25 year old male Married, wife 23 years old Infertility for 1 year Timing – every other day No lubricants. No toxins – heat , alcohol or smoking
• No trauma, infections • PMH – some question of some delay in development with problems with learning at school • PSH - none • Meds – none • Female eval – normal cycles, G0P0
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CASE #1 • P/E – – – – –
Tall, thin, NAD HEENT - ?thryroid enlargement CVS/RS normal GI normal GU decreased pubic hair, small phallus. Testes small 1cmx2cmx2cm – Normal vas/no epididymal thickening – gynecomastia
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Semen analysis • • • •
Volume 1cc pH 7.2 Conc 0 M/cc Motility -
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Key Questions: • What do you want to do next? • Can he have children or not? • What other concerns are there for this patient, especially men’s health?
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SESSION 3 CASE #2
CASE #2 • 24 year old male presents to you because of infertility. His wife noticed a “lump in his scrotum” • Non painful and doesn’t remember when it started • PMH neg • PSH neg • Meds/All neg • P/E
CT scan – LNs enlarged in the abdomen 2-3 cm CXR neg Surgery – Radical orchiectomy Do you bank sperm before the orchiectomy?
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Enlarged Lymph nodes on CT • Treatment ? • Risks? • Cancer in the LNs • Treatment? • Side effects?
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SESSION 1 SMALL GROUP CASE DISCUSSIONS
Please spend the next 20 minutes doing the following: • Discuss the case scenarios that were just reviewed. • One attendee per table will be chosen as a volunteer to lead and encourage communication among the group. • Use the handouts on the table to submit written questions which will then be collected by AUA Staff.
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CASE #1 DISCUSSION:
• What do you want to do next? • Can he have children or not? • What other concerns are there for this patient, especially men’s health?
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Differential Diagnosis • Obstruction? What level? – Congenital or acquired? – Why is this not likely? • No history of infection/trauma/surgery • Vas not thickened and present • Testes size
• Spermatogenic Problem? – How can you tell? • Testes size
