Marah Hehemann

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.

Scrotal Ultrasound for Pain: Low Frequency of Absolute Surgical Indications

OBJECTIVE To examine the results of scrotal ultrasounds (US) conducted for scrotal or testicular pain and review the pathologic findings of orchiectomies done for lesions that were suspicious for malignancy on US. MATERIALS AND METHODS We retrospectively reviewed the indications and findings of all scrotal US completed at our institution from 2002 to 2014. If a patient underwent an orchiectomy for an intratesticular lesion that was concerning for malignancy on US, the pathology report was also reviewed. RESULTS There were 18,593 scrotal US performed, with 7,668 (41.2%) conducted for scrotal pain. Of the US performed for pain, 80.4% revealed benign or normal findings, and only 2.2% demonstrated a finding that is an absolute indication for surgery (intratesticular lesion suspicious for malignancy 0.8%, abscess 0.7%, torsion 0.6%, infiltrative process such as lymphoma 0.1%). For those patients undergoing an orchiectomy, 75% had malignancy on pathologic analysis. CONCLUSION The majority of the 7668 US performed to evaluate scrotal or testicular pain reveal normal or benign findings. A low percentage demonstrates a finding that necessitates urgent or emergent surgery.

Impact of Post-hospital Syndrome on Penile Prosthesis Outcomes: A Period of Global Health Risk

Purpose: Post-hospital syndrome is an acquired transient period of health vulnerability following inpatient admission. We assessed the impact of a preoperative hospitalization on outcomes following penile prosthesis surgery and sought to optimize surgical timing after inpatient admission. Materials and Methods: We used the Healthcare Cost and Utilization Project State Inpatient Databases and State Ambulatory Surgery Database for California from 2007 to 2011 and for Florida from 2009 to 2014. Patients were identified as having undergone prosthesis placement by ICD-9 and CPT codes. The primary exposure was post-hospital syndrome, defined as any inpatient admission 90 days or less before prosthesis placement. Patients were further categorized by how recently the inpatient hospitalization occurred. The primary study outcome was 30-day hospital readmission. Secondary outcomes were length of stay, and device and postoperative complications. Results: We identified 16,923 patients who received a penile prosthesis, of whom 477 (3%) had post-hospital syndrome exposure 90 days or less before prosthesis placement. After risk adjustment patients with post-hospital syndrome had higher odds of 30-day readmission (OR 3.0, 95% CI 2.2–4.1), length of stay 2 days or longer (OR 1.7, 95% CI 1.3–2.3) and device complications (OR 1.7, 95% CI 1.2–2.5). When categorizing patients by 30-day intervals, we found a linear decrease in the risk of 30-day readmission as the interval increased between post-hospital syndrome exposure and prosthesis surgery. Conclusions: Post-hospital syndrome exposure is a risk adjusted predictor of 30-day readmissions, prolonged length of stay and device complications. Medical optimization and delayed surgery can help combat the adverse effects associated with post-hospital syndrome exposure and may improve surgical outcomes.

MP42-07 SONIC HEDGEHOG REGULATION OF RHABDOSPHINCTER MUSCLE

persists following the resolution of colitis, and that linaclotide, an FDA approved guanylate cyclase-C (GC-C) agonist, is able to attenuate these changes [3]. We hypothesise that these CCH-induced changes are the result of altered sensitivity of afferents both within the colon and bladder wall and within the dorsal root ganglion (DRG), and that oral linaclotide administration may act to reduce this hypersensitivity. METHODS: We investigated healthy C57BL/6J mice and mice with CCH, 28 days after intra-colonic TNBS administration. CCH mice were randomly assigned to either chronic linaclotide (3mg/kg/day) or placebo (water) administration, consisting of a once daily oral gavage for 2 weeks prior to experimentation. Ex-vivo electrophysiological recordings determined bladder afferent and contractile sensitivity to abMe-ATP (30mM), carbachol (1mM), and capsaicin (10mM) as well as whole cell patch clamp of retrogradely traced bladder DRG neurons in all four groups. RESULTS: Bladder DRG from mice with CCH display hyperexcitability, with a significant reduction in rheobase compared to controls (p 0.01). CCH mice also display significantly enhanced afferent responses to abMe-ATP (p 0.001), carbachol (p 0.001), and capsaicin (p 0.001). CCH mice treated with linaclotide display attenuated DRG hyperexcitability and normalised afferent responses to agonists (p 0.01) compared to placebo (p 0.01). CONCLUSIONS: Mice with CCH also display increased bladder afferent excitability within both the DRG and bladder wall, indicating cross-organ sensitisation. Chronic oral administration of linaclotide, a locally acting GC-C agonist that inhibits colonic nociceptors, reverses these colitis-induced changes in bladder afferent sensitivity. Common sensory pathways may allow agents that reduce abdominal pain to improve urological symptoms. 1. Lamb, K., et al. AJPGI, 2006. 2. Ustinova et al, Neurourology and Urodynamics, 2010. 3. Grundy, L., et al., MP28-06. The Journal of Urology, 2016.

MP45-08 CAVERNOUS NERVE CRUSH INJURY INDUCES APOPTOSIS IN THE PELVIC PLEXUS INCLUDING PELVIC AND HYPOGASTRIC NERVES

on Matrigel in growth factor reduced medium for three to five days. Pelvic ganglia/CN were exposed to Affi-Gel beads containing: 1.) SHH protein, 2.) 5e1 and cyclopamine SHH inhibitors, and 3.) SHH protein delivered by PA. Additional pelvic ganglia/CN tissue underwent CN crush and were exposed to SHH protein or mouse serum albumin protein (control) by PA in vivo for 4 days with an additional 4 days in culture. Sprouting was evaluated for number of sprouts and their length, and by immunohistochemical analysis for sprouting markers (GAP43 and nNOS). RESULTS: Sprouting of neurons in the pelvic ganglia and CN were increased with SHH treatment. Sprouts were more abundant, longer in length, and had increased branching, in comparison to controls. Sprouting was even further enhanced in CN injured nerves with SHH treatment. Sprouting did not occur in the presence of either SHH inhibitor. The CN had similar sprouting potential at 4 and 9 days after crush injury. SHH induced sprouting even when not delivered to the CN until 4 days after injury. Sprouts continued to grow in organ culture once initiated with SHH PA in vivo. Localization of SHH delivery makes a difference in sprouting potential. Sprouts formed in response to SHH treatment stained strongly for nNOS protein. CONCLUSIONS: SHH PA treatment promotes CN regeneration by enhancing sprouting of pelvic ganglia and CN neurons. Understanding the mechanism of SHH PA action on neuronal tissue is critical for translation to prostatectomy patients and to further enhance regeneration.

MP35-13 VASECTOMY AND THE GENDER GAP: SHIFTING DEMOGRAPHICS OF THE UROLOGIC WORKFORCE

multiple comparison analysis, sperm concentration (p1⁄40.042) and progressive motility (p1⁄40.03) were significantly lower in heavy smokers; similarly, DFI values were significantly higher in Group 3 patients than in no smokers (p1⁄40.025). At multivariable analyses, FSH (OR 1.1, p1⁄40.02) and being heavy smokers (OR 4.1, p1⁄40.006) were independent predictors for pathologic DFI score after accounting for age, BMI and CCI. Similarly, being heavy smokers achieved independent predictor status for pathologic sperm count (OR 2.7, p1⁄40.047) and pathologic total progressive motility (OR 6.3, p1⁄40.002), after accounting for the same variables. CONCLUSIONS: The routine assessment of DFI is getting increasing clinical relevance. Heavy cigarette smoking emerged as the most detrimental factor impacting on the DFI rate, along with an impaired sperm concentration and progressive motility.

MP35-12 SURGICAL TREATMENT OF MALE FACTOR INFERTILITY: DOES INSURANCE COVERAGE MATTER?

multiple comparison analysis, sperm concentration (p1⁄40.042) and progressive motility (p1⁄40.03) were significantly lower in heavy smokers; similarly, DFI values were significantly higher in Group 3 patients than in no smokers (p1⁄40.025). At multivariable analyses, FSH (OR 1.1, p1⁄40.02) and being heavy smokers (OR 4.1, p1⁄40.006) were independent predictors for pathologic DFI score after accounting for age, BMI and CCI. Similarly, being heavy smokers achieved independent predictor status for pathologic sperm count (OR 2.7, p1⁄40.047) and pathologic total progressive motility (OR 6.3, p1⁄40.002), after accounting for the same variables. CONCLUSIONS: The routine assessment of DFI is getting increasing clinical relevance. Heavy cigarette smoking emerged as the most detrimental factor impacting on the DFI rate, along with an impaired sperm concentration and progressive motility.

Prostate Cancer in the Elderly Male: Diagnostic and Management Considerations

Purpose of ReviewAlong with an aging US population comes the growing need for clinical guidelines inclusive of and specific to this unique group. Prostate cancer (PCa) is increasingly recognized as a substantial cause of mortality and morbidity in the elderly. This review seeks to address the unmet need for standardized PCa screening and management protocols for geriatric men and to synthesize recommendations based on recent literature.Recent FindingsGuidelines regarding PCa screening in elderly men are still being optimized, with many organizations moving toward inclusion of pre-screening global health assessment. Physician compliance with screening and treatment of PCa in geriatric patients is suboptimal, despite advanced age being a predictor of advanced disease. Elderly patients may experience treatment-related side effects which differ from their younger counterparts.SummaryProviders treating older men are encouraged to utilize comprehensive health assessments which account for comorbidities, functional status, and global well-being, along with shared decision-making, in determining diagnostic and therapeutic pathways.

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