Kozomara M, Birkhäuser V, Anderson CE, et al. Neurogenic lower urinary tract dysfunction in the first year after spinal cord injury: a descriptive study of urodynamic findings. J Urol. 2023;209(1):225-232.

Special thanks to Drs Andrew Lai and Omer Acar at the University of Illinois at Chicago.

Patients sustaining spinal cord injuries often enter the urological sphere due to development of neurogenic lower urinary tract dysfunction. Although baseline lower urinary tract assessment is performed when they arrive in our offices, there are no clear recommendations on the time point for the first urodynamic assessment nor the frequency of testing in the first year. These authors recruited nearly 100 patients to perform urodynamic investigation at multiple time points in the first year after spinal cord injuries. They detected at least 1 unfavorable parameter in 90% of patients that increased the risk of upper tract deterioration. More concerning is that three-quarters of these patients manifested at least 1 unfavorable parameter at their 1-month assessment. This challenges the assumption that the detrusor remains acontractile early after injury and suggests that earlier assessments by urologists should be made to avoid urological comorbidities of an often life-changing injury.

Prunty M, Rhodes S, Rivero MJ, et al. National adherence to guidelines for antimicrobial prophylaxis for patients undergoing radical cystectomy. J Urol. 2023;209(2):329-336.

Special thanks to Drs Andrew Lai and Omer Acar at the University of Illinois at Chicago.

An adherence rate of 28% is rarely acceptable in any medical circumstance. Yet for antibiotic prophylaxis at the time of radical cystectomy with ileal conduit diversions, that’s the proportion of adherence to the American Urological Association guidelines. These authors performed regression analysis using a database from 2015-2020 to highlight a potential area of improvement in our specialty. Guidelines-based antibiotic usage was associated with lower odds of infection events, including urinary tract infections, pyelonephritis, and pneumonia. Surprisingly, 28% is double the adherence reported between 2003 and 2013. While this study certainly has its limitations, the rise of pathogens with difficult-to-treat resistance is undeniable and has only amplified the call for responsible antibiotic stewardship.

Aboukhshaba A, Punjani N, Doukakis S, Zaninovic N, Palermo G, Schlegel PN. Testicular sperm characteristics in men with nonobstructive azoospermia and their impact on intracytoplasmic sperm injection outcome. Fertil Steril. 2022;117(3):522-527.

Special thanks to Drs Catherine Gu and Martin Kathrins at the Brigham and Women’s Hospital.

Microsurgical testicular sperm extraction is a procedure performed for men with azoospermia due to spermatogenic dysfunction, a condition that affects about 1% of men. Since testicular sperm lack progressive motility, determination of which extracted sperm are viable and appropriate for intracytoplasmic sperm injection (ICSI) remains a major clinical challenge.

The sperm characteristics of 198 men treated at a single high-volume institution who successfully underwent microsurgical testicular sperm extraction were retrospectively reviewed, including their subsequent fertilization and clinical pregnancy rates. Sperm characteristics were examined for motility and morphology. On uni- and multivariable analyses, use of motile sperm yielded significant advantages regarding fertilization rate (48%) and clinical pregnancy rate (44%) compared to nonmotile sperm, with rates of 20% and 19%, respectively. The only morphological sperm characteristic that resulted in a difference in fertilization and clinical pregnancy rates was the presence of a normal acrosome, with fertilization and pregnancy rates of 49% vs 35% and 44% vs 27%, respectively.

Sperm were variably exposed to pentoxyifylline to induce motility. Given the observation of in vitro fertilization cell culture toxicity with pentoxyifylline exposure, it is difficult to ascertain the exact effect it may have had on subsequent fertilization and clinical pregnancy rates. Would the results of ICSI with nonmotile sperm have been even better than published if the sperm were simply injected, and not exposed to this chemical?

These findings support the use of nonmotile testicular sperm when necessary. They provide insight into the effects of various sperm characteristics on fertilization and pregnancy rates, areas where research is still incomplete. It should be noted that the authors’ institution is known for using almost exclusively fresh sperm for ICSI. Though this may affect the results’ generalizability for those institutions that utilize frozen-thawed testicular sperm for ICSI, these findings may still ultimately expand beyond the borders of men with azoospermia due to spermatogenic dysfunction to help identify the best sperm for all couples undergoing ICSI.