Sherwin Zargaroff

Prostate cancer diagnosis is associated with an increased risk of erectile dysfunction after prostate biopsy.

There have been several studies that have suggested there may be a relationship between prostate biopsy and erectile function and LUTS. Previous studies have suggested a specific association between the type of local anaesthesia administered and/or the number of biopsies performed. Other studies have suggested an exacerbation of LUTS after prostate biopsy. The present study identifies a positive cancer diagnosis as a novel characteristic that may explain a relationship between biopsy and worsening erectile function.

Vasectomy demographics and postvasectomy desire for future children: Results from a contemporary national survey

OBJECTIVE To describe the longitudinal demographics and family planning attitudes of vasectomized men with the use of the National Survey for Family Growth (NSFG). DESIGN Retrospective cohort analysis of the NSFG with the use of national projections and multivariable regressions. SETTING In-home survey. PATIENT(S) The NSFG sampled 10,403 men aged 15-45 years from 2006 to 2010 regarding family planning attitudes. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Vasectomy and desire for children. RESULT(S) There were 3,646,339 (6.6%) vasectomized men aged 18-45 years in the U.S. On multivariable regression the following factors increased the odds of having a vasectomy: currently married (odds ratio [OR] 7.814), previously married (OR 5.865), and increased age (OR 1.122) and income (OR 1.003). The odds of having a vasectomy increased with number of children. The following factors decreased the odds of having a vasectomy: immigrant status (OR 0.186), African American (OR 0.226), Hispanic (OR 0.543), Catholic (OR 0.549), and other non-Protestant religion (OR 0.109). Surprisingly, an estimated 714,682 (19.6%) vasectomized men in the U.S. desire future children. Men practicing a religion (OR 8.575-15.843) were more likely than atheists to desire children after vasectomy. 71,886 (2.0%) vasectomized men reported having a vasectomy reversal. CONCLUSION(S) This study highlights the importance of preoperative counseling for permanency of vasectomy and reveals an opportunity to counsel couples about vasectomy versus tubal ligation.

National Trends in the Treatment of Penile Prosthesis Infections by Explantation Alone vs. Immediate Salvage and Reimplantation

INTRODUCTION A penile prosthesis infection (PPI) is either treated with explantation of the prosthesis with a possible delayed reimplantation or a salvage procedure with an immediate reimplantation of the prosthesis. AIM We used a large, all-payer national database to investigate the use of the salvage procedure in the setting of PPI. METHODS The study used years 2000-2009 of the Nationwide Inpatient Sample to identify PPIs treated with immediate salvage or explantation alone. Admissions were then stratified by various parameters to compare differences in the salvage rates. MAIN OUTCOME MEASURES Salvage Rate of Penile Prosthesis infection. RESULTS A total of 1,557 patients were treated with an explantation only (82.7%) or salvage (17.3%) for PPI, a proportion that remained stable over the study period. The patients treated with salvage were younger (60.4 vs. 65.1 years), more likely to be discharged home (87.3% vs. 61.9%), and were less likely to have a severe presentation (7.2% vs. 31.6%) than those who were explanted only (P < 0.001). These factors were confirmed on multivariate regression analysis. The regression also revealed that treatment at rural hospitals had lower odds of salvage than treatment at urban teaching hospitals. Race, comorbid diabetes, and insurance status did not independently affect the salvage rate. There was no significant difference in total hospital charges between groups. CONCLUSIONS Salvage rates have remained low over the past decade. Our study elucidated several factors decreasing the chances of salvage after PPI including age, severity of presentation, and hospital setting.

Relating economic conditions to vasectomy and vasectomy reversal frequencies: a multi-institutional study.

PURPOSE It was theorized that the use of permanent contraceptive methods may vary with economic conditions. We evaluated the relationship between vasectomy/vasectomy reversal frequencies at several large referral centers and national economic indicators during 2 recessions spanning 2001 to 2011. MATERIALS AND METHODS We performed an institutional review board approved, retrospective chart review to identify the number of vasectomies/vasectomy reversals per month at several large referral centers from January 2001 to July 2011. The rates of these procedures were pooled, correlated with national economic data and analyzed in a multivariate linear regression model. RESULTS A total of 4,599 vasectomies and 1,549 vasectomy reversals were performed at our institutions during the study period. The number of vasectomies per month positively correlated with the unemployment rate (r=0.556, p<0.001) and personal income per capita (r=0.276, p=0.002). The number of reversals per month negatively correlated with the unemployment rate (r=-0.399, p<0.001) and personal income per capita (r=-0.305, p<0.001). Neither vasectomy nor vasectomy reversal frequency significantly correlated with the inflation rate or the S&P 500®. Regression models confirmed that the unemployment rate explained more of the variance in vasectomy/vasectomy reversal frequencies than other indicators. CONCLUSIONS We noted a correlation between the number of vasectomies/vasectomy reversals performed at our institutions and national economic indicators. The strongest association was with the unemployment rate. This points to the importance of financial pressure on family planning decisions.

2287 SEMEN ANALYSIS PARAMETERS FOR MEN WITH NEWLY DIAGNOSED CANCER

INTRODUCTION AND OBJECTIVES: As increasing numbers of men are undergoing fertility preservation prior to cancer therapy, differences in pre-therapy semen analysis parameters (SA) have been suggested for the various neoplasms. Specifically, testicular cancer has been implicated in impairing spermatogenesis more than other malignancies. Here we compare SA parameters of various malignancies and perform a subgroup analysis of testicular cancer patients by histology (seminoma vs nonseminoma), stage, and whether the sperm sample was obtained before or after orchiectomy. METHODS: Newly diagnosed male cancer patients aged 18-55 who attempted to store sperm at our institution between 2002 and 2010 were identified using electronic medical records. We excluded men unable to produce an ejaculate and those who had previously received systemic chemotherapy or radiotherapy. Demographic, cancer, and SA data was collected for all men. Dependent variables included semen volume, sperm concentration, motility, morphology (strict criteria), and total motile count (TMC). SPSS version 19.0 was used for ANOVA and two-tailed Students T-tests. RESULTS: Amongst the 270 men included in our study, 50% (135/270) had at least 1 semen parameter below the WHO V minimum range, and this rate was also found for the subset of men with testicular cancer. Patient age at banking had no relationship with semen parameters across all cancers. Men with testicular cancer had significantly (p 0.05) lower sperm concentration and TMC than men with blood, CNS, prostate, or sarcoma malignancies, as well as non-testicular malignancies as a group (Table 1). Within the subset of 75 testicular cancer patients, semen parameters were not significantly affected by histologic type, stage, or whether the sample was collected before or after orchiectomy (Table 1). Testicular cancer patients required more visits to complete sufficient sperm storage compared to other patients (1.9 vs 1.6, p 0.05). CONCLUSIONS: Prior to cancer therapy, 50% of the 270 men in our study had at least 1 abnormal semen parameter. We did not find testicular cancer subtype, stage, or orchiectomy status to have an effect on semen parameters. Interestingly, men with testicular cancer had significantly lower sperm concentration and TMC than men with other cancers. Further studies will be needed to clarify if this is due to underlying, pre-existing deficiencies in spermatogenesis versus deficits related to immunological response to the testicular malignancy.