Douglas W. Soderdahl

Monitoring of suspected infertile men with varicocele by the sperm penetration assay

Although varicocele remains the most frequently diagnosed cause of male infertility, and improvement in semen quality is associated with repair of varicocele, improvement in spermatozoal fertilizing capacity has not been conclusively demonstrated. The sperm penetration assay was employed to monitor prospectively surgical (n = 59) and nonsurgical (n = 40) groups of men with varicocele. There were no significant increases in the average count, motility, morphologic features, or sperm penetration assay results for either group. Varicocele surgery enhanced assayable egg penetration rates in 14 of the 59 patients (23.7%), whereas the nonsurgical group had 10% spontaneous improvement. Of those in the surgery group who showed assayable fertility enhancement and were attempting conception, pregnancies were achieved in 70% (7 of 10 patients). Of patients in the nonsurgical group who improved in the assay, no pregnancies were obtained.

Nonpsychotic genital self-mutilation

The case of a sixty-four-year-old man who progressively created a penoscrotal hypospadias on himself is presented. Although genital self-mutilation is normally considered symptomatic of deep psychotic disturbance, the details and evaluation of this case would classify it as nonpsychotic, though unusual behavior.

“Acute scrotum” in Henoch-schönlein syndrome

Two patients with Henoch-Schönlein syndrome presented with clinical pictures mimicking testicular torsion. No evidence of testicular torsion was found. A review of the literature revealed that testis torsion is very rarely associated with testicular involvement in Henoch-Schönlein syndrome, and hence only rarely is surgical exploration required.

Per os pubis (POP) urethropexy

This series of 24 female patients with stress urinary incontinence managed surgically by a pubis-pubovaginal fascia fixation demonstrates success comparable or superior to other techniques. Several advantages in carefully selected patients are noted.

Colocutaneous fistula: an unusual complication of retroperitoneal lymphadenectomy.

The unusual complication of colocutaneous fistula following retroperitoneal lymphadenectomy for testis tumor is presented. Etiology, management and prevention are emphasized.

Scrotal Pathology in the Outpatient Setting in Operation Iraqi Freedom

The purpose of this study was to describe the incidence and pathology of scrotal pain among military men deployed in Operation Iraqi Freedom. It is a retrospective review of patients seen by the urology service at a U.S. Army combat support hospital (CSH) in Iraq from March 29, 2007 to August 12, 2007. Of the 222 outpatient visits to the urology service 81 (36%) had 1 or more scrotal complaints for a total of 90 scrotal-related problems. The vast majority (86%) were found to have epididymitis. Scrotal sonograms on these patients found only 1 patient with a testicular neoplasm. Varicocele (6.2%), spermatocele (4.9%), and hydrocele (2.5%) accounted for the remaining scrotal findings. Urologic referrals for scrotal problems are common in the deployed environment. We feel the best treatment for chronic scrotal pain in theater is conservative with urologic referral in patients who fail their initial course of therapy.

Variability in the human-hamster in vitro assay for fertility evaluation**Supported by grant HD-11555 from the National Institutes of Health, United States Public Health Service, Bethesda, Maryland.

Sources of variability in the zona-free hamster egg penetration assay were evaluated. Internal consistency in the assay was examined in replicate experiments using sperm from 23 donors. The average difference in the percentage of fertilization between the replicates was 3.9%. Optimal preincubation conditions and insemination time were examined and shown to be 0.5 to 1.0 X 10(7) sperm/ml and 2 to 3 hours. Abstinence time was found to be a variable, and a critical abstinence of more than 12 hours was required. Prolonged exposure to seminal plasma (i.e., more than 30 minutes) produced a reduction in the fertilization test results. If the variables studied here are consistently controlled, then changes in the assay results greater than the experimental error should reflect true changes in the semen sample.