About

Dr. Sriram V. Eleswarapu is an Associate Clinical Professor and a physician-scientist specializing in urological quality of life in men. His clinical and surgical practice focuses on male infertility, low testosterone, erectile and ejaculatory dysfunction, Peyronie's disease, testicular pain, prostate enlargement, and other male urologic conditions. He has advanced training in andrology, microsurgery, and penile implant surgery. His laboratory research concentrates on urological biomaterials development, tissue engineering, and 3D modeling for Peyronie's disease and penile deformities. Dr. Eleswarapu completed a dual-degree MD/PhD program at Baylor College of Medicine and Rice University, followed by residency training in general surgery and urology at the Vattikuti Urology Institute (Henry Ford Hospital), and fellowship training in andrology at UCLA.

Research topics

• Computer Science
• Medicine
• Psychology
• Sociology
• World Wide Web
• Pathology
• Statistics
• Internal medicine
• Psychiatry
• Clinical psychology
• Social psychology
• Gynecology

Selected publications

• Exploring the Clinical Landscape of Priapism Related to Intracavernosal Injection Therapy: Patient Characteristics, Management Patterns, and Erectile Dysfunction Outcomes

  Urology · 2025-04-25 · 1 citations

  articleOpen access

  OBJECTIVE: To evaluate the clinical characteristics, risk factors, and outcomes of priapism following intracavernosal injection (ICI) therapy, with specific focus on comparing in-office, prescribed, and recreational ICI patterns. METHODS: A retrospective review identified patients presenting with priapism (ICD-10: N48.3) at a single institution from November 2015 through September 2024. Cases were classified as acute ischemic, recurrent ischemic, or non-ischemic, and stratified by ICI administration setting: in-office, prescribed, or recreational. Demographics, clinical presentation, management strategies, and erectile function outcomes were analyzed using descriptive statistics. RESULTS: Of 186 priapism cases, 102 (54.8%) were ICI-related. Among these, 75.4% presented as acute ischemic and 24.5% as recurrent ischemic (mean 2.5 ± 0.7 recurrences). In-office and prescribed injections each accounted for 39.2% of cases, while recreational use comprised 21.6%. Median priapism duration varied significantly by setting: 3 hours (IQR: 2-4) for in-office, 7 hours (IQR: 6-12) for prescribed, and 30 hours (IQR: 12-63) for recreational use (P <.001). Recreational users demonstrated significantly higher rates of human immunodeficiency virus (HIV) and illicit drug use (P <.001). Post-priapism outcomes revealed that 57% of patients discontinued prescribed ICI therapy, while 65% of previously unaffected recreational users developed de novo erectile dysfunction. CONCLUSION: ICI-induced priapism represents a significant clinical challenge, with the duration of priapism varying markedly between in-office, prescribed, and recreational use. The high rate of ICI discontinuation following priapism suggests a substantial impact on ED management decisions. The association between recreational use and adverse outcomes, including de novo ED, identifies an important area for clinical outreach and risk mitigation strategies.

  PublisherOA PDFDOI

• Risk factors, diagnosis, and long-term erectile dysfunction outcomes in priapism: a retrospective analysis of 186 cases from a single institution

  International Journal of Impotence Research · 2025-04-22 · 1 citations

  articleOpen access

  A retrospective analysis of 186 priapism cases between 2015-2024 was conducted using ICD-10 codes (N48.3) in a single high-volume institution. Data on age, race, insurance status, priapism subtype, etiology, and treatment outcomes were collected. The median age at presentation was 50.5 years (IQR: 39.3-60.0), with most patients being White (60.2%). Black and Asian patients tended to present at younger ages than White patients (45 and 38 vs. 55.5 years, p < 0.05). Black patients had longer priapism durations than White patients (36 vs. 7.8 h, p < 0.001). Commercial insurance was most common (60.2%), but those with Medi-Cal/Medicaid or self-pay had longer episodes compared to commercial payers (25 and 39 vs. 7 h, respectively, p < 0.05). Acute ischemic priapism was the most common subtype (63.4%), with intracavernosal injection therapy (54.8%) as the leading cause followed by medications such as Trazodone. Multivariate analysis revealed that ischemic priapism duration was the strongest predictor of de novo ED, with episodes lasting more than 36 h significantly increasing the risk (OR = 61.3, p < 0.001), although episodes over 20 h were also found to increase the risk (OR = 25.2, p = 0.007). These results emphasize the importance of early intervention and addressing health disparities to reduce long-term complications.

  PublisherOA PDFDOI

• PD18-04 RACIAL AND ETHNIC DIFFERENCES IN ERECTILE DYSFUNCTION TREATMENT: A COHORT ANALYSIS OF AQUA REGISTRY PATIENTS

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

• MP35-10 PREVALENCE OF HYPOGONADISM AND TESTOSTERONE SCREENING PRACTICES IN MEN WITH OSTEOPENIA AND OSTEOPOROSIS: A RETROSPECTIVE COHORT STUDY

  The Journal of Urology · 2025-04-08 · 1 citations

  article
  PublisherDOI

• IP18-23 TRENDS IN SURGICAL MANAGEMENT OF ERECTILE DYSFUNCTION: DATA FROM THE AUA QUALITY (AQUA) REGISTRY

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

• Ejaculatory function after robotic waterjet ablation for the treatment of benign prostatic hyperplasia: a systematic review

  International Journal of Impotence Research · 2025-05-14 · 3 citations

  reviewOpen accessSenior author

  Robotic waterjet ablation (RWJA), known by the trade name of Aquablation, is a minimally invasive, heat-free technique for treating benign prostatic hyperplasia (BPH) that offers comparable efficacy to transurethral resection of the prostate (TURP). Unlike TURP, RWJA utilizes targeted tissue mapping, potentially enhancing the preservation of sexual function, particularly antegrade ejaculation. This systematic review evaluated sexual outcomes following RWJA, emphasizing ejaculatory dysfunction and antegrade ejaculation preservation. A literature search conducted through January 1, 2025, in PubMed, Embase, and Cochrane databases identified 15 studies involving 1533 patients. Preservation rates of antegrade ejaculation post-RWJA ranged from 72 to 99.6%. Erectile function remained stable across all reviewed studies. Notably, a randomized controlled trial comparing RWJA to TURP demonstrated significantly lower rates of ejaculatory dysfunction in the RWJA group, maintained for up to five years. Despite promising findings indicating durable preservation of ejaculatory function, there remain limitations due to a scarcity of randomized controlled trials and limited long-term follow-up beyond 12 months. Future comparative studies evaluating RWJA against other minimally invasive BPH treatments are needed to further validate these findings and better define the sexual function outcomes associated with this innovative procedure.

  PublisherOA PDFDOI

• REPRODUCTIVE UROLOGISTS PREFER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD OVER VASECTOMY REVERSAL FOR POST-VASECTOMY PAIN SYNDROME

  Fertility and Sterility · 2025-12-01

  articleSenior author
  PublisherDOI

• Contemporary approaches and treatment perspectives for chronic scrotal content pain: insights from a national practice patterns survey of reproductive urologists

  International Journal of Impotence Research · 2025-06-04

  articleOpen accessSenior author

  A 25-item electronic survey was circulated to reproductive urologists from around the US to evaluate current national diagnostic and therapeutic practices for the management of chronic scrotal content pain (CSCP). Questions addressed physician demographics, referral patterns, diagnostic protocols, treatment approaches, and outcome perceptions. Forty-one of 183 (22.4%) invited participants completed the survey. Among ten conservative treatment options, reassurance (41.5%) and NSAIDs (31.7%) were most frequently ranked first, while opioid medications were the least preferred, with 56.1% of respondents ranking them last of the ten options. Microsurgical denervation of the spermatic cord was the most commonly utilized surgical procedure overall (95.1%) and the first choice for post-vasectomy pain syndrome (PVPS) in 63.0% of respondents. Vasectomy reversal was the surgery of choice for PVPS in only 22.0% of respondents. Respondents perceived higher complete symptom resolution (median: 75% vs. 25%) and lower failure rates (median: 10% vs. 20%) in patients who had surgery versus those who had only conservative measures. Only 7.3% of participants reported using validated assessment tools such as the Chronic Orchialgia Symptom Index. These results demonstrate that wide variability persists in CSCP management among reproductive urologists, though there is consensus that surgery has a higher success rate as compared to conservative management.

  PublisherOA PDFDOI

• Nutraceutical COMP-4 confers protection against endothelial dysfunction through the eNOS/iNOS-NO-cGMP pathway

  PLoS ONE · 2025-02-06 · 1 citations

  articleOpen accessCorresponding

  The nutraceutical COMP-4 -consisting of L-citrulline, ginger extract, and herbal components Paullinia cupana and muira puama-has been shown previously to stimulate the production of nitric oxide (NO) in a variety of tissue types. We hypothesized that COMP-4 may have a protective, stimulatory effect on the vascular endothelial cell. Human umbilical arterial endothelial cells were incubated for 24 hours with or without COMP-4 and, to replicate impairment of endothelial function, co-incubated with or without H2O2. NO intracellular content, nitrite formation and cGMP content in culture media, nitric oxide synthase (NOS) isoforms and mRNA content, pro-inflammatory cytokines, and PAI-1 expression and activity were measured. COMP-4 increased endothelial cell production of NO and cGMP and the expression of both endothelial NOS (eNOS) and inducible NOS (iNOS), in tandem with a reduction in cytokine expression and activity of PAI-1. Co-incubation of COMP-4 with H2O2 reversed detrimental effects of H2O2 on endothelial function, evidenced by improvement in NO availability and abrogation of the pro-inflammatory milieu. These results suggest that COMP-4 exerts a stimulatory effect on endothelial cell eNOS and iNOS to increase NO bioavailability, leading to a reduction in pro-inflammatory cytokines, particularly the prothrombotic PAI-1.

  PublisherDOI

• The impact of tucking on fertility among transgender women: A systematic review

  International Journal of Transgender Health · 2024-08-07 · 2 citations

  reviewOpen access

  Introduction: Tucking involves maneuvering the testicles into the inguinal canal and compressing one's penis and scrotum posteriorly for a smoother pelvic area. A study based in Baltimore reports that 74.7% of transgender women engage in this practice. Objectives: Fertility preservation is a significant concern for many transgender women, however, the implications of tucking on fertility remain underexplored. This review aims to bridge this knowledge gap. Methods: Using PRIMSA guidelines, a systematic search across various databases was conducted to identify studies evaluating the impact of genital tucking on fertility. Keywords related to tucking, transgender identity, and fertility were utilized. Results: In total, 127 manuscripts were identified, of which 11 satisfied the inclusion and exclusion criteria. Four studies noted significant differences in semen parameters between cisgender men and transgender women prior to gender-affirming hormone therapy suggesting tucking as a potential factor. Two studies documented tucking prior to semen analysis but did not establish a definitive link between tucking and lower semen parameters in transgender women. One study, with a larger sample size of 113 transgender women, discovered an odds ratio of 7.95 between extensive tucking and low total motile sperm count. One year-long study on daily tucking reported a decline of up to 98% in total motile sperm count, and a complementary paper noted an increase in abnormal sperm morphology. Two case reports observed that after a 3-4 month cessation from tucking, semen parameters returned to normal. Conclusion: The review highlights the prevalence of tucking among transgender women and the negative impact on fertility it may have. Temporary cessation of tucking may improve semen parameters for fertility preservation. A harm reduction approach should be implemented to balance fertility aspirations with the management of gender dysphoria.

  PublisherDOI

Frequent coauthors

• Jesse N. Mills

  University of California, Los Angeles

  81 shared

• Vadim Osadchiy

  University of California, Los Angeles

  49 shared

• Tommy Jiang

  31 shared

• John T. Sigalos

  University of California, Los Angeles

  23 shared

• Cindy M. Duke

  University of Nevada, Las Vegas

  22 shared

• Robert H. Shahinyan

  University of California, Los Angeles

  19 shared

• Arash Amighi

  University of Washington

  18 shared

• Kyriacos A. Athanasiou

  University of California, Irvine

  17 shared

Education

• M.D.

  University of Southern California

• Ph.D.

  University of Southern California

Awards & honors

• Top doctors, Los Angeles Magazine's Top Doctors 2025
• Top Doctors, Los Angeles Magazine, 2024
• Super Doctors® Southern California Rising Stars, 2026
• Best Poster Award, American Urological Association Virtual E…
• American Urological Association / Urology Care Foundation Re…