Determining the Feasibility of Managing Erectile Dysfunction in Humans With Placental-Derived Stem Cells.

INTRODUCTION: Stem cell therapy is thought to improve wound healing and promote vasculogenesis and has also been investigated as a treatment for patients with erectile dysfunction (ED), which is usually caused by a microvascular disease such as diabetes mellitus or hypertension. OBJECTIVE: To determine the feasibility and effects of using placental matrix-derived mesenchymal stem cells (PM-MSCs) in the treatment of patients with ED. METHODS: Participants were recruited from a private practice urology in Coral Springs, Florida. Each patient received an injection of PM-MSCs and was followed up with at 6 weeks, 3 months, and 6 months to assess peak systolic velocity (PSV), end diastolic velocity, stretched penile length, penile width, and erectile function status based on the International Index of Erectile Function questionnaire. RESULTS: Eight patients were injected with PM-MSCs. At the 6-week follow-up, PSV ranged from 25.5 cm/s to 56.5 cm/s; at 3 months, PSV ranged from 32.5 cm/s to 66.7 cm/s. Using unpaired t tests, the increase in PSV was statistically significant (P<.05). At 6 months, PSV ranged from 50.7 cm/s to 73.9 cm/s (P<.01). Changes in measured end diastolic velocity, stretched penile length, penile width, and International Index of Erectile Function scores were not statistically significant. At the 6-week follow-up, 2 patients for whom previous oral therapies failed had the ability to sustain erections on their own. At the 3-month follow-up, 1 additional patient was able to achieve erections on his own. CONCLUSION: To our knowledge, this is one of the first human studies to report on the feasibility of using stem cell therapy to treat patients with ED. The results indicate that this treatment may be beneficial, and further investigations with larger sample sizes should be conducted. (ClinicalTrials.gov number NCT02398370).

Effects of Stem Cell Treatment in Human Patients With Peyronie Disease.

CONTEXT: Peyronie disease (PD) is a connective tissue disorder involving the formation of fibrous plaques in the tunica albuginea. Abnormal plaques and scar tissue create a chronic state of inflammation, causing increased curvature of the penis as well as erectile dysfunction. OBJECTIVE: To determine the feasibility and effects of using placental matrix-derived mesenchymal stem cells (PM-MSCs) in the management of PD. METHODS: In a prospective study, patients with PD were injected with PM-MSCs, and followed up at 6-week, 3-month, and 6-month intervals to assess changes in plaque volume, penile curvature, and erectile function status (measured using peak systolic velocity, end-diastolic velocity, and the International Index of Erectile Function questionnaire). RESULTS: In the 5 patients enrolled in the study, statistically significant increases in peak systolic velocity occurred after PM-MSC injection (P<.01). Of a total of 10 plaques managed, 7 had disappeared completely at 3-month follow-up. Changes in end-diastolic velocity, stretched penile length, and penile girth were not statistically significant. CONCLUSION: To our knowledge, this study is the first on the use of stem cells to manage PD in humans. The results suggest that PM-MSCs may be beneficial and effective as a nonsurgical treatment in patients with PD. Future studies with long-term follow-up in a larger sample of patients are warranted. (ClinicalTrials.gov number NCT02395029).

Recurrent transitional cell carcinoma in a scrotal abscess.

We discuss a case of recurrent transitional cell carcinoma to the scrotum 5 years after cystectomy, along with its postoperative management and implications.

Evaluating the risk of epididymal injury during hydrocelectomy and spermatocelectomy.

PURPOSE: We evaluated the risk of epididymal injury in patients undergoing hydrocelectomy and spermatocelectomy, and determined risk factors that may increase the chance of epididymal injury. To our knowledge the incidences of epididymal injury during hydrocelectomy and spermatocelectomy have not previously been reported. MATERIALS AND METHODS: The pathology reports of all patients undergoing hydrocelectomy and spermatocelectomy at a single institution from 1990 to 2003 were retrospectively reviewed to determine if a portion of the epididymis was present in the pathology specimen. Patients with epididymis present then underwent a chart review to determine possible risk factors for epididymal injury. RESULTS: A total of 338 adults underwent unilateral or bilateral hydrocelectomy from 1990 to 2003. Another 111 patients underwent spermatocelectomy during this period. In 19 patients (5.62%) epididymal injuries were documented during hydrocelectomy and in 19 (17.12%) epididymal injuries were documented during spermatocelectomy. No specific risk factors could be identified. CONCLUSIONS: The risk of epididymal injury during hydrocelectomy and spermatocelectomy is significant. Patients must be informed of this risk since epididymal injury may lead to infertility. To our knowledge this is the first published report documenting the incidence and risk of epididymal injury during hydrocelectomy or spermatocelectomy.

Distinguishing splenosis from renal masses using ferumoxide-enhanced magnetic resonance imaging.

A 43-year-old man with a history of splenectomy was found to have a solid renal mass on computed tomography. Magnetic resonance imaging with ferumoxide characterized this mass as ectopic splenic tissue and nephrectomy was avoided.

Morphology and the sperm penetration assay.

OBJECTIVE: To assess the ability of Kruger morphology to predict the outcome of the sperm penetration assay (SPA). DESIGN: A retrospective review using univariate and multivariate analysis, t tests, and logistic regression was performed to examine the correlation between Kruger morphology and the optimized zona-free hamster egg sperm penetration assay (O-HESPA). SETTING: University hospital. PATIENT(S): One hundred fifteen private-practice patients who underwent semen analysis, including Kruger morphology and O-HESPA, as part of an infertility evaluation between 1997-2000 were retrospectively reviewed. INTERVENTION(S): Retrospective analysis of the sperm penetration assay. MAIN OUTCOME MEASURE(S): Univariate and multivariate analysis, Student's t test, and logistic regression were performed to analyze Kruger morphology, count, and viability and their relationship to SCI result. RESULT(S): Univariate analysis demonstrated a statistically significant correlation between SCI and sperm count, viability, and Kruger morphology. Multivariate analysis demonstrated statistically significant correlations between SCI and count and viability. There was no correlation between Kruger morphology and SCI. Logistic regression was performed on the SCI results, using count, Kruger morphology, and viability. Sperm count was found to be the only variable that was statistically significant with respect to SCI results. CONCLUSION: This study demonstrated that Kruger morphology assessment cannot be used to predict the results of SCI or replace it in the management of the infertile couple.