ABSTRACT
Ejaculatory dysfunction is not only psychologically distressing but can become a significant obstacle for men who wish to conceive. Dysfunction comes in the form of anejaculation, reduced ejaculation, retrograde ejaculation, painful ejaculation, or premature ejaculation. Most treatments for lower urinary tract symptoms related to benign prostatic hyperplasia, which commonly occurs in aging men, carry significant risks of absent, reduced, or retrograde ejaculation. This review focuses on such risks that accompany both the medical and surgical management of lower urinary tract symptoms/benign prostatic hyperplasia and how these risks impact male fertility.
Subject(s)
5-alpha Reductase Inhibitors/adverse effects , Adrenergic alpha-Antagonists/adverse effects , Ejaculation/drug effects , Infertility, Male/chemically induced , Lower Urinary Tract Symptoms/therapy , Premature Ejaculation/chemically induced , Prostatectomy/adverse effects , Prostatic Hyperplasia/therapy , Fertility/drug effects , Humans , Infertility, Male/physiopathology , Infertility, Male/therapy , Male , Premature Ejaculation/physiopathology , Premature Ejaculation/therapy , Recovery of Function , Risk Factors , Treatment OutcomeABSTRACT
The number of practicing female urologists has increased from < 2% in 1980 to 9.2% in 2018. Despite this increase, urology trails far behind medical fields overall and surgical subspecialties, in achieving gender parity. Barriers, such as pervasive biases and institutional policies, exist at the medical student, resident, and practicing urologist levels. Once recognized as detrimental, action can be taken to combat these forces to allow for advancement of women in the field of urology. This will result in a richer workforce better able to serve its patient population and advance the field.
Subject(s)
Health Workforce/statistics & numerical data , Physicians, Women/statistics & numerical data , Urology , Female , Humans , Sexism , United StatesABSTRACT
Ejaculatory duct obstruction is an uncommon but surgically correctable cause of male infertility. With the advent and increased use of high-resolution transrectal ultrasonography, anomalies of the ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, the diagnosis should be suspected in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on transrectal ultrasound (TRUS). Although additional larger prospective and comparative studies are needed, it appears that TRUS with aspiration is the most effective method for diagnosis. While intrusive, it is less invasive than vasography. The most robust and published evidence for treatment involves transurethral resection of ejaculatory duct (TURED). More recent experience with antegrade endoscopic approaches are promising and may also be considered. An alternative to surgeries for reversal of obstruction is sperm retrieval for in vitro fertilization/intracytoplasmic sperm injection. A thorough discussion of all alternatives, including risks and benefits, should be held with couples facing this uncommon condition to allow them to make informed decisions regarding management.
Subject(s)
Azoospermia/surgery , Ejaculatory Ducts/surgery , Endoscopy , Infertility, Male/surgery , Sperm Retrieval , Urologic Surgical Procedures, Male/methods , Azoospermia/complications , Azoospermia/diagnostic imaging , Azoospermia/physiopathology , Ejaculatory Ducts/diagnostic imaging , Ejaculatory Ducts/physiopathology , Endoscopy/adverse effects , Fertility , Humans , Infertility, Male/diagnosis , Infertility, Male/etiology , Infertility, Male/physiopathology , Male , Risk Factors , Sperm Injections, Intracytoplasmic , Sperm Retrieval/adverse effects , Treatment Outcome , Ultrasonography, Interventional , Urologic Surgical Procedures, Male/adverse effectsABSTRACT
As men age, medical and surgical diseases involving the genitourinary tract become more common. The conditions themselves, if not their treatments, can negatively impact the fertility potential of an affected man. Many older men maintain the desire to father children, so it is critical to understand the disturbed anatomy and physiology involved to properly counsel that individual. Should this or that treatment regimen be employed? Should sperm banking be undertaken before institution of a permanently ablative/suppressive therapy? What are the long-term consequences of one therapy over another vis-à-vis sperm production, sperm quality, and/or sperm transport? In this context, some of the more common genitourinary afflictions of the older male and the treatment options that are available will be discussed.
Subject(s)
Fertility , Infertility, Male/etiology , Male Urogenital Diseases/therapy , Paternal Age , Spermatogenesis , Spermatozoa/pathology , Age Factors , Aged , Aged, 80 and over , Fertility/drug effects , Fertility/radiation effects , Humans , Infertility, Male/physiopathology , Infertility, Male/prevention & control , Male , Male Urogenital Diseases/complications , Male Urogenital Diseases/physiopathology , Middle Aged , Risk Assessment , Risk Factors , Spermatogenesis/drug effects , Spermatogenesis/radiation effects , Spermatozoa/drug effects , Spermatozoa/radiation effectsABSTRACT
Microscopic and gross hematuria present unique and difficult diagnostic and management challenges in the already complex general surgery patient. This article provides the general surgeon with relevant knowledge in the pathophysiology, anatomy, etiologies, workup, and treatments of hematuria. In addition common causes of hematuria that may be encountered by the general surgeon (including trauma, urinary tract infection, urolithiasis, and malignancy), the difficult to manage clinical situation of clot urinary retention is presented. This article provides a urologic framework of thinking for the clinician to best manage a general surgery patient who has hematuria.
