Friday, May 19, 2017

Using SMART Goals in Male Infertility

Smoking-bad for sperm
Abdominal obesity-bad for sperm
Sedentary lifestyle-bad for sperm

Tell a patient, "lose weight", "eat better", "exercise" -worthless for sperm

Better approach- SMART

1: Walk track once this week and call me to tell me
2: Eat one vegetarian meal next week. 
3: Go one day without smoking.

Small, manageable, achievable, relavent, and testable goals.  Now that is SMART.

Wednesday, May 17, 2017

Just a few things I learned at #AUA17

Great meeting in Boston at the AUA. Here are just a few things, at the top of my head, that I learned.

  • Neonatal circumcision protects against penile cancer but not penile warts
  • HPV strain 16 is the most common type associated with penile cancer
  • The HPV vaccine in close to 100% effective vs strain 16
And from another course:
  • Using a tunica vaginalis patch can result in more testis saves during treatment for acute testis torsion
  • It is ok to place a testis prosthesis at the time of an orchiectomy for non-salvageable testes
and more...


Tuesday, November 24, 2015

MRI Guided Prostate Biopsies:Amazing Technology

The images below show a subtle lesion proven on biopsy to be high grade prostate cancer.  

Wednesday, November 18, 2015

Mapping for sperm

Sperm production within the testis can be haphazard and sporadic.   The absence of sperm in one area does not mean that sperm will be absent in another area.   This fact has important implications for men with azoospermia who require sperm retrieval procedures. 
Where is the best place to look for sperm within a testicle?

Answer: depends and varies case by case.  

There are 2 strategies that urologists employ to maximize sperm retrieval rates in men with non obstructive azoospermia: the mTESE and the TFNA mapping.  Both have advantages and disadvantages.  I have adopted the mapping as my first step.   It allows me to determine if sperm is present and where in an efficient and minimally invasive way PRIOR to committing the man to an invasive sperm retrieval procedure and the woman to IVF.   When I find sperm on a mapping I can then proceed with confidence to the next step, the TESE.   If I don't find sperm on a mapping, then I recommend mTESE   

Friday, October 09, 2015