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Pagani RL, Ohlander S. Editorial Commentary. Urol Pract 2022; 9:329-330. [PMID: 37145783 DOI: 10.1097/upj.0000000000000303.01] [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] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Rodrigo L Pagani
- Department of Urology, University of Illinois Chicago, Chicago, Illinois
| | - Samuel Ohlander
- Department of Urology, University of Illinois Chicago, Chicago, Illinois
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Tradewell MB, Cazzaniga W, Pagani RL, Reddy R, Boeri L, Kresch E, Morgantini LA, Ibrahim E, Niederberger C, Salonia A, Ramasamy R. Algorithms for Predicting the Probability of Azoospermia from Follicle Stimulating Hormone: Design and Multi-Institutional External Validation. World J Mens Health 2022; 40:600-607. [PMID: 35118840 PMCID: PMC9482862 DOI: 10.5534/wjmh.210138] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/01/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose To predict the probability of azoospermia without a semen analysis in men presenting with infertility by developing an azoospermia prediction model. Materials and Methods Two predictive algorithms were generated, one with follicle stimulating hormone (FSH) as the only input and another logistic regression (LR) model with additional clinical inputs of age, luteinizing hormone, total testosterone, and bilateral testis volume. Men presenting between 01/2016 and 03/2020 with semen analyses, testicular ochiodemetry, and serum gonadotropin measurements collected within 120 days were included. An azoospermia prediction model was developed with multi-institutional two-fold external validation from tertiary urologic infertility clinics in Chicago, Miami, and Milan. Results Total 3,497 participants were included (n=Miami 946, Milan 1,955, Chicago 596). Incidence of azoospermia in Miami, Milan, and Chicago was 13.8%, 23.8%, and 32.0%, respectively. Predictive algorithms were generated with Miami data. On Milan external validation, the LR and quadratic FSH models both demonstrated good discrimination with areas under the receiver-operating-characteristic (ROC) curve (AUC) of 0.79 and 0.78, respectively. Data from Chicago performed with AUCs of 0.71 for the FSH only model and 0.72 for LR. Correlation between the quadratic FSH model and LR model was 0.95 with Milan and 0.92 with Chicago data. Conclusions We present and validate algorithms to predict the probability of azoospermia. The ability to predict the probability of azoospermia without a semen analysis is useful when there are logistical hurdles in obtaining a semen analysis or for reevaluation prior to surgical sperm extraction.
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Affiliation(s)
- Michael B Tradewell
- Department of Urology, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milano, Italy
| | - Rodrigo L Pagani
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Rohit Reddy
- Department of Urology, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milano, Italy
| | - Eliyahu Kresch
- Department of Urology, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Luca A Morgantini
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Emad Ibrahim
- Department of Urology, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Neurological Surgery, University of Miami Miller School of Medicine and Jackson Health System, Miami, FL, USA
| | - Craig Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milano, Italy
| | - Ranjith Ramasamy
- Department of Urology, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA.
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Tradewell MB, Cazzaniga W, Pagani RL, Boeri L, Kresch E, Morgantini LA, Ibrahim E, Niederberger C, Ramasamy R. ALGORITHMS FOR PREDICTING THE PROBABILITY OF AZOOSPERMIA FROM FOLLICLE STIMULATING HORMONE: DESIGN AND MULTI-INSTITUTIONAL EXTERNAL VALIDATION. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.264] [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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Schwarzman LS, Pagani RL, Ohlander SJ, Mima M, Abern MR, Andriole GL, Freedland SJ, Moreira DM. Diagnostic Properties of Total and Free Prostate-Specific Antigen to Predict Overall and Clinically Significant Prostate Cancer Among Men With Low Testosterone and Prior Negative Biopsy. Urology 2019; 137:97-101. [PMID: 31733275 DOI: 10.1016/j.urology.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/07/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether total serum PSA, free-PSA ratio and PSA density have similar diagnostic properties for detecting prostate cancer (PCa) and clinically-significant (cs) PCa in men with normal testosterone compared to men with low testosterone with a prior negative biopsy. METHODS We conducted a retrospective analysis of 3295 men undergoing a 2-year prostate biopsy following a negative prestudy biopsy in the placebo arm of the Reduction by Dutasteride of PCa Events (REDUCE) study. Men were divided in 2 groups based on testosterone level < or ≥300 ng/dL. Diagnostic properties of total serum PSA, free-PSA ratio, and PSA density to predict PCa and csPCa, defined as Gleason score ≥7, were determined for several thresholds and plotted as receiver operator characteristic curves. RESULTS A total of 603 men (18.3%) had low testosterone. The prevalence of PCa and csPCa was 92 (15.3%) and 27 (4.5%), respectively, for low testosterone men compared to 458 (17.0%) and 138 (5.1%), correspondingly, for normal testosterone men. Total PSA, free-PSA ratio and PSA density showed similar sensitivity, specificity, and accuracy to predict PCa and csPCa among low testosterone men compared to normal testosterone men. CONCLUSION Among subjects in a clinical trial with a prior negative biopsy, total PSA, free-PSA ratio and PSA density have comparable diagnostic characteristics for PCa screening in low and normal testosterone men.
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Affiliation(s)
| | - Rodrigo L Pagani
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Samuel J Ohlander
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Mahmoud Mima
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Michael R Abern
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Stephen J Freedland
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; Section of Urology, Durham, VA; Medical Center, Durham, NC
| | - Daniel M Moreira
- Department of Urology, University of Illinois at Chicago, Chicago, IL.
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Pagani RL, Ohlander SJ, Niederberger CS. Microsurgical varicocele ligation: surgical methodology and associated outcomes. Fertil Steril 2019; 111:415-419. [PMID: 30827515 DOI: 10.1016/j.fertnstert.2019.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/04/2018] [Accepted: 01/02/2019] [Indexed: 12/27/2022]
Abstract
The impact of clinical varicoceles on semen parameters and male infertility has long been established. In the era of assisted reproduction, clinical discussion has questioned the role of varicocelectomy, offering the potential to bypass, rather than treat, varicocele-associated male infertility. However, current literature supports improved semen parameters and reproductive outcomes following repair. This article presents the stepwise operative approaches to microsurgical varicocelectomy and discusses the recent publications on outcomes.
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Arzuaga X, Smith MT, Gibbons CF, Skakkebæk NE, Yost EE, Beverly BEJ, Hotchkiss AK, Hauser R, Pagani RL, Schrader SM, Zeise L, Prins GS. Proposed Key Characteristics of Male Reproductive Toxicants as an Approach for Organizing and Evaluating Mechanistic Evidence in Human Health Hazard Assessments. Environ Health Perspect 2019; 127:65001. [PMID: 31199676 PMCID: PMC6792367 DOI: 10.1289/ehp5045] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/22/2019] [Accepted: 05/30/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND Assessing chemicals for their potential to cause male reproductive toxicity involves the evaluation of evidence obtained from experimental, epidemiological, and mechanistic studies. Although mechanistic evidence plays an important role in hazard identification and evidence integration, the process of identifying, screening and analyzing mechanistic studies and outcomes is a challenging exercise due to the diversity of research models and methods and the variety of known and proposed pathways for chemical-induced toxicity. Ten key characteristics of carcinogens provide a valuable tool for organizing and assessing chemical-specific data by potential mechanisms for cancer-causing agents. However, such an approach has not yet been developed for noncancer adverse outcomes. OBJECTIVES The objective in this study was to identify a set of key characteristics that are frequently exhibited by exogenous agents that cause male reproductive toxicity and that could be applied for identifying, organizing, and summarizing mechanistic evidence related to this outcome. DISCUSSION The identification of eight key characteristics of male reproductive toxicants was based on a survey of known male reproductive toxicants and established mechanisms and pathways of toxicity. The eight key characteristics can provide a basis for the systematic, transparent, and objective organization of mechanistic evidence relevant to chemical-induced effects on the male reproductive system. https://doi.org/10.1289/EHP5045.
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Affiliation(s)
- Xabier Arzuaga
- National Center for Environmental Assessment, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Martyn T. Smith
- University of California, Berkeley, School of Public Health, Berkeley, California, USA
| | - Catherine F. Gibbons
- National Center for Environmental Assessment, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Niels E. Skakkebæk
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Erin E. Yost
- National Center for Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Brandiese E. J. Beverly
- Office of Health Assessment and Translation, National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Andrew K. Hotchkiss
- National Center for Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Russ Hauser
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rodrigo L. Pagani
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Steven M. Schrader
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA (retired)
| | - Lauren Zeise
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Sacramento, California, USA
| | - Gail S. Prins
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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