Vol. 179, No. 4, Supplement, Wednesday, May 21, 2008 THE JOURNAL OF UROLOGY® 593

1731NOMOGRAM TO PREOPERATIVELY PREDICT THE PROBABILITY OF EPIDIDYMOVASOSTOMYDavid M Fenig*, Michael W Kattan, Jesse N Mills, Maria Ginsberg, Larry I Lipshultz. Houston, TX, and Cleveland, OH.

INTRODUCTION AND OBJECTIVE: Up to six percent of men undergoing vasectomy may undergo vasectomy reversal in their lifetime.1 Most men will require vasovasostomy (VV). A smaller subset of patients will require epididymovasostomy (EV) however, which is a more delicate and technically demanding procedure. Optimal outcomes

therefore, if an EV was predicted preoperatively, it would warrant a

based on preoperative patient characteristics in order to better predict the need for an EV.

METHODS: We evaluated patients undergoing primary vasectomy reversal over a 4 year period. Preoperative and intraoperative patient data were collected in a prospectively maintained database. We evaluated the ability of age, years since vasectomy, and presence or absence of a granuloma to preoperatively predict the need for an EV in a given patient. A nomogram was created and assessed for predictive accuracy. Decision to proceed with VV or EV was made intraoperatively

parts.RESULTS: 271 patients were included in our cohort. Mean

patient age was 42 years. Patient age was not positively correlated with an EV. Mean time from vasectomy to reversal was 9.7 years. Time to reversal and the presence of a sperm granuloma were included as predictors of EV. The nomogram below demonstrates that a patient undergoing vasectomy reversal 13 years after vasectomy without bilateral granulomas on physical examination has an approximately 50% chance of requiring a vasoepididymostomy.

CONCLUSIONS: EV can be preoperatively predicted based on years since vasectomy and presence of a sperm granuloma on physical examination. Urologists can use this nomogram to better inform patients of their potential need for an EV. The urologist can then better decide, based on their own microsurgical skills, whether a specialist referral is needed. 1. Potts JM, Pasqualotto FF, Nelson D, Thomas AJ Jr., Agarwal A: Patient characteristics associated with vasectomy reversal. J Urol, 161: 1835, 1999

Source of Funding: None

1732FRESH MOTILE TESTICULAR SPERM RETRIEVED FROM NON-OBSTRUCTIVE AZOOSPERMIC PATIENTS HAS THE SAME POTENTIAL TO ACHIEVE FERTILIZATION AND PREGNANCY VIA ICSI AS SPERM RETRIEVED FROM OBSTRUCTIVE AZOOSPERMIC PATIENTSSatoru Kanto*, Yoichi Arai, Koichi Kyono. Sendai, Japan.

INTRODUCTION AND OBJECTIVE: Microdissection testicular sperm extraction (MD-TESE) achieves a better sperm retrieval rate (SRR) than conventional TESE. To date, however, the pregnancy rate

has not been well documented.

patients. Of the 58 cases, 40 were diagnosed as NOA and 18 were

diagnosed with the documentation of markedly reduced spermatogenesis both intra-operatively and histologically. MD-TESE was timed to coincide

fetal heartbeat on transvaginal ultrasonography. The unpaired two-tailed Student’s t test was used to compare mean maternal age between the

to compare the pregnancy rates between the subgroups.

diagnosed with NOA and 18 OA. Motile testicular sperm were retrieved from 18 OA patients (100%). Testicular sperm was retrieved from 17 of 40 NOA patients (43%). Of the 17 cases, motile sperm were retrieved in 16 cases. Sperm retrieval rate (SRR) was 7/26 (27%) in SCO, 3/6 in maturation arrest (MA), and 8/8 in hypospermatogenesis (HS). Average Johnsen’s scores were 1.44 in SCO, 4.97 in MA, and 5.31 in HS. The

age between the subgroups of both OA and NOA. All pregnancies were achieved via ICSI with fresh motile testicular sperm.

CONCLUSIONS: Fresh motile testicular sperm retrieved

pregnancy as sperm retrieved from OA patients. The microdissection testicular sperm extraction procedure (MD-TESE) might contribute to the high retrieval rate of fresh motile testicular sperm even in NOApatients.

Source of Funding: None

1733METABOLIC SYNDROME IN MEN WITH KLINEFELTER SYNDROMETomomoto Ishikawa*, Kohei Yamaguchi, Yutaka Kondo, Atsushi Takenaka, Masato Fujisawa. Kobe, Japan.

INTRODUCTION AND OBJECTIVE: Klinefelter syndrome (KFS) is the most common sex-chromosome disorder, and is a frequent cause of hypogonadism and infertility. Male hypogonadism is an independent risk factor for the development of metabolic syndrome. Accordingly, the aim of this study was to investigate the metabolic syndrome, and sex hormones in patients with KFS, 46XY males with

METHODS: We examined 60 patients with KFS (33.6±5.3 years), 60 patients with NOA with 46XY (33.2±5.1 years), and 50 patients with OA (35.1±6.7 years). Height, weight, waist circumference, and blood

for sex hormones, total cholesterol (T-chol), high-density lipoproteins (HDL) and low-density lipoprotein (LDL) cholesterol, triglyceride (TG) and plasma glucose. The blood sample was drawn between 9:00 and 10:00

Panel III (ATP-III) criteria. RESULTS: Height, weight, waist circumferences were

BP among three groups. LDL cholesterol of KFS patients (132.9±29.4

mg/dL) and OA patients (106.1±27.9 mg/dL) (p<0.05 and p<0.01). HDL

dL) compared with NOA (58.7±11.7 mg/dL) and OA patients (59.5±17.9 mg/dL) (p<0.05 and p<0.05). T-chol, TG, and fasting glucose were

compared with NOA (5.1±2.3 ng/mL) and OA (5.7±2.1 ng/mL) patients (p<0.001, and p<0.001). The serum free T level of KFS, NOA, and OA patients was 6.3±3.9 pg/mL, 9.7±3.2 pg/mL, and 13.0±3.5 pg/mL,

594 THE JOURNAL OF UROLOGY® Vol. 179, No. 4, Supplement, Wednesday, May 21, 2008

respectively. The differences between KFS and NOA, KFS and OA, NOA

in FSH, LH, and free T level. CONCLUSIONS: We provided the important message of

the metabolic syndrome in KFS. Hypogonadism in KFS may cause an unfavorable change in body composition and metabolic syndrome. Hypogonadism is frequent in KFS, and we recommend that patients in KFS with low testosterone level should be treated properly with testosterone replacement.

Source of Funding: None

1734THE ASSESSMENT OF SERUM HORMONE LEVELS IN PATIENTS WITH NON-OBSTRUCTIVE AZOOSPERMIA AFTER MICRODISSECTION TESTICULAR SPERM EXTRACTIONYutaka Kondo*, Tomomoto Ishikawa, Kohei Yamaguchi, Atsushi Takenaka, Masato Fujisawa. Kobe, Japan.

INTRODUCTION AND OBJECTIVE: Testicular sperm extraction (TESE), in combination with intracytoplasmic sperm injection,

microdissection TESE (MD-TESE), which is less invasive and results in high sperm retrieval rate, is preferred. Even in patients with Klinefelter syndrome (KS), who usually present small testis and hypogonadism, MD-TESE has been successfully performed. Although recent studies reported that MD-TESE procedures might impair testosterone production, little studies compared postoperative serum hormone levels between 46XYmales with NOA and KS have been reported. In this study, we assayed serum hormone levels after MD-TESE and compared postoperative testicular damage between 46XY males with NOA and KS.

METHODS: The records were retrospectively evaluated for

KS) who were underwent MD-TESE from January 2001 to November 2006 in Kobe University Hospital. Karyotyping test was performed on a sample of blood to all patients. Serum follicle-stimulating hormone

were evaluated before and at 6 and 12 months after surgery. For rate-of-change analysis, these hormone levels at 6 and 12 months after MD-TESE in each patient were expressed as arbitrary units relative to baseline concentration, set as a value of “1.”

RESULTS: In 46XY males with NOA, serum levels of FSH at

increased from baseline concentrations (p = .001, .01, and .003,

of LH at 12 months and T at 6 and 12 months compared to baseline

concentrations at all time after surgery (0.79-fold at 6 months, p = .007, and 0.77-fold at 12 months, p = .003). FSH and LH concentrations in

rate of change of T concentrations (p = .02 at 6 months and .03 at 12 months, respectively).

CONCLUSIONS: Long term hormonal follow up is recommended after MD-TESE, particularly in patients with KS. We recommend that patients in KS with low T level after MD- TESE may be treated properly to prevent the long-term deleterious consequences of hypogonadism.

Source of Funding: None

1735SIGNIFICANT INCIDENCE OF HYPOANDROGENISM IN INFERTILE MENBeneranda S Ford*, Lawrence S Ross, Craig S Niederberger. Chicago, IL.

INTRODUCTION AND OBJECTIVE: In 1997, Sigman and Jarow observed that the incidence of endocrinopathy in men with > 10 million sperm/ml was low enough to recommend an endocrine study unnecessary if this threshold was met. In the present era, increasing men

sperm may be extracted for ICSI. We sought to determine the incidence

< 300 ng/dl in a modern infertile male population undergoing evaluation, and verify the results in a subset analysis as calculated by bioavailable testosterone by the free testosterone index (FTI).

METHODS: Patient records for men presenting with infertility

ml (oligospermia) and sperm density > 20 million/ml (normospermia). Incidence of total T < 300 ng/dl was determined in each group and

calculated using the FTI with total testosterone, albumin and sex hormone binding globulin (SHBG).

incidence of hypoandrogenism by FDA criteria in men with OA was similar to the general population at 16.7%. 45.0% of men with NOA had total T < 300 ng/dl. Interestingly, 42.9% men with oligospermia and 35.3% of men with sperm density > 20 million/ml but presenting with infertility had total T < 300 ng/dl. Comparing incidence of hypoandrogenism in the infertile non-obstructive groups to that of OA, the difference was

of 16 men were available with total T, SHBG and albumin to calculate bioavailable T by the FTI. 83.3% of men with NOA had bioavailable T < 200 ng/dl.

CONCLUSIONS: The incidence of hypoandrogenism by FDAcriteria for men with NOA is high at 45.0%. Subset analysis calculating

incidence of hypoandrogenism in men with OA (with an incidence expected to be similar to the general population) to men with NOA,oligospermia and sperm density > 20 million/ml but presenting with

1990s, but the widespread use of the FDA criteria for hypoandrogenism and an increasing presentation of men with NOA may account for the

term follow-up.Source of Funding: None

1736THE GR/GR POLYMORPHISM IS CLINICALLY IRRELEVANTPeter J Stahl*, Anna Mielnik, Michael B Marean, Peter N Schlegel, Darius A Paduch. New York, NY.

INTRODUCTION AND OBJECTIVE: Y chromosome microdeletion (YCM) screening provides prognostic information that guides the management of infertile men. Patients with classic YCMsare at risk for spermatogenic failure and have predictably altered outcomes of microsurgical testicular sperm extraction (microTESE). With more widespread genetic diagnostics, increasing numbers of

clinical sequelae of the gr/gr deletion are unclear. Studies have been limited by small ethnically homogenous patient populations and have

men, the largest to date. METHODS: We screened 1997 men for YCMs from 1997-2007

by PCR of sequence tagged sites (STS). Prior to 2004 patients were not initially screened for the gr/gr polymorphism. In all possible cases, these patients were re-screened using our DNA repository. 258 patients without available semen analyses and 329 patients without banked

testicular ultrasounds, and microTESE outcomes were retrospectively

the sy1291 STS. We have previously published our detailed screening methods.

Frequency of the gr/gr polymorphism in the screened populationSperm Concentration(million per mL)

NumberScreened

Number of gr/gr Deletions Detected gr/gr Frequency

989 43 4.3%<1 197 6 3.0%1 - <5 120 12 10.0%5 - <20 61 6 9.8%20+ 43 6 14%Total 1410 73 5.2%