influence of ginger (Zingiber officinale) on human sperm quality and DNA fragmentation: a double-blind randomized clinical trial

Background: although the effectiveness of ginger as an antioxidant agent has been exploited, little human research has been conducted on its activity on male reproductive functions

Objective: this study was designed to investigate the effects of ginger [Zingiber officinale] on sperm DNA fragmentation [SDF] in infertile men

Materials and Methods: this randomized double-blind, placebo-controlled trial with a 1:1 allocation was performed on 100 infertility treatment candidates who were admitted to Royan Institute for Reproductive Biomedicine, Tehran, Iran. Patients were randomly assigned to receive one of two treatments: ginger and placebo. Patients were given a 3-month oral treatment [members received capsules containing 250 mg of ginger powder twice a day in ginger and a placebo in other group]. Before and after treatment, standardized semen samples were obtained to determine sperm concentration, motility, and SDF according to World Health Organization

Results: there was no significant difference between two groups regarding SDF at baseline [53.48. 95%CI: 37.95-69.02] in cases and [56.75, 95%CI: 40.01-73.5] in controls. The average positive percentage of SDF in patients receiving ginger [17.77, 95%CI: 6.16-29.39] was lower compared with placebo [40.54, 95%CI: 23.94-57.13] after three month of treatment [p=0.02]. In multivariate analysis, SDF was significantly lower in patients receiving ginger compared with placebo [mean difference: 3.21, 95%CI: 0.78-5.63, p=0.009]. There were no significant differences between two groups regarding to semen parameters

Conclusion: the present study has demonstrated that ginger in a controlled study of efficacy was effective in decreasing SDF in infertile men

Improving continuing medical education by enhancing interactivity: lessons from Iran

Introduction: Continuing Medical Education [CME] has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners

Methods: Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general

Results: The participants' experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers' use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME

Conclusion: Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME

Predictive factors of successful microdissection testicular sperm extraction in patients with presumed sertoli cell-only syndrome

To evaluate predictive factors of successful microdissection-testicular sperm extraction [MD-TESE] in patients with presumed Sertoli cell-only syndrome [SCOS]. In this retrospective analysis, 874 men with non-obstructive azoospermia [NOA], among whom 148 individuals with diagnosis of SCOS in prior biopsy, underwent MD-TESE at Department of Andrology, Royan Institute, Tehran, Iran. The predictive values of follicle stimulating hormone [FSH], luteinizing hormone [LH], and testosterone [T] levels, testicular volume, as well as male age for retrieving testicular sperm by MD-TESE were analyzed by multiple logistic regression analysis. Testicular sperm were successfully retrieved in 23.6% men with presumed SCOS. Using receiver operating characteristic [ROC] curve analysis, it was shown that sperm retrieval rate in the group of men with FSH values >15.25% was 28.9%. This was higher than the group of men with FSH

Expression of glycogen synthase kinase 3-beta [GSK3-beta] gene in azoospermic men

The Wnt/beta- The Wnt/beta-catenin signaling pathway is involved in many developmental processes in both fetal and adult life; its abnormalities can lead to disorders including several types of cancers and malfunction of specific cells and tissues in both animals and humans. Its role in reproductive processes has been proven. This study was designed to evaluate the expression of the key regulator of this signaling pathway GSK3-beta and its presumed role in azoospermia. WNT3[a] protein concentration and GSK3-beta gene expression levels were measured and compared between two groups of infertile men. The test groups consisted of 10 patients with obstructive and 10 non-obstructive azoospermia. The control group was selected among healthy men after vasectomies that were willing to conceive a child using a testicular biopsy technique. Samples were obtained by testicular biopsy and screened for the most common mutations [84, 86 and 255] in the SRY region before analyzing. GSK3-beta gene expression was assessed quantitatively by real time-PCR. The WNT3[a] protein concentration had no significant difference between the two test groups and controls. Expression of GSK3-beta was down-regulated in non-obstructive azoospermia [3.10 +/- 0.19] compared with normal [7.12 +/- 0.39] and obstructive azoospermia [6.32 +/- 0.42] groups [p=0.001]. Down-regulation of GSK-3beta may cause to non-obstructive azoospermia. Regulation and modification of GSK-3beta gene expression by drugs could be used as a therapeutic solution

[Predictive value of semen parameters and age of the couple in pregnancy outcome after Intrauterine insemination]

Intrauterine insemination [IUI] is one of the most common methods in infertility treatment, but its efficiency in infertile couples with male factor is controversial. This study is a retrospective study about correlation between semen parameters and male and female age with successful rate of IUI in patients attending to Royan Institute. A total of 998 consecutive couples in a period of 6 months undergoing IUI were included. They were classified into two groups: couples with successful and unsuccessful pregnancy. Main outcome was clinical pregnancy. Data about male and female ages and semen analysis including concentration, total sperm motility, class A motility, class B motility, class A+B motility and normal morphology was extracted from patients' records. Semen samples were collected by masturbation or coitus after 2 to 7 days of abstinence. Their female partners were reported to have no chronic medical conditions and have normal menstrual cycles. One hundred and fifty seven of total 998 cycles [15.7%] achieved pregnancy. The average of female age in successful and unsuccessful group was 28.95 +/- 4.19 and 30.00 +/- 4.56 years, respectively. Mean of male age was 33.97 +/- 4.85 years in successful group and 34.44 +/- 4.62 years in unsuccessful group. In successful and unsuccessful groups, average of sperm concentration was 53.62 +/- 38.45 and 46.26 +/- 26.59 [million sperm/ml], normal morphology of sperm was 8.98 +/- 4.31 [%] and 8.68 +/- 4.81 [%], sperm total motility was 47.24 +/- 18.92 [%] and 43.70 +/- 20.22 [%] and total motile sperm count was 80.10 +/- 63.61 million and 78.57 +/- 68.22 million, respectively. There was no significant difference in mean of females' age and males' age between successful and unsuccessful groups [P<0.05]. In addition, there was no significant difference in semen parameters including concentration, total sperm motility, class A motility, class B motility, class A+B motility and normal morphology between two groups. It was shown that common semen analysis and male and female ages cannot predict IUI outcome.

Urethroscopic holmium: YAG laser ablation of large urethral stone after two-stage urethroplasty

Hairball in a urethral diverticulum has rarely been reported. These hairballs are usually formed in the diverticulum coated with a hair bearing epithelium and can lead to urinary obstruction or infection. Using laser is a safe way to ablate such stones

Fistula repair after hypospadias surgery using buccal mucosal graft

The aim of this study was to evaluate the success rate of urethrocutaneous fistula repair using buccal mucosal graft in patients with a previous hyposadias repair. We reviewed records of our patients with urethrocutaneous fistula developed after hypspadias repair in whom buccal mucosal graft fistula repair had been performed. All of the patients had been followed up for 24 postoperative months. A successful surgical operation was defined as no fistula recurrence or urethral stricture. Retrograde urethrography and urethrocystoscopy would be performed in patients who had any history of decreased force and caliber of urine or any difficulty in urination. Fistula repair using buccal mucosa patch graft had been done in 14 children with urethrocutaneous fistula developing after hypospadias reconstruction. The mean age of the children was 8.70 +/- 1.00 years old [range, 4 to 11 years]. Seven fistulas were in the midshaft, 4 were in the penoscortal region, and 3 were in the coronal region. Repair of the fistulas was successful in 11 of 14 patients [78.6%]. In the remaining children, the diameter of the fistula was smaller than that before the operation, offering a good opportunity for subsequent closure. Our findings showed that fistula repair using buccal mucosal graft can be on the acceptable techniques for repairing fistulas developed after hypopadias repair

Value of prostate-specific antigen and prostate-specific antigen density in detection of prostate cancer in an Iranian population of men

The objective of this study was to evaluate the value of serum prostate-specific antigen [PSA] and prostate-specific antigen density [PSAD] in the diagnosis of prostate cancer. A total of 330 consecutive patients suspected of having prostate cancer due to either abnormal digital rectal examination or elevated serum PSA levels underwent transrectal ultrasonography-guided sextant biopsy of the prostate. The PSA and PSAD values were assessed based on the biopsy results. One hundred and twenty-one patients [36.7%] had prostate cancer. In this group, the mean PSA was 31.60 +/- 30.85 ng/mL [range, 1.9 ng/mL to 166.0 ng/mL] and the mean PSAD was 0.83 +/- 1.01 [range, 0.04 ng/mL/ cm[3] to 6.38 ng/mL/cm[3]]. In those without prostate cancer the mean PSA and PSAD levels were 13.80 +/- 18.72 ng/mL [range, 0.4 ng/mL to 130.0 ng/mL; P < .001] and 0.24 +/- 0.32 [range of 0.01 ng/mL/cm[3] to 2.29 ng/mL/ cm[3] P < .001]. The receiver operating characteristic curve analysis revealed that the discriminating power of serum PSA for detecting prostate cancer, as estimated by the area under the curve, was 0.74 while that for PSAD was 0.81 [P < .001]. For the PSA range of 3.5 ng/mL to 41 ng/mL [gray zone] the areas under the curve was 0.68 for PSA, while it was 0.78 for PSAD [P < .001]. The use of PSAD instead of PSA in the diagnosis of prostatic cancer improves the diagnostic accuracy

Supracrural rerouting as a technique urology for resolution of posterior urethral disruption defects

Selection of an acceptable method for the treatment of posterior urethral disruption defects would be highly desirable. We determined the efficacy and success rate of some techniques including supracrural rerouting for removing of these defects among our patients. Records of 200 consecutive men treated with anastomotic urethroplasty for traumatic posterior urethral strictures were reviewed at our teaching hospital. Prior treatment, surgical approach, and ancillary techniques required during reconstruction were evaluated. Success rate due to posterior urethral reconstruction was achieved in 78.0% of cases. Supracrural urethral rerouting was performed in 11 patients [5.5%], of whom 7 sustained recurrent stricture requiring intervention. The highest success rate of defect resolving was reported by urethral mobilization [92.4%]. Supracrural rerouting is not an acceptable technique and can result in postoperative complications such as recurrent stricture in most of the patients with posterior urethral disruption defects

Surgical repair of posterior urethral defects. Review of literature and presentation of experiences

The main objective of the present review article was to study the different aspects of reconstructive surgery for posterior urethral defects by reviewing the published articles and presentation of our experiences in the reconstructive urology division at Shohada-e-Tajrish hospital. The Medline was searched with the keywords of posterior urethroplasty, end-to-end anastomosis, excisional urethroplasty, anastomotic urethroplasty, pelvic fracture, bulboprostatic anastomosis, and urethral repair. The search was limited to papers published from 1980 to September 2008. We selected the relevant published articles in this database and also presented our experience at our reconstructive urology division. Of over 5000 search results, we selected 38 relevant articles with substantial contribution to the subject. Pelvic fracture due to accidents was the most common etiology of pelvic fracture urethral distraction defect that usually involved the membranous urethra. Surgical treatment of this disorder with perineal anastomotic urethroplasty was accompanied by a success rate of 82% to 95% in different studies. The most important complications of this surgery include urinary incontinence and impotence; however, the incidence of these complications has been reduced by using new surgical techniques. Complete preoperative assessment, the use of suitable reconstructive techniques, and in particular, the use of flexible cystoscopy can lead to acceptable outcomes of the surgical repair of pelvic fracture urethral distraction defects

Clean intermittent catheterization with triamcinolone ointment following internal urethrotomy

Our aim was to evaluate clean intermittent catheterization [CIC] results in combination with triamcinolone ointment for lubrication of the catheter after internal urethrotomy. Seventy patients who underwent internal urethrotomy were assigned into 2 groups and performed CIC with either triamcinolone 1% ointment or a water-based gel [control] for lubrication of the catheter. They continued CIC regimen up to 6 month and were followed up for 12 months. Retrograde urethrography and urethrocystoscopy were done 6 and 12 months postoperatively. In case of obstructive symptoms or any difficulty in passing the urethral catheter, internal urethrotomy would be performed, if needed, and the same follow-up protocol would be started again. The recurrence rates after the first and second urethrotomy attempts were compared between the two groups. Thirty patients in the triamcinolone group and 34 in the control group completed the study. There were no significant differences in the baseline characteristics of the patients or the etiology of the stricture between the two groups. There was a 30.0% recurrence rate in the patients of the triamcinolone group versus 44.1% in those of the control group after the first internal urethrotomy [P = .24]. Following the second internal urethrotomy, the urethra was stabilized in 88.9% of the patients in the triamcinolone group and 60.0% those in the control group [P = .15]. Administration of triamcinolone ointment in patients on CIC regimen after internal urethrotomy only slightly decreased the stricture recurrence rate, and its possible effects should be more investigated

Fournier Gangrene: a series of 12 patients

Fournier gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia, the perineum, or the abdominal wall that is associated with high morbidity and mortality. In this series, we describe 12 patients with Fournier gangrene who had presented to our medical center. Twelve men had been diagnosed with Fournier gangrene in Shohada-e- Tajrish hospital between March 2002 and September 2005. Their medical records were reviewed and the Fournier Gangrene Severity Index scores before and after the treatment were determined. Fifty percent of the patients were diabetic and their mean age was 58.2 ' 17.8 years. The mean delay between the onset of the disease and the admission was 4.9 days and the mortality rate was 16.6%. The median Fournier Gangrene Severity Index scores before the admission and at the time of discharge were 4.5 [range, 0 to 11] and 0 [range, 0 to 9], respectively [P = .005]. One of the patients who died had the scores of 11 and 9, respectively. Split-thickness skin graft was performed for 5 patients [41.7%]. In Fournier gangrene, a rapid diagnosis and emergent surgical intervention is crucial. The Fournier Gangrene Severity Index seems to be an excellent tool for outcome prediction

Diagnostic application of flexible cystoscope in pelvic fracture urethral distraction defects

The aim of this study was to evaluate the diagnostic value of antegrade flexible cystoscopy in pelvic fracture urethral distraction defects [PFUDD]. Between 1999 and 2004, a total of 111 patients with PFUDD were evaluated by antegrade flexible cystoscopy. The flexible cystoscope was introduced into the posterior urethra and the area was evaluated for any probable fistula, false passages, or displacement of the posterior urethra. For preventing misalignment, flexible cystoscope was also used during the urethroplasty to open the posterior urethra at its exact distal point. Posterior urethra ended distal to the external sphincter in 16 patients [14.4%]. Five [4.5%] and 9 [8.1%] patients had severe displacement of the posterior end of the urethra and bladder neck false passage, respectively. Prostatic urethrorectal fistula was detected in 1 patient. Another 1 patient had bladder rhabdomyoma. Flexible cystoscopy is a valuable procedure in the evaluation of the bladder, the bladder neck, and the posterior urethra in patients with urethral distraction defects and complements voiding cystography before the surgery. It is also helpful for showing the exact distal point of the proximal urethra during urethroplasty in cases with displaced posterior urethra