Introduction Clinicians primarily focus on the presence or absence of anterograde ejaculation following surgery for benign prostatic hyperplasia (BPH). Failing to assess dysfunctional ejaculation and associated bother in a granular fashion can underestimate the prevalence and significance of ejaculatory dysfunction in this population. Objectives This scoping review provides critical appraisal of existing tools assessing ejaculatory function and associated bother, emphasizing the importance of adequate history-taking, preoperative counseling, and supplemental questions that should be used prior to and after treatment. Methods A literature review was conducted using pertinent keywords from 1946 to June 2022. Eligibility criteria included men developing ejaculatory dysfunction following BPH surgery. Measured outcomes included the assessment of patient bother related to ejaculatory function, pre- and postoperative scores from the Male Sexual Health Questionnaire (MSHQ). and Danish Prostate Symptom sexual function domain (DAN-PSSsex). Results Results of this study included only 10 documented patients’ bother due to ejaculatory dysfunction following treatment. Pre- and postoperative MSHQ were used as the diagnostic tool in 43/49 studies, one study documented “preservation of anterograde ejaculation”, and one used DAN-PSSsex. Q1–4 of the MSHQ were used in 33/43 studies, 3/43 used Q1, 3, 5–7, 1/43 used solely Q4, 1/43 used Q1–3 + Q6 and Q7, and 5/43 used the entire MSHQ. No studies used post-ejaculation urinalysis to diagnose retrograde ejaculation. Only four studies explicitly documented bother and found 25–35% of patients were bothered with a “lack of ejaculate” or “other ejaculation difficulties” during sexual activity after BPH surgery. Conclusions There are currently no studies stratifying patient bother by various components of ejaculation (force, volume, consistency, sensation of seminal expulsion, painful ejaculation, etc.) after BPH surgery. Opportunities for improvement exist in reporting ejaculatory dysfunction related to BPH treatment. A comprehensive sexual health history is needed. Further investigation into effects of BPH surgical treatments on specific characteristics of the patient’s experience of ejaculation is required.
Introduction Despite the importance of sexual health, physicians may not be adequately equipped to diagnose and treat sexual dysfunction. Topics related to healthy sexual function (pleasure, masturbation, communication, sex toys/tools, and anal sex practices) are largely omitted from medical education. It is vital that urologists are trained to ask detailed questions about sexual health, counsel on healthy sexual habits, and identify and treat sexual dysfunction. Objective To determine the level of comfort among urology residents in taking a comprehensive sexual health history, identifying sexual dysfunction, and treating patients of various gender identities and sexual orientations. Methods An anonymous electronic survey was distributed to current urology residents in the United States. The survey contained five demographics questions and twenty-three questions tied to sexual health competencies. Participants were asked to provide their education year, current age, medical school location, residency location, and estimated hours of sexual health education during training (excluding STI/STD content). Survey questions targeted previously established sexual education competency domains. Results A total of 52 urology residents participated in the study. Participant post-graduate years ranged from 1-6. 61.5% of participants stated they received only 0-3 hours of formal sex education during medical school and 46.3% reported having any formal sex education during urology residency. 80% of participants felt comfortable asking patients about self-erogenous stimulation, but only 27% of responders felt comfortable answering questions about anal stimulation devices, and 35% of responders felt comfortable answering questions about vaginal stimulation devices. Greater than 94% of residents feel “very comfortable” or “somewhat comfortable” with describing male sexual dysfunction and performing physical exam for a man with sexual dysfunction, but only 59% felt the same towards female sexual dysfunction. When describing medicines used for sexual function, 100% of residents are comfortable doing so for men, but only 63% are comfortable doing the same for women. When counseling transgender males or females on sexual practice/therapies/surgeries, only 29% of residents felt comfortable. Conclusions There are knowledge gaps in sexual medicine literacy confidence among urology residents surveyed. Lack of a comprehensive sexual health education curriculum during medical training may be affecting patient care. Women and sexual and gender minority (LGBTQ) patients may be at higher risk of being treated by a urologist without comfort in managing their sexual health. Sexual health education optimization during urology residency has the potential to promote improved understanding of the sexual health of women and sexual and gender minorities and improve the evaluation and management of sexual dysfunction in general. Disclosure No
Introduction Despite the importance of sexual health, physicians may not be adequately equipped to diagnose and treat sexual dysfunction. Topics related to healthy sexual function (pleasure, masturbation, communication, sex toys/tools, and anal sex practices) are largely omitted from medical education. It is vital that urologists are trained to ask detailed questions about sexual health, counsel on healthy sexual habits, and identify and treat sexual dysfunction. Objective To determine the level of comfort among urology residents in taking a comprehensive sexual health history, identifying sexual dysfunction, and treating patients of various gender identities and sexual orientations. Methods An anonymous electronic survey was distributed to current urology residents in the United States. The survey contained five demographics questions and twenty-three questions tied to sexual health competencies. Participants were asked to provide their education year, current age, medical school location, residency location, and estimated hours of sexual health education during training (excluding STI/STD content). Survey questions targeted previously established sexual education competency domains. Results A total of 52 urology residents participated in the study. Participant post-graduate years ranged from 1-6. 61.5% of participants stated they received only 0-3 hours of formal sex education during medical school and 46.3% reported having any formal sex education during urology residency. 80% of participants felt comfortable asking patients about self-erogenous stimulation, but only 27% of responders felt comfortable answering questions about anal stimulation devices, and 35% of responders felt comfortable answering questions about vaginal stimulation devices. Greater than 94% of residents feel “very comfortable” or “somewhat comfortable” with describing male sexual dysfunction and performing physical exam for a man with sexual dysfunction, but only 59% felt the same towards female sexual dysfunction. When describing medicines used for sexual function, 100% of residents are comfortable doing so for men, but only 63% are comfortable doing the same for women. When counseling transgender males or females on sexual practice/therapies/surgeries, only 29% of residents felt comfortable. Conclusions There are knowledge gaps in sexual medicine literacy confidence among urology residents surveyed. Lack of a comprehensive sexual health education curriculum during medical training may be affecting patient care. Women and sexual and gender minority (LGBTQ) patients may be at higher risk of being treated by a urologist without comfort in managing their sexual health. Sexual health education optimization during urology residency has the potential to promote improved understanding of the sexual health of women and sexual and gender minorities and improve the evaluation and management of sexual dysfunction in general. Disclosure No
320 Background: The use of transperineal (TP) prostate biopsy has gained in popularity due to reduced risk of infectious events, however evidence regarding cancer detection rates versus transrectal (TR) prostate biopsy is lacking. Our objective was to examine whether transperineal (TP) MRI-fusion targeted prostate biopsy (MRI-TBx) resulted in improved detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology (ISUP) grade group ≥2, as compared to TR MRI-TBx. Methods: Retrospective review of all patients who underwent MRI-TBx at a tertiary care academic center. A cohort of patients who underwent TP MRI-TBx was compared to a second cohort of patients who underwent TR MRI-TBx. The primary outcome of interest was detection of csPCa, however detection of ISUP grade group 1 prostate cancer (GG1 PCa) was also examined. Analyses were performed on a lesion level basis. Multivariable logistic regression analyses were performed to assess for predictors of csPCa detection. Results: A total of 389 and 1144 lesions from 303 and 836 patients who underwent TP MRI-TBx vs TR MRI-TBx respectively were included in the analysis. The detection of both csPCa (39.6% vs 29.6%, p <0.001) and GG1 PCa (34.4% vs 21.1%, p <0.001) was higher for TP MRI-TBx vs. TR MRI-TBx. On multivariable analysis adjusted for age, prior biopsy status, Prostate Imaging–Reporting and Data System (PIRADS) score, prostate volume, PSA, size of PIRADS lesion, and zone of PIRADS lesion, TP MRI-TBx remained an independent predictor of csPCa (odds ratio [OR] 1.49, 95% CI 1.13-1.98). Surprisingly, transperineal biopsy was not a significant predictor of csPCa for Transition zone lesions (OR 1.24, p = 0.35), but was for Peripheral zone lesions (OR = 1.84, p < 0.001). Conclusions: Performance of TP MRI-TBx demonstrates improved detection of both csPCa and GG1 PCa. This difference is not dependent on anterior/transition zone location. This has important implications in risk assessment for localized prostate cancer, including counseling for active surveillance and definitive management strategies. [Table: see text]
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