Vadim Osadchiy

All Publications

• Urine microbes and predictive metagenomic profiles associate with abnormalities in sperm parameters: implications for male subfertility. F&S science Osadchiy, V., Belarmino, A., Kianian, R., Sigalos, J. T., Furtado, T. P., Ancira, J. S., Kanie, T., Mangum, S. F., Tipton, C. D., Hsieh, T. M., Mills, J. N., Eleswarapu, S. V. 2024; 5 (2): 163-173

  Abstract

  To explore the taxonomic and predicted functional relationship between the urine microbiome and alterations of semen analysis (SA) parameters.Cross-sectional study.Academic medical center.Men presenting for fertility evaluation or men presenting for vasectomy consultation with proven biological paternity were recruited and stratified on the basis of alterations, or lack thereof, in SA parameters.Changes in the functional and taxonomic urine microbiome profiles of participants with or without alterations in SA parameters.Seventy-three participants were included in our study. Men with abnormal sperm motility (N = 27) showed a nearly 50-fold higher abundance of Dialister micraerophilus compared with those with normal sperm motility (N = 46). This relationship persisted on canonical correlational analysis (r = 0.439). Men with abnormal sperm concentration (N = 20) showed a lower abundance of Enterococcus faecalis and Staphylococcus aureus, compared with those with normal sperm concentration (N = 53). The urine of participants with impaired sperm motility demonstrated dramatic differences in predictive functional profiles in pathways involved in oxidation-reduction balance and cell longevity.Our findings underscore differences in the urinary microbiome and abnormalities in semen parameters, especially sperm motility. By incorporating predictive functional profiling, we also highlight possible mechanisms that may drive the observed differences in sperm parameters.

  View details for DOI 10.1016/j.xfss.2024.01.002

  View details for PubMedID 38336233

• Combination clomiphene citrate and anastrozole duotherapy improves semen parameters in a multi-institutional, retrospective cohort of infertile men. Translational andrology and urology Osadchiy, V., Munoz-Lopez, C., Jiang, T., Naelitz, B. D., Parekh, N., Vij, S. C., Mills, J. N., Lundy, S. D., Eleswarapu, S. V. 2024; 13 (2): 245-251

  Abstract

  In men with impaired semen parameters, empiric medical therapies such as clomiphene citrate, a selective estrogen receptor modulator (SERM), and anastrozole, a selective aromatase inhibitor, are often employed. The effects of jointly administering these agents on semen parameters are not well understood. Here, we describe the findings of our multi-center, retrospective cohort study of men with idiopathic primary or secondary infertility. Twenty-one men were treated with combination therapy (anastrozole and clomiphene) and 69 men were treated with monotherapy (anastrozole). Patients with pre-treatment normozoospermia and recent or current exogenous testosterone therapy were excluded. Baseline and post-treatment semen and sex hormone parameters were compared among groups. The median follow-up duration was 91 days [interquartile range (IQR), 64-117 days]. Following treatment, 43% of men in the combination therapy group demonstrated normozoospermia, compared to 25% in the monotherapy group. Furthermore, men in the combined group demonstrated marked improvements in total motile sperm count (TMSC) [11.3 vs. 2.1 million (M), P=0.03]. There were no significant differences in hormone levels among the two groups following treatment. Combination therapy with clomiphene citrate and anastrozole was associated with modest benefits in post-treatment semen parameters, when compared to anastrozole monotherapy. These benefits may contribute to improvements in pregnancy outcomes with less invasive assisted reproductive technologies, such as intrauterine insemination (IUI). Future investigations with larger sample sizes and prospective study designs are necessary.

  View details for DOI 10.21037/tau-23-454

  View details for PubMedID 38481873

  View details for PubMedCentralID PMC10932640

• Semen microbiota are dramatically altered in men with abnormal sperm parameters. Scientific reports Osadchiy, V., Belarmino, A., Kianian, R., Sigalos, J. T., Ancira, J. S., Kanie, T., Mangum, S. F., Tipton, C. D., Hsieh, T. M., Mills, J. N., Eleswarapu, S. V. 2024; 14 (1): 1068

  Abstract

  There has recently been an explosion of studies implicating the human microbiome in playing a critical role in many disease and wellness states. The etiology of abnormal semen analysis (SA) parameters is not identified in 30% of cases; investigations involving the semen microbiome may bridge this gap. Here, we explore the relationship between the semen microbiome and alterations of sperm parameters. We recruited men presenting for fertility evaluation or vasectomy consultation with proven biological paternity. SA and next generation sequencing was performed. Differential abundance testing using Analysis of composition of Microbiota with Bias Correction (ANCOM-BC) was performed along with canonical correlational analysis for microbial community profiling. Men with abnormal (N = 27) sperm motility showed a higher abundance of Lactobacillus iners compared to those with normal (N = 46) sperm motility (mean proportion 9.4% versus 2.6%, p = 0.046). This relationship persisted on canonical correlational analysis (r = 0.392, p = 0.011). Men with abnormal sperm concentration (N = 20) showed a higher abundance of Pseudomonas stutzeri (2.1% versus 1.0%, p = 0.024) and Pseudomonas fluorescens (0.9% versus 0.7%, p = 0.010), but a lower abundance of Pseudomonas putida (0.5% versus 0.8%, p = 0.020), compared to those with normal sperm concentration (N = 53). Major limitations are related to study design (cross-sectional, observational). Our results suggest that a small group of microorganisms may play a critical role in observed perturbations of SA parameters. Some of these microbes, most notably Lactobacillus iners, have been described extensively within other, fertility-related, contexts, whereas for others, this is the first report where they have potentially been implicated. Advances in our understanding of the semen microbiome may contribute to potentially new therapeutic avenues for correcting impairments in sperm parameters and improving male fertility.

  View details for DOI 10.1038/s41598-024-51686-4

  View details for PubMedID 38212576

  View details for PubMedCentralID PMC10784508

• Endocrine disruptors and male sexual health. The journal of sexual medicine Osadchiy, V., Eleswarapu, S. V. 2023; 21 (1): 1-3

  View details for DOI 10.1093/jsxmed/qdad126

  View details for PubMedID 38175540

• The Seminal Microbiome and Male Factor Infertility. Current sexual health reports Osadchiy, V., Mills, J. N., Mayer, E. A., Eleswarapu, S. V. 2020; 12 (3): 202-207

  Abstract

  Focusing on studies published within the last decade, we review the literature on the seminal microbiome and male factor infertility. We highlight potential mechanisms by which microbes may impact fertility and underscore key limitations and clinical implications of these studies.The seminal microbiome encompasses a metabolically and phylogenetically diverse group of microorganisms. Lactobacillus was consistently associated with normal semen analysis parameters and fertility; Anaerococcus was negatively associated with semen quality. These microbes may participate in a complex cross-talk with the host immune system, thereby modulating local and perhaps systemic inflammatory responses, impacting semen quality.Research investigating the intersection between the seminal microbiome and male fertility is still in its infancy. Recent investigations have been exclusively cross-sectional, correlational studies, limiting the clinical applicability of published research. Prospective studies with more sophisticated methodologies are necessary.

  View details for DOI 10.1007/s11930-020-00273-5

  View details for PubMedID 33746642

  View details for PubMedCentralID PMC7968069

• Semen static oxidation-reduction potential is not helpful in evaluating male fertility. Andrology Furtado, T. P., Osadchiy, V., Furtado, M. H. 2025; 13 (6): 1432-1438

  Abstract

  Infertility affects a significant percentage of couples worldwide, with male infertility contributing substantially in a considerable number of cases. Research indicates that oxidative stress is a critical factor impacting male fertility.To explore the relationship between semen static oxidation-reduction potential (sORP), sperm parameters, and validated biomarkers of oxidative stress in infertile men.This cross-sectional study involved 202 men diagnosed with idiopathic male factor infertility and male partners from couples with unexplained infertility. Multivariable linear regression to query the associations between sORP, sperm parameters, and oxidative aggression biomarkers (lipid peroxidation, mitochondrial membrane potential, annexin V, and sperm DNA fragmentation).SORP has no linear association with any semen analysis parameter. Furthermore, its relationship with validated biomarkers of oxidative stress was inconsistent. sORP was inversely related to lipid peroxidation (multivariable linear regression coefficient: -0.64), positively associated with sperm DNA fragmentation (multivariable linear regression coefficient: 3.20), and unrelated to mitochondrial membrane potential or annexin V.There is no clear or consistent relationship between sORP and validated oxidative aggression biomarkers or sperm parameters. Our findings suggest that sORP is unlikely to be helpful in the evaluation of a male with idiopathic infertility.

  View details for DOI 10.1111/andr.13759

  View details for PubMedID 39388524

• Penile cancer awareness and knowledge among adult patients in an ambulatory urology clinic. Translational andrology and urology Kamkari, N. A., Osadchiy, V., Wood, E. L., Williams, K. C., Piqueiras, E., Donin, N. M. 2025; 14 (4): 1129-1137

  Abstract

  Penile cancer (PeCa) is a rare urologic malignancy in the United States, and public awareness remains low. In this brief report, we design and execute a survey to evaluate knowledge and awareness of PeCa focusing on general PeCa knowledge, treatment options, and willingness to recommend a preventative intervention. Study participants were recruited with a study flyer from the waiting room of two Los Angeles community-based urology clinics. All patients were English-speaking and over 18 years old. Study recruitment took place from October 2021 to June 2022 and 83 participants were included. The majority of respondents were men (90%) and white (87%), with a mean age 63 years. Ninety-eight percent of respondents reported either knowing "nothing" or "a little" about PeCa; 69% of respondents did not know a person could get cancer on the penis. Knowledge of risk factors for PeCa was particularly poor, with respect to phimosis (5% correctly identified this as a risk factor), balanitis (28%), and human papilloma virus (HPV) (44%). The majority of respondents, however, reported that they would recommend administration of an HPV vaccine for the prevention of PeCa (89%) once informed of HPV as a risk factor. Our findings underscore the lack of knowledge and awareness of PeCa, which may contribute to future delays in care.

  View details for DOI 10.21037/tau-2025-41

  View details for PubMedID 40376514

  View details for PubMedCentralID PMC12076246

• Epigenetic aging of semen is associated with inflammation. Epigenetics Feng, J., Rubbi, L., Kianian, R., Mills, J. N., Osadchiy, V., Sigalos, J. T., Eleswarapu, S. V., Pellegrini, M. 2024; 19 (1): 2436304

  Abstract

  Male infertility has been a primary cause of global infertility, affecting 8-12% of couples worldwide. Previous studies have shown that semen quality decreases with advanced aging with an increased presence of inflammatory cells. In this study, we examined changes in the epigenome across a diverse cohort that includes both fertile and infertile men. We also compare the age-associated changes in semen to those observed in buccal swabs in order to characterize differences in epigenetic aging across diverse tissues. We found that variations in the semen methylome associated with aging are linked to inflammatory genes. Many age-associated sites are demethylated with advanced aging and are associated with the activation of inflammatory pathways. By contrast, we do not observe age-associated changes in inflammatory genes in buccal swab methylomes, which instead are characterized by changes to bivalent promoters. Our findings highlight the potential of epigenetic markers as indicators of male reproductive health.

  View details for DOI 10.1080/15592294.2024.2436304

  View details for PubMedID 39637179

  View details for PubMedCentralID PMC11622584

• Understanding Pediatric Experiences With Symptomatic Varicoceles: Mixed Methods Study of an Online Varicocele Community. JMIR formative research Sollender, G. E., Jiang, T., Finkelshtein, I., Osadchiy, V., Zheng, M. H., Mills, J. N., Singer, J. S., Eleswarapu, S. V. 2024; 8: e50141

  Abstract

  BACKGROUND: Varicoceles affect up to 30% of postpubertal adolescent males. Studying this population remains difficult due to this topic's sensitive nature. Using the popularity of social media in this cohort and natural language processing (NLP) techniques, our aim was to identify perceptions of adolescent males on an internet varicocele forum to inform how physicians may better evaluate and counsel this pediatric population.OBJECTIVE: We aimed to characterize themes of discussion and specific concerns expressed by adolescents using a mixed methods approach involving quantitative NLP and qualitative annotation of an online varicocele community.METHODS: We extracted posts from the Reddit community "r/varicocele" (5100 members) with criteria of discussant age ≤21 years and word count >20. We used qualitative thematic analysis and the validated constant comparative method, as well as an NLP technique called the meaning extraction method with principal component analysis (MEM/PCA), to identify discussion themes. Two investigators independently interrogated 150 randomly selected posts to further characterize content based on NLP-identified themes and calculated the Kaiser-Meyer-Olkin (KMO) statistic and the Bartlett test. Both quantitative and qualitative approaches were then compared to identify key themes of discussion.RESULTS: A total of 1103 posts met eligibility criteria from July 2015 to June 2022. Among the 150 randomly selected posts, MEM/PCA and qualitative thematic analysis separately revealed key themes: an overview of varicocele (40/150, 27%), management (29/150, 19%), postprocedural experience (28/150, 19%), seeking community (26/150, 17%) and second opinions after visiting a physician (27/150, 18%). Quantitative analysis also identified "hypogonadism" and "semen analysis" as concerns when discussing their condition. The KMO statistic was >0.60 and the Bartlett test was <0.01, indicating the appropriateness of MEM/PCA. The mean age was 17.5 (SD 2.2; range 14-21) years, and there were trends toward higher-grade (40/45, 89% had a grade of ≥2) and left-sided varicoceles. Urologists were the topic of over 50% (53/82) of discussions among discussants, and varicocelectomy remained the intervention receiving the most interest. A total of 60% (90/150) of discussants described symptomatic varicoceles, with 62 of 90 reporting pain, 24 of 90 reporting hypogonadism symptoms, and 45 of 90 reporting aesthetics as the primary concern.CONCLUSIONS: We applied a mixed methods approach to identify uncensored concerns of adolescents with varicoceles. Both qualitative and quantitative approaches identified that adolescents often turned to social media as an adjunct to doctors' visits and to seek peer support. This population prioritized symptom control, with an emphasis on pain, aesthetics, sexual function, and hypogonadism. These data highlight how each adolescent may approach varicoceles uniquely, informing urologists how to better interface with this pediatric population. Additionally, these data may highlight the key drivers of decision-making when electing for procedural management of varicoceles.

  View details for DOI 10.2196/50141

  View details for PubMedID 39388695

• The Promise of Artificial Intelligence in Peyronie's Disease. Current urology reports Furtado, T. P., Osadchiy, V., Eleswarapu, S. V. 2024; 26 (1): 3

  Abstract

  The application of artificial intelligence (AI) to enhance clinical decision-making in Peyronie's disease (PD) has generated significant interest. This review explores the current landscape of AI in PD evaluation.Recent advances in 3D modeling offer a more sophisticated approach to assessing PD deformities; however, the implementation of 3D modeling in clinical practice faces challenges, including the need for specialized equipment and time-consuming data processing, sometimes taking several hours of labor. AI holds promise for overcoming these hurdles through its ability to efficiently process large volumes of data and to perform accurate predictions based on such data. Future integration of AI with 3D modeling techniques could revolutionize PD evaluation by improving patient counseling, surgical planning, and clinical decision-making. Significant gaps in the literature have yet to be addressed, including the absence of robust evidence that incorporating such technology is superior to standard diagnostics.

  View details for DOI 10.1007/s11934-024-01233-5

  View details for PubMedID 39305366

  View details for PubMedCentralID PMC11416409

• Collagenase Clostridium histolyticum for Peyronie's disease: a contemporary atlas of complications and their management. Sexual medicine reviews Furtado, T. P., Osadchiy, V., Andino, J. J., Eleswarapu, S. V., Mills, J. N. 2024; 12 (3): 491-496

  Abstract

  Collagenase Clostridium histolyticum (CCH) remains the only Food and Drug Administration-approved medical treatment for Peyronie's disease (PD). The initial IMPRESS I and II trials (Investigation for Maximal Peyronie's Reduction Efficacy and Safety), which led to Food and Drug Administration approval, revealed a rate of treatment-related adverse events as high as 84%. Studies fail to provide clear definitions of complications.To review complications, provide a CCH complication atlas, and propose management strategies for commonly encountered complications.We performed a literature review using PubMed. A photographic atlas was provided regarding complications in patients in a high-volume CCH center for PD.Complications were identified and classified by nature and severity. We followed a standardized previously published grading system for hematomas. Complications include bruising, swelling, hematoma formation, back pain, and, rarely, corporal rupture. Complications were discussed, and hematomas were graded by penile surface area. Complication photographs were graded and displayed. Treatment-related adverse effects do not affect overall results.Recognizing and grading complications associated with CCH therapy for PD is crucial for effective patient management and informed decision making. A standardized grading system allows for consistency in reporting and comparing hematoma complication rates across studies and patient populations. Herein we provide images that will help clinicians identify and confidently manage common complications that may occur in any CCH program.

  View details for DOI 10.1093/sxmrev/qeae004

  View details for PubMedID 38491199

• Cannabis and male sexual health: contemporary qualitative review and insight into perspectives of young men on the internet. Sexual medicine reviews Shahinyan, G. K., Hu, M. Y., Jiang, T., Osadchiy, V., Sigalos, J. T., Mills, J. N., Kachroo, N., Eleswarapu, S. V. 2023; 11 (2): 139-150

  Abstract

  Cannabis use is increasing across the United States, yet its short- and long-term effects on sexual function remain controversial. Currently, there is a paucity of studies exploring the relationship between cannabis and men's health.To summarize the available literature on cannabis and men's health and provide insight into lay perceptions of this topic.We performed a qualitative PubMed review of the existing literature on cannabis and men's health according to the PRISMA guidelines. Separately, we analyzed relevant themes in online men's health forums. We utilized a Google cloud-based platform (BigQuery) to extract relevant posts from 5 men's health Reddit forums from August 2018 to August 2019. We conducted a qualitative thematic analysis of the posts and quantitatively analyzed them using natural language processing and a meaning extraction method with principal component analysis.Our literature review revealed a mix of animal and human studies demonstrating the negative effects of cannabis on semen parameters and varying effects on erectile function and hormone levels. In our analysis of 372 686 Reddit posts, 1190 (0.3%) included relevant discussion on cannabis and men's health. An overall 272 posts were manually analyzed, showing that online discussions revolve around seeking answers and sharing the effects of cannabis on various aspects of sexual health and quality of life, often with conflicting experiences. Quantitative analysis revealed 1 thematic cluster related to cannabis, insecurity, and mental/physical health.There is a limited number of quality human studies investigating the effects of cannabis on men's health. Men online are uncertain about how cannabis affects their sexual health and seek more information. As the prevalence of cannabis use increases, so does the need for research in this area.

  View details for DOI 10.1093/sxmrev/qeac010

  View details for PubMedID 36763944

• Guideline-Nonconformant Investigational Treatments for Erectile Dysfunction: What are Patients Learning? Urology Hu, M. Y., Ho, D. R., Weinberger, J. M., Osadchiy, V., Mills, J. N., Eleswarapu, S. V. 2023; 173: 111-118

  Abstract

  To evaluate the validity of YouTube content on shockwave, platelet-rich plasma, and stem cell therapies for erectile dysfunction (ED). The consumerization of men's health is particularly notable among regenerative ED treatments, and the popularity of these treatments has been amplified by social media sites such as YouTube.We searched YouTube utilizing the following terms: "shockwave therapy-," "platelet-rich plasma- and "stem cell therapy-" "-for erectile dysfunction." The first 50 resulting videos per query were screened (inclusion criteria: relevant title/content, English language, >100 views) and judged by 2 independent graders using the validated DISCERN instrument for consumer health information. Regression analysis assessed association of video characteristics with DISCERN score.Seventy-one unique videos met criteria. More content featured non-physicians (37%) or non-urologist physicians (35%) than urologists (28%). Mean DISCERN score was low at 42.8 of 80. DISCERN score significantly differed by video category and characteristics. Educational and urologist-featuring videos were associated with higher score. News reports were associated with lower score. Only 3 videos mentioned investigational/experimental status of the therapies. Only 2 cited society guidelines.Most YouTube videos on regenerative ED therapies are unreliable and from non-urologists. The misrepresentation of proven efficacy may be encouraging patients to seek these still investigational treatments at high fiscal costs to the patient. Videos with urologists were more likely to be higher quality and guideline based. The urological and academic communities should continue to leverage the power of social media to provide evidence-backed consumer health information in this space.

  View details for DOI 10.1016/j.urology.2022.11.044

  View details for PubMedID 36584789

• Temporal Changes of Clomiphene on Testosterone Levels and Semen Parameters in Subfertile Men. The world journal of men's health Jiang, T., Sigalos, J. T., Osadchiy, V., Santamaria, A., Zheng, M. H., Modiri, N., Regets, K. V., Mills, J. N., Eleswarapu, S. V. 2023; 41 (1): 198-203

  Abstract

  Clomiphene citrate (CC) is prescribed off-label in men to improve testosterone and sperm parameters, but the duration of treatment needed to reach maximal benefit remains unclear. Our objective was to examine temporal effects of CC on total testosterone (TT) and semen analysis (SA) using longitudinal follow-up data in treated men.We analyzed an IRB-approved database of men treated with CC (25 mg q.d. or 50 mg q.o.d.) from January 2016 through May 2021. We identified patients with 3, 6, 9, and 12 month follow-up data for TT and 3, 6, and 9 month follow-up SA. Mean absolute changes in TT and sperm concentration compared to baseline were calculated, along with 95% confidence intervals. Men with prior genitourinary procedures or hormone therapy were excluded. Paired t-tests were used to compare TT and sperm concentration at each time point to baseline (alpha=0.05).One hundered thirty-four men received CC, mean age 37.7 years (SD 6.7, range 24-52). TT at all follow-ups (3, 6, 9, and 12 months) were available for 25 men, and SA at 3, 6, and 9 months for 26 men. Baseline TT was 358±145 ng/dL and sperm concentration was 13±17.2 M/mL. Significant improvement in TT was identified at 3 months (62.7 ng/dL, 95% CI: 0.49-125.0, p=0.048), additional benefit at 6 months (181.8 ng/dL, 95% CI: 114.1-249.5, p<0.01), and plateau at 9 and 12 months. Improvement in sperm concentration was first observed at 9 months (20.7 M/mL, 95% CI: 10.2-31.2, p<0.01). Semen volume and sperm motility did not change.Duration of treatment with clomiphene may impact testosterone and sperm concentration, and the historical 3 month milestone may be insufficient for clinical and research evaluation. Men taking CC may experience plateau in TT at 6 months and first benefit in sperm concentration at 9 months.

  View details for DOI 10.5534/wjmh.220010

  View details for PubMedID 35791301

  View details for PubMedCentralID PMC9826904

• 3D-printed phantoms to quantify accuracy and variability of goniometric and volumetric assessment of Peyronie's disease deformities. International journal of impotence research Walker, D. T., Jiang, T., Santamaria, A., Osadchiy, V., Daniels, D., Sturm, R. M., Mills, J. N., Eleswarapu, S. V. 2022; 34 (8): 786-789

  Abstract

  Characterization of Peyronie's disease (PD) involves manual goniometry and penile length measurement. These techniques neglect volume loss or hourglass deformities. Inter-provider variability complicates accuracy. Using 3D-printed models, we aimed to evaluate measurement accuracy and variability and establish computational assessment workflows. Five digital phantoms were created: 13.0 cm cylinder, 13.0 cm hourglass cylinder, 15.0 cm cylinder with 40° angulation, 12.0 cm straight penis, and 12.9 cm PD penis with 68° angulation and hourglass. Lengths, volumes, and angles were determined computationally. Each phantom was 3D-printed. Ten urology providers determined lengths, angles, and volumes with measuring tape, goniometer, and volume calculator. Provider versus computational measurements were compared to determine accuracy using t-tests or Wilcoxon rank-sum tests. No significant differences were observed between manual assessment of length of penile models and designed length in penile models. Average curvature angles from providers for bent cylinder and PD phantoms were 38.3° ± 3.9° (p = 0.25) and 57.5° ± 7.2° (p = 0.006), respectively. When assessing for volume, hourglass cylinder and bent cylinder showed significant differences between designed volume and provider averages. All assessments of length, angle, and volume showed significant provider variability. Our results suggest manual measurements suffer from inaccuracy and variability. Computational workflows are useful for improved accuracy and volume assessment.

  View details for DOI 10.1038/s41443-021-00486-9

  View details for PubMedID 34743194

  View details for PubMedCentralID PMC9758050

• Initial gonadotropin levels and sperm parameters differentiate the response to clomiphene citrate in subfertile men. Translational andrology and urology Jiang, T., Osadchiy, V., Santamaria, A., Zheng, M. H., Modiri, N., Sigalos, J. T., Regets, K. V., Mills, J. N., Eleswarapu, S. V. 2022; 11 (2): 116-123

  Abstract

  Efficacy of clomiphene citrate (CC) in the treatment of male subfertility remains unclear, with inconsistent results in the literature and limited guidance from professional organizations. We sought to stratify the response to clomiphene in men based on their initial gonadotropins and semen parameters.We conducted a retrospective analysis of 234 patients from an academic center who took CC for subfertility. Patients with pre-treatment and 3 months follow-up total testosterone (TT) and semen analyses were included. Patients with previous hormone therapy, genitourinary surgery, prior success in conceiving pregnancy, or only one semen analysis were excluded. Primary outcomes were magnitudes of improvement in TT and semen parameters at 3 months. Student's t-test (alpha =0.05) was used for univariate analyses; multivariable linear regression was used for multivariate analysis.One hundred and thirty-seven patients met inclusion criteria. Thirty-four percent of patients experienced improvement in sperm concentration after 3 months of CC treatment, 13% decreased, and 53% showed no change. Using a pre-treatment TT cutoff of 300 ng/dL and gonadotropin thresholds of 7 miU/mL, initial TT did not affect magnitude of improvement in semen parameters, while lower initial gonadotropins showed statistical improvement across all outcomes. Multivariate analysis showed pre-treatment follicle stimulating hormone (FSH) was inversely correlated with improvement in TT [odds ratio (OR): 2.64e-05, 95% confidence interval (CI): 1.32e-09 to 5.28e-01, P=0.04] and sperm concentration (OR: 0.22, 95% CI: 5.70e-02 to 8.48e-01, P=0.03). We also provide initial gonadotropin cutoffs that suggest statistical benefit from CC use.Men with lower gonadotropin levels may expect greater degree of improvement in both hormone and semen parameters with use of CC. Men with azoospermia do not benefit based on semen analyses alone. Degree of non-azoospermia does not affect magnitude of improvement. CC had decreasing efficacy at higher initial gonadotropin levels. These data may provide guidance in stratifying and counseling men for CC treatment.

  View details for DOI 10.21037/tau-21-987

  View details for PubMedID 35280658

  View details for PubMedCentralID PMC8899152

• Impact of the COVID-19 Pandemic on Patient Preferences and Decision Making for Symptomatic Urolithiasis. Journal of endourology Jiang, T., Osadchiy, V., Weinberger, J. M., Zheng, M. H., Owen, M. H., Leonard, S. A., Mills, J. N., Kachroo, N., Eleswarapu, S. V. 2021; 35 (8): 1250-1256

  Abstract

  Background: Pandemic restrictions have changed how patients approach symptomatic kidney stones. We used a mixed-methods digital ethnographic approach to evaluate social media discussions about patient concerns and preferences for urolithiasis care during the COVID-19 pandemic. Materials and Methods: We retrospectively analyzed kidney stone-related discussions on a large social media platform using qualitative analysis and natural language processing-based sentiment analysis. Posts were mined for demographic details, treatments pursued, and health care encounters. Pre-COVID-19 (January 1, 2020-February 29, 2020) and COVID-19 (March 1, 2020-June 1, 2020) posts were extracted from the popular online Reddit discussion board, "r/KidneyStones," which is dedicated to discussions related to urolithiasis. Results: We extracted n = 649 posts (250 pre-COVID-19, 399 COVID-19); 150 from each cohort underwent thematic analysis and data extraction. Quantitative sentiment analysis was performed on 418 posts (179 pre-COVID-19, 239 COVID-19) that described stone-related decision making before intervention. Notable discussion themes during COVID-19 focused on barriers to care and concerns about stone management. Discussants exhibited more negative and anxious tones during COVID-19, based on sentiment analysis (p < 0.01). Patient preferences shifted away from in-person visits and procedures (p < 0.001). Mean reported stone size among those visiting emergency room (ER) increased from 5.1 to 10.5 mm (p < 0.001). The proportion of discussants preferring conservative management with stones ≥10 mm increased (12.5% pre-COVID-19 vs 26% during COVID-19, p = 0.002). Opioid mentions increased from 9% to 27% of posts (p < 0.001) and were most associated with conservative management discussions. Conclusions: Online discussion forums provide contemporaneous insight into patients' experiences during a time when traditional patient-centered research methodologies are limited due to social distancing. During the pandemic, patients with symptomatic kidney stones expressed anxiety regarding outpatient encounters and reluctance toward procedural intervention. Patients opted instead for at-home conservative treatment beyond clinical guidelines and reserved ER visits for larger stones, potentially causing self-harm. Opioid discussions proliferated, an alarming consequence of the pandemic.

  View details for DOI 10.1089/end.2020.1141

  View details for PubMedID 33478351

  View details for PubMedCentralID PMC8390773

• Digital ethnographic analysis of prostate cancer discussions on social media. BJUI compass Eleswarapu, S. V., Jiang, T., Mills, J. N., Osadchiy, V. 2021; 2 (2): 82-85

  View details for DOI 10.1002/bco2.64

  View details for PubMedID 35474884

  View details for PubMedCentralID PMC8988692

• Low Testosterone on Social Media: Application of Natural Language Processing to Understand Patients' Perceptions of Hypogonadism and Its Treatment. Journal of medical Internet research Osadchiy, V., Jiang, T., Mills, J. N., Eleswarapu, S. V. 2020; 22 (10): e21383

  Abstract

  Despite the results of the Testosterone Trials, physicians remain uncomfortable treating men with hypogonadism. Discouraged, men increasingly turn to social media to discuss medical concerns.The goal of the research was to apply natural language processing (NLP) techniques to social media posts for identification of themes of discussion regarding low testosterone and testosterone replacement therapy (TRT) in order to inform how physicians may better evaluate and counsel patients.We retrospectively extracted posts from the Reddit community r/Testosterone from December 2015 through May 2019. We applied an NLP technique called the meaning extraction method with principal component analysis (MEM/PCA) to computationally derive discussion themes. We then performed a prospective analysis of Twitter data (tweets) that contained the terms low testosterone, low T, and testosterone replacement from June through September 2019.A total of 199,335 Reddit posts and 6659 tweets were analyzed. MEM/PCA revealed dominant themes of discussion: symptoms of hypogonadism, seeing a doctor, results of laboratory tests, derogatory comments and insults, TRT medications, and cardiovascular risk. More than 25% of Reddit posts contained the term doctor, and more than 5% urologist.This study represents the first NLP evaluation of the social media landscape surrounding hypogonadism and TRT. Although physicians traditionally limit their practices to within their clinic walls, the ubiquity of social media demands that physicians understand what patients discuss online. Physicians may do well to bring up online discussions during clinic consultations for low testosterone to pull back the curtain and dispel myths.

  View details for DOI 10.2196/21383

  View details for PubMedID 33026354

  View details for PubMedCentralID PMC7578816

• Social Media Sensationalism in the Male Infertility Space: A Mixed Methodology Analysis. The world journal of men's health Zaila, K. E., Osadchiy, V., Shahinyan, R. H., Mills, J. N., Eleswarapu, S. V. 2020; 38 (4): 591-598

  Abstract

  Infertile couples increasingly turn to the internet for medical guidance. The aims of this study were: (1) to identify popular male infertility content on social media, and (2) to assess the accuracy and quality of this content. We hypothesized that inaccurate/misleading information proliferates online.We used the analytics module BuzzSumo to identify article links that were most shared on Facebook, Pinterest, Reddit, and Twitter related to male infertility during September 2018 to August 2019. We excluded articles with <100 engagements, defined as "likes," "comments," and "shares." Two researchers graded content as accurate, misleading, or inaccurate by comparing content to references cited and contemporary research. Inter-rater reliability was determined with Cohen's κ. Binary logistic regression was performed to compare user engagement with accurate versus inaccurate/misleading articles.Fifty-two unique article links were identified, with 421,004 total engagements. Thirty-four articles referenced 15 scientific studies; no reference was available for 18 links. Fifty-six percent of articles were accurate and 44% misleading/inaccurate (κ=0.743). No significant difference was found in total engagement between accurate vs. misleading/inaccurate links (p=0.805). Twenty-four percent of engagements referenced studies using non-human models, and 26% of studies had sample sizes <100.Social media platforms foster engagement with male infertility information. However, sensationalism predominates, as patients are highly likely to encounter misleading/inaccurate information, articles that overstate implications of animal research, and conclusions made based on limited sample sizes. Urologists should consider adding social media to their armamentarium to stave off misinformation and engage proactively with patients.

  View details for DOI 10.5534/wjmh.200009

  View details for PubMedID 32378368

  View details for PubMedCentralID PMC7502321

• Is It All in My Head? Self-reported Psychogenic Erectile Dysfunction and Depression Are Common Among Young Men Seeking Advice on Social Media. Urology Jiang, T., Osadchiy, V., Mills, J. N., Eleswarapu, S. V. 2020; 142: 133-140

  Abstract

  To characterize themes of discussion and specific concerns expressed by users of an internet erectile dysfunction (ED) community using a mixed-methodology approach involving quantitative natural language processing (NLP) and qualitative annotation of content.We extracted posts and responses from the Reddit community r/ErectileDysfunction (3100 members) during June 2018 to May 2019. We applied an NLP technique called the meaning extraction method with principal component analysis to computationally identify themes of discussion. We manually annotated a subset (30%) of posts based on NLP-derived themes to evaluate specific content.We analyzed 329 posts and 1702 responses. Meaning extraction method with principal component analysis identified key themes: hypogonadism symptoms, masturbation/sex, evaluation/treatment, alternative therapies, and partner factors (posts); and performance anxiety, hypogonadism evaluation, pornography, and pharmacotherapy (responses). Subset annotation of 100 posts revealed a median author age of 24 years (Interquartile Range (IQR): 20-31). 48% of discussants believed their ED was psychogenic, 38% reported depressive symptoms, and 2% mentioned self-harm/suicidality either attributed to or associated with their ED. 28% of discussants reported seeing a health care professional for ED, and 20% attempted abstinence from pornography/masturbation as a self-prescribed intervention.Social media platforms like Reddit empower young men to discuss ED concerns. Fewer than one-third reported seeing a doctor for ED, suggesting that men turn to peers on the internet first, despite risk of misinformation. A majority attributed symptoms to psychological etiologies and excess pornography/masturbation. Depression, self-harm, and suicide emerged as potent concerns. These data underscore the importance of engaging proactively with young men, both in the consultation room and online.

  View details for DOI 10.1016/j.urology.2020.04.100

  View details for PubMedID 32437776

• Popularity and worldwide reach of targeted, evidence-based internet streaming video interventions focused on men's health topics. Translational andrology and urology Zaila, K. E., Osadchiy, V., Anderson, A. S., Eleswarapu, S. V., Mills, J. N. 2020; 9 (3): 1374-1381

  Abstract

  Streaming video has emerged as a dominant content-delivery medium for healthcare information, with over 30 million visitors daily to the YouTube platform alone. Videos related to men's health have proliferated, but content produced by trained health care providers remains scarce. We evaluated educational YouTube streaming videos created in collaboration with a large, university-based health system focused on male factor infertility, men's health, and Peyronie's disease, uploaded during 2016-2018. All videos featured a board-certified urologist with fellowship training in andrology. Using YouTube's native analytics tools, we extracted data on views, engagement, and geographic reach through 8/2019. We obtained data for streaming videos on male infertility (n=3), general men's health (n=2), and Peyronie's disease (n=1). Video length ranged from 29 to 51 min, with a mean video duration of 39 min 41 sec. Actual mean watch time by viewers ranged from 3:45 to 8:30. The total view count was 646,684, with a watch time of nearly 3 million mins, reaching viewers in 47 countries. Fifty-three percent of watch time was on a mobile device and 33% on a personal computer. As patients increasingly turn to the internet for health information, health systems and physicians may wish to leverage high impact social media platforms such as YouTube to share evidence-based content. This study highlights the impressive reach a health system-sponsored video intervention using YouTube can have in sharing accurate video content related to a diverse range of men's health topics. This is the first health systems-based streaming-video intervention to leverage the video streaming and social media platform YouTube, to facilitate sharing reputable, high quality, and evidence-based men's health content.

  View details for DOI 10.21037/tau-20-580

  View details for PubMedID 32676422

  View details for PubMedCentralID PMC7354348

• Efficacy of a preprostatectomy multi-modal penile rehabilitation regimen on recovery of postoperative erectile function. International journal of impotence research Osadchiy, V., Eleswarapu, S. V., Mills, S. A., Pollard, M. E., Reiter, R. E., Mills, J. N. 2020; 32 (3): 323-328

  Abstract

  To evaluate the efficacy of a novel, multi-modal, preoperative approach to postprostatectomy penile rehabilitation (PR), we performed a retrospective review of patients who underwent nerve-sparing robotic-assisted laparoscopic prostatectomy (NS-RALP). All patients were evaluated at a comprehensive, academic sexual medicine clinic between 2016 and 2017. The "prehabilitation" PR group (n = 106) consisted of men who were seen in the pre-op period and began tadalafil and L-citrulline 2 weeks prior to surgery. Vacuum erectile device (VED) therapy was started at 1-month post-op. These interventions were continued throughout the 12-month follow-up period. Individuals refractory to these therapies could start treatment with intracavernosal injections. The postprostatectomy PR group (n = 25) consisted of men who were not seen in the pre-op period and started the above therapies immediately following their first visit. A higher percentage of men in the prehabilitation group reported return of erectile function within 12 months (56% vs. 24%, P = 0.007). The prehabilitation group also showed better compliance with PR (PDE5i [96% vs. 64%, P < 0.001], L-citrulline [93% vs. 49%, P < 0.001], and VED [55% vs. 20%, P < 0.001]). Seventy-eight percent of men who attended 4-5 follow-up visits reported return of erectile function. Our results suggest that men undergoing a preoperative protocol show superior recovery of erectile function following NS-RALP. Further studies with prospective designs are warranted.

  View details for DOI 10.1038/s41443-019-0187-y

  View details for PubMedID 31474755

  View details for PubMedCentralID 1751036

• Understanding Patient Anxieties in the Social Media Era: Qualitative Analysis and Natural Language Processing of an Online Male Infertility Community. Journal of medical Internet research Osadchiy, V., Mills, J. N., Eleswarapu, S. V. 2020; 22 (3): e16728

  Abstract

  Couples struggling with infertility are increasingly turning to the internet for infertility-related content and to connect with others. Most of the published data on infertility and the internet only address the experiences of women, with limited studies focusing exclusively on internet discussions on male factor infertility.The aim of this study was to understand the concerns and experiences of discussants on an online male infertility community and to provide insight into their perceptions of interactions with health care professionals.Using the large-scale data analytics tool BigQuery, we extracted all posts in the r/MaleInfertility community (877 members) of the social media website and discussion board Reddit from November 2017 to October 2018. We performed a qualitative thematic analysis and quantitative semantic analysis using Language Inquiry and Word Count 2015 of the extracted posts to identify dominant themes and subthemes of discussions. Descriptive statistics and semantic analytic Z-scores were computed.From the analysis of 97 posts, notable themes and subthemes emerged: 70 (72%) posts shared personal experiences, including feeling emasculated or isolated or describing a negative (28/97, 29%), positive (13/97, 13%), or neutral (56/97, 58%) experience with a health care professional; 19% (18/97) of the posts posed questions about personal semen analysis results. On the basis of semantic analysis, posts by men had higher authenticity scores (Z=3.44; P<.001), suggesting more honest or personal texts, but lower clout scores (Z=4.57; P<.001), suggesting a more tentative or anxious style of writing, compared with posts by women.To our knowledge, this study represents the first evaluation of a social media community focused exclusively on male infertility using mixed methodology. These results suggest a role for physicians on social media to engage with patients and connect them to accurate resources, in addition to opportunities to improve in-office patient education.

  View details for DOI 10.2196/16728

  View details for PubMedID 32154785

  View details for PubMedCentralID PMC7093775