Since their discovery near the close of the 20 th century (1), selective androgen receptor modulators (SARMs) have been heralded as the possible future of androgen therapy (2). As satisfaction, side effects, preparations, and perceptions have limited the utility of testosterone therapy (TTh), SARMs are poised to fundamentally alter the field of androgen therapy (2).SARMs are chemically engineered small molecule drugs that can selectively exert varying degrees of agonist and antagonist effects on the androgen receptor (AR) throughout the body. Like androgens, SARMs enter the cytoplasm and bind to the AR. After translocating to the nucleus, the SARM-AR complex acts as a transcriptional regulator and recruits cofactors and coregulatory proteins, modulating the transcriptional response to binding of the AR complex (3,4). While the AR is universally expressed, SARM-AR complexes can have varied effects due to variable cofactor recruitment (5). These complex configurations, along with tissue-dependent differences in AR expression patterns and regulatory milieu, allow for immense diversity of actions (4).SARMs promise novel, convenient therapies that facilitate tissue-specific benefits without off-target side effects (6). Given the myriad drawbacks of TTh that can limit its use, including currently available formulations and common adverse effects, one can understand the excitement surrounding SARMs. Although still in the early stages of

Our preliminary exploration indicates that various advanced imaging modalities, when properly utilized and supported during surgery, can be useful in complementing the CT data and laparoscopic display. This study suggests that various imaging modalities, such as ones utilized in this case, can be beneficial intraoperatively depending on the surgical step involved and may be more helpful than 3D printed models. We also present factors to consider when evaluating advanced imaging modalities during complex surgery.

Background: Male infertility can be associated with secondary sexual characteristics, hypogonadism, and several findings in the examination of external genitalia. We sought to identify if stretched penile length (SPL) is associated with infertility or baseline testosterone. Methods: We performed a retrospective review of all males age 18-59 presenting to a Men's health clinic from 2014 to 2017. SPL of patients with infertility were compared to patients with any other complaint. Patients with Peyronie's disease, prior penile surgery, prostatectomy, on testosterone replacement, clomiphene or β-hCG were excluded from our study. Baseline characteristics were compared between the two groups (infertile vs. other). Linear regression was used to assess the association between infertility and testosterone with SPL after adjusting for patient age, BMI, and race. Scatterplot was used for correlation between testosterone and SPL. Results: Six hundred and sixty-four men were included in our study (161 infertile, 503 other). The unadjusted mean SPL in the infertile group was 12.3 cm compared to 13.4 cm in the other group (P<0.001). The significance remained when adjusted for age, BMI, testosterone and race (12.4 vs. 13.3, P<0.001). Mean total testosterone in the infertile group was not significantly different than the other group (414 vs. 422, P=0.68). Infertile men were younger than the other group (33.2 vs. 42.1 years, P<0.001). BMI did not significantly differ (28.9 vs. 28.9 kg/m 2 , P=0.57). There was a weak positive correlation between testosterone and penile size in both the infertile group (r=0.20, P=0.01) and the other group (r=0.24, P<0.001). Conclusions: Though SPL differed amongst our groups, adult testosterone levels did not. If developmental levels of testosterone exposure accounted for some of the differences in SPL between our two groups, these variations did not persist into adulthood. It remains unknown if reduced length is a result of genetic or congenital factors associated with infertility. Further investigation is needed to better understand the association of shorter SPL with male infertility.