Levels and drivers of burnout during the COVID-19 pandemic among a diverse group of resident physicians.

Objectives: Evidence has shown significant impacts of the COVID-19 pandemic on physicians. We hypothesized that these effects would impact surgical and non-surgical resident education differently, with non-surgical specialties being more heavily impacted by frontline work and surgical specialties losing elective cases.

Methods: We examined well-being and burnout among resident physicians in surgical and non-surgical specialties during the peak of the COVID-19 pandemic using the Mayo Physician Well-Being Index (WBI).

Dissecting the role of radical cystectomy and urinary diversion in post-operative complications: an analysis using the American College of Surgeons national surgical quality improvement program database.

Objective: To characterize the contribution of the extirpative and reconstructive portions of radical cystectomy (RC) to complications rates, and assess differences between urinary diversion (UD) types.

Materials And Methods: We conducted a retrospective cohort study comparing patients undergoing UD alone or RC+UD for bladder cancer from 2006 to 2017 using ACS National Surgical Quality Improvement Program database. The primary outcome was major complications, while secondary outcomes included minor complications and prolonged length of stay.

Innovative Approaches to Battling Resident Burnout in a Urology Residency Program.

Introduction: Data suggest many U.S. physicians experience burnout, affecting up to 65% of U.

Penile vascular abnormalities in young men with persistent side effects after finasteride use for the treatment of androgenic alopecia.

Background: The constellation of persistent sexual, neurological, and physical adverse effects in patients who discontinue 5α-reductase inhibitors (5ARIs) has garnered recent concern. The objective of this study was to evaluate potential penile vascular changes and persistent adverse effects of 5ARIs in men treated for androgenic alopecia (AGA).

Methods: This was a prospective case-control study with 25 subjects with a history of 5ARI use for AGA and 28 controls.

Pioglitazone's beneficial effects on erectile function preservation after cavernosal nerve injury in the rat are negated by inhibition of the insulin-like growth factor-1 receptor: a preclinical study.

To determine if the insulin-like growth factor-1 (IGF-1) pathway is involved in the improvement in erectile function recovery in rats after nerve crush injury treated with pioglitazone (Pio). Sprague-Dawley rats were divided into four groups. The first group received sham operation (n = 5).

Effect of collagenase Clostridium histolyticum on penile vascular and morphological parameters in patients with Peyronie's disease.

Background: To examine the changes in penile vascular parameters after the administration of collagenase Clostridium histolyticum (CCH) in patients with Peyronie's disease (PD).

Methods: We retrospectively reviewed the records for all patients treated with CCH for PD between 04/2014 and 05/2017 who underwent penile duplex Doppler ultrasound (PDDU) after pharmacologically induced erection both before and after four cycles of CCH treatment. The primary outcomes measured were changes in peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) after CCH treatment.

Racial variations in response to intralesional collagenase clostridium histolyticum in men with Peyronie's disease.

Background: An examination of potential racial variations between Caucasian American (CA) and African American (AA) men in the efficacy and safety of collagenase clostridium histolyticum (CCH) in the treatment of Peyronie's disease (PD).

Methods: We retrospectively reviewed the records for all patients treated with CCH for PD between 04/2014 and 05/2017. Patients were divided into two groups based on their self-reported race.

Safety and Efficacy of Collagenase Clostridium histolyticum in the Treatment of Acute-Phase Peyronie's Disease.

Background: Peyronie's disease (PD), defined as the abnormal formation of fibrous plaque(s) in the tunica albuginea of the penis, is a chronic condition that afflicts 3% to 13% of the US male population; there is no current research on the efficacy and safety of collagenase Clostridium histolyticum (CCH) in the treatment of acute phase PD.

Aim: To examine the efficacy and safety of CCH in the treatment of acute-phase PD.

Methods: We retrospectively reviewed the records for all patients treated with CCH for PD from April 2014 through April 2017.

Testosterone deficiency in adults and corresponding treatment patterns across the globe.

The global prevalence of testosterone deficiency (TD) ranges from 10-40%. The actual diagnosis of TD is controversial, as a wide range of total testosterone (TT) thresholds are used for diagnosis (200-400 ng/dL), and physicians differ in their emphasis placed on clinical symptoms. There are also significant global differences in the prescription patterns of testosterone replacement therapy (TRT).

Practice Patterns in the Diagnosis and Management of Hypogonadism: A Survey of Sexual Medicine Society of North America Members.

Objective: To describe practice patterns in the diagnosis and treatment of hypogonadism, as the optimal approaches are controversial. Multiple therapeutic options are currently available for hypogonadal men and treatment patterns vary considerably. The safety of testosterone therapy (TTh) remains understudied.

Collagenase in the treatment of Peyronie's disease: patient selection and perspectives.

The safety and efficacy of the use of collagenase (CCH) for the treatment of Peyronie's disease has been confirmed over the past several years. However, identification of the ideal patient population for use of this treatment is not well established. Multiple studies have attempted to delineate various patient-specific factors that may predict response to treatment with CCH, with the intent of enhancing patient selection.

Testosterone Replacement Therapy and Components of the Metabolic Syndrome.

Introduction: The prevalence of metabolic syndrome (MetS) is rapidly increasing in the United States and, because of its strong association with male hypogonadism, has become a significant topic of interest in the sexual medicine community. At the center of this conversation is the efficacy and safety of testosterone replacement therapy (TRT) as a therapeutic option for HG and MetS.

Aim: To provide a review of the current literature pertaining to TRT and MetS.

Current Perspectives on Stem Cell Therapy for Erectile Dysfunction.

Introduction: Erectile dysfunction (ED) is a common sexual disorder that affects the lives of millions of male patients and their partners. Various medical and surgical therapies exist, with the most common being oral intake of phosphodiesterase 5 inhibitors. One therapeutic strategy in preclinical development to treat ED is stem cell transplantation.

Left Atrial Enlargement on Transthoracic Echocardiography Predicts Left Atrial Thrombus on Transesophageal Echocardiography in Ischemic Stroke Patients.

Transesophageal echocardiogram (TEE) is superior to transthoracic echocardiogram (TTE) in detecting left atrial thrombus (LAT), a risk factor for stroke, but is costly and invasive, carrying a higher risk for complications. To determine the utility of using left atrial enlargement (LAE) on TTE to predict LAT on TEE. AIS patients who presented in 06/2008-7/2013 and underwent both TTE and TEE were identified from our prospective stroke registry.

Impact of Number of Cycles of Collagenase Clostridium Histolyticum on Outcomes in Patients With Peyronie's Disease.

Objective: To analyze the impact of the number of cycles of collagenase Clostridium histolyticum (CCH) intralesional injection therapy on outcomes to further characterize CCH therapy.

Methods: We conducted a retrospective review of the records of all patients treated with CCH for Peyronie disease between April 2014 and March 2016. Collected variables included demographics, pre- and posttreatment sexual function, penile curvature, penile vascular findings, and treatment outcomes.

Collagenase Clostridium Histolyticum for the Treatment of Peyronie's Disease: A 'Real World' Clinical Perspective.

The introduction of collagenase Clostridium histolyticum (CCH) as a treatment option for Peyronie's disease (PD), defined as the abnormal formation of collagen on the tunica albuginea of the penis, has provided patients with a promising new conservative therapy. Studies have shown that CCH improves curvature by an average of 17°, and although patient and sexual partner satisfaction is high, the improvement has arguable clinical implications. Similarly, the efficacy and cost of CCH contrasts strongly with more invasive surgical management, and is further limited by rare, but serious, complications and several contraindications.

Surgery is not indicated for the treatment of premature ejaculation.

Premature ejaculation (PE) is considered the most common male sexual disorder, affecting up to 75% of men at some point in their lives. While medical management is the mainstay of therapy, surgical options such as dorsal nerve neurectomy (DNN), hyaluronic acid (HA) gel glans penis augmentation, and circumcision have been studied as alternative forms of treatment. Preliminary studies have suggested that DNN and HA gel glans penis augmentation are relatively safe and effective, but due to a lack of large, multicenter, randomized-control trials with long-term follow-up, the International Society of Sexual Medicine (ISSM) has been unable to endorse DNN or HA gel glans penis augmentation as options in the treatment of PE.

Clinical use of alprostadil topical cream in patients with erectile dysfunction: a review.

Erectile dysfunction (ED) is a common and debilitating disorder seen in over 50% of men older than 70 years. Oral phosphodiesterase type 5 (PDE5) inhibitors are the mainstay of treatment for ED, but cannot be used by a significant subset of patients due to systemic side effects and drug-drug interactions. Second-line therapy may include intracavernosal therapies, but are associated with poor compliance due to their invasive nature.

Intravenous Tissue Plasminogen Activator for Wake-Up Stroke: A Propensity Score-Matched Analysis.

Goal: To evaluate the safety and efficacy of intravenous (IV) tissue plasminogen activator (tPA) in the treatment of wake-up stroke (WUS) using propensity score (PS) analysis.

Materials And Methods: Consecutive acute ischemic stroke patients meeting inclusion criteria were retrospectively identified from our stroke registry between July 2008 and May 2014, and classified as stroke onset less than or equal to 4.5 hours treated with tPA (control; n = 369), tPA-treated WUS (n = 46), or nontreated WUS (n = 154).

Avanafil for the treatment of erectile dysfunction.

Introduction: Erectile dysfunction (ED) affects millions of men worldwide, and the incidence of ED will continue to increase as the aging population grows. The first generation of phosphodiesterase-5 (PDE5) inhibitors, the mainstay of oral ED therapy, has revolutionized the treatment of this condition, but not without some drawbacks. Avanafil, the only United States and European Union-approved second-generation PDE5 inhibitor, is a safe and efficacious alternative to its predecessors.

A review of surgical strategies for penile prosthesis implantation in patients with Peyronie's disease.

The introduction of the inflatable penile prosthesis (IPP) has revolutionized the treatment of patients with both Peyronie's disease (PD) and erectile dysfunction (ED). A thorough literature review was performed in order to review the surgical strategies used to treat PD, using the PubMed online database with the keywords "penile prosthesis", "surgical management" and "Peyronie's disease". Patient satisfaction rates of 72-100% and partner satisfaction rates of 89% have been reported in the literature, although strong preoperative education may be needed to prepare patients for risks such as penile shortening, seen in up to 54% of patients.

Results of SMSNA Survey Regarding Complications Following Intralesional Injection Therapy With Collagenase Clostridium Histolyticum for Peyronie's Disease.

Introduction: Intralesional injection of collagenase clostridium histolyticum (CCH) for Peyronie's disease (PD) can result in serious adverse events such as hematoma formation and corporal rupture.

Aim: To investigate the prevalence of complications from CCH and management trends among CCH prescribers.

Methods: A survey was sent to all 693 members of the Sexual Medicine Society of North America (SMSNA) with valid email addresses.

Outcomes of Surgical Management of Men With Peyronie's Disease With Hourglass Deformity.

Objective: To investigate the outcomes of two surgical interventions for Peyronie's disease (PD) with hourglass deformity: partial excision and grafting (PEG) or inflatable penile prosthesis (IPP) implantation.

Materials And Methods: Retrospective data were collected from two centers: Technical University of Munich (PEG) and Tulane University Medical Center (IPP). Collected variables included patient demographics, sexual function, penile vascular measurements, and treatment outcomes.