Vas deferens to rete testis anastomosis for obstructive azoospermia.

PURPOSE: This video aims to present an in-depth, step-by-step tutorial on microsurgical reconstruction for obstructive azoospermia, featuring a distinctive case involving anastomosis from vas deferens to rete testis. The primary aim of this endeavor is to offer thorough and practical insights for healthcare professionals and researchers within the realm of reproductive medicine. The video endeavors to disseminate expertise, methodologies, and perspectives that can be advantageous to individuals grappling with obstructive azoospermia, providing a significant contribution to the progress of reproductive medicine and the augmentation of existing treatment alternatives. MATERIALS AND METHODS: Surgical footage was recorded using the ORBEYE 4K 3D Orbital Camera System by Olympus America, with patient consent acquired for research purposes. Additionally, a retrospective examination of patient records was undertaken to compile relevant medical histories. RESULTS: This video furnishes an exhaustive guide to microsurgical reconstruction for obstructive azoospermia, encompassing a distinctive instance of anastomosis from vas deferens to rete testis. State-of-the-art technology, such as the ORBEYE 4K 3D Orbital Camera, heightens procedural transparency, accentuating the significance of advanced instrumentation. The ethical underpinning is emphasized by obtaining patient consent for footage utilization, and a retrospective chart review augments the repository of valuable patient data. This comprehensive approach serves as an invaluable reservoir of knowledge for medical professionals and underscores excellence in clinical and ethical healthcare research. CONCLUSIONS: Anastomosis from vas deferens to rete testis emerges as a viable surgical reconstruction alternative for obstructive azoospermia, particularly when confronted with non-dilated tubules within the epididymis.

Patient Satisfaction with Oral Testosterone Undecanoate in Men Who Received Prior Testosterone Therapy: An Open-Label, Single-Center Clinical Trial.

PURPOSE: To evaluate patient satisfaction and symptom control in hypogonadal men transitioning from other testosterone therapies to oral testosterone undecanoate (TU). MATERIALS AND METHODS: In this open-label clinical trial, men aged 18 to 75 years with hypogonadism were switched to oral TU after a sufficient washout of previous testosterone therapies. Treatment satisfaction and symptom control were primarily measured using the 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9) and quantitative androgen deficiency in aging males (qADAM) questionnaires, respectively. Secondary outcomes included changes in serum testosterone (T), estradiol (E2), hematocrit (HCT), and prostate-specific antigen (PSA) levels. RESULTS: Forty-one men participated, with significant improvements in all TSQM-9 scores observed over 6 months. Symptom control as measured by qADAM remained consistent. There was a significant increase in serum T and E2 levels, but HCT and PSA levels remained stable. CONCLUSIONS: Switching to oral TU from other testosterone therapies is associated with increased patient satisfaction and stable hypogonadal symptom control.

Low-dose prednisone is an effective rescue for deteriorating semen parameters following vasovasostomy.

OBJECTIVE: This retrospective study aimed to evaluate the effectiveness of low-dose prednisone as a rescue therapy for patients with deteriorating semen parameters following vasovasostomy. MATERIALS AND METHODS: Electronic medical records were queried at the University of Miami with documented CPT code 55400 (Bilateral Vasovasostomy) between January 2016 and April 2023. Records were then reviewed to identify patients who demonstrated ≥50% decrease in semen parameters, specifically sperm concentration, motility and total motile sperm count. Patients who were treated with 6 weeks of low-dose prednisone were identified, and baseline semen parameters and subsequent changes after prednisone therapy were assessed. A Mann-Whitney U Test was used to compare semen parameter changes before and after prednisone. Adverse effects associated with prednisone were monitored. RESULTS: A total of 8 patients were identified with deteriorating semen parameters who were treated with 6 weeks of low-dose prednisone. Following prednisone therapy, all patients demonstrated improvements in total motile sperm count (TMSC), with a median improvement of 6 million. The median relative improvement in TMSC was 433%. Sperm concentration and motility also improved compared to post-operative baseline. No adverse effects were reported during the treatment period. CONCLUSIONS: Low-dose prednisone therapy appears to be a safe and effective intervention for managing deteriorating semen parameters following VV. The observed improvements in TMSC suggest the potential of prednisone to rescue patients with delayed failure after VV. Further research with larger sample sizes is warranted to confirm the safety and efficacy of low-dose prednisone as a rescue therapy in this specific patient population. Optimizing VV outcomes is crucial in male infertility, and further exploration of steroid therapy and innovative biotechnologies is warranted.

Primer on Female Infertility for the Reproductive Urologist.

This review is intended to serve as an aid in decision-making and patient counseling for the reproductive urologist when female factor infertility is found concurrently with male factor infertility. This review pairs the pathophysiology of female infertility with its implications for the treatment of male infertility, which most commonly includes ovulatory disorders, tubal abnormalities, and uterine abnormalities. By gaining a deeper understanding of these factors, reproductive urologists can employ a tailored approach to managing male factor infertility, taking into account the female partner's specific medical history.

Fertility outcomes in men with prior history of anabolic steroid use.

OBJECTIVE: To study sperm parameters recovery and fertility outcomes in men with azoospermia or severe oligospermia caused by anabolic steroid use who underwent a standardized treatment regimen for spermatogenesis recovery. DESIGN AND SUBJECTS: A retrospective analysis of a cohort of men with a prior history of anabolic steroid use and infertility complaints (between 2018 and 2022) was conducted. EXPOSURE: The standardized treatment approach involved discontinuing testosterone replacement therapy and administering a combination regimen of clomiphene citrate and human chorionic gonadotropin for a minimum of 3 to 6 months. MAIN OUTCOME MEASURES: The main outcome measures included changes in sperm parameters, predominantly sperm concentration, and subsequent pregnancy outcomes. RESULTS: A total of 45 men (median age 37 years, IQR 32-45) met the inclusion criteria for this analysis. Median duration of prior T use was 4 years (IQR 1.3-10), with the 2 most common modalities consisting of injection therapy (43.5%) and oral therapy (34.8%). The median initial sperm concentration was 0 million/cc (IQR 0-1.15), and 23 (51.1%) men initially presented with azoospermia. The median duration of combination human chorionic gonadotropin/clomid therapy was 5 months (IQR 3-12). In initially azoospermic men (N: 23), 5 were lost to follow-up, 6 (33.3%) progressed to severe oligospermia (<5 million/cc), 6 (33.3%) to oligospermia (<15 million/cc), 1 (5.6%) to normozoospermia (>15 million/cc), and 5 (27.8%) remained azoospermic after medical treatment for 6 months. Among the 24 couples who responded to the follow-up call, a total of 9 (37.5%) achieved a successful subsequent pregnancy. Of these, 33.3% (3 couples) used assisted reproductive technology, whereas 66.7% (6 couples) conceived naturally. On logistic regression analysis, no significant predictors for improved sperm parameters or successful pregnancy were identified. CONCLUSION: Despite appropriate treatment regimens, a significant proportion of men with a prior history of anabolic steroid use continue to exhibit severe oligospermia, with more than half showing limited improvement in semen parameters after 6 months of treatment. Only a fraction of men achieves normozoospermia after treatment. Further research is needed to explore predictors for improved sperm parameters and successful pregnancy outcomes in men with a history of anabolic steroid use.

A fragility index analysis of clinical trials evaluating low-intensity extracorporeal shockwave therapy for erectile dysfunction.

Erectile dysfunction is a common sexual dysfunction that affects a significant proportion of men. Low-intensity extracorporeal shockwave therapy has been evaluated in multiple clinical trials as a therapeutic option for men with erectile dysfunction. The robustness of these clinical trials is not well defined, as the trials are hindered by inconsistent treatment protocols, small study arm size and short follow-up intervals. The fragility index is a statistical analysis which is used to evaluate the robustness of clinical trials. It is calculated by evaluating the minimum number of patients in a given trial arm that would be required to have an alternative outcome to alter the statistical significance of the results. The lowest fragility index in statistically significant trials is 1, meaning that if just one participant experienced an alternate outcome, the results would no longer achieve statistical significance. The upper limit is determined by the number of participants in a given arm of the trial. Herein, a scoping review of clinical trials evaluating the efficacy of low-intensity extracorporeal shockwave therapy in erectile dysfunction to determine the fragility index of trials with clinically significant results. We hypothesized that the fragility index would be low, indicating the results are less robust and generalizable.

Misconceptions of Vaping Among Young Adults.

Background Vaping is growing in popularity worldwide, especially among young adults. To develop effective tobacco prevention interventions, first, there must be an understanding of the attitudes and perceptions of young adults toward the use of vaping. Highlighting perception discrepancies between races may allow physicians to more effectively counsel their patients regarding the risks of vaping. Methodology We conducted an online survey using Amazon Mechanical Turk (MTurk, https://www.mturk.com/) to identify misconceptions about vaping among adults aged 18 to 24 years who currently vape. The survey consisted of 18 questions evaluating reasons for vaping, history of tobacco use, and thoughts on the adverse effects of vaping. The Penn State Electronic Cigarette Dependence Index was implemented to assess dependence. Exclusion criteria comprised respondents who did not vape and were under the age of 18 or over the age of 24. Results A total of 1,009 responses were received with 66% identifying as male (n = 667) and 33% (n = 332) identifying as female. Sixty-nine percent of patients smoked cigarettes or used another form of tobacco previously (n = 692). Of those respondents, 81% indicated that they had since quit using tobacco products (excluding vaping). Switching to vaping was the most common reason for quitting cigarettes or other forms of tobacco, with health concerns and social purposes being the second and third most common reasons provided, respectively. When asked whether vaping had negative health impacts, only 238 (24%) participants strongly agreed with this statement, while a majority (64%) neither agreed nor disagreed or only somewhat agreed. Most participants were white or Caucasian (n = 777). When asked whether smoking or vaping had more severe health implications, 55% of white or Caucasian participants, 41% of Asian participants, and 32% of black or African American participants indicated that vaping was worse than smoking cigarettes. The average Penn State dependence score was 8.7, suggesting medium dependence. Conclusions Our survey sample of 1,006 young adults who vape indicated that the majority did not perceive vaping as significantly harmful. A comprehensive smoking prevention policy, educational interventions, and quit support are needed to enhance awareness among young adults about the health effects associated with vaping. Such interventions should also consider the novel shift toward the replacement of smoking with vaping.

Are varicoceles the holy grail of Andrology?

Varicoceles are a common condition affecting up to 15% of men in the general population, and up to 40% of men with infertility. A varicocele is an abnormal dilation of the veins within the scrotum, which can lead to reduced sperm production and testicular damage, resulting in infertility. Despite the prevalence of varicoceles, much remains to be discovered about their diagnosis, treatment, and long-term impact. Varicoceles are considered the 'holy grail' of Andrology because they represent a complex, multifactorial condition that requires a comprehensive approach to diagnosis and treatment. While surgical repair of varicoceles has been shown to improve fertility outcomes in some cases, there is still debate about the best approach to diagnosis and treatment, and long-term outcomes are not well understood. Advances in diagnostic imaging, such as color Doppler ultrasound, have improved our ability to identify varicoceles, but more research is needed to fully understand the impact of this condition on male fertility and overall health. As such, varicoceles represent an ongoing area of investigation in Andrology with much progress to be made in terms of diagnosis, treatment, and long-term impact.

Safety Aspects and Rational Use of Testosterone Undecanoate in the Treatment of Testosterone Deficiency: Clinical Insights.

Testosterone deficiency is diagnosed by a serum total testosterone level below 300 ng/dL in combination with symptoms such as decreased energy and libido. These symptoms can be ameliorated by restoring serum testosterone to the physiologic range with testosterone therapy (TT). There are numerous forms of testosterone therapy, such as injectable, transdermal, nasal, and subcutaneous applications. There are also multiple formulations of injection, such as testosterone cypionate, testosterone enanthate, and testosterone undecanoate. Testosterone undecanoate (TU) is a long-acting ester formulation of testosterone that can be provided in an injectable or oral form. Oral testosterone undecanoate is marketed as Andriol, Jatenzo, Tlando, and Kyzatrex. Oral TU provides a convenient option for many patients, which may increase compliance with TT. Injectable testosterone undecanoate is marketed as Aveed and Nebido. Injectable TT remains the most cost-effective therapeutic option and is appropriate for most patients as an initial therapy. This review describes the pharmacokinetics of these testosterone undecanoate products and provides a guide for prescribers using these medications. While many forms of testosterone are appropriate for TT, a patient-centered discussion focused on goals of care should best guide physician prescription of these medications.

Ejaculation: the Process and Characteristics From Start to Finish.

Purpose of Review: Semen analysis serves as the initial step in the evaluation of male infertility. However, given the difficulty in interpreting abnormal findings, physicians and patients often struggle with understanding the results. In this review, we aim to review the normal physiology of ejaculation and create an accessible resource for interpreting abnormal semen volume, viscosity, liquefaction, pH, appearance, and color. Recent Findings: Emerging evidence has revealed that men with genitourinary tract infections have a greater number of seminal leukocytes, which may result in clumping of motile sperm and altered morphology. Hence, these patients may have abnormal sperm parameters secondary to their health status. Recent findings have further characterized the semen liquefaction process, suggesting that increased levels of semenogelin and decreased levels of proteases and plasminogen activators (e.g., urokinase and chymotrypsin) may be associated with the failure of semen to convert to a watery consistency. Summary: This article creates a resource which may be referenced when abnormalities in semen analysis are encountered. We offer a comprehensive overview of normal ejaculation physiology and abnormal variants in male ejaculate volume-including aspermia, anejaculation, retrograde ejaculation, and hypo- and hyperspermia-and their potential etiologies. Additionally, we discuss several processes (infection, inflammation, and dysfunction of male sex glands) which may affect semen viscosity, liquefaction, and pH. Finally, our discussion of the potential colors of male ejaculate is meant to reduce the anxiety of both patient and provider. Through a better understanding of the process and varying characteristics of ejaculation, physicians may adequately counsel their patients on abnormal findings and concerns regarding infertility.

Patient Satisfaction After Switching to Jatenzo (Oral Testosterone Undecanoate): Update on an Open-label, Single-arm Clinical Trial.

This is the first study investigating patient satisfaction among men receiving oral testosterone decanoate (TU) who were previously using other forms of testosterone therapy. Oral TU appeared to lead to greater patient satisfaction in comparison to previous modalities and similar improvements in hypogonadal symptoms. TU represents a favorable and viable option for hypogonadal individuals who are unhappy with existing treatment options.

Semen Cryopreservation in Men with Cancer: Identifying Patterns and Challenges.

OBJECTIVE: The aim of this study was to determine the proportion of male cancer patients who undergo semen cryopreservation before chemotherapy after referral was placed, identify factors associated with completing the procedure, and explore reasons for not moving forward with it. METHODS: The electronic medical records of men with cancer who were referred to a reproductive urologist identified with an ICD-10 code for a fertility preservation procedure (Z31.62, Z31.84) between November 2021 and February 2023 were reviewed. Cancer type, semen cryopreservation rates, and reasons for opting out of the procedure were recorded. RESULTS: Of the 128 men diagnosed with cancer who were referred for cryopreservation during the study period, n:67 (52%) underwent semen cryopreservation. Those who did not undergo the procedure tended to be older, with a median age of 38 years compared to those that did it (33 years) (p: 0.10). The most common reasons for non-compliance included financial burden, and lack of interest. CONCLUSION: While it is recommended that patients consider fertility preservation prior to chemotherapy, our findings suggest that only half of male cancer patients completed the procedure despite referral. Further work is needed to determine barriers to access and increase awareness of fertility preservation prior to chemotherapy.

Male Sexual Health Implications of the 2022 Global Monkeypox Outbreak.

The 2022 global monkeypox (MPX) outbreak is the largest in history to occur outside of endemic African regions. Disease spread during this outbreak has been primarily through human-to-human transmission, with sexual contact being of particular concern. Clinical presentations have commonly featured genital, perianal, and oral lesions associated with sexual activity among men who have sex with men (MSM), who compose the vast majority of MPX cases. This review discusses the epidemiology, clinical features, and evaluation of MPX with regards to men's sexual health. Comparisons were made between MPX and its relative from the Orthopoxvirus genus, smallpox, in order to make informed inferences on the potential effects of MPX on men's sexual health. This review also discusses the role of men's health specialists and urologists in addressing the current outbreak.

JATENZO®: Challenges in the development of oral testosterone.

Testosterone therapy (TT) for the treatment of testosterone deficiency (TD) can be administered via several routes of administration. Due to a variety of concerns such as hepatotoxicity, an oral formulation has long been absent in the United States. Recently, JATENZO® (testosterone undecanoate) oral capsules was approved by the US FDA as an oral option for men suffering from TD. In this article, we will discuss the history and challenges in the development of a viable oral formulation of exogeneous TT and examine how JATENZO® addresses these concerns.