Advances in andrology moving quickly into practice

It often takes years before medical advances make their way from the laboratory bench to the physician's office. Such is not the case in andrology. In many instances, the cutting edge will be of clinical relevance very soon for urologists who treat male infertility, according to Craig S. Niederberger, chief of andrology at the University of Illinois, Chicago.

One instance, Dr. Niederberger noted, is recurrent varicoceles. Urologists are often at a loss for what to do with patients who have failed initial surgical treatment for a painful varicocele. A team of Canadian researchers will present data at the upcoming AUA meeting showing that repeat varicocelectomy is warranted in these men. In their study of patients who underwent repeat microsurgical varicocelectomy, they reported a favorable response rate of 90% 1 year after surgery.

"So if the fidelity of sperm DNA increases after varicocelectomy, you can imply that this is one of the potential mechanisms for male subfertility and one of the mechanisms for addressing it surgically," noted Dr. Niederberger.

The answer, according to urologists presenting at the AUA meeting, is to go with the vasovasostomy. They found that men who undergo bilateral vasovasostomy in this instance experience a return of sperm to the ejaculate postoperatively.

Similarly, urologic surgeons know that a decade or more after vasectomy, a successful reversal will likely require a vasoepididymostomy (VE). Little is known, though, exactly when that cutoff occurs.

As it turns out, no specific cutoff was found when a group of Canadian researchers studied the problem. While it was true in their study that the more time that had passed since vasectomy, the more likely a VE would be required, a significant proportion of men who had undergone vasectomy fewer than 10 years earlier still needed the procedure.

In fact, another group of investigators was able to establish specific rates of VE at various time intervals post-vasectomy. The rates ranged from 3% within 3 years after the procedure to 36% after 10 or 11 years and 70% 18 to 19 years later.

"This clearly aids the physician in counseling the patient very accurately regarding the probability of doing a very demanding procedure with a relatively lower success rate," Dr. Niederberger said.

Other advances AUA attendees will also learn about data from a study showing that subfertility in older men may result from androgen therapy for symptoms of andropause. They found that almost 7% of patients studied experienced subfertility for this reason. These patients' sperm parameters improved after exogenous androgen therapy was discontinued.

The fresh-versus-frozen-sperm debate will also come to the forefront at the AUA meeting. One study examines the effect of cryopreservation on sperm hyaluronan binding. Not only did cryopreservation have no ill effect on hyaluronan binding, it actually improved the process.

"Evidence continues to mount that cryopreservation has enormous practical value and is an effective tool that offers the urologist real value in his or her practice," Dr. Niederberger said.