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Gross MS, Reinstatler L, Henry GD, Honig SC, Stahl PJ, Burnett AL, Maria PP, Bennett NE, Kava BR, Kohler TS, Beilan JA, Carrion RE, Munarriz RM. Multicenter Investigation of Fungal Infections of Inflatable Penile Prostheses. J Sex Med 2020; 16:1100-1105. [PMID: 31255212 DOI: 10.1016/j.jsxm.2019.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Fungal infections of inflatable penile prostheses (IPPs) are inadequately understood in the literature. AIM To review a multi-institution database of IPP infections to examine for common patient and surgical factors related to IPP fungal infections. METHODS This is a retrospective Institutional Review Board-approved analysis of 217 patients at 26 institutions who underwent salvage or device explant between 2001 and 2018. Patient data were compiled after an extensive record review. OUTCOMES 26 patients (12%) with fungal infections were identified. RESULTS 23 of 26 patients (83%) with a fungal IPP infection were either diabetic or overweight. 15 patients had undergone primary IPP implantation, and the other 11 had previously undergone an average of 1.7 IPP-related surgeries (range 1-3; median 2). The average age at implantation was 63 years (range 31-92; median 63). 18 of the 26 patients with fungal infection had diabetes (69%), with a mean hemoglobin A1c (HbA1c) value of 8.4 (range 5.8-13.3; median 7.5). Twenty-two patients (85%) were overweight or obese. The mean body mass index for all patients was 30.1 kg/m2 (range 23.7-45 kg/m2; median 28.4 kg/m2), and that for diabetic patients was 30.8 kg/m2 (range 24.1-45 kg/m2, median 29.7 kg/m2). Ninety-one percent of implants were placed with intravenous antibiotics, consistent with current American Urological Association guidelines: an aminoglycoside plus first- or second-generation cephalosporin or vancomycin or ampicillin/sulbactam or piperacillin/tazobactam. 65% (17 of 26) of infected IPPs had only fungal growth in culture. No patient had concomitant immunosuppressive disease or recent antibiotic exposure before IPP implantation. CLINICAL IMPLICATIONS More than two-thirds of the fungal infections occurred in diabetic patients and 85% occurred in overweight or obese patients, suggesting that antifungal prophylaxis may be appropriate in these patients. STRENGTHS & LIMITATIONS This is the largest series of fungal infections reported to date in the penile prosthesis literature. The overall number of such cases, however, remains small. CONCLUSION Fungal infections represent 12% of all penile prosthesis infections in our series and were seen mostly in diabetic or overweight patients, who may benefit from antifungal prophylaxis. Gross MS, Reinstatler L, Henry GD, et al. Multicenter Investigation of Fungal Infections of Inflatable Penile Prostheses. J Sex Med 2019;16:1100-1105.
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Affiliation(s)
- Martin S Gross
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
| | - Lael Reinstatler
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Stanton C Honig
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Peter J Stahl
- Department of Urology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Arthur L Burnett
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pedro P Maria
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jonathan A Beilan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Rafael E Carrion
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ricardo M Munarriz
- Department of Urology, Boston University Medical Center, Boston, MA, USA
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Baas W, O'Connor B, Welliver C, Stahl PJ, Stember DS, Wilson SK, Köhler TS. Worldwide trends in penile implantation surgery: data from over 63,000 implants. Transl Androl Urol 2020; 9:31-37. [PMID: 32055463 DOI: 10.21037/tau.2019.09.26] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 11/06/2022] Open
Abstract
Background Penile prosthesis implantation represents the gold standard of treatment for severe or medically refractory erectile dysfunction (ED). We sought to address the paucity of currently available literature about global penile prosthesis usage in regard to geography, patient age, surgical approach, implanter volume, and etiology of ED. Methods From device manufacturer information, we compiled data on over 63,000 implants performed worldwide. Data was grouped and then analyzed to examine trends in penile implantation between the years of 2005-2012. Results The number of implants was seen to steadily increase over the study period. Of the 63,013 total procedures recorded, 85.9% were performed within the United States. 60-78% of procedures were done using the penoscrotal (PS) approach, with only Belgium/Netherlands as an outlier with an infrapubic (INF) majority. The US was notable for having an increasing number of implanters doing 16-30, 31-50, or >100 implants yearly. Etiology of ED worldwide was variable, but "organic," post-prostatectomy, and diabetes accounted for the vast majority of cases worldwide. Conclusions Penile prosthesis implantation is an increasing practice, as evidenced by a steady increase in the number of implants performed over a 7-year study period. Acceptance of this treatment option for ED is variable by region with the US leading the annual number of implantations by a wide margin. Worldwide, there appears to be a predominance of surgeons placing implants via the PS approach.
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Affiliation(s)
- Wesley Baas
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Blake O'Connor
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | - Peter J Stahl
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Doron S Stember
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
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Zuniga KB, Margolin EJ, De Fazio A, Ackerman A, Stahl PJ. The association between elevated serum oestradiol levels and clinically significant erectile dysfunction in men presenting for andrological evaluation. Andrologia 2019; 51:e13345. [PMID: 31317572 DOI: 10.1111/and.13345] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 01/04/2023] Open
Abstract
The goal of this study was to investigate the association between serum oestradiol levels and clinically significant erectile dysfunction in a cohort of men presenting for andrological evaluation. Retrospective review was conducted of patients that presented to a urologist with practice in andrology over an 18-month period. Patients completed the Male Sexual Health Questionnaire and had serum total testosterone and oestradiol measurements prior to 10:30 a.m. via immunoassay. t Tests, chi-square tests and multivariate logistic regression were used to compare clinical characteristics between those with adequate erectile function (erection scale score > 2) vs. clinically significant erectile dysfunction (erection scale score ≤ 2). Among 256 patients, average age was 49 years (SD 15), average serum oestradiol was 22.3 pg/ml (SD 10.6), and average serum total testosterone was 465.9 pg/ml (SD 206.3). On multivariate logistic regression, serum oestradiol was associated with clinically significant erectile dysfunction (OR 1.52 per SD increase, 95% CI 1.11-2.09, p = 0.009) when controlling for serum total testosterone, age, body mass index and smoking status. These results warrant future studies on the utility of measuring serum oestradiol in patients with erectile dysfunction and the use of aromatase inhibitors in patients with erectile dysfunction and elevated serum oestradiol.
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Affiliation(s)
- Kyle B Zuniga
- College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
| | - Ezra J Margolin
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Adam De Fazio
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Anika Ackerman
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Peter J Stahl
- Department of Urology, Columbia University Medical Center, New York, New York
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Gross MS, Vollstedt AJ, Cleves MA, Glina S, Honig SC, Perito P, Stahl PJ, Gayá MR, Gheiler E, Ralph DJ, Köhler T, Stember DS, Carrion R, Maria P, Brant WO, Garber B, Burnett AL, Eid JF, Henry GD, Munarriz R. Multicenter investigation on the influence of climate in penile prosthesis infection. Int J Impot Res 2019; 32:387-392. [PMID: 31043705 DOI: 10.1038/s41443-019-0148-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 11/09/2022]
Abstract
The purpose of this study is to investigate the relationship between inflatable penile prosthesis (IPP) infection, time of year, climate, temperature and humidity. This is a retrospective IRB-approved analysis of 211 patients at 25 institutions who underwent salvage procedure or device explant between 2001 and 2016. Patient data were compiled after an extensive review of all aspects of their electronic medical records. Climate data were compiled from monthly norms based on location, as well as specific data regarding temperature, dew point, and humidity from dates of surgery. Rigorous statistical analysis was performed. We found that penile prosthesis infections occurred more commonly in June (n = 24) and less frequently during the winter months (n = 39), with the lowest number occurring in March (n = 11). One-hundred thirty-nine infections occurred at average daily temperatures greater than 55 °F, compared to 72 infections at less than 55 °F. The incidence rate ratio for this trend was 1.93, with a p-value of <0.001. Humidity results were similar, and fungal infections correlate with daily humidity. Infected implants performed in the fall and summer were over 3 and 2.3 times, respectively, more likely to grow Gram-positive bacteria compared to implants performed in spring (p = 0.004; p = 0.039). This was consistent across geographic location, including in the Southern hemisphere. We found trends between climate factors and IPP infection like those seen and proven in other surgical literature. To our knowledge these data represent the first exploration of the relationship between temperature and infection in prosthetic urology.
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Affiliation(s)
| | | | - Mario A Cleves
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sidney Glina
- Faculdade de Medicina do ABC/Instituto H.Ellis, São Paulo, Brazil
| | | | | | - Peter J Stahl
- Columbia University College of Physicians & Surgeons, New York City, NY, USA
| | | | | | | | | | | | | | - Pedro Maria
- Albert Einstein College of Medicine, New York City, NY, USA
| | | | - Bruce Garber
- Hahnemann University Hospital, Philadelphia, PA, USA
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Lipsky MJ, Onyeji I, Golan R, Munarriz R, Kashanian JA, Stember DS, Stahl PJ. Diabetes Is a Risk Factor for Inflatable Penile Prosthesis Infection: Analysis of a Large Statewide Database. Sex Med 2019; 7:35-40. [PMID: 30674445 PMCID: PMC6377380 DOI: 10.1016/j.esxm.2018.11.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/06/2018] [Accepted: 11/14/2018] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Although diabetes mellitus (DM) is often discussed as a risk factor for inflatable penile prosthesis (IPP) infection, the link between DM diagnosis and IPP infection remains controversial. High-quality population-based data linking DM to an increased risk of IPP infection have not been published. AIM To evaluate the association of DM with IPP infection in a large public New York state database. METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for men who underwent initial IPP insertion from 1995-2014. Diabetic patients were identified using ICD-9-CM codes. Patients presenting for first operation with diagnosis or Current Procedural Terminology codes suggestive of prior IPP surgery were excluded. Chi-squared analyses were performed to compare infection rates in diabetics and non-diabetics within the pre- and postantibiotic impregnated eras. Multivariate Cox proportional hazards models were constructed to evaluate whether or not DM was independently associated with IPP infection in the time periods before (1995-2003) and after (2004-2014) the widespread availability of antibiotic impregnated penile prostheses. MAIN OUTCOME MEASURE Time to prosthesis infection was measured. RESULTS 14,969 patients underwent initial IPP insertion during the study period. The overall infection rate was 343/14,969 (2.3%). Infections occurred at a median 3.9 months after implant (interquartile ratio: 1.0-25.0 months). Infectious complications were experienced by 3% (133/4,478) of diabetic patients and 2% (210/10,491) of non-diabetic patients (P < .001). Diabetes was associated with a significantly increased IPP infection risk on multivariable analysis controlling for age, race, comorbidities, insurance status, annual surgeon volume, and era of implantation (Hazard Ratio: 1.32, 95% CI: 1.05-1.66, P = .016). CONCLUSION Our analysis supports the notion that DM is a risk factor for IPP infection. This has important implications for patient selection and counseling, and raises the question of whether this increased risk can be mitigated by optimization of glycemic control before surgery. Lipsky MJ, Onyeji I, Golan R, et al. Diabetes Is a Risk Factor for Inflatable Penile Prosthesis Infection: Analysis of a Large Statewide Database. Sex Med 2019;7:35-40.
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Affiliation(s)
- Michael J Lipsky
- Department of Urology, New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY, USA.
| | - Ifeanyi Onyeji
- Department of Urology, New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY, USA
| | - Ron Golan
- Department of Urology, New York Presbyterian Hospital/ Weill Cornell Medical Center, New York, NY, USA
| | - Ricardo Munarriz
- Center for Sexual Medicine, Boston University School of Medicine, Department of Urology, Boston, MA, USA
| | - James A Kashanian
- Department of Urology, New York Presbyterian Hospital/ Weill Cornell Medical Center, New York, NY, USA
| | - Doron S Stember
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Peter J Stahl
- Department of Urology, New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY, USA
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Margolin EJ, Pagano MJ, Aisen CM, Onyeji IC, Stahl PJ. Beyond Curvature: Prevalence and Characteristics of Penile Volume-Loss Deformities in Men With Peyronie's Disease. Sex Med 2018; 6:309-315. [PMID: 30342867 PMCID: PMC6302132 DOI: 10.1016/j.esxm.2018.07.003] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/21/2018] [Accepted: 07/25/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Non-curvature penile deformities associated with loss of erect penile volume are often overlooked and have not been thoroughly investigated. AIM To describe the prevalence and functional impact of penile volume-loss deformities in our cohort of men with Peyronie's disease (PD). METHODS We retrospectively examined medical records of patients with PD consecutively evaluated by a specialized urologist from December 2012 to June 2016. We excluded patients with prior surgical correction of PD, prior penile prosthesis, and inadequate erection during office examination. All patients underwent deformity assessment of the erect penis after intracavernosal injection. The assessment included measurement of penile curvature; evaluation for hourglass deformities, indentations, and distal tapering; and application of axial force to assess for penile buckling. Prior to the deformity assessment, each patient completed the Male Sexual Health Questionnaire and was asked if he experienced psychological distress and functional impairment related to his penile deformity. MAIN OUTCOME MEASURE The primary clinical parameters that we evaluated were presence or absence of axial instability, functional impairment, psychological distress, penile pain, erectile dysfunction, ejaculatory dysfunction, sexual dissatisfaction, decreased sexual activity, and decreased sexual desire. RESULTS 128 patients met criteria for inclusion. 83 patients (65%) had volume-loss deformities. Unilateral indentations, hourglass deformities, and distal tapering were present in 50 (39%), 30 (23%), and 16 (13%) patients, respectively. Penile curvature <10° degrees was present in 115 patients (90%). After controlling for angle of curvature, patients with volume-loss deformities had significantly higher rates of axial instability (odds ratio [OR] = 3.5, P = .01) and psychological distress (OR = 2.6, P = .03), as well as decreased sexual activity (OR = 2.7, P = .02), than patients with non-volume-loss deformities. CONCLUSION Volume-loss penile deformities are highly prevalent in men with PD. These deformities are associated with penile axial instability and psychological distress, which may contribute to decreased frequency of sexual activity. Margolin EJ, Pagano MJ, Aisen CM, et al. Beyond curvature: prevalence and characteristics of penile volume-loss deformities in men with Peyronie's disease. Sex Med 2018;6:309-315.
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Affiliation(s)
- Ezra J Margolin
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Matthew J Pagano
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Carrie M Aisen
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Ifeanyi C Onyeji
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Peter J Stahl
- Department of Urology, Columbia University Medical Center, New York, NY, USA.
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Asafu-Adjei D, Benson C, Thompson S, Chung DE, Li G, Rutman M, Kashanian J, Stember D, Stahl PJ. MP32-06 DELAY IN PENILE PROSTHESIS AND ARTIFICIAL URINARY SPHINCTER SURGERY FOLLOWING RADICAL PROSTATECTOMY: LESSONS FROM A STATEWIDE DATABASE. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1056] [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: 10/17/2022]
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Asafu-Adjei D, Moran G, Lipsky M, Li G, Stember D, Stahl PJ. PD18-12 IMPLANT SELECTION PATTERNS AND REOPERATION RATES IN IMMUNOCOMPROMISED PATIENTS THAT UNDERWENT PENILE PROSTHESIS SURGERY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.989] [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: 10/17/2022]
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Kashanian JA, Golan R, Sun T, Patel NA, Lipsky MJ, Stahl PJ, Sedrakyan A. Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State. J Sex Med 2017; 15:245-250. [PMID: 29292061 DOI: 10.1016/j.jsxm.2017.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/04/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Penile prostheses (PPs) are a discrete, well-tolerated treatment option for men with medical refractory erectile dysfunction. Despite the increasing prevalence of erectile dysfunction, multiple series evaluating inpatient data have found a decrease in the frequency of PP surgery during the past decade. AIMS To investigate trends in PP surgery and factors affecting the choice of different PPs in New York State. METHODS This study used the New York State Department of Health Statewide Planning and Research Cooperative (SPARCS) data cohort that includes longitudinal information on hospital discharges, ambulatory surgery, emergency department visits, and outpatient services. Patients older than 18 years who underwent inflatable or non-inflatable PP insertion from 2000 to 2014 were included in the study. OUTCOMES Influence of patient demographics, surgeon volume, and hospital volume on type of PP inserted. RESULTS Since 2000, 14,114 patients received PP surgery in New York State; 12,352 PPs (88%) were inflatable and 1,762 (12%) were non-inflatable, with facility-level variation from 0% to 100%. There was an increasing trend in the number of annual procedures performed, with rates of non-inflatable PP insertion decreasing annually (P < .01). More procedures were performed in the ambulatory setting over time (P < .01). Important predictors of device choice were insurance type, year of insertion, hospital and surgeon volume, and the presence of comorbidities. CLINICAL IMPLICATIONS Major influences in choice of PP inserted include racial and socioeconomic factors and surgeon and hospital surgical volume. STRENGTHS AND LIMITATIONS Use of the SPARCS database, which captures inpatient and outpatient services, allows for more accurate insight into trends in contrast to inpatient sampling alone. However, SPARCS is limited to patients within New York State and the results might not be generalizable to men in other states. Also, patient preference was not accounted for in these analyses, which can play a role in PP selection. CONCLUSIONS During the past 14 years, there has been an increasing trend in inflatable PP surgery for the management of erectile dysfunction. Most procedures are performed in the ambulatory setting and not previously captured by prior studies using inpatient data. Kashanian JA, Golan R, Sun T, et al. Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State. J Sex Med 2018;15:245-250.
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Affiliation(s)
- James A Kashanian
- Department of Urology, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA.
| | - Ron Golan
- Department of Urology, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Tianyi Sun
- Department of Health Services and Policy Research, Weill Cornell Medicine, New York, NY, USA
| | - Neal A Patel
- Department of Urology, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Michael J Lipsky
- Department of Urology, New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Peter J Stahl
- Department of Urology, New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Art Sedrakyan
- Department of Health Services and Policy Research, Weill Cornell Medicine, New York, NY, USA
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Lipsky MJ, Golan R, Onyeji I, Munarriz R, Kashanian JA, Stember DS, Stahl PJ. MP25-12 DIABETES IS A RISK FACTOR FOR IPP INFECTION: ANALYSIS OF A LARGE STATEWIDE DATABASE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.762] [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: 10/19/2022]
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Lipsky MJ, Sui W, Small AC, Munarriz R, Kashanian JA, Stember DS, Stahl PJ. PD31-03 CONTEMPORARY TRENDS IN THE SURGICAL MANAGEMENT OF PEYRONIE′S DISEASE IN NEW YORK STATE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1381] [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: 11/28/2022]
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Lipsky MJ, Sui W, Small AC, Robins DJ, Mlynarczyk CM, Brandes SB, Stahl PJ. MP79-14 PENILE FRACTURE INCIDENCE AND PHYSICIAN COMPLIANCE WITH UROTRAUMA GUIDELINES IN NEW YORK STATE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2498] [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: 10/19/2022]
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Gross MS, Phillips EA, Carrasquillo RJ, Thornton A, Greenfield JM, Levine LA, Alukal JP, Conners WP, Glina S, Tanrikut C, Honig SC, Becher EF, Bennett NE, Wang R, Perito PE, Stahl PJ, Rosselló Gayá M, Rosselló Barbará M, Cedeno JD, Gheiler EL, Kalejaiye O, Ralph DJ, Köhler TS, Stember DS, Carrion RE, Maria PP, Brant WO, Bickell MW, Garber BB, Pineda M, Burnett AL, Eid JF, Henry GD, Munarriz RM. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017; 14:455-463. [PMID: 28189561 DOI: 10.1016/j.jsxm.2017.01.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/27/2016] [Accepted: 01/03/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines. AIM To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections. METHODS This retrospective institutional review board-exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device. MAIN OUTCOME MEASURES Intraoperative culture data from infected IPPs. RESULTS Two hundred twenty-seven intraoperative cultures (2002-2016) were obtained at salvage or explantation. No culture growth occurred in 33% of cases and gram-positive and gram-negative organisms were found in 73% and 39% of positive cultures, respectively. Candida species (11.1%), anaerobes (10.5%) and methicillin-resistant Staphylococcus aureus (9.2%) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25% of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62% to 86% of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation. CONCLUSION This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success. Gross MS, Phillips EA, Carrasquillo RJ, et al. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017;14:455-463.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sidney Glina
- Faculdade de Medicina do ABC/Instituto H. Ellis, Bela Vista, SP, Brazil
| | | | | | | | | | - Run Wang
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Peter J Stahl
- Columbia University College of Physicians & Surgeons, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Miguel Pineda
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Stahl PJ. Recovery of spermatogenesis after hormone therapy: what to expect and when to expect it. Fertil Steril 2017; 107:338-339. [PMID: 28160921 DOI: 10.1016/j.fertnstert.2016.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Peter J Stahl
- Male Reproductive & Sexual Medicine, New York-Presbyterian Hospital/Columbia University Medical Center; and Department of Urology, Columbia University College of Physicians & Surgeons, New York, New York
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Onyeji IC, Sui W, Pagano MJ, Weinberg AC, James MB, Theofanides MC, Stember DS, Anderson CB, Stahl PJ. Impact of Surgeon Case Volume on Reoperation Rates after Inflatable Penile Prosthesis Surgery. J Urol 2016; 197:223-229. [PMID: 27545573 DOI: 10.1016/j.juro.2016.08.083] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE We investigated the impact of surgeon annual case volume on reoperation rates after inflatable penile prosthesis surgery. MATERIALS AND METHODS The New York Statewide Planning and Research Cooperative System database was queried for inflatable penile prosthesis cases from 1995 to 2014. Multivariate proportional hazards regression was performed to estimate the impact of surgeon annual case volume on inflatable penile prosthesis reoperation rates. We stratified our analysis by indication for reoperation to determine if surgeon volume had a similar effect on infectious and noninfectious complications. RESULTS A total of 14,969 men underwent inflatable penile prosthesis insertion. Median followup was 95.1 months (range 0.5 to 226.7) from the time of implant. The rates of overall reoperation, reoperation for infection and reoperation for noninfectious complications were 6.4%, 2.5% and 3.9%, respectively. Implants placed by lower volume implanters were more likely to require reoperation for infection but not for noninfectious complications. Multivariable analysis demonstrated that compared with patients treated by surgeons in the highest quartile of annual case volume (more than 31 cases per year), patients treated by surgeons in the lowest (0 to 2 cases per year), second (3 to 7 cases per year) and third (8 to 31 cases per year) annual case volume quartiles were 2.5 (p <0.001), 2.4 (p <0.001) and 2.1 (p=0.01) times more likely to require reoperation for inflatable penile prosthesis infection, respectively. CONCLUSIONS Patients treated by higher volume implanters are less likely to require reoperation after inflatable penile prosthesis insertion than those treated by lower volume surgeons. This trend appears to be driven by associations between surgeon volume and the risk of prosthesis infection.
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Affiliation(s)
- Ifeanyi C Onyeji
- Department of Urology, Columbia University Medical Center, New York, New York.
| | - Wilson Sui
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Mathew J Pagano
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Aaron C Weinberg
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Maxwell B James
- Department of Urology, Columbia University Medical Center, New York, New York
| | | | | | | | - Peter J Stahl
- Department of Urology, Columbia University Medical Center, New York, New York
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Sui W, Onyeji IC, James MB, Stahl PJ, RoyChoudhury A, Anderson CB. Risk Factors for Priapism Readmission. J Sex Med 2016; 13:1555-61. [PMID: 27496074 DOI: 10.1016/j.jsxm.2016.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/07/2016] [Revised: 06/27/2016] [Accepted: 07/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Priapism is a urologic emergency with a tendency to recur in some patients. The frequency of, time to, and risk factors for priapism recurrence have not been well characterized. AIM To identify predictors of priapism readmission. METHODS We used the New York Statewide Planning and Research Cooperative System database to identify patients presenting to emergency departments with priapism from 2005 through 2014. Patients were tracked up to 12 months after initial presentation. Proportional hazards regression was used to identify risk factors for priapism readmission. MAIN OUTCOME MEASURES Readmissions for priapism. RESULTS The analytic cohort included 3,372 men with a diagnosis of priapism. The average age at first presentation was 39 ± 18 years and 40% were black. Within 1 year, 24% of patients were readmitted for recurrent priapism, 68% of whom were readmitted within 60 days. On multivariate analysis, sickle cell disease (hazard ratio [HR] = 2.5, 95% CI = 2.0-3.0), drug abuse or psychiatric disease (HR = 1.9, 95% CI = 1.6-2.2), erectile dysfunction history (HR = 1.9, 95% CI = 1.5-2.3), other than commercial medical insurance (HR = 1.2, 95% CI = 1.0-1.4), and inpatient admission for initial priapism event (HR = 0.5, 95% CI = 0.4-0.6) were significant risk factors for readmission. CONCLUSION Nearly one fourth of patients with priapism were readmitted for recurrent priapism within 1 year of initial presentation. Most readmissions were within 60 days. Future research should focus on strategies to decrease recurrences in high-risk patients.
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Affiliation(s)
- Wilson Sui
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Ifeanyi C Onyeji
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Maxwell B James
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Peter J Stahl
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Arindam RoyChoudhury
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
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Pagano MJ, De Fazio A, Levy A, RoyChoudhury A, Stahl PJ. Age, Body Mass Index, and Frequency of Sexual Activity are Independent Predictors of Testosterone Deficiency in Men With Erectile Dysfunction. Urology 2016; 90:112-8. [DOI: 10.1016/j.urology.2015.12.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 01/26/2023]
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Gaffney CD, Pagano MJ, Kuker AP, Stember DS, Stahl PJ. Osteoporosis and Low Bone Mineral Density in Men with Testosterone Deficiency Syndrome. Sex Med Rev 2015; 3:298-315. [PMID: 27784602 DOI: 10.1002/smrj.63] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 12/13/2022]
Abstract
INTRODUCTION Testosterone deficiency syndrome (TDS) is a risk factor for low bone mineral density (BMD) and osteoporosis. Knowledge of the relationship between TDS and bone health, as well as the practical aspects of how to diagnose and treat low BMD, is therefore of practical importance to sexual medicine practitioners. AIM The aim of this study was to review the physiologic basis and clinical evidence of the relationship between TDS and bone health; and to provide a practical, evidence-based algorithm for the diagnosis and management of low BMD in men with TDS. METHODS Method used was a review of relevant publications in PubMed. MAIN OUTCOME MEASURES Pathophysiology of low BMD in TDS, morbidity, and mortality of osteoporosis in men, association between TDS and osteoporosis, indications for dual X-ray absorptiometry (DXA) scanning in TDS, evidence for testosterone replacement therapy (TRT) in men with osteoporosis, treatment for osteoporosis in the setting of TDS. RESULTS Sex hormones play a pleomorphic role in maintenance of BMD. TDS is associated with increased risk of osteoporosis and osteopenia, both of which contribute to morbidity and mortality in men. DXA scanning is indicated in men older than 50 years with TDS, and in younger men with longstanding TDS. Men with TDS and osteoporosis should be treated with anti-osteoporotic agents and TRT should be highly considered. Men with osteopenia should be stratified by fracture risk. Those at high risk should be treated with anti-osteoporotic agents with strong consideration of TRT; while those at low risk should be strongly considered for TRT, which has a beneficial effect on BMD. CONCLUSION Low BMD is a prevalent and treatable cause of morbidity and mortality in men with TDS. Utilization of a practical, evidence-based approach to diagnosis and treatment of low BMD in men with TDS enables sexual medicine practitioners to make a meaningful impact on patient quality of life and longevity. Gaffney CD, Pagano MJ, Kuker AP, Stember DS, and Stahl PJ. Osteoporosis and low bone mineral density in men with testosterone deficiency syndrome.
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Affiliation(s)
| | - Matthew J Pagano
- Department of UrologyColumbia University Medical CenterNew YorkNYUSA
| | - Adriana P Kuker
- Division of EndocrinologyDepartment of MedicineColumbia University Medical CenterNew YorkNYUSA
| | - Doron S Stember
- Department of UrologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Peter J Stahl
- Department of UrologyColumbia University Medical CenterNew YorkNYUSA.
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Pagano MJ, Stahl PJ. Variation in Penile Hemodynamics by Anatomic Location of Cavernosal Artery Imaging in Penile Duplex Doppler Ultrasound. J Sex Med 2015; 12:1911-9. [DOI: 10.1111/jsm.12958] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Stahl PJ, Cogan C, Mehta A, Bolyakov A, Paduch DA, Goldstein M. Concordance among sperm deoxyribonucleic acid integrity assays and semen parameters. Fertil Steril 2015; 104:56-61.e1. [PMID: 25989978 DOI: 10.1016/j.fertnstert.2015.04.023] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/14/2015] [Accepted: 04/15/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the concordance of sperm chromatin structure assay (SCSA) results, epifluorescence TUNEL assay results, and standard semen parameters. DESIGN Prospective, observational study. SETTING Tertiary referral andrology clinic. PATIENT(S) A total of 212 men evaluated for subfertility by a single physician. INTERVENTION(S) Clinical history, physical examination, semen analysis, SCSA, and TUNEL assay. MAIN OUTCOME MEASURE(S) Spearman's rank correlation coefficients (r) between SCSA DNA fragmentation index (DFI), percentage TUNEL-positive sperm, and semen analysis parameters. RESULT(S) There was a positive correlation between SCSA DFI and TUNEL (r = 0.31), but the strength of this correlation was weaker than has previously been reported. The discordance rate between SCSA and TUNEL in classifying patients as normal or abnormal was 86 of 212 (40.6%). The SCSA DFI was moderately negatively correlated with sperm concentration and motility. The TUNEL results were unrelated to standard semen parameters. CONCLUSION(S) The SCSA DFI and percentage TUNEL-positive sperm are moderately correlated measures of sperm DNA integrity but yield different results in a large percentage of patients. The DFI is well-correlated with semen analysis parameters, whereas TUNEL is not. These data indicate that the SCSA and TUNEL assay measure different aspects of sperm DNA integrity and should not be used interchangeably.
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Affiliation(s)
- Peter J Stahl
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York.
| | - Chava Cogan
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Alex Bolyakov
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Darius A Paduch
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Marc Goldstein
- Department of Urology, Weill Cornell Medical College, New York, New York
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Abstract
Vasectomy is the most common urological procedure in the United States with 18% of men having a vasectomy before age 45. A significant proportion of vasectomized men ultimately request vasectomy reversal, usually due to divorce and/or remarriage. Vasectomy reversal is a commonly practiced but technically demanding microsurgical procedure that restores patency of the male excurrent ductal system in 80–99.5% of cases and enables unassisted pregnancy in 40–80% of couples. The discrepancy between the anastomotic patency rates and clinical pregnancy rates following vasectomy reversal suggests that some of the biological consequences of vasectomy may not be entirely reversible in all men. Herein we review what is known about the biological sequelae of vasectomy and vasectomy reversal in humans, and provide a succinct overview of the evaluation and surgical management of men desiring vasectomy reversal.
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Affiliation(s)
- Aaron M Bernie
- Department of Urology and Institute of Reproductive Medicine; Weill Cornell Medical College; New York-Presbyterian Hospital; New York, NY USA
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22
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Abstract
Erectile function recovery after radical prostatectomy (RP) is an increasingly prominent quality-of-life outcome following surgery. Following RP many men, despite the advent of cavernous nerve-sparing surgical technique, have moderately or significantly impaired erectile function (EF). The term penile rehabilitation (PR) is used to define interventions that maintain the health of erectile tissue in the context of nervous, vascular, and structural tissue injury. The goal of PR is to regain, as closely re-approximate, preoperative erectile function. PR is based on an increasing volume of preclinical and clinical data, but conclusive evidence of efficacy has not been established, and therefore the concept of PR remains controversial. The optimal PR regimen has not been established, but all strategies rely on one or more erectile dysfunction treatments to be administered on a regular basis regardless of actual use for sexual activity. This review highlights recent studies and evidence related to PR.
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Abstract
Technical refinements in sperm retrieval methods and the application of advanced reproductive technologies (ART) using surgically retrieved sperm have enabled biological paternity in azoospermic men who were considered untreatable 20 years ago. Achievement of optimal reproductive outcomes in these patients benefits greatly from a multistep, interdisciplinary process of sperm acquisition that involves reproductive endocrinologists, urologists, or other specialists in male subfertility, and laboratory personnel with expertise in characterizing and isolating sperm from surgically retrieved specimens. The critical steps in this process are discussed in this chapter.
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Affiliation(s)
- Peter J Stahl
- Department of Urology, Columbia University Medical Cente, 161 Fort Washington Ave 11th floor, New York, NY, 10032, USA
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O'Bryan MK, Grealy A, Stahl PJ, Schlegel PN, McLachlan RI, Jamsai D. Genetic variants in the ETV5 gene in fertile and infertile men with nonobstructive azoospermia associated with Sertoli cell-only syndrome. Fertil Steril 2012; 98:827-35.e1-3. [PMID: 22771031 DOI: 10.1016/j.fertnstert.2012.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 06/12/2012] [Accepted: 06/12/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the association between genetic variants in the ETV5 gene with nonobstructive azoospermia (NOA) associated with Sertoli cell-only (SCO) syndrome. DESIGN Genetic association study. SETTING University. PATIENT(S) Australian men (65 SCO, 53 NOA, and 242 fertile men) and American men (86 SCO and 54 fertile men). INTERVENTION(S) Paraffin-embedded human testicular tissue was sectioned and processed for immunofluorescence. Direct DNA sequencing and polymerase chain reaction-based SNP detection were performed to define genetic variants in the ETV5 gene. MAIN OUTCOME MEASURE(S) The localization of ETV5 in the human testis and the presence of ETV5 genetic variants in fertile and infertile men. RESULT(S) ETV5 is localized to the cytoplasm and nucleus of Sertoli and germ cells in adult human testes. We identified six previously reported and six new genetic variants in the ETV5 gene. Of these, the allele frequency of the homozygous +48845 G>T (TT allele) variant was significantly higher in the SCO and NOA Australian men compared with fertile men. CONCLUSION(S) The homozygous +48845 G>T (TT allele) variant confers a higher risk for male infertility associated with NOA and SCO in Australian men.
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Affiliation(s)
- Moira K O'Bryan
- Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
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25
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Abstract
Medical treatment of men with primary spermatogenic failure remains largely ineffective in contrast to those with secondary testicular failure. Treatment has been attempted with a multitude of agents ranging from hormones to nutritional supplements (antioxidants). While some studies have demonstrated benefit to some treatments, no treatments have consistently demonstrated efficacy nor has it been possible to reliably identify patients likely to benefit. Idiopathic spermatogenic failure likely results from multiple discrete defects in sperm production that are as yet unidentified. A better understanding of these defects will yield more effective treatment options and appropriate triage of patients to specific therapeutic regimens. This review focuses on the rationale and current evidence for hormonal and antioxidant therapy in medical treatment of male infertility, spermatogenic failure in particular. Although empiric medical therapy for spermatogenic failure has been largely replaced by assisted reproductive techniques, both treatment modalities could play a role, perhaps as combination therapy.
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Affiliation(s)
- Ranjith Ramasamy
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
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Abstract
Knowledge of normal male reproductive function and familiarity with the diagnostic evaluation and treatment of male subfertility is beneficial for most physicians. Male subfertility is often correctable, may be genetically transmissible, and may be associated with occult health-threatening conditions. Herein we present an overview of male reproductive medicine, which has been revolutionized in the past two decades by dramatic scientific and therapeutic advances. The development of intracytoplasmic sperm injection and its successful application to sperm retrieved from the epididymis or testis have made biological paternity possible in men previously considered sterile. Microsurgical techniques for vasal-epididymal reconstruction and sperm retrieval have been refined. Novel tests of semen quality have been developed. Medical therapies to improve sperm production, such as estrogen receptor modulation and aromatase inhibition, have been used increasingly in clinical practice. Finally, associations between male subfertility and a spectrum of health-threatening conditions have been recognized.
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Affiliation(s)
- Peter J Stahl
- Weill Cornell Medical College, New York, New York, USA.
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Hsiao W, Stahl PJ, Osterberg EC, Nejat E, Palermo GD, Rosenwaks Z, Schlegel PN. Successful treatment of postchemotherapy azoospermia with microsurgical testicular sperm extraction: the Weill Cornell experience. J Clin Oncol 2011; 29:1607-11. [PMID: 21402606 DOI: 10.1200/jco.2010.33.7808] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED PURPOSE; Advances in chemotherapy have led to greater longevity and paternity may be an important consideration for postchemotherapy survivors of childhood cancers. While traditionally considered sterile, men who are azoospermic after chemotherapy can be treated with microdissection testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). PATIENTS AND METHODS Oncologic data, pretreatment hormone profiles, testicular histology, and outcomes of microdissection TESE-ICSI were reviewed. ICSI was performed in a programmed in vitro fertilization cycle using fresh spermatozoa. Embryos were transferred into the uterine cavity on the third day after microinjection. RESULTS Eighty-four microdissection TESE procedures were performed in 73 patients. The mean time elapsed since chemotherapy was 18.6 years (range, 1 to 34 years). Spermatozoa were retrieved in 37% of patients and in 42.9% of overall procedures. A 57.1% fertilization rate (per injected oocyte) was achieved with ICSI allowing a 50% clinical pregnancy rate with a live birth rate of 42% overall. There were 15 deliveries, with a total of 20 children born. Hypospermatogenesis seen on preoperative biopsy was associated with 100% sperm retrieval while exposure to alkylating agents resulted in a significantly lower sperm retrieval rate. Patients with testicular cancer had the highest sperm retrieval rates while patients previously treated for sarcoma had the lowest retrieval rates. CONCLUSION To our knowledge, this represents the largest series of postchemotherapy microdissection TESE-ICSI to date. Sperm were retrieved in 37% of patients despite a prevalence of Sertoli cell-only pattern on preoperative biopsy. Although prechemotherapy sperm cryopreservation is recommended, treatment with microdissection TESE and ICSI are effective treatment options for many azoospermic men after chemotherapy.
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Affiliation(s)
- Wayland Hsiao
- Weill Cornell Medical College, James Buchanan Brady Foundation, New York, NY 10065, USA
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Stahl PJ, Mielnik A, Margreiter M, Marean MB, Schlegel PN, Paduch DA. Diagnosis of the gr/gr Y chromosome microdeletion does not help in the treatment of infertile American men. J Urol 2010; 185:233-7. [PMID: 21074808 DOI: 10.1016/j.juro.2010.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE The phenotypic effects of the gr/gr partial azoospermia factor c deletion vary geographically and to our knowledge have not been reported in the American population. We evaluated the clinical characteristics of infertile American men with the gr/gr deletion. MATERIALS AND METHODS We retrospectively reviewed clinical data on 1,410 infertile men tested for the gr/gr deletion. We analyzed sperm concentration and the outcome of microdissection testicular sperm extraction with respect to gr/gr status. RESULTS We identified 73 men with gr/gr deletions, including 43 of 989 (4.3%) with azoospermia, 18 of 317 (5.7%) with severe oligospermia (less than 5 million sperm per ml), 6 of 61 (9.8%) with oligospermia (5 to less than 20 million sperm per ml) and 6 of 43 (14%) infertile men with normospermia (greater than 20 million sperm per ml). A gr/gr deletion correlated with higher sperm production. The gr/gr deletion rate was higher in men with normospermia than in those with a sperm concentration of less than 20 million and less than 5 million per ml (p = 0.021 and 0.006, respectively). Microdissection testicular sperm extraction was done in 22 azoospermic men with gr/gr deletions and sperm were retrieved in 14 (64%). This retrieval rate was similar to that at our center in men with idiopathic nonobstructive azoospermia (p = 0.13). CONCLUSIONS Diagnosis of the gr/gr deletion did not predict impaired sperm production in our patient population and did not appear to alter the prognosis for surgical sperm retrieval. Despite the established modulatory impact of the gr/gr deletion on sperm production in some populations at this time the clinical value of testing infertile American men for the gr/gr deletion is not clear.
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Affiliation(s)
- Peter J Stahl
- Department of Urology, Weill Cornell Medical College, New York, New York, USA.
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Stahl PJ, Masson P, Mielnik A, Marean MB, Schlegel PN, Paduch DA. A decade of experience emphasizes that testing for Y microdeletions is essential in American men with azoospermia and severe oligozoospermia. Fertil Steril 2009; 94:1753-6. [PMID: 19896650 DOI: 10.1016/j.fertnstert.2009.09.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 07/31/2009] [Accepted: 09/08/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the benefit of Y microdeletion testing. DESIGN Retrospective analysis. SETTING University-based male fertility clinic and genetics laboratory. PATIENT(S) A total of 1,591 men with sperm concentrations less than 5 million sperm/mL. INTERVENTION(S) Semen analysis, Y microdeletion testing, microdissection testicular sperm extraction (TESE). MAIN OUTCOME MEASURE(S) Sperm concentration, incidence and nature of Y microdeletions, microdissection TESE outcome. RESULT(S) We identified 149 microdeletions (9.4%). 10.4% of azoospermic men and 10.1% of men with sperm concentrations >0-1 million sperm/mL harbored microdeletions. Two-thirds of microdeletions in azoospermic men were AZFa, AZFb, AZFb+c, or complete Yq deletions. Virtually all microdeletions in oligozoospermic patients were AZFc deletions. Seven hundred eighteen patients underwent microdissection TESE, including 41 with microdeletions. Microdissection TESE failed in all patients with AZFa, AZFb, AZFb+c, and complete Yq deletions. Sperm were retrieved in 15/21 AZFc deleted patients (71.4%). The presence of an AZFc deletion was associated with increased likelihood of sperm retrieval when compared with the 48.8% retrieval rate in 385 idiopathically azoospermic men who consecutively underwent microdissection TESE at our institution during the study period. Clinical pregnancy was achieved in 10/15 azoospermic AZFc deleted patients for whom sperm were successfully retrieved. CONCLUSION(S) Of azoospermic and severely oligozoospermic American men, 10% harbor Y microdeletions that alter prognosis for surgical sperm retrieval and are vertically transmissible. Y microdeletion testing is essential for genetic and preoperative counseling in these patients.
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Affiliation(s)
- Peter J Stahl
- Department of Urology, Weill Cornell Medical College, New York, New York 10065, USA
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Stahl PJ, Mielnik A, Marean MB, Schlegel PN, Paduch DA. THE GR/GR POLYMORPHISM IS CLINICALLY IRRELEVANT. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61744-9] [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: 11/15/2022]
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Stahl PJ, Mielnik A, Marean MB, Schlegel PN, Paduch DA. IDENTIFICATION OF CANDIDATE GENES FOR INDIVIDUAL STEPS IN SPERMATOGENESIS. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61806-6] [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: 10/22/2022]
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Broadbelt NV, Stahl PJ, Chen J, Mizrahi M, Lal A, Bozkurt A, Poppas DP, Felsen D. Early upregulation of iNOS mRNA expression and increase in NO metabolites in pressurized renal epithelial cells. Am J Physiol Renal Physiol 2007; 293:F1877-88. [PMID: 17881462 DOI: 10.1152/ajprenal.00238.2007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pressure is an important physiological regulator, but under abnormal conditions it may be a critical factor in the onset and progression of disease in many organs. In vivo, proximal tubular epithelial cells are subjected to pressure as a result of ureteral obstruction, which may influence the production of nitric oxide (NO), a ubiquitous multifunctional cytokine. To directly explore the effect of pressure on the expression and activity of NO synthase (NOS) in cultured proximal tubular epithelial cells, a novel pressure apparatus was developed. Cells were subjected to pressures of 20-120 mmHg over time (5 min-72 h). RT-PCR demonstrated an increase in inducible NOS (iNOS) and sGC, while endothelial NOS remained unchanged. Real-time PCR (qPCR) confirmed an earlier induction of iNOS transcript subjected to 60 mmHg compared with cytokine mix. iNOS protein expression was significantly increased following 60 mmHg of pressure for 24 h. Use of nuclear factor-kappaB inhibitors was shown to prevent the increase in iNOS expression following 60 mmHg for 2 h. NO and cGMP were increased with the application of pressure. The addition of the irreversible iNOS inhibitor (1400W) was shown to prevent this increase. We demonstrate that with the use of a simply designed apparatus, pressure led to an extremely early induction of iNOS and a rapid activation of NOS activity to increase NO and cGMP in proximal tubule epithelial cells. The rapid effects of pressure on iNOS may have important implications in the obstructed kidney.
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Affiliation(s)
- Nalini V Broadbelt
- Dept. of Urology, Institute for Pediatric Urology, Weill Cornell Medical Center, New York, NY 10021, USA
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Abstract
PURPOSE Edward Loughborough Keyes was a renowned urologist, decorated war hero, prolific writer and beloved professor. Having served as president of the American Association of Genitourinary Surgeons, the American Urological Association, the International Urological Society and the Clinical Urological Association, Keyes in large part steered the course of urology during the early twentieth century. MATERIALS AND METHODS We reviewed letters, original publications and historical records pertaining to Doctor Keyes found in the New York Hospital archives, the American Urological Association historical record, the medical literature and the popular press. RESULTS Edward Loughborough Keyes, Jr. received his M.D. from Columbia in 1895, and went on to hold academic positions in urology at Georgetown, the New York Polyclinic Medical School, St. Vincent's Hospital, Memorial Hospital, New York University and at the Cornell University Medical College, where he spent most of his career. He authored the premier urology textbook of his day, Urology, and published prolifically on a myriad of urological conditions. Doctor Keyes served in World War I as consultant in urology to General John J. Pershing, commander of the American Expeditionary Force. During the war he and Hugh Hampton Young led modern history's first public campaign against sexually transmitted disease, and in America he was one of the leaders of the American social hygiene movement from which contemporary sexual education evolved. He spoke Spanish and French fluently, wrote poetry and prose prolifically, and was beloved for his good humor. He died at the age of 75 in New York. CONCLUSIONS Edward Loughborough Keyes is remembered as one of the great urologists of the early twentieth century.
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Affiliation(s)
- Peter J Stahl
- Department of Urology, Weill Medical College of Cornell University, New York, New York 10021, USA.
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Blaivas JG, Weiss JP, Desai P, Flisser AJ, Stember DS, Stahl PJ. LONG-TERM FOLLOWUP OF AUGMENTATION ENTEROCYSTOPLASTY AND CONTINENT DIVERSION IN PATIENTS WITH BENIGN DISEASE. J Urol 2005; 173:1631-4. [PMID: 15821519 DOI: 10.1097/01.ju.0000154891.40110.08] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated long-term outcomes in patients undergoing augmentation enterocystoplasty (AC) (with or without an abdominal stoma) or continent urinary diversion in patients with benign urological disorders. MATERIALS AND METHODS This was a retrospective study of 76 consecutive adults who underwent AC (with or without an abdominal stoma) or continent urinary diversion because of benign urological conditions. The outcomes assessed were a patient satisfaction questionnaire, continence status, catheterization status, bladder capacity, bladder compliance, detrusor instability, maximum detrusor pressure, upper tract status, significant postoperative morbidity, need for reoperation, persistent diarrhea and vitamin B12 deficiency. RESULTS The 76 patients (18 men and 58 women) were 19 to 80 years old (mean age 49). Followup was 1 to 19 years (mean 8.9). Preoperative diagnoses were neurogenic bladder in 41 patients, refractory detrusor overactivity in 9, interstitial cystitis in 7, end stage bladder disease in 7, radiation cystitis in 3, exstrophy in 3, postoperative urethral obstruction in 3 and low bladder compliance in 3. A total of 50 patients underwent simple AC, 15 underwent AC with an abdominal stoma and 11 underwent continent supravesical diversion. Of the 71 evaluable patients 49 (69%) considered themselves cured, 14 (20%) considered themselves improved and 8 (11%) considered treatment to have failed. All 7 patients with interstitial cystitis had failed treatment. Mean bladder capacity increased from 166 to 572 ml and mean maximum detrusor pressure decreased from 53 to 14 cm H2O. Serum creatinine improved or remained normal in all patients. Five patients experienced persistent diarrhea requiring intermittent antispasmodics but none had vitamin B12 deficiency, pernicious anemia or malabsorption syndrome. Long-term complications were stomal stenosis or incontinence in 11 of 26 patients (42%) with stomas, de novo bladder and renal stones in 2 of 71 (3%) and 1 of 71 (1%), respectively, and recurrent bladder stones in 6%. Small bowel obstruction occurred in 5 of 71 patients (7%), requiring surgical exploration in 4 (6%). CONCLUSIONS AC and urinary diversion provide a safe and effective long-term therapy in patients with refractory neurogenic bladder but stomal problems in patients with continent diversion continue to be a source of complications.
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Affiliation(s)
- Jerry G Blaivas
- Joan and Sanford I. Weill Medical College of Cornell University, Bronx, New York, USA
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Stern JM, Chen J, Peters SB, Stahl PJ, El-Chaar M, Felsen D, Poppas DP. Testosterone treatment of human foreskin in a novel transplant model. Urology 2004; 63:999-1003. [PMID: 15135007 DOI: 10.1016/j.urology.2003.11.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2003] [Accepted: 11/26/2003] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine whether testosterone would increase angiogenesis in human foreskin, because of the known effects of testosterone on endothelial cells and vascular endothelial growth factor expression. Surgical management of complex hypospadias in a patient who has undergone multiple procedures is technically very challenging. It is possible that therapy to increase the blood supply to this tissue could be beneficial. METHODS We used a newly developed model of human skin transplantation, in which full-thickness human foreskin is transplanted subcutaneously onto the dorsum of a nude rat. At 10 days after transplantation, tissue was treated with either testosterone gel or vehicle control. After an additional 7 days, the tissue was harvested, embedded in paraffin, stained for factor VIII to assess vascularity, and examined histologically. RESULTS The testosterone-treated tissue demonstrated increased factor VIII staining (31.14 +/- 1.53 vessels per high-power field) compared with the control group (18.25 +/- 2.3 vessels per high-power field; P <0.0005). Histologic analysis revealed less collagen in the testosterone-treated group compared with the control group. CONCLUSIONS Treatment of human foreskin with testosterone, in a transplant model, increased vascularity and decreased early fibrosis. Testosterone treatment may improve the surgical management of complex hypospadias repair.
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Affiliation(s)
- Joshua M Stern
- Institute for Pediatric Urology, Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York 10021, USA
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Stahl PJ, Chen J, Robenzadah A, Wang B, Felsen D, Poppas DP. 703: Pressure Induces Renal Epithelial Cell Nitric Oxide Production. J Urol 2004. [DOI: 10.1016/s0022-5347(18)37952-7] [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: 11/26/2022]
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Blaivas JG, Weiss JP, Desai P, Flisser AJ, Stember DS, Stahl PJ. 660: Enterocystoplasty & Continent Diversion in Patients with Benign Urologic Disorders. J Urol 2004. [DOI: 10.1016/s0022-5347(18)37922-9] [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: 10/17/2022]
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Affiliation(s)
- P J Stahl
- Weill Medical College of Cornell University, The Paediatric Urology Center, New York-Presbyterian Hospital, NY, USA
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Stahl PJ, Felsen D. Transforming growth factor-beta, basement membrane, and epithelial-mesenchymal transdifferentiation: implications for fibrosis in kidney disease. Am J Pathol 2001; 159:1187-92. [PMID: 11583944 PMCID: PMC1850494 DOI: 10.1016/s0002-9440(10)62503-5] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- P J Stahl
- Center for Pediatric Urology and Minimally Invasive Urologic Surgery, Weill Medical College of Cornell University, New York, New York 10021-4896, USA
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