Search

Objective To define the current proportion of underrepresented minority (URM) academic urologists in leadership positions. Methods A cross-sectional observational study of leadership positions in active United States Urology Residency Programs in 2020 was conducted. Academic urologists in leadership positions were electronically mailed a survey asking about personal and professional demographics. Self-reported variables including administrative position, race, and ethnicity were collected and analyzed. Results Over the study period, 133 urologists completed the survey out of a possible 320 academic urologists for a response rate of 41.6%. Overall, African-Americans represented 9.0%, Hispanics represented 3.8%, and American Indians/Alaska Natives made up 0.8% of leadership roles in the study sample. African-Americans comprised 8.5% (4 of 47) and Hispanics comprised 2.1% (1 of 47) of department chairs. African-Americans made up 7.4% (4 of 54) and Hispanics made up 1.9% (1 of 54) of program directors. The highest proportion of African-Americans in leadership positions was seen in oncology (18.2%), minimally invasive surgery (18.2%), and general urology (10%). The only subspecialties with Hispanics in leadership positions were in andrology/sexual medicine (16.7%) and female urology (15.4%). There were no reported URMs in leadership positions in endourology, neurourology, pediatrics, and reconstructive urology. Conclusions To our knowledge, this study is the first to quantify the representation of URM urologists in academic leadership. There are multiple subspecialties without URMs in leadership positions. This information is vital to understanding the presence and lack of racial representation of the leadership of our field.

Introduction Historically, sexual health research has focused on men who have sex with women (MSW) and most research examining the sexual health of men who have sex with men (MSM) has focused on HIV transmission. Despite a high prevalence of sexual health disorders among MSM, there is limited research that has evaluated the diversity of sexual issues in these patients. Objectives The purpose of this review is to describe the unique sexual behaviors, concerns, and dysfunctions of MSM by evaluating the literature on sexual health in this specific patient population. Methods A PubMed literature search was conducted through December 2020 to identify all relevant publications related to the sexual health, sexual practices, and sexual dysfunction of MSM. Original research, review articles, and meta-analyses were reviewed, including comparisons of sexual behavior and dysfunction between MSM and non-MSM populations and between gay/bisexual men and heterosexual men. Approximately 150 relevant articles were reviewed and 100 were included in the manuscript. Results Minority stress can lead to an increase in high-risk sexual behavior, sexual dysfunction, and mental health disorders in MSM. MSM engage in a variety of sexual behaviors, which can lead to differences in sexual dysfunction, such as anodyspareunia during receptive anal intercourse. MSM have higher rates of erectile dysfunction than non-MSM counterparts. MSM have unique activators of sexual pathologies, such as insertive anal intercourse for Peyronie's disease. Prostate cancer treatment may cause MSM to change sexual roles and practices following treatment due to ED, anodyspareunia, or decrease in pleasure from receptive anal intercourse after prostatectomy. Conclusion MSM have been neglected from sexual medicine research, which translates to disparities in health care. Further research that focuses on the MSM population is necessary to better educate healthcare practitioners so that MSM patients can receive adequate care that is tailored to their specific needs. PJ Cheng, Sexual Dysfunction in Men Who Have Sex With Men. Sex Med Rev 2021;XX:XXX–XXX.

Post-SSRI sexual-dysfunction (PSSD) is an iatrogenic syndrome, the underlying neurobiological mechanisms of which are unclear. Symptom onset follows cessation of serotonergic antidepressants i.e. Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSRI's, SNRI's), and Tricyclic antidepressants (TCA's). PSSD symptoms include genital anesthesia, erectile dysfunction and orgasmic/ejaculatory anhedonia, and should be differentiated from depression-related sexual-dysfunction. Recently, accumulated data of numerous case-reports suggest additional non-sexual symptoms including, anhedonia, apathy, and blunted affect. PSSD gained official recognition after the European medical agency concluded that PSSD is a medical condition that persists after discontinuation of SSRI's and SNRI's.To review possible underlying neurobiological mechanisms of this syndrome, update information on the pathophysiology, present a list of potential risk-factors and discuss potential management options for PSSD.Extensive literature review on the main symptom-patterns of this disorder was undertaken using PubMed. It includes introductory explications of relevant neurobiology with the objective of generating hypothesis.Precipitating factors for PSSD include previous exposure to certain drugs, genetic predisposition, psychological stress or chemical stressful reaction to antidepressants along pre-existing medical conditions affecting neuroplasticity. Different theories have been proposed to explain the pathophysiology of PSSD: epigenetic gene expression, dopamine-serotonin interactions, serotonin neurotoxicity and hormonal changes. The diagnosis of PSSD is achieved by excluding all other etiologies of sexual-dysfunction. Treatment is challenging, and many strategies have been suggested without definitive outcomes. We offer the contours of a future neurobiological research agenda, and propose several underlying mechanisms for the various symptoms of PSSD which could be the foundation for a future treatment algorithm.There is a need for well-designed neurobiological research in this domain, as well as in the prevalence, pathophysiology, and treatment of PSSD. Practitioners should be alert to the distinctive features of PSSD. Misdiagnosing this syndrome might lead to harmful treatments including reinstatement of medications which generated PSSD. Sexual Medicine Reviews. Peleg LC, Rabinovitch D, Lavie Y, et al. Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors. Sex Med Rev 2022;10:91-98.

BACKGROUND Premature ejaculation (PE) is a highly prevalent male sexual dysfunction. Its current definition, together with the most used diagnostic tools, does not include non-vaginal sexual intercourse such as anal sex, self-masturbation and/or partnered-masturbation, and other forms of sexual stimulation. However, diagnostic psychometry currently available is exclusively evaluating PE in the vaginal coitus. OBJECTIVES To validate a new tool, the Masturbatory Premature Ejaculation Diagnostic Tool (MPEDT), by assessing the control over ejaculation and its psychological effects during self-masturbation, rather than heterosexual vaginal intercourse. MATERIALS AND METHODS We studied 135 male patients aging from 18 to 40 years seeking medical care for PE in the Infertility and Sexual Medicine Department from June to September 2020. All the participants were asked to fill the PEDT and MPEDT questionnaires to estimate the PE symptoms during, respectively, intercourse and self-masturbation. The reliability/validity, the factor analysis of the tool, and the diagnostic sensitivity/specificity of MPEDT were calculated. RESULTS The overall Cronbach alpha was 0.884. In our adjusted model, both RMSEA (Root Mean Square Error of Approximation) and SRMR (Standardized Root Mean Square Residual) were lower than 0.08, while Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), Non-Normed Fit Index (NNFI), and Comparative Fit Index (CFI) were higher than 0.9. The area under the ROC curve (AUC) is 0.943±0.015. The results suggest MPEDT points being ≤5 as "normal", ≥7 as "PE during self-masturbation" and 6 as "suspected PE", with the sensitivity of 91.9% and specificity of 88.1%. DISCUSSION An efficient diagnostic psychometric tool is needed for the individuals who, based on the impaired control over ejaculation during self-masturbation, may also suffer from PE during partnered intercourse. MPEDT is able to evaluate the existence of PE symptoms not necessarily during heterosexual intercourse but rather during self-masturbation, possibly aiding to the diagnosis, as well as planning and follow-up of a prompt therapeutical strategy. CONCLUSION MPEDT could be considered a new, objective and reliable diagnostic tool for the evaluation of the existence of PE symptoms. This article is protected by copyright. All rights reserved.

Despite physicians frequently caring for patients with sexual health issues, only 50% of United States medical schools require formal education in sexual medicine, and there are currently no guidelines pertaining to this with research which found that medical trainees are ill-equipped to provide sexual healthcare.This study aims to identify areas to improve sexual health training in order to increase physician confidence and competence in evaluating and training patients with sexual health problems.A prospective survey was sent via REDCap to medical students (n = 190, 68.6%), residents (n = 75, 27.1%), and fellows (n = 11, 3.9%) via a known listserv. Participants (N = 276, ∼15% response rate) were asked to provide demographic information, whether they received sexual health training during medical school and rate their confidence in addressing patients' sexual health concerns.Medical students and residents currently do not receive sufficient education on sexual health and medicine, particularly in fields outside of OB-GYN and Urology, leaving them underqualified and less confident than needed for adequate patient care.65.6% of trainees reported receiving formal sexual health education, while 13.9% received informal education, and 20.6% received no education during medical school. Although trainees desire to understand a patients' sexual health (P.001), only residents in a relevant field (Urology, OB-GYN) felt confident in their ability to assist patients with a sexual health issue (P = .013). All other trainees lacked confidence in attending to sexual health concerns (P.001), regardless of training level (P.1).More efforts should be made to integrate sexual health education into medical school curriculum.The strength of this study includes specific evaluation of medical student and resident confidence level with 15 individual sexual health topics. The limitations include that the demographic was regionally confined to the Midwest of the United States and women were more strongly represented among medical students.Due to the lack of standardized education, medical trainees (except for Urology and OB-GYN residents) feel unprepared to treat patients with sexual health issues, and medical schools should make sexual health education mandatory. Beebe S, Payne N, Posid T, et al. The Lack of Sexual Health Education in Medical Training Leaves Students and Residents Feeling Unprepared. J Sex Med 2021;18:1998-2004.

OBJECTIVE The purpose of this first french guideline is to provide a clinical framework for the diagnosis, treatment and follow-up of anterior urethral strictures. The statements are established by the subgroup working on uro-genital reconstruction surgery (GURU) from the CAMS-AFU (Andrology and Sexual Medicine Committee from the French Association of Urology). MATERIAL AND METHODS These guidelines are adapted from the Male Urethral Stricture : American Urological Association Guideline 2016, updated by an additional bibliography from January 2016 to December 2019. Twenty-seven main scenarios seen in clinical practice are identified: from diagnosis, to treatment and follow-up. In addition, this guidelines are powered by anatomical diagrams, treatment algorithms, summaries and follow-up tables. RESULTS Anterior urethral strictures are a common condition (0,1 a 1,4 %) in men. The diagnosis is based on a trifecta including an examination with patient reported questionnaires, urethroscopy and retrograde urethrography with voiding cystourethrography. Short meatal stenosis can be treated by dilation or meatotomy, otherwise a urethroplasty can be performed. First line treatment of penile strictures is urethroplasty. Short bulbar strictures (

Background Vaginal agenesis, most commonly referred as Mayer–Rokitansky–Kuster–Hauser (MRKH) Syndrome, is mostly diagnosed as primary amenorrhea in teenage girls; although there is plenty of literature concerning the formation of a neovagina, limited research has focused on the psychological burden of this diagnosis to the girls. Aim To enlighten health providers into the finer aspects of sexuality through the own words and experiences of girls with MRKH under our care. Methods Women currently undergoing vaginal dilation or who had completed vaginal dilation within the past year were recruited from February 2019 to January 2020. A gynecologist with training in Sexual Medicine conducted a semistructured interview, which was recorded and then transcribed to identify common themes among interviewees. Outcomes The main outcome explored was the narrative experiences of women with MRKH. Results 7 women participated, with a mean age of 19.7 (range 17–22 years). None of the girls felt stigmatized, however one reported significant distress at diagnosis, stemming from the attitude of health care professionals and exacerbated by an earlier age at disclosure. All girls accepted that VDT was successful, when it was initiated after they had felt sexual interest and arousal. Exact quantification of the vaginal length at onset, worried 4 as they felt pressurized to achieve a specific length. A few girls reported anxiety over sharing the diagnosis with an intimate partner. All of them pretended at some point to have menses. Childbearing was an important issue for most of the interviewees, but it did not concern them for the time being. All girls had supporting families. However, 5 did not want to share information about VDT with them. One girl reported that openness in discussing genital anatomy, VDT and sexuality, helped her both in completing treatment and adapting in a sexual relationship. Clinical Implications A multidisciplinary team should aim for age-appropriate disclosure and consultation and guide women through VDT and their sexual relations. Strengths and Limitations This is a thorough account of women's perceptions regarding VDT and sexuality in MRKH. However, our conclusions may be limited by the small number of participants. Conclusion Gradual provision of information at disclosure and adjusted timing at VDT may reduce stress in girls with MRKH. Tsitoura A, Michala L. The Sexuality of Adolescents and Young Women With MRKH Syndrome: A Qualitative Study. J Sex Med 2021;XX:XXX–XXX.

A variety of devices are available for the management of patients with erectile dysfunction, Peyronie's disease, penile dysmorphophobia, for support before and after penile prosthesis insertion, and after radical prostatectomy. Traction devices include, but are not limited to, Penimaster PRO (MSP Concept, Berlin, Germany), Andropenis and Andropeyronie (Andromedical, Madrid, Spain), and the Restorex (PathRight Medical, Plymouth, USA). The other type of devices are vacuum devices such the Osbon ErecAid (Timm Medical, MN, USA). Different devices are optimal for different clinical applications, and robust and contemporary clinical data show a variety of strengths and weaknesses for each device. Research currently favours the use of traction devices for improvement of penile curvature and erectile function in patients with Peyronie's disease compared with vacuum devices; Penimaster Pro and Restorex have been shown to be associated with the best outcomes in this indication. Vacuum devices are favoured for treatment of erectile dysfunction and penile length loss after radical prostatectomy; the Osbon ErecAid is the most well-studied device for this indication. Research into other uses of vacuum and traction devices, such as for penile dysmorphophobia or before and after penile prosthesis, is very limited. Compliance, cost and availability remain substantial challenges, and further high-quality evidence is required to clarify the role of traction devices in urology and sexual medicine.

Zusammenfassung Hintergrund Die Anlage eines transurethralen Dauerkatheters (DK) oder suprapubischen Harnblasenkatheters (SPK) in lebenslanger Indikation stellt einen Eingriff mit relevanten Komplikationen, Komorbiditäten und möglichen Auswirkungen auf die katheterassoziierte Lebensqualität des Betroffenen dar. Letztere wurde aber bisher noch nicht untersucht. Methodik Zur Anwendung kam ein validiertes Assessment zur katheterbezogenen Lebensqualität mit 25 Items in 5 Domänen. Befragt wurden im Rahmen eines Katheterwechsels Patienten mit einem DK oder SPK in lebenslanger Intention, die diesen mindestens 3 Monate trugen. Ergebnisse Fragebögen von 357 Patienten, davon 260 Männer und 97 Frauen, 193 mit SPK und 162 mit DK (2 ohne Angabe) lagen vor. Patienten mit DK waren mit 78,9 ± 11,1 Jahren signifikant älter als solche mit SPK mit 74,4 ± 12,6 Jahren (p Schlussfolgerung Die gefundenen Ergebnisse sollten in die Aufklärung zu einer lebenslangen Katheterableitung einfließen bzw. im Kontext möglicher Alternativen wie z. B. einer operativen Desobstruktion oder einer Hilfsmittelversorgung mit dem Patienten bzw. Betreuungspersonen besprochen werden.

Background: The Fourth International Consultation on Sexual Medicine defined erectile dysfunction (ED) as a consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction homocysteine (Hcy) is a toxic, nonproteogenic sulfur-containing amino acid synthesized from dietary methionine in the liver and is metabolized either via trans-sulfuration or remethylation pathway.Objective: To investigate serum Hcy levels in ED patients as compared to those in healthy controls, and to explore its correlation with severity of ED.Patients and methods: This study consisted of 30 ED-affected men and 50 age-matched controls who were free from ED. All participants were recruited from the Andrology Outpatient Clinic of Mansoura University Hospital, between October 2019 and September 2020.Results: Serum Hcy was significantly higher in ED cases compared to controls (P < 0.001). The mean of serum Hcy in cases was 24.17 ± 11.502 µmol/L versus 8.43 ± 9.076 µmol /L in controls. 23 out of 30 ED cases (76.66 %) had hyperhomocysteinemia (> 15 μmol/L). On the other hand, 6 out of 50 controls (12 %) had elevated level of Hcy. Elevation of Hcy levels was associated with an increased risk of ED, and that a cut-off value of 8.28 µmol/L was able to detect ED patients with a corresponding sensitivity and specificity of 90.0% and 78% respectively.Conclusion: Elevated Hcy is associated with ED and may represent an important risk factor and play a pathophysiologic role in ED. Hence, Hcy-lowering agents, such as folic acid and vitamin B12, seem reasonable choices for the prevention and management of this condition.

Context The present summary of the European Association of Urology (EAU) guidelines is based on the latest guidelines on male sexual health published in March 2021, with a last comprehensive update in January 2021. Objective To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health. Evidence acquisition A literature review was performed up to January 2021. The guidelines were updated, and a strength rating for each recommendation was included based on either a systematic review of the evidence or a consensus opinion from the expert panel. Evidence synthesis Late-onset hypogonadism is a clinical condition in the ageing male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/or action. A comprehensive diagnostic and therapeutic work-up, along with screening recommendations and contraindications, is provided. Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Along with a detailed basic and advanced diagnostic approach, a novel decision-making algorithm for treating ED in order to better tailor therapy to individual patients is provided. The EAU guidelines have adopted the definition of premature ejaculation (PE), which has been developed by the International Society for Sexual Medicine. After the subtype of PE has been defined, patient’s expectations should be discussed thoroughly and pharmacotherapy must be considered as the first-line treatment for patients with lifelong PE, whereas treating the underlying cause must be the initial goal for patients with acquired PE. Haemospermia is defined as the appearance of blood in the ejaculate. Several reasons of haemospermia have been acknowledged; the primary goal over the management work-up is to exclude malignant conditions and treat any other underlying cause. Conclusions The 2021 guidelines on sexual and reproductive health summarise the most recent findings, and advise in terms of diagnosis and treatment of male hypogonadism and sexual dysfunction for their use in clinical practice. These guidelines reflect the multidisciplinary nature of their management. Patient summary Updated European Association of Urology guidelines on sexual and reproductive health are presented, addressing the diagnosis and treatment of the most prevalent conditions in men. Patients must be fully informed of all relevant diagnostic and therapeutic options and, together with their treating physicians, decide on optimal personalised management strategies.

Intralesional Collagenase Clostridium histolyticum (CCh) was the first non-surgical therapy approved for Peyronie’s disease (PD). However, CCh’s cost and poor market uptake has led to its discontinuation in Europe and Canada. In Canada, Xiaflex® is the trade name for CCh and it is produced by Paladin Labs Inc, an operating company of Endo International. The paper aims to better understand Canadian CCh providers’ perspectives regarding its treatment efficacy and the potential impact of its discontinuation. All Xiaflex®-approved Canadian providers were asked to complete an anonymous 21-question survey using an online platform. Analysis consisted of descriptive statistics. Outcomes of interest included previous experience with CCh, protocols utilized, experience with insurance coverage, clinical and patient-reported outcomes, and provider perspectives on the discontinuation of CCh. Overall response rate was 48.3% (29/60). A total of 89% of respondents were male, 61% were in practice more than 10 years, 32% were in an academic practice, and 46% had completed an Andrology/Sexual Medicine fellowship. A total of 93% of respondents felt that CCh was superior to other intralesional therapies for PD. In all, 86% reported a patient satisfaction rate of at least 50%, and the majority (75%) saw a clinically meaningful response. Only 7% expressed difficulty obtaining insurance coverage, with many providers (71%) achieving an insurance approval rate between 75 and 100%. Only 54% of respondents reported that they would continue treating PD in light of CCh’s discontinuation, and 96% felt that CCh’s discontinuation represents a loss to Canadian patients. In light of CCh’s discontinuation, most (79%) are now more likely to offer surgical treatment. In conclusion, most CCh providers found CCh to be effective and were dismayed by its discontinuation. The survey demonstrated that due to the withdrawal of CCh from Canada, physicians’ abilities to offer effective medical therapy may become limited, with more providers offering surgical options for PD.

Social media services, especially Twitter, are used as a commonly sharing tool in the scientific world. This widespread use of Twitter would be an effective method in spreading academic publications. So, we aimed to investigate the relationship between Twitter mentions and traditional citations of articles in sexual medicine journals in this study. We reviewed the articles published in seven journals of sexual medicine (2 years after the publication of the articles) between January 2018 and June 2018. In the first half of 2018, 410 articles were extracted. Of these, 352 (85.9%) were original articles, while 58 (14.1%) were review articles. The median number of citations of the articles mentioned at least once on Twitter was 7 (interquartile range: 0–111) for Google Scholar, whereas it was 0 (interquartile range: 0–63) for Scopus, respectively. It was 4 (interquartile range: 0–25) for Google Scholar and 0 (interquartile range: 0–7) for Scopus. The publications mentioned on Twitter were cited more than the non-mentioned publications in the traditional-based citation system (p

Specific developments in reproductive health occurred in Eastern Europe, especially in the second half of the twentieth century. During state socialism, it was experts, not social movements, who furthered the agenda of women’s health and sexuality. New analyses from the region and written mostly by authors who speak the local languages attest to the wealth of histories, highlighting different timelines of reproductive health developments, the unexpected causes behind them, and the social actors and institutions which played decisive roles.

As the field of sexual medicine continues to grow, there has been increasing attention to the importance of the sociocultural components of the biopsychosocial model. Although important in all medical practice, culture and sexual health are particularly entwined, so engaging with sociocultural aspects of the patient experience as part of evaluation and treatment is necessary to optimize patient outcomes in this field. We invite clinicians to consider the importance of sexual health literacy, cultural humility, and support for patient volition as key aspects of moving care towards a model that embraces all aspects of the biopsychosocial model. The aim of the current paper is to provide readers with concrete steps and illustrative examples to help guide this process. Bober SL, Chevalier L. Culture and Sexual Medicine: A Road Map for Clinical Inquiry and Practice. J Sex Med 2021;18:1475–1478.

Introduction Quantitative patient-reported outcome (PRO) measures ideally are analyzed on their original scales and responder analyses are used to aid the interpretation of those primary analyses. As stated in the FDA PRO Guidance for Medical Product Development (2009), one way to lend meaning and interpretation to such a PRO measure is to dichotomize between values where within-patient changes are considered clinically important and those that are not. But even a PRO scale with a cutoff score that discriminates well between responder and non-responders is fraught with some misclassification. Methods Using estimates of sensitivity and specificity on classification of responder status from a PRO instrument, formulas are provided to correct for such responder misclassification under the assumption of no treatment misclassification. Two case studies from sexual medicine illustrate the methodology. Results Adjustment formulas on cell counts for responder misclassification are a direct extension of correction formulas for misclassification on disease from a two-way cross-classification table of disease (yes, no) and exposure (yes, no). Unadjusted and adjusted estimates of treatment effect are compared in terms of odds ratio, response ratio, and response difference. In the two case studies, there was considerable underestimation of treatment effect. Discussion and conclusions The methodology can be applied to different therapeutic areas. Limitations of the methodology, such as when adjusted cell estimates become negative, are highlighted. The role of anchor-based methodology is discussed for obtaining estimates of sensitivity and specificity on responder classification. Correction for treatment effect bias from misclassification of responder status on PRO measures can lead to more trustworthy interpretation and effective decision-making. Clinicaltrials.gov: NCT00343200

Surgery for urinary incontinence is indicated after failure of conservative treatment with pelvic floor therapy. Different sling systems are the established treatment option for urinary incontinence for female and male patients. Tension-free vaginal tapes represent the standard of care in the surgical treatment of female stress urinary incontinence. In male patients with mild or moderate stress urinary incontinence, fixed repositioning slings or adjustable compressive slings represent minimally invasive alternatives to the artificial urinary sphincter. The use of surgical mesh material has been widely discussed within the last years. The current US Food and Drug Administration warning was focused on the use of transvaginal mesh implants in female patients with pelvic organ prolapse. Within the current debate, surgery for stress urinary incontinence and surgery for pelvic organ prolapse have often not been differentiated. With this ongoing discussion about the use of foreign material in reconstructive surgery, laparoscopic colposuspension might be performed more often in the near future.

Our study aimed to assess the methodological strengths and weaknesses of erectile dysfunction clinical practice guidelines (CPGs) for individuals using the AGREE II tool. Erectile dysfunction related CPGs were identified from three databases: the National Guideline Clearinghouse, the Guidelines International Network, and PubMed between 2000 and 2020. We designed an independent assessment for each of the erectile dysfunction related CPGs using the AGREE II tool. Four appraisers performed these assessments. The literature search identified 8 CPGs that met our inclusion criteria. The evaluation of the AGREE II domains of each individual revealed that the median scores of domains related to applicability were quite low (39%). Also, the median scores of domains related to the rigour of development and the stakeholder involvement were relatively low (53% and 63%). We determined the highest median scores in three AGREE II domains: clarity of presentation (80.5%), editorial independence (77%), and scope and purpose (89.5%). We found that the European Association of Urology (EAU), the American Urological Association (AUA), and the British Society for Sexual Medicine (BSSM) guidelines had >60% in >4 domains and that their average AGREE II scores were over 70%. In the Canadian Diabetic Association (CDA) and the Japanese Society for Sexual Medicine (JSSM) guidelines, we found that >4 domains were >60%, but their average AGREE II scores were below 70%. The British Medical Journal (BMJ), the Canadian Urologic Association (CUA), and the Malaysian Urologic Association (MUA) guidelines had >60% in

Background: Many people have sexual dysfunctions for the simple reason that they believe in certain fallacies and mythical ideas.Aim: To assess the opinion of female doctors compared with nonmedical women regarding sexual myths.Patients and Methods: Participants included 822 married women divided into two groups: a medical group including 432 (52.6%) female doctors (not working in the field of sexual medicine) and a nonmedical group including 390 (47.4%) women. The tool was a self-report questionnaire to assess opinions about eight sexual myths in addition to demographic data.Results: Most nonmedical women believed in seven of the eight myths, whereas most female doctors believed in only two myths. Age of women, their residence, and their educational level were determining factors in believing sexual myths.Conclusion: Nonmedical women are more liable to believe in sexual myths. The need to spread proper sexual knowledge via sexual education is a dire need.

Die von der Deutschen Krebsgesellschaft (DKG) initiierten onkologischen Zertifizierungen zielen darauf, die Behandlung onkologischer Patienten so zu verbessern, dass sie in jeder Phase ihrer Erkrankung eine Behandlung von hochster Qualitat erfahren. In regelmasigen Audits mussen die zertifizierten Zentren ihre fachliche Eignung und Interdisziplinaritat nachweisen. In Punkt 1.8. des Erhebungsbogens fur die Zertifizierungen werden Qualitatskriterien fur die onkologische Pflege definiert. Aus der fehlenden einheitlichen Definition von „onkologischem Pflegekonzept“ und „onkologischer Pflegeberatung“ ergeben sich Herausforderungen und vielfaltige Interpretationsmoglichkeiten der Vorgaben mit entsprechend heterogenen Ergebnissen. Wichtigste Voraussetzung fur onkologische Pflegekonzepte ist die Ziel- und Zweckklarung, danach ist die methodengeleitete Erstellung anhand der vorgestellten Gliederungspunkte sinnvoll. Auch fur die onkologische Pflegeberatung ist ein strukturiertes Vorgehen vonnoten. Ein wesentliches Ziel ist ein einheitliches Verstandnis von einem onkologischen Pflegekonzept und onkologischer Pflegeberatung. Mit den vorgestellten Methoden befahigen onkologische Pflegekonzepte die Pflegenden, qualitatsorientiert und nicht nur nach Zertifizierungsvorgaben zu agieren. Onkologische Pflegekonzepte sollen eine Chance fur die onkologische Pflege darstellen, ihre Leistungsfahigkeit und den Nutzen fur die Interessengruppen transparent zu machen. Ein moglicher Inhalt ist etwa die onkologische Pflegeberatung. Mit dem antizipierten Fachwissen nehmen onkologischer Fachpflegende eine Schlusselfunktion im multidisziplinaren Team ein. Fur Patienten ist eine strukturierte, individuelle Beratung eine der wirksamsten Unterstutzungsmoglichkeiten fur das Selbstmanagement.

The following article summarizes the current evidence including postoperative success rates and complications for various surgical options in the treatment of urinary incontinence. Due to different inclusion criteria and inconsistent definitions of study endpoints, the analysis of available studies is difficult. Thus, comparative studies with new devices for established treatment options should be planned. Structured processes used in certified continence centers improve the quality of care. Furthermore by documenting relevant complications, comparisons of treatment results thus become possible and provide evidence for the use of different surgical options in the treatment of urinary incontinence.

Premature ejaculation (PE) and poor ejaculatory control are multidimensional sexual symptoms estimated to affect almost one-third of men, severely impairing the overall quality of life of patients and their partners. However, patients who do not completely fulfil the definition criteria for PE rarely receive a diagnosis or adequate treatment, with the risk of subsequent progression from initial, subclinical symptoms to clinically overt PE, frequently with other sexual comorbidities. Thus, the current definitions of PE warrant review, in order to consider and propose a new taxonomy encompassing other unaddressed, crucial clinical aspects of PE. These newly proposed criteria include the recommendation for a primary screening for erectile dysfunction (ED), as PE and ED can be comorbid in up to 50% of patients but have never before been considered as a unified clinical entity. In order to facilitate clinical practice and improve clinical management of men with PE and comorbid conditions, we propose and define the new taxonomic clinical entities of subclinical PE (SPE) and loss of control of erection and ejaculation (LCEE). Application of these diagnoses to men who meet the criteria for SPE and/or LCEE, but not the overt conditions, could improve access to treatment for these patients and reduce progression to the more serious clinical disorder.

Introduction: Infertility is a global public health problem; cost-effective patient-friendly treatment modalities along with psychosexual intervention strategies are essential for infertility control/prevention/management among ethnically disparate populations. Objectives: This study aimed to assess differential in vitro fertilization (IVF) success trends among infertile women of South Indian ethnicity. Materials and Methods: Prospective, observational study designed in a hospital-based setting with active enrollment of infertile women undergoing IVF/intracytoplasmic sperm injection (ICSI) at Indira IVF Center, Chennai, Tamil Nadu, India (April-September 2019); inclusion criteria: age >35 years, South Indian ethnicity, married >1 year, absence of full-term clinical pregnancy, endometrial thickness Results: Mean age and endometrial thickness of study participants were 33.3 years (SD ±1.9) and 8.7 mm (SD ±0.5), respectively; average Body Mass Index (BMI) and anti-müllerian hormone (AMH) levels were 28.4 kg/m2 and 4.7 ng/mL, respectively. Embryos transferred/month: 7 in April/13 in May/24 in June/36 in July/24 in August/30 in September, and pregnancies: 4/8/17/26/20/22 for the months of April, May, June, July, August, and September 2019, respectively. Subgroup stratification demonstrated M-II vs total oocytes retrieved were 76%, 73%, 60%, 71%, 77%, and 77%. Overall IVF success rates were 57% in April/62% in May/71% in June/72% in July/83% in August/73% in September; frozen embryo transfer success was 0 in April-May/67% in June/73% in July/89% in August/100% in September 2019. English/Tamil-speaking infertile women self-reported treatment-related satisfaction rates of 80% to 100%. Conclusion: M-II oocytes’ yield, sociodemographics of infertile women, and increasing age/aberrant AMH/BMI profiles/endometrial receptivity/diminished ovarian reserve are promising predictors of IVF/ICSI success in genetically distinct patient population subset(s). Future multicentric gene epidemiology studies with larger sample size and precision-based psychiatric assessments/interventions are warranted for development of predictive biomarkers in infertility management.

Published literature shows low intensity extracorporeal shock wave therapy (LIESWT) and low intensity pulsed ultrasound (LIPUS) therapy to improve erectile function and penile hemodynamic by inducing neovascularisation and promoting tissue regeneration. Key opinion leaders across the Asia Pacific region attended the recent biennial meeting of the Asia Pacific Society for Sexual Medicine in Australia, and presented the current evidence on LIESWT and LIPUS for erectile dysfunction (ED). The clinical findings were internally discussed, and the quality of evidence was graded based on the Oxford Centre for Evidence- Based Medicine recommendations. Existing literature supports the use of LIESWT and LIPUS in men with ED, with many clinical studies reported encouraging results with improved erectile function, good safety profile and short-term durability. However, controversial exists due to sampling heterogeneity, non-standardised treatment protocol and lack of large multiinstitutional studies. There is a need to better define which subgroup of ED population is best-suited, and specific treatment protocol to optimise shock wave energy delivery. More stringent and larger multi-institutional randomised placebo-controlled trials are warranted before clinical adoption of LIESWT and LIPUS as the new standard of care for men with ED.

Male stress urinary incontinence is predominantly iatrogenic, whereby radical prostatectomy is the most frequent cause. The first-line treatment of postoperative stress urinary incontinence is physiotherapy, in which training of pelvic floor muscles and sphincter play a major role. If conservative treatment fails surgical treatment is recommended. Nowadays, various options are available for the surgical treatment of stress urinary incontinence in men. Therefore, every patient with persistent postoperative urinary incontinence with psychological strain and desire for treatment should be offered surgical treatment. The selection of the surgical method should primarily be made depending on the contraindications.