Wyrwoll MJ, Köckerling N, Vockel M, et al. Genetic architecture of azoospermia-time to advance the standard of care. Eur Urol. 2023;83(5):452-462.

Special thanks to Dr Alayman Hussein at Minia University, Egypt.

Is there a need to expand genetic testing for male infertility? The commonly used genetic tests in men with azoospermia and cryptozoospermia include cystic fibrosis gene mutation assessment in obstructive azoospermia due to congenital bilateral absence of the vas deferens and chromosomal aberrations such as Klinefelter syndrome and microdeletions of the Y-chromosomal azoospermia factors in azoospermia due to spermatogenic dysfunction.

The aim of this prospective study was to determine the association of other genes to male infertility. Whole exome sequencing was performed in over 600 men with crypto- or azoospermia men within the authors’ Male Reproductive Genomics study with a structured analysis of the clinical validity of candidate genes.

The authors reported 75 likely pathogenic variants obtained by whole exome sequencing in a little more than one-third of the 60 selected genes as possible causes in about 1 in 12 of men with crypto- or azoospermia. Based on this finding, they propose that now is the time to advance the standard of care in the genetic testing of infertile males. Providing more definitive genetic diagnoses in clinical practice will contribute to reaching better treatment decisions and improve the prediction of successful testis sperm extraction in azoospermia due to spermatogenic dysfunction.

Soyster ME, Arnold PJ, Burns RT, et al. Ileal ureter utilization in patients with previous urinary diversions. Urology. 2023;177:184-188.

Special thanks to Drs Andrew Lai and Mahmoud Mima at the University of Illinois at Chicago.

We urologists have great appreciation for ileal ureter reconstruction procedures and commend those who perform them in challenging patients with pre-existing lower urinary tract surgery. These authors shared their experience with patients who developed ureteral strictures in the setting of prior urinary diversions or augmentations. They identified 19 patients and reported complications in one-third. Surprisingly, there were no differences in renal function, and none of the patients required renal replacement therapy. These results reflect the quality of care provided at a tertiary referral center and will serve as an anchor when counseling some of the most urologically complex patients in our field.

Ramos-Carpinteyro R, Ferguson EL, Chavali JS, Geskin A, Soputro N, Kaouk J. Single-port transvesical robot-assisted radical prostatectomy: the surgical learning curve of the first 100 cases. Urology. 2023;178:76-82.

Special thanks to Drs Andrew Lai and Simone Crivellaro at the University of Illinois at Chicago.

We urologists were the first to really adopt the da Vinci single-port robotic system, and this remarkable new platform has allowed us to revisit traditional and perhaps even antiquated surgical approaches. Several centers have recently published promising outcomes for patients undergoing single-port robot-assisted simple prostatectomy via transvesical access. Continuing in this innovative vein, these authors took on transvesical radical prostatectomy with this paper focusing on the learning curve, which they estimate to be between 10 and 30 cases. To put this in perspective, studies suggest that the learning curve for the da Vinci Xi robot-assisted laparoscopic radical prostatectomy is at least 100 cases. For prostate laser enucleation, experts have generally assessed a learning curve of 25 to 50 cases. Certainly, while their aggressively low estimate may reflect results in the hands of experienced robotic surgeons, their data show great promise and may help accelerate the adoption of the single-port platform for radical prostatectomy.