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Introduction Materials and methods Results Conclusions There is inconsistent data regarding the possible inaccuracies in dynamic penile color Doppler duplex ultrasound (CDDU) measurements in men with penile curvature because of Peyronie's disease (PD). We sought to explore the relationship between the degree of penile curvature and CDDU parameters in men with PD.Comprehensive data from 154 consecutive men presenting with PD as their primary complaint at a single academic center were prospectively collected and analyzed. All men underwent CDDU. Penile curvature was measured using a goniometer at time of maximum erection during CDDU. Patients were grouped based on CDDU parameters into—normal (average peak systolic velocity [PSV] ≥ 35 cm/s and resistance index [RI] ≥ 0.85) and pathological CDDU (average PSV < 35 cm/s and/or RI < 0.85). Descriptive statistics was used to compare the two subcohorts. Linear regression models were fitted to explore the association between the degree of penile curvature and dynamic CDDU parameters.Overall, the median interquartile range (IQR) age was 56 (48−63) years. The median (IQR) PSV and degree of penile curvature were 48.8 cm/s (37.9−58.5) and 40 degrees (30‐60), respectively. At CDDU, the degrees of penile curvature were as follows: 10–30 degrees in 63 (40.9%) men, 30–70 degrees in 70 (45.5%) men, and 70–90 degrees in 21 (13.6%) men, respectively. Of all, 116 (75.3%) patients showed a PSV > 35 cm/s and RI ≥ 0.85. Patients with pathologic vs. normal CDDU parameters did not differ in median (IQR) curvature (32.5° [30°−58.7°] vs. 40° [30°−65°], p = 0.5) or in the distribution across curvature range groups. Linear regression analysis revealed that the degree of penile curvature did not significantly correlate with PSV at CDDU (coefficient: 0.06, p = 0.3).Our study confirms the lack of a significant correlation between the severity of penile curvature and CDDU parameters in men presenting with PD. These findings emerge to be relevant in terms of a more accurate management work‐up for PD patients and hold insightful medicolegal implications and in the real‐life setting. [ABSTRACT FROM AUTHOR]

Background: Daily (once a day [OaD]) tadalafil intake is a valuable option for men favoring spontaneous over scheduled sexual intercourse. Aim: The study sought to assess the rate of and the clinical factors associated with spontaneous, medication-free erectile function (EF) recovery after discontinuation of tadalafil 5 mg OaD in a cohort of young men seeking first medical help for psychogenic erectile dysfunction (ED) as their primary complaint. Methods: Data from 96 consecutive patients <50 years of age seeking first medical help for ED and prescribed tadalafil 5 mg OaD were analyzed. Patients completed the International Index of Erectile Function (IIEF) and underwent baseline penile color Doppler ultrasound. Follow-up involved clinical assessments or phone interviews. Spontaneous medication-free EF recovery was defined as IIEF EF domain score >22 after tadalafil discontinuation, prompting cessation of follow-up. Descriptive statistics compared tadalafil OaD responders and nonresponders. Cox regression hazard models explored the association between baseline characteristics and EF recovery risk post–drug discontinuation. Kaplan-Meier analyses estimated EF recovery probability over time. Outcomes: The primary outcome was EF recovery after discontinuation of tadalafil 5 mg OaD. Results: Overall, median age was 39 (interquartile range [IQR], 32-45) years. Of all, 82 (85.4%) patients achieved EF recovery after tadalafil OaD discontinuation, while 14 (14.6%) patients were identified as nonresponders. Median tadalafil usage time (from beginning to discontinuation) was 3 (IQR, 2-11) months. The most common treatment-emergent adverse event was headache in 9 (9.4%) patients. Nonresponders were older (43 [IQR, 42-45] years vs 38 [IQR, 31-44] years; P = .03), had higher body mass index (25.5 [IQR, 23.4-29.9] kg/m2 vs 23.6 [IQR, 21.8-25.9] kg/m2; P = .04), and reported lower baseline IIEF EF domain scores (12 [IQR, 7-15] vs 15 [IQR, 10-22]; P = .02) than responders. Nonresponders and responders did not differ in terms of baseline ED severity, Charlson comorbidity index, smoking, alcohol consumption, regular physical exercise, and color Doppler ultrasound parameters. Upon Cox regression analysis, younger age (hazard ratio, 0.95; 95% confidence interval, 0.92-0.99; P = .01) was associated to EF recovery, after adjusting for baseline ED severity, body mass index, smoking, and Charlson comorbidity index ≥1. The Kaplan-Meier analysis displays the probability of EF recovery over time, indicating rates of 43%, 60%, and 72% at 3-, 6-, and 12-month follow-up intervals, respectively. Clinical Implications: Tadalafil 5 mg OaD is an effective short-term treatment for psychogenic ED, allowing its discontinuation after achieving a normal medication-free EF. Strengths and Limitations: The main limitations are the limited number of participants and the potential neglect of confounding factors. Conclusion: Almost 1 out of 2 young men with primary psychogenic ED who were prescribed with tadalafil 5 mg OaD recovered spontaneous medication-free EF after 3 months of treatment. Overall, the younger the patient was, the higher the chance there was of spontaneous EF recovery after drug discontinuation. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the distribution of sperm DNA fragmentation (SDF) values and their association with clinical and seminal parameters in idiopathic infertile men. Design, Patients, Measurements: Data from 3224 primary infertile men (belonging to couples having failed to conceive a pregnancy within 12 months) who underwent a thorough diagnostic work‐up were analysed. A SDF value ≥ 30% (according to Sperm Chromatin Structure Assay) was considered pathologic. We excluded: (1) men with genetic abnormalities; (2) men with history of cryptorchidism; (3) men with biochemical hypogonadism; (4) men with clinical varicocele; and (5) men with other possible known aetiological factors. Descriptive statistics and logistic regression analyses were used to describe the whole cohort. Results: Of all, 792 (23%) men with at least one abnormal WHO semen parameter but without any identified aetiologic factor for infertility, were considered as idiopathic infertile men. Of 792, 418 (52.7%) men had SDF ≥30%. Men with pathologic SDF were older (p =.02), had higher Follicle‐stimulating hormone (FSH) (p =.04) but lower total testosterone (p =.03) values than those with SDF <30%. The homoeostatic model assessment index for insulin resistance (HOMA‐IR) was higher in men with SDF ≥30% (p =.01). Idiopathic infertile men with SDF ≥30% presented with lower sperm concentration (p <.001) and lower progressive sperm motility (p <.01) than those with SDF < 30%. Logistic regression analysis revealed that older age (OR: 1.1, p =.02) and higher HOMA‐IR score (OR: 1.8, p =.03) were associated with SDF ≥ 30%, after accounting for FSH and sperm concentration values. Conclusions: Approximately half of infertile men categorized as idiopathic had pathologic SDF values. Idiopathic infertile men with pathologic SDF showed worse clinical, hormonal and semen parameters than those with normal SDF values. These results suggest that including SDF testing could be clinically relevant over the real‐life management work‐up of infertile men. [ABSTRACT FROM AUTHOR]

Background Objectives Materials and methods Results Conclusion The effects of bariatric surgery on testosterone levels in men with obesity and hypogonadism have not been thoroughly explored yet.To investigate the possible effects of bariatric surgery on T levels in obese hypogonadal men by comparing T levels before and after surgery using a comprehensive claims database.The TriNetX US Collaborative Network database was used to identify men ages 18–80 who underwent a bariatric procedure and had a serum T value of < 350 ng/dL prior to surgery. Men who received testosterone therapy before/or after surgery were excluded. We conducted a retrospective self‐matched cohort analysis to examine the difference in serum T levels before and after bariatric surgery. A sub‐analysis was carried out to explore differences between men who reached eugonadal status or maintained low T levels following surgery. Descriptive statistics detailed sociodemographic and clinical characteristics, with continuous and categorical data compared using unpaired t‐tests and chi‐square analysis, respectively. Changes in T levels and body mass index (BMI) before and after surgery were compared using an unpaired t‐test with a < 0.05 set for significance. All analyses were conducted using the TriNetX platform which utilizes both Python and R software.The study analyzed 69 hypogonadal men who underwent bariatric surgery and had T levels assessed before and after the procedure. The mean (standard deviation) pre‐surgery serum T level was 208 ± 79 ng/dL, which post‐surgery increased to 371 ± 164 ng/dL, marking an average increase of 163 ± 164 ng/dL. Likewise, the mean (standard deviation) body mass index decreased from 42.9 ± 9.0 to 38.8 ± 5.7 kg/m2. Post‐surgery, 45% (31 men) achieved eugonadal status, while 55% (38 men) continued to have low T levels. A comparison between the post‐surgery eugonadal cohort and the persistent low T cohort revealed that the former had higher pre‐surgery serum T levels (235 ± 71 ng/dL vs. 184 ± 80.4 ng/dL, p = 0.007), a higher pre‐surgery body mass index (45.5 ± 4.5 kg/m2 vs. 41.1 ± 11.5 kg/m2, p = 0.041), and a significantly greater reduction in body mass index post‐surgery (7.3 ± 7.2 kg/m2 vs. 2.0 ± 12.8 kg/m2, p = 0.04). Notably, the increase in T was significantly higher in the eugonadal cohort compared to the persistent low testosterone cohort (257 ± 143 ng/dL vs. 95 ± 178 ng/dL, p < 0.0001).This study provides evidence of bariatric surgery's positive effect on serum T levels in obese men with baseline low T. Almost one out of two men with low T reached normal T levels after bariatric surgery. As the most comprehensive study to date, it validates and substantiates previous work suggesting that weight loss can improve T levels physiologically. [ABSTRACT FROM AUTHOR]