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Burg ML, Kohli P, Ha N, Mora R, Kurup T, Sidhu H, Rodman J, Cacciamani GE, Samplaski MK. Gender disparities among publications within international sexual medicine urology journals and the impact of blinding in the review process. J Sex Med 2024; 21:117-121. [PMID: 38128068 DOI: 10.1093/jsxmed/qdad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND While female urologists are known to publish at less frequency than their male peers, The Journal of Sexual Medicine was reported to have among the highest growth in female authorship from 2002 to 2020 in urology journals. AIM We sought to assess the frequency of female authorship in sexual medicine journals worldwide and the factors that affect this, including the blinded/unblinded review process. METHODS Eleven sexual medicine journals were assessed for geographic location, peer review method, and SCImago Journal Rank citation index (a metric of citation frequency and prestige). Journals were grouped into top, middle, and bottom quartiles based on metric score. Web of Science was used to access the publications' first, second, last, and corresponding authors from the past 5 years. An internet search or Gender-API.com was used to determine the gender identities of authors. Univariate and multivariable logistic regression models were performed. OUTCOMES Outcomes included the likelihood of female authorship (first, second, last, and corresponding) based on journal location and ranking, the clustering of female authors, the journal's peer review process, and the frequency of female editorial board members. RESULTS Overall, 8938 publications were identified. Women represented 30.7%, 31.3%, 21.3%, and 18.7% of the first, second, last, and corresponding authors, respectively; gender was unable to be assessed for 2.6%, 17.2%, 7.3%, and 2.7%. On univariate analysis, journals from North America, in the top quartile, and with a double-blind review process were more likely to have female authors (P < .001). On multivariate analysis, articles were more likely to have a female first author if they had a double-blind peer review process (odds ratio [OR], 1.20; 95% CI, 1.02-1.40), a female second author (OR, 2.54; 95% CI, 2.26-2.85), or a female corresponding author (OR, 7.80; 95% CI, 6.69-9.10). CLINICAL IMPLICATIONS Gender-concordant mentoring and universal double-blind manuscript review processes may minimize the impact of gender bias and increase female authorship rates, in turn producing more diverse research. STRENGTHS AND LIMITATIONS This is the first study assessing female authorship in sexual medicine journals. Limitations include not assessing every author listed on articles and being unable to determine gender identities for some authors. CONCLUSION Female authorship rates are higher than reported rates of practicing female urologists but still lower than their male peers. Female authors were more likely to be published in journals with double-blind peer review processes and when publishing with additional female authors.
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Affiliation(s)
- Madeleine L Burg
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Priya Kohli
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Nhi Ha
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Richard Mora
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Trisha Kurup
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Hannah Sidhu
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Jack Rodman
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA 90033, United States
| | - Giovanni E Cacciamani
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
- European Association of Urology-Young Academic Urologists, Arnhem, NL-6803, the Netherlands
| | - Mary K Samplaski
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
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Asanad K, Horns JJ, Driggs N, Samplaski MK, Hotaling JM. Untreated hypogonadism and testosterone replacement therapy in hypogonadal men are associated with a decreased risk of subsequent prostate cancer: a population-based study. Int J Impot Res 2024:10.1038/s41443-023-00820-3. [PMID: 38177194 DOI: 10.1038/s41443-023-00820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/08/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
We sought to understand the relationship between hypogonadism and testosterone replacement therapy (TRT) in hypogonadal men on the risk of developing localized and metastatic prostate cancer. We used the Merative MarketScan database of commercial claims encounters to identify men diagnosed with hypogonadism. These men were matched to eugonadal men who served as controls. Multivariate negative binomial regression analysis of prostate cancer diagnoses, hypogonadism, and TRT in hypogonadal men adjusting for various known confounding factors was used to understand the impact of hypogonadism and TRT on prostate cancer risk. We identified 3,222,904 men who met inclusion criteria, of which 50% were diagnosed with hypogonadism (1,611,452) and each were matched to a control (1,611,452). The incidence of prostate cancer was 2.16%, 1.55%, and 1.99% in eugonadal controls, hypogonadal men on TRT, and hypogonadal men without TRT, respectively (p < 0.001). Untreated hypogonadism was independently associated with a decreased risk of localized prostate cancer (IRR 0.46, 95% CI 0.43-0.50, p < 0.001) compared to eugonadal controls. Hypogonadal men on TRT also had a significantly decreased risk of localized prostate cancer (IRR 0.49, 95% CI 0.45-0.53, p < 0.001). Furthermore, hypogonadal men on TRT (IRR 0.21, 95% CI 0.19-0.24, p < 0.001) or without TRT (IRR 0.20, 95% CI 0.18-0.22, p < 0.001) both had significantly decreased risk of metastatic prostate cancer, respectively. Our population-based analysis suggests that untreated hypogonadism in men is associated with a 50% decreased incidence of localized prostate cancer and an 80% decreased incidence of metastatic prostate cancer. TRT in hypogonadal men was also associated with a decreased risk of subsequent prostate cancer. Further research is needed to better understand the relationship between hypogonadism and TRT in hypogonadal men on the risk of subsequent prostate cancer.
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Affiliation(s)
- Kian Asanad
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Joshua J Horns
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT, USA
| | - Nathan Driggs
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT, USA
| | - Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.
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Asanad K, Greenfeld E, Scherer SW, Yuen R, Marshall CR, Lo K, Mullen B, Lau S, Jarvi KA, Samplaski MK. Uncovering the Association Between Complete AZFc Microduplications and Spermatogenic Ability: The First Reported Series. Cureus 2023; 15:e51140. [PMID: 38283528 PMCID: PMC10811380 DOI: 10.7759/cureus.51140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose This article aims to report the first series of men with complete AZFc microduplications and their clinical and reproductive characteristics. Methods We sampled 3000 men who presented for reproductive urology evaluation from 2012-2020, of which 104 men underwent high-resolution Y-chromosome microarray testing, and five men were identified to have complete AZFc microduplications. Medical, surgical, and reproductive histories were obtained. Semen and hormonal parameters as well as response to fertility therapies were recorded. Results Five men were identified as having complete AZFc microduplications. The mean age was 33.75 years, representing 0.2% (5/3000) of men presenting for fertility investigation, 4.8% (5/104) of men undergoing microarray testing, and 21% (5/24) of men with AZFc abnormalities. Two of the men had prior undescended testicles and one had several autoimmune processes. The mean follicle-stimulating hormone (FSH) was 5.5 IU/L, luteinizing hormone (LH) 3.6 IU/L, and testosterone 14.56 nmol/L. One man was azoospermic, one man alternated between severe oligospermia and rare non-motile sperm, one had variable parameters, with one semen analysis demonstrating azoospermia and a second demonstrating a total motile sperm count (TMSC) of 4 ×106, one man was persistently oligospermic with TMSCs ranging 3.96-12.6 ×106, and one man initially had severe oligospermia, with a mean TMSC of 1.5 ×106, which increased to 21.7 ×106 after intervention (varicocele embolization, clomiphene citrate). This last man then fathered a spontaneous pregnancy. Conclusion AZFc complete microduplications are a rare cause of spermatogenic failure but not an uncommon form of AZFc abnormality. Clinically, they represent a heterogeneous group, having a variable reproductive potential. Cases should be managed on an individual basis.
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Affiliation(s)
- Kian Asanad
- Institute of Urology, University of Southern California Keck School of Medicine, Los Agneles, USA
| | - Elena Greenfeld
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital Joseph and Wolf Lebovic Health Complex, Toronto, CAN
| | - Stephen W Scherer
- McLaughlin Center and Department of Molecular Genetics, Mount Sinai Hospital, Toronto, CAN
| | - Ryan Yuen
- McLaughlin Center and Department of Molecular Genetics, Mount Sinai Hospital, Toronto, CAN
| | - Christian R Marshall
- McLaughlin Center and Department of Molecular Genetics, Mount Sinai Hospital, Toronto, CAN
| | - Kirk Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, CAN
| | - Brendan Mullen
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, CAN
| | - Susan Lau
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, CAN
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, CAN
| | - Mary K Samplaski
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, USA
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Mora RM, Lin J, Beeder L, Rodman J, Adler BL, Ochoa M, Samplaski MK. The association of leprosy with male fertility and sexual function: a single center study. LEPROSY REV 2023. [DOI: 10.47276/lr.94.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Richard Mateo Mora
- University of Southern California Institute of Urology, 1441 Eastlake Avenue, Los Angeles, California, USA
| | - Jeffery Lin
- University of Southern California Institute of Urology, 1441 Eastlake Avenue, Los Angeles, California, USA
| | - Lauren Beeder
- Parkland Hospital, Department of Urology, 5200 Harry Hines Blvd, Dallas, Texas, USA
| | - Jack Rodman
- University of Southern California, Clinical and Translational Science Institute, 2250 Alcazar Street, CSC 200 Los Angeles, California, USA
| | - Brandon L. Adler
- University of Southern California, Department of Dermatology, 1441 Eastlake Avenue, Ezralow Tower, Suite 5301, Los Angeles, California, USA
| | - Maria Ochoa
- University of Southern California, Department of Dermatology, 1441 Eastlake Avenue, Ezralow Tower, Suite 5301, Los Angeles, California, USA
| | - Mary K. Samplaski
- University of Southern California Institute of Urology, 1441 Eastlake Avenue, Los Angeles, California, USA
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Chen J, Jarvi K, Lajkosz K, Smith J, Lau S, Lo K, Grober E, Samplaski MK. How far will they go? Distance and driving times that north American men travel to see a reproductive urologist. Andrologia 2022; 54:e14551. [PMID: 36054603 PMCID: PMC9787797 DOI: 10.1111/and.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/19/2022] [Accepted: 07/24/2022] [Indexed: 12/30/2022] Open
Abstract
Male factor infertility affects about 50% of infertile couples. However, male factor infertility is largely under-evaluated due to multiple reasons. This study is to determine the time men travel for fertility evaluation, and factors associated with driving longer. Data from the Andrology Research Consortium were analysed. Driving distance and time were calculated by comparing "patient postal code" with "clinic postal code", then stratified into quartiles. Patients with the longest driving times (> 75th percentile [Q4]) were compared with those having shorter driving times. Logistic regression analysis was used to identify factors associated with longer driving times. Sixteen clinics and 3029 men were included. The median driving distance was 18.1 miles, median driving time was 32 min, and Q4 driving time was 49 min. Factors correlated with having Q4 driving time were age > 30 years, native Indian and Caucasian race, body mass index (BMI) > 30 kg/m2 , history of miscarriage, children with previous partner, self-referral, prior vasectomy, and prior marijuana use. On logistic regression, males aged < 30 years were more likely to be in Q4 for driving time versus older males. Blacks and Asians were less likely to travel further than Caucasians. Overweight/obese men, those having children with previous partner, and with prior vasectomy were more likely to be in Q4 travelling time. Factors correlated with longer driving times include younger age, native Indian and Caucasian race, higher BMI, children with prior partner, and prior vasectomy. These may reflect groups that drive long distances for reproductive care. The study provides an opportunity to better access these groups and minimise their barriers to fertility care.
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Affiliation(s)
- Jian Chen
- Institute of Urology, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Keith Jarvi
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Katherine Lajkosz
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - James Smith
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Susan Lau
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Kirk Lo
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Ethan Grober
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Mary K. Samplaski
- Institute of Urology, University of Southern CaliforniaLos AngelesCaliforniaUSA
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Asanad K, Sholklapper T, Samplaski MK, Cacciamani GE. Global online interest in finasteride sexual side effects. Int J Impot Res 2022:10.1038/s41443-022-00612-1. [PMID: 36100687 DOI: 10.1038/s41443-022-00612-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/09/2022]
Abstract
Prior literature has suggested that finasteride may negatively impact men's sexual health. In 2011, the Food and Drug Administration (FDA) provided a warning on finasteride drug labels to incorporate sexual side effects such as reduced libido and erectile dysfunction. We aimed to evaluate global online interest in finasteride sexual side effects, their penetrance and variation, and how they compared overtime. We also aimed to evaluate the influence of the FDA label warnings on web-based searches for finasteride side effects. We utilized Google search engine from January 2004 to December 2020 to include separate trends from web searches of "Propecia," "Propecia side effects," "finasteride", "finasteride side effects", and "post-finasteride syndrome" compared amongst the United States, United Kingdom, and Australia. We performed join-point regression analysis. We compared the annual relative search volume (ARSV) and annual percentage change (APC) to evaluate for loss or gain of interest in the respective key terms. We determined that the average ARSV for "finasteride" was 14.8% in 2004 and increased significantly to 57.3% in 2020 (APC: +9.25%, 95% CI 8 to 10.5, p < 0.001). Likewise, there was significant increased interest in "finasteride side effects" (APC: +20.7, p < 0.001) and "post-finasteride syndrome" (APC: +29.2; p < 0.001) in the United States overtime. Finally, when we compared trends before and after the FDA warnings, the average ASRV of "finasteride", "finasteride side effects", and "post-finasteride syndrome" all increased significantly (p = 0.001, p = 0.014, p < 0.001), respectively. Thus, it is evident that there is a global web-based interest in finasteride and its sexual health side effects, particularly after the FDA warning in 2011. There is boosted public awareness, and thus providers should have more detailed and careful conversations with patients prior to starting a 5α-reductase inhibitor such as finasteride.
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Affiliation(s)
- Kian Asanad
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tamir Sholklapper
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mary K Samplaski
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Asanad K, Nusbaum D, Fuchs G, Rodman JCS, Samplaski MK. The impact of male infertility faculty on urology residency training. Andrologia 2022; 54:e14457. [PMID: 35545606 PMCID: PMC9540376 DOI: 10.1111/and.14457] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to determine the impact of having male infertility on urology residents' infertility training experience, surgical confidence, and In‐Service‐Exam Infertility/Sexual Medicine subscores. We electronically surveyed urology residents throughout the United States querying exposure to infertility faculty and fertility knowledge. Univariable and multivariable analysis was performed to determine predictors of higher In‐Service Exam Infertility/Sexual Medicine sub‐scores and self‐rated infertility competency. Fifty‐four of 72 respondents (75%) reported that male infertility comprises ≤10% of their training. Of the 63 residents who have a reproductive urologist on faculty, 66.7%, 47.6%, and 49.2% have scrubbed/observed a microsurgical varicocelectomy, vasectomy reversal and testicular sperm extraction, respectively. Residents exposed to infertility faculty are more likely to self‐rate their infertility understanding as “excellent” or “good” (p = 0.04 and p = 0.02, respectively), and 14.4× more likely to feel confident performing infertility procedures, versus residents lacking faculty (p < 0.001). Residents having formal microsurgical training have better self‐rated infertility understanding (p < 0.001), non‐obstructive azoospermia management (p = 0.01), and competency performing infertility procedures (p < 0.001). Residents exposed to fertility faculty are more likely to feel confident performing fertility procedures after residency (p = 0.001). In conclusion, infertility comprises a minority of residency training. Most residents anticipate performing infertility procedures in practice, despite two‐thirds lacking confidence performing these. Having an infertility faculty and formal microsurgical training improves residents' surgical confidence, non‐obstructive azoospermia management, and global male infertility understanding. A structured educational curriculum may improve resident infertility training.
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Affiliation(s)
- Kian Asanad
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - David Nusbaum
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Gerhard Fuchs
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - John C S Rodman
- University of Southern California, Southern California Clinical and Translational Science Institute, Los Angeles, California, USA
| | - Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, California, USA
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Samplaski MK, Rodman JCS, Perry JM, Marks MBF, Zollman R, Asanad K, Marks SF. Sperm granulomas: Predictive factors and impacts on patency post vasectomy reversal. Andrologia 2022; 54:e14439. [PMID: 35524153 PMCID: PMC9541413 DOI: 10.1111/and.14439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/06/2022] [Accepted: 03/18/2022] [Indexed: 12/04/2022] Open
Abstract
The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post‐VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.
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Affiliation(s)
- Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - John C S Rodman
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, California, USA
| | | | | | - Robert Zollman
- International Center for Vasectomy Reversal, Tucson, Arizona, USA
| | - Kian Asanad
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Sheldon F Marks
- International Center for Vasectomy Reversal, Tucson, Arizona, USA
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Ortega DG, Lizana M, Asanad K, Samplaski MK. Complete testicular-epididymal dissociation presenting as adult chronic orchialgia. Urol Case Rep 2022; 42:102032. [PMID: 35530534 PMCID: PMC9073289 DOI: 10.1016/j.eucr.2022.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/15/2022] [Indexed: 10/27/2022] Open
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10
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Mora RM, Mehta P, Ziltzer R, Samplaski MK. Systematic Review: The Neovaginal Microbiome. Urology 2022; 167:3-12. [PMID: 35276200 DOI: 10.1016/j.urology.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/05/2022] [Accepted: 02/27/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review neovaginal colonization and inflammatory patterns, and factors that may impact this. METHODS A systematic review of the neovaginal microbiome was conducted in concordance with PRISMA guidelines through October 2021. RESULTS Thirteen articles were included, totaling 458 patients. Neovaginal constructions were most commonly performed with penile and scrotal skin grafts, sigmoid segments, and peritoneal grafts. The neovaginal microflora identified were generally polymicrobial and shared similarities with the native tissue. Nine studies identified Lactobacillus: 5/6 for penile skin, 1/3 for sigmoid, 1/1 for peritoneum, and 2/3 for other graft types, suggesting that the neovagina may support Lactobacillus either innately, via rectal migration or oral probiotic supplementation. A polymicrobial, bacterial vaginosis-like environment was found in nine studies. Inflammatory markers were also described: 2/6 for penile skin, 2/3 for sigmoid, 0/1 for peritoneum, and 1/3 for other graft types. Scant data were available on the impact of postsurgical duration, oral hormones, dilating, sexual practices, or douching on the neovaginal microbiome. CONCLUSION Understanding and optimizing the polymicrobial neovaginal microenvironment may improve surgical outcomes, specifically inflammatory, pain, and infectious. Future research should focus on standardizing testing and classification systems, and treating neovaginal dysbiosis.
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Affiliation(s)
- Richard Mateo Mora
- University of Southern California Institute of Urology, 1441 Eastlake Avenue, Los Angeles, California, USA.
| | - Preeya Mehta
- University of Southern California, 1985 Zonal Avenue, Los Angeles, California, USA.
| | - Ryan Ziltzer
- University of Southern California, 1985 Zonal Avenue, Los Angeles, California, USA.
| | - Mary K Samplaski
- University of Southern California Institute of Urology, 1441 Eastlake Avenue, Los Angeles, California, USA.
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Morris JR, Falk O, Samplaski MK, Dupree JM, Kenfield S, Narayanan NP, Matthews WJ, Lamb DJ, Smith J. MOTILITY AND TOTAL MOTILE COUNT DECLINE OBSERVED WITH A NOVEL MAIL-IN SEMEN CRYOPRESERVATION SYSTEM. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Asanad K, Matthew Coward R, Mehta A, Smith JF, Vij SC, Nusbaum DJ, Rodman JCS, Samplaski MK. Factors Influencing the Decision for Fresh vs Cryopreserved Microdissection Testicular Sperm Extraction for Non-Obstructive Azoospermia. Urology 2021; 157:131-137. [PMID: 34331998 DOI: 10.1016/j.urology.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/14/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine reproductive urologists' (RU) practice patterns for microdissection testicular sperm extraction (microTESE) and factors associated with use of fresh vs frozen microTESE for non-obstructive azoospermia. MATERIALS AND METHODS We electronically surveyed Society for Study of Male Reproduction members with a 21-item questionnaire. Our primary outcomes were to determine RU preference for fresh or frozen microTESE and to understand barriers to performing microTESE. Pearson's chi-square and Fisher's exact tests were used to analyze categorical outcomes and candidate predictor variables. Firth logistic regression was performed to identify the predictors for preferring and performing fresh vs frozen microTESE. RESULTS A total of 208 surveys were sent with 76 responses. Most (63.0%) primarily perform frozen microTESE for non-obstructive azoospermia, while 37.0% primarily perform fresh. However, in an ideal practice, 59.3% prefer fresh microTESE, 22.2% prefer frozen microTESE, and 18.5% had no preference. MicroTESE is performed most often (61.1%) at surgical centers not affiliated with a fertility practice. The most commonly reported barriers for both fresh and frozen microTESE are cost (42.6%), scheduling (33.3%), and andrologist unavailability (16.7%). There are no statistically significant differences between these barriers and performing fresh vs frozen microTESE. On multivariable analysis, reproductive endocrinology and infertility-based surgical center (OR 22.9; 95% CI 1.1-467.2; P = 0.04) and professional fee $2,500-$4,999 (OR 20.7; 95% CI 1.27-337.9; P = 0.03) are significant predictors of performing fresh microTESE. CONCLUSION Frozen microTESE is performed more commonly than fresh, despite most RU preferring fresh microTESE in an ideal setting. Both fresh and frozen microTESE have a role in reproductive care. Barriers to performing fresh microTESE include cost, scheduling and andrologist availability.
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Affiliation(s)
- Kian Asanad
- University of Southern California Institute of Urology
| | | | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine
| | - James F Smith
- Department of Urology, University of California San Francisco
| | - Sarah C Vij
- Department of Urology, Cleveland Clinic Foundation Glickman Urological and Kidney Institute
| | | | - John C S Rodman
- University of Southern California, Southern California Clinical and Translational Science Institute
| | - Mary K Samplaski
- University of Southern California Institute of Urology, Los Angeles, CA.
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Chertack N, Baky F, Samplaski MK, Vij SC, Bakare T. The Impact of Race and Gender on 30-Day Urologic Surgery Complications. Urology 2021; 162:77-83. [PMID: 34029606 DOI: 10.1016/j.urology.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the effect of race and gender on complications after urologic surgeries. MATERIALS AND METHODS The American College of Surgeons' National Surgical Quality Improvement Program data was utilized for patients undergoing urologic surgeries. Patient demographics and comorbidities were analyzed. Postoperative complications occurring in a 30-day postoperative period were noted and classified per the Clavien-Dindo classification. RESULTS From 2008-2018, 284,050 patients underwent urologic surgery. The majority were men (80%) and identified as non-Hispanic white (80%). Complications occurred in 12%, including 9% minor, 5% major, and mortality in 0.6%. Univariate analysis found female gender, non-Hispanic black and Native American race, and patient comorbidities (hypertension, diabetes, heart failure, lung disease, chronic kidney disease) to be associated with increased risk of complications. Female gender remained a significant predictor on multivariable logistic regression, and Hispanic race was found to be an independent negative predictor of postoperative complications, although these results did not appear clinically significant. On exclusion of gender-specific urologic surgeries, female gender was associated with higher likelihood of minor complications, but male gender was associated with higher likelihood of major complications or mortality. CONCLUSION Race was not associated with postoperative complication rate. Patient comorbidities are associated with an increased risk of 30-day postoperative complications. Females were more likely to have minor and males were more likely to major complications. Optimizing patient comorbidities preoperatively is key to improving postoperative outcomes.
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Affiliation(s)
- Nathan Chertack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas TX
| | - Fady Baky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas TX
| | - Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Tolulope Bakare
- Department of Urology, University of Texas Southwestern Medical Center, Dallas TX.
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14
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Samplaski MK, Falk O, Honig S, Shin D, Matthews W, Smith JF. Development and validation of a novel mail-in semen analysis system and the correlation between one hour and delayed semen analysis testing. Fertil Steril 2021; 115:922-929. [PMID: 33423785 DOI: 10.1016/j.fertnstert.2020.10.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and validate a novel, mail-in semen analysis (SA) system. DESIGN Prospective cohort. SETTING Not applicable. PATIENT(S) Ejaculates from normospermic men. INTERVENTION(S) One-hour SA, then repeat SAs (on same ejaculate) over 52 hours using a novel technique for maintaining sperm viability. MAIN OUTCOME MEASURE(S) World Health Organization SA parameters. RESULT(S) One-hour SA on 104 ejaculates in the validation phase of the study demonstrated normal semen parameters. With up to 52 hours of observation and four subsequent SA measurements/ejaculate, concentration remained stable, motility decreased by 0.39%/h, and normal morphology decreased by 0.1%/h. Measured 1-hour and calculated motility (correlation coefficients 0.87) and morphology (correlation coefficients 0.82) strongly were correlated. CONCLUSION This novel, mail-in, Clinical Laboratory Improvement Amendments-approved SA testing system demonstrates a strong degree of correlation between 1-hour and delayed SA testing. Given the linear motility and morphology decrease and stability of sperm concentration, this test may be used in clinical practice to evaluate semen quality for fertility evaluations. Furthermore, this approach significantly improves the ease, comfort, and efficiency of obtaining a SA, likely breaking down early barriers to accessing successfully a male fertility evaluation.
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Affiliation(s)
- Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, California
| | - Owen Falk
- Fellow Health Incorporated, San Francisco, California
| | - Stanton Honig
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - David Shin
- Department of Urology, Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | - James F Smith
- Departments of Urology, Obstetrics, Gynecology, and Reproductive Sciences, Philip R. Lee Institute for Health Policy, San Francisco, California.
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15
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Yip W, Vij SC, Li J, Samplaski MK. The effect of trainee involvement on surgical outcomes and complications of male infertility surgical procedures. Andrologia 2020; 52:e13719. [PMID: 32557781 DOI: 10.1111/and.13719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/28/2020] [Indexed: 11/27/2022] Open
Abstract
In this study, we sought to determine the effect of trainee (resident or fellow physician) involvement in male infertility surgical procedures on patient surgical outcomes and complications. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was retrospectively reviewed for fertility surgical procedures from 2006 to 2012. The procedures included were as follows: epididymectomy, spermatocelectomy, varicocelectomy ± hernia repair, ejaculatory duct resection, vasovasostomy, vasoepididymostomy and 'unlisted procedure male genital system' (to capture sperm retrieval procedures). A variety of peri- and post-operative outcomes were examined. Trainee and nontrainee-involved groups were compared by Wilcoxon rank sum tests, followed by logistic regression, univariate and multivariate analyses. 924 cases were included: 309 with trainees and 615 without. The median post-graduate trainee year was 3 (range: 0-10). Patients in the trainee-involved cohort had higher rates of chronic obstructive pulmonary disease, steroid usage and black race. Mean operative time was 42.5% longer in trainee-involved cases, even after controlling for other covariates (76.2 vs. 49.5 min, p = .00). Hospital stay length was also longer in trainee-involved cases (0.41 vs. 0.35 days, p = .02). There were no differences in superficial infections (p = 1.00), deep wound infections (p = 1.00), urinary tract infections (p = .26), or reoperations (p = .23) with or without trainee involvement.
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Affiliation(s)
- Wesley Yip
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Sarah C Vij
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jianbo Li
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
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16
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Thaker H, Ko EY, Sabanegh ES, Brannigan RE, Alukal JP, Samplaski MK. Empirical medical therapy for idiopathic male infertility. F S Rep 2020; 1:15-20. [PMID: 34223207 PMCID: PMC8244321 DOI: 10.1016/j.xfre.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/02/2022] Open
Abstract
Objective To determine if there has been a change in empirical medical therapy (EMT) practices since a 2010 American Urological Association survey reported that 25% of urologists treated infertile men who were pursuing a pregnancy with testosterone (T). Design Survey-based cohort study of AUA members. Setting Practice patterns were evaluated of urologists in academic and nonacademic hospital centers. Patient(s) Practice patterns were evaluated in the treatment of men with idiopathic infertility. Interventions(s) None. Main Outcome Measure(s) Subgroup analysis by means of univariate analysis between means (Fisher exact test) and descriptive proportions was used to compare male infertility fellowship–trained urologists (RUs) to general urologists (non-RUs). Result(s) A total of 191 urologists responded (4.7%). Excluding trainees, 164 responses (85.9%) were analyzed: 134 (82.3%) were from non-RUs and 29 from (17.7%) RUs. Over all, 65.9% treated male infertility with a combination of EMT and surgery (93.1% of RU vs. 60.4% of non-RUs). The most common medications used by RUs were clomiphene (100%), anastrozole (85.7%), and hCG/LH (82.1%). Non-RUs used these less frequently. Overall, 24.4% of the urologists reported that they would use T to treat male infertility: 14.4% (n = 4) of RUs and 24.4% (n = 30) of non-RUs. Conclusion(s) A total of 65.9% of urologists would treat male infertility with the use of EMT and surgery. The most common EMTs were clomiphene, anastrozole, and hCG/LH. Of concern, 24.4% of urologists considered T to treat male infertility, a medication with known contraceptive potential. This is unchanged from the 2010 survey, and confirms the need for reproductive medicine guidelines that include the topic of EMT use in infertile men.
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Affiliation(s)
- Hatim Thaker
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edmund Y Ko
- Department of Urology, Loma Linda University, Loma Linda, California
| | | | | | - Joseph P Alukal
- Department of Urology, Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, California
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17
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Zganjar A, Nangia A, Sokol R, Ryabets A, Samplaski MK. Fertility in Adolescents With Klinefelter Syndrome: A Survey of Current Clinical Practice. J Clin Endocrinol Metab 2020; 105:5586853. [PMID: 31608942 DOI: 10.1210/clinem/dgz044] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/22/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Progress has been made in determining the fertility timeline and potential in adolescents with Klinefelter syndrome; however, medical professionals are currently without protocols to guide treatment. OBJECTIVE To evaluate the current practices regarding fertility and andrology care in adolescent males with Klinefelter syndrome. DESIGN A 24-question survey was developed to elicit practitioner background/expertise and management practices. This was distributed to members of the Society for the Study of Male Reproduction, the Pediatric Endocrine Society, and the Endocrine Society. SETTING N/A. PATIENTS Adolescent males with Klinefelter syndrome. INTERVENTION None. MAIN OUTCOME MEASURED Current practices regarding fertility and andrology care. RESULTS 232 responses were received from 133 (57%) adult endocrinologists, 60 (26%) pediatric endocrinologists, and 39 (17%) urologists. Among these, 69% of respondents were in academics, 62% practiced for > 10 years, and 65% received formal training in Klinefelter syndrome. All specialties encouraged sperm banking in late puberty, however most disagreed with the practice in early puberty. Seventy-eight percent agreed that testicular biopsy should be offered if no sperm was found in the ejaculate. The perceived optimal age for testicular biopsy varied among specialists. Clinical symptoms of hypogonadism (28%), rising gonadotropin levels (15%), and testosterone levels (15%) were the most commonly cited reasons for initiation of testosterone replacement therapy. CONCLUSION Fertility preservation practices in adolescents with Klinefelter syndrome vary greatly within and among the specialties caring for these patients. These findings should guide future research and highlight the importance of establishing clinical practice guidelines.
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Affiliation(s)
- Andrew Zganjar
- University of Kansas Medical Center - Department of Urology, Kansas City, KS, USA
| | - Ajay Nangia
- University of Kansas Medical Center - Department of Urology, Kansas City, KS, USA
| | - Rebecca Sokol
- University of Southern California - Departments of Medicine and Obstetrics and Gynecology, Keck School of Medicine, Los Angeles, CA, USA
| | - Anna Ryabets
- University of Southern California - Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA
| | - Mary K Samplaski
- University of Southern California - Keck School of Medicine, Institute of Urology, Los Angeles, CA, USA
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18
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Asanad K, Nusbaum DJ, Samplaski MK. National opioid prescription patterns and patient usage after routine vasectomy. Andrologia 2020; 52:e13563. [DOI: 10.1111/and.13563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/10/2019] [Accepted: 02/19/2020] [Indexed: 01/07/2023] Open
Affiliation(s)
- Kian Asanad
- Institute of Urology University of Southern California Los Angeles CA USA
| | - David J. Nusbaum
- Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Mary K. Samplaski
- Institute of Urology University of Southern California Los Angeles CA USA
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19
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Nassiri N, English M, Lashkari N, Wei J, Samplaski MK. Reproductive Urologist and Gynecologist Involvement in Postvasectomy Sperm Retrieval Procedures at American Fertility Clinics. Urology 2019; 133:116-120. [DOI: 10.1016/j.urology.2019.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/24/2019] [Accepted: 08/12/2019] [Indexed: 02/07/2023]
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20
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Beeder L, Samplaski MK. Analysis of online discussion boards for male infertility. Andrologia 2019; 51:e13422. [PMID: 31642097 DOI: 10.1111/and.13422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/27/2019] [Accepted: 08/06/2019] [Indexed: 11/29/2022] Open
Abstract
We aimed to identify what information patients and partners are seeking on male infertility forums. Online discussion boards were identified. Posts were analysed in three steps: open coding, axial coding and selective coding, to determine common themes. A total of 1,118 posts were analysed. The majority of posts (20.2%) were related to "Questions about male fertility diagnosis and testing", with 47.8% asking for assistance interpreting semen analysis results. About 15.7% of posts were about "Feelings associated with male infertility", with 26.7% expressing anger or frustration, 26.1% encouraging hope, 21% seeking hope and 12.5% expressing fear. About 15.4% of posts were about "Lifestyle factors to improve male fertility", 24.4% of which were about vitamins and 6.4% about intercourse timing. About 15.4% of posts were about "Male infertility conditions", with 43% about semen parameters. Other themes included "Questions about male factor treatments", "Questions about assisted reproductive technologies (ART)", "Relationship issues", "Asking for advice", "Financial concerns" and "Information sharing". About 63.6% of posts were written by female partners [t(1,117) = 9.451, p < .001]. The most common posts posed questions about male fertility diagnosis and testing. Users discussed feelings involved in infertility, and counselling should be integrated. About 63.6% of posts were by partners, highlighting the importance of partners having access to infertility information.
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Affiliation(s)
- Lauren Beeder
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
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21
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Beeder LA, Samplaski MK. Effect of antidepressant medications on semen parameters and male fertility. Int J Urol 2019; 27:39-46. [DOI: 10.1111/iju.14111] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/25/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Lauren A Beeder
- Keck School of MedicineUniversity of Southern California Los AngelesCaliforniaUSA
| | - Mary K Samplaski
- Institute of Urology University of Southern California Los Angeles California USA
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22
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Samplaski MK, Smith JF, Lo KC, Hotaling JM, Lau S, Grober ED, Trussell JC, Walsh TJ, Kolettis PN, Chow VDW, Zini AS, Spitz A, Fischer MA, Domes T, Zeitlin SI, Fuchs EF, Hedges JC, Sandlow JI, Brannigan RE, Dupree JM, Goldstein M, Ko EY, Hsieh TCM, Bieniek JM, Shin D, Nangia AK, Jarvi KA. Reproductive endocrinologists are the gatekeepers for male infertility care in North America: results of a North American survey on the referral patterns and characteristics of men presenting to male infertility specialists for infertility investigations. Fertil Steril 2019; 112:657-662. [PMID: 31351700 DOI: 10.1016/j.fertnstert.2019.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To characterize the referral patterns and characteristics of men presenting for infertility evaluation using data obtained from the Andrology Research Consortium. DESIGN Standardized male infertility questionnaire. SETTING Male infertility centers. PATIENT(S) Men presenting for fertility evaluation. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Demographic, infertility history, and referral data. RESULT(S) The questionnaires were completed by 4,287 men, with a mean male age of 40 years ± 7.4 years and female partners age of 37 years ± 4.9 years. Most were Caucasian (54%) with other races being less commonly represented (Asian 18.6%, and African American 5.5%). The majority (59.7%) were referred by a reproductive gynecologist, 19.4% were referred by their primary care physician, 4.2% were self-referred, and 621 (14.5%) were referred by "other." Before the male infertility investigation, 12.1% of couples had undergone intrauterine insemination, and 4.9% of couples had undergone in vitro fertilization (up to six cycles). Among the male participants, 0.9% reported using finasteride (5α-reductase inhibitor) at a dose used for androgenic alopecia, and 1.6% reported exogenous testosterone use. CONCLUSION(S) This broad North American patient survey shows that reproductive gynecologists are the de facto gateway for most male infertility referrals, with most men being assessed in the male infertility service being referred by reproductive endocrinologists. Some of the couples with apparent male factor infertility are treated with assisted reproductive technologies before a male factor investigation. The survey also identified potentially reversible causes for the male infertility including lifestyle factors such as testosterone and 5α-reductase inhibitor use.
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Affiliation(s)
- Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, California
| | - James F Smith
- Department of Urology, University of California, San Francisco, California
| | - Kirk C Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital and; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Susan Lau
- Division of Urology, Department of Surgery, Mount Sinai Hospital and
| | - Ethan D Grober
- Division of Urology, Department of Surgery, Mount Sinai Hospital and
| | - J C Trussell
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York
| | - Thomas J Walsh
- Department of Urology, University of Washington, Seattle, Washington
| | - Peter N Kolettis
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Victor D W Chow
- Department of Urologic Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Armand S Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Aaron Spitz
- Orange County Urology Associates, Laguna Hills, California
| | - Marc A Fischer
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Trustin Domes
- Saskatoon Urology Associates, Saskatoon, Saskatchewan, Canada
| | - Scott I Zeitlin
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Eugene F Fuchs
- Department of Urology, Oregon Health & Science University, Portland, Oregon
| | - Jason C Hedges
- Department of Urology, Oregon Health & Science University, Portland, Oregon
| | - Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - James M Dupree
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Marc Goldstein
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Edmund Y Ko
- Department of Urology, Loma Linda University, Loma Linda, California
| | | | - Jared M Bieniek
- Tallwood Urology & Kidney Institute, Hartford HealthCare, Farmington, Connecticut
| | - David Shin
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Ajay K Nangia
- Department of Urology Surgery, University of Kansas Health System, Kansas City, Kansas
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital and; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
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Abstract
PURPOSE OF REVIEW The classification of morphologically normal sperm has been progressively redefined. Concurrently, our understanding of the significance of sperm morphology in relation to male factor infertility has evolved. In this review, we will discuss the evolution of sperm morphology assessment and factors that contribute to its measurement variability. We will examine the impact of sperm morphology on natural pregnancy, IUI, IVF, and ICSI outcomes. RECENT FINDINGS There is a lack of consensus on sperm morphology classification, technique, and inter-observer grading variability. Current evidence suggests sperm morphology has low predictive value for pregnancy success, for both natural and assisted reproduction. Additionally, the threshold for what is considered an adequate percentage of morphologically normal sperm has changed over time. These variables have called into question the relevance of this variable in predicting fertility outcomes. Our understanding of the impact of sperm morphology on reproductive outcomes continues to evolve and seems to play less of a role than initially thought.
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Affiliation(s)
- Rachel B Danis
- Division of Reproductive Endocrinology, University of Southern California, 2020 Zonal Avenue, IRD 534, Los Angeles, CA, 90033, USA.
| | - Mary K Samplaski
- Institute of Urology, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA
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24
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Clemesha CG, Thaker H, Samplaski MK. 'Testosterone Boosting' Supplements Composition and Claims Are not Supported by the Academic Literature. World J Mens Health 2019; 38:115-122. [PMID: 31385468 PMCID: PMC6920068 DOI: 10.5534/wjmh.190043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/23/2019] [Accepted: 05/13/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose Men take testosterone (T) boosting supplements to naturally improve T levels. We evaluated the composition and advertised claims of “T boosting” supplements, and supporting published evidence. Materials and Methods Fifty “T booster” supplements were evaluated for active ingredients and product claims, discovered via Google search. PubMed was reviewed for any literature supporting the claims, followed by review of Recommended Daily Allowance (RDA) and upper tolerable intake level (UL) for each component. Results Ninety percent of supplements claimed to “boost T”, 50% “improve libido”, and 48% “feel stronger”. One-hundred nine unique components were found, with a mean number of 8.3 per product. On PubMed, 24.8% of supplements had data showing an increase in T with supplementation, 10.1% had data showing a decrease in T, and 18.3% had data showing no change in T. No data were found on 61.5% of supplements on their effect on T. Supplements contained a median 1,291% of the RDA for vitamin B12, 807.6% for vitamin B6, 272% of zinc, 200% of vitamin B5, and 187.5% of vitamin B3. Thirteen products exceeded the US Food and Drug Administration UL of ingredients (zinc, vitamin B3, and magnesium). Conclusions Ninety percent of “T booster” supplements claimed to boost T. However, only 24.8% of these had data to support these claims. A total of 10.1% contained components with data suggesting a negative effect on T. Many had supra-therapeutic doses of vitamins and minerals, occasionally over the UL. Patients should be informed that “T booster” supplements may not have ingredients to support their claims.
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Affiliation(s)
- Chase G Clemesha
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hatim Thaker
- Institute of Urology, University of Southern California, Los Angeles, CA, USA.
| | - Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
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25
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Abstract
Background The accuracy of online medical information is variable. A 2014 Cochrane review did not support a robust improvement in male infertility after antioxidant supplementation. Many subfertile men take vitamins in hopes of improving their fertility. We sought to evaluate the content of online information for male fertility vitamins, and compare this with the published literature. Methods We searched Google to assess online information regarding vitamins and male infertility. Websites were evaluated for authorship, content, claims and validity. We then reviewed the Recommended Daily Allowance and upper tolerable intake level for each vitamin, and compared this with the supplements actual content. Results Four websites were posted by an academic source, 7 private clinic, 31 industry, 8 were patient blogs and 50 other sources. Reproductive claims made by websites included: Improved sperm count: 65; improved pregnancy rates: 42; improved live birth rates: 9; healthier offspring: 18. Overall, 76 websites claimed some improvement in semen parameters; 85 claimed some improved reproductive outcome. 26 websites were supported by peer-reviewed literature. None of the supplements had more than the upper tolerable intake level of any of the vitamins, but several were over the RDA, most commonly zinc, vitamin B12 and selenium. Conclusions Many websites claim improvements in a variety of male reproductive outcomes after vitamin supplementation. These are often not supported by the medical literature. We need to provide evidence-based information to patients so that they can have realistic expectations of the benefits that vitamins may have on male reproductive outcomes.
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Affiliation(s)
- Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Chase G Clemesha
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Affiliation(s)
- Mary K Samplaski
- Section of Male Infertility, Andrology and Microsurgery, Department of Urology, University of Southern California, Los Angeles, California
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Abstract
OBJECTIVE To examine posts on Internet discussion groups related to vasectomies, and identify common ideas through a structured theme analysis. MATERIALS AND METHODS Internet discussion boards were identified using the search term "vasectomy." Three discussion boards were identified as having the most posts and were chosen for analysis. Using an iterative and structured analysis process, each post was analyzed using thematic analysis in 3 steps (open coding, axial coding, and selective coding) to determine common themes. RESULTS A total of 129 posts were analyzed. The most common posts related to changes in sexual function after vasectomy. The second most common theme was pain after vasectomy. There were also posts about considerations before vasectomy, planning for postvasectomy care, what to expect after vasectomy, potential issues after vasectomy and how to manage these, and feelings about vasectomy. Some of the information present did not have a factual basis. CONCLUSION Posts dedicated to postvasectomy pain and sexual dysfunction were of the highest quantity. There was no medical provider input to these discussion boards. Educational efforts should be targeted to these areas and should include a health-care professional.
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Affiliation(s)
- Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, CA.
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Affiliation(s)
- Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
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Abstract
The effect of varicocele repair on male fertility remains controversial. It would be helpful to determined which men would benefit most from varicocele repair, and target repair efforts at those individuals. A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. The greatest improvements in semen parameters were found in men with larger varicoceles. While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man (www.fertilitytreatmentresults.com). Limited data consistently demonstrates the greatest improvements in DNA fragmentation rates in men with higher baseline DNA fragmentation rates. With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. In addition, varicocele repair does seem to reduce the need for more invasive modalities of ART. In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
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Affiliation(s)
- Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
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Samplaski MK, Bachir BG, Lo KC, Grober ED, Lau S, Jarvi KA. Cocaine Use in the Infertile Male Population: A Marker for Conditions Resulting in Subfertility. Curr Urol 2015. [PMID: 26195962 DOI: 10.1159/000365687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We sought to evaluate the incidence and effect of cocaine use in the infertile male population. MATERIALS AND METHODS Men presenting for fertility evaluation reporting cocaine usage were identified via prospectively collected database. Data were analyzed for usage patterns, reproductive history, associated drug use and medical conditions, hormonal and semen parameters. RESULTS Thirty-eight out of 4,400 (0.9%) men reported cocaine use. Most used cocaine every 3 months or less. Compared with non-cocaine using men, cocaine users reported more recreational drug use (89 vs. 9.2%), marijuana use (78.9 vs. 11.4%), chlamydia (10.5 vs. 3%), herpes (7.9 vs. 2.5%), and tobacco use (55.3 vs. 19.5%). After excluding men with causes for azoospermia, the mean semen parameters for cocaine users were: volume 2.47 ± 1.02 ml; concentration 53.55 ± 84.04 × 10(6)/ml; motility 15.72 ± 12.26%; total motile sperm count 76.67 ± 180.30 × 10(6). CONCLUSIONS Few (< 1%) men in our infertile population reported the use of cocaine, and the frequency of use was low. Given the low use rates and limitations of reporting bias, it is difficult to determine the direct effect of cocaine use on male fertility. However, while infrequent cocaine use seems to have limited impact on semen parameters, men reporting cocaine use represent a different cohort of men than the overall infertile population, with higher rates of concurrent substance abuse, tobacco use and infections, all of which may negatively impact their fertility. Reported cocaine users should be screened for concurrent drug use and infections.
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Affiliation(s)
- Mary K Samplaski
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Bassel G Bachir
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Kirk C Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada ; Faculty of Medicine, Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Ethan D Grober
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Susan Lau
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada ; Faculty of Medicine, Institute of Medical Science, University of Toronto, Ontario, Canada ; Lunenfeld Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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Samplaski MK, Dimitromanolakis A, Lo KC, Grober ED, Mullen B, Garbens A, Jarvi KA. The relationship between sperm viability and DNA fragmentation rates. Reprod Biol Endocrinol 2015; 13:42. [PMID: 25971317 PMCID: PMC4432573 DOI: 10.1186/s12958-015-0035-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/27/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In humans, sperm DNA fragmentation rates have been correlated with sperm viability rates. Reduced sperm viability is associated with high sperm DNA fragmentation, while conversely high sperm viability is associated with low rates of sperm DNA fragmentation. Both elevated DNA fragmentation rates and poor viability are correlated with impaired male fertility, with a DNA fragmentation rate of >30% indicating subfertility. We postulated that in some men, the sperm viability assay could predict the sperm DNA fragmentation rates. This in turn could reduce the need for sperm DNA fragmentation assay testing, simplifying the infertility investigation and saving money for infertile couples. METHODS All men having semen analyses with both viability and DNA fragmentation testing were identified via a prospectively collected database. Viability was measured by eosin-nigrosin assay. DNA fragmentation was measured using the sperm chromosome structure assay. The relationship between DNA fragmentation and viability was assessed using Pearson's correlation coefficient. RESULTS From 2008-2013, 3049 semen analyses had both viability and DNA fragmentation testing. A strong inverse relationship was seen between sperm viability and DNA fragmentation rates, with r=-0.83. If viability was ≤50% (n=301) then DNA fragmentation was ≥ 30% for 95% of the samples. If viability was ≥75% (n=1736), then the DNA fragmentation was ≤30% for 95% of the patients. Sperm viability correlates strongly with DNA fragmentation rates. CONCLUSIONS In men with high levels of sperm viability≥75%, or low levels of sperm viability≤ 30%, DFI testing may be not be routinely necessary. Given that DNA fragmentation testing is substantially more expensive than vitality testing, this may represent a valuable cost-saving measure for couples undergoing a fertility evaluation.
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Affiliation(s)
- Mary K Samplaski
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | | | - Kirk C Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
| | - Ethan D Grober
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | - Brendan Mullen
- Department of Pathology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | - Alaina Garbens
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
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Lo KC, Yildiz C, Zhu Y, Lambourne MD, Mullen JBM, Samplaski MK, Jarvi KA, McKerlie C. Human Fetal Testicular Tissue Xenotransplantation: A Platform to Study the Effect of Gonadotropins on Human Germ Cell Development In Utero. J Urol 2015; 194:585-91. [PMID: 25656291 DOI: 10.1016/j.juro.2015.01.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE We examined the effects of long-term hCG stimulation on germ cell maturation, and Sertoli and Leydig cell function in a xenotransplantation model of the human fetal testis. MATERIALS AND METHODS A total of 20 human fetal testes were ectopically xenografted on 20 castrated NCr male nude mice. Grafts were collected for analysis 24 weeks later. Mice were treated with saline as the control or with hCG beginning 4 weeks after the grafts were transplanted. RESULTS Of the grafts 65% survived at 24 weeks. In contrast to untreated pregrafted samples, hCG stimulated xenografts showed significantly increased density of seminiferous tubule formation with Sertoli cell migration to the basement membrane. Germ cell proliferation and differentiation from gonocytes (M2A(+)) to prespermatogonia (MAGE-4A(+)) were observed in graft samples recovered from the hCG and nonhCG treated groups at 24 weeks of treatment. Leydig cells in hCG treated grafts produced significantly more testosterone than nonhCG treated grafts. Although further studies are required to investigate the potential for further differentiation and maturation of xenografted human fetal testes, normal in utero testicular development was reproduced under long-term hCG stimulation. CONCLUSIONS This model represents a means to study long-term effects of gonadotoxins or hormonal stimulation on the maturation of human fetal testes.
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Affiliation(s)
- Kirk C Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
| | - Cengiz Yildiz
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yingchun Zhu
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Melissa D Lambourne
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John Brendan M Mullen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mary K Samplaski
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Colin McKerlie
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Physiology and Experimental Medicine Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
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Samplaski MK, Yu C, Kattan MW, Lo KC, Grober ED, Zini A, Lau S, Jarvi KA. Nomograms for predicting changes in semen parameters in infertile men after varicocele repair. Fertil Steril 2014; 102:68-74. [DOI: 10.1016/j.fertnstert.2014.03.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 11/30/2022]
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Samplaski MK, Deault-Bonin M, Lo KC. Genetic and Epigenetic Changes After Spermatogonial Stem Cell Culture and Transplantation. EJIFCC 2014; 25:27-41. [PMID: 27683455 PMCID: PMC4975189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Men with testicular failure, either primary or secondary, have been shown to be interested in fertility preservation. Spermatogonial stem cell (SSC) transplantation is currently being investigated as a treatment for this. Currently this experimental technique consists of cryopreservation of a testicular biopsy prior to cancer treatment, followed by optional in vitro expansion of SSCs and auto transplantation after cancer treatment. This technique may restore the pool of SSCs resulting in restoration of spermatogenesis. While this technique has not been applied to humans due to its highly experimental nature and concerns of malignant contamination, animal studies have been successful. While the offspring obtained from SSCs appear to be healthy in rodent models, there is relatively little data on any genetic and epigenetic changes that occur in either the transplanted SSCs or offspring. In humans, male germ cells undergo unique and extensive chromatin and epigenetic remodeling soon after their destiny as a spermatocyte has been secured. Errors in this remodeling may cause altered genetic information to be transmitted to offspring, resulting in abnormalities. This is particularly pertinent for cancer patients as SSCs obtained from these men may have a predisposition for genetic instability even prior to starting gonadotoxic therapies. In this article, landmarks in the evolution of SSC transplantation are reviewed, along with presently known genetic, epigenetic, and imprinting abnormalities that may occur after in vitro propagation and transplantation.
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Affiliation(s)
- Mary K. Samplaski
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marie Deault-Bonin
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kirk C. Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada, Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada,Department of Surgery, Mount Sinai Hospital University of Toronto 60 Murray Street, 6th floor, Box# 19 Toronto, Ontario, Canada M5T3L9 1-416-586-46131-416-586-8354
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Samplaski MK, Daniel A, Jarvi K. Vasectomy as a reversible form of contraception for select patients. Can J Urol 2014; 21:7234-7240. [PMID: 24775578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION To provide an effective form of birth control, men may choose a reversible or permanent form of contraception. Vasectomy is presently offered as a permanent option for male contraception. We have had patients who were interested in vasectomy and reversal as a temporary birth control option. The purpose of this paper is to determine if vasectomy should be offered for selected couples as a temporary form of contraception and under which circumstances. MATERIALS AND METHODS A literature review was conducted to determine the available reversible contraceptive options, risks, failure rates and contraindications to each, and the risks and success rates of vasectomy and vasectomy reversal. RESULTS Reversible contraceptives include hormonally based methods for women, non-hormonal anatomic barrier devices and spermatocidal agents. Hormone based therapies may be contraindicated in women with cardiovascular disease, hypertension, and some cancers. Non-hormonal contraceptives are generally less effective and may be unacceptable for some couples due to higher failure rates, difficulty of use and lack of acceptance. Both vasectomy and vasectomy reversal are low risk procedures. Reversal may be performed with a high degree of success, particularly with a short obstructive interval (97% patency if performed < 3 years following vasectomy). CONCLUSION While vasectomy should be considered a permanent form of sterilization for most couples, there are select couples, unable or unwilling to use other forms of birth control, who would benefit from an informed discussion about using a vasectomy as a reversible form of contraception.
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Affiliation(s)
- Mary K Samplaski
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Mary K Samplaski
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Samplaski MK, Lo KC, Grober ED, Millar A, Dimitromanolakis A, Jarvi KA. Phenotypic differences in mosaic Klinefelter patients as compared with non-mosaic Klinefelter patients. Fertil Steril 2014; 101:950-5. [PMID: 24502895 DOI: 10.1016/j.fertnstert.2013.12.051] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 12/04/2013] [Accepted: 12/29/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether men with Klinefelter syndrome (KS) have the same phenotype as men with mosaic KS. DESIGN Subject identification via prospectively collected database. SETTING Male infertility specialty clinic. PATIENT(S) Men undergoing a fertility evaluation from 2005 to 2012 at a single male infertility specialty clinic and having a karyotype demonstrating KS (mosaic or non-mosaic). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Testicular size, and semen and hormone parameters, genetic evaluation, and signs of testosterone (T) deficiency using validated questionnaires. RESULT(S) Of 86 men identified with KS, 6 (6.7%) were mosaic KS, and 80 (93.3%) were non-mosaic KS. Men with mosaic KS had lower baseline luteinizing hormone (LH) levels (10.31 IU/L ± 5.52 vs. 19.89 IU/L ± 6.93), lower estradiol levels (58.71 ± 31.10 pmol/L vs. 108.57 ± 43.45 pmol/L), larger mean testicular volumes (11 ± 7.3 mL vs. 6.35 ± 3.69 mL), and a higher mean total sperm count (4.43 ± 9.86 M/mL vs. 0.18 ± 1.17 M/mL). A higher proportion of men with mosaic KS had sperm in the ejaculate: 3 (50%) of 6 versus 3 (3.75%) of 80. The Sexual Health Inventory for Men (SHIM) and Androgen Deficiency in the Aging Male (ADAM) questionnaire scores were not different between groups. CONCLUSION(S) Men with mosaic KS seem to be more well androgenized than their non-mosaic KS counterparts, both with respect to hormones and sperm in the ejaculate.
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Affiliation(s)
- Mary K Samplaski
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kirk C Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ethan D Grober
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Adam Millar
- Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Apostolos Dimitromanolakis
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Lunenfeld Tannenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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Samplaski MK, Lo K, Grober E, Jarvi K. Finasteride use in the male infertility population: effects on semen and hormone parameters. Fertil Steril 2013; 100:1542-6. [DOI: 10.1016/j.fertnstert.2013.07.2000] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/30/2013] [Accepted: 07/30/2013] [Indexed: 11/15/2022]
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Snow-Lisy DC, Sabanegh ES, Samplaski MK, Morris VB, Labhasetwar V. Superoxide dismutase-loaded biodegradable nanoparticles targeted with a follicle-stimulating hormone peptide protect Sertoli cells from oxidative stress. Fertil Steril 2013; 101:560-7. [PMID: 24289999 DOI: 10.1016/j.fertnstert.2013.10.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/20/2013] [Accepted: 10/23/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate targeted superoxide dismutase (SOD)-loaded biodegradable nanoparticles' (NPs) ability to protect Sertoli cells from hydrogen peroxide (H2O2)-induced oxidative stress. DESIGN Cell culture controlled experimental study. SETTING Research laboratory. CELLS Mouse testis Sertoli cells (TM4). INTERVENTIONS Sertoli cells were exposed to 0-200 μg/mL plain media, unconjugated NPs, or FSH peptide-conjugated NPs for 2 or 24 hours to assess uptake. Next, Sertoli cells were exposed to 0-50 mmol H₂O₂ with 0-1 mg/mL unconjugated SOD-loaded NPs, FSH-conjugated SOD-loaded NPs, or equivalent units of SOD in solution as a control for 2-6 hours to assess influence on cell survival after oxidative stress. MAIN OUTCOME MEASURE(S) Cell viability, flow cytometry, and microscopy. RESULT(S) FSH peptide targeting improved uptake of NPs by Sertoli cells. FSH-conjugated SOD-NPs significantly protected Sertoli cells at 6 hours of H₂O₂--induced oxidative stress, with 100% survival with FSH-conjugated SOD-NPs compared with unconjugated SOD-NPs (45%) or SOD in solution (36%). CONCLUSION(S) Conjugation of NPs with FSH peptide improves cellular uptake and survival when SOD-loaded NPs are coincubated with Sertoli cells undergoing oxidative stress. This study represents a step toward developing NPs for the targeted treatment of testicular oxidative stress.
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Affiliation(s)
- Devon C Snow-Lisy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Edmund S Sabanegh
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mary K Samplaski
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Viola B Morris
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vinod Labhasetwar
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
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Samplaski MK, Loai Y, Wong K, Lo KC, Grober ED, Jarvi KA. Testosterone use in the male infertility population: prescribing patterns and effects on semen and hormonal parameters. Fertil Steril 2013; 101:64-9. [PMID: 24094422 DOI: 10.1016/j.fertnstert.2013.09.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 08/07/2013] [Accepted: 09/03/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze how frequently and why men presenting with infertility take testosterone (T) and if negative effects of T on semen parameters are reversed following cessation. DESIGN Analysis of a prospectively collected database. SETTING Male Infertility clinic. PATIENT(S) Men presenting for fertility evaluation from 2008 to 2012. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The frequency and reason for T use in the infertile male population, and semen and hormonal parameters while on T and following discontinuation. RESULT(S) A total of 59/4,400 men (1.3%) reported taking T. T was prescribed by a variety of physicians, including endocrinologists (24%), general practitioners (17%), urologists (15%), gynecologists (5%), and reproductive endocrinologists (3%). Only one of the men admitted that he had obtained T from an illicit source. More than 82% of men were prescribed T for the treatment of hypogonadism, but surprisingly, 12% (7/59) were prescribed T to treat their infertility. While on T, 88.4% of men were azoospermic, but by 6 months after T cessation, 65% of the men without other known causes for azoospermia recovered spermatogenesis. CONCLUSION(S) In Canada, T was not commonly used by men presenting for fertility investigation (1.3%). Close to 2/3 of infertile men using T recovered spermatogenesis within 6 months of T discontinuation.
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Affiliation(s)
- Mary K Samplaski
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yasir Loai
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Wong
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kirk C Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ethan D Grober
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Samplaski MK, Li J, Shoskes DA. Clustering of UPOINT Domains and Subdomains in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Contribution to Symptom Severity. J Urol 2012; 188:1788-93. [DOI: 10.1016/j.juro.2012.07.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Indexed: 01/22/2023]
Affiliation(s)
- Mary K. Samplaski
- Department of Urology, Glickman Urological and Kidney Institute and Quantitative Health Sciences (JL), Cleveland Clinic, Cleveland, Ohio
| | - Jianbo Li
- Department of Urology, Glickman Urological and Kidney Institute and Quantitative Health Sciences (JL), Cleveland Clinic, Cleveland, Ohio
| | - Daniel A. Shoskes
- Department of Urology, Glickman Urological and Kidney Institute and Quantitative Health Sciences (JL), Cleveland Clinic, Cleveland, Ohio
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Samplaski MK, Li J, Shoskes DA. Inclusion of erectile domain to UPOINT phenotype does not improve correlation with symptom severity in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 2011; 78:653-8. [PMID: 21664651 DOI: 10.1016/j.urology.2011.04.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/08/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the addition of an erectile dysfunction (ED) domain to the UPOINT (Urinary, Psychosocial, Organ-specific, Infection, Neurologic/systemic, and Tenderness) system in our patients. The UPOINT system classifies men with chronic prostatitis/chronic pelvic pain syndrome into 6 domains. The domain number correlates with the symptom severity, and UPOINT-guided therapy has been shown to significantly improve symptoms. This was recently confirmed in a large Italian cohort, but was only true in a German cohort if an ED domain was added ("S," resulting in "UPOINTS"). METHODS A total of 100 recent patients with chronic prostatitis/chronic pelvic pain syndrome were classified using the UPOINT system. An additional "S" domain was retrospectively added for men with bothersome ED. Symptom severity was assessed using the National Institutes of Health Chronic Prostatitis Symptom Index. RESULTS The "S" domain was positive in 28% of the patients. A stepwise positive correlation was found between the number of positive UPOINT domains and symptom severity (Pearson r=.27, P=.006). The "S" domain reduced this correlation (Pearson r=.25, P=.01). ED had no effect on the total Chronic Prostatitis Symptom Index (24.8 vs 24.7) or on the subscores for pain (11.5 vs 11.6) or quality of life (8.8 vs 8.9). On multivariate analysis, the number of UPOINT domains was the strongest predictor of the total Chronic Prostatitis Symptom Index (relative increase 4.1, 95% confidence interval 1.5-6.7, P=.002), a relationship lost with UPOINTS (relative increase 1.0, 95% confidence interval -2.1-4.2, P=.53). CONCLUSION In our patients, ED did not independently affect the chronic pelvic pain syndrome symptom severity or quality of life. Although ED should be elicited and appropriately treated in men with chronic prostatitis/chronic pelvic pain syndrome, our data do not support the utility of using ED as an independent UPOINT domain.
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Affiliation(s)
- Mary K Samplaski
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Samplaski MK, Wood HM, Lane BR, Remzi FH, Lucas A, Angermeier KW. Functional and quality-of-life outcomes in patients undergoing transperineal repair with gracilis muscle interposition for complex rectourethral fistula. Urology 2011; 77:736-41. [PMID: 21377021 DOI: 10.1016/j.urology.2010.08.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 08/05/2010] [Accepted: 08/07/2010] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the results and quality of life outcomes of transperineal repair using gracilis muscle interposition in patients who were candidates for attempted preservation of bowel and bladder function. There is currently no widely accepted procedure for the treatment of complex RUF, such as those complicated by radiotherapy, previous attempts at repair, or large in size. METHODS Thirteen patients who underwent transperineal repair with gracilis muscle interposition for complex RUF were identified. Records were reviewed for fistula etiology, prior repair, intraoperative findings, hospital course, complications, diversion reversal, and outcome. Follow-up data were gathered from clinic visits and questionnaires. RESULTS Preoperative diagnoses included: prostate cancer (PCA) (12) and imperforate anus (1). Treatment for PCA included radical prostatectomy (4); brachytherapy (BT) (3); external beam radiation therapy (EBRT) + BT (3); cryoablation (1); and EBRT + cryoablation (1). Five patients underwent prior unsuccessful repair. There were no intraoperative complications. Postoperative complications included fecal incontinence (3) and bladder neck contracture (1). Nine patients (75%) reported some degree of urinary incontinence, with 2 patients reporting this as significant, defined as incontinence "most of the time." Suprapubic catheters were removed after 6 weeks, and median stomal reversal was at 17.5 weeks (12-28). One patient developed a recurrent RUF. All patients completed quality-of-life questionnaires assessing urinary and fecal outcome. Fecal outcome measures were generally better than urinary, but both were reasonable given the complexity of the situation. CONCLUSIONS Transperineal repair with gracilis muscle interposition is an effective treatment for selected patients with complex RUF. Our experience demonstrates low morbidity, high success rates, and reasonable bowel and bladder function postoperatively.
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Affiliation(s)
- Mary K Samplaski
- Center for Genitourinary Reconstruction, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Abstract
Renal mass sampling (RMS) can be carried out by core biopsy or fine needle aspiration with each presenting potential advantages and limitations. The literature about RMS is confounded by a lack of standardized techniques, ambiguous terminology, imprecise definitions of accuracy, substantial rates of non-informative biopsies, and recurrent diagnostic challenges with respect to eosinophilic neoplasms. Despite these concerns, RMS has an expanding role in the evaluation and treatment of renal masses, in order to stratify biological aggressiveness and guide management that can range from surgery to active surveillance. Non-informative biopsies can be managed with surgical excision or repeat biopsy, with the latter showing encouraging results in recent studies. We propose a new classification in which all biopsies are categorized as non-informative versus informative, with the latter being subclassified as confirmed accurate, presumed accurate or confirmed inaccurate. This terminology will facilitate the comparison of results from various studies and stimulate progress. Incorporation of novel biomarkers and molecular fingerprinting into RMS protocols will likely allow for more rational management of patients with renal masses in the near future.
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Affiliation(s)
- Mary K Samplaski
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Samplaski MK, Agarwal A, Sharma R, Sabanegh E. New generation of diagnostic tests for infertility: Review of specialized semen tests. Int J Urol 2010; 17:839-47. [DOI: 10.1111/j.1442-2042.2010.02619.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PURPOSE Tumor location assessment is essential to plan nephron sparing kidney surgery. We describe a method to quantify the proximity of kidney tumors to the renal central sinus for reporting and surgical management. MATERIALS AND METHODS Centrality index scoring was done using standard 2-dimensional cross-sectional computerized tomography images in 133 consecutive patients undergoing transperitoneal laparoscopic partial nephrectomy between September 2003 and November 2005. The Pythagorean theorem was used to calculate the distance from tumor center to kidney center. The distance was divided by tumor radius to obtain the centrality index. We assessed the correlation of the centrality index with laparoscopic partial nephrectomy operative parameters and the urological complication rate. Centrality index accuracy and interobserver variability were assessed. RESULTS A centrality index of 0 equates to a tumor that is concentric with the center of the kidney. A centrality index of 1 equates to a tumor with its periphery touching the kidney center. As the centrality index increases, the tumor periphery becomes more distant from the kidney center. Multivariate regression analysis revealed an association of the centrality index with warm ischemia time (p = 0.004), which is a surrogate for technical complexity. Interobserver correlation of centrality index values was greater than 93% with an estimated learning curve of 14 cases required for measurement variability to decrease below 10% of the mean centrality index of 10 consecutive cases. CONCLUSIONS Centrality index scoring provides a clinically useful measure of tumor centrality. This system may allow improved clinical and radiological assessment of kidney tumors, and improved reporting of quantitative tumor site.
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Affiliation(s)
- Matthew N Simmons
- Department of Urological Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Samplaski MK, Coleman J, Goldfarb D. Post-transplantation lymphoproliferative disorder in the renal transplant ureter. Urology 2010; 75:516-9. [PMID: 20080291 DOI: 10.1016/j.urology.2009.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 10/23/2009] [Accepted: 10/26/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Mary K Samplaski
- Glickman Urologic and Kidney Foundation, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Samplaski MK, Somani N, Palmer JS. Apocrine Hidrocystoma on Glans Penis of a Child. Urology 2009; 73:800-1. [DOI: 10.1016/j.urology.2008.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 03/01/2008] [Accepted: 03/07/2008] [Indexed: 10/21/2022]
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