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Published in Asim Kurjak, Ultrasound and Infertility, 2020
Joseph G. Schenker, Aby Lewin, Menashe Ben-David
The examination of ejaculate is undertaken with regard to morphological, biochemical, and vitality aspects (Figure 8). Approximately 20% of infertile males are azoospermic. Azoospermia may be due to spermatogenic failure, obstruction of any level of the genital tract, or retrograde ejaculation. The algorithmic approach to the evaluation and treatment of the azoospermic male is shown in Figure 10. In most azoospermic males, there is little hope of restoring normal spermatogenesis. Only in cases of hypogonadotrophic hypogonadism was fertility achieved following administration of HMG-HCG therapy and more recently following application of Gn-RH analogs. Cryptorchidism is a potentially preventable cause of infertility, if the testis is brought into the scrotum early in life. When the epididimis or vas has become obstructed because of veneral disease, tuberculosis, or after acute nonspecific epididimitis, the obstruction can often by surgically corrected in about 40 to 50% of the cases. Pregnancies in cases of retrograde ejaculation were obtained following pharmacological therapy or recovery of sperm from the urinary bladder.
Device solutions for a challenging spine surgery: minimally invasive transforaminal lumbar interbody fusion (MIS TLIF)
Published in Expert Review of Medical Devices, 2019
Arash J. Sayari, Dil V. Patel, Joon S. Yoo, Kern Singh
Osteobiologic agents such as mitogenic cytokines and other growth factors lend strong osteoinductive properties, and are commonly used in conjunction with autografts and allografts to enhance fusion. The most studied osteobiologic is rhBMP-2, which is used off-label in more than a quarter of all lumbar fusions and is gaining widespread use [57,58]. Given the difficulty with decortication and bone grafting in MIS settings, rhBMP-2 has demonstrated success in creating a more favorable fusion environment. However, rhBMP2 has been a topic of debate with multiple reports suggesting major complications such as postoperative radiculitis, retrograde ejaculation, osteolysis, and cancer [59,60]. Specifically, retrograde ejaculation has been noted in cases of anterior lumbar interbody fusions [61]. Other complications such as bone overgrowth and heterotopic ossification in the neuroforamen may result in new or recurrent radiculopathy requiring a revision decompression [62,63]. During an MIS TLIF, rhBMP-2 can be placed within the disc space, or, more commonly, within the interbody device. Successful outcomes have been reported when rhBMP-2 was used alone and with alternatives during MIS TLIF [64]. A fusion rate of 99.1% was achieved when rhBMP-2 was used with local autograft and a bone graft extender, while local autograft and bone graft extender without rhBMP-2 still demonstrated a fusion rate of 93.1% and reduced costs significantly [64]. Therefore, while off-label use of rhBMP-2 may offer slightly higher fusion rates in MIS TLIFs, it may be clinically insignificant and should be weighed against the potential complications and significant increases in cost.