Infection stones-which account for 10-15% of all urinary calculi-are thought to form in the presence of urease-producing bacteria. These calculi can cause significant morbidity and mortality if left untreated or treated inadequately; optimal treatment involves complete stone eradication in conjunction with antibiotic therapy. The three key principles of treating struvite stones are: removal of all stone fragments, the use of antibiotics to treat the infection, and prevention of recurrence. Several methods to remove stone fragments have been described in the literature, including the use of urease inhibitors, acidification therapy, dissolution therapy, extracorporeal shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy (PCNL), and anatrophic nephrolithotomy. PCNL is considered to be the gold-standard approach to treating struvite calculi, but adjuncts might be used when deemed necessary. When selecting antibiotics to treat infection, it is necessary to acquire a stone culture or, at the very least, urine culture from the renal pelvis at time of surgery, as midstream urine cultures do not always reflect the causative organism.

Microdissection testicular sperm extraction (microTESE) is considered the gold standard method for surgical sperm retrieval among patients with non-obstructive azoospermia (NOA). In this review, we will discuss the optimal evaluation of NOA patients and strategies to medically optimize NOA patients prior to microTESE. In addition, we will also discuss technical principles and pearls to maximize the chances of successful sperm retrieval, sperm retrieval rates (SRR) based upon testicular histology, predictors of successful sperm retrieval, gonadal recovery following microTESE, and potential complications.

Studies examining diet, exercise/physical activity, and body habitus are characterized by conflicting conclusions, difficult confounders, and imperfect end points to judge male reproductive potential. However, convincing trends have emerged implicating consumption of saturated fats, pesticide exposure, high intensity exercise, and extremes of body mass index as detrimental to male fertility. Data assessing modifiable risk factors and subfertility in male partners has emphasized the notion of moderation. Balancing dietary fat, moderation of physical activity, and the management of a healthy body habitus favor both improvement of semen quality and birth outcomes. These observations provide actionable data for the reproductive urologist to better counsel men presenting with infertility.

Purpose Both testosterone deficiency (TD) and prostate cancer (CaP) have increasing prevalence with age. However, because of the relationship between CaP and androgen receptor activation, testosterone therapy (TT) among patients with known CaP has been approached with caution. Materials and Methods We identified a cohort of 82 hypogonadal men with CaP who were treated with TT. These included 50 men treated with Radiation Therapy (XRT), 22 with Radical Prostatectomy (RP), 8 managed with Active Surveillance (AS), 1 with Cryotherapy and 1 with High-Intensity Focused Ultrasound. We monitored prostate specific antigen (PSA), testosterone, hemoglobin, biochemical recurrence (BCR) and PSA Velocity (PSAV). Results Median patient age was 75.5 years and median follow up was 41 months. We found an increase in both testosterone (p<0.001) and PSA (p=0.001) levels in the entire cohort. PSA increased in the AS patients, however no patients were upgraded to higher Gleason Score on subsequent biopsies, and none have yet gone on to definitive treatment. We did not have any cases of BCR amongst RP patients, but 3 XRT patients (6%) experienced BCR. It is unclear whether these were related to TT or reflected the natural biology of their disease. We calculated the mean PSAV to be 0.001, 0.12, and 1.1 ug/L/yr for the RP, XRT, and AS groups, respectively. Conclusions In the absence of randomized placebo controlled trials, our study supports the hypothesis that TT may be oncologically safe in hypogonadal men following definitive treatment or active surveillance for CaP.

Sperm returns to the ejaculate sooner among men undergoing a VV compared to VE. Late failures are heterogeneously defined in the literature but do occur at non-insignificant rates. As such, clinicians should discuss considerations for sperm cryopreservation.

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Introduction and Objectives: AUA Best Practice Guidelines for uretero-scopic stone treatment recommend antibiotics coverage for less than 24 hours after the procedure. The purpose of this study was to evaluate if the rate of post-operative urinary tract infection (UTI) differed in patients receiving a single dose of antibiotics pre-operatively compared to those patients who also received post-operative antibiotics. Methods: A retrospective review was performed of consecutive patients at two institutions, University of British Columbia and Massachusetts General Hospital, Harvard. All patients were given a single dose of antibiotics prior to ureteroscopic stone treatment. A subset of patients were also given post-operative antibiotics ranging in time and selection of antibiotic. Patients who displayed symptoms of infection had a urine culture performed for speciation and antibiotic sensitivity. Results: Eighty one patients underwent ureteroscopy for renal calculi. Patients with pre and post operative antibiotics were compared to those receiving only pre-operative antibiotics. Eight (9.9%) patients in total (2 from pre-operative antibiotic and 6 from the pre and post-operative antibiotic group, P=0.219) developed UTI's in the post-operative period. Surgical factors such as ureteral access sheath, bilateral procedures, use of basket or laser was not associated with rates of infection or whether the surgeon prescribed post-operative antibiotics. Risk factors such as pre-operative stenting, nephrostomy tubes, and foley catheters did not differ between groups or predispose patients to post operative infections. Conclusions: Our data suggests that post-operative antibiotics do not decrease infection rates following ureteroscopic stone treatment, even among patients with risk factors for infection. A single pre operative dose is sufficient. Objectives: To determine predictors of Fluoroscopy Time (FT) during Percutaneous Nephrolithotomy (PCNL) and assess the impact of urology PostGraduate Trainees (PGTs) and S.T.O.N.E. Nephrolithometry Score. Methods: A prospective review of patients undergoing PCNL between 2010 and 2013 at a tertiary health care centre was performed. Patients' demographics, stone characteristics, including S.T.O.N.E. Nephrolithometry Score, and operative data were compared among PGTs. Predictors of FT were determined using univariate and multivariate models. Results: A total of 103 PCNLs were assisted by 10 PGTs from PostGraduate Years (PGY) 4 and 5 [37 (35.9%) and 66 (64.1%) cases, respectively)]. Sixty percent of patients were males with a mean age of 55.2±1.5 years and a mean BMI of 26.4±0.5 kg/m2. The mean S.T.O.N.E score was 7.7±0.1, with tubeless PCNL in 53 (51.5%) cases. The mean FT was 120±5 seconds, mean operative time was 102±3.5 minutes and mean length of hospital stay was 4.2±0.34 days. The overall stone-free rate was 72.8%. PGY-5 trainees used significantly less FT than PGY-4 trainees (115±6 vs. 130±7 sec; p=0.04). FT significantly correlated with the number of involved calyces (r= 0.24, p= ...

Infertility due to nonobstructive azoospermia is treatable with the use of testicular sperm extraction and IVF. The optimal approach for sperm retrieval is microdissection testicular sperm extraction (mTESE). This systematic review summarizes and evaluates the literature pertaining to patient optimization before mTESE, mTESE technique, and post-mTESE testicular tissue processing. Preoperative patient optimization has been assessed in terms of adjuvant hormone therapy and varicocele repair. Limited data are available for adjuvant medical therapy, and although also limited, data for varicocele repair support increased sperm retrieval, pregnancy, and return of sperm to the ejaculate. Post-mTESE tissue processing has few comparative studies; however, most studies support the combination of mechanical mincing and use of type 4 collagenase for tissue disintegration along with pentoxifylline to assist in identifying motile and viable spermatozoa for intracytoplasmic sperm injection. (Fertil Steril Ò 2019;111:420-6. Ó2019 by American Society for Reproductive Medicine.