Female Urology

In men with varicoceles, spermatic vein embolization can significantly improve the chances for pregnancy, German researchers suggest.

National Report-With another year of Medicare payment cuts looming in 2007, declining reimbursement is no surprise as the number one current concern among practicing urologists, according to an exclusive survey from Urology Times and its sister publication, Contemporary Urology. Changes in reimbursement are followed closely by malpractice, office overhead, pay for performance, and increasing regulations as the top five issues that urologists are extremely or very concerned about, the first State of the Specialty survey found.

Three new staff members have joined the Cleveland Clinic Glickman Urological Institute: Jeffrey Palmer, MD, is the director of minimally invasive surgery, pediatric urology; Courtenay K. Moore, MD, is a specialist in female urology; and Edmund Sabanegh, MD, is head of the section of male infertility.

Although needle biopsies are being used for localization, the majority of prostate cancers are multifocal in nature and invisible on gray scale ultrasonography.

Atlanta-Men whose infertility is due to varicocele may be able to improve the likelihood of achieving impregnation by undergoing bilateral, rather than unilateral varicocelectomy, when indicated. This was the conclusion of the authors of a Canadian study presented here at the AUA annual meeting.

Atlanta-Two separate studies have found that men and women dealing with infertility suffer from depression and anxiety at a greater rate than the general population.

Atlanta-If you're going to perform a vasectomy reversal, use a microscope. Despite the additional time and cost involved, microsurgical vasovasostomy is superior to the loupe-assisted macroscopic technique, findings from a recent study from Korea confirm.

Atlanta-Male patients who carry any of the 25 gene mutations related to cystic fibrosis (CF) may also have anomalies of the reproductive tract, including unilateral or bilateral absence of the vas deferens or epididymal obstruction.

This story about the operating microscope and the vas has two morals.

Men with increased body mass index are significantly more likely to be infertile than are normal-weight men, according to research conducted at the National Institute of Environmental Health Sciences and published in Epidemiology (2006; 17:520-3).

Atlanta-Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has a huge impact on men's sexuality, but a combination of pelvic muscle trigger point release physiotherapy and relaxation training can go a long way toward improving sexual dysfunction in these men, said Rodney U. Anderson, MD, professor of urology, Stanford University School of Medicine, Stanford, CA.

Atlanta-Urologists can add one more alternative, plant-based medication to the list of intriguing possibilities for treating urologic disease. This one is a rye-pollen extract called Cernilton that showed promising results in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in a preliminary, placebo-controlled study from Germany.

Atlanta-Bisphosphonates have already been shown to reduce loss of bone mineral density (BMD) in men undergoing androgen deprivation therapy and to reduce skeletal events and markers of bone turnover in men with metastatic prostate cancer. However, the drugs carry risks and can be expensive. That's why Dror Michaelson, MD, PhD, an assistant in medicine at Massachusetts General Hospital and instructor at Harvard Medical School, Boston, examined the effects of zoledronic acid (Zometa) in a once-annual dosing schedule that is much reduced compared with that used in past trials.

Bone scans may no longer be necessary as follow-up in patients with PSA levels less than 5.0 ng/mL, researchers reported in the Journal of Urology (2006; 176:70-4).

Independent of maternal age and multiple other factors, the odds of miscarriage are significantly higher in pregnancies conceived from fathers 40 years of age or older than from fathers under 25 years of age, according to the authors of a study published in Obstetrics & Gynecology (2006; 108:369-77).

Horsham, PA-Biocoat, Inc. has received FDA approval of the PICSI sperm selection device to facilitate assisted reproduction.

Atlanta-Five new compounds-none an antimuscarinic and all in different classes-are showing potential for overactive bladder. They may also have applications in BPH, chronic prostatitis/chronic pelvic pain syndrome, and painful bladder syndrome/interstitial cystitis (PBS/IC).

From the genetic basis of male reproductive dysfunction to the psychology of those who suffer from it, men who experience infertility issues continue to benefit from research into all facets of the condition.

Atlanta-The idea that abuse plays a role in pelvic pain syndromes in women has been a controversial one. Now, another study is adding to that debate.

Heat sensitivity may make testicular cancer, and possibly other malignancies, more susceptible to standard treatments and die off more readily, according to a commentary in last week's JAMA (2006; 296:445-8).

Malvern, PA and Woodstock, GA-The new LithoGold spark gap shockwave lilthotripsy unit from Siemens Medical Solutions, USA, and Shockwave Technical Service, a division of Tissue Regeneration Technologies, LLC, is built into the housing of the Siemens Modularis system, ensuring compatibility with Siemens' C-arms and the Modularis table. The unit incorporates the STS SmartTrode intelligent electrode, which automatically adjusts to the specified energy level. FDA 510(k) review is pending.

Atlanta-In a recent study of nearly 6,500 men treated for localized pros-tate cancer, researchers found that being obese did not significantly affect the need for secondary treatment, nor did it result in decreased overall or disease-specific survival.

Chicago-A widely studied protein can help urologists find sperm to be used for in vitro fertilization and may even indicate another future pharmaceutical application of the substance, according to research presented here at the American Society of Andrology annual meeting here.

Among the more than 1,700 scientific papers presented at the 2006 AUA annual meeting, the focus was less on new medical or procedural innovations than on the benefits and risks of current tests and therapies.

Atlanta-Men who are being treated with androgen deprivation therapy for progressive prostate cancer face a second, less-recognized risk: osteoporosis and bone fracture. An initial report from a 2-year trial shows that weekly treatment with the oral bisphosphonate alendronate (Fosamax) can halt and even reverse the bone loss associated with androgen deprivation therapy.