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Rabinowitz MJ, Li O, Pil EH, Eaton CK, Kohn TP, Haney NM, Herati AS. Antidepressant nonadherence and sexual dysfunction among young adult males: the cross-sectional YAMAN study. World J Urol 2024; 42:295. [PMID: 38709300 DOI: 10.1007/s00345-024-05003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
PURPOSE Selective serotonin reuptake inhibitors are associated with high rates of nonadherence and sexual dysfunction, yet the correlation between these findings in young adult men is poorly characterized. We aimed to evaluate if young adult men are less willing to adhere to antidepressant treatment due to intolerable side effects, such as sexual dysfunction. METHODS Deidentified, compensated survey that assessed baseline demographics, PHQ-8 and GAD-7 scores, attitudes towards antidepressant medication side effects, and perceptions of antidepressant medications including selective serotonin reuptake inhibitors, bupropion, and mirtazapine. RESULTS From 665 delivered surveys, 505 respondents completed their survey (response rate: 76%), of which 486 were included for final analysis. After seeing common side effect profiles, our sample's willingness to take sexual function-sparing agents, such as bupropion or mirtazapine, was significantly greater than selective serotonin reuptake inhibitors (p < 0.001), with no significant difference between bupropion and mirtazapine (p = 0.263). The negative influence of erectile dysfunction and anorgasmia scored significantly higher than other common antidepressant side effects like weight gain, nausea, and dry mouth (range: p < 0.001, p = 0.043). With the exception of insomnia, participants indicated that experiencing sexual dysfunction while taking an antidepressant medication would lead to nonadherence at a significantly higher frequency than any other side effect assessed (range: p < 0.001, p = 0.005). CONCLUSION The risk of experiencing sexual side effects when taking antidepressants could lead young adult men to become nonadherent to these medications. Strategies to augment the effectiveness of antidepressants, such as shared decision-making and the use of sexual function-sparing agents, are critical.
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Affiliation(s)
- Matthew J Rabinowitz
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Oscar Li
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen H Pil
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cyd K Eaton
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nora M Haney
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amin S Herati
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Kohn TP, DuComb W, Sury K, Choi U, Bivalacqua TJ. Reply by Authors. Urol Pract 2024; 11:516. [PMID: 38564802 DOI: 10.1097/upj.0000000000000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Indexed: 04/04/2024]
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Kohn TP, DuComb W, Sury K, Choi U, Bivalacqua TJ. Clinical Practice Patterns for Surgical Shunts and Penile Prosthesis Placement in Men With Priapism: A Retrospective Large Claims Database Analysis. Urol Pract 2024; 11:507-513. [PMID: 38526420 DOI: 10.1097/upj.0000000000000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION The objective of this study was to assess the rates of surgical shunting and prosthesis placement for acute ischemic priapism using a large multi-institutional claims database. METHODS A US claims database network (TriNetX Diamond Network) was queried from 2010 to 2020. We constructed a cohort of men ages ≥ 16 years who (1) had a diagnosis of priapism and (2) underwent an irrigation of the corpora cavernosa for priapism. We assessed the number of men who then had a surgical penile shunt or penile prosthesis placement. Demographics, time to surgical procedure, and order of procedures were collected. RESULTS A total of 6392 men were identified with the diagnosis of priapism and the procedure of corpora cavernosal irrigation. Of these men, 693 (11%) proceeded to surgical shunt. One hundred forty-four men (2%) underwent initial penile prosthesis placement. Of the men undergoing initial penile prosthesis, only 17 of 144 (12%) cases occurred within the first month of corpora cavernosal irrigation. Finally, when assessing choice of initial shunts vs initial penile prosthesis before and after 2015, overall rates of initial shunt (10.0% vs 8.5%, P < .0001) and initial prosthesis (3.1% vs 2.1%, P < .0001) were lower after 2015 when compared with rates prior to 2015. CONCLUSIONS In this US claims-based analysis of men presenting with ischemic priapism and treated with initial irrigation, a small percentage (11%) of men went on to receive surgical shunting, and only 2% received an initial prosthesis. Men receiving initial prostheses were more likely to have more comorbidities, and overall surgical management of priapism has decreased over time.
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Affiliation(s)
- Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William DuComb
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kiran Sury
- Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Una Choi
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trinity J Bivalacqua
- Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Agrawal P, Singh SM, Hsueh J, Grutman A, An C, Able C, Choi U, Kohn J, Clifton M, Kohn TP. Testosterone therapy in females is not associated with increased cardiovascular or breast cancer risk: a claims database analysis. J Sex Med 2024; 21:414-419. [PMID: 38459625 DOI: 10.1093/jsxmed/qdae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/22/2024] [Accepted: 02/04/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Testosterone therapy (TTh) has been shown to improve libido in women with sexual dysfunction, but its utilization has been limited due to concern for cardiovascular events and past studies reporting highly variable results. AIM To assess the association of TTh in women with major adverse cardiac events (MACEs), including heart attack, stroke, or death, using a large database. METHODS The TriNetX Diamond Network was queried from 2009 to 2022. Our study cohort included adult females with ≥3 systemic testosterone prescriptions within a year. Our control cohort excluded females with any testosterone prescriptions, polycystic ovary syndrome, or androgen excess. Both cohorts excluded females with prior heart failure, unstable angina, intersex surgery (female to male), personal history of sex reassignment, or gender identity disorders. Propensity matching between the cohorts was performed. A subanalysis by age was conducted (18-55 and >55 years). OUTCOMES We evaluated the association of TTh to the following: MACE, upper or lower emboli or deep vein thrombosis (DVT), pulmonary embolism (PE), breast neoplasm, and hirsutism within 3 years of TTh. RESULTS When compared with propensity-matched controls, adult females with TTh had a lower risk of MACE (risk ratio [RR], 0.64; 95% CI, 0.51-0.81), DVT (RR, 0.61; 95% CI, 0.42-0.90), PE (RR, 0.48; 95% CI, 0.28-0.82), and malignant breast neoplasm (RR, 0.48; 95% CI, 0.37-0.62). Similarly, females aged 18 to 55 years with TTh had a lower risk of MACE (RR, 0.49; 95% CI, 0.28-0.85) and DVT (RR, 0.48; 95% CI, 0.25-0.93) and a similar risk of malignant breast neoplasm (RR, 0.62; 95% CI, 0.34-1.12). Females aged ≥56 years with TTh had a similar risk of MACE (RR, 0.84; 95% CI, 0.64-1.10), DVT (RR, 0.82; 95% CI, 0.50-1.36), and PE (RR, 0.52; 95% CI, 0.26-1.05) and a significantly lower risk of malignant breast neoplasm (RR, 0.51; 95% CI, 0.38-0.68). Risk of hirsutism was consistently higher in those with TTh as compared with propensity-matched controls. CLINICAL IMPLICATIONS Our results contribute to safety data on TTh, a therapy for sexual dysfunction in women. STRENGTHS AND LIMITATIONS The TriNetX Diamond Network allows for significant generalizability but has insufficient information for some factors. CONCLUSIONS We found a decreased risk of MACE among women with TTh as compared with matched controls and a similar risk of MACE in postmenopausal women while demonstrating a similar or significantly lower risk of breast cancer on age-based subanalysis.
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Affiliation(s)
- Pranjal Agrawal
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Sajya M Singh
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Jessica Hsueh
- School of Medicine, Georgetown University, Washington, DC 20007, United States
| | - Aurora Grutman
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Clemens An
- Larner College of Medicine at the University of Vermont, Burlington, VT 05405, United States
| | - Corey Able
- University of Texas Medical Branch at Galveston, Galveston, TX 77555, United States
| | - Una Choi
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Jaden Kohn
- Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD 21287, United States
| | - Marisa Clifton
- The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD 21287, United States
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD 21287, United States
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Maremanda AP, Du Comb W, Able C, Kohn TP, Unal S, Burnett AL. Erectile dysfunction and Peyronie's disease diagnosis rates after penile fracture-a retrospective claims database cohort analysis. Int J Impot Res 2024; 36:125-128. [PMID: 37542153 DOI: 10.1038/s41443-023-00746-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
Our objective was to analyze the rates of erectile dysfunction and Peyronie's disease following a penile fracture using a large, multi-institutional claims database. Inclusion criteria included men ages 15 or older with a diagnosis of penile fracture and any office visit within 5 years of the penile fracture. Exclusion criteria included prior erectile dysfunction, prescription of erectile aids, or penile prosthesis placement. Our primary outcome was the diagnosis of erectile dysfunction or prescription of phosphodiesterase-5 inhibitors within 5 years. A secondary analysis assessed rates of Peyronie's disease following penile fracture. 1242 men were identified with penile fracture and subsequently matched to men without penile fracture, resulting in equal cohorts of 1227 men. Men with a history of penile fracture were more likely to receive a diagnosis of erectile dysfunction or require phosphodiesterase-5 inhibitors (RR 3.18, 95% CI: 2.30-4.40). Men who did not undergo immediate repair had higher rates of erectile dysfunction or treatment (RR: 1.84, 95% CI: 1.22-2.78). Men over the age of 45 years who had a penile fracture were more likely to develop erectile dysfunction or treatment compared to men under 45 years (RR: 1.65, 95% CI: 1.14-2.39). Rates of Peyronie's disease were higher in men with a history of penile fracture (5.8% vs 0%, p < 0.0001). Rates of Peyronie's disease were lower if immediate repair of the fracture was performed (RR: 0.20, 95% CI: 0.10-0.41). Men over the age of 45 years with penile fracture were more likely to develop Peyronie's Disease within 5 years compared to men under the age of 45 years penile fracture (RR: 3.72, 95% CI: 1.94-7.16). Penile fracture increases the risk of both erectile dysfunction and Peyronie's disease, especially those treated with conservative measures or over the age of 45 years compared to patients under 45 years with a penile fracture.
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Affiliation(s)
| | - William Du Comb
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corey Able
- University of Texas Medical Branch, Galveston, TX, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Selman Unal
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Agrawal P, Singh SM, Able C, Kohn TP, Herati AS. Sleep disorders are associated with testosterone deficiency and erectile dysfunction-a U.S. claims database analysis. Int J Impot Res 2024; 36:78-82. [PMID: 36473958 DOI: 10.1038/s41443-022-00649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
The relationship between male genitourinary conditions and sleep disorders has previously only been reported in single-institution studies with small cohorts. Our objective was to assess the association of erectile dysfunction (ED) and testosterone deficiency with various sleep disorders using a large claims database. The TriNetX Diamond database was queried in June 2022. In men aged 40-70 years, insomnia, sleep apnea, and circadian rhythm sleep disorder were each independently assessed to determine the association with ED and testosterone deficiency and then followed by propensity score matching performed for age, hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, tobacco usage, and obesity. Testosterone deficiency was more likely to be found in men diagnosed with sleep apnea (odds ratio (OR) 1.66 [95% confidence interval (CI) 1.65-1.67]), insomnia (OR 1.74 [95% CI 1.73-1.76]), and circadian rhythm dysfunction (OR 2.63 [95% CI 2.54-2.73]) compared to matched controls. ED was more likely to be found in men diagnosed with sleep apnea (OR 1.02 [95% CI 1.01-1.03]), insomnia (OR 1.30 [95% CI 1.30-1.31]), and circadian rhythm dysfunction (OR 1.54 [95% CI 1.49-1.59]) compared to matched controls. Our results emphasize the negative impact of poor sleep on diseases of the male genitourinary system by identifying these relationships in the largest cohort in the U.S. reported to date.
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Affiliation(s)
- Pranjal Agrawal
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sajya M Singh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corey Able
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA.
| | - Amin S Herati
- The James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA
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Kohn TP, Agrawal P, Ory J, Hare JM, Ramasamy R. Reply by Authors. J Urol 2024; 211:292-293. [PMID: 38193410 DOI: 10.1097/ju.0000000000003786.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 11/02/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pranjal Agrawal
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jesse Ory
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joshua M Hare
- The Interdisciplinary Stem Cell Institute and Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Ranjith Ramasamy
- Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, Miami, Florida
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Kohn TP, Agrawal P, Ory J, Hare JM, Ramasamy R. Rises in Hematocrit Are Associated With an Increased Risk of Major Adverse Cardiovascular Events in Men Starting Testosterone Therapy: A Retrospective Cohort Claims Database Analysis. J Urol 2024; 211:285-293. [PMID: 37948758 DOI: 10.1097/ju.0000000000003786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Elevated hematocrit (Hct) can result in increased risk of major adverse cardiovascular events (MACE) in men receiving testosterone therapy (TTh). However, the impact of the magnitude of the change in Hct from baseline after starting TTh has never been assessed. MATERIALS AND METHODS To assess whether an increase in Hct after initiating TTh is associated with an increased risk of MACE within 3 and 24 months of initiating TTh, we queried the TriNetX Research network database for men over the age of 18 with Hct values obtained within 6 months before starting TTh, and who had follow-up Hct measurements within 3 and 24 months after beginning TTh from 2010 to 2021. Men with and without a subsequent increase in Hct after initiating TTh were propensity matched. MACE was defined as myocardial infarction, stroke, or death. RESULTS After matching, 10,511 men who experienced an any increase in Hct after initiating TTh and an equal number of controls who did have an increase in Hct were included. Compared to controls who did not have an increase in Hct after starting TTh, the men who had an increase in subsequent Hct had a significantly increased risk of MACE compared to men with no change in Hct. CONCLUSIONS We demonstrate that increases in Hct from baseline are associated with increased risk of MACE, compared to men whose Hct remains stable while receiving TTh.
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Affiliation(s)
- Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pranjal Agrawal
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jesse Ory
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joshua M Hare
- The Interdisciplinary Stem Cell Institute and Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Ranjith Ramasamy
- Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, Miami, Florida
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Able C, Stewart C, Gabrielson AT, Overholt T, Banner S, Gilliam K, Srinivasan A, Haney N, Kohn TP, Crigger CB, Gerber J. National Postoperative Opioid Prescribing Rates Following Pediatric Urology Procedures Before and After the 2018 American Academy of Pediatrics Challenge to Reduce Opioid Prescribing: A Claims Database Analysis. Urology 2024; 184:217-223. [PMID: 38043907 DOI: 10.1016/j.urology.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To evaluate trends in opioid prescribing rates following pediatric urologic surgery. METHODS We queried the TriNetX Research database for patients under age 18 who underwent one of seven common pediatric urology procedures. We identified the proportion of patients that received an oral opioid prescription within 5days of surgery. The primary analysis evaluated the trend in postoperative opioid prescriptions using 3-month intervals from January 2010 to December 2022. We performed an interrupted time series analysis assessing trends in opioid prescribing patterns both before and after the American Academy of Pediatrics challenge. RESULTS Of the 81,644 pediatric urology procedures, 29,595 (36.2%) received a postoperative opioid prescription, including 29.8% of circumcisions, 25.8% of hydrocelectomies, 39.6% of hypospadias repairs, 42.7% of pyeloplasties, 42.8% of ureteral reimplants. For all procedures we observed rising rates of opioid prescribing, increasing by 0.9% per 3-month interval prior to the challenge statement release from 2010 to 2018. We observed an overall significant decrease in opioid prescribing by 2.2% per 3-month interval following the challenge statement release. Additionally, since 2018, there was a significant decrease in opioid prescribing in all of the race, ethnicity, and age cohorts. CONCLUSION Opioid prescribing following pediatric urology procedures has sharply decreased following the 2018 American Academy of Pediatrics challenge statement which underscores the value of cross-specialty quality improvement initiatives. Nonetheless, opioid prescribing remains high with potential racial or age disparities that warrant further investigation.
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Affiliation(s)
- Corey Able
- University of Texas Medical Branch School of Medicine, Department of Surgery, Division of Urology, Galveston, TX
| | - Courtney Stewart
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Andrew T Gabrielson
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tyler Overholt
- Atrium Health Wake Forest Baptist, Department of Urology, Winston-Salem, NC
| | - Steven Banner
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Kelli Gilliam
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Aditya Srinivasan
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Nora Haney
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Chad B Crigger
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan Gerber
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
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Able C, Kohn JR, Kohn TP. Medication-associated priapism events: validation of findings from the FDA pharmacovigilance database using insurance claim database. Int J Impot Res 2024; 36:97-99. [PMID: 35347301 DOI: 10.1038/s41443-022-00562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Corey Able
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX, USA
| | - Jaden R Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Ostdiek-Wille GP, Bavitz KC, Kohn TP, Deibert CM. Attention-deficit hyperactivity disorder medication use is associated with testosterone hypofunction-results from a national claims database analysis. Int J Impot Res 2023:10.1038/s41443-023-00805-2. [PMID: 38129694 DOI: 10.1038/s41443-023-00805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/13/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
Male hypogonadism is not a risk associated with attention-deficit hyperactivity disorder (ADHD) stimulant medications, but recent studies have explored this connection. Though the pathophysiologic connection remains unclear, we predicted that long-term use of ADHD stimulant medications could increase the risk of hypogonadism in post-pubertal males. Utilizing TriNetX, LLC Research Network data from January 2000 through December 2019, men older than 18 with ADHD receiving long-term stimulant medication (>36 monthly prescriptions) were selected for the study population. Two control groups were constructed: individuals with ADHD but no stimulant medication use, and individuals without ADHD or stimulant medication use. A diagnosis of testicular hypofunction (ICD-10: E29.1) within five years of long-term ADHD stimulant medication use was the chosen primary outcome. After propensity score matching, 17,224 men were analyzed in each group. Of the men with long-term ADHD stimulant medication use, 1.20% were subsequently diagnosed with testicular hypofunction compared to 0.67% of individuals with ADHD without stimulant medication use (RR: 1.78, 95% CI: 1.42-2.23) and 0.68% in men without ADHD or stimulant medication use (RR: 1.75, 95% CI: 1.39-2.19). Therefore, chronic ADHD stimulant medication use was found to be significantly associated with a subsequent diagnosis of testicular hypofunction.
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Affiliation(s)
| | - Kyle C Bavitz
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Grutman AJ, Stewart C, Able C, Agrawal P, Galansky L, Gabrielson A, Haney N, Kohn TP, Crigger CB. Postoperative Opioid Prescribing in Adolescents and Young Adults After Urologic Procedures Is Associated With New Persistent Opioid Use Disorder: A Large Claims Database Analysis. Urology 2023; 182:211-217. [PMID: 37696308 DOI: 10.1016/j.urology.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To assess the risk of persistent opioid use following various urologic procedures in adolescents and young adults. MATERIALS AND METHODS The TriNetX LLC Diamond Network was queried for patients aged 13-21years who underwent pyeloplasty, hypospadias repair, inguinal hernia repair, inguinal orchiopexy, hydrocelectomy, or circumcision. Cohorts of patients prescribed and not prescribed postoperative opioids were created and propensity-matched for age, race/ethnicity, psychiatric diagnoses, and preoperative pain diagnoses. The primary outcome was new persistent opioid use, defined as new opioid use 3-9months after index procedure without another surgery requiring anesthesia during the postoperative timeframe. RESULTS Of 32,789 patients identified, 66.0% received a postoperative opioid prescription. After propensity score matching for each procedure, 18,416 patients were included: 197 for pyeloplasty, 469 for hypospadias repair, 1818 for inguinal hernia repair, 2664 for inguinal orchiopexy, 534 for hydrocelectomy, and 3526 for circumcision. Overall, 0.41% of patients who did not receive postoperative opioids developed new persistent opioid use, whereas 1.69% of patients who received postoperative opioids developed new persistent opioid use (P < .05). Patients prescribed postoperative opioids had statistically higher odds of developing new persistent opioid use for hypospadias repair (RR: 17.0; 95% CI: 2.27-127.2), inguinal orchiopexy (RR: 3.46; 95% CI: 1.87-6.4), inguinal hernia repair (RR: 2.18; 95% CI: 1.07-4.44), and circumcision (RR: 4.83; 95% CI: 2.60-8.98). CONCLUSION The use of postoperative opioids after urological procedures in adolescents and young adults is associated with a significant risk of developing new persistent opioid use.
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Affiliation(s)
| | - Courtney Stewart
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Corey Able
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | | | - Logan Galansky
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Gabrielson
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nora Haney
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chad B Crigger
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Choi UE, Able C, Grutman AJ, Maremanda AP, Nicholson RC, Gabrielson A, Kohn TP. Post-infection erectile dysfunction risk - comparing COVID-19 with other common acute viral infections: a large national claims database analysis. Int J Impot Res 2023:10.1038/s41443-023-00794-2. [PMID: 37978203 DOI: 10.1038/s41443-023-00794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
It is unknown if the risk of erectile dysfunction (ED) following Coronavirus-19 (COVID-19) infection is virus-specific. Our study assessed the risk of ED in COVID-19 patients as compared to patients with other common viral infections. The TriNetX COVID-19 Research Network was queried. We examined cohorts of men aged ≥18 years infected with: COVID-19, influenza, respiratory syncytial virus, enterovirus, acute viral hepatitis, mononucleosis, and herpes zoster. Men were included if they had at least one outpatient follow-up visit within 18 months and excluded if they had one of the other viruses of interest or a prior ED diagnosis or treatment, prostatectomy, pelvis radiation, or chronic hepatitis infection. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). COVID-19 positive men were less likely to develop ED or have a PDE5i prescription than men with infected with herpes zoster [Relative Risk (RR): 0.37, 95% Confidence Interval (CI) 0.27-0.49] and more likely to develop ED or have a PDE5i prescription than men with no acute viral illness (RR: 1.33, 95% CI 1.25-1.42). In this national propensity-matched cohort study comparing post-infection ED risk and PDE5i prescriptions, we found that COVID-19 was no more likely to result in a diagnosis of ED or prescription of PDE5i when compared to all acute viral illnesses except herpes zoster, which was more likely to result in a diagnosis of ED or prescription of PDE5i when compared to COVID-19. These findings suggest an inflammatory etiology (perhaps due to cytokine release, endothelial dysfunction, or blunted hormone signaling) behind any acute infection can result in a heightened ED risk; however, further studies are required to investigate the connection between other viral infections and ED.
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Affiliation(s)
- Una E Choi
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corey Able
- Department of Urology, Division of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Aurora J Grutman
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ankith P Maremanda
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan C Nicholson
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Gabrielson
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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14
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Choi UE, Nicholson RC, Agrawal P, Watts E, Kohn TP, Kohn JR, Clifton M. Involvement of vulva in lichen sclerosus increases the risk of antidepressant and benzodiazepine prescriptions for psychiatric disorder diagnoses. Int J Impot Res 2023:10.1038/s41443-023-00793-3. [PMID: 37973860 DOI: 10.1038/s41443-023-00793-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
While vulvar lichen sclerosus (VLS) causes intense pruritus, associated risks of mood disorders and prescription patterns and impact of concurrent sexual dysfunction are unknown. We queried TriNetX Diamond Network between 2009 and 2022, conducting three comparisons after propensity-score matching for demographics and relevant comorbidities: (1) women with lichen sclerosus (LS) sparing the vulva vs. women with VLS; (2) VLS patients who received treatment within 6 months of diagnosis vs. patients who did not and (3) VLS patients with vs. without sexual dysfunction. Outcomes included new depressive episodes, anxiety disorder, major depressive disorder (MDD), and prescriptions of antidepressants or benzodiazepines. After matching, VLS was associated with increased depressive episode [risk ratio (RR) 1.39], anxiety disorder (RR 1.93), and MDD (RR 2.00) diagnoses compared to LS sparing the vulva. Next, VLS treatment was associated with decreased risk of depressive episode (RR 0.60) and anxiety disorder (RR 0.72). Finally, concurrent sexual dysfunction was associated with increased benzodiazepine (RR 3.50), vaginal estrogen (RR 6.20), antipruritic agents (RR 3.90), and topical anti-inflammatory (RR 2.61) prescriptions. In conclusion, vulvar involvement is associated with increased risk of antidepressant and benzodiazepine prescriptions, and diagnosis of depressive episode, anxiety disorder, or MDD.
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Affiliation(s)
- Una E Choi
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Pranjal Agrawal
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emelia Watts
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA.
| | - Jaden R Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marisa Clifton
- The James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA
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15
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Able C, Agrawal P, Kohn TP. Commentary on: "Oxycodone prescription after inflatable penile prosthesis has risks of persistent use: a TriNetX Analysis". Int J Impot Res 2023:10.1038/s41443-023-00778-2. [PMID: 37816869 DOI: 10.1038/s41443-023-00778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023]
Affiliation(s)
- Corey Able
- Division of Urology, Department of Surgery, University of Texas Medical Branch School of Medicine, Galveston, TX, USA.
| | - Pranjal Agrawal
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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16
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Haney NM, Li O, Agrawal P, Kohn TP, Crigger C, Sholklapper T, DiCarlo H, Gearhart JP. Prevalence of opioid and benzodiazepine use in adult patients with the exstrophy-epispadias complex. J Pediatr Urol 2023; 19:562.e1-562.e8. [PMID: 37120367 DOI: 10.1016/j.jpurol.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/21/2023] [Accepted: 03/27/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Bladder exstrophy (BE), cloacal exstrophy (CE), and epispadias (E) are variants of the exstrophy-epispadias complex (EEC). These children require opioids and benzodiazepines to achieve pain management and immobilization for a lifetime of surgeries. It is hypothesized that these children would be sensitized to opiates and benzodiazepines as adults. The objective was to identify incidence of opiate and benzodiazepine use in adult EEC patients. METHODS A US Health network, TriNetX Diamond was queried from 2009 to 2022. Incidence of prescriptions for benzodiazepines and opioids were calculated for adults aged 18-60 years with a diagnosis of BE, CE, or E. RESULTS A total of 2627 patients were identified: 337 with CE, 1854 patients with BE, and 436 with E. Of these, 55.5% of CE, 56.4% of BE, and 41.1% of E had received any opioid prescription. Non-EEC controls had lower rates of opioids at 0.3%. E had a lower likelihood than BE or CE of receiving opioids (p < 0.0001, p < 0.0001). Benzodiazepines were prescribed in 30.3% of CE, 24.4% of BE, 18.3% of E, and 0.1% of controls. CE had a higher likelihood of benzodiazepines than both BE and E (p = 0.022, p < 0.001, respectively). E group had the lowest likelihood of benzodiazepine prescription (p = 0.007 when compared to BE) and all groups were significantly higher than controls (p < 0.0001 for all comparisons). For BE, females were more likely to be prescribed opioids (p = 0.039) and benzodiazepines (p = 0.027) than males. Sub-analyses revealed BE females had higher rates of surgical procedures (general, cardiac, gastrointestinal, and maternity) and chronic diagnoses (generalized anxiety disorder, major depressive disorder, chronic pain) compared to males with BE. Older age was associated with higher likelihood of opioid or benzodiazepine prescriptions in BE (p < 0.001), CE (p = 0.004), and E (p = 0.002). DISCUSSION Across the EEC, adult patients with the most severe anomalies of CE were more likely to have received opioids and benzodiazepines. Females with BE were prescribed more opioid and benzodiazepines than males with BE. Mirroring the US population, female sex and increasing age were associated with higher rates of prescriptions, chronic diagnoses, and surgical procedures. Limitations include the lack of granular data and ability to correlate results with childhood surgeries. CONCLUSION Adult EEC patients have higher rates of opioid and benzodiazepine prescriptions, with a high percentage of co-prescribing when compared to healthy controls. Across the spectrum, those with more severe anomalies, female sex, and increasing age were more likely to have received prescriptions.
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Affiliation(s)
- Nora M Haney
- Jeffs Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Oscar Li
- Jeffs Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pranjal Agrawal
- Jeffs Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- Jeffs Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chad Crigger
- Jeffs Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tamir Sholklapper
- Jeffs Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heather DiCarlo
- Jeffs Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Gearhart
- Jeffs Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Able C, Kohn TP, Gabrielson AT. How Requiring Programs to Lock Residency Rank Lists Prior to Applicant Rank List Submission Could Provide a Hybrid Option Combining the Best of Virtual and In-person Interviews. J Urol 2023; 210:403-405. [PMID: 37232791 DOI: 10.1097/ju.0000000000003562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Corey Able
- Division of Urology, The University of Texas Medical Branch, Galveston, Galveston, Texas
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew T Gabrielson
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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18
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Agrawal P, Singh SM, Able C, Dumas K, Kohn J, Kohn TP, Clifton M. Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer. Obstet Gynecol 2023; 142:660-668. [PMID: 37535961 DOI: 10.1097/aog.0000000000005294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/25/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To assess the risk of recurrence of breast cancer associated with vaginal estrogen therapy in women diagnosed with genitourinary syndrome of menopause with a history of breast cancer using a large U.S. claims database. METHODS A U.S. health research network (TriNetX Diamond Network) was queried from January 2009 to June 2022. Our cohort consisted of women diagnosed with breast cancer within 5 years before the initial genitourinary syndrome of menopause diagnosis. Patients with active disease , defined as those undergoing mastectomy, radiation treatment, or chemotherapy within 3 months before diagnosis of genitourinary syndrome of menopause, were excluded. Recurrence was defined as mastectomy, radiation, chemotherapy, or secondary malignancy within 3 months to 5 years after the initiation of vaginal estrogen therapy for genitourinary syndrome of menopause. The study cohort included those with three or more vaginal estrogen prescriptions. The control cohort included women with breast cancer without any vaginal estrogen prescriptions after genitourinary syndrome of menopause diagnosis. Propensity matching was performed. A subanalysis by positive estrogen receptor status, when available, was performed. RESULTS We identified 42,113 women with a diagnosis of genitourinary syndrome of menopause after breast cancer diagnosis with any estrogen receptor status, 5.0% of whom received vaginal estrogen. Of the initial cohort, 10,584 patients had a history of positive estrogen receptor breast cancer, and 3.9% of this group received vaginal estrogen. Risk of breast cancer recurrence was comparable between those who received vaginal estrogen and those who did not in both the any estrogen receptor (risk ratio 1.03, 95% CI 0.91-1.18) and positive estrogen receptor (risk ratio 0.94, 95% CI 0.77-1.15) status analyses. CONCLUSION In a large, claims-based analysis, we did not find an increased risk of breast cancer recurrence within 5 years in women with a personal history of breast cancer who were using vaginal estrogen for genitourinary syndrome of menopause.
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Affiliation(s)
- Pranjal Agrawal
- Johns Hopkins University School of Medicine, the Johns Hopkins Department of Gynecology and Obstetrics, and the James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, Maryland; and the University of Texas Medical Branch, Galveston, Texas
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Sajya M Singh
- Johns Hopkins University School of Medicine, the Johns Hopkins Department of Gynecology and Obstetrics, and the James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, Maryland; and the University of Texas Medical Branch, Galveston, Texas
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Corey Able
- Johns Hopkins University School of Medicine, the Johns Hopkins Department of Gynecology and Obstetrics, and the James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, Maryland; and the University of Texas Medical Branch, Galveston, Texas
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Kathryn Dumas
- Johns Hopkins University School of Medicine, the Johns Hopkins Department of Gynecology and Obstetrics, and the James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, Maryland; and the University of Texas Medical Branch, Galveston, Texas
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Jaden Kohn
- Johns Hopkins University School of Medicine, the Johns Hopkins Department of Gynecology and Obstetrics, and the James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, Maryland; and the University of Texas Medical Branch, Galveston, Texas
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Taylor P Kohn
- Johns Hopkins University School of Medicine, the Johns Hopkins Department of Gynecology and Obstetrics, and the James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, Maryland; and the University of Texas Medical Branch, Galveston, Texas
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Marisa Clifton
- Johns Hopkins University School of Medicine, the Johns Hopkins Department of Gynecology and Obstetrics, and the James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, Maryland; and the University of Texas Medical Branch, Galveston, Texas
- Each author has confirmed compliance with the journal's requirements for authorship
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19
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Wang S, Meilchen C, Agrawal P, Rostom M, Agrawal G, Able C, Dubin JM, Gabrielson AT, Kohn TP. Do Articles Shared by Academic Medicine Social Media Influencers Drive Future Citation Rates? Urology 2023; 178:167-172. [PMID: 37268170 DOI: 10.1016/j.urology.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the role of influential figures within social media (SoMe) in driving future citations. METHODS All original articles published in the Journal of Urology and European Urology in 2018 were identified. For each article, number of mentions on any SoMe platform, article's Twitter reach, and total citations were collected. Article characteristics such as type of study, article topic, and open access status were identified. Total academic research output was obtained for first and last authors of included articles. Influential SoMe figures were defined as users that tweeted about included articles and had over 2000 followers. For these accounts, we collected total followers, total tweets, engagement statistics, verification status, and academic characteristics such as total citations and total prior publications. The impact of SoMe, article, and academic characteristics on future citations was assessed using panel data regression analysis. RESULTS We identified 394 articles with 8895 total citations and 460 SoMe influencers. On panel data regression modeling, tweets about a specific article were associated with future citations (0.17 citations per tweet about an article, P < .001). SoMe influencer characteristics were not associated with increased citations (P > .05). The following non-SoMe-associated characteristics were predictive of future citations (P < .001): study type (prospective studies received 12.9 more citations than cross-sectional studies), open access status (4.3 citations more if open access, P < .001), and previously well-published first and last authors. CONCLUSION While SoMe posts are associated with increased visibility and higher future citation rates, SoMe influencers do not appear to drive these outcomes. Instead, high quality and accessibility were more predictive of future citability.
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Affiliation(s)
- Shirley Wang
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD
| | | | - Pranjal Agrawal
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD
| | - Mary Rostom
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD
| | - Gaurish Agrawal
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD
| | - Corey Able
- Division of Urology, University of Texas Medical Branch, Galveston, TX
| | - Justin M Dubin
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Taylor P Kohn
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD.
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20
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Venigalla G, Kohn TP, Pozzi E, Ramasamy R. Vasectomy has No Impact on Future Lower Urinary Tract Symptoms Diagnoses: A Retrospective Cohort Claims Database Analysis. JU Open Plus 2023; 1. [PMID: 37090164 PMCID: PMC10122437 DOI: 10.1097/ju9.0000000000000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Purpose The aim of this study was to assess whether there is an association between vasectomy and benign prostatic hyperplasia with associated lower urinary tract symptoms (BPH/LUTS) due to inflammatory etiology. Materials and Methods We assessed the incidence of BPH/LUTS in men who had undergone vasectomy in a matched cohort analysis using the TriNetX Research Network. We identified men aged 30 to 60 years who underwent vasectomy and had a follow-up visit within 6 months to 5 years after vasectomy from January 2010 through December 2022 and compared them with matched controls. Outcomes recorded include diagnoses of BPH (N40, N40.1), BPH-related medication prescriptions, and BPH-related procedures. We accounted for confounding variables through propensity score-matching for age; race; and history of comorbid medical conditions: hyperlipidemia (International Classification of Disease-10: E78), metabolic syndrome (E88.81), overweight or obesity (E66), testicular hypofunction (E29.1), hypertension (I10-I16), nicotine dependence (F17), and obstructive sleep apnea (G47.33). Results There was no significant difference in BPH diagnosis between postvasectomy men vs controls (0.84% vs 0.80%, RR: 0.95, 95% CI 0.86-1.05) or BPH/LUTS diagnosis (0.48% vs 0.44%, RR: 0.92, 95% CI 0.81-1.05) within 6 months to 5 years after vasectomy, respectively. No differences in BPH medication prescription (0.94% vs 0.84%) or rate of BPH procedures (0.022% vs 0.017%) were detected between the 2 groups. Conclusions This study suggests that vasectomy does not increase the risk of BPH development and/or LUTS worsening compared with the general population, providing assurance to both patients and health care providers who may consider vasectomy as a safe family planning option.
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21
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Stewart CA, Whellan A, Kohn TP. Expanding the Repertoire of Diagnostic Testing in Male Fertility. Fertil Steril 2023; 119:761. [PMID: 36948441 DOI: 10.1016/j.fertnstert.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Courtney A Stewart
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Alexis Whellan
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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22
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Able CA, Gabrielson AT, Meilchen C, Kohn JR, Kohn TP. Perioperative opioid prescribing after male fertility procedures is associated with new persistent opioid use: retrospective analysis of a large claims database. Fertil Steril 2023; 119:401-408. [PMID: 36529185 DOI: 10.1016/j.fertnstert.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the risk of new persistent opioid use in opioid-naïve men who underwent male fertility procedures. DESIGN Retrospective cohort study using a claims database. SETTING A database linking electronic medical record data and claims-assessing men who underwent fertility procedures between 2010 and 2021. PATIENT(S) Opioid-naïve men who underwent fertility procedures (open or laparoscopic varicocelectomy, spermatocele excision, and testicular excisional or incisional biopsy) without further surgical intervention requiring anesthesia in the 2 years after the index procedure. Those with and without perioperative opioid prescriptions were propensity score matched on age, race/ethnicity, smoking status, mental health diagnoses, and preoperative pain diagnoses. INTERVENTION(S) Perioperative opioid prescription. MAIN OUTCOME MEASURE(S) The primary outcome was the incidence of new persistent opioid use (opioid prescription 3-9 months after the index fertility procedure). The secondary outcome was prolonged opioid use (opioid prescription 9-24 months after the index fertility procedure). RESULT(S) A total of 387,565 men who underwent fertility procedures were identified, of whom 25.1% received an opioid prescription. After propensity score matching, 97,215 men were included; 4.7% of men who received a perioperative opioid prescription developed new persistent opioid use compared with 2.2% of those without a perioperative opioid prescription (risk ratio, 2.16; 95% confidence interval, 2.05-2.27; number needed to harm, 39). When assessing each unique fertility procedure independently, men who received perioperative opioids had statistically higher odds of developing new persistent opioid use for all procedure types. Men with new persistent opioid use were much more likely to go on and develop prolonged opioid use than men without new persistent opioid use. CONCLUSION(S) Opioid prescription after male fertility procedures is associated with a significant risk of new persistent opioid use, emphasizing the importance of judicious opioid prescribing for male fertility procedures.
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Affiliation(s)
- Corey A Able
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, Texas
| | | | - Chris Meilchen
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, Texas
| | - Jaden R Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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23
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Zhang TR, Able C, Ramasamy R, Kohn TP. United States vasectomy incidence rises following the reversal of Roe v. Wade in a national clinical and claims database. Fertil Steril 2023:S0015-0282(23)00234-0. [PMID: 36967058 DOI: 10.1016/j.fertnstert.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/04/2023] [Accepted: 03/20/2023] [Indexed: 03/28/2023]
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24
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Nugent LF, Haney NM, Kohn TP. Home sperm testing-increasing uses for direct-to-consumer tests. Fertil Steril 2023; 119:218. [PMID: 36502933 DOI: 10.1016/j.fertnstert.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Liam F Nugent
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nora M Haney
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Agrawal P, Singh SM, Kohn J, Kohn TP, Clifton M. Sleep Disorders Are Associated with Female Sexual Desire and Genital Response - A U.S. Claims Database Analysis. Urology 2023; 172:79-83. [PMID: 36455681 DOI: 10.1016/j.urology.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the association of common sleep disorders with female sexual dysfunction. MATERIALS AND METHODS We conducted a cross-sectional analysis using the TriNetX Diamond Network. Adult women diagnosed with insomnia, obstructive sleep apnea, or circadian rhythm sleep disorder were assessed to determine the association with female sexual dysfunction, hypoactive sexual desire disorder, female orgasmic disorder, and female sexual arousal disorder. A propensity-score matched control cohort for age, race, ethnicity, tobacco use, outpatient service utilization, obesity, hyperlipidemia, diabetes mellitus, hypertensive disease, ischemic heart disease, and surgical procedures on the female genital system was generated, excluding those with any sleep disorders, sleep deprivation, or morbid obesity with alveolar hypoventilation. All cohorts excluded those with any antidepressant or antipsychotic prescriptions. RESULTS Our query yielded 1,317,491 women diagnosed with sleep apnea, 1,538,567 with insomnia, and 58,902 with circadian rhythm sleep disorder. Women with sleep apnea and insomnia had higher odds of hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorder compared to matched controls. Women with sleep apnea, insomnia, or circadian rhythm sleep disorder all had a significantly higher odds of female sexual dysfunction compared to matched controls. CONCLUSION In this large cross-sectional analysis, sleep disorders were strongly associated with female sexual dysfunction. It is thus crucial for providers to screen for poor sleep when conducting a thorough evaluation for sexual dysfunction in women to diagnose highly prevalent sleep disorders and improve overall health.
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Affiliation(s)
| | - Sajya M Singh
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jaden Kohn
- The Johns Hopkins Department of Gynecology and Obstetrics, Baltimore, MD
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, MD.
| | - Marisa Clifton
- The James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, MD
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Rostom M, Ramasamy R, Kohn TP. History of testosterone therapy through the ages. Int J Impot Res 2022; 34:623-625. [PMID: 35075296 DOI: 10.1038/s41443-021-00493-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/17/2021] [Accepted: 10/28/2021] [Indexed: 11/08/2022]
Abstract
The symptoms of testosterone deficiency have been known throughout history with evidence dating back to the twenty-first century BCE when men were castrated to be docile and obedient servants. Experimentation ingesting mammalian testicles began during the reign of the Roman empire and continued through the nineteenth century with claims that the substance found within these testicles could improve energy, erectile function, and urination. In the twentieth century, studies transplanting animal testes onto other castrated animals suggested that a substance produced in the testicle was responsible for systemic effects. Then in 1929, Adolf Butendant was the first to isolate testosterone and shortly after synthetic formulations of testosterone were created. While testosterone therapy is an important treatment for testosterone deficiency, the history of testosterone therapy has not been without abuse from doping scandals in the twentieth century and the use of testosterone therapy for conversion therapy and treatment of psychiatric disease. Today, there are clear and appropriate clinical uses of testosterone set by the American Urological Association to treat clinically significant testosterone deficiency. Still, even with such guidelines, the potential for misuse and abuse remains high in physicians and athletes. There is a long history that has led to the development of testosterone therapy and when used appropriately can significantly improve the quality of life for men with testosterone deficiency.
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Affiliation(s)
- Mary Rostom
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Kohn TP, Nguyen HMT, Rajanahally S, Hellstrom W, Hsieh T, Raheem OA. Global Trends in Prevalence, Treatments, and Costs of Penile Prosthesis for Erectile Dysfunction in Men. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bedrick BS, Kohn TP, Pecker LH, Christianson MS. Fertility preservation for pediatric patients with hemoglobinopathies: Multidisciplinary counseling needed to optimize outcomes. Front Endocrinol (Lausanne) 2022; 13:985525. [PMID: 36353243 PMCID: PMC9638952 DOI: 10.3389/fendo.2022.985525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/30/2022] [Indexed: 01/19/2023] Open
Abstract
Hemoglobinopathies are autosomal recessive disorders that occur when genetic mutations negatively impact the function of hemoglobin. Common hemoglobinopathies that are clinically significant include sickle cell disease, alpha thalassemia, and beta thalassemia. Advancements in disease-modifying and curative treatments for the common hemoglobinopathies over the past thirty years have led to improvements in patient quality of life and longevity for those who are affected. However, the diseases, their treatments and cures pose infertility risks, making fertility preservation counseling and treatment an important part of the contemporary comprehensive patient care. Sickle cell disease negatively impacts both male and female infertility, primarily by testicular failure and decreased ovarian reserve, respectively. Fertility in both males and females with beta thalassemia major are negatively impacted by iron deposition due to chronic blood transfusions. Hematopoietic stem cell transplant (HSCT) is currently the only curative treatment for SCD and transfusion dependent beta thalassemia. Many of the conditioning regimens for HSCT contain chemotherapeutic agents with known gonadotoxicity and whole-body radiation. Although most clinical studies on toxicity and impact of HSCT on long-term health do not evaluate fertility, gonadal failure is common. Male fertility preservation modalities that exist prior to gonadotoxic treatment include sperm banking for pubertal males and testicular cryopreservation for pre-pubertal boys. For female patients, fertility preservation options include oocyte cryopreservation and ovarian tissue cryopreservation. Oocyte cryopreservation requires controlled ovarian hyperstimulation (COH) with ten to fourteen days of intensive monitoring and medication administration. This is feasible once the patient has undergone menarche. Follicular growth is monitored via transvaginal or transabdominal ultrasound, and hormone levels are monitored through frequent blood work. Oocytes are then harvested via a minimally invasive approach under anesthesia. Complications of COH are more common in patients with hemoglobinopathies. Ovarian hyperstimulation syndrome creates a greater risk to patients with underlying vascular, pulmonary, and renal injury, as they may be less able to tolerate fluids shifts. Thus, it is critical to monitor patients undergoing COH closely with close collaboration between the hematology team and the reproductive endocrinology team. Counseling patients and families about future fertility must take into consideration the patient's disease, treatment history, and planned treatment, acknowledging current knowledge gaps.
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Affiliation(s)
- Bronwyn S. Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Taylor P. Kohn
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lydia H. Pecker
- Department of Medicine, Division of Adult Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mindy S. Christianson
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Mindy S. Christianson,
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Gabrielson AT, Meilchen CK, Kohn JR, Kohn TP. AUTHOR REPLY. Urology 2021; 158:31-32. [PMID: 34895631 DOI: 10.1016/j.urology.2021.05.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew T Gabrielson
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jaden R Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Wang SL, Bedrick BS, Kohn TP. What is the role of varicocelectomy in infertile men with clinical varicoceles and elevated sperm DNA fragmentation? Fertil Steril 2021; 116:657-658. [PMID: 34462098 DOI: 10.1016/j.fertnstert.2021.06.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Shirley L Wang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bronwyn S Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Gabrielson AT, Meilchen CK, Kohn JR, Kohn TP. The COVID-19 Residency Application Cycle Did Not Affect Geographic Dispersal Patterns Among Applicants Entering the Urology Match: A Quantitative Mapping Study. Urology 2021; 158:26-32. [PMID: 34324912 DOI: 10.1016/j.urology.2021.05.093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether pandemic-related restrictions with video-based interviewing increased geographic clustering of urology applicants matching at a residency program near where they were raised or attended medical school. MATERIALS AND METHODS We utilized publicly available data from the urology match to compare dispersal patterns between applicants matching during the COVID-19 application cycle (2021) and those matching in the 5 prior application cycles (2016-2020). Variables included home state, undergraduate institution, medical school, and residency. Latitudes and longitudes were obtained for each institution and home state. The primary endpoint was distance (miles, as the most direct path) between medical school and residency program. We also assessed dispersal patterns by American Urological Association section. RESULTS Of the 1965 applicants matching to a urology program between 2016 and 2021, medical school was identified for 1956 (99.7%) applicants, undergraduate program for 1551 (79%) applicants, and home state for 1351 (69%) applicants. Comparing the COVID-19 application cycle to the 5 prior application cycles, there was no significant difference in the median distance between medical school and residency, undergraduate university and residency, or home state and residency. Similarly, there was no significant difference in the proportion of applicants matching at their home institution, matching from medical schools without a home urology program, matching from medical schools with a historically low volume of urology applicants (<1 matched applicant per year), or matching from a D.O. PROGRAM CONCLUSION Virtual interviewing and the loss of in-person clinical rotations did not significantly alter dispersal patterns or hamper an applicant's ability to match at program outside their geographic region.
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Affiliation(s)
- Andrew T Gabrielson
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jaden R Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
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Rabinowitz MJ, Kohn TP, Ellimoottil C, Alam R, Liu JL, Herati AS. The Impact of Telemedicine on Sexual Medicine at a Major Academic Center During the COVID-19 Pandemic. Sex Med 2021; 9:100366. [PMID: 34049265 PMCID: PMC8240353 DOI: 10.1016/j.esxm.2021.100366] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Telemedicine has the potential to improve access to care; however, its utility in the field of sexual medicine remains in question. AIM To examine the importance of video visits for the treatment of male sexual medicine at our academic center during the period of peak telemedicine use in April 2020. METHODS We collected and compared deidentified data from all nonprocedure, adult outpatient encounters conducted as either office visits in April 2019 (n = 1,949) or video visits in April 2020 (n = 608). The primary International Classification of Diseases codes (ICD-10) labeled as diagnoses from all encounters were collected, with most encounters linked to several disease codes (n = 4,584). Demographic data were also collected. We performed comparative analyses on Stata (College Station, TX, USA) with significance set at α = .05. MAIN OUTCOME MEASURES Disease codes were categorized based on their use and classification in urological care and the proportion that each category made up within the outpatient practice was calculated. RESULTS In comparison to the office visits, which took place in April 2019, male sexual medicine visits in April 2020, during the peak of telemedicine use, made up a significantly larger overall share of our practice (P = .012), defined by relative rises in encounters pertaining to male hypogonadism, infertility, penile abnormalities, and testicular abnormalities. Outpatients seen over video visits were also younger than outpatients seen during the previous year over office visits (58.9 vs 60.8, P = .008). Further, race and ethnicity characteristics in the outpatient population were unaffected during the period of telemedicine use. CONCLUSIONS During the period of historically high telemedicine use following the SARS-CoV-2 outbreak, encounters associated with male sexual medicine made up a significantly larger portion of our outpatient practice. Although the full influence of the COVID-19 pandemic cannot be delineated, our findings suggest telemedicine use is compatible with the field of sexual medicine. Rabinowitz MJ, Kohn TP, Ellimoottil C, et al. The Impact of Telemedicine on Sexual Medicine at a Major Academic Center During the COVID-19 Pandemic. Sex Med 2021;9:100366.
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Affiliation(s)
- Matthew J Rabinowitz
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chad Ellimoottil
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Ridwan Alam
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James L Liu
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amin S Herati
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Kohn TP, Rajanahally S, Hellstrom WJG, Hsieh TC, Raheem OA. Global Trends in Prevalence, Treatments, and Costs of Penile Prosthesis for Erectile Dysfunction in Men. Eur Urol Focus 2021; 8:803-813. [PMID: 34034995 DOI: 10.1016/j.euf.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Penile prosthesis is a durable and effective treatment for erectile dysfunction (ED). Even as other treatment options for ED have been brought to market, penile prosthetic surgery remains a mainstay for urologists treating ED. No systematic study has yet summarized the global trends in penile prosthetic surgery. OBJECTIVE To systematically review studies of trends in penile prosthetic surgery to determine global movements in implantation rates, malleable versus inflatable prosthetic surgery, inpatient versus outpatient implantation surgery, proportion of men with ED undergoing penile prosthetic surgery, and prosthetic cost. EVIDENCE ACQUISITION A systematic review of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov was performed for studies assessing trends in penile prosthetic surgeries and costs associated with penile prosthetic device and inclusive surgical costs. EVIDENCE SYNTHESIS Twenty-seven studies were identified during the systematic review, comprising 447,204 penile prosthetic surgeries reported from 1988 to 2019. A trend analysis demonstrates that rates of penile prosthetic surgery declined dramatically in the late 1980s and early 1990s, but have demonstrated modest growth since the mid-2000s. Outpatient inflatable penile prosthetic surgery has strongly trended upward. Costs of penile prosthetic device have matched the rate of inflation, but inclusive surgical cost has radically outpaced inflation. Growth has mainly been seen in the USA, with a more modest global growth. CONCLUSIONS Penile prosthesis remains a viable option for the treatment of ED. Trends such as outpatient surgery and inflatable penile prosthesis placement may be driving the recent steady growth of penile prosthetic surgeries, but surging inclusive surgical cost may present a barrier for some patients without insurance coverage. PATIENT SUMMARY Penile prostheses continue to be an important treatment for erectile dysfunction. While the volume of penile prosthetic surgeries dropped when phosphidiesterase-5 inhibitors became available, prosthetic surgery is becoming more patient centric, as seen by increases in inflatable prosthetic placement and outpatient surgery.
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Affiliation(s)
- Taylor P Kohn
- Department of Urology, Johns Hopkins, Baltimore, MD, USA
| | | | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California, San Diego, La Jolla, CA, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Alam R, Rabinowitz MJ, Kohn TP, Peña VN, Liu JL, Bhanji Y, Herati AS. Resident involvement in the prostatic urethral lift: implementing innovative technology in an academic setting. Asian J Androl 2021; 23:616-620. [PMID: 33885003 PMCID: PMC8577266 DOI: 10.4103/aja.aja_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adoption of the prostatic urethral lift (PUL) as a treatment for benign prostatic hyperplasia highlights the importance of training residents with novel technology without compromising patient care. This study examines the effect of resident involvement during PUL on patient and procedural outcomes. Retrospective chart review was conducted on all consecutive PUL cases performed by a single academic urologist between October 2017 and November 2019. Trainees in post-graduate year (PGY) 1-3 are considered junior residents, while those in PGY 4-6 are senior residents. The International Prostate Symptom Score (IPSS) and quality of life (QOL) scores were used to measure outcomes. Simple and mixed-effects linear regression models were used to compare differences. There were 110 patients with a median age of 66.4 years. Residents were involved in 73 cases (66.4%), and senior residents were involved in 31 of those cases. Resident involvement was not associated with adverse perioperative outcomes with respect to the number of implants fired, the percentage of implants successfully placed, or the postoperative catheterization rate. After adjustment for confounding factors, junior residents were associated with significantly longer case length compared to the attending alone (+12.6 min, P = 0.003) but senior residents were not (+2.4 min, P = 0.59). IPSS and QOL scores were not significantly affected by resident involvement (P = 0.12 and P = 0.21, respectively). The presence of surgeons-in-training, particularly those in the early stages, prolongs PUL case length but does not appear to have an adverse impact on patient outcomes.
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Affiliation(s)
- Ridwan Alam
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Matthew J Rabinowitz
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Taylor P Kohn
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Vanessa N Peña
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - James L Liu
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Yasin Bhanji
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Amin S Herati
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Kohn TP, Peña V, Redett Iii RJ, Burnett AL. Penile allotransplantation: early outcomes from reported cases and survivorship considerations. Minerva Urol Nephrol 2021; 73:333-341. [PMID: 33781015 DOI: 10.23736/s2724-6051.21.04144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vascular composite allografts are at the forefront of medical and surgical innovation. With this new technique and the ability to transplant a face, hands, an abdominal wall, a uterus, or even a penis, patients can undergo operations that may drastically improve their quality of life. Although this process presents significant opportunities it is not always an easy road and requires significant upfront counseling and life-long immunosuppression. Often the recovery course is long, with functionality taking months to years to gain. Immunosuppression must be used to prevent rejection of the allograft although it has serious long-term side-effects. Only five patients have undergone penile allotransplantation but reported outcomes from these small numbers have nonetheless offered significant lessons with each patient. While the operation is still in its infancy, it is certain that shared experiences by surgical teams will yield improved outcomes in the future.
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Affiliation(s)
- Taylor P Kohn
- Johns Hopkins School of Medicine, Brady Urological Institute, Baltimore, MD, USA
| | - Vanessa Peña
- Johns Hopkins School of Medicine, Brady Urological Institute, Baltimore, MD, USA
| | - Richard J Redett Iii
- Vascularized Composite Allotransplantation (VCA) Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arthur L Burnett
- Johns Hopkins School of Medicine, Brady Urological Institute, Baltimore, MD, USA -
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Softness K, Kohn TP, Perecman A, Carrasquillo R. Access to male fertility preservation information and referrals at National Cancer Institute Cancer Centers. Andrologia 2021; 53:e14020. [PMID: 33687100 DOI: 10.1111/and.14020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 12/01/2022] Open
Abstract
Cancer treatment can lead to infertility, which is a significant source of financial and emotional distress for cancer patients and survivors. Given that future fertility and sexual function are critical quality of life issues, we hypothesise that access to subspecialist care is not uniformly distributed. Therefore, we sought to identify access gaps in male sexual health and infertility care at NCI cancer centres across US Census Regions. All 64 clinical NCI cancer centre websites were examined for language related to male sexual health and fertility. A phone-based survey was used to establish cancer centre referral patterns to andrologists and sperm banks. We utilised the Society for the Study of Male Reproduction member directory to determine geographic locations for andrologists relative to each centre. We found that the presence of information regarding male sexual health information was not associated with region. The presence of andrologists within 5-miles of a CC was significantly higher in the Northeast compared to all other census regions. Our work describes the access gap in fertility services at NCI cancer centres and how this differs by region of the country. These data can inform patients, and encourage centres to provide improved access to oncofertility care.
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Affiliation(s)
- Kenneth Softness
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Taylor P Kohn
- The James Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Aaron Perecman
- Department of Urology, The Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Robert Carrasquillo
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Rabinowitz MJ, Huffman PJ, Haney NM, Kohn TP. Y-Chromosome Microdeletions: A Review of Prevalence, Screening, and Clinical Considerations. Appl Clin Genet 2021; 14:51-59. [PMID: 33603438 PMCID: PMC7886244 DOI: 10.2147/tacg.s267421] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/18/2021] [Indexed: 11/24/2022] Open
Abstract
Deletions within the male-specific region of the Y-chromosome, known as Y-Chromosome Microdeletions (YCMs), are present in as many as 5% and 10% of severe oligospermic and azoospermic men, respectively. These microdeletions are distinguished by which segment of the Y chromosome is absent, identified as AZFa (the most proximal segment), AZFb (middle), and AZFc (distal). The reported prevalence of YCMs within the world’s populations of infertile men displays vast heterogeneity, ranging from less than 2% to over 24% based on region and ethnicity. AZFc is the most commonly identified YCM, and its phenotypic presentation provides for the highest chance for fertility through artificial reproductive techniques. Conversely, deletions identified in the subregions of AZFa, AZFb, or any combination of regions containing these segments, are associated with low probabilities of achieving pregnancy. A putative mechanism explaining this discrepancy lies within the expression of autosomal, DAZ-like genes which could serve to “rescue” wild type AZFc gene expression and hence spermatogenesis. Nevertheless, recent reports challenge this dogma and stress the importance of further analysis when an AZFb deletion is detected. The screening thresholds to determine which oligospermic and azoospermic men are tested for potential YCMs has been recently contested. More recent literature supports lowering the threshold from 5 million sperm/mL of ejaculate to 1 million/mL as the frequency of YCMs in men with sperm concentrations between 1 and 5 million sperm/mL is very low (~0.8%). As such, subsequent guidelines should recommend a lower screening threshold. While YCMs are extremely common globally, the understanding of their clinical significance in the field remains scattered and without consensus. Furthermore, very little is currently known about partial deletions within the AZFc region, such as b1/b3, b2/b3, and gr/gr. Hence, this review aimed to summarize and discuss modern trends in the epidemiology, screening guidelines, and clinical considerations pertaining to YCMs.
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Affiliation(s)
- Matthew J Rabinowitz
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip J Huffman
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nora M Haney
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Scovell JM, Benz K, Samarska I, Kohn TP, Hooper JE, Matoso A, Herati AS. Association of Impaired Spermatogenesis With the Use of Immune Checkpoint Inhibitors in Patients With Metastatic Melanoma. JAMA Oncol 2021; 6:1297-1299. [PMID: 32556068 DOI: 10.1001/jamaoncol.2020.1641] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karl Benz
- James Buchanan Brady Urological Institutions, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Iryna Samarska
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Taylor P Kohn
- James Buchanan Brady Urological Institutions, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jody E Hooper
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Andres Matoso
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Amin S Herati
- James Buchanan Brady Urological Institutions, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Rabinowitz MJ, Alam R, Liu JL, Kohn TP, Bhanji Y, Peña VN, Herati AS. Prostatic Urethral Lift in Patients With Obstructive Median Lobes: A Single Surgeon Experience at an Academic Center. Urology 2021; 154:237-242. [PMID: 33493510 DOI: 10.1016/j.urology.2021.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the long-term efficacy of prostatic urethral lift (PUL) for treating men, with or without an obstructive median lobe (OML), who suffer from lower urinary tract symptoms attributed to benign prostatic hyperplasia. MATERIALS AND METHODS A retrospective review was performed on all consecutive PUL cases with or without OML from October 2017 to November 2019 by a single academic surgeon. Outcomes were measured using the International Prostate Symptoms Survey (IPSS) with quality of life (QoL) scores. Comparative testing and mixed-effects linear regression analysis were utilized with significance set at α = 0.05 and performed with Stata (College Station, TX). RESULTS A total of 110 PUL procedures were performed on 106 patients (4 repeat surgeries) with a median age of 66.5 (interquartile range: 60.4-73.7). Twenty-three patients (21.7%) had an OML. Following PUL, patients in both groups showed significant improvements in IPSS (P <.001) and QoL (P <.001) scores. When stratifying by OML and controlling for confounding, IPSS scores in both groups displayed statistically significant improvement at follow-up visits, with no statistically significant intergroup difference (P = .32). The same held true for QoL improvements, with no statistically significant difference between groups (P = .18). The presence of an OML resulted in minimal effects on perioperative outcomes and complications but required significantly more implants (P = .008). CONCLUSION PUL is a minimally invasive procedure effective at reducing lower urinary tract symptoms and improving the lives of men with benign prostatic hyperplasia without incurring risks of serious complications. These improvements were equivalent and upheld in patients who presented with OML.
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Affiliation(s)
- Matthew J Rabinowitz
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ridwan Alam
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - James L Liu
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yasin Bhanji
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vanessa N Peña
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amin S Herati
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
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Hanson BM, Kohn TP, Pastuszak AW, Scott RT, Cheng PJ, Hotaling JM. Round spermatid injection into human oocytes: a systematic review and meta-analysis. Asian J Androl 2021; 23:363-369. [PMID: 33565426 PMCID: PMC8269823 DOI: 10.4103/aja.aja_85_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction. This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection (ROSI), a technique which utilizes immature precursors of spermatozoa for fertilization. An electronic search was performed to identify relevant articles published through October 2018. Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included. Fertilization rate, pregnancy rate, and resultant delivery rate were assessed following ROSI. Meta-analysis outcomes were analyzed using a random-effects model. Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers. The fertilization rate after ROSI was 38.7% (95% confidence interval [CI]: 31.5%-46.3%), while the pregnancy rate was 3.7% (95% CI: 3.2%-4.4%). The resultant delivery rate was low, with 4.3% of embryo transfers resulting in a delivery (95% CI: 2.3%-7.7%). The pregnancy rate per couple was 13.4% (95% CI: 6.8%-19.1%) and the resultant delivery rate per couple was 8.1% (95% CI: 6.1%-14.4%). ROSI has resulted in clinical pregnancies and live births, but success rates are considerably lower than those achieved with mature spermatozoa. While this technique may be a feasible alternative for men with azoospermia who decline other options, couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.
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Affiliation(s)
- Brent M Hanson
- Department of Reproductive Endocrinology and Infertility, IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ 07920, USA
| | - Taylor P Kohn
- Department of Urology, The Brady Urological Institute at Johns Hopkins University, Baltimore, MD 21287, USA
| | - Alexander W Pastuszak
- Department of Surgery, University of Utah Center for Reconstructive Urology and Men's Health, Salt Lake City, UT 84108, USA
| | - Richard T Scott
- Department of Reproductive Endocrinology and Infertility, IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ 07920, USA
| | - Philip J Cheng
- Department of Reproductive Endocrinology and Infertility, IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ 07920, USA.,Department of Surgery, University of Utah Center for Reconstructive Urology and Men's Health, Salt Lake City, UT 84108, USA
| | - James M Hotaling
- Department of Reproductive Endocrinology and Infertility, IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ 07920, USA.,Department of Surgery, University of Utah Center for Reconstructive Urology and Men's Health, Salt Lake City, UT 84108, USA
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41
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McBride JA, Kohn TP, Mazur DJ, Lipshultz LI, Coward RM. Sperm retrieval and intracytoplasmic sperm injection outcomes in men with cystic fibrosis disease versus congenital bilateral absence of the vas deferens. Asian J Androl 2021; 23:140-145. [PMID: 32930103 PMCID: PMC7991824 DOI: 10.4103/aja.aja_48_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Recent data suggest that cystic fibrosis transmembrane conductance regulator (CFTR) gene alterations negatively impact male fertility beyond obstruction. We sought to compare gene alterations, sperm retrieval rates, and intracytoplasmic sperm injection (ICSI) outcomes among men with cystic fibrosis (CF) disease and congenital bilateral absence of the vas deferens (CBAVD) only. We retrospectively evaluated all men who underwent surgical sperm retrieval at two academic, high-volume andrology centers from 2010 to 2018. Only men with documented CFTR alterations and obstructive azoospermia from either CBAVD or CF were included. Differences between groups for CFTR abnormality, sperm retrieval, and ICSI outcomes were statistically analyzed. Overall,39 patients were included with 10 in the CF and 29 in the CBAVD groups. Surgical sperm retrieval rates were significantly lower in the CF group for sperm concentration (14.8 × 106 ml-1vs 61.4 × 106 m-1, P = 0.02) and total motile sperm count (2.9 million vs 11.4 million, P = 0.01). This difference was only predicted by homozygous delta F508 CFTR mutations (P < 0.05). The CF group also demonstrated a significantly higher rate of rescue testicular sperm extraction (70.0% vs 27.6%, P < 0.03) and lower fertilization rate with ICSI (32.5% vs 68.9%, P < 0.01). In conclusion, those with CF demonstrated lower sperm quality, greater difficulty with sperm retrieval, and worse ICSI outcomes compared with CBAVD-only patients. Homozygous delta F508 CFTR mutations appear to significantly impair spermatogenesis and sperm function.
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Affiliation(s)
- J Abram McBride
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Taylor P Kohn
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Daniel J Mazur
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC 27599, USA.,UNC Fertility, Raleigh, NC 27617, USA
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Abstract
Non-obstructive azoospermia is a distinct diagnosis within male infertility in which no sperm is found in the ejaculate as a result of spermatogenesis failure. Because of the increased prevalence of genetic abnormalities in men with non-obstructive azoospermia, male infertility guidelines recommend screening for karyotype abnormalities and Y chromosome microdeletions in this population. Numerous karyotype abnormalities may be present resulting in impaired spermatogenesis, including: Klinefelter syndrome, translocations, and deletions. Y chromosome microdeletions of the AZFa, AZFb, AZFc subregions all can also result in non-obstructive azoospermia with the possibility of sperm being present if only the AZFc subregion is deleted. While these are the two genetic tests recommended by the guidelines, nearly 50%-80% of non-obstructive azoospermia has no identifiable cause and is deemed idiopathic. Several other genetic defects can lead to non-obstructive azoospermia including Kallmann syndrome, mild androgen insensitivity syndrome, and TEX11. While many additional candidate genes have been proposed, many have yet to be verified or are so infrequent in the population that screening is cost-ineffective. Much research is still required in the genetics of non-obstructive azoospermia and will require multi-institutional initiatives to better understand the genetics of condition.
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Affiliation(s)
- Vanessa N Peña
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amin S Herati
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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43
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Rabinowitz MJ, Kohn TP, Peña VN, Samarska IV, Matoso A, Herati AS. Onset of azoospermia in man treated with ipilimumab/nivolumab for BRAF negative metastatic melanoma. Urol Case Rep 2020; 34:101488. [PMID: 33299797 PMCID: PMC7704337 DOI: 10.1016/j.eucr.2020.101488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 01/09/2023] Open
Abstract
Azoospermia is classified as the complete absence of sperm in ejaculate and accounts for 10–15% of male infertility. Many anticancer drugs are known to cause defects in spermatogenesis, but the effects of immune checkpoint inhibitor cancer therapy on spermatogenesis remains largely unknown. Presented here is a normozoospermic man (60 million sperm/cc of ejaculate) who received a trial combination treatment of Ipilimumab/Nivolumab to treat BRAF negative, stage IV metastatic melanoma. Two years after the treatment, the patient presented as completely azoospermic. The patient subsequently underwent microdissection testicular sperm extraction, during which no sperm was retrieved, and sertoli-only pathology was elucidated. Normozoospermic man became azoospermic after Ipilimumab/Nivolumab treatment. Testicular biopsy revealed sertoli-only pathology. Effect of Ipilimumab/Nivolumab on spermatogenesis remains largely unknown.
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Affiliation(s)
- Matthew J Rabinowitz
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vanessa N Peña
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Iryna V Samarska
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andres Matoso
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amin S Herati
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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44
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Peña V, Kohn TP. Growing evidence links male infertility and genitourinary malignancies. Fertil Steril 2020; 114:957. [DOI: 10.1016/j.fertnstert.2020.08.1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
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45
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Dave CN, Kohn TP, Patel HD, Arafa A, Burnett AL. Inflatable penile prosthesis outcomes after pelvic radiation. Can J Urol 2020; 27:10382-10387. [PMID: 33049191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
UNLABELLED INTRODUCTION Few studies have compared surgical outcomes after 3-piece inflatable penile prosthesis (IPP) surgery in patients exposed to pelvic radiation therapy (RT) compared to a radiation naïve control group. MATERIALS AND METHODS A total of 715 consecutive patients underwent 3-piece IPP placement between 2007-2018. There were 101 men exposed to pelvic RT before or after IPP for a variety of malignancies and 153 men met inclusion criteria for the control group, which included men undergoing IPP surgery with a history of radical prostatectomy but no exposure to pelvic RT. RESULTS Patients in the RT group had a higher body mass index (kg/m²) (28.7 versus 27.8, p = 0.003) and higher Charlson co-morbidity index score (6 versus 5; p < 0.001). At a median follow up of 5 years (IQR 2-8 years), there was an 18.4% surgical complication rate in the radiation group compared to 11.5% in the control group, though this was not statistically significant (p = 0.141). Timing of radiation, prior artificial urinary sphincter (AUS) status, co-implantation of an AUS, and brand of prosthesis were not associated with increased rate of complications. On multivariable logistic regression analysis, exposure to RT was not significantly associated with increased risks of complications (OR: 1.31; CI 0.55-3.12). CONCLUSIONS This study shows no significant increase in risk of surgical complication in patients exposed to pelvic RT and supports the use of IPP in men with a history of RT and refractory erectile dysfunction.
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Affiliation(s)
- Chirag N Dave
- Johns Hopkins University School of Medicine, Brady Urological Institute, Baltimore, Maryland, USA
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46
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Peña V, Kohn TP, Bhanji Y, Alam R, Liu J, Gabrielson AT, Rabinowitz MJ, Herati AS. TESTICULAR ULTRASOUND AS A PROGNOSTIC FACTOR FOR IMPROVEMENT IN SEMEN PARAMETERS AFTER VARICOCELECTOMY. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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47
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Abstract
The COVID-19 pandemic has brought unique challenges to the delivery of undergraduate medical education, particularly for current third-year medical students who are preparing to apply to residency. In mid-March, medical schools suspended all clinical rotations for the remainder of the 2019-2020 academic year. As such, third-year medical students may not be able to complete sufficient clinical experiences to make important career choices before they have to submit their residency applications. While the decision to suspend clinical rotations was necessary to protect students, specialty organizations and residency programs must mitigate the deficits in students' clinical education caused by the COVID-19 pandemic.In this Perspective, the authors identify potential challenges for third-year medical students and advocate for solutions to improve the residency application process for students and programs. First, they propose delaying the date that programs can access applicant data through the Electronic Residency Application Service, thereby affording students more time to complete clinical experiences, solidify their specialty decision, and strengthen their residency application. Second, the authors recommend a restriction on the number of visiting rotations that students are expected to complete to allow for a more equitable distribution of these important experiences. Third, they suggest that program directors from each specialty agree on a maximum number of applications per applicant (based on historical data) to curb an upsurge in applications that may stem from the unique circumstances created by COVID-19 without causing applicants undue stress. Lastly, the authors advocate that residency programs develop infrastructure to conduct video-based interviews and engage students through virtual networking events.Amidst the unique environment created by COVID-19, the authors urge governing bodies, specialty organizations, and residency programs to consider these recommendations to improve the efficiency and reduce the stress surrounding the 2021 Match.
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Affiliation(s)
- Andrew T. Gabrielson
- A.T. Gabrielson is a urology resident, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaden R. Kohn
- J.R. Kohn is a gynecology and obstetrics resident, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hayley T. Sparks
- H.T. Sparks is a pediatrics resident, Department of Pediatrics, Children’s National Hospital, Washington, DC
| | - Marisa M. Clifton
- M.M. Clifton is assistant professor, female pelvic medicine and reconstructive surgery, and director, urology residency program, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Taylor P. Kohn
- T.P. Kohn is a urology resident, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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48
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Best JC, Blachman-Braun R, Gonzalez D, Patel P, Kohn TP, Ramasamy R. OLDER AGE AND LOWER SPERM MOTILITY ARE ASSOCIATED WITH ELEVATED SPERM DNA FRAGMENTATION INDEX. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Patel P, Kohn TP, Cohen J, Shiff B, Kohn J, Ramasamy R. Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey. JAMA Netw Open 2020; 3:e2010806. [PMID: 32678451 PMCID: PMC7368166 DOI: 10.1001/jamanetworkopen.2020.10806] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The opportunity to discuss fertility preservation is essential for patients of reproductive age with newly diagnosed cancer before the initiation of treatment. OBJECTIVE To identify factors associated with fertility preservation counseling among patients of reproductive age before initiating chemotherapy. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data obtained from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative, an oncologist-led quality assessment program that surveys approximately 400 oncology practices biannually, from January, 2015, to June, 2019. MAIN OUTCOMES AND MEASURES The primary outcome was whether reproductive risks were discussed before initiation of chemotherapy. Multivariate logistic regression was performed to identify factors associated with fertility preservation counseling, controlling for age, sex, race/ethnicity, cancer type, year of study, region, clinic type (academic vs private), annual clinic volume, and rates of insurance coverage. RESULTS Among the 6976 patients of reproductive age (3571 men [51%]; mean (SD) age, 42.5 [7.1] years), with reproductive age ranging from 18 to 40 years for 3405 women and from 18 to 50 years for 3571 men, clinics reported that 3036 of 6976 patients (44%) received counseling regarding the risk of infertility associated with chemotherapy. Women were more likely to be informed (1912 of 3405 [56%]) compared with men (1126 of 3571 [32%]) (P < .001). Factors associated with reduced likelihood of fertility risk discussion included male sex (odds ratio [OR], 0.73; 95% CI, 0.60-0.90), increasing age (OR, 0.93; 95% CI, 0.92-0.94), private practice setting (OR, 0.70; 95% CI, 0.53-0.93), and lack of multidisciplinary team planning (OR, 0.54; 95% CI, 0.41-0.70). Factors associated with increased likelihood of fertility risk discussion included having breast cancer (OR, 1.39; 95% CI, 1.12-1.73) and lymphatic or hematopoietic cancers (OR, 1.79; 95% CI, 1.33-2.40), participating in each subsequent study year (OR, 1.16; 95% CI, 1.08-1.24), receiving care in an academic clinic (OR, 1.45; 95% CI, 1.05-2.01), and being a practice offering clinical trial enrollment (OR, 1.60; 95% CI, 1.13-2.29). States with legislatively mandated coverage of fertility preservation had significantly higher rates of fertility risk discussion compared with states without legislation (48.6% vs 39.6%, P < .001). CONCLUSIONS AND RELEVANCE The findings suggest that clinicians are more likely to counsel younger patients and female patients about reproductive risks before initiation of chemotherapy. State laws mandating fertility preservation coverage may be associated with improved frequency of fertility counseling before chemotherapy. Further awareness and implementation of ASCO guidelines appear to be needed to improve rates of fertility risk discussion and referrals to fertility specialists before chemotherapy.
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Affiliation(s)
- Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Taylor P. Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jordan Cohen
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Benjamin Shiff
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Jaden Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
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50
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Kohn JR, Haney NM, Nichols PE, Rodriguez KM, Kohn TP. Varicocele Repair Prior to Assisted Reproductive Technology: Patient Selection and Special Considerations. Res Rep Urol 2020; 12:149-156. [PMID: 32426301 PMCID: PMC7196200 DOI: 10.2147/rru.s198934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/21/2020] [Indexed: 01/02/2023] Open
Abstract
Clinical varicoceles are one of the most commonly identified physical exam abnormalities in men presenting with infertility. Clinical varicoceles can cause impaired spermatogenesis and surgical correction can improve semen parameters in select men. Increasingly, andrologists are performing varicocele repairs prior to intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) to boost male fertility potential. In this review, we evaluated the available literature 1) to determine if varicocelectomy prior to IUI or assisted reproductive technologies proved to improve sperm production or pregnancy outcomes; and 2) to identify who may be the ideal candidate for pre-IUI/ART varicocelectomy. Overall, few studies have explored this topic and little can be concluded about the impact of varicocelectomy prior to IUI. The evidence, however, does support that correcting a clinical varicocele can increase pregnancy outcomes in couples who plan to pursue IVF or ICSI. When selecting patients for varicocelectomy prior to IUI or ART, clinicians should evaluate female age as improvement in semen parameters can take 6 months after varicocelectomy and this duration of time may be deleterious in cases of advanced maternal age when each cycle becomes increasingly important. Overall, the currently limited literature regarding clinical varicoceles correction demonstrates that pregnancy rates can be increased when comparing patients who have undergone varicocelectomy prior to ART with those who had clinical varicocele but did not undergo surgery.
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Affiliation(s)
- Jaden R Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nora M Haney
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Katherine M Rodriguez
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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