A Rare Case of Urothelial Carcinoma with Divergent Differentiation Showing Multiple Varied Histomorphology with Review of Literature

Urothelial carcinoma with divergent differentiation is a variant of urothelial carcinoma and it is being increasingly recognizedwith the increase in awareness and advancement of immunohistochemistry. It is important to quantify the degrees of eachdifferentiation for the prognosis and treatment of the patient. Here, we present a unique case of urothelial carcinoma of urinarybladder with divergent differentiation showing urothelial, squamous, papillary, and glandular differentiation.

A Study of the Surgical Outcome and Impact on Semen Parameters after Laparoscopic Varicocelectomy and Sub Inguinal Varicocelectomy

Varicocele is the dilatation of pampiniform plexuses which can cause infertility. Incidence of varicocele is around 15-80 % and remains the most common treatable cause of infertility in men. The aim of this study was to identify the preferred method of varicocelectomy in patients with infertility, which gives optimal improvement in semen parameters. This study compares laparoscopic varicocelectomy and subinguinal varicocelectomy.METHODSThis is a prospective interventional study carried out in the Department of Urology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai from August 2017 to July 2019. We included patients with documented infertility with clinical varicocele. Only couples with no other attributable causes including female factors for infertility were included. Patients with previous history of surgery for inguinal hernia, testicular pathology were excluded from the study. We included 25 patients who satisfied the inclusion criteria. They were subjected to physical examination, doppler study and semen analysis. The patients were randomised into 2 groups, A & B by random allocation. Group A (12 patients) underwent laparoscopic varicocelectomy and group B (13 patients) underwent subinguinal varicocelectomy. All patients were regularly followed up at 3 months and 6 months period post-surgery.RESULTSReview at immediate post-operative period, follow ups at 3 & 6 months were undertaken. History of conception, clinical examination, semen analysis according to WHO 2010 manual and doppler studies by Sarchetsi scale were performed. Three factors in seminal parameters namely sperm concentration, motility & morphology were assessed. Varicocele recurrence was also assessed. There had been a statistically significant improvement in semen parameters in all the patients who underwent varicocelectomy (p value p< 0.005). On comparing the laparoscopic and sub-inguinal surgical techniques, there was no significant variation in increase in sperm concentration, sperm motility and morphology.CONCLUSIONSVaricocelectomy improves the semen parameters. No significant variation was observed when the different surgical approaches of varicocelectomy were compared.