To our knowledge this is the largest study to explore the natural history of PD. A minority of men experienced improvement in penile abnormality, while penile length decreased during the 1-year followup. This information will permit clinicians to provide patients with realistic expectations at presentation for the evaluation of PD.

TESE/ICSI is a successful intervention for the majority of patients with azoospermia and Klinefelter syndrome. Sperm retrieval and ICSI success in men with Klinefelter syndrome are comparable with other men with nonobstructive azoospermia treated at our center.

Activation of the AP-1 complex of transcription factors is one of the earliest nuclear responses to mitogenic stimuli. We demonstrate directly that AP-1 activity is required for human cells to proliferate in response to serum. We also find that activity of the AP-1 complex is selectively reduced in old human fibroblasts prior to their entering a fully senescent state. Levels of Fos protein induced through diverse signal transduction pathways, the amount of AP-1 DNA binding activity in vitro, and the activity of an AP-1-dependent reporter gene in vivo are substantially decreased as fibroblasts age. Moreover, the composition of the AP-1 complex changes, so that old cells produce predominantly Jun-Jun homodimers instead ofFos-Jun heterodimers. Changes in AP-1 activity may be due in part to changes in posttranslational modification of Fos protein that impair its ability to form active DNA-binding heterodimers with Jun These data suggest that changes in AP-1 activity may contribute to the inability of senescent cells to proliferate in response to mitogens.Human diploid fibroblasts (HDFs) undergo a finite number of population doublings in vitro (1), which is inversely proportional to the age of the donor. This observation and the direct correlation seen between the maximum life span of animal species and the replicative life span of their fibroblasts cultured in vitro (2) suggest that mechanisms underlying HDF senescence in vitro may play a role in the decline of many functions seen during aging in vivo (for a review, see ref.3). Senescent HDFs are unable to proliferate in response to normally mitogenic extracellular stimuli and appear to be blocked within the G1 phase of the cell cycle (4, 5). Because growth factor receptors generally appear to be functional in senescent HDFs (6), the block to proliferation apparently lies between the stimulation of membrane receptors and the initiation of S phase.Expression of several cellular genes including c-fos (7-9), c-Ha-ras (10), and c-myc (11, 12) is required for cells to progress through the G1 phase of the cell cycle and enter into DNA synthesis. But expression of these and other cell-cycleregulated genes is not appreciably reduced in senescent cells (13), with one reported exception, that of c-fos (14). c-fos is a particularly attractive candidate as a control point for cell proliferation since it encodes a transcription factor with the potential to regulate events later in progression through GU. Fos is a member of a family of transcription factors that contain highly conserved positively charged DNA-binding domains and leucine-zipper motifs. Fos proteins act in heterodimeric complexes with members of the Jun family of protooncogenes by binding to specific regulatory elements termed AP-1 sites (for review, see ref. 15). We show here that AP-1-binding factors constitute a control point for G1 progression by selectively inactivating AP-1-binding factors in living cells. Moreover, we show that as cells begin to age they show a striking decline in AP-1 activity. We s...

Although vasoepididymostomy remains a technically demanding microsurgical procedure, recent technical innovations of TIVE and LIVE offer better or comparable outcomes compared with EE and ES procedures with the use of fewer sutures, which simplifies the performance of the anastomosis. In addition, the late failure rate is lower with the use of the intussusception techniques (LIVE and TIVE) with only 1 late failure in 22 men with return of sperm to the ejaculate procedures (4%) compared with 11 of 30 (37%) in the nonintussusception groups (p =0.006).

To our knowledge we report the first randomized prospective study using the Da Vinci robot for microsurgery. We believe that the improved stability and motion reduction during microsurgical suturing with the robot helped achieve excellent patency rates for vasovasostomy and vasoepididymostomy. The robot may also allow experienced microsurgeons to perform microsurgical procedures in patients at remote locations where no experienced microsurgeons are available.

No abstract

Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are extremely prevalent in aging men. LUTS describes the symptoms that occur with dysfunction of micturition. Both storage and emptying symptoms occur. Storage symptoms refer to urinary frequency, urgency, urge incontinence, nocturia, and dysuria. Emptying symptoms include hesitancy, straining, decreased force of stream, and incomplete emptying of the bladder, including urinary retention (Wein, 1981). BPH refers specifically to the histologic benign proliferation in the prostate gland, which may or may not be associated with LUTS.Erectile dysfunction (ED) is also an extremely common problem in older men. ED is defined as the consistent inability to maintain a penile erection sufficient for adequate sexual relations (NIH, 1993). The purpose of this review is to explore the link between the 2 conditions. Simply as a result of their predominance in older men, these 2 conditions are very likely to coexist. But is age the only link between LUTS and ED?Several other hypotheses exist that link LUTS and ED. First, some have postulated that the negative impact that LUTS has on the quality of life causes ED. Second, other studies have examined the role of a hyperadrenergic state in the pelvis associated with LUTS that adversely affects erectile function. Third, pharmacotherapy for BPH may affect erectile function. Finally, in the past, invasive therapy for BPH was thought to cause ED. This paper will explore the pathophysiologic link between LUTS and ED. Age, LUTS, and EDDefining BPH and LUTS-BPH is estimated to be present in 40% of men by age 50 and in more than 80% of men older than 80 years (Berry et al, 1984). On the basis of a prostate size in excess of 20 mL and a peak urinary flow rate of less than 15 mL/s, a Scottish study estimated that 14% of men in their 40s have BPH (Garraway et al, Correspondence to: Dr John P. Mulhall, 525 E 68th St, Starr 900, New York, NY 10021 (e-mail: jpm2005@med.cornell.edu).Received for publication September 23, 2003; accepted for publication March 29, 2004. 1991). This analysis also estimated that up to 43% of men older than 60 years have BPH. Definitions are important because, although the pathologic process is present within the prostate, many men are not symptomatically affected. Thus, even though BPH is frequently present in older men, the incidence of LUTS may be lower.An important contribution to our understanding of the progression of LUTS was provided by the Olmsted County Study. More than 2000 men aged 40-79 years were followed. Peak urinary flow was found to decrease by 2 mL/s each decade, and prostate size was estimated to increase by 0.6 mL/y. Those men with prostates greater than 40 mL were significantly more likely to suffer from LUTS. Men with large prostates were twice as likely to be bothered by their symptoms and also twice as likely to feel that their symptoms interfered with the activities of daily life (Girman et al, 1999). Moderate-to-severe LUTS has been found to occur in 8%-58% of men...

Currently, the classification of cirrhotic patients is normally done using the CTP score. However, preoperative platelet levels and INR more accurately predict the difficulty of cholecystectomy than CTP score, because intraoperative hemorrhage is the primary concern in these patients. This study demonstrates that preoperative degree of coagulopathy, and not Child's class, should guide the surgeon's approach and expectations when LC is performed in a cirrhotic patient.