Male and female sexual function and dysfunction; andrology

Zhou Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China, Department of Gastrointestinal Surgery, West China Hos-pital, Sichuan University, Chengdu, Chin

Re: Tomato and Lycopene and Multiple Health Outcomes: Umbrella Review

N Li, X Wu, W Zhuang, L Xia, Y Chen, C Wu, Z Rao, L Du, R Zhao, M Yi, Q Wan and

Y Zhou

Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China, Department of Gastrointestinal Surgery, West China Hos-pital, Sichuan University, Chengdu, China, Department of Gastroenterology, West China HosHos-pital, Sichuan University, Chengdu, China, Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China, and Chinese Evidence-Based Medicine/Cochrane Center, Chengdu, China Food Chem 2021; 343: 128396.

Editorial Comment: Men often ask what they can do to improve their fertility Here’s a sys-tematic review of tomato and lycopene, and male health was one of the covered areas While the data are limited, sperm quality may be improved by lycopene However, the review was expansive and found beneficial effects of tomato and lycopene for cancer (including prostate cancer), coro-nary heart disease, cerebrovascular disease and metabolic syndrome I’ll add tomato and lycopene

to my discussion of modifiable risk factors during patient visits for male fertility, as even if the limited data on male reproductive health don’t pan out, the positive effect on overall health ap-pears substantial

Re: Impact of Sleep on Female and Male Reproductive Functions: A

Systematic Review

G Caetano, I Bozinovic, C Dupont, D Leger, R Levy and N Sermondade

APHP, H^otel-Dieu, Centre du Sommeil et de la Vigilance, Centre de Reference Narcolepsies et Hypersomnies Rares, Service de Pathologies Pro-fessionnelles et Environnementales, Paris, France, Service de Biologie de la Reproduction CECOS, H^opital Tenon (AP-HP), Paris, France, and Sorbonne Universite, Centre de Recherche Saint-Antoine, Inserm US938, Paris, France

Fertil Steril 2021; 115: 715e731.

Editorial Comment:This systematic review investigated the literature reporting on altered sleep patterns and reproductive health, detailing effects on ovarian function, sperm, natural fertility and in vitro fertilization As expected, the studies were not entirely in agreement What was un-expected to me was how many studies did point to a poor effect on sperm: generally, semen analysis parameters are so variable that they wash out many potentially observable effects, and so if something is observed, it’s probably significant I found this systematic review fascinating, informative and useful: sleep is an important historical feature to elucidate from a man seeking fertility care

Craig Niederberger, MD

Male and Female Sexual Function and Dysfunction; Andrology

Re: Postoperative Penile Prosthesis Pain: Is It Worse in Diabetic

Patients?

L Reinstatler, D Rodrı´guez, B Goddard, M Apoj, M Rezaee, M Gross and R Munarriz

Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and Boston University School of Medicine, Boston, Massachusetts

Int J Impot Res 2021; 33: 286e290.

Editorial Comment:Inflatable penile prosthesis (IPP) surgery is an effective, safe and satisfactory treatment option for medication-refractory erectile dysfunction Postoperative complications include infection, mechanical failure, erosion and pain Current literature suggests the need for a better

approach to postoperative pain management after IPP surgery Clinical studies have demonstrated that postoperative pain is different in diabetic patients

The authors sought to determine if there is a difference in pain after IPP placement in diabetics This was a single-institution retrospective review The main outcome measure was the number of 30-day postoperative visits for pain The secondary outcome included differences in how pain was managed The top hemoglobin A1c (HbA1c) quartile was compared with the other HbA1c quartiles Diabetes was present in 92 (54.4%) patients and 96% of these had HbA1c>8

Significant postoperative pain was more common in patients with HbA1c >8 (41% vs 13%,

p[0.047) and resulted in more unplanned visits (27% vs 11%, p[0.042) Patients with HbA1c >8 with significant postoperative pain were more likely to be managed with opioids and gabapentin (30%

vs 14%, p[0.05)

Very important data

Suggested Reading

Montorsi F, Capogrosso P, Deh o F et al: Penile prosthesis insertion in the era of antibiotic stewardship: are postoperative antibiotics necessary? Letter J Urol 2021; 205: 1849.

Dropkin BM, Chisholm LP, Dallmer JD et al: Penile prosthesis insertion in the era of antibiotic stewardship-are postoperative antibiotics necessary? J Urol 2020; 203: 611.

Re: Non-Invasive and Surgical Penile Enhancement Interventions for

Aesthetic or Therapeutic Purposes: A Systematic Review

J Romero-Otero, C Manfredi, D Ralph, D Osmonov, P Verze, F Castiglione,

E C Serefoglu, G Bozzini and B Garcı´a-Gomez

Urology Department, Hospital Universitario 12 Octubre, Instituto de Investigacion Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain, Urology Department, Hospital Universitario HM Monteprı´ncipe, Madrid, Spain, Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples ’Federico II,’ Naples, Italy, Institute of Urology, University College London Hospitals, London, UK, Department of Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany, Department of Medicine, Surgery and Dentistry

’Scuola Medica Salernitana,’ University of Salerno, Salerno, Italy, Department of Urology, University College London Hospitals NHS Trust, London,

UK, Department of Urology, Biruni University School of Medicine, Istanbul, Turkey, and Department of Urology, ASST Valle Olona, Busto Arsizio, Lombardy, Italy

BJU Int 2021; 127: 269e291.

Editorial Comment:To systematically review the literature in order to investigate the efficacy and safety of surgical and noninvasive penile enhancement procedures for aesthetic and therapeutic purposes, a review was performed using the MEDLINEÒ database Articles published from January

2010 to December 2019, written in English, including>10 cases, and reporting objective length and/

or girth outcomes were included Studies without primary data and conference abstracts were excluded The main outcome measure was objective length and/or girth improvement The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement

Out of 220 unique records, a total of 57 were reviewed Eighteen studies assessed interventions for penile enhancement in 1,764 healthy men complaining of small penis Thirty-nine studies investi-gated 2,587 men with concomitant pathologies consisting mostly of Peyronie’s disease and erectile dysfunction Twenty-five studies evaluated noninvasive interventions and 32 studies assessed sur-gical interventions, for a total of 2,192 and 2,159 men, respectively Noninvasive interventions, including traction therapies and injection of fillers, were safe and mostly efficacious, whereas surgical interventions were associated with minor complications and mostly increased penile dimensions and/

or corrected penile curvature

Overall, the quality of studies was low, and standardized criteria to evaluate and report efficacy and safety of procedures, as well as patient satisfaction, were missing

Very timely data

Re: Concurrent Penile Prosthesis and Artificial Urinary Sphincter versus Penile

Prosthesis and Male Sling: A National Multi-Institutional Analysis of National

Surgical Quality Improvement Program Database Comparing Postoperative

Morbidity

M I Khalil, A K Bramwell, N R Bhandari, N Payakachat, B Machado, R Davis,

M H Kamel, A Safaan and O A Raheem

Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, Department of Urology, Faculty of Medicine, Ain Shams University, Cairo, Egypt, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, and Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana

World J Mens Health 2021; 39: 75e82.

Editorial Comment: The authors aimed to assess the 30-day morbidity in patients undergoing combined insertion of penile prosthesis (PP) and artificial urinary sphincter (AUS) vs PP and male sling (MS) The National Surgical Quality Improvement Program database was queried to identify patients who underwent placement of AUS or MS combined with PP Patient demographics, post-operative morbidity including complications, readmission and reoperation rates were recorded Student t-test and chi-square or Fisher’s exact test were used as appropriate

Forty-one patients met selection criteria between 2010 and 2016 Overall, 26 patients received PP and AUS vs 15 who received PP and MS Average age was similar in both groups (64.86.6 years vs 62.36.3 years, p[0.254) Diabetes mellitus was more prevalent in PPþMS group compared to AUSþPP group (46.7% vs 11.5%, p[0.022) Average length of stay was higher in PPþAUS group compared to PPþMS group (2.20.6 days vs 1.80.4 days, p[0.017) Postoperative morbidity was reported in 4 patients in PPþAUS group There were no reported complications in the PPþMS group

In the PPþAUS group, complications included 1 patient who developed urinary tract infection, 1 who developed surgical site infection, readmission in 2 for postoperative infection, and 1 return to the operating room There was no reported prosthesis explantation or revision in either group

While this is a small series, the data are provocative

Re: Global Trends in Prevalence, Treatments, and Costs of Penile Prosthesis

for Erectile Dysfunction in Men

T P Kohn, S Rajanahally, W J G Hellstrom, T.-C Hsieh and O A Raheem

Department of Urology, Johns Hopkins Hospital, Baltimore, Maryland, Atlanta Urology Associates, Atlanta, Georgia, Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana, and Department of Urology, University of California, San Diego, La Jolla, California

Eur Urol Focus 2021; Epub ahead of print doi: 10.1016/j.euf.2021.05.003

Editorial Comment: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

The authors systematically reviewed 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

A systematic review of MEDLINEÒ, EMBASEÒ, 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

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 However, there has been modest growth in penile prosthesis implantation 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 U.S., with a more modest global growth Important data to bear in mind

Re: Female Sexual DysfunctiondAwareness and Education among Resident Physicians

A L Millman, K Rebullar, R D Millman and Y Krakowsky

Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada, and Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Calgary, Alberta, Canada Urology 2021; 150: 175e179.

Editorial Comment: The authors sought to develop a better understanding of the strengths and deficiencies of female sexual health education and the attitudes toward female sexual health amongst urology, obstetrics and gynecology, psychiatry, and family medicine trainees Female sexual dysfunction (FSD) is characterized as distress related to sexual pain, interest/arousal or orgasm Despite the high prevalence of FSD there are few clinical resources available for patients and pro-viders in Canada

An anonymous online survey explored trainee knowledge of, and experiences with, female sexual dysfunction Questions regarding male sexual dysfunction (MSD) were included as a comparison

In all, 114 residents participated in the survey and 107 were included in the final analysis Re-spondents receive significantly more teaching and exposure to MSD compared to FSD in medical school and residency (when obstetrics and gynecology excluded) A total of 96% of respondents agreed that FSD is an important educational topic in residency, while only 12% felt their residency program provides adequate teaching and exposure to FSD

Although physician trainees recognize the importance of education related to FSD, the majority report little time being allocated to it in their training programs An opportunity seems to exist for training in FSD

Allen D Seftel, MD

Pediatric Urology

Re: Individualized Care for Patients with Intersex (Differences of Sex Development): Part 4/5 Considering the Ifs, Whens, and Whats

Regarding Sexual-Reproductive System Surgery

K Bangalore Krishna, B A Kogan, T Mazur, P Hoebeke, G Bogaert and P A Lee

Penn State College of Medicine, Hershey, Pennsylvania, Albany Medical Center, Albany, New York, University of Buffalo, Buffalo, New York, University Hospital, Gent, Belgium, and University Hospital, UZLeuven, Leuven, Belgium

J Pediatr Urol 2021; 17: 338e345.

Editorial Comment:We do not usually feature review articles in the survey, but this one is worth reading The authors present 4 examples of challenging patients’ and the panel’s thought process as they contemplate a surgical plan and discuss the potential risks and benefits of future surgical, medical or observational therapy, and review of the sexual reproductive anatomy during infancy and early childhood with the patient (if older) and his or her family

The first case is a 46XX assigned female newborn with congenital adrenal hyperplasia The second case is a newborn with complete androgen insensitivity syndrome in which the authors discuss the potential risks and benefits and timing of gonadectomy The third case examines the physical and psychological impact of penile shaft hypospadias and discusses whether surgery is justified or not in the infant The fourth case involves an adult woman with classic congenital adrenal hyperplasia, born with a urogenital sinus and clitoromegaly who, now as an adolescent, is requesting surgery