All Publications

  • Female Sexual Function During the COVID-19 Pandemic in the United States. Sexual medicine Bhambhvani, H. P., Chen, T., Kasman, A. M., Wilson-King, G., Enemchukwu, E., Eisenberg, M. L. 2021; 9 (4): 100355


    INTRODUCTION: International studies have demonstrated increasing rates of sexual dysfunction amidst the coronavirus disease 2019 (COVID-19) pandemic; however, the impact of the pandemic on female sexual function in the United States is unknown.AIM: To assess the impact of the COVID-19 pandemic on female sexual function and frequency in the United States.METHODS: A pre-pandemic survey containing the Female Sexual Function Index (FSFI) and demographic questions was completed by adult women in the United States from October 20, 2019 and March 1, 2020. The same women were sent a follow-up survey also containing the FSFI, as well as the Patient Health Questionnaire for Depression and Anxiety with 4 items (PHQ-4), and questions pertaining to mask wearing habits, job loss, and relationship changes. Risk for female sexual dysfunction (RFSD) was defined as FSFI < 26.55.MAIN OUTCOME MEASURE: Differences in pre-pandemic and intra-pandemic female sexual function, measured by the FSFI, and sexual frequency.RESULTS: Ninety-one women were included in this study. Overall FSFI significantly decreased during the pandemic (27.2 vs 28.8, P=.002), with domain-specific decreases in arousal (4.41 vs 4.86, P=.0002), lubrication (4.90 vs 5.22, P=.004), and satisfaction (4.40 vs 4.70, P=.04). There was no change in sexual frequency. Contingency table analysis of RFSD prior to and during the pandemic revealed significantly increased RFSD during the pandemic (P=.002). Women who developed RFSD during the pandemic had higher PHQ-4 anxiety subscale scores (3.74 vs 2.53, P=.01) and depression subscale scores (2.74 vs 1.43, P=.001) than those who did not. Development of FSD was not associated with age, home region, relationship status, mask wearing habits, knowing someone who tested positive for COVID-19, relationship change, or job loss and/or reduction during the pandemic.CONCLUSION: In this population of female cannabis users, risk for sexual dysfunction increased amidst the COVID-19 pandemic and is associated with depression and anxiety symptoms. Bhambhvani HP, Chen T, Wilson-King AM, etal. Female Sexual Function During the COVID-19 Pandemic in the United States. Sex Med 2021;9:100355.

    View details for DOI 10.1016/j.esxm.2021.100355

    View details for PubMedID 34174585

  • The association between testosterone, estradiol and their ratio and mortality among US men. Andrologia Belladelli, F., Del Giudice, F., Kasman, A., Salonia, A., Eisenberg, M. L. 2021: e13993


    While studies have suggested that testosterone is associated with a man's health, the relationship with other sex steroids remains uncertain. The current study aimed to investigate the association between sex steroids (i.e. testosterone, estradiol and the testosterone:estradiol ratio) and mortality in a representative sample of 1,109 US men. Three NHANES continuous cycles (1999-2000, 2001-2002, 2003-2004) were included in our study. Serum testosterone and estradiol levels were evaluated along with sociodemographic, lifestyle and health factors. Cox proportional hazards models were used. The adjusted risk of death for men with low testosterone levels was 1.66 (95% CI=1.00-2.74, p=.05). The adjusted risk of death for men with abnormal estradiol levels was 0.96 (95% CI=0.48-1.91, p=.91). The adjusted risk of death for men with low testosterone to estradiol ratio was 1.27 (95% CI=0.82-1.97, p=.88). Relevant lifestyle and health factors significantly attenuated the associations. The adjusted risk of CVD-related death for men with low testosterone levels was 2.43 (95% CI=1.07-5.50, p=.03). In conclusion, a significant association between testosterone and mortality and testosterone to estradiol ratio and CVD-related mortality was identified.

    View details for DOI 10.1111/and.13993

    View details for PubMedID 33666951

  • Association of daily step count and serum testosterone among men in the United States. Endocrine Del Giudice, F., Glover, F., Belladelli, F., De Berardinis, E., Sciarra, A., Salciccia, S., Kasman, A. M., Chen, T., Eisenberg, M. L. 2021


    PURPOSE: To describe the association between daily activity (i.e., daily step counts and accelerometer intensity measures) and serum TT levels in a representative sample of US adults aged 18 years or older.METHODS: A retrospective cohort study was carried out utilizing the NHANES (National Health and Nutrition Examination Survey) 2003-2004 cycle. Physical activity was measured with a waist-worn uniaxial accelerometer (AM-7164; ActiGraph) for up to 7 days using a standardized protocol. Using linear and multivariable logistic regression controlling for relevant social, demographic, lifestyle, and comorbidity characteristics, we assessed the association between daily step counts and TT.RESULTS: A total of 279 subjects with a median age 46 (IQR: 33-56) were included in the analysis. 23.3% of the cohort had a low serum TT level (TT<350ng/dl). Compared to men who took <4000 steps per day, men who took >4000 or >8000 steps/day had a lower odd of being hypogonadal (OR 0.14, 95% CI: 0.07-0.49 and 0.08, 95%CI: 0.02-0.44, respectively). While a threshold effect was noted on average, TT increased 7ng/dL for each additional 1000 steps taken daily (beta-estimate: 0.007, 95% CI: 0.002-0.013).CONCLUSIONS: Patients with the lowest daily step counts had higher odds of being hypogonadal. The current work supports a possible association between daily steps, total testosterone, and hypogonadism for men in the US.

    View details for DOI 10.1007/s12020-021-02631-2

    View details for PubMedID 33580402

  • Primary malignancies of the epididymis: clinical characteristics and prognostic factors. The Canadian journal of urology Bhambhvani, H. P., Greenberg, D. R., Kasman, A. M., Eisenberg, M. L. 2021; 28 (1): 10522–29


    INTRODUCTION We sought to describe clinical characteristics and identify prognostic factors among patients with primary malignancies of the epididymis (PMEs).MATERIALS AND METHODS: The Surveillance, Epidemiology, and End Results (SEER) database (1975-2015) was queried to identify patients with PME. Descriptive statistics and multivariable Cox proportional hazards models were used.RESULTS: Eighty-nine patients with PME were identified. Median age was 57 years (5-85), and median overall survival (OS) was 16.8 years. The most commonly represented histologies were rhabdomyosarcoma (19.1%), B-cell lymphoma (16.9%), leiomyosarcoma (16.9%), and liposarcoma (12.4%). In multivariable analysis, tumor size ≥ 4 cm was associated with worse OS (HR = 4.46, p = 0.01) compared to tumors < 4 cm. Patients with nonsarcomatoid histology had OS similar to patients with sarcomatoid histology (HR = 0.95, p = 0.92). Disease with regional invasion (HR = 5.19, p = 0.007) and distant metastasis (HR = 29.80, p = 0.0002) had worse OS compared to localized disease. Receipt of radiotherapy was associated with enhanced OS (HR = 0.10, p = 0.006), whereas receipt of chemotherapy was not associated with OS.CONCLUSIONS: We describe the largest cohort of PMEs to date. Larger lesions and tumor stage were independently associated with poor overall survival, while receipt of radiotherapy was associated with enhanced overall survival.

    View details for PubMedID 33625342

  • Racial and socioeconomic disparities in retroperitoneal lymph node dissection and survival in nonseminomatous germ cell tumor: A population-based study. Urologic oncology Bhambhvani, H. P., Greenberg, D. R., Kasman, A. M., DeRouen, M. C., Cheng, I., Eisenberg, M. L., Shah, S. A. 2021


    BACKGROUND: Though testicular cancer is the most common cancer in young men, there is a paucity of epidemiologic studies examining sociodemographic disparities in adjuvant therapy and outcomes. We examined the associations of sociodemographic factors with retroperitoneal lymph node dissection (RPLND) and survival among patients with nonseminomatous germ cell tumors (NSGCTs).METHODS: Within the Surveillance Epidemiology and End Results database (2005-2015), we identified 8,573 patients with nonseminomatous germ cell tumors. Multivariable logistic regression and Fine-Gray competing-risks regression models were constructed to examine the association of sociodemographic factors (neighborhood SES (nSES), race, and insurance) with, respectively, adjuvant RPLND within 1 year of diagnosis and cancer-specific mortality.RESULTS: Patients in the lowest nSES quintile (OR 0.59, 95% CI = 0.40-0.88, P = 0.01) and Black patients (OR 0.41, 95% CI = 0.15-1.00, P= 0.058) with stage II disease were less likely to receive RPLND compared to those in the highest quintile and White patients, respectively. Stage III patients with Medicaid (OR 0.64, 95% CI = 0.46-0.89, P= 0.009) or without insurance (OR 0.46, 95% CI = 0.27-0.76, P= 0.003) were less likely to receive RPLND compared to patients with private insurance. Lowest quintile nSES patients of all disease stages and Black patients with stage I disease (HR = 2.64, 95% CI = 1.12-6.20, P = 0.026) or stage II disease (HR=4.93, 95% CI = 1.48-16.44, P = 0.009) had higher risks of cancer-specific mortality compared to highest quintile nSES and White patients, respectively.CONCLUSIONS: This national study found multilevel, stage-specific sociodemographic disparities in receipt of RPLND and survival.

    View details for DOI 10.1016/j.urolonc.2020.12.016

    View details for PubMedID 33423934

  • AUTHOR REPLY. Urology Del Giudice, F. n., Kasman, A. M., Eisenberg, M. L. 2021; 147: 148–49

    View details for DOI 10.1016/j.urology.2020.07.089

    View details for PubMedID 33390199

  • The Association between Mortality and Male Infertility: Systematic Review and Meta-analysis. Urology Francesco, D. G., Alex M, K. n., Tony, C. n., Ettore, D. B., Maria, B. G., Alessandro, S. n., Matteo, F. n., Giuseppe, L. n., Federico, B. n., Andrea, S. n., Michael L, E. n. 2021


    To summarize the current body of evidence on the relationship between impaired male fertility and the risk of early death through a systematic review and meta-analysis of population-based retrospective cohort studies.PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases were searched from inception to August 2020 according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Pooled Risk Ratio (RR), Risk Difference (Δr), Hazard Ratio (HR) and Standardized Mortality Ratio (SMR) differences among male factor infertility cohorts were compared to fertile/normospermic control populations or to national mortality data.Six studies from 2006 to 2020 met inclusion criteria. Three studies examined male infertility and mortality (ntot=202,456; ndeaths=1396), while four studies examined survival in relation to semen parameters (ntot= 59,291; ndeaths= 643). Comparing infertile to fertile men, pooled HR for the risk of death was 1.26 (95%CI:1.01-1.59). Pooled RR and Δr of death for combined oligo- and azoospermic men vs. normospermic men was 1.67 (95%CI:1.26-2.21) and 0.37% (95%CI:0.18-0.55%) respectively. When comparing oligo- and normospermic men to azoospermic men, the cumulative HR was 1.31 (95%CI:1.11-1.54) and 2.17 (95%CI:1.55-3.04) respectively. Infertile men had a lower overall risk of death compared to the overall population (SMR, 0.38, 95%CI:0.31-0.45).Compared to fertile men, infertile men had a higher risk of death. Moreover, the risk of death increased with increasing severity of semen quality impairment. However, compared to men from the general population, infertile men have a lower risk of death suggesting that social determinants of health are also important.

    View details for DOI 10.1016/j.urology.2021.02.041

    View details for PubMedID 33819517

  • The Association of the COVID-19 Pandemic on Male Sexual Function in the United States: A Survey Study of Male Cannabis Users. Sexual medicine Chen, T. n., Bhambhvani, H. P., Kasman, A. M., Eisenberg, M. L. 2021; 9 (3): 100340


    International studies have suggested that social disruptions caused by the COVID-19 pandemic have led to sexual dysfunction, but the impact on males in the United States is less defined.To examine changes in male sexual function during the COVID-19 pandemic and to evaluate associated demographic variables.Prepandemic survey data was collected between October 20, 2019 and March 1, 2020 on adult males in the United States. Follow-up survey data collected for comparison during the COVID-19 pandemic between August 1, 2020 and October 10, 2020 included International Index of Erectile Function (IIEF) scores, Patient Health Questionnaire for Depression and Anxiety with 4 items (PHQ-4) scores, and questions regarding sexual frequency. Questions were also asked about mask-wearing habits, job loss, relationship changes, and proximity to individuals who tested positive for COVID-19.Differences in prepandemic and pandemic male sexual function assessed by self-reported IIEF domain scores and sexual frequency RESULTS: Seventy six men completed both prepandemic and pandemic surveys with a mean age of 48.3 years. Overall, there were no differences in either overall IIEF score or any subdomain score when comparing men's pre-pandemic and pandemic survey data. There was an increase in sexual frequency during the pandemic with 45% of men reporting sex ten or more times per month during the pandemic compared to only 25% of men prior to the pandemic (P = .03). Among the subgroup of 36 men who reported a decrease in IIEF, the decrease was an average of 3.97, and significantly associated with higher PHQ-4 depression subscale scores (1.78 vs 1.03, P = .02).The COVID-19 pandemic is associated with increased sexual frequency and no change in overall sexual function in males in the United States. Interventions intended to promote male sexual health during the COVID-19 pandemic should include a focus on mental health. T Chen, HP Bhambhvani, AM Kasman, et al. The Association of the COVID-19 Pandemic on Male Sexual Function in the United States: A Survey Study of Male Cannabis Users. J Sex Med 2021;XX:XXX-XXX.

    View details for DOI 10.1016/j.esxm.2021.100340

    View details for PubMedID 33789175

  • Impact of uni- or multifocal perineural invasion in prostate cancer at radical prostatectomy. Translational andrology and urology Sciarra, A., Maggi, M., Del Proposto, A., Magliocca, F. M., Ciardi, A., Panebianco, V., De Berardinis, E., Salciccia, S., Di Pierro, G. B., Gentilucci, A., Kasman, A. M., Chung, B. I., Ferro, M., de Cobelli, O., Del Giudice, F., Busetto, G. M., Gallucci, M., Frisenda, M. 2021; 10 (1): 66–76


    Background: Aim of this study was to correlate perineural invasion (PNI) with other clinical-pathological parameters in terms of prognostic indicators in prostate cancer (PC) cases at the time of radical prostatectomy (RP).Methods: Prospective study of 288 consecutive PC cases undergoing RP. PNI determination was performed either in biopsy or in RP specimens classifying as uni- and multifocal PNI. The median follow-up time was 22 (range, 6-36) months.Results: At biopsy PNI was found in 34 (11.8%) cases and in 202 (70.1%) cases at the time of surgery. Among those identified at RP 133 (46.1%) and 69 (23.9%) cases had uni- and multi-PNI, respectively. Presence of PNI was significantly (P<0.05) correlated with unfavorable pathological parameters such higher stage and grade. The percentage of extracapsular extension in PNI negative RP specimens was 18.6% vs. 60.4% of PNI positive specimens. However, the distribution of pathological staging and International Society of Urological Pathology (ISUP) grading did not vary according to whether PNI was uni- or multifocal. The risk of biochemical progression increased 2.3 times in PNI positive cases was significantly associated with the risk of biochemical progression (r=0.136; P=0.04). However, at multivariate analysis PNI was not significantly associated with biochemical progression [hazard ratio (HR): 1.87, 95% confidence interval (CI): 0.68-3.12; P=0.089]. Within patients with intermediate risk disease, multifocal PNI was able to predict cases with lower mean time to biochemical and progression free survival (chi-square 5.95; P=0.04).Conclusions: PNI at biopsy is not a good predictor of the PNI incidence at the time of RP. PNI detection in surgical specimens may help stratify intermediate risk cases for the risk of biochemical progression.

    View details for DOI 10.21037/tau-20-850

    View details for PubMedID 33532297

  • Modeling the contribution of the obesity epidemic to the temporal decline in sperm counts. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica Kasman, A., Del Giudice, F., Shkolyar, E., Porreca, A., Busetto, G. M., Lu, Y., Eisenberg, M. L. 2020; 92 (4)


    OBJECTIVE: Total sperm count (TSC) has been declining worldwide over the last several decades due to unknown etiologies. Our aim was to model the contribution that the obesity epidemic may have on declining TSC.MATERIALS AND METHODS: Obesity rates were determined since 1973 using the WHO's Global Health Observatory data. A literature review was performed to determine the association between TSC and obesity. Using the measured obesity rates and published TSC since 1973, a model was created to evaluate the association between temporal trends in obesity/temperature and sperm count.RESULTS: Since 1973, obesity prevalence in the United States was increased from 41% to 67.9%. A review of the literature showed that body mass index (BMI) categories 2, 3, and 4 were associated with TSC (millions) of 164.27, 155.71, and 142.29, respectively. The contribution to change over time for obesity from 1974 to 2011 was modeled at 1.8%. When the model was changed to represent the most extreme possible contribution to obesity reported, the modeled change over time rose to 7.2%. When stratified according to fertility status, the contribution that BMI had to falling sperm counts for all comers was 1.7%, while those presenting for fertility evaluation was 2.1%.CONCLUSIONS: While the decline in TSC may be partially due to rising obesity rates, these contributions are minimal which highlights the complexity of this problem.

    View details for DOI 10.4081/aiua.2020.4.357

    View details for PubMedID 33348967

  • Reproductive sequelae of parental severe illness before the pandemic: implications for the COVID-19 pandemic. Fertility and sterility Kasman, A. M., Bhambhvani, H. P., Li, S., Zhang, C. A., Stevenson, D. K., Shaw, G. M., Simard, J. F., Eisenberg, M. L. 2020; 114 (6): 1242–49


    OBJECTIVE: To investigate, with pre-COVID-19 data, whether parental exposure to severe systemic infections near the time of conception is associated with pregnancy outcomes.DESIGN: Retrospective cohort study.SETTING: Population-based study covering births within the United States from 2009 to2016.PARTICIPANTS: The IBM MarketScan Research database covers reimbursed health care claims data on inpatient and outpatient encounters that are privately insured through employment-sponsored health insurance. Our analytic sample included pregnancies to paired fathers and mothers.INTERVENTIONS(S): Parental preconception exposure (0-6 months before conception) to severe systemic infection (e.g., sepsis, hypotension, respiratory failure, critical care evaluation).MAIN OUTCOME MEASURE(S): Preterm birth (i.e., live birth before 37 weeks) and pregnancy loss.RESULT(S): A total of 999,866 pregnancies were recorded with 214,057 pregnancy losses (21.4%) and 51,759 preterm births (5.2%). Mothers receiving intensive care in the preconception period had increased risk of pregnancy loss, as did fathers. Mothers with preconception sepsis had higher risk of preterm birth and pregnancy loss, and paternal sepsis exposure was associated with an increased risk of pregnancy loss. Similar results were noted for hypotension. In addition, a dose response was observed for both mothers and fathers between preconception time in intensive care and the risk of preterm birth and pregnancy loss.CONCLUSION(S): In a pre-COVID-19 cohort, parental preconception severe systemic infection was associated with increased odds of preterm birth and pregnancy loss when conception was soon after the illness.

    View details for DOI 10.1016/j.fertnstert.2020.09.153

    View details for PubMedID 33280730

  • The association between cannabis use and testicular function in men: a systematic review and meta-analysis. Andrology Belladelli, F., Del Giudice, F., Kasman, A., Jensen, T. K., Jorgensen, N., Salonia, A., Eisenberg, M. L. 2020


    OBJECTIVE: To evaluate the association between cannabis use and testicular function (as assessed through semen quality and serum hormone levels) in different populations.EVIDENCE REVIEW: Systematic review and meta-analysis of population-based retrospective cohort studies. PRISMA guidelines were used for abstracting data and assessing data quality and validity. Data were pooled using a fixed-effect or random-effects model depending on the heterogeneity of studies included. Pooled risk ratio (RR) of having any sperm abnormality and Testosterone, FSH, and LH standardized mean differences among male cannabis users and non-users, and meta-regression analysis according to age, and year of publication.RESULTS: Nine studies were evaluted which included 4014 men with semen data and 4787 with hormonal data. Overall among 1158 cannabis users, 44.9% had impaired semen parameters. Compared to 24.5% of the 2856 nonusers. The relative risk among cannabis users for any abnormal semen parameter was 1.159 (95%CI: 0.840; 1.599, p=0.369). The standardized mean difference between users and non-users testosterone levels was -0.139 (95%CI: -0.413; 0.134, p= 0.318). For FSH, the standardized mean difference estimate was -0.142 (95%CI: -0.243; -0.0425, p=0.005), while for LH the standardized mean difference estimate was -0.318 (95%CI: -0.810-0.175; p= 0.206).CONCLUSIONS: The current evidence does not suggest clinically significant associations between cannabis use and testicular function. However, we cannot exclude an effect of cannabis due to the limited and heterogeneous studies. Additional, well-designed studies will be needed to define the association between cannabis use and the male reproductive system.

    View details for DOI 10.1111/andr.12953

    View details for PubMedID 33251770

  • Safety and Feasibility of Outpatient Surgery in Benign Prostatic Hyperplasia: a Systematic Review and Meta-analysis. Journal of endourology Salciccia, S., Del Giudice, F., Maggi, M., Eisenberg, M., Chung, B. I., Conti, S. L., Kasman, A., Vilson, F. L., Ferro, M., Lucarelli, G., Viscuso, P., Di Pierro, G., Busetto, G. M., Luzi, M., Sperduti, I., Ricciuti, G. P., De Berardinis, E., Sciarra, A. 2020


    PURPOSE: Most of endourological procedures along the urinary tract have been widely practiced as outpatient operations, including surgery for BPH. This systematic review and meta-analysis was conducted to assess safety and feasibility of outpatient surgery for patients suffering from symptomatic BPH candidate for endoscopic disobstruction.MATERIALS AND METHODS: PubMed, Web of Science, Cochrane, and Embase were searched up until March 30, 2020. MINORS tool was utilized to assess the quality of included studies and a pooled measure of failure or event rate (FR, ER) estimate was calculated. Further sensitivity analysis, subgroup analysis, and meta-regression were conducted to investigate contribution of moderators to heterogeneity.RESULTS: Twenty studies with a total of 1626 patients treated according to outpatient criteria for endoscopic BPH surgery were included. In total, 18 studies reporting data on immediate hospital readmission and/or inability to discharge after endoscopic procedure presented FR estimates ranging from 1.7% to 51.1%. Pooled FR estimate was 7.8% (95% confidence interval [CI]: 5.2%-10.3%); Heterogeneity: Q=76.85; d.f.=17, p<.001; I2= 75.12%. Subgroup analysis according to surgical technique revealed difference among the three approaches with pooled FR of 3% (95%CI: 1%-4.9%), 7.1% (95%CI: 3.9-10.4) and 11.8% (95%CI: 7-16.7%) for TURP, Green-light and HoLEP respectively (p<.001). At meta-regression analysis, none of the retrieved covariates were able to significantly influence the cumulative outcomes reported. ER for postoperative complications and early outpatient visit showed a pooled estimate of 18.6% (95%CI: 13.2%-23.9%) and 7.7% (95%CI: 4.3%-11%) respectively.CONCLUSIONS: Our analysis revealed how transurethral procedures for BPH on an outpatient setting are overall reliable and safe. Of note, there were significant outcome differences between groups with regard of type of surgical procedure, perioperative prostate volume and discharge protocol suggesting the need for further prospective analysis to better elucidate the best strategy in such outpatient conduct.

    View details for DOI 10.1089/end.2020.0538

    View details for PubMedID 33081521

  • Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis. Global spine journal Bhambhvani, H. P., Kasman, A. M., Zhang, C. A., Hu, S. S., Eisenberg, M. L. 2020: 2192568220962435


    STUDY DESIGN: Retrospective cohort.OBJECTIVES: Delayed ejaculation (DE) is a distressing condition characterized by a notable delay in ejaculation or complete inability to achieve ejaculation, and there are no existing reports of DE following lumbar spine surgery. Inspired by our institutional experience, we sought to assess national rates of DE following surgery of the lumbar spine.METHODS: We queried the Optum De-identified Clinformatics Database for adult men undergoing surgery of the lumbar spine between 2003 and 2017. The primary outcome was the development of DE within 2 years of surgery. Multivariable logistic regression was performed to identify factors associated with the development of DE.RESULTS: We identified 117918 men who underwent 162646 lumbar spine surgeries, including anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLF), and more. The overall incidence of DE was 0.09%, with the highest rate among ALIF surgeries at 0.13%. In multivariable analysis, the odds of developing DE did not vary between anterior/lateral lumbar interbody fusion, PLF, and other spine surgeries. A history of tobacco smoking (OR = 1.47, 95% CI 1.00-2.16, P = .05) and obesity (OR = 1.56, 95% CI 1.00-2.44, P = .05) were associated with development of DE.CONCLUSIONS: DE is a rare but distressing complication of thoracolumbar spine surgery, and patients should be queried for relevant symptoms at postoperative visits when indicated.

    View details for DOI 10.1177/2192568220962435

    View details for PubMedID 33047620

  • Relationship Between Male Age, Semen Parameters and Assisted Reproductive Technology Outcomes. Andrology Kasman, A. M., Li, S., Zhao, Q., Behr, B., Eisenberg, M. L. 2020


    BACKGROUND: Low semen quality often obligates the use of assisted reproductive technology (ART); however, the association between semen quality and ART outcomes is uncertain.OBJECTIVES: To further assess the impact of semen quality on ART outcomes.MATERIALS AND METHODS: A retrospective cohort study was carried out at a single academic reproductive medicine center (January 2012-December 2018). Patients undergoing at least one ART cycle utilizing freshly ejaculated sperm from the male partner were included. We assessed the association between semen quality (as stratified based on WHO 5th edition criteria), paternal age (< or ≥40), and reproductive/perinatal outcomes. To evaluate the differences in ART outcomes by semen parameters and age, generalized estimating equations were applied for rates of fertilization, pregnancy, implantation, miscarriage, live birth, blast formation, gestational age, and normal embryo biopsy.RESULTS: 2063 couples were identified who underwent 4517 ART cycles. Average ages of the male and female partners were 39.8 and 37.7, respectively. Lower pregnancy rates were observed in cycles with lower sperm motility (i.e. <40%; 39.9% vs 44.1%) and total motile count (i.e. <9 million; 38.3% vs 43.5%). When examining only cycles utilizing ICSI, only a lower motility count was associated with a decline in pregnancy rate (39.1% vs 44.9%). No association was identified between semen quality and gestational age or birth weight. Paternal age was not associated with ART outcomes. However, among ART cycles in women <40, aneuploidy rate was higher for older men (p< 0.001). In cycles with women>40, no association between aneuploidy and male age was identified.DISCUSSION: Sperm motility is associated with pregnancy rates, while other semen parameters are not. In cycles in women <40, paternal age is associated with embryo aneuploidy rate.CONCLUSION: Paternal factors are associated with ART outcomes and future studies should explore mechanisms by which semen quality is associated with ART outcomes.

    View details for DOI 10.1111/andr.12908

    View details for PubMedID 32964702

  • Clinicopathologic features, outcomes, and prognostic factors of testicular sarcoma: a population-based study. International urology and nephrology Bhambhvani, H. P., Greenberg, D. R., Kasman, A. M., Eisenberg, M. L. 2020


    PURPOSE: To describe clinical characteristics and identify prognostic factors among men with testicular sarcoma, and to compare survival with other testicular cancers.METHODS: The surveillance, epidemiology, and end results (SEER) database (1975-2016) was queried to identify adults with testicular sarcoma. Multivariable Cox proportional hazards, Fine and Gray competing-risks regression, propensity score matching, and Kaplan-Meier analyses were used.RESULTS: 230 men were included in this study. Median age at diagnosis was 58years (range 18-94), and median OS was 10.3years. Patients with tumors larger than 8cm in size had worse OS (HR 1.88, p=0.016) compared to patients with tumors<8cm. Disease with distant metastasis was associated with worse OS (HR 4.70, p<0.0001) and worse CSS (HR 11.41, p<0.0001) as compared to disease localized to the testis. Men with rhabdomyosarcoma had worse CSS (HR 3.25, p=0.03) as compared to men with liposarcoma. Testicular sarcoma patients had worse OS than matched patients with either seminomatous germ cell tumors (GCTs, p<0.0001) or nonseminomatous GCTs (p=0.0019), and similar survival to matched patients with sex cord stromal tumors, testicular lymphoma, or sarcomas of the lower limb-the most common anatomic site of origin of soft tissue sarcomas.CONCLUSIONS: In the largest cohort of men with testicular sarcoma to date, we identified tumor size, disease extent, and rhabdomyosarcoma histology as independent predictors of worse survival. Stage-adjusted survival was worse as compared to men with GCTs, and similar to men with sex cord stromal tumors, testicular lymphoma, and sarcomas of other primary sites.

    View details for DOI 10.1007/s11255-020-02634-4

    View details for PubMedID 32895865

  • Assessment of the Association of Cannabis on Female Sexual Function With the Female Sexual Function Index. Sexual medicine Kasman, A. M., Bhambhvani, H. P., Wilson-King, G., Eisenberg, M. L. 2020


    INTRODUCTION: Cannabis use has increased in the last decade, and the impact of cannabis on female sexual function remains unclear.AIM: To assess the impact of frequency of use, chemovar (tetrahydrocannabinol, cannabinol, or both) type, and method of consumption on female sexual function among cannabis users.METHODS: Adults who visited a single-partner cannabis dispensary's locations were invited to participate in an uncompensated, anonymous online survey October 20, 2019 and March 12, 2020. The survey assessed baseline demographics, health status, cannabis use habits as well as used the validated Female Sexual Function Index (FSFI) to assess sexual function.MAIN OUTCOME MEASURE: The main outcomes of this study are the total FSFI score (sexual dysfunction cutoff <26.55) and subdomain scores including desire, arousal, lubrication, orgasm, satisfaction, and pain.RESULTS: A total of 452 women responded with the majority between the ages of 30-49years (54.7%) and in a relationship or married (81.6%). Of them,72.8% reported using cannabis more than 6 times per week, usually through smoking flower (46.7%). Women who reported more cannabis use, reported higher FSFI scores (29.0 vs 26.7 for lowest vs highest frequencies of reported use, P=.003). Moreover, an increase in cannabis use frequency by one additional use per week was associated with an increase in total FSFI (beta=0.61, P=.0004) and subdomains including desire domain (P=.02), arousal domain (P=.0002), orgasm domain (P=.002), and satisfaction domain (P=.003). For each additional step of cannabis use intensity (ie, times per week), the odds of reporting female sexual dysfunction declined by 21% (odds ratio: 0.79, 95% confidence interval: 0.68-0.92, P=.002). Method of consumption of cannabis and chemovar type did not consistently impact FSFI scores or odds of sexual dysfunction.CONCLUSION: Increased frequency of marijuana use is associated with improved sexual function among female users, whereas chemovar type, method of consumption, and reason for use does not impact outcomes. Kasman AM, Bhambhvani HP, Wilson-King G, etal. Assessment of the Association of Cannabis on Female Sexual Function With the Female Sexual Function Index. Sex Med 2020;XX:XXX-XXX.

    View details for DOI 10.1016/j.esxm.2020.06.009

    View details for PubMedID 32713800

  • Association between male infertility and male-specific malignancies: systematic review and meta-analysis of population-based retrospective cohort studies. Fertility and sterility Del Giudice, F., Kasman, A. M., De Berardinis, E., Busetto, G. M., Belladelli, F., Eisenberg, M. L. 2020


    OBJECTIVE: To investigate the current evidence that correlates impaired male fertility with the risk of developing male-related malignancies.DESIGN: Systematic review and meta-analysis of population-based retrospective cohort studies.SETTING: Not applicable.PATIENT(S): Men diagnosed with impaired fertility status and subsequently observed to determine incidence risk in developing testicular cancer (TCa) or prostate cancer (PCa).INTERVENTION(S): Not applicable.MAIN OUTCOME MEASURE(S): Pooled risk ratio (RR) differences among male factor infertility subjects compared with a fertile control population, and meta-regression analysis according to age at baseline, mean follow-up, range of study time, and year of publication.RESULT(S): Six studies met the inclusion criteria and were critically examined. Four studies examined male infertility and TCa (n = 161,634; 174 TCa cases), and four examined infertility in relation to PCa (n = 183,950 men; 377 PCa cases) from 1963 to 2014. The pooled RR was 2.033 (95% confidence interval [CI], 1.66-2.48); heterogeneity: Q = 3.04 (degree of freedom [df] = 3); I2 = 1.55% for TCa and 1.68 (95% CI, 1.17-2.4); Q = 23.3(df = 3); I2 = 87.1% for PCa.CONCLUSION(S): Male infertility was associated with a subsequent risk of both TCa and PCa. Although the clinical significance of these findings remains uncertain, future studies should evaluate the underlying mechanisms to determine whether testis and prostate screening practices should be altered in men with male infertility.CLINICAL TRIAL REGISTRATION NUMBER: PROSPERO 167277.

    View details for DOI 10.1016/j.fertnstert.2020.04.042

    View details for PubMedID 32709378

  • Clinical correlation among male infertility and overall male health: A systematic review of the literature. Investigative and clinical urology Del Giudice, F., Kasman, A. M., Ferro, M., Sciarra, A., De Berardinis, E., Belladelli, F., Salonia, A., Eisenberg, M. L. 2020; 61 (4): 355–71


    Purpose: Ongoing evidence has suggested the role of male factor infertility as a potential predictor of mortality and general health status. The aim of the present review is to update the current knowledge base regarding the association between male factor infertility and general health through a critical review of the literature.Materials and Methods: A systematic review of the literature was carried out from inception to November 2019 in order to evaluate significant associations between male infertility and adverse health outcomes such as cardiovascular, oncologic, metabolic and autoimmune diseases as well as overall mortality.Results: In all, 27 studies met inclusion criteria and were critically examined. Five studies examined male infertility and cardiovascular disease risk, 11 examined oncologic risk (e.g., overall cancer risk, testis and prostate cancer), 8 examined aggregate chronic medical diseases and 5 infertility related to incidence of mortality, for a total of 599,807 men diagnosed with any male factor infertility covering a period from 1916 to 2016.Conclusions: A man's fertility and overall health appear to be interconnected. Therefore, a diagnosis of male infertility may allow a window into future comorbidity and/or mortality which may help guide clinical decisions and counseling. Several possible etiologies such as genetic, epigenetic, developmental, and lifestyle-based factors need to be further evaluated in order to establish the underlying mechanisms between male infertility and health.

    View details for DOI 10.4111/icu.2020.61.4.355

    View details for PubMedID 32665992

  • Development of robust artificial neural networks for prediction of 5-year survival in bladder cancer. Urologic oncology Bhambhvani, H. P., Zamora, A., Shkolyar, E., Prado, K., Greenberg, D. R., Kasman, A. M., Liao, J., Shah, S., Srinivas, S., Skinner, E. C., Shah, J. B. 2020


    PURPOSE: When exploring survival outcomes for patients with bladder cancer, most studies rely on conventional statistical methods such as proportional hazards models. Given the successful application of machine learning to handle big data in many disciplines outside of medicine, we sought to determine if machine learning could be used to improve our ability to predict survival in bladder cancer patients. We compare the performance of artificial neural networks (ANN), a type of machine learning algorithm, with that of multivariable Cox proportional hazards (CPH) models in the prediction of 5-year disease-specific survival (DSS) and overall survival (OS) in patients with bladder cancer.SUBJECTS AND METHODS: The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 program database was queried to identify adult patients with bladder cancer diagnosed between 1995 and 2010, yielding 161,227 patients who met our inclusion criteria. ANNs were trained and tested on an 80/20 split of the dataset. Multivariable CPH models were developed in parallel. Variables used for prediction included age, sex, race, grade, SEER stage, tumor size, lymph node involvement, degree of extension, and surgery received. The primary outcomes were 5-year DSS and 5-year OS. Receiver operating characteristic curve analysis was conducted, and ANN models were tested for calibration.RESULTS: The area under the curve for the ANN models was 0.81 for the OS model and 0.80 for the DSS model. Area under the curve for the CPH models was 0.70 for OS and 0.81 for DSS. The ANN OS model achieved a calibration slope of 1.03 and a calibration intercept of -0.04, while the ANN DSS model achieved a calibration slope of 0.99 and a calibration intercept of -0.04.CONCLUSIONS: Machine learning algorithms can improve our ability to predict bladder cancer prognosis. Compared to CPH models, ANNs predicted OS more accurately and DSS with similar accuracy. Given the inherent limitations of administrative datasets, machine learning may allow for optimal interpretation of the complex data they contain.

    View details for DOI 10.1016/j.urolonc.2020.05.009

    View details for PubMedID 32593506

  • POST-OPERATIVE OPIOID FREE URETEROSCOPY: A PROTOCOL PILOT STUDY Kasman, A., Schmidt, B., Spradling, K., Chow, C., Wu, M., Hunt, R., Sockol, A., Smith, H., Shah, J., Conti, S. LIPPINCOTT WILLIAMS & WILKINS. 2020: E162
  • Association of preconception paternal health on perinatal outcomes: analysis of U.S. claims data. Fertility and sterility Kasman, A. M., Zhang, C. A., Li, S., Stevenson, D. K., Shaw, G. M., Eisenberg, M. L. 2020


    OBJECTIVE: To assess whether paternal health is associated with maternal peripartum and neonatal outcomes.DESIGN: Retrospective cohort study.SETTING: University research departments.PATIENT(S): Analytic sample of children born to paired fathers and mothers covering live births within the United States between 2009-2016.INTERVENTION(S): Paternal health status (e.g., metabolic syndrome diagnoses, individual chronic disease diagnoses).MAIN OUTCOME MEASURE(S): Primary outcome of preterm birth (i.e., live birth before 37 weeks), and secondary outcomes of low birth weight, neonatal intensive care unit (NICU) stay, gestational diabetes, preeclampsia, eclampsia, and length of maternal stay.RESULT(S): The IBM Marketscan Research database covers reimbursed health care claims data on inpatient and outpatient encounters who are privately insured through employment-sponsored health insurance. We assessed 785,809 singleton live births, with 6.6% born preterm. The presence of paternal comorbidities was associated with higher odds of preterm birth, low birth weight (LBW), and NICU stay. After adjusting for maternal factors, fathers with most or all components of the metabolic syndrome had 19% higher odds of having a child born preterm (95% CI 1.11-1.28), 23% higher odds of LBW (95% CI 1.01-1.51), and 28% higher odds of NICU stay (95% CI 1.08-1.52). Maternal morbidity (e.g., gestational diabetes or preeclampsia) was also positively associated with preconception paternal health.CONCLUSION(S): Increased preconception paternal comorbidity may be associated with negative infant and maternal outcomes. Although the paternal effect remains modest, these findings highlight the importance of the health of both parents, particularly the mother, on healthy pregnancy.

    View details for DOI 10.1016/j.fertnstert.2019.12.026

    View details for PubMedID 32147174

  • Increased mortality among men diagnosed with impaired fertility: analysis of US claims data. Urology Giudice, F. D., Kasman, A. M., Li, S. n., Belladelli, F. n., Ferro, M. n., de Cobelli, O. n., De Berardinis, E. n., Gian, M. B., Eisenberg, M. L. 2020


    to determine whether male infertility or impaired spermatogenesis is associated with mortality.The Optum de-identified Clinformatics® Data Mart database was queried from 2003 through 2017. Infertile men were compared to subjects undergoing semen analysis (i.e. infertility testing). Infertile men with oligozoospermia or azoospermia were included. Mortality was determined by data linkage to the Social Security Administration Death Master File. Results were adjusted for age, smoking, obesity, year of evaluation and health care visits as well as for most prevalent comorbidities. We separately examined men with prevalent or incident cardiovascular disease (CVD) and cancer (Ca) diagnoses to determine associations with mortality.A total of 134,796 infertile men and 242,282 controls were followed for a mean of 3.6 and 3.1 years respectively. Overall, infertile men had a higher risk of death (Hazard Ratio [HR]= 1.42, 95%CI: 1.27-1.60) The diagnosis of azoospermia was associated with a significantly increased risk of death (HR= 2.01, 95%CI: 1.60 - 2.53) with a higher trend among men with oligospermia (HR: 1.17, 95%CI: 0.92-1.49) compared to controls. Sub-analysis was done excluding prevalent cardiovascular and malignant disease (alone and combined) showing similar hazard ratios.Male infertility is associated with a higher risk of mortality especially among azoospermic men. Prevalent disease (which is known to be higher among infertile men) did not explain the higher risk of death among infertile men. The implications for treatment and surveillance of infertile men require further study.

    View details for DOI 10.1016/j.urology.2020.07.087

    View details for PubMedID 33017614

  • Association between preconception paternal health and pregnancy loss in the USA: an analysis of US claims data. Human reproduction (Oxford, England) Kasman, A. M., Zhang, C. A., Li, S. n., Lu, Y. n., Lathi, R. B., Stevenson, D. K., Shaw, G. M., Eisenberg, M. L. 2020


    Is preconception paternal health associated with pregnancy loss?Poor preconception paternal health is associated with a higher risk of pregnancy loss as confirmed in sensitivity analyses accounting for maternal age and health.Preconception paternal health can negatively impact perinatal outcomes.Retrospective cohort study of US insurance claims database from 2009 to 2016 covering 958 804 pregnancies.US insurance claims database including women, men and pregnancies within the USA between 2007 and 2016. Paternal preconception health status (e.g. metabolic syndrome diagnoses (MetS), Charlson comorbidity index (CCI) and individual chronic disease diagnoses) was examined in relation to pregnancy loss (e.g. ectopic pregnancy, miscarriage and stillbirth).In all, 958 804 pregnancies were analyzed. The average paternal age was 35.3 years (SD 5.3) and maternal age was 33.1 years (SD 4.4). Twenty-two percent of all pregnancies ended in a loss. After adjusting for maternal factors, the risk of pregnancy loss increased with increasing paternal comorbidity. For example, compared to men with no components of MetS, the risk of pregnancy loss increased for men with one (relative risk (RR) 1.10, 95% CI 1.09-1.12), two (RR 1.15, 95% CI 1.13-1.17) or three or more (RR 1.19, 95% CI 1.14-1.24) components. Specifically, less healthy men had a higher risk of siring a pregnancy ending in spontaneous abortion, stillbirth and ectopic pregnancies. Similar patterns remained with other measures of paternal health (e.g. CCI, chronic diseases, etc.). When stratifying by maternal age as well as maternal health, a similar pattern of increasing pregnancy loss risk for men with 1, 2 or 3+ MetS was observed. A statistically significant but weak association between timing of pregnancy loss and paternal health was found.Retrospective study design covering only employer insured individuals may limit generalizability.Optimization of a father's health may improve pregnancy outcomes.National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085). M.L.E. is an advisor for Sandstone Diagnostics, Dadi, Hannah and Underdog. No other competing interests were declared.N/A.

    View details for DOI 10.1093/humrep/deaa332

    View details for PubMedID 33336240

  • Association between infertility and mental health of offspring in the United States: a population based cohort study. Human fertility (Cambridge, England) Kasman, A. M., Zhang, C. A., Luke, B. n., Eisenberg, M. L. 2020: 1–6


    There exist conflicting data in regard to the health outcomes of offspring born to infertile couples and follow up of offspring can be challenging. The objective of the study was to determine the association between infertility in men and women and the mental health of their offspring. The present study analyzes data obtained from the IBM Marketscan™ Commercial Claims and Encounters database from 2007 through 2015. Overall, 271,603 children of males with male factor infertility, 328,571 children of females with female factor infertility, 663,568 children of males who later underwent vasectomy were identified. The odds of psychosis were increased in offspring of those with male factor infertility (OR 1.25, 95% CI 1.22-1.29) and female factor infertility (OR 1.20, 95% CI 1.17-1.23). Offspring of infertile males (OR 1.19, 95% CI 1.13-1.26) and infertile females (OR 1.20, 95% CI 1.14-1.26) had an increased odds of autism compared to the reference group. In addition, offspring of infertile males (OR 1.48, 95% CI 1.28-1.7) and infertile females (OR 1.52, 95% CI 1.33-1.73) had higher odds of being diagnosed with an intellectual disability. Therefore, offspring of infertile men or women may have an increased risk of developing psychosis, autism, or intellectual disability.

    View details for DOI 10.1080/14647273.2020.1805799

    View details for PubMedID 32781859

  • Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study. Sexual medicine Kasman, A. M., Bhambhvani, H. P., Eisenberg, M. L. 2020


    Prevalence and bother of ejaculatory dysfunction (EjD) has yet to be evaluated in a men's health referral population.To evaluate the prevalence and associated risk factors of EjD in men presenting to a men's health clinic.A retrospective review examined patients presenting to an outpatient men's health clinic who completed the Sexual Health Inventory for Men and the Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD) Short Form. Patient factors including demographics, comorbidities, and medication were examined. Descriptive statistics and multivariable logistic regression were used.The main outcomes of this study are Sexual Health Inventory for Men and MSHQ-EjD scores.A total of 63 (24%) of patients presenting to the urology clinic were characterized as having EjD based on questionnaire responses. The mean age for men with EjD was 53.8 years, while those without was 42.6 years (P < .001). Of men with EjD, 74.6% were at least moderately bothered (MSHQ-EjD ≥3). Men with EjD were more likely to have erectile dysfunction (77.8%) compared with those without (21%, P < .001) as well as a history of a pelvic cancer (20.6% vs 6%, P = .001). On multivariable regression, erectile dysfunction (odds ratio: 15.04, 95% confidence interval: 6.76-35.92, P < .0001) and alpha inhibitor prescription (odds ratio: 6.82, 95% confidence interval: 1.57-30.16, P = .01) were associated with a higher odds of EjD. ED was found to be a mediator of the relationship between EjD and age, as the age association was lost in the ED population on multivariable regression compared with the non-ED population where it remained significant.EjD is common among patients presenting to a men's health clinic and may present at varying ages, though it is more common in those aged 50 years or older; it is independent of age and race. EjD is associated with erectile dysfunction, pelvic cancer history, and use of alpha inhibitors, presenting a population that could be considered for screening. Kasman AM, Bhambhvani HP, Eisenberg ML. Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study. J Sex Med 2020;XX:XXX-XXX.

    View details for DOI 10.1016/j.esxm.2020.05.002

    View details for PubMedID 32553504

  • A Survey Exploring the Relationship Between Cannabis Use Characteristics and Sexual Function in Men. Sexual medicine Bhambhvani, H. P., Kasman, A. M., Wilson-King, G. n., Eisenberg, M. L. 2020


    Cannabis is the most commonly used drug in the United States; however, the effects of cannabis use on male sexual function are poorly understood.To characterize the contemporary landscape of cannabis use and to assess the associations between male sexual function and the frequency of use, the primary method of consumption, or cannabis chemovar (tetrahydrocannabinol or cannabidiol) among current users.We surveyed adults who visited a single cannabis dispensary for baseline demographic information, medical history, cannabis use habits, and sexual function as assessed by the International Index of Erectile Function (IIEF). An IIEF-5 < 21 was considered erectile dysfunction.The main outcome measure of the study was male sexual function via the IIEF domain scores.A total of 325 men completed the survey with a mean age of 46.7 years. 71.1% of the men were Caucasian and 52.6% were married. 13 men (4%) were never users; 29 men (8.9%) used 1-2 times/week; 51 men (15.7%) used 3-5 times/week, and 232 men (71.4%) used 6+ times/week. The average IIEF-5 score was 22.3 with 19.4% of the men having erectile dysfunction. In univariate analysis, men using cannabis more frequently had a higher overall IIEF (65.36 vs 60.52, P = .001), erectile domain (27.32 vs 25.74, P = .03), orgasm domain (9.08 vs 8.12, P < .001), intercourse satisfaction domain (12.42 vs 11.31, P = .006), and overall satisfaction domain (8.11 vs 7.05, P = .002). In multivariable analysis, compared to men who used cannabis 0 times/week, those who used 6 times/week had an increased overall IIEF (69.08 vs 64.64, P-value adjusted = 0.02), intercourse satisfaction domain (P-value adjusted = 0.04), and overall satisfaction domain (P-value adjusted = 0.02). The primary method of consumption (eg, smoking, edibles, etc.) and cannabinoid composition (eg, cannabidiol vs tetrahydrocannabinol dominant) were not associated with sexual function.We report an association between the increased frequency of cannabis use and increased male sexual function. However, while the increased frequency of use was statistically significant with regard to the IIEF scores, the clinical significance of this is likely low, and selection bias may limit the generalizability of these findings. The method of consumption and cannabis chemovar were not associated with sexual function. Bhambhvani HP, Kasman AM, Wilson-King G, et al. A Survey Exploring the Relationship Between Cannabis Use Characteristics and Sexual Function in Men. J Sex Med 2020;XX:XXX-XXX.

    View details for DOI 10.1016/j.esxm.2020.06.002

    View details for PubMedID 32561331

  • New insights to guide patient care: the bidirectional relationship between male infertility and male health. Fertility and sterility Kasman, A. M., Del Giudice, F. n., Eisenberg, M. L. 2020


    Male reproduction is a complex process, and numerous medical conditions have the potential to alter spermatogenesis. In addition, male factor infertility may be a biomarker for future health. In the present review, we discuss the current literature regarding the association between systemic diseases and fertility, which may impact clinical outcomes or semen parameters. A number of conditions that have systemic consequences were identified, including genetic (e.g., cystic fibrosis, DNA mismatch repair alterations), obesity, psychological stress, exogenous testosterone, and a variety of common medications. As such, the infertility evaluation may offer an opportunity for health counseling beyond the discussion of reproductive goals. Moreover, male infertility has been suggested as a marker of future health, given that poor semen parameters and a diagnosis of male infertility are associated with an increased risk of hypogonadism, cardiometabolic disease, cancer, and even mortality. Therefore, male fertility requires multidisciplinary expertise for evaluation, treatment, and counseling.

    View details for DOI 10.1016/j.fertnstert.2020.01.002

    View details for PubMedID 32089256

  • Male infertility and future cardiometabolic health: Does the association vary by sociodemographic factors? Urology Kasman, A. M., Li, S. n., Luke, B. n., Sutcliffe, A. G., Pacey, A. A., Eisenberg, M. L. 2019


    To determine whether the association between male infertility and incident cardiometabolic disease is modified by socioeconomics, race, or geographic region.Retrospective review of data from insurance claims from Optum's de-identified Clinformatics® Data Mart Database. Subjects were men, 18-50 years old, with an associated diagnosis of infertility in the United States between 2003 and 2016. Analytic sample were men captured by the Optum's de-identified Clinformatics® Data Mart Database with an associated diagnosis of infertility. Men were classified as either infertile, or not, based on diagnosis or procedural codes. Cardiometabolic health outcomes were then assessed using CPT codes for diabetes, hypertension, hyperlipidemia, and heart disease. Confounding factors were controlled for such as race, education, socioecomonic status, and region. The main outcomes were development of diabetes, hypertension, hyperlipidemia, and heart disease.A total of 76,343 males were diagnosed with male factor infertility, 60,072 males who underwent fertility testing, and 183,742 males that underwent vasectomy (control population). For all men, infertile men had a higher risk of incident hypertension, diabetes, hyperlipidemia, and heart disease when compared to those undergoing vasectomy. Identical associations were found across all education, income, racial, and geographic strata.Our study suggests that men with infertility have a higher risk of cardiometabolic disease in the years following a fertility evaluation regardless of race, region, or socioeconomic status.

    View details for DOI 10.1016/j.urology.2019.06.041

    View details for PubMedID 31377255

  • Combination therapy in overactive bladder-untapped research opportunities: A systematic review of the literature. Neurourology and urodynamics Kasman, A. n., Stave, C. n., Elliott, C. n. 2019


    Overactive bladder (OAB) affects over 17% of the population and significantly effect the health-related quality of life. The treatments for OAB include first line (lifestyle modification, pelvic floor muscle training), second line (anticholinergic or beta-3 agonist medications), and third line therapies (intradetrusor botulinum toxin injection, sacral neurostimulation [SNM], or percutaneous tibial nerve stimulation [PTNS]). For those with urinary incontinence secondary to OAB, complete continence is the goal of therapy, though cure rates are only 5% to 40%. The use of combination therapies can be employed in refractory OAB, however, the efficacy of pooled modalities is relatively unknown. Our objective was to determine the volume of data supporting combination therapy in treating OAB.We systematically reviewed PubMed, EMBASE, the Cochrane Library, and Google Scholar for articles published before October 2018. Each was independently reviewed by two reviewers and examined in detail if they met inclusion criteria.A total of 32 studies met inclusion criteria and were reviewed. Most large prospective studies evaluated combinations of medications with behavioral therapy or medications together. Combination therapy studies of third-line treatments were rare and centered on medication with PTNS. No studies examined intradetrusor botulinum toxin injections in combination with another therapy and only one retrospective study briefly examined SNM therapy in combination with medication.Combination therapy, with certain first, second, and third-line OAB therapies, appears to be efficacious. There is a further need for carefully designed combination therapy studies, particularly those including third line modalities.

    View details for DOI 10.1002/nau.24158

    View details for PubMedID 31483070

  • Association between use of marijuana and time to pregnancy in men and women: findings from the National Survey of Family Growth FERTILITY AND STERILITY Kasman, A. M., Thoma, M. E., McLain, A. C., Eisenberg, M. L. 2018; 109 (5): 866–71


    To determine if regular use of marijuana has an impact on time to pregnancy.Retrospective review of cross-sectional survey data from male and female respondents aged 15-44 years who participated in the 2002, 2006-2010, and 2011-2015 National Survey of Family Growth.Not applicable.The National Survey of Family Growth is a nationally representative population-based sample derived from stratified multistage area probability sampling of 121 geographic areas in the U.S. Our analytic sample was participants who were actively trying to conceive.Exposure status was based on the respondents' answers regarding their marijuana use in the preceding 12 months.The main outcome was estimated time to pregnancy, which was hypothesized before analysis to be delayed by regular marijuana use.A total of 758 male and 1,076 female participants responded that they were actively trying to conceive. Overall, 16.5% of men reported using any marijuana while attempting to conceive, versus 11.5% of women. The time ratio to pregnancy for never smokers versus daily users of marijuana in men was 1.08 (95% confidence interval 0.79-1.47) and in women 0.92 (0.43-1.95), demonstrating no statistically significant impact of marijuana use on time to pregnancy.Our study suggests that neither marijuana use nor frequency of marijuana use was associated with time to pregnancy for men and women.

    View details for PubMedID 29555335

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