Optimizing human semen cryopreservation by reducing test vial volume and repetitive test vial sampling.

OBJECTIVE: To investigate optimal test vial (TV) volume, utility and reliability of TVs, intermediate temperature exposure (-88°C to -93°C) before cryostorage, cryostorage in nitrogen vapor (VN2) and liquid nitrogen (LN2), and long-term stability of VN2 cryostorage of human semen. DESIGN: Prospective clinical laboratory study. SETTING: University assisted reproductive technology (ART) laboratory. PATIENT(S): A total of 594 patients undergoing semen analysis and cryopreservation. INTERVENTION(S): Semen analysis, cryopreservation with different intermediate steps and in different volumes (50-1,000 µL), and long-term storage in LN2 or VN2. MAIN OUTCOME MEASURE(S): Optimal TV volume, prediction of cryosurvival (CS) in ART procedure vials (ARTVs) with pre-freeze semen parameters and TV CS, post-thaw motility after two- or three-step semen cryopreservation and cryostorage in VN2 and LN2. RESULT(S): Test vial volume of 50 µL yielded lower CS than other volumes tested. Cryosurvival of 100 µL was similar to that of larger volumes tested. An intermediate temperature exposure (-88°C to -93°C for 20 minutes) during cryopreservation did not affect post-thaw motility. Cryosurvival of TVs and ARTVs from the same ejaculate were similar. Cryosurvival of the first TV in a series of cryopreserved ejaculates was similar to and correlated with that of TVs from different ejaculates within the same patient. Cryosurvival of the first TV was correlated with subsequent ARTVs. Long-term cryostorage in VN2 did not affect CS. CONCLUSION(S): This study provides experimental evidence for use of a single 100 µL TV per patient to predict CS when freezing multiple ejaculates over a short period of time (<10 days). Additionally, semen cryostorage in VN2 provides a stable and safe environment over time.

Five year expanded prostate cancer index composite-based quality of life outcomes after prostatectomy for localized prostate cancer.

OBJECTIVE: To document the Expanded Prostate cancer Index Composite (EPIC) results for men followed for 5 years after radical prostatectomy. PATIENTS AND METHODS: EPIC and demographic information were prospectively obtained from 434 patients who received questionnaires preoperatively and 1, 4, 12, 24, 36, 48 and 60 months postoperatively. Paired t-tests compared scores at individual time points. Percentage return to baseline was calculated at all postoperative time points and multivariate analyses evaluated postoperative trends. RESULTS: The mean age of patients was 63.4 years. Mean urinary function and incontinence worsen after prostatectomy, with recovery stable 12 months after surgery. Mean urinary bother returned to baseline by 4 months post-prostatectomy. Some 55.8% and 77.5% of patients return to their urinary function and bother baselines, respectively, 1 year after surgery. Mean sexual function and bother both declined after surgery, with new stable baselines achieved by 24 and 36 months post-prostatectomy, respectively. Of the patients, 24.2% returned to their sexual function baseline by 24 months. No postoperative improvement was noted in mean sexual bother until the 12 months post-prostatectomy. Of the patients, 36.8% returned to their sexual bother baseline by 36 months. Minimal change was noted in the bowel and hormonal domains. CONCLUSIONS: Mean urinary function and incontinence did not recover to preoperative baseline after prostatectomy, although it did not add distress because mean urinary bother returned to pre-prostatectomy levels. Mean sexual function declined post-prostatectomy, with continued recovery up to 24 months. Sexual bother recovered later but, once it reached a new baseline, the distress does not lessen with time, probably indicating an inability to adjust to their functional loss.

Quality of life outcomes following treatment for localized prostate cancer: is there a clear winner?

PURPOSE OF REVIEW: The majority of men treated for localized prostate cancer are cured of their disease. As a result, it is important to discuss long-term quality of life (QoL) expectations when counseling patients regarding treatment options. The varying QoL outcomes for radical prostatectomy, external beam radiotherapy, brachytherapy, and cryotherapy will be reviewed. RECENT FINDINGS: Robotic and radical prostatectomy has similar outcomes with significant initial worsening of urinary continence and sexual function. External beam radiation has less impact on continence and sexual function but noteworthy bowel toxicity. Brachytherapy results in the most irritative urinary symptoms, with decreased sexual and bowel QoL as well. Cryotherapy greatly reduces sexual function. SUMMARY: Every patient has unique pretreatment variables, priorities, and preferences. It is crucial to fully explain the range of oncologic and QoL implications when counseling patients regarding treatment for localized prostate cancer.

Feasibility and safety of robot-assisted salvage prostatectomy for recurrent prostate cancer following radiation therapy.

We report a comparison of perioperative complications and pathologic outcomes in patients with locally radiorecurrent prostate cancer treated by open radical retropubic or robot-assisted prostatectomy. The results of our study demonstrate that both surgical approaches were feasible and safe without any significant perioperative complications (death, rectal injury) with comparable short-term outcomes.

Urethral diverticulum after endoscopic urethrotomy: case report.

Diverticula of the male penile urethra are rare clinical entities. Urethral diverticula in males may be associated with trauma, infection, impacted calculi or stricture disease. Herein, we present an unusual case of a 57-year-old man with erectile dysfunction and a symptomatic urethral diverticulum after endoscopic urethrotomy for a pendulous urethral stricture. One year after surgical repair involving urethral stricture excision, end-to-end primary urethroplasty, and closure of the diverticular neck, the patient is voiding well but has persistent erectile dysfunction unresponsive to phosphodiesterase-5 inhibitors.

Calcium oxalate stone formation in genetic hypercalciuric stone-forming rats.

BACKGROUND: Over 54 generations, we have successfully bred a strain of rats that maximizes urinary calcium excretion. The rats now consistently excrete 8 to 10 times as much calcium as controls, uniformly form poorly crystalline calcium phosphate kidney stones, and are termed genetic hypercalciuric stone-forming (GHS) rats. These rats were used to test the hypothesis that increasing urinary oxalate excretion would not only increase the supersaturation with respect to the calcium oxalate solid phase, but also would increase the ratio of calcium oxalate-to-calcium phosphate supersaturation and result in calcium oxalate stone formation. METHODS: To increase urine oxalate excretion an oxalate precursor, hydroxyproline, was added to the diet of male GHS rats. The GHS rats were fed a standard 1.2% calcium diet alone or with 1%, 3% or 5% trans-4-hydroxy-l-proline (hydroxyproline). RESULTS: The addition of 1% hydroxyproline to the diet of GHS rats led to an increase in urinary oxalate excretion, which did not increase further with the provision of additional hydroxyproline. The addition of 1% and 3% hydroxyproline did not alter calcium excretion while the provision of 5% hydroxyproline led to a decrease in urine calcium excretion. The addition of 1% hydroxyproline led to an increase in urinary calcium oxalate supersaturation, which did not further increase with additional hydroxyproline. The addition of 1% and 3% hydroxyproline did not alter urinary supersaturation with respect to calcium hydrogen phosphate while the addition of 5% hydroxyproline tended to lower this supersaturation. Compared to rats fed the control and the 3% hydroxyproline diet the addition of 5% hydroxyproline increased the ratio of calcium oxalate supersaturation to calcium phosphate supersaturation. Virtually all rats formed stones. In the control and 1% hydroxyproline group, all of the stones were composed of calcium and phosphate (apatite), in the 3% hydroxyproline group the stones were a mixture of apatite and calcium oxalate, while in the 5% hydroxyproline group all of the stones were calcium oxalate. CONCLUSIONS: The provision of additional dietary hydroxyproline to GHS rats increases urinary oxalate excretion, calcium oxalate supersaturation and the ratio of calcium oxalate-to-calcium phosphate supersaturation, resulting in the formation of calcium oxalate kidney stones. Thus, with the addition of a common amino acid, the GHS rats now not only model the most common metabolic abnormality found in patients with nephrolithiasis, hypercalciuria, but form the most common type of kidney stone, calcium oxalate.