Is varicocelectomy in non-obstructive azoospermic patients has an effective role?

Objective: Evaluation of the role of varicocelectomy in azoospermic patients

Patients and Methods: From Oct. 1998 to April 2007 188 nonobstructive azoospermic patients have undergone varicocelectomy; all patients were examined clinically and generally especially for the presence of varicocele, clinical or subclinical and classified in grades, testicular volume was estimated and routine investigations, including complete hormonal assay were done semen analysis for at least 3 times and U/S scrotum with Doppler for all cases. All patients were with history of primary infertility except 6 cases of secondary infertility, prevaricocelectomy and 3 to 6ms post-varicocelectomy semen parameters were compared and analyzed

Results: Postoperative semen analysis revealed overall sperm detection in 36 patients 18.8% of cases and 19 patients 10.6% of cases have shown spermatid and many spermatogenic cells in subsequent semen analysis. It was shown that 14, 8 patients [40%, 31%] respectively of huge or large preoperative varicocele were improved in detection of sperms in the ejaculate,9 patients 13% of grade II or moderate varicocele have been improved but grade I and subclinical varicocele showed little improvement. Regarding the relation with testicular volume there was significant improvement in 8,10 patients [49%, 45.6%], in cases presented with accepted or within normal testicular volume

Conclusions: Our study revealed that varicocelectomy in azoospermic patient can play an effective role in the management of male infertility and can result in pregnancy in some patients with accepted testicular volume or in the presence of preoperative large or evident varicocele, also there was considerable improvements in spermatogenesis in the other patients which could improve the assisted reproductive techniques results

Modified magpi for repair of distal hypospadias

To evaluate a modified technique, of MAGPI for primary repair of distal hypospadias. 32 patients with distal hypospadias meatal position was glanular in 15 cases, coronal in 13 cases and subcoronal position in 4 cases underwent primary hypospadias repair by modified MAGPI technique. The follow up period was ranged from 3 to 20 months mean [12 months]. The mean age was 6.8 years ranged from 2 to 11 years. Modified MAGPI technique was successful in 29 boys [90.5%] with good cosmetic, functional results and vertical slit meatus. The complication rate was 9, 4% [3/32], retraction of meatus in two cases and dehiscence of glanular flap in one case. The modified MAGPI technique is applicable for repair of distal hypospadias, create a vertically oriented, and slit like meatus resulting in ideal cosmoses in the majority of selected cases and low rate of complications. it is suitable for art outpatient surgical setting

Role of urodynamic findings in revision of many concepts about chronic prostatitis syndrome

Objective: to evaluate urodynamic ally, patients with chronic prostatitis syndrome to define a specific urodynamic pattern in each prostatitis group that might add information about the pathogenesis of the syndrome and treating such patients more efficiently

Patients and Methods: fifty patients aged from 24-50 years with symptoms suggestive of chronic prostatitis, were evaluated by standard four-glass test using direct microscopy and culture for all specimens. Patients were classified according to National Institutes of Health Classifications System into non-inflammatory chronic pelvic pain syndrome [NiCPPS [Group1]], chronic bacterial prostatitis [CBP [Group 2]], and inflammatory chronic pelvic pain syndrome [ICPPS [Group 3]. Patients with documented urethritis urinary tract infection, lower urinary tract neuropathy or history of lower urinary tract surgery are excluded from the study. Furthermore all patients were evaluated by transrectal ultrasound and through urodynamic study including flowmetry, filling cystometry, pressure flow study [PFS] and electromyography of distal urethral sphincter [EMG]. Out of 50 patients pressure flow study [PFS] and EMG are conducted in only 27 patients, while the remainder cannot complete these urodynamic sturdies. Results were statistically analyzed rising F tests where P>0.05 was significant

Results: the common urodynamic finding represent decreased mean Q max the three groups of chronic prostatitis syndrome [l6 +/- 3 ml/sec]. However no significant difference between groups regarding the Q max [P value ~0.05] Out of the 50 who underwent filing cystometry, 30 patients [60%] had a first sensation of filling and 33 patients [66%] had a desire to void at low volumes [0.05]. Of 27 patients who underwent IPFS] and EMG, 16 patients had an obstructed pattern of micturition. However there was no significant difference between NICPPS and CBP group regarding [PFS] [P>0.05]. EMG study of distal urethral sphincter [27 patients] reveal that 9 patients from 16 patients with NICPPS and 2 patients from 11 with CBP show EMG activity during voiding, and there was a statistically significant difference between both groups [P <0.05, Chi square 3.9]

Conclusion: complaints, transrectal ultrasound and urodynamic findings were generally similar in the 3 groups of prostatitis syndrome. Therefore, the differentiation of the syndrome into 3 groups based on results of direct microscopic examination and cultures of the 4-glass test seem to be not logical. In addition, urodynamic evaluation explores sensory and motor dysfunctions, which may not only help in pathophysiological explanation of this syndrome but also in planning treatment