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Men who experience painful recurrent varicoceles after undergoing conservative treatment and failed surgical repair are best served by microsurgical varicocelectomy, according to Canadian researchers.Of 11 men who had failed standard varicocelectomy and experienced pain before and after surgery, 10 experienced a favorable response following microsurgical repair, according to investigators."In my mind, microsurgical varicocelectomy is the gold standard, and non-microsurgical repair is sub-standard," said lead author Armand Zini, MD, associate professor of urology at McGill University, Montreal. "However, few urologists are able to perform this procedure, since they have not been trained properly."

The adverse side effects of hormone therapy in prostate cancer patients may be more severe and may manifest sooner than many believe, according to two separate studies discussed here yesterday.

Measurement of two cytokines in expressed prostatic secretions (EPS) might provide diagnostic guidance for patients with chronic prostatitis/chronic pelvic pain syndrome (CPPS), according to a study presented at the AUA annual meeting.

Kingston, Ontario--An interstitial cystitis (IC) drug has shown modest benefit in men with chronic pelvic pain syndrome (CPPS). Although the study doesn't open new therapeutic doors, it does raise interesting questions about how similar IC and CPPS may be or whether some men are being misdiagnosed.

Urologists treating patients with advanced prostate cancer should anticipate a number of advances this year and next. They will also need to anticipate some of the challenges these advances will create, according to Paul F. Schellhammer, MD, program director of the Virginia Prostate Center and professor of urology at Eastern Virginia Medical School, Norfolk.

It often takes years before medical advances make their way from the laboratory bench to the physician's office. Such is not the case in andrology. In many instances, the cutting edge will be of clinical relevance very soon for urologists who treat male infertility, according to Craig S. Niederberger, chief of andrology at the University of Illinois, Chicago.

More effective treatment will come as interstitial cystitis becomes better defined and research makes inroads on the epidemiology and etiology of this enigmatic and difficult-to-treat condition.

Tamoxifen (Nolvadex) reduces the frequency of gynecomastia and breast pain in prostate cancer patients taking bicalutamide (Casodex), according to a study in Lancet Oncology (2005; 6:295-300).

Human epidermal growth factor receptor 2 (HER-2), associated with breast cancer, is a key culprit in prostate cancer recurrence, say researchers from the University of North Carolina at Chapel Hill.

Cryosurgery appears to be a promising primary treatment for prostate cancer, even in men with high-risk features, according to results of a 4-year study published in Cancer (2005; 103:1625-30).

Tamoxifen (Nolvadex) reduces the frequency of gynecomastia and breast pain in prostate cancer patients taking bicalutamide (Casodex), according to a study in Lancet Oncology (2005; 6:295-300).

Istanbul, Turkey--Chronic prostatitis appears to be significantly associated with psychological disorders, such as depression, anxiety, and panic, according to the results of a German study. The study also found that pelvic pain symptoms are far less prevalent than expected (3.2%), while the mean age of afflicted men was significantly higher than noted in previous trials (60.6 years).

Istanbul, Turkey--Transurethral microwave thermotherapy of the prostate offers a 50% improvement in pain in up to two-thirds of patients with chronic prostatitis/chronic pelvic pain syndrome, which is comparable to other treatment modalities, according to researcher Christof Kastner, MD, PhD. The therapy also appears to promise good durability 2 years post-procedure.

Istanbul, Turkey--Biofeedback physical therapy and pelvic floor re-education appear to offer symptomatic improvement in men with chronic pelvic pain syndrome type III, Dutch researchers say. The techniques appear to work by improving relaxation and demonstrating proper use of pelvic floor muscles.

Hormone therapy increased the incidence of all types of incontinence at 1 year among women who were continent at baseline.

Honolulu--Ureteroscopy may be safe and effective for the diagnosis and treatment of renal colic and urolithiasis during pregnancy, according to research findings presented at the annual Kimbrough Urological Seminar.

Antimuscarinics are recommended as first-line pharmacotherapy for OAB. They act to reduce urgency, stabilize detrusor overactivity, and increase bladder capacity.

ACMI Corp. said it has created a Gynecology and Surgical Specialties business unit to concentrate on growth opportunities in women's health and other key surgical specialties.

Physical therapy, perineural injections may provide relief without surgery, experts say

In general, we recommend cryoablation for patients with localized, high-grade tumors and higher-volume disease who are not potent or not interested in maintaining their potency.

The risk of bone fractures increases for those prostate cancer patients on androgen-deprivation therapy by more than 40%, according an article in last week's New England Journal of Medicine (2005; 352:154-64).

Prostate cancer patients receiving androgen deprivation therapy are frequently not screened nor treated for osteoporosis, according to an article in the online edition of Cancer (Dec. 13, 2004).

Philadelphia--Men being treated with radiation therapy for testicular cancer should be encouraged to cryopreserve sperm, say authors of a small study presented at the American Society for Reproductive Medicine annual meeting.

Philadelphia--Treatment for testicular cancer caused the rates of severe oligozoospermia and azoospermia to rise from 7% to 27% and 0% to 12%, respectively, in a study that suggests a need for sperm banking in men treated for the disease.

Toronto--Although few published studies exist on the prevention of thromboembolic disorders in urologic surgery, the risk of such disorders appears to be similar to that seen in other major surgical procedures.Therefore, urologists should concentrate on identifying patients at sufficient risk to warrant routine thromboprophylaxis, said the co-author of a new set of antithrombotic guidelines from the American College of Chest Physicians.

Philadelphia--A new study shows that fertilization rates with cryopreserved sperm are not inferior to those with "fresh" sperm, although it will be several more years before researchers can determine whether the rates are equal in nature.

Philadelphia--Vasectomy reversal is a viable option for men who desire restoration of fertility despite obstructive intervals exceeding 14 years, according to the results of a study by Cleveland Clinic researchers.

Philadelphia--Vitamin D may play a role in sperm physiology and male infertility, according to findings from new basic research presented at the American Society for Reproductive Medicine 60th annual meeting.

Urology Associates of North Texas (UANT) has agreed to merge with a six-physician urology group in Forth Worth.

Caxias do Sul, Brazil--Men over the age of 40 years may have lower semen quality, but not necessarily lower sperm morphology. That's an important fact to remember when evaluating these men for infertility, suggests a study by Brazilian researchers.