Faculty Bibliography

PURPOSE OF REVIEW/OBJECTIVE:Therapies for the treatment of severe male factor infertility have advanced well beyond our knowledge of the conditions we are treating. An intact Y chromosome is necessary for optimal spermatogenesis. It is imperative for the clinician to understand the molecular basis and clinical implications of anomalies that might afflict the Y chromosome. RECENT FINDINGS/RESULTS:The molecular geography of the Y chromosome has recently been described, allowing correlations to be made to various clinical states of severe spermatogenic compromise. Microdeletions of parts of the Y chromosome are found in a small number of men with spermatogenic failure involving, predominantly, three regions termed AZFa, AZFb, and AZFc. SUMMARY/CONCLUSIONS:It is necessary that a Y chromosomal microdeletion assay be carried out prior to any intervention using ejaculated sperm or prior to any surgical procedure to try to find spermatozoa in an azoospermic man.

INTRODUCTION/BACKGROUND:Premature ejaculation (PE) is the most common form of male sexual dysfunction. Until very recently, scientific investigation of PE has been hampered by a lack of standardized definitions and objective, validated questionnaires. Small numbers of randomized controlled studies evaluating various treatment options have also added to the challenges facing the clinicians who manage PE. AIM/OBJECTIVE:This article provides a summary of some of the more relevant the peer-reviewed literature pertaining to the medical therapy of premature ejaculation. METHODS:A retrospective review of peer reviewed publications relevant to the field of premature ejaculation and related medical therapies. MAIN OUTCOME MEASURES/METHODS:Review of safety and efficacy of various medical therapies for premature ejaculation. RESULTS:Selective serotonin release inhibitors have been the most promising agents to date. The on-demand "PRN" use of these agents is more convenient, but its efficacy is less well established. Chronic use of this class of medications has been associated with minor, but bothersome side effects. More recently, concern over the risk of an increased suicide rate in young men upon initiation of SSRIs has dampened enthusiasm. Recent experience with the use of Tramadol raises the hope that this might prove to be an agent as effective as SSRIs with less worrisome risk of side-effects. New trials on novel formulations of topical solutions are currently underway in the United States. CONCLUSIONS:Interest in medical therapy for PE is rapidly increasing and reflected in a disproportionate number of publications in this field in the past few years. Clinical research in this field is hampered by the complexity, variability among different men and cultures, and subjectivity of PE. Reliable, appropriately controlled and assessed studies are generally lacking and carefully devised, methodically conducted research is much needed.

The aim of this study is to describe the finding of vicarious excretion of intravascular contrast media in association with endovascular management of an aortic aneurysm and to discuss the clinical significance. Vicarious excretion of intravascular contrast material through the hepatobiliary system will be encountered occasionally following endovascular procedures. Plain abdominal images obtained for the purpose of graft position and structural integrity will increase recognition of this finding. Vicarious hepatobiliary excretion of parenteral contrast media, while associated with renal obstruction or parenchymal pathology, is not pathognomonic for renal pathology.

INTRODUCTION/BACKGROUND:Priapism has been reported as a rare effect of the commonly used alpha 1-antagonists through direct inhibition of the sympathetic input necessary for detumescence. Although previously reported as an adverse event in a patient with spinal cord injury, to the best of our knowledge, terazosin-induced priapism in an otherwise healthy man has not been previously described. AIM/OBJECTIVE:We describe an otherwise healthy man with lower urinary symptoms who developed priapism after ingestion of the commonly prescribed alpha-blocker terazosin. RESULTS:The priapism resolved after a combination of cavernosal aspiration and alpha-agonist administration. CONCLUSION/CONCLUSIONS:Priapism is an extremely rare side effect of alpha-blocker therapy and has previously been described in association with other alpha-blockers, as well as with terazosin, in a spinal cord-injured patient. We report a case of priapism specifically associated with terazosin prescribed for lower urinary tract symptoms in an otherwise healthy man.

INTRODUCTION/BACKGROUND:We describe a 51-year-old man with a history of radiation therapy and large bowel diversion for rectal cancer who underwent an uneventful penile implant surgery for erectile dysfunction that was refractory to conservative therapy. The patient presented with acute left lower extremity swelling and pain a few days after surgery. Workup revealed compression of the pelvic veins by the prosthesis reservoir. AIM/OBJECTIVE:To highlight an avoidable, adverse event related to penile prosthesis reservoirs. METHODS:Retrospective review of a clinical case. RESULTS:The patient underwent repositioning of the reservoir followed by venous thrombectomy and Greenfield filter placement. CONCLUSION/CONCLUSIONS:To the best of our knowledge, this is the first report of an early diagnosis and successful thrombectomy of the external iliac and common femoral vein thrombosis secondary to reservoir compression. Awareness of this possible adverse event and the management strategy are helpful to surgeons who perform penile prosthesis surgery.

INTRODUCTION/BACKGROUND:Growing evidence has linked circumcision with some protection against HIV infection. Should nations with a high HIV infection rate encourage male circumcision? METHODS:Four people with expertise and/or interest in the area of circumcision and HIV were asked to contribute their opinions. MAIN OUTCOME MEASURE/METHODS:To provide food for thought, discussion, and possible further research in a poorly discussed area of sexual medicine. RESULTS:Three clinical trials in Africa showed the benefit of circumcision in reducing HIV incidence in men. Sadeghi-Nejad cites these, but balances this with the pandemic in India, and the cultural implications of circumcision. Pollack cites these studies as well, but reinforces the World Health Organization and UNAIDS recommendations that male circumcision should not replace safe sex. As a Nigerian, Aisuodionoe-Shadrach discusses the indirect ways in which circumcision can reduce the spread of HIV, and advocates the surgery, although he proposes infant circumcision may be wiser. Ira Sharlip, President of the International Society for Sexual Medicine, explains some of the physiology involved while again citing the three recent African studies. He questions who would be circumcised and who would perform the procedure if pro-circumcision policies were adopted. CONCLUSION/CONCLUSIONS:While three clinical trials in Africa were halted after it became evident that circumcision was beneficial in protecting against HIV, further information on the health risks and benefits of male circumcision is needed. Ethical decisions need to be made and medical recommendations developed before circumcision can be considered for HIV prevention.