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were performed and all were in younger patients. Overall 97% of men in both age groups would undergo the surgery again, and 97% in both groups would recommend the procedure to others. These data confirm that older men can do quite well with penile prosthesis surgery, and age by itself should not be the deciding factor for this procedure. Tomas L. Griebling, MD, MPH
Suggested Reading Brinkman MJ, Henry GD, Wilson SK et al: A survey of patients with inflatable penile prostheses for satisfaction. J Urol 2005; 174: 253.
Male Infertility Re: Age Does Not Adversely Affect Sperm Retrieval in Men Undergoing Microdissection Testicular Sperm Extraction R. Ramasamy, N. N. Trivedi, J. E. Reifsnyder, G. D. Palermo, Z. Rosenwaks and P. N. Schlegel Department of Urology, Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York Fertil Steril 2014; 101: 653e655.
Abstract available at http://jurology.com/ Editorial Comment: Much has been written lately about worsening male reproductive health with advancing age, and these investigators compared microsurgical testis sperm outcomes of men older than 50 years to those who were younger. After age 50 the surgical sperm retrieval rate did not decrease. In fact, at 74% it was significantly greater than the 54% rate in younger men. The average follicle-stimulating hormone level was greater at 32.0 IU/l in older men compared to 24.1 IU/l in younger men, and the finding of hypospermatogenesis increased in men older than 50. It appears that while increasing follicle-stimulating hormone levels may indicate worsening spermatogenesis with advancing male age, the story is complex, and microsurgical testis sperm extraction remains an effective method of obtaining sperm even in older men. Craig Niederberger, MD
Re: Is Ex Vivo Microdissection Testicular Sperm Extraction Indicated for Infertile Men Undergoing Radical Orchiectomy for Testicular Cancer? Case Report and Literature Review N. Haddad, K. Al-Rabeeah, R. Onerheim and A. Zini Division of Urology, Department of Surgery, McGill University Health Center and Division of Pathology, St. Mary’s Hospital Center, Montreal, Quebec, Canada Fertil Steril 2014; 101: 956e959.
Abstract available at http://jurology.com/ Editorial Comment: These investigators describe successfully extracting sperm from a testis excised for cancer and subsequent histological analysis of the whole testis that demonstrated significant areas of spermatogenesis missed by their simple surgical extraction. This is an interesting article for several reasons. The first is that we typically do not have a full histopathological analysis in men undergoing surgical sperm extraction, and one wonders how many foci of spermatogenesis
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are missed even with a technique such as microsurgical testis sperm extraction. Another issue is that the patient described had subtle physical examination findings, and it was ultrasonography that revealed a tumor, begging the question of whether we should be screening more infertile men with ultrasound. Finally, we do not know the safeness of sperm retrieved from a cancerous testis, and obtaining informed consent and monitoring outcomes for these patients are of paramount importance. Craig Niederberger, MD
Suggested Reading Ho GT, Gardner H, DeWolf WC et al: Influence of testicular carcinoma on ipsilateral spermatogenesis. J Urol 1992; 148: 821. Williams DH, Karpman E, Sander JC et al: Pretreatment semen parameters in men with cancer. J Urol 2009; 181: 736. Ramasamy R, Reifsnyder JE, Husseini J et al: Localization of sperm during microdissection testicular sperm extraction in men with nonobstructive azoospermia. J Urol 2013; 189: 643.
Re: Eliminating Acute Lymphoblastic Leukemia Cells from Human Testicular Cell Cultures: A Pilot Study H. Sadri-Ardekani, C. H. Homburg, T. M. van Capel, H. van den Berg, F. van der Veen, C. E. van der Schoot, A. M. van Pelt and S. Repping Center for Reproductive Medicine and Department of Pediatric Oncology, Women’s and Children’s Hospital, and Departments of Cell Biology and Histology, Academic Medical Center, University of Amsterdam and Experimental Immunohematology, Sanquin Research at the Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Amsterdam, The Netherlands, and Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran Fertil Steril 2014; 101: 1072e1078.e1.
Abstract available at http://jurology.com/ Editorial Comment: Childhood cancer is horrific, with tragedy compounded by the loss of future paternity in prepubertal boys undergoing cytotoxic chemotherapy. One likely future solution could be cryopreserved testis tissue later activated and autotransplanted into the postpubertal host. These investigators studied an important safety issue, ie whether acute lymphoblastic leukemia (ALL) cells could survive a promising culture system for use in enriching healthy testis stem cells. The authors demonstrated that ALL cells died in culture before 2 weeks, addressing a significant concern about this strategy for preserving fertility in young boys with cancer. Craig Niederberger, MD
Re: Analysis of International Practice Patterns Regarding Postvasectomy Fertility Options O. Blach, A. N. Shridharani and J. I. Sandlow Departments of Urology, Royal Sussex County Hospital, Brighton, United Kingdom, and Medical College of Wisconsin, Milwaukee, Wisconsin Urology 2014; 83: 1065e1070.
Abstract available at http://jurology.com/ Editorial Comment: Like many specialized urological procedures, vasectomy reversal is performed by a diverse array of urologists. The results of this survey conducted in the United States and United Kingdom demonstrate that point clearly. It seems what is often lacking is a discussion of other forms of fertility treatments, especially advanced female reproductive care. If urologists are to integrate care with their counterparts treating women, we must understand these treatments and educate our residents accordingly. This article ultimately serves as a call to arms for residency programs to more
MALE INFERTILITY
255
fully educate urologists entering the workforce in the broader scope of reproductive care. Our patients, the male half of the couple, deserve that. Craig Niederberger, MD
Suggested Reading Kolettis PN, Sabanegh ES, Nalesnik JG et al: Pregnancy outcomes after vasectomy reversal for female partners 35 years old or older. J Urol 2003; 169: 2250. Meng MV, Greene KL and Turek PJ: Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol 2005; 174: 1926.
Re: Clinical Outcome of Microsurgical Varicocelectomy in Infertile Men with Severe Oligozoospermia N. Enatsu, K. Yamaguchi, K. Chiba, H. Miyake and M. Fujisawa Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan Urology 2014; 83: 1071e1074.
Abstract available at http://jurology.com/ Editorial Comment: The question of whether to perform varicocelectomy in men with severe oligospermia is a difficult one. If the improvement in seminal parameters is small, then the couple may still require in vitro fertilization to have a child, and the father has undergone an additional procedure. These investigators performed a retrospective analysis with some reasonable definitions of successful varicocelectomy and, not surprisingly, observed that men with more sperm did better after the procedure while those with preoperative sperm concentrations less than 2 million per ml did not. While the results of this study do not necessarily mandate refraining from offering varicocelectomy to men with sperm densities less than 2 million per ml, they really make one think twice about it. Craig Niederberger, MD
Suggested Reading Kim ED, Leibman BB, Grinblat DM et al: Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol 1999; 162: 737. Meng MV, Greene KL and Turek PJ: Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol 2005; 174: 1926.
253
were performed and all were in younger patients. Overall 97% of men in both age groups would undergo the surgery again, and 97% in both groups would recommend the procedure to others. These data confirm that older men can do quite well with penile prosthesis surgery, and age by itself should not be the deciding factor for this procedure. Tomas L. Griebling, MD, MPH
Suggested Reading Brinkman MJ, Henry GD, Wilson SK et al: A survey of patients with inflatable penile prostheses for satisfaction. J Urol 2005; 174: 253.
Male Infertility Re: Age Does Not Adversely Affect Sperm Retrieval in Men Undergoing Microdissection Testicular Sperm Extraction R. Ramasamy, N. N. Trivedi, J. E. Reifsnyder, G. D. Palermo, Z. Rosenwaks and P. N. Schlegel Department of Urology, Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York Fertil Steril 2014; 101: 653e655.
Abstract available at http://jurology.com/ Editorial Comment: Much has been written lately about worsening male reproductive health with advancing age, and these investigators compared microsurgical testis sperm outcomes of men older than 50 years to those who were younger. After age 50 the surgical sperm retrieval rate did not decrease. In fact, at 74% it was significantly greater than the 54% rate in younger men. The average follicle-stimulating hormone level was greater at 32.0 IU/l in older men compared to 24.1 IU/l in younger men, and the finding of hypospermatogenesis increased in men older than 50. It appears that while increasing follicle-stimulating hormone levels may indicate worsening spermatogenesis with advancing male age, the story is complex, and microsurgical testis sperm extraction remains an effective method of obtaining sperm even in older men. Craig Niederberger, MD
Re: Is Ex Vivo Microdissection Testicular Sperm Extraction Indicated for Infertile Men Undergoing Radical Orchiectomy for Testicular Cancer? Case Report and Literature Review N. Haddad, K. Al-Rabeeah, R. Onerheim and A. Zini Division of Urology, Department of Surgery, McGill University Health Center and Division of Pathology, St. Mary’s Hospital Center, Montreal, Quebec, Canada Fertil Steril 2014; 101: 956e959.
Abstract available at http://jurology.com/ Editorial Comment: These investigators describe successfully extracting sperm from a testis excised for cancer and subsequent histological analysis of the whole testis that demonstrated significant areas of spermatogenesis missed by their simple surgical extraction. This is an interesting article for several reasons. The first is that we typically do not have a full histopathological analysis in men undergoing surgical sperm extraction, and one wonders how many foci of spermatogenesis
MALE INFERTILITY
254
are missed even with a technique such as microsurgical testis sperm extraction. Another issue is that the patient described had subtle physical examination findings, and it was ultrasonography that revealed a tumor, begging the question of whether we should be screening more infertile men with ultrasound. Finally, we do not know the safeness of sperm retrieved from a cancerous testis, and obtaining informed consent and monitoring outcomes for these patients are of paramount importance. Craig Niederberger, MD
Suggested Reading Ho GT, Gardner H, DeWolf WC et al: Influence of testicular carcinoma on ipsilateral spermatogenesis. J Urol 1992; 148: 821. Williams DH, Karpman E, Sander JC et al: Pretreatment semen parameters in men with cancer. J Urol 2009; 181: 736. Ramasamy R, Reifsnyder JE, Husseini J et al: Localization of sperm during microdissection testicular sperm extraction in men with nonobstructive azoospermia. J Urol 2013; 189: 643.
Re: Eliminating Acute Lymphoblastic Leukemia Cells from Human Testicular Cell Cultures: A Pilot Study H. Sadri-Ardekani, C. H. Homburg, T. M. van Capel, H. van den Berg, F. van der Veen, C. E. van der Schoot, A. M. van Pelt and S. Repping Center for Reproductive Medicine and Department of Pediatric Oncology, Women’s and Children’s Hospital, and Departments of Cell Biology and Histology, Academic Medical Center, University of Amsterdam and Experimental Immunohematology, Sanquin Research at the Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Amsterdam, The Netherlands, and Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran Fertil Steril 2014; 101: 1072e1078.e1.
Abstract available at http://jurology.com/ Editorial Comment: Childhood cancer is horrific, with tragedy compounded by the loss of future paternity in prepubertal boys undergoing cytotoxic chemotherapy. One likely future solution could be cryopreserved testis tissue later activated and autotransplanted into the postpubertal host. These investigators studied an important safety issue, ie whether acute lymphoblastic leukemia (ALL) cells could survive a promising culture system for use in enriching healthy testis stem cells. The authors demonstrated that ALL cells died in culture before 2 weeks, addressing a significant concern about this strategy for preserving fertility in young boys with cancer. Craig Niederberger, MD
Re: Analysis of International Practice Patterns Regarding Postvasectomy Fertility Options O. Blach, A. N. Shridharani and J. I. Sandlow Departments of Urology, Royal Sussex County Hospital, Brighton, United Kingdom, and Medical College of Wisconsin, Milwaukee, Wisconsin Urology 2014; 83: 1065e1070.
Abstract available at http://jurology.com/ Editorial Comment: Like many specialized urological procedures, vasectomy reversal is performed by a diverse array of urologists. The results of this survey conducted in the United States and United Kingdom demonstrate that point clearly. It seems what is often lacking is a discussion of other forms of fertility treatments, especially advanced female reproductive care. If urologists are to integrate care with their counterparts treating women, we must understand these treatments and educate our residents accordingly. This article ultimately serves as a call to arms for residency programs to more
MALE INFERTILITY
255
fully educate urologists entering the workforce in the broader scope of reproductive care. Our patients, the male half of the couple, deserve that. Craig Niederberger, MD
Suggested Reading Kolettis PN, Sabanegh ES, Nalesnik JG et al: Pregnancy outcomes after vasectomy reversal for female partners 35 years old or older. J Urol 2003; 169: 2250. Meng MV, Greene KL and Turek PJ: Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol 2005; 174: 1926.
Re: Clinical Outcome of Microsurgical Varicocelectomy in Infertile Men with Severe Oligozoospermia N. Enatsu, K. Yamaguchi, K. Chiba, H. Miyake and M. Fujisawa Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan Urology 2014; 83: 1071e1074.
Abstract available at http://jurology.com/ Editorial Comment: The question of whether to perform varicocelectomy in men with severe oligospermia is a difficult one. If the improvement in seminal parameters is small, then the couple may still require in vitro fertilization to have a child, and the father has undergone an additional procedure. These investigators performed a retrospective analysis with some reasonable definitions of successful varicocelectomy and, not surprisingly, observed that men with more sperm did better after the procedure while those with preoperative sperm concentrations less than 2 million per ml did not. While the results of this study do not necessarily mandate refraining from offering varicocelectomy to men with sperm densities less than 2 million per ml, they really make one think twice about it. Craig Niederberger, MD
Suggested Reading Kim ED, Leibman BB, Grinblat DM et al: Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol 1999; 162: 737. Meng MV, Greene KL and Turek PJ: Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol 2005; 174: 1926.
