Raul I. Clavijo

Pentoxifylline treatment and penile calcifications in men with Peyronie's disease

This retrospective cohort study from a single clinical practice enrolled patients with evidence of calcified Peyronies disease (PD) plaques detected on penile ultrasound at the time of initial presentation. The primary objective was to describe the effect of pentoxifylline (PTX) treatment on subtunical calcifications in men with PD. A PD-specific questionnaire was administered and sonographic evaluations were performed at baseline and follow-up visits. Descriptive statistics and χ(2) analysis were used to characterize the effect of PTX on calcified tunical plaques. In all, 71 men (mean age: 51.9 years) with PD and sonographic evidence of calcification were identified. Of them, 62 of these men were treated with PTX for a mean duration of 1 year, and nine with vitamin E or no treatment. Improvement or stabilization in calcium burden at follow-up was noted in 57 (91.9%) of men treated with PTX versus four (44.4%) of those not treated with PTX (P<0.001). PTX users were much less likely to have a subjective worsening of their clinical condition (25.0% versus 78.3%, P=0.002). Treatment with PTX appeared to stabilize or reduce calcium content in PD plaques. A randomized controlled trial is warranted to further explore this effect.

Varicoceles: prevalence and pathogenesis in adult men

Varicocele, or dilation of the pampiniform venous plexus, affects up to 15% of men. However, few of these men encounter problems with fertility. This discrepancy between men with varicocele and the number of adversely affected men has led to abundant research to identify the mechanisms for formation of varicocele as well as the pathologic mechanisms by which varicoceles affect fertility potential. In this review, we discuss the prevalence of varicocele in adults, the anatomic features of varicocele, the leading theories as to how varicocele can negatively affect fertility potential, and finally, the current literature on the impact of varicocele on testosterone production.

Reproductive outcomes in men with karyotype abnormalities: Case report and review of the literature

Reciprocal translocations of autosomal chromosomes are present in about 1/625 men, yet often there are no symptoms except primary infertility. Abnormal segregation during meiosis often produces sperm and subsequent embryos with unbalanced translocations that often ultimately result in spontaneous abortions. We report on a 37-year-old man and his 39-year-old wife who complained of primary infertility. Previous in vitro fertilization (IVF) had resulted in pregnancy, but two spontaneous abortions. Upon chromosomal testing, the man was diagnosed with a reciprocal translocation and his wife was diagnosed with mosaic Turners syndrome. Through testicular sperm extraction (TESE) and IVF with preimplantation genetic screening (PGS), they succeeded in having two healthy children. Since men with different karyotype abnormalities can have male infertility, we reviewed the literature and summarized the reproductive outcomes for men with both autosome and sex chromosomal karyotype abnormalities.

Clinically Symptomatic Vasitis: Clinical Correlations in a Rare Condition

Vasitis, or inflammation of the vas deferens, is a rare condition. When diagnosed pathologically, it has been linked to vasectomy, prostatectomy, and herniorrhaphy. When diagnosed clinically, relationships with potential causative factors are unclear. We investigated the clinical factors associated with clinically symptomatic vasitis in a retrospective series of patients. From the history, physical examination, and clinical course, we analyzed associated risk factors. Clinical care patterns were also examined to assess the effectiveness of different treatments. Among 11 patients, the mean patient age at presentation was 47 years (range 29–60 years). The mean diameter of the affected vas deferens was 0.97 cm. Associated procedures included ipsilateral herniorrhaphy (4 patients), radical prostatectomy (2 patients), perianal fistulectomy (1 patient), and bilateral testicular biopsy (1 patient). Furthermore, epididymitis was reported in one patient after testicular trauma, and another patient had congenital unilateral absence of the vas deferens. No patient had a history of vasectomy. Three patients were HIV positive and 6 were active smokers. Six of the 11 patients improved with medical management that included nonsteroidal and steroidal anti-inflammatories and antibiotics. One patient was lost to follow-up. Similar to studies of pathologically detected vasitis, this unique study of clinical vasitis suggests that prior herniorrhaphy, prostatectomy, and possibly HIV infection may be risk factors for its development. In addition, the use of anti-inflammatories and antibiotics warrants further investigation as potentially effective treatments.

Microsurgical identification and excision of an intratesticular mass

OBJECTIVE To demonstrate a step-by-step approach to microsurgical partial orchiectomy (PO) in a man with a small intratesticular mass. DESIGN Video presentation. SETTING University hospital. PATIENT(S) A 22-year-old man with right testicular pain and swelling found to have a small, nonpalpable 8-mm hypoechoic testicular mass on ultrasound. Tumor markers were negative. INTERVENTION(S) Partial orchiectomy. MAIN OUTCOME MEASURE(S) Intraoperative technique with commentary highlighting tips for a successful resection. RESULT(S) This video provides a brief introduction to and indications for PO as an alternative to radical orchiectomy. We describe the microsurgical approach to PO through an inguinal incision for the resection of a small intratesticular mass. CONCLUSION(S) Microsurgical PO should be considered for select patients as an alternative to radical orchiectomy. The microscopic approach provides a more precise resection with limited collateral damage to surrounding parenchyma.

V11-02 A RANDOMIZED CLINICAL TRIAL ON SAFETY AND EFFICACY OF LOW INTENSITY SHOCKWAVES FOR THE TREATMENT OF ERECTILE DYSFUNCTION – COMPARISON OF TWO TREATMENT SCHEDULES

INTRODUCTION AND OBJECTIVES: We aim to evaluate the safety and efficacy of low intensity shockwave treatment (LISWT) for erectile dysfunction (ED). Further, we sought to report 1 month and 3 months post-treatment follow-up data from an ongoing phase II randomized clinical trial. METHODS: Men with ED (n?1⁄4?30) between the ages of 30 and 80 years who had a baseline International Index of Erectile Function questionnaire (IIEF-EF) score between 11-26, total testosterone between 300 and 1000 ng/dL in AM, phosphodiesterase inhibitor washout period of at least 4 weeks and had 1 month follow-up data were included in this analysis. We excluded patients with previous radical prostatectomy, extensive pelvic or back surgery, HbA1c > 7.5%, or in use of antidepressants. Patients were randomized in a 1:1 ratio into two treatment schedules for a total number of 3600 shocks using the Direx Renova LISWT device. Group A received 720 shocks on a five-day consecutive treatment schedule for one week and group B received 600 shocks every other day on a 6 days schedule for two weeks. Subjects reported the IIEF and Erection Hardness Score (EHS) questionnaires at baseline, 1 month and 3 months follow up. RESULTS: Mean þ/IIEF-EF score at base line was 17.5 þ/0.8 for group A, and 17.7 þ/1.1 for group B. 1 month follow-up group A revealed an increasing in the IIEF-EF score from 17.5 þ/0.8 to 20.1þ/1.5 (p 1⁄4 0.10). However, group B had a lower increase in the IIEF-EF score at 1 month follow up 17.7 þ/1.1 to 19 þ/1.1 (p1⁄40.15). Mean þ/IIEF-EF score after three-month follow-up was 20.8þ/2.5 and 22.1þ/1.3 for group A and B respectively. Group A and B had a significant increase in the EHS-EF score at 1 month follow-up (p<0.001 and p<0.02 respectively). However, no significant difference was found on the mean þ/EHS-EF score at 3 months follow-up despite an increase in the EHS-EF score in both groups (3.1þ/0.2 and 3.1þ/0.16). CONCLUSIONS: Ongoing Phase II clinical trial of the effect of LISWT on ED revealed a promising effect on recovery of the erectile function at 3 months follow-up. In this interim analysis, a clinically and statistically relevant effect of LISWT was observed. Long-term follow-up is needed to determine efficacy of shockwave therapy for erectile dysfunction.

MP91-02 EFFECTS OF LOW-INTENSITY EXTRACORPOREAL SHOCK WAVE THERAPY ON ERECTILE DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

INTRODUCTION AND OBJECTIVES: In recent years, medical expulsive therapy has been questioned in the management of distal ureteric stones. Therefore, we conducted a prospective randomized study to evaluate the possible role of tadalafil individually and in comparison with proven tamsulosin as well as a placebo therapy in distal ureteric stone expulsion. METHODS: Between January 2015 and March 2016, 327 patients who presented with distal ureteric stones of size 5e10 mm were randomly divided into three groups: tadalafil (Group A), tamsulosin (Group B), and placebo (Group C). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up, endoscopic treatment and adverse effects of drugs were noted. RESULTS: A statistically significant expulsion rate of 86.0% in Group A compared with 66.0% in Group B and 38.0% in Group C was observed. Also a shorter stone expulsion time in Group A (13.5 2.5) in comparison to Group B (16.4 3.5) and Group C (24.8 4.5) was observed. Statistically significant differences were noted in renal colic episodes and analgesic requirement in Group A in comparison to Group B and Group C. No serious adverse effects were noted. CONCLUSIONS: Tadalafil is safe, efficacious, and well tolerated as medical expulsive therapy for distal ureteric stones. This study showed that tadalafil increases ureteric stone expulsion quite significantly along with better control of pain and significantly lower analgesic requirement.

PD08-04 WHOLE EXOME SEQUENCING OF A CONSANGUINEOUS TURKISH FAMILY IDENTIFIES A MUTATION IN X-LINKED FHL1 IN BROTHERS WITH MALE FACTOR INFERTILITY

CONCLUSIONS: We observed statistically significant changes in the expression of key genes in the NFkB and TGFb/BMP/Hedgehog pathways as well as major dysregulation in additional genes of the Notch, Wnt, Jak/Stat, TGFb, PPAR, p53, and oxidative stress signaling pathways upon Ift140 knockdown in mouse male germ cells. The data suggests that silencing of Ift140 inhibits apoptosis, which may in turn cause spermatogenic failure.

V9-10 TRANSURETHRAL RESECTION OF EJACULATORY DUCTS: A STEP-BY-STEP GUIDE

18 items, each on a 5-point Likert scale. Trainee scores were assessed and compared for improvement over the course of the training course. RESULTS: The most common mistakes made by our trainees revolved around sitting position, hand tremor, instrument handling, needle control, suture placement, and knot tying. The errors were most prevalent early on and there were statistically significant improvements across all domains by the end of the MIM training course (Table). CONCLUSIONS: A MIM training program is an effective tool for teaching MIM skills. By incorporating intense supervision and continuous evaluation into an MIM training program, MIM trainees can avoid the development of bad habits that may be difficult to overcome and potentially have a negative impact on surgical outcomes.

Transurethral resection of ejaculatory ducts: a step-by-step guide

OBJECTIVE To demonstrate the key components for completing a successful transurethral resection of ejaculatory ducts (TURED) for completely obstructed ejaculatory ducts (EDs). DESIGN Video presentation. SETTING University Hospital. PATIENT(S) A 40-year-old man presenting with primary infertility and abnormal semen analysis (pH 6.4, volume of 0.7 cc, concentration 16 million/cc, and 7% motility) in whom a transrectal ultrasonography revealed dilated seminal vesicles measuring more than 1.5 cm and seminal vesicle aspiration detected no sperm in the aspirate. INTERVENTION(S) Transurethral resection of ejaculatory ducts. MAIN OUTCOME MEASURE(S) Intraoperative technique with commentary highlighting tips for a successful TURED. RESULT(S) This video provides a step-by-step guide for TURED, including transrectal ultrasonography-guided seminal vesicle puncture for instillation of methylene blue to allow more precise identification of EDs. Vesiculography was performed near the end of the procedure to assess for patency of EDs and confirm both sides had been opened. (Institutional review board approval was obtained for this presentation.) CONCLUSION(S): The key portions for performing a successful TURED includes seminal vesicle instillation of methylene blue for easier identification of EDs. Vesiculography is performed near the end of the procedure to ensure both EDs have been opened as well as to assess for passive drainage of the seminal vesicles through the newly open EDs.