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Male infertility is a common disease. Male infertility is also a core competency of urology training and clinical practice. In this white paper from the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology, we identify and define different physician productivity plans. We then describe the advantages and disadvantages of various physician productivity measurement systems for male infertility practices. We close with recommendations for measuring productivity that we hope urologists and administrators can use when creating productivity plans for male infertility practices. [ABSTRACT FROM AUTHOR]

Purpose: Infection of a penile prosthesis is a devastating complication that necessitates the removal of all device components. Many aspects of preoperative and intraoperative infection prophylaxis practices have been examined but the specific relevant factors remain unknown. We determined whether use of a mandatory checklist of perioperative practices believed to reduce the risk of prosthesis infection would impact patient safety., Materials and Methods: We retrospectively reviewed men with erectile dysfunction who underwent penile prosthesis insertion. Only patients who had not previously undergone penile prosthesis surgery were included in the study. After an outbreak of infections, a mandatory checklist comprised of best infection prophylaxis practices was developed and was required for all subsequent implant surgeries. Patient cohorts were divided into 3 groups of baseline period, outbreak period and intervention period. Statistical analysis was performed using the chi-square test, Fisher's exact test and ANOVA., Results: During the baseline period 2 of 68 (2.9%) inflatable penile prosthesis devices became infected. During the outbreak period 6 of 11 (54.5%) devices became infected, representing an incidence risk ratio 18.55 times that of the baseline period. After the implementation of the preoperative checklist the incidence risk ratio decreased to 0.0 in the intervention period with 0 of 52 devices (0%) becoming infected., Conclusions: After an outbreak of an unusually high number of penile prosthesis infections, implementation of a required checklist brought the rate down to zero. Although the specific factors that led to the infection outbreak and subsequent cessation of infections are unknown, we have shown that use of a checklist was associated with a dramatic impact on patient safety., (Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Vasectomy is a commonly practiced form of male contraception with over half a million procedures performed annually. Among urologists who perform the procedure, there is considerable variation in pre-procedure patient counseling, vasectomy technique, and post-procedure practices regarding confirmation of sterility. We report an overview of the vasectomy literature published within the past year with a focus on guidelines that have been recently published by two major organizations, the American Urological Association (AUA) and the European Association of Urology (EAU).

Purpose: We examined the incidence of resume fraud among urology residency applicants by determining the rate of misrepresented publications listed in applications to a urology residency program., Materials and Methods: Applications from all 147 urology residency applicants to a program from the 2007 application cycle were analyzed. Verification of listed publications was attempted by querying PubMed, Google Scholar and MEDLINE. Univariate analysis was conducted to assess associations between unverifiable publications and applicant demographics., Results: Of the applicants who submitted publications 19% (14 of 71) had at least 1 unverifiable publication, which represented 9% (14 of 147) of the entire applicant pool. There were no statistically significant associations between misrepresented publications and applicant demographics., Conclusions: Applicants had a low but still unacceptable rate of misrepresented publications and this trend in academic medicine is of great concern., (Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

A man who desires restoration of fertility after vasectomy has two main treatment options for having his genetic child: vasectomy reversal or sperm extraction with subsequent in vitro fertilization with intracytoplasmic sperm injection. Microsurgical reconstructive techniques and their widespread availability have made vasectomy reversal a realistic option for many couples; however, vasectomy reversal outcomes are varied because there are many factors that alter the chance of success. Some of these factors become known preoperatively, whereas others can only be ascertained at the time of surgery. Intraoperatively, the urologist must identify factors and understand how they will affect the decision to proceed. This article systematically reviews each of these phases of decision-making and management.

This article provides an updated analysis of the varicocele literature published since 1994. The present authors have followed the format of the previous review and have included a summary of the results from the 1994 article at the end of each section.

Objectives: Although systemic antibiotic prophylaxis is not recommended for class I (clean) cases according to the Centers for Disease Control and Prevention guidelines, they are often used for varicocelectomy. This study was designed to determine whether antibiotic prophylaxis is necessary for varicocelectomy., Methods: We conducted a retrospective review of 278 patients who had undergone microsurgical varicocelectomy. No antibiotics were used. All patients were seen within 4 weeks of surgery and evaluated for signs of infection., Results: Only 2 patients developed culture-positive infection. Five additional patients had signs of infection as defined by the Centers for Disease Control and Prevention., Conclusions: The results of this study have shown that antibiotic prophylaxis is not warranted for patients undergoing varicocelectomy.

The stimulatory role of testosterone in the production and release of prostate-specific antigen (PSA) has been well characterized. Testosterone production by the testes is dependent on a functional hypothalamic-pituitary-gonadal axis. High prolactin levels have been shown to disrupt this axis, resulting in decreases in gonadotropins and testosterone levels. We report a patient with prostate cancer and elevated PSA levels followed with "watchful waiting" for several years who experienced a precipitous decrease in PSA level over a 3 month period. The patient was found to have an asymptomatic prolactin-secreting pituitary macroadenoma.

Radiopharmaceutic tracers are used commonly to diagnose and monitor benign and malignant conditions of the genitourinary system. Most often, these tracers assess renal function and obstruction in "normal" and transplanted renal units. More recently, especially with the advent of positron emission tomography (PET)/CT, the role of nuclear pharmaceutics in the staging and monitoring of malignancies has expanded.

Objectives: To determine whether use of the digital rectal examination (DRE) results in decreased participation in prostate cancer (PCa) screening, which, in turn, would result in lower detection. Population-based PCa screening includes prostate-specific antigen (PSA) measurement with or without a DRE. PSA and DRE screening provide greater sensitivity than PSA alone; however, the increased participation rate resulting from PSA-alone screening may result in a greater detection rate., Methods: We performed a survey of 13,580 healthy men undergoing PSA-only population-based screening. In addition to the basic demographic information, the survey asked whether the participant would still be willing to participate in the screening if it included a DRE. We modeled the willingness to participate to assess the effect of PSA screening versus PSA and DRE screening on the basis of previously published data and our results., Results: The results of our study indicated that only 78% of men would participate in screening that included both DRE and PSA. Thus, 7800 men of a theoretical population of 10,000 would participate in a screening that included both DRE and PSA. The positive screen rate (PSA > or = 4.0 ng/mL and/or abnormal DRE) would then have been 2013, with 472 PCa cases and 1540 negative biopsies. In the PSA-alone arm, all 10,000 men would have agreed to participate, and the positive screen rate (PSA > or = 4.0 ng/mL) would have been 1480, with 499 PCa cases and 980 negative biopsies. The PSA-alone arm would thus have detected 27 more cancers and performed 560 fewer negative biopsies., Conclusions: The results of our study have demonstrated that DRE is a significant barrier to participation in PCa screening. PSA plus DRE-based programs result in fewer cases of PCa detected, with a significant increase in negative biopsies. We, therefore, suggest that future mass screening efforts include only PSA determination and omit the DRE.

Purpose: We determine whether practice patterns of pediatricians contribute to delays in diagnosing and treating adolescents with varicoceles., Materials and Methods: A survey consisting of 11 multiple-choice questions was mailed to 5,000 pediatricians selected by zip code in New York State. Zip codes were chosen to reflect urban, suburban and rural counties., Results: A total of 544 of the 5000 (10.9%) surveys were returned, and 92 (16.9%) pediatricians acknowledged that they did not routinely perform physical examinations of the genitalia of adolescent males patients. Of 497 pediatricians who routinely or occasionally examine the genitalia 54 (10.9%) did not examine for the presence of varicoceles. When pediatricians were asked how they assess for the presence of varicoceles, 13 of 521 (2.5%) only used visual inspection, 50 (9.6%) only examined patients in the supine position and 379 (72.7%) of these pediatricians never used Valsalva maneuvers. Of 517 respondents 442 (85.5%) referred patients with varicoceles to a urologist for followup and 72 (13.9%) did no further evaluation. When asked to indicate what they thought was the greatest concern regarding the pediatric varicocele, 327 of 497 (65.0%) pediatricians indicated deterioration of future infertility, 120 (30.0%) indicated testicular growth retardation, 105 (24.2%) indicated pain and 18 (4.3%) indicated cosmesis., Conclusions: A significant percentage of pediatricians do not routinely perform physical examinations for varicoceles or appropriately examine for varicoceles, despite the majority being aware of the potential significance of varicoceles. This study demonstrates the need for increased educational efforts among pediatricians regarding the need for physical examination of the genitalia, the techniques for appropriate physical examination, and the need for appropriate referral and followup of adolescents with varicoceles.

Objective: To determine if there is correlation between the size of radical prostatectomy specimens and perioperative complications including intraoperative blood loss., Methods: One hundred twenty consecutive retropubic radical prostatectomy cases were retrospectively reviewed. Perioperative complications, intraoperative blood loss, pathologic stage, and size of the prostatectomy specimen were recorded. Logistic regression was used to determine whether variables such as age, PSA, and prostate weight are significant predictors of perioperative complications and intraoperative blood loss., Results: The final analysis included a total of 117 cases. Significant complications were seen in 10 patients (8.5%). The median weight of the prostatectomy specimen in the group with major complications was 44.5 g (range 24-219) which was significantly higher than the median weight of 39.9 g (range 13-124) for the group without any complications (p = 0.034). The size of the prostate gland predicted the likelihood of a perioperative complication better than chance. A prostate size greater than 37 g was 10 times more likely to encounter major complications. Our analysis also indicated a statistically significant positive correlation between the weight of the prostatectomy specimen and intraoperative blood loss (p = 0.046)., Conclusions: Prostate size correlates with a higher risk of major perioperative complications and higher intraoperative blood loss.