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Fung ACH, Ye HY, Lau TWS, Lui VCH, Wong KKY. Does the Choice of Suture Materials Affect the Vas Deferens After Hernia Ring Closure in Inguinal Hernia Surgery: An Experimental Study in Rats. J Pediatr Surg 2023:S0022-3468(23)00092-1. [PMID: 36894446 DOI: 10.1016/j.jpedsurg.2023.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Laparoscopic inguinal hernia repair is a commonly performed procedure in children. Currently, monofilament polypropylene and braided silk are the two most frequently used materials. Studies have suggested more tissue inflammatory reactions with the use of multifilament non-absorbable sutures. However, little is known about the effects of suture materials on adjacent vas deferens. The aim of this experiment was to compare the effect of non-absorbable monofilament and multifilament sutures on vas deferens in laparoscopic hernia repair. METHODS All animal operations were performed by a single surgeon under aseptic conditions and anaesthesia. Ten male Sprague Dawley rats were divided into two groups. In Group I, "hernia repair" was performed using 5.0 Silk. In Group II, polypropylene sutures (Prolene®; Ethicon, Somerville, N.J., USA) were used. All animals also received sham operations in the left groin as a control. After 14 days, the animals were euthanised and a segment of vas deferens just adjacent to the suture was excised for histological review by an experienced pathologist who was blind to the treatment groups of the respective specimens. RESULTS The body sizes of the rats in each group were comparable. Group I had significantly smaller vas deferens than Group II (diameter: 0.2 vs. 0.6 ± 0.2, p = 0.005). Silk sutures appeared to cause more tissue adhesion than Prolene® sutures, as graded by blind assessors (adhesion grade: 2.8 ± 1.3 vs. 1.8 ± 0.8, p = 0.1), although this did not reach statistical significance. There was no significant difference in the histological fibrosis score and inflammation score. CONCLUSION The only effect of non-absorbable sutures on vas deferens in this rat model was the reduced cross-sectional area of vas deferens and increased tissue adhesion when using silk sutures. However, there was no significant histological difference in inflammation or fibrosis caused by either material.
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Zhang ZQ, Zhou YL, Pan ZB, Ju JJ, Shen WC, Hu YX, Qi SQ. Application of Noncontact Laparoscopic High Ligation of the Hernia Sac of the Vas Deferens in Children with Indirect Inguinal Hernia. J Laparoendosc Adv Surg Tech A 2022; 32:1121-1125. [PMID: 35838592 DOI: 10.1089/lap.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: This study aims to evaluate the usefulness of vas deferens noncontact laparoscopic high ligation of the hernia sac in children with indirect inguinal hernia (IIH). Materials and Methods: The clinical data of 146 male children with IIH treated in the Anhui Children's Hospital from January 2018 to June 2019 were analyzed retrospectively. There were 82 patients in the observation group in which the inner ring opening was sutured and closed using the vas deferens noncontact suture and 64 patients in the control group in which the peritoneum at the inner ring opening was closed using the intradermal suture. The operation time, surgical complications, postoperative complications, and recurrence rate were compared between the two groups (followed up for 2 years). Results: The operation was successful in all the patients in both groups. In the observation group, there was one case of intraoperative spermatic cord vascular injury and one case of infra-abdominal wall vascular injury, and no intraoperative complications occurred in the control group. The operation time was 12.8 ± 1.4 minutes in the control group and 10.4 ± 2.6 minutes in the observation group (P < .01). The two groups of patients were followed up for 2 years, and no complications and no recurrence occurred. Conclusion: The vas deferens noncontact laparoscopic high ligation of the hernia sac to close the inner ring opening has several advantages: The operation is simple; the operation time is shorter than the traditional method, avoiding the possibility of vas deferens injury; and it is a safe, reliable, and effective surgical method. However, due to the small number of clinical cases in this study, its long-term effect requires further observation.
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Affiliation(s)
- Zhen-Qiang Zhang
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Yu-Liang Zhou
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Zhu-Bin Pan
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Jun-Jun Ju
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Wei-Chen Shen
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Yi-Xin Hu
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Shi-Qin Qi
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
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Wang T, Yu Z, Liu Z, Liu X, Li M, Gu L, Lan R, Wang S, Yang J, Liu J. Intra-abdominal robot-assisted vasovasostomy of obstructive azoospermia in an Asian population following multiple bilateral inguinal herniorrhaphy in childhood: a case report and literature review. Transl Androl Urol 2021; 10:2521-2527. [PMID: 34295738 PMCID: PMC8261426 DOI: 10.21037/tau-21-133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/05/2021] [Indexed: 11/06/2022] Open
Abstract
Iatrogenic injury to the vas deferens is an indication for vasovasostomy (VV). Various surgical approaches, including pure microsurgical VV (MVV), pelviscrotal laparoscopic-assisted VV (LAVV), and intra-abdominal robot-assisted VV (RAVV), have been reported to restore vasal patency. MVV is often faced a formidable challenge to provide tension-free VV due to an inadequate vas deferens length. Alternatively, pelviscrotal LAVV is much more effective for the identification and retrieval of the pelvic vas deferens prior to performing MVV. However, vasal laparoscopic mobilization could still be limited by insufficient vasal length for extracorporeal transfer in some cases. The addition of robotic assistance, on the other hand, allows the performance of “in-situ” vasal anastomoses and offers unique features compared with pure MVV/LAVV. However, few such approaches have been described in the literature. This study presents the initial results and validation of robot-assisted VV in an Asian population who had undergone triple herniorrhaphy. Briefly, Intra-operative findings demonstrated a large defect of the vas deferens, and a two-layer bilateral tension-free RAVV was performed to pursue the possibility of naturally achieved pregnancy. With our promising results, intra-abdominal RAVV may be described as a practical approach for cases with iatrogenic large defects of the vas deferens within the inguinal canal.
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Affiliation(s)
- Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuo Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingchao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Longjie Gu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruzhu Lan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xi W, Gan D, Cuihua S, Peitao W. A QUESTIONNAIRE SURVEY ON AWARENESS OF REPRODUCTIVE PROTECTION AND AUTOLOGOUS SPERM PRESERVATION AMONG CANCER PATIENTS. jomh 2020; 16:e19-e28. [DOI: 10.15586/jomh.v16i3.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Uchida M, Iida S, Hoshi K, Kojo K, Tsuchiya H, Yamasaki K, Miyazaki J, Iwamoto T. Laparoscopy-assisted vasovasostomy for post-herniorrhaphy vas deferens obstruction. IJU Case Rep 2020; 3:72-75. [PMID: 32743475 PMCID: PMC7292088 DOI: 10.1002/iju5.12150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Repair of obstructive azoospermia caused by childhood herniorrhaphy may be difficult. Therefore, intracytoplasmic sperm injection using testicular sperm is performed. However, vasovasostomy combined with laparoscopic surgery is challenging. CASE PRESENTATION A 42-year-old man underwent inguinal hernia repair at age 3. He had normal testicular size, azoospermia, normal hormone levels (follicle-stimulating hormone, luteinizing hormone, and testosterone), absence of Y chromosome micro deletion, and karyotype:46XY, t(1:21)(p34.1:q22.3). He was diagnosed with obstructive azoospermia. Repeated intracytoplasmic sperm injections using testicular sperm resulted in miscarriages. Vasovasostomy combined with laparoscopic surgery was subsequently performed. Postoperative semen analysis result was almost normal. After intracytoplasmic sperm injection of ejaculated sperm, his wife got pregnant. CONCLUSION Even if patients have chromosomal abnormalities, performing microsurgical re-anastomosis first is recommended. To our knowledge, this is the first case of a laparoscopy-assisted vasovasostomy for post-herniorrhaphy vas deferens obstruction in Japan.
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Affiliation(s)
- Masahiro Uchida
- Reproduction CenterInternational University of Health and Welfare HospitalNasushiobaraJapan
- Department of UrologyTsukuba Gakuen HospitalTsukubaJapan
| | - Shuichi Iida
- Suzuki Memorial HospitalIwanumaJapan
- Prefectural Art Museum Mae Ladies Mental ClinicShizuokaJapan
| | | | - Kosuke Kojo
- Reproduction CenterInternational University of Health and Welfare HospitalNasushiobaraJapan
- Department of UrologyUniversity of TsukubaTsukubaJapan
| | - Haruki Tsuchiya
- Reproduction CenterInternational University of Health and Welfare HospitalNasushiobaraJapan
| | - Kazumitsu Yamasaki
- Reproduction CenterInternational University of Health and Welfare HospitalNasushiobaraJapan
- Suzuki Memorial HospitalIwanumaJapan
| | - Jun Miyazaki
- Reproduction CenterInternational University of Health and Welfare HospitalNasushiobaraJapan
- Department of UrologySchool of MedicineInternational University of Health and WelfareNaritaJapan
| | - Teruaki Iwamoto
- Reproduction CenterInternational University of Health and Welfare HospitalNasushiobaraJapan
- Division of Male InfertilitySanno HospitalCenter for Human Reproduction International University of Health and WelfareTokyoJapan
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Ito K, Ichioka K, Dahal S, Matsui Y, Nakayama T, Hatayama H, Ogawa O, Negoro H. Barriers for sperm cryopreservation in advanced germ cell tumor patients: a 20-year experience. Int J Clin Oncol 2020; 25:906-911. [PMID: 31894434 DOI: 10.1007/s10147-019-01607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/16/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to investigate barriers to sperm cryopreservation for patients with advanced germ cell tumors. METHODS We reviewed data collected from patients who underwent chemotherapy for advanced germ cell tumors in our institutions from 1996 to 2016. We divided sperm cryopreservation procedures into three steps: offering information about sperm cryopreservation, patients' decision making and sperm collection, and investigating the barriers in each step. RESULTS Of the 91 patients, 43 (47%) successfully completed sperm cryopreservation. Thirty (33%) patients were not offered information about sperm cryopreservation from the doctors. Nine patients (9.9%) were offered but declined preservation. Nine patients (9.9%) were not able to provide sperm because of azoospermia (5) and anejaculation (4). Among 43 patients who successfully provided sperm, 10 (23%) had their cryopreserved sperm used for 21 cycles of in vitro fertilization. Ten pregnancies and 7 fatherhoods were achieved. Thirteen patients (30%) had their cryopreserved sperm discarded without use, whereas 20 (47%) continued preserving their sperm for a median 12.5 years. CONCLUSIONS Not only offering proper information about sperm cryopreservation, but also shared decision making prior to chemotherapy, and considering fertility preservation before orchiectomy are imperative. The rate of use of preserved sperm was relatively high, but decision making for sperm disposal should also be supported.
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Affiliation(s)
- Katsuhiro Ito
- Department of Urology, Kyoto University Hospital, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
- Ichioka Urological Clinic, Symphonia-Oike 1F, Higashinotoin-Nijo sagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Kentaro Ichioka
- Ichioka Urological Clinic, Symphonia-Oike 1F, Higashinotoin-Nijo sagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Sachiko Dahal
- Center For Reproductive Endocrinology and Infertility, Adachi Hospital, Higashinotoin-Nijosagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Yoshiyuki Matsui
- Department of Urology, Kyoto University Hospital, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
- Ichioka Urological Clinic, Symphonia-Oike 1F, Higashinotoin-Nijo sagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Takahiro Nakayama
- Center For Reproductive Endocrinology and Infertility, Adachi Hospital, Higashinotoin-Nijosagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Hiroshi Hatayama
- Center For Reproductive Endocrinology and Infertility, Adachi Hospital, Higashinotoin-Nijosagaru, Nakagyo-ku, Kyoto, 6040837, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Hospital, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
| | - Hiromitsu Negoro
- Department of Urology, Kyoto University Hospital, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan.
- Ichioka Urological Clinic, Symphonia-Oike 1F, Higashinotoin-Nijo sagaru, Nakagyo-ku, Kyoto, 6040837, Japan.
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Uçar MA, Arikan F, Coşkun HŞ, Kondak Y, Tatlı AM, Göksu SS. Fertility in testicular cancer patients: a single-centre study in Turkey. Int J Clin Oncol 2019; 25:495-500. [DOI: 10.1007/s10147-019-01534-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022]
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Liang ZY, Zhang FB, Li LJ, Li JP, Wu JG, Chen C, Zhu YM. Clinical application of cross microsurgical vasovasostomy in scrotum for atypical obstructive azoospermia. J Zhejiang Univ Sci B 2019; 20:282-286. [PMID: 30829015 DOI: 10.1631/jzus.b1800303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Seminal duct obstruction may result in obstructive azoospermia (OA) and severe oligoasthenoteratozoospermia (OAT) (<0.5 million/mL) (Nordhoff et al., 2015). Cases of partial OA and OAT can be treated effectively by microsurgical anastomosis (Goldstein and Kim, 2013) to obtain successful surgical reversal. However, microsurgical vasovasostomy (VV) (Dickey et al., 2015) and vasoepididymostomy (VE) (Peng et al., 2017) are not suitable for patients with atypical OA and poor epididymis conditions or unpredictable obstruction of the distal vas deferens. For those patients, cross anastomosis may be applied instead of routine VE or VV. A single-center, retrospective, comparison study was conducted, which assessed the usefulness of the cross VV (CVV) in the scrotum for indication and efficacy. A total of 77 cases with OA or OAT were included, and 20 cases implemented cross anastomosis, including unilateral CVV (UCVV) in 4 cases, unilateral VE plus CVV (UVE+CVV) in 11 cases, and unilateral VV-based CVV (UVV+CVV) in 5 cases. The other 57 cases received no cross-matching anastomosis. The patency and natural pregnancy rates in one year were 75.0% and 50.0%, respectively, in the UCVV group; 54.5% and 27.3%, respectively, in the UVE+CVV group; and 60.0% and 40.0%, respectively, in the UVV+CVV group. The CVV in the scrotum in the selected patients with OA and severe OAT could yield good results. We regard the CVV in the scrotum as an efficacious operation with a lower risk of injury in cases of atypical OA.
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Affiliation(s)
- Zhong-Yan Liang
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Feng-Bin Zhang
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Le-Jun Li
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Jing-Ping Li
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Jing-Gen Wu
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Chong Chen
- Department of Ultrasonography, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Yi-Min Zhu
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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Dias TR, Agarwal A, Pushparaj PN, Ahmad G, Sharma R. New Insights on the Mechanisms Affecting Fertility in Men with Non-Seminoma Testicular Cancer before Cancer Therapy. World J Mens Health 2018; 38:198-207. [PMID: 30588784 PMCID: PMC7076305 DOI: 10.5534/wjmh.180099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/22/2018] [Accepted: 11/25/2018] [Indexed: 01/02/2023] Open
Abstract
Purpose Patients with non-seminoma testicular cancer (NSTC) cancer can be subfertile or infertile, and present reduced sperm quality, but the underlying mechanisms are unknown. The aim of this study was to compare the sperm proteome of patients with NSTC, who cryopreserved their sperm before starting cancer treatment, with that from healthy fertile men. Materials and Methods Semen volume, sperm motility and sperm concentration were evaluated before the cryopreservation of samples from patients with NSTC (n=15) and the control group (n=15). Sperm proteomic analysis was performed by liquid chromatography-tandem mass spectrometry and the differentially expressed proteins (DEPs) between the two groups were identified using bioinformatic tools. Results A total of 189 DEPs was identified in the dataset, from which five DEPs related to sperm function and fertilization were selected for validation by Western blot. We were able to validate the underexpression of the mitochondrial complex subunits NADH:Ubiquinone Oxidoreductase Core Subunit S1 (NDUFS1) and ubiquinol-cytochrome C reductase core protein 2 (UQCRC2), as well as the underexpression of the testis-specific sodium/potassium-transporting ATPase subunit alpha-4 (ATP1A4) in the NSTC group. Conclusions Our results indicate that sperm mitochondrial dysfunction may explain the observed decrease in sperm concentration, total sperm count and total motile count in NSTC patients. The identified DEPs may serve as potential biomarkers for the pathophysiology of subfertility/infertility in patients with NSTC. Our study also associates the reduced fertilizing ability of NSTC patients with the dysregulation of important sperm molecular mechanisms.
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Affiliation(s)
- Tania R Dias
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Universidade da Beira Interior, Covilhã, Portugal.,Department of Microscopy, Laboratory of Cell Biology, Institute of Biomedical Sciences Abel Salazar and Unit for Multidisciplinary Research in Biomedicine, University of Porto, Porto, Portugal
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Peter N Pushparaj
- Center of Excellence in Genomic Medicine Research, Faculty of Applied Medical Sciences, Jeddah, Saudi Arabia
| | - Gulfam Ahmad
- Division of Pathology, School of Medical Sciences, Sydney University, Sydney, Australia
| | - Rakesh Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
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Namekawa T, Imamoto T, Kato M, Komiya A, Ichikawa T. Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade. Reprod Med Biol 2018; 17:343-355. [PMID: 30377390 PMCID: PMC6194271 DOI: 10.1002/rmb2.12207] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In the era of improving assisted reproductive technology (ART), patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction with intracytoplasmic sperm injection. Vasal repair, including vasovasostomy (VV) and vasoepididymostomy (VE), is the only option that leads to natural conception. METHODS This article reviews the surgical techniques, outcomes, and predictors of postoperative patency and pregnancy, with a focus on articles that have reported over the last 10 years, using PubMed database searches. MAIN FINDINGS The reported mean patency rate was 87% and the mean pregnancy rate was 49% for a patient following microscopic VV and/or VE for vasectomy reversal. Recently, robot-assisted techniques were introduced and have achieved a high rate of success. The predictors and predictive models of postoperative patency and pregnancy also have been reported. The obstructive interval, presence of a granuloma, and intraoperative sperm findings predict postoperative patency. These factors also predict postoperative fertility. In addition, the female partner's age and the same female partner correlate with pregnancy after surgery. CONCLUSION In the era of ART, the physician should present and discuss with both the patient with OA and his partner the most appropriate procedure to conceive by using these predictors.
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Affiliation(s)
- Takeshi Namekawa
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Takashi Imamoto
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Mayuko Kato
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Akira Komiya
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Tomohiko Ichikawa
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
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Machen GL, Harris SE, Bird ET, Brown ML, Ingalsbe DA, East MM, Reyes M, Kuehl TJ. Utilization of cryopreserved sperm cells based on the indication for storage. Investig Clin Urol 2018; 59:177-181. [PMID: 29744474 PMCID: PMC5934279 DOI: 10.4111/icu.2018.59.3.177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/19/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose Cryopreservation of sperm from human semen has been available since the 1950s. The actual utilization of available cryopreservation technology has been infrequently reported. We set out to examine the utilization and outcomes of cryopreserved sperm cells based on the indication for storage. Materials and Methods A dataset was developed from retrospective review. The purposes for cryopreservation, eventual utilization, and outcomes of use for insemination were recorded. The types of utilization were accumulated as proportions for different purposes. The timing for use of samples for insemination procedures was evaluated using survival statistics. The frequency of patients arranging to destroy samples was also reported. Results From September 1988 through March 2015, 1442 samples were cryopreserved. Samples were cryopreserved for four primary purposes: infertility treatments focused on intrauterine insemination (IUI) or in vitro fertilization/intracellular injection (IVF/ICSI), for fertility preservation related to cancer treatment, or prior to military deployment. Total utilization rates were 19.3%. Samples cryopreserved for IUI were more likely to be used (64.3%), while samples cryopreserved as backup for IVF/ICSI were more likely to be destroyed (29.8%). Pregnancy rates varied based on the indication and ART used. Pregnancies per cycle were 35% for IVF/ICSI and were 10% for IUI. Conclusions Cryopreservation of sperm is a valuable and underutilized resource, particularly amongst male cancer patients. This technology can facilitate infertility treatments based on a variety of indications, including deployment-a patient cohort unique to our dataset.
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Affiliation(s)
- Graham Luke Machen
- Division of Urology, Department of Surgery, Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Stephanie E Harris
- Division of Urology, Department of Surgery, Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Erin T Bird
- Division of Urology, Department of Surgery, Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Monica L Brown
- Department of Pathology, Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Dale A Ingalsbe
- Department of Pathology, Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Milaida M East
- Department of Pathology, Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Michelle Reyes
- Department of Obstetrics and Gynecology, Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Thomas J Kuehl
- Department of Obstetrics and Gynecology, Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
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Wang J, Liu Q, Zhang Y, Cheng Y, Li S, Zeng H, Zhu Z. Treatment for Vas Deferens Obstruction Following Childhood Herniorrhaphy. Urology 2017; 112:80-84. [PMID: 29056578 DOI: 10.1016/j.urology.2017.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To enhance the management of inguinal obstruction, and to present the procedures and results of our surgical strategy for vas deferens obstruction following childhood herniorrhaphy. METHODS We treated a total of 56 patients diagnosed with obstructive azoospermia following bilateral inguinal herniorrhaphy. First, conventional inguinal open surgery was performed. If the abdominal vas was not identified in the inguinal region, laparoscopy was used to retrieve the deeper abdominal vas deferens, which was obstructed above the internal inguinal ring. Then, microsurgical vasovasostomy (VV) was performed. Overall patency and natural pregnancy rates were determined. RESULTS We terminated the surgery in 16 patients with pasty vasal fluid and no sperm. When bilateral remnants of the vas deferens were found, laparoscopic mobilization was not required, and 22 (55.0%) patients underwent bilateral VV with patency and natural pregnancy rates of 90.9% (20 of 22) and 50.0% (11 of 22), respectively. When a unilateral end could not be found, 7 (17.5%) patients underwent unilateral laparoscopy-assisted VV plus unilateral VV, with patency and natural pregnancy rates of 85.7% (6 of 7) and 42.9% (3 of 7), respectively. When bilateral ends were not found, 11 (27.5%) patients underwent bilateral laparoscopy-assisted VV, with patency and natural pregnancy rates of 81.8% (9 of 11) and 27.3% (3 of 11), respectively. Overall, our surgery yielded a patency rate of 87.5% (35 of 40) and a natural pregnancy rate of 42.5% (17 of 40). CONCLUSION Our treatment for vas deferens obstruction following childhood herniorrhaphy yielded good postoperative outcomes in terms of sperm concentration and motility, vas patency, and natural pregnancy, with no complications.
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Affiliation(s)
- Jin Wang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qian Liu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Youpeng Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yongbiao Cheng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Sen Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hanqing Zeng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhaohui Zhu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Chen XF, Chen B, Liu W, Huang YP, Wang HX, Huang YR, Ping P. Microsurgical vasoepididymostomy for patients with infectious obstructive azoospermia: cause, outcome, and associated factors. Asian J Androl 2017; 18:759-62. [PMID: 26924282 PMCID: PMC5000800 DOI: 10.4103/1008-682x.175095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Azoospermia is of great importance to male infertility. Obstructive azoospermia (OA) due to infection is the most prevalent form of OA in China and has been less studied. We aim to observe the treatment outcome of microsurgical vasoepididymostomy (VE) and also to identify the factors relative to the result after reconstructive surgery. Two hundred and eight men presenting with OA due to infection during the study period from July 2010 to July 2013 were prospectively evaluated. Clinical examination, semen analysis, serum follicle stimulating hormone (FSH), and scrotal ultrasound were done before surgical exploration. Among the 198 men who were selected for surgical procedures, 159 candidates underwent microsurgical VE with sperm detected in the epididymal fluid. As for the other 39 cases, reconstruction was not feasible. The average age was 28.5 ± 3.9 years (range 22–38), with average follow-up being 16.5 ± 5.9 months (range 4–28). According to the 150 cases being followed after VE procedures, the total patency rate was 72% (108/150). During follow-up, 38.7% (58/150) natural pregnancies occurred, with overall live birth rate being 32.7% (49/150). Our data suggested that microsurgical VE is an effective therapy for postinfectious epididymal OA. Individualized counseling with prognosis based on etiology should be offered to patients to select optical therapy.
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Affiliation(s)
- Xiang-Feng Chen
- Center for Reproductive Medicine, Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135; Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127; Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Bin Chen
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Wei Liu
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yan-Ping Huang
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Hong-Xiang Wang
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yi-Ran Huang
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Ping Ping
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
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Tamburrino L, Cambi M, Marchiani S, Manigrasso I, Degl'Innocenti S, Forti G, Maggi M, Baldi E, Muratori M. Sperm DNA fragmentation in cryopreserved samples from subjects with different cancers. Reprod Fertil Dev 2017; 29:637-645. [DOI: 10.1071/rd15190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/14/2015] [Indexed: 12/19/2022] Open
Abstract
Sperm cryopreservation is widely used by cancer patients undergoing chemo- or radiotherapy. Evidence suggests that IVF outcome with cryopreserved spermatozoa from cancer patients is less successful. To determine whether sperm DNA fragmentation (SDF) is involved in the lower fertilising ability of cryopreserved spermatozoa of cancer patients, SDF was evaluated in thawed spermatozoa from 78 men affected by different cancers and 53 men with non-cancer pathologies. SDF was assessed by the terminal deoxyribonucleotidyl transferase-mediated dUTP–digoxigenin nick end-labelling (TUNEL), propidium iodide (PI), flow cytometry procedure, which allows determination of two different cell populations (PIbrighter and PIdimmer) and thus to determine the percentage of DNA fragmented sperm in both. PIdimmer spermatozoa are totally unviable, whereas PIbrighter spermatozoa with SDF may be motile and morphologically normal, having higher biological relevance in the reproductive process. We found that the proportion of DNA fragmented PIbrighter cells was significantly higher in thawed spermatozoa from cancer than non-cancer patients. Moreover, a positive correlation was found between the degree of DNA fragmentation and sperm motility in the PIbrighter population of spermatozoa from cancer patients that wasn’t seen in non-cancer patients. The results of the present study suggest that higher SDF levels may contribute to the lower IVF success of cryopreserved spermatozoa from cancer patients and that evaluation of SDF could complement genetic counselling as part of the routine management of cancer patients who seek fertility preservation.
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Jiang HT, Guo JN, Liu ZQ, Yuan Q, Zhou ZY, Liu Y, Xiao KF, Yang JG. The importance of laparoscopy in the surgical reconstruction of inguinal vas injury. Asian J Androl 2016; 19:258-259. [PMID: 26732110 PMCID: PMC5312230 DOI: 10.4103/1008-682x.170438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hong-Tao Jiang
- Department of Urology, Minimally Invasive Urology of Shenzhen Research and Development Center of Medical Engineering and Technology, Shenzhen People's Hospital, Jinan University Second Clinic Medical College, Shenzhen 518020, China
| | - Ji-Nan Guo
- Department of Urology, Minimally Invasive Urology of Shenzhen Research and Development Center of Medical Engineering and Technology, Shenzhen People's Hospital, Jinan University Second Clinic Medical College, Shenzhen 518020, China
| | - Zeng-Qin Liu
- Department of Urology, Minimally Invasive Urology of Shenzhen Research and Development Center of Medical Engineering and Technology, Shenzhen People's Hospital, Jinan University Second Clinic Medical College, Shenzhen 518020, China
| | - Qian Yuan
- Department of Urology, Minimally Invasive Urology of Shenzhen Research and Development Center of Medical Engineering and Technology, Shenzhen People's Hospital, Jinan University Second Clinic Medical College, Shenzhen 518020, China
| | - Zhen-Yu Zhou
- Department of Urology, Minimally Invasive Urology of Shenzhen Research and Development Center of Medical Engineering and Technology, Shenzhen People's Hospital, Jinan University Second Clinic Medical College, Shenzhen 518020, China
| | - Yu Liu
- Department of Laboratory Medicine, Shenzhen People's Hospital, Shenzhen 518020, China
| | - Ke-Feng Xiao
- Department of Urology, Minimally Invasive Urology of Shenzhen Research and Development Center of Medical Engineering and Technology, Shenzhen People's Hospital, Jinan University Second Clinic Medical College, Shenzhen 518020, China
| | - Jiang-Gen Yang
- Department of Urology, Minimally Invasive Urology of Shenzhen Research and Development Center of Medical Engineering and Technology, Shenzhen People's Hospital, Jinan University Second Clinic Medical College, Shenzhen 518020, China
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Namekawa T, Imamoto T, Kato M, Sazuka T, Fuse M, Sakamoto S, Kawamura K, Ichikawa T. Testicular function among testicular cancer survivors treated with cisplatin-based chemotherapy. Reprod Med Biol 2015; 15:175-181. [PMID: 29259434 DOI: 10.1007/s12522-015-0232-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022] Open
Abstract
Purpose The aim of our study was to identify the clinical predictors of spermatogenesis recovery in testicular cancer (TC) patients after chemotherapy and to determine the recuperation period for spermatogenesis. Methods Patients treated for TC from January 1982 to November 2001 at Chiba University Hospital were retrospectively assessed. Thirty-five patients who met the following criteria were examined-(i) underwent both high orchiectomy and cisplatin-based chemotherapy; (ii) had semen analyses and hormonal measurements; and (iii) were alive with no evidence of disease. Clinical variables associated with normalization of spermatogenesis after chemotherapy were examined. Time to recover normospermia was also evaluated using Kaplan-Meier analysis. Results The observation period was 13.3 ± 5.6 years. Reappearance of sperm was confirmed in 85.7 % of patients, and 54.3 % of patients recovered normospermia. Age at diagnosis <25 years (p = 0.0057), number of chemotherapy cycles <4 cycles (p = 0.0042), and follicle-stimulating hormone at the end of chemotherapy <18 mIU/ml (p = 0.0220) were independent factors related to post-chemotherapy normalization of semen findings. The median (95 % CI) time to recover normospermia was 40 (range 22-96) months. Conclusions These findings help to predict whether spermatogenesis will recover and its timing. They may also help clinicians identify and manage TC patients at a higher risk of prolonged azoospermia after chemotherapy.
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Affiliation(s)
- Takeshi Namekawa
- Department of Urology Graduate School of Medicine, Chiba University 1-8-1 Inohana-cho, Chuo-ku 260-8670 Chiba Japan
| | - Takashi Imamoto
- Department of Urology Graduate School of Medicine, Chiba University 1-8-1 Inohana-cho, Chuo-ku 260-8670 Chiba Japan
| | - Mayuko Kato
- Department of Urology Graduate School of Medicine, Chiba University 1-8-1 Inohana-cho, Chuo-ku 260-8670 Chiba Japan
| | - Tomokazu Sazuka
- Department of Urology Graduate School of Medicine, Chiba University 1-8-1 Inohana-cho, Chuo-ku 260-8670 Chiba Japan
| | - Miki Fuse
- Department of Urology Graduate School of Medicine, Chiba University 1-8-1 Inohana-cho, Chuo-ku 260-8670 Chiba Japan
| | - Shinichi Sakamoto
- Department of Urology Graduate School of Medicine, Chiba University 1-8-1 Inohana-cho, Chuo-ku 260-8670 Chiba Japan
| | - Koji Kawamura
- Department of Urology Graduate School of Medicine, Chiba University 1-8-1 Inohana-cho, Chuo-ku 260-8670 Chiba Japan
| | - Tomohiko Ichikawa
- Department of Urology Graduate School of Medicine, Chiba University 1-8-1 Inohana-cho, Chuo-ku 260-8670 Chiba Japan
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Lei B, Xing R, Zhou X, Lv D, Wan B, Shu F, Zhong L, Wu H, Mao X. Neutral alpha-1,4-glucosidase and fructose levels contribute to discriminating obstructive and nonobstructive azoospermia in Chinese men with azoospermia. Andrologia 2015; 48:670-5. [PMID: 26610429 DOI: 10.1111/and.12498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/27/2022] Open
Affiliation(s)
- B. Lei
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou Guangdong Province China
- Department of Urology; Peking University Shenzhen Hospital; Shenzhen Guangdong Province China
| | - R. Xing
- Department of Urology; Weihai Hospital; Qingdao University; Qingdao Shandong Province China
| | - X. Zhou
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou Guangdong Province China
| | - D. Lv
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou Guangdong Province China
| | - B. Wan
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou Guangdong Province China
| | - F. Shu
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou Guangdong Province China
| | - L. Zhong
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou Guangdong Province China
| | - H. Wu
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou Guangdong Province China
| | - X. Mao
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou Guangdong Province China
- Department of Urology; Peking University Shenzhen Hospital; Shenzhen Guangdong Province China
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