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Urologist
46 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score Rankings
University of Pennsylvania (1964)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Male Infertility
Best Doctors in America, 2012, 2013
South Jersey Magazine "Top Physician" 2010
Associations
American Board of Urology
American Urological Association
American Society for Reproductive Medicine

Affiliations ?

Dr. Marmar is affiliated with 10 hospitals.

Hospital Affilations

Score

Rankings

  • Our Lady Of Lourdes Medical Center
    Urology
    1600 Haddon Ave, Camden, NJ 08103
    • Currently 3 of 4 crosses
    Top 50%
  • Cooper University Hospital
    Urology
    1 Cooper Plz, Camden, NJ 08103
    • Currently 1 of 4 crosses
  • Virtua West Jersey Hospital - Marlton
    Urology
    94 Brick Rd, Marlton, NJ 08053
    • Currently 1 of 4 crosses
  • West Jersey Hospital-Camden
  • Cooper Hospital Umc
  • Virtua Memorial
    1000 Atlantic Ave, Camden, NJ 08104
  • Cooper Medical Center
  • Virtua-West Jersey Health System
  • Pennsylvania Hospital of the University of Pennsylvania Health System
  • Cooper Hospital/U M C
  • Publications & Research

    Dr. Marmar has contributed to 53 publications.
    Title Link Between Low-dose Environmentally Relevant Cadmium Exposures and Asthenozoospermia in a Rat Model.
    Date April 2008
    Journal Fertility and Sterility
    Excerpt

    OBJECTIVE: To define the mechanism(s) underlying an association between asthenozoospermia and elevated blood, seminal plasma, and testicular cadmium levels in infertile human males using a rat model of environmentally relevant cadmium exposures. SETTING: University medical center andrology research laboratory. ANIMAL(S): Male Wistar rats (n = 60), documented to be sensitive to the testicular effects of cadmium. INTERVENTION(S): Rats were given ad libitum access to water supplemented with 14% sucrose and 0 mg/L, 5 mg/L, 50 mg/L, or 100 mg/L cadmium for 1, 4, or 8 weeks beginning at puberty. MAIN OUTCOME MEASURE(S): Testicular cadmium levels were determined by atomic absorption, cauda epididymal sperm motility by visual inspection, and testicular gene expression by DNA microarray hybridization. RESULT(S): Chronic, low-dose cadmium exposures produced a time- and dose-dependent reduction in sperm motility. Transcription of genes regulated by calcium and expression of L-type voltage-dependent calcium channel mRNA splicing variants were altered by cadmium exposure. Expression of calcium binding proteins involved in modulation of sperm motility was unaffected. CONCLUSION(S): A causal relationship between elevated testicular cadmium and asthenozoospermia was identified. Aberrrant sperm motility was correlated with altered expression of L-type voltage-dependent calcium channel isoforms found on the sperm tail, which regulate calcium and cadmium influx.

    Title Results of Vasovasostomy or Vasoepididymostomy After Failed Percutaneous Epididymal Sperm Aspirations.
    Date March 2008
    Journal The Journal of Urology
    Excerpt

    PURPOSE: After undergoing vasectomy approximately 4% to 6% of men change their minds and desire more children. In the past they had 2 options: 1) vasectomy reversal and 2) sperm retrieval and intracytoplasmic sperm injection. However, in our practices we began to receive requests for another option: reconstructive microsurgery after failed percutaneous epididymal sperm aspiration. MATERIALS AND METHODS: In this report we combined our collective experience with 8 patients who requested reconstructive microsurgery after failed percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection. RESULTS: Our intraoperative findings demonstrated minimal trauma to the epididymis resulting from percutaneous epididymal sperm aspiration. At surgery sperm were found in the testicular vas fluid in 10 of 16 vasal units, and vasovasostomy was possible on at least 1 side in 7 of 8 patients. Vasoepididymostomy was possible when needed. Of the 8 couples 4 achieved pregnancy (50%). CONCLUSIONS: Vasovasostomy or vasoepididymostomy is possible after percutaneous epididymal sperm aspiration.

    Title Efficacy of Varicocelectomy in Improving Semen Parameters: New Meta-analytical Approach.
    Date October 2007
    Journal Urology
    Excerpt

    OBJECTIVES: To determine the efficacy of varicocelectomy in improving semen parameters. METHODS: A meta-analysis was performed to evaluate both randomized controlled trials and observational studies using a new scoring system. This scoring system was developed to adjust and quantify for various potential sources of bias, including selection bias, follow-up bias, confounding bias, information or detection bias, and other types of bias, such as misclassification. Of 136 studies identified through the electronic and hand search of references, only 17 studies met our inclusion criteria. The study population was infertile men with clinically palpable unilateral or bilateral varicocele and at least one abnormal semen parameter who had undergone surgical varicocelectomy (high ligation or inguinal microsurgery). Only those studies that had at least three semen analyses (ie, sperm count, motility, and morphology) per patient, before and after surgical varicocelectomy, were included. RESULTS: The combined analysis demonstrated that the sperm concentration increased by 9.71 x 10(6)/mL (95% confidence interval [CI] 7.34 to 12.08, P <0.00001) and motility increased by 9.92% (95% CI 4.90 to 14.95, P = 0.0001) after microsurgical varicocelectomy. Similarly, the sperm concentration increased by 12.03 x 10(6)/mL (95% CI 5.71 to 18.35, P = 0.0002) and motility increased by 11.72% (95% CI 4.33 to 19.12, P = 0.002) after high ligation varicocelectomy. The improvement in World Health Organization sperm morphology was 3.16% (95% CI 0.72 to 5.60, P = 0.01) after both microsurgery and high ligation varicocelectomy. CONCLUSIONS: Surgical varicocelectomy significantly improves semen parameters in infertile men with palpable varicocele and abnormal semen parameters.

    Title Reassessing the Value of Varicocelectomy As a Treatment for Male Subfertility with a New Meta-analysis.
    Date September 2007
    Journal Fertility and Sterility
    Excerpt

    OBJECTIVE: To determine the efficacy of varicocelectomy as a treatment for male factor infertility by improving the chance of spontaneous pregnancy. DESIGN: Meta-analysis. SETTING: Cleveland Clinic's Glickman Urological Institute. PATIENT(S): Infertile men with abnormal results on semen analyses and a palpable varicocele. INTERVENTION(S): Surgical varicocelectomy. MAIN OUTCOME MEASURE(S): Spontaneous pregnancy outcome. RESULT(S): The odds of spontaneous pregnancy after surgical varicocelectomy, compared with no or medical treatment for palpable varicocele, were 2.87 (95% confidence interval [CI], 1.33-6.20) with use of a random-effects model or 2.63 (95% CI, 1.60-4.33) with use of a fixed-effects model. The number needed to treat was 5.7 (95% CI, 4.4-9.5). CONCLUSION(S): Surgical varicocelectomy in infertile men with palpable lesions and at least one abnormal semen parameter improves the odds of spontaneous pregnancy in their female partners. Five studies were included (two randomized, three observational). All were scored for bias. Our study suggests that varicocelectomy in selected patients does indeed have beneficial effects on fertility status.

    Title Voltage-dependent Calcium Channels in Mammalian Spermatozoa Revisited.
    Date August 2007
    Journal Frontiers in Bioscience : a Journal and Virtual Library
    Excerpt

    The last few years have seen an explosion in the number of voltage-dependent ion channel sequences detected in sperm and testes. The complex structural paradigm of these channels is now known to include a pore-forming alpha1 subunit(s) whose electrophysiological properties are modulated by an intracellular beta subunit, a disulfide-linked complex of a membrane-spanning delta subunit with an extracellular alpha2 subunit, and a transmembrane gamma subunit. Many of these are alternatively spliced. Furthermore, the known number of genes coding each subtype has expanded significantly (10 alpha1, 4 beta, 4 alpha2delta, 8 gamma). Recently, the CatSper gene family has been characterized based on similarity to the voltage-dependent calcium channel alpha1 subunit. From among this multiplicity, a wide cross-section is active in sperm, including many splice variants. For example, expression of the various alpha1 subunits appears strictly localized in discrete domains of mature sperm, and seems to control distinct physiological roles such as cellular signaling pathways. These include alpha1 alternative splicing variants that are regulated by ions passed by channels in developing sperm. Various combinations of ion channel sequence variants have been studies in research models and in a variety of human diseases, including male infertility. For example, rats that are genetically resistant to testes damage by lead seem to respond to lead ions by increasing alpha1 alternative splicing. In contrast, in varicocele-associated male infertility, the outcome from surgical correction correlates with suppression of alpha1 alternative splicing, Ion channel blockers remain attractive model contraceptive drugs because of their ability to modulate cholesterol levels. However, the large number of sperm ion channel variants shared with other cell types make ion channels less attractive targets for male contraceptive development than a few years ago. In this review, the genetics, structure and function of voltage-dependent calcium channels and related CatSper molecules will be discussed, and several practical clinical applications associated with these channels will be reported.

    Title Sperm Harvesting and Cryopreservation During Vasectomy Reversal is Not Cost Effective.
    Date May 2006
    Journal Fertility and Sterility
    Excerpt

    OBJECTIVE: To determine whether sperm harvesting and cryopreservation at the time of vasectomy reversal is cost-effective. DESIGN: Model of actual costs and results at five institutions. SETTING: Multicenter study comprising five centers, including university hospitals and private practices. PATIENT(S): Men undergoing vasectomy reversal. INTERVENTION(S): We established two models for vasectomy reversal. The first model was sperm harvesting and cryopreservation at the time of vasectomy reversal. The second model was sperm harvesting at the time of IVF only if the patient remained azoospermic after vasectomy reversal. Vasectomy reversal procedures modeled included bilateral vasovasostomy and bilateral epididymovasostomy. The costs for each procedure at the five institutions were collated and median costs determined. MAIN OUTCOME MEASURE(S): Median cost of procedure and calculated financial comparisons. RESULT(S): The median cost of testicular sperm extraction/cryopreservation performed at the time of bilateral vasovasostomy was $1,765 (range, $1,025-$2,800). The median cost of microsurgical epididymal sperm aspiration or testicular sperm extraction with cryopreservation performed at the time of epididymovasostomy was $1,209 (range, $905-$2,488). The average of the median costs for percutaneous sperm aspiration or testicular sperm aspiration for those patients with a failed vasectomy reversal was $725 (range, $400-$1,455). CONCLUSION(S): Sperm retrieval with cryopreservation at the time of vasectomy reversal is not a cost-effective management strategy.

    Title Varicoceles.
    Date March 2006
    Journal The Journal of Urology
    Title The Safety of Ultrasonically Guided Testis Aspiration Biopsies and Efficacy of Use to Predict Varicocelectomy Outcome.
    Date September 2005
    Journal Human Reproduction (oxford, England)
    Excerpt

    BACKGROUND: We hypothesized that infertile men with varicoceles have molecular/genetic defects that interact with varicoceles to induce infertility. Studies directly on testis tissue appeared to be a way to link histology, markers for molecular/genetic defects and spermatogenesis, but testis biopsies may induce morbidity. In this report, we present safety and efficacy data on ultrasonically guided, single stick, percutaneous aspiration. METHODS: Biopsies were performed on 115 infertile men with varicoceles and five men with obstructive azoospermia. Morbidity was examined by pre- and post-biopsy ultrasound, efficacy by ability of two markers to predict >50% increase in sperm density post-operatively. All patients had three pre- and three post-operative semen analyses. RESULTS: 78.3% of patients had no ultrasonic testicular defects immediately post-biopsy. By 2 months, 100% had no defects. Biopsy markers [testicular cadmium (<0.453 ng/mg tissue) and an intact calcium channel mRNA sequence] predicted >50% increase in sperm density with 82.9 and 90.5% accuracy, respectively. CONCLUSIONS: Ultrasonically controlled, percutaneous aspiration testis biopsies are safe. Specimens so acquired can assist study of molecular/genetic markers associated with spermatogenesis in infertile men with varicoceles. Tissue cadmium level, calcium channel sequence and other markers may predict outcome of varicocele surgery.

    Title Deletions in L-type Calcium Channel Alpha1 Subunit Testicular Transcripts Correlate with Testicular Cadmium and Apoptosis in Infertile Men with Varicoceles.
    Date May 2005
    Journal Fertility and Sterility
    Excerpt

    OBJECTIVE: To identify and understand predictors of successful varicocelectomy. DESIGN: Examination of testicular L-type voltage-dependent calcium channel (L-VDCC) mRNAs and proteins in testis biopsies and comparison of presence and absence of various mRNAs with testicular cadmium levels, with apoptosis, and with sperm count change after varicocelectomy. SETTING: University clinical urology practice and research laboratories. PATIENT(S): Infertile men with varicocele (left varicocele only, n = 18; bilateral varicoceles, n = 26) and controls (men with obstructive azoospermia undergoing testicular sperm extraction before intracytoplasmic sperm injection; n = 7). INTERVENTION(S): Left testis biopsies by percutaneous needle aspiration biopsy. Varicocele repair by subinguinal approach. MAIN OUTCOME MEASURE(S): Calcium channel mRNA sequence by reverse transcription-polymerase chain reaction and amplicon analysis; calcium channel protein distribution by immunocytochemistry; cadmium levels by atomic absorption and apoptosis by deoxynucleotidyl transferase labeling; and sperm counts in the ejaculate before and after varicocelectomy. RESULT(S): Calcium channel mRNAs are polymorphic in human testis biopsies from different men. Proteins from sequence-deleted exons 7 and/or 8 localize to germ cell membranes. Expression of undeleted L-type calcium channel mRNAs correlates with normal testes cadmium and increased sperm count after varicocelectomy. Apoptosis is lower in such cases. CONCLUSION(S): Expression of normal testicular L-VDCC sequence in exons 7-8 predicts postvaricocelectomy sperm count increase. Deletions may alter calcium channel function and affect testicular cadmium and apoptosis.

    Title Bilateral Increased Apoptosis and Bilateral Accumulation of Cadmium in Infertile Men with Left Varicocele.
    Date October 2004
    Journal Human Reproduction (oxford, England)
    Excerpt

    BACKGROUND: Varicoceles are associated with venous flux that may cause increased heat and interstitial pressure within the testes, but these effects are variable. Some men with varicocele have infertility, but others do not. We question whether other factors contribute to the infertility, and whether these other factors could be identified by specific molecular/genetic markers. Can such markers predict the outcome of varicocele repair? Can these markers be demonstrated bilaterally in unilateral left varicocele? METHODS: Limited bilateral testes biopsies were obtained by ultrasonically guided percutaneous aspiration at the time of varicocelectomy. In each specimen, cadmium levels were determined by atomic absorption and the percentage apoptosis within the seminiferous tubules was quantified. RESULTS: The percentage of apoptotic nuclei and cadmium levels were high in some men with varicocele. There was a concordance of these values in both testes despite the presence of left-sided varicocele only. These values were inversely related to an increase in sperm concentration after varicocelectomy. CONCLUSIONS: Cadmium, a metal ion inducer of apoptosis, may contribute to this form of male infertility. Apoptosis may deplete the sperm concentration among men with varicocele and infertility. Pre-operative measurements of apoptosis and cadmium content may predict the outcome of varicocele repair.

    Title Increased Seminal Plasma Lead Levels Adversely Affect the Fertility Potential of Sperm in Ivf.
    Date August 2003
    Journal Human Reproduction (oxford, England)
    Excerpt

    BACKGROUND: Lead remains in high levels in the environment and is known to reduce fertility in animal models, but a direct link between lead exposures and human infertility has not yet been established. METHODS: In a prospective, double-blind study of the metal ion levels and sperm function, semen was obtained from partners of 140 consecutive women undergoing their first IVF cycle. Lead in seminal plasma was determined by atomic absorption spectroscopy. Motile sperm populations were assessed for surface receptors for mannose binding, and the ability to undergo premature ('spontaneous'), and free mannose-induced acrosome reactions. Fertile donor (n = 9) sperm were exposed to exogenous lead during capacitating incubations and then assessed for mannose receptor expression and acrosome loss. RESULTS: Lead levels were negatively correlated with IVF rates. Lead levels were negatively correlated to two of the three sperm function biomarkers (mannose receptors, mannose-induced acrosome reactions). Lead levels positively correlated with the spontaneous acrosome reaction. These findings were mimicked by in-vitro exposure of fertile donor sperm to lead. CONCLUSIONS: Multiple sperm parameters are affected as lead levels rise. Increased lead levels may contribute to the production of unexplained male infertility.

    Title A Minimally Invasive Vasectomy with the No Suture, Inline Method for Vas Occlusion.
    Date February 2002
    Journal International Journal of Fertility and Women's Medicine
    Excerpt

    OBJECTIVE: The current vasectomy methods, including the no scalpel vasectomy (NSV), have received considerable attention in recent years, because they are minimally invasive and utilize special instruments to expose the vas. However, at least 28 different methods for vas occlusion have been utilized with these procedures, and some postoperative complications have been attributed to the method of vas occlusion. Therefore, in this report we will critique the existing methods for vas occlusion and introduce a new and rapid method. PATIENTS AND METHODS: The NSV instruments were used to expose the vas, but, in addition, a fine skin hook, a short-bladed tenotomy scissors, and a hand-held, hotwire cautery were used for the new no suture, inline method of vas occlusion. No ligatures were placed around the vas, no portion of the vas was removed, and the mesentery behind the vas was not disturbed. The vas sheath was disrupted, there was luminal cautery on both the abdominal and testicular sides, a section of vas was detubularized and trimmed, and its epithelium was destroyed by cautery. This technique has been performed in 158 consecutive cases. RESULTS: All patients have demonstrated complete azoospermia on two follow-up semen analyses, with no pregnancies reported. CONCLUSION: This new method of vas occlusion seems to be rapid and compatible with the NSV instruments.

    Title The Pathophysiology of Varicoceles in the Light of Current Molecular and Genetic Information.
    Date February 2002
    Journal Human Reproduction Update
    Excerpt

    Varicoceles are a common cause of male infertility, but despite data being obtained from animal models and human studies the pathophysiology remains unclear. Recently, molecular and genetic information has been reported on men with varicoceles which may shed new light onto the causes of decreased semen parameters and poor sperm function. Here, a number of studies are reviewed in an attempt to develop a working hypothesis for the relationship of varicoceles and infertility. New studies on testicular tissue of men with varicoceles have demonstrated increased apoptosis among developing germ cells, which may be the cause of oligospermia. Other studies with semen have shown increased levels of reactive oxygen species (ROS) in association with poor sperm motility. Recent studies of morphologically abnormal spermatozoa have demonstrated disruption of the sperm head actin by cadmium, a cation reported to be present in high concentrations among some men with varicoceles. Finally, microdeletions of the alpha-1 subunit of the sperm calcium channels in a proportion of men with varicoceles suggests a genetic defect leading to abnormal acrosomal function. The intent of this review was to explain the pathophysiology of varicoceles, and the findings seem to support a 'co-factor' hypothesis. In order for varicoceles to be associated with infertility, they exist as 'co-factors' along with other molecular/genetic problems.

    Title The Diagnosis and Treatment of Male Infertility in the New Millennium.
    Date December 2001
    Journal International Journal of Fertility and Women's Medicine
    Excerpt

    Treatment of male infertility accomplished far-reaching advances in the past decade. Semen analysis has given rise to sperm function tests. Microsurgery, e.g., reversal of vasectomy, has reached new heights in sperm retrieval directly from the testis/epididymis and in intracytoplasmic sperm injection (ICSI). Furthermore, genetic testing-for an ever-widening range of anomalies-is the norm in modern clinical practice. This review of what is possible, and now even common, in male infertility treatment focuses on sperm function, and then deficits/anomalies and their treatment; and testicular function and dysfunction, with descriptions of hormonal and surgical techniques that now offer fatherhood to men with types of infertility that strongly imply the need for genetic counseling.

    Title Evaluation of Prostate Volume by Transrectal Ultrasonography for Use in a Brachytherapy Program.
    Date December 2001
    Journal Urology
    Excerpt

    OBJECTIVES: To evaluate two methods of measuring the prostate volume using transrectal ultrasonography. The measurements were performed in vivo at preplanning and again preoperatively in connection with brachytherapy. The accurate measurement of the prostate volume is important in a brachytherapy program for treatment planning. METHODS: A total of 43 patients with biopsy-proven prostate cancer underwent prospective determination of the prostate volume, by one physician, using transrectal ultrasonography. Volume calculations were made at the preplanning and preoperative settings, both by a hand-held rectal probe using the prolate ellipsoid formula and by a mounted probe in a stepping device using the planimetric method. RESULTS: The coefficient of variation between the preplanning and preoperative prostate volumes with the probe holder was less than 3% compared with the hand-held probe, which was greater than 10%. The difference between the median values at the preplanning and preoperative settings by serial planimetry was 2.5 cm(3) (range 0.2 to 9.4). The difference in the median volumes between the preplanning and preoperative ellipsoid calculations was 6.7 cm(3) (range 0.3 to 38.7). The difference between the median values with the ellipsoid volume was significant (P <0.001). The Pearson correlation coefficient for all values using the planimetric method was 0.92 versus 0.58 for the ellipsoid method. The correlation coefficient was significantly greater for the planimetric method (P <0.001). CONCLUSIONS: On the basis of these data, planimetric prostate volume determination, by a single ultrasonographer, is an accurate and reproducible method with applicability to a brachytherapy program.

    Title A Modified Acrosome Induction Test.
    Date March 2000
    Journal Archives of Andrology
    Excerpt

    Many types of acrosome induction tests require special equipment and reagents that are not available to most clinicians; thus, simpler tests seem desirable. A modified acrosome induction test has been developed that uses basic reagents and a light microscope, which are available in most office settings. A hypoosmotic swelling test and a double stain (Bismark brown and rose Bengal) were combined to evaluate the viable acrosome reaction (AR) among 74 infertile men and 42 control men. The study included 34 infertile males without varicoceles, 20 with nonrepaired varicoceles and 20 with repaired varicoceles. On each test day, a specimen from a fertile donor was run as a control. The spontaneous acrosome reaction was recorded in semen before and after capacitation. The final % viable acrosome reaction equaled the capacitated value minus the spontaneous value for whole semen. The mean % viable AR among the control specimens was 16% with no values less than 10%. This mean value for controls was significantly greater than the mean % viable AR in each patient group. There were no overlaps in the 95% confidence intervals. When the study group was stratified according to normal acrosome induction tests or >10% viable AR, 30 patients had a normal test and 44 had abnormal tests. Six patients with varicoceles and an abnormal acrosome induction test had a varicocelectomy, and 2 (33%) converted their acrosome induction test to normal after at least 6 months of follow-up. Nine patients had in vitro fertilization (IVF), 3 had a poor result, and all had an abnormal acrosome induction test. Six had a good result with IVF and all 6 had a normal acrosome induction test. Thus, the acrosome induction test described in this report may be performed in any office laboratory to detect subtle male factor problems. The results may be helpful for planning IVF, intracytoplasmic sperm injection, or varicocele surgery for infertile men.

    Title Modified Vasoepididymostomy with Simultaneous Double Needle Placement, Tubulotomy and Tubular Invagination.
    Date February 2000
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Recently a new technique for vasoepididymostomy was described which included tubular invagination by the triangulation method with a patency rate of 92%. Although these early data were encouraging, some technical problems were noted with the technique. After placing the first suture there was often tubular leakage and collapse. The tubulotomy was difficult and in some cases a suture was inadvertently cut. A modified technique is presented for vasoepididymostomy with tubular invagination, including some methods described in rat models. Only 2 sutures are used with simultaneous double needle placement. MATERIALS AND METHODS: The 2-suture technique was used on 19 men who had undergone at least 1 vasoepididymostomy during vasectomy reversal procedures. RESULTS: Patency was demonstrated in 7 of 9 men (77.7%) who underwent modified bilateral vasoepididymostomy and 6 of 7 (85.7%) who underwent unilateral vasoepididymostomy and unilateral vasovasostomy. Pregnancies were reported in both groups. The overall operating time for the modified technique was about 35 to 45 minutes per side. CONCLUSIONS: Modified vasoepididymostomy with simultaneous needle placement, tubulotomy and invagination resulted in early patency in a high percentage of patients. Tubular invagination may have advantages compared to other conventional methods of vasoepididymostomy but more followup is needed.

    Title Use of Diuretic Renogram in Evaluation of Patients Before and After Endopyelotomy.
    Date March 1999
    Journal Urology
    Excerpt

    OBJECTIVES: Endopyelotomy is a widely accepted alternative in the treatment of ureteropelvic junction (UPJ) obstruction, with success rates between 63% and 88%. However, various methods have been used to evaluate patients with UPJ obstruction, making it difficult to compare results. Diuretic renography has the potential to unify the evaluation if performed in standard ways. In this report, we present a standardized protocol for diuretic renography. METHODS: Nineteen endopyelotomies were performed by one surgeon (E.B.K.) at our institution. The 16 patients were evaluated with technetium 99m MAG-3 diuretic renography. The presence or absence of obstruction was classified according to the differential renal function, time activity curves, and Tmax to T 1/2max time. Three patients had a postoperative Whitaker's test. RESULTS: Eight patients had pre- and postoperative diuretic renograms at our institution. This group was stratified by their differential renal function. Among 4 patients with differential renal function greater than 35%, 3 of 4 showed progressive improvement in renal function postoperatively, 4 of 4 had a Tmax to T 1/2max time less than 10 minutes, and 3 of 4 ha d unobstructed time activity curves. Five patients had postoperative renograms only. Of these 5 patients, 4 had differential renal function greater than 35% and 3 of 5 had normal-appearing curves and normal Tmax to T 1/2max time. Three patients required a second endopyelotomy and 2 of these underwent a dismembered pyeloplasty. CONCLUSIONS: Standardized diuretic renography should be used as an objective test for the evaluation of patients with UPJ obstruction. The successful outcome of an endopyelotomy depends on the preoperative renal function of the involved kidney. Whitaker's test may be used for equivocal cases.

    Title The Fate of Cryopreserved Sperm Acquired During Vasectomy Reversals.
    Date February 1999
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Intraoperative sperm banking has been recommended during vasectomy reversal. These specimens are maintained as insurance for possible future intracytoplasmic sperm injection. We evaluated the fate of specimens collected intraoperatively from 48 vasectomy reversal patients. MATERIALS AND METHODS: Of 75 men 48 (64.0%) agreed to intraoperative sperm banking during vasectomy reversal. A total of 135 vials of epididymal sperm, 81 vials of testicular tissue and 13 vials of vasal sperm were cryopreserved. RESULTS: Among couples who stored sperm 10 (20.8%) voluntarily discarded the specimens within 4 months of vasectomy reversal. Specimens from 31 couples (64.5%) remain in storage. Seven couples (14.6%) have used frozen sperm for intracytoplasmic sperm injection. In 3 of these couples the men were azoospermic after surgery, 2 men had 10,000 to 15,000 sperm per ml. in the ejaculate with limited motility and 2 had 1 to 2 million sperm per ml. with limited motility. The 7 women who underwent intracytoplasmic sperm injection ranged between 37 and 39 years old, which was older than the mean age of the remaining study group (32.7 years). With intracytoplasmic sperm injection fertilization was achieved in all cases and 20 of 47 eggs (42.5%) developed into embryos. Of 7 women 4 achieved biochemical pregnancies (57.1%) and 2 (28.6%) delivered newborns with epididymal sperm. Natural pregnancy occurred in 7 of 16 vasectomy reversal couples (43.7%) who were followed at least 18 months postoperatively but the time to pregnancy averaged 1 year. CONCLUSIONS: Cryopreservation of sperm collected at vasectomy reversal is recommended for patients undergoing vasoepididymostomy or vasovasostomy. The couples who used the cryopreserved sperm for intracytoplasmic sperm injection included husbands whose postoperative ejaculate remained azoospermic or severely oligospermic and wives who were approaching 40 years old. Only a limited number of couples (14.6% of the study group) have used the cryopreserved sperm but the delivered newborn rate (28.6%) was comparable to other intracytoplasmic sperm injection data. The natural pregnancy rate after vasectomy reversal was 43.7% but the time to pregnancy after surgery was lengthy (average 1 year). These findings may be helpful for counseling couples who are planning vasectomy reversal surgery and may be considering intraoperative sperm banking.

    Title The Emergence of Specialized Procedures for the Acquisition, Processing, and Cryopreservation of Epididymal and Testicular Sperm in Connection with Intracytoplasmic Sperm Injection.
    Date December 1998
    Journal Journal of Andrology
    Excerpt

    Epididymal and testicular spermatozoa have been used widely for ICSI among men with obstructive azoospermia and NOA. New aspiration and biopsy techniques are available, and several sperm preparation methods have been described to isolate sperm. Most samples have sufficient sperm for cryopreservation. Accordingly, clinicians must sort through these new procedures to develop treatment plans that best suit their practices. In the future, other methods will be developed, and clinicians will have to critically review them prior to use.

    Title Complete Replication of Human Sperm Genome in Egg Extracts from Xenopus Laevis.
    Date April 1998
    Journal Biology of Reproduction
    Excerpt

    To examine the ability of Xenopus egg extracts to support a complete replication cycle of human sperm genome, demembranated human spermatozoa were incubated with the extract from activated Xenopus laevis eggs. Most sperm heads were decondensed within 15 min. The heads became round within 30 min with diameters of 10-30 microns. The process of DNA replication in the pronuclei was monitored by two methods, bromodeoxyuridine incorporation and flow cytometry. The results indicate that DNA replication was initiated approximately 1.5 h after membrane structure formation and that it lasted up to 9 h. The amounts of DNA in most pronuclei were doubled by 4-9 h, depending on which donor toad was the source of the egg extract. Inclusion of the protein synthesis inhibitor, cycloheximide (100 micrograms/ml), had no obvious effect on human sperm DNA replication but appeared to prevent the pronuclei from degradation after a prolonged period (> 6 h) of incubation. After storage in liquid nitrogen for > 1.5 mo, the efficiency of the egg extracts in supporting sperm head decondensation and DNA replication was reduced for human sperm but not for Xenopus sperm. Possible applications of the use of Xenopus egg extract for human sperm activation and DNA replication are discussed.

    Title Management of the Epididymal Tubule During an End-to-side Vasoepididymostomy.
    Date July 1995
    Journal The Journal of Urology
    Excerpt

    Microsurgical repairs of epididymal obstruction have improved because of specific tubule anastomoses. However, these techniques require considerable microsurgical skills and any modifications to organize and simplify these procedures seem desirable. Four modifications are described for the management of the epididymal tubule during end-to-side vasoepididymostomy, including closed tubule fixation, micro-tubulotomy, micro-suction and placement of double-armed sutures through the epididymal tubule before attachment of the vas. These procedures have been performed on 51 patients. "Mixed procedures," or a modified vasoepididymostomy on 1 side and a vasovasostomy on the other, were done in 32 cases and "pure procedures," which included bilateral modified end-to-side vasoepididymostomy (16) and unilateral procedures (3), were done in 19. The semen and pregnancy data for the 19 cases of pure procedures were patency rate 58% in 11 and pregnancy rate 42% in 8. These modifications appeared to be helpful to organize and simplify several aspects of the procedure, and the results were improved compared to other techniques.

    Title Urethral Stricture and Semen Quality.
    Date April 1995
    Journal International Journal of Fertility and Menopausal Studies
    Excerpt

    OBJECTIVE--To study the relationship between urethral stricture and infertility, which has not been well studied in the past. PATIENTS AND METHODS--In this study in West Africa, the mean semen values from 90 fertile controls and 32 infertile controls were compared to 40 men with incomplete urethral strictures (IUS) and 56 men with complete urethral strictures after treatment. Testicular biopsies were performed on 30 patients. Sexually transmitted urethritis accounted for 79% of the strictures within this group of patients. Repair of the strictures restored ejaculate in 39 men, and 22 men had normospermia (20 million/mL); however, the remainder had either azoospermia or oligospermia. The biopsies revealed normal spermatogenesis in 5 men, which suggested ductal obstruction, but 14 patients had destruction of seminiferous tubules suggesting end organ failure. Eleven other men had hypospermatogenesis, maturation arrest, or premature sloughing of cells, which may be amenable to treatment. CONCLUSIONS--These data suggest that early medical treatment and repair of urethral stricture may improve fertility for men with urethral strictures, especially strictures following infectious urethritis. Testicular biopsies may aid in the diagnosis of persistent infertility among these men, and should be considered as part of the work-up.

    Title Subinguinal Microsurgical Varicocelectomy: a Technical Critique and Statistical Analysis of Semen and Pregnancy Data.
    Date September 1994
    Journal The Journal of Urology
    Excerpt

    A total of 606 modified subinguinal microscopic varicocelectomies was performed on 466 outpatients using local anesthesia and sedation. The patients selected for these procedures were infertile for at least 12 months and had at least 1 semen parameter below threshold level: less than 20 million per ml., less than 50% motility or less than 40% normal morphological forms. The lymphatics, spermatic artery and vas were preserved, whereas all refluxive veins were transected or obliterated. Postoperative complications were limited to transient epididymal discomfort in 5.5% of the patients, ecchymosis at the wound site in 3.4% and wound inflammation in 2.4%. There was only 1 permanent hydrocele. The palpable recurrence rate was 0.82% per procedure. The median values for each semen parameter were compared preoperatively and postoperatively by the Wilcoxon signed rank test. The differences in the median values were significant for all parameters. As an alternative statistical model, the average preoperative semen value was subtracted from the average postoperative semen value for each parameter. The median differences were 10.8 million sperm per ml. for sperm density, 13.9% for motility and 3.8% for normal morphological forms. These differences were significantly greater than zero by the Wilcoxon signed rank test. The intra-quartile ranges for these differences suggested that postoperatively more than 75% of the patients had a difference of greater than zero for sperm density and per cent motility, and 63% had a difference of greater than zero for normal morphology. The 1-year pregnancy rate was 35.6% for 186 varicocelectomy patients compared to 15.8% for 19 medically treated men with varicocele. The difference between the true 1-year pregnancy rates was 19.8% and the 95% confidence intervals estimated bounds of 1.91 to 37.5%. These data suggest that outpatient subinguinal microscopic varicocelectomy has minimal morbidity and recurrence, and may be beneficial for select patients.

    Title Microsurgical Aspiration of Sperm from the Epididymis: a Mobile Program.
    Date May 1993
    Journal The Journal of Urology
    Excerpt

    We report data from 25 microsurgical aspirations of the epididymis on 22 men. There were 14 men with congenital absence of the vas, 6 with failed vasoepididymostomy, 1 with adult cystic fibrosis and 1 with a childhood hernia repair. The specimens were used for assisted reproductive technologies, including in vitro fertilization and tubal embryo transfer. The protocol for aspiration, ovulation induction and sperm processing evolved during the course of these studies, and the patients were classified into 2 groups on the basis of methodology. Seventeen procedures were performed for the in-house in vitro fertilization team but 8 other procedures were done for nearby in vitro fertilization centers, and the final prepared sperm samples were transported as part of our mobile program. Group 1 patients underwent standard aspiration techniques, standard ovulation induction and sperm processing by wash and swim up. Among this group there were no fertilizations or pregnancies with 8 in-house and 2 transported specimens. Group 2 patients had leuprolide suppression before ovulation induction, direct intratubular aspiration and a complex sperm preparation, including pentoxifylline stimulation, mini-Percoll filtration and incubation with human follicular fluid. Among this group there were 2 fertilizations and 1 pregnancy with 9 in-house cases, and 3 fertilizations and 2 pregnancies with 6 transported specimens. These results suggest that a mobile program for microsurgical aspirations of sperm from the epididymis and in vitro fertilization or tubal embryo transfer is feasible within the framework of a strict protocol.

    Title Insemination Data on Men with Varicoceles.
    Date June 1992
    Journal Fertility and Sterility
    Excerpt

    OBJECTIVE: To determine possible benefits of sperm processing and intrauterine insemination (IUI) for a group of men with a varicocele history who had not achieved a pregnancy by natural coitus (mean duration of infertility 42.2 months). DESIGN: A retrospective study including infertile men with varicoceles who were classified by their semen analyses and sperm penetration assays (SPAs). SETTING: Private practice of infertility. PATIENTS: Seventy-one infertile couples. The husbands had a varicocele history and were grouped into four clinical categories (14 untreated, 5 medical treatment, 34 varicocelectomies, and 18 varicocelectomies plus medical treatment). The wives were studied or treated before IUI. INTERVENTIONS: Varicocelectomies were performed on the males when indicated. Female studies included laparoscopies as indicated intrauterine insemination with Tomcat catheter (Sherwood Medical, St. Louis, MO) was performed in all cases. MAIN OUTCOME MEASURES: Overall pregnancy rates (PRs) and fecundity rates with sperm processing and IUI. RESULTS: Six pregnancies occurred with 66 cycles of sperm processing and IUI among 28 men with normal SPAs (PR 21%, fecundity rate = 0.09). In contrast, there were no pregnancies with 121 cycles among 43 varicocele patients with abnormal SPA results or with low values for all three semen parameters. CONCLUSIONS: Sperm processing and IUI may be beneficial for selected patients with varicoceles who had not achieved a pregnancy by coitus.

    Title The Status of Vasectomy Reversals.
    Date February 1992
    Journal International Journal of Fertility
    Excerpt

    Vasectomy reversals are being requested in increasing numbers. Non-urologists are often the first physicians consulted about such procedures. In some instances, these physicians know very little about the procedures, and the consultation leads to confusion and frustration. In this report, current facts on vasectomy reversals will be provided for the benefit of non-urologists.

    Title A Modified Vasoepididymostomy Performed with the Sling and Blanket Technique.
    Date February 1990
    Journal The Journal of Urology
    Excerpt

    A modification is presented for the end-to-end type of vasoepididymostomy known as the sling and blanket. We have exploited the differences in size between the vas and epididymis to gain a mechanical advantage. When the epididymis is transected the redundant tunic is preserved. The sling is created from the tunic, which is drawn forward and sutured to the vas posteriorly about 1 cm. from its cut end. The sling provides support so that the end-to-end anastomosis between the vas lumen and specific epididymal tubule may be completed in 1 plane and without rotation. The blanket is created from the remaining epididymal tunic, which is sutured anteriorly to cover the anastomosis and stabilize the vas. The procedure was performed on 8 patients with primary epididymal obstruction. The patency rate was 50% and the pregnancy rate was 25%. Although vasoepididymostomy remains a difficult microsurgical operation, this modification seems to be beneficial in selected cases.

    Title The Use of a Vacuum Constrictor Device to Augment a Partial Erection Following an Intracavernous Injection.
    Date November 1988
    Journal The Journal of Urology
    Excerpt

    Intracavernous injections and vacuum constrictor devices have been used for the nonoperative management of impotence and sexual dysfunction. Although most men are able to use these methods successfully, it currently is well known that up to 30 to 35 per cent of the patients may have only a partial response to the injections. We observed 22 men with partial tumescence after an intracavernous injection of papaverine (15 to 30 mg.) and phentolamine (0.5 to 1.0 mg.). The penis was not rigid and the buckling pressures never exceeded 50 mm. Hg after 20 minutes of observation. In each case we immediately applied a vacuum constrictor device because these devices had been used successfully by other men with similar diagnoses. A total of 21 men responded within 30 to 60 seconds and achieved a rigid erection with buckling pressures of greater than 100 mm. Hg (16) and 60 mm. Hg (5). These findings indicate that a vacuum constrictor device may be used to augment a partial response to an intracavernous injection and that the availability of injections and vacuum constrictor devices provides these men with a more complete nonoperative program.

    Title Penile Plethysmography on Impotent Men Using Vacuum Constrictor Devices.
    Date October 1988
    Journal Urology
    Excerpt

    Vacuum constrictor devices achieve an erection-like state of the penis by means of a clear plastic cylinder, a vacuum pump, and a constrictor ring. Although these devices are noninvasive compared with penile injections and implants, they have been used less often in clinical practice. Part of the hesitancy to prescribe these devices has been related to the lack of published data concerning the effects of constriction on penile blood flow. In this report, we utilized penile plethysmography to estimate penile blood flow on 51 men before, during, and after the use of the constrictor ring. All patients demonstrated a 70-75 percent decline in the amplitude of the pulse-volume curve during constriction, but continuous blood flow was maintained in each case. Within sixty seconds after removal of the ring, the amplitude returned to baseline values for all men, including 12 patients with a penile brachial index of less than 0.7. Among 33 patients, there was evidence of a transient increase of amplitude following constriction, which was consistent with a postischemic hyperemia. These findings suggest normal penile blood flow, and indicate that the use of constrictor rings may be safe for patients with these tracings. Penile plethysmography appears to be a useful technique to help with patient selection and constrictor ring fit. Follow-up tracings probably should be scheduled at periodic intervals for men utilizing these rings and devices.

    Title Use of Papaverine During Vasovasostomy.
    Date August 1986
    Journal Urology
    Title Transseptal Crossed Vasovasostomy.
    Date December 1985
    Journal The Journal of Urology
    Excerpt

    We examined 11 patients with acquired obstructive azoospermia resulting from irreparable obstruction of 1 vas deferens and severe damage to the contralateral testis. All of the patients underwent transseptal crossed vasovasostomy with no morbidity. Of 8 patients evaluated with postoperative semen analyses 4 (50 per cent) demonstrated total sperm counts of 29 to 205 million and 2 pregnancies (25 per cent) have been reported, with followup ranging from 5 months to 2 years. The etiologies of the vasal obstruction included previous inguinal surgery in 7 patients, vasectomy in 1, ejaculatory duct obstruction in 1, ectopic ureter in 1 and vasal agenesis in 1. Factors leading to loss of the contralateral testis were torsion in 5 patients, mumps orchitis in 2, varicocele in 1, pediatric inguinal herniorrhaphy in 1, epididymal blow out in 1 and unknown in 1. A representative case involving a unilateral ectopic ureter emptying into the seminal vesicle and subsequent contralateral testicular torsion is presented. The results indicate that a transseptal crossed vasovasostomy should be done in patients satisfying the criteria presented.

    Title Comprehensive Scrotal Flow and Scan Technique for Detection of Varicoceles.
    Date June 1985
    Journal Urology
    Excerpt

    We describe a noninvasive modified radionuclide technique, the "comprehensive scrotal flow and scan," for the detection of varicoceles. The procedure utilizes in-vivo-labeled pyrophosphate red blood cells and 99mTc-pertechnetate as a blood pool scanning agent. The procedure includes an immediate flow study along with early and delayed static images, both in the upright and supine position. These studies were examined by visual inspection and by computer analysis. Data were obtained from 50 patients and 8 control subjects. The technique demonstrated a 91.1 per cent sensitivity when compared to physical examination and an 84.6 per cent sensitivity when compared to venography from patients with subclinical or poorly palpable varicoceles.

    Title The Management of Varicoceles by Microdissection of the Spermatic Cord at the External Inguinal Ring.
    Date May 1985
    Journal Fertility and Sterility
    Excerpt

    A new technique for the management of varicoceles was carried out on 71 infertile men. The procedure combined microdissection of the spermatic cord at the external inguinal ring, ligation of the dilated veins, and controlled sclerosis of small cross-collateral veins. These procedures were performed on an outpatient basis and usually with local anesthesia. The surgery was completed within 20 to 30 minutes, and the postoperative morbidity was minimal. Twenty-four cases were followed for at least 18 months postoperatively. Among this group, the mean values for sperm density and sperm motility increased after surgery. The difference between the means were significant (P less than 0.001). The pregnancy rate among this group was 29.3%.

    Title Clinical Experience with an Artificial Spermatocele.
    Date October 1984
    Journal Journal of Andrology
    Excerpt

    Artificial spermatoceles were implanted into three patients with congenital absence of the vas. In each case, the testicular biopsy demonstrated normal spermatogenesis, and the dilated epididymal tubule was packed with spermatozoa. The ciliated epididymal mucosa appeared normal despite the tubular dilatation. The spermatoceles were constructed of expanded polytetrafluoroethylene, and they were microsurgically implanted over the cut end of the epididymis. The grafts were aspirated monthly for up to six months, and the aspirates containing spermatozoa were used for artificial insemination. Spermatozoa were consistently retrieved from each patient, but no pregnancies have resulted. The most obvious finding was that the spermatozoa lacked motility. In the discussion, other problems related to artificial spermatoceles are reviewed, including epididymal development and sperm maturation, aspiration techniques, and sperm storage.

    Title Male Contraceptive Sought.
    Date May 1984
    Journal Planned Parenthood Review
    Title The Identification of Functioning Plasma Cells in Cervical Tissue by an Immunoperoxidase Technique.
    Date August 1981
    Journal International Journal of Fertility
    Excerpt

    The detection of sperm agglutinating antibodies in the blood has become a basic screening test for the infertility workup. However, documentation of these antibodies in the cervical mucus has been variable because procurement and preparation of this genital secretion is often difficult. In this report the local immune response has been examined in cervical tissue instead of mucus. A small biopsy was taken from the endo- and ectocervix and treated by an immunoperoxidase technique. Functioning plasma cells were clearly identified. This technique may be adaptable for clinical practice as part of the evaluation of immune infertility.

    Title Values for Zinc in Whole Semen, Fractions of Split Ejaculate, and Expressed Prostatic Fluid.
    Date February 1981
    Journal Urology
    Excerpt

    Since the prostate gland secretes specific substances, several investigators have suggested that measurement of these products may be useful for the evaluation of prostatitis. In our laboratory we have measured seminal zinc as a marker of prostatic secretion to establish normal values and define the confidence limits for this assay. Zinc assays were performed on whole semen, fractions of the split ejaculate, and expressed prostatic fluid from among a population of 456 men. We hope that these data will be useful when compared with data from patients with prostatic disease.

    Title Functional Role of Spermagglutinating Antibodies in Men.
    Date December 1980
    Journal Fertility and Sterility
    Excerpt

    The presence of spermagglutinating antibodies in blood and semen has been associated with reduced fertility in men. In this study 203 men were screened for infertility. An antibody measurement was performed on the blood and semen of each patient. Each semen specimen was also examined for spontaneous agglutination. Twelve patients with a positive reaction in the blood underwent a sperm-cervical mucus contact test. We have attempted to correlate the findings in blood with the observed functional results in semen and cervical mucus. We believe that these simple tests should be included in the infertility work-up in order to determine the presence of immune infertility.

    Title A Protocol for Evaluation of Prostatitis.
    Date December 1980
    Journal Urology
    Excerpt

    The traditional office diagnosis of prostatitis has been based on clinical history, rectal palpation of the gland, and a microscopic examination of the expressed prostatic fluid. In light of present day information this appraoch appears to be incomplete. We have examined 41 consecutive patients with complaints of prostatitis along with 17 controls. In each case expressed prostatic fluid was collected under sterile conditions. On each specimen, we performed a bacterial culture, microscopic examination for white blood cells, and assay for zinc. The intent of this protocol was to classify clearly those with bacterial prostatitis from those with nonbacterial prostatitis and prostatodynia. We believe this approach is simple to perform even in the setting of a busy office practice.

    Title Modification of the Friberg Microagglutination Tray Technique for Detection of Sperm Antibodies.
    Date November 1980
    Journal Archives of Andrology
    Excerpt

    The Friberg microagglutination tray technique for the detection of sperm-agglutinating antibodies in the serum has several advantages over other techniques. Microquantities of a single-donor sperm specimen may be used for several tests and the agglutinates may be examined directly with an inverted lense microscope. However, in its original form, there were a few technical problems. The technique has been modified to eliminate the problems. The donor sperm is filtered through a glass wool filter. The procedure was adapted for Terasaki tissue culture plates. With these modifications the technique seems more practical for clinical usage.

    Title An Estimate of the Fertility Potential of the Fractions of the Split Ejaculate in Terms of the Motile Sperm Count.
    Date October 1979
    Journal Fertility and Sterility
    Excerpt

    The motile sperm count is a simple index which is equivalent to the product of sperm density (millions of sperm per milliliter) and percentage of motility (motile sperm per 100 sperm x 0.01). Since other studies have demonstrated a positive correlation between this index and the pregnancy rate, it has been hypothesized that the motile sperm count could be useful for expressing the potential fertility of individual semen specimens. Collection of semen by the split ejaculate technique and subsequent artificial insemination homologous (AIH) with the best split fraction has been used for the treatment of oligospermia. We calculated the motile sperm count for whole semen and the first fraction of split ejaculates from 45 men who were studied for infertility. Subsequently, 15 couples agreed to AIH with the first fraction of the split ejaculate. The data indicate that the motile sperm count may be a reasonable index for comparing the potential fertility of the semen specimens and thereby estimating the chances of successful AIH.

    Title Statisical Comparison of the Parameters of Semen Analysis of Whole Semen Versus the Fractions of the Split Ejaculate.
    Date January 1979
    Journal Fertility and Sterility
    Excerpt

    The split ejaculate has proven to be a reliable method for concentrating sperm in a small volume. However, there is some controversy whether the spermatozoa in the most sperm-rich fraction of the split ejaculate has better motility than the spermatozoa in whole semen. In this study, at least two specimens of whole semen and two split ejaculates were obtained from 45 infertile males. The mean values for the parameters of the semen analysis were compared statistically. Our data indicate that increased sperm density is a consistent finding with the split ejaculate, even for severely oligospermic men. However, improved sperm motility with the split ejaculate is more variable. On the other hand, patients with mild oligospermia (10 to 40 million sperm/ml of whole semen) and high semen volumes (greater than 5.0 ml) demonstrated improvement in all parameters in the split ejaculate.

    Title Urethrographic Manifestations of Venereal Warts (condyloma Acuminata).
    Date April 1978
    Journal Radiology
    Excerpt

    Intraurethral spread of venereal warts is a serious complication. Urethral involvement may be extensive and is associated with severe irritative symptoms. Spread to the bladder is possible. Recurrence are frequent and eradication difficult. We describe the urethrographic appearance of intraurethral verrucae and believe it to be strongly suggestive of the diagnosis. Voiding cystourethrography is recommended, and satisfactory visualization may be obtained with either voiding or retrograde urethrography. Voiding urethrography following intravenously administered contrast (excretory voiding cystourethrography) is particularly advantageous since it avoids the need for urethral instrumentation and, therefore, cannot contribute to retrograde spread of these contagious growths.

    Title Postcoital-voiding Insemination: Technique for Patients with Retrograde Ejaculation and Infertility.
    Date April 1977
    Journal Urology
    Excerpt

    Three patients with infertility secondary to retrograde ejaculation demonstrated motile sperm in their urine after coitus. These patients were instructed to alkalinize their urine and void directly into the vagina after intercourse. The technique was called "postcoital-voiding insemination." Three pregnancies have resulted. The technique appears to be a good alternative to bladder catheterization and artificial insemination.

    Title Semen Zinc Levels in Infertile and Postvasectomy Patients and Patients with Prostatitis.
    Date February 1976
    Journal Fertility and Sterility
    Excerpt

    The semen zinc levels were determined in 18 volunteers, 132 patients postvasectomy, and in 19 patients with prostatitis. The mean values for semen zinc were the same in the volunteers and postvasectomy patients. However, the mean zinc concentration in the volunteers and postvasectomy patients was significantly different from that of the patients with prostatitis. When a group of 12 patients with prostatitis was given supplementary zinc sulfate, the levels of semen zinc rose dramatically and were significantly different from those before treatment. As part of an infertility evaluation, 153 specimens from 72 men who had not fathered a child were examined. A complete semen analysis of each specimen was made, including the semen zinc concentration. The specimens were separated into four arbitrary groups with differing fertility potential. The groups were organized by sperm counts (less than 20 million sperm/ml, 20 to 60 million sperm/ml, 60 to 100 million sperm/ml, and greater than 100 million sperm/ml). There was a trend toward increasing zinc concentrations in the groups with increasing fertility potential. Eleven patients with oligospermia and low semen zinc levels were given supplementary zinc sulfate, 80 mg three times/day for 6 months to 1 year. The parameters of the semen analysis improved in all categories. There were three pregnancies during the period of treatment.

    Title Preoperative Urography in Hypotensive Patients with Severe Trauma.
    Date May 1975
    Journal Urology
    Excerpt

    In hypotensive patients with severe trauma including renal injuries, the preoperative urogram is generally of poor quality. In many instances these patients are taken to the operating room with no films at all. We have proposed a protocol for the resuscitation of severely injured patients, following which we performed a carefully monitored high-dosage urogram. We demonstrated in 16 patients that diagnostic films can be obtained even in severely injured patients who were initially in shock.

    Title The Management of Resistant Chancroid in Vietnam.
    Date July 1972
    Journal The Journal of Urology
    Title Is the Umbrella Filter Safe?
    Date June 1972
    Journal The New England Journal of Medicine
    Title The Transurethral Resection Reaction Secondary to Intraperitoneal Extravasation of Irrigating Solution.
    Date November 1970
    Journal The Journal of Urology
    Title The Management of Ureteral Obstruction with Silicone Rubber Splint Catheters.
    Date November 1970
    Journal The Journal of Urology
    Title The Activity of Serum Enzymes Following Prostatic Operation.
    Date August 1969
    Journal The Journal of Urology
    Title Angiographic Management of Pseudoaneurysm and Arteriocalyceal Fistula Following Blunt Trauma: Case Report and Review of the Literature.
    Date
    Journal The Canadian Journal of Urology
    Excerpt

    We report a case of blunt trauma causing both a pseudoaneurysm and an arteriocalyceal fistula. These 2 lesions have not previously been reported occurring simultaneously as a complication of renal trauma. Pathophysiology, clinical presentation, and management options are discussed. Angiography in this case was both diagnostic and therapeutic. Selective and superselective gelfoam embolization led to immediate resolution of both injuries.

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