James Kashanian

Are men shortchanged on health? Perspective on health care utilization and health risk behavior in men and women in the United States

Background:  Significant gender disparities exist in life expectancy and major disease morbidity. There is a need to understand the major issues related to men’s health that contributes to these significant disparities. It is hypothesized that, high‐risk behaviors and low utilization of all and preventive health services contribute to the higher mortality and the higher and earlier morbidity in men.

Nitrofurantoin: the return of an old friend in the wake of growing resistance.

To re‐evaluate the first‐ and second‐line therapies for treating uncomplicated urinary tract infection (UTI), as although fluoroquinolones are commonly used for this purpose, its level of use is thought to be inappropriately excessive and will eventually have a detrimental impact; thus we hypothesise that nitrofurantoin might be the best choice for this indication, due to its low frequency of use and its high susceptibility rate in common UTI pathogens.

Metabolic and cardiovascular effects of androgen deprivation therapy

Prostate cancer is the most common gender‐specific malignancy in men in the USA. Androgen‐deprivation therapy (ADT) is commonly used in the treatment of metastatic or recurrent prostate cancer. The use of ADT is increasing with the advocacy of adjuvant and neoadjuvant ADT for treating asymptomatic patients with locally advanced prostate cancer. Although the use of ADT has resulted in improved survival in men with advanced prostate cancer, ADT, with its resulting severe hypogonadism, causes profound metabolic side‐effects. We comprehensively reviewed previous reports using Medline searches of English‐language literature (1950 to the present), with the keywords ‘hypogonadism’, ‘testosterone’, ‘androgen deprivation therapy’, ‘hormonal treatment’, ‘prostate cancer’, ‘diabetes’, ‘metabolic syndrome’, and ‘cardiovascular disease’. Men with prostate cancer who undergo long‐term ADT are at greater risk of developing dyslipidaemia, insulin resistance, hyperglycaemia and metabolic syndrome. These metabolic and physiological changes are a direct result of the induced severe hypogonadism and might predispose patients to a greater risk of cardiovascular morbidity and mortality. There is a need for prospective studies aimed and designed to investigate the metabolic and cardiovascular adverse effects of ADT, and assess the benefit/risk ratio, especially in special populations such as diabetics.

Erectile Dysfunction and Testosterone Deficiency

A definitive role of testosterone in erectile function has been controversial; however, recent evidence is becoming available which substantiates a key function for this hormone. Testosterone deficiency is associated with a decline in erectile function and testosterone levels are inversely correlated with increasing severity of erectile dysfunction. Erectile dysfunction can be caused by multifactorial pathologies. In particular, erectile dysfunction may be the first symptom of cardiovascular disease. Animal studies have demonstrated that castration causes vascular smooth muscle cell atrophy, venous leakage, adipocytes in the subtunical space, loss of elastic fibers and increase in collagen deposition. Testosterone increases the expression of nitric oxide synthase and phosphodiesterase type 5, both principal enzymes involved in the erectile process. Testosterone replacement alone in hypogonadal men can restore erectile function. A significant proportion of men who fail to respond to a PDE5 inhibitor are testosterone deficient. Testosterone replacement therapy can convert over half of these men into phosphodiesterase type 5 responders. It is now recommended that testosterone levels should be assessed in all patients with erectile dysfunction.

Can lifestyle modification affect men’s erectile function?

Erectile dysfunction (ED) is a common condition affecting millions of men worldwide. The pathophysiology and epidemiologic links between ED and risk factors for cardiovascular disease (CVD) are well-established. Lifestyle modifications such as smoking cessation, weight reduction, dietary modification, physical activity, and psychological stress reduction have been increasingly recognized as foundational to the prevention and treatment of ED. The aim of this review is to outline behavioral choices which may increase ones risk of developing ED, to present relevant studies addressing lifestyle factors correlated with ED, and to highlight proposed mechanisms for intervention aimed at improving erectile function in men with ED. These recommendations can provide a framework for counseling patients with ED about lifestyle modification.

MP25-12 DIABETES IS A RISK FACTOR FOR IPP INFECTION: ANALYSIS OF A LARGE STATEWIDE DATABASE

number of IPP devices and procedures performed. The median time to development of infection after most recent IPP surgery was 2 months (IQR 1-3.3 months). No clinical or demographic differences were identified between the infection and non-infection cohorts, including age, DM status, tobacco usage, Charleston Comorbidity Index score, prior prostatectomy, prior hernia repair, or Peyronie0s disease. CONCLUSIONS: Infection rates of revision/salvage IPP surgery increase with each subsequent IPP placement or following IPPrelated surgeries. The majority of patients experience at least one infection by their 4th device. This data could provide relevant information necessary for appropriate patient counseling.

MP25-14 SURGERY FOR INFECTED PENILE PROSTHESES IN NEW YORK STATE: PRACTICE PATTERNS, OUTCOMES AND IMPACT OF SURGEON FACTORS

both the pre(HR 1.43, 95% CI 1.08-1.88, p1⁄40.013) and post-antibiotic impregnated (HR 1.69, 95% CI 1.19-2.41, p1⁄40.004) eras. CONCLUSIONS: Our analysis strongly supports the notion that DM is a risk factor for IPP infection. In the contemporary era of antibiotic-impregnated devices, IPP recipients with DM are at 1.7-fold increased risk of infection compared with non-diabetic men. This has important implications for patient selection and counseling, and raises the question of whether this increased risk can be mitigated by optimization of glycemic control prior to surgery.

MP74-05 PRACTICE PATTERNS IN SURGICAL STERILIZATION: AN ANALYSIS OF US UROLOGIST SURGICAL LOGS

INTRODUCTION AND OBJECTIVES: To consider the feasible surgical options and increase patients’ willingness to seek vasectomy reversal. We report on the techniques for simple and ambulatory miniincision supermicrosurgical vasovasostomy(3-4 layer anastomosis by 9-0 or/and 10-0 nylon with >10x magnification) using a double-ringed clamp (Moon’s clamp), which makes use of dilators, approximators, and background material unnecessary. We also report the results METHODS: Ambulatory mini-incision supermicrosurgical vasovasostomy was conducted on 263 patients who satisfied surgical eligibility requirements for vasovasostomy and safety criteria for local anesthesia. We recorded and retrospectively analysed the operation time, postoperative recovery, and the results of postoperative semen analysis. RESULTS: A mean time of 25.5 min was spent isolating the bilateral vas deferens. All patients were discharged on the day of surgery and returned to their ordinary activities 24e48 h after surgery. No hematoma or infection occurred, except in one patient. Postoperative semen analysis showed that the surgery was successful in 182 patients (96.8%). CONCLUSIONS: Simple ambulatory mini-incision microsurgical vasectomy reversal using Moon’s clamp under local anaesthesia could be a surgically feasible option, with the advantages of a low-risk operation and the achievement of successful vasovasostomy without other accessory devices, for patients who wish to return to their daily activities quickly with minimal complications. Source of Funding: none