Genetic variation in leptin and leptin receptor genes as a risk factor for idiopathic male infertility

The aim of this study was to examine whether there is an association among genetic variability in leptin (LEP) and leptin receptor (LEPR) genes and male infertility. We performed a case-control study and were searching for an association between polymorphisms of LEP and LEPR genes and male infertility. The study group consisted of 317 patients with idiopathic infertility and a control group of 241 fertile men from Slovenia. Four single nucleotide polymorphisms (SNPs) in LEP gene and four single nucleotide polymorphisms (SNPs) in LEPR gene were chosen and genotyped. Statistically significant SNP was further validated in additional 255 infertile patients and 168 controls from Serbia and Macedonia. In the Slovenian population, we found a statistically significant difference in genotype distribution for rs10244329 polymorphism in LEP gene (recessive genotype model, p value = 0.048). The trend toward statistically significant difference in genotype distribution for rs10244329 polymorphism was confirmed in the Serbian and Macedonian populations (p value = 0.07). Our data suggest that genetic variability in the LEP gene might be associated with male infertility warranting further confirmation and mechanistic investigations.

[Combined hormono-radiotherapy in treatment of locally advanced prostate cancer]

Numerous questions regarding combined hormono-radiotherapy in the treatment of locally advanced prostate cancer still remain open. We present results of combined treatment in 133 our patients with locally advanced prostate cancer. All patients recieved hormonotherapy as neoadjuvant, concomitant with radiotherapy (tumor dose range 65-72 Gy), and adjuvant. In six months follow-up time, complete regression (CR) was noted in 120 patients (90%), partial regression (PR) in 6 (4.5%), stabile disease (SD) in 2 (1.5%) and progression of disease (PD) in 5 patients (4%). In mean follow up time of 17 months (6-77), 13 patients relapsed. Five-year time to progression was 70%. Five-year disease-free interval for CR patients was 70%. At the date of last control CR was noted in 116 patients (87%), PR in 2 patients (2%), SD in 7 patients (5%), and 8 patients (6%) had progressive disease. Second malignancy was noted in 4 patients. Multidisciplinary studies directed towards the optimisation of combined treatment are ongoing. There are no definitive conclusions.

[Percutaneous-retrograde recanalization of ureteral stricture with a curved metal stent]

Our own experience in application of a combined percutaneous-retrograde approach for recanalization of the urethral structures in 4 patients in presented. Metallic guide is placed via the previously created percutaneous nephrostomy while dilatation or insertion of the metallic stent is performed retrogradely. The approach is used in the strictures in which percutaneou's placement of the recanalization balloon catheter into the stricture site was impossible. The method was successfully applied in all 4 cases in absence of any complications.

[Ileal conduit--quality of life]

Removal of the urinary bladder--cystectomy--imposes the problem of urine derivation. The most sophisticated forms of urinary derivation imply those where the continent urinary reservoir is anastomosed to the urethra. One of these is Came's enteroplasty. In our hospital this technique was applied on 52 patients. Postoperative complications and obtained results suggest that this form of urinary derivation is an important step forward not only to incontinent forms of derivation, but to non-orthotopic continent urinary derivations, as well. All patients in our series were very successful in reintegration into the normal life, i.e. they were able to achieve a high quality of life after otherwise mutilating surgical procedure.

[Quality of life in patients with a modified Mainz-pouch II urinary diversion]

The type of urinary derivation after radical cystectomy due to urinary bladder carcinoma does not influence survival substantially, but it may influence the quality of life of the patients very much. One of modifications of classical ureterosigmoidostomy that has been focused by urologist in recent years in the sigma rectum pouch (Mainy pouch II), for its substantially improved aspects of quality of life and earlier occupational rehabilitation of these patients. In the period August 1994 through March 1998 we made Meinz pouch II (the modification implies fixation of the pouch to the parietal peritoneum and implantation of the ureter into the pouch as suggested by Camey-Le-Duc). This surgical technique is associated with lots of advantages as the continent form of urinary derivation, and as a fairly simple surgical technique it is an improvement in this type of surgery. Intactness of the abdominal wall (no urostoma), frequency of defecation/urination in 3-4 hr intervals during the day and 4-5 hours during the night, absolutely volitonal control of these functions, rapid postoperative recovery with stabilization of renal function parameters, low percentage of ascending infections, higher degree of occupational rehabilitation, i.e. lower incidence of disability and good psychosocial status are all advantages of this method in the light of the quality of life of these otherwise very difficult patients.

[Surgical treatment and quality of life in patients with carcinoma of the penis]

Penile carcinoma is a rare disease with the annual incidence of 1-2 cases per 100,000 men. About 95% of all penile malignancies are squamous cell carcinoma. At the Clinic of Urology in the period 1988-1998 we treated 58 patients with penile carcinoma. Nine of these (15.5%) were subjected to total penectomy due to the extent of the lesion, while partial amputation of the penis was performed in 84.5% (49 cases). The aim of the therapy was to completely remove the primary lesion with adequate margins. Postoperative follow-up comprised, among other things, evaluation of the quality of life as reflected in pain, sexuality and emotional distress. Quality of life of patients subjected to partial penectomy where no cases of relapse were recorded, was satisfactory, while in cases of total penectomy about 24% (14 patients) suffered marked emotional distress induced by the loss of the mark of male sexuality and sexual impotence. In the light of the prominent problems related to the quality of life induced by severe psychological influence of penis amputation, local excision, Mohs's operation and laser therapy are increasingly used in the treatment of penile carcinoma.

Kallikrein therapy of infertile men with varicocele and impaired sperm motility

A randomized group of 65 men with oligoasthenozoospermia and left side varicocele was subjected to a controlled study with kallikrein. Kallikrein (600 units orally per day) was given to 38 men for a period of 3 months. The other group of 27 men remained untreated but were followed up during the same period of time. After kallikrein treatment significant improvements in sperm quality could be observed: percentage of motile spermatozoa from 24.47 +/- 9.01 to 35.26 +/- 11.80, percentage of morphologically normal spermatozoa from 58.42 +/- 5.86 to 71.05 +/- 8.12. There was no improvement in sperm parameters in the untreated group of men. The results suggest that kallikrein therapy is useful for those men who refuse an operative or radiologic treatment of their varicocele and also as a primary or associated therapy of patients who underwent ligature or occlusion of spermatic veins.