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Gül M, Fode M, Urkmez A, Capogrosso P, Falcone M, Sarikaya S, Sokolakis I, Morgado A, Morozov A, Albersen M, Russo GI, Serefoglu EC. A clinical guide to rare male sexual disorders. Nat Rev Urol 2024; 21:35-49. [PMID: 37670085 DOI: 10.1038/s41585-023-00803-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 09/07/2023]
Abstract
Conditions referred to as 'male sexual dysfunctions' usually include erectile dysfunction, ejaculatory disorders and male hypogonadism. However, some less common male sexual disorders exist, which are under-recognized and under-treated, leading to considerable morbidity, with adverse effects on individuals' sexual health and relationships. Such conditions include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction, hard-flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction. Information about these disorders usually originates from case-control trials or small case series; thus, the published literature is scarce. As the aetiology of these diseases has not been fully elucidated, the optimal investigational work-up and therapy are not well defined, and the available options cannot, therefore, adequately address patients' sexual problems and implement appropriate treatment. Thus, larger-scale studies - including prospective trials and comprehensive case registries - are crucial to better understand the aetiology, prevalence and clinical characteristics of these conditions. Furthermore, collaborative efforts among researchers, health-care professionals and patient advocacy groups will be essential in order to develop evidence-based guidelines and novel therapeutic approaches that can effectively address these disorders. By advancing our understanding and refining treatment strategies, we can strive towards improving the quality of life and fostering healthier sexual relationships for individuals suffering from these rare sexual disorders.
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Affiliation(s)
- Murat Gül
- Department of Urology, Selcuk University School of Medicine, Urology, Konya, Turkey.
| | - Mikkel Fode
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ahmet Urkmez
- Department of Urology, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Paolo Capogrosso
- Department of Urology, ASST Sette Laghi, Circolo and Fondazione Macchi Hospital, Varese, Italy
| | - Marco Falcone
- Department of Urology, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Selcuk Sarikaya
- Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ioannis Sokolakis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Medical School Thessaloniki,Greece, Thessaloniki, Greece
| | - Afonso Morgado
- Department of Urology, Centro Hospitalar São João, Porto, Portugal
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Giorgio Ivan Russo
- Urology section, Department of Surgery, University of Catania, Catania, Italy
| | - Ege Can Serefoglu
- Department of Urology, Biruni University, School of Medicine, Istanbul, Turkey
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Xi GP, Yang RX, Zhang J, Ma YM, Zhong XY. Clinical characteristics, allergic response to autologous semen, and desensitization in patients with postorgasmic illness syndrome. Sex Med 2023; 11:qfad068. [PMID: 38239929 PMCID: PMC10795926 DOI: 10.1093/sexmed/qfad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/17/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Postorgasmic illness syndrome (POIS) is rare and includes a cluster of physical and cognitive symptoms that occur after ejaculation. The pathogenesis and effective treatments remain unclear. Aim This study aimed to characterize the symptomatology of POIS, study the allergic response of autologous semen in patients and controls, and evaluate the effects of desensitization therapy. Methods The clinical characteristics of 24 Chinese patients with POIS were analyzed. Skin prick tests, intracutaneous tests, and specific IgE detection were performed with autologous semen. Five patients were desensitized via subcutaneous injections of autologous semen. Outcomes Evaluated outcomes included the clinical features of POIS; scores of the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and visual analog scale (VAS) of symptoms; skin reactions; desensitization with diluted autologous seminal fluid; and the IgE reactivity patterns of immunoblotting and enzyme-linked immunosorbent assay in vitro. Results The most common symptom cluster was the general cluster, and the most prevalent symptoms were extreme fatigue and inattention. A total of 66.67% (14/21) of the patients had no symptoms or milder symptoms after nocturnal emission than after intercourse or masturbation. Of the patients, 87.5% (21/24) had psychiatric symptoms and 53.85% (7/13) had abnormal sex hormone levels. The SAS and SDS scores of the high and low VAS groups were significantly higher than those of the control group. Pearson analysis showed that the correlation coefficient between the SAS and VAS was 0.607 (P < .01) and that between the SDS and VAS was 0.490 (P < .05). The patients and healthy donors all had positive intracutaneous test results with their own semen, negative skin prick test results, and no IgE specific to autologous semen. Most patients (4/5) did not achieve ideal therapeutic effects with desensitization. Clinical Implications Allergy is not the main pathogenesis of POIS, and desensitization with autologous semen is not effective for most patients. Strengths and Limitations This project included the largest number of patients with POIS in China and assessed the allergic response to autologous semen and the effect of desensitization therapy. There is no objective method for evaluating the efficacy of desensitization with autologous semen. Conclusions IgE-mediated semen allergy is not the main pathogenesis of POIS, and there is a positive chance that POIS is related to psychological factors. Most patients do not respond to desensitization with autologous semen, and POIS treatment should be individualized, especially in cases with uncertain causes.
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Affiliation(s)
- Guang-Peng Xi
- Department of Allergy, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Ruo-Xuan Yang
- Department of Pharmacology, College of Pharmacy, Harbin Medical University, Harbin, 157131, China
| | - Jing Zhang
- Department of Allergy, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Yue-Mei Ma
- Department of Allergy, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Xiao-Yan Zhong
- Department of Microbiology, College of Basic Medicine, Harbin Medical University, Harbin, 157131, China
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Ismail AMA. Complementary role of Benson's relaxation technique in post orgasmic illness syndrome. Aging Male 2023; 26:2174511. [PMID: 36724808 DOI: 10.1080/13685538.2023.2174511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Ali Mohamed Ali Ismail
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Chea M, Teng M, Chesnel C, Lagnau P, Amarenco G, Hentzen C. Postorgasmic illness syndrome: one or several entities? A retrospective cohort study. J Sex Med 2023; 20:1407-1413. [PMID: 37872743 DOI: 10.1093/jsxmed/qdad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Postorgasmic illness syndrome (POIS) is a rare syndrome in which patients experience various physical and cognitive symptoms after ejaculation, and its pathophysiology remains unknown. AIM The aim of this study was to characterize the clinical presentations, disease course, and treatment outcomes in outpatients, as well as to examine the validity of the preliminary criteria and symptom clusters of POIS. METHODS This retrospective monocentric study was conducted in a neurourology department, with patients included from 2010 to 2023. The diagnostic criteria and symptom cluster descriptions were based on previous studies. OUTCOMES The study focused on the clinical features of POIS, the complementary tests performed, the treatments tried, and their effectiveness. RESULTS Thirty-seven men were included in the study, with symptom onset occurring at a mean ± SD age of 23.6 ± 7.4 years. The mean time from ejaculation to symptom onset was 1 hour 22 minutes ± 3 hours 42 minutes. The mean duration of symptoms was 4.7 ± 3.4 days. Seventeen patients (46%) developed the symptoms primarily, whereas in 20 (54%) they appeared secondarily. All preliminary criteria were met in 19 patients (51%). The most common symptom clusters were "general" in all 37 patients (100%; eg, asthenia and concentration difficulties) and "head" in 35 patients (95%; mostly headache and a foggy feeling). In terms of treatments, antihistamines and nonsteroidal anti-inflammatory drugs were tried and partially improved symptoms for some patients. CLINICAL IMPLICATIONS This study helps to further characterize POIS by specifying the most frequent symptoms and comparing them with the initial criteria. STRENGTHS AND LIMITATIONS To our knowledge, this is one of the largest cohorts of patients consulting for symptoms suggestive of POIS. There are limitations due to the retrospective nature of the data collection, such as missing data and imprecision of treatment efficacy. CONCLUSION The majority of participants met at least 3 of the preliminary diagnostic criteria, with a majority of symptoms in the general and head clusters. However, the determination of predictive factors for treatment response based on the typology of the disorders remains to be established.
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Affiliation(s)
- Maryane Chea
- GRC-01 GREEN Group of Clinical Research in Neurourology, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Maëlys Teng
- GRC-01 GREEN Group of Clinical Research in Neurourology, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Camille Chesnel
- GRC-01 GREEN Group of Clinical Research in Neurourology, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Philippe Lagnau
- GRC-01 GREEN Group of Clinical Research in Neurourology, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Gérard Amarenco
- GRC-01 GREEN Group of Clinical Research in Neurourology, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Claire Hentzen
- GRC-01 GREEN Group of Clinical Research in Neurourology, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
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Duran MB, Rubin RS, Reisman Y, Serefoglu EC. Recognition and practice patterns of sexual medicine experts towards postorgasmic illness syndrome. Int J Impot Res 2023:10.1038/s41443-023-00753-x. [PMID: 37604984 DOI: 10.1038/s41443-023-00753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
Post-orgasmic illness syndrome (POIS) is a rare, but debilitating cluster of symptoms, occurring after ejaculation with unknown mechanism and uncertain treatment. To the best of our knowledge, this study, which is thought to be the first in the literature, is aimed to investigate the practice patterns of sexual medicine experts towards POIS. Worldwide sexual medicine experts were invited to participate anonymously in an online, open survey using SurveyMonkey between November 14, 2022, and January 15, 2023. In total 211 sexual medicine experts filled the survey. The majority of the participants were urologists (83.9%). Most participants stated that the available information about POIS was inadequate for both patients and physicians. 47.9% of the participants stated psychological disorder, 46.4% stated bio-psycho-social reasons for the responsibility for the pathophysiology of POIS. 56.4% of the participants stated that they would refer the patient for psychotherapy/sexual therapy to a sexologist, 41.7% would prefer antihistamine drugs to manage symptoms. Only 18% of participants reported symptom improvement in more than 30% of the patients. This survey study among sexual medicine experts from different parts of the world has developed representative estimates of knowledge, attitudes and practice patterns regarding POIS worldwide.
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Affiliation(s)
- Mesut Berkan Duran
- Department of Urology, Pamukkale University, School of Medicine, Denizli, Turkey
| | - Rachel S Rubin
- Department of Urology, Georgetown University, Georgetown, Washington, DC, 20007, USA
| | - Yacov Reisman
- Reuth Rehabilitation Hospital, Tel-Aviv, Israel
- Flare-Health, Amstelveen, The Netherlands
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey.
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Zizzo J, F Sávio L, Ramasamy R, F N Lima T. Postorgasmic Illness Syndrome: An Update. Eur Urol Focus 2023; 9:22-24. [PMID: 36283946 DOI: 10.1016/j.euf.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022]
Abstract
Postorgasmic illness syndrome (POIS) is a rare condition affecting men who experience a cluster of flu-like and allergic symptoms after ejaculation. POIS can occur after intercourse, masturbation, or spontaneous ejaculation, and may persist for up to 7 d. Recurrent symptoms often negatively impact quality of life and sexual activity, leaving those affected with mental sequelae, diminished concentration, and mood changes. While it has been shown that various treatment options can alleviate symptoms in the short term, acute management remains controversial. In addition, follow-up data are severely lacking, resulting in the absence of established long-term management options for men suffering from POIS. This review highlights hallmark studies and the current state and promising developments surrounding clinical approaches to POIS. PATIENT SUMMARY: In this review, we discuss what is known about postorgasmic illness syndrome (POIS), a disease that causes flu-like symptoms in some men after ejaculation. Little research has been on POIS, so its causes, diagnosis, and appropriate treatments are poorly understood.
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Affiliation(s)
- John Zizzo
- Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Luís F Sávio
- Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Thiago F N Lima
- Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Hamdi G, Ben Ammar H, Charaa O, Brahmi L, Maamri A, Zalila H. The first Tunisian case of postorgasmic illness syndrome: A case report. Clin Case Rep 2021; 9:e05120. [PMID: 34824857 PMCID: PMC8605164 DOI: 10.1002/ccr3.5120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 11/11/2022] Open
Abstract
Postorgasmic illness syndrome (POIS) is a rare and singular syndrome. About fifty cases have been reported in the medical literature. Through a clinical observation, we illustrate the first case diagnosed in Tunisia and the difficulties in the etiological diagnosis and the therapeutic management of this syndrome. Given the shortage of cases reported in the literature, the syndrome of POIS remains poorly identified and subsequently misdiagnosed. The clinical diagnosis is relatively simple, yet etiological and therapeutic questions remain to overcome.
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Affiliation(s)
- Ghada Hamdi
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
| | - Hanen Ben Ammar
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
| | - Oumaima Charaa
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
| | - Lina Brahmi
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
| | - Amira Maamri
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
| | - Haifa Zalila
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
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Sonkodi B, Kopa Z, Nyirády P. Post Orgasmic Illness Syndrome (POIS) and Delayed Onset Muscle Soreness (DOMS): Do They Have Anything in Common? Cells 2021; 10:cells10081867. [PMID: 34440637 PMCID: PMC8392034 DOI: 10.3390/cells10081867] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022] Open
Abstract
Post orgasmic illness syndrome is a rare, mysterious condition with an unknown pathomechanism and uncertain treatment. The symptoms of post orgasmic illness syndrome last about 2–7 days after an ejaculation. The current hypothesis proposes that the primary injury in post orgasmic illness syndrome is an acute compression proprioceptive axonopathy in the muscle spindle, as is suspected in delayed onset muscle soreness. The terminal arbor degeneration-like lesion of delayed onset muscle soreness is theorized to be an acute stress response energy-depleted dysfunctional mitochondria-induced impairment of Piezo2 channels and glutamate vesicular release. The recurring symptoms of post orgasmic illness syndrome after each ejaculation are suggested to be analogous to the repeated bout effect of delayed onset muscle soreness. However, there are differences in the pathomechanism, mostly attributed to the extent of secondary tissue damage and to the extent of spermidine depletion. The spermidine depletion-induced differences are as follows: modulation of the acute stress response, flu-like symptoms, opioid-like withdrawal and enhanced deregulation of the autonomic nervous system. The longitudinal dimension of delayed onset muscle soreness, in the form of post orgasmic illness syndrome and the repeated bout effect, have cognitive and memory consequences, since the primary injury is learning and memory-related.
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Affiliation(s)
- Balázs Sonkodi
- Department of Health Sciences and Sport Medicine, University of Physical Education, 1123 Budapest, Hungary
- Correspondence:
| | - Zsolt Kopa
- Department of Urology, Semmelweis University, 1082 Budapest, Hungary; (Z.K.); (P.N.)
| | - Péter Nyirády
- Department of Urology, Semmelweis University, 1082 Budapest, Hungary; (Z.K.); (P.N.)
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Natale C, Gabrielson A, Tue Nguyen HM, Dick B, Hellstrom WJG. Analysis of the Symptomatology, Disease Course, and Treatment of Postorgasmic Illness Syndrome in a Large Sample. J Sex Med 2020; 17:2229-2235. [PMID: 33008782 DOI: 10.1016/j.jsxm.2020.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postorgasmic illness syndrome (POIS) is a rare syndrome of unknown etiology where patients experience distressing physical and psychological after ejaculatory sequelae. AIM To better characterize the epidemiology, symptomatology, disease course, and treatment of POIS, with specific interest placed on examining relationships between disease presentation and measures of disease burden. METHODS A 30-item questionnaire was distributed to an online community of patients with POIS from June 2019 to January 2020. We assessed diagnostic criteria and clusters of symptomatology described in prior studies. Outcome measures include self-reported measures of symptom severity, disease burden, and behavioral changes. Statistical correlations were assessed with Pearson's chi-squared (χ2) and ordinal regression analyses. OUTCOMES The main outcome measures of this study are self-reported measures of symptom severity, disease burden, and behavioral changes. RESULTS The sample consisted of 302 men (mean age: 32.6 ± 11.4 years, mean age of onset: 19.1 ± 7.8 years) with 89% satisfying ≥3 diagnostic criteria. Common symptoms were difficulty concentrating (254, 84%), extreme fatigue (250, 83%), irritability (225, 74%), and muscle weakness (212, 70%). Common symptom clusters were general (219, 72%), muscle (137, 45%), and head (93, 31%). Common behavioral modifications were avoiding masturbation (215, 71%), schedule changes (213, 71%), and abstinence (186, 62%). Head and throat symptom clusters demonstrated worse disease burden outcomes. Professional medical advice was sought by 51% of participants. Attempted treatments included pharmacotherapy, vitamins, supplements, and herbs with variable efficacy. CLINICAL IMPLICATIONS This study further characterizes POIS, including how patients respond to the condition, how it is treated in the community, and presentations that may be associated with more severe disease. STRENGTHS & LIMITATIONS This is the largest study to date that concerns patients suffering from POIS and includes a diverse, global population. Limitations include that the survey was only administered in English and within 1 online community, that results were self-reported, and that the response rate was low (32%). CONCLUSIONS Characterizing symptom cluster, but not number of diagnostic criteria, may offer prognostic value, and investigation to elucidate pathophysiology and potential treatments for POIS is necessary. Natale C, Gabrielson A, Tue Nguyen HM, et al. Analysis of the Symptomatology, Disease Course, and Treatment of Postorgasmic Illness Syndrome in a Large Sample. J Sex Med 2020;17:2229-2235.
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Affiliation(s)
- Caleb Natale
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Andrew Gabrielson
- Johns Hopkins School of Medicine, James Buchanan Brady Urological Institute, Baltimore, MD, USA
| | | | - Brian Dick
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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