The emergence of immune checkpoint inhibitors (ICIs) has provided previously unachievable curative therapy for many patients, particularly those with metastatic melanoma.¹ However, the long-term outcomes for patients using ICIs are only beginning to be investigated. One important potential unexplored adverse effect is impaired male fertility. The current American Society of Clinical Oncology guidelines (July 2018) state that “sperm cryopreservation is effective, and health care providers should discuss sperm banking with postpubertal males receiving cancer treatment.”^2(p1995) The direct association of ICI treatment with spermatogenesis has not been explored, to our knowledge.³ It will be critical to determine the risk to future male fertility for patients undergoing ICI therapy to accurately guide pretreatment counseling. To address the association between the potential gonadotoxic effect of ICIs and spermatogenesis, to our knowledge, we performed the first retrospective review of an index patient who became infertile after ICI therapy and subsequently died, and we performed a retrospective cohort cadaver study of patients with metastatic melanoma.

Azoospermia is classified as the complete absence of sperm in ejaculate and accounts for 10–15% of male infertility. Many anticancer drugs are known to cause defects in spermatogenesis, but the effects of immune checkpoint inhibitor cancer therapy on spermatogenesis remains largely unknown. Presented here is a normozoospermic man (60 million sperm/cc of ejaculate) who received a trial combination treatment of Ipilimumab/Nivolumab to treat BRAF negative, stage IV metastatic melanoma. Two years after the treatment, the patient presented as completely azoospermic. The patient subsequently underwent microdissection testicular sperm extraction, during which no sperm was retrieved, and sertoli-only pathology was elucidated.

Infections are among the most feared and devastating complications of penile prosthesis infections, often requiring surgical exploration and explantation are prosthesis infections. While the rate of infections have decreased due to antibiotic prophylaxis, antiseptic device preparation, increased sterility in implantation techniques and device modifications, infections still occur at a rate of 1–3%. This article reviews the formation of biofilms on penile prostheses and novel, experimental methods to prevent and eradicate them.