Puneet Masson

The Shang Ring device for adult male circumcision: a proof of concept study in Kenya.

Objective:To assess safety, preliminary efficacy, and acceptability of the Shang Ring, a novel disposable device for adult male circumcision in Kenya. Methods:Forty HIV-negative men were recruited in Homa Bay, Kenya. Circumcisions were performed by a trained physician or nurse working with 1 assistant. Follow-up was conducted at 2, 7, 9, 14, 21, 28, 35, and 42 days after circumcision. Rings were removed on day 7. Pain was assessed using a visual analog scale (VAS) (0 = no pain, 10 = worst possible). Men were interviewed at enrollment and on days 7 and 42. Results:All 40 procedures were completed successfully. Mean procedure and device removal times were 4.8 (SD ± 2.0) and 3.9 (SD ± 2.6) minutes, respectively. There were 6 mild adverse events, including 3 penile skin injuries, 2 cases of edema, and 1 infection; all resolved with conservative management. In addition, there were 3 partial ring detachments between days 2-7. None required treatment or early ring removal. Erections with the ring were well tolerated, with a mean pain score of 3.5 (SD ± 2.3). By day 2, 80% of men were back to work. At 42 days, all participants were very satisfied with their circumcision and would recommend the procedure to others. Conclusions:Our results demonstrate that the Shang Ring is safe for further study in Africa. Acceptability of the Shang Ring among participants was excellent. With short procedure times, less surgical skill required, and the ease with which it can be used by nonphysicians, the Shang Ring could facilitate rapid roll-out of male circumcision in sub-Saharan Africa.

Current practices in fertility preservation in male cancer patients

The incidence of a cancer diagnosis in children and young adolescents is increasing. With better treatments, the number of young cancer survivors living through reproductive age is increasing. Fertility preservation of these men and women has become essential and needs to be discussed prior to the start of cancer treatment. Here we review the current guidelines for male oncofertility patients and highlight some of the important gonadotoxic effects of chemotherapy, radiotherapy and surgery. Options for fertility preservation are also discussed along with resources that should be made available to all patients.

Automatic Tracking and Motility Analysis of Human Sperm in Time-Lapse Images

We present a fully automated multi-sperm tracking algorithm. It has the demonstrated capability to detect and track simultaneously hundreds of sperm cells in recorded videos while accurately measuring motility parameters over time and with minimal operator intervention. Algorithms of this kind may help in associating dynamic swimming parameters of human sperm cells with fertility and fertilization rates. Specifically, we offer an image processing method, based on radar tracking algorithms, that detects and tracks automatically the swimming paths of human sperm cells in timelapse microscopy image sequences of the kind that is analyzed by fertility clinics. Adapting the well-known joint probabilistic data association filter (JPDAF), we automatically tracked hundreds of human sperm simultaneously and measured their dynamic swimming parameters over time. Unlike existing CASA instruments, our algorithm has the capability to track sperm swimming in close proximity to each other and during apparent cell-to-cell collisions. Collecting continuously parameters for each sperm tracked without sample dilution (currently impossible using standard CASA systems) provides an opportunity to compare such data with standard fertility rates. The use of our algorithm thus has the potential to free the clinician from having to rely on elaborate motility measurements obtained manually by technicians, speed up semen processing, and provide medical practitioners and researchers with more useful data than are currently available.

Erectile Dysfunction in the Elderly

Erectile dysfunction (ED) is a common disorder among older men. In the elderly, chronic comorbidities and the decline of physiologic processes associated with aging combine to impair erectile function. Nevertheless, the desire for sexual activity persists in many older men despite the occurrence of ED, which consequently can have a significant negative impact on quality of life. Multiple safe, efficacious, and convenient options for the treatment of ED have produced excellent results in elderly men, but their application requires an understanding of nuances related to comorbidities, medication interactions, and physical limitations inherent in that population. This review will focus on those nuances, as well as recent advances in the field, with a comprehensive discussion on the epidemiology, pathophysiology, comorbidities, evaluation, and treatment of ED in the elderly.

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.