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Proton-pump inhibitors (PPIs) are among the most widely used drugs worldwide. PPI use has recently been linked to adverse changes in semen quality in healthy men; however, the effects of PPI use on semen parameters remain largely unknown specifically in cases with male factor infertility. We examined whether PPI use was associated with detrimental effects on semen parameters in a large population of subfertile men. We retrospectively reviewed data from 12 257 subfertile men who had visited our fertility clinic from 2003 to 2013. Patients who reported using any PPIs for >3 months before semen sample collection were included; 7698 subfertile men taking no medication served as controls. Data were gathered on patient age, medication use, and conventional semen parameters; patients taking any known spermatotoxic medication were excluded. Linear mixed-effect regression models were used to test the effect of PPI use on semen parameters adjusting for age. A total of 248 patients (258 samples) used PPIs for at least 3 months before semen collection. In regression models, PPI use (either as the only medication or when used in combination with other nonspermatotoxic medications) was not associated with statistically significant changes in semen parameters. To our knowledge, this is the largest study to compare PPI use with semen parameters in subfertile men. Using PPIs was not associated with detrimental effects on semen quality in this retrospective study.

The placement of artificial urinary sphincters (AUSs) is a common procedure for stress incontinence following treatment for prostate cancer. Complications are relatively rare, and the most common reasons for device removal and revision are cuff erosion, infection, and mechanical failure. We present a case of a 66-year-old male with a history of radiation therapy for prostate cancer that developed a deep venous thrombosis (DVT) and pulmonary embolism (PE) following his second AUS due to compression by a pressure regulating balloon (PRB). Compression of the femoral vein was not originally diagnosed as the cause for DVT on initial hospitalization, and there was an additional hospitalization due to worsening symptoms prior to identification of PRB compression. This is the first published case of migrating PRB causing femoral DVT and PE following the placement of a second AUS in an irradiated tissue field, and one of two published cases of DVT due to PRB compression.

Epithelioid hemangioendotheliomas (EHE) are rare soft tissue tumors and only 17 cases involving the penis have been reported in the literature. These tumors are often incorrectly diagnosed as Peyronie's disease or superficial penile thrombosis. We present the case of a 59-year-old male referred to our institution with EHE after being incorrectly diagnosed with Peyronie's disease. A color Doppler ultrasound of the penis showed a highly vascular mass superficial to the tunica albuginea and a subsequent biopsy demonstrated EHE with low-grade features. Complete local excision was performed and given the patient's low-risk pathological features, he has been followed with only close surveillance. Early recognition of epithelioid vascular tumors is important and using adequate imaging modalities is critical to avoid prolonged periods of misdiagnosis.

Context: Established guidelines advocate for the administration of antimicrobial prophylaxis (AMP) within 60 min of the surgical incision. An internal audit of genitourinary prosthetics at our institution revealed, we were compliant in only 25% of cases and led to the development of a standardized protocol emphasizing administration of AMP in the OR by the anesthesia provider and specific duties for each member of the surgical team (anesthesia, surgery, and nursing). Aims: The aim was to describe the system factors that we recognized as responsible and determine our protocols effect on compliance. Settings and Design: A retrospective review of urologic prosthetics cases performed by a single surgeon at our institution from October 2009 to January 2011 was conducted. Sixty consecutive cases occurring: Prior to the protocol, immediately after, and 18 months after it went into effect were reviewed. Statistical Analysis: Categorical data were compared using the Fisher's exact test and continuous variables using the Student's t -test at the P > 0.05 significance level. Results: System factors associated with noncompliance included: Location of antibiotic administration (OR vs. preoperative area) and timing of the case (first case vs. not). Ninety-six percent of noncompliance was the result of AMP being administered too early. Compliance increased from 25% to >91% and the proportion of AMP administered in the OR increased from 20% to >88%. No drop-off in compliance occurred 18 months after initiation of the protocol. Conclusion: A defined protocol in conjunction with shifting administration of AMP to the OR and into the hands of the anesthesia provider can achieve a durable increase in compliance with established guidelines.