Akash A. Kapadia's research while affiliated with Oregon Health and Science University and other places

The prevalence of males on testosterone therapy (TT) seeking vasectomy reversal (VR) is rising. As medical therapy (MT) to recover spermatogenesis after TT has been previously described, our study’s objective is to present our institution’s management and outcomes of VR in men previously on TT. We performed a retrospective case series of vasectomy patients on TT with subsequent VR by a single microsurgeon between March, 2010 and March, 2022. 14 men undergoing VR during the study period met inclusion criteria. The median age at VR was 43 years with a median obstructive interval of 11 years. Median time from MT to VR was 5 months. Post-operative semen analysis was performed in 10 men and all demonstrated patency. 2 patients had very low sperm counts secondary to continuing TT following VR contrary to medical advice and 5 men with patency achieved pregnancy. Our study noted a high rate of vasovasostomy (VV) (96%) and sustained patency despite a 12-year median obstructive interval. Our findings support favorable outcomes with less stringent VV indications after MT in patients previously on TT that desire VR. The use of MT reduces the recommended wait times for VR after TT discontinuation by more than half.

This chapter describes three common types of priapism: ischemic, non‐ischemic, and stuttering priapism. It aims to discuss the epidemiology, etiology, pathophysiology, and treatment for all types of priapism in a clinically oriented and practical manner. Information on non‐ischemic priapism is exclusively based on reports from case series of patients with blunt perineal trauma. Ischemic priapism is a penile compartment syndrome characterized by hypoxia, hypercapnia, and acidosis within the corpora cavernosa. The majority of episodes of ischemic priapism are idiopathic; however, a detailed evaluation is required to exclude potential inciting events or influences. Non‐ischemic priapism is a result of unregulated increased cavernous arterial inflow causing penile tumescence. Stuttering priapism is characterized by a pattern of recurrent ischemic priapism. Treatment for priapism is also directed by the AUA Guideline, and is based upon the type of priapism identified on evaluation. The duration of priapism is the most important predictor of erectile function recovery after treatment.

Infertility affects nearly 15% of couples worldwide and is defined as failure to conceive a natural pregnancy after 1 year of regular unprotected intercourse. Despite gender biases in evaluation, 20% of infertile couples are found to have male factor as the sole cause, while another 30% of couples will be infertile in part due to male factor, resulting in approximately equal contribution of both genders to the cause. Semen analysis is the most widely accepted screening tool to evaluate for male factor infertility. If abnormalities are identified, formal evaluation by a urologist is paramount.

Introduction Improved survivorship after treatment of pediatric malignancies has dramatically increased, while pre-treatment fertility preservation in this population has not kept pace. New guidelines emphasize fertility preservation in young adolescents, but the impact of these guidelines is unknown. Objectives We sought to evaluate the rate of fertility preservation among at-risk adolescents diagnosed with cancer at our institution, as well as evaluate barriers to fertility preservation. Design We performed an IRB-approved historical cohort study of adolescent males 13 years and older evaluated in the Pediatric Hematology-Oncology clinic at Doernbecher Children’s Hospital from 2010 to 2018. Electronic chart review was used assess discussion of fertility preservation and barrier to successful preservation in boys with a new diagnosis of cancer who received systemic chemotherapy and/or gonadal or pelvic irradiation. Results 82 boys were included in the study. Forty-two (51%) received counselling about fertility preservation, and of those 29 (70%) successfully banked sperm. Neither counseling for fertility preservation nor success at sperm banking differed by patient age, but both differed by malignancy. Patients with Hodgkin’s lymphoma had the highest rate of counselling, while those with leukemia had the lowest. Acute illness as a barrier to preservation was found in 40% of those who did not receive counselling. Discussion Our study demonstrates a stagnant rate of fertility counseling and preservation despite increased advocacy. The retrospective nature of our study limited our ability to assess the counselling that occurred, and the lack of granular race data limited study of the implicit selection bias that may be involved in such counseling. As more institutions move toward a multi-disciplinary care model, we believe that pediatric urologists or fertility specialists must play a vocal role in the care of these at-risk adolescents. Conclusion Despite increasing advocacy for fertility preservation, our data shows no significant change in previously reported trends. Patients with Hodgkin’s lymphoma have a higher rate of counseling and cryopreservation in comparison to those with other malignancies.

Guiding a couple with nonobstructive azoospermia requires an integrated approach to care by the urologist and the reproductive endocrinologist. After informing the couple of the implications of the diagnosis, care must be taken to outline the options of parenthood. Most experts agree that sperm retrieval in men can be challenging. This article describes various options of sperm retrieval, historic and contemporary, and highlights the advantages and disadvantages of each. The authors find that using a testicular map can invariably help guide sperm retrieval and overall fertility care. The right approach is one that involves a shared decision with the couple.

Objective: To provide pregnancy and live birth rates from a contemporary series of vasectomy reversals in men with female partners aged ≥35 years and to correlate the results with IVF. Setting: Tertiary academic referral center. Design: Retrospective comparative study of prospectively collected database. Patient(s): Two hundred forty-six men who underwent vasectomy reversal for fertility with female partner aged ≥35 years. Intervention(s): Vasovasostomy or vasoepididymostomy. Main outcome measure(s): Correlation of pregnancy and live birth rate of this cohort by age groups with most recently published pregnancy and live birth rate per IVF cycle. Result(s): One hundred thirty-six men who underwent vasectomy reversal between 2006 and 2014 met our inclusion criteria. Overall pregnancy and live birth rates were 35% and 30%, respectively. Subgroup analysis by female age groups (35-37, 38-40, >40 years) demonstrated pregnancy and live birth rates comparable to those per IVF cycle by age groups according to a recently published (2015) national report. Conclusion(s): Vasectomy reversal should be strongly considered in men with a partner aged ≤40 years. Additionally, vasectomy reversal can be considered in carefully selected patients even with a partner aged >40 years.