[Evaluating Y chromosome microdeletions in infertile men with severe oligozoospermia or azoospermia at Imam Reza Hospital In Meshad]

Male factors account for nearly 50% of infertilities, among which genetic defects constitute some of the major ones. Microdeletion of the long arm of Y chromosome has been seen in about 7% of infertile men. The importance of these microdeletions lies in the possibility of their occurrence in the off-springs in ART and their de novo appearance. This cross-sectional descriptive-analytical study was performed on 47 individuals with azoospermia or severe oligozoospermia. The cases were recruited when they attended Imam Reza Hospital in Mashad during 2006-2008. Hormone profile, including FSH, was measured and karyotyping, testicular biopsy and Y chromosome microdeletion detection, using 11 pairs of sequence-tagged site [STS method] sets which were specific for AZF and SRY loci, were performed. Three out of four patients with azoospermia had Y chromosome microdeletion [8.5%]. Klinefelter's syndrome and deletion of SRY region were each seen in two patients [4.3%]. Multiple AZF region deletions were seen in 75% of Y chromosome microdeletions and deletions in AZFa, AZFb and AZFc regions were seen in 25%, 75% and 100% of the cases, respectively. The prevalence of AZF deletion in patients with and without FSH abnormality were 17.6% and 3.3%, respectively, however, the differences were not statistically significant [p = 0.125]. In patients with azoospermia and severe oligozoospermia, AZF deletion were 11.1% and 5%, respectively [p = 0.628]. In addition, there were no significant differences in AZF deletion between patients suffering from varicocele or other related disease [p = 1.0]. Family history had no significant effect on AZF deletion [p = 0.239]. Testicular biopsy showed Sertoli-cell-only syndrome in three out of four patients with AZF microdeletions. Male factor infertility is associated with a high incidence of Y chromosome microdeletions and transmission of these defects to the off-springs in ART, aside from their de novo occurrence, seems probable. Therefore, it would be wise to look for microdeletions in cases with severe oligozoospermia or cases with non-obstructive azoospermia. There seems to be a correlation between the prevalence of AZF regional deletions and the degree of spermatogenesis disruption but this finding needs further scientific evidence

Bilateral same-session ureteroscopy: Its efficacy and safety for diagnosis and treatment

To report the results of bilateral same-session ureteroscopy in patients with bilateral pathologies in urinary system. From among nearly 3000 patients who had undergone diagnostic or therapeutic ureteroscopy in our center, 23 [13 females and 10 males] were treated with bilateral same-session ureteroscopy. Pathologies included bilateral ureteral stone in 19, hematuria of unknown etiology in 3, and bilateral obstructive uropathy in 1. Hospital and follow-up records of the patients were reviewed in this study. Of 19 patients with bilateral ureteral stone, 11 had anuria and increased serum creatinine. Ureteroscopy was successful in 9, and the stones were fragmented. Ureteroscopy insertion was not successful in 1, and in 1 another, upper ureteral stone was pushed into the Kidney. Six patients had normal urine output and normal serum creatinine. In 5 of them, ureteroscopy was done and the stones were fragmented, but due to ureteral stricture, ureteroscopy was impossible in 1. In 2 patients with oliguria and increased serum creatinine, bilateral ureteral stones were extracted successfully. Of 3 patients with hematuria of unknown origin, 2 had normal ureteroscopy, and 1 had a small non-opaque stone that was extracted successfully. In 1 patient with obstructive uropathy and the diagnosis of obstructive megaureter, bilateral ureteroscopy was done and bilateral ureteral stents were placed. Finally, from 23 patients, 21 had successful bilateral same-session ureteroscopy. Postoperative complications included pyrogenic infection in 2 and gross hematuria in 4, all of which were resolved with medical treatment. Bilateral same-session ureteroscopy is an appropriate therapeutic and diagnostic option, with its own specific indications. It can reduce hospital stay, prevent multiple anesthesias, and alleviate the costs. We recommend this approach in patients with bilateral ureteral pathologies, provided that they are amenable to ureteroscopy