 207 couples completed the questionnaire (165 with 700CX™ vs 42 with Titan®). Overall satisfaction was high. Both showed great reliability for sexual intercourse and high compliance with prior expectations. Most patients were able to manage the penile prosthesis correctly within 6 months. Postoperative penile shortening led to some dissatisfaction in 42% and 46% of cases (700CX™ /Titan®). Significant differences were found in three questions of patients' questionnaire. There were more patients satisfied with the 700CX™ (P = 0.0001). No patient with Titan® implant took longer than 6 months to optimal management. Only 4% of patients with 700CX™ implant were dissatisfied with the deflation, in contrast to 24% with the Titan® (P = 0.0031). Of the two partners' questions, one showed a statistically significant difference (P = 0.0026). It seems that group 700CX™ would recommend to re-implant the prosthesis with a greater tendency. The overall satisfaction was very high for both prostheses. The final aspect of the erected and flaccid penis was satisfactory, but both groups showed significant discontent with its final size. Partners' overall satisfaction was high.

ResumenLas alteraciones de la eyaculación constituyen un problema de consulta frecuente en urología y en cierta medida, en la consulta general. Su importancia radica, además de su alta prevalencia, en el detrimento psicológico que repercute en la calidad de vida de los pacientes, sus parejas, y por constituir una posible causa de infertilidad. Dada la complejidad del control de la función eyaculatoria, las causas pueden ser múltiples y por lo tanto es necesario un abordaje integral del bienestar biopsicosocial del paciente para lograr un manejo adecuado de esta afección. Por otro lado, si bien es imprescindible entender los aspectos fisiopatológicos de estas disfunciones para comprender su manejo, hay que hacer notar que su diagnóstico es eminentemente clínico. Sobre este último tópico es que existe gran controversia, ya que existe variabilidad en la definición de algunos de estos trastornos, lo que afecta la capacidad de detección del clínico, su manejo y también la calidad de los estudios clínicos que investigan su tratamiento. El tratamiento adecuado parte con un correcto diagnóstico clínico y, como se dijo anteriormente, exige un abordaje multidisciplinario. De hecho es históricamente un campo compartido con la psiquiatría, incluyendo el DSM criterios estrictos para su diagnóstico. Existen diversas terapias dependiendo del diagnóstico de cada trastorno, las que van desde tratamientos farmacológicos hasta terapias psicológicas según sea la situación clínica.SummaryEjaculatory disorders constitute a frequent consultation problem in urology, and to a certain extent, in general practice. Their importance is based, besides a high prevalence, on the psychological damage that affects patients and their couple’s quality of life and because they could be a possible cause of infertility. Given the ejaculatory control complexity, there might be several causes and therefore it is necessary an integral approach of the patient’s biopsychosocial wellbeing to achieve the right treatment of this affection. Although it is essential to understand physiopathological aspects of this disorders to understand their management, it is necessary to highlight that its diagnosis is mainly clinical. It is on this last subject that great controversy exists, given the variability of some of these disorders’ definitions, which affect the clinicians detection capacity, its management and also the quality of the clinical studies which investigate its treatment. Proper treatment starts with a right diagnosis and, as stated before, demands a multidisciplinary approach. In fact it has been historically a shared field with psychiatry, including DSM strict criteria for its diagnosis. There are many therapies according to the clinical situation of each disorder, and those go from pharmacological to psychological treatments.

Resumen Objetivos Determinar la frecuencia de la disfuncion erectil (DE) en consultas de uro-andrologia de Espana, definir el perfil epidemiologico de los pacientes y analizar las pautas de diagnostico y tratamiento en funcion de la especializacion en el tratamiento de la DE del centro. Material y metodos Estudio observacional, descriptivo, transversal, no intervencionista y nacional, en pacientes con DE ≥ 18 anos que acudieron a consulta entre noviembre de 2009 y febrero de 2010. Participaron 10 centros de uro-andrologia, uno de ellos especializado en el tratamiento de la DE desde el punto de vista multidisciplinario. En una visita unica se recogieron antecedentes sociodemograficos, clinicos, andrologicos y de pareja del paciente, asi como los estudios diagnosticos complementarios y las pautas de tratamiento y manejo de la DE propuestos en primera instancia. Resultados Participaron 405 pacientes de 20–85 anos, en los que se confirmo una alta prevalencia de factores de riesgo cardiovascular, como la edad, la hipertension arterial, la diabetes mellitus, la hiperlipidemia y la obesidad abdominal. La educacion y el asesoramiento en aspectos sexologicos y de pareja ofrecidos al paciente (counselling) , y el abordaje activo de los factores de riesgo modificables, de acuerdo con lo recomendado en las guias de manejo de la disfuncion sexual masculina, se aplicaron mas frecuentemente en el centro especializado en el tratamiento de la DE respecto al resto de centros uro-andrologicos. Conclusion La adecuacion a las recomendaciones de manejo de la disfuncion sexual en el varon en Espana, con el fin de dar una respuesta satisfactoria a la salud sexual y cardiovascular del varon, es aun limitada, siendo necesaria una labor de concienciacion y adaptacion a nuevas formas de valoracion y enfoque terapeutico de esta afeccion por parte de los profesionales dedicados a este ambito de la medicina.

Resumen El objetivo del estudio es comparar la evolucion de la prevalencia de tabaquismo en la poblacion estudiantil de ensenanza media de la comarca de La Garrotxa entre 1982 y 1986. Se realizaron dos encuestas, siguiendo la misma metodologia, a dos muestras de la poblacion estudiantil de 13 a 25 anos en ambos sexos. El numero total de encuestados fue de 1.039 en 1982 y de 1.133 en 1986. La proporcion de fumadores fue inferior en el ano 1986 respecto a 1982, pues disminuyo del 55% al 35%. Esta diferencia se debe a una reduccion en los grupos de edad menores de 17 anos de ambos sexos y se mantiene despues de ajustar por edad, sexo y centro de estudios. La edad de inicio del habito se retraso en casi un ano de 1982 a 1986. La proporcion de padres fumadores no vario. Concluimos que la prevalencia de tabaquismo ha disminuido en los grupos de edad mas jovenes, y que ello es debido probablemente a un retraso en la edad de inicio del habito.