Use of the aromatase inhibitor letrozole to treat male infertility.

OBJECTIVE: Report the case of induction of spermatogenesis with the aromatase inhibitor letrozole. DESIGN: Case report. SETTING: University Infertility center. PATIENT(S): A 31-year-old man with primary infertility, normal volume azoospermia, normal follicle stimulating hormone (FSH) levels and pattern of nonobstructive azoospermia (NOA) on a testicular biopsy. INTERVENTION(S): The patient was given the aromatase inhibitor letrozole for 4 months and had repeated FSH, testosterone, LH levels, semen analyses, and finally a testicular biopsy. MAIN OUTCOME MEASURE(S): Results of a testis biopsy. RESULT(S): Testis biopsy showed normal spermatogenesis following 4 months of letrozole therapy. CONCLUSION(S): This is the first case report on the use of letrozole to treat male infertility and the first case report on the induction of spermatogenesis in a man with NOA using any aromatase inhibitor.

Mini-incision microsurgical vasectomy reversal using no-scalpel vasectomy principles and instruments.

OBJECTIVES: Men who have undergone a vasectomy have 2 options available to allow them to have biologically related children: vasectomy reversal or sperm retrieval with in vitro fertilization. Of the men who have undergone vasectomy, 2%-11% eventually undergo reversal. The high cost and reproductive risks associated with in vitro fertilization weigh against sperm retrieval with in vitro fertilization, and the surgical risks and postoperative recovery (eg, time off from work, postoperative pain) are important factors that couples consider before choosing vasectomy reversal. To reduce the morbidity of a vasectomy reversal, we have developed techniques to perform a microsurgical vasectomy reversal through a mini-incision in the scrotum. METHODS: The vas deferens is grasped through the skin with the no-scalpel vasectomy ring forceps, a 1-cm incision is made through the skin and dartos directly on top of the elevated vas deferens, and the latter is delivered into the surgical field. The other side of the vas is delivered through the same incision in a similar fashion, and the anastomosis is performed with the usual technique. RESULTS: Application of the no-scalpel vasectomy principals and instruments have allowed us to minimize the scrotal incision (generally to

Tissue factor expression correlates with disease-specific survival in patients with node-negative muscle-invasive bladder cancer.

Tissue factor (TF), a transmembrane glycoprotein responsible for initiating the extrinsic pathway of blood coagulation plays a key role in cancer growth, metastasis and angiogenesis. Various studies have demonstrated the prognostic potential of TF expression in several cancers. However, its role in bladder cancer is unclear. This study evaluated the prognostic potential of TF expression in muscle-invasive bladder tumors from patients treated with radical cystectomies. Immunohistochemical staining using a monoclonal antibody (mAb) anti-TF was carried out on sections of tissue microarray blocks containing cores of muscle-invasive bladder tumors (4 cores/tumor) from 218 patients. The intensity of the staining was evaluated on a scale from 0 to 3 by two independent observers who were both unaware of the clinicopathological characteristics of the samples. TF was expressed in 77.6% of tumors, independently from baseline characteristics (age, gender, stage and grade) as assessed using the chi(2) and Student t tests. During follow-up (median: 2.6 years), 45.4% of the patients died from the progression of their cancer. Kaplan-Meier survival showed that among the 103 patients with node-negative (N0) transitional cell carcinoma (TCC), those with TF-positive tumors had shorter bladder cancer-specific survival (p = 0.0276). Moreover, multivariate Cox regression analysis showed they had a 3.15-fold greater risk of dying from bladder cancer (95% CI: 1.1-9.0; p = 0.032). In conclusion, TF expression was an independent predictor of disease-specific survival in N0 muscle-invasive TCCs treated by radical cystectomy and therefore, might help identify patients at higher risk of disease progression. These patients could potentially benefit from adjuvant chemotherapy.