Predicting the Fragility of Renal Calculi in Response to Shock Wave Lithotripsy through their Radiographic Appearance

Objectives To evaluate the radiological characteristics of renal stones on plain X-ray film of the kidneys; ureters and bladder (KUB) area as predictors of stone fragility during shock wave lithotripsy (SWL). Patients and Methods This prospective study included 336 patients who had a single renal pelvic stone =20 mm and were managed by SWL at 3 different centers. The patients were classified according to the radiological appearance of the stone on KUB film in terms of homogeneity; smoothness of the outline; and radiodensity in comparison to the last rib. The primary endpoint was the stone-free rate (SFR) within 3 months post-SWL. Multivariate regression analysis was used to compare the results. Results The overall SFR was 71.43. SFR was significantly higher in heterogeneous compared with homogenous stones (86vs. 53; p0.01) and in rough compared with smooth surface calculi (77vs. 61; p0.01). SFRs for stones with density less than; similar to or higher than that of the last rib were 82; 69and 56; respectively (p0.01). Multivariate analysis showed a positive proportional relationship between stone fragility (SWL outcome) and one or more favorable radiological criteria. Conclusion The radiological characteristics of renal calculi could predict their fragility after SWL. Stones which were heterogeneous; rough; or less dense than the last rib on KUB film were more likely to disintegrate during SWL

Spontaneous pregnancy outcome after surgical repair of clinically palpable varicocele in young men with abnormal semen analysis

Objective: The beneficial effect of varicocele repair in male infertility remains unresolved. The aim of this study was to identify the benefit from varicocele treatment based on pregnancy rate rather than improvement of semen quality.Subjects and Methods: This study included 141 infertile men with varicocele detected by clinical examination and confirmed by venous reflux on continuous wave Doppler ultrasonography (US). Measurement of Body Mass Index (BMI) and hormonal assays were performed in all patients. A total of 233 sub-inguinal varicocele repairs were done. Couples were followed up with semen analysis and pregnancy detection for 6, 12 and 18 months. Statistical analysis was performed using the chi-square, t-test and Mann-Whitney test where appropriate (p <0.05 accepted as statistically significant).Results: The spontaneous pregnancy rate was significantly greater in men with low or normal BMI. There were statistically significant differences between postoperative mean sperm count (64.7±6.8 and 10.5±1.8 million/ml) and progressive motility (38.3±2.4 and 17.7±1.8%) for spontaneous pregnancy and non-pregnancy, respectively. There were also significant changes from pre- to postoperative mean sperm concentration (21.5±2.1 and 64.7±3.8 million/ml), progressive motility (12.9±1.8 and 31.7±1.4%) and normal morphology (54±1.3 and 81.3±4.6%) in the spontaneous pregnancy cohort. Comparing pre- and postoperative serum hormone levels, FSH and prolactin decreased significantly in spontaneous pregnancy (6.57±0.65 to 4.6±0.53 IU/L and 166.2±11.8 to 149.3±10.4 pmol/L, respectively) and increased in non-pregnancy (9.05±0.71 IU/L and 187.8±13.3 pmol/L, respectively).Conclusion: Spontaneous pregnancy after sub-inguinal varicocelectomy is significantly affected by BMI, sperm concentration, progressive motility and morphology. The decrease of FSH may predict the spontaneous pregnancy outcome