Tissue Engineering for Penile Reconstruction.

The penis is a complex organ with a development cycle from the fetal stage to puberty. In addition, it may suffer from either congenital or acquired anomalies. Penile surgical reconstruction has been the center of interest for many researchers but is still challenging due to the complexity of its anatomy and functionality. In this review, penile anatomy, pathologies, and current treatments are described, including surgical techniques and tissue engineering approaches. The self-assembly technique currently applied is emphasized since it is considered promising for an adequate tissue-engineered penile reconstructed substitute.

Can a Low Sperm Concentration without Assessing Motility Confirm Vasectomy Success? A Retrospective Descriptive Study.

PURPOSE: A fresh post-vasectomy semen analysis showing 100,000 nonmotile sperm/mL or less confirms sterility. Mailed sample or self-testing at home with SpermCheck® Vasectomy decreases the inconvenience of producing a fresh sample, but without assessing motility. We evaluated if there is a sperm concentration under which no motile sperm are observed that could fortify the use of these alternatives. MATERIALS AND METHODS: We conducted a study of post-vasectomy semen analyses performed at the andrology laboratory of the Quebec City university hospital, Canada. Sperm concentration and motility were assessed on fresh noncentrifuged 10 µL samples at 400× magnification. We calculated the proportion of post-vasectomy semen analysis showing motile sperm according to sperm concentration for all and first prescribed post-vasectomy semen analysis by the 5 physicians who performed the most vasectomies. RESULTS: We identified 6,492 post-vasectomy semen analyses prescribed by 169 physicians. The 5 vasectomists prescribed 95.6% (6,204) of the post-vasectomy semen analyses; 96.1% (5,965) were first tests. We observed motility in all sperm concentration strata but it decreased with lower concentrations. At the first post-vasectomy semen analysis, among patients with less than 1 million, 250,000 and 100,000 sperm/mL, 0.5% (27/5,842) and 0.3% (19/5,760 and 17/5,725) had motility, respectively. CONCLUSIONS: If the first post-vasectomy semen analysis on a mailed sample shows less than 1 million sperm/mL, we recommend requesting an additional mailed sample instead of a fresh sample. SpermCheck Vasectomy could falsely indicate a successful vasectomy in a very small proportion of cases. The optimal post-vasectomy semen analysis strategy must involve shared decision making, balancing the inconvenience of providing a fresh sample with the risk of a false-negative result.

Switching Cancers: A Systematic Review Assessing the Role of Androgen Suppressive Therapy in Bladder Cancer.

CONTEXT: Bladder cancer demonstrates striking gender-based differences in incidence, with a role for androgens possibly implicated in the development and progression of the disease. Emerging preclinical and clinical evidence suggests that there may be a role for antiandrogen therapy in bladder cancer. OBJECTIVE: This systematic review assessed the current clinical evidence evaluating androgen suppressive therapy (AST) for the treatment or prevention of bladder cancer. EVIDENCE ACQUISITION: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, MEDLINE was searched for full-text articles detailing clinical outcomes or incidence of bladder cancer among patients who received AST, defined as gonadotropin-releasing hormone agonists or equivalent, androgen receptor antagonists, or 5-alpha reductase inhibitors. EVIDENCE SYNTHESIS: A total of 12 studies were included. Five studies focused on prostate cancer patients, with one study in men with lower urinary tract symptoms. Among these studies, a lower incidence of bladder cancer was observed in five, with adjusted risk reduction estimates ranging from 7% to 47%. Six studies evaluating 11 820 bladder cancer patients investigated clinical outcomes among men who received a form of AST. Three out of four studies evaluating recurrence-free survival found a benefit for AST, with adjusted hazard ratios for recurrence of non-muscle-invasive cancer ranging from 0.29 to 0.53. Limitations included large variability in data sources and methodologies, as well as no data on tolerability. CONCLUSIONS: Current evidence indicates that antiandrogen therapies exert a favorable influence on bladder tumors. Further prospective studies are needed to assess their therapeutic potential. PATIENT SUMMARY: Androgen suppressive therapy is commonly prescribed for the treatment of prostate-related problems. Prior research indicates that there may be a role for these treatments in patients with bladder cancer. In this review, we evaluate the current evidence that strongly suggests that these agents may be effective against bladder cancer.

Receipt of 5-Alpha Reductase Inhibitors Before Radical Cystectomy: Do They Render High-Grade Bladder Tumors Less Aggressive?

PURPOSE: To assess whether receipt of 5-alpha reductase inhibitors (5-ARIs) influences the findings on surgical pathology at the time of radical cystectomy (RC) and subsequent clinical outcomes. 5-ARIs may slow the progression of non-muscle-invasive bladder cancer. PATIENTS AND METHODS: We retrospectively reviewed all patients who underwent RC at our institution between 2009 and 2017. Men were included who had urothelial cancer in the RC specimen. Patients with nonurothelial pathology or who had no cancer in the specimen were excluded. Odds ratios for pathologic features and hazard ratios for survival were adjusted for baseline patient characteristics and disease stage. RESULTS: Our study cohort included 338 men; 48 patients (14%) were receiving dutasteride or finasteride at time of RC, 58 (17%) metformin, and 195 (58%) statins. Among patients receiving 5-ARIs, there was a lower proportion of positive margins (P = .08) and lymphovascular invasion (P = .05). This was statistically significant when patients with urothelial carcinoma variants were excluded. Multivariable logistic regression analysis demonstrated that 5-ARI receipt was associated with a lower odds ratio (OR) for the presence of lymphovascular invasion (OR = 0.49; 95% confidence interval, 0.24-1.00; P = .049) and positive surgical margins (OR = 0.30; 95% confidence interval, 0.09-1.07; P = .063). Further, 5-ARI receipt was associated with better overall survival, with an adjusted hazard ratio of 0.40 (95% confidence interval, 0.19-0.83; P = .015). No similar tendencies were observed with metformin or statins. CONCLUSION: 5-ARIs may exert a protective biologic effect on the invasive properties of high-grade urothelial carcinoma. Further research is needed to understand the therapeutic implications.