ABSTRACT
OBJECTIVE: The goal of this study was to compare the semen parameters of two successive samples obtained within an interval of less than 60 minutes from patients planning to undergo intrauterine insemination (IUI) whose first samples exhibited low semen quality. METHODS: Thirty-two consecutive patients were enrolled in the study. On the day of IUI, the semen analysis of the samples initially presented by all patients met at least two of the following criteria: sperm concentration <5×10(6)/mL, total sperm count <10×10(6), progressive sperm motility (a+b) in the native sample <30%, and total motile sperm count (TMSC) <4×10(6). A successive semen sample was obtained no more than 60 minutes after the first sample. RESULTS: Compared to the first sample, the second exhibited significantly (p<0.05) improved sperm concentration, TMSC, progressive motility, and vitality. Regarding TMSC, the most critical parameter on the day of IUI, 23 patients (71.8%) improved it, while nine (28.2%) displayed poorer outcomes. CONCLUSION: In defined cases, requesting a second successive ejaculate on the day of insemination may result in a high percentage of cases in an improvement of the quality of the sample.
Subject(s)
Humans , Insemination , Semen Analysis , Semen , Sperm Count , Sperm Motility , SpermatozoaABSTRACT
Presentar una serie clínica de doce pacientes sometidos a denervación de cordón espermático asistida con lupas como tratamiento del Dolor Testicular Crónico ldiopático (DTCI). Pacientes y métodos: Diecisiete pacientes (rango de edad 18 a 70 años) con DTCI no respondedores a analgésicos orales fueron enrolados prospectivamente en la primera etapa del estudio. Se realizó un bloqueo del cordón espermático con Bupivacaína a todos los pacientes. Aquellos pacientes que respondieron al bloqueo (n= 12) fueron sometidos a denervación del cordón espermático asistida con lupas (magnificación 3. 5x) por via subinguinal. El seguimiento incluyó un ecodoppler testicular a los siete días post cirugía y Escala Visual Análoga (EVA) del dolor a los 3 y 6 meses. Resultados: La duración promedio de la cirugía fue de 70 minutos (rango: 50 a 90 minutos). En el control de los siete días los doce pacientes presentaron un ecodoppler normal sin evidencias de isquemia en ninguna de las unidades testiculares sometidas a cirugía (n= 13). Respecto de la EVA a los tres y seis meses, nueve pacientes (75 por ciento) estaban completamente libres de dolor con un EVA igual a O. Tres pacientes persistían con molestias, dos con un EVA de 1 que no requerían analgésicos, y uno con EVA de 2 que requería analgésicos de manera intermitente. Dos pacientes fueron reoperados 6 y 8 semanas después de la cirugía primaria, uno por un hematocele y el segundo por un linfocele, ambos evolucionaron de manera favorable con ecodoppler normal después de la segunda cirugía. Conclusión: La denervación de cordón espermático asistida con lupas es una alternativa eficaz para el tratamiento del DTCI y puede constituirse en una buena alternativa terapéutica para el manejo de estos pacientes...
To present a clinical series of twelve patients that underwent loupe assisted spermatic cord denervation as a treatment for idiopathic Chronic Testicular Pain (ICTP). Patients and methods: Seventeen non responders to oral analgesics patients (age range 18 - 70 years) with ICTP were prospective/y enrolled in the first stage of the study. A spermatic cord block with bupivacaine was performed in all patients. Twelve patients who responded to the bupivacaine cord block underwentloupe assisted (3. 5x magnification) spermatic cord denervation through a subinguinal/ approach. Postoperative follow-up included color doppler ultrasound of the testes seven days after surgery and Visual Analog Scale (VAS) pain questionnaire at 3 and 6 months. Results: The median operation time was 70 minutes (range 50 - 90 min). Seven days after surgery all patients had a normal color Doppler ultrasound without evidence of ischemia in any of the operated testes (n=13). At three and six months after surgery nine patients (75 percent) were absolutely pain free (VAS=O). Three patients remained with pain; two had a VAS 1 that did not interfere with daily activities and required no analgesics, the third patient had a VAS 2 and occasionally required analgesics to manage pain. Two patients needed reoperations, 6 and 8 weeks after primary surgery, one for hematocele and another for lymphocele, both had a favorable outcome and normal color doppler ultrasounds after the second surgery. Conclusion: Loupe assisted spermatic cord denervation is an efficient alternative for the management of ICTP and may become a good therapeutic option for these patients...