Nicola Frego

Anti-Mullerian Hormone-to-Testosterone Ratio is Predictive of Positive Sperm Retrieval in Men with Idiopathic Non-Obstructive Azoospermia

The lack of clinically-reliable biomarkers makes impossible to predict sperm retrieval outcomes at testicular sperm extraction (TESE) in men with non-obstructive azoospermia (NOA), resulting in up to 50% of unnecessary surgical interventions. Clinical data, hormonal profile and histological classification of testis parenchyma from 47 white-Caucasian idiopathic NOA (iNOA) men submitted to microdissection TESE (microTESE) were analyzed. Logistic regression analyses tested potential clinical predictors of positive sperm retrieval. The predictive accuracy of all variables was evaluated using the receiver operating characteristic-derived area under the curve, and the clinical net benefit estimated by a decision-curve analysis (DCA). Overall, 23 (49%) and 24 (51%) patients were classified as positive and negative sperm retrievals at microTESE. While circulating hormones associated to a condition of primary hypogonadism did not predict sperm retrieval, levels of anti-Mullerian hormone (AMH) and the ratio AMH-to-total Testosterone (AMH/tT) achieved independent predictor status for sperm retrieval at microTESE, with a predictive accuracy of 93% and 95%. Using cutoff values of <4.62 ng/ml for AMH and <1.02 for AMH/tT, positive sperm retrieval was predicted in all individuals, with 19 men out of 47 potentially spared from surgery. DCA findings demonstrated clinical net benefit using AMH and AMH/tT for patient selection at microTESE.

Age at First Presentation for Erectile Dysfunction: Analysis of Changes over a 12-yr Period

BACKGROUND The awareness regarding erectile dysfunction (ED) may have increased over the past decade due to the widespread availability of phosphodiesterase type 5 inhibitors and the growing knowledge of a link between ED and mens overall health. OBJECTIVE We examined whether the increased awareness of ED has led to observable changes in patient characteristics among first-time assessments for ED. DESIGN, SETTING, AND PARTICIPANTS Data was collected from 1586 men seeking their first medical attention for ED at a single academic center during 2005-2017. INTERVENTION Patients completed the International Index of Erectile Function (IIEF) to assess ED. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Local polynomial regression models explored the relationship between patient characteristics and the year of first-time assessment. Linear and logistic regression models estimated the association between the time at first assessment and the investigated outcomes. Restricted cubic splines tested the nonlinearity for continuous variables. RESULTS AND LIMITATIONS We observed a nonlinear correlation between age and year of assessment (p=0.0003); the probability that a patient aged <40 yr presented for ED increased from 13.5% in 2006 to 21.7% in 2017 (p=0.002). Patients assessed over the last period were significantly healthier (Charlson Comorbidity Index≥1; odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92-0.99, p=0.02). We observed an increase in the rate of smokers (OR: 1.19, 95% CI: 1.14-1.23, p<0.0001) and in regularly physically active men (OR: 1.05; 95% CI: 1.01-1.08, p=0.008) over the same period. No changes were observed in terms of baseline IIEF-Erectile function scores over time. The single center design is the main limitation of the study. CONCLUSIONS Age at first presentation for ED significantly decreased over the past decade. Physicians should carefully assess EF even at younger age groups, suggesting lifestyle modifications and relevant treatments for comorbid conditions as soon as possible. PATIENT SUMMARY Patients presenting for erectile dysfunction (ED) are younger than they were 10 yr ago. These findings may suggest an increase in ED awareness. Likewise, this age reduction could represent a worrisome increase in terms of ED incidence in young men.

The role of neutrophil-to-lymphocyte ratio in men with erectile dysfunction-preliminary findings of a real-life cross-sectional study

The aim of this study was to investigate the role of systemic inflammation by means of the neutrophil‐to‐lymphocyte ratio (NLR) in men with erectile dysfunction (ED). Complete demographic, clinical, and laboratory data from 279 consecutive men with newly diagnosed ED were analyzed. Health‐significant comorbidities were scored with the Charlson Comorbidity Index (CCI). A complete blood count was requested for every man, and the NLR was calculated for every individual. Patients were invited to complete the IIEF questionnaire. Logistic regression models tested the odds (OR, 95% CI) of severe ED (defined as IIEF‐EF <11, according to Cappelleris criteria) after adjusting for age, BMI, comorbidities (CCI >0), metabolic syndrome, NLR, cigarette smoking, and color duplex Doppler ultrasound parameters. Likewise, LNR values were also dichotomized according to the most informative cutoff predicting severe ED using the minimum p value approach. Median [IQR] age of included men was 51 [40–64] years. Of all, 87 (31%) men had severe ED. Men with severe ED were older (median [IQR] age: 61 [47–67] vs. 49 [39–58] years) and had a higher rate of CCI>0 [46/87 (53%) vs. 44/192 (23%) patients]. Thereof, NLR was dichotomized according to the most informative cutoff (NLR>3); patients with severe ED more frequently had NLR>3 as compared to all other ED patients [namely, 18/87 (21%) vs. 13/192 (7%)]. At multivariable logistic regression analysis, NLR>3.0 emerged as an independent predictor (OR [CI] 2.43 [1.06; 5.63]) of severe ED, after accounting for other clinical variables. A NLR>3 increased the risk of having severe ED in our cohort, boosting the already existing evidence linking systemic inflammation to ED. Moreover, this easily obtainable index can be clinically useful in better risk‐stratifying patients with ED.

Clinical Profile of Young Patients with Erectile Dysfunction: Preliminary Findings of a Real-life Cross-sectional Study

BACKGROUND Erectile dysfunction (ED) is an increasingly common complaint among men aged <40 yr. OBJECTIVE To assess clinical factors potentially associated with impaired erectile function (EF) in a cohort of young men seeking first medical help for ED as their primary complaint. DESIGN, SETTING, AND PARTICIPANTS Complete sociodemographic and clinical data for 307 consecutive patients aged <40 yr were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. Patients completed the International Index of Erectile Function (IIEF) and Becks Inventory for Depression (BDI) and were categorised into two groups: those with impaired EF (IIEF-EF <26) and those with normal IIEF-EF scores. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics and logistic regression analyses were used to test the association between risk factors and impaired EF. RESULTS AND LIMITATIONS Overall, 78 patients (25%) had normal and 229 (75%) had impaired IIEF-EF scores. Among ED patients, 90 (29%) had IIEF-EF scores suggestive of severe ED. The two cohorts did not differ in terms of median age, body mass index, prevalence of hypertension, general health status, smoking history, or alcohol use. No differences were reported for serum sex hormones and lipid profiles. Patients with ED reported higher median BDI scores (7, interquartile range [IQR] 3-13) than those with normal EF (5, IQR 1-9). Overall, the higher the BDI score, the lower was the IIEF-EF domain score (odds ratio 1.08, 95% confidence interval 1.02-1.15; p=0.01). The single-centre cohort is the main study limitation. CONCLUSIONS Overall, young men with impaired EF showed comparable clinical characteristics to those with normal IIEF-EF; conversely, young individuals with worse EF had BDI scores suggestive of significant mood deflection. PATIENT SUMMARY Young men complaining of erectile dysfunction show significant mood deflection in comparison to patients with normal erectile function. Conversely, the clinical characteristics are similar between the two groups.

High Blood Pressure Is a Highly Prevalent but Unrecognised Condition in Primary Infertile Men: Results of a Cross-sectional Study

BACKGROUND Although most of the components related to metabolic syndrome were shown to have a detrimental effect on male fertility, the effects of high blood pressure (HBP) have been partially analysed. OBJECTIVE To investigate the prevalence and impact of hypertension on clinical and semen parameters in a cohort of white European men presenting for couples infertility at a single tertiary referral academic centre. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study was performed including analysis of data from 2185 primary infertile men. Comorbidities were scored with Charlson Comorbidity Index (CCI; categorised 0 vs ≥1). HBP was defined as blood pressure ≥140/90mmHg. Semen analyses followed the 2010 World Health Organization reference criteria. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics and logistic regression analyses tested the association among semen parameters, clinical characteristics, and HBP. RESULTS AND LIMITATIONS Overall, HBP was found in 6.8% of infertile patients and in 3.6% of age-comparable men without known fertility problems. Of 148 patients, 85 (58%) were either unaware of their HBP or not adequately medically-controlled. +HBP men were older (median age [interquartile range], 37 [33-40] vs 39 [36-44] yr; p<0.001), had higher CCI scores (X2=25.6; p<0.001), higher BMI (25.1 [23.3-27.3] vs 26.8 [24.9-29.4]; p<0.001), and a waist circumference >102cm in a greater proportion of individuals (41% vs 23%; X2=4.68 p<0.05) than -HBP men. Hypertensive and normotensive men did not differ in terms of hormonal milieu and semen parameters. Patients did not differ in terms of HPB rates according to oligozoospermia, asthenozoospermia, and teratozoospermia status. The lack of a real control group represents the main limitation of the study. CONCLUSIONS Hypertension and unrecognised or not adequately controlled HBP are highly prevalent among white European primary infertile men. Hypertension per se did not have an impact on hormonal and semen parameters. PATIENT SUMMARY Because of its effects in terms of overall prospective mens health, high blood pressure must be comprehensively considered over the basic work-up of every infertile man in the outpatient clinic setting.

Undiagnosed prediabetes is highly prevalent in primary infertile men - results from a cross-sectional study

To study the prevalence and the risk associated with prediabetes (PreDM) in primary infertile men.

PD13-07 MEN WITH INSULIN RESISTANCE ARE AT INCREASED RISK OF AZOOSPERMIA: RESULTS FROM A CROSS-SECTIONAL STUDY

to model the costs of screening and treatment of infertile men at risk for TC. RESULTS: Using incidence, prevalence and census data, the number of infertile men in the U.S. was calculated to be 2,350,000. Using co-prevalence data, 375 new cases of TC per year were estimated in the infertile male population. Screening using testicular selfexamination (TSE) resulted in no cost burden. Prior to treatment, confirmation of the diagnosis of TC in men with testicular masses included tumor markers and scrotal ultrasound; these costs are folded into treatment costs. Early treatment was defined as radical orchiectomy followed by low-dose chemotherapy. Late TC treatment was defined as radical orchiectomy followed by chemotherapy and retroperitoneal lymph node dissection (RPLND), as well as salvage chemotherapy. The total cost associated with early treatment of infertile men diagnosed with TC using TSE was

MP81-15 THE ROLE OF NEUTROPHIL-TO-LYMPHOCYTE RATIO IN MEN WITH ERECTILE DYSFUNCTION – PRELIMINARY FINDINGS OF A REAL-LIFE CROSS-SECTIONAL STUDY

7,035,394, in contrast with a total cost of

MP81-20 THE ROLE OF SYSTEMIC INFLAMMATION IN DETERMINING HEALTH STATUS IN MEN WITH SEXUAL DYSFUNCTION – A WORRISOME SCENARIO IN YOUNG MEN

19,350,096 for late treatment of this population. Thus, the cost savings resulting from early detection of TC in infertile men using TSE is approximately

MP84-12 DOES CALCULATED FREE TESTOSTERONE OVERCOME TOTAL TESTOSTERONE IN PROTECTING FROM SEXUAL SYMPTOMS IMPAIRMENT? FINDINGS OF A CROSS-SECTIONAL STUDY

12,314,701 per year. CONCLUSIONS: Infertile men are at increased risk for TC. We find that early screening for TC among infertile men via TSE can result in early TC detection and significant cost savings resulting from early treatment. Despite U.S. Preventive Services Task Force (USPSTF) recommendations against TSE, TSE among infertile men represents a cost effective means of early TC detection in this at risk population.