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Objectives To investigate the impact of sleep quality in hypogonadal symptoms and sexual function in men working non-standard shifts. Methods Men treated at a single andrology clinic between July-October 2014 completed questionnaires assessing sleep quality, hypogonadal symptoms (Androgen Deficiency in the Aging Male – ADAM/qADAM), and sexual function (International Index of Erectile Function – IIEF). Serum hormone levels were assessed at the time of survey completion. Results 182 men were identified as working non-standard shifts (work that starts before 7am or after 2pm, rotates, or regularly includes hours outside of the standard 7am to 6pm work day) with a mean±SD age of 41.1±10.8 years. Of men working non-standard shifts, those with better sleep quality had fewer hypogonadal symptoms and better sexual function. Multivariate regression analysis revealed significant linear associations between sleep quality and qADAM score (p=0.008), positive ADAM responses (p=0.003), and IIEF score (p=0.0004) were observed. When comparing individual groups, men who were “very satisfied” (n=60) with sleep quality had higher qADAM scores than men who were “somewhat dissatisfied” (p=0.02), and men who were “very dissatisfied” had significantly lower IIEF scores than men who were “very satisfied” (p=0.001) and “somewhat satisfied” (p=0.005). No associations between sleep quality and mean serum testosterone (T), free T, estrogen, DHEA, FSH, and LH levels were observed. Conclusions Men who work non-standard shifts and have poor sleep quality are at increased risk for hypogonadal symptoms and sexual dysfunction. These effects may be improved with a shift in schedule or techniques to improve sleep quality.

Objective To determine the association between sleep quality and lower urinary tract symptom (LUTS) severity in men working non-standard shifts, a population at risk for poor sleep quality. Materials and Methods Men who presented to a single andrology clinic between July and October 2014 and worked non-standard shifts completed the International Prostate Symptom Score (IPSS) and responded to questions regarding their work habits, sleep-quality, and physical/cognitive function. We assessed the relationship between age, sleep-quality, physical/cognitive function and severity of LUTS. Results 228 men with a mean±SD age of 41.8±5.7 (range 21–76) years reported working non-standard shifts with the majority working these for more than 1 year (81%). Men with difficulties falling asleep reported more severe LUTS than men who did not have difficulty falling asleep (IPSS score 9 vs. 6, p<0.001). Men who reported difficulty staying asleep or falling back asleep after awakening also reported more severe LUTS (IPSS scores 6 vs. 13, p=0.004; 5 vs. 13, p<0.001, respectively). Men with a decreased sense of wellbeing or decreased physical/cognitive function also reported more severe LUTS (IPSS score 6 vs. 9, p<0.0010; 6 vs. 10, p=0.016, respectively). All findings were independent of subject age. Conclusion Men working non-standard shifts who have difficulty falling asleep, staying asleep, and falling back asleep report more severe LUTS than men without similar sleep difficulties. Men with a decreased sense of wellbeing or decreased physical/cognitive function also report worse LUTS. These findings implicate sleep quality as a possible risk factor for LUTS symptom severity.

Erectile dysfunction has been explored as a condition secondary to elevated prolactin; however, the mechanisms by which elevated prolactin levels cause erectile dysfunction have not yet been clearly established. We here present a patient with a history of prolactinoma who suffered from persistent erectile dysfunction despite testosterone supplementation and pharmacological and surgical treatment for the prolactinoma.  Patients who have had both prolactinemia and erectile dysfunction have been reported in the literature, but we find no report of a patient with persistent erectile dysfunction in the setting of testosterone supplementation and persistent hyperprolactinemia refractory to treatment. This case provides evidence supporting the idea that suppression of erectile function occurs in both the central and peripheral nervous systems independent of the hypothalamic-pituitary-gonadal axis.

This paper provides a description of a model to evaluate various suture materials and knot strengths in isolation of the tendon itself. This allowed us to evaluate mechanical differences between looped and non-looped sutures for polyamide, which are commonly used in flexor tendon repair. These differences between sutures may impact choices for a suture type selected for these repairs.