Female Urology

Washington--Even after surgical ablation, posterior urethral valves (PUVs) in boys can cause bladder and kidney problems in later years. But now, for the first time, a team of pediatric urologists has shown that PUVs also can affect sex accessory glands and, ultimately, fertility. Justine M. Schober, MD, a pediatric urologist at Hamot Medical Center, Erie, PA, reported the group's findings here at the 2005 American Academy of Pediatrics Section on Urology annual meeting.

Beaver Creek, CO--Intermittent androgen suppression (IAS) is reported to be beneficial in select men with advanced prostate cancer, although definitive data are not yet available.

San Francisco--A never-before-seen virus associated with prostate cancer suggests that infection may play a role in the development of the disease in genetically susceptible individuals. The new virus, XMRV, is 25 times more likely to be present in prostate cancer patients with a specific genetic mutation than it is in the general male population, researchers reported at the American Society of Clinical Oncology 2006 Prostate Cancer Symposium here.

Advanced Urology Associates, Inc., and Urology Inc. have merged to form Physicians Urology, which will become the largest fully integrated urology practice in the Akron, OH area with physicians experienced in a range of specialties.

The National Cancer Institute has launched a 3-year initiative to identify genetic alterations that make people susceptible to prostate and breast cancer.

Dietary or supplemental antioxidants do not appear to be associated with a decreased risk of prostate cancer among men in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, suggests a study published last month in the Journal of the National Cancer Institute (2006; 98:245-54).

Baltimore--Psychological treatment, particularly cognitive behavioral therapy, can help ease chronic pain. That's why these therapies may be able to do the same for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients, argued Judith Turner, PhD, at the NIDDK-sponsored Chronic Pelvic Pain/Chronic Prostatitis Scientific Workshop here.

Fiber is cleared for use with Holmium laser in BPH

Baltimore?What causes chronic pain in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)? This could be the wrong question to ask, said Jeffrey S. Mogil, PhD, at the NIDDK-sponsored Chronic Pelvic Pain/Chronic Prostatitis Scientific Workshop. The better question may be: Why do these particular men have chronic pain, whereas others do not?

Researchers are taking a broader view of chronic pain that will allow development of new treatment strategies.

The use of opiates in chronic nonmalignant pain has its share of proponents and opponents among urologists who specialize in chronic pelvic pain.

Baltimore--Scientific thinking about pain in general and chronic pain in particular has changed drastically in the last 50 years. Providers who treat chronic pain syndrome, such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), need to discard the old models if they are going to help patients.

In one study, 85% of the CP/CPPS patients had decreased frequency of sexual contact because of their pain, 67% said it interfered with or ended relationships, and 43% said it inhibited forming new relationships.

Baltimore--Psychological treatment, particularly cognitive behavioral therapy, can help ease chronic pain. That's why these therapies may be able to do the same for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients, argued Judith Turner, PhD, at the NIDDK-sponsored Chronic Pelvic Pain/Chronic Prostatitis Scientific Workshop here.

Past terminology has held management back, Dr. Baranowski argued. The 'itis' of prostatitis, for example, has encouraged patients to seek anti-inflammatory or long-term antibiotic therapies that often don't help.

Baltimore?Someday, you may be using neurophysiologic testing for follow-up and possibly even diagnosis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) before you turn to the four-glass or modified test. That's because, increasingly, CP/CPPS is being recognized not as a disorder of the prostate, but as a neurologic disorder?a chronic pain syndrome that may begin in the viscera, but becomes a nervous system disorder as pain is centralized.

Baltimore--As the focus on pelvic pain syndromes moves away from the organs to the nervous system, researchers such as Ursula Wesselmann, MD, PhD, are trying to find out how acute pain develops into chronic pain.

Montreal--Men with a body mass index indicative of being overweight or obese may exhibit changes in endocrine levels—notably lower testosterone levels—that could contribute to infertility, new research shows. It is possible, therefore, that fertility problems could be ameliorated with weight loss in some men.

Montreal--In case your patients need another reason to quit, recent research indicates that smoking tobacco reduces the ability of sperm to fertilize an egg. There appears to be a dose-response relationship, with heavy smokers at greater risk for more severe impairment of sperm, according to a study presented at the American Society for Reproductive Medicine annual meeting here. It remains to be seen whether quitting smoking or even cutting down will lead to improvements in sperm functions that support fertilization.

Montreal--Idiopathic, primary nonobstructive azoospermia (NOA) is linked to a genetic defect known as a dysfunctional DNA mismatch repair pathway that also places these men at increased risk for cancer and other medical illnesses. Given that the problem is genetic in origin, the consequences of this defect may be of significance for both patients and their offspring, researchers say. Both concerns require close monitoring by physicians.

Montreal--The anti-estrogen agent clomiphene citrate (Clomid, Milophene, Serophene) may provide an easier, less expensive treatment for infertility among some men with hypogonadotropic hypo-gonadism [HH], according to a small retrospective study. The agent may be worth trying before the more expensive and difficult-to-administer gonadotropins are employed.

Montreal--As the controversy over whether to perform vasovasostomy or vasoepididymostomy for vasectomy reversal rages, two small studies have provided some new insight into when to choose one surgical technique over the other. One study demonstrates that expert surgeons can provide better results with vasoepididymostomy among patients with vasospermia, defined as no sperm in the vasal fluid, regardless of the condition of the vasal fluid. The second study suggests that the presence of sperm parts in the vasal fluid signals that vasovasostomy might be the better option.

Montreal--Although testicular sperm extraction (TESE) may provide somewhat better pregnancy rates than the use of ejaculated sperm for intracytoplasmic sperm injection for men with low sperm counts, a higher-than-average proportion of abnormal sperm, or almost no sperm in the ejaculate, TESE does have important disadvantages. It is up to patients and their physicians to choose the appropriate procedure, based on individual circumstances and clinical features, researchers say.

Montreal--The level of inhibin B may be a better marker of male infertility than both the typically used follicle stimulating hormone (FSH) and luteinizing hormone (LH), according to new research. These findings have yet to be confirmed in a large, prospective trial, however.

Washington--For children with ambiguous genitalia at birth, surgical techniques have improved vastly, but deciding when and whether to do surgery hasn't gotten easier. That was apparent from the lively and sometimes contentious panel and audience discussion here at the American Academy of Pediatrics Section on Urology annual meeting.