What We Learned from AUA24!

The annual American Urological Association annual convention was held in San Antonio to start May off. This convention is a great way for urologists to learn about many areas of urology including my focus in breakthrough technology in fertility and vasectomy, sexual dysfunction, prostate cancer screening, and treatment of obstructive urination, which is urinary frequency. Many useful emerging technologies were presented to physicians.

I had a chance to attend the conference and here are a few of my big takeaways that I’ll be monitoring and incorporating at The Y Factor in Houston!

  1. A new exciting development in the field of fertility is focused on the refinement of the surgical technique to encounter sperm in man with a zero sperm count. Specifically, it involves processing a tissue in the operating room to be able to find small pockets of sperm that would be present in testicular tissue that otherwise is not making sperm. This in operating room tissue processing assists the in vitro fertilization labs encounter sperm at time of IVF.
  2. Developments in sexual dysfunction treatment for men who have delayed ejaculation. This has been a difficult problem to treat. There is now relief for this medical problem which focuses on medication that affects the pituitary. This treatment has created significant good responses in some men. Treating testosterone is also important for erectile dysfunction and delayed ejaculation.
  3. There was a panel discussion about injection therapy versus surgical therapy for men who have plaque and calcification in the penis known as Peyronie’s disease. A collagenase calcium dissolving injectable medication has increased efficacy (straightening of the penis) from 30% up to 60% as long as there is a patient driven compliance to extend the plaque through modeling (stretching device like Restorex). Surgery is still a good option for deep plaque calcification (seen on ultrasound) and hourglass constricting deformity.
  4. On the cancer front, men who have an elevated PSA benefit from MRI testing of the prostate to see if there are suspicious lesions which need focal directed biopsy, in addition to sampling other areas of the prostate. The goal is to use pre biopsy testing (PSA and MRI and other markers) to identify men at risk for aggressive cancer. A genetic test called Decipher is now available for men who test positive (diagnosed) with prostate cancer and who get placed in a group that does not require treatment because the prostate cancer is small and slow growing (Active Surveillance). The Decipher test and MRI imaging of the prostate defines the risk of their untreated prostate cancer evolving into a more aggressive form. This allows patients and physicians to better decide if definite cancer treatment is needed.
  5. Frequent urinating with a large prostate is a serious problem in men as they age. In addition to the large prostate causing obstruction, the large prostate causes an overactive bladder. Men who have urinary frequency which is causing them to get up at night should be treated with a medication to address both the prostate and a medication to address the bladder. This dual medication treatment has produced the greatest improvement in symptoms in men. There are surgical procedures available as well, but men need to discuss this with a trained urologist how different surgeries could impact ejaculation. Some men might choose to have a procedure (MIST and others) that might be less effective in improving urination, but maintains the ejaculation and pleasurable sensation that men describe during orgasm.
  6. Updates on low testosterone therapy were focused on how low testosterone worsens sleep apnea and individuals with sleep apnea will have continual fatigue and mental cloudiness. Any man presenting with fatigue, memory loss and cognitive decline should consider sleep study testing to identify sleep apnea.
  7. On the male fertility testing front, because of normal fluctuations in semen analysis in men, it is difficult to use the traditional semen analysis to gauge a man’s fertility. New genetic tests (fragmentation and epigenetics) are available that allow us to understand a sperm‘s fertilization capability specifically by looking at the integrity quality of the DNA within the sperm. These specialized ejaculated semen tests should be used in couples who have failed fertility treatment, or have suffered recurrent spontaneous abortions.
  8. In the area of vasectomy, there’s no significant changes to our current in office counseling information. Conference presentations emphasize that complication rates of a vasectomy continue to be extremely low-there is one percent chance that the vasectomy does not result in a zero per count, and there is a 1-in-2000 chance that down the road that the vasectomy site opens leading to future pregnancy. This 1-2000 vasectomy failure rate is very favorable compared to the higher failure rates of other birth control. Pain from a vasectomy is still reported in the 1-2%.
  9. Several studies followed vasectomy patients after the procedure and reported a 8% regret rate. The take home point is that clinics and physicians need to continue to educate that a vasectomy should be considered a permanent form of birth control for couples wanting no future fertility

Russel H. Williams, MD

Dr. Russel H. Williams is the founder, CEO and CMO of The Y Factor and brings more than 20 years of experience. Dr. Williams earned his Medical Degree at the University of Texas at Dallas Southwestern Medical Center, where he graduated at the top of his class. He completed his urology residency at Baylor College of Medicine in Houston, then completed a male reproductive medicine and microsurgery visiting fellowship at the New York-Presbyterian/Weill Cornell Medical Center in Manhattan, New York. Dr. Williams is an active member of the American Urological Association, American Society for Reproductive Medicine, and peers recognize him as one of only a handful of Reproductive Urologists focusing on men’s urological wellness & fertility.

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