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Prospective randomized control trial of a neuroprotective wrap for the spermatic cord after denervation for chronic orchialgia
RAVE at 120 min (60-180) was significantly faster than MVE at 161 min (120-240), P¼0.001. Mean post-op total motile sperm counts were not significantly higher in RAVV/RAVE versus MVV/MVE, but the rate of post-op sperm count recovery was significantly greater in RAVV/RAVE. Improved efficiency and eliminated need for a skilled assistant has reduced the cost of RAVV/RAVE to less than the regional average cost of MVV/ MVE. CONCLUSION: The use of robotic assistance in vasectomy reversal appears to decrease operative duration and improve the rate of recovery of post-op total motile sperm counts. Further evaluation is needed.
RESULTS: Patency data and pregnancy and/or one year of follow-up data were available on 122 men. Overall patency and pregnancy rates were 93% and 45% respectively, with 99% off VV patent and 81% of either VV/EV or EV patent. There was no difference in patency or pregnancy based on BMI, regardless of type of procedure. Findings are summarized below. Vasectomy Reversal Outcome Based on BMI
BMI
P-421 Wednesday, October 19, 2011 PROSPECTIVE RANDOMIZED CONTROL TRIAL OF A NEUROPROTECTIVE WRAP FOR THE SPERMATIC CORD AFTER DENERVATION FOR CHRONIC ORCHIALGIA. S. J. Parekattil, A. Gudeoglu, J. Brahmbhatt, K. B. Priola, M. S. Cohen. Urology, Winter Haven Hospital & University of Florida, Winter Haven, FL. OBJECTIVE: Return or persistence of pain after microsurgical denervation of the spermatic cord for chronic orchialgia is quite disappointing for patients. One cause for this phenomenon could be neuroma formation or irritation of the ligated ends of the nerve fibers in the spermatic cord. Neuroprotective wraps have been safely and successfully utilized in peripheral nerve repair procedures to minimize such neuroma or scar formation. This study evaluates the impact of a neuroprotective wrap placed around the spermatic cord after the denervation procedure. DESIGN: Prospective randomized control trial. MATERIALS AND METHODS: 6 patients with similar bilateral chronic orchialgia who where scheduled for bilateral robotic assisted microsurgical denervation of the spermatic cord by a single surgeon where selected. A neuroprotective wrap (bio-inert matrix derived from porcine gut: Axoguard, Axogen Inc., Gainesville, FL) was randomly placed on one side of each patient around the spermatic cord after completion of the denervation procedure. The contra-lateral side (with no wrap) for each patient was the control. Pain was assessed preoperatively and post-operatively at 1, 3, 6 and 12 months using an externally validated pain impact questionnaire (PIQ-6, QualityMetric Inc, Lincoln, RI). RESULTS: The median pain scores were less on both sides after surgery compared to pre-op (median pre-op score ¼ 77). Median PIQ-6 scores on the wrap side were: 52, 40, 50 and 59 at 1, 3, 6 and 12 months post-op respectively. The median scores on the non-wrap side were: 59, 56, 60 and 68 respectively. The median pain scores on the side with the wrap were significantly less than the non-wrap side. CONCLUSION: This study despite its small sample size, seems to indicate a possible benefit to using a neuroprotective wrap around the spermatic cord after denervation procedures for chronic orchialgia. Further evaluation is needed.
N
OBJECTIVE: Our objective was to determine whether the Body Mass Index (BMI) of a man affects the success of microsurgical vasectomy reversal with regards to patency and pregnancy. DESIGN: Retrospective chart review of men undergoing vasectomy reversal at a large academic institution. MATERIALS AND METHODS: A retrospective chart review was performed on a total of 211 men having undergone vasectomy reversal at our institution between August 2003 and August 2010. Patients underwent vasovasostomy (VV), vasoepididymostomy (EV) or a combination of both (VV/EV) as required, based on intraoperative findings. Patients were excluded if BMI at the time of surgery was unavailable or if patency data were unavailable. All patients in this study were followed until spontaneous pregnancy was obtained through intercourse or intrauterine inseminations.
FERTILITY & STERILITYÒ
Overall Pregnancy (%)
EV R 1 side
Pregnancy with VV only (%)
18.5-24.9 26 26/26 (100) 8/16 (50) 6/26 (23) 6/13 (46) 25.0-29.9 56 53/56 (95) 14/36 (39) 17/56 (30) 11/23 (48) 30.0-34.9 32 30/32 (94) 9/18 (50) 9/32 (28) 6/13 (46) 35.0-39.9 5 3/5 (60) 1/2 (50) 3/5 (60) 1/1 (100) >40 3 2/3 (67) 2/3 (67) 2/3 (67) 1/1 (100) Total 122 114/122 (93) 34/75 (45) 37/122 (30) 25/51 (49)
Pregnancy with EV R 1 side 2/3 (67) 3/13 (23) 3/5 (60) 0/1 (0) 1/2 (50) 9/24 (38)
CONCLUSION: BMI does not appear to be a predictive factor on success of vasectomy reversal in regards to patency, pregnancy, or the need for vasoepididymostomy.
P-423 Wednesday, October 19, 2011 REDUCTION OF INCREASED SPERM DNA FRAGMENTATION INDEX USING LOW-DOSE CLOMIPHENE CITRATE TREATMENT AMONG INFERTILE MALES. H. Asakura, Y. Nakahara, K. Hatake, T. Furukawa, M. Tanioka. Ohgimachi Ladies’ Clinic, Aisei Medical Corporation, Osaka, Japan. OBJECTIVE: Increased sperm DNA fragmentation is associated with reduced reproductive outcome. Varicocelectomy and anti-oxidant treatments were reported to decrease sperm DNA fragmentation index (DFI). Clomiphene citrate (CC) has been used to improved sperm quality, but its effect on sperm DFI is unknown. Effect of CC on sperm DFI was longitudinally evaluated. DESIGN: Retrospective analysis of clinical data at a single institution. MATERIALS AND METHODS: 32 male partners (mean age 38.0, 95%CI 35.5 to 40.5) with abnormal semen parameters or increased DFI received CC 25mg daily for 3 months. Pre and post treatment semen quality including sperm DFI were evaluated (HalospermÒ). The study protocol was approved by the institutional IRB. The parameters were logarithmically transformed if normality of distribution was not accepted. MedCalcÒ was used for statistical analysis. RESULTS: By treatment with CC, average sperm concentration increased from 25.3 to 34.4 million/ml (P<0.05). Average sperm DFI was decreased from 37.9 to 31.1% (P<0.05) with average 6.8% reduction. 20 of 32 males had decrement of sperm DFI. Changes in sperm motility (36.7 to 38.4%) and strict morphology (4.5 to 4.5%) were not significant.
P-422 Wednesday, October 19, 2011 EFFECT OF BODY MASS INDEX ON PATENCY AND PREGNANCY RATES AFTER MICROSURGICAL VASECTOMY REVERSAL. J. Sandlow, J. Bodie. Dept. of Urology, Medical College of Wisconsin, Milwaukee, WI; Dept. of Urology, University of Minnesota, Minneapolis, MN.
Overall patency (%)
Changes in semen parameters by CC treatment
Parameters Volume (ml) Concentration (million/ml) Motility (%) Strict morphology (%) DFI (%)
Significance of change
Pre-treatment
Post-treatment
3.0 25.3
3.1 34.4
P¼0.38 P¼0.03
36.7 4.5 37.9
38.4 4.5 31.1
P¼0.59 P¼0.95 P¼0.01
Paired T-test (N ¼ 32) CONCLUSION: Sperm DNA fragmentation of infertile male partners was significantly reduced with short course of low dose clomiphene citrate treatment. It is speculated that increased in gonadotropins and androgens by CC led to decrease in caspase activity and apoptotic effect on sperm DNA. Further trail and evaluation is needed to reveal its clinical relevance to reproductive performance.
S231
RESULTS: Patency data and pregnancy and/or one year of follow-up data were available on 122 men. Overall patency and pregnancy rates were 93% and 45% respectively, with 99% off VV patent and 81% of either VV/EV or EV patent. There was no difference in patency or pregnancy based on BMI, regardless of type of procedure. Findings are summarized below. Vasectomy Reversal Outcome Based on BMI
BMI
P-421 Wednesday, October 19, 2011 PROSPECTIVE RANDOMIZED CONTROL TRIAL OF A NEUROPROTECTIVE WRAP FOR THE SPERMATIC CORD AFTER DENERVATION FOR CHRONIC ORCHIALGIA. S. J. Parekattil, A. Gudeoglu, J. Brahmbhatt, K. B. Priola, M. S. Cohen. Urology, Winter Haven Hospital & University of Florida, Winter Haven, FL. OBJECTIVE: Return or persistence of pain after microsurgical denervation of the spermatic cord for chronic orchialgia is quite disappointing for patients. One cause for this phenomenon could be neuroma formation or irritation of the ligated ends of the nerve fibers in the spermatic cord. Neuroprotective wraps have been safely and successfully utilized in peripheral nerve repair procedures to minimize such neuroma or scar formation. This study evaluates the impact of a neuroprotective wrap placed around the spermatic cord after the denervation procedure. DESIGN: Prospective randomized control trial. MATERIALS AND METHODS: 6 patients with similar bilateral chronic orchialgia who where scheduled for bilateral robotic assisted microsurgical denervation of the spermatic cord by a single surgeon where selected. A neuroprotective wrap (bio-inert matrix derived from porcine gut: Axoguard, Axogen Inc., Gainesville, FL) was randomly placed on one side of each patient around the spermatic cord after completion of the denervation procedure. The contra-lateral side (with no wrap) for each patient was the control. Pain was assessed preoperatively and post-operatively at 1, 3, 6 and 12 months using an externally validated pain impact questionnaire (PIQ-6, QualityMetric Inc, Lincoln, RI). RESULTS: The median pain scores were less on both sides after surgery compared to pre-op (median pre-op score ¼ 77). Median PIQ-6 scores on the wrap side were: 52, 40, 50 and 59 at 1, 3, 6 and 12 months post-op respectively. The median scores on the non-wrap side were: 59, 56, 60 and 68 respectively. The median pain scores on the side with the wrap were significantly less than the non-wrap side. CONCLUSION: This study despite its small sample size, seems to indicate a possible benefit to using a neuroprotective wrap around the spermatic cord after denervation procedures for chronic orchialgia. Further evaluation is needed.
N
OBJECTIVE: Our objective was to determine whether the Body Mass Index (BMI) of a man affects the success of microsurgical vasectomy reversal with regards to patency and pregnancy. DESIGN: Retrospective chart review of men undergoing vasectomy reversal at a large academic institution. MATERIALS AND METHODS: A retrospective chart review was performed on a total of 211 men having undergone vasectomy reversal at our institution between August 2003 and August 2010. Patients underwent vasovasostomy (VV), vasoepididymostomy (EV) or a combination of both (VV/EV) as required, based on intraoperative findings. Patients were excluded if BMI at the time of surgery was unavailable or if patency data were unavailable. All patients in this study were followed until spontaneous pregnancy was obtained through intercourse or intrauterine inseminations.
FERTILITY & STERILITYÒ
Overall Pregnancy (%)
EV R 1 side
Pregnancy with VV only (%)
18.5-24.9 26 26/26 (100) 8/16 (50) 6/26 (23) 6/13 (46) 25.0-29.9 56 53/56 (95) 14/36 (39) 17/56 (30) 11/23 (48) 30.0-34.9 32 30/32 (94) 9/18 (50) 9/32 (28) 6/13 (46) 35.0-39.9 5 3/5 (60) 1/2 (50) 3/5 (60) 1/1 (100) >40 3 2/3 (67) 2/3 (67) 2/3 (67) 1/1 (100) Total 122 114/122 (93) 34/75 (45) 37/122 (30) 25/51 (49)
Pregnancy with EV R 1 side 2/3 (67) 3/13 (23) 3/5 (60) 0/1 (0) 1/2 (50) 9/24 (38)
CONCLUSION: BMI does not appear to be a predictive factor on success of vasectomy reversal in regards to patency, pregnancy, or the need for vasoepididymostomy.
P-423 Wednesday, October 19, 2011 REDUCTION OF INCREASED SPERM DNA FRAGMENTATION INDEX USING LOW-DOSE CLOMIPHENE CITRATE TREATMENT AMONG INFERTILE MALES. H. Asakura, Y. Nakahara, K. Hatake, T. Furukawa, M. Tanioka. Ohgimachi Ladies’ Clinic, Aisei Medical Corporation, Osaka, Japan. OBJECTIVE: Increased sperm DNA fragmentation is associated with reduced reproductive outcome. Varicocelectomy and anti-oxidant treatments were reported to decrease sperm DNA fragmentation index (DFI). Clomiphene citrate (CC) has been used to improved sperm quality, but its effect on sperm DFI is unknown. Effect of CC on sperm DFI was longitudinally evaluated. DESIGN: Retrospective analysis of clinical data at a single institution. MATERIALS AND METHODS: 32 male partners (mean age 38.0, 95%CI 35.5 to 40.5) with abnormal semen parameters or increased DFI received CC 25mg daily for 3 months. Pre and post treatment semen quality including sperm DFI were evaluated (HalospermÒ). The study protocol was approved by the institutional IRB. The parameters were logarithmically transformed if normality of distribution was not accepted. MedCalcÒ was used for statistical analysis. RESULTS: By treatment with CC, average sperm concentration increased from 25.3 to 34.4 million/ml (P<0.05). Average sperm DFI was decreased from 37.9 to 31.1% (P<0.05) with average 6.8% reduction. 20 of 32 males had decrement of sperm DFI. Changes in sperm motility (36.7 to 38.4%) and strict morphology (4.5 to 4.5%) were not significant.
P-422 Wednesday, October 19, 2011 EFFECT OF BODY MASS INDEX ON PATENCY AND PREGNANCY RATES AFTER MICROSURGICAL VASECTOMY REVERSAL. J. Sandlow, J. Bodie. Dept. of Urology, Medical College of Wisconsin, Milwaukee, WI; Dept. of Urology, University of Minnesota, Minneapolis, MN.
Overall patency (%)
Changes in semen parameters by CC treatment
Parameters Volume (ml) Concentration (million/ml) Motility (%) Strict morphology (%) DFI (%)
Significance of change
Pre-treatment
Post-treatment
3.0 25.3
3.1 34.4
P¼0.38 P¼0.03
36.7 4.5 37.9
38.4 4.5 31.1
P¼0.59 P¼0.95 P¼0.01
Paired T-test (N ¼ 32) CONCLUSION: Sperm DNA fragmentation of infertile male partners was significantly reduced with short course of low dose clomiphene citrate treatment. It is speculated that increased in gonadotropins and androgens by CC led to decrease in caspase activity and apoptotic effect on sperm DNA. Further trail and evaluation is needed to reveal its clinical relevance to reproductive performance.
S231