Despite strong association between erectile dysfunction (ED) and cardiovascular disease (CVD), there is a paucity of clear clinical guidelines detailing when and how to evaluate for ED in patients with known CVD, or vice versa. This systematic review discuss the role of cardiologists and urologists in the characterization of risk and management of CVD in the setting of ED, as well as contrasting the current evaluation of CVD and ED from the standpoint of published consensus statements. A comprehensive literature review utilizing MEDLINE®, the Cochrane Library® Central Search, and the Web of Science was performed to identify all published peer-reviewed articles in the English language describing ED and CVD across various disciplines. There is strong consensus that men with ED should be considered at high risk of CVD. Available risk assessment tools should be used to stratify the coronary risk score in each patient. The 2012 Princeton III Consensus Conference expanded on existing cardiovascular recommendations, proposing an approach to the evaluation and management of cardiovascular risk in men with ED and no known CVD. This systematic review highlights the similarities and differences of the existing clinical guidelines and recommendations regarding assessment and management of ED and CVD, as well as the pathophysiological linkage between ED and CVD, which may permit physicians, including urologists, to perform opportunistic screening and initiate secondary prophylaxis with regard to cardiovascular risk factors, particularly in young, nondiabetic men with ED.

Low back pain has a 70% higher prevalence in members of the armed forces than in the general population, possibly due to the loads and positions soldiers experience during training and combat. Although the influence of heavy load carriage on standing lumbar spine posture in this population is known, postures in other operationally relevant positions are unknown. Therefore, the purpose of this study was to characterize the effect of simulated military operational positions under relevant loading conditions on global and local lumbar spine postures in active duty male US Marines.Secondary objectives were to evaluate if intervertebral disc degeneration and low back pain affect lumbar spine postures. Magnetic resonance images were acquired on an upright scanner in the following operational positions: natural standing with no external load, standing with body armor (11.3 kg), sitting with body armor, and prone on elbows with body armor. Custom software was used to measure global lumbar spine posture: lumbosacral flexion, sacral slope, lordosis, local measures of intervertebral angles, and intervertebral distances. Sitting resulted in decreased lumbar lordosis at all levels of the spine except L1−L2. When subjects were prone on elbows, a significant increase in local lordosis was observed only at L5−S1 compared with all other positions. Marines with disc degeneration (77%) or history of low back pain (72%) had decreased lumbar range of motion and less lumbar extension than healthy Marines. These results indicate that a male Marine's pathology undergoes a stereotypic set of postural changes during functional tasks, which may impair performance. This article is protected by copyright. All rights reserved

Cardiovascular disease is the leading cause of death in the United States. Testosterone is the principal male sex hormone and plays an important role in men's health and well-being. Historically, testosterone was believed to adversely affect cardiovascular function. However, contemporary literature has refuted this traditional thinking; testosterone has been suggested to have a protective effect on cardiovascular function through its effects on the vascular system. Data from modern research indicate that hypogonadism is closely related to the development of various cardiovascular risk factors, including hyperlipidemia and insulin resistance. Several studies have demonstrated beneficial effects of testosterone supplementation therapy on reversing symptoms of hypogonadism and improving cardiovascular disease risk profiles. In this review, we perform a critical analysis on the association between testosterone and cardiovascular disease.

Giant congenital melanocytic nevi (GCMNs) create cosmetic disfigurements and pose risk for malignant transformation. Adult GCMN cases are uncommon because most families opt for surgical treatment during childhood. We review the current literature on GCMN and present an interesting case of an adult with a GCMN encompassing the entire back with painful nodules exhibiting gross involvement of his back musculature, without pathologic evidence of malignancy. Surgical management was deferred in childhood because of parental desires to allow the patient to make his own decision, and treatment in adulthood was pursued on the basis of the significant impairment of the patient's quality of life and self-esteem due to the massive size and deforming nature of the nevus. The treatment strategy used for this young adult male patient involved a massive en bloc excision of the GCMN with partial resection of the latissimus dorsi, followed by a 5-week staged reconstructive process using dermal regenerative matrices and split-thickness skin grafting. Because of the shift in GCMN management from early surgical management to more conservative management, we may see an increase in adult cases of GCMN. Thus, it is critical to better understand the controversy surrounding early versus delayed management of GCMN.

INTRODUCTION AND OBJECTIVES:The perineal area has been evasive to office based approaches given its sensitivity, difficult access requiring lithotomy or exacerbated lithotomy positioning. Indeed, general or spinal anesthesia is commonly required for a prostate biopsy if performed thru the perineum. The emergence of MRI-Ultrasound (MR/ US) fusion biopsies has led to an increased precision in the diagnosis of prostate cancer. However, this fusion technology is mostly implemented using the transrectal technique. Herein, we present our method to block the perineum making it feasible to perform procedures (Prostate Biopsy and Cryoablation) safely in the office setting under local anesthesia METHODS: This study evaluated consecutive men who presented to our office for a transperineal procedure, either MR/US Fusion Biopsy or Cryoablation performed using a novel perineal block. The procedures were performed between August 2014 and September 2017. The information was collected prospectively using the Focalyx App (ISO, Android). For this report we queried diagnostic and treatment information such as: age, PSA, DRE findings, clinical stage, WHO Modified Gleason scores, co-morbidities, biopsy and treatment duration, Pain -measured with wonker baker pain faces scale -and claviendindo system 30 day outcomes post procedure outcomes.RESULTS: A total of 1,015 procedures were performed, 626 were Transperineal Biopsies (TBX) and 389 Transperineal Cryoablations (TPC). There was a statistically significant difference in the mean times of the procedures 22' and 60' for TBX and TPC, respectively. However, pain measures were similar as the median and mean pain referred after TBX were 2 and 2.5 with respective pain measures for TPC of 2 and 1.7. A total of 33 (3%) adverse events within 30 days were recorded, 18 (2.8%) after TBX and 15 after TPC (3.9%). There was one episode of UTI after TBX requiring admission due to presumptive sepsis, however, blood cultures were negative. In the TPC group 4 of the 11 patients with urinary retention greater than 3 weeks required a TURP. There was one patient (TPC) who developed a vasovagal episode and sustained a fall requiring hospital admission CONCLUSIONS: Our study shows that transperineal procedures performed under local anesthesia are well tolerated and harbor low rates (<4%) of adverse events. This novel block provides the urologist to access the perineum safely in the office setting