Citations

Introduction The World Health Organization (WHO) endorses male circumcision as an effective human immunodeficiency virus (HIV) prevention intervention in settings where the expected impact is greatest, including Sub-Saharan Africa. Data on cost implications of early infant male circumcision (EIMC) are limited. The ShangRing (SR) is a WHO pre-qualified device for circumcision. We sought to perform a comprehensive cost assessment alongside a randomized controlled trial (RCT) of the SR versus the standard of care Mogen clamp (MoC) for EIMC to enable future scale-up towards a cost-effective HIV prevention strategy. Methods We collected resource utilization and economic data as part of an RCT of infants aged 0–60 days old undergoing EIMC in Kenya, Tanzania, and Uganda. Cost data for both the SR and MoC included baseline facility costs, direct costs, and indirect costs. The Decision Makers Program Planning Tool v1.0 was used to perform a direct cost comparison of these two devices. The Goals model was used to compare the costs of EIMC in 2023 using the present value of money to circumcise an adolescent male 15 years from now. Results A total of 1,378 infant males underwent circumcision, 689 via SR and 689 via MoC. The overall cost of a single EIMC in Kenya, Tanzania, and Uganda were 61.30 United States Dollars ($), $47.14, and $64.59 respectively for the SR, and $56.38, $50.43, and $58.57 respectively for the MoC. In Kenya, EIMC would be less expensive based on nominal present costs in 2023 compared to waiting for adolescent circumcision at age 15 years in 2038. This finding is reversed in Tanzania and Uganda. Conclusions The overall cost of EIMC via SR versus MoC is comparable in an RCT. With scale-up utilizing lower level personnel, the cost of SR may be further reduced. The SR is an attractive alternative for future EIMC initiatives in Sub-Saharan Africa to further reduce HIV burden.

Abstract Introduction The EROS (Erectile Restoration Outcomes and Satisfaction) registry provides prospective, questionnaire-based follow-up after IPP, established in 2020. Objective We sought to assess general trends in the open-ended responses portion of the questionnaire. Methods Data were collected from 2020 to 2025, with a total of 568 responses. The survey included six open-ended questions pertaining to lifestyle change since IPP, reasons not to repeat the procedure, impediments to use, dissatisfaction, what patients wish they had known more about the procedure, and other recommendations. Evaluable data included 6-month responses from Rochester, Jacksonville, and Phoenix. Results Open-ended feedback was given by 66% of patients on what they wished they had known, 54% gave other recommendations, 38% gave lifestyle feedback, 7% elaborated upon reasons not to use, 3% on reasons for dissatisfaction, and 2% on reasons they would not repeat IPP. There was an overall very positive response (“Significant Improvement”, n=74.3%) from those who underwent the IPP placement, with some patients reporting that it was far more convenient than other forms of treatment, and even increased spontaneity in their sexual lives, leading to improved relationships. Among the reported responses are increased confidence (n=39.4%), increased sexual activity (n=13.3%), and improved health and exercise levels (n=6.6%). When questioning patients about why they would not repeat the procedure and what their sources of dissatisfaction were, among those who responded to each question (n=12, n=16), the most frequently reported complaint was the exaggeration of pre-existing curves (n=41.7%, n=25.0%), particularly due to Peyronie’s disease. When questioned about what prevents use, the main responses were partner-related or due to personal problems (n=45.2%). The patients did not have many recommendations, but hoped for a better way to deflate and inflate the device (n=20.4%) and reported adequate pre-operative education and use of the pump. The table below outlines the categories of responses and the percentage of each keyword reported per question type. Conclusions In addition to standard pre-operative IPP counseling, providers should also focus on potential difficulties with device inflation/deflation, length loss (IPP not in the glans), pain/ recovery expectations, the potential for new or worsened curve (erect or flaccid), and potential changes in sensation. IPP satisfaction is high, as only 2% of patients gave responses on why they would not repeat the IPP, with many men expressing an increased level of overall confidence. Disclosure No

Abstract Introduction There is wide variation in male fertility preservation practices. While physician preference accounts for some of this diversity, practice patterns often reflect multiple extrinsic factors including patient demographics, equipment availability, laboratory protocols, and state law. Objective We sought to characterize national trends in sperm retrieval and storage across reproductive urology practices in the United States. Methods An anonymous 34-item survey characterizing provider demographics, practice settings, fertility preservation procedures, andrology laboratory practices, and cryopreservation expenses was designed. Practicing reproductive urologists were identified using information available through professional societies. Our survey was constructed using the Qualtrics platform and distributed electronically between October 2024 and May 2025. Results 39 responses were received by urologists practicing across 21 states (response rate: 21%, n=189). A majority (74%, n=29) of survey responders practiced at academic medical centers, with others practicing at non-academic hospitals (8%, n=3) and private practices (13%, n=5). The most common indications for fertility preservation reported included oncologic care (42%), gamete storage for planned ART (31%), transgender care (18%), pre-vasectomy sperm banking (10%), and pre-deployment banking for military personnel (5%). Nearly all providers performed microsurgical sperm retrievals (97%, n=38, Figure) and oncologic testicular sperm extractions (85%, n=33) when indicated. More than half of providers offered conventional testicular sperm extractions (72%, n=28), microsurgical epididymal sperm aspirations (59%, n=23), testicular sperm aspirations (56%, n=22), penile vibratory stimulation (54%, n=21), or percutaneous epididymal sperm aspirations (52%, n=20). Fewer providers offered post-mortem sperm retrieval (49%, n=19), pre-pubertal testicular tissue cryopreservation (36%, n=14), or electroejaculation (31%, n=12). Most respondents (62%, n=24) had access to an on-site andrology laboratory. Semen analyses were evaluated using manual (53%, n=20), computer-assisted (11%, n=4), or combinatorial methods (26%, n=10). Though many (37%, n=14) providers were uncertain about institutional costs for semen specimen processing, a plurality of respondents (40%, n=15) reported fees ranging from $100-500 with the remainder (23%, n=9) reporting fees exceeding $500. Respondents most frequently reported semen storage fees ranging between $100-300 per year (39%, n=15), while approximately a third (31%, n=12) estimated these costs to range between $300-600 per year. However, 18% (n=7) of respondents reported higher costs for specimen storage and 13% (n=5) were uncertain about the expense of this service. Conclusions This multi-institutional, geographically diverse survey reveals significant variation in reproductive urology practice patterns and cost associated with semen analyses and storage. Future studies will explore differences in practice patterns to better understand the factors influencing this variation and their effect on male reproductive healthcare. In the absence of society guidelines, reproductive urologists must collaborate, share best practices, and maintain price transparency to ensure sperm retrieval remains accessible and affordable. Disclosure No

Abstract Introduction The U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization (June 2022), which overturned Roe v. Wade, has prompted significant shifts in reproductive health behavior, particularly among men. Several studies have reported trends in vasectomy-related interest and procedural volume following the decision, suggesting a growing inclination to pursue vasectomy as a long-term contraceptive option amid changing abortion access on national and statewide levels. Emerging research has also begun to explore the motivations behind this trend, pointing to a complex interplay of personal, social, and policy-related factors. However, the current body of evidence is fragmented, spanning various settings and study designs. Thus, there is a need to map the breadth and scope of this literature, identify key themes, and highlight gaps in knowledge. Objective To review the published literature assessing changes in vasectomy interest and utilization following the Dobbs decision. Methods This scoping review was conducted in accordance with established methodological frameworks to systematically map the existing literature on vasectomy trends in the United States following the Dobbs decision. A scoping review was chosen rather than a systematic review or meta-analysis due to the heterogeneity in study designs, populations, and outcome measures. Eligible studies included peer-reviewed articles examining adult patients concerning vasectomy in U.S. settings, with a focus on changes in utilization, interest, or related behaviors in response to abortion policy shifts. A comprehensive search strategy was developed to capture English-language peer-reviewed literature from 2010 onward. Searches were conducted in January 2025 across six databases: PubMed (n=207), Embase (n=243), Scopus (n=195), Web of Science (n=48), Cochrane Library (n=17), and ClinicalTrials.gov (n=0). Search terms included variations of “vasectomy” and “abortion.” Two independent reviewers screened articles and extracted data using a piloted form on the Covidence platform, collecting information on study characteristics, population demographics, outcomes related to vasectomy trends, patient motivations, and contextual policy factors. Results A total of 405 unique records were identified through the literature search, with 34 articles reviewed in full text. Seventeen studies met final inclusion criteria. Internet search analyses (29%, n=5) demonstrated increased interest in both vasectomy and tubal ligation following the Dobbs decision, with all reporting greater relative increases for “vasectomy” across short-, mid-, and long-term timeframes. Procedural trend analyses (29%, n=5) showed overall increases in vasectomy volume compared with 6-month to 5-year pre-Dobbs baselines. Six studies found that men undergoing or seeking vasectomy post-Dobbs were significantly younger. Five studies reported higher proportions of childless or fewer-child patients. Additionally, five studies identified shifts in marital or partner status, with increased rates of single, unpartnered, or nonmarried patients post-Dobbs. Geographic differences were observed across 47% of studies (n=8), with greater vasectomy and tubal ligation interest reported in states with abortion trigger laws or more restrictive abortion environments. Conclusions This scoping review identified key demographic and geographic patterns in vasectomy trends following the Dobbs decision. Findings underscore increased interest and utilization, particularly among younger, childless, and unpartnered men, and highlight regional variation aligned with abortion policy restrictiveness. These results warrant further prospective study on patient-level motivations for permanent sterilization. Disclosure No

Abstract Introduction Erectile Dysfunction (ED) is becoming increasingly recognized as a potential marker of chronic medical conditions. Recent research has examined the association between ED and Parkinson’s disease. In fact, recent findings indicate that men with ED have upwards of a fourfold higher risk of developing Parkinson’s disease compared to those without a diagnosis of ED. Objective Our research investigates associations between self-reported ED severity and neurobiological factors, including measures of cognitive function and neuroimaging of dopaminergic integrity. Methods We performed a retrospective analysis of 93 male research participants with ED extracted from an observational cohort study of aging and Parkinson’s disease biomarkers. Though some patients experienced some age-related mild cognitive changes, all participants were classified as clinically neurologically healthy. Patients received cognitive testing through the Montreal Cognitive Assessment (MoCA), with scores ranging from 0-30. Neuroimaging of the bilateral caudate and putamen, components of the striatum implicated in Parkinson’s disease pathology and dopaminergic binding, was measured through dopamine transporter SPECT imaging (DaTScan) binding ratios. ED was self-reported using questions 22-23 on the Scales for Outcomes in Parkinson’s Disease – Autonomic Dysfunction (SCOPA-AUT). Question 22 stated “In the past month, have you been impotent (unable to have or maintain an erection?)” and question 23 stated “In the past month, how often have you been unable to ejaculate?”. SCOPA-AUT scores ranged from 0 (sometimes) to 3 (often) and were averaged across both questions. Patients taking dopaminergic Parkinson’s disease medications or PDE5 inhibitors at baseline were excluded due to potential confounding. Due to violations of normality assumption, numerical associations utilized an age-adjusted partial spearman correlation coefficient. Descriptive statistics are displayed as median (IQR). Results Of the 93 selected participants, one individual was excluded due to incomplete neuroimaging DaTScan data. Therefore, 92 patients were included in our analysis. The median age of participants was 67.3 years (61.4 – 73.0) and the median MoCA score was 27.2 (26.0, 28.7) which represents minimal cognitive impairment. Age-adjusted spearmen correlation coefficient showed no association between MoCA measured cognitive performance and ED severity (r = -0.116, p = 0.275). Age-adjusted associations of striatal DaTScan showed a significant, mild relationship between ED severity and both right caudate dopamine binding ratios (r = 0.236, p=0.0242) and left putamen dopamine binding ratios (r = 0.262, p = 0.0121). However, associations between ED severity and both left caudate (r = 0.150, p = 0.155) and right putamen (r = 0.143, p = 0.176) dopamine binding ratios did not reach statistical significance. Conclusions Although no association was observed between ED severity and cognitive function, greater ED severity was significantly associated with increased striatal dopaminergic binding. This positive, age-adjusted association may reflect a compensatory dopaminergic response similar to that seen in the early stages of Parkinson’s disease. Overall, our findings suggest that ED could serve as a potential marker of central dopaminergic and autonomic alterations, even in the absence of clinically evident neurological disease. Disclosure No

Abstract Introduction Infertility insurance benefits remain a key concern for individuals pursuing medical training during peak reproductive years. While urologists play a central role in managing male infertility, the availability and visibility of fertility benefits during urology residency remain poorly characterized. Delays in family building are common among male trainees, often paralleling those of their partners. By the time individuals pursue fertility care, partners may already be within or approaching advanced reproductive age. Additionally, male infertility is increasingly recognized as a marker of systemic health conditions, underscoring the importance of adequate evaluation and support. Objective To assess the prevalence, scope, and accessibility of infertility treatment coverage across U.S. urology residency programs. Methods A total of 148 accredited U.S. urology residency programs were identified and evaluated from the American Urologic Association that participated in last year’s match. Each program's public-facing urology department website, affiliated graduate medical education (GME) website (with linked benefits booklet if applicable), and program details were reviewed. Programs were assessed for the availability of information regarding infertility treatment benefits, gender-specific coverage (male, female, or unspecified), institutional details describing benefit access, and available data such as lifetime coverage limits and cycle caps. Data were descriptively analyzed. Results Out of 148 programs, 40 (27%) provided available information regarding infertility treatment benefits while 140 programs (95%) provided information on general medical benefits. Among these 40 programs, 22 (55%) specified coverage for female fertility services, 16 (40%) included male-specific benefits, and 18 (45%) referenced fertility coverage without specifying sex. Six programs (15%) included information on female-only benefits, whereas none exclusively listed male-specific benefits. (Table 1) Male fertility services were variably represented among the 40 programs with fertility benefit information. There were 6 programs (15%) specified sperm cryopreservation, 4 programs (10%) that included sperm extraction, and 1 program (2.5%) mentioned covering vasectomy reversal. Among programs that disclosed cost-related information, the average lifetime medical fertility benefit was $17,500 (n=8), with an additional $7,800 for pharmacy benefits (n=10). The average of total lifetime fertility coverage maximum was $28,375 (n=20). Only 4 programs (10%) specified a cycle limit, averaging 2.75 cycles. Regional variation in the availability of fertility benefit information was observed, with the Western, North Central, and South Central regions demonstrating the highest proportions of programs providing infertility treatment benefit information (56%, 31%, and 29%, respectively), and the New York region the lowest (5.9%). However, these differences did not reach statistical significance (p = 0.092). Conclusions Fewer than one-third of U.S. urology residency programs provide accessible information regarding infertility treatment coverage. Male-specific services, despite the specialty’s clinical focus and the growing recognition of infertility as a systemic health concern, remain underrepresented. The limited transparency of fertility benefits, almost always requiring indirect access through GME resources, may hinder informed reproductive planning. As many male trainees delay childbearing alongside their partners, timely and visible support for infertility coverage is essential. Improving the availability and clarity of these benefits may help address both reproductive and broader health needs for future urologists. Disclosure No

Abstract Introduction While microdeletions in the azoospermia factor (AZF) regions of the Y chromosome are a well-recognized cause of genetic male infertility, reproductive outcomes and broader health profiles among affected men remain poorly characterized. Objective We explore the distribution of AZF deletion subtypes and evaluate comorbidities and fertility management patterns in this unique population. Methods We performed a multi-institutional retrospective cohort study of men diagnosed with AZF deletions following evaluation by a reproductive urologist and genetic testing. The primary exposure variable was the AZF subtype (AZFa, AZFb, AZFc, or multilocus [e.g., AZFabc]).Clinical data were extracted to assess the presence of comorbidities, including hypertension, diabetes mellitus, hyperlipidemia, liver disease, and cardiac disease. Descriptive statistics were used to characterize the distribution of AZF subtypes, comorbidity profile, and outcomes of sperm retrieval procedures within our cohort. Results Among 40 men with confirmed AZF microdeletions across three academic centers, four patients with SRY translocations were excluded. Of the remaining 36, AZFc was the most common subtype (75%), followed by multilocus (16.6%), AZFa (5.5%), and AZFb (2.7%). The median age was 32.8 years (IQR: 29.2–33.6) and median BMI was 28.6 kg/m2 (IQR: 25.6–32.8). Comorbid conditions were identified in 8% of the cohort, with hyperlipidemia (13.9%), hypertension (11%), and diabetes (11%) most commonly reported. Sperm retrieval was attempted in 31% (n=11) of patients, exclusively among those with AZFc (n=10) andAZFb (n=1) deletions. Microscopic testicular sperm extraction (mTESE) was the predominant technique (91%). Sperm was successfully retrieved in 46% of these cases, all within the AZFc subgroup. Conclusions This study advances limited literature on AZF microdeletions by characterizing systemic health profiles and post-diagnosis infertility management. Our results support a broad phenotype associated with genetic causes of male infertility. In this cohort of men with YCMD, AZFc was the most prevalent subtype. Compared to national estimates for similarly aged men, our findings suggest that men with YCMD may have a distinct comorbidity profile compared to the general population, with an elevated prevalence of metabolic disease. Our findings reinforce male infertility as a heterogeneous condition that may serve as an early marker for broader metabolic disease. In addition, nearly all patients who underwent sperm retrieval were within the AZFc group. Fertility management trends favored mTESE, with moderate success rates in sperm retrieval, particularly among AZFc patients. Our results highlight provider preferences in surgical fertility management in patients withYCMD. Our findings underscore the need for a holistic approach to men with YCMD, addressing both surgical fertility management and systemic health risks. Clear patient counseling on sperm retrieval success rates and early identification of comorbidities may redefine outcomes for this unique population. Our results support a broad phenotype associated with genetic causes of male infertility. Disclosure No