Serum levels of enclomiphene and zuclomiphene in men with hypogonadism on long-term clomiphene citrate treatment.

Objectives: To determine the relative concentrations of enclomiphene (ENC) and zuclomiphene (ZUC) isomers in men with hypogonadism on long-term clomiphene citrate (CC) therapy, and to determine whether patient age, body mass index (BMI) or duration of therapy were predictive of relative concentrations of ENC and ZUC.

Patients And Methods: Men already receiving CC 25 mg daily therapy for secondary hypogonadism for a minimum of 6 weeks were recruited to have their ENC and ZUC levels assessed. Total testosterone, free testosterone, oestradiol, follicle stimulating hormone (FSH), and luteinizing hormone (LH) before initiation of and while on CC therapy were recorded for all patients.

Sexual Side Effects of Medical and Surgical Benign Prostatic Hyperplasia Treatments.

Treatments for lower urinary tract symptoms due to benign prostatic hyperplasia can be evaluated by multiple metrics. A balance within the confines of patient expectations is key to determining the ideal treatment. A troubling adverse event for some patients is sexual dysfunction.

Fertility-related quality of life from two RCT cohorts with infertility: unexplained infertility and polycystic ovary syndrome.

Study Question: Does fertility-related quality of life (FertiQOL) differ by infertility diagnosis between women with polycystic ovary syndrome (PCOS) and their partners, compared with couples with unexplained infertility (UI)?

Summary Answer: Women with PCOS report lower QOL than those with UI, whereas males with UI report lower QOL than males with PCOS partners.

What Is Known Already: The fertility-specific QOL survey, FertiQOL, has been used to examine fertility-related QOL in a number of worldwide cohorts. Few data have addressed fertility-related QOL as a function of infertility diagnosis.

A summary of the controversy surrounding off-label medications in men's health.

While there are common and accepted practices in men's health, barriers exist to treatment of these disorders with Food and Drug Administration (FDA) approved medications. In male factor infertility, these barriers include studies that are often underpowered for desired outcomes. This has led to the use of medications previously examined in females in an off-label fashion for treatment of male infertility.

Stone volume is best predictor of operative time required in retrograde intrarenal surgery for renal calculi: implications for surgical planning and quality improvement.

Retrograde intrarenal surgery (RIRS) is highly successful at eliminating renal stones of various sizes and compositions. As urologists are taking on more complex procedures using RIRS, this has led to an increase in operative (OR) times. Our objective was to determine the best predictor of OR time in patients undergoing RIRS.

Successful Outcomes in Robot-Assisted Laparoscopic Pyeloplasty Using a Unidirectional Barbed Suture.

Introduction: Intracorporeal suturing is considered to be the most challenging aspect of laparoscopic and robotic surgery. To overcome this problem, barbed self-retaining sutures have been effectively employed in various minimally invasive endourologic surgeries. However, the use of this suture has been recently cautioned for pyeloplasty due to a high failure rate.

Pros, cons, and ethics of HPV vaccine in teens-Why such controversy?

Introduction: Human papillomavirus (HPV) infection remains one of the most commonly sexually transmitted infections in both females and males. HPV viruses are associated with several manifestations including genital warts, but more importantly for urology practitioners, cervical and penile carcinomas and recurrent genital condylomata in both sexes. The incidence of HPV-related carcinomas has increased in cervical, oropharyngeal, vulvar, penile, and anal cancers.

The role of laparoscopy in children with groin problems.

The use of laparoscopic surgery has grown dramatically in recent years in most all types of surgery. Historically, the early use of laparoscopic surgery was for pelvic and groin problems. In this article we review the current technique, indications, benefits and complications of laparoscopy in diagnosis and management of various groin problems in children including undescended testes (non-palpable and palpable) and inguinal hernia.

Self-assessment of surgical technique leads to reduction of positive surgical margins in partial nephrectomy.

The background of the study was to examine potential causes for a positive surgical margin (PSM) and develop strategies to improve surgical outcomes. A retrospective review of consecutive partial nephrectomy cases for renal cell carcinoma was performed. We divided the patients into 2 groups.

Oral enclomiphene citrate raises testosterone and preserves sperm counts in obese hypogonadal men, unlike topical testosterone: restoration instead of replacement.

Objectives: To determine the effects of daily oral doses of enclomiphene citrate compared with topical testosterone gel treatment on serum total testosterone (TT), luteinising hormone (LH), follicle-stimulating hormone (FSH), and sperm counts in men with secondary hypogonadism.

Patients And Methods: Two parallel randomised, double-blind, double-dummy, placebo-controlled, multicentre, phase III studies were undertaken to evaluate two doses of enclomiphene citrate vs testosterone gel (AndroGel(®) 1.62%) on TT, LH, FSH, and sperm counts in overweight men aged 18-60 years with secondary hypogonadism.

Manufacturers' data show increasing implanted cylinder sizes and measured corporal lengths in inflatable penile implants.

Introduction: We sought to determine whether measured corporal length (MCL) or implanted device size (IDS) has changed.

Methods: Data were obtained from the two major penile implant companies from the years of 2005-2010 and analyzed. While we requested similar data, companies supplied information at their discretion with MCL provided by American Medical Systems and IDS provided by Coloplast.

Exploring Urological Surgery Wait Times as a Quality Indicator of Care: A Case Study of Different Health Care Systems.

Introduction: We determined and compared wait times for urological procedures at 2 centers in different health care systems to more fully understand the usefulness of wait times as a quality indicator.

Methods: A retrospective review of patient wait times for transurethral bladder tumor resection was performed at Albany Medical Center, Albany, New York and Kingston General Hospital, Kingston, Ontario, Canada. The time from the decision for surgery until the completion of surgery (Wait 2) was determined for 495 consecutive patients during calendar years 2011 and 2012.

An Appeal to the Global Health Community for a Tripartite Innovation: An "Essential Diagnostics List," "Health in All Policies," and "See-Through 21(st) Century Science and Ethics".

Diagnostics spanning a wide range of new biotechnologies, including proteomics, metabolomics, and nanotechnology, are emerging as companion tests to innovative medicines. In this Opinion, we present the rationale for promulgating an "Essential Diagnostics List." Additionally, we explain the ways in which adopting a vision for "Health in All Policies" could link essential diagnostics with robust and timely societal outcomes such as sustainable development, human rights, gender parity, and alleviation of poverty.

Natural history of testicular size in boys with varicoceles.

Introduction: Testicular size is commonly used as a proxy for future fertility in adolescent boys diagnosed with varicoceles. Surgery is often performed based on a 15-20% reduction in volume of the ipsilateral testicle when compared to the unaffected side. Recent European Association of Urology guidelines, however, have highlighted the risk of overtreatment.

Interinstitutional variability in testicular volumes and varicocele presence by ultrasound: surprising discrepancies and implications for clinical decision making.

Objective: To determine the variability of testicular ultrasound (US) volumes and the clinical implications.

Methods: A retrospective review identified 73 patients (62 adult and 11 adolescents) who had testicular US scans performed at both our institution (Urological Institute at Northeastern New York) and at an outside facility (outside hospital study). Testicular volume (TV) was measured using the Lambert formula: length × width × height × 0.

Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma: population-based and single-institutional analysis.

Purpose: Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma is unclear. To assess whether PN provides adequate cancer control in high-risk disease (HRD), survival outcomes were compared in both a population-based cohort and an institutional cohort.

Methods: Surveillance, Epidemiology, and End Results database and a prospectively maintained institutional database were queried for patients with RCC who underwent PN or RN for a localized tumor ≤7 cm and were found to have high-grade and/or high-stage disease (HRD).

Children's anxious reactions to an invasive medical procedure: The role of medical and non-medical fears.

This study investigated the relationship of medical and non-medical fears to children's anxiety, pain, and distress during an invasive medical procedure, the voiding cystourethrogram. Parents of 34 children completed the Fear Survey Schedule-II prior to their child's procedure. Child distress behaviors during the procedure were audiotaped and coded using the Child-Adult Medical Procedure Interaction Scale-Revised.

Management of undescended testis may be improved with educational updates for referring providers.

Objective: A large proportion of boys referred for undescended testis (UDT) is not managed optimally prior to the referral, with the majority seen at >1 year of age and many having unnecessary ultrasound (US). Our objective was to assess the magnitude of these problems in our area and to determine if unnecessary US decreased following interventions to educate referring providers (RPs).

Materials And Methods: A chart review was done on new patients referred for UDT from January 2010 to June 2012.

High recurrence rate at 5-year followup in children after upper urinary tract stone surgery.

Purpose: Pediatric urolithiasis has been treated with shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy with high success rates during short-term followup. We studied our success rate and modifiable risk factors in patients with at least 5 years of followup postoperatively.

Materials And Methods: Retrospective chart review was performed for patients younger than 18 years who underwent upper tract stone surgery between 1999 and 2007, were stone-free afterward and had at least 5 years of followup.

Challenges of disorders of sex development: diverse perceptions across stakeholders.

Background/aims: Disorders of sex development (DSD) are congenital conditions in which chromosomal, gonadal, or anatomic sex development is atypical. Optimal management is patient- and family-centered and delivered by interdisciplinary teams. The present pilot study elicits concerns held by important stakeholders on issues affecting young patients with DSD and their families.

Is parental anxiety and coping associated with girls' distress during a VCUG? Preliminary findings.

Purpose: We investigated the relationship between parental anxiety/coping strategies and girls' distress during VCUGs.

Methods: Parents of 32 girls (age 4-10, mean 5.8 years) completed a trait anxiety measure and a measure of parental reactions to children's distress.