Hyperandrogenism secondary to testicular cancer typically arises in patients in whom Leydig cell hyperplasia or neoplasia can be identified. Additionally, benign and malignant adrenocortical tumors can also present with signs and symptoms of hyperandrogenism. We report a case of a 40-year-old gentleman who experienced several months of weight gain, worsening gynecomastia, and mood changes secondary to high testosterone and estradiol levels. Workup initially was negative for testicular malignancy and positive for a benign-appearing lesion in the adrenal gland. Despite adrenalectomy, symptoms continued to persist and ultimately a testicular cancer without Leydig cell involvement was identified.

PURPOSE OF REVIEW: The application of artificial intelligence (AI) to enhance clinical decision-making in Peyronies disease (PD) has generated significant interest. This review explores the current landscape of AI in PD evaluation. RECENT FINDINGS: Recent advances in 3D modeling offer a more sophisticated approach to assessing PD deformities; however, the implementation of 3D modeling in clinical practice faces challenges, including the need for specialized equipment and time-consuming data processing, sometimes taking several hours of labor. AI holds promise for overcoming these hurdles through its ability to efficiently process large volumes of data and to perform accurate predictions based on such data. Future integration of AI with 3D modeling techniques could revolutionize PD evaluation by improving patient counseling, surgical planning, and clinical decision-making. Significant gaps in the literature have yet to be addressed, including the absence of robust evidence that incorporating such technology is superior to standard diagnostics.

Purpose of review

Focusing on studies published within the last decade, we review the literature on the seminal microbiome and male factor infertility. We highlight potential mechanisms by which microbes may impact fertility and underscore key limitations and clinical implications of these studies.

Recent findings

The seminal microbiome encompasses a metabolically and phylogenetically diverse group of microorganisms. Lactobacillus was consistently associated with normal semen analysis parameters and fertility; Anaerococcus was negatively associated with semen quality. These microbes may participate in a complex cross-talk with the host immune system, thereby modulating local and perhaps systemic inflammatory responses, impacting semen quality.

Summary

Research investigating the intersection between the seminal microbiome and male fertility is still in its infancy. Recent investigations have been exclusively cross-sectional, correlational studies, limiting the clinical applicability of published research. Prospective studies with more sophisticated methodologies are necessary.

Background

The major connective tissues of the knee joint act in concert during locomotion to provide joint stability, smooth articulation, shock absorption, and distribution of mechanical stresses. These functions are largely conferred by the intrinsic material properties of the tissues, which are in turn determined by biochemical composition. A thorough understanding of the structure-function relationships of the connective tissues of the knee joint is needed to provide design parameters for efforts in tissue engineering.

Methodology/principal findings

The objective of this study was to perform a comprehensive characterization of the tensile properties, collagen content, and pyridinoline crosslink abundance of condylar cartilage, patellar cartilage, medial and lateral menisci, cranial and caudal cruciate ligaments (analogous to anterior and posterior cruciate ligaments in humans, respectively), medial and lateral collateral ligaments, and patellar ligament from immature bovine calves. Tensile stiffness and strength were greatest in the menisci and patellar ligament, and lowest in the hyaline cartilages and cruciate ligaments; these tensile results reflected trends in collagen content. Pyridinoline crosslinks were found in every tissue despite the relative immaturity of the joints, and significant differences were observed among tissues. Notably, for the cruciate ligaments and patellar ligament, crosslink density appeared more important in determining tensile stiffness than collagen content.

Conclusions/significance

To our knowledge, this study is the first to examine tensile properties, collagen content, and pyridinoline crosslink abundance in a direct head-to-head comparison among all of the major connective tissues of the knee. This is also the first study to report results for pyridinoline crosslink density that suggest its preferential role over collagen in determining tensile stiffness for certain tissues.

Men's health is a unique field that requires a multi-disciplinary approach to appropriately treat the full spectrum of men's health needs. Given that interest in men's health is relatively new, the definition of a men's health clinic continues to evolve. Originally conceived as testosterone replacement centers, men's health clinics are increasingly understood to encompass male endocrine, surgical, urologic, physical performance, and psychological issues. As interest in men's health continues to grow, it is important to focus on the field's future, including pharmacies, telemedicine, and the diffusion of healthcare.

BACKGROUND: Despite a lack of evidence, a number of regenerative therapies have become popularized treatments for erectile dysfunction (ED). Platelet-rich plasma (PRP) injections and shockwave therapy have received significant attention through direct-to-consumer marketing and are advertised as viable alternatives to guideline-backed therapies. Additionally, focused low-intensity shock wave therapy (LiSWT) has become conflated with acoustic or radial wave therapy (rWT), although their mechanism of wave generation and tissue penetration is distinct. GAINSWave, a marketing platform for acoustic wave therapy, has also pervaded the marketplace. We aim to evaluate the relative impact of direct-to-consumer marketing of shockwave therapy and PRP by analyzing the quantity of Google internet search queries for selected regenerative and guideline-backed non-regenerative therapies for ED. METHODS: National Google Search trends in the United States (www.google.com/trends) were analyzed to characterize interest in different forms of therapy for ED. Search trends for PRP, LiSWT (and various iterations), intracavernosal injections (ICI), intraurethral injections (IU), vacuum erectile device (VED), and GAINSWave were analyzed. Monthly search data were compiled over multiple years, ending at 2/28/2020, just before the COVID-19 pandemic and state of emergency in the United States. Macro-level changes in public interest were quantified using yearly averages. RESULTS: Patterns in Google Search interest in PRP and LiSWT increased respectively by 3-fold and 275-fold over the decade, representing a larger share of Google Searches by 2020. Trends in Google Search interest in selected types of shockwave therapy for ED also show that queries for GAINSWave commanded public interest, increasing by 219-fold from 2016 to 2020. CONCLUSIONS: Regenerative therapies for ED have produced interest surpassing other adjunct guideline-backed therapies, despite receiving the designation of experimental or investigational therapies. The establishment of GAINSWave also constitutes an inflection point for the whole shockwave market: searches for shockwave therapy increased by 782% between 2016 and 2020. Direct-to-consumer marketing of PRP and shockwave therapy has upturned the customary role of physicians in counseling patients about evidence-based therapies for ED. This increase in public interest in GAINSWave emphasizes its success as a marketing platform. The urological community should consider strategies to address misinformation, such as search-engine optimization, social media, and educational outreach.

Introduction

Collagenase Clostridium histolyticum (CCH) remains the only Food and Drug Administration-approved medical treatment for Peyronie's disease (PD). The initial IMPRESS I and II trials (Investigation for Maximal Peyronie's Reduction Efficacy and Safety), which led to Food and Drug Administration approval, revealed a rate of treatment-related adverse events as high as 84%. Studies fail to provide clear definitions of complications.

Objectives

To review complications, provide a CCH complication atlas, and propose management strategies for commonly encountered complications.

Methods

We performed a literature review using PubMed. A photographic atlas was provided regarding complications in patients in a high-volume CCH center for PD.

Results

Complications were identified and classified by nature and severity. We followed a standardized previously published grading system for hematomas. Complications include bruising, swelling, hematoma formation, back pain, and, rarely, corporal rupture. Complications were discussed, and hematomas were graded by penile surface area. Complication photographs were graded and displayed. Treatment-related adverse effects do not affect overall results.

Conclusion

Recognizing and grading complications associated with CCH therapy for PD is crucial for effective patient management and informed decision making. A standardized grading system allows for consistency in reporting and comparing hematoma complication rates across studies and patient populations. Herein we provide images that will help clinicians identify and confidently manage common complications that may occur in any CCH program.

BACKGROUND: Sperm banking refers to the collection and storage of sperm cells for future use. Despite the recommendations of major medical societies, sperm banking is not discussed sufficiently with patients at risk of future fertility. Majority of Americans utilize the internet regarding health information. The aim of this study is to assess the reading level and the quality of online health information on sperm banking. METHODS: The top 50 search results from Google, Bing, and Yahoo were selected after searching for the term sperm banking. Duplicate pages, advertisements, news and magazines, blog posts, videos, paid subscriptions, articles intended for health professionals, and non-related pages were excluded. Four validated readability and two quality assessment tools were used to score the text. Websites were divided into five categories: academic, hospital-affiliated, commercial, non-profit health advocacy, and non-categorized. Descriptive statistics, one sample t-test, and Pearsons correlation coefficient were used to analyze the data. RESULTS: Forty-one webpages were included. The mean Flesch Reading Ease Score (FRES) for all pages was 46.9/100 and the mean reading level was 11th grade, compared to the recommended 6th grade level, across various assessment tools. Utilizing the DISCERN Instrument, quality of online health information was fair. Seven percent of pages received a good quality score and no pages received a score of excellent. On average, 1.5 out of 4 criteria categorized by the JAMA Benchmark, a validated quality assessment tool, were met. The hospital-affiliated webpages received the best reading scores and commercial pages received the highest quality scores. CONCLUSIONS: Online health information on sperm banking available in English is of poor quality based on several quality assessment tools and at a reading level significantly higher than what is recommended. Further efforts are needed by providers and healthcare institutions to improve the quality of information available to patients.

PURPOSE:Infertile couples increasingly turn to the internet for medical guidance. The aims of this study were: (1) to identify popular male infertility content on social media, and (2) to assess the accuracy and quality of this content. We hypothesized that inaccurate/misleading information proliferates online. MATERIALS AND METHODS:We used the analytics module BuzzSumo to identify article links that were most shared on Facebook, Pinterest, Reddit, and Twitter related to male infertility during September 2018 to August 2019. We excluded articles with <100 engagements, defined as "likes," "comments," and "shares." Two researchers graded content as accurate, misleading, or inaccurate by comparing content to references cited and contemporary research. Inter-rater reliability was determined with Cohen's κ. Binary logistic regression was performed to compare user engagement with accurate versus inaccurate/misleading articles. RESULTS:Fifty-two unique article links were identified, with 421,004 total engagements. Thirty-four articles referenced 15 scientific studies; no reference was available for 18 links. Fifty-six percent of articles were accurate and 44% misleading/inaccurate (κ=0.743). No significant difference was found in total engagement between accurate vs. misleading/inaccurate links (p=0.805). Twenty-four percent of engagements referenced studies using non-human models, and 26% of studies had sample sizes <100. CONCLUSIONS:Social media platforms foster engagement with male infertility information. However, sensationalism predominates, as patients are highly likely to encounter misleading/inaccurate information, articles that overstate implications of animal research, and conclusions made based on limited sample sizes. Urologists should consider adding social media to their armamentarium to stave off misinformation and engage proactively with patients.

Streaming video has emerged as a dominant content-delivery medium for healthcare information, with over 30 million visitors daily to the YouTube platform alone. Videos related to men's health have proliferated, but content produced by trained health care providers remains scarce. We evaluated educational YouTube streaming videos created in collaboration with a large, university-based health system focused on male factor infertility, men's health, and Peyronie's disease, uploaded during 2016-2018. All videos featured a board-certified urologist with fellowship training in andrology. Using YouTube's native analytics tools, we extracted data on views, engagement, and geographic reach through 8/2019. We obtained data for streaming videos on male infertility (n=3), general men's health (n=2), and Peyronie's disease (n=1). Video length ranged from 29 to 51 min, with a mean video duration of 39 min 41 sec. Actual mean watch time by viewers ranged from 3:45 to 8:30. The total view count was 646,684, with a watch time of nearly 3 million mins, reaching viewers in 47 countries. Fifty-three percent of watch time was on a mobile device and 33% on a personal computer. As patients increasingly turn to the internet for health information, health systems and physicians may wish to leverage high impact social media platforms such as YouTube to share evidence-based content. This study highlights the impressive reach a health system-sponsored video intervention using YouTube can have in sharing accurate video content related to a diverse range of men's health topics. This is the first health systems-based streaming-video intervention to leverage the video streaming and social media platform YouTube, to facilitate sharing reputable, high quality, and evidence-based men's health content.