Nicholas N. Tadros

A single dose of a non-steroidal anti-inflammatory drug (NSAID) prevents severe pain after ureteric stent removal: a prospective, randomised, double-blind, placebo-controlled trial

The problem of severe pain after ureteric stent removal, its incidence and prevention, has not been previously described. The present paper is the first to determine the incidence of severe pain after ureteric stent removal. It also shows that a single dose of NSAID before ureteric stent removal can prevent this pain in a significant number of patients.

Growing teratoma syndrome: clinical and radiographic characteristics.

To present an overview of our surgical experience in the management of growing teratoma syndrome.

Midline Extraperitoneal Approach for Retroperitoneal Lymph Node Dissection for Testicular Germ Cell Tumor

INTRODUCTION Retroperitoneal lymph node dissection (RPLND) for the treatment of testicular germ cell tumor is technically difficult and associated with significant morbidity. We postulated that a novel midline extraperitoneal (EP) approach might minimize the morbidity. TECHNICAL CONSIDERATIONS We describe a midline extraperitoneal approach in detail. The operative time, estimated blood loss, lymph node yield, return of bowel function, length of stay, and postoperative complications were retrospectively reviewed. From April 2010 to May 2011, 12 consecutive patients underwent EP-RPLND at 2 tertiary centers by a single surgeon, including 5 primary and 7 postchemotherapy RPLNDs. The clinical characteristics and outcomes were compared with those from a matched cohort of transperitoneal-RPLND patients. RESULTS The median follow-up was 173 and 201 days in the EP and transperitoneal groups, respectively. The EP group had a shorter mean operative time of 292 versus 337 minutes (P = .02) and lower estimated blood loss of 305 versus 575 mL (P = .05). More lymph nodes were retrieved in the EP group (44 vs 27 nodes, P = .0006). Finally, an earlier return of bowel function (1.7 vs 2.9 days, P = .0001) and a shorter median length of stay (3.3 vs 5.3 days, P = .0001) was seen in the EP group. CONCLUSION EP-RPLND can be performed safely without prolonged operative times or compromised lymph node retrieval, even in the postchemotherapy setting, and is associated with a faster return of bowel function and shortened length of stay.

Reduction in Opioid Prescribing Using a Post-operative Pain Management Protocol Following Scrotal and SubInguinal Surgery

Introduction: Excess prescribing of opioid pain medication increases medical costs and the potential for abuse by patients and others. We sought to improve our understanding of postoperative pain and opioid use after scrotal and subinguinal urological surgery to develop a protocol for pain management. Methods: We retrospectively analyzed opioid prescribing and usage in 20 patients undergoing scrotal or subinguinal surgery. Collected data were used to develop a standardized postoperative protocol. This protocol included enhanced pain management education and limiting outpatient opioid prescriptions. Outcomes analysis was then performed for 60 consecutive patients via questionnaire. Statistical analysis was performed using the Wilcoxon rank sum test and ANOVA. Linear regression was performed comparing age and narcotic use. Results: Comparison of preprotocol and postprotocol implementation opioid prescriptions and consumption showed a statistically significant decrease in the number of tablets prescribed but no difference in opioid usage. Preprotocol and postprotocol opioid prescription usage was 20 and 10 tablets, respectively, while median usage was 3.5 and 3 tablets, respectively. Conclusions: Evaluation of postoperative pain management revealed excessive prescribing of opioid medications compared to actual usage. Our protocol resulted in a significant decrease in opioid prescribing without compromising management of postoperative pain. Adjunct treatments for pain, including scrotal support, ice packs, elevation and nonsteroidal anti‐inflammatory drugs, may improve postoperative pain control without increasing opioid usage. The combination of enhanced patient education and reduced opioid prescribing may result in decreased opioid use, opioid abuse and medication costs.

MP07-19 INVOLVEMENT OF OXIDATION REDUCTION POTENTIAL IN THE PATHOPHYSIOLOGY OF MALE INFERTILITY IN PATIENTS WITH VARICOCELE

CONCLUSIONS: Our results point out, that smoking could possibly lead to a reduction of sugar binding proteins on the human sperm glycocalyx. This could be a reason for a decreased binding capacity of sperms to the female reproductive tract which could lead to a reduced fertility potential of smokers. Further work is necessary to lighten the exact molecular interaction between spermatozoa and female reproductive tract. Based on these facts it might be possible to examine new diagnostic and therapeutic approach in the future.

PD68-02 SPERM EXTRACTION LOCATION CAN AFFECT EARLY EMBRYO MORPHOKINETICS

INTRODUCTION AND OBJECTIVES: Testicular sperm extraction (TESE) is successful in identifying a small number of sperm in 50% of men with non-obstructive azoospermia (NOA). Traditionally, sperm are isolated from testicular tissue using a combination of standard light microscopy, tissue digestion and time analyzing the specimen in hope to isolate rare spermatozoa. Here we discuss our results utilizing fluorescence-activated cell sorting (FACS) of testis tissue to increase the efficiency in the isolation of spermatozoa. METHODS: Testicular tissue was obtained from 10 patients: 2 cadaveric specimens with normal spermatogenesis and 8 specimens from wasted testicular tissue from microTESE. The specimens were prepared by sharp cutting followed by mechanical disaggregation with a Medimachine (BD Biosciences, USA) and passed through a 50and 30micron filter. The specimens were then stained with DNA-stains To-Pro3 or SYTO 17(ThermoFischer, USA) and incubated. Sperm from a normal semen sample were stained similarly and used as controls for gating during flow cytometry . Then, cell sorting was completed using a FACSAria II (BD Biosciences, USA) to isolate spermatozoa. Each sorted specimen underwent standard light microscopy to identify spermatozoa. RESULTS: Using this technique, spermatozoa were successfully isolated and recovered in both cadaveric specimens. Of the 8 patients undergoing microTESE , 3 (38%) had spermatozoa recovered using standard tissue processing and 4 (50%) had spermatozoa recovered using FACS. Notably, in our cohort, both patients with maturation arrest had a negative microTESE with standard tissue processing, but had successful isolation of spermatozoa using FACS. CONCLUSIONS: Our initial experience using fluorescenceactivated cell sorting for rare spermatozoa isolation from testicular tissue proves the technical feasibility of this process. As this research continues to be refined and implemented, the clinical application of this technique has the potential to increase the rate of successful TESE to isolate spermatozoa.

Conversion of Low-Flow Priapism to High-Flow State Using T-Shunt with Tunneling

Introduction. The three types of priapism are stuttering, arterial (high-flow, nonischemic), and venoocclusive (low-flow, ischemic). These are usually distinct entities and rarely occur in the same patient. T-shunts and other distal shunts are frequently combined with tunneling, but a seldom recognized potential complication is conversion to a high-flow state. Case Presentation. We describe 2 cases of men who presented with low-flow priapism episodes that were treated using T-shunts with tunneling that resulted with both men having recurrent erections shortly after surgery that were found to be consistent with high-flow states. Case 1 was a 33-year-old male with sickle cell anemia and case 2 was a 24-year-old male with idiopathic thrombocytopenic purpura. In both cases the men were observed over several weeks and both men returned to normal erectile function. Conclusions. Historically, proximal shunts were performed only in cases when distal shunts failed and carry a higher risk of serious complications. T-shunts and other distal shunts combined with tunneling are being used more frequently in place of proximal shunts. These cases illustrate how postoperative erections after T-shunts with tunneling can signify a conversion from low-flow to high-flow states and could potentially be misdiagnosed as an operative failure.

The safety of prostate biopsy procedures in the research setting: A 10-year multicenter experience.

87 Background: The safety of routine prostate biopsies has recently been called into question, citing increasing rates of complications compared to historical data. We examined our experience with prostate biopsies done as a component of multiple clinical research trials. METHODS The safety of routine prostate biopsies has recently been called into question, citing increasing rates of complications compared to historical data. We examined our experience with prostate biopsies done as a component of multiple clinical research trials. RESULTS 141 charts had adequate documentation. A mean of 12 +/- 4 cores were obtained during the procedures (8-26). Of these patients, 136 of the 141 had no adverse events during or after their biopsies. Of the five adverse events, there were three (2.2%) minor and two (1.4%) major complications. The minor complication group consisted of three patients with mild, but prolonged hematuria (12-14 days). Of the two major complications, one patient had hematospermia for 28 days and the second patient was diagnosed with prostatitis 18 days after biopsy and required multiple antibiotics. No patient required any further intentions or hospitalizations. There was no correlation between complication rate and study type (p=0.662) or treatment setting (p=0.411). Overall, 96.5% of patients undergoing prostate biopsies for research purposes had no adverse events or complications related to the procedure. CONCLUSIONS Research related prostate biopsy procedures can be performed in a diverse range of treatment settings and do not incur any increased risk versus clinical biopsies.

Benefits and consequences of testosterone replacement therapy: A review

Late onset hypogonadism (LOH) is an issue of increasing concern. Studies have shown the importance of testosterone in the maintenance of homeostasis, especially with respect to bone health, sexual function, diabetes, cardiovascular risk, mental health and cognition. Much of the dysfunction in hypogonadism can be reversed or improved with testosterone replacement therapy (TRT). Physicians worry about the possible consequences of TRT, especially regarding the prostate. By reviewing the literature, we have found there are significant benefits to TRT, and fears of adverse effects on the prostate are largely unfounded, though there is a great need for larger studies with longer periods of follow-up, especially to evaluate adverse events.