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Article ; Online: Orchiectomy as Bridge or Alternative to Vaginoplasty.

Hehemann, Marah C / Walsh, Thomas J

2019 Volume 46, Issue 4, Page(s) 505–510

Abstract: Simple orchiectomy for gender affirmation is a low-risk, minimally invasive, generalizable procedure that eliminates circulating endogenous testosterone, allowing reduced hormonal supplementation. This article describes a technique that serves as a step ... ...

Abstract	Simple orchiectomy for gender affirmation is a low-risk, minimally invasive, generalizable procedure that eliminates circulating endogenous testosterone, allowing reduced hormonal supplementation. This article describes a technique that serves as a step in definitive phenotypic transition while maximally preserving healthy tissue for future sex reassignment surgery. Orchiectomy should be offered routinely as a bridge or alternative to vaginoplasty, particularly in the setting of limited access to specialized centers for transgender surgery.
MeSH term(s)	Female ; Gender Dysphoria/surgery ; Gynecologic Surgical Procedures ; Humans ; Male ; Orchiectomy ; Sex Reassignment Surgery ; Transsexualism/psychology ; Vagina/surgery
Language	English
Publishing date	2019-08-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	192293-2
ISSN	1558-318X ; 0094-0143
ISSN (online)	1558-318X
ISSN	0094-0143
DOI	10.1016/j.ucl.2019.07.005
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Article: Can lifestyle modification affect men's erectile function?

Hehemann, Marah C / Kashanian, James A

Translational andrology and urology

2015 Volume 5, Issue 2, Page(s) 187–194

Abstract: Erectile dysfunction (ED) is a common condition affecting millions of men worldwide. The pathophysiology and epidemiologic links between ED and risk factors for cardiovascular disease (CVD) are well-established. Lifestyle modifications such as smoking ... ...

Abstract	Erectile dysfunction (ED) is a common condition affecting millions of men worldwide. The pathophysiology and epidemiologic links between ED and risk factors for cardiovascular disease (CVD) are well-established. Lifestyle modifications such as smoking cessation, weight reduction, dietary modification, physical activity, and psychological stress reduction have been increasingly recognized as foundational to the prevention and treatment of ED. The aim of this review is to outline behavioral choices which may increase ones risk of developing ED, to present relevant studies addressing lifestyle factors correlated with ED, and to highlight proposed mechanisms for intervention aimed at improving erectile function in men with ED. These recommendations can provide a framework for counseling patients with ED about lifestyle modification.
Language	English
Publishing date	2015-12-15
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2851630-8
ISSN	2223-4691 ; 2223-4691 ; 2223-4683
ISSN (online)	2223-4691
ISSN	2223-4691 ; 2223-4683
DOI	10.21037/tau.2016.02.05
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Article ; Online: Penile Girth Enlargement Strategies: What's the Evidence?

Hehemann, Marah C / Towe, Maxwell / Huynh, Linda My / El-Khatib, Farouk M / Yafi, Faysal A

Sexual medicine reviews

2019 Volume 7, Issue 3, Page(s) 535–547

Abstract: Introduction: Most men seeking penile girth augmentation have physiologically normal penises but may suffer from severe preoccupation with penis size known as penile dysmorphophobic disorder.: Aim: To describe the medical, procedural, and ... ...

Abstract	Introduction: Most men seeking penile girth augmentation have physiologically normal penises but may suffer from severe preoccupation with penis size known as penile dysmorphophobic disorder. Aim: To describe the medical, procedural, and reconstructive techniques available for penile girth enhancement and to review the success and complications of each modality. Methods: A comprehensive review of peer-reviewed publications on the topic was performed through a PubMed search. Key search terms included penis, enhancement, enlargement, phalloplasty, reconstruction, girth, and augmentation. Main outcome measure: We wanted to summarize the motivations behind penile girth enhancement and review the outcomes for girth augmentation treatments. Results: Various medical, traction, injection, prosthetic, and reconstructive modalities have been studied for penile girth enhancement, with increases in girth ranging from 0-4.9 cm. Complications were reported in a minority of patients, but they may be devastating and include penile fibrosis, sexual dysfunction, device infection, and death. Conclusion: A variety of penile girth augmentation techniques have been studied. Clinical guidelines are lacking, and complications of penile girth enhancement are likely underreported. Until more rigorous investigation with accurate reporting of complications is achieved, penile girth augmentation procedures should be considered experimental. Hehemann MC, Towe M, Huynh LM, et al. Penile Girth Enlargement Strategies: What's the Evidence? Sex Med 2019;7:535-547.
MeSH term(s)	Humans ; Male ; Penile Diseases/physiopathology ; Penile Diseases/surgery ; Penile Erection/physiology ; Penile Prosthesis ; Penis/physiopathology ; Penis/surgery ; Reconstructive Surgical Procedures/methods
Language	English
Publishing date	2019-01-04
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2722257-3
ISSN	2050-0521 ; 2050-0513
ISSN (online)	2050-0521
ISSN	2050-0513
DOI	10.1016/j.sxmr.2018.11.003
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Article ; Online: The association between guideline-based exercise thresholds and low testosterone among men in the United States.

Fantus, Richard J / Chang, Cecilia / Hehemann, Marah C / Bennett, Nelson E / Brannigan, Robert E / Helfand, Brian T / Halpern, Joshua A

Andrology

2020 Volume 8, Issue 6, Page(s) 1712–1719

Abstract: Background: Exercise and weight loss have been shown to improve serum testosterone (T) in obese individuals. However, the association between low T levels and guideline-based exercise thresholds has not been determined.: Objective: Using the recently ...

Abstract	Background: Exercise and weight loss have been shown to improve serum testosterone (T) in obese individuals. However, the association between low T levels and guideline-based exercise thresholds has not been determined. Objective: Using the recently updated Physical Activity Guidelines Advisory Committee (PAGAC) recommendations, we sought to investigate the relationship between recommended activity levels and the prevalence of low T levels. Materials and methods: The2011-2016 National Health and Nutrition Examination Survey (NHANES) was used to identify men ages 18 to 80 years who answered the physical activity questionnaire and underwent serum T testing. Men were categorized based on PAGAC activity level: less than recommended, recommended and greater than recommended. Multivariable logistic regressions were used to determine the association between low T (<300 ng/dL) and activity level across body mass index (BMI) categories while adjusting for potential confounders. Results: Of the 7372 men who met the inclusion criteria, the majority (4372, 59.3%) exceeded the recommended amount of activity, whereas only 2326 (31.6%) exercised less than the recommended amount. On multivariable analysis, obese men whose activity exceeded the recommended amount were less likely to have low T (OR 0.523, 95% CI 0.409-0.669, P < .001) compared with men who did not meet the recommended activity level. Discussion and conclusions: Using a large, nationally representative cohort, we demonstrated that obese men whose activity exceeded PAGAC recommendations had a decreased likelihood of having low T levels. Given the numerous benefits of exercise, these data provide a basis for counseling obese patients regarding the association between exercise and decreased prevalence of low T.
MeSH term(s)	Adult ; Body Mass Index ; Diet ; Exercise/physiology ; Humans ; Life Style ; Male ; Middle Aged ; Nutrition Surveys ; Obesity/blood ; Surveys and Questionnaires ; Testosterone/blood ; Testosterone/deficiency ; United States ; Weight Loss/physiology
Chemical Substances	Testosterone (3XMK78S47O)
Language	English
Publishing date	2020-07-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2696108-8
ISSN	2047-2927 ; 2047-2919
ISSN (online)	2047-2927
ISSN	2047-2919
DOI	10.1111/andr.12849
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Article: Examining Online Traffic Patterns to Popular Direct-To-Consumer Websites for Evaluation and Treatment of Erectile Dysfunction.

Wackerbarth, Joel J / Fantus, Richard J / Darves-Bornoz, Annie / Hehemann, Marah C / Helfand, Brian T / Keeter, Mary Kate / Brannigan, Robert E / Bennett, Nelson E / Halpern, Joshua A

Sexual medicine

2021 Volume 9, Issue 1, Page(s) 100289

Abstract: Background: Direct-to-consumer (DTC) Internet-based prescription and pharmacy platforms offer electronic consultation for evaluation and pharmacologic treatment of erectile dysfunction (ED) without a physical exam or in-person visit, presenting a ... ...

Abstract	Background: Direct-to-consumer (DTC) Internet-based prescription and pharmacy platforms offer electronic consultation for evaluation and pharmacologic treatment of erectile dysfunction (ED) without a physical exam or in-person visit, presenting a potentially dramatic shift in care for this condition. Aim: To characterize the extent to which DTC prescribing sites for ED generate traffic and attract individual users. Methods: Using SEMRush, a marketing software platform that provides analytics regarding website traffic, we examined online site visits to 6 major DTC prescribing websites offering ED evaluation and treatment from October 2017 through December 2019. Outcomes: We recorded trends in the number of unique visitors over time, visitor referral patterns, and the proportion of overall visitors to individual sites. Results: During the study period, the total number of unique, quarterly visitors increased by 1,688% from 655,733 in the 4th quarter (Q4) 2017 to over 11 million in Q4 2019. In 2019, there were on average 4,971,674 visits to all sites combined each month. For the 2 largest sites (Hims and Roman), visitors predominantly reached the site via direct web address (27.3%) or search engine referral (27.3%). Clinical implications: An increasingly large number of potential patients are utilizing DTC prescribing platforms for the diagnosis and treatment of ED, which do not require physical exams or treatment of other comorbid conditions. Strength & limitations: Demonstrates high demand for ED DTC prescribing services using independent market research software and characterizes the number of visits for the first time. Limitations include the lack of individual demographics and lack of information regarding what proportion of unique visits lead to evaluation and treatment using the services. Conclusion: The dramatic increase in visits to DTC prescribing sites that treat ED represents a paradigm shift in ED care, and it is imperative that clinicians and researchers work to understand how patients utilize online telemedicine, the safety and efficacy of online management of ED, and the potential downstream implications of its widespread use. Wackerbarth JJ, Fantus RJ, Darves-Bornoz A, et al. Examining Online Traffic Patterns to Popular Direct-To-Consumer Websites for Evaluation and Treatment of Erectile Dysfunction. Sex Med 2021;9:100289.
Language	English
Publishing date	2021-01-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2734882-9
ISSN	2050-1161
ISSN	2050-1161
DOI	10.1016/j.esxm.2020.100289
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Article: Evaluation of the impact of marijuana use on semen quality: a prospective analysis.

Hehemann, Marah C / Raheem, Omer A / Rajanahally, Saneal / Holt, Sarah / Chen, Tony / Fustok, Judy N / Song, Kelly / Rylander, Heather / Chow, Emma / Ostrowski, Kevin A / Muller, Charles H / Walsh, Thomas J

Therapeutic advances in urology

2021 Volume 13, Page(s) 17562872211032484

Abstract: Aims: To assess if marijuana consumption - prevalent among men of reproductive age and becoming widespread due to decriminalization - is associated with changes in semen parameters. Marijuana's active metabolite, tetrahydrocannabinol, can alter ... ...

Abstract	Aims: To assess if marijuana consumption - prevalent among men of reproductive age and becoming widespread due to decriminalization - is associated with changes in semen parameters. Marijuana's active metabolite, tetrahydrocannabinol, can alter signaling pathways within spermatozoa, affecting spermatogenesis and fertility. Methods: We prospectively evaluated semen analyses (SA) from men presenting for infertility evaluation at one institution from July 2017 to April 2018. Participants completed a reproductive health questionnaire including items regarding marijuana consumption. SA was performed in accordance with World Health Organization (WHO) 5th Edition criteria. SA parameters included volume (ml), concentration (million/ml), motility (%), progressive motility (%), and Tygerberg strict morphology (%). Results: A total of 409 patients completed the questionnaire; 174 (43%) men reported marijuana use (ever-users). Current and past users comprised 71 (17%) and 103 (25%), respectively. Compared with never-users, current and past users had a significantly higher likelihood of abnormal sperm strict morphology (33.1% Conclusion: Marijuana use is common among men presenting for fertility evaluation, and may have a detrimental effect on semen quality, particularly morphology and volume, but may be protective against abnormal sperm motility. Large, prospective studies of both semen quality and fertility in this growing, at-risk population are warranted.
Language	English
Publishing date	2021-07-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2492591-3
ISSN	1756-2880 ; 1756-2872
ISSN (online)	1756-2880
ISSN	1756-2872
DOI	10.1177/17562872211032484
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Article ; Online: Editorial comment.

Ellimoottil, Chandy / Hehemann, Marah / Quek, Marcus L

Urology

2013 Volume 82, Issue 5, Page(s) 1075; discussion 1075

MeSH term(s)	Cytodiagnosis/methods ; Frozen Sections/methods ; Humans ; Kidney Neoplasms/surgery ; Nephrectomy/methods ; Nephrons/surgery
Language	English
Publishing date	2013-11
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	192062-5
ISSN	1527-9995 ; 0090-4295
ISSN (online)	1527-9995
ISSN	0090-4295
DOI	10.1016/j.urology.2013.06.054
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Article ; Online: Impact of Post-Hospital Syndrome on Penile Prosthesis Outcomes: A Period of Global Health Risk.

Kirshenbaum, Eric J / Nelson, Marc / Hehemann, Marah C / Kothari, Anai N / Eguia, Emanuel / Farooq, Ahmer / Bresler, Larissa / Gupta, Gopal / Santos, Grace Delos

The Journal of urology

2018 Volume 201, Issue 1, Page(s) 154–159

Abstract: Purpose: Post-hospital syndrome is an acquired transient period of health vulnerability following inpatient admission. We assessed the impact of a preoperative hospitalization on outcomes following penile prosthesis surgery and sought to optimize ... ...

Abstract	Purpose: Post-hospital syndrome is an acquired transient period of health vulnerability following inpatient admission. We assessed the impact of a preoperative hospitalization on outcomes following penile prosthesis surgery and sought to optimize surgical timing after inpatient admission. Materials and methods: We used the Healthcare Cost and Utilization Project State Inpatient Databases and State Ambulatory Surgery Database for California from 2007 to 2011 and for Florida from 2009 to 2014. Patients were identified as having undergone prosthesis placement by ICD-9 and CPT codes. The primary exposure was post-hospital syndrome, defined as any inpatient admission 90 days or less before prosthesis placement. Patients were further categorized by how recently the inpatient hospitalization occurred. The primary study outcome was 30-day hospital readmission. Secondary outcomes were length of stay, and device and postoperative complications. Results: We identified 16,923 patients who received a penile prosthesis, of whom 477 (3%) had post-hospital syndrome exposure 90 days or less before prosthesis placement. After risk adjustment patients with post-hospital syndrome had higher odds of 30-day readmission (OR 3.0, 95% CI 2.2-4.1), length of stay 2 days or longer (OR 1.7, 95% CI 1.3-2.3) and device complications (OR 1.7, 95% CI 1.2-2.5). When categorizing patients by 30-day intervals, we found a linear decrease in the risk of 30-day readmission as the interval increased between post-hospital syndrome exposure and prosthesis surgery. Conclusions: Post-hospital syndrome exposure is a risk adjusted predictor of 30-day readmissions, prolonged length of stay and device complications. Medical optimization and delayed surgery can help combat the adverse effects associated with post-hospital syndrome exposure and may improve surgical outcomes.
MeSH term(s)	Aged ; California ; Florida ; Global Health ; Hospitalization ; Humans ; Male ; Middle Aged ; Penile Implantation ; Penile Prosthesis ; Postoperative Complications/etiology ; Retrospective Studies ; Risk Assessment ; Socioeconomic Factors ; Syndrome ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2018-08-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1016/j.juro.2018.08.039
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Ui VI Zs.91: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Pelvic and hypogastric nerves are injured in a rat prostatectomy model, contributing to development of stress urinary incontinence.

Hehemann, Marah / Choe, Shawn / Kalmanek, Elizabeth / Harrington, Daniel / Stupp, Samuel I / McVary, Kevin T / Podlasek, Carol A

Scientific reports

2018 Volume 8, Issue 1, Page(s) 16432

Abstract: Urinary incontinence affects 40% of elderly men, is common in diabetic patients and in men treated for prostate cancer, with a prevalence of up to 44%. Seventy-two percent of prostatectomy patients develop stress urinary incontinence (SUI) in the first ... ...

Abstract	Urinary incontinence affects 40% of elderly men, is common in diabetic patients and in men treated for prostate cancer, with a prevalence of up to 44%. Seventy-two percent of prostatectomy patients develop stress urinary incontinence (SUI) in the first week after surgery and individuals who do not recover within 6 months generally do no regain function without intervention. Incontinence has a profound impact on patient quality of life and a critical unmet need exists to develop novel and less invasive SUI treatments. During prostatectomy, the cavernous nerve (CN), which provides innervation to the penis, undergoes crush, tension, and resection injury, resulting in downstream penile remodeling and erectile dysfunction in up to 85% of patients. There are other nerves that form part of the major pelvic ganglion (MPG), including the hypogastric (HYG, sympathetic) and pelvic (PN, parasympathetic) nerves, which provide innervation to the bladder and urethra. We examine if HYG and PNs are injured during prostatectomy contributing to SUI, and if Sonic hedgehog (SHH) regulatory mechanisms are active in the PN and HYG nerves. CN, PN, HYG and ancillary (ANC) of uninjured, sham and CN crush/MPG tension injured (prostatectomy model) adult Sprague Dawley rats (n = 37) were examined for apoptosis, sonic hedgehog (SHH) pathway, and intrinsic and extrinsic apoptotic mechanisms. Fluorogold tracing from the urethra/bladder was performed. PN and HYG response to SHH protein was examined in organ culture. TUNEL, immunohistochemical analysis for caspase-3 cleaved, -8, -9, SHH, Patched and Smoothened (SHH receptors), and neurite formation, were examined. Florogold positive neurons in the MPG were reduced with CN crush. Apoptosis increased in glial cells of the PN and HYG after CN crush. Caspase 9 was abundant in glial cells (intrinsic), while caspase-8 was not observed. SHH and its receptors were abundant in neurons and glia of the PN and HYG. SHH treatment increased neurite formation. PN and HYG injury occur concomitant with CN injury during prostatectomy, likely contributing to SUI. PN and HYG response to SHH treatment indicates an avenue for intervention to promote regeneration and prevent SUI.
MeSH term(s)	Animals ; Apoptosis ; Hedgehog Proteins/metabolism ; Hypogastric Plexus/injuries ; Hypogastric Plexus/pathology ; Male ; Nerve Crush/adverse effects ; Nerve Fibers/pathology ; Organ Culture Techniques ; Pelvis/injuries ; Pelvis/innervation ; Pelvis/pathology ; Prostatectomy/adverse effects ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; Urinary Incontinence, Stress/etiology ; Urinary Incontinence, Stress/metabolism ; Urinary Incontinence, Stress/pathology
Chemical Substances	Hedgehog Proteins ; Shh protein, rat
Language	English
Publishing date	2018-11-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-018-33864-3
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Article ; Online: Risk factors for hypogonadism in young men with erectile dysfunction.

Huang, I-Shen / Mazur, Daniel J / Kahn, Barbara E / Kate Keeter, Mary / Desai, Anuj S / Lewis, Kevin / Tatem, Alexander J / Hehemann, Marah C / Brannigan, Robert E / Bennett, Nelson E

Journal of the Chinese Medical Association : JCMA

2019 Volume 82, Issue 6, Page(s) 477–481

Abstract: Background: The objective of this study is to evaluate the hormone profile of young men with the chief complaint of erectile dysfunction (ED) and determine the comorbidities in this population.: Methods: A retrospective chart review of men aged 18 to ...

Abstract	Background: The objective of this study is to evaluate the hormone profile of young men with the chief complaint of erectile dysfunction (ED) and determine the comorbidities in this population. Methods: A retrospective chart review of men aged 18 to 40 years who presented with ED and had a hormone evaluation but without prior medication for hormone manipulation from 2002 to 2016 was performed at a tertiary care institution. Data were obtained on demographics, comorbidities, medications, and hormonal evaluations. Results: A total of 2292 men with ED were identified and 2130 of them received testosterone level evaluation. The most common comorbidities that men were actively being treated for were depression (22.3%), anxiety (16.1%), hypertension (15.6%), diabetes (7.2%), cancer (6.2%), and cardiovascular disease (3.3%). The average total testosterone level was 368 ± 160 ng/dL; 10.7% of men had hypogonadism. Multivariate analysis demonstrated age, body mass index (BMI), depression, and cancer predicted a hypogonadal status. Patients with BMI > 28.2 kg/m, age > 34 years, cancer diagnosis, or depression were 3.350-fold, 1.447-fold, 2.317-fold, or 1.420-fold more likely to be diagnosed hypogonadal than nonoverweight, age ≤ 34 years, noncancer, or nondepressive patients. Conclusion: The majority of men under the age of 40 with ED exhibit a normal hormonal milieu. Young ED men with BMI > 28.2 kg/m, age >34 years, cancer diagnosis, or depression are at risk for hypogonadism.
MeSH term(s)	Adolescent ; Adult ; Body Mass Index ; Erectile Dysfunction/complications ; Humans ; Hypogonadism/etiology ; Male ; Retrospective Studies ; Risk Factors ; Testosterone/blood ; Young Adult
Chemical Substances	Testosterone (3XMK78S47O)
Language	English
Publishing date	2019-04-01
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2107283-8
ISSN	1728-7731 ; 1726-4901
ISSN (online)	1728-7731
ISSN	1726-4901
DOI	10.1097/JCMA.0000000000000099
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