Jeremy T. Choy

The determination of reproductive safety in men during and after cancer treatment

Fertility-related concerns are frequently encountered in the course of providing care to oncologic patients. Male cancer survivors who desire paternity after cancer treatment face the question of whether their posttherapy sperm can be safely used in either natural or assisted conception attempts. Although the reproductive risks of using sperm genetically compromised by chemotherapy or radiotherapy include impaired embryonal development, pregnancy loss, and congenital anomalies in offspring, there is a general lack of consensus in the literature concerning the persistence of sustained genotoxic effects, making it difficult to assuredly quantify the level of risk involved. Transmission of chemotherapeutic agents via seminal plasma is another potential risk that has not yet been well evaluated. Sperm chromosomal aneuploidy rates and DNA fragmentation indices provide means of assessing genomic damage that could prove useful in genetic counseling efforts. Ultimately, additional research is needed to clarify investigational discrepancies and establish a stronger body of evidence that would allow for the development of clinical guidelines to assist cancer patients considering posttreatment conception in their decision-making processes.

Predictors of Spermatogenesis in Orchiectomy Specimens

OBJECTIVE To evaluate the presence of spermatogenesis in orchiectomy specimens of patients with testicular cancer to determine possible predictors of success with oncologic testicular sperm extraction of the cancerous testis at orchiectomy. MATERIALS AND METHODS We retrospectively reviewed the pathology reports and slides from 83 men who underwent radical orchiectomy for testicular cancer at 2 institutions from 1999 to 2010. The presence or absence of spermatogenesis in each specimen was determined. Data on tumor histopathologic type, serum tumor markers, and tumor size were also obtained and analyzed to detect any associations with the presence of spermatogenesis. RESULTS The 83 specimens included 41 pure seminomas, 36 nonseminomatous and mixed germ cell tumors, and 6 benign lesions. Overall, spermatogenesis was detected in 48 of 77 (62%) cancerous specimens. Spermatogenesis was present in 22 of 41 (54%) pure seminomas and 26 of 36 (72%) nonseminomatous and mixed germ cell tumors, with no significant difference found between the 2 subtypes (P = .11). No association was found between tumor marker levels and the presence of spermatogenesis. A logistic regression model revealed a statistically significant inverse relationship between tumor size and spermatogenesis presence (P = .004). CONCLUSION At orchiectomy, most cancerous testes contained active spermatogenesis and, thus, represent a viable source for sperm cryopreservation with oncologic testicular sperm extraction. A small tumor size proved to be a positive prognostic indicator for the presence of spermatogenesis, although a larger tumor size did not preclude the presence of spermatogenesis.

The men's health center: Disparities in gender specific health services among the top 50 "best hospitals" in America

Objective Gender-specific integrated health services have long existed in the arena of womens health care, but mens health centers (MHCs) have only recently emerged as a novel practice model. Here, we seek to evaluate the prevalence and format of MHCs found in the leading academic medical centers in the United States. Methods The US News & World Reports Top 50 Ranked Hospitals for Urology was used as our cohort. Data were gathered on the presence of MHCs and types of providers and conditions treated. An equivalent search was performed for womens health centers (WHCs). Results Sixteen of 50 (32%) promoted some type of MHC, compared to 49 of 50 (98%) offering a WHC. Eight of the top 15 ranked institutions (53%) had an MHC compared to eight of 35 (23%) remaining programs. Six of 16 MHCs incorporated providers from a variety of medical disciplines, including urologists, internists, endocrinologists, cardiologists, and psychologists, while another six of 16 MHCs were staffed solely by urologists. Eight of 16 provided services for exclusively urologic issues, four of 16 offered additional services in treatment of other medical conditions, and four of 16 did not specify. Conclusion A considerable disparity exists between the prevalence of gender-specific health services, with WHCs being much more numerous than MHCs. All but one leading institution had WHCs compared to less than one-third having MHCs. Our findings also highlight the heterogeneous nature of mens health programs, as they exhibit great variability in program type and focus, yet are all being marketed under the “Mens Health” banner.

2284 THE MEN'S HEALTH CENTER: AN EMERGING MODEL OF INTEGRATIVE HEALTH CARE DELIVERY FOR MEN

oxygen saturation (TSI%) in the detrusor were successfully monitored during natural filling. A consistent pattern of gradual increase in detrusor oxygenation and blood volume during bladder filling followed by a drop at the point of urgency were observed in all subjects. Figure 1 shows an example of NIRS data during natural filling. The effects of heart rate and respiratory cycle on detrusor hemodynamics were also identified. CONCLUSIONS: Noninvasive NIRS monitors changes in detrusor hemodynamics and oxygenation during bladder filling. Our observation supports the ability of the coiled vasculature in the detrusor to supply a greatly increased surface area of bladder wall during filling. By detecting different patterns of bladder hemodynamics during natural filling, NIRS might provide unique information on quality and type of bladder dysfunctions, noninvasively.

Re: Effects of the Reduced Form of Coenzyme Q10 (Ubiquinol) on Semen Parameters in Men with Idiopathic Infertility: A Double-Blind, Placebo Controlled, Randomized Study

analysis of semen parameters, largely controlled for these confounders and observed an increase in sperm counts with no changes in motility and morphology. When comparing the study cohort with two previously studied cohorts of Danish men, more men in the study cohort for Jørgensen et al. had arbitrarily defined ‘‘suboptimal’’ sperm concentrations and fewer normal forms than in the comparison cohorts. The investigators concluded that Danish men are at increased risk for subfertility and utilization of assisted reproductive technologies (ART). This conclusion is disconcerting, largely because few conclusive data support a decline in male, or couple, fertility in Denmark or globally. Although crude birth and conception rates in Denmark have declined [3,4], it is difficult to separate cultural reasons, such as the use of contraception and abortion, from biological or environmental reasons for this decline. One must also remember that semen quality cannot be used to define fertility. Furthermore, risk factors for ART for either male or female fertility failure are incompletely defined, and no statistical model incorporating all fertility risk factors exists. Therefore, the conclusion that a decrement in sperm motility or normal morphology is resulting in a decline in fertility, despite an increase in sperm count, may be erroneous.

A critical analysis of the reported association between vasectomy and frontotemporal dementia.

those men of lower socioeconomic status; these men may thus be less likely to receive specialized medical care. Men of higher socioeconomic status may be more likely to receive a correct diagnosis of PPA in a specialized center. This population is also more likely to undergo a vasectomy. Furthermore, men with vasectomies generally have several children, and therefore may be more likely to be brought in by family for early signs or symptoms of dementia, thus facilitating the correct diagnosis of a rare disorder such as PPA. THE ROLE OF MISCLASSIFICATION BIAS Misclassification bias is a common challenge for retrospective epidemiological studies. In this study, the PPA subjects are more likely to have been placed in the incorrect classification of occurrence of vasectomy than are the control subjects. It would seem likely that the control group of mentally intact individuals, who are generally well educated and motivated to volunteer for a study would more accurately recount vasectomy occurrence in comparison to a patient with dementia. The PPA group had a similar educational level, but education level of the corroborating partners was not controlled. Due to the small sample size of the study, misclassification of even a small numberofsubjectscouldsignificantlyimpacttheapparentassociation of PPA with vasectomy. Although in this study the possibility of misclassification was reduced by partner verification, it may still play a role due to the mental impairment of the subjects and retrospective nature of determining vasectomy status performed several decades earlier.