Separate submission of standard lymphadenectomy in 6 packets versus en bloc lymphadenectomy in bladder cancer

Our aim was to evaluate detection of nodal metastasis during radical cystectomy with standard pelvic lymph node dissection versus en bloc lymphadenectomy for the treatment of bladder cancer. Hospital records of a total of 77 patients with radical cystectomy and either standard pelvic lymph node dissection or en bloc lymphadenectomy were reviewed. Nodal dissection specimens during standard lymphadenectomy were sent for pathology examination in 6 separate containers marked as external iliac, internal iliac, and obturator groups from both sides. En bloc dissection specimens were sent in 2 containers marked as the right and the left pelvic nodes. Clinical and pathological findings of these two groups were compared in terms of the number of dissected lymph nodes, number of nodes with metastasis, lymph node density, and clinical outcomes. There were 34 patients with standard lymph node dissection and 43 with en bloc lymphadenectomy [anterior pelvic exenteration]. Age, sex, duration of the disease, number of transurethral resections prior to cystectomy, pathological grade at cystectomy, and stage of the primary tumor were comparable in the two groups of patients. The median numbers of nodes removed per patient were 15.5 [range, 4 to 48] and 7.0 [range, 1 to 24] in those with standard and en bloc lymphadenectomy, respectively [P<.001]. Nodal involvement was detected in 10 [29.4%] and 9 [20.9%] patients, respectively [P=.43]. Although nodal involvement was not significantly different between the two groups, standard lymphadenectomy submitted in 6 different containers significantly improved the nodal yield over en bloc resection. Obturator nodes were the most commonly involved nodes in our study

Surgical ligation of scrotal varicocele for male factor infertility is a valid option of treatment

To evaluate the role of surgical ligation of scrotal varicocele for treatment of male factor infertility. We studied 60 patients who presented with infertility and were also found to have scrotal varicocele. Patients with other probable causes contributing to infertility were excluded. Diagnosis was made by clinical examination and scrotal ultrasonography. All the patients underwent either laparoscopic varicocelectomy or open retroperitoneal high ligation of the testicular veins. Operative time and hospital stay was recorded. All patients were evaluated for postoperative improvement of semen parameters and development of any postoperative complication. The results were analyzed by commercially available software. During the study period 5 patients were lost to follow up and were excluded. The rest of patients [n=55] were young, with age ranging from 20 - 35 years [Mean age 27.8 years, SD + 4.38]. All patients had unilateral left sided varicocele; two patients [3.6%] had grade I varicocele, 21 patients [38.2%] had grade II varicocele and 32 patients [58.2%] had grade III varicocele. Statistically significant improvement in sperm density [p value < 0.05], sperm activity [p value < 0.05] and sperm morphology [p value < 0.05] was observed after the surgical ligation. The mean operative time was 54.88 minutes [SD + 13]. The mean hospital stay in laparoscopic procedure was 33.4 [SD + 15.3]. Minor complications were noted in 13 patients and included superficial wound infection in 3 patients, 6 patients exhibited testicular pain and persistence of varicocele in 4 patients. Surgical ligation of scrotal varicocele is a safe and effective mode of treatment of male factor infertility in selected population