Parameters affecting the success rate of microscopic testicular sperm extraction in male patients with a solitary testis and non-obstructive azoospermia

PURPOSE

We aimed to compare the success rate of spermatozoa retrieval through microscopic testicular sperm extraction (mTESE) in non-obstructive azoospermic (NOA) men with a solitary testis with that of mTESE in NOA men with bilateral testes and the parameters affecting these rates.

METHODS

A retrospective cross-sectional study of factors contributing to infertility in NOA patients with a solitary testis and men with bilateral testes was carried out. In this multicenter study, 74 patients with NOA with a solitary testis were matched with 74 patients with bilateral testes in terms of age, duration of infertility, and volume of the solitary testis from 2770 patients with NOA with bilateral testes. Hormonal parameters, presence of varicocele, history of varicocelectomy, history of undescended testis and karyotype analysis results were compared.

RESULTS

Spermatozoa were obtained from 40 (54.1%) patients with a solitary testis and 42 (56.76%) patients with bilateral testes. No differences were found regarding age, duration of infertility, or mean testicular volume between patients with a solitary testis and patients with bilateral testes. When serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were compared regardless of sperm retrieval status, it was observed that both levels were greater in the group of patients with a solitary testis (p < 0.01). Patients with solitary and bilateral testes from whom spermatozoa were obtained had larger testes than those from whom spermatozoa could not be obtained (p < 0.05). Similarly, the serum levels of FSH and LH were significantly greater in patients with a solitary testis than in those with bilateral testes (p < 0.05).

CONCLUSIONS

To the best of our knowledge, this is the first study in the literature to evaluate the parameters that influence mTESE outcome in NOA patients with a solitary testis and NOA patients with bilateral testes. Greater testicular volume was found to positively affect spermatozoa retrieval for patients with a solitary testis. The higher levels of FSH and LH in patients with a solitary testis than in patients with bilateral testes of similar testicular volume may be due to a compensatory mechanism developed by the hypothalamic-pituitary-gonadal axis. The fact that these hormones are higher in patients with a solitary testis does not mean that the number of spermatozoa obtained through mTESE will be decreased.

Microdissection testicular sperm extraction in non-obstructive azoospermic patients with solitary testis: a retrospective case-control study

Obtaining sperm from the testis surgically and using these sperm with the intracytoplasmic sperm injection technique, has opened the way for the possibility of biological fathering in men with non-obstructive azoospermia (NOA). We aimed to evaluate our sperm retrieval rate (SRR) by microdissection testicular sperm extraction (micro-TESE) in NOA patients with solitary testis. In this retrospective case-control study, fortyfive patients with NOA who had a congenital or acquired solitary testis were included, between September 2003 and January 2022. These patients were randomly matched with patients with NOA who had bilateral testes, using a 1:3 matching ratio. We found that SRR by micro-TESE in patients with solitary testis was similar to NOA patients with bilateral testis (51.1% vs. 50.4%). Age, infertility period, ejaculate volume, serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone, history of varicocelectomy, history of orchiopexy, testicular stimulation therapy before micro-TESE, testicular volume, genetic status, TESE side, micro-TESE success, complications and histopathological evaluation results of both groups were evaluated, there was a statistically significant difference in only serum FSH and LH levels. There was no difference between the groups in terms of complications and hormonal effects in the early postoperative period. Micro-TESE in NOA patients with solitary testis has similar sperm retrieval and complication rates as NOA patients with bilateral testis.

The relationship between premature ejaculation and the timing of pre-adult circumcision

We aimed to investigate the relationship between premature ejaculation and the age when men had been circumcised before adulthood. A total of 2,768 sexually active male patients aged between 18 and 65 years were included in this study. A multicentre study was conducted prospectively with the participation of 20 centres. A survey consisting of 12 questions prepared by the researchers, as well as the validated Turkish versions of the five-item Premature Ejaculation Diagnostic Tool, was administered to all participants. The study included 1,603 participants who met the inclusion criteria. There was no significant difference in the Premature Ejaculation Diagnostic Tool and self-reported ejaculation time between the participants who had been circumcised at different ages during childhood. Remembering circumcision experience with fear or anxiety did not increase the risk of sexual dysfunction compared to the participants who described their experience with happiness or with no particular emotion. There was no significant difference in Premature Ejaculation Diagnostic Tool scores or the self-reported ejaculation time of the participants circumcised at different ages. The age of childhood circumcision, having a fearful or anxious circumcision experience, does not affect the risk of premature ejaculation in adult life.

Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study

Introduction

Coronavirus disease 2019 (COVID-19) pandemic caused unprecedented restrictions in outpatient services and surgical practices in urology as in other medical branches as well as in all areas of life.

Aim

To investigate whether there have been variations in the presentations of male patients with sexual and reproductive health problems to the outpatient urology clinics during the COVID-19 pandemic and to understand the underlying factors for these variations, if any.

Methods

Male patients aged ≥18 years who presented to the outpatient urology clinics in 12 centers across Turkey from February 1, 2020 to June 1, 2020 were retrospectively evaluated. The patients were divided into 2 groups: those who presented to the outpatient clinic from February 1, 2020 to March 11, 2020 comprised the “pre–COVID-19 pandemic period” group, whereas those who presented to the outpatient clinic from March 12, 2020 to June 1, 2020 comprised the “COVID-19 pandemic period” group and compared with each other.

Main Outcome Measures

The main outcome of this study was the number and diagnose of patients presented to urology outpatient clinics.

Results

Andrological problems were detected in 721 of 4,955 male patients included in the study. During the COVID-19 pandemic period, there was a significant increase in andrological diagnosis in these patients compared with the pre–COVID-19 pandemic period (n = 293 [17%] vs n = 428 [13.2%], P < .001, respectively). Similarly, there was a statistically significant increase in the number of patients diagnosed with male reproductive or sexual health problems during the COVID-19 pandemic period (n = 107 [6.2%] vs n = 149 [4.6%], P = .016 and n = 186 [10.8%] vs n = 279 [8.6%], P = .013, respectively). The number of patients diagnosed with erectile dysfunction during the pandemic was also significantly higher than the pre–COVID-19 pandemic period (n = 150 [8.7%] vs n = 214 [6.6%], P = .008).

Conclusion

Presentations to the outpatient urology clinics owing to andrological problems markedly increased during the pandemic period. Although these problems are of multifactorial origin, psychogenic factors are also considered to significantly trigger these problems.

Duran MB, Yildirim O, Kizilkan Y, et al. Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study. Sex Med 2021;9:100292.

Expression of maspin in testis tumors with germ cells andits relation with angiogenesis factors

BACKGROUND/AIM

We aimed to evaluate the importance of maspin expression in testicular tumors with germ cells, its effect on prognosis, and the relation with angiogenesis factors.

MATERIALS AND METHODS

The paraffin blocks of the orchiectomy materials of 32 patients who had undergone orchiectomy due to testicular tumors were taken within the scope of the study. The specimens of the cases included in the study group were reexamined under light microscope.

RESULTS

While just one maspin-positive sample was found in the seminoma cases, maspin stained positively in 6 of the nonseminoma germ cell tumors (NSGCTs). No statistical difference was found between maspin and tumor stage, size, alpha fetoprotein values, vascular endothelial growth factor, Ki-67, and CD31. A statistically positive correlation was only determined between maspin and p53 (P < 0.001).

CONCLUSION

Maspin protein, whose expression in some tumors is accepted as a poor prognostic factor, is also expressed in testicular tumors with germ cells. However, according to our study, it is difficult to say whether this protein is a favorable or poor prognostic factor in testicular tumors and to understand how the effect mechanism works. The positive correlation between maspin and p53 in the NSGCTs makes us think that maspin might have displayed an effect on the p53 pathway.

Can We Predict the Outcome of Varicocelectomy Based on the Duration of Venous Reflux?

OBJECTIVE

To investigate the outcome of varicocelectomy based on the duration of venous reflux (DVR) of the pampiniform plexus veins.

MATERIALS AND METHODS

In total, 138 patients with clinically palpable varicoceles were evaluated for DVR with color Doppler ultrasonography from May 2009 to August 2014. The DVR was defined as the DVR of a varicocele in the supine position during the Valsalva maneuver. Patients with bilateral, recurrent, or subclinical varicoceles; hormonal imbalances involving follicle-stimulating hormone, luteinizing hormone, or total testosterone; azoospermia; and intraoperative or postoperative complications were excluded. Of the 138 patients, 76 met the inclusion criteria. All patients were treated with subinguinal microscopic varicocelectomy. Restoration of all three semen parameters (concentration, motility, and morphology) to normal values 6 months postoperatively was considered to indicate treatment success. The patients were divided into those with a DVR of <4.5 seconds (Group 1) and ≥4.5 seconds (Group 2).

RESULTS

The mean age of the patients was 29.39 (±6.03) years. No statistically significant relationship was found between the success rate and varicocele grade. The cutoff DVR value was calculated as 4.5 seconds using a receiver operating characteristics curve according to patients who underwent successful treatment. The success rates of Groups 1 and 2 were 40.0% and 88.2%, respectively (P = .0001).

CONCLUSION

The results of this analysis indicate that a DVR of ≥4.5 seconds predicts better outcomes of varicocelectomy.

Single injection results of endoscopic treatment of vesicoureteric reflux with different tissue-bulking substances in patients with end stage renal failure

PURPOSE

To evaluate the outcome of subureteral injections by using calcium hydroxyapatite (CaHa), dextranomer/hyaluronic acid copolymer (Dx/HA), and polydimethylsiloxane (PDS) in patients with end-stage renal failure (ESRF) who have vesicoureteral reflux (VUR).

PATIENTS AND METHODS

One hundred-one patients (166 renal units) with ESRF secondary to VUR were included in this retrospective study. The reflux was bilateral in 65 of the cases. CaHa, Dx/HA and PDS were used in 57, 26, and 18 patients, respectively. All patients were reviewed with regard to age, sex, reflux grade, type of injected materials, injectable agent volume, and outcome.

RESULTS

The reflux resolved completely in 30 patients (50/96 renal units, 52.1%), in 17 patients (27/44 renal units, 61.4%), and in 4 patients (5/26 renal units, 19.2%) with CaHa, Dx/HA, and PDS, respectively. Regression rates of reflux to grade I with these agents in the same order were 3.1% (2 patients, 3/96 renal units), 4.5% (1 patient, 2/44 renal units), and 11.5% (2 patients, 3/26 renal units). Thus, the overall success rate were noted as 55.2%, 65.9%, and 30.7%, respectively. There was no difference among these three injectables with regard to overall success rates (P = 0.062). No significant correlation with age, reflux grade, agent volume, and significant difference with sex were observed (P > 0.05).

CONCLUSIONS

In this group of patients, the success rate of the subureteral injection treatment does not appear to be affected by the type of the injectable agent. In addition, the cure rates were independent from the individual factors, reflux grades, and injected volumes.

Which factors may effect urinary leakage following percutaneous nephrolithotomy?

OBJECTIVE

To evaluate the factors that may effect urinary leakage following percutaneous nephrolithotomy (PCNL).

METHODS

Four hundred and thirty-three patients who underwent PCNL were reviewed retrospectively. The factors that may lead to leakage after surgery were analyzed as categorized into four groups according to individual variables (age, sex, body mass index); renal factors (previous surgery, extracorporeal shock wave lithotripsy history, presence of hydronephrosis); stone burden; and surgical features (access number, type of dilatation, presence of nephrostomy catheter). These data were compared for the presence and duration of urinary leakage.

RESULTS

There was no statistically significant correlation between individual factors and both the presence of leak (POL) and the duration of leak (DOL) (P > 0.05). Among renal factors, only presence and degree of hydronephrosis was significantly correlated with POL (P < 0.001) and DOL (P < 0.001). The mean cumulative stone burden neither had impact on POL nor correlated with DOL (P > 0.05). Among surgical factors, dilatation with a Nephromax dilator significantly increased incidence of POL when compared with an Amplatz dilator (P < 0.001), yet did not change DOL. Using an internal ureteral stent significantly decreased incidence of POL and DOL (P < 0.001). DOL increased with catheter diameter and stay time (P < 0.05).

CONCLUSION

Several yet simple factors appear to be effective in postoperative urine leakage from the access sites after percutaneous stone surgery. Precautions may also be simple if these factors are considered preoperatively.

Labial fusion causing urinary incontinence and recurrent urinary tract infection in a postmenopausal female: a case report

A 73-year-old postmenopausal woman was admitted with recurrent urinary tract infection and a history of incontinence. General physical examination was normal. Complete labial fusion was noticed on genital examination. Surgical intervention was performed. This therapy alleviated incontinence and recurrent urinary tract infection.

Renal transplant outcome after endoscopic treatment of vesicoureteral reflux using the subureteric injection of calcium hydroxyapatite

OBJECTIVES

To evaluate the results of end-stage renal failure in transplanted cases due to vesicoureteral reflux after a subureteric injection of calcium hydroxyapatite (Coaptite).

MATERIALS AND METHODS

Twenty-three patients (39 renal units) with end-stage renal failure secondary to vesicoureteral reflux were included. Reflux was bilateral in 16 cases and unilateral in 7 of the cases. There were 3 degrees of reflux according to the distribution of renal units. They were low-grade reflux (grades 1 and 2; n=10); medium-grade reflux (grade 3; n=23); and high-grade reflux (grades 4 and 5; n=6).

RESULTS

Reflux resolved completely in 17 patients (28 renal units; 71.8%). There was a regression to grade 1 in 3 patients (5 renal units; 12.8%). Twenty-one patients underwent renal transplant; however, 2 of the patients were excluded from the study as it was not possible to monitor them after transplant. Within an approximately 18.6 month follow-up (range, 3-36 months), 1 of the cases had acute, and 3 of the cases had chronic rejection.

CONCLUSIONS

Successful results can be achieved in reflux treatment by an injection of subureteric calcium hydroxyapatite before transplant in patients with end-stage renal failure that developed secondary to vesicoureteral reflux.