Female Urology

Montreal--In case your patients need another reason to quit, recent research indicates that smoking tobacco reduces the ability of sperm to fertilize an egg. There appears to be a dose-response relationship, with heavy smokers at greater risk for more severe impairment of sperm, according to a study presented at the American Society for Reproductive Medicine annual meeting here. It remains to be seen whether quitting smoking or even cutting down will lead to improvements in sperm functions that support fertilization.

Montreal--Idiopathic, primary nonobstructive azoospermia (NOA) is linked to a genetic defect known as a dysfunctional DNA mismatch repair pathway that also places these men at increased risk for cancer and other medical illnesses. Given that the problem is genetic in origin, the consequences of this defect may be of significance for both patients and their offspring, researchers say. Both concerns require close monitoring by physicians.

Montreal--The anti-estrogen agent clomiphene citrate (Clomid, Milophene, Serophene) may provide an easier, less expensive treatment for infertility among some men with hypogonadotropic hypo-gonadism [HH], according to a small retrospective study. The agent may be worth trying before the more expensive and difficult-to-administer gonadotropins are employed.

Montreal--As the controversy over whether to perform vasovasostomy or vasoepididymostomy for vasectomy reversal rages, two small studies have provided some new insight into when to choose one surgical technique over the other. One study demonstrates that expert surgeons can provide better results with vasoepididymostomy among patients with vasospermia, defined as no sperm in the vasal fluid, regardless of the condition of the vasal fluid. The second study suggests that the presence of sperm parts in the vasal fluid signals that vasovasostomy might be the better option.

Montreal--Although testicular sperm extraction (TESE) may provide somewhat better pregnancy rates than the use of ejaculated sperm for intracytoplasmic sperm injection for men with low sperm counts, a higher-than-average proportion of abnormal sperm, or almost no sperm in the ejaculate, TESE does have important disadvantages. It is up to patients and their physicians to choose the appropriate procedure, based on individual circumstances and clinical features, researchers say.

Montreal--The level of inhibin B may be a better marker of male infertility than both the typically used follicle stimulating hormone (FSH) and luteinizing hormone (LH), according to new research. These findings have yet to be confirmed in a large, prospective trial, however.

Washington--For children with ambiguous genitalia at birth, surgical techniques have improved vastly, but deciding when and whether to do surgery hasn't gotten easier. That was apparent from the lively and sometimes contentious panel and audience discussion here at the American Academy of Pediatrics Section on Urology annual meeting.

I predict that we will find that MR urography will rapidly develop and eventually come to be the imaging technique of choice in adult and pediatric urology.

Montreal--Spermatogenesis markers that can be easily obtained from a noninvasive testis biopsy may predict which patients will respond to surgical varicocele repair. Testis biopsy, therefore, should be part of the regular workup for male infertility patients, suggest the authors of the 2005 Society for Male Reproduction and Urology Prize paper presented here at the American Society for Reproductive Medicine annual meeting.

Washington--When hydronephrosis is diagnosed antenatally in an infant, is pyeloplasty needed? More often than not, the indication is not clear.

Men with infertility and abnormal sperm counts have a 20-fold greater incidence of testicular cancer than men in the general population, according to a study published in the Journal of Urology (2005; 174:1819-22).

Washington--Counterfeit prescription drugs pose a "potentially serious health threat" in the United States, one that can result in serious or deadly consequences for patients because of unscrupulous acts of profiteers who take advantage of a lack of uniform regulation and enforcement.

Montreal--While long-term studies on vaginal meshes used in pelvic organ prolapse surgery are lacking, several meshes are being studied in experimental settings and are being found effective and safe at providing anatomical correction.

Montreal--Vaginal delivery may cause significant pelvic floor trauma in as many as one-third of first-time deliveries. This trauma appears, upon ultrasound, to primarily affect the levator ani muscle, according to new research from Australia.

Montreal--Women who are choosing to have a Caesarean section instead of a vaginal delivery to avoid incontinence later in life should opt for vaginal delivery and should focus on their lifestyle choices, which can influence the likelihood that they will develop incontinence, according to research presented here at the International Continence Society annual meeting.

Montreal--Findings from a large cohort study presented at the International Continence Society annual meeting here have led to reference values for clinicians conducting preoperative urodynamic studies in women with stress urinary incontinence.

Montreal--Procedures using tension-free vaginal tape (TVT, Gynecare/Ethicon, Somerville, NJ) or the recently introduced trans-obturator tape (TOT, Mentor Corp., Santa Barbara, CA) appear to provide equal outcomes in the treatment of stress urinary incontinence. However, TOT may leave a subset of patients more comfortable because it is associated with a lower risk of urgency symptoms, according to a prospective, multicenter, randomized Italian study presented at the International Continence Society here.

New data from The National Birth Defects Prevention Study provide additional evidence that pregnancy-related intake of progestins is associated with increased hypospadias risk.

New data from The National Birth Defects Prevention Study provide additional evidence that pregnancy-related intake of progestins is associated with increased hypospadias risk.

Chicago--A study of cytokines in expressed prostatic secretions (EPS) has identified two potential candidates as diagnostic markers for inflammatory and noninflammatory forms of chronic prostatitis/chronic pelvic pain syndrome (CPPS), according to researchers from Northwestern University Medical Center in Chicago.

Paris--Most cases of chronic pelvic pain syndrome (CPPS) are spontaneous with unknown causes, and more studies are needed on all aspects of the condition, said Anthony Schaeffer, MD, who chaired the Committee on Prostatitis and Chronic Pelvic Pain at the International Consultation on New Developments in Prostate Cancer and Prostate Diseases here.

Paris--An expert committee charged with examining coming trends in new therapeutic targets and treatments for metastatic prostate cancer painted a positive picture of the future, with chemotherapy, vaccines, and gene therapy all potentially playing a role. But the committee also recognized a milestone advancement of the recent past.

Reflecting the growth of robotics in modern surgery, the University of California, Irvine, School of Medicine will host a 3-day event covering developments in robotic surgery.

Minnetonka, MN--The Halo kidney stone basket from Sacred Heart Medical, Inc. features improved basket symmetry and stability to ensure complete capture and retrieval of small stones and fragments, as well as a 1.5F diameter sheath to permit simultaneous use of laser fiber for intracorporeal lithotripsy without compromising irrigation or visibility.

These procedures can be performed with or without concomitant hysterectomy or continence procedures.

Montreal--The first report of improved sperm DNA integrity after specific surgical therapy was presented at the AUA annual meeting in San Antonio. Although the cohort was small and the statistical significance slim, the study's authors say the data support the beneficial effect of varicocelectomy on human spermatogenesis.

Testosterone therapy appears to improve sexual function in postmenopausal women, primarily the symptoms of sexual desire, arousal, and orgasmic response, according to an evidence-based position statement from The North American Menopause Society.

Combining physical and psychological therapy for chronic pelvic pain syndrome (CPPS, or chronic nonbacterial prostatitis) can provide relief for many patients who have pain refractory to conventional treatments, according Stanford (CA) University researchers.

A new estimate shows that chronic prostatitis, especially nonbacterial prostatitis, is common in American men and that most diagnosis and treatment takes place in the primary care setting.

General patterns of genetic expression have been identified in postmenopausal women with stress urinary incontinence that are not present in postmenopausal women without the condition. This is the first step toward being able to identify patients most at risk for stress incontinence early on, with the eventual hope of helping to prevent the condition, said researchers from the University of Rochester (NY) Medical Center.