Category: Urology


Male factor infertility: A contemporary overview of investigation, diagnosis and management

Journal of Clinical Urology, Ahead of Print. <br/>Infertility, defined as the failure to achieve a clinical pregnancy after 1 year of regular, unprotected sexual intercourse, is a public health issue of global concern. It affects up to 12% of couples worldwide. While traditionally, research and treatment have focused on female causes of infertility, male factors contribute to up to 70% of cases and therefore deserve appropriate recognition. The purpose of this comprehensive review is to detail the diagnostic work-up, investigations and management of male factor infertility. We discuss much-debated pathologies, such as varicocele, and novel investigations, including sperm DNA fragmentation and reactive oxygen species.Level of evidence: Not applicable

The negative impact of timed intercourse in infertile couples: A prospective cohort study

Journal of Clinical Urology, Ahead of Print. <br/>Objective:To study the differences in sexual dysfunction and time to pregnancy (TTP) between infertile couples pursuing timed intercourse (TI – around the time of ovulation) and regular intercourse (RI – at least twice a week).Methods:In this prospective cohort study, we recruited all infertile couples presenting to the regional infertility clinics from January 2016 to December 2018, pursuing TI (n = 283) or RI (n = 88), and having no pre-existing sexual or psychiatric illness, and no medical contraindications to frequent intercourse. Sexual dysfunction was assessed using the Arizona Sexual Experience Scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The couples for whom natural conception was possible were followed up to determine TTP using Kaplan–Meier analysis.Results:TI significantly increased the risk of sexual dysfunction than RI for both males and females, even after adjusting for age, medical disorders, obesity, smoking, cause of infertility, and previous assisted reproductive techniques. TI increased the risk of erectile dysfunction, premature ejaculation, male hypoactive sexual dysfunction, female sexual interest-arousal disorder, and female orgasmic disorder. The TTP for natural conception was similar between them.Conclusion:TI increased the risk of sexual dysfunction without accelerating the time to achieve pregnancy, compared with RI.Level of evidence:Not applicable

Effects of body fat components on early renal functions of individuals following kidney donation

Journal of Clinical Urology, Ahead of Print. <br/>Objective:Obesity stands as a risk factor for the chronic kidney disease. The objective of this study was to investigate the relationship between early renal function following kidney donation and the measurements of body fat components.Methods:In total, 86 donors followed up for at least 6 months postoperatively were included. Height and weight measurements and results of laboratory analysis of all donors were recorded retrospectively. Visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), hepatic fat (HF), pancreatic fat (PF) and splenic fat (SF) measurements were performed, and pancreatic splenic fat fraction difference (P−S) and pancreatic splenic fat fraction ratio (P/S) were calculated by a radiologist using the records of preoperative computed tomography scans of donors.Results:The estimated glomerular filtration rate (eGFR), serum creatinine and spot urinary microalbumin/creatinine ratio values of the donors at the sixth month postoperatively were statistically different from those of the preoperative values (p < 0.001). In addition, the individuals were divided into two categories based on the postoperative eGFR: ⩾ 60 mL/min/1.73 m2 and < 60 mL/min/1.73 m2. Age, low-density lipoprotein (LDL) level and VAT/SAT ratio were lower in group eGFR: ⩾ 60 (p < 0.001, p = 0.03, p = 0.007, respectively). Age and VAT/SAT ratio were the parameters found to be affecting the eGFR significantly, and VAT/SAT ratio (0.729, 95% CI: 0.602–0.856, p = 0.007) had higher predictive value in receiver operating characteristic curve (ROC).Conclusion:Preoperative measurements of body fat components may provide significant information to predict postoperative renal functions of kidney donor candidates.Level of evidence:Not applicable.

Ethnic and gender trends at the annual British Association of Urological Surgeons (BAUS) meeting: A review of BAUS programmes over a 13-year period (2009–2021)

Journal of Clinical Urology, Ahead of Print. <br/>Objective:In this paper, we wanted to review the annual British Association of Urological Surgeons (BAUS) programme to analyse the female and ethnic minority (EM) representation and find out whether there is ethnic and gender disparity, and if it does reflect the reality of the workforce.Methods:To investigate gender and EM representation, we requested data for BAUS annual meetings over a 13-year period (2009–2021). All speakers and chairpersons for all four sub-sections including Endourology, Oncology, Andrology and Female, Neurological and Urodynamic urology (FNUU) were collated. We also looked at the geographic distribution of the speakers (London area, rest of England, Scotland, Northern Ireland and Wales). Data were analysed separately before and after the COVID-19 pandemic (cut-off March 2020), as in the latter 2 years, the meeting was held virtually.Results:A total of 2569 speakers (range: 135–323 speakers/year) were included in our analysis and 2187 (85%) speakers were from the United Kingdom. Of the UK speakers, more than three-quarters (76.6%, n = 1676) were males and females of White ethnicity and (23.4%, n = 511) were EM. The vast majority of speakers throughout the years were males (86%, n = 1891) with only 14% (n = 296) females regardless of their origin and ethnicity. The presence of EM females was only 1.9% (n = 43). The percentage of female representation rose consistently over time from 6.7% (n = 8) in 2009 to 21.1% (n = 44) in 2020, suggesting an upward trend. Regional distribution showed 31%, 63%, 3.6%, 1.6% and 0.2% from London, Rest of England, Scotland, Wales and Northern Ireland, respectively. Both gender and EM representation doubled in the last 2 years during the pandemic (p < 0.001).Conclusion:Annual BAUS meetings have seen a higher proportion of ethnic and gender representation in recent years. However, considering the workforce within urology, more needs to be done to address this historical disparity. Hopefully, the BAUS 10-point programme will provide a framework for addressing Equality, Diversity and Inclusion issues related to this bias.Level of evidence:Not applicable.