William D Steers

University of Virginia, Charlottesville, Virginia, United States

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Publications (194)847.17 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Myoendothelial junctions are specialised projections of cell : cell contact through the internal elastic lamina between endothelial cells and vascular smooth muscle cells. These junctions allow for endothelial cells and vascular smooth muscle cells to make direct membrane apposition and are involved in cell : cell communication. In this study, we evaluated for the presence of myoendothelial junctions in murine corporal tissue and used plasminogen activator inhibitor (PAI)-1-deficient mice, which lack myoendothelial junctions, to determine whether myoendothelial junctions affect erectile function. Transmission electron microscopy demonstrated the presence of myoendothelial junctions in the corporal tissue of wild-type mice and confirmed the decreased junction numbers in the tissue of PAI-1−/− mice. A potential role for myoendothelial junctions in tumescence was established; in that, PAI-1−/− mice demonstrated a significantly longer time to achieve maximal intracavernous pressure. Treatment of PAI-1−/− mice with recombinant PAI-1 restored the number of myoendothelial junctions in the corporal tissue and also induced a significant decrease in time to maximal corporal pressures. Myoendothelial junctions were similarly identified in the human corporal tissue. These results suggest a critical role for myoendothelial junctions in erectile pathophysiology and therapies aimed at restoring myoendothelial junction numbers in the corporal tissue may provide a novel therapy for erectile dysfunction.
    Andrologia 12/2014; DOI:10.1111/and.12395 · 1.63 Impact Factor
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    ABSTRACT: Lower urinary tract symptoms (LUTS) become prevalent with aging and affect millions; however, therapy is often ineffective because etiology is unknown. Existing assays of LUT function in animal models are often invasive, however a non-invasive assay is required to study symptom progression and determine genetic correlates. Here we present a spontaneous voiding assay which is simple, reproducible, quantitative and non-invasive. Young females from eight strains of inbred mice - 129S1/SvImJ, A/J, C57BL/6J, NOD/ShiLtJ, NZO/H1LtJ, CAST/EiJ, PWK/PhJ, and WSB/EiJ - were tested for urination patterns on filter paper. Repeat testing at different times of the day showed minimal within individual and within strain variation, but all parameters (spot number, total volume, percentage area in primary void, corner voiding and center voiding) exhibited significant variation between strains. Calculation of the intraclass correlation coefficient, an estimate of broad sense heritability (H2), for each time of day and for each voiding parameter, revealed highly significant heritability (spot number, 61%; percentage urine in primary void, 90%; total volume, 94% [afternoon data]). Cystometrograms confirmed strong strain-specific urodynamic characteristics. Behavior/voiding correlation analysis showed no correlation with anxiety phenotypes. Diagnostically, the assay revealed LUTS in several systems, including demonstration of voiding abnormalities in older C57BL/6J mice (18-24 months), in a model of protamine sulfate induced urothelial damage and in a model of sucrose-induced diuresis. This assay may be used to derive pathophysiological LUT readouts from mouse models. Voiding characteristics are heritable traits, opening the way for genetic studies of LUTS using outbred mouse populations.
    AJP Renal Physiology 04/2014; 306(11). DOI:10.1152/ajprenal.00074.2014 · 3.25 Impact Factor

  • The Journal of Urology 04/2014; 191(4):e150. DOI:10.1016/j.juro.2014.02.566 · 4.47 Impact Factor

  • Neurourology and Urodynamics 12/2013; 33(8). DOI:10.1002/nau.22518 · 2.87 Impact Factor
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    ABSTRACT: To determine if prostatic inflammation at the time of radical prostatectomy (RP) was associated with the International Prostate Symptom Score (IPSS). We performed a proof of principle analytic case control study of patients who underwent RP between January 2005 and August 2008 for lower urinary tract symptoms (LUTS). We reviewed pathology slides of those who had a change of 4 points or greater, as measured by the IPSS and correlated inflammation with change in IPSS. Multivariate linear regression analyses were performed to determine the association of IPSS with degree of inflammation based on the number of inflammatory cells. Of 249 patients, 136 had complete data and 47 (18.8%) underwent pathologic review. The median change in IPSS for the study cohort was -7.0 points compared to +1.0 point for the control cohort. On univariate analysis, the average improvement in IPSS in patients with severe inflammation was (r = -6.02, 95% confidence interval [CI] -11.0 to -1.1, P = .018) after RP. On multivariate analysis, adjusting for age, body mass index (BMI), year of surgery, history of prostatitis, Gleason score, prostate-specific antigen (PSA), prostate weight, and nerve sparing status, only patients with severe prostatic inflammation had significant improvement in their IPSS (r = -5.93, 95% CI -10.81 to -1.04, P = .004). Prostatic inflammation measured in prostatectomy specimens is associated with worse baseline IPSS than matched cohorts. Specifically, severe inflammation is an independent predictor of IPSS improvement at 1 year after RP.
    Urology 11/2013; 83(1). DOI:10.1016/j.urology.2013.07.080 · 2.19 Impact Factor
  • Seong Ho Lee · Jeffrey J Lysiak · William D Steers ·
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    ABSTRACT: Aims: To determine whether cavernous nerve injury (CNI) alters lower urinary tract function, we assessed bladder and urethral function over time in a mouse model of CNI. Methods: Twelve-week-old male C57BL/6 mice were divided into three groups: unoperated (UO; n = 6), sham-operated (SO; n = 18), and bilateral CNI (n = 30) group. At 1, 2, 4, 6, 8, 10 days bladder and urethral function were evaluated in these three groups using cystometry (CMG) and leak point pressure (LPP) recording under anesthesia. Results: There was no significant difference in maximum detrusor pressure between groups at all times. Compared with the UO group, bladder compliance, and capacity in the CNI group were significantly decreased at Days 1, 2, 4 (P < 0.05) and recovered gradually from Day 6 to Day 10. In the SO group, they were decreased at Day 1, however, recovered more rapidly than the CNI group. Non-voiding contractions (NVC) developed in the CNI group at all times. Intercontraction interval were significantly decreased in SO and CNI groups and recovered more rapidly in SO group. In the SO group NVC were observed only at Days 1 and 2. LPP in the CNI group was decreased significantly at Days 1 and 2 (P < 0.05) and rapidly recovered with time compared with the UO and SO groups. Conclusion: In a mouse model of CNI, a transient decrease in bladder compliance, capacity, LPP and increased NVC was observed. These changes gradually recovered from Day 6 after CNI. Our findings suggest that CNI may affect bladder and urethral function, but alterations are reversible.
    Neurourology and Urodynamics 09/2013; 32(7). DOI:10.1002/nau.22354 · 2.87 Impact Factor
  • William D. Steers ·
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    ABSTRACT: In this review I describe the history leading to the creation of the subspecialty of female pelvic medicine and reconstructive surgery and its fellowships, the process involved in the current requirements for subspecialty certification and fellowship applications, and the implications for urological training.Results and conclusionsThe route to subspecialty certification and fellowships for female urology in the USA is a lesson in politics, education, medical rivalries and perseverance, with the goal of improving care for women. This decade-long journey culminated in the recognition of a separate subspecialty by the American Board of Medical Specialties in 2011, accreditation by the American Council for Graduate Medical Education in2012, and certification to be awarded by the Boards of Obstetrics and Gynecology and Urology in 2013. It remains to be seen whether this effort will improve resident education and patient care, or represent a marketing tool in the competitive USA healthcare environment. While many of the details and regulatory issues are specific to the USA, elements of the curriculum and procedures should be relevant to other countries.
    Arab Journal of Urology 06/2013; 11(2):113-116. DOI:10.1016/j.aju.2013.01.003
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    ABSTRACT: Purpose: This systematic review focuses on the relationship between nocturia and depression/anxiety. Our objective is to provide an overview of current data on the epidemiology, pathophysiology and patient management implications of the association between nocturia and depression/anxiety. Materials and methods: We queried PubMed®, Web of Science® and Embase™ in July 2012 to identify abstracts, and original, review and editorial articles on nocturia and mood disorders, specifically depression and anxiety. The search was done using the key words "nocturia," "depression" and "anxiety." We complied with the Assessment of Multiple Systemic Reviews (AMSTAR) instrument. We retrieved a total of 500 records, including 95, 81 and 324 from PubMed, Web of Science and Embase, respectively. Results: Cross-sectional (level 3) data indicated that nocturia and depression/anxiety are strongly associated. One prospective study contended that depression leads to nocturia in a unidirectional relationship. Nocturia poses a greater risk for depression in men vs women. Results conflict on the effect of serotonin reuptake inhibitors on nocturia. Conclusions: The results of this systematic review suggest a bidirectional association between depression and nocturia. The relationship between anxiety and nocturia is less clear. Practicing clinicians should consider administering a brief self-administered scale to assess for depression in patients with nocturia.
    The Journal of urology 05/2013; 190(3). DOI:10.1016/j.juro.2013.03.126 · 4.47 Impact Factor
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    ABSTRACT: Introduction. Diabetes mellitus (DM) is a major risk factor for developing erectile dysfunction (ED) and men with DM are often less responsive to phosphodiesterase type 5 (PDE5) inhibitors than ED due to other causes. Aims. The aim of this study was to explore potential mechanisms whereby PDE5 inhibitors may have reduced efficacy in type 2 DM. Methods. At 4 weeks of age, mice were either fed a high-fat diet (HFD) for 22–36 weeks or fed regular chow (control). An additional group of mice in the same genetic background had a genetic form of type 1 DM. Main Outcome Measures. Glucose tolerance testing, intracorporal pressures (ICPs), oxidative stress (OS), apoptotic cell death (active caspase-3 and apostain), PDE5, p53, and cyclic guanosine monophosphate (cGMP) levels, and histological examination of inflow arteries were performed in mice fed a HFD and control mice. A group of mice with type 1 DM were studied for PDE5 expression levels. Results. All mice fed a HFD had impaired glucose tolerance compared with the age-matched mice fed on standard chow diet (control). HFD fed mice had reduced maximum ICPs following in vivo cavernous nerve electrical stimulation and increased apoptotic cell death, OS, and p53 levels in the corporal tissue. Interestingly, PDE5 levels were increased and cGMP levels were decreased. In contrast, mice with type 1 DM did not have increases in PDE5. Conclusions. Taken together, our results suggest that type 2 DM-induced ED is associated with findings that could lead to reduced cGMP and may account for reduced efficacy of PDE5 inhibitors. Ellati RT, Dokun AO, Kavoussi PK, Steers WD, Annex BH, and Lysiak JJ. Increased phosphodiesterase type 5 levels in a mouse model of type 2 diabetes mellitus. J Sex Med **;**:**–**.
    Journal of Sexual Medicine 07/2012; 10(2). DOI:10.1111/j.1743-6109.2012.02854.x · 3.15 Impact Factor
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    ABSTRACT: We examined the association between the use of medications and the prevalence of urinary incontinence in gender specific analyses of a community based, representative sample. A population based epidemiological study was conducted of 5,503 men and women 30 to 79 years old residing in Boston, Massachusetts (baseline data collected from 2002 to 2005). Urological symptoms were ascertained in a 2-hour, in person interview. Urinary incontinence was defined as urine leakage occurring weekly or more often during the last year. Medications used in the last month were considered current use. Associations of 20+ medications and prevalent urinary incontinence were examined using multivariate logistic regression (ORs and 95% CIs) with adjustments for known urinary incontinence risk factors. The prevalence of urinary incontinence in the analysis sample was 9.0% in women and 4.6% in men. For women the prevalence was highest among users of certain antihistamines (28.4%) and angiotensin II receptor blockers (22.9%). For men the prevalence was highest among angiotensin II receptor blocker (22.2%) and loop diuretic (19.1%) users. After final multivariate adjustment there were significant positive associations for certain antihistamines, beta receptor agonists, angiotensin II receptor blockers and estrogens with urinary incontinence in women (all ORs greater than 1.7), and a borderline significant association for anticonvulsants (OR 1.75; 95% CI 1.00, 3.07). Among men only anticonvulsants were associated with urinary incontinence after final adjustments (OR 2.50; 95% CI 1.24, 5.03), although angiotensin II receptor blockers showed an adjusted association of borderline significance (OR 2.21; 95% CI 0.96, 5.10). Although a cross-sectional analysis cannot determine causality, our analysis suggests certain medications should be further examined in longitudinal analyses of risk to determine their influence on urological symptoms.
    The Journal of urology 05/2012; 188(1):183-9. DOI:10.1016/j.juro.2012.02.2575 · 4.47 Impact Factor

  • The Journal of Urology 04/2012; 187(4):e659. DOI:10.1016/j.juro.2012.02.1448 · 4.47 Impact Factor
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    ABSTRACT: Microdissection testicular sperm extraction markedly improves the sperm retrieval rates in men with nonobstructive azoospermia. However, localizing sperm foci can be time-consuming and it is not always successful. Fiberoptic confocal fluorescent microscopy offers the advantage of rapid in vivo detection of fluorescently labeled sperm in the seminiferous tubules. After establishing the feasibility of fiberoptic confocal fluorescent microscopy to identify antibody labeled sperm in vivo C57/B6 mice underwent intraperitoneal injection of busulfan to induce azoospermia. During spermatogenesis reestablishment at approximately 16 weeks the mice were anesthetized and the testes were delivered through a low midline incision. Fluorescein isothiocyanate labeled antibody to intra-acrosomal protein Hs-14 was injected retrograde into a single murine rete testis. The testes were imaged in vivo with fiberoptic confocal fluorescent microscopy and sperm foci were detected. The respective seminiferous tubules were excised and squash prepared for immunofluorescence microscopy. Sperm foci were identified in the testis injected with fluorescently tagged antibody by in vivo fiberoptic confocal fluorescence microscopy. The contralateral control testis of each mouse showed no specific signal. Immunofluorescence microscopy of the excised tubules provided morphological confirmation of the presence of labeled sperm with an absence in controls. Findings were consistent in the feasibility portion of the study and in the busulfan model of nonobstructive azoospermia. Fiberoptic confocal fluorescent microscopy was feasible during microdissection testicular sperm extraction in an azoospermic mouse model to identify fluorescently labeled sperm in vivo. Translation to the clinical setting could decrease operative time and improve the sperm harvest rate.
    The Journal of urology 03/2012; 187(5):1918-23. DOI:10.1016/j.juro.2011.12.053 · 4.47 Impact Factor
  • William D Steers ·

    European Urology 12/2011; 61(5):885-6; discussion 886-7. DOI:10.1016/j.eururo.2011.12.035 · 13.94 Impact Factor
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    ABSTRACT: Lower urinary tract symptoms (LUTS) such as urinary frequency and urgency are bothersome and associated with reduced quality of life. Atypical antipsychotics (AAPs) have been implicated in increasing the risk of urinary incontinence. In a large community-based sample of men and women, we examined the associations of AAP and selective serotonin reuptake inhibitor (SSRIs) use with LUTS. Data were collected (2002-2005) from a generalizable sample of Boston, MA, USA, residents aged 30-79 (N = 5503). LUTS were assessed using the American Urologic Association Symptom Index (AUA-SI). The prevalence of clinically-significant LUTS was estimated using a cutoff AUA-SI score of 8+ to indicate moderate-to-severe symptoms. Confounder-adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated from multivariate logistic regression to estimate the associations for psychoactive drugs used in the previous month (SSRIs, AAPs, both) and LUTS. Among women, AAP users had a higher prevalence of LUTS (46.2%) compared with SSRI users (23.5%) and those with depressive symptoms not using SSRIs or AAPs (26.3%). Corresponding prevalence estimates among men were 32.7%, 29.8%, and 33.3%. In multivariate models, AAP use was significantly associated with LUTS among women when used either with (OR = 2.72, 95% CI:1.45-5.10) or without (OR = 3.05, 95% CI:1.30-7.16) SSRIs, but SSRI use without AAP use was not associated with LUTS compared with nonusers without depressive symptoms. No associations were observed among men. In our study, AAPs but not SSRIs were associated with increased prevalence of LUTS among women only. Further prospective research is needed to determine time sequence and cause and effect.
    European Journal of Clinical Pharmacology 12/2011; 68(5):783-91. DOI:10.1007/s00228-011-1170-9 · 2.97 Impact Factor
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    SA Hall · NN Maserejian · CL Link · WD Steers · JB McKinlay ·

    International braz j urol 12/2011; 37(6):796-797. DOI:10.1590/S1677-55382011000600027 · 0.88 Impact Factor

  • The Spine Journal 10/2011; 11(10):S110. DOI:10.1016/j.spinee.2011.08.273 · 2.43 Impact Factor
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    ABSTRACT: We examined the evaluation of and management for lower urinary tract symptoms/benign prostatic hyperplasia by physician specialty (urologist vs primary care physician). The BPH Registry and Patient Survey is a longitudinal, observational, disease registry cohort of patients enrolled from January 2004 to February 2005 in the United States. The survey examines patient outcomes and physician practice patterns in the management of lower urinary tract symptoms associated with clinical benign prostatic hyperplasia. It includes 402 urologist and primary care physician practices throughout the United States. Included in this study were 6,924 men with lower urinary tract symptoms/benign prostatic hyperplasia managed by watchful waiting or medical therapy. Data were collected on demographics, clinical characteristics and lower urinary tract symptoms/benign prostatic hyperplasia management using physician and patient completed forms. Multivariate analysis was done by physician specialty. Based on multivariate analysis urologists were more likely than primary care physicians to perform urinalysis (OR 3.9), serum prostate specific antigen (OR 1.2) and post-void residual urine (OR 18.9) measurement, uroflowmetry (OR 17.3), prostate ultrasound (OR 7.7) and biopsy (OR 3.5), renal ultrasound (OR 4.0) and cystoscopy (OR 4.6) but less likely to measure creatinine (OR 0.1). Men seeing urologists were twice as likely as men seeing primary care physicians to be treated with benign prostatic hyperplasia medical therapy vs watchful waiting. Significant differences by physician specialty were also observed for specific benign prostatic hyperplasia medical therapies. Significant differences in practice patterns were observed between primary care physicians and urologists in the evaluation of and management for lower urinary tract symptoms/benign prostatic hyperplasia. These data establish valuable benchmarks and identify possible interventions that may improve the standard of care.
    The Journal of urology 09/2011; 186(3):971-6. DOI:10.1016/j.juro.2011.04.081 · 4.47 Impact Factor
  • Andrew J Lightfoot · Henry M Rosevear · William D Steers · Chad R Tracy ·
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    ABSTRACT: We assessed the need for academic urologists in 2010 and for the following 5 years. An 8-question survey was emailed to the 115 accredited academic urology residency programs recognized by the American Urological Association. Questions were related to the anticipated number of hires during the next 5 years, ideal minimum level of training, areas of expertise needed, current top need and allotted research time. Of 115 chairs or division heads 91 (79%) responded to the survey. Of all chairs 71% (65 of 91) expect to hire 2 to 4 physicians in the next 5 years. In total 91 chairs will be attempting to fill 292 openings. When carried out to 115 chairs, there will be 369 openings in the next 5 years (or 74 per year). The ideal minimum level of training was cited as clinical/research fellowship (37.1%), clinical fellowship (33.6%) and residency (10.5%). Areas of expertise needed most from each respective program include female urology/neurourology (51.7%), oncology (44.8%), and pediatrics and general urology (36.8%). The current top needs for respective programs include pediatrics 23.3%, female urology/neurourology 21.1% and oncology 18.9%. Of the chairs and division heads currently attempting to fill positions 53.5% have been searching for 2 or more years. There will be a tremendous need for academic urologists in the next 5 years. This need is thought to be due to an increased number of physicians retiring and decreased level of compensation compared to private practice.
    The Journal of urology 06/2011; 185(6):2283-7. DOI:10.1016/j.juro.2011.02.058 · 4.47 Impact Factor

  • The Journal of Urology 04/2011; 185(4). DOI:10.1016/j.juro.2011.02.1994 · 4.47 Impact Factor

  • The Journal of Urology 04/2011; 185(4). DOI:10.1016/j.juro.2011.02.2425 · 4.47 Impact Factor

Publication Stats

8k Citations
847.17 Total Impact Points


  • 1990-2014
    • University of Virginia
      • • Department of Medicine
      • • Department of Urology
      • • Department of Obstetrics and Gynecology
      Charlottesville, Virginia, United States
  • 2011
    • New England Research Institutes
      Watertown, Massachusetts, United States
    • University of Iowa
      • Department of Urology
      Iowa City, Iowa, United States
  • 2008
    • The National Institute of Diabetes and Digestive and Kidney Diseases
      베서스다, Maryland, United States
    • University of Texas Southwestern Medical Center
      • Department of Urology
      Dallas, Texas, United States
  • 2007-2008
    • Virginia Commonwealth University
      • Division of Urology
      Richmond, Virginia, United States
    • University of Toronto
      Toronto, Ontario, Canada
  • 1998-2004
    • Virginia Department of Health
      Ричмонд, Virginia, United States
  • 2003
    • Chungnam National University
      Daiden, Daejeon, South Korea
  • 1995-1999
    • Walter Reed National Military Medical Center
      • Department of Surgery
      Washington, Washington, D.C., United States
  • 1988-1994
    • University of Pittsburgh
      • • Department of Urology
      • • Department of Medicine
      Pittsburgh, Pennsylvania, United States
  • 1993
    • Mayo Clinic - Rochester
      Рочестер, Minnesota, United States