Daniel J. Mazur

Influences of neuroregulatory factors on the development of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction in aging men.

As men age, there is an increase in the frequency of pathologic diseases affecting the genitourinary tract. Most notable among these changes are the rising prevalence of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). The pathogenesis of these conditions seems to be multifactorial and includes age-related changes in the nervous system and neuroregulatory factors, such as nitric oxide and RhoA/Rho-kinase. Various pharmacologic agents that target these pathways, such as α-blockers and PDE-5is, underscore the contribution of neuroregulatory factors on the development of LUTS/BPH and ED.

Management of Non-catheter-associated Complicated Urinary Tract Infection

This article presents an overview of non-catheter-associated complicated urinary tract infection (UTI) from a urologic point of view. Discussion includes the evaluation and workup a complicated UTI through history, physical examination, laboratory analysis, and radiographic studies. Specific types of complicated UTI, such as urinary obstruction and renal abscess, are reviewed.

Update on Antibiotic Prophylaxis for Genitourinary Procedures in Patients with Artificial Joint Replacement and Artificial Heart Valves

Infection of artificial joint replacements and heart valves is an uncommon but serious complication encountered anytime after the implantation of these prostheses. It is known that bacteremia can lead to infection of a prosthetic device. However, there is no strong evidence to correlate urologic procedures with the development of periprosthetic joint infection or prosthetic valve endocarditis. Therefore, antibiotic prophylaxis for the prevention of endocarditis is not recommended in patients undergoing urologic procedures. However, guidelines regarding prophylaxis to prevent infection of an artificial joint in the setting of a genitourinary procedure are more varied.

Scrotal Ultrasound for Pain: Low Frequency of Absolute Surgical Indications

OBJECTIVE To examine the results of scrotal ultrasounds (US) conducted for scrotal or testicular pain and review the pathologic findings of orchiectomies done for lesions that were suspicious for malignancy on US. MATERIALS AND METHODS We retrospectively reviewed the indications and findings of all scrotal US completed at our institution from 2002 to 2014. If a patient underwent an orchiectomy for an intratesticular lesion that was concerning for malignancy on US, the pathology report was also reviewed. RESULTS There were 18,593 scrotal US performed, with 7,668 (41.2%) conducted for scrotal pain. Of the US performed for pain, 80.4% revealed benign or normal findings, and only 2.2% demonstrated a finding that is an absolute indication for surgery (intratesticular lesion suspicious for malignancy 0.8%, abscess 0.7%, torsion 0.6%, infiltrative process such as lymphoma 0.1%). For those patients undergoing an orchiectomy, 75% had malignancy on pathologic analysis. CONCLUSION The majority of the 7668 US performed to evaluate scrotal or testicular pain reveal normal or benign findings. A low percentage demonstrates a finding that necessitates urgent or emergent surgery.

Simultaneous Urethrocutaneous and Urethrocavernous Fistula After Proximal Corporospongiosal Shunt for Priapism

Proximal corporospongiosal shunts are used for the most refractory cases of priapism. Here, we present the case of a 58-year-old man whose priapism was only partially responsive to phenylephrine injections and distal shunting. Proximal shunting was required, and he subsequently developed fistulization of the proximal penile urethra into the skin and the corpora cavernosa. The formation of simultaneous urethrocutaneous and urethrocavernous fistulae is a rare complication of proximal corporospongiosal shunts that can be initially managed with urinary diversion with a suprapubic tube.

Role of gram-positive bacteria in chronic pelvic pain syndrome (CPPS)

Chronic pelvic pain syndrome (CPPS) is a complex disorder that affects a large proportion of all men. A limited understanding of its etiology and pathogenesis is reflected by the absence of effective therapies. Although CPPS is deemed clinically non‐infectious with no well‐defined etiological role for microbes, bacteria is readily isolated from both healthy and patient prostate secretion and urine samples. Our laboratory has previously demonstrated that a specific gram‐negative bacterial isolate can induce CPPS‐like symptoms in mice. Here we aimed to expand on these findings examining the role of gram‐positive patient‐derived bacteria in CPPS.

MP35-13 VASECTOMY AND THE GENDER GAP: SHIFTING DEMOGRAPHICS OF THE UROLOGIC WORKFORCE

multiple comparison analysis, sperm concentration (p1⁄40.042) and progressive motility (p1⁄40.03) were significantly lower in heavy smokers; similarly, DFI values were significantly higher in Group 3 patients than in no smokers (p1⁄40.025). At multivariable analyses, FSH (OR 1.1, p1⁄40.02) and being heavy smokers (OR 4.1, p1⁄40.006) were independent predictors for pathologic DFI score after accounting for age, BMI and CCI. Similarly, being heavy smokers achieved independent predictor status for pathologic sperm count (OR 2.7, p1⁄40.047) and pathologic total progressive motility (OR 6.3, p1⁄40.002), after accounting for the same variables. CONCLUSIONS: The routine assessment of DFI is getting increasing clinical relevance. Heavy cigarette smoking emerged as the most detrimental factor impacting on the DFI rate, along with an impaired sperm concentration and progressive motility.

MP35-12 SURGICAL TREATMENT OF MALE FACTOR INFERTILITY: DOES INSURANCE COVERAGE MATTER?

multiple comparison analysis, sperm concentration (p1⁄40.042) and progressive motility (p1⁄40.03) were significantly lower in heavy smokers; similarly, DFI values were significantly higher in Group 3 patients than in no smokers (p1⁄40.025). At multivariable analyses, FSH (OR 1.1, p1⁄40.02) and being heavy smokers (OR 4.1, p1⁄40.006) were independent predictors for pathologic DFI score after accounting for age, BMI and CCI. Similarly, being heavy smokers achieved independent predictor status for pathologic sperm count (OR 2.7, p1⁄40.047) and pathologic total progressive motility (OR 6.3, p1⁄40.002), after accounting for the same variables. CONCLUSIONS: The routine assessment of DFI is getting increasing clinical relevance. Heavy cigarette smoking emerged as the most detrimental factor impacting on the DFI rate, along with an impaired sperm concentration and progressive motility.

MP11-08 REASSESMENT OF NON-TRADITIONAL UROPATHOGENS IN CHRONIC PELVIC PAIN SYNDROME (CP/CPPS)

maintained at day7 after LPS injection. Comprehensive cytokine assay (ELISA) showed that more than 2 folds of down-regulation of both inflammatory promoting cytokines (IL-1 alpha, IL-6) and chemokines (CCL3, CXCL1) were observed in epididymitis model of IDO KO mice compared with WT mice. On the other hand, more than 1.5 folds of upregulation of inflammatory inhibiting cytokines (IL-4, IL-10) were observed in epididymitis model of IDO KO mice. The peak expression of IL-1 alpha, IL-6, CCL3 and CXCL1 were at day1 and that of IL-4 was at day3. The expression of IL-10 increased in time dependent manner. Same results were introduced from separate quantitative analysis and immunohistochemical staining. After treatment of IDO inhibition and LPS, IL-1 alpha, IL-6, CCL3 and CXCL1 were significantly downregulated anytime in time series compared with WT mice using ELISA method (p<0.05). IL-4 and IL-10 were significantly up-regulated anytime in time series compared with WT mice (p<0.05). In the group of IDO inhibition, epididymal ductal structure was maintained at day7 after LPS injection and little invasion of inflammatory cells were observed anytime in time series. CONCLUSIONS: IDO should be involved in epididymal immunological reaction via cytokines. To inhibit IDO would contribute to protection of epididymis tissue when inflammation occurs in epididymis. Therefore, IDO might be a novel target for the therapy of the epididymitis in addition to antibodiotics.