Deferens Research Articles

ECFS standards of care on CFTR-related disorders: Identification and care of the disorders

This is the third paper in the series providing updated information and recommendations for people with cystic fibrosis transmembrane conductance regulator (CFTR)-related disorder (CFTR-RD). This paper covers the individual disorders, including the established conditions - congenital absence of the vas deferens (CAVD), diffuse bronchiectasis and chronic or acute recurrent pancreatitis - and also other conditions which might be considered a CFTR-RD, including allergic bronchopulmonary aspergillosis, chronic rhinosinusitis, primary sclerosing cholangitis and aquagenic wrinkling. The CFTR functional and genetic evidence in support of the condition being a CFTR-RD are discussed and guidance for reaching the diagnosis, including alternative conditions to consider and management recommendations, is provided. Gaps in our knowledge, particularly of the emerging conditions, and future areas of research, including the role of CFTR modulators, are highlighted.

Regional modulation of toll-like receptor signaling pathway genes in acute epididymitis in mice.

Region-specific immune environments in the epididymis influence the immune responses to uropathogenic Escherichia coli (UPEC) infection, a relevant cause of epididymitis in men. Toll-like receptors (TLRs) are essential to orchestrate immune responses against bacterial infections. The epididymis displays region-specific inflammatory responses to bacterial-derived TLR agonists, such as lipopolysaccharide (LPS; TLR4 agonist) and lipoteichoic acid (LTA; TLR2/TLR6 agonist), suggesting that TLR-associated signaling pathways could influence the magnitude of inflammatory responses in epididymitis. To investigate the expression and regulation of key genes associated with TLR4 and TLR2/TLR6 signaling pathways during epididymitis induced by UPEC, LPS, and LTA in mice. Epididymitis was induced in mice using UPEC, ultrapure LPS, or LTA, injected into the interstitial space of the initial segment or the lumen of the vas deferens close to the cauda epididymidis. Samples were harvested after 1, 5, and 10 days for UPEC-treated animals and 6 and 24h for LPS-/LTA-treated animals. Ex vivo epididymitis was induced by incubating epididymal regions from naive mice with LPS or LTA. RT-qPCR and Western blot assays were conducted. UPEC infection up-regulated Tlr2, Tlr4, and Tlr6 transcripts and their associated signaling molecules Cd14, Ticam1, and Traf6 in the cauda epididymidis but not in the initial segment. In these epididymal regions, LPS and LTA differentially modulated Tlr2, Tlr4, Tlr6, Cd14, Myd88, Ticam1, Traf3, and Traf6 expression levels. NFKB and AP1 activation was required for LPS- and LTA-induced up-regulation of TLR-associated signaling transcripts in the cauda epididymidis and initial segment, respectively. The dynamic modulation of TLR4 and TLR2/TLR6 signaling pathways gene expression during epididymitis indicates bacterial-derived antigens elicit an increased tissue sensitivity to combat microbial infection in a spatial manner in the epididymis. Differential activation of TLR-associated signaling pathways may contribute to fine-tuning inflammatory responses along the epididymis.

Regulation of increased expression of genes involved in mitochondrial dynamics of testicular tissue (PGC1-α and OPA1) in azoospermia model rats in interventions based on laser and physical activity

Background: The underlying molecular mechanisms and effects of physical exercise on azoospermia are not well understood.The purpose of this research is to investigate the effect of cell therapy, laser and activity on the expression of genes involved in mitochondrial biogenesis in azoospermia model rats. Methods: 40 8-week-old rats were randomly selected, and then the azoospermia model was induced with the drug busulfan with a dose of 40 mg, and after one month, each group of rats was divided into groups. One month after the creation of a one-time model, stem cells were transplanted in the vas deferens in the amount of one million cells for each mouse. After a week of cell transplantation, a laser with a wavelength of 632.8 nm And the power of 10 milliwatts and energy of 3 joules was applied three times during the entire study period with an interval of one week and after the healing of the wound of the cell transplant area on the abdomen, daily for 30 minutes, 5 days in They performed swimming exercises every week for 8 weeks. Results: Induction of azoospermia model decreased the expression of PGC1α gene and increased the expression of OPA1 gene, which the implementation of each of the interventional methods of laser, exercise, laser-activity and cell-activity reversed these changes. Conclusion: Therefore, it can be said that in azoospermia model rats, the simultaneous use of interventional methods of activity and laser therapy has the best effectiveness.

Histological Authentication of Reproductive Structures of Little Indian Squid Loliolus (Loliolus) hardwickei, Grey, 1849 (Cephalopoda: loliginidae)

The work deals with the oogenesis, spermatogenesis and associated reproductive structures of the little Indian squid Loliolus (Loliolus) hardwickei. Histological descriptions of the ovary, oviduct, testis and needham sac were made, the various changes observed during maturation were described and the functional significance was discussed. The female reproductive system consists of the ovary, glandular oviduct, lace-like oviducal funnel, paired nidamental gland, accessory nidamental glands and a seminal receptacle for sperm storage on the ventral side of the buccal cavity. The average size of the cells of the ovary varied from 7.635±3.466 µm (primary oogonia) to 1191.114±288.188µm (Ripe oocyte). Oocyte resorption or the presence of atretic oocytes was observed in some sections. The male reproductive system consists of the testis, vas deferens, spermatophoric organ, spermduct, the system of spermatophoric glands (SG) and spermatophoric sac (Needham sac) and penis. The spermatogenesis passed through the differentiation of primodial germ cells, primary and secondary spermatogonia, primary and secondary spermatocytes, rounded spermatids, and elongated spermatids to spermatozoa or sperms. The testis is connected to a thin-walled Needham sac by the spermatophoric duct. The testis is made up of numerous seminiferous tubules and is enveloped by tunica albuginea made up of connective tissue. Histological authentication of reproductive structures in L(L) hardwickei serves the specific purpose of providing a detailed understanding of the species' reproductive biology, which has implications for ecological, environmental, and conservation management efforts.

(130) Multicenter Study Comparing Stripping vs Ligation of Vas Deferens During Microscopic Denervation of Spermatic Cord in Men with Chronic Orchialgia Across the US

Abstract Introduction Microdenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers advocate ligation of the vas during denervation while others perfer stripping of the Vas deferens to preserve the vasal artery, hence preserving vasculature to testis and possibly decreasing post operative congestion pain. Objective This multicenter study analyzes outcomes of patients that underwent MSCD by either stripping or ligating the vas deferens. Methods A retrospective chart review of 85 patients who underwent MSCD from 2020–2023 was performed. Patients’ demographics including history of prior surgical procedures was recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain or no improvement in pain. Results 85 patients underwent MSCD with a median (IQR) age of 36 (25.5–46.5) years and median duration of pain of 16 months. 37 patients underwent stripping of vas while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. 21(43.5%) patients had prior inguinal scrotal surgery in ligation group compared to 5 (13.5%) in the stripping group p=0.003. The etiology of pain was similar between the groups. The response to MSCD between the 2 groups was similar (p=0.968), with similar post op complications (Table 1). Conclusions In men with intractable chronic scrotal content with no interest in preserving fertility, ligation or stripping of the vas deferens yields similar outcomes with regards to pain resolution. Both techniques are safe with no reports of any testicular atrophy. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(221) Anatomical Transcriptome Atlas of the Male Mouse Reproductive System During Aging

Abstract Introduction The elderly males undergo degenerative fertility and testicular endocrine function that jeopardize the reproductive health and well-being. However, the mechanisms underlying reproductive aging are unclear. Objective This study aims to investigate the phenotypes and transcriptomes of seven regions of the male mouse reproductive tract: the testis, efferent ductules, initial segment, caput, corpus and cauda epididymidis, and vas deferens, in adult (3 months) and aged (21 months) mice. Methods Quantitative PCR, immunohistochemistry, immunofluorescent staining, and enzyme-linked immunosorbent assay were performed for the analysis of gene expression in mice, human tissues, and semen samples. Aged male mice showed both systematic and reproductive changes, and remarkable histological changes were detected in the testis and proximal epididymis. Transcriptomes of the male reproductive tract were mapped, and a series of region-specific genes were identified and validated in mouse and/or human tissues, including Protamine 1 (Prm2), ADAM metallopeptidase domain 28 (Adam28), Ribonuclease A family member 13 (Rnase13), WAP four-disulfide core domain 13 (Wfdc13), and Wfdc9. Meanwhile, age-related transcriptome changes of different regions of the male reproductive tract were characterized. Results Notably, increased immune response was functionally related to the male reproductive aging, especially the T cell activation. An immune response-associated factor, phospholipase A2 group IID (Pla2g2d), was identified as a potential biomarker for reproductive aging in mice. And the PLA2G2D level in human seminal plasma surged at approximately 35 years of age. Furthermore, we highlighted Protein tyrosine phosphatase receptor type C (Ptprc), Lymphocyte protein tyrosine kinase (Lck), Microtubule associated protein tau (Mapt), and Interferon induced protein with tetratricopeptide repeats 3 (Ifit3) as critical molecules in the aging of initial segment, caput, caput, and cauda epididymidis, respectively. Conclusions This study provides an RNA-seq resource for the male reproductive system during aging in mice, and is expected to improve our understanding of male reproductive aging and infertility. Disclosure No.

Gyraulus laevis and G. parvus (Mollusca: Gastropoda), two distinct species

Lorencová et al. (2021) found by barcoding of Gyraulus laevis from Europe and G. parvus from Northern America that the tested gene fragments are similar and so the authors believed that both taxa are conspecific. However, they ignored anatomical and morphological differences which have to be considered because genetic data are not a priori higher weighted than morphology. Summarized we can say that Gyraulus parvus and G. laevis are distinct species, because, (1) they differ in the vas deferens, (2) the penultimate whorl in G. parvus tends to be elevated (visible in the adults only), and (3) G. laevis occurs in shallow water of lakes and ponds, while G. parvus prefers (in Europe) artificial water bodies.

Sex matters in preclinical research.

International Women's Day 2024 has a theme of inclusion. As publishers of preclinical research, we aim to show how inclusion of females in research advances scientific rigor and improves treatment reliability. Sexual reproduction is key to all life across the plant and animal kingdoms. Biological sex takes many forms that are morphologically differentiated during development: stamens versus pistils in plants; color and plumage in birds; fallopian tubes versus vas deferens in mammals; and differences in size, for instance, males are smaller in the fruit fly Drosophila melanogaster. Physical differences may be obvious, but many traits may be more obscure, including hormonal, physiological and metabolic factors. These traits have a big influence on disease and responses to treatment. Thus, we call for improved inclusion, analysis and reporting of sex as a biological variable in preclinical animal modeling research.

The Utilization of Fine-Needle Vasography to Localize Obstruction of the Male Reproductive Tract

ObjectivesTo report our experience using fine needle vasography (FNV) to identify a site of obstruction and determine candidacy for reconstructive procedures in patients presenting with suspected obstructive azoospermia or cryptozoospermia. MethodsWe report a multi-institutional case series of patients with suspected complete or partial obstructive azoospermia. Patients that were included had azoospermia or cryptozoospermia, presence of palpable vasa, testicles ≥12 ml, and FSH <7.6 IU/L. All patients underwent testicular biopsy prior to or at the time of FNV to confirm spermatogenesis. FNV was performed using a 25-gauge angiocatheter, with radio-opaque dye visualized under fluoroscopy. Descriptive statistics are reported as median and interquartile range (IQR). ResultsA total of 16 patients underwent vasography from 2014-2022 with three surgeons. Twelve patients presented with azoospermia, and four with cryptozoospermia. A total of 7 (44%) men were found to have distal obstruction on FNV. Of the eight men with prior inguinal hernia repairs, two were confirmed to have an obstruction at the level of the inguinal canal. Of the six patients with a history of genitourinary infection, four had an obstruction at the level of the epididymis (with normal FNV), while two had atresia of the vas deferens in the pelvis. ConclusionFNV is an effective, minimally-invasive way to identify the site of complete or partial obstruction in patients presenting with suspected obstructive azoospermia / cryptozoospermia. It additionally permits identification of men who are candidates for epididymovasostomy reconstruction and helps to differentiate between ejaculatory duct obstruction (EDO) and other causes of blockage.

Two New Species of Freshwater Planarian (Platyhelminthes, Tricladida, Dugesiidae, Dugesia) from Southern China Exhibit Unusual Karyotypes, with a Discussion on Reproduction in Aneuploid Species

Two new species of the genus Dugesia from Southern China are described by applying an integrative approach, including morphological, karyological, histological, and molecular information. In the molecular phylogenetic tree, the two new species, Dugesia pendula Chen &amp; Dong, sp. nov. and Dugesia musculosa Chen &amp; Dong, sp. nov., fall into an Eastern Palearctic/Oriental clade and an Oriental/Australasian clade, respectively, while sharing only a rather distant relationship. The separate specific status of the two new species is supported also by their genetic distances. Dugesia pendula is characterized by the following features: symmetrical openings of the oviducts into the bursal canal, a duct between seminal vesicle and diaphragm, small diaphragm, dorsally located seminal vesicle, a penis papilla suspended from the dorsal wall of the male atrium, and mixoploid karyotype with diploid complements of 2n=2x=14+0−1 B-chromosome and triploid complements of 2n=3x=21+0−1 B-chromosome, with all chromosomes being metacentric. Dugesia musculosa is characterized by the following features: asymmetrical openings of the oviducts into the bursal canal; a ventrally displaced ejaculatory duct with a terminal opening; two diaphragms; a bursal canal provided with a strong, thick layer of circular muscle, which extends from the copulatory bursa to the common atrium and gonoduct; the left vas deferens opening at the midlateral wall of the seminal vesicle, while the right sperm duct opens at the dorsolateral wall of the seminal vesicle; and karyotype consisting of complicated diploid and aneuploid mosaicism, with diploid complements of 2n=2x=16 and 2n=2x=16−17th-18th, with all chromosomes being metacentric. The uncommon karyotypes, combined with the asexual reproduction of aneuploid animals, are evaluated in the context of the relationship between ploidy levels and reproductive modalities in the genus Dugesia.

Regulation of nerve-evoked contractions of the murine vas deferens

Stimulation of sympathetic nerves in the vas deferens yields biphasic contractions consisting of a rapid transient component resulting from activation of P2X1 receptors by ATP and a secondary sustained component mediated by activation of α1-adrenoceptors by noradrenaline. Noradrenaline can also potentiate the ATP-dependent contractions of the vas deferens, but the mechanisms underlying this effect are unclear. The purpose of the present study was to investigate the mechanisms underlying potentiation of transient contractions of the vas deferens induced by activation of α1-adrenoceptors. Contractions of the mouse vas deferens were induced by electric field stimulation (EFS). Delivery of brief (1s duration) pulses (4 Hz) yielded transient contractions that were inhibited tetrodotoxin (100 nM) and guanethidine (10 µM). α,β-meATP (10 µM), a P2X1R desensitising agent, reduced the amplitude of these responses by 65% and prazosin (100 nM), an α1-adrenoceptor antagonist, decreased mean contraction amplitude by 69%. Stimulation of α1-adrenoceptors with phenylephrine (3 µM) enhanced EFS and ATP-induced contractions and these effects were mimicked by the phorbol ester PDBu (1 µM), which activates PKC. The PKC inhibitor GF109203X (1 µM) prevented the stimulatory effects of PDBu on ATP-induced contractions of the vas deferens but only reduced the stimulatory effects of phenylephrine by 40%. PDBu increased the amplitude of ATP-induced currents recorded from freshly isolated vas deferens myocytes and HEK-293 cells expressing human P2X1Rs by 93%. This study indicates that: (1) potentiation of ATP-evoked contractions of the mouse vas deferens by α1-adrenoceptor activation were not fully blocked by the PKC inhibitor GF109203X and (2) that the stimulatory effect of PKC on ATP-induced contractions of the vas deferens is associated with enhanced P2X1R currents in vas deferens myocytes.

Congenital unilateral absence of the vas deferens

Introduction: A 65-year-old male with a known history of unilateral renal agenesis was found to have concurrent absence of the vas deferens ipsilaterally. Case Report: The patient presented with organic erectile dysfunction and wanted to proceed with surgical management. Routine pre-operative evaluation confirmed history of a left solitary kidney, and physical exam revealed absence of the right vas deferens. Previous imaging confirmed right renal agenesis, and with subsequent absence of the right vas deferens noted on physical exam, this confirmed embryological arrest as the cause of the anatomic abnormality. Conclusion: Congenital unilateral absence of the vas deferens (CUAVD) is an uncommon finding that is largely found during infertility evaluations and vasectomy consults. It is important to understand genetic components and embryological origins of CUAVD to appropriately evaluate patients for additional defects.

(137) Sealed Vasectomy Procedure Prior Studies and Now Good Laboratory Practices FDA Study: Human, Porcine, Canine and Rabbit Subjects

Abstract Introduction The Sealed Vasectomy Procedure (SVP) is a new bipolar radiofrequency sealing tool for transdermal vasectomy in hopes of making the procedure a faster, simpler, and safer office procedure. Testing has been successful in rabbits with excellent wound healing, complete vas occlusion on histology, and no sperm in post procedural semen analysis. Further studies in larger animals were then done in canine, porcine and human vas deferens that showed good sealing of the vas deferens. FDA-approval are needed before its application in humans. The next step in FDA approval process is a FDA prescribed Good Laboratory Practices (GLP) animal study. Objective Evaluate the effectiveness of the SVP in sealing the vas deferens in rabbit, canine, porcine and in humans. Now presenting the FDA prescribed GLP study. Methods Rabbit studies have been previously described including AUA22 best video award. We preformed microscopic evaluation of the vas deferens tissues from canines treated with the SVP at either 40 or 60 watts, euthanized at 14 days post-treatment under the conditions of this study. Human vas deferens specimens after removal from the patient were then immediately treated with SVP tool on benchtop. Porcine vas deferens samples were procured and underwent benchtop testing. The GLP study was done at Charles River in Kalamazoo, Michigan. The GLP study was on 6 canines: 3 with the outside the skin method and 3 canines with the transdermal method. All were terminal after a period of healing of up to 28 days. Results 9 canine, 6 human, and 20 porcine vas deferens were included in SVP testing. Human, porcine, and canine specimens demonstrated tissue coagulation and fibrosis in the treated vasa deferentia by Pathology. (See Figure 1 Human and 2 Canine) For the FDA GLP prescribed study, all 6 dogs survived and were euthanized at 28 days post-treatment. Pathology for the GLP study was done by Charles River. Conclusions SVP is a potentially exciting novel vasectomy procedure that appears to provide good sealing of the vas deferens in the rabbit &amp; canine animal model and on benchtop for the human &amp; porcine vas deferens. The FDA GLP study is done and awaits FDA submission. FDA-approval is still needed before use in humans. Disclosure Yes, this is sponsored by industry/sponsor: Signati. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Signati.

(056) Cross-sectional Analysis of the Vas Deferens and Its Associated Blood Supply

Abstract Introduction In performing both vasectomy and vasectomy reversal, a precise understanding of the local anatomy and blood supply of the vas deferens and associated structures is essential. However, the exact importance and contribution of the perivasal versus intramural vessels in perfusion to the vas deferens has not been investigated. This may be clinically relevant as the perivasal blood supply may be prone to compromise with bipolar electrocautery during the vasectomy reversal, potentially resulting in a poor blood supply to the anastomosis which can detrimentally affect outcomes. Objective To highlight the importance and contributions of the perivasal and intramural vessels in the blood supply to the vas deferens Methods 92 consecutive bilateral vas deferens specimens from 46 patients undergoing first time vasectomy were examined. H&amp;E slides were reviewed by a senior genitourinary pathologist to describe architectural and growth pattern of the small arteries. Intramural (arterioles in the muscular coat of a vas deferens) and perivasal (those located in the vas adventitia immediately juxtaposed to the organ) arterioles were counted microscopically. Clinical data, including patient age and ethnicity, were obtained by reviewing medical charts. Results The average number of perivasal arteries surrounding the bilateral vas deferens in each patient was 15 ± 4 whereas the number of intramural arteries was 4.5 ± 3. There was no linear trend between the age of our patients or the number of intramural or perivasal arteries. Five patients (11%) had less than 2 total intramural arteries. Conclusions Our study found significantly more perivasal arteries than intramural arteries in vas deferens samples. Interestingly, this association did not seen to vary with patient age. To our knowledge, this represents the first study to demonstrate this anatomical relationship and suggests there may be greater reliance on perivasal arteries for overall vas deferens perfusion, thus emphasizing the importance of prioritizing the preservation of the perivasal blood supply during vasectomy. This may be particularly relevant should a future reversal be considered. Future directions may include examining specimens of patients undergoing vasectomy reversal and evaluating the relevant vasculature and procedure outcome/success. Disclosure No.

(276) Self-Performed Bilateral Testicle Amputation for Gender Affirmation

Abstract Introduction Genital gender-affirming care is an essential aspect of care for individuals with gender dysphoria. Bilateral orchiectomy is performed for both hormonal control and for gender identity physical transition. The time and financial costs required to access such procedures can be prohibitive, leading to pursuit of morbid gender affirmation outside of healthcare systems. While genital self-mutilation is rare, up to 32% of cases have been found to involve self-castration. Management of this varies but in severe cases prompt surgical repair is imperative. We present a case report of a non-binary patient who underwent self-amputation of both testicles, with subsequent primary closure of the perineum. Objective A 34-year-old non-binary individual with autism spectrum disorder and gender dysphoria presented with uncontrolled bleeding after self-amputating both testicles (Photo 1). This was done with use of a zip tie around the scrotal base, application of lidocaine cream to the scrotum, and a sterilized kitchen knife. The patient performed this to eliminate the physical and psychological effects of testosterone, and cited lack of access to care as a motivating factor. Methods Psychiatry consultation confirmed decision-making capacity without acute severe mental illness, and no substance abuse was involved. Sperm cryopreservation was discussed with the patient but was declined. While awaiting capacity assessment, measurements of the testicular arteries and vas deferens were obtained to assess the possibility of reanastomosis, which was deemed technically feasible. Results After the patient was deemed decisional they were taken to the operating room for vascular control and planned primary closure and possible skin grafting. Cystoscopy confirmed no concomitant urethral injury. Intraoperatively the bilateral spermatic cords were tied off to achieve hemostasis. Skin closure was able to be performed primarily with a favorable result (Photo 2). Conclusions We present a unique case of a non-binary individual with gender dysphoria who underwent successful self-amputation of both testicles. This case highlights the significant barriers faced by individuals seeking gender affirmation procedures and the lengths to which patients may go to conform with their gender identity. Our case also highlights important management steps, including sperm cryopreservation, decisional capacity evaluation, and reattachment versus primary closure with or without skin grafting. The patient's decision to pursue self-amputation underscores the urgent need for improved access to gender-affirming procedures and mental health support for individuals with gender dysphoria. Disclosure No.

Clinical and diagnostic features of a paraprostatic cyst of a true uterus masculinus in a male cat presented with tenesmus

AbstractA 5‐year 11‐month‐old, male, neutered, Bengal cross cat was examined for a 5‐week history of tenesmus. Positive contrast urethrocystography and computed tomography scan demonstrated a fluid‐filled structure occupying the pelvic canal. Midline coeliotomy and symphysiotomy revealed a large cystic structure dorsal to the urethra in the area of the prostate. This structure was communicating with the urethra via a duct and both vas deferens were inserting in it. The duct was ligated and partial ablation and omentalisation of the structure was performed. Histopathological examination identified features consistent with a true uterus masculinus. Bacteriology of the cystic fluid cultured Escherichia coli and Bacteroides fragilis. The cat recovered uneventfully and with no ongoing clinical issues.

(079) Stripping vs Ligation of Vas Deferens in Microscopic Denervation of Spermatic Cord in Men with Chronic Orchialgia: A Multicenter Study

Abstract Introduction Microdenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers advocate ligation of the vas during denervation while others perfer stripping of the Vas deferens to preserve the vasal artery, hence preserving vasculature to testis and possibly decreasing post operative congestion pain. Objective This multicenter study analyzes outcomes of patients that underwent MSCD by either stripping or ligating the vas deferens Methods A retrospective chart review of 85 patients who underwent MSCD from 2020-2023 was performed. Patients’ demographics including history of prior surgical procedures was recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain or no improvement in pain. Results 85 patients underwent MSCD with a median (IQR) age of 36 (25.5-46.5) years and median duration of pain of 16 months. 37 patients underwent stripping of vas while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. 21(43.5%) patients had prior inguinal scrotal surgery in ligation group compared to 5 (13.5%) in the stripping group p=0.003. The etiology of pain was similar between the groups. The response to MSCD between the 2 groups was similar (p=0.968), with similar post op complications (Table 1). Conclusions In men with intractable chronic scrotal content with no interest in preserving fertility, ligation or stripping of the vas deferens yields similar outcomes with regards to pain resolution. Both techniques are safe with no reports of any testicular atrophy. Disclosure No.

(182) Transurethral Laser Incision of Ejaculatory Duct for Complete Ejaculatory Duct Obstruction

Abstract Introduction It is estimated that approximately 5% of men presenting with infertility suffer from ejaculatory duct obstruction (EDO). Patients suspected to have EDO typically have a palpable vas deferens and normal testicular exam. On semen analysis, low volume and acidic pH should increase suspicion, and transrectal ultrasound is most commonly the first diagnostic modality utilized to confirm the diagnosis when suspecting EDO. Objective The objective of this surgical video is to describe the use of holmium laser for the management of ejaculatory duct obstruction (EDO) in the setting of obstructive azoospermia. Methods This was a 35 year old male with no significant past medical history who presented with obstructive azoospermia. His partner was a 32 year old female with no significant past medical history, with regular menstrual cycles, and a normal female reproductive evaluation. Semen analysis was significant for low volume (0.5 mL) azoospermia with an acidic pH (6.8). Abdominal and pelvic computerized tomography (CT) scan from 2017 when the patient presented for appendicitis noted an incidental finding of a 9.9 cm prostatic cyst. Thus, a transrectal ultrasound (TRUS) guided aspiration was performed in the ambulatory clinic which demonstrated a large prostatic cyst, with non-motile sperm in the aspirate. The patient was consented for Cystoscopy with transurethral laser incision of ejaculatory ducts. A 22 French (F) cystoscope was used, first for pan-cystourethroscopy, and then to cannulate the right ejaculatory duct with 5F pollack catheter and guide wire. Guide wire and catheter positioning within the cyst was confirmed with fluoroscopy. A 24F resectoscope with a laser bridge working element and 550 micron holmium laser fiber at settings of 1 Joule of energy and 10 hertz frequency to incise the right ejaculatory duct, circumferentially around the wire. The ejaculatory duct was incised and cyst was drained until the ejaculatory duct and thus prostatic cyst could be cannulated and examined with the cystoscope. On examination of the cyst, no vasal openings were identified. Left seminal vesiculography was attempted but unsuccessful due to significant contrast extravasation into the urethra. Results The case went well and was uncomplicated. There were no immediate or delayed complications or adverse effects reported by the patient. Post-operative instructions included rest for 1 week, followed by ejaculation every other day for 3 months. Semen analysis and transrectal ultrasound will be performed at 3 months post-operative. Conclusions Transurethral laser incision of ejaculatory duct is a safe surgical intervention for management of complete ejaculatory duct obstruction, and is demonstrated successfully in this step-by-step surgical video. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.

(329) Exploring the Incidence of Sexual and Reproductive Health Concern in Men with Cystic Fibrosis and CBAVD: An Analysis of a Multi-Institutional Database

Abstract Introduction Cystic Fibrosis (CF) is a genetically inherited disease with a highly variable phenotype that results from a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Manifestations of CF include impacts on function of the lungs, liver, pancreas, and reproductive system. While CF is known to be associated with infertility due to congenital bilateral absence of the vas deferens (CBAVD), men with CF also frequently report additional sexual and reproductive health issues, often linked to low testosterone levels. Objective In this study we aimed to investigate the prevalence of low testosterone (T) in men with CF and CBAVD, and hypothesized hypothesized that low T would be under-evaluated and under-treated in the CF population compared to CBAVD and the general population. Methods We used TrinetX, a multi-institutional insurance claims database, to create a cohort of men over 18 years old with CF or CBAVD. We then queried each cohort to assess how many men had a T level measured, and if hypogonadal (below 300 ng/dL), how many received T therapy (TT). Results There were 14,033 men over age 18 years with a diagnosis of CF and 3,439 men over age 18 with a diagnosis of CBAVD in the TriNetX database. Serum T levels were measured in 10.1% of men with CF and 8.9% of men with CBAVD. While mean serum T level in both groups was within the normal range (defined as a total testosterone &amp;gt;300 ng/dL), 32.7% (n=464) of the men with CF and 43% (n=132) of the men with CBAVD were hypogonadal. The majority of men with T&amp;lt;300 ng/dL went on to appropriately receive TT: 59.3% of men with CF and 78% with CBAVD (figure 1). Conclusions Our data suggests that hypogonadism is highly prevalent in men with CF and CBAVD. These data suggest that despite a high rate of infertility in men with CF and CBAVD, the majority do not undergo hormonal evaluation. Investigation and appropriate treatment of TD may significantly improve quality of life. Disclosure No.

Activity of enzymes destroying extracellular nucleotides in the tissues of rats with the valproate model of autism

BACKGROUND: Ectonucleotidases hydrolyze extracellular nucleotides and thus can control the effect of these substances on purinergic P1 and P2 receptors.&#x0D; AIM: To evaluate the activity of ectonucleotidases in the smooth muscle tissues of internal organs of 9-month-old rats with the valproate model of autism using high-performance liquid chromatography.&#x0D; MATERIAL AND METHODS: Autism was modeled in outbred Wistar rats by administering valproic acid (500 mg/kg) subcutaneously to pregnant females on days 12–13 of pregnancy. The born offspring were used in the study when the rats reached 270±8 days. Animals were guillotined under light ether anesthesia, the bladder, uterus, vas deferens, and duodenum were isolated, and smooth muscle tissue samples were prepared. Total ectonucleotidase activity was determined by incubating tissue samples with adenosine triphosphate (reaction substrate) for 10 minutes with further assessment of the content of the substrate and reaction products (adenosine diphosphate, adenosine monophosphate) in the incubate using high-performance liquid chromatography. Mathematical and statistical processing of the results was carried out using Microsoft Excel and IBM SPSS Statistics 26.0 software. Group comparisons were made using the nonparametric Mann–Whitney U test. Differences were considered significant at p 0.05.&#x0D; RESULTS: In rats with the valproate model of autism, the activity of ectonucleotidases in the smooth muscle tissues of the vas deferens (609.5±153.9) and uterus (232.7±2) was significantly lower than control values (2114.6±524.3, p=0.040; 539.6±63.5, p=0.010, respectively). In the duodenum (1808.4±184.5) and bladder (1021.3±280.7) we did not find a significant difference compared to the control values (2115.0±393.3, p=0.712; 2302.3±615.8, p=0.274, respectively). This study allows us to evaluate the possible contribution of purinergic transmission to the changes we found earlier in the contractile activity of smooth muscle tissue in rats with the valproate model of autism.&#x0D; CONCLUSION: In 9-month-old rats with a model of autism, the activity of ectonucleotidases in the smooth muscle tissues of the reproductive organs is reduced; no such changes were found in the tissues of the intestines and bladder.