The utility of sildenafil citrate for infertile men with sexual dysfunction: a pilot study.

Objective: To investigate the use the sildenafil citrate, recognized as a first-line therapy for men with erectile dysfunction (ED), and which is safe and effective in men with various causes and severity of ED, including psychogenic ED, in a population of infertile men with sexual dysfunction.

Patients And Methods: Infertility is a major source of life stress and might be associated with sexual dysfunction through the erosion of self-esteem and self-confidence, and in stimulating discord in a relationship. Men presenting for evaluation of fertility who on questioning by the physician reported the recent onset of sexual dysfunction, had a history taken, a physical examination, hormonal profile, and completed the International Index of Erectile Function (IIEF), a validated inventory for assessing sexual dysfunction.

Defining the clinical characteristics of Peyronie's disease in young men.

Introduction: Peyronie's disease (PD) is usually seen in men in their fifth decade of life.

Aim: In this study, we investigated the characteristics of the disease in young men.

Main Outcome Measures: The demographics, clinical features, and associated comorbidities of the patients with PD were retrospectively reviewed.

Microsurgical reconstruction of iatrogenic injuries to the epididymis from hydrocelectomy.

Purpose: We determined the feasibility and outcome of microsurgical reconstruction of the excurrent ductal tract in men with obstruction secondary to iatrogenic injury to the epididymis from hydrocelectomy.

Materials And Methods: A retrospective chart review was done to identify men with iatrogenic injury to the epididymis or scrotal vas deferens and a history of hydrocelectomy. The outcome of microsurgical reconstruction was assessed by postoperative semen analysis.

Recombination in men with Klinefelter syndrome.

Klinefelter syndrome (KS: 47,XXY), occurs in one in 1000 male births. Men with KS are infertile and have higher rates of aneuploidies in sperm compared with normal fertile men. In the course of analyzing recombination in a population of infertile men, we observed that four men in our study presented with KS.

Defective recombination in infertile men.

Two percent of men are infertile owing to defects in sperm production. In 10-15% of cases, Y chromosome deletions that encompass critical spermatogenesis genes are detected; in the remaining cases, the cause of infertility is unknown. In model organisms, defects in recombination genes cause infertility, germ cell aneuploidy and subsequent development of inviable or abnormal progeny.

Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach.

Purpose: The groin approach to varicocelectomy is performed by an inguinal (aponeurosis of external oblique opened) or subinguinal (external oblique aponeurosis intact) technique. We describe the number and relationship of internal and external spermatic arteries, veins and lymphatics within the subinguinal portion of the spermatic cord in infertile men undergoing microscopic varicocelectomy and compare these findings to the microanatomy observed with the inguinal approach.

Materials And Methods: A total of 48 consecutive patients underwent 84 microsurgical subinguinal varicocelectomies during which the detailed intraoperative microanatomy of the spermatic cord and gubernacula was recorded.

The diagnosis and treatment of the azoospermic patient in the age of intracytoplasmic sperm injection.

Microsurgical reconstruction remains the treatment of choice for men with reconstructable obstructive azoospermia. Sperm retrieval techniques performed with ICSI are highly effective for men in whom reconstruction is not feasible. In men with nonobstructive azoospermia, the optimization of spermatogenesis with hormonal therapy and, when appropriate, microsurgical varicocelectomy can result in the appearance of adequate sperm in the ejaculate for ICSI.

Preservation of renal function in children with myelomeningocele managed with basic newborn evaluation and close followup.

Purpose: Children with myelomeningocele who leak with high intravesical pressures are at risk for upper urinary tract deterioration. Urodynamic study shortly after birth and routinely thereafter has been advocated to predict which newborns are at risk for upper tract deterioration. We hypothesize an approach that excludes routine application of urodynamic evaluation in neonates, reserving this study for use only when clinically indicated, is a safe and effective management option.

Ultrasound guided needle localization and microsurgical exploration for incidental nonpalpable testicular tumors.

Purpose: We describe a technique by which incidental, nonpalpable intratesticular tumors are excised using intraoperative ultrasonography and the operating microscope.

Materials And Methods: Men with impalpable intratesticular tumors incidentally detected by ultrasonography underwent intraoperative ultrasound guided needle localization and microsurgical exploration of the mass. The testis was delivered through an inguinal incision and placed on ice to minimize warm ischemia.