Both motor complications (UPDRS-IV) and NMS (NMSS) were associated with mortality at 4 years, being motor complications an independent predictor of it.

Background: Publications of microsurgical testicular sperm extraction (mTESE) techniques and outcomes are heterogeneous, which may limit creation of best surgical practices.Objective: To study the quality and heterogeneity of published mTESE outcomes via a methodological analysis. Materials/Methods:A systematic methodological analysis of all published literature on the use of mTESE in men with non-obstructive azoospermia from 1999 to the July 2020 was performed. PubMed and MEDLINE searches were performed using the search terms "microdissection TESE OR microsurgical TESE." Publications were evaluated on their reporting of pre-operative factors, intraoperative techniques, surgical and clinical outcomes, and adverse events.Results: Fifty-five studies met inclusion criteria. Surgical technique and sperm retrieval rates were the most reported criteria. Reporting on the presence of an embryologist intraoperatively was observed in approximately 30% of articles, while other procedural details including method of sperm quantification, quantity retrieved, and number of cryopreserved vials were observed in fewer than 10% of articles. Clinical outcomes, including pregnancy rates and live birth rates, were reported in fewer than 40% of the articles. Fetal outcomes including fetal and neonatal anomalies were rarely reported. Fetal growth restriction, preterm delivery, small or large for gestational age, and NICU admissions were never reported. Conclusion:There are inconsistencies in reporting quality of mTESE outcomes, specifically a lack of information on the quantity and quality of sperm retrieved, the role of embryology intraoperatively, and clinical outcomes, such as live birth rate and fetal anomalies. These gaps may guide development of standardized reporting guidelines to better assess and compare clinical outcomes across institutions and maintain focus on couples-centric fertility outcomes in future mTESE studies.

No abstract

No abstract

Introduction The management of pharmacotherapy-refractory erectile dysfunction includes placement of an inflatable penile prosthesis (IPP). Although invasive, placement of an IPP is considered a safe procedure with high patient satisfaction rates. Broadly, these devices have two different inflation mechanisms: a two-piece (2p) device consisting of a pump and inflation cylinders, and a three-piece (3p) device, which incorporates a low-pressure reservoir. The relative difference in concealability has long been considered a major factor in patient decision-making. However, the difference in durability and subsequent need for revision amongst the two types of devices have not yet been explored. Objective To investigate differences in longevity and need for revision in patients with 2p and 3p IPPs. Methods After receiving institutional review board approval, a retrospective chart review was performed on all patients that underwent IPP revision or exchange for mechanical failure from 2001 to 2021 at our institution. Only patients who underwent revision of the initial device placed were included in the analysis. Men with retired IPP models or who underwent salvage protocol for infected prosthetics were excluded. Baseline characteristics, including history of diabetes or cardiovascular disease, smoking history, prior radical prostatectomy and/or pelvic radiation, and prior incontinence surgery were recorded. Cox proportional hazard models adjusted for age were developed comparing time to revision between 2p and 3p devices. Baseline characteristics were compared with descriptive statistics. Statistical significance was defined as p < 0.05. Results A total of 64 men underwent IPP exchange or revision during the study period, including 38 and 26 men undergoing revision of 2p and 3p devices, respectively. Baseline characteristics are included in Table 1. The median number of days until first revision was 2,695 for 2p IPP compared to 2,101 for 3p IPP (p = 0.27). On unadjusted proportional hazard analysis, there was a significant longevity benefit for 2p IPP compared to all 3p devices [HR: 1.80 95% CI (1.09, 3.00), p = 0.02]. When controlled for patient age, 2p IPPs continued to have a significant longevity benefit compared to 3p devices [HR 1.87 95% CI (1.13, 3.09), p = 0.02]. Conclusions Amongst our institutional cohort, 2p IPPs have significantly longer durability compared to 3p devices. These findings may be used to counsel patients who are deciding between different devices for management of their erectile dysfunction. Disclosure No