Cost Removed! Do Different Factors Influence Motivation for Vasectomy Reversal When Cost Is Not an Issue?

INTRODUCTION: Vasectomy is a relatively common procedure performed for the purposes of sterilization; however, up to 6% of men that undergo vasectomy wish for its reversal at some point. Few studies have examined the motivation behind vasectomy reversal (VR), especially within special populations, such as the U.S. Military. The aim of this study was to examine the motivations of U.S. Military service members (SMs) who opted for VR surgery, considering their unique access to free health care. MATERIALS AND METHODS: We conducted a retrospective record review of microsurgical VRs performed by a single surgeon (DJH) between January 2020 and May 2023. We evaluated patient's age at which vasectomy was performed, age at VR, reasons for seeking VR surgical care, number of children fathered before the vasectomy, and the age of the current partner. RESULTS: A total of 106 patients underwent VR during the study period, and 102 of them had their medical records available for review. The average age at the time of vasectomy was 31.3 years, while the average age at VR was 40.2 years. The average spousal age at the time of seeking VR was 34.8 years. Before undergoing vasectomy, the men had fathered an average of 2.7 children. Most men were enlisted members of the military (68) and of all service branches, Army represented the greatest number (50). The vast majority of men (76) cited having a new partner after divorce as the primary motivation for seeking VR. Within this group, 57 were remarried, 15 were in a new relationship, 3 were newly engaged, and 1 desired fertility for future relationships. Additionally, 21 sought VR to have more children with the same spouse. Among them, motivating factors included changes to financial status and improvement in partner's health condition. A minority of patients (2) desired VR due to post vasectomy pain syndrome or religious beliefs. CONCLUSIONS: Our study demonstrates that the primary driver for seeking VR surgical care among SMs was the desire for fertility with a new partner, which correlates with trends in the civilian sector. Approximately 20% of the men cited the wish to have more children with the same partner as their motivation. Non-fertility reasons, such as religious beliefs and post vasectomy pain syndrome, were also observed, albeit less frequently.

Acellular Dermal Matrix Tissues in Genitourinary Reconstructive Surgery: A Review of the Literature and Case Discussions.

INTRODUCTION: There have been major advancements in the field of urologic reconstruction and gender-affirming surgeries over the past 10 years. These operations have become increasingly complex involving multiple revisions, with limited healthy native tissue availability. Grafts are frequently needed when a patient's own tissue is expected to have poor wound-healing properties. To reduce the morbidity associated with autologous grafts and complications associated with synthetic grafts, acellular dermal matrices (ADMs) can be used as substitutes in genitourinary surgery as they demonstrate decreased immunogenicity and retaine structural integrity. OBJECTIVES: The purpose of this review is to describe the importance and potential uses of ADMs by reviewing the literature and highlighting key examples of our institution's expanded application of ADM grafts in genitourinary reconstruction. METHODS: We performed a literature review for the use of ADMs in genitourinary surgery including the search terms acellular dermal matrix, alloderm, extracellular matrix, penis, penile reconstruction, intrapenile prosthesis, phalloplasty, neophallus, urethroplasty, artificial urinary sphincters, Peyronie's disease, and urology. We highlight 5 representative genitourinary reconstructive cases performed at this institution where ADMs contributed to surgical success. Genitourinary reconstructive surgeries that have used ADMs in the literature included neophallus construction for gender affirmation, phalloplasty for trauma, penile augmentation, and plaque excision and grafting for Peyronie's disease. RESULTS: Biomechanical studies across different graft types are limited in genitourinary applications. Initial studies using ADMs indicate benefits of limited inflammatory response, finite elasticity, and substantial tensile strength, acceptably mimicking properties of the native tissue. CONCLUSION: Our experience and the current literature suggest that human ADM is a valuable option for tunica albuginea replacement, but its use to support free grafts should be cautioned secondary to graft take. Haney NM, Huang MM, Liu JL, et al. Acellular Dermal Matrix Tissues in Genitourinary Reconstructive Surgery: A Review of the Literature and Case Discussions. Sex Med Rev 2021;9;488-497.

Nonalcoholic Fatty Liver Disease, Male Sexual Dysfunction, and Infertility: Common Links, Common Problems.

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is considered a hallmark of metabolic syndrome (MetS) and a significant contributor to cardiovascular disease (CVD). With the alarming rates of obesity in the United States and worldwide, efforts at understanding, preventing, and treating MetS and its components are being increasingly undertaken by scientists and clinicians. A strong association between MetS and male sexual problems is already well established. More recent animal and human studies have further evaluated the relationship of NAFLD with male sexual problems and infertility. The molecular and physiological mechanisms correlating these conditions are incompletely established at this time, however. AIM: To review and analyze current literature associating NAFLD with andrologic disorders, including erectile dysfunction (ED), infertility, and hypogonadism. METHODS: The PubMed database was searched using terms "erectile dysfunction," "hypogonadism," "male infertility," and "nonalcoholic fatty liver disease" for articles published between January 1980 and June 2018. MAIN OUTCOME MEASURES: We present a summary of the recent clinical and experimental evidence and discuss the possible pathophysiological mechanisms relating NAFLD development and progression to ED, a hypogonadal state, and infertility. RESULTS: A total of 132 articles were reviewed. These included human observational and clinical studies and animal and basic science research relating NAFLD to the development and progression of ED, hypogonadism, and infertility in men. CONCLUSION: There is growing evidence linking NAFLD to male sexual and reproductive dysfunction. A complex interplay of pathophysiological processes underlying these entities and further relating them to the MetS components may ultimately aid the identification and development of novel diagnostic and therapeutic approaches. Hawksworth DJ, Burnett AL. Nonalcoholic Fatty Liver Disease, Male Sexual Dysfunction, and Infertility: Common Links, Common Problems Sex Med Rev 2020;8:274-285.

Ilioinguinal and iliohypogastric neuralgia as an etiology of bladder pain syndrome.

Chronic neuropathic pain due to iliohypogastric (IH) or ilioinguinal (IL) nerve entrapment or injury may demonstrate as referred pain to the genito-urinary organs. Our patient is a 67-year-old woman who presented with a 9-month history of bladder pain, dyspareunia and nocturia that all began following a laparoscopic pyeloplasty. This report describes improvement of bladder pain syndrome following surgical resection of the II and IH nerves.

Penile fracture in a patient with Ehlers-Danlos syndrome: A case report.

The association of penile fracture with Ehlers-Danlos syndrome (EDS) has never been described. Our patient is a 41-year-old male with EDS who presented with a traumatic penile fracture, ten days following sexual intercourse. This report recognizes the possible heightened risk of structural penile injury in patients with connective tissue disorders such as EDS and emphasizes a need for a high index of suspicion of occult urethral injury and special considerations in surgical management of these complex cases.

Penile Allotransplantation: Pushing the Limits.

The current techniques for organ transplantation are being pushed to new limits. Thanks to the well-established concepts of vascularized composite allotransplantation, the idea of penile transplantation has come to the forefront of genitourinary reconstruction. The recent successful penile transplantation surgeries present a revolutionary option for a challenging penile disfigurement.

Infertility in Patients With Klinefelter Syndrome: Optimal Timing for Sperm and Testicular Tissue Cryopreservation.

Male factor infertility is a complex issue presenting many diagnostic and management challenges. It is responsible for about 50% of all causes of infertility and thus carries significant medical, financial, and psychological implications for the couples struggling with conception. Klinefelter syndrome is the most common chromosomal male anomaly associated with male infertility. This review focuses specifically on non-obstructive azoospermia secondary to Klinefelter syndrome and discusses controversies surrounding fertility management in patients with this genetic disorder.

Advances made in the treatment of testicular cancer in the U.S. Military: 1946 to the present.

Testicular cancer is presently one of the most curable solid tumors, and thanks to diagnostic, surgical, and medical advances over the last several decades, the treatment of this tumor serves as a paradigm for multimodal treatment of solid malignancies. Due to testicular cancer's predilection for younger patients, many of the seminal improvements and discoveries were made possible as a result of initial investigatory groundwork laid by military physicians treating servicemen. This article reviews historical contributions of the United States Military Medical Departments in the arena of testicular cancer treatment in the post-World War II era.

Evaluation of the 8q24 prostate cancer risk locus and MYC expression.

Polymorphisms at 8q24 are robustly associated with prostate cancer risk. The risk variants are located in nonprotein coding regions and their mechanism has not been fully elucidated. To further dissect the function of this locus, we tested two hypotheses: (a) unannotated microRNAs (miRNA) are transcribed in the region, and (b) this region is a cis-acting enhancer. Using next generation sequencing, 8q24 risk regions were interrogated for known and novel miRNAs in histologically normal radical prostatectomy tissue. We also evaluated the association between the risk variants and transcript levels of multiple genes, focusing on the proto-oncogene, MYC. RNA expression was measured in histologically normal and tumor tissue from 280 prostatectomy specimens (from 234 European American and 46 African American patients), and paired germline DNA from each individual was genotyped for six 8q24 risk single nucleotide polymorphisms. No evidence was found for significant miRNA transcription within 8q24 prostate cancer risk loci. Likewise, no convincing association between RNA expression and risk allele status was detected in either histologically normal or tumor tissue. To our knowledge, this is one of the first and largest studies to directly assess miRNA in this region and to systematically measure MYC expression levels in prostate tissue in relation to inherited risk variants. These data will help to direct the future study of this risk locus.