Does inhibin-B help us to confidently refuse diagnostic testicular biopsy in azoospermia?

In the recent years, the use of laboratory blood factors such as FSH and inhibin-B for the assessment of spermatogenesis in different studies has increased; of course, the conflicting results have also been achieved. To investigate if the measurement of inhibin-B can help surgeon to reduce unnecessary diagnostic testicular biopsies in males with azoospermia. This cross-sectional study was done during July 2006 to September 2007 on 41 patients with azoospermia. FSH and inhibin-B were measured and bilateral open testicular biopsy was performed for all patients. Sperm was seen in 29% of biopsies that in 100% of these samples inhibin-B was more than 100 pg/mL and FSH was less than twice the normal [p=0.001]. Inhibin-B had significant correlation inversely with testicular fibrosis and Sertoli cell only syndrome [p=0.043 and p=0.011, respectively] and directly with incomplete spermatocytic maturation arrest and obstructive azoospermia [p=0.027 and p=0.013, respectively]. FSH was only correlated with obstructive azoospermia [p=0.001]. We suggest that if FSH is less than twice the normal, inhibin-B should be measured and if its level is less than 100 pg/mL, we can cancel about the half of unnecessary diagnostic testicular biopsies

Prostate-specific antigen doubling time as a predictor of Gleason grade in prostate cancer

Our aim was to evaluate the value of serum prostate-specific antigen doubling time [PSADT] to differentiate patients with high-grade prostate cancer who require more aggressive therapy from those with low-grade cancer. Of 460 patients with extended 12-core transrectal ultrasonography-guided biopsy of the prostate, 59 with confirmed prostate cancer were selected. They had not received any previous treatment for prostate cancer and had at least 2 consecutive serum PSA tests with a rising trend. The PSADT was calculated in patients with 2 serum PSA levels measured with an interval more than 3 months. Of 59 patients with prostate cancer, 35 [59.3%] had low-grade and 24 [40.7%] had high-grade tumors. There was no difference in age between the two groups. The median PSADT in patients with high-grade tumors were 12.70 months [range, 0.7 to 44.8 months] and 25.00 months [range, 1.65 to 41.2 months; P=.001]. A total of 21 patients with high-grade tumors [87.5%] had a PSADT less than 12 months, while only 9 of those with low-grade tumors [25.7%] had a PSADT less than 12 months. A PSADT with low-grade tumors [25.7%] had a PSADT less than 12 months. A PSADT cutoff of 12 months provided a sensitivity of 74% and a specificity of 87% for differentiation of high-grade from low-grade cancers. We concluded that men with a short PSADT [<12 months] were at a higher risk of harboring a high-grade prostate cancer. Our data suggests PSADT can identify patients with high-grade tumors who require more aggressive therapy

Pediatric cystine calculi in west of Iran a study of 22 cases

Cystinuria is an autosomal recessive disorder which clinically presents as cystine calculi. In this study, we reviewed cystine calculi cases in the west of Iran to determine their common presentations and response to different therapeutic modalities. Between 1999 and 2005, we had 22 pediatric patients [11 boys and 11 girls] with cystine calculi. The demographic characteristics and clinical data of the patients as well as the treatment results were reviewed. The mean age of the patients was 34.20 ' 42.99 months [range, 4 to 156 months]. They were followed for a mean duration of 23 months [range, 3 to 70 months]. Thirteen patients [59.1%] had bilateral and 9 [41%] had unilateral kidney calculi. The sizes of the calculi were between 2 mm and 20 mm. Nine patients [41%] had renal atrophic changes and 1 [4.5%] had obstructive acute renal failure. Hydration and urinary alkalinization were administrated to all of the patients which yielded an excellent result in 54.5% and a poor response in 27.2%. Captopril started for 5 patients was effective only in 1. D-penicillamine had no favorable response. Extracorporeal shockwave lithotripsy was successful in 5 attempts and failed in 4. Surgical interventions were performed for 13 patients [59.1%] and 6 [27.2%] required more than 1 surgical operation. We recommend metabolic workup of childhood urolithiasis and appropriate medical management of its underlying disease. We also recommend minimally invasive urologic techniques including shockwave lithotripsy only when there are clear indications for nonmedical procedures