ABSTRACT Background Varicocelectomy has been shown to improve semen parameters in men with infertility; however, not all men experience improvement. Identifying preoperative predictors of semen parameter improvement is necessary for counseling and treatment planning. Objective To determine if preoperative total testicular volume is associated with improved total motile sperm count (TMSC) after microsurgical varicocelectomy and to establish an optimal volume threshold for predicting clinical outcomes. Materials and Methods We retrospectively reviewed 110 men who underwent microsurgical varicocelectomy for infertility between January 2017 and May 2024. Inclusion criteria were adult men with preoperative TMSC <15 million and a history of at least 12 months of infertility. Testicular volume was assessed clinically by physical examination. The primary outcome was the upgrade in TMSC category after surgery, defined as a change from azoospermia, in vitro fertilization (IVF), or intrauterine insemination (IUI) to a higher category. Statistical analyses included Wilcoxon signed‐rank, t ‐tests, chi‐squared tests, multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis. Results Of the 110 men, 56 (51%) demonstrated improvements in TMSC category. Men who experienced improvement had higher preoperative total testicular volume (33.0 mL vs. 23.4 mL, p < 0.001). ROC curve analysis identified a total testicular volume threshold of ≥25.5 mL, which was associated with a 12‐fold increased odds of improvement (OR 12.0, 95% CI: 2.6–77.5, p = 0.003). In multivariable analysis, age, BMI, procedure laterality, varicocele grade, and preoperative FSH and total testosterone levels were not independently associated with postoperative improvement in TMSC. Discussion and Conclusions Preoperative total testicular volume is a strong predictor of improvement in TMSC following microsurgical varicocelectomy. These findings support the use of testicular volume in preoperative evaluation.

INTRODUCTION:Y-chromosome microdeletions, particularly in the azoospermia factor c (AZFc) region, are a common genetic cause of male infertility. This study evaluates sperm retrieval rates (SRRs) and testicular histology across age groups in men with isolated AZFc deletions. METHODS:We identified men with isolated complete AZFc microdeletions who underwent microdissection testicular sperm extraction from 2000 to 2024. Genitourinary pathology reports categorized histology as Sertoli cell-only, tubular atrophy, maturation arrest, or hypospermatogenesis. χ2 tests compared histology and SRR. Multivariable logistic regression assessed factors associated with successful sperm retrieval. RESULTS:Of 1473 patients who underwent Y-chromosome microdeletion testing, 72 with isolated AZFc microdeletions underwent microdissection testicular sperm extraction. Patients were stratified by age 35 years or younger (n = 51) and older than 35 years (n = 21). Overall, germ cells were identified in 59.7% of cases, with no difference between patients 35 years or younger (58.8%) and older than 35 years (61.9%; P = .81). The overall SRR was 50%, with no difference by the age group (≤35 years: 51.0%, older than 35 years: 47.6%; P = .80). On multivariable analysis, age older than 35 years (odds ratio [OR] 0.82, 95% CI [0.28-2.40]) and the presence of spermatogenesis during biopsy (OR 1.66, 95% CI [0.59-4.69]) were not associated with SRR. Follicle-stimulating hormone levels between 12.4 and 24.0 mIU/mL were associated with higher SRR (OR 7.04, 95% CI [1.83-27.1]). CONCLUSIONS:Patient age was not a strong predictor of sperm retrieval success in men with complete AZFc deletion. Follicle-stimulating hormone levels within an intermediate range were associated with higher SRRs, suggesting that hormonal context may inform patient counseling. Reproductive urologists should counsel patients that age alone is unlikely to meaningfully influence sperm retrieval.

OBJECTIVE:To assess the impact of microsurgical subinguinal varicocelectomy on sperm capacitation, semen parameters, pregnancy rates, and live birth outcomes in men with clinical varicoceles. PATIENTS AND METHODS:We retrospectively reviewed 260 consecutive men with clinical varicoceles who underwent a microsurgical subinguinal varicocelectomy procedure by a single surgeon from January 2019 to March 2024. Of these, 46 men had pre- and postoperative semen analyses and sperm capacitation tests. The primary outcome measure was change in the sperm capacitation score (Cap-Score™; Androvia LifeSciences, Mountainside, NJ, USA). Secondary outcome measures included change in semen parameters, change in probability of generating a pregnancy (PGP), pregnancy rates, and live birth rates. RESULTS:Among all 46 patients, there was an improvement in median sperm concentration (21.9 vs 30.0 million/mL; P < 0.01), mean total motile sperm count (TMSC; 33.9 vs 49.5 million; P = 0.04), mean sperm capacitation as measured by Cap-Score (23.6% vs 27.7%; P < 0.01), and mean PGP (27.4% vs 34%; P < 0.01) after varicocelectomy. Of the 33 couples trying to conceive, 24 (72.7%) achieved a live birth or ongoing clinical pregnancy after varicocelectomy; however, 13 of these 24 couples (54.1%) utilised in vitro fertilisation. A normal postoperative sperm concentration and Cap-Score were associated with a 60% chance of achieving pregnancy via natural conception or intrauterine insemination (IUI). CONCLUSION:Significant improvements in sperm concentration, TMSC, Cap-Score, and PGP were observed at 3 months after surgery. Patients with a normal post-varicocelectomy Cap-Score and semen concentration had the highest probability of conception naturally or through IUI.

Objective To synthesize emerging mechanistic, preclinical, and clinical evidence evaluating the impact of GLP-1RAs on male fertility, including effects on testicular function, reproductive hormones, semen parameters, and sexual function. Methods A comprehensive literature search was conducted across PubMed, MEDLINE, and Embase through May 31, 2025, identifying relevant preclinical and clinical studies examining GLP-1RAs and male reproductive health. Results The search strategy identified 16 clinical studies meeting our inclusion criteria, and these studies were included in the summary tables for review. GLP-1 receptors are present in male reproductive tissues. Preclinical studies indicate GLP-1RAs enhance spermatogenesis, hormone profiles, and sperm function in obese/diabetic rodent models via cAMP/PKA and PI3K/Akt pathways. In vitro data show improved sperm motility and Sertoli cell metabolism with GLP-1RAs. Limited clinical studies suggest potential improvements in semen parameters and testosterone levels in obese hypogonadal men, though heterogeneous results highlight the need for further research. Conclusion GLP-1RAs likely have a beneficial effect on male fertility, particularly in the setting of metabolic dysfunction, but clinical evidence is limited. Larger prospective studies are needed to confirm safety and efficacy.

To explore the frequency and predictive factors of erectile dysfunction diagnosis after colorectal cancer surgery. The Surveillance, Epidemiology, and End Results—Medicare database was used to identify a national sample of men undergoing surgery for colorectal cancer from 2004 to 2015. Men aged > 65 years with any index surgery within 1 year of diagnosis of colorectal cancer were included. Men with a history of prior erectile dysfunction, metastatic cancer, or genitourinary cancer prior to their index procedure were excluded. The primary outcome was a new diagnosis of erectile dysfunction within 2 years of the index procedure. A total of 28,248 men aged > 65 years who underwent colorectal cancer surgery were identified. The rates of erectile dysfunction diagnosis 2 years after surgery were 3.6

You have accessJournal of UrologyCME1 Apr 2023MP30-05 CONCORDANCE OF TESTIS HISTOLOGY AMONG MEN UNDERGOING BILATERAL TESTICULAR SPERM EXTRACTION PROCEDURES Jessica Marinaro, Jonathan Gal, and James Kashanian Jessica MarinaroJessica Marinaro More articles by this author , Jonathan GalJonathan Gal More articles by this author , and James KashanianJames Kashanian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For men undergoing a microdissection testicular sperm extraction (mTESE) procedure, if sperm are not found in one testis, a bilateral procedure is typically performed; however, this invasive dissection may have adverse effects. While testicular histology may predict sperm retrieval rates (SRRs), little is known about the concordance of histology between testes. Since this may inform the utility of performing a bilateral versus unilateral dissection, our objective was to assess the rate of histological concordance between left and right testis biopsies and as well as the overall sperm retrieval rate (SRR) for these patients. METHODS: We retrospectively reviewed electronic medical records using CPT codes 55899 and 54505 for 1 surgeon from 6/2016 to 8/2022. Men were included if they underwent a testicular sperm extraction (TESE) or mTESE procedure. Biopsies were evaluated by 4 pathologists at our institution. Histology was classified as Sertoli-cell only (SCO), maturation arrest (MA; early or late), active spermatogenesis (AS), or tubular atrophy (TA). Each pattern was reported as a percentage contributing to a total of 100%. A successful sperm retrieval was defined as the presence of sperm after processing by an andrology lab. RESULTS: Of 128 men who underwent a TESE or mTESE, 38 (29.7%) had a bilateral procedure. Mean demographics for these 38 men included an age at surgery of 39.4 ± 7.0 years, baseline testosterone 400.1 ± 198.0 ng/dL, baseline FSH 18.7 ± 14.9 mIU/mL, right testis volume 10.1 ± 6.4 mL, and left testis volume 10.2 ± 6.4 mL. Thirty-one men (31/38, 81.6%) had biopsies sent for histology from both testes. Of these, 9 (29.0%) had the same histology in the same proportions bilaterally, 14 (45.2%) had the same predominant histology but in variable proportions, and 8 (25.8%) had discordant predominant histology. Ten of 31 men (32.3%) had sperm retrieved; of these, 6 (60%) had no evidence of spermatogenesis on either histology specimen. CONCLUSIONS: While it is known that there is often heterogeneity within the testis, this study confirms that there is also significant heterogeneity between each testis for >25% of men. Though histology may help to predict SRRs, this study emphasizes that histology alone is not reliable in determining which men will have sperm present after processing by an andrology lab. Ultimately, while histology may provide patients and providers with useful information on testicular architecture, it should not be the only factor in clinical decision making, such as who should undergo a bilateral procedure or repeat procedure. Source of Funding: Authors JM and JG are supported in part by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e392 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Marinaro More articles by this author Jonathan Gal More articles by this author James Kashanian More articles by this author Expand All Advertisement PDF downloadLoading ...

Erectile dysfunction (ED) is common in men. There are various etiologies including vascular disorders, neurologic disorders, iatrogenic/medication-induced, hormone abnormalities, and psychogenic factors. Regardless of etiology, evaluation of ED requires a comprehensive history with emphasis on sexual history and focused physical examination. Treatment should be based on specific cause of disease. Medications, erection devices, and surgery are options for men with ED.

OBJECTIVE To assess changes in antibiotic prophylaxis for inflatable penile prosthesis surgery following publi-cation of the American Urological Association (AUA) Best Practice Statement in April 2008. MATERIALS AND METHODS The Premier Healthcare Database was queried for inflatable penile prosthesis surgeries from January 2000 to March 2020. The primary outcome was administration of an AUA-adherent antimi-crobial regimen and secondary outcome was 90-day explant. Piecewise linear regression was used to compare antimicrobial trends before vs after guideline publication. Multivariable logistic regression models were constructed for primary and secondary outcomes. RESULTS A total of 26,574 patients who underwent inflatable penile prosthesis surgery were identified, of whom 17,754 (67%) received AUA-adherent antibiotics. After guideline publication, there was a 42% relative increase in AUA-adherent regimen usage, with an increase in the usage trend on piecewise linear regression (from 0.1% to 0.8% of encounters per quarter, R-2 = 0.75, P < .001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0% of encounters per quarter, R-2 = 0.84, P < .001) and vancomycin (0.1%-0.7%, R-2 = 0.77, P < .001). On multivari-able regression, odds of AUA-adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54-1.80, P < .001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07-2.35, P < .01). Nonadherence to an AUA-recommended regimen with use of nonstandard antibiotics (OR: 1.16, 95% CI: 0.78-1.71, P = .5) or excess antibiotics (OR: 0.91, 95% CI: 0.62-1.30, P = .6) was not independently associated with increased risk of 90-day explant. CONCLUSIONS Publication of the AUA Best Practice Statement was associated with subsequent increases in the usage of guideline-adherent antibiotic regimens, particularly vancomycin and gentamicin, despite absence of level-1 evidence supporting this combination. UROLOGY 172: 131-137, 2023. (c) 2022 Elsevier Inc.

Despite many available treatments for Peyronie's disease (PD), practice patterns of available therapeutics are not well characterized.

In the survivorship setting, adolescent and young adult (AYA) cancer survivors frequently demonstrate little knowledge of infertility risk, are unclear regarding their fertility status, and may under- or overestimate their treatment-related risk for infertility. In female AYA survivors, ovarian function usually parallels fertility, and can be assessed with serum hormone levels and ultrasonography. Posttreatment fertility preservation may be appropriate for survivors at risk for primary ovarian insufficiency. In male AYA survivors, fertility and gonadal function are not always equally affected, and can be assessed with a semen analysis and serum hormones, respectively. As reproductive health issues are commonly cited as an important concern by survivors of AYA cancer, multidisciplinary care teams including oncology, endocrinology, psychology, and reproductive medicine are advocated, with the aim of optimal provision of fertility advice and care for AYA cancer survivors.

Research question: What is the impact of advancing paternal age, stratifying for maternal age, on fresh embryo transfer cycle outcomes? Design: All first autologous fresh embryo transfer cycles between 2013 and 2019 at a single high-volume academic institution were retrospectively reviewed. Female age was dichotomized along the cohort median of (37 years) (Female-Young [F-Y]: <37 years; Female-Old [F-O]: >= 37 years). Male age was stratified along the cohort median (38 years) and 90th centile (48 years) (Male-Young [M-Y]: <38 years; Male-Intermediate [M-I]: <= 38 and >48 years; Male-Old [M-O]: >= 48 years). The primary outcome of interest was the odds of live birth using logistic regression. Secondary outcomes included odds of implantation, clinical intrauterine pregnancy and pregnancy loss. All models were adjusted for continuous female age, use of surgically retrieved testicular spermatozoa, severe oligozoospermia and cleavage- versus blastocyst-stage embryo transfer. Results: A total of 6704 couples were included and were divided into six groups based on paternal/maternal age groups (F-Y/M-Y: 2288; F-Y/M-I: 750; F-Y/M-O: 97; F-O/M-Y: 679; F-O/M-I: 2310; F-O/M-O: 580). While some associations were seen on univariable logistic regression, none of the groups with increasing paternal age showed any statistically significant differences on multivariable logistic regression with respect to implantation, clinical intrauterine pregnancy, pregnancy loss or live birth. Conclusions: Advanced paternal age does not impact clinical outcomes in fresh transfer cycles. The authors postulate that IVF with or without intracytoplasmic sperm injection is able to overcome the deleterious effects of advancing paternal age on sperm quality and subsequent embryo performance.