A continuous infusion of 0.25% bupivacaine at 4 mL/hour through the ON-Q elastomeric infusion pump is a safe and effective adjunct in postoperative pain management after laparoscopy. Initial experience with the ON-Q Pain Relief System results in decreased narcotic use and decreased length of hospitalization compared with traditional postoperative pain management.
Varicocele correction presents a possible method to optimize a couples' reproductive potential or decrease the need for complex assisted reproductive technology.
INTRODUCTION
Erythrocytosis is the most common dose-limiting adverse effect of testosterone therapy (TTh), but the mechanisms of T-mediated erythropoiesis remain unclear. In this study, we examine risk factors for erythrocytosis associated with TTh.
METHODS
Retrospective review of 179 hypogonadal men on TTh in a single andrology clinic was performed. Demographic data, TTh formulation and duration of treatment, and 5α reductase inhibitor (5ARI) use were assessed. Serum dihydrotestosterone (DHT), total T (TT), free T (FT), follicle stimulating hormone (FSH), luteinizing hormone (LH), Hematocrit (Hct), and lipid levels were extracted and changes during treatment determined. Spearman’s rank correlation was used to identify relationships between change in Hct (ΔHct) and study variables.
RESULTS
Of 179 patients, 49 (27%) developed a ≥10% ΔHct and 36 (20.1%) developed erythrocytosis (Hct ≥50%) at a median follow-up of 7 months. Topical gels were used by 41.3% of patients, injectable T by 52.5%, and subcutaneous pellets by 6.1%. More men who developed ΔHct ≥10% used injectable T than men with ΔHct <10% (65% vs. 48%, p=0.035), and were less likely to be on 5ARI (2% vs. 15%, p=0.017). Men with ΔHct ≥10% had higher post-treatment DHT levels (605.0 vs. 436.0 ng/dL, p=0.017) and lower LH and FSH levels than men with ΔHct <10%. Spearman’s rank correlations yielded relationships between ΔHct and post-treatment DHT (ρ=0.258, p=0.001) and TT (ρ=0.171, p=0.023).
CONCLUSION
DHT may play a role in TTh-related erythrocytosis, and monitoring of DHT levels during TTh should be considered. In men who develop erythrocytosis, 5ARIs may be therapeutic.
Anogenital distance (AGD) is used to define degree of virilization of genital development, with shorter length being associated with feminization and male infertility. The first exon of the androgen receptor (AR) consists of a polymorphic sequence of cytosine-adenine-guanine (CAG) repeats, with longer CAG repeat lengths being associated with decreased receptor function. We sought to determine if there is an association between AGD and AR CAG repeat length. A cross-sectional, prospective cohort of men evaluated at a urology clinic at a single institution was recruited. AGD (the distance from the posterior scrotum to the anal verge) and penile length (PL) were measured. Sanger DNA sequence analysis was used to define CAG repeat length. AGD and CAG repeat lengths in 195 men were determined. On unadjusted analysis, there was no linear relationship between CAG repeat length and PL (P=0.17) or AGD (P=0.31). However, on sub-population analyses, those men with longer CAG repeat lengths (>26) had significantly shorter AGDs compared to men with shorter CAG repeat lengths. For example, the mean AGD was 41.9 vs. 32.4 mm with a CAG repeat length ≤26 vs. >26 (P=0.01). In addition, when stratifying the cohort based on AGD, those with AGD less than the median (i.e. 40 mm) had a longer CAG repeat length compared to men with an AGD >40 mm (P=0.02). In summary, no linear relationship was found between AGD and AR CAG repeat length overall.
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