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Scovell JM, Stovsky M, Partin A, Lotan Y, Baniel J, Dineen M, Hafron J, Manickam K, Pliskin M, Wagner M, Kestranek A, Klein EA. IsoPSA Performance Characteristics are Unaffected by 5-Alpha Reductase Inhibitors or Alpha-Blockers: Results From the IsoPSA Validation Study. Urology 2023:S0090-4295(23)00092-4. [PMID: 36804443 DOI: 10.1016/j.urology.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To. determine the impact of 5-α reductase inhibitors or α-blockers on IsoPSA performance for the detection of actionable prostate cancer. MATERIALS AND METHODS This is a secondary analysis of data from an institutional review board approved, prospective, multicenter(8-sites) study evaluating IsoPSA in men ≥ 50 years of age with a total PSA ≥ 4 ng/mL with planned prostate biopsy who met previously described inclusion and exclusion criteria. Analytic groups included (i)all subjects, (ii-iii)+/- 5-ARI use, (iv-v)+/- α-blocker use. The performance characteristics of IsoPSA in these groups were assessed by ROC curve, sensitivity, and specificity (SP) analysis. RESULTS A total of 1385 men were recruited with 888 men included in final analysis. Actionable prostate cancer, defined as GG2+, was identified in a total of 316 patients with 40 and 217 patients reporting 5-ARI and α-blocker use respectively. Sensitivity to detect both prostate cancer and actionable cancer was similar between patient subsets (P >.05). SP was similar between patients regardless of 5-ARI(P >.05). Increased SP was noted in patients on α-blockers(GG1+: No-α-blocker: 0.360 vs α-blocker: 0.529, P <.05; GG2+: No-α-blocker: 0.40 vs α-blocker: 0.61, P <.05). ROC analysis demonstrates that IsoPSA performance is unaffected by 5-ARI or α-blocker use for prostate cancer and actionable cancer (GG2+) detection. CONCLUSION The performance of IsoPSA for detecting any prostate cancer and clinically actionable prostate cancer is unaffected by commonly used medications (5-ARI and α-blockers) for symptoms of benign prostatic hyperplasia.
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Affiliation(s)
- Jason M Scovell
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH
| | | | - Alan Partin
- Johns Hopkins James Buchanan Brady Urological Institute, Baltimore, MD
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jack Baniel
- Rabin Medical Center Department of Urology, Petah Tikvah, Israel
| | | | - Jason Hafron
- Michigan Institute of Urology, West Bloomfield, MI
| | | | | | | | | | - Eric A Klein
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH.
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Scovell JM, Hettel D, Abouassaly R, Almassi N, Berglund R, Breaux T, Weight C, Isac W, Zampini A, Stark E, Rochelle R, Kestranek A, Stovsky M, Klein EA. IsoPSA ® Reduces Provider Recommendations for Biopsy and Magnetic Resonance Imaging in Men with Total Prostate Specific Antigen ≥4 ng/ml: A Real-World Observational Clinical Utility Study. Urol Pract 2022; 9:173-180. [PMID: 37145695 DOI: 10.1097/upj.0000000000000291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We assessed the impact of the IsoPSA® test for prostate cancer risk assessment on provider patient management decisions in a real-world clinical setting. METHODS A total of 38 providers, including advanced practice providers, fellowship trained oncologists and general urologists in the Cleveland Clinic health system including both community-based practices and academic locations, enrolled 900 men being evaluated for prostate cancer; 734 met inclusion criteria (age ≥50 years, total serum prostate specific antigen [PSA] ≥4 and <100 ng/ml and no history of prostate cancer) and IsoPSA indication for use. A standard template was used to document biopsy recommendation prior to and after receiving IsoPSA results. The primary outcome was the number of biopsy and magnetic resonance imaging recommendation changes occurring after IsoPSA testing. RESULTS IsoPSA testing resulted in a 55% (284 vs 638) net reduction in recommendations for prostate biopsy for men with total PSA ≥4 ng/ml. Additionally, a 9% reduction in recommendations for magnetic resonance imaging was observed. There was strong concordance between IsoPSA results and provider recommendations for prostate biopsy, with 87% of patients with an IsoPSA index above the threshold recommended for biopsy and 92% of patients with an IsoPSA index below the threshold not recommended for biopsy. CONCLUSIONS In a real-world clinical setting, providers from diverse training backgrounds and practice settings readily adopted IsoPSA with substantial reductions in the rate of recommended prostate biopsies in patients with elevated PSA values (≥4 ng/ml). There was a high concordance between recommendation for or against prostate biopsy and the IsoPSA result.
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Affiliation(s)
- Jason M Scovell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Hettel
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nima Almassi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan Berglund
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Todd Breaux
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wahib Isac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anna Zampini
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Elizabeth Stark
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Affiliation(s)
- Jason M Scovell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland OH.
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Scovell JM, Ory J. Intracytoplasmic sperm injection outcomes are comparable in ejaculated sperm but poor in testicular sperm. But why? An opportunity to further understand the AZFc region. Fertil Steril 2021; 116:66. [PMID: 34020777 DOI: 10.1016/j.fertnstert.2021.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Jason M Scovell
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jesse Ory
- Department of Urology, University of Miami, Miami, Florida.
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Scovell JM, Bournat JC, Szafran AT, Solis M, Moore J, Rivera A, Chen CH, Zhang J, Wilken N, Seth A, Jorgez CJ. PRSS50 is a testis protease responsible for proper sperm tail formation and function. Development 2021; 148:240271. [PMID: 33913480 DOI: 10.1242/dev.197558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/18/2021] [Indexed: 02/06/2023]
Abstract
Multiple morphological abnormalities of the sperm flagella (MMAF) are a major cause of asthenoteratozoospermia. We have identified protease serine 50 (PRSS50) as having a crucial role in sperm development, because Prss50-null mice presented with impaired fertility and sperm tail abnormalities. PRSS50 could also be involved in centrosome function because these mice showed a threefold increase in acephalic sperm (head-tail junction defect), sperm with multiple heads (spermatid division defect) and sperm with multiple tails, including novel two conjoined sperm (complete or partial parts of several flagellum on the same plasma membrane). Our data support that, in the testis, as in tumorigenesis, PRSS50 activates NFκB target genes, such as the centromere protein leucine-rich repeats and WD repeat domain-containing protein 1 (LRWD1), which is required for heterochromatin maintenance. Prss50-null testes have increased IκκB, and reduced LRWD1 and histone expression. Low levels of de-repressed histone markers, such as H3K9me3, in the Prss50-null mouse testis may cause increases in post-meiosis proteins, such as AKAP4, affecting sperm formation. We provide important insights into the complex mechanisms of sperm development, the importance of testis proteases in fertility and a novel mechanism for MMAF.
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Affiliation(s)
- Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Juan C Bournat
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Adam T Szafran
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Minerva Solis
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Joshua Moore
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Armando Rivera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX 77030, USA
| | - Ching H Chen
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jason Zhang
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Nathan Wilken
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Abhishek Seth
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX 77030, USA
| | - Carolina J Jorgez
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX 77030, USA
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Scovell JM, Benz K, Samarska I, Kohn TP, Hooper JE, Matoso A, Herati AS. Association of Impaired Spermatogenesis With the Use of Immune Checkpoint Inhibitors in Patients With Metastatic Melanoma. JAMA Oncol 2021; 6:1297-1299. [PMID: 32556068 DOI: 10.1001/jamaoncol.2020.1641] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karl Benz
- James Buchanan Brady Urological Institutions, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Iryna Samarska
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Taylor P Kohn
- James Buchanan Brady Urological Institutions, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jody E Hooper
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Andres Matoso
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Amin S Herati
- James Buchanan Brady Urological Institutions, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Payne K, Kenny P, Scovell JM, Khodamoradi K, Ramasamy R. Twenty-First Century Viral Pandemics: A Literature Review of Sexual Transmission and Fertility Implications in Men. Sex Med Rev 2020; 8:518-530. [PMID: 32713674 PMCID: PMC7378513 DOI: 10.1016/j.sxmr.2020.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The 21st century has seen a series of viral pandemics that have collectively infected millions of individuals. To understand factors that may contribute to viral spread and address long-term health sequelae for survivors, it is important to review evidence regarding viral presence in semen, sexual transmission potential, and possible effects on fertility. AIM To review the current literature regarding the sexual transmissibility of recent viral pandemics and their effects on semen parameters and fertility. We review evidence for the following viruses: Ebola, Zika, West Nile, pandemic influenza, severe acute respiratory syndrome (SARS), and SARS-corona virus-2 (SARS-CoV-2). METHODS A literature search was conducted to identify relevant studies. Titles and abstracts were reviewed for relevance. References from identified articles were searched and included, if appropriate. MAIN OUTCOME MEASURES The main outcome measure of this study was reviewing of peer-reviewed literature. RESULTS Both the Ebola virus and Zika virus are present in semen, but only the Zika virus shows consistent evidence of sexual transmission. Current evidence does not support the presence of the West Nile virus, pandemic influenza, SARS, and SARS-CoV-2 in semen. The Zika virus appears to alter semen parameters in a way that diminishes fertility, but the effect is likely time limited. The West Nile virus and SARS have been associated with orchitis in a small number of case reports. Viruses that cause febrile illness, such as pandemic influenza, SARS, and SARS-CoV-2, are associated with decreased sperm count and motility and abnormal morphology. SARS and SARS-CoV-2 may interact with angiotensin-converting enzyme 2 receptors present in the testes, which could impact spermatogenesis. CONCLUSIONS We have reported the presence in semen, sexual transmission potential, and fertility side effects of recent viral pandemics. Overall, semen studies and fertility effects are highly understudied in viral pandemics, and rigorous study on these topics should be undertaken as novel pandemics emerge. Payne K, Kenny P, Scovell JM, et al. Twenty-First Century Viral Pandemics: A Literature Review of Sexual Transmission and Fertility Implications for Men. Sex Med Rev 2020;8:518-530.
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Affiliation(s)
- Kelly Payne
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Peter Kenny
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kajal Khodamoradi
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Scovell JM, Bruce D, Ramasamy R. Re: Health Consequences of Androgenic Anabolic Steroid Use. Eur Urol 2019; 75:878-879. [DOI: 10.1016/j.eururo.2019.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/22/2019] [Indexed: 11/25/2022]
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Thirumavalavan N, Scovell JM, Balasubramanian A, Kohn TP, Ji B, Hasan A, Pastuszak AW, Lipshultz LI. The Impact of Microsurgical Repair of Subclinical and Clinical Varicoceles on Total Motile Sperm Count: Is There a Difference? Urology 2018; 120:109-113. [PMID: 29981299 PMCID: PMC6221979 DOI: 10.1016/j.urology.2018.06.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/25/2018] [Accepted: 06/21/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine if subclinical varicocele repair produces similar results to palpable varicocele repair. METHODS Retrospective review was performed on 190 infertile men who underwent a microsurgical varicocele repair by two surgeons from 2009 to 2017. Improvement in total motile sperm count (TMC) that enables men limited to in vitro fertilization (IVF) or intrauterine insemination (IUI) to undergo IUI or natural conception (upgrade) is clinically meaningful. Using TMC, men were grouped into three pre- and postoperative categories: IVF, (TMC < 5 million), IUI (TMC 5-9 million), or natural pregnancy (TMC > 9 million). Changes in category after varicocele repair were assessed. We compared the proportion of men in each category with clinical varicoceles to those with subclinical varicoceles. RESULTS Men with clinical and subclinical varicoceles had improvements in TMC after surgery (change in TMC of 9.3 ± 19.5, 7.7 ± 22.6 million, P < 0.001 for both, respectively). There was no difference in TMC improvement between men with clinical and subclinical varicoceles (P = 0.66). Of men initially limited to IVF, 11% improved to IUI, and 38% to natural pregnancy. Of patients starting in IUI category, 22% transitioned to natural pregnancy category. No difference exists in the proportion of men who "upgraded" between palpable or subclinical varicoceles. CONCLUSION Men with subclinical varicoceles have similar, clinically meaningful improvement in TMC after varicocele repair compared with men with palpable varicoceles.
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Affiliation(s)
| | - Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX
| | | | - Taylor P Kohn
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Byung Ji
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Asad Hasan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | | | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
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Thirumavalavan N, Scovell JM, Link RE, Lamb DJ, Lipshultz LI. Does Solid Organ Transplantation Affect Male Reproduction? Eur Urol Focus 2018; 4:307-310. [PMID: 30194032 DOI: 10.1016/j.euf.2018.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/01/2018] [Accepted: 08/17/2018] [Indexed: 12/28/2022]
Abstract
Patients undergoing solid organ transplantation have experienced increased graft survival rates over the past several decades. With increased longevity making fatherhood a viable option, many patients desire to pursue this path. However, many patients and practitioners are likely unaware of the feasibility and safety for a man on a transplant immunosuppression regimen to safely pursue fatherhood. In this review, we discuss effects of organ transplantation and post-transplantation treatment on male hormones, fertility, and the risk to potential offspring. Briefly, providers should be aware that organ transplant recipients may be at an increased risk for hypogonadism and erectile dysfunction, but fathering a child is a realistic and safe aspiration. PATIENT SUMMARY: In this mini-review, we discuss the effects of solid organ transplantation (such as lung, heart, kidney, and liver) on a man's sexual health, and his ability to have children. We focus on the most common problems encountered by patients after their transplant, and the effects of medications.
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Affiliation(s)
- Nannan Thirumavalavan
- Scott Department of Urology, Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Jason M Scovell
- Scott Department of Urology, Center for Reproductive Medicine, Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Richard E Link
- Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Dolores J Lamb
- Departments of Urology and Genetic Medicine, Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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Rai A, Scovell JM, Xu A, Balasubramanian A, Siller R, Kohn T, Moon Y, Yadav N, Link RE. Patient-specific Virtual Simulation-A State of the Art Approach to Teach Renal Tumor Localization. Urology 2018; 120:42-48. [PMID: 29960005 DOI: 10.1016/j.urology.2018.04.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/19/2018] [Accepted: 04/27/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To test whether a novel visuospatial testing platform improves trainee ability to convert two-dimensional to three-dimensional (3D) space. METHODS Medical students were recruited from Baylor College of Medicine and McGovern Medical School (Houston, TX). We 3D reconstructed 3 partial nephrectomy cases using a novel, rapid, and highly accurate edge-detection algorithm. Patient-specific reconstructions were imported into the dV-Trainer (Mimics Technologies, Seattle, WA) as well as used to generate custom 3D printed physical models. Tumor location was altered digitally to generate 9 physical models for each case, 1 with the correct tumor location and 8 with sham locations. Subjects were randomized 1:1 into the dV-Trainer (intervention) and No-dV-Trainer (control) groups. Each subject completed the following steps: (1) visualization of computed-tomographic images, (2) visualization of the reconstructed kidney and tumor in the dV-Trainer (intervention group only), and (3) selection of the correct tumor location on the 3D printed models (primary outcome). Normalized distances from the correct tumor location were quantified and compared between groups. RESULTS A total of 100 subjects were randomized for this study. dV-Trainer use significantly improved subjects ability to localize tumor position (tumor localization score: 0.24 vs 0.38, P < .001). However, subjects in the No-dV-Trainer group more accurately assigned R.E.N.A.L. scores. CONCLUSION Even brief exposure to interactive patient-specific renal tumor models improves a novice's ability to localize tumor location. Virtual reality simulation prior to surgery could benefit trainees learning to localize renal masses for minimally invasive partial nephrectomy.
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Affiliation(s)
- Arun Rai
- Scott Department of Urology, Houston, TX
| | - Jason M Scovell
- Scott Department of Urology, Houston, TX; Translational Biology and Molecular Medicine, Houston, TX
| | - Ang Xu
- Scott Department of Urology, Houston, TX
| | | | | | | | - Young Moon
- Scott Department of Urology, Houston, TX
| | | | - Richard E Link
- Scott Department of Urology, Houston, TX; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX.
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Thirumavalavan N, Balasubramanian A, Scovell JM, Kohn TP, Ji BC, Hasan A, Pastuszak AW, Lipshultz LI. PD01-12 RESULTS OF CORRECTION OF SUBCLINICAL VARICOCELES ARE SIMILAR TO IMPROVEMENTS SEEN AFTER REPAIR OF PALPABLE VARICOCELES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Scovell JM, von Rundstedt FC, Bian SX, Lee D, Mayer WA, Link RE. Author Reply. Urology 2017; 103:250. [DOI: 10.1016/j.urology.2016.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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von Rundstedt FC, Scovell JM, Bian SX, Lee D, Mayer WA, Link RE. Percent of Tracer Clearance at 40 Minutes in MAG3 Renal Scans Is More Sensitive Than T 1/2 for Symptomatic Ureteropelvic Junction Obstruction. Urology 2017; 103:245-250. [PMID: 28161380 DOI: 10.1016/j.urology.2016.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/30/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To increase the diagnostic sensitivity of standard MAG3 diuretic renal scans for ureteropelvic junction obstruction (UPJO) by exploring the utility of an alternative measurement P40, the percentage of maximal tracer counts present at 40 minutes. MATERIALS AND METHODS Patients with strong clinical and anatomic evidence for UPJO may have a normal T1/2, making definitive diagnosis difficult. We reviewed the charts of 142 consecutive patients who underwent successful laparoscopic or robotic-assisted laparoscopic pyeloplasty for UPJO between 2005 and 2015. Both pre- and postoperative renal scan images were available for 37 symptomatic patients with primary unilateral UPJO and 2 kidneys. We defined P40 as the percentage of maximal tracer counts present at 40 minutes. We identified the upper limit of normal (97.5th percentile, +2SD) for P40 using the preoperative renal scans from the unaffected kidney. We compared the sensitivity of P40 to T1/2 to identify symptomatic UPJO. RESULTS In our cohort, 51% of symptomatic patients (n = 19) had a normal T1/2 (median 8.9 minutes; interquartile range: 7.5 minutes) and 49% (n = 18) had an abnormal T1/2 (median: 40 minutes; interquartile range: 0 minute). None of the patients had an abnormal P40 on their unaffected kidney. All patients with an abnormal T1/2 also had an abnormal P40. P40 increased the sensitivity of the renal scan from 49% (n = 18 of 37) to 73% (n = 27 of 37) when compared to T1/2. The majority of patients (95%) demonstrated an improvement in P40 after pyeloplasty. CONCLUSION P40 markedly increases the sensitivity of a renal scan for diagnosing symptomatic UPJO and may be another valuable marker in addition to T1/2 to document functional improvement in drainage after pyeloplasty.
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Affiliation(s)
- Friedrich-Carl von Rundstedt
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Department of Urology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Shelly X Bian
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dominic Lee
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Department of Urology, St. George Hospital, Kogarah, New South Wales, Australia
| | - Wesley A Mayer
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Richard E Link
- Scott Department of Urology, Baylor College of Medicine, Houston, TX.
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Scovell JM, Pastuszak AW, Slawin J, Badal J, Link RE, Lipshultz LI. Author Reply. Urology 2017; 99:202. [DOI: 10.1016/j.urology.2016.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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von Rundstedt FC, Scovell JM, Agrawal S, Zaneveld J, Link RE. Utility of patient-specific silicone renal models for planning and rehearsal of complex tumour resections prior to robot-assisted laparoscopic partial nephrectomy. BJU Int 2016; 119:598-604. [PMID: 27862866 DOI: 10.1111/bju.13712] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe our experience using patient-specific tissue-like kidney models created with advanced three-dimensional (3D)-printing technology for preoperative planning and surgical rehearsal prior to robot-assisted laparoscopic partial nephrectomy (RALPN). PATIENTS AND METHODS A feasibility study of 10 patients with solid renal masses who underwent RALPN after preoperative rehearsal using 3D-print kidney models. A single surgeon performed all surgical rehearsals and procedures. Using standard preoperative imaging and 3D reconstruction, we generated pre-surgical models using a silicone-based material. All surgical rehearsals were performed using the da Vinci® robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA) before the actual procedure. To determine construct validity, we compared resection times between the model and actual tumour in a patient-specific manner. Using 3D laser scanning in the operating room, we quantified and compared the shape and tumour volume resected for each model and patient tumour. RESULTS We generated patient-specific models for 10 patients with complex tumour anatomy. R.E.N.A.L. nephrometry scores were between 7 and 11, with a mean maximal tumour diameter of 40.6 mm. The mean resection times between model and patient (6:58 vs 8:22 min, P = 0.162) and tumour volumes between the computer model, excised model, and excised tumour (38.88 vs 38.50 vs 41.79 mm3 , P = 0.98) were not significantly different. CONCLUSIONS We have developed a patient-specific pre-surgical simulation protocol for RALPN. We demonstrated construct validity and provided accurate representation of enucleation time and resected tissue volume. This simulation platform can assist in surgical decision-making, provide preoperative rehearsals, and improve surgical training.
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Affiliation(s)
- Friedrich-Carl von Rundstedt
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Department of Urology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Smriti Agrawal
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Richard E Link
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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Kanabur P, Scovell JM, Ramasamy R. Re: Vasectomy and Prostate Cancer Incidence and Mortality in a Large US Cohort. Eur Urol 2016; 71:494-495. [PMID: 27865629 DOI: 10.1016/j.eururo.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Pratik Kanabur
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
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Kanabur P, Scovell JM, Ramasamy R. WITHDRAWN: Re: Vasectomy and Prostate Cancer Incidence and Mortality in a Large US Cohort. Eur Urol 2016:S0302-2838(16)30759-X. [PMID: 27838173 DOI: 10.1016/j.eururo.2016.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/26/2016] [Indexed: 11/17/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.eururo.2016.11.008. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Pratik Kanabur
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Scovell JM, Pastuszak AW, Slawin J, Badal J, Link RE, Lipshultz LI. Impaired Sleep Quality is Associated With More Significant Lower Urinary Tract Symptoms in Male Shift Workers. Urology 2016; 99:197-202. [PMID: 27639796 DOI: 10.1016/j.urology.2016.05.076] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 05/16/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the association between sleep quality and severity of lower urinary tract symptoms (LUTS) in men working nonstandard shifts, a population at risk of poor sleep quality. METHODS Men who presented to a single andrology clinic between July and October 2014 and worked nonstandard shifts completed the International Prostate Symptom Score (IPSS) and responded to questions regarding their work habits, sleep quality, and physical or cognitive function. We assessed the relationship between age, sleep quality, physical or cognitive function, and severity of LUTS. RESULTS A total of 228 men with a mean ± standard deviation age of 41.8 ± 5.7 (range 21-76) years reported working nonstandard shifts, with the majority working these shifts for more than 1 year (81%). Men with difficulties falling asleep reported more severe LUTS than men who did not have difficulty falling asleep (IPSS score 9 vs 6, P <.001). Men who reported difficulty staying asleep or falling back asleep after awakening also reported more severe LUTS (IPSS scores 6 vs 13, P = .004; 5 vs 13, P <.001, respectively). Men with a decreased sense of well-being or decreased physical or cognitive function also reported more severe LUTS (IPSS score 6 vs 9, P <.0010; 6 vs 10, P = .016, respectively). All findings were independent of subject age. CONCLUSION Men working nonstandard shifts who have difficulty falling asleep, staying asleep, and falling back asleep report more severe LUTS than men without similar sleep difficulties. Men with a decreased sense of well-being or decreased physical or cognitive function also report worse LUTS. These findings implicate sleep quality as a possible risk factor for LUTS symptom severity.
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Affiliation(s)
- Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | - Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX.
| | - Jeremy Slawin
- Department of Urology, NYU Langone Medical, New York, NY
| | | | - Richard E Link
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
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20
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Rai S, Scovell JM, Palmer J, Ramasamy R. Re: Effects of Testosterone Treatment in Older Men. Eur Urol 2016; 70:539-40. [DOI: 10.1016/j.eururo.2016.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/20/2016] [Indexed: 11/24/2022]
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21
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Hollander AB, Pastuszak AW, Hsieh TC, Johnson WG, Scovell JM, Mai CK, Lipshultz LI. Cabergoline in the Treatment of Male Orgasmic Disorder-A Retrospective Pilot Analysis. Sex Med 2016; 4:e28-33. [PMID: 26944776 PMCID: PMC4822480 DOI: 10.1016/j.esxm.2015.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/08/2015] [Accepted: 09/19/2015] [Indexed: 01/18/2023] Open
Abstract
Introduction Male orgasmic disorder is common, with few treatment options. Cabergoline is a dopamine agonist that acts centrally to normalize serum prolactin that could improve orgasmic dysfunction. Aims To determine whether cabergoline increases the potential for orgasm in men with orgasmic disorder. Methods A retrospective chart review of men treated in a single andrology clinic for delayed orgasm or anorgasmia in a pilot study using cabergoline 0.5 mg twice weekly was performed. Duration of treatment and response were noted. Medical records were examined for other factors including history of prostatectomy and concomitant androgen supplementation. Main Outcome Measures Subjective improvement in orgasmic function resulting from cabergoline treatment. Results Of 131 men treated with cabergoline for orgasmic disorder, 87 (66.4%) reported subjective improvement in orgasm and 44 (33.6%) reported no change in orgasm. Duration of therapy (P = .03) and concomitant testosterone therapy (P = .02) were associated with a significant positive response to cabergoline treatment. No differences were found between injectable and non-injectable testosterone formulations (P = .90), and neither age (P = .90) nor prior prostatectomy (P = .41) influenced the outcome of cabergoline treatment. Serum testosterone levels before (P = .26) and after (P = .81) treatment were not significantly different in responders vs non-responders. Conclusion Cabergoline is a potentially effective and easy-to-administer treatment for male orgasmic disorder, the efficacy of which appears to be independent of patient age or orgasmic disorder etiology. Prospective randomized trials are needed to determine the true role of cabergoline in the treatment of this disorder.
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Affiliation(s)
- Adam B Hollander
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Tung-Chin Hsieh
- Department of Urology, University of California-San Diego, San Diego, CA, USA
| | - William G Johnson
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christina K Mai
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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22
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Scovell JM, Ramasamy R. Words of Wisdom. Re: X-Linked TEX11 Mutations, Meiotic Arrest, and Azoospermia in Infertile Men. Eur Urol 2015; 68:1101. [PMID: 26545573 DOI: 10.1016/j.eururo.2015.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Pastuszak AW, Gomez LP, Scovell JM, Khera M, Lamb DJ, Lipshultz LI. Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate-Specific Antigen. Sex Med 2015; 3:165-73. [PMID: 26468380 PMCID: PMC4599554 DOI: 10.1002/sm2.76] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Numerous testosterone (T) formulations are available, each with differing effects on serum parameters. Aim The aim of this study was to compare the long-term effects of topical, injectable, and implantable pellet T formulations in hypogonadal men. Methods Retrospective review of hypogonadal men treated with a single T formulation was performed: 47 men on T gels, 57 on injectable T, and 74 on T pellets were identified. Total T (TT), calculated free T (FT), estradiol (E), hemoglobin (Hgb), hematocrit (Hct), prostate-specific antigen (PSA), total cholesterol (Tchol), triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol were evaluated at baseline and every 3–6 months for 3 years. Serum parameters were compared using a mixed model linear regression for repeated measures. Main Outcome Measures Effects of topical, injectable, and pellet T formulations on serum hormone levels, Hgb, Hct, lipid parameters and PSA. Results Men in the injectable T group were younger (42.5 ± 12.3 years) than in the gel (54.1 ± 9.8 years) or pellet groups (53.8 ± 13.0 years), and baseline FT, Hgb, and Hct were higher in the injectable T group than in gel or pellet groups. Increases in TT and FT were observed throughout follow-up in all groups. Increases in E were observed at in all T groups and throughout follow-up in injectable and gel groups. No PSA increases were observed. Erythrocytosis (Hct > 50%) was more common with injectable T (66.7%) than with T gels (12.8%) or pellets (35.1%, P < 0.0001). Transient changes in cholesterol, TG, and LDL were observed, and no significant changes were seen in HDL for any group. Conclusions All T formulations increase serum T and FT. More significant increases in E occur with injectable T and T gels. Changes in Hgb and Hct are most significant with injectable T, and effects on lipids are variable and inconsistent. Selection of T formulations must account for individual patient preferences and the effects of each formulation.
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Affiliation(s)
- Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA
| | - Lissette P Gomez
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA
| | - Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA
| | - Dolores J Lamb
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA ; Department of Cell Biology, Baylor College of Medicine Houston, TX, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA
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Ramasamy R, Golan R, Wilken N, Scovell JM, Lipshultz LI. Association of Free Testosterone With Hypogonadal Symptoms in Men With Near-normal Total Testosterone Levels. Urology 2015. [PMID: 26199166 DOI: 10.1016/j.urology.2015.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the association between hypogonadal symptoms and free testosterone (FT) levels in men with near-normal total testosterone (T) levels (250-350 ng/dL) and to determine whether a discriminatory threshold for FT exists below which hypogonadal symptoms become more prevalent. METHODS We reviewed the charts of 3167 men who presented to an outpatient men's health clinic. Two hundred thirty-one men had symptoms of "low testosterone" and serum testosterone levels between 250 and 350 ng/dL. We evaluated hypogonadal symptoms using the Androgen Deficiency in the Adult Male (ADAM) and quantitative ADAM (qADAM) questionnaires. Serum levels of T and sex hormone-binding globulin were collected on the same day that men completed their questionnaires. We used linear regression to determine whether a threshold of FT exists for hypogonadal symptoms. We performed univariate and multivariable analyses to evaluate factors that predicted a low FT level. RESULTS The median age was 43.5 years, and the median testosterone and FT levels were 303 ng/dL and 6.3 ng/dL, respectively. Prevalence and severity of hypogonadal symptoms (ADAM and qADAM) were similar between men with low (<6.4 ng/mL) and normal FT levels. There was an association between age and 3 of the 10 hypogonadal symptoms (decreased enjoyment in life, sadness, and deterioration of work performance) with a low FT on a univariate analysis. Only younger age was positively associated with FT on multivariable analysis. CONCLUSION We did not observe a relationship between hypogonadal symptoms and FT in men with near-normal testosterone levels. Symptom-specific FT thresholds could not be defined, as age remains an important confounder.
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Affiliation(s)
| | - Ron Golan
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Nathan Wilken
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX
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25
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Butler P, Scovell JM, Ramasamy R, Lipshultz LI. Words of Wisdom. Re: incidence of prostate cancer in hypogonadal men receiving testosterone therapy: observations from 5-year median followup of 3 registries. Eur Urol 2015; 67:1186-7. [PMID: 25944034 DOI: 10.1016/j.eururo.2015.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Peter Butler
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Ranjith Ramasamy
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Larry I Lipshultz
- Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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Scovell JM, Butler P, Ramasamy R, Lamb DJ. Re: Testosterone Treatment Is a Potent Tumor Promoter for the Rat Prostate. Eur Urol 2015; 67:814-5. [DOI: 10.1016/j.eururo.2014.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Scovell JM, Ramasamy R, Wilken N, Kovac JR, Lipshultz LI. Hypogonadal symptoms in young men are associated with a serum total testosterone threshold of 400 ng/dL. BJU Int 2015; 116:142-6. [PMID: 25345995 DOI: 10.1111/bju.12970] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the association between hypogonadal symptoms and serum total testosterone (TT) levels in young men (aged <40 years), in an attempt to determine whether there exists a clear-cut discriminatory threshold of TT below which hypogonadal symptoms become more prevalent. PATIENTS AND METHODS We retrospectively reviewed the charts of 352 men who presented to an outpatient Men's Health Clinic with chief complaint of 'low testosterone'. Sexual, psychological and physical symptoms were evaluated using the Androgen deficiency in Aging Male (ADAM) questionnaire. Serum levels of TT were collected on the same day that men completed their ADAM questionnaires. We subsequently performed univariate (t-test, chi-square) and multivariate analyses (ordinal logistic regression) to evaluate factors that predicted a low TT level. RESULTS The probability of hypogonadal symptoms increased at a serum TT level of 400 ng/dL. A cluster of symptoms: two psychological ('decreased energy', 'sadness'), and three physical ('decreased strength and endurance', 'decreased ability to play sports', and 'deterioration in work performance') were most strongly associated with serum TT levels of <400 ng/dL. On multivariable analysis, only 'lack of energy' predicted a TT level of <400 ng/dL. CONCLUSIONS Hypogonadal symptoms in men aged <40 years can be associated with a TT level of <400 ng/dL. Of the hypogonadal symptoms evaluated with the ADAM questionnaire, 'lack of energy' appears to be the most important symptom that predicts a TT level of <400 ng/dL.
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Affiliation(s)
- Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Ranjith Ramasamy
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Nathan Wilken
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jason R Kovac
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Scovell JM, Mata DA, Ramasamy R, Herrel LA, Hsiao W, Lipshultz LI. Association between the presence of sperm in the vasal fluid during vasectomy reversal and postoperative patency: a systematic review and meta-analysis. Urology 2015; 85:809-13. [PMID: 25697786 DOI: 10.1016/j.urology.2014.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the association between the presence of sperm in the vasal fluid during vasectomy reversal (VR) and postoperative patency. METHODS We performed a systematic review and meta-analysis of the English-language literature reporting on the association between the presence of sperm in the intraoperative vasal fluid (ie, whole or parts vs none) and patency (ie, patent or not) after microsurgical vasovasostomy for men with obstructive azoospermia due to vasectomy. Odds ratios (OR) and 95% confidence intervals were calculated to quantify the strength of the association reported by each study. Meta-analysis was performed using a random-effects model. RESULTS Four case series and 2 retrospective cohort studies of a total of 1293 eligible patients were identified. The mean age at VR was 37.8 years, and the mean obstructive interval was 7.1 years. The unadjusted OR of postoperative patency was 4.1 times higher (95% confidence interval, 2.3-7.3) given the presence of intravasal sperm or sperm parts as opposed to their absence at the time of VR (Q = 3.4; df = 5; P = .6; I(2) = 22%). The pooled OR should be interpreted with caution as only the 2 retrospective cohort studies reported meaningful data on this association. Because of inconsistent reporting, analysis of other vasal fluid characteristics (eg, consistency) and outcomes (eg, pregnancy) was not possible. CONCLUSION The presence of whole sperm or sperm parts in the vasal fluid during VR is positively associated with postoperative patency. Our review highlights the poor methodological quality of existing evidence and underscores the need for more thorough follow up and higher standards of reporting in future studies.
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Affiliation(s)
- Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Douglas A Mata
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Ranjith Ramasamy
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Lindsey A Herrel
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Wayland Hsiao
- Department of Urology, Kaiser Permanente, Oakland, CA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX.
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Abstract
Hypogonadism is a condition in which the endogenous secretion of testosterone is either insufficient or inadequate to maintain serum testosterone levels within normal range, and may manifest as a variety of signs and symptoms. Age-related hypogonadism is due to a combination of primary hypogonadism (testicular failure) and secondary hypogonadism (hypothalamic-pituitary axis failure). This review provides insight into the mechanisms resulting in the multifactorial nature of acquired androgen-deficiency, and outlines the current controversy regarding testosterone-replacement therapy in aging males.
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Affiliation(s)
- Ron Golan
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Jason M. Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Ranjith Ramasamy
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
- Corresponding author: One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030,
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30
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Mederos MA, Bernie AM, Scovell JM, Ramasamy R. Can Serum Testosterone Be Used as a Marker of Overall Health? Rev Urol 2015; 17:226-230. [PMID: 26839520 PMCID: PMC4735669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Low serum testosterone has been associated with obesity, type 2 diabetes, metabolic syndrome, and atherosclerosis. Individuals with these comorbidities are at increased risk of premature death and other adverse health effects. Clinical data portend low testosterone as a risk factor for developing these conditions which are supported by the hypogonadal-obesity-adipocytokine hypothesis. The authors support comprehensive evaluation for these comorbid conditions in men found to have low serum testosterone.
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Affiliation(s)
| | - Aaron M Bernie
- Department of Urology, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY
| | - Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX
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Abstract
Late-onset hypogonadism (LOH) is typically defined as the cluster of symptoms appearing in aging men and accompanied by a decrease in serum testosterone levels. The identification of a simple screening tool with a high level of sensitivity and specificity to predict LOH has remained a challenge. To identify men with LOH, a variety of self-administered questionnaires have been developed including The Saint Louis University Androgen Deficiency in the Aging Male (ADAM) Questionnaire, The Quantitative ADAM (qADAM) Questionnaire, The Aging Male Symptoms (AMS) rating scale, The Massachusetts Male Aging Study (MMAS) questionnaire and The New England Research Institutes (NERI) hypogonadism questionnaire. The applicability of these questionnaires in the clinical setting is debated because some of the symptoms associated with LOH could be attributed to the natural process of aging and comorbidities. The goal of this review is to compare the utility and the validity of the different LOH questionnaires.
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Affiliation(s)
- Aaron M Bernie
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College , New York, NY , USA and
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Scovell JM, Link RE. A nephropleural fistula complicated by distal ureteral obstruction results in tension hydrothorax after percutaneous nephrostolithotomy. Urology 2014; 84:e28-9. [PMID: 25440992 DOI: 10.1016/j.urology.2014.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Abstract
We present the case of a patient with nephrocalcinosis and chronic kidney disease who underwent percutaneous nephrostolithotomy via a mid-pole access. After nephroureteral stent removal, the patient developed a tension hydrothorax due to the rare combination of a nephropleural fistula and ipsilateral distal ureteral obstruction. This complication was managed by percutaneous nephrostomy and thoracostomy placement and subsequent thoracoscopic surgery without further sequelae.
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Affiliation(s)
- Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Richard E Link
- Scott Department of Urology, Baylor College of Medicine, Houston, TX.
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Ramasamy R, Wilken N, Scovell JM, Kovac JR, Lipshultz LI. Hypogonadal symptoms are associated with different serum testosterone thresholds in middle-aged and elderly men. Urology 2014; 84:1378-82. [PMID: 25288577 DOI: 10.1016/j.urology.2014.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 06/16/2014] [Accepted: 07/29/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the association between hypogonadal symptoms and total serum testosterone levels in middle-aged and elderly men (aged > 40 years), and to identify whether there exists a clear-cut discriminatory threshold of total testosterone below which the probability of hypogonadal symptoms increases. METHODS We retrospectively reviewed the charts of 360 men who presented to an outpatient men's health clinic with a chief complaint of low testosterone. Sexual, psychological, and physical symptoms were evaluated using the androgen deficiency in the aging male (ADAM) questionnaire. Serum levels of total testosterone were collected on the same day on which men completed their ADAM questionnaires. We performed the univariate (t test, chi-square, and binary logistic regression) and multivariate analyses (binary logistic regression) to evaluate the total testosterone threshold and the symptoms that predicted a low-testosterone level. RESULTS A cluster of symptoms: 1 sexual (decreased libido), 1 psychological (decreased energy), and 3 physical (decreased strength or endurance, decreased ability to play sports, and falling asleep after dinner) were most associated with total serum testosterone levels of ≤ 300 ng/dL. The threshold testosterone serum levels that were associated with an increased prevalence of these hypogonadal symptoms ranged from 320 to 375 ng/dL. On multivariate analysis, age, but not symptoms on the ADAM questionnaire, predicted a total testosterone level of < 300 ng/dL. CONCLUSION A distinct constellation of hypogonadal symptoms exists at various serum testosterone levels. Consequently, identification of the thresholds for specific symptom management will be critical in establishing patient-centered treatment algorithms.
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Affiliation(s)
| | - Nathan Wilken
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Jason R Kovac
- Department of Urology, Baylor College of Medicine, Houston, TX
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Scovell JM, Ramasamy R, Lipshultz LI. Re: Testosterone Lab Testing and Initiation in the United Kingdom and the United States, 2000 to 2011. Eur Urol 2014; 66:786-7. [DOI: 10.1016/j.eururo.2014.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ramasamy R, Wilken N, Scovell JM, Lipshultz LI. Effect of testosterone supplementation on symptoms in men with hypogonadism. Eur Urol 2014; 67:176-177. [PMID: 25199721 DOI: 10.1016/j.eururo.2014.08.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
Testosterone supplementation regimens are efficacious for improving both hypogonadal symptoms and serum total testosterone levels. Younger men appear to respond better to symptom improvement following testosterone therapy.
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Affiliation(s)
- Ranjith Ramasamy
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Nathan Wilken
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Larry I Lipshultz
- Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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Ramasamy R, Scovell JM, Lipshultz L. The Influence of Testosterone Replacement Therapy in Older Men: An Age and Comorbidity Matched Cohort Study. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ramasamy R, Kovac JR, Scovell JM, Lipshultz LI. Words of wisdom. Re: In older men an optimal plasma testosterone is associated with reduced all-cause mortality and higher dihydrotestosterone with reduced ischemic heart disease mortality, while estradiol levels do not predict mortality. Eur Urol 2014; 65:844-5. [PMID: 24559901 DOI: 10.1016/j.eururo.2013.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ranjith Ramasamy
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jason R Kovac
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Larry I Lipshultz
- Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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Scovell JM, Ramasamy R. Should Men Take Prenatal Vitamins? Reprod Syst Sex Disord 2014; 3:1000139. [PMID: 25763298 PMCID: PMC4352710 DOI: 10.4172/2161-038x.1000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jason M Scovell
- Division of Male Reproductive Medicine and Surgery, Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Ranjith Ramasamy
- Division of Male Reproductive Medicine and Surgery, Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Scovell JM, Chan RC, Khavari R. Prolapse of a single system large ureterocele containing multiple stones in a pregnant woman. Urology 2014; 83:e3-4. [PMID: 24581544 DOI: 10.1016/j.urology.2013.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 11/15/2013] [Accepted: 11/20/2013] [Indexed: 11/28/2022]
Abstract
Periurethral masses are uncommon in adult women, with little guidance on initial management. We describe a case of a 29-year-old pregnant woman with a single-system ureterocele prolapse complicated by multiple calculi ranging from 1 to 2.5 cm.
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Affiliation(s)
| | - Robert C Chan
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, TX
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Hollander AB, Scovell JM, Mercado MA, Choi JM, Sanchez EJ, Stamatakis L, Goh A, Link RE, Mayer WA. MP72-14 PERIOPERATIVE INJECTION OF LIPOSOMAL BUPIVACAINE REDUCES NARCOTIC MEDICATION REQUIREMENT AFTER LAPARO-ENDOSCOPIC SINGLE SITE DONOR NEPHRECTOMY WITH SHORTER OPERATING TIME THAN SUB-FASCIAL CONTINUOUS LOCAL ANESTHESIA. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Scovell JM, Hollander AB, Link RE. PD32-11 RELATIONSHIP BETWEEN AGE AND QUANTITATIVE 24-HOUR URINE CHEMISTRIES IN PATIENTS WITH NEPHROLITHIASIS. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ramasamy R, Scovell JM, Kovac JR, Lipshultz LI. Elevated serum estradiol is associated with higher libido in men on testosterone supplementation therapy. Eur Urol 2014; 65:1224-5. [PMID: 24480244 DOI: 10.1016/j.eururo.2014.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Ranjith Ramasamy
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jason M Scovell
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jason R Kovac
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Larry I Lipshultz
- Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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Ramasamy R, Scovell JM, Wilken NA, Kovac JR, Lipshultz LI. Management of erectile dysfunction in the hypogonadal man: a case-based review. Rev Urol 2014; 16:105-109. [PMID: 25337039 PMCID: PMC4191629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Erectile dysfunction (ED) has emerged as an important marker of cardiovascular and overall health, independent of other known conventional risk factors. ED often precedes coronary artery disease in half of affected subjects, and could indicate the presence of cardiovascular pathology. The pathophysiology and role of androgens in sexual function are described, along with the relevant literature on the effects of aging in erectile and gonadal function. The concept of testosterone supplementation (TST) in men with ED is reviewed. The authors utilize clinical vignettes to discuss the appropriate management of two clinical cases of men at different life stages who have ED in the setting of hypogonadism and propose a treatment algorithm. In patients of all ages, proper identification of the underlying pathophysiology of decreased libido and erectile function is paramount in choosing between the use of TST, phosphodiesterase type 5 inhibitors, or both, in the management of these disorders.
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Affiliation(s)
- Ranjith Ramasamy
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Nathan A Wilken
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Jason R Kovac
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
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