The Change of Erectile Function Post Recovery from COVID-19 Infection.

INTRODUCTION: We assess the correlation between COVID-19 infection and erection and evaluate the effect of aging and comorbidities on the male sexuality of patients with COVID-19 infection. METHODS: 100 patients were enrolled and diagnosed with COVID-19 based on reverse transcription-polymerase chain reaction tests of oropharyngeal and nasopharyngeal swabs according to the WHO guidelines. The International Index of Erectile Function (IIEF-5) questionnaire was used to evaluate sexual function. RESULTS: Patients were divided into two groups: the first group of 42 patients <50 years of age with a mean age (±SD) of 35.83 ± 7.8 and the second group of 58 patients ≥50 years of age with a mean age of 58.64 ± 7.7. The mean (±SD) IIEF in the first group pre-COVID-19 infection was 14.2 ± 2.37 while post-COVID-19 was 8.7 ± 2.77, 11.3 ± 2.9, 12.1 ± 3.02 at 1, 3, 6 months, respectively (p < 0.001), while in the second group, the mean (±SD) IIEF pre-COVID-19 infection was 10.04 ± 4.62 while post-COVID was 5.0 ± 2.1, 6.56 ± 2.6, 8.18 ± 2.04 at 1, 3, 6 months, respectively (p < 0.001). On multivariate analysis, old patients infected with COVID-19 and associated with comorbidities such as diabetes mellitus (OR = 8.53, CI = 0.00-2.01), hypertension (OR = 3.908, CI = 0.000-3.07), ischemic heart disease (OR = 2.863, CI = 0.000-2.68), and liver disease (OR = 0.670, CI = 0.000-1.670) were significantly correlated to erectile dysfunction (p < 0.001). CONCLUSION: COVID-19 significantly affects erection mostly in older patients with comorbidities, leading to subsequent use of oral and intracavernosal injection therapy for erectile dysfunction.

The Pandemic, Telemedicine, and Andrology: What Have We Learned?

INTRODUCTION AND OBJECTIVE: Telemedicine has gained wide acceptance during the COVID-19 pandemic. Worldwide lockdowns made this interface an indispensable one for patient care. Recent evidence suggests that urology patients were receptive to telemedicine;however, no systematic review has been done to date on andrology patients in particular and their perception of telemedicine. METHOD(S): Three electronic databases: PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed s and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients "wishing for telemedicine consultation", "preferring telemedicine over in person", "accepting the current telemedicine arrangement", "having needs addressed with teleconsultation", or "willingness to do a teleconsultation". RESULT(S): Of the 1128 retrieved s, 56 underwent fulltext review and 12 were included in the final analysis, comprising a total cohort of >4021 cases. All 8 studies that assessed perception of andrology patients to telemedicine showed that most patients had "positive perception". Telemedicine was shown to save an average cost of $149-252/patient. Pooled analyses of positive response to telemedicine were 68.7% (95% CI = 49.4-83.1%, p=0.057) and of patients who recommended telemedicine were 65.1% (95% CI = 18.4-93.9%, p=0.577). 84.6% pooled proportion for recommending video compared to 38.9 % pooled proportion for recommending telephone practice, p=0.035. In the telephone-only encounters, 27.1% of patients preferred in-person visits as security and privacy of any mode of telecommunication were of concern. CONCLUSION(S): Most patients have a positive perception of telemedicine, particularly with videoconferencing and less so with telephone visits. Telemedicine will plausibly continue to be integral in andrology practice.

Ethnic and gender trends at the annual British Association of Urological Surgeons (BAUS) meeting: A review of BAUS programmes over a 13-year period (2009-2021)

Objective: In this paper, we wanted to review the annual British Association of Urological Surgeons (BAUS) programme to analyse the female and ethnic minority (EM) representation and find out whether there is ethnic and gender disparity, and if it does reflect the reality of the workforce. Method(s): To investigate gender and EM representation, we requested data for BAUS annual meetings over a 13-year period (2009-2021). All speakers and chairpersons for all four sub-sections including Endourology, Oncology, Andrology and Female, Neurological and Urodynamic urology (FNUU) were collated. We also looked at the geographic distribution of the speakers (London area, rest of England, Scotland, Northern Ireland and Wales). Data were analysed separately before and after the COVID-19 pandemic (cut-off March 2020), as in the latter 2 years, the meeting was held virtually. Result(s): A total of 2569 speakers (range: 135-323 speakers/year) were included in our analysis and 2187 (85%) speakers were from the United Kingdom. Of the UK speakers, more than three-quarters (76.6%, n = 1676) were males and females of White ethnicity and (23.4%, n = 511) were EM. The vast majority of speakers throughout the years were males (86%, n = 1891) with only 14% (n = 296) females regardless of their origin and ethnicity. The presence of EM females was only 1.9% (n = 43). The percentage of female representation rose consistently over time from 6.7% (n = 8) in 2009 to 21.1% (n = 44) in 2020, suggesting an upward trend. Regional distribution showed 31%, 63%, 3.6%, 1.6% and 0.2% from London, Rest of England, Scotland, Wales and Northern Ireland, respectively. Both gender and EM representation doubled in the last 2 years during the pandemic (p < 0.001). Conclusion(s): Annual BAUS meetings have seen a higher proportion of ethnic and gender representation in recent years. However, considering the workforce within urology, more needs to be done to address this historical disparity. Hopefully, the BAUS 10-point programme will provide a framework for addressing Equality, Diversity and Inclusion issues related to this bias. Level of Evidence: Not applicable.Copyright © British Association of Urological Surgeons 2022.

The pandemic, telemedicine, and andrology: what have we learned?

BACKGROUND: Telemedicine gained wide acceptance during the COVID-19 pandemic, as it was deemed critical for patient care when lockdowns were implemented worldwide. While there is evidence to suggest that urology patients were receptive to telemedicine, no systematic review has been done to date on andrology patients and their perception of telemedicine. METHODS: Three electronic databases, PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients "wishing for telemedicine consultation", "preferring telemedicine over in person", "accepting the current telemedicine arrangement", "having needs addressed with teleconsultation", or "willingness to do a teleconsultation". RESULTS: Of the 1128 retrieved abstracts, 56 underwent full-text review and 12 were included in the final analysis, comprising a total cohort of >4021 cases. Video visits were evaluated in 5 studies, telephone encounters were analyzed in 2 studies, and both methods were examined in 1 randomized control study. Three studies showed that andrology and sexual medicine are compatible with telemedicine, with few 30- and 90-day in-person revisit rates. Telemedicine was shown to save an average cost of US$149-$252 per patient, and 8 studies that directly assessed andrology patient perceptions of telemedicine showed that most patients had a "positive perception."Pooled analyses of the positive responses to telemedicine were 68.7% (95% CI, 49.4%-83.1%, P = 0.057), and those of patients who recommended telemedicine were 65.1% (95% CI, 18.4%-93.9%, P = 0.577). While the percentage of patients recommending telemedicine was high among studies using videoconferencing, the percentage dropped in studies using telephone visits only. The difference between recommending video and telephone practices was statistically significant, with 84.6% pooled proportion for recommending video practice compared to 38.9% pooled proportion for recommending telephone practice, P = 0.035. In the telephone-only encounters, up to 27.1% of patients preferred in-person visits, as security and privacy of any mode of telecommunication were of concern. CONCLUSIONS: Most patients have a positive perception of telemedicine, particularly with videoconferencing and less so with telephone visits. These results suggest that telemedicine will likely continue to play a pivotal role in andrology and sexual medicine practices.

Evaluation of Online Andrology Medical Services in Central Regions of China During the COVID-19 Pandemic: A Cross-Sectional Data Analysis Study.

To provide an overview of the current situation, challenges, and trends in online medical services from the perspective of andrology and promote the development of online medical services. Users of the Learning Alliance of Urology, who mainly worked in central regions of China, were invited to complete the questionnaire that included information on the participants and their institutions and their involvement in and concerns for online medical services. We received 875 complete responses. The percentage of online andrology patients at most institutions was less than 30%. The most common services were online appointment registration (92.7%) and online payment (81.8%). Online chat consultation (77.7%) was the most common form of consultation. Only 1 in 5 of the institutions had constructed their Internet hospital. Factors related to the percentage of online andrology patients included specialized andrology clinics and wards, sufficient time for doctors to provide online services, more diversified services, and online clinic training. The biggest challenge for online medical services was diagnosis and treatment safety. It is essential to raise awareness of online medical services for hospitals and patients and strengthen standardized management and training of online medical services, especially applicable to central regions of China. However, online medical services cannot wholly replace offline services due to insufficient diagnosis and treatment.

IVF laboratory COVID-19 pandemic response plan: a roadmap.

BACKGROUND: The potential of COVID-19 severe pandemic necessitates the development of an organized and well-reasoned plan for the management of embryology/andrology laboratories while safeguarding the wellbeing of patients and IVF staff. MAIN BODY: A COVID-19 pandemic response plan was proposed for embryology and andrology laboratories for pre-pandemic preparedness and pandemic management in anticipation of a possible second coronavirus wave. Preparation involves many plans and logistics before a pandemic risk rises. Many operational changes can be considered during the pandemic. This plan includes logistical arrangements, reducing labor needs, conserving supplies, and protective measures for embryologists and gametes/embryos. CONCLUSION: The unpredictable emergence of the COVID-19 pandemic dictates the need for a preparedness plan for embryology/andrology laboratories, which includes an action-oriented plan to secure the safety of all stakeholders.

The impact of COVID-19 pandemic on reconstructive urologic surgery and andrology Spanish units' practice during the state of alarm in 2020: National survey.

INTRODUCTION: In Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as "non-urgent" (andrology and reconstructive surgery) were postponed or even unattended. MATERIAL AND METHODS: In May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties. RESULTS: We observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails). CONCLUSIONS: The negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined.

Staying connected in a disconnected COVID world with urology podcasts. A review of the growing trend

Introduction: The outbreak of the Wuhan Covid-19 virus has had a significant impact across all industries. How we practice, medicine has seen substantial change. Consequently, medical education has diminished as it has not been deemed essential given the current climate. Here in Australia and other parts of the globe, experienced education restrictions across all the Health Science Universities and university hospitals. Given the substantial research output in Urology and the necessity of local, national, and global conferences, education within the specialty has suffered. Therefore, there has been significant demand for medical education to be delivered through alternative mediums. In contrast to the Spanish flu of 1918- 1920, we have the luxury of modern technology and a plethora of platforms to deliver education in the field of Urology. One such platform is podcasts. Aim: We aim to investigate whether the Urology industry has invested in podcasts since the outbreak of COVID-19 to combat this educational dilemma. Methods: On October 12th, 2021, we searched the term Urology on Spotify. We excluded all non-English podcasts that were not Urology-focused, podcasts that didn't make Urology the focus, and channels that didn't show continued and consistent output, i.e., < 5 episodes. We included all podcasts that focused on Urology education, non-English podcats that were clearly Urology focused (i.e., Anotomia Urologica), and included podcats on sexual health that had a Urology focus (i.e. 'The Full release'). Results: We obtained 97 podcasts on the Spotify search engine using the above criteria. After excluding podcats based on our above methodology, we had 63 results. Of the 63 results, 33 were in English. Out of the 33 in English, one was on andrology, four on urological products, one on sexual health, two on Urology anecdotes, two on prostate health, 14 on general Urology education for trainees, two on urology pediatrics, 3 were patientfocused, three were for guideline updates and one on the news in Urology. Of the 63 podcasts, 53 were created post the outbreak of the COVID-19 outbreak. Conclusion: In conclusion, 84% of educational Urology podcasts today have been created post the outbreak of the COVID-10 outbreak, confirming our hypothesis.

[The impact of COVID-19 pandemic on reconstructive urologic surgery and andrology Spanish units' practice during the state of alarm in 2020: National survey]. / Impacto de la pandemia en la actividad de las unidades de cirugía reconstructiva urológica y de andrología en España durante el estado de alarma (COVID-19) en 2020: resultados de una encuesta nacional.

Introduction: In Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as «non-urgent¼ (andrology and reconstructive surgery) were postponed or even unattended. Material and methods: In May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties. Results: We observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails). Conclusions: The negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined.

ELEVATED ROS LEVELS AND DNA FRAGMENTATION IN SPERM FROM CONVALESCENT MEN IN SARS-COV-2 INFECTION

INTRODUCTION AND OBJECTIVE: Current evidence has proven the systemic nature of COVID19, including its involvement in the male reproductive tract. We aimed to investigate seminal parameters of moderate-to-severe COVID-19 men during the convalescence phase. METHODS: This cross-sectional study included 18 to 50-yearold men with confirmed moderate-to-severe COVID-19. Patients were enrolled 15 to 45 days after the diagnosis. After a urologist's initial clinical evaluation, semen samples were obtained by masturbation and processed within one hour. Semen analysis was performed using the World Health Organization (WHO) manual (6th edition). Sperm function tests were conducted in an andrology laboratory, including Reactive oxygen species (ROS), DNA fragmentation, lipid peroxidation, and Creatine Kinase (CK) analysis. An essential endocrine evaluation was performed. Patients with a history of disorders that could impair testicular function were excluded. A group of pre-vasectomy baseline samples was used as a control group. Statistical analysis was performed using R version 4.0.5. One-tailed and paired T-tests were used for comparisons between groups. RESULTS: The sample size was 26 men (mean 34.3±6.5 years;range: 21-50 years). Sperm concentration (mean 38.74±32, P <0.01) and total motile count (mean 55.3±66.8, P <0.01) were significantly reduced in the COVID-19 group. The DNA fragmentation (mean 41.1±29.2) and ROS (mean 4.84±8.7) were significantly higher in post-infection patients. Other parameters such as WHO/ Kruger morphology and progressive motility were also reduced in the disease group, albeit not statistically significant. Total testosterone (mean 409.2±201.2) was lower in the convalescent men. All semen samples were negative for SARS-CoV-2 using the PCR analysis. CONCLUSIONS: Our findings indicate that male reproductive injury can be a relevant component of SARS-CoV-2 systemic infection. High DNA fragmentation and ROS, hallmarks of tissue injury, might signal a direct testicular involvement. The morphological and functional damage could represent significant impairment of the male reproductive health if persistent after convalescence.

ANDROLOGY IN THE ERA OF COVID

OBJECTIVE: The last year has represented a challenging time for andrology laboratories due to the COVID-19 pandemic. Public health guidelines and government regulations intended to reduce the spread of COVID-19 caused a shift in patient practices across healthcare. They impacted the infertility laboratory by changing where and how semen samples are collected. The current study compared the quality of semen being collected for routine semen analysis (SA), and therapeutic IUI cycles, comparing the first year of the pandemic with the previous twelve-month period in a regional fertility center. MATERIALS AND METHODS: Institutional rules, public health guidelines, and government regulations required the majority (> 98%) of semen samples collected at a regional fertility center to be collected off-site starting March 18th, 2020. The center serves a catchment basin of approximately 300 miles in diameter, meaning some patients might travel for 1-2 hrs to deliver samples collected at home or have to make other arrangements for a collection location closer to the laboratory. To determine what impact the delay in processing and other factors, such as stress, might be having on semen quality, the center conducted a study comparing the standard semen parameters in two arms. The COVID-19 arm were patients seen from March 18th, 2020 to March 17th, 2021, and they were compared to the Pre-COVID-19 arm, who were seen from March 18th, 2019 to March 17th, 2020. Semen Analysis parameters analyzed for all samples included volume, concentration/mL, motility, morphology, total concentration, and total motile concentration. IUI samples were also analyzed for post-wash total concentration and total motile concentration. Resulting Data were compared using student's T-test. RESULTS: A total of 423 SA and 378 IUI records were compared. As expected, off-site collection significantly increased the time from collection to completion of the procedure (P < 0.001). Numerous semen parameters of the standard semen analysis were 10-20% lower in the pandemic year when collecting off-site than the same parameter in the 12 months before the pandemic when on-site collection was used. Focusing on IUI data, the average processing time from collection to finish increased 26 to 48 mins (p < 0.006). Average Total motile sperm has decreased from 49 to 42 million (14%;P < 0.05) between groups. Pregnancy data is pending. CONCLUSIONS: The pandemic has presented challenges to all reproductive centers. The challenges appear to have had a negative effect on the overall semen quality of patients. While it is unclear how much of an impact delays in processing are having, the data is highly suggestive they are impacting patient treatment. IMPACT STATEMENT: While delivery of reproductive health care continued during the pandemic, changes in public health guidelines and governmental regulations have impacted patient care thereby causing a reduction in semen quality. Public health officials and practices may need to reevaluate how semen samples are collected for diagnostics and treatment to mitigate this reduction in quality while maintaining the overall health of patients and staff.

CRYOPRESERVED SEMINAL SAMPLES FROM PATIENTS WITH ACUTE COVID-19 HAVE THE WORST POST-THAW QUALITY WHEN COMPARED TO OTHER ANDROLOGICAL DISEASES

OBJECTIVE: To evaluate the effect of COVID-19 in sperm cryopreservation processes, including functional parameters evaluated pre-cryopreservation and post-thaw, and to compare post-thaw results from COVID-19 patients to samples from others systemic and andrological Disease MATERIALS AND METHODS: In this cross-sectional study, 37 semen samples of male patients aged 18 to 45 years at Division of Urology, Department of Surgery, Hospital das Clinicas of the University of Sao Paulo or at Androscience- Science and Innovation Center in Andrology, High-Complex Clinical and Research Andrology Laboratory, were initially recruited from April 2020 to April 2021. Patients were categorized as acute COVID-19 (n=15), confirmed by RT-PCR (COVID-19 group), and healthy individuals with normozoospermic semen samples (n=22;Control group). Were evaluated seminal parameters, cryosurvival rates (%), mitochondrial activity (%;3,30 -diaminobenzidine stain), reactive oxygen species levels (ROS;chemiluminescent technique) and DNA fragmentation (%;SCSA method) in precryopreservation and post-thaw samples. Samples were cryopreserved by the slow freezing technique. A complementary retrospective study was performed comparing post-thawed samples from COVID-19 group with data from patients with others male diseases: Male infertility (n=35);Severe infertility (n=62), caused severe oligozoospermia, grade 3 varicocele, gonadal dysgenesis, testicular nodule, testicular hypotrophy;testicular cancer (n=55);and other malignant diseases (leukemia, lymphoma, sarcoma, multiple myeloma;n=30). Was used T-test to statistical analysis (p<0.05). RESULTS: Macroscopy analysis of COVID-group revealed abnormal viscosity in 53.33%, semen volume = 4.50 ± 1.72 ml and pH = 8.13 ± 0.23. COVID-19 fresh samples demonstrated mean of progressive motility = 29.07±16.83%, sperm morphology = 2.07±1.58%, and DNA fragmentation index = 42.91±33.38%. Cryopreservation decreased progressive motility (to 5.39±7.92%;p=0.02), sperm vitality (70.46±8.50 vs. 72.20±23.27;p=0.042) and ROS (0.516±0.978 vs. 4.393±9.956 x 104 cpm;p=0.018). When we compared with cryopreserved normozoospermic samples, there was observed a significant difference in HDS (p=0.002). Cryosurvival rate from COVID-19 samples was 19.93;19.71%, and had significant difference when compared with severe infertility (40.16;31.05%;p=0.003), and other malignant diseases (53.14;28.55%, <0.001). CONCLUSIONS: Seminal samples from patients with COVID-19 showed reduced fertile potential, especially when compared to the reference values. In the comparisons performed with samples from patients with different andrological diagnoses, common in the specialized andrology laboratory routine, we can suggest that samples from patients with the acute form of COVID-19 had the worst quality, with low cryosurvival rates. This information contribute to the conduct of these patients during assisted reproduction routines and preservation of male fertility. IMPACT STATEMENT: It will contribute to conducts in the cryopreservation of sperm in patients with acute COVID-19.

EFFECT OF COVID-19 mRNA VACCINES ON SPERM QUALITY

OBJECTIVE: Fertility related safety data was neither reported in the clinical trials nor evaluated in animal models prior to emergency use authorization (EUA) for two novel mRNA vaccines, BNT162b2 and mRNA-127.1,2 Despite excellent safety profiles for both vaccines, 44% of Americans are hesitant in receiving the vaccine. Although the specific reasons for COVID-19 vaccine hesitancy are unknown, concerns over fertility has previously decreased other vaccine uptake. As COVID-19 vaccination in the United States opens to children and adolescents, evaluating any potential impact of the vaccine on male reproduction is imperative for public reassurance. We hypothesized that since both vaccines only contain mRNA encoding the SARS-CoV-2 spike protein without biologic ability to replicate live virus, the vaccines would not decrease semen parameters. MATERIALS AND METHODS: We conducted a single-center prospective cohort study after IRB approval from the University of Miami (#20201451). Healthy men aged 18-50 scheduled for mRNA COVID-19 vaccination in Miami, Florida were recruited.Participants provided a semen sample after 2-7 days of abstinence, prior to receiving the first dose of either vaccine and about 72 days after the second dose. Specimens were self-collected into a wide-mouth sterile container and semen analysis (SA) performed by HCLD trained andrology clinicians examined semen volume, concentration, motility, and total motile sperm count (TMSC). RESULTS: 45 men provided a semen sample. Neither median sperm concentration nor total motile sperm count (TMSC) declined post vaccination (Figure 1). There was no clinically significant change in TMSC. Only 12 (26.6%) men had a marginal decrease in TMSC. In fact, the remaining 33 (73.3%) men demonstrated normal sperm parameters. Importantly, 8 (17%) men with oligospermia prior to vaccination did not experience a decrease in spermatogenesis. Only one subject had an abnormal TMSC (TMSC ≤ 9) after vaccination. CONCLUSIONS: After receiving the two doses of the vaccines, we did not observe a clinically significant sperm parameter decline within the cohort, suggesting the vaccines do not negatively impact male fertility potential. IMPACT STATEMENT: This is the first male fertility evaluation of the COVID-19 mRNA vaccines, in which we found that the vaccines do not negatively impact semen parameters. (Table Presented).

THE USE OF ONLINE TOOLS AND APPLICATIONS AS AN ADAPTATION FOR SCIENTIFIC EDUCATION IN ANDROLOGY DURING THE COVID-19 PANDEMIC

OBJECTIVE: To determine online tools and applications for scientific education in andrology during the COVID-19 pandemic. MATERIALS AND METHODS: Amid the COVID-19 pandemic and its ensuing restrictions, the American Center for Reproductive Medicine (ACRM) at Cleveland Clinic, organized several fully virtual programs, namely, the Online Summer Mentorship in Scientific Writing (June - August 2020, 28 participants) and Online Training in Assisted Reproductive Technology (ART) (December 2020 - March 2021, 2444 participants). ACRM adapted its annual training programs to an entirely virtual platform, which was achieved using online communication tools such as WhatsApp, Dropbox, Instagram, Facebook, LinkedIn, Cisco WebEx, and email correspondence. To determine the perception of the participants towards the use of such tools in the organization and delivery of these online training programs, the participants answered surveys at the end of each program. This study reports the results obtained from 2472 respondents of these surveys. RESULTS: In terms of preference for online communication platforms between students, mentors and management, the 28 participants of the inaugural Online Summer Mentorship program rated their applications usage preference as WhatsApp (32.1%), Google Meet (28.6%), Skype (17.9%), e-mail (14.3%) and Zoom (7.1%). Similarly, more than 80% of the 2,444 participants of the Online Training in ART program rated the sharing of information using the various electronic platforms as either very good or excellent. Here, the preferred platform appeared to be WhatsApp, with a rating of 86% compared to Dropbox (85%), or Cisco WebEx (81%). A total of 58.1% of the participants strongly agreed that WhatsApp was used effectively to share detailed information and materials about the course. CONCLUSIONS: Among the various communication applications and tools used for the ACRM online programs during the COVID-19 pandemic, WhatsApp appeared to be one of the preferred tools by the participants for networking and collaborations. This study provides an example of utilization of online tools and applications to support organization and continuity in scientific education in Andrology, amidst the physical distancing and travel restrictions imposed during the current COVID-19 pandemic. IMPACT STATEMENT: Routinely used online communication tools are valuable and accessible resources for delivery of knowledge, organization of training programs and sharing of data in academic and scientific education in Andrology during the COVID-19 pandemic.

COVID Pandemic Impact on Healthcare Provision and Patient Psychosocial Distress: A Multi-National Cross-Sectional Survey among Asia-Pacific Countries.

PURPOSE: COVID pandemic significantly affected the delivery and maintenance of healthcare system, resulting in greater utilization of digital health interventions. MATERIALS AND METHODS: This multi-national cross-sectional survey was administered to clinicians working in major Asia-Pacific cities during the mandatory social lockdown period in June 2020. Clinical demographics and professional data, delivery of Andrology-related healthcare services, and patient distress based on validated questionnaires such as Depression and Anxiety Stress Scales (DASS) and Decisional Engagement Scale (DES) were collected. RESULTS: Telehealth medicine was instituted in all the centres with the majority of centres (92.9%) reported a 50% or more reduction in out-patient related services. The numbers of phone calls, emails correspondence and educational webinars have significantly increased. Despite the provision of reasons for changes in healthcare service and delay in surgery, more than half of the patients (57.1%) rated 2 on the DASS score for the item on patients over-react to situations, while a third of the patients (35.7%) scored a 2 for DASS item on patients being more demanding or unreasonable. The DES scores were more positive with most patients reported a score above 7 out of 10 in terms of items on accepting current arrangement (85.7%), confident in clinician decision-making about treatment (92.9%) and comfortable that the decision is consistent with their preferences (71.4%). Most patients (85.7%) indicated their preferences for more detailed information on healthcare provision. CONCLUSIONS: Our study showed telehealth services were integrated early and successfully during the COVID pandemic and patients were generally receptive with minimal psychosocial distress.

A Web-Based Global Educational Model for Training in Semen Analysis during the COVID-19 Pandemic.

PURPOSE: In response to the COVID-19 pandemic, the American Center for Reproductive Medicine (ACRM) transitioned its annual training in assisted reproductive technology (ART) from a hands-on, laboratory-based training course to a fully online training endorsed by the American College of Embryology. Here we describe our experience and assess the quality of an online training format based on participant outcomes for the first three modules of a planned series of online ART training. MATERIALS AND METHODS: These modules included manual semen analysis, sperm morphology and ancillary semen tests (testing for leukocytospermia, sperm vitality, and anti-sperm antibody screening). The virtual format consisted of lecture presentations featuring laboratory protocols with corresponding video demonstrations of routine techniques and best practices. Practical scenarios, troubleshooting, and clinical interpretation of laboratory results were also discussed. At the end of each module, an optional multiple choice question test was held as a prerequisite to obtain certification on the topics presented. Course quality was assessed using participant responses collected via online surveys. RESULTS: The digital delivery methods used were found to have largely or completely met the participants' expectations for all questions (>85%). The majority (>87%) of the participants either strongly agreed or agreed that the course content was well-structured with appropriate depth, and that their overall expectations of the course had been met. CONCLUSIONS: This training format appears to be a realistic teaching option to freely share highly specialized expertise and technical knowledge with participants from anywhere in the world with varying levels of competency or experience.

An online educational model in andrology for student training in the art of scientific writing in the COVID-19 pandemic.

In 2020, the COVID-19 pandemic led to the suspension of the annual Summer Internship at the American Center for Reproductive Medicine (ACRM). To transit it into an online format, an inaugural 6-week 2020 ACRM Online Mentorship Program was developed focusing on five core pillars of andrology research: scientific writing, scientific methodology, plagiarism understanding, soft skills development and mentee basic andrology knowledge. This study aims to determine mentee developmental outcomes based on student surveys and discuss these within the context of the relevant teaching and learning methodology. The mentorship was structured around scientific writing projects established by the team using a student-centred approach, with one-on-one expert mentorship through weekly formative assessments. Furthermore, weekly online meetings were conducted, including expert lectures, formative assessments and social engagement. Data were collected through final assessments and mentee surveys on mentorship outcomes. Results show that mentees (n = 28) reported a significant (p < .0001) improvement in all criteria related to the five core pillars. These results illustrate that the aims of the online mentorship program were achieved through a unique and adaptive online educational model and that our model has demonstrated its effectiveness as an innovative structured educational experience through the COVID-19 crisis.

Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic caused unprecedented restrictions in outpatient services and surgical practices in urology as in other medical branches as well as in all areas of life. AIM: To investigate whether there have been variations in the presentations of male patients with sexual and reproductive health problems to the outpatient urology clinics during the COVID-19 pandemic and to understand the underlying factors for these variations, if any. METHODS: Male patients aged ≥18 years who presented to the outpatient urology clinics in 12 centers across Turkey from February 1, 2020 to June 1, 2020 were retrospectively evaluated. The patients were divided into 2 groups: those who presented to the outpatient clinic from February 1, 2020 to March 11, 2020 comprised the "pre-COVID-19 pandemic period" group, whereas those who presented to the outpatient clinic from March 12, 2020 to June 1, 2020 comprised the "COVID-19 pandemic period" group and compared with each other. MAIN OUTCOME MEASURES: The main outcome of this study was the number and diagnose of patients presented to urology outpatient clinics. RESULTS: Andrological problems were detected in 721 of 4,955 male patients included in the study. During the COVID-19 pandemic period, there was a significant increase in andrological diagnosis in these patients compared with the pre-COVID-19 pandemic period (n = 293 [17%] vs n = 428 [13.2%], P < .001, respectively). Similarly, there was a statistically significant increase in the number of patients diagnosed with male reproductive or sexual health problems during the COVID-19 pandemic period (n = 107 [6.2%] vs n = 149 [4.6%], P = .016 and n = 186 [10.8%] vs n = 279 [8.6%], P = .013, respectively). The number of patients diagnosed with erectile dysfunction during the pandemic was also significantly higher than the pre-COVID-19 pandemic period (n = 150 [8.7%] vs n = 214 [6.6%], P = .008). CONCLUSION: Presentations to the outpatient urology clinics owing to andrological problems markedly increased during the pandemic period. Although these problems are of multifactorial origin, psychogenic factors are also considered to significantly trigger these problems.MB Duran, O Yildirim, Y Kizilkan, et al. Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study. Sex Med 2020;XX:XXX-XXX.