Have You Read?

By: Craig Niederberger, MD, FACS | Posted on: 01 Oct 2022

Shahinyan GK, Weinberger JM, Shahinyan RH, Yang SC, Mills JN, Eleswarapu SV. Analysis of direct-to-consumer marketing of platelet-rich plasma for erectile dysfunction in the US. JAMA Netw Open. 2022;5(5):e2214187.

Special thanks to Drs. Blake Johnson, Samuel Gold, and Tolulope Bakare at the UT Southwestern Medical Center.

Platelet-rich plasma (PRP) has gained attention in popular culture because of use by high-profile figures such as Tiger Woods and the Kardashians after orthopedic injuries and cosmetic procedures. Driven by demand for regenerative treatments for erectile dysfunction and unregulated direct-to-consumer advertising, intracavernosal PRP injections, the so-called “Priapus” or “P shot,” have grown in popularity over the past 5 years despite limited research into their safety and efficacy.

To get a sense of just how popular and lucrative PRP is, these investigators analyzed cost to consumer, injection protocols, and clinician credentials across 109 U.S. clinics offering PRP for erectile dysfunction. The average price per injection was $1,507. In some clinics, a single injection is offered, while others offer a myriad of treatments without a standardized protocol and no clear way to measure success. By specialty, clinicians offering PRP were 9% urology, 25% family or internal medicine, and 7% ob-gyn, and 22% were nonphysicians.

Despite an absence of clinical trial data demonstrating efficacy, PRP injections for erectile dysfunction are being offered increasingly by nonphysicians and physicians alike, without specific training in male sexual dysfunction and at high cost to the consumer. In fact, the AUA classifies PRP as an investigational therapy that should not be offered for payment.

The authors posit that the growth of PRP for erectile dysfunction is driven by consumerization of sexual health. One need only turn on a television to see evidence of this trend with the widespread marketing for low testosterone treatments. As cited in this article, testosterone prescriptions tripled between 2001 and 2011. We may see a similar proliferation in sales of PRP for erectile dysfunction in the coming years and need to be prepared for it.

Hudnall M, Goyette B, Ambulkar S, et al. Self-reported race/ethnicity is not associated with abnormal semen parameters after accounting for body mass index and socioeconomic status. J Urol. 2022;208:164-170.

Special thanks to Drs. Rabun Jones and Mahmoud Mima at the University of Illinois at Chicago.

Is there a relationship between race or ethnicity and abnormal semen parameters? Previous studies suggested there is, but is it real? The authors of this study investigated whether that association would be maintained when controlling for BMI and social determinants of health including insurance status and neighborhood income. They did a retrospective review of 2,750 men who had semen analyses from 2002 to 2021 at an academic center and not only found that Black men had significantly lower median sperm concentration, lower volume, and total motile sperm count, but also that their Black patients were of an older median age, had a higher median BMI, were more likely to have public insurance, and had the lowest median neighborhood income. When controlling for age alone, Black men had significantly higher odds of abnormal sperm concentration and total motile sperm count. However, when BMI, neighborhood income, and insurance status were included in multivariable logistic regression, the association was not statistically significant. These results raise important questions regarding access to fertility care and the way race or ethnicity is factored into both research and clinical decision making. There is always more to the story than a box checked by a patient on an intake form!

Abou Zeinab M, Beksac AT, Corse T, et al. The multi-institutional experience in single-port robotic transvesical simple prostatectomy for benign prostatic hyperplasia management. J Urol. 2022;208(2):369-378.

Special thanks to Drs. Andrew Lai and Omer Acar at the University of Illinois at Chicago.

It is amazing to witness emerging technology that allows us to revisit antiquated surgical approaches to treat the same disease processes. The single-port transvesical robot-assisted simple prostatectomy is a novel modality in our armamentarium that has gained considerable popularity in the management of markedly enlarged prostate glands owing to its technical similarity to open simple adenomectomy and its minimally invasive nature. In this study, surgeons at 3 high-volume academic institutions combined their data on single-port transvesical prostate enucleations. On average, patients had brief hospital stays including 42% same-day discharges, shorter catheter indwell times, low peri- and postoperative complication rates, and impressive functional outcomes. Remarkably, most of the patients reported a 9-month median quality of life score of 0, or “delighted.” Circumferential vesicourethral mucosal anastomosis, which minimizes the risk of bleeding and need for continuous bladder irrigation, coupled with an extraperitoneal approach were the technical nuances that facilitated expedited recovery. While currently available only in the hands of highly experienced surgeons and OR teams, this promising option will surely offer patients a valid choice in managing their large prostates.