Female Urology

The last few years have witnessed an enormous interest in androgen replacement therapy for late-onset hypogonadism-also known as "androgen deficiency in the aging male." As urologists, we frequently deal with sexual dysfunction and are seen as experienced on issues of prostate health.

Varicocele is a common clinical finding, present in approximately 15%of adult men. When the patient with a varicocele visits a urologist, itis often due to testicular discomfort or fertility-related concerns. Atthe 2003 meeting of the American Society for Reproductive Medicine, bothof these issues were addressed and are discussed in this issue of UrologyTimes.

San Antonio--Repair of clinically significant varicoceles may resultin nearly a 25% chance of natural conception, even in men who do not demonstratesignificant improvements in their postoperative seminal parameters, accordingto University of Iowa researchers.

San Antonio--Biomaterial wraps are a promising adjunct for vasovasostomy,according to results of an animal study that incorporated a biomaterialmatrix and a sealant into the conventional three-suture anastomosis. Researcherscalled this "polishing the gold standard" because of the highpatency rate of the standard procedure.

San Antonio--A retrospective study of men with cancer who elected to cryopreservetheir sperm because of cancer therapy found that 20% of men had alreadyreceived one or more cycles of chemotherapy. The recognized toxic effectsof chemotherapy and radiation on sperm cells make this a questionable practice

New Jersey has become the second state in the nation, following California, to legalize stem cell research. Among its provisions, the legislation has implications for the treatment of infertility.

Among men undergoing cryotherapy for prostate cancer, 95% showed no biochemical evidence of cancer recurrence at a follow-up of 3.5 years in a small study presented at the Radiological Society of North America annual meeting.

Los Angeles-After a follow-up of almost 2 years, 70% of patients withstress urinary incontinence reported no repeat SUI after surgery with syntheticpolypropylene sling material, according to UCLA researchers.

Treatment with a transdermal testosterone patch significantly increased sexual desire and sexual activity in women with hypoactive sexual desire disorder (HSDD) resulting from the surgical removal of both ovaries, a recent study showed.

An oral bisphosphonate may slow the development of symptomatic bone metastases and reduce the risk of death from this disease, new data show.

Chemoprevention is the use of natural or synthetic agents to avert the induction of, or to inhibit, delay, or suppress the progression of cancers or other diseases. Carcinogenesis is a process that occurs over a period of months to years and is under the influence of a range of genetic and environmental factors.

Although antibiotics are commonly used to treat symptoms of chronic pelvicpain syndrome, this approach is beneficial in a relatively small subsetof patients, and urologists must consider alternative treatment modalities,including physical therapy. In this exclusive Urology Times interview, JeannettePotts, MD, discusses current research and her own views on the diagnosisand treatment of chronic prostatitis. Dr. Potts is a member of the staffat the Cleveland Clinic Glickman Urological Institute. The interview wasconducted by Philip M. Hanno, MD, of the department of urology, Universityof Pennsylvania, Philadelphia.

Prostate cancer is the most prevalent non-cutaneous cancer diagnosed in men today, still accounting for a significant amount of morbidity and mortality in spite of increased screening efforts and advances in treatment.

Chicago-The selective endothelin receptor antagonist atrasentan significantly attenuates changes in biochemical markers of bone metabolism and disease progression in a group of patients with advanced hormone-refractory prostate cancer that had progressed on placebo, according to the results of a randomized clinical trial.

Presented by Allen D. Seftel, MD, Case Western Reserve University, Cleveland

Presented by Larry Lipshultz, MD, Baylor College of Medicine, Houston.

Presented by Richard Grady, MD, University of Washington, Seattle.

Presented by Donald A. Elmajian, MD, Lousiiana State University, Shreveport

Urologic laparoscopy has assumed an important role as an alternative to open surgery. Advancement in techniques and equipment result in continuous expansion of the indications for urologic laparoscopy.

Chicago-Two alpha blockers appear to have modest efficacy in treatingchronic prostatitis/chronic pelvic pain syndrome, according to separatestudies presented here at the AUA annual meeting.

Chicago-The etiology of male factor infertility remains one ofthe larger mysteries confronting urologists. A study from Baylor Collegeof Medicine suggests that the origins of the problem might lie with thetestes and may not involve either inflammation or oxidative radicals, assome have suggested.

Chicago-Radical prostatectomy patients taking sildenafil postoperativelywere seven times more likely to report a return to spontaneous erectionsthan those taking placebo in a multi-institutional, double-blind study presentedhere yesterday.

Chicago-Women who undergo cesarean section without a trial of labor appearto be significantly less likely to experience stress urinary incontinencethan those who deliver vaginally or underwent a CS for obstructed labor,according to a study from Israel.

Chicago-Six weeks of antimicrobial therapy with levofloxacin (Levaquin)appears to improve symptoms of chronic prostatitis/chronic pelvic pain syndromein men, although the benefits are not sustained, according to a Canadianstudy presented yesterday.

Chicago-Two alpha-blockers appear to have modest efficacy in treatingchronic prostatitis/chronic pelvic pain syndrome, according to separatestudies presented here.

Auxilium Pharmaceuticals, Inc., introduces Testim testosterone topicalgel to supplement low levels of testosterone in men with hypogonadism. Duringclinical trials, patients reported a 59% increase in sexual activity anda 78% increase in days with a spontaneous erection over a 90-day period,according to the company. Initial analysis of long-term data suggests thatthe gel also improves bone mineral density.

Nearly one in 10 men who walk into the outpatient office of a urologist leave with a coded diagnosis of prostatitis. Urologists have described the traditional approach to the diagnosis and management of the chronic prostatitis syndromes as one of the most frustrating areas of urologic practice.

Seattle-A retrospective review of patients with secondary azoospermia has uncovered an alarming tumor rate and a high sperm recovery rate, reiterating the importance of urologic evaluation in this population.

House approves national liability insurance bill; CMS outlines changesin Medicare

Seattle-Microsurgical vasectomy reversal has higher success rates whenperformed for couples with the same female partner, underscoring the importanceof counseling patients when considering reconstructive surgery.