StreamDx Urine Flowmeter

The 2017 Translational Medicine Symposium was held on Feb. 27th. The symposium addressed how clinicians' ideas and research results can have an impact on patient care - if they are translated into clinical practice. The symposium was a collaboration of the Entrepreneurial Faculty Scholars (EFS) program, led by Dr. Glenn D. Prestwich, the HHMI Med to Grad program (U2M2G), co-directed by Drs. Anthea Letsou and Dean Li, and the Center for Medical Innovation. Intended as a great opportunity for faculty, students, and postgraduate entrepreneurs to get acquainted with the complex and non-linear process of translating medical devices, diagnostics, therapeutics, digital health applications, and research tools so they can be used to impact patient care. Clinician innovators and entrepreneurs shared their experiences and a panel of experts discussed opportunities, barriers, and steps in creating impactful healthcare innovations

StreamDx Urine Flowmeter (Slides)

The 2017 Translational Medicine Symposium was held on Feb. 27th. The symposium addressed how clinicians' ideas and research results can have an impact on patient care - if they are translated into clinical practice. The symposium was a collaboration of the Entrepreneurial Faculty Scholars (EFS) program, led by Dr. Glenn D. Prestwich, the HHMI Med to Grad program (U2M2G), co-directed by Drs. Anthea Letsou and Dean Li, and the Center for Medical Innovation. Intended as a great opportunity for faculty, students, and postgraduate entrepreneurs to get acquainted with the complex and non-linear process of translating medical devices, diagnostics, therapeutics, digital health applications, and research tools so they can be used to impact patient care. Clinician innovators and entrepreneurs shared their experiences and a panel of experts discussed opportunities, barriers, and steps in creating impactful healthcare innovations

Penile prosthesis implantation technique for patients with a neophallus

Introduction and objective: Erectile function is an important goal for many patients post-phalloplasty. Our objective is to demonstrate a technique for placement of a single-cylinder inflatable penile prosthesis (IPP) in patients with a neophallus. Surgical procedure: IPP placement is performed 1-2 years post-phalloplasty for optimal return of sensation and vascularization. The patient voids preoperatively. Since the bladder is emptied immediately before surgery, we opt not to place a catheter in the potentially tortuous urethra and place the reservoir as early as possible to avoid significant bladder filling, which decreases the risk of bladder injury. Cefazolin and Gentamicin are administered preoperatively and a low concentration Chlorhexidine Gluconate solution is used for irrigation. An infrapubic incision is made and dissection is carried down to the pubic symphysis. The reservoir is placed in the midline prevesical space. Sharp dissection is used to develop a space in the dorsal midline of the neophallus opposite the neourethra, which is palpable without a catheter, prior to sequential distal dilation. After measuring proximally and distally, the appropriately sized device is selected and modified with a shortened, blunted tip and proximal synthetic graft. Previously placed 3–0 FiberWire anchoring sutures on the pubic bone are secured to the proximal aspect of the device. The device is then inflated to facilitate placement into the dilated space distally before tying down the sutures. Pump placement proceeds contralateral to the vascular pedicle in the most dependent aspect of the neoscrotum. Once the tubing is connected, device cycling is performed to ensure proper placement and functioning. Results: Patients are discharged the same day with the device 60% inflated. Sexual activity may occur as early as 8 weeks postoperatively. Complications are seen in up to 40% of patients. Conclusion: Continued improvements in devices and techniques are necessary to decrease complications and improve surgical outcomes as more patients pursue IPP placement post-phalloplasty

Cardiovascular autonomic neuropathy, erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes: findings from the DCCT/EDIC.

PURPOSE: We evaluated the association between cardiovascular autonomic neuropathy (CAN), erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in men with type 1 diabetes (T1DM). MATERIALS & METHODS: Male T1DM participants (n=635) in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications Study (DCCT/EDIC) were studied. CAN was assessed by standardized cardiovascular reflex tests including changes in R-R variation with deep-breathing, Valsalva maneuver (Valsalva ratio), and changes in supine-to-standing diastolic blood pressure. ED was assessed by a proxy item from the International Index of Erectile Function (IIEF), and LUTS by the American Urological Association Symptom Index (AUASI). Multivariable logistic regression models estimated the association between CAN, ED and/or LUTS, adjusting for time-weighted glycemic control, blood pressure, age, and other covariates. RESULTS: Men who developed ED and/or LUTS during EDIC had significantly lower R-R variation and Valsalva ratio at DCCT closeout and EDIC year 16/17 compared to those without ED or LUTS. In adjusted analysis, participants with CAN had 2.65 greater odds of ED and LUTS (95% CI=1·47,4·79). CONCLUSIONS: These data suggest that CAN predicts the development of urological complications in men with long-standing T1DM. Studies evaluating the mechanisms contributing to these interactions are warranted for targeting effective prevention or treatment

Dissecting mammalian spermatogenesis using spatial transcriptomics

Single-cell RNA sequencing has revealed extensive molecular diversity in gene programs governing mammalian spermatogenesis but fails to delineate their dynamics in the native context of seminiferous tubules, the spatially confined functional units of spermatogenesis. Here, we use Slide-seq, a spatial transcriptomics technology, to generate an atlas that captures the spatial gene expression patterns at near-single-cell resolution in the mouse and human testis. Using Slide-seq data, we devise a computational framework that accurately localizes testicular cell types in individual seminiferous tubules. Unbiased analysis systematically identifies spatially patterned genes and gene programs. Combining Slide-seq with targeted in situ RNA sequencing, we demonstrate significant differences in the cellular compositions of spermatogonial microenvironment between mouse and human testes. Finally, a comparison of the spatial atlas generated from the wild-type and diabetic mouse testis reveals a disruption in the spatial cellular organization of seminiferous tubules as a potential mechanism of diabetes-induced male infertility

Consensus and diversity in the management of varicocele for male infertility: Results of a global practice survey and comparison with guidelines and recommendations

Purpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men