Lynn L. Woo

Outcomes of vasectomy reversal performed for men with the same female partners.

Abstract Objectives To review the fertility outcomes of patients who underwent vasectomy reversal and attempted conception with the same female partners. Methods A retrospective review of two surgeons’ experience was performed. Patency was defined as the presence of motile sperm. Patients with less than 6 months of follow-up were excluded from the patency rate analysis unless they had sperm in the semen sample. Similarly, patients with less than 6 months of follow-up or no ongoing interest in establishing conception were excluded from the pregnancy rate analysis unless they had established a pregnancy. Results Of 200 consecutive men, 34 (17%) underwent microsurgical vasectomy reversal with the same female partner. All but two of the couples had previous proven fertility. The procedures performed for those who pursued fertility were bilateral vasovasostomy (n = 27), vasovasostomy/vasoepididymostomy (n = 4), and bilateral vasoepididymostomy (n = 1). The mean obstructive interval was 5 years (range 4 months to 10 years). The mean female partner age was 31.9 years (range 26 to 38). The median follow-up was 8 months (range 1 to 48). Patency was achieved in 27 (93%) of 29, and pregnancy occurred in 15 (60%) of 25 cases with sufficient follow-up. The ongoing or delivered rate was 56% (14 of 25). Female factor problems were present in three couples, and two miscarriages occurred for couples with known female factor problems. Conclusions Microsurgical vasectomy reversal may have higher success rates when performed for couples with the same female partner. These results may be related to a shorter obstructive interval and a history of previous fertility as a couple.

Impact of Parturition on Chemokine Homing Factor Expression in the Vaginal Distention Model of Stress Urinary Incontinence

PURPOSE Human childbirth simulated by vaginal distention is known to increase the expression of chemokines and receptors involved in stem cell homing and tissue repair. We hypothesized that pregnancy and parturition in rats contributes to the expression of chemokines and receptors after vaginal distention. MATERIALS AND METHODS We used 72 age matched female Lewis rats, including virgin rats with and without vaginal distention, and delivered rats with and without vaginal distention. Each rat was sacrificed immediately, or 3 or 7 days after vaginal distention and/or parturition, and the urethra was harvested. Relative expression of chemokines and receptors was determined by real-time polymerase chain reaction. Mixed models were used with the Bonferroni correction for multiple comparisons. RESULTS Vaginal distention up-regulated urethral expression of CCL7 immediately after injury in virgin and postpartum rats. Hypoxia inducible factor-1α and vascular endothelial growth factor were up-regulated only in virgin rats immediately after vaginal distention. CD191 expression was immediately up-regulated in postpartum rats without vaginal distention compared to virgin rats without vaginal distention. CD195 was up-regulated in virgin rats 3 days after vaginal distention compared to virgin rats without vaginal distention. CD193 and CXCR4 showed delayed up-regulation in virgin rats 7 days after vaginal distention. CXCL12 was up-regulated in virgin rats 3 days after vaginal distention compared to immediately after vaginal distention. Interleukin-8 and CD192 showed no differential expression. CONCLUSIONS Vaginal distention results in up-regulation of the chemokines and receptors expressed during tissue injury, which may facilitate the spontaneous functional recovery previously noted. Pregnancy and delivery up-regulated CD191 and attenuated the expression of hypoxia inducible factor-1α and vascular endothelial growth factor in the setting of vaginal distention, likely by decreasing hypoxia.

DEVELOPMENT OF SEMINOMA FOLLOWING CONSERVATIVE TREATMENT OF TESTICULAR EPIDERMOID CYST

Epidermoid cysts account for approximately 1% to 2% of all resected testicular masses. These are benign lesions without malignant potential, and conservative management with enucleation is generally preferred over orchiectomy. No cases of local recurrence or metastases have been reported. We report a case of enucleation of an epidermoid cyst with subsequent development of a seminoma in the same testis 5 years later.