Faculty Bibliography

OBJECTIVES/OBJECTIVE:To evaluate mail-in semen collection services for cryopreservation, focusing on costs, transparency, and efficacy due to the advancements of direct access to fertility testing and treatment. METHODS:Using Google, we identified eight prominent companies offering mail-in sperm cryopreservation services. We analyzed their costs, storage practices, marketing strategies, and prescription requirements. For comparison, we examined academic institutions offering similar services, exploring differences in pricing, processes, and accessibility. RESULTS:The average upfront cost to process and freeze sperm was $730 (range $329 to $1575) with 10-year storage costs of $3117, on average (range $1450 to $5500), which may or may not be guaranteed to remain level. Not all services disclosed future costs such as transport, thawing, and disposal fees, with some firms being less transparent. Two firms offered client depositor storage on-site and the remainder outsourced to partner labs scattered around the country. One facility offered storage of tissue samples for men with azoospermia; none of the companies required men to have an order from their doctor to use the service. CONCLUSIONS:Mail-in cryopreservation services provide convenience but present challenges, including varying costs, transparency issues, and potential limitations in medical oversight. Integrating these services into traditional healthcare settings could optimize patient outcomes and satisfaction.

INTRODUCTION/UNASSIGNED:Individuals choose to undergo vasectomy reversal for a variety of reasons, including remarriage or due to the death of a child. To be proficient in this procedure, the surgeons need to be high volume and the trainees require a safe environment to develop their microsurgical skills. To overcome this challenge, we used three-dimensional (3D) printing to create a synthetic model of the vas deferens with properties similar to the human vas deferens. We distributed this model to experienced microsurgeons for evaluation. METHODS/UNASSIGNED:The vas deferens model was created using thermoplastic polyurethane filament. The filament was then infused with a foaming agent to allow for temperature-dependent tuning of the material's stiffness. The model's outer diameter was 1 mm and the inner lumen was 0.5 mm. Fellowship-trained male reproductive urologists were recruited from the Society for the Study of Male Reproduction website. They used our model and judged it on several factors by completing a 13-question survey. RESULTS/UNASSIGNED:We received completed evaluations from five microsurgeons. Eighty percent of the surgeons were able to complete a full anastomosis on the model using 9-0 and 10-0 sutures. The majority of the completed anastomoses were performed using the one-layer technique. The average responses for the model's usefulness as a practice tool, a training tool, and overall assessment ranged from 72 to 79 out of 100. Comments for the improvement included the need for a more flexible and softer model. CONCLUSIONS/UNASSIGNED:We created a 3D-printed synthetic vas deferens that serves as a valuable training and practice tool.

This monograph, written by the pioneers of IVF and reproductive medicine, celebrates the history, achievements, and medical advancements made over the last 40 years in this rapidly growing field.

This multicenter retrospective chart review study performed on 162 cryptorchid patients and on 34 subjects with retractile testes suggests that cryptorchidism and retractile testes can alter spermatogenesis, with more serious damage observed in bilateral cryptorchidism. This spermatogenetic impairment is probably related to the lack of an appropriate or timely surgical correction.

OBJECTIVE:To report a multiinstitutional experience of men presenting with infertility secondary to inguinal hernia repair using polypropylene mesh. SUMMARY BACKGROUND DATA/BACKGROUND:An estimated 80% of inguinal hernia operations involve placement of a knitted polypropylene mesh to form a "tension-free" herniorrhaphy. The prosthetic mesh induces a chronic foreign-body fibroblastic response creating scar tissue that imparts strength to the floor and leads to fewer recurrences. However, little is known about the long-term effects of the polypropylene mesh on the vas deferens, especially with regard to fertility. METHODS:Eight institutions in the United States reported a total of 14 cases of azoospermia secondary to inguinal vasal obstruction related to previous polypropylene mesh herniorrhaphy. Patient characteristics and operative findings were forwarded to 1 center for tabulation of data. RESULTS:Mean patient age was 35.5 years with an average duration of infertility of 1.8 years. Mean number of years between urologic evaluation and herniorrhaphy was 6.3 years. Types of inguinal hernia repair previously performed were: open (10), laparoscopic (2), or both (2). Nine patients had bilateral obstruction and 5 patients had unilateral obstruction with contralateral testicular atrophy or epididymal obstruction. Surgical exploration revealed a dense fibroblastic response encompassing the polypropylene mesh with either trapped or obliterated vas in all patients. Surgical reconstruction was performed in 8 of 14 men (57%). CONCLUSION/CONCLUSIONS:Reconstruction to restore fertility can be difficult secondary to fibrotic reaction. Before undergoing polypropylene mesh herniorrhaphy, men, especially of young reproductive age or with a solitary testicle, need to be carefully advised of potential obstruction and compromise to future fertility.

Penile fracture is an uncommon, but well-described, entity that requires emergent treatment. The classic, "text-book" history, a blow to the erect penis accompanied by a "snap," pain, and immediate detumescence, is not universally present. We report 2 cases of "false" penile fracture, a condition that closely mimics "true" penile fracture. Perhaps the most distinguishing symptoms are the absence of the "snap" and gradual detumescence, both of which suggest false fracture but are not specific. It is our intention to bring this condition to the attention of general urologists who may see it in clinical practice and to guide them in its management.

Our objective was to determine whether or not male reproductive microsurgery is adaptable to current robotic technology. We devised a model vas deferens system using rat vasa deferentia and completed vasal anastomosis with full-thickness and mucosal robotically placed, Sharpoint 10-0 bicurve nylon sutures. Experienced and inexperienced microsurgeons performed separate anastomoses. Both groups of microsurgeons completed anastomoses with accuracy and enhanced comfort. The robotic graspers had the dexterity to delicately handle the 10-0 sutures and needles. We conclude that through our model vas deferens system, we demonstrated the feasibility of applying robotic technology to male reproductive microsurgery. This pilot study reveals some advantages of the robot and suggests future use of this system in a new urological application domain.

Prostatitis and infertility are common disorders in men and many researchers have investigated a possible link between the two disorders. After almost 3 decades of research the answer to this question remains unknown, although ample evidence exists to support a relationship between male infertility and prostatitis. This paper discusses this evidence and then derives a rational treatment approach to the man with infertility and prostatitis.

PURPOSE/OBJECTIVE:We describe a simple and time efficient technique for repairing a diaphragmatic injury occurring during right hand assisted laparoscopic radical nephrectomy. MATERIALS AND METHODS/METHODS:A dual layer polypropylene and polyglactin mesh was created extracorporeally by sewing a 2 x 2 piece of polypropylene mesh to a 2 x 2 piece of polyglactin mesh with 4, 4-zero interrupted polyglactin sutures. This dual layer was then positioned manually over the diaphragmatic rent and secured with a laparoscopic stapling device. A 16Fr chest tube was placed at the conclusion of the procedure. RESULTS:Overall operative time was 3.5 hours with an estimated blood loss of 100 cc. Repair of the diaphragmatic injury extended operative time by 25 minutes. Extubation was done at the conclusion of the case and the chest tube was removed within 36 hours of the procedure. The patient was discharged home on postoperative day 3. At 14 months of followup the patient remained disease-free on radiography and without pulmonary or gastrointestinal sequelae. CONCLUSIONS:We describe a simple and time efficient technique for repairing diaphragmatic injury occurring during right hand assisted laparoscopy. This technique takes advantage of the manual and tactile sensation provided by the hand assistance device, provides a tension-free repair and avoids laparoscopic suturing.

To determine whether or not obstructive interval (OI) negatively affects patency rates in epididymovasostomy (EV) as a sole procedure alone, we reviewed medical records from obstructive azoospermia (OA) patients who underwent unilateral or bilateral epididymovasostomy. For the purpose of analysis, patients were placed into short OI (15 years or less) or long OI (more than 15 years) categories. Patency rate for the short OI group was 58%, compared to 15% for the long OI group (P<0.01). In conclusion, we observed that patency rates worsened with obstructive interval greater than 15 years. Epididymovasostomy is a challenging procedure that may not be successful, and, thus, patients should be counseled that obstructive interval might affect surgical outcomes. We routinely perform testicular sperm extraction (TESE) with sperm cryopreservation in this patient population due to the high likelihood that it will ultimately be required for assisted reproductive technology (ART).