Renal cell carcinoma (RCC) presenting with cough is a rare phenomenon, which is likely an immune-mediated paraneoplastic syndrome. To our knowledge, there are a few individual case reports and one case series in the literature. We report our experience with chronic cough as the presenting symptom for RCC. A retrospective chart review was performed on cases presenting with RCC and cough at two institutions. A recent case at a third institution was also included. The literature was reviewed via an Ovid MEDLINE search to reveal fourteen previously reported cases. Eight new cases were identified of patients presenting with a cough and subsequently being diagnosed with RCC. All cases of RCC were identified incidentally due to imaging obtained during a workup for chronic cough. Average age at presentation was 66.5 years old (range 54–79). Renal tumor size ranged from 3.8 to 10 cm. Final pathology was clear cell renal cell carcinoma in all patients, with one patient having Xp11 translocation. Six of the patients had resolution of the cough after resection of the primary tumor despite one patient with metastatic disease. One other patient reported a significant improvement. The final patient had transient improvement in her cough after cytoreductive nephrectomy. Chronic cough is a rare presentation of RCC. Treatment of the primary tumor with resection or embolization may lead to resolution of the cough, even in some patients with metastatic disease.

OBJECTIVE To assess clinical safety (primary) and efficacy (secondary) of histotripsy for treatment of symptomatic benign prostatic enlargement in a first-in human study. METHODS Twenty-five male subjects with moderate to severe lower urinary tract symptoms, prostate size between 30 and 80 g, and no evidence of prostate cancer were enrolled at 2 sites in a prospective, singlearm study. Treatment consisted of acoustic energy delivery through the perineum with integrated real-time transrectal ultrasound monitoring using the Vortx R-x system. Follow-up evaluations were performed on postoperative day 1 and 1, 3, and 6 months. RESULTS Twenty-five men underwent histotripsy treatment with no serious intraoperative adverse events. Postoperatively, 3 cases of transient urinary retention (< 3 days), 1 case of urinary retention (8 days in duration, defined as serious), a minor anal abrasion, and microscopic hematuria were considered device-related adverse events. Debulking of targeted prostate tissue was not observed with transrectal ultrasound imaging or with endoscopic visualization, and clinically meaningful improvement in uroflow or postvoid residual urine (PVR) did not occur. However, International Prostate Symptom Score improvement at 1 month was 12.5 (52.4%) +/- 6.6 points (n = 25), at 3 months was 11.9 (50.8%) +/- 7.6 points (n = 24), and at 6 months was 10.4 (44.0%) +/- 7.6 points (n = 24) (P < .001). CONCLUSION Prostate histotripsy was safe and well tolerated in this pilot human trial with improvement in lower urinary tract symptoms. (C) 2018 Elsevier Inc.

Objective: To investigate optimal test vial (TV) volume, utility and reliability of TVs, intermediate temperature exposure (-88 degrees C to -93 degrees C) before cryostorage, cryostorage in nitrogen vapor (VN2) and liquid nitrogen (LN2), and long-term stability of VN2 cryostorage of human semen.Design: Prospective clinical laboratory study.Setting: University assisted reproductive technology (ART) laboratory.Patient(s): A total of 594 patients undergoing semen analysis and cryopreservation.Intervention(s): Semen analysis, cryopreservation with different intermediate steps and in different volumes (50-1,000 mu L), and long-term storage in LN2 or VN2.Main Outcome Measure(s): Optimal TV volume, prediction of cryosurvival (CS) in ART procedure vials (ARTVs) with pre-freeze semen parameters and TV CS, post-thaw motility after two-or three-step semen cryopreservation and cryostorage in VN2 and LN2.Result(s): Test vial volume of 50 mu L yielded lower CS than other volumes tested. Cryosurvival of 100 mu L was similar to that of larger volumes tested. An intermediate temperature exposure (-88 degrees C to -93 degrees C for 20 minutes) during cryopreservation did not affect post-thaw motility. Cryosurvival of TVs and ARTVs from the same ejaculate were similar. Cryosurvival of the first TV in a series of cryopreserved ejaculates was similar to and correlated with that of TVs from different ejaculates within the same patient. Cryosurvival of the first TV was correlated with subsequent ARTVs. Long-term cryostorage in VN2 did not affect CS.Conclusion(s): This study provides experimental evidence for use of a single 100 mu L TV per patient to predict CS when freezing multiple ejaculates over a short period of time (<10 days). Additionally, semen cryostorage in VN2 provides a stable and safe environment over time. ((c) 2015 by American Society for Reproductive Medicine.)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-Based Medicine & Outcomes (I)1 Apr 201356 PRACTICE-BASED COLLABORATION TO IMPROVE THE USE OF IMMEDIATE INTRAVESICAL CHEMOTHERAPY (IVC) FOR NON-MUSCLE-INVASIVE BLADDER CANCER Daniel Barocas, James Montie, Timothy Bradford, Frank Burks, David Morris, Daniel Murtagh, Peter Knapp, Timothy Schuster, Ronald Suh, Rodney Dunn, Alice Liu, and David Miller Daniel BarocasDaniel Barocas Nashville, TN More articles by this author , James MontieJames Montie Ann Arbor, MI More articles by this author , Timothy BradfordTimothy Bradford Richmond, VA More articles by this author , Frank BurksFrank Burks Royal Oak, MI More articles by this author , David MorrisDavid Morris Nashville, TN More articles by this author , Daniel MurtaghDaniel Murtagh Toledo, OH More articles by this author , Peter KnappPeter Knapp Indianapolis, IN More articles by this author , Timothy SchusterTimothy Schuster Toledo, OH More articles by this author , Ronald SuhRonald Suh Indianapolis, IN More articles by this author , Rodney DunnRodney Dunn Ann Arbor, MI More articles by this author , Alice LiuAlice Liu Ann Arbor, MI More articles by this author , and David MillerDavid Miller Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1432AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Because its use is supported by level I evidence and clinical guidelines, the Urological Surgery Quality Collaborative (USQC) initiated a project aimed at understanding the quality improvement potential (QIP) for administration of IVC in real-world practice. METHODS Methods: USQC is a consortium of community and academic practices engaged in quality improvement activities based on shared data collection, performance feedback, and educational interventions. For both ideal (1-2 papillary tumors, clinical stage Ta or T1, completely resected) and non-ideal cases, we examined use of IVC at baseline and after an intervention that included feedback of utilization data and review of clinical guidelines.) For cases where IVC was not used, surgeons provided explanations that were classified as appropriate (e.g., non-ideal case, deep resection, allergy) or modifiable (e.g., surgeon not convinced of benefit, IVC not ordered preoperatively). From these data, we calculated measures of “judicious use” [use in ideal cases + appropriate non-use] and QI potential [use in non-ideal cases + non-use due to modifiable factors] and assessed whether these changed after the intervention. RESULTS Results: From Sept 2010 to Aug 2012, we accrued 2,794 cases from 5 USQC sites. The use of IVC varied significantly across practices before and after intervention for both ideal and non-ideal cases (p<0.01 for each) (Figure). While overall utilization in ideal (38% vs 35%, p=0.36) and non-ideal cases (15% vs 12%, p=0.08) was similar before and after the interventions, two practices achieved significant reductions in use among non-ideal cases (Figure). The high proportion of judicious use (82.9% vs 83.4%), and the relatively low QIP (17.1% vs 15.7%, p=0.785 for both) remained stable after the intervention. CONCLUSIONS Discussion: Utilization of IVC was much higher than reported previously, and non-use in ideal cases is most often for appropriate reasons. In most practices, utilization did not change after performance feedback and education, suggesting that urologists are adequately informed about the risks and benefits of MMC. The results also suggest a potential “ceiling effect”, wherein it may be difficult to significantly improve care that is relatively high quality at baseline. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e23 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Barocas Nashville, TN More articles by this author James Montie Ann Arbor, MI More articles by this author Timothy Bradford Richmond, VA More articles by this author Frank Burks Royal Oak, MI More articles by this author David Morris Nashville, TN More articles by this author Daniel Murtagh Toledo, OH More articles by this author Peter Knapp Indianapolis, IN More articles by this author Timothy Schuster Toledo, OH More articles by this author Ronald Suh Indianapolis, IN More articles by this author Rodney Dunn Ann Arbor, MI More articles by this author Alice Liu Ann Arbor, MI More articles by this author David Miller Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement Loading ...

Purpose: Perioperative instillation of intravesical chemotherapy after bladder tumor resection is supported by level I evidence showing a 30% decrease in tumor recurrence. However, studies of administrative data sets show poor use in practice.Materials and Methods: We prospectively evaluated the use of perioperative intravesical chemotherapy in a multipractice quality improvement collaborative. Cases were categorized as ideal for intravesical chemotherapy (1 or 2 papillary tumors, cTa/cT1 and completely resected) and nonideal. The reasons for not administering intravesical chemotherapy in ideal cases were classified as appropriate or modifiable. Before and after comparative feedback and educational interventions we calculated judicious use of intravesical chemotherapy (nonuse in nonideal cases plus use in ideal cases plus appropriate nonuse in ideal cases) and quality improvement potential (use in nonideal cases plus nonuse in ideal cases attributable to modifiable factors).Results: We accrued a total of 2,794 cases at the 5 sites in 22 months. The rate of use in ideal cases was 38% before and 34.8% after intervention (p = 0.36), while use in nonideal cases decreased from 15% to 12% (p = 0.08). Overall, intravesical chemotherapy was used judiciously in 83.0% to 85.7% of cases, while the remaining 14.3% to 17.0% represented quality improvement potential.Conclusions: Judicious use of perioperative intravesical chemotherapy is relatively high in routine practice. Most instances of nonuse represent appropriate clinical judgment. Utilization did not change after quality improvement interventions, suggesting that there may a ceiling effect that makes it difficult to improve care that is high quality at baseline. Moreover, decreasing unnecessary use of an intervention may be easier than encouraging appropriate use of potentially toxic therapy.

PURPOSE:Despite its established efficacy in reducing recurrence rates for patients with urothelial carcinoma, immediate intravesical chemotherapy is reportedly used infrequently. Accordingly, the Urological Surgery Quality Collaborative implemented a project aimed at understanding and improving the use of immediate intravesical chemotherapy.MATERIALS AND METHODS:Surgeons in 5 Urological Surgery Quality Collaborative practices prospectively collected clinical and baseline intravesical chemotherapy use data for patients undergoing bladder biopsy or transurethral bladder tumor resection from September 2010 through January 2012. In the second phase of data collection (June 2011 through January 2012) treating surgeons also documented reasons for not administering intravesical chemotherapy. We defined patients with 1 to 2 clinical stage Ta/T1, completely resected, papillary tumor(s) as ideal candidates for treatment with immediate intravesical chemotherapy. For ideal and nonideal patients we examined baseline use of intravesical chemotherapy across Urological Surgery Quality Collaborative practices as well as reasons for not administering therapy among ideal patients.RESULTS:Among 1,931 patients 37.2% met criteria as ideal cases for intravesical chemotherapy administration. We observed significant variation in the use of intravesical chemotherapy across Urological Surgery Quality Collaborative practices for ideal (range 27% to 50%) and nonideal cases (9% to 24%) (p <0.001). Reasons for not treating ideal candidates included lack of confirmation of malignancy (4, 2.8%), uncertainty regarding the benefits of intravesical chemotherapy (28, 19.6%) and logistic factors such as the unavailability of medication (34, 23.8%).CONCLUSIONS:Use of immediate intravesical chemotherapy by Urological Surgery Quality Collaborative practices is higher than reported elsewhere but still varies widely, even among ideal candidates. Efforts to optimize use will be aided by disseminating evidence supporting indications and benefits of intravesical chemotherapy, and by addressing local logistic factors that limit access to this evidence-based therapy.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 201261 UNDERSTANDING AND IMPROVING UTILIZATION OF IMMEDIATE INTRAVESICAL CHEMOTHERAPY FOR PATIENTS WITH BLADDER CANCER David Miller, Dan Murtagh, Rodney Dunn, Ronald Suh, Frank Burks, Timothy Bradford, Donald Moylan, Timothy Schuster, Peter Knapp, and James Montie David MillerDavid Miller Ann Arbor, MI More articles by this author , Dan MurtaghDan Murtagh Toledo, OH More articles by this author , Rodney DunnRodney Dunn Ann Arbor, MI More articles by this author , Ronald SuhRonald Suh Indianapolis, IN More articles by this author , Frank BurksFrank Burks Royal Oak, MI More articles by this author , Timothy BradfordTimothy Bradford Richmond, VA More articles by this author , Donald MoylanDonald Moylan Royal Oak, MI More articles by this author , Timothy SchusterTimothy Schuster Toledo, OH More articles by this author , Peter KnappPeter Knapp Indianapolis, IN More articles by this author , and James MontieJames Montie Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.106AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite its established efficacy in reducing recurrence rates for certain patients with urothelial carcinoma of the bladder, immediate intravesical chemotherapy (IVC) is reported to be used infrequently in current urologic practice. Accordingly, the Urological Surgery Quality Collaborative (USQC) implemented a project aimed at understanding and improving utilization of IVC following endoscopic treatment of patients with bladder tumors. METHODS The USQC comprises nearly 150 urologists from five practices. From Sept 2010 through Oct 2011, we prospectively collected clinical and baseline IVC utilization data for patients undergoing bladder biopsy or TURBT at 5 USQC sites. In the second phase of data collection (June-Oct 2011), treating surgeons also documented reasons for not administering IVC. Based on current clinical guidelines, we defined patients with 1-2 clinical stage Ta/T1, completely-resected, papillary tumor(s) as ideal candidates for treatment with immediate IVC. For this group of patients, we examined baseline utilization of IVC across USQC practices, as well as reasons for not administering guideline-recommended therapy. RESULTS Among 1,638 patients accrued during the study interval, 37.2% (n=609) met the ideal case criteria. Immediate IVC was administered in 36.5% of ideal patients. We observed significant variation in use of IVC across USQC practices for both ideal (range 26%-49%) and non-ideal cases (10%-23%) (p-values <0.05) (Figure). Among ideal cases not receiving IVC, reasons for not treating included, among others, lack of confirmation of malignancy (n=14, 13.6%), uncertainty regarding the benefits of IVC (n=28, 27.2%), and logistic factors such as unavailable medication or insufficient PACU resources (n=23, 22.3%). CONCLUSIONS Among practices in the USQC, utilization of immediate IVC is higher than reported elsewhere; however, its use still varies widely—even among potentially ideal candidates. Efforts to increase utilization among ideal patients will be aided by disseminating evidence supporting the indications and benefits of immediate IVC, and by addressing local logistic factors (e.g., availability of medication in different sites of care) that may limit access to this beneficial therapy. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e26 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Miller Ann Arbor, MI More articles by this author Dan Murtagh Toledo, OH More articles by this author Rodney Dunn Ann Arbor, MI More articles by this author Ronald Suh Indianapolis, IN More articles by this author Frank Burks Royal Oak, MI More articles by this author Timothy Bradford Richmond, VA More articles by this author Donald Moylan Royal Oak, MI More articles by this author Timothy Schuster Toledo, OH More articles by this author Peter Knapp Indianapolis, IN More articles by this author James Montie Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PURPOSE:We describe findings from a Urological Surgery Quality Collaborative project focused on improving the use of radiographic staging in men with newly diagnosed prostate cancer.MATERIALS AND METHODS:From May 2009 through September 2010 Urological Surgery Quality Collaborative surgeons collected uniform data for men with newly diagnosed prostate cancer. During this period we implemented 3 phases of data collection. Unlike the baseline phase, the second and third rounds were preceded by collaborative quality improvement interventions, including comparative performance feedback, and review and dissemination of clinical guidelines. We evaluated the use of bone scans and computerized tomography across prostate cancer risk strata, Urological Surgery Quality Collaborative practice locations, and before and after quality improvement interventions.RESULTS:We collected data for 858 men with prostate cancer. Based on the D'Amico classification 44%, 39% and 17% of the men had low, intermediate and high risk cancer, respectively. Overall 25% and 22% of patients underwent staging with a bone scan or computerized tomography, respectively, ordered by a Urological Surgery Quality Collaborative urologist. Urological Surgery Quality Collaborative practices differed significantly in their baseline use of bone scans and computerized tomography for men with low and intermediate risk cancer (p<0.01). Compared with baseline practice patterns (31% bone scans, 28% computerized tomography), urologists in Urological Surgery Quality Collaborative practices ordered fewer bone and computerized tomography scans in post-intervention phases 2 (23%, 21%) and 3 (16%, 13%) of data collection (p<0.01), including a significant reduction in the use of these studies in patients with low and intermediate risk cancer (p<0.05).CONCLUSIONS:Following collaborative feedback on baseline use and review of clinical guidelines, urologists in Urological Surgery Quality Collaborative practices dramatically reduced variations in practice patterns and improved adherence with recommended staging practices.

OBJECTIVES With the increased use of prostate-specific antigen screening, younger men are being diagnosed with prostate cancer. A subset of these men is still interested in potentially having children after cancer treatment. To our knowledge, the topic of future fertility in patients with newly diagnosed prostate cancer has not previously been reported.METHODS The charts of 8 patients with prostate cancer who were interested in future fertility before treatment were retrospectively reviewed. Preceding definitive treatment, the men underwent fertility counseling and were counseled to preserve semen before treatment.RESULTS All 8 patients decided to have their semen stored using cryopreservation before their operation. After undergoing radical prostatectomy, one of the patients and his wife underwent successful intrauterine insemination and bore a child.CONCLUSIONS A subset of men, regardless of age, diagnosed with prostate cancer will be interested in preserving their fertility for the future. Fertility options and potential counseling should be part of the routine pretreatment appointments in men undergoing treatment of prostate cancer. (c) 2007 Elsevier Inc.

OBJECTIVES:Urinary retention after urethral catheter removal is a well-established complication of radical prostatectomy (RP). Its effect on subsequent urethral stricture formation has not been established. The objective of this study was to evaluate the association between post-RP early urinary retention (EUR) and subsequent symptomatic urethral stricture formation.METHODS:A total of 1289 patients who underwent RP from January 1998 to November 2004 at our tertiary medical center were included in a prospective database project. EUR was defined as that which occurred 7 days or earlier after urethral catheter removal and was identified by retrospective chart review. Multivariate logistic regression models were constructed to evaluate the association between EUR and symptomatic urethral stricture formation.RESULTS:Of the 1289 patients, 44 (3.4%) experienced EUR, and 16 of these patients (36.4%) developed symptomatic urethral strictures. The stricture rate for patients without EUR was 9.0% (112 of 1245). Compared with the patients without EUR, the patients with EUR had a greater rate of bladder neck contracture (94% versus 68%, P = 0.04) and exhibited a significantly decreased time to stricture formation (1.6 months versus 3.0 months, P = 0.002). After adjusting for patient age, clinical stage, surgeon, and Gleason score, the odds of developing a symptomatic urethral stricture were 4.7 times greater in the patients with EUR (95% confidence interval 2.3 to 9.6).CONCLUSIONS:The results of this study have shown that patients with EUR after RP are at a significantly greater risk of developing symptomatic urethral strictures, tend to form bladder neck contractures instead of more distal strictures, and to form strictures sooner after surgery. EUR might be a previously unrecognized risk factor for the development of post-RP urethral stricture.

You have accessJournal of UrologyDiscussed Poster, Monday, May 22, 2006, 9:00 am - 12:00 pm1 Apr 2006675: Early Urinary Retention After Catheter Removal Following Radical Prostatectomy is Associated with Future Urethral Stricture Formation Jeffrey S. Montgomery, Bishoy A. Gayed, Stephanie Daignault, David P. Wood, James E. Montie, John T. Wei, and Timothy G. Schuster Jeffrey S. MontgomeryJeffrey S. Montgomery More articles by this author , Bishoy A. GayedBishoy A. Gayed More articles by this author , Stephanie DaignaultStephanie Daignault More articles by this author , David P. WoodDavid P. Wood More articles by this author , James E. MontieJames E. Montie More articles by this author , John T. WeiJohn T. Wei More articles by this author , and Timothy G. SchusterTimothy G. Schuster More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)32921-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "675: Early Urinary Retention After Catheter Removal Following Radical Prostatectomy is Associated with Future Urethral Stricture Formation." The Journal of Urology, 175(4S), p. 218 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 218 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Jeffrey S. Montgomery More articles by this author Bishoy A. Gayed More articles by this author Stephanie Daignault More articles by this author David P. Wood More articles by this author James E. Montie More articles by this author John T. Wei More articles by this author Timothy G. Schuster More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 23, 2006, 1:00 - 4:00 pm1 Apr 20061305: Epidemiology of Surgically Treated Erectile Dysfunction in the United States from 1988 to 2002 David A. Taub, Brent K. Hollenbeck, John T. Wei, Dana A. Ohl, and Timothy G. Schuster David A. TaubDavid A. Taub More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck More articles by this author , John T. WeiJohn T. Wei More articles by this author , Dana A. OhlDana A. Ohl More articles by this author , and Timothy G. SchusterTimothy G. Schuster More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33518-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1305: Epidemiology of Surgically Treated Erectile Dysfunction in the United States from 1988 to 2002." The Journal of Urology, 175(4S), p. 420 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 420 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information David A. Taub More articles by this author Brent K. Hollenbeck More articles by this author John T. Wei More articles by this author Dana A. Ohl More articles by this author Timothy G. Schuster More articles by this author Expand All Advertisement PDF downloadLoading ...

Premature ejaculation is a common entity that can have a significant impact on an individual's sexual satisfaction and quality of life. Both behavioral and pharmacological options are available and effective for men presenting with this condition.

Premature ejaculation is a common entity that can have a significant impact on an individual's sexual satisfaction and quality of life. Both behavioral and pharmacological options are available and effective for men presenting with this condition.

Test vials were cryopreserved with semen samples to determine expectations of sperm cryosurvival. Using the lowest volume possible in test vials that accurately represents post-thaw survival of remaining cryopreserved samples provides the greatest volume for future therapeutic use. Studies were conducted to determine the lowest optimal volume of semen to cryopreserve in test vials by evaluating the post-thaw sperm motility and forward progression of semen samples frozen in various aliquots. Additionally, an assessment was made to determine if the liquid nitrogen vapor step in traditional slow-rate sperm freezing can be eliminated when storing samples in a nitrogen vapor freezer. Institutional Review Board approved laboratory study. Ten human semen samples were diluted 1:1 over ten minutes with three aliquots of freezing medium containing TEST Yolk Buffer (TYB) with 12% v/v glycerol (Irvine Scientific, Santa Ana, CA, USA). Samples were then placed into cryovials in duplicate aliquots of 50, 100, 200, 300, 400 and 1000 μl and equilibrated in an ice bath at 4° C for 45 min. One vial of each aliquot volume were placed into liquid nitrogen vapor for 20 min and then into the liquid nitrogen vapor freezer (Method 1). The remaining vials were placed directly into the liquid nitrogen vapor freezer (Method 2). After one week storage specimens were thawed at room temperature. Post-thaw sperm motility and forward progression were determined in duplicate in a blinded fashion. Results were statistically analyzed by ANOVA or Students t-test with independent variables being volume of frozen aliquots and freezing methods used. Post-thaw sperm motility for 50 μl aliquots using Method 1 (27 ± 3; mean ± S.E.) and Method 2 (23 ± 2) were significantly lower than larger aliquots for Method 1 (36 ± 1) and Method 2 (35 ± 1; P<0.005). There was no significant difference in post-thaw sperm motility when comparing 100, 200, 300, 400 and 1000 μl aliquot volumes for Method 1 or 2 (P>0.05). No difference was observed in post-thaw sperm forward progression for Method 1 when comparing various volumes tested. Using Method 2, a significant difference in post-thaw sperm forward progression was noted for 50 μl aliquots (64 ± 2) compared to 300 μl (70 ± 2), 400 μl (72 ± 1), and 1000 μl (72 ± 1; P<0.05). No other significant differences were observed when remaining aliquot volumes were compared. There was no significant difference in post-thaw sperm motility and forward progression when comparing similar volumes of semen using either Method 1 or 2 (P>0.05). When slow-rate freezing semen, test vials should be in a minimum of 100 μl aliquots. Although similar sperm recovery rates can be obtained using larger volumes, the smaller volume allows for more semen allocated to therapeutic use, which may be beneficial to patients providing a limited number of samples. Additionally, after diluting semen samples with freezing medium and cooling to 4° C, samples can be placed directly into the liquid nitrogen vapor freezer without compromising sperm recovery rates.

ObjectiveTesticular-derived spermatozoa motility, reflecting viability, is key to intracytoplasmic sperm injection success. Experiments were conducted to compare number of motile sperm isolated from testicular aspirations incubated in different media over time.DesignProspective side-by-side comparative laboratory study.Materials and methodsDiagnostic and/or therapeutic fine needle testicular aspirations were performed on 14 men with non-obstructive azoospermia. Seminiferous tubules were manually dissected and seminiferous epithelial content dispersed into a single cell suspension. Number of non-motile and motile sperm/20 high-powered fields was assessed initially at the time of cell dispersion and following incubation at 37°C for 24 and 48 hours in either HEPES buffered human tubal fluid + protein (H-HTF) in atmospheric conditions or Ham's F10 + protein (F10) in 5% CO2 and air. Statistical analyses were performed with paired Student's t-test and ANOVA with repeat measures.ResultsInitially following seminiferous tubule micro-dissection, total sperm found was 93 ± 22 (mean ± SE) and mean number of motile sperm/20 high-powered fields was 3 ± 2. In H-HTF sperm motility increased in 8 of 14 samples after 24 hours of culture (18 ± 9) and 11 of 14 samples after 48 hours of culture (19 ± 9), although these increases were not significant. Mean number of motile sperm/20 high-powered fields significantly increased in all 14 samples following incubation in F10 for 24 hours (30 ± 11, paired t-test, P=0.03) and 48 hours of culture (33 ± 13, P=0.04). Testicular sperm motility increased significantly after incubation in F10 compared to HTF at both 24 and 48 hours of culture (repeated measures ANOVA, P=0.05).ConclusionIncubation of spermatozoa from fine needle testicular aspirations facilitates motile spermatozoa isolation. More motile spermatozoa were isolated after incubation in F10 than in H-HTF. There was no significant increase in motile sperm isolated between 24 and 48 hours. Following seminiferous tubule micro-dissection, culture of testicular spermatozoa for 24 hours in Ham's F10 is an efficient means of collecting motile spermatozoa for ICSI. ObjectiveTesticular-derived spermatozoa motility, reflecting viability, is key to intracytoplasmic sperm injection success. Experiments were conducted to compare number of motile sperm isolated from testicular aspirations incubated in different media over time. Testicular-derived spermatozoa motility, reflecting viability, is key to intracytoplasmic sperm injection success. Experiments were conducted to compare number of motile sperm isolated from testicular aspirations incubated in different media over time. DesignProspective side-by-side comparative laboratory study. Prospective side-by-side comparative laboratory study. Materials and methodsDiagnostic and/or therapeutic fine needle testicular aspirations were performed on 14 men with non-obstructive azoospermia. Seminiferous tubules were manually dissected and seminiferous epithelial content dispersed into a single cell suspension. Number of non-motile and motile sperm/20 high-powered fields was assessed initially at the time of cell dispersion and following incubation at 37°C for 24 and 48 hours in either HEPES buffered human tubal fluid + protein (H-HTF) in atmospheric conditions or Ham's F10 + protein (F10) in 5% CO2 and air. Statistical analyses were performed with paired Student's t-test and ANOVA with repeat measures. Diagnostic and/or therapeutic fine needle testicular aspirations were performed on 14 men with non-obstructive azoospermia. Seminiferous tubules were manually dissected and seminiferous epithelial content dispersed into a single cell suspension. Number of non-motile and motile sperm/20 high-powered fields was assessed initially at the time of cell dispersion and following incubation at 37°C for 24 and 48 hours in either HEPES buffered human tubal fluid + protein (H-HTF) in atmospheric conditions or Ham's F10 + protein (F10) in 5% CO2 and air. Statistical analyses were performed with paired Student's t-test and ANOVA with repeat measures. ResultsInitially following seminiferous tubule micro-dissection, total sperm found was 93 ± 22 (mean ± SE) and mean number of motile sperm/20 high-powered fields was 3 ± 2. In H-HTF sperm motility increased in 8 of 14 samples after 24 hours of culture (18 ± 9) and 11 of 14 samples after 48 hours of culture (19 ± 9), although these increases were not significant. Mean number of motile sperm/20 high-powered fields significantly increased in all 14 samples following incubation in F10 for 24 hours (30 ± 11, paired t-test, P=0.03) and 48 hours of culture (33 ± 13, P=0.04). Testicular sperm motility increased significantly after incubation in F10 compared to HTF at both 24 and 48 hours of culture (repeated measures ANOVA, P=0.05). Initially following seminiferous tubule micro-dissection, total sperm found was 93 ± 22 (mean ± SE) and mean number of motile sperm/20 high-powered fields was 3 ± 2. In H-HTF sperm motility increased in 8 of 14 samples after 24 hours of culture (18 ± 9) and 11 of 14 samples after 48 hours of culture (19 ± 9), although these increases were not significant. Mean number of motile sperm/20 high-powered fields significantly increased in all 14 samples following incubation in F10 for 24 hours (30 ± 11, paired t-test, P=0.03) and 48 hours of culture (33 ± 13, P=0.04). Testicular sperm motility increased significantly after incubation in F10 compared to HTF at both 24 and 48 hours of culture (repeated measures ANOVA, P=0.05). ConclusionIncubation of spermatozoa from fine needle testicular aspirations facilitates motile spermatozoa isolation. More motile spermatozoa were isolated after incubation in F10 than in H-HTF. There was no significant increase in motile sperm isolated between 24 and 48 hours. Following seminiferous tubule micro-dissection, culture of testicular spermatozoa for 24 hours in Ham's F10 is an efficient means of collecting motile spermatozoa for ICSI. Incubation of spermatozoa from fine needle testicular aspirations facilitates motile spermatozoa isolation. More motile spermatozoa were isolated after incubation in F10 than in H-HTF. There was no significant increase in motile sperm isolated between 24 and 48 hours. Following seminiferous tubule micro-dissection, culture of testicular spermatozoa for 24 hours in Ham's F10 is an efficient means of collecting motile spermatozoa for ICSI.