Direct-To-Consumer Internet Prescription Platforms Overlook Crucial Pathology Found During Traditional Office Evaluation of Young Men With Erectile Dysfunction.

Autor: Shahinyan RH; Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Amighi A; Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Carey AN; Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Yoffe DA; Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Hodge DC; Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Pollard ME; Scott Department of Urology, Baylor College of Medicine, Houston, TX., Nork JJ; United States Naval Hospital, Guam., Mills JN; Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Eleswarapu SV; Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: SEleswarapu@mednet.ucla.edu.
Jazyk: angličtina
Zdroj: Urology [Urology] 2020 Sep; Vol. 143, pp. 165-172. Date of Electronic Publication: 2020 Jun 11.
DOI: 10.1016/j.urology.2020.03.067
Abstrakt: Objective: To determine comorbidities in young men with erectile dysfunction (ED) who are increasingly targeted by direct-to-consumer (DTC) internet platforms that sell phosphodiesterase-5 (PDE-5) inhibitors without comprehensive clinical evaluation; and, further, to characterize the portrayal of DTC platforms by popular news media.
Methods: We retrospectively reviewed all men age ≤40 evaluated for ED at an andrology clinic during January 2016-March 2019 to obtain demographics, exam and lab findings, and treatments. Five news sources were analyzed during the study period to characterize whether articles about DTC platforms were positive, critical, or balanced/neutral.
Results: We identified 388 patients, with age 29.5 ± 5.0 years, 15% rate of obesity, 20% prediabetes or diabetes, 54% dyslipidemia, and 20% hypogonadism. Serum lab findings associated with subfertility were found in 11%. Semen analysis was conducted in 64 men, of whom 40% were abnormal. Varicoceles were found in 35%. PDE-5 inhibitor was prescribed to 328 men (88%). Off-label empiric therapies included clomiphene (32.9%) or aromatase inhibitor (12.1%). Testosterone replacement was initiated in 9.7%. Analysis of news coverage revealed 18 articles, of which 61% portrayed DTC platforms exclusively in a positive light.
Conclusion: Office consultation identified young men with significant comorbidities that would be missed by DTC platforms, which employ only questionnaires for health screening. DTC platforms present themselves as medical authorities without following AUA Guidelines, yet garner mostly positive press coverage. Patients engaging these platforms may falsely believe they are receiving adequate medical assessment. Urologists may do well to incorporate telemedicine to enfranchise young men with evidence-based evaluation.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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