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Chest X-ray: Chest x-ray may be done to symptoms nausea buy 250mg levaquin look for bladder cancer which has spread to medications causing thrombocytopenia discount levaquin master card the lungs treatment yeast infection nipples breastfeeding discount 750 mg levaquin amex. Ultrasound: Ultrasound uses sound waves to symptoms internal bleeding levaquin 750 mg without prescription make pictures of the organs inside your body. It can be useful in deciding the size of the tumor and whether it has spread beyond the bladder to nearby organs or tissues. Doctors do not usually order this test unless you have symptoms of bone pain or if blood tests show the cancer might have spread to your bones. Grade If cancer cells are found in the tissue sample from the bladder, a pathologist studies the sample under a microscope to learn the grade of the tumor. Your doctor uses this grade along with other factors to decide your treatment options. Staging If bladder cancer is diagnosed, the next step is to choose the best way to treat it. To help do this, your doctor checks how deep the cancer cells have grown and whether it has spread (the cancer stage). Bladder Cancer Staging Shayne Davidson Illustration 17 University of Michigan Rogel Cancer Center Bladder Cancer Handbook Treatment for Bladder Cancer Bladder cancer is treated in many different ways using treatments that are the standard of care. A clinical trial is a research study to test new treatments to measure if it is useful and safe. Descriptions of the most common treatment options for bladder cancer are listed below. Once your treatment plan has been developed by your oncologist, you and your family members or friends will receive patient education and instructions on how to care for yourself during treatment. Surgery Surgery to remove the tumor (Transurethral resection): Is the removal of the tumor and surrounding tissue during an operation. You may have painful or bloody passing of urine up to five days after the procedure. Partial cystectomy: the surgeon removes only a part of the bladder containing cancer cells. This may be an option if your cancer is limited to one part of the bladder that can be easily removed without harming bladder function. Cystectomy (removal of entire bladder): A radical cystectomy is an operation that removes the entire bladder, along with lymph nodes. In men, along with the removal of the bladder and lymph nodes the prostate and seminal vesicles are usually removed, as well. With robotic surgery, men who want to keep their ability to have an erection are sometimes able to have a nerve-sparing surgery, which lowers the risk of nerve damage. This method is only available to men who have no signs of cancer in the bladder neck or prostatic urethra, no carcinoma in situ and no signs of prostate cancer. In women, along with the removal of the bladder and lymph nodes the uterus, ovaries and part of the vagina are usually removed as well. As a result, women will not be able to get pregnant and will go into premature menopause. A highly selective group of women, with robotic surgery, can have nerve sparing surgery. This involves careful removal of tissue on each side of the vagina, where nerves responsible for sexual function are found. Nerve-sparing surgery may help to stop vaginal dryness, pain with intercourse, and loss of the ability to have an orgasm. Because bladder cancer surgery may affect your sex life, it may be helpful for you and your partner to talk about your feelings. If you?d like to talk to a counselor about your feelings, your doctor can refer you. When the entire bladder is removed, the surgeon makes another way for urine to be collected from the kidneys and stored. You may wear a flat pouch outside of your body under your clothes or the surgeon may use part of your intestine to create a pouch inside your body. Depending on your treatment plan, you will receive an additional handbook on one of the following bladder surgeries:? The surgeon will create a pouch which is brought out through an opening made on your abdomen. A medical oncologist is a doctor who specializes in treating cancer with medication. A patient with muscle-invasive bladder cancer which is found only in the bladder often get chemotherapy before (neo adjuvant therapy) or after (adjuvant therapy) cystectomy to reduce the risk of the cancer spreading to other parts of the body. If your doctor decides that chemotherapy is the right choice to treat your bladder cancer, you will receive a handbook on chemotherapy. Radiation Radiation can be used on select patients for bladder preservation or in patients with small cell bladder cancer that is sensitive to chemo-radiation. Radiation therapy uses high-energy beams aimed at your cancer to kill the cancer cells. If your doctor decides that radiation is the right choice to treat you bladder cancer, you will receive a handbook on radiation therapy. This treatment is given through your urethra and straight into the bladder by a small catheter. If your doctor decides that this how your cancer will be treated, you will receive a separate handbook on immunotherapy. The usual course of treatment is once a week for six weeks or maintenance doses as decided by your doctor. This group has been used as the benchmark for newly founded groups across the country. A support group is a gathering of people who share a common health concern or interest. Patient and family support, reassurance, education and guidance are key for treatment recovery and long term quality of life. He founded the first Bladder Cancer Support Group at the University of Michigan about 15 years ago. Today, the Bladder Cancer Support Group is thriving with nearly 40-80 attendees at most meetings. Acts as a forum for patients and families to lend support, strength, and ideas to each other. The group has been involved in advocacy, getting better education to those diagnosed with bladder cancer, and being mentors to those newly diagnosed with bladder cancer. This list includes their contact information, type of bladder cancer treatment, and their doctor. The Bladder Cancer Support Group brings people together facing like issues and gives a place to share their story. Patients may qualify for assistance from cancer-specific organizations or other charitable foundations. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy. The solution contains live, weakened bacteria (Bacille Calmette-Guerin) that activate the immune system. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration. Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. A series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine.

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Utility of Urological manifestations of chronic schistosomal biofeedback for the daytime syndrome of urinary frequency myeloradiculopathy medicine during pregnancy buy levaquin in india. Eur J Obstet Gynecol genitourinary prolapse repair and prophylactic tension-free Reprod Biol treatment effect definition 750mg levaquin fast delivery. Detrusor hyperreflexia inhibited by anal Double-blind medicine 75 yellow buy generic levaquin 500mg on-line, placebo-controlled study of magnesium dilatation medicine side effects buy levaquin 750 mg low price. Another aspect of incontinence: prevalence among female patients attending a acute urinary retention in young patients. Sexual function in cystometry, urethral pressure profilometry and pelvic floor women attending a urogynecology clinic. Int Urogynecol J electromyography in the evaluation of female patients with Pelvic Floor Dysfunct. A model for Urge incontinence in elderly people: factors predicting the predicting motor urge urinary incontinence. Place of the free detrusor contractile function in women with neuropathic flow curve in the urodynamic investigation of children. Expression of tolerability and safety of propiverine hydrochloride in intercellular adhesion molecules in the bladder of patients children and adolescents with congenital or traumatic with interstitial cystitis. Efficacy and safety 4 of a neurokinin-1 receptor antagonist in postmenopausal 830. The women with overactive bladder with urge urinary influence of urinary incontinence on the quality of life of incontinence. A comparison perceived by patients with interstitial cystitis/painful of two diagnostic procedures for female urinary bladder syndrome. Chronic pudendal management of dysuria, urinary frequency, and vaginal nerve neuromodulation in women with idiopathic refractory discharge. Protocol with a novel minimally invasive implantable mini management of dysuria, urinary frequency, and vaginal stimulator. Clinical studies of cerebral and urinary grading of detrusor instability using a computerized tract function in elderly people with urinary incontinence. Brain neuromodulation in women with idiopathic detrusor control of normal and overactive bladder. Urodynamic assessment of bladder assessment of detrusor instability in patients treated with function. Transobturator Extracorporeal magnetic innervation therapy: assessment of slings for stress incontinence: using urodynamic parameters clinical efficacy in relation to urodynamic parameters. Urethral instability and sacral nerve stimulation-a who underwent tethered cord release for occult spinal better parameter to predict efficacy? Intravesical detrusor injections of botulinum a toxin in patients with oxybutynin: practicalities of clinical use. Treatment of elderly surface electromyography in women with urinary women with urge incontinence in middle tennessee: a incontinence and in healthy volunteers. Pubovaginal Comprehensive evaluation of bladder and urethral sling surgery for simple stress urinary incontinence: dysfunction symptoms: development and psychometric analysis by an outcome score. Results of the results of transurethral collagen injection for female stress tension-free vaginal tape procedure for the treatment of incontinence: assessment by urinary incontinence score. Tension-free X-1F, X-1H vaginal tape for stress urinary incontinence: Is there a 860. Treatment of Increased expression of connexin 43 in the overactive urgency and urge incontinence with flavoxate in the neurogenic detrusor. Vasoactive ultrastructural detrusor changes following endoscopic intestinal polypeptide in the normal and unstable bladder. Int Quality of life and seeking help in women with urinary Urogynecol J Pelvic Floor Dysfunct. Is low bladder incontinence in women treated by ischemic compression compliance predictive of detrusor overactivity? Tolerability discontinuation of lithium augmentation in elderly patients and steady-state pharmacokinetics of terodiline and its with unipolar depression. Int Urogynecol J Pelvic of overactive bladder and epidemiology of urinary Floor Dysfunct. Factors prescription insurance coverage in the decision to associated with nursing interventions to reduce pharmacologically manage symptoms of overactive incontinence in hospitalized older adults. A minimally of delivery: does cesarean delivery reduce bladder invasive technique for outpatient local anaesthetic symptoms later in life? Familial risk incontinence and pelvic organ prolapse in nulliparous of urinary incontinence in women: population based cross women. Analysis of long-term Elmiron therapy Bladder compliance in neurologically intact women. Use of women: its prevalence and its management in a health amitriptyline in the treatment of interstitial cystitis. Treatment of outcome and quality of life following enterocystoplasty for neurogenic detrusor overactivity in spinal cord injured idiopathic detrusor instability and neurogenic bladder patients by conditional electrical stimulation. Vaginal Transcutaneous electrical nerve stimulation and temporary pessaries in managing women with pelvic organ prolapse S3 neuromodulation in idiopathic detrusor instability. The Desmopressin, as a "designer-drug," in the treatment of bladder cooling test for urodynamic assessment: analysis of overactive bladder syndrome. Has the true agonist, evokes bladder relaxation and increases micturition prevalence of voiding difficulty in urogynecology patients reflex threshold in the dog. Urinary incontinence during sexual chloride (Urispas) and meladrazine tartrate (Lisidonil). Sacral bladder neck suspension: a clinical and urodynamic neuromodulation in Norway: clinical experience of the first investigation, including actuarial follow-up over four years. Frequency of toxin B is not an effective treatment of refractory de novo urgency in 463 women who had undergone the overactive bladder. The overactive bladder in children: a potential future indication modified Pereyra procedure in recurrent stress urinary for tolterodine. X and tolerability of extended-release tolterodine and 4 immediate-release oxybutynin in Japanese and Korean 940. Pelvic patients with an overactive bladder: a randomized, placebo floor spasms in children: an unknown condition responding controlled trial. The dose-finding study of the novel anti-muscarinic agent after-contraction in paediatric urodynamics. Symptom bladder capacity after bladder biofeedback predicts long assessment tool for overactive bladder syndrome- term outcome in children with nocturnal enuresis. The use bladder biofeedback in the treatment of children with of salivary stimulant pastilles to improve compliance in refractory nocturnal enuresis associated with idiopathic women taking oxybutynin hydrochloride for detrusor detrusor instability and small bladder capacity. Bladder neck electrical conductivity in female urinary urgency and urge incontinence. Possible application of urinary stress incontinence using a method for Raman microspectroscopy to verify the interstitial cystitis postoperative adjustment of sling tension (Remeex diagnosis after potassium sensitivity test: phenylalanine or System). Health-related consequences intravaginal slingplasty for treatment of urinary stress of overactive bladder: an economic perspective. The frequency analysis of extended-release formulations of oxybutynin of disorders of the lower urinary tract, urinary incontinence and tolterodine for the management of urge incontinence. Int Urogynecol J overactive bladder symptoms on employment, social Pelvic Floor Dysfunct. Urinary with a diagnosis of interstitial cystitis: common things are incontinence and diabetes in postmenopausal women. Lumbar maintenance study of oral pilocarpine tablets for radiation epidural blockade for management of pain in interstitial induced xerostomia. Double balloon test in patients with overactive bladder due to positive pressure urethrography is a more sensitive test than cerebrovascular accidents and bladder outlet obstruction. Development of a Improving neuromodulation technique for refractory non-invasive treatment system for urinary incontinence voiding dysfunctions: two-stage implant. The psychometric testing of X-1I a urinary incontinence nursing assessment instrument. Urinary toxin A in patients with refractory idiopathic detrusor dysfunction and autonomic control in amyloid neuropathy. Incomplete Urodynamic evaluation of patients with autosomal emptying and urinary retention in multiple-system atrophy: dominant pure spastic paraplegia linked to chromosome when does it occur and how do we manage it? Surgical patient characteristics and therapeutic choices for therapeutic index of tension-free vaginal tape and interstitial cystitis: analysis of 282 Japanese patients. X-1B Urinary incontinence in elderly women: findings from the Health, Aging, and Body Composition Study.

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Are ulcerative and nonulcerative interstitial cystitis/painful bladder syndrome 2 distinct diseases? Experimental autoimmune cystitis: a potential murine model for ulcerative interstitial cystitis medications going generic in 2016 order genuine levaquin online. Evidence-based criteria for pain of interstitial cystitis/painful bladder syndrome in women symptoms of the flu order levaquin uk. Psychometric validation of the O?leary-Sant interstitial cystitis symptom index in a clinical trial of pentosan polysulfate sodium medicine vs medication purchase levaquin 750 mg online. Are patient symptoms predictive of the diagnostic and/or therapeutic value of hydrodistention? Symptoms and cystoscopic findings in patients with untreated interstitial cystitis medications for rheumatoid arthritis purchase levaquin 750mg with amex. Possible mechanisms inducing glomerulations in interstitial cystitis: relationship between endoscopic findings and expression of angiogenic growth factors. Hydrodistension under local anesthesia for patients with suspected painful bladder syndrome/ interstitial cystitis: safety, diagnostic potential and therapeutic efficacy. Cystoscopic findings consistent with interstitial cystitis in normal women undergoing tubal ligation. Bladder pain syndrome: do the different morphological and cystoscopic features correlate? The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain. Clinical phenotyping of women with interstitial cystitis/painful bladder syndrome: a key to classification and potentially improved management. A pilot clinical trial of oral pentosan polysulfate and oral hydroxyzine in patients with interstitial cystitis. Effect of amitriptyline on symptoms in treatment naive patients with interstitial cystitis/painful bladder syndrome. Efficacy of pentosan polysulfate in the treatment of interstitial cystitis: a meta-analysis. Treatment of ulcer and nonulcer interstitial cystitis with sodium pentosanpolysulfate: a multicenter trial. Safety and efficacy of concurrent application of oral pentosan polysulfate and subcutaneous low-dose heparin for patients with interstitial cystitis. Treatment of interstitial cystitis with immunosuppression and chloroquine derivatives. Absorption of alkalized intravesical lidocaine in normal and inflamed bladders: a simple method for improving bladder anesthesia. Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis. Urodynamic results of intravesical heparin therapy for women with frequency urgency syndrome and interstitial cystitis. Comparison of intravesical botulinum toxin type A injections plus hydrodistention with hydrodistention alone for the treatment of refractory interstitial cystitis/painful bladder syndrome. Trigonal injection of botulinum toxin A in patients with refractory bladder pain syndrome/interstitial cystitis. Safety and efficacy of hyperbaric oxygen therapy for the treatment of interstitial cystitis: a randomized, sham controlled, double-blind trial. A prospective, single-blind, randomized crossover trial of sacral vs pudendal nerve stimulation for interstitial cystitis. The long-term efficacy of sacral neuromodulation in the management of intractable cases of bladder pain syndrome: 14 years of experience in one centre. Minimum 6-year outcomes for interstitial cystitis treated with sacral neuromodulation. Oral cimetidine gives effective symptom relief in painful bladder disease: a prospective, randomized, double-blind placebo-controlled trial. Clinical response to an oral prostaglandin analogue in patients with interstitial cystitis. A randomized double-blind trial of oral L-arginine for treatment of interstitial cystitis. Improvement in interstitial cystitis symptom scores during treatment with oral L-arginine. Effect of long-term oral L-arginine on the nitric oxide synthase pathway in the urine from patients with interstitial cystitis. Elevated nitric oxide in the urinary bladder in infectious and noninfectious cystitis. A randomized double-blind placebo-controlled crossover trial of the efficacy of L-arginine in the treatment of interstitial cystitis. Effects of L-arginine treatment on symptoms and bladder nitric oxide levels in patients with interstitial cystitis. The dual serotonin and noradrenaline reuptake inhibitor duloxetine for the treatment of interstitial cystitis: results of an observational study. The functional results of partial, subtotal and total cystoplasty with special reference to ureterocaecocystoplasty, selective sphincterotomy and cystocystoplasty. Experiences with colocystoplasties, cecocystoplasties and ileocystoplasties in urologic surgery: 40 patients. Interstitial cystitis: thirteen patients treated operatively with intestinal bladder substitutes. Treatment of interstitial cystitis: comparison of subtrigonal and supratrigonal cystectomy combined with orthotopic bladder substitution. Urinary conduit formation using a retubularized bowel from continent urinary diversion or intestinal augmentations: ii. Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. A review of the efficacy of surgical treatment for and pathological changes in patients with chronic scrotal pain. Early and late morbidity after vasectomy: a comparison of chronic scrotal pain at 1 and 10 years. Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial. Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Value of diagnostic ultrasound in patients with chronic scrotal pain and normal findings on clinical examination. Microsurgical denervation of the spermatic cord as primary surgical treatment of chronic orchialgia. Microsurgical denervation of the spermatic cord for chronic orchialgia: long-term results from a single center. Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation. Intravesical potassium sensitivity in patients with interstitial cystitis and urethral syndrome. Urethral syndrome and associated risk factors related to obstetrics and gynecology. Bedside testing for chronic pelvic pain: discriminating visceral from somatic pain. The role of laparoscopy in the management of pelvic pain in women of reproductive age. A randomised trial of photographic reinforcement during postoperative counselling after diagnostic laparoscopy for pelvic pain. A randomized clinical trial to compare two different approaches in women with chronic pelvic pain. Radiologic findings of pelvic venous congestion in an adolescent girl with angiographic confirmation and interventional treatment. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. The usefulness of laparoscopy and hysteroscopy in the diagnostics and treatment of infertility. Dyspareunia and chronic pelvic pain after polypropylene mesh augmentation for transvaginal repair of anterior vaginal wall prolapse.

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Surgical treatment is the most effective and reliable method of bringing testes into the scrotum treatment 101 500mg levaquin with visa. Surgical treatment during the first or second year of life may have a positive effect on subsequent fertility [145] medicine 8 capital rocka buy levaquin online. However x medications cheap levaquin online, there is no definitive proof of the protective effect of early orchidopexy symptoms zoloft withdrawal discount 500mg levaquin amex. In men with a history of unilateral cryptorchidism, paternity is almost equal (89. In men with unilateral cryptorchidism, paternity is independent of age at orchidopexy and preoperative testicular location and size [146]. However, a history of unilateral cryptorchidism may result in reduced fertility potential and therefore a longer time to achieve pregnancy. In men with bilateral cryptorchidism, oligozoospermia can be found in 31% and azoospermia in 42%. In cases of bilateral cryptorchidism and azoospermia, orchidopexy performed even in adult life might lead to the appearance of spermatozoa in the ejaculate [147]. Orchidopexy performed before the age of puberty has been reported to decrease the risk of testicular cancer [149]. However, this and other similar reports are based on retrospective data and do not exclude the possibility that boys undergoing early and late orchidopexy represent different pathogenetic groups of testicular maldescent. Although 15-20% of retained testes descend during hormonal treatment, one-fifth of these reascend later, which is why hormonal treatment is no longer recommended. If the spermatic cords or the spermatic vessels are too short to allow proper mobilisation of the testis into the scrotum, a staged orchidopexy (Fowler-Stephenson procedure) can be performed, using open surgery, laparoscopy, or microsurgery. Some retrospective studies have indicated that early treatment (during the first 2 years of life) has a beneficial effect on preserving future fertility [151], whereas a recent randomised study showed that surgery at 9 months resulted in a partial catch-up of testicular growth until at least age 4 years vs. The results clearly indicate that early surgery has a beneficial effect on testicular growth. Testicular volume is an approximate indirect measure of spermatogenic activity, therefore, it is possible that orchidopexy at an early age might improve future spermatogenesis. Furthermore, as indicated above, correction of bilateral cryptorchidism, even in adulthood, can lead to sperm production in previously azoospermic men [147]. Vascular damage is the most severe complication of orchidopexy and can cause testicular atrophy in 1-2% of cases. In men with non-palpable testes, the postoperative atrophy rate was 12% in those cases with long vascular pedicles that enabled scrotal positioning. Postoperative atrophy in staged orchidopexy has been reported in up to 40% of patients [150]. Paternity in men with unilateral cryptorchidism is almost equal to that in men without cryptorchidism. A Early orchidopexy (6-12 months of age) might be beneficial for testicular development in adulthood. A recent meta-analysis reported some improvement in sperm quality and spontaneous pregnancy rate [155]. Follicle-stimulating hormone might be beneficial in a selection of patients [155]. Concerning natural conception the role of antioxidants needs further investigations [157]. Three of the four methods of male contraception have been in use for hundreds of years. The typical first-year failure rates of traditional male methods are high (withdrawal 19%, periodic abstinence 20%, and condoms 3-14%) compared to the failure rates of 0. For men, male contraceptive methods must be acceptable, cheap, reversible, and effective. The method nearest to being generally available clinically is hormonal male contraception, which is based on the suppression of gonadotropins and testosterone substitution to maintain male sexual function and bone mineralisation, and to prevent muscle wasting [160]. However, a combination of testosterone with progestin results in complete suppression of spermatogenesis in all races, and provides contraceptive efficacy equivalent to female hormonal methods [161]. Before vasectomy, the couple should be fully informed about the benefits and risks, especially as an Australian telephone survey found that 9. The least invasive approach is no-scalpel vasectomy [164], which is also associated with a low rate of complications [165]. The most effective occlusion technique is cauterisation of the lumen of the vas deferens and fascial interposition [166-168]. Most techniques can be carried out safely under local anaesthesia in an outpatient clinic. Potential systemic effects of vasectomy, including atherosclerosis, have not been proven, and there is no evidence of a significant increase in any systemic disease after vasectomy. An increased rate of prostate cancer in men who underwent vasectomy has not been detected [162, 169]. Acute local complications associated with vasectomy include haematoma, wound infection, and epididymitis in up to 5% of cases [162]. However, patients should be informed preoperatively that, although rare, long-term recanalisation might occur [171]. Persistent motility is a sign of vasectomy failure, and the procedure will need to be repeated. The longer the interval is from vasectomy to reversal, the lower is the pregnancy rate. In a study of 1,469 men who had undergone microsurgical vasectomy reversal, patency and pregnancy rates were 97% and 76%, respectively, for an interval up to 3 years after vasectomy; 88% and 53% for 3-8 years, 79% and 44% for 9-14 years, and 71% and 30% for > 15 years [174]. If secondary epididymal obstruction occurs, tubulovasostomy is needed to reverse the vasectomy (see Chapter 3D) [109]. Patients seeking consultation about vasectomy must be informed about the surgical method, risk A* of failure, irreversibility, the need for post-procedure contraception until clearance, and the risk of complications. Microsurgical vasectomy reversal is a low-risk and (cost-) effective method of restoring fertility. However, specific data are not available to confirm that these diseases have a negative influence on sperm quality and male fertility in general. A concentration of >103 cfu/mL urinary tract pathogens in the ejaculate is indicative of significant bacteriospermia. The sampling time can influence the positive rate of microorganisms in semen and the frequency of isolation of different strains [180]. The ideal diagnostic test for Chlamydia trachomatis in semen has not yet been established [181]. Ureaplasma urealyticum is pathogenic only in high concentrations (>103 cfu/mL ejaculate). No more than 10% of samples analysed for ureaplasma exceed this concentration [182]. Normal colonisation of the urethra hampers the clarification of mycoplasma-associated urogenital infections, using samples such as the ejaculate [183]. Although leukocytospermia is a sign of inflammation, it is not necessarily associated with bacterial or viral infections [185]. All investigations have given contradictory results, and have not confirmed that chronic prostatitis has a decisive role in altering conventional semen parameters [188-190]. Among sexually active men < 35 years of age, epididymitis is most often caused by C. Non-sexually transmitted epididymitis is associated with urinary tract infection and occurs more often in men aged > 35 years [206]. Transiently decreased sperm counts and forward motility are observed [204, 207, 208]. Development of stenosis in the epididymal duct, reduction of sperm count, and azoospermia are more important in the follow-up of bilateral epididymitis (see Chapter 3D). B trachomatis must be instructed to refer their sexual partners for evaluation and treatment. The most convincing evidence for a general decline in male reproductive health is the increase in testicular cancer seen in western countries [212].

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