Benign Conditions

Benign Prostatic Hyperplasia

Bladder Cancer

Female Urology

Genitourinary Cancers

Genomic Testing

Hormone Therapy

Kidney Cancer

Challenging Anatomy

Innovative Techniques

Laser Lithotripsy

PCNL Tech & Devices

Ureteroscopy Tech & Devices

Kidney Stones

Men's Health

Next-Generation Imaging

Voiding Dysfunction

OAB and Incontinence

Pediatrics

Controveries in Urologic Cancer

Drug Therapy

Prostate Cancer

Sexual Dysfunction

UTUC

Cosmetic Surgery

Urologic Surgery

Business

Practice Management

Malpractice Consult

Health Law & Policy

Media

Case-Based Peer Perspectives

Investigator Perspectives 

Medical World News

Podcasts

Urology Medical Perspectives

UTv Videos

Peer Exchange

Virtual Tumor Board

Insights

Peers & Perspectives

Conferences

Conference Listing

Conference Previews 

Conference Recaps

Publications

Urology Times Journal

Editorial Advisory Board

Urologists in Cancer Care

Supplements and Featured Publications

CME/CE

Resources

Begin Your Journey: Tackling Burnout

Interactive Tools

Job Board

Partners

Subscribe

Urology Times is the leading resource for urologists & allied health professionals offering clinical analysis, policy perspectives, & practical advice.

About Us

Advertise

Contact Us

Terms and Conditions

Privacy

Do not sell my Personnal Information

Urology Times | News & Insights for Urologists & Health Professionals

Facebook

Twitter

LinkedIn

Spotlight

UroView

Clinical

1rem

Clinical Focus

Clinical Case Vignette Series: Integrating Recent Data into Practice to Improve Outcomes in Advanced Prostate Cancer

Robert Dreicer, MD, MS, MACP, FASCO; Neal Shore, MD, FACS; Michael Morris, MD; Alicia K. Morgans, MD, MPH

Medical Crossfire®: How Will Emerging Data Inform Treatment Planning for Patients With Prostate Cancer in the Community?

Howard I. Scher, MD; Scott T. Tagawa, MD, MS, FACP; Mary-Ellen Taplin, MD

Medical Crossfire®: How Does Recent Evidence on PARP Inhibitors and Combinations Inform Treatment Planning for Prostate Cancer Now and In the Future?

® Assistant Managing Editor Ben Saylor spoke with Dr. Michael Lutz. He discusses common myths and misconceptions surrounding men’s health and the urologist’s role in dispelling them. Lutz is a partner in the Michigan Institute of Urology and president of the MIU Men’s Health Foundation.

“I think it's really important to understand the role of prevention and early detection,” says Michael Lutz, MD.

The urologist's role in dispelling men's health myths

® Assistant Editor Janelle Hart spoke with 

 He discusses why clinicians and patients are reluctant to incorporate holistic medicine into their health management, and how he believes this will change in the future. Espinosa is a holistic clinician and clinical assistant professor of urology at NYU Langone Health in New York City, New York.

“I think that the audience should know that there is a movement going on,” says Geo Espinosa, ND.

Destigmatizing Urology: Dr. Espinosa discusses lifestyle changes

 He discusses perceived masculinity as a major barrier for men who need care for testosterone deficiency. He also discusses how urologists can create a more supportive environment for this reluctant population of patients. Dubin is an andrology fellow at Northwestern University in Chicago, Illinois.

“We need to create this safe, comfortable, welcoming environment for men to talk about the things that they need to talk about,” says Justin Dubin, MD.

Destigmatizing Urology: Dr. Justin Dubin discusses testosterone deficiency

 paper, “Male Infertility Websites: What are Our Patients Reading?” for which she served as senior author. Samplaski is an associate professor of clinical urology at Keck School of Medicine of USC, Los Angeles.

“The available information [on] male infertility websites right now is not of good quality,” Samplaski says.

Dr. Mary Samplaski discusses online resources regarding male infertility

This episode's guest is Ranjith Ramasamy, MD. He discusses findings from the recent Journal of Urology paper, Effect of Natesto on Reproductive Hormones, Semen Parameters, and Hypogonadal Symptoms: A Single Center, Open Label, Single Arm Trial. Ramasamy is director of male reproductive medicine and surgery and associate professor of urology at the University of Miami Miller School of Medicine.

Dr. Finkelstein discusses telemedicine for pediatric post-op visits

How to get started with HIFU for prostate cancer

What patients undergoing HIFU should expect postoperatively

Ramasamy talks about the findings of a recent study published in the Journal of Urology.

Speaking of Urology: Dr. Ranjith Ramasamy discusses nasal testosterone gel and sperm parameters

The study has enrolled 8 patients to assess the safety and efficacy of the device in sealed vasectomy procedures.

IDE trial of sealed vasectomy procedure hits enrollment goal

“The association of lower testosterone concentrations with higher all-cause mortality was present irrespective of luteinizing hormone concentrations, indicating that low testosterone was the main factor," says Bu B. Yeap, MBBS, FRACP, PhD.

Study finds associations between low testosterone and all-cause, CVD mortality

Data showed that 87.8% of treated patients and 96.1% of patients who completed the study achieved normal 24-hour mean plasma testosterone values (222 to 800 ng/dL) at 90-day follow-up. 

Published data show safety, efficacy of testosterone undecanoate in hypogonadism

The oral TRT study plans to enroll 20 male patients aged 18 to 49 years who meet the American Urological Association’s criteria for hypogonadism and who have not previously used TRT. 

Study initiated to explore effect of oral TRT on spermatogenesis

The study is set to begin in January 2024.

FDA grants IDE approval for study of vasectomy device

Olivia Paulsen shares next steps and key takeaways from. astudy of Peyonie's disease in men who have sex with men

Study finds negative mental health impact of Peyronie’s disease 

 discusses potential future work and key takeaways from the study, “A Contemporary Glimpse into the Perceptions, Characteristics, and Psychosocial factors of Peyronie's disease Among Men Who Have Sex With Men,” which was presented at the 2024 American Urological Association (AUA) Annual Meeting in San Antonio, Texas. Paulsen is a medical student at Idaho College of Osteopathic Medicine in Meridian, Idaho.

Is there any future work planned based on this study?

Personally, I would like to do another survey that makes those questions a little more granular. One of the questions that I got when I was at AUA was, what is a negative experience with a urologist, which I think is a really good question. We didn't define that. So, it's really hard for a urologist to improve the experience for patients when we're not defining that experience. Only 30% of our respondents were men who have sex with men. So, there was a big discrepancy there. I'd like to get it distributed through institutions perhaps rather than through social media, because you can't control who's responding when you put things on the internet.

What are the overall take-home messages from this study?

From what we can gather from this study, there is no statistically significant difference in the biopsychosocial impact between men who have sex with men and men who do not have sex with men who also have Peyronie's disease. But Peyronie's disease does impact mental health, so I think it's important to consider that when you're evaluating people for Peyronie's. Perhaps it's worth giving them questionnaires like the PHQ-9 or GAD-7 to monitor their mental health status and encourage or ask if they even have support around them. Until we get a better understanding of what a negative experience looks like, I think it's just a good thing to keep in the back of your mind when we're talking to these patients to make sure that they have a better experience.

This transcription has been edited for clarity.

Videos

“Perhaps it's worth giving them questionnaires like the PHQ-9 or GAD-7 to monitor their mental health status and encourage or ask if they even have support around them,” says Olivia Paulsen. 

Dr. Justin Dubin describes the rationale of a study exploring erectile dysfunction medication use

Dr. Dubin on the direct-to-consumer market for erectile dysfunction medications

, discusses the rationale for the study, “Beyond the prescription: trends and challenges in erectile dysfunction medications among young adult men,” for which he served as the senior author. Dubin is a urologist focused on men’s health at Memorial Healthcare System in South Florida.

We were interested in this study because erectile dysfunction is the most prevalent sexual dysfunction that men have; about 50% of men at some point in their lives will have erectile dysfunction. But we have seen an increasing trend in erectile dysfunction in younger men. Statistically, usually it's about 40% in their 40s, 50% in their 50s, 60% in their 60s, 70% in their 70s have erectile dysfunction. Anecdotally, I have seen a lot of young men, and other providers who are in the men's health space have seen a lot of young men, for erectile dysfunction. So, we were interested in this study, at least capturing first off, the prevalence of men under the age of 40 [with] erectile dysfunction. But more importantly, with the rise of direct to consumer, we were interested in seeing how many of our patients are using them.

I will tell you, just from our experiences, direct to consumer care has become incredibly popular amongst men. It is one of the leading resources for men's health, especially for erectile dysfunction. Direct to consumer does have some benefits; they've done a really excellent job of destigmatizing conversations around erectile dysfunction. I mean, you see advertisements for this stuff literally everywhere. I often see patients who are coming to me, and they're saying, "Doc, I've tried Cialis, I've tried Viagra at X or Y company. And now I'm interested in coming and talking to you about it."

There are some risks, of course, with direct to consumer. Obviously, you're just giving a medication; it's theoretically potentially a band-aid for something that you may be missing. There was a great study, I believe it was out of UCLA, where they identified that there is a good portion of men [for whom] you would miss a diagnosis of obesity, infertility, low testosterone, diabetes, [or] high blood pressure that you would otherwise catch if they came into the clinic and were assessed by an actual doctor. However, what direct to consumer does provide is convenience and privacy. Men's health has a huge stigma on it.

So, what we decided to do was we surveyed men under the age of 40. We asked them a whole bunch of questions, including giving them an IIEF, which is a validated score for erectile dysfunction. We asked them where they get their erectile dysfunction meds if they've ever taken them, where they prefer to get them, what they prioritize in making that decision, and why they're taking the medications. That was why we did the study. We wanted to see if people were truly using these direct-to-consumer products as a gateway of getting into the men's health space.

“However, what direct to consumer does provide is convenience and privacy. Men's health has a huge stigma on it,” says Justin M. Dubin, MD. 

Dr. Pereira discusses the efficacy of perioperative subcutaneous heparin in preventing VTE following IPP surgery

Study: Subcutaneous heparin reduces VTE incidence following IPP surgery

, highlights the background and key findings from the study, “Peri-operative subcutaneous heparin is safe and reduces incidence of venous thromboembolism following placement of inflatable penile prostheses,” which was presented at the 

2024 American Urological Association Annual Meeting

 in San Antonio, Texas. Pereira is an andrology fellow at the University of Indiana in Indianapolis.

Patients undergoing IPP surgery have several risk factors for cardiovascular events, such as VTE. Our project aimed to identify and assess the safety of using subcutaneous heparin perioperatively in patients undergoing IPP surgery. The idea is subcutaneous heparin could reduce the chance to have a VTE post-op, without increasing the risk to have hematomas postoperatively. We revealed all patients that underwent IPP in our hospital in the past 2 years, 50% of them received subcutaneous heparin perioperatively, and 50% did not. What we saw among over 400 patients [was] that indeed, subcutaneous heparin did not increase the hematoma chance, but it reduced the chance to have venous thrombotic events. Actually, we found that patients that did not receive subcutaneous heparin had an incidence for VTE of 0.71% vs 0 in patients that did receive subcutaneous heparin.

"What we saw among over 400 patients [was] that indeed, subcutaneous heparin did not increase the hematoma chance, but it reduced the chance to have venous thrombotic events," says Thairo Pereira, MD. 

Dr. Catherine Nam discusses key takeaways from a publication on the struggles of male infertility

Dr. Nam discusses challenges faced by men with infertility 

, highlights key points that were discussed in the editorial, “The deafening silence of male infertility,” for which she served as the lead author. Nam is a urology resident at the University of Michigan in Ann Arbor, MI.

One of the main things that we wanted to highlight from multiple angles is the psychological burden of infertility. Especially for male infertility, it's quite hard, because it has significant implications in terms of the social norm of masculinity and the psychological aspects of that. It also has sexual dysfunction, and it also affects the relationship that they have with their partners as well. So, we wanted to highlight that from a professional psychological perspective, as well as from the patient's perspective. [We wanted to highlight] a little bit of what it means to be providing care for male infertility, while also navigating the challenges of fertility yourself when you're a urologist in the sphere. One of the quotes from one of our patients that really resonated with me as I was working on this piece was, "not the standard plan, but our plan". [This is] highlighting all the different ways in which you can get to the same outcome of achieving pregnancy and childbirth, but it takes a lot of twists and turns that patients don't expect a lot of times.

In addition to the psychological and emotional burden associated with infertility, it's also been growing in incidence. I think having the epidemiological background of why this might be happening [and] some of the risk factors that are associated with the decreasing sperm count worldwide over the last few decades is important to understand. This is a trend where it's becoming more and more common, so this is going to be a growing issue for a lot of our patients as well.

I think a main thing that we have to talk about whenever we talk about infertility is access to care. A lot of the insurance coverage does not cover male infertility workup or management in particular. I think there's a lot more advocacy that can be done to make it be more accessible. The financial burden associated with it is also astronomical for a lot of our patients. There's been a lot of advocacy from the ASRM [American Society for Reproductive Medicine] and RESOLVE or other organizations in the sphere, but I think there's a lot of room for growth and opportunity there as well. [For] our underrepresented minorities, both from a racial perspective as well as gender diverse individuals, there's a lot more effort that needs to be taken into place to make sure that the infertility care that we provide is inclusive of all individuals and more accessible to them as well.

This transcription has been edited for clarity

“In addition to the psychological and emotional burden associated with infertility, it's also been growing in incidence,” says Catherine S. Nam, MD. 

Dr. Landon Trost on CCH injections at the point of max curve for Peyronie's disease

Dr. Trost on injecting CCH at the point of max curve in Peyronie’s disease

, highlights a key aspect of the study, “Changes in point of maximal curvature during collagenase clostridium histolyticum injections for Peyronie’s disease,” for which he served as the senior author. Trost is the founder and director of the Male Fertility and Peyronie’s Clinic in Orem, Utah.

One thing goes along with the study, and it's implicit in the study, but may not be pulled out easily. Over the years, we tried multiple different techniques, everything from feeling the plaque to just measuring the first time, marking with a pen, ultrasound-guided. We tried multiple things. We never published ultrasound-guided one. You’re more accurate in doing your first injection while the person still has the erection. That's controversial, but that's implicit in this study. We always went where the point of max curve was, not necessarily where the plaque was. I found particularly with calcified plaques, your curve often is on the leading edge of that calcified plaque, not within the calcified plaque itself. So, always going where the point of max curve is gives a much better outcome compared to if you're using any other technique. That makes sense surgically too. If you're cutting anything out, tumor or whatever the case, you always go to wherever it's tethered. You're always pulling on the tissue, looking for where it's tethered, and that's where you cut. That's essentially what you're doing if you inject when the person has an erection, and you can see exactly where that point of max curve is. That's going to help achieve better outcomes.

“So, always going where the point of max curve is gives a much better outcome compared to if you're using any other technique,” says Landon Trost, MD.

In this video, Matthew J. Ziegelmann, MD, discusses future research building on the recent Urology paper, “Incremental Treatment Response by Cycle With Collagenase Clostridium Histolyticum for Peyronie's Disease: a Pooled Analysis of Two Phase 3 Trials.”Ziegelmann is a urologist at Mayo Clinic in Rochester, Minnesota.

[Collagenase clostridium histolyticum (Xiaflex)] is an incredibly important part of the treatment armamentarium for Peyronie's disease in the US. I certainly have an interest in continuing to pursue research in this realm, as do many others. I think the next steps, and this is sort of the unanswered question in Peyronie's disease and in intralesional therapy with collagenase, who is the right candidate? We have criteria that have been set out by the package insert for the medication based on the inclusion criteria for these studies. It's 30-degree curvature with a palpable plaque. Usually, it's in the setting of someone who doesn't have significant calcification of that scar that prevents administration of the medication. But beyond that, we still see a nonresponder rate. We saw that in these original phase 3 data; we see that in clinical practice every day. That's an incredibly frustrating thing for patients undoubtedly, but for us as clinicians too, because we want to be offering these rigorous therapies if we think they're going to work. So who is that patient? Who is that patient who's going to respond? In this study, we actually did another analysis saying, Okay, if you had calcification in your scar—not severe calcification, but some calcification—did that predict whether you would respond or what the overall outcomes were for the cohort? The answer was no. We also looked at the direction of curve: up/down, left/right. Downward curvature was not included, so it was basically dorsal or lateral and dorsolateral. That didn't seem to predict outcomes as well. We need to find other predictors. That has been attempted with the datasets we have based on some of these clinical series. But it's still really early. That's where I think the research needs to take us. Who are these patients who don't respond? And on the flip side, who are the patients who have this incredible response? Who are those guys who go from a 45-degree curve to nearly perfectly straight? And how can we identify those mega responders? Those are things that I'm interested in and I think a lot of other people who study this are interested in as well.

This transcription was edited for clarity.

“[Collagenase clostridium histolyticum (Xiaflex)] is an incredibly important part of the treatment armamentarium for Peyronie's disease in the US,” says Matthew J. Ziegelmann, MD.

Evaluating responders to collagenase clostridium histolyticum treatment for Peyronie disease

, discusses the ideal patient population for treatment with intracavernosal injections for erectile dysfunction. Broghammer is an associate professor of Urology at the University of Kansas Medical Center.

“You do need to be a little bit careful because of the risk of priapism,” says Joshua A. Broghammer, MD.

Dr. Broghammer on patient selection for treatment with intracavernosal injections

In this expert panel video, Kevin J. Campbell, MD, MS; Kelli Gross, MD; Darshan P. Patel, MD; Mary K. Samplaski, MD; and James M. Hotaling, MD, MS, discuss the case of a 35-year-old man who had a vasectomy 7 years prior who desires to have children.

Two main options exist: sperm retrieval with assisted reproductive therapies or vasectomy reversal, according to Kevin J. Campbell, MD, MS.

Expert Forum: Fertility after vasectomy?

 gives an overview of Healthy Now: A Men’s Health Coalition and discusses how the group will help men with their sexual health. Khera is a professor and the F. Brantley Scott Chair in Urology at Baylor College of Medicine in Houston, Texas.

“Healthy Now is really committed to making access to care available to all men,” says Mohit Khera, MD, MBA, MPH.

Dr. Mohit Khera on new men’s health coalition

, discusses the impact of COVID-19 and the vaccine on pregnancy and fertility. Sadeghi-Nejad is a professor of Surgery/Urology at Rutgers New Jersey Medical School, chief of Urology at the VA NJ Health Care System, and the director of the Center for Male Reproductive Medicine at the Hackensack University Medical Center.

“Pregnant women have not been part of the vaccine clinical trials, but the CDC reported that there have been more than 150,000 women who got the vaccine while they were pregnant and there were absolutely no adverse effects,” says Hossein Sadeghi-Nejad, MD. 

Men's Health

Latest News