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Depression and sleep problems are highly prevalent disorders that are often comorbid with other medical disorders. We evaluated the prevalence and associations of these conditions in patients presenting to a Men’s Health clinic. In this retrospective study, 124 patients presenting to a Men’s Health clinic completed three urological questionnaires (International Index of Erectile Function [IIEF-5], International Prostate Symptom Score [IPSS], and Androgen Deficiency in Aging Males [ADAM]); and four non-urological questionnaires (Patient Health Questionnaire for depression [PHQ-9], STOP-BANG Sleep Apnea [OSA STOP-BANG], Insomnia Severity Index [ISI], and Epworth Sleepiness Scale [ESS]). Questionnaire results were evaluated in conjunction with patient clinical history and associated laboratory values via univariate and multivariate analysis. The mean age of the study participants was 54.1 years (SD 16). Comorbidities included hypertension (22.5%), vascular disease (15%), and diabetes mellitus (13.3%). Body Mass Index (BMI) was >25 in 77.3%. IIEF-5 scores were moderate-severe in 47.9%, ADAM questionnaire was positive in 79%, and IPSS scores were moderate-severe in 42.9% of patients. PHQ-9 demonstrated mild-severe depression in 38.6%, STOP-BANG showed intermediate-high risk for sleep apnea in 55.2%, ISI indicated moderate-severe insomnia in 18.1%, and ESS revealed mild-severe sleepiness in 16.6% of participants. On univariate analysis, BMI was associated with scores on the PHQ-9 (p = 0.035), STOP-BANG (p

We compared the effectiveness of targeted prophylaxis to augmented empirical prophylaxis and single agent empirical prophylaxis to prevent sepsis after transrectal prostate biopsy.We retrospectively reviewed the records of transrectal prostate biopsies performed during 3 years at 13 Southern California Kaiser Permanente® departments of urology. Targeted prophylaxis was guided by rectal culture bacterial susceptibility for use of a single prophylactic antibiotic while for empirical prophylaxis 1 antibiotic (single agent empirical prophylaxis) or multiple antibiotics (augmented empirical prophylaxis) were given according to the usual practice of the urologist. Sepsis was the primary outcome analyzed.We reviewed 15,236 transrectal prostate biopsy cases. Targeted prophylaxis, single agent empirical prophylaxis and augmented empirical prophylaxis were administered in 26%, 58% and 16% of cases, respectively. The overall incidence of post-biopsy sepsis was 0.64%. On multivariable analysis there was no significant difference in the rate of post-biopsy sepsis after targeted prophylaxis compared to empirical prophylaxis (single agent and augmented empirical prophylaxis together) (OR 0.86, 95% CI 0.53-1.41, p = 0.561). However, on subanalysis augmented empirical prophylaxis showed a significantly lower incidence of sepsis than single agent empirical or targeted prophylaxis (OR 0.35, 95% CI 0.16-0.76, p = 0.008). Based on blood and urine cultures 38% of the patients with sepsis after transrectal prostate biopsy had been given the correct prophylactic antibiotic prior to biopsy. On multivariable analysis Asian/Pacific Islander or Hispanic/Latino ethnicity was associated with a higher incidence of harboring fluoroquinolone resistant bacteria on rectal swab cultures.This large retrospective study showed that augmented empirical prophylaxis was statistically superior to single agent empirical and targeted prophylaxis. Sepsis developed in a significant number of patients despite being given a prophylactic antibiotic to which the sepsis causing bacteria were sensitive.

Here we propose an efficient diode-end-pumped actively Q-switched 1176-nm Nd:YAG/Nd:YVO

PURPOSE Although penile duplex Doppler ultrasonography (PDDU) is a common and integral procedure in a Peyronie's disease workup, the intracavernosal injection of vasoactive agents can carry a serious risk of priapism. Risk factors include young age, good baseline erectile function, and no coronary artery disease. In addition, patients with Peyronie's disease undergoing PDDU in an outpatient setting are at increased risk given the inability to predict optimal dosing. The present study was conducted to provide support for a standard protocol of early administration of phenylephrine in patients with a sustained erection after diagnostic intracavernosal injection of vasoactive agents to prevent the deleterious effects of iatrogenic priapism. MATERIALS AND METHODS This was a retrospective review of Peyronie's disease patients who received phenylephrine reversal after intracavernosal alprostadil (prostaglandin E1) administration to look at the priapism rate. Safety was determined on the basis of adverse events reported by subjects and efficacy was determined on the basis of the rate of priapism following intervention. RESULTS Patients with Peyronie's disease only had better hemodynamic values on PDDU than did patients with Peyronie's disease and erectile dysfunction. All of the patients receiving prophylactic phenylephrine had complete detumescence of erections without adverse events, including no priapism cases. CONCLUSIONS The reversal of erections with phenylephrine after intracavernosal injections of alprostadil to prevent iatrogenic priapism can be effective without increased adverse effects.

Peyronie’s disease (PD) is postulated to be a disorder of penile wound healing, resulting in fibrosis of the tunica albuginea and plaque formation. It can lead to penile deformity, discomfort, and curvature prohibiting sexual intercourse. The disease has two phases.

We report herein the enhancement of output power and optical efficiency of a quasi-three-level Nd:YVO₄ laser through a double-end polarized pumping scheme, which improves the usually insufficient pump absorption of the short laser gain medium with low doping concentration, and meanwhile alleviates the influence of thermal effect. 17.7 W laser output at 914 nm is obtained under the launched 808-nm pump of 53.0 W, corresponding to an optical efficiency of 33.4%.

Two catalysts that consist of cobalt-bismuth complex oxides were prepared by different methods. These two catalysts, which exhibited different catalytic properties for wet oxidation of acetic acid, were investigated by XRD, TEM, ESR and XPS, and the interaction between Co and Bi was studied. It has been found that this kind of interaction was reinforced due to a close contact of the nanometer-sized Bi2O3 with Co3O4 and the catalytic activity of Co-Bi catalyst was greatly improved by this kind of interaction. The mechanism of the wet oxidation of acetic acid over Co-Bi catalyst is also discussed in this paper.

We report herein an efficient eye-safe Raman laser, which is based upon Nd:YVO₄₋YVO₄ and in-band pumped by a wavelength-locked laser diode array at 878.6 nm. By virtue of mitigated thermal load and improved pump absorption, a maximum average output power of 5.2 W at 1525 nm is obtained under the incident pump power of 30.6 W with the pulse repetition frequency of 140 kHz, corresponding to an optical efficiency of 17.0%.

A multisegmented Nd:YVO4 laser operating at 1342 nm that is in-band pumped by a wavelength-locked 878.6 nm laser diode is reported here. We achieve an output power of 12.45 W at 1342 nm for an absorbed pump power of 35.6 W, corresponding to an optical-to-optical efficiency of 34.9% and a slope efficiency of 36.1%. To the best of our knowledge, it is the highest optical-to-optical efficiency of Nd:YVO4 lasers operating at 1342 nm with an output power more than 10 W.

INTRODUCTION AND OBJECTIVES: The quality of the nerve preservation during nerve-sparing radical prostatectomy is believed to contribute to postoperative erectile function. We report our outcomes of subjective nerve preservation with objective erectile function in patients undergoing bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (RALP). METHODS: A review of bilateral nerve-sparing RALP performed at a single institution from 2004 to June 2011 was performed. Eligibility criteria included complete intraoperative data and a minimum 2 year postoperative follow-up. The quality of each nerve-sparing (NS) procedure was subjectively classified on each side and prospectively recorded as good/total athermal NS (3), fair/partial or thermal NS (2), or poor/limited or excessive thermal NS (1). Patients were stratified by their combined score of each side (range 2-6). All patients were followed for a minimum of 24 months for assessment of erectile function. The primary outcome measure of potency was maintenance of an erection sufficient for penetration during vaginal intercourse. 95% confidence intervals were calculated, comparison of proportions was performed, and one-way ANOVA and Tukey HSD test were used to analyze other key characteristics. RESULTS: During the study period, a total of 240 RALPs met the inclusion critera and were subsequently stratified based on their graded nerve-sparing score. Table 1 summarizes key patient characteristics of each group as well as 24-month potency outcomes. Patients with a nerve-sparing score of 6 had a significantly higher potency rate at 24 months as compared to patients with a score of 2 (p