Effect of female partner age on pregnancy rates after vasectomy reversal.

OBJECTIVE: To determine the effect of female partner age on pregnancy rates after vasectomy reversal. DESIGN: Retrospective review. SETTING: Two academic infertility practices. PATIENT(S): Men undergoing vasectomy reversal and their partners. INTERVENTION(S): Microsurgical vasectomy reversal. MAIN OUTCOME MEASURE(S): Patency and pregnancy rates. RESULT(S): Two hundred ninety-four patients met the inclusion criteria. Groups were similar with regard to types of procedure performed (vasovasostomy or vasoepididymostomy), obstructive interval, female factors, number of repeat procedures, and quality of vasal fluid. Patency rates were 90%, 89%, 90%, 86%, and 83% for patients with female partners aged 20-24, 25-29, 30-34, 35-39, and 40+ years, respectively. Pregnancy rates were 67%, 52%, 57%, 54%, and 14% for patients with female partners aged 20-24, 25-29, 30-34, 35-39, and 40+ years, respectively. The pregnancy rate for couples with female partner aged 40 or older was lower than for those with the female partner aged 39 or younger (14% vs. 56%). CONCLUSION(S): Pregnancy rates for vasectomy reversal were good regardless of female age as long as the partner was 39 years old or younger. Pregnancy rates were lower if the female partner was 40 or more years old.

Retrograde stenting for obstruction of the renal transplant ureter.

OBJECTIVES: To present our experience with retrograde stent placement and stent exchange for transplant ureteral obstruction. METHODS: A review of our renal transplant database was performed to identify all renal transplant patients who underwent attempted retrograde ureteral stenting for allograft ureteral obstruction or attempted allograft ureteral stent exchange between May 1992 and April 2004. A retrospective review was performed. RESULTS: Forty patients underwent 52 attempted retrograde ureteral stent placements, and 11 patients underwent a total of 27 attempted stent exchanges. In patients with ureteral obstruction, the most common clinical signs and symptoms were nausea, vomiting, diarrhea, abdominal pain, fever, decreased urine output, edema, and an elevated serum creatinine. Of the 52 cases of allograft ureteral obstruction and attempted retrograde ureteral stent placement, 28 (53.8%) were managed successfully with retrograde ureteral stenting. Of the 27 attempted stent exchange procedures, a successful exchange was accomplished in 23 cases (85.2%). CONCLUSIONS: Cystoscopy with retrograde allograft stent placement is a reasonable first approach to the management of transplant ureteral obstruction and is successful in more than one half of cases.

Evidence for ERK1/2 phosphorylation controlling contact inhibition of proliferation in Madin-Darby canine kidney epithelial cells.

Increasing cell density arrests epithelial cell proliferation by a process termed contact inhibition. We investigated mechanisms of contact inhibition using a model of contact-inhibited epithelial cells. Hepatocyte growth factor (HGF) treatment of contact-inhibited Madin-Darby canine kidney (MDCK) cells stimulated cell proliferation and increased levels of phosphorylated ERK1/2 (phospho-ERK1/2) and cyclin D1. MEK inhibitors PD-98059 and U0126 inhibited these HGF-dependent changes, indicating the dependence on phosphorylation of ERK1/2 during HGF-induced loss of contact inhibition. In relation to contact-inhibited high-density cells, low-density MDCK cells proliferated and had higher levels of phospho-ERK1/2 and cyclin D1. PD-98059 and U0126 inhibited low-density MDCK cell proliferation. Trypsinization of high-density MDCK cells immediately increased phospho-ERK1/2 and was followed by a transient increase in cyclin D1 levels. Reformation of cell junctions after trypsinization led to decreases in phospho-ERK1/2 and cyclin D1 levels. High-density MDCK cells express low levels of both cyclin D1 and phospho-ERK1/2, and treatment of these cells with fresh medium containing HGF but not fresh medium alone for 6 h increased phospho-ERK1/2 and cyclin D1 levels compared with cells without medium change. These data provide evidence that HGF abrogates MDCK cell contact inhibition by increasing ERK1/2 phosphorylation and levels of cyclin D1. These results suggest that in MDCK cells, contact inhibition of cell proliferation in the presence of serum occurs by cell density-dependent regulation of ERK1/2 phosphorylation.

Gene expression alterations during HGF-induced dedifferentiation of a renal tubular epithelial cell line (MDCK) using a novel canine DNA microarray.

Hepatocyte growth factor (HGF) elicits a broad spectrum of biological activities, including epithelial cell dedifferentiation. One of the most widely used and best-studied polarized epithelial cell lines is the Madin-Darby canine kidney (MDCK) cell line. Here, we describe and validate the early response of polarized monolayers of MDCK cells stimulated with recombinant HGF using a novel canine DNA microarray designed to query 12,473 gene sequences. In our survey, eight genes previously implicated in the HGF signaling pathway were differentially regulated, demonstrating that the system was responsive to HGF. Also identified were 117 genes not previously known to be involved in the HGF pathway. The results were confirmed by real-time PCR or Western blot analysis for 38 genes. Of particular interest were the large number of differentially regulated genes encoding small GTPases, proteins involved in endoplasmic reticulum translation, proteins involved in the cytoskeleton, the extracellular matrix, and the hematopoietic and prostaglandin systems.

Transvaginal ultrasound for the diagnosis of urethral diverticulum.

PURPOSE: We reviewed our experience with urethral diverticula and transvaginal ultrasound to evaluate female patients with this condition. MATERIALS AND METHODS: All female patients who underwent transvaginal ultrasound during evaluation for urethral diverticulum at our institution between May 1995 and April 2002 were identified by searching a data base. We reviewed the diagnostic evaluation and compared diagnostic techniques with transvaginal ultrasound for diagnosing urethral diverticulum. RESULTS: Of the 25 patients with suspected urethral diverticulum who underwent transvaginal ultrasound as a diagnostic procedure 10 (40%) were diagnosed with urethral diverticulum, including 10 in whom it was confirmed by surgery or other diagnostic procedures. Transvaginal ultrasound was less expensive than the other diagnostic modalities and in no case did it miss a urethral diverticulum that was identified by another diagnostic technique. Urethral diverticulum was detected on 1 of 3 voiding cystourethrograms (33%) and this study missed the diagnosis in 1 case that was diagnosed by transvaginal ultrasound. Three cases of urethral diverticulum were noted on transvaginal ultrasound after they were missed by cystoscopy. Videourodynamics were unable to diagnose urethral diverticulum. CONCLUSIONS: Transvaginal ultrasound is effective for evaluating patients with suspected urethral diverticulum. It is less expensive and may identify diverticula missed by other diagnostic modalities.