Publications (51) View all
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Article: Reproducibility and Reliability of Semen Analyses in Youths at Risk for Infertility.
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ABSTRACT: PURPOSE: There is little normative data on semen analyses in youths at risk for, but who do not present with, infertility. Standard practice amongst infertility specialists includes evaluation of two separate semen samples given the degree of within-subject variability. We hypothesize that males transitioning from pediatric to adult care who are at risk for infertility would similarly have this variability. MATERIALS AND METHODS: A retrospective review of patients with a history of cryptorchidism or varicocele who submitted two semen samples for evaluation of fertility potential was conducted. The within-subject coefficient of variation (CV(w)) and intraclass correlation coefficient (ICC) were calculated for each semen parameter to evaluate reproducibility and reliability, respectively. RESULTS: A total of 79 subjects were studied. Mean age ± SD was 18.8 ± 1.2 years (range 17.8 - 24.7). The CV(w) was high for each semen parameter, ranging from 36% for volume and motility to 82% for total motile count (TMC). ICC for a single SA ranged from 0.55 for motility to 0.88 for total count. ICC for TMC was 0.78 [95% CI, 0.67 - 0.85], consistent with substantial reliability. CONCLUSIONS: Although within-patient variability of individual SA parameters was found, overall there was substantial agreement between consecutive semen analyses in this population at risk for infertility -- particularly regarding TMC, which is the most important determinant of fertility from a SA. Therefore, it is possible to appropriately classify some young men based on the result of a single measurement as they transition from pediatric to adult care.The Journal of urology 02/2013; · 4.02 Impact Factor -
Article: Comparison of Semen Analyses amongst Youths with a History of Cryptorchidism or Varicocele.
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ABSTRACT: PURPOSE: We aimed to determine the relative semen quality of youths with a diagnosis of cryptorchidism (UDT) or varicocele (Vx), as a surrogate for ultimate paternity potential. We hypothesized that youths with a Vx would have a lower risk of subfertility, based on semen analysis (SA), than their counterparts with surgically corrected UDT. MATERIALS AND METHODS: A retrospective review of patients with a history of UDT or Vx was performed. Patients were placed into one of three groups based on their diagnosis: Group1, untreated Vx; Group2, treated bilateral UDT; Group3, treated unilateral UDT. Age and semen parameters (density, volume, count, motility, total motile count (TMC)) were compared for each group. RESULTS: A total of 193 subjects were studied. Median age [IQR] of the group was 18.3 [18.1-19.3], 18.6 [18.3-21.0], 18.5 [18.2-19.6] years, respectively, for Group1 (n=76), Group2 (n=21), and Group3 (n=96). TMC (million sperm) for Group1, Group2, and Group3 was: 14.6 [4.7-29.3], 4.0 [0-38.0], 34.1 [7.6-90.8], respectively. No significant difference existed between the groups for age, volume (p=0.106), or motility (p=0.197). However, density (p=0.0001), count (p=0.0001), and TMC (p=0.0002) all achieved significance; for each of these parameters, a significant difference could be shown between both Group1 vs. Group3 and Group2 vs. Group3, but not between Group1 vs. Group2. CONCLUSIONS: Semen quality of youths with a varicocele more closely resembles that of those with bilateral UDT than those with unilateral UDT. This is very concerning and should challenge current paradigms of management for adolescents with a varicocele.The Journal of urology 02/2013; · 4.02 Impact Factor -
Article: Undescended testis histology correlation with adult hormone levels and semen analysis.
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ABSTRACT: Cryptorchidism has been associated with infertility. We hypothesize that a positive correlation exists between testicular histopathology at orchiopexy and future fertility potential in patients with cryptorchidism. Patients with cryptorchidism who underwent orchiopexy with bilateral testis biopsies were followed into adulthood. Testis histology was stratified into groups based on total germ cells per tubule and adult dark spermatogonia per tubule. After age 18 years, patients underwent hormonal testing and semen analysis. Mean semen analysis parameters and hormone levels were compared among histopathology groups. A total of 91 patients with unilateral undescended testes and 19 with bilateral undescended testes had data for review. No significant differences in semen analysis parameters were seen among the germ cells per tubule groups. In unilateral undescended testis, sperm density and sperm count in the abnormal adult dark spermatogonia per tubule group remained within normal range but were significantly decreased (p = 0.005 and p = 0.028). Follicle-stimulating hormone levels were significantly higher in patients with unilateral undescended testis with abnormal adult dark spermatogonia per tubule but remained within normal range (p = 0.009). Sperm density was below normal range and was significantly decreased in the abnormal adult dark spermatogonia per tubule group in the bilateral undescended testes cohort (p = 0.0496). In bilateral undescended testes follicle-stimulating hormone level, sperm count and percent motility in the abnormal adult dark spermatogonia per tubule group were outside normal clinical range but these results were not statistically significant (p = 0.07-0.2). Total germ cell histopathology at the time of orchiopexy was not associated with significant changes in hormone levels or semen analysis results in adulthood. Testis biopsy at orchiopexy may be limited in predicting future fertility in unilateral undescended testis but more clinically useful in predicting fertility potential for those with bilateral undescended testes.The Journal of urology 08/2012; 188(4 Suppl):1429-35. · 4.02 Impact Factor -
Article: Nephron-sparing partial nephrectomy for bilateral Wilms' tumor.
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ABSTRACT: Partial nephrectomy is increasingly used in children with bilateral Wilms' tumor (BWT) or contralateral recurrence. Nephron-sparing surgery seeks to achieve complete tumor removal while preserving functional renal parenchyma. Previous series have documented high rates of complications, recurrence, and mortality. Twelve patients (4 boys and 8 girls aged 9-42 months) with BWT or contralateral recurrence were treated at our institution with unilateral or bilateral partial nephrectomy. Preoperative imaging, operative notes, and pathology reports were reviewed. Outcomes analyzed included complications, recurrence, readmission rate, postoperative glomerular filtration rate (GFR), and survival. All patients underwent successful nephron-sparing resection using standard techniques, with only 2 patients requiring unilateral nephrectomy. Median length of stay was 3 days. There were no major complications or urine leaks. Two patients were lost to follow-up. The remaining 10 were followed up for a median of 36 months (range, 3-79 months). There have been no recurrences or unplanned readmissions. Mean GFR is 107.7 (± 32.8) mL/min per 1.73 m(2), with no patient having a GFR below the lower limit of normal for age. Nephron-sparing resection is a safe and effective approach for children with BWT or contralateral recurrence and should be part of the multimodality therapeutic approach to this disease.Journal of Pediatric Surgery 06/2012; 47(6):1234-8. · 1.45 Impact Factor -
Article: Delayed presentation of posterior urethral valves in discordant twins.
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ABSTRACT: Concordant and discordant presentations of posterior urethral valves (PUV) in twins have been described. Twin gestation may complicate the diagnosis of PUV based on prenatal evaluation. A case series of 2 sets of twin births is presented, each of which was discordant for the diagnosis of PUV. A delay in diagnosis occurred in both cases, despite prenatal ultrasound abnormalities. This delay could result from failed sensitivity of prenatal ultrasound or from postnatal evaluation of the incorrect twin. Caution must be exercised during follow-up of abnormalities identified on prenatal ultrasound in diseases in which there are no external distinguishing characteristics.Urology 02/2012; 79(6):1365-7. · 2.43 Impact Factor
