Men's Health

Guideline-directed care often leads to better outcomes, but that’s not the case with the AUA’s antibiotic prophylaxis guidelines for diabetic patients undergoing primary penile prosthesis implantation. Authors of an ongoing study have found that adhering to the antibiotic prophylaxis guidelines results in a five-fold increased infection risk among diabetic penile prothesis patients, greatly increasing their risk for explantation.

Results from analyses of data collected in the randomized, placebo-controlled Reduction by Dutasteride of prostate Cancer Events (REDUCE) trial point to a potential role for statins in attenuating age-related prostate enlargement.

A recent study found low levels of free testosterone in older men with prostate cancer could increase these men’s odds of facing erectile dysfunction after undergoing radical prostatectomy.

Findings from an analysis of data collected prospectively over an 18-year period provide further evidence supporting guidelines that recommend holmium laser enucleation of the prostate as the size-independent gold standard for surgical management of BPH, say urologists from McGill University, Montreal.

Urology Times interviewed four leading urologists who are experts in BPH to get their take on the most important BPH studies of 2018 and 2019.

A set of evidence-based nomograms for predicting recovery of erectile function after radical prostatectomy is now available, and the developers hope that surgeons will use these tools to provide prostate cancer patients with a more accurate personalized estimate of their sexual function outcome.

A patient-reported outcomes survey that is widely used to determine whether men are experiencing erectile dysfunction (ED) fails to ask three critical questions that could uncover whether men truly have ED and the extent to which they face challenges, researchers say.

Results from analyses of data collected in the randomized, placebo-controlled Reduction by Dutasteride of prostate Cancer Events (REDUCE) trial point to a potential role for statins in attenuating age-related prostate enlargement.

Researchers comparing cost and outcomes for surgery, collagenase clostridium histolyticum (CCH [Xiaflex]), and RestoreX traction therapy for Peyronie’s disease found traction is the most cost-effective option for achieving 20% or greater curvature improvement, but CCH or surgery might be more cost-effective and efficacious in specific scenarios.

Androgen deprivation therapy for advanced prostate cancer may increase the likelihood of urethral atrophy in men with an artificial urinary sphincter (AUS), thereby contributing to an increased risk of AUS cuff erosion.

"I basically choose the procedure based on the patient’s anatomy," says one urologist.

The long-term durability of surgical modalities for management of BPH varies significantly, findings from a retrospective study suggest.

Data from prospective clinical trials show that the efficacy of high-velocity waterjet ablation (Aquablation using the AquaBeam System) for improving BPH-related signs and symptoms is the same in patients with a large-to-very large prostate as in men with a small-to-moderate size gland, said Naeem Bhojani, MD, at the AUA annual meeting in Chicago.

"We have entered a renaissance in the care for patients with benign prostatic hyperplasia-related lower urinary tract symptoms," writes Steven A. Kaplan, MD.

Urologists should be open minded that more people are turning to the Internet for health care advice or services and should consider reaching patients where they live and work by implementing telemedicine, when it makes sense, or in their own online communications, according to Aaron Spitz, MD, of Orange County Urology Associates in California.

Novel sites catering to men emerge, along with conflicting views about Internet-based care.

Researchers at the Mayo Clinic report that they have developed a legitimate penile traction therapy device for men with Peyronie’s disease that may work when used for just 30 to 90 minutes daily.

A study evaluating outcomes of the prostatic urethral lift (PUL; UroLift System) in clinical practice show that the efficacy and safety documented in the selected group of men enrolled in clinical trials is maintained across the broader spectrum of patients who present for treatment of symptomatic BPH in the real-world setting.

The treatment provides an alternative to simple prostatectomy in men with large prostates.

Low-intensity extracorporeal shock wave therapy is a safe treatment for men with erectile dysfunction and might work to improve, or even cure, ED in some patients. But there remain important unanswered questions, including which patients are ideal candidates and which protocol and devices are best.

"Men’s centers here are offering testosterone treatments without doing much testing beforehand. They also give little or no warning about potential comorbidities of testosterone," says one urologist.

"Targeted counseling regarding sleep hygiene improvements may positively affect several urologic disorders while also facilitating a host of overall health benefits," write Hudson Pierce and Bilal Chughtai, MD.

The second-generation AdVance XP male sling system offered good mid-term results for the treatment of post-radical prostatectomy male stress urinary incontinence, researchers reported at the AUA annual meeting in Chicago.

Men with low levels of free testosterone 3 months after undergoing radical prostatectomy could face increased chance of early recurrence of prostate cancer, according to researchers from the University of California Irvine.

Male partners of infertile couples experience substantial emotional and psychological distress, which is often unrecognized, according to new data presented at the AUA annual meeting in Chicago.

A new study is suggesting that severe male factor infertility may predispose a man to lower cognitive function.

This article briefly reviews the current guidelines and proposes a clinical care pathway for health care practitioners who perform the initial evaluation of infertile couples.

Novel therapies are promising but face questions about patient selection and efficacy.

"The observations that penile prosthesis surgical infections occurring early are frequently associated with anaerobic bacterial organisms and that these infections overall comprise diverse pathogens including fungal organisms fundamentally alter conventional thinking related to this topic area," writes Arthur L. Burnett, II, MD, MBA.

Isolated anaerobic organisms appear to occur most rapidly on average when infections occur following surgical intervention with an inflatable penile prosthesis (IPP), according to data presented at the 2018 AUA annual meeting in San Francisco.