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2290 A TEN YEAR REVIEW OF VASECTOMY PATHOLOGY: STRENGTHENING THE CASE AGAINST ROUTINE HISTOLOGICAL EVALUATION
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THE JOURNAL OF UROLOGY姞
Vol. 187, No. 4S, Supplement, Wednesday, May 23, 2012
is affected by relationship and paternity status, as men who are in a relationship or fathers are more likely to agree to use of their sperm after their death.
Source of Funding: None
2290 A TEN YEAR REVIEW OF VASECTOMY PATHOLOGY: STRENGTHENING THE CASE AGAINST ROUTINE HISTOLOGICAL EVALUATION. Gregory Roberts*, Chris Davidson, Kingston, Canada
Source of Funding: The Miami Project to Cure Paralysis and the State of Florida Department of Health
2289 POSTHUMOUS SPERM UTILIZATION IN MEN PRESENTING FOR SPERM BANKING: AN ANALYSIS OF PATIENT CHOICE Alexander W. Pastuszak*, Win Shun Lai, Tung-Chin Hsieh, Larry I. Lipshultz, Houston, TX INTRODUCTION AND OBJECTIVES: Postmortem use or retrieval of a man’s sperm is controversial, a situation exacerbated by a lack of uniform guidelines. Pre-existing affirmative consent for postmortem retrieval or utilization of banked sperm is the clearest permission for posthumous sperm use, but is infrequently considered by or obtained from men for whom postmortem sperm harvesting is requested. Thus, the rate of affirmative consent for postmortem sperm retrieval or use is unclear. Men who bank sperm, however, present a cohort that can be queried for frequency of consent for postmortem sperm use. METHODS: A retrospective review of medical records and consents for 361 patients presenting for sperm banking from 20092011 was performed. Banked specimens were either ejaculated or surgically obtained sperm. Demographic information was obtained for each patient, and men were grouped by reason for sperm banking, relationship status, prior children, and whether consent for postmortem use of sperm was given. The frequency of postmortem consent was determined within each group. RESULTS: Men were grouped based on reason for banking, which included fertility problems (“Infertility”) and malignancy prior to treatment (“Cancer”). Mean⫾SD age of the infertility and cancer groups was 40.1⫾9.9 years and 27.1⫾9.6 years, respectively. Of the 361 men, 85.9% provided affirmative consent for postmortem sperm use (Table 1). In the infertility group 87.4% of men consented. Of these, 92.9% men in a relationship and 62.5% single men provided affirmative consent. Regarding paternity status, 64.7% men with children and 56.6% men without children consented to posthumous sperm use. Within the cancer cohort, 83.8% men consented. Of men ⬍18 years old, 65.2% consented and 85.8% men ⱖ18 years old consented. Relationship status yielded 93.2% men in relationships and 79.4% single men consenting. Paternity status in the cancer group yielded 95.8% with and 82.4% of men without children consenting to postmortem sperm use. CONCLUSIONS: The majority of men presenting for sperm banking gave an affirmative consent to postmortem use of their sperm, irrespective of their reason for banking. Postmortem utilization consent
INTRODUCTION AND OBJECTIVES: An AUA policy statement concludes that routine histologic confirmation is unnecessary in performing vasectomy because the finding of azoospermia after a bilateral vasectomy is the standard for success. Despite this clear direction, many centers continue to send all routine vasectomy specimens for pathological evaluation. Perhaps the continuing practice stems from hospital policy, tradition, or possibly clinician uneasiness with what histology might reveal. Until now, no complete review of a large cohort of vasectomy histology with correlation of abnormal results to semen analysis has been reported. This study evaluates a 10-year cohort of routine histological evaluation of vasectomy specimens to determine A) If ominous diagnoses are found in specimens B) The percentage of abnormal vasectomy specimens, and C) To ascertain if abnormal histology correlates with abnormal post operative semen analysis. METHODS: A retrospective review of an electronic pathology database from 1999 to 2009 was completed. All data came from a single pathology lab, and all vasectomy procedures over the ten years uniformly sent specimens for evaluation. Only bilateral vasectomy for the purpose of male sterility were considered. RESULTS: A total of 3883 procedures were completed with 7766 individual specimens submitted. Average patient age was 37. Only 17 cases or 0.44% were reported as absence of vas deferens in specimen. This translates into less than 5 per 1000 cases. 82% of abnormal specimens were determined to be vascular or nerve tissue, with the remainder being adipose or fibrous tissue. Of the 17 abnormal cases, 12 (71%) completed post-operative semen analysis and 2 patients directly repeated the procedure with success. Even with clear pathological confirmation of “failed vasectomy”, 42% of semen analyses showed absence of spermatozoa in the hanging drop. No malignancy, hyperplasia or suspicious histology were reported in all specimens. One case was reported as osseous metaplasia, a benign calcification. CONCLUSIONS: The likelihood of dangerous pathology in vasectomy is essentially nil. Considering the cost of histological examination, the rarity of excising structures other than the vas deferens and the relatively high probability that even if the histology is abnormal the semen analysis will be sterile, physicians should consider only sending difficult cases to pathology. Ultimately, post-op semen analysis will determine success or failure of vasectomy, not histology. Source of Funding: None
2291 THE RELATIONSHIP BETWEEN ANDROGEN RECEPTOR CAG REPEAT LENGTH AND ANOGENITAL DISTANCE Tung-Chin Hsieh*, Houston, TX; Michael L Eisenberg, Stanford, CA; Alexander W Pastuszak, Matthew G McIntyre, Houston, TX; Rustin C Walters, Portsmouth, VA; Dolores J Lamb, Larry I Lipshultz, Houston, TX INTRODUCTION AND OBJECTIVES: Anogenital distance (AGD) is a validated metric of genital development, with shorter length
THE JOURNAL OF UROLOGY姞
Vol. 187, No. 4S, Supplement, Wednesday, May 23, 2012
is affected by relationship and paternity status, as men who are in a relationship or fathers are more likely to agree to use of their sperm after their death.
Source of Funding: None
2290 A TEN YEAR REVIEW OF VASECTOMY PATHOLOGY: STRENGTHENING THE CASE AGAINST ROUTINE HISTOLOGICAL EVALUATION. Gregory Roberts*, Chris Davidson, Kingston, Canada
Source of Funding: The Miami Project to Cure Paralysis and the State of Florida Department of Health
2289 POSTHUMOUS SPERM UTILIZATION IN MEN PRESENTING FOR SPERM BANKING: AN ANALYSIS OF PATIENT CHOICE Alexander W. Pastuszak*, Win Shun Lai, Tung-Chin Hsieh, Larry I. Lipshultz, Houston, TX INTRODUCTION AND OBJECTIVES: Postmortem use or retrieval of a man’s sperm is controversial, a situation exacerbated by a lack of uniform guidelines. Pre-existing affirmative consent for postmortem retrieval or utilization of banked sperm is the clearest permission for posthumous sperm use, but is infrequently considered by or obtained from men for whom postmortem sperm harvesting is requested. Thus, the rate of affirmative consent for postmortem sperm retrieval or use is unclear. Men who bank sperm, however, present a cohort that can be queried for frequency of consent for postmortem sperm use. METHODS: A retrospective review of medical records and consents for 361 patients presenting for sperm banking from 20092011 was performed. Banked specimens were either ejaculated or surgically obtained sperm. Demographic information was obtained for each patient, and men were grouped by reason for sperm banking, relationship status, prior children, and whether consent for postmortem use of sperm was given. The frequency of postmortem consent was determined within each group. RESULTS: Men were grouped based on reason for banking, which included fertility problems (“Infertility”) and malignancy prior to treatment (“Cancer”). Mean⫾SD age of the infertility and cancer groups was 40.1⫾9.9 years and 27.1⫾9.6 years, respectively. Of the 361 men, 85.9% provided affirmative consent for postmortem sperm use (Table 1). In the infertility group 87.4% of men consented. Of these, 92.9% men in a relationship and 62.5% single men provided affirmative consent. Regarding paternity status, 64.7% men with children and 56.6% men without children consented to posthumous sperm use. Within the cancer cohort, 83.8% men consented. Of men ⬍18 years old, 65.2% consented and 85.8% men ⱖ18 years old consented. Relationship status yielded 93.2% men in relationships and 79.4% single men consenting. Paternity status in the cancer group yielded 95.8% with and 82.4% of men without children consenting to postmortem sperm use. CONCLUSIONS: The majority of men presenting for sperm banking gave an affirmative consent to postmortem use of their sperm, irrespective of their reason for banking. Postmortem utilization consent
INTRODUCTION AND OBJECTIVES: An AUA policy statement concludes that routine histologic confirmation is unnecessary in performing vasectomy because the finding of azoospermia after a bilateral vasectomy is the standard for success. Despite this clear direction, many centers continue to send all routine vasectomy specimens for pathological evaluation. Perhaps the continuing practice stems from hospital policy, tradition, or possibly clinician uneasiness with what histology might reveal. Until now, no complete review of a large cohort of vasectomy histology with correlation of abnormal results to semen analysis has been reported. This study evaluates a 10-year cohort of routine histological evaluation of vasectomy specimens to determine A) If ominous diagnoses are found in specimens B) The percentage of abnormal vasectomy specimens, and C) To ascertain if abnormal histology correlates with abnormal post operative semen analysis. METHODS: A retrospective review of an electronic pathology database from 1999 to 2009 was completed. All data came from a single pathology lab, and all vasectomy procedures over the ten years uniformly sent specimens for evaluation. Only bilateral vasectomy for the purpose of male sterility were considered. RESULTS: A total of 3883 procedures were completed with 7766 individual specimens submitted. Average patient age was 37. Only 17 cases or 0.44% were reported as absence of vas deferens in specimen. This translates into less than 5 per 1000 cases. 82% of abnormal specimens were determined to be vascular or nerve tissue, with the remainder being adipose or fibrous tissue. Of the 17 abnormal cases, 12 (71%) completed post-operative semen analysis and 2 patients directly repeated the procedure with success. Even with clear pathological confirmation of “failed vasectomy”, 42% of semen analyses showed absence of spermatozoa in the hanging drop. No malignancy, hyperplasia or suspicious histology were reported in all specimens. One case was reported as osseous metaplasia, a benign calcification. CONCLUSIONS: The likelihood of dangerous pathology in vasectomy is essentially nil. Considering the cost of histological examination, the rarity of excising structures other than the vas deferens and the relatively high probability that even if the histology is abnormal the semen analysis will be sterile, physicians should consider only sending difficult cases to pathology. Ultimately, post-op semen analysis will determine success or failure of vasectomy, not histology. Source of Funding: None
2291 THE RELATIONSHIP BETWEEN ANDROGEN RECEPTOR CAG REPEAT LENGTH AND ANOGENITAL DISTANCE Tung-Chin Hsieh*, Houston, TX; Michael L Eisenberg, Stanford, CA; Alexander W Pastuszak, Matthew G McIntyre, Houston, TX; Rustin C Walters, Portsmouth, VA; Dolores J Lamb, Larry I Lipshultz, Houston, TX INTRODUCTION AND OBJECTIVES: Anogenital distance (AGD) is a validated metric of genital development, with shorter length