Parviz K. Kavoussi, M.D., F.A.C.S. Reproductive Urologist
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Spring 06 2 27.Qxp
University of California, Irvine School of Medicine Spring 2006 UCI Medical Center Department of Urology 101 THE CITY DRIVE SOUTH ORANGE, CA 92868-5395 N E W S L E T T E R Re-United: The facts about vasectomy reversal "When a man consents to undergo a vasectomy, he is usually instructed that the procedure should be considered Aaron Spitz, MD to be permanent and irreversible.... Nonetheless, even the Assistant Clinical Professor Male Reproductive Medicine most insightful, thoughtful decision can ultimately prove and Surgery wrong. When that decision is a vasectomy, a man may still change his mind." re you considering a vasec- tomy. Therefore, before undergoing a tomy reversal? Thousands vasectomy, a man should be as sure as A of men undergo vasectomy possible that he is finished having chil- each year as a permanent means of dren. Nonetheless, even the most birth control, yet for some of these men insightful, thoughtful decision can ulti- life brings unexpected turns, which mately prove wrong. When that deci- leads them to change their mind. For sion is a vasectomy, a man may still Epididymo-vasostomy some, there is a strong desire to have change his mind. sperm travel from the testicle to the another child a few years later. For urethra. It feels like a piece of under- others, there may be a tragic loss of a What is a vasectomy? cooked spaghetti in each side of the child. For many men, a new marriage To understand the vasectomy reversal, scrotum. The sperm are produced in brings a new opportunity for creating a it is important to understand the vasec- the testicle, and then they exit out the family. -
Reproductive MEDICINE Approximately One in Six Couples Will Experience Difficulty Conceiving
reproductive MEDICINE Approximately one in six couples will experience difficulty conceiving. Our team can help. Welcome to the CMC Center for Reproductive Medicine at CMC Women’s Institute. From the moment you enter our office, you will experience the warm and welcoming atmosphere, the expert medical care and the success that truly makes the CMC Center for Reproductive Medicine one of the best centers in the region. Our physicians have over 50 years combined experience and are the only all board-certified Reproductive Endocrinology and Infertility team near Charlotte. Whether your infertility issue is simple or complex, our caring team will do everything it can to help you achieve your dream of having a baby. “The nurses are your biggest cheerleaders, and the doctors are your rock which helps you through to the next steps. Whenever I see my girls smile and giggle, every shot, test and office visit suddenly becomes a part of the story of how our family was created. There are no words to express my gratitude for the doctors and staff at CMC Center for Reproductive Medicine.” -Melissa Harrison Highly Trained When “high tech” treatment is needed, our physicians provide comprehensive care, seeking out the most effective new technologies with the best trained andrology and embryology specialists in the region. Our services include: Fertility Services • Intrauterine sperm inseminations (IUI) We believe that open communication is one of the most important elements of fertility • In vitro fertilization (IVF) treatment. This is why our entire staff is committed to listening to your concerns and • Donor egg program keeping you fully informed throughout your entire treatment plan. -
Reproductive Endocrinology and Infertility the American Board of Obstetrics and Gynecology, Inc
1 2019 Bulletin for Subspecialty Certification in Reproductive Endocrinology and Infertility The American Board of Obstetrics and Gynecology, Inc. 2915 Vine St., Dallas, TX 75204 First in Women’s Health This Bulletin, issued in January 2018, represents the official statement of the 2019 requirements for subspecialty certification in Reproductive Endocrinology and Infertility 2 Important Information for all Candidates 1. Beginning in calendar year 2020, all physicians who have completed an ABOG or ACGME fellowship in Reproductive Endocrinology and Infertility must achieve ABOG subspecialty certification within 8 years of completion of their training. If certification is not achieved within 8 years, the physician no longer will be eligible to apply for either the qualifying or certifying subspecialty examination unless an additional 6 months of subspecialty training is completed. Physicians who have completed subspecialty training in calendar year 2012 or earlier must be subspecialty certified by 2020 or will be required to complete an additional 6 months of training before regaining eligibility to apply for certification. 2. The preparation of case lists for the Certifying Examination has changed. Candidates will no longer submit paper case lists. Rather, submission will be electronic. Candidates MUST use the electronic reproductive endocrinology and infertility case list forms that will be posted on their ABOG Personal Page in early 2018. 3. Fellows may take up to 8 weeks off each of the fellowship years. The total time off may not exceed 15 weeks over the three years. 4. All fees must be paid by credit card through the ABOG website (www.abog.org) and are payable in US Dollars only. -
Vasectomy Reversal (VR)
Vasectomy Reversal (VR) ! Need to know Please read this before your Vasectomy Reversal Preparing for the VR • Do not eat or drink after midnight if your operation is in the morning and not after 7.00am if it is in the afternoon. • Please shave the hair at the front and sides of the scrotum from the base of the penis down. You do not need to shave the pubic hair • Take supportive underpants (not your best) or a jockstrap into the hospital with you and to theatre to wear after the operation. • Arrange a week off work. • Avoid intercourse for two weeks after the operation and heavy lifting for four weeks. REF 0000.0 – 12/15 What to expect during the VR • An infection of the scrotum rarely occurs but if it does, • An incision is placed on each side of the scrotum that will present a few days after the surgery and is apparent are a little larger than those used for the vasectomy. because the pain becomes worse rather than better and the scrotum becomes red. • The vas is a very small muscular tube with a 2mm outer diameter and an inner diameter through which If you experience any of the above complications or sperm flow (the lumen), of less than 1/2mm. Since the have any other problem occur after your VR, please structure is so small, the stitches must be placed very call the Clinic or your Surgeon if outside clinic exactly so that there is minimal scarring. Too much hours. scarring can cause the lumen of the vas to close and the procedure to fail. -
Surgical Management of Male Infertility
6 Surgical Management of Male Infertility Sandro C Esteves, Alaa Hamada, Ashok Agarwal (Sandro C Esteves) tertiary center for male reproduction, CHAPTER CONTENTS potentially surgical correctable conditions were identi- fied in 34.4% of the male partners. Azoospermia is iden- ♦ Surgical Treatment to Improve Sperm Production tified in about one-third of the individuals. Despite the ♦ Reconstructive Surgeries of Ductal System feasibility of reconstructive surgery in only about 30% of ♦ Ejaculatory Duct the azoospermic subgroup, most of the remaining would ♦ Sperm Retrieval Techniques be candidates for sperm retrieval techniques, if enrolled ♦ Preoperative Planning in assisted reproduction programs. These figures are ♦ Operative Procedure clearly shown in Table 1. ♦ Postoperative Care and Results Two major advances have recently occurred in the surgical management of male infertility. The first was the implementation of microsurgery which increased success rates for reconstruction of the reproductive tract. The second was the development of intracytoplasmic INTRODUCTION sperm injection (ICSI) and the demonstration that sper- matozoa retrieved from either the epididymis or the testis nfertility is a common problem in the urologic prac- were capable of fertilization and pregnancy.2,3 Thereafter, Itice. Approximately, 8% of men in reproductive age several sperm retrieval methods have been developed may ask for medical consultation for fertility problems. to collect epididymal and testicular sperm for ICSI in Of these, 1–10% carries conditions that compromise the azoospermic men. Microsurgery was incorporated to this reproductive potential.1 The essential roles of the urolo- armamentarium, either for collection of sperm from the gist in this context are to diagnose, to counsel, to provide epididymis in men with obstructive azoospermia or from medical or surgical treatment whenever possible or to the testicle in those with nonobstructive azoospermia correctly refer the male patient for assisted conception. -
Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009†
Human Reproduction, Vol.24, No.11 pp. 2683–2687, 2009 Advanced Access publication on October 4, 2009 doi:10.1093/humrep/dep343 SIMULTANEOUS PUBLICATION Infertility The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009† F. Zegers-Hochschild1,9, G.D. Adamson2, J. de Mouzon3, O. Ishihara4, R. Mansour5, K. Nygren6, E. Sullivan7, and S. van der Poel8 on behalf of ICMART and WHO 1Unit of Reproductive Medicine, Clinicas las Condes, Santiago, Chile 2Fertility Physicians of Northern California, Palo Alto and San Jose, California, USA 3INSERM U822, Hoˆpital de Biceˆtre, Le Kremlin Biceˆtre Cedex, Paris, France 4Saitama Medical University Hospital, Moroyama, Saitana 350-0495, JAPAN 53 Rd 161 Maadi, Cairo 11431, Egypt 6IVF Unit, Sophiahemmet Hospital, Stockholm, Sweden 7Perinatal and Reproductive Epidemiology and Research Unit, School Women’s and Children’s Health, University of New South Wales, Sydney, Australia 8Department of Reproductive Health and Research, and the Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland 9Correspondence address: Unit of Reproductive Medicine, Clinica las Condes, Lo Fontecilla, 441, Santiago, Chile. Fax: 56-2-6108167, E-mail: [email protected] background: Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide. -
The History of Microsurgery in Urological Practice
Chen-1 The History of Microsurgery in Urological Practice Mang L. Chen1, Gregory M. Buncke2 and Paul J. Turek3 1G.U. Recon, San Francisco, CA, 94114 2The Buncke Clinic, San Francisco, CA 94114 3The Turek Clinic, Beverly Hills, CA 90210 Correspondence to: Mang Chen, MD G.U. Recon 45 Castro St, Suite 111 San Francisco, CA 94114 Tel: 415-481-3980 Email: [email protected] Chen-2 Abstract Operative microscopy spans all surgical disciplines, allowing human dexterity to perform beyond direct visual limitations. Microsurgery started in otolaryngology, became popular in reconstructive microsurgery, and was then adopted in urology. Starting with reproductive tract reconstruction of the vas and epididymis, microsurgery in urology now extends to varicocele repair, sperm retrieval, penile transplantation and free flap phalloplasty. By examining the peer reviewed and lay literature this review discusses the history of microsurgery and its subsequent development as a subspecialty in urology. Keywords: urology, microsurgery, phalloplasty, vasovasostomy, varicocelectomy Chen-3 I. Introduction Microsurgery has been instrumental to surgical advances in many medical fields. Otolaryngology, ophthalmology, gynecology, hand and plastic surgery have all embraced the operating microscope to minimize surgical trauma and scar and to increase patency rates of vessels, nerves and tubes. Urologic adoption of microsurgery began with vasectomy reversals, testis transplants, varicocelectomies and sperm retrieval and has now progressed to free flap phalloplasties and penile transplantation. In this review, we describe the origins of microsurgery, highlight the careers of prominent microsurgeons, and discuss current use applications in urology. II. Birth of Microsurgery 1) Technology The birth of microsurgery followed from an interesting marriage of technology and clinical need. -
Minimally Invasive Reproductive Surgery
EPRODU R CT F I O V E Y S Society of T U E I R G C E O O S N Reproductive E S H T ASRM F O 84 UNDED 19 Surgeons FALL 2017 Note from the Editor Message from SRS President, Dr. Ceana Nezhat Dear SRS Members: Dear Colleagues: I am very excited to provide for you It has been an exciting five years serving the membership of the Society of the latest updates from SRS. Reproductive Surgeons. As the President of SRS, I had big shoes to fill and great expectations to match the standards of previous presidents. I could not be more pleased with the accomplishments of the SRS. A successful SRS Fellows Bootcamp was held earlier this year in Houston, My vision and focus as President has been the revitalization of reproductive surgery TX and was led by Dr. Samantha among the members of the American Society for Reproductive Medicine (ASRM), Pfeifer. This issue highlights this by means of furthering educational opportunities and increasing membership wonderful event which received activities. I am pleased to report we have taken great strides in both directions. The very positive feedback from both continuing education for the next generation of reproductive surgeons is of the upmost fellows and faculty. importance. We established an intensive didactic and hands-on surgical boot camp tailored to reproductive endocrinology fellows and junior faculty. Following the success Dr. Camran Nezhat’s team has of our first two SRS-SREI Boot Camps, we are working towards making the 2018 boot contributed a great article on camp even better with plans to increase available spots to meet high demand. -
UROLOGY AUA Honors Dr
IN THIS ISSUE THE UNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM Lawrence Ross Honored 1 New Residents and Fellows 2 UROLOGY AUA Honors Dr. Prins 4 5 Summer 2020 Urology Graduates Look Ahead Publications 7 DISTINGUISHED CONTRIBUTION AWARD— FROM LAWRENCE S. ROSS, MD DR. NIEDERBERGER Welcome to the Lawrence S. Ross, MD, Clarence C. Saelhof Professor 2020 issue. Emeritus at UI Urology, has received many honors during his 50+ year medical career: the Distinguished Since we last published, a lot Reproductive Urology Award from the Society has happened for the Study of Male Reproduction in 2012 and in the world— a Distinguished Service Award from the Chicago notably the onset Urological Society last year, among many others. of the COVID-19 pandemic, which This year, Dr. Ross added to his list of honors when the has created American Urological Association (AUA) named him a upheaval on so recipient of its Distinguished Contribution Award, given many levels. Like all of you, we have for “contributions to the field of reproductive medicine put public health and the safety of and for many years of dedicated service to the AUA.” our patients, colleagues, and families first. We hope you and those close Dr. Ross, a past president of the AUA, who also served on the association’s board to you are well and safe. for five years, is humbled by the recognition. “It is a very big thing in a urological career, even if you’ve been president, to be recognized like this. This is a singular In the article in this issue about honor in one’s academic career.” receiving a Presidential Citation from the American Urological Association, The Distinguished Contribution Award is given to only a few AUA members every Gail S. -
Successful Unilateral Vasectomy Reversal in a Lion (Panthera Leo)
Open Veterinary Journal, (2019), Vol. 9(4): 322–326 ISSN: 2226-4485 (Print) Case Report ISSN: 2218-6050 (Online) DOI: http://dx.doi.org/10.4314/ovj.v9i4.8 Submitted: 30/04/2019 Accepted: 14/10/2019 Published: 29/11/2019 Successful unilateral vasectomy reversal in a lion (Panthera leo) Marcelo Marconi1*, José Manuel de la Torre2, Cristian Palma3, Hector Gallegos1, Evelyn Soto4, Sebastián Celis5, Camila de la Torre5, Carolina Ortiz5, Alberto Duarte5 and Ignacio Idalsoaga5 1Andrology Unit, Department of Urology, Pontificia Universidad Catolica, Santiago, Chile 2Department of Urology, El Carmen Hospital, Santiago, Chile 3Department of Urology, Clinica Las Condes, Santiago, Chile 4Andromed, Santiago, Chile 5Department of Veterinary Medicine, Buin Zoo, Buin, Chile Abstract Background: In 2016, the veterinarian team of Buin Zoo in Chile decided to try to increase the lion population. At that time, the zoo had three lions; two females and one male. The 9-year-old male had been vasectomized 5 years ago at the same institution for birth control. Considering the fact that in humans, vasectomy reversal has excellent reproductive outcomes, a team of human urologists, highly experienced in vasectomy reversal was contacted to perform the procedure. Case description: Surgery was performed on June 16, 2016 under general anesthesia, with the vasectomy site accessed through the previous scar localized in the lower groin. After opening the skin, dartos and tunica vaginalis, we were able to identify the previous vasectomy site. After liberating both vas ends and checking for permeability, a microsurgical anastomosis (magnification 25×) was performed. The surgery took 80 minutes with minimal bleeding, and no surgical complications were observed. -
Robotic Surgery for Male Infertility
Robotic Surgery for Male Infertility Annie Darves-Bornoz, MD, Evan Panken, BS, Robert E. Brannigan, MD, Joshua A. Halpern, MD, MS* KEYWORDS Robotic surgical procedures Infertility Male Vasovasostomy Varicocele KEY POINTS Robotic-assisted approaches to male infertility microsurgery have potential practical benefits including reduction of tremor, 3-dimensional visualization, and decreased need for skilled surgical assistance. Several small, retrospective studies have described robotic-assisted vasectomy reversal with com- parable clinical outcomes to the traditional microsurgical approach. Few studies have described application of the robot to varicocelectomy, testicular sperm extrac- tion, and spermatic cord denervation. The use of robotic-assistance for male infertility procedures is evolving, and adoption has been limited. Rigorous studies are needed to evaluate outcomes and cost-effectiveness. INTRODUCTION with intraperitoneal and pelvic surgery. On the other hand, many of the theoretic and practical ad- Up to 15% of couples have infertility, with approx- 1,2 vantages offered by the robotic approach are imately 50% of cases involving a male factor. A highly transferrable to surgery for male infertility: substantial proportion of men with subfertility have surgically treatable and even reversible etiologies, High quality, 3-dimensional visualization is such as a varicocele or vasal obstruction. The essential for any microsurgical procedure. introduction of the operating microscope revolu- Improved surgeon ergonomics are always desir- tionized the field of male infertility, dramatically able, particularly given the surgeon morbidity improving visualization of small, complex associated with microsurgery.3 anatomic structures. The technical precision Filtering of physiologic tremor can improve pre- afforded has improved operative outcomes across cision during technically demanding micro- the board. -
Microsurgical Vasectomy Reversal: Results and Predictors of Success
9REVUE Andrologie 2005, 15, N~ 167-171 Microsurgical vasectomy reversal : results and predictors of success Gert R. DOHLE, Marij SMIT Andrology unit, Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands ABSTRACT successfully. The results of vasectomy reversal procedu- res can be improved substantially if the surgeon is able to perform a vaso-epididymostomy in cases of a secondary Microsurgical vasectomy reversal is a challenge for the epididymal obstruction, occurring in about 25% of men physician but successful treatment depends on the expe- with an interval of more than 10 years. rience and skills of the surgeon. Fertility can often be res- tored, thus avoiding the need for artificial reproductive techniques. Also, the surgical procedures can be combi- Key words : male infertility, microsurgery, vasectomy rever- ned with sperm aspiration and cryopreservation, to be sal, vasoepididymostemy used for Intracytoplasmic sperm injection (ICSI) in cases of surgical failure. We describe the results of 217 vasova- sostomy procedures, with special emphasis on recent technical refinements and prognostic indicators. I. INTRODUCTION Between 1998 and 2002 we performed 217 vasovasosto- my-procedures in an outpatient clinic setting. Microsurgery in urology is mainly applied in obstructive Refertilisation was successful in 76.5%, spontaneous pre- male infertility and varicocele repair. Other indications are gnancy occurred in 42% of the couples after a follow-up vascular erectile dysfunction and penile or testicular vas- of at least 1 year. The main prognostic factors determi- cular trauma. Obstructions of the male genital tract repre- ning the outcome of the surgery was the interval between sent 5-10% of the causes of male infertility and in 70-80% vasectomy and refertilisation and the age of the female of these men surgical repair can be performed [11].