Sexual Dysfunction: Non-standard shift work predicts low T

Amy I. Guise, MDOther AUA 2017 take-home messages in sexual dysfunction included a study indicating that obstructive sleep apnea correlated with increased venous leak as well as a finding that wounded veterans from Iraq and Afghanistan with genitourinary injuries had higher injury severity scores and were more likely to have urinary and sexual dysfunction than those without GU injuries. The take-home messages were presented by Amy I. Guise, MD, of Froedtert & Medical College of Wisconsin, Milwaukee.

When matched for a control, hypogonadal men between age 18 and 65 who used testosterone replacement had a modest improvement in cardiovascular-free events but a higher risk of obstructive sleep apnea.

97% of patients who underwent inflatable penile prosthesis (IPP) surgery using a preoperative anesthetic block consisting of ropivacaine, lidocaine, bicarbonate, and dexamethasone were discharged home on postoperative day zero without opioid prescriptions and instructed to use acetaminophen and NSAIDs for postoperative pain control. During 30-day follow-up, 88% of patients did not require opioid prescriptions for adequate pain control.

Of 2,500 men screened for hypogonadism, 766 who worked non-standard shifts had worse hypogonadal symptom scores in a validated questionnaire. Non-standard shift work was an independent predictor of lower serum testosterone.

On penile Doppler ultrasound, obstructive sleep apnea correlated with increased venous leak.

An Internet-based survey saw no difference in erectile dysfunction among athletic non-cyclists, avid cyclists, and non-avid cyclists. However, there was a trend toward urethral strictures in cyclists, though an increased time standing and higher handlebar height decreased risk of numbness.

Continue to the next page for more take-home messages.

• Among female cyclists versus non-cyclist athletes, there was no difference in the mean storage and voiding sub-scores or the total I-PSS score. However, when adjusted for age, there was a higher ratio of self-reported urinary tract infections.

• The initial loss of stretched penile length was seen at 10 days after prostatectomy but recovered fully by 12 months. Pelvic MRIs at 10 days and 12 months showed a vertical repositioning of the membranous urethra by 4 mm, but this recovered at the 12-month image.

• A nickel titanium alloy penile prosthesis created with a 3D printer that is activated by change in temperature demonstrated safety and feasibility, though the research is still in the prototype phase.

• At the initial IPP revision, there is a 6.8% risk of infection, but by the time of the fifth revision, there is a 100% risk of implant infection.

• A study of patients with implant infections showed that 30% of patients grew gram-positive organisms and 47% grew gram-negative organisms, which is in contrast to the historical values of 77% and 20%, respectively.

• The idea of high prosthetic infection rate in immunocompromised population was challenged. In one study of 32 HIV patients, only two had infections; and 26 transplant patients in a second study had zero infections.

• In men with post-prostatectomy erectile dysfunction and concomitant mild stress urinary incontinence or climacturia who were undergoing IPP insertion, a procedure in which a “mini-jupette” graft is sewn to the medial edges of the corporotomies demonstrated an 86% resolution of climacturia and 88% resolution of mild stress incontinence.

• Wounded veterans from Iraq and Afghanistan with genitourinary injuries had higher injury severity scores and were more likely to have urinary and sexual dysfunction than those without GU injuries. When care was transitioned to the Veteran’s Health Administration, only 3% of patients were receiving treatment for those conditions.

• IX-01 is a selective oral oxytocin receptor antagonist intended for the treatment of men with lifelong premature ejaculation. Doses of 400 and 800 mg taken at 6 hours before intercourse showed a 3.6-fold increase in improvement, with higher improvement at the 800-mg dose, in intravaginal ejaculatory latency times.

• Examination of 10 abstracts discussing early outcomes of injectable collagenase clostridium histolyticum (XIAFLEX) found no variation in outcomes by race, no increase in adverse outcomes when used off-label in the acute phase, and no improvement when used with a vacuum erection device or penile traction device.

• A study that sequenced the genomes of a father/son duo who both have Peyronie’s disease and Dupuytren’s disease identified 150 single nucleotide variants, showing genetic alterations in the pathways involved in collagen deposition and cell proliferation and inflammation as well as GI epithelial maintenance.

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