Susanne A. Quallich

Anejaculation and retrograde ejaculation.

Anejaculatory infertility is a challenge for the treating physician. Accurate diagnosis and choice of treatment plan must carefully proceed to maximize success rates while maintaining cost-effectiveness. In this article the authors review ejaculatory infertility evaluation and treatment.

Chronic testicular pain in adult men: an integrative literature review.

Past investigations of chronic testicular pain provide a sparse representation of the men with this condition and lack key details to aid our understanding of this important men’s health condition. As a chronic pain syndrome, more research is necessary to understand the phenomenon of chronic testicular pain and the pain experience of these men. This integrative literature review provides a summary of the current state of the science of chronic testicular pain in men, identifies the gaps in our knowledge, and provides recommendations to address this knowledge gap.

Anejaculation: An Electrifying Approach

Anejaculation within the context of a male infertility evaluation can be a distressing condition for patients. A variety of causes for anejaculation have been identified, and although the condition cannot be reversed, in many cases a minimally invasive treatment is feasible, allowing the patient to pursue his desire for children. In most cases, men suffering from anejaculation due to spinal cord injury (SCI) are excellent candidates for ejaculation induction procedures and low-level assisted reproductive techniques. In many SCI men, penile vibratory ejaculation can be performed by the patient himself and home insemination performed as a very low cost alternative. Surgical sperm retrieval and intracytoplasmic sperm injection should be first-line therapy only in non-SCI anejaculatory men.

Chronic unexplained orchialgia: a concept analysis.

AIMS To conduct an analysis of the concept of chronic unexplained orchialgia. BACKGROUND Chronic unexplained orchialgia is a concept unique to mens health; however, clarity is lacking regarding the precise meaning of the key attributes of this important concept. DESIGN Walker and Avants framework was used to guide this concept analysis. DATA SOURCES Literature sources included bibliographic databases. REVIEW METHODS Literature published in English from January 1970 to December 31, 2012 was reviewed. Thematic analysis identified critical attributes, antecedents and consequences of the concept. RESULTS Based on the analysis, a contemporary definition for chronic unexplained orchialgia is proposed, rooted in the concept of chronic pain. This definition is based on the concept analysis and the defining attributes that were identified in the literature. Chronic unexplained orchialgia is a subjective negative experience of adult men, perceived as intermittent or continuous pain of variable intensity, present at least three months, localizing to the testis(es) in the absence of objective organic findings and that interferes with quality of life. CONCLUSION This analysis provides a precise definition for chronic unexplained orchialgia and distinguishes it from other similar terms. This concept analysis provides conceptual clarity that can guide understanding and development of a conceptual framework, middle range theory, or situation-specific theory. Further exploration of this concept is recommended to uncover the influence of social, sexual and cultural factors.

Review of Advanced Nursing Practice in Denmark with an Exemplar

Michigan Medicine Department of Urology, University of Michigan, Ann Arbor, Michigan Urological Department, Herlev Hospital, Herlev, Denmark University of Copenhagen, Copenhagen, Denmark Correspondence SA Quallich, Department of Urology, University of Michigan Health System, 3875 Taubman Center, 1500 E. Medical Center Drive, SPC 5330, Ann Arbor, MI 48109-5330. Email: quallich@umich.edu Advances in independent nursing practice can expand the professional identity of nurses. Although there is no formal recognition for an advance practice nursing role in Denmark, there are clear examples of nursing expanding its scope to meet the meet of individual patients and larger community needs. Many Danish nurses work with expanded competencies in surgical settings, medical settings, psychiatric environments, and are instrumental in promoting continuity of care for patients who have chronic conditions. Expansion of the nursing role is an example of health care evolving to meet societal and patient needs, even within a controlled research environment, and will promote job satisfaction and retention among its most experienced nurses. This paper offers a review of expanded nursing roles in Denmark and offers further evidence of expanded autonomy for nurses in a clinical research environment.

Medication Minute: Clostridium Histolyticum (Xiaflex®) for the Treatment Of Peyronie’s Disease

&NA; Quallich, S.A. (2017). Clostridium histolyticum (Xiaflex®) for the treatment of Peyronies disease.

PD05-02 FEASIBILITY TESTING OF A MALE CHRONIC GENITAL PAIN CLINIC TO IDENTIFY MEN WITH CHRONIC UNEXPLAINED ORCHIALGIA

INTRODUCTION AND OBJECTIVES: Chronic pain is an important public health issue across the world. Men with chronic unexplained orchialgia (CUO) are an understudied population, for whom there are significant knowledge gaps related to prevalence, demographics, etiology, and reliable treatment. This research begins to address these knowledge gaps. METHODS: This was a one-year feasibility study consisting of a convenience sample of men with chronic genital pain (non-pelvic pain) seen in an adult urology specialty clinic focused on men with CUO, and staffed by a nurse practitioner. RESULTS: A total of 228 men were evaluated in this half-day clinic (Figure 1): 107 were new referrals; 15 were scheduled for a second opinion; and 106 were previously evaluated for pain issues. In 125 men a diagnosis other than pain or pain at non-scrotal/testicular sites was identified, meaning that in 84% of men referred for “unexplained” orchialgia an actual cause was established. The algorithm for evaluation is shown in Figure 2. This is the first project to report the range of diagnoses associated with CUO in a given timeframe. After identifying etiologies, 20 men had true unexplained pain. This busy academic department sees over 38,000 visits a year, suggesting a prevalence for true CUO at < 1%. CONCLUSIONS: Far fewer men than anticipated had truly unexplained chronic orchialgia. Offering a dedicated clinic for men with chronic genital pain provided rapid access to specialized expertise and accelerated diagnosis of etiologies for chronic genital pain. Conservative symptom management was the first course of treatment pursued during the timeframeof data collection. This specializedclinic decreases costs to the healthcare system, utilizing a staged screening strategy that maximized the value of tests and treatments offered, and by scheduling men with a specialized, but non-surgical, clinician. Future researchwill include ongoing data collection to achieve a larger sample size. Source of Funding: none

Men’s Urology: Vasectomy, Orchialgia, Testosterone Deficiency, Male Fertility, Peyronie’s Disease and Penile Inflammation

Objectives 1. Present an overview of men’s health within the context of urology. 2. Explain the process for vasectomy. 3. Describe the state of the science for chronic unexplained orchialgia. 4. Establish criteria for screening men for low testosterone and determining who requires further evaluation. 5. Compare treatment strategies for testosterone deficiency-based patient need. 6. Examine male infertility as an area of health disparity. 7. Review current techniques used to evaluate male infertility and describe methods for preserving male fertility. 8. Discuss Peyronie’s disease and its treatment. 9. Review diagnosis and management of inflammatory conditions of the penis.

Neoplasms of the Penile and Testis

Both penile and testicular cancers have a low incidence in the United States, but both diagnoses are psychologically challenging for the patient and his family. Several risk factors for both are well-established, as are medical and surgical treatment protocols. Social and cultural factors can have a significant impact when men may seek care, and contribute to identification and treatment delays.

Competencies for the Nurse Practitioner Working with Adult Urology Patients.

The role of the nurse practitioner (NP) has expanded into specialty domains. This document proposes 24 competencies specific to the urology NP, which are also consistent with the recommendations of National Organization of Nurse Practitioner Faculties (NONPF) and compliment the American Urologic Association (AUA) 2014 white paper on the incorporation of advanced practice providers in urology practices. It describes three levels of practice and experience progression for the urology NP working with adult patients, independent of specific clinical setting. These urology-specific competencies supplement and complement the core competencies and population-focused competencies of generalist nurse practitioners.