SIX YEARS OF EXPERIENCE WITH MICROSURGICAL LONGITUDINAL INTUSSUSCEPTION VASOEPIDIDYMOSTOMY (LIVE): A PROSPECTIVE ANALYSIS

Vol. 179, No. 4, Supplement, Wednesday, May 21, 2008

THE JOURNAL OF UROLOGY®

the post-op day 3 ureteral peristaltic activity measured 66, 0, 8 events per hour respectively (p=0.002). For groups 1, 2 and 3 the post-op day 7 ureteral peristaltic activity measured 61, 12, 0 events per hour respectively (p=0.049). Table 1 shows the results of the retrograde and gross evaluations of the ureters. CONCLUSIONS: The RS was able to be deployed safely in the porcine model using standard technique. As with a standard stent, VLJQL¿FDQWXUHWHUDOGLODWLRQDQGGHFUHDVHLQSHULVWDOVLVZDVQRWHGZLWK the ribbon stent, albeit with a trend toward greater dilation with the RS. Although no statistical difference between either the control or RS was detected further clinical evaluation of the RS is in progress. Table 1: Retrograde and gross ureteral dilation (change) from baseline (mm) Retrograde Gross Gross Groups Kg RetrogradeDistal Retrograde Mid Proximal Distal Mid No Stent 32 0 0 0 1 0 Standard Stent 32 5.8 3.6 5.9 3.6 8.6 Ribbon Stent 30 6.4 6.1 10.9 9.2 7.6 Anova value 0.77 0.612 0.28 0.31 0.40 0.19

Gross Proximal 0.5 9 13.9 0.187

Source of Funding:%RVWRQ6FLHQWL¿F

1725 NEW STONE HOLDER MIMICS IN-VIVO STONE MOVEMENT FOR IN-VITRO CHARACTERIZATION OF SHOCKWAVE LITHOTRIPTERS Michael N Ferrandino*, Sean A Pierre, W Neal Simmons, Victor A Leitao, Jun Qin, Franklin H Cocks, Glenn M Preminger, Pei Zhong. Durham, NC. INTRODUCTION AND OBJECTIVE: Most in vitro stone IUDJPHQWDWLRQ VWXGLHV DUH FDUULHG RXW LQ D ¿QJHU FRW RU PHVK KROGHU 7KHVHUHSUHVHQWLGHDOL]HGPRGHOVZKHUHWKHVWRQHLVDOZD\VORFDWHGDW WKHIRFDOSRLQWRIWKHOLWKRWULSWHUWKLVLVUDUHO\WKHFDVHin vivo. We have developed a novel stone holder that more closely mimics the stone movement associated with lithotripsy in vivo, and thus allow for better FKDUDFWHUL]DWLRQRIOLWKRWULSWHUSHUIRUPDQFH METHODS: The membrane holder (MBH) consists of two plastic rings and two silicon membranes that “sandwich” the stone. These rings have a central area of 3cm diameter where the stone is placed. %HJR6WRQHSKDQWRPVZHUHXVHGWRSHUIRUPOLWKRWULSV\LQVWDQGDUG¿QJHU cot, MBH, and in porcine kidneys in vivo with a Siemens-Modularis Litho electromagnetic lithotripter with 2000 shocks at energy level 4.0. Stone comminution was determined by the percentage of fragments which passed through a 2mm mesh. RESULTS: The MBH allows fragments to spread laterally from WKHIRFDOSRLQW6WRQHFRPPLQXWLRQZDVVWDWLVWLFDOO\VLJQL¿FDQWO\EHWWHU LQWKH¿QJHUFRW“ DVFRPSDUHGWR0%+“S 0.05) and in vivo models (46.0±14%, p < 0.05). Stone comminution was statistically similar between the MBH and in vivo models (p > 0.05). &21&/86,216 &KDUDFWHUL]DWLRQ RI D OLWKRWULSWHU in vitro requires analysis of fragmentation properties, which may be performed with different holders. No single holder is ideal for all situations, making the use of different holders necessary to better understand and FKDUDFWHUL]H VKRFNZDYH DQG VWRQH LQWHUDFWLRQ &RQYHQWLRQDO VWRQH KROGHUVPD\EHRYHUSUHGLFWLQJWKHFRPPLQXWLRQHI¿FLHQF\RIOLWKRWULSWHUV Our new holder may more closely mimic what occurs during stone comminution with shock-wave lithotripsy in vivo. Source of Funding: None

591

Infertility: Evaluation and Therapy (I) Moderated Poster Session 59 Wednesday, May 21, 2008

8:00 - 10:00 am

1726 INTRA UTERINE GROWTH RETARDATION INDUCED SUBFERTILITY IS CORRECTED BY PLACENTAL GENE THERAPY WITH INSULIN LIKE GROWTH FACTOR-1 Suzi Demirbag*, Jignesh Parvadia, Sachin Vaikunth, Ursula Harkness, Arturo Maldonado, Maria Ripberger, Datis Alaee, Barbara Kalinowska, Eva Uzvolgyi, Timothy Crombleholme. Cincinnati, OH. ,1752'8&7,21$1'2%-(&7,9(7KHUHLVDUHFRJQL]HG association between the intrauterine growth retardation (IUGR) and male sub-fertility and other chronic diseases such as cardiovascular disease, type 2 diabetes. Insulin-like growth factor-1 (IGF-1) has a major LQÀXHQFHRQIHWDODQGSRVWQDWDOJURZWK:HK\SRWKHVL]HGWKDW,8*5 induced sub-fertility could be corrected if IUGR could be corrected by placental gene therapy. To test this hypothesis we examined the effect of recombinant adenoviral mediated placental gene transfer of IGF-1 (Ad-IGF-1) on postnatal testes histology. METHODS: We had 3 groups of time mated Sprague-Dawley UDWVRQGD\RIDGD\JHVWDWLRQ&RQWUROQ  8WHULQH$UWHU\/LJDWLRQ (UAL, n=3), and UAL+ Ad-IGF-1 (1x108 & 1x109 PFU, n=9) injected on GD\0DOHUDWVZHUHVDFUL¿FHGDWZHHNV7HVWLFOHVOLYHUKHDUW aorta, pancreas, and adrenals were harvested. Seminiferous Tubule Area (STA), Germinal Layer Area (GLA), Sertoli cell, Spermatogonia, and Spermatocyte counts per tubule were calculated. Analysis was made by ANOVA. 5(68/76 67$ ZDV VLJQL¿FDQWO\ ORZHU LQ 8$/ FRPSDUH WR control (0.44±.08 vs 0.035±.01mm2, p=0.001) and higher in UAL+AdIGF1compare to UAL (0.035±.01vs0.32±.09mm 2 p=0.001). GLA was VLJQL¿FDQWO\ ORZHU LQ 8$/ FRPSDUH WR FRQWURO “YV“ mm2 S   DQG VLJQL¿FDQWO\ KLJKHU LQ 8$/$G,*)FRPSDUH WR UAL (0.01±.001vs0.2±.007 mm2, p=0.001). Sertoli cell counts were VLJQL¿FDQWO\ ORZHU LQ 8$/ FRPSDUH WR FRQWURO  “YV“ S   DQG VLJQL¿FDQWO\ KLJKHU LQ 8$/$G,*)FRPSDUH WR 8$/ “YV“S  6SHUPDWRF\WHFRXQWVZHUHVLJQL¿FDQWO\ lower in UAL compare to control (229.33±21.71vs103.77±9.10, p=0.01) DQGVLJQL¿FDQWO\KLJKHULQ8$/$G,*)FRPSDUHWR8$/6SHUPDWRJRQLD FRXQWVZHUHVLJQL¿FDQWO\ORZHULQ8$/FRPSDUHWR&RQWURO“ vs39.66±11.54, p=0.03). CONCLUSIONS: There is a link between low birth weight and increased risk of sub-fertility in the adult male rats. Ad-IGF-1 partially corrects the fertility parameters. These results provide proof of concept that placental gene therapy may be an effective strategy for treatment of male infertility related to IUGR. Source of Funding: None

1727 SIX YEARS OF EXPERIENCE WITH MICROSURGICAL LONGITUDINAL INTUSSUSCEPTION VASOEPIDIDYMOSTOMY (LIVE): A PROSPECTIVE ANALYSIS Peter T Chan*, Richard Lee, Philip S Li, Jamie Libman, Marc Goldstein. Montreal, QC, Canada, and New York, NY. INTRODUCTION AND OBJECTIVE: Various studies KDYH FOHDUO\ HVWDEOLVKHG WKDW IRU REVWUXFWLYH D]RRVSHUPLD VXUJLFDO reconstruction is a more cost-effective option than upfront assisted reproduction. Vasoepididymostomy is considered the most challenging reconstructive microsurgery in Urology. We have previously described a 2-stitch longitudinal intussusception vasoepididymostomy (LIVE) that allows a larger opening in the epididymal tubule for anastomosis. We hereby report our six-years of clinical experience and post-operative outcomes. 0(7+2'6)URPWRPHQZLWKD]RRVSHUPLD due to epididymal obstruction had undergone intussusception vasoepididymostomy bilaterally or, in a functionally solitary testis, XQLODWHUDOO\3RVWRSHUDWLYHRXWFRPHVZHUHDQDO\]HGSURVSHFWLYHO\ RESULTS: Mean age was 39.3 yrs for men and 33.2 yrs for their female partners. Etiologies of obstruction were: post-vasectomy

592

THE JOURNAL OF UROLOGY®

(69%), infection (22%), iatrogenic (5%), trauma (1%) and idiopathic (3%). Median duration of obstruction was 18.7 yrs. Previous failed attempts at reconstruction were found in 38% of patients. Mean follow-up period was 16.3 (1-29) months. Overall patency (> 10,000 sperm/ml) rate was 92% (66/72). Early patency was achieved in 73% (41/56) of cases at 4-6 weeks post-operatively. Median best sperm count was 12.9 (0.01-24) x 106/ml with a 23 (0-48)% forward motility. The late “shut-down” rate in this cohort was 4% (2/49) at 1 year post-op. Among patients with follow-up over 1 year, the natural pregnancy rate was 31% (11/36). Median time to achieve natural pregnancy was 15.3 (3-33) months. Pregnancy was achieved with IVF/ICSI in an additional 39% (23/59) of cases, all using fresh ejaculated sperm. CONCLUSIONS: Currently, LIVE is our procedure of choice for all cases of vasoepididymostomy. A high patency rate with a reasonable natural pregnancy rate was achieved using LIVE. Even when assisted reproductive technology is needed, fresh ejaculated sperm can be used without requiring a subsequent sperm retrieval procedure. Our clinical experience supports LIVE as an effective reconstruction approach male for epididymal obstruction with natural pregnancy rates competitive with primary IVF/ICSI. Source of Funding: Canadian Institutes of Health Research.

Vol. 179, No. 4, Supplement, Wednesday, May 21, 2008

infertile patients that did not have varicocele repair, as well as all fertile patients that had undergone a vasectomy reversal. Semen analyses and quantitative ROS activity before and after varicocele repair were compared by a rank sum test. ROS test result status was compared by chi squared analysis. ROS activity in the different populations was compared by ANOVA on ranks. RESULTS: The median and interquartile ranges for ROS activities of the 2,224 infertile men without a varicocele, and the 17 men that had undergone a vasectomy reversal, were 2 (1-5) and 1.3  UHVSHFWLYHO\6L[W\IRXULQIHUWLOHPDOHVZHUHLGHQWL¿HGDVKDYLQJ undergone a varicocele repair with a median ROS activity before surgery of 3.65 (2-10.8). The differences in ROS activity among the 3 SRSXODWLRQVZDVVWDWLVWLFDOO\VLJQL¿FDQWS ,QWKRVHSDWLHQWVWKDW KDG D YDULFRFHOH UHSDLU VHPHQ VDPSOHV ZHUH DQDO\]HG D PHGLDQ RI 2 months before surgery (range 0-20). Postoperative semen analysis were performed a median of 6 months after varicocele repair (range 3-50). Quantitative ROS activity decreased from a median of 3.65 before surgery to a median of 2.00 after surgery (p=0.036). CONCLUSIONS: Varicoceles significantly impair fertility WKURXJK R[LGDWLYH VWUHVV ,Q RXU FRKRUW YDULFRFHOH UHSDLU VLJQL¿FDQWO\ reduced ROS activity in the seminal plasma of infertile males, but not to the level of fertile males. Source of Funding: None

1728 ORCHIDOPEXY IN ADULTHOOD IMPROVE MALE FERTILITY Mohamed N Mhiri*, Hichem Jallouli, Mahdi Bouassida, Mohamed Gassara, Ahmed Sahnoun, Hammadi Fakhfakh, Ali Bahloul. Sfax, Tunisia. INTRODUCTION AND OBJECTIVE: Undescended testis (UT) is a frequent congenital disease which is often diagnosed and treated during childhood. Untreated cryptorchidism until puberty may lead to male infertility. The aims of this study are to asses how orchidopexy at adulthood could improve, in some extent semen parameters and chances of procreation. METHODS: A cohort of 33 infertile men with UT underwent orchidopexy in our institution. No other associated causes of infertility were found in all patients. Mean patients age was 31,2 years ( 24 - 35 years). UT was bilateral in 36,4 % of the cases and unilateral in 63,6 %. 87ZDVLQLQJXLQDOSRVLWLRQLQDOOSDWLHQWVZLWKDPHDQVL]HZDVRI ml. Preoperative semen analysis showed severe to mild oligo-asthenoWHUDWR]RRVSHUPLD DQGD]RRVSHUPLD  RESULTS: After orchidopexy, motile sperm was obtained in WKHHMDFXODWHLQRID]RRVSHUPLFSDWLHQWVZLWKDPHDQFRQFHQWUDWLRQ of 1,6.106VSHUPDWR]RLGVPODQGDVLJQL¿FDQWLQFUHDVHRIFRQFHQWUDWLRQ DQGVSHUPDWR]RLGVPRWLOLW\LQRIWKHRWKHUSDWLHQWVUHVSHFWLYHO\ from 9,4 to 14,7×106 VSHUPDWR]RLGV  PO DQG IURP  WR î6. Moreover, spontaneous pregnancy was achieved in 4 couples (12 %) after a mean follow-up of 13 months (7 to 22 months). CONCLUSIONS: Surgical correction of UT at adulthood can improve semen quality and increase the rate of paternity. However, late orchidopexy does not prevent subsequent testicular cancer. Source of Funding: None

1729 THE EFFECT OF VARICOCELE REPAIR ON SEMEN REACTIVE OXYGEN SPECIES ACTIVITY IN INFERTILE MEN Mohit Khera*, Bobby B Najari, Joseph P Alukal, Osama Mohamed, Ethan D Grober, Wesley Ekeruo, Larry I Lipshultz. Houston, TX. INTRODUCTION AND OBJECTIVE: Varicocele is the leading cause of infertility in the world and is present in almost 40% of infertile men. Recent data suggests that oxidative stress is a cause of sperm dysfunction in varicocele patients. While semen reactive oxygen species (ROS) activity has been correlated with varicocele grade, there is very limited data on the effects of varicocele repair on semen ROS activity in infertile men. METHODS: We conducted a retrospective review of patient charts from 2001 to 2007. All infertile male patients that had undergone a varicocele repair and who had a semen analysis with ROS performed before and after the surgery were included in the study. Additionally, ROS activity before surgery was compared to ROS activity in all

1730 THE USE OF SPERM BOUND TO THE OOCYTE ZONA PELLUCIDA FOR INTRACYTOPLASMIC SPERM INJECTION: PRELIMINARY RESULTS Assumpto Iaconelli, Debora Rodrigues, Daniela Braga, Rita Figueira, Tatiana C S Bonetti, Fabio F Pasqualotto, Edson Borges*. Sao Paulo, Brazil, and Caxias do Sul, Brazil. INTRODUCTION AND OBJECTIVE: In infertile men, a small SURSRUWLRQRIVSHUPLVFDSDEOHRIELQGLQJWRWKH]RQDSHOOXFLGD=3 in vitro and there is a relationship between normal sperm morphology in WKHPHGLXPDQGWKHSURSRUWLRQRIVSHUPERXQGWRWKH=3,WZDVUHSRUWHG WKDWVSHUPZLWKGHQDWXUHG'1$JHQHUDOO\GRQRWELQGWRWKH=37KHVH HYLGHQFHVVXJJHVWWKDW=3KDVWKHFDSDFLW\WRVHOHFWLYHO\ELQGQRUPDO functional sperm. The present study evaluated the use of sperm bound WRWKH=3IRULQWUDF\WRSODVPLFVSHUPLQMHFWLRQ,&6,  METHODS: This pilot study included 8 ICSI cycles in which women were 31.4 ± 3.07 y-old. For each patient, mature oocytes were VSOLW LQ WZR JURXSV =3JURXS Q   LQ ZKLFK =3ERXQG VSHUP ZDV LQMHFWHGDQGFRQWUROJURXSQ  LQZKLFKQRQ=3ERXQGVSHUPZDV LQMHFWHG)RUVSHUP=3ELQGLQJLPPDWXUHRRF\WHVZHUHLQFXEDWHGZLWK 5µL of sperm sample (concentration: 2 x106/mL) for 2 h. After incubation, VSHUPERXQGWRWKH=3ZHUHUHPRYHGDQGXVHGIRU,&6,)HUWLOL]DWLRQ and high quality embryos rates were compared between the groups. 7RVWXG\WKHLQÀXHQFHRIWKH=3ELQGLQJRQKLJKTXDOLW\HPEU\RVUDWH a logistic regression analysis was conducted. 5(68/767KHIHUWLOL]DWLRQUDWHZDVVLPLODUDPRQJWKHJURXSV (80.5 vs   IRU =3 DQG FRQWUROJURXSV UHVSHFWLYHO\ p=0.302), KRZHYHU HYHQ WKRXJK LW ZDV QRW REVHUYHG D VWDWLVWLFDOO\ VLJQL¿FDQW GLIIHUHQFH WKH KLJKTXDOLW\ HPEU\RV UDWH ZHUH KLJKHU ZKHQ =3 bound sperm was injected (79.0 vsIRU=3DQGFRQWUROJURXSV respectively, p= 0.212). In addition, the logistic regression analysis VKRZHGWKDW=3ERXQGVSHUPLQMHFWLRQSRVLWLYHO\LQÀXHQFHVWKHIRUPDWLRQ RIKLJKTXDOLW\HPEU\RV25 ,&  KRZHYHU ZLWKWKHVPDOOVDPSOHVL]HDQDO\VHGLQWKLVVWXG\LWZDVQRWVWDWLVWLFDOO\ VLJQL¿FDQWp=0.207). &21&/86,216 6SHUP FDSDEOH RI ELQGLQJ WR WKH =3 represents a sperm population satisfying a necessary condition for IHUWLOL]DWLRQ 7KH ELQGLQJ SURFHVV KDV EHHQ VKRZQ WR EH VHOHFWLYH ZLWK UHVSHFW WR VSHFL¿F FKDUDFWHULVWLFV RI VSHUP +RZHYHU ZKHWKHU these characteristics are associated with paternal effects in embryo development is still unclear. The present study evaluated the usefulness RID=3ELQGLQJVSHUPVHOHFWLRQDQGLWZDVREVHUYHGWKDW=3ERXQG VSHUP GLGQ¶W LPSURYH IHUWLOL]DWLRQ  KRZHYHU RQFH IHUWLOL]HG HPEU\R GHYHORSPHQWPD\EHSRVLWLYHO\DIIHFWHG7KHVH¿QGLQJVVXJJHVWWKDW WKHXVHRI=3ERXQGVSHUPPD\EHDWRROWRVHOHFWPRUHFRPSHWHQW VSHUPDWR]RDDEOHWRLPSURYHHPEU\RGHYHORSPHQW7KLVLVVWXG\LVWR EHFRQWLQXHGWRFRQ¿UPWKHUHVXOWV Source of Funding: None