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Article: Non-testosterone management of male hypogonadism: an examination of the existing literature.

Krzastek, Sarah C / Smith, Ryan P

2020 Volume 9, Issue Suppl 2, Page(s) S160–S170

Abstract: Testosterone deficiency is defined as a total testosterone level <300 ng/dL confirmed on two early morning lab draws. Testosterone therapy has historically been offered to men with symptomatic testosterone deficiency in the form of injections, gels, or ... ...

Abstract	Testosterone deficiency is defined as a total testosterone level <300 ng/dL confirmed on two early morning lab draws. Testosterone therapy has historically been offered to men with symptomatic testosterone deficiency in the form of injections, gels, or pellets. However, these treatments are invasive or have undesirable effects including the risk of drug transference. Additionally, testosterone therapy has been associated with increases in hematocrit and controversy remains regarding the risk of cardiovascular and thromboembolic events while on testosterone therapy. As such, much interest has recently been focused on alternative treatment options for testosterone deficiency in the form of orally-administered medications with more favorable side effect profiles. Lifestyle modifications and varicocelectomy have been shown to raise endogenous testosterone production. Similarly, SERMs and aromatase inhibitors (AIs) have been shown to raise testosterone levels safely and effectively. Human chorionic gonadotropin (hCG) remains the only FDA-approved non-testosterone treatment option for testosterone deficiency in men. However, this medication is expensive and requires patient-administered injections. Over the counter herbal supplements and designer steroids remain available though they are poorly studied and are associated with the potential for abuse as well as increased hepatic and cardiovascular risks. This review aims to discuss the existing treatment alternatives to traditional testosterone therapy, including efficacy, safety, and side effects of these options. The authors suggest that the SERM clomiphene citrate (CC) holds the greatest promise as a non-testosterone treatment option for testosterone deficiency.
Language	English
Publishing date	2020-03-19
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.2019.11.16
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: An update on the best approaches to prevent complications in penile prosthesis recipients.

Krzastek, Sarah C / Smith, Ryan

Therapeutic advances in urology

2019 Volume 11, Page(s) 1756287218818076

Abstract: Placement of inflatable penile prosthesis is a procedure frequently performed for medication-refractory erectile dysfunction. Device implantation is not without risks, and as the frequency of device implantation increases, so do associated complications. ...

Abstract	Placement of inflatable penile prosthesis is a procedure frequently performed for medication-refractory erectile dysfunction. Device implantation is not without risks, and as the frequency of device implantation increases, so do associated complications. The aim of this work is to review the most frequent operative complications associated with implantation of inflatable penile prostheses, and to review the best approaches to prevent these most common complications. Complications can broadly be categorized as infectious, noninfectious tissue-related, device-related, or related to patient and partner satisfaction. With understanding of these complications and ways to avoid them, as well as with appropriate patient selection and counseling, the inflatable penile prosthesis is an excellent option for the treatment of erectile dysfunction.
Language	English
Publishing date	2019-01-08
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2492591-3
ISSN	1756-2880 ; 1756-2872
ISSN (online)	1756-2880
ISSN	1756-2872
DOI	10.1177/1756287218818076
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Article ; Online: Editorial Comment.

Krzastek, Sarah C / Smith, Ryan P

The Journal of urology

2019 Volume 201, Issue 4, Page(s) 791

MeSH term(s)	Humans ; Infertility, Male ; Male ; Semen Analysis
Language	English
Publishing date	2019-04-04
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1097/01.JU.0000554778.62163.51
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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)
Zs.MO 331: Show issues

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Article ; Online: EDITORIAL COMMENT.

Krzastek, Sarah C / Smith, Ryan P

Urology

2019 Volume 132, Page(s) 116

MeSH term(s)	Humans ; Infertility ; Male ; Semen Analysis ; Sperm Count ; Spermatozoa
Language	English
Publishing date	2019-10-03
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	192062-5
ISSN	1527-9995 ; 0090-4295
ISSN (online)	1527-9995
ISSN	0090-4295
DOI	10.1016/j.urology.2019.06.039
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Zs.A 1142: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 275: Show issues

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Article: Clay modeling as a learning tool for medical trainees in urology: a narrative review and pilot study.

Leung, Shannon J / Blottner, Minna / Wheeler, Sydney / Zee, Rebecca S / Roseman, J Tyler / Klausner, Adam P / Krzastek, Sarah C

Translational andrology and urology

2024 Volume 13, Issue 2, Page(s) 320–330

Abstract: Background and objective: Coronavirus disease 2019 (COVID-19) necessitated a transition to virtual education which limits hands-on opportunities and student engagement. To adapt, a pilot study investigating clay modeling as an alternative educational ... ...

Abstract	Background and objective: Coronavirus disease 2019 (COVID-19) necessitated a transition to virtual education which limits hands-on opportunities and student engagement. To adapt, a pilot study investigating clay modeling as an alternative educational tool for medical students was incorporated in a virtual and in-person sub-internship for prospective urology applicants. We aim to review the literature supporting the use of clay modeling in medical education as well as describe our experience with the activity as a way to engage trainees and evaluate early surgical skills. Methods: The current literature on clay modeling in medical and early surgical education was reviewed using multiple search queries in PubMed. A total of thirteen publications were identified and analyzed, with zero articles specifically discussing urological anatomy or surgery. The pilot study was conducted through the traditional in-person sub-internship as well as through a novel virtual sub-internship at a single academic U.S. Urology residency program. Students were instructed to create a three-dimensional model of a genitourinary organ using modeling clay. Anonymized surveys were collected. Responses of virtual and in-person students were compared. Key content and findings: Clay modeling has been shown in the literature to be beneficial in medical and early surgical education through the use of active learning. Twenty-five total virtual (N=6) and in-person (N=19) students participated in the clay modeling activity. Survey ratings were mixed, with 100% positive responses amongst the virtual group in the areas of "relevance" and "creatively challenging" compared to the in-person cohort, 31.6% of whom responded positively to "relevance" and 47.4% for "creatively challenging" respectively. Overall, students responded positively for the exercise being "creatively challenging" (n=15, 60%) and "enjoyable" (n=16, 64%). Positive results echoed the student perspectives described in the current literature on clay modeling. Conclusions: Clay modeling has previously been used in the in-person classroom setting as a learning supplement or replacement for dissection classes but has not been previously described for use in the virtual learning environment or within the field of Urology. With ongoing need to develop novel teaching modalities, clay modeling may be a unique tool to enhance learning, and evaluate technical skill, and boost engagement for medical trainees.
Language	English
Publishing date	2024-02-02
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-23-57
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Article: The use of low-intensity extracorporeal shockwave therapy in management of erectile dysfunction following prostate cancer treatment: a review of the current literature.

Matthew, Ashley N / Rogers, Devin E / Grob, Gabrielle / Blottner, Minna / Kodama, Sarah / Krzastek, Sarah C

Translational andrology and urology

2023 Volume 12, Issue 6, Page(s) 1023–1032

Abstract: Background and objective: Erectile dysfunction (ED) is a prevalent and impactful complication post definitive management of prostate cancer. The mechanism of ED is thought to be secondary to vascular and neural injury as well as corporal smooth muscle ... ...

Abstract	Background and objective: Erectile dysfunction (ED) is a prevalent and impactful complication post definitive management of prostate cancer. The mechanism of ED is thought to be secondary to vascular and neural injury as well as corporal smooth muscle damage with resultant fibrosis. The use of penile rehabilitation in ED following treatment for prostate cancer has been studied. Low-intensity extracorporeal shockwave therapy (Li-ESWT) is a novel treatment for ED thought to stimulate neovascularization and nerve regeneration, and as such, has gained interest in treatment of ED related to radical prostatectomy or radiation therapy. Herein, we performed a narrative review on the use of Li-ESWT in management of ED following treatment for prostate cancer. Methods: A literature review was performed using PubMed and Google Scholar. Studies evaluating Li-ESWT following prostate cancer treatment were included. Key content and findings: We identified three randomized controlled trials and two observational studies that assessed use of Li-ESWT for ED after prostate surgery. Use of Li-ESWT across most studies showed improvements in the International Index of Erectile Function-erectile function (IIEF-EF) domain scores, but this improvement was not statistically significant. Additionally, use of Li-ESWT in an early versus delayed fashion does not appear to affect changes in long-term sexual function scores. No data on use of Li-ESWT after radiotherapy were identified. Conclusions: There is a paucity of data regarding use of Li-ESWT for penile rehabilitation in treatment of ED post-prostate cancer therapy. Current protocols for Li-ESWT are not standardized and have a limited number of participants with short duration of follow-up. Additional evaluation is needed to determine optimal Li-ESWT protocols. Ideally, studies should have longer follow-up to truly evaluate the clinical significance of Li-ESWT in the treatment of post-prostatectomy ED. Furthermore, the role of Li-ESWT after radiotherapy remains elusive.
Language	English
Publishing date	2023-05-22
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-22-791
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Article: Myoepithelial carcinoma of the bladder: Case report and review of the literature.

Bednarz, Christopher / Lanyi, Shira / Wilson, Brandon / Smith, Steven C / Hampton, Lance / Krzastek, Sarah C

Urology case reports

2023 Volume 47, Page(s) 102351

Abstract: Myoepithelial carcinoma is a neoplasm that classically arises in the parotid glands, nasopharynx, paranasal sinus, and nasal cavity of the head and neck. It rarely arises in other organs or soft tissues and involvement of genitourinary organs is ... ...

Abstract	Myoepithelial carcinoma is a neoplasm that classically arises in the parotid glands, nasopharynx, paranasal sinus, and nasal cavity of the head and neck. It rarely arises in other organs or soft tissues and involvement of genitourinary organs is distinctly rare. We describe a case of a 21-year-old male, presenting with nausea, weight loss, and worsening suprapubic pain over 3 months, found to have a large mass at the dome of the bladder. Partial cystectomy was ultimately performed revealing myoepithelial carcinoma of the bladder. The patient is free of disease at four years without the need for systemic therapy.
Language	English
Publishing date	2023-02-08
Publishing country	United States
Document type	Case Reports
ZDB-ID	2745459-9
ISSN	2214-4420
ISSN	2214-4420
DOI	10.1016/j.eucr.2023.102351
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Article: Non-cutaneous presentation of mycosis fungoides involving the penile corpora: Case report and review of current literature.

Kodama, Sarah / Matthew, Ashley N / Wilson, Brandon / Fogg, Ryan / Krzastek, Sarah C

Urology case reports

2023 Volume 51, Page(s) 102606

Abstract: Mycosis fungoides involvement of genitalia is rare. We present a 63-year-old man with history of cutaneous T cell lymphoma with large cell transformation status post multiple electron beam radiation cycles who presented with a new, enlarging penile mass. ...

Abstract	Mycosis fungoides involvement of genitalia is rare. We present a 63-year-old man with history of cutaneous T cell lymphoma with large cell transformation status post multiple electron beam radiation cycles who presented with a new, enlarging penile mass. He underwent ultrasound, MRI, and excisional biopsy. Pathological results indicated hematogenous spread of T cell lymphoma with large cell transformation. Peri-operative radiation was performed, and the patient had significant reduction in penile mass size but some subsequent erectile dysfunction. In discussion of this case, we examine management of penile mycosis fungoides.
Language	English
Publishing date	2023-10-30
Publishing country	United States
Document type	Case Reports
ZDB-ID	2745459-9
ISSN	2214-4420
ISSN	2214-4420
DOI	10.1016/j.eucr.2023.102606
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Article: Corpus spongiosum flap: a unique technique in the management of urosymphyseal fistula.

Patel, Jill S / Krzastek, Sarah C / Roseman, John T / Klausner, Adam P / Anele, Uzoma A

American journal of clinical and experimental urology

2023 Volume 11, Issue 1, Page(s) 69–74

Abstract: Urosymphseal fistulas are a debilitating but treatable consequence of the combination of radiotherapy and endoscopic interventions in prostate cancer patients. Treatment includes fistula excision with a tissue flap to prevent communication of involved ... ...

Abstract	Urosymphseal fistulas are a debilitating but treatable consequence of the combination of radiotherapy and endoscopic interventions in prostate cancer patients. Treatment includes fistula excision with a tissue flap to prevent communication of involved structures and provide structural and vascular support. We introduce a unique surgical approach of mobilizing and utilizing a corpus spongiosum flap in urosymphyseal fistula repair. A retrospective study identified two patients who underwent repair with a pedicled corpus spongiosum flap at our institution. The corpus spongiosum had adequate length and vascularization and limited the need for extra-pelvic muscle flaps, thus maintaining muscle integrity in the abdomen and thighs. Following extirpative surgery, both patients had durable fistula closure, decreased pelvic pain, and resolution of lower urinary tract symptoms and osteomyelitis. These cases highlight the potential of the corpus spongiosum to be a reasonable alternative interpositional flap in genitourinary reconstruction.
Language	English
Publishing date	2023-02-25
Publishing country	United States
Document type	Case Reports
ISSN	2330-1910
ISSN	2330-1910
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Article ; Online: Characterization of Cystoscopy Performance and Reporting Practices at Academic Urology Centers.

Namugosa, Mary / Matthew, Ashley N / Fogg, Ryan / Klausner, Adam P / Krzastek, Sarah C

Urology practice

2023 Volume 11, Issue 2, Page(s) 249–253

MeSH term(s)	Humans ; Cystoscopy ; Urology ; Urinary Bladder Neoplasms
Language	English
Publishing date	2023-12-28
Publishing country	United States
Document type	Journal Article
ISSN	2352-0787
ISSN (online)	2352-0787
DOI	10.1097/UPJ.0000000000000511
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