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Re: Satisfaction Profiles in Men Using Intracavernosal Injection Therapy
SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
Re: Paternal Body Mass Index is Associated With Decreased Blastocyst Development and Reduced Live Birth Rates Following Assisted Reproductive Technology H. W. Bakos, R. C. Henshaw, M. Mitchell and M. Lane Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, Robinson Institute, University of Adelaide, Adelaide, Australia Fertil Steril 2011; 95: 1700 –1704.
Objective: To determine the relationship between paternal body mass index (BMI), embryo development and pregnancy, and live birth outcomes after assisted reproductive technology (ART). Design: Retrospective analysis of ART cycles. Setting: Major assisted reproduction center. Patient(S): Three hundred five couples undergoing ART in a private fertility clinic. Intervention(S): No intervention was undertaken in patients involved in this study. Main Outcome Measure(S): Live birth outcomes and clinical pregnancy rates. Result(S): No significant relationship between paternal BMI and early embryo development was found. However, increased paternal BMI was associated with decreased blastocyst development, clinical pregnancy rates and live birth outcomes. Conclusion(S): To our knowledge, this is the first report linking increased paternal BMI and clinical pregnancy and live birth rates after ART treatment. Further work to elucidate the mechanisms involved is required. Editorial Comment: The association between female obesity and worsening in vitro fertilization outcomes is well known, and evidence is accumulating that male obesity is associated with impaired semen quality as well as endocrine dysfunction. However, is male obesity associated with worsening in vitro fertilization outcomes? These investigators report that increasing male BMI is correlated to impaired blastocyst development, decreased clinical pregnancy rates and lower live birth outcomes. Should this effect be true, the first question is why, and the second is, does weight loss help? Craig Niederberger, M.D.
Socioeconomic Factors, Urological Epidemiology and Practice Patterns Re: Satisfaction Profiles in Men Using Intracavernosal Injection Therapy W. Hsiao, N. Bennett, P. Guhring, J. Narus and J. P. Mulhall Department of Urology, Center for Male Reproductive Medicine, Weill Cornell Medical College, New York, New York J Sex Med 2011; 8: 512–517.
Introduction: Intracavernosal injection therapy (ICI) is a well-established second-line therapy used in the treatment of erectile dysfunction (ED). Controversy exists as to whether oral phosphodiesterase type 5 inhibitors (PDE5i) or injection therapy lead to higher satisfaction. Aim: This study addressed ICI satisfaction in a modern cohort of patients in the PDE5i era. Methods: Patients on ICI for at least 6 months were included in our study. Patients were administered the International Index of Erectile Function (IIEF) at the initial visit. On subsequent visits, patients were administered the IIEF and the Erection Hardness Scale (EHS). Main Outcome Measures: Study end points were change in baseline scores in the satisfaction domains (SD) of the IIEF, type of injection medication used, and predictors of satisfaction. Multiple logistic regressions were performed for predictors of satisfaction. Results: One hundred twenty-two patients met inclusion criterion. Mean time to follow-up was 25⫾12 months (range 6 –106 months). Sixty-five percent of patients continued injections at the time of follow-up. When SD scores were examined, intercourse SD scores increased from 4.8⫾1.7 at baseline to 12.3⫾3.1 (P ⬍0.01); overall SD scores increased from 4.1⫾1.8 to 7.2⫾2.0 (P ⬍0.05). On multivariate analysis,
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SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
predictors of satisfaction included older age (odds ratio [OR] ⫽ 2.1), younger partner age (OR ⫽ 2.5), clinically significant increase in the erectile function domain score (OR ⫽ 3.1), and attainment of a “fully rigid” erection (EHS 4) (OR ⫽ 6.8). Conclusions: We have evaluated satisfaction in a modern cohort of ICI patients. While dropout rates are significant, for those patients who continue to inject, we have found high levels of satisfaction using the IIEF, the gold standard for evaluation of erectile function. On multivariate analysis, we found that older age, younger partner age, and fully rigid erections were predictors of increased satisfaction. ICI remains a robust second-line therapy in the treatment of ED even in the era of PDE5i. Editorial Comment: As urologists, we saw fewer patients with erectile dysfunction in 2011, if only because many primary care providers have become comfortable prescribing PDE5i, and these agents can be quite effective. For the patient who fails or cannot take PDE5i, ICI remains a viable option. This study shows that roughly 65% of patients on ICI stay on the treatment and are relatively satisfied with the therapy. Of course, we can therefore assume that roughly 35% of patient who start ICI are dissatisfied with the treatment and discontinue it. If nothing else, this study indicates that there is still a role for the urological surgeon in the treatment of male sexual dysfunction. David F. Penson, M.D., M.P.H.
Re: Fifteen-Year Trend in the Use of Male Reproductive Surgery: Analysis of the Healthcare Cost and Utilization Project Data A. Ketefian, J. Hu, A. A. Bartolucci, P. N. Schlegel and R. Azziz; Society of Reproductive Surgeons, Inc. Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California BJU Int 2011; 107: 1118 –1123.
Objective: To determine trends in male reproductive surgeries. Materials and Methods: A database analysis was performed using the Healthcare Cost and Utilization Project databases from 1988, 1992 and 1998 –2002. SAS statistical software was used to estimate the total numbers of reproductive surgeries and their variances for each year. Results: The number of male reproductive surgeries has declined during the period of study, both in the inpatient and outpatient arenas. The number of procedures with a diagnosis of infertility has also declined. Conclusion: The number of male reproductive surgeries has declined from 1988 to 2002. Editorial Comment: Is surgery for male factor infertility going the way of the dinosaur? Data from this study definitely seem to imply that that may be the case. The authors present data from the inpatient and outpatient settings and show that the number of procedures for male factor infertility steadily declined from 1988 to 2002. Although the outpatient data are limited to the state of New Jersey, I suspect that this is still a national trend. This finding has important implications regarding manpower needs and graduate medical education in urology. David F. Penson, M.D., M.P.H.
Re: Paternal Body Mass Index is Associated With Decreased Blastocyst Development and Reduced Live Birth Rates Following Assisted Reproductive Technology H. W. Bakos, R. C. Henshaw, M. Mitchell and M. Lane Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, Robinson Institute, University of Adelaide, Adelaide, Australia Fertil Steril 2011; 95: 1700 –1704.
Objective: To determine the relationship between paternal body mass index (BMI), embryo development and pregnancy, and live birth outcomes after assisted reproductive technology (ART). Design: Retrospective analysis of ART cycles. Setting: Major assisted reproduction center. Patient(S): Three hundred five couples undergoing ART in a private fertility clinic. Intervention(S): No intervention was undertaken in patients involved in this study. Main Outcome Measure(S): Live birth outcomes and clinical pregnancy rates. Result(S): No significant relationship between paternal BMI and early embryo development was found. However, increased paternal BMI was associated with decreased blastocyst development, clinical pregnancy rates and live birth outcomes. Conclusion(S): To our knowledge, this is the first report linking increased paternal BMI and clinical pregnancy and live birth rates after ART treatment. Further work to elucidate the mechanisms involved is required. Editorial Comment: The association between female obesity and worsening in vitro fertilization outcomes is well known, and evidence is accumulating that male obesity is associated with impaired semen quality as well as endocrine dysfunction. However, is male obesity associated with worsening in vitro fertilization outcomes? These investigators report that increasing male BMI is correlated to impaired blastocyst development, decreased clinical pregnancy rates and lower live birth outcomes. Should this effect be true, the first question is why, and the second is, does weight loss help? Craig Niederberger, M.D.
Socioeconomic Factors, Urological Epidemiology and Practice Patterns Re: Satisfaction Profiles in Men Using Intracavernosal Injection Therapy W. Hsiao, N. Bennett, P. Guhring, J. Narus and J. P. Mulhall Department of Urology, Center for Male Reproductive Medicine, Weill Cornell Medical College, New York, New York J Sex Med 2011; 8: 512–517.
Introduction: Intracavernosal injection therapy (ICI) is a well-established second-line therapy used in the treatment of erectile dysfunction (ED). Controversy exists as to whether oral phosphodiesterase type 5 inhibitors (PDE5i) or injection therapy lead to higher satisfaction. Aim: This study addressed ICI satisfaction in a modern cohort of patients in the PDE5i era. Methods: Patients on ICI for at least 6 months were included in our study. Patients were administered the International Index of Erectile Function (IIEF) at the initial visit. On subsequent visits, patients were administered the IIEF and the Erection Hardness Scale (EHS). Main Outcome Measures: Study end points were change in baseline scores in the satisfaction domains (SD) of the IIEF, type of injection medication used, and predictors of satisfaction. Multiple logistic regressions were performed for predictors of satisfaction. Results: One hundred twenty-two patients met inclusion criterion. Mean time to follow-up was 25⫾12 months (range 6 –106 months). Sixty-five percent of patients continued injections at the time of follow-up. When SD scores were examined, intercourse SD scores increased from 4.8⫾1.7 at baseline to 12.3⫾3.1 (P ⬍0.01); overall SD scores increased from 4.1⫾1.8 to 7.2⫾2.0 (P ⬍0.05). On multivariate analysis,
245
246
SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
predictors of satisfaction included older age (odds ratio [OR] ⫽ 2.1), younger partner age (OR ⫽ 2.5), clinically significant increase in the erectile function domain score (OR ⫽ 3.1), and attainment of a “fully rigid” erection (EHS 4) (OR ⫽ 6.8). Conclusions: We have evaluated satisfaction in a modern cohort of ICI patients. While dropout rates are significant, for those patients who continue to inject, we have found high levels of satisfaction using the IIEF, the gold standard for evaluation of erectile function. On multivariate analysis, we found that older age, younger partner age, and fully rigid erections were predictors of increased satisfaction. ICI remains a robust second-line therapy in the treatment of ED even in the era of PDE5i. Editorial Comment: As urologists, we saw fewer patients with erectile dysfunction in 2011, if only because many primary care providers have become comfortable prescribing PDE5i, and these agents can be quite effective. For the patient who fails or cannot take PDE5i, ICI remains a viable option. This study shows that roughly 65% of patients on ICI stay on the treatment and are relatively satisfied with the therapy. Of course, we can therefore assume that roughly 35% of patient who start ICI are dissatisfied with the treatment and discontinue it. If nothing else, this study indicates that there is still a role for the urological surgeon in the treatment of male sexual dysfunction. David F. Penson, M.D., M.P.H.
Re: Fifteen-Year Trend in the Use of Male Reproductive Surgery: Analysis of the Healthcare Cost and Utilization Project Data A. Ketefian, J. Hu, A. A. Bartolucci, P. N. Schlegel and R. Azziz; Society of Reproductive Surgeons, Inc. Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California BJU Int 2011; 107: 1118 –1123.
Objective: To determine trends in male reproductive surgeries. Materials and Methods: A database analysis was performed using the Healthcare Cost and Utilization Project databases from 1988, 1992 and 1998 –2002. SAS statistical software was used to estimate the total numbers of reproductive surgeries and their variances for each year. Results: The number of male reproductive surgeries has declined during the period of study, both in the inpatient and outpatient arenas. The number of procedures with a diagnosis of infertility has also declined. Conclusion: The number of male reproductive surgeries has declined from 1988 to 2002. Editorial Comment: Is surgery for male factor infertility going the way of the dinosaur? Data from this study definitely seem to imply that that may be the case. The authors present data from the inpatient and outpatient settings and show that the number of procedures for male factor infertility steadily declined from 1988 to 2002. Although the outpatient data are limited to the state of New Jersey, I suspect that this is still a national trend. This finding has important implications regarding manpower needs and graduate medical education in urology. David F. Penson, M.D., M.P.H.