Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction.This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection(ROSI),a techn...Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction.This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection(ROSI),a technique which utilizes immature precursors of spermatozoa for fertilization.An electronic search was performed to identify relevant articles published through October 2018.Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included.Fertilization rate,pregnancy rate,and resultant delivery rate were assessed following ROSI.Meta-analysis outcomes were analyzed using a random-effects model.Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers.The fertilization rate after ROSI was 38.7%(95%confidence interval[CI]:31.5%–46.3%),while the pregnancy rate was 3.7%(95%CI:3.2%–4.4%).The resultant delivery rate was low,with 4.3%of embryo transfers resulting in a delivery(95%CI:2.3%–7.7%).The pregnancy rate per couple was 13.4%(95%CI:6.8%–19.1%)and the resultant delivery rate per couple was 8.1%(95%CI:6.1%–14.4%).ROSI has resulted in clinical pregnancies and live births,but success rates are considerably lower than those achieved with mature spermatozoa.While this technique may be a feasible alternative for men with azoospermia who decline other options,couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.展开更多
Recent data suggest that cystic fibrosis transmembrane conductance regulator(CFTR)gene alterations negatively impact male fertility beyond obstruction.We sought to compare gene alterations,sperm retrieval rates,and in...Recent data suggest that cystic fibrosis transmembrane conductance regulator(CFTR)gene alterations negatively impact male fertility beyond obstruction.We sought to compare gene alterations,sperm retrieval rates,and intracytoplasmic sperm injection(ICSI)outcomes among men with cystic fibrosis(CF)disease and congenital bilateral absence of the vas deferens(CBAVD)only.We retrospectively evaluated all men who underwent surgical sperm retrieval at two academic,high-volume andrology centers from 2010 to 2018.Only men with documented CFTR alterations and obstructive azoospermia from either CBAVD or CF were included.Differences between groups for CFTR abnormality,sperm retrieval,and ICSI outcomes were statistically analyzed.Overall,39 patients were included with 10 in the CF and 29 in the CBAVD groups.Surgical sperm retrieval rates were significantly lower in the CF group for sperm concentration(14.8×10^(6)ml^(-1)vs 61.4×10^(6)ml^(−1),P=0.02)and total motile sperm count(2.9 million vs 11.4 million,P=0.01).This difference was only predicted by homozygous delta F508 CFTR mutations(P<0.05).The CF group also demonstrated a significantly higher rate of rescue testicular sperm extraction(70.0%vs 27.6%,P<0.03)and lower fertilization rate with ICSI(32.5%vs 68.9%,P<0.01).In conclusion,those with CF demonstrated lower sperm quality,greater difficulty with sperm retrieval,and worse ICSI outcomes compared with CBAVD-only patients.Homozygous delta F508 CFTR mutations appear to significantly impair spermatogenesis and sperm function.展开更多
Adoption of the prostatic urethral lift(PUL)as a treatment for benign prostatic hyperplasia highlights the importance of training residents with novel technology without compromising patient care.This study examines t...Adoption of the prostatic urethral lift(PUL)as a treatment for benign prostatic hyperplasia highlights the importance of training residents with novel technology without compromising patient care.This study examines the effect of resident involvement during PUL on patient and procedural outcomes.Retrospective chart review was conducted on all consecutive PUL cases performed by a single academic urologist between October 2017 and November 2019.Trainees in post-graduate year(PGY)1–3 are considered junior residents,while those in PGY 4–6 are senior residents.The International Prostate Symptom Score(IPSS)and quality of life(QOL)scores were used to measure outcomes.Simple and mixed-effects linear regression models were used to compare differences.There were 110 patients with a median age of 66.4 years.Residents were involved in 73 cases(66.4%),and senior residents were involved in 31 of those cases.Resident involvement was not associated with adverse perioperative outcomes with respect to the number of implants fired,the percentage of implants successfully placed,or the postoperative catheterization rate.After adjustment for confounding factors,junior residents were associated with significantly longer case length compared to the attending alone(+12.6 min,P=0.003)but senior residents were not(+2.4 min,P=0.59).IPSS and QOL scores were not significantly affected by resident involvement(P=0.12 and P=0.21,respectively).The presence of surgeons-in-training,particularly those in the early stages,prolongs PUL case length but does not appear to have an adverse impact on patient outcomes.展开更多
文摘Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction.This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection(ROSI),a technique which utilizes immature precursors of spermatozoa for fertilization.An electronic search was performed to identify relevant articles published through October 2018.Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included.Fertilization rate,pregnancy rate,and resultant delivery rate were assessed following ROSI.Meta-analysis outcomes were analyzed using a random-effects model.Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers.The fertilization rate after ROSI was 38.7%(95%confidence interval[CI]:31.5%–46.3%),while the pregnancy rate was 3.7%(95%CI:3.2%–4.4%).The resultant delivery rate was low,with 4.3%of embryo transfers resulting in a delivery(95%CI:2.3%–7.7%).The pregnancy rate per couple was 13.4%(95%CI:6.8%–19.1%)and the resultant delivery rate per couple was 8.1%(95%CI:6.1%–14.4%).ROSI has resulted in clinical pregnancies and live births,but success rates are considerably lower than those achieved with mature spermatozoa.While this technique may be a feasible alternative for men with azoospermia who decline other options,couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.
文摘Recent data suggest that cystic fibrosis transmembrane conductance regulator(CFTR)gene alterations negatively impact male fertility beyond obstruction.We sought to compare gene alterations,sperm retrieval rates,and intracytoplasmic sperm injection(ICSI)outcomes among men with cystic fibrosis(CF)disease and congenital bilateral absence of the vas deferens(CBAVD)only.We retrospectively evaluated all men who underwent surgical sperm retrieval at two academic,high-volume andrology centers from 2010 to 2018.Only men with documented CFTR alterations and obstructive azoospermia from either CBAVD or CF were included.Differences between groups for CFTR abnormality,sperm retrieval,and ICSI outcomes were statistically analyzed.Overall,39 patients were included with 10 in the CF and 29 in the CBAVD groups.Surgical sperm retrieval rates were significantly lower in the CF group for sperm concentration(14.8×10^(6)ml^(-1)vs 61.4×10^(6)ml^(−1),P=0.02)and total motile sperm count(2.9 million vs 11.4 million,P=0.01).This difference was only predicted by homozygous delta F508 CFTR mutations(P<0.05).The CF group also demonstrated a significantly higher rate of rescue testicular sperm extraction(70.0%vs 27.6%,P<0.03)and lower fertilization rate with ICSI(32.5%vs 68.9%,P<0.01).In conclusion,those with CF demonstrated lower sperm quality,greater difficulty with sperm retrieval,and worse ICSI outcomes compared with CBAVD-only patients.Homozygous delta F508 CFTR mutations appear to significantly impair spermatogenesis and sperm function.
文摘Adoption of the prostatic urethral lift(PUL)as a treatment for benign prostatic hyperplasia highlights the importance of training residents with novel technology without compromising patient care.This study examines the effect of resident involvement during PUL on patient and procedural outcomes.Retrospective chart review was conducted on all consecutive PUL cases performed by a single academic urologist between October 2017 and November 2019.Trainees in post-graduate year(PGY)1–3 are considered junior residents,while those in PGY 4–6 are senior residents.The International Prostate Symptom Score(IPSS)and quality of life(QOL)scores were used to measure outcomes.Simple and mixed-effects linear regression models were used to compare differences.There were 110 patients with a median age of 66.4 years.Residents were involved in 73 cases(66.4%),and senior residents were involved in 31 of those cases.Resident involvement was not associated with adverse perioperative outcomes with respect to the number of implants fired,the percentage of implants successfully placed,or the postoperative catheterization rate.After adjustment for confounding factors,junior residents were associated with significantly longer case length compared to the attending alone(+12.6 min,P=0.003)but senior residents were not(+2.4 min,P=0.59).IPSS and QOL scores were not significantly affected by resident involvement(P=0.12 and P=0.21,respectively).The presence of surgeons-in-training,particularly those in the early stages,prolongs PUL case length but does not appear to have an adverse impact on patient outcomes.
