AZFb deletions predict the absence of spermatozoa with testicular sperm extraction: preliminary report of a prognostic genetic test.

Genetic abnormalities, including partial deletions of the Y-chromosome, are commonly detectable in men with non-obstructive azoospermia (NOA). NOA can be treated using testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI). Recent studies have shown that the presence of deletions involving the AZFc region do not appear to affect the chance of retrieving spermatozoa or have a significant impact on fertilization or pregnancy rates with ICSI. We investigated the effect of Y-chromosome partial deletions on the chance of sperm retrieval with TESE. Eighty attempts at sperm retrieval were performed using TESE on men who were previously evaluated for Y-chromosome partial deletions. Y-chromosome analysis was performed using a polymerase chain reaction (PCR)-based technique with 35 sequence-tagged-sites. Of the 80 men, nine (11%) had partial Y-chromosome deletions detected. Two azoospermic men with AZFc deletions had successful sperm retrieval, ICSI and a subsequent clinical pregnancy. Seven men had deletions involving the AZFb region (three men had isolated AZFb deletions, one had AZFa, AZFb and AZFc deleted, and three had AZFb and AZFc deleted). None of the seven men had spermatozoa extracted by TESE, a result that is significantly different from the overall 64% (47/73) sperm retrieval rate achieved at our centre (P = 0.001). Two men with AZFb deletions had cells consistent with round spermatids identified and injected into oocytes without effecting any normal fertilizations. Although preliminary, these results suggest that the presence of an AZFb deletion is a significantly adverse prognostic finding for TESE. Men with AZFb deletions should be apprised of these results before attempting TESE-ICSI. Alternatives such as donor insemination or adoption should be considered or therapy delayed until improved results with round spermatid injections are likely.

Unilateral hydronephrosis in infants: are measurements of contralateral renal length useful?

PURPOSE: We investigated whether measurement of contralateral renal length in newborns with unilateral hydronephrosis may help to assess clinically significant hydronephrosis in the affected kidney. MATERIALS AND METHODS: We reviewed our experience with 53 newborns who had unilateral hydronephrosis presumed secondary to ureteropelvic junction obstruction. We divided the patients according to the presence of mild hydronephrosis and no obstruction on a furosemide renogram, severe hydronephrosis and obstruction on a furosemide renogram or a unilateral multicystic kidney. RESULTS: We found no significant correlation between findings on the affected and opposite normal sides. Contralateral hypertrophy, hypotrophy and normal sized kidneys were frequent findings. CONCLUSIONS: We conclude that measurement of contralateral renal length is not helpful in the evaluation of newborns with unilateral hydronephrosis.

The effect of sequential compression devices on intraoperative blood loss during radical prostatectomy.

We reviewed 109 consecutive patients undergoing radical retropubic prostatectomy to determine the effect of intermittent pneumatic compression devices on intraoperative blood loss. Sequential compression devices were used intraoperatively and perioperatively in 86 patients, while 23 underwent surgery without these devices. There were no identifiable selection factors between the 2 groups. Median intraoperative blood loss was 885 cc without sequential compression devices and 800 cc when they were used. These results are at odds with previous reports in the urological literature and suggest that anatomical control of the dorsal vein complex negates any potential influence of sequential compression devices on blood loss during radical prostatectomy.

Prospective development of a cost-efficient program for radical retropubic prostatectomy.

OBJECTIVES: We designed and implemented a broad-based program to decrease costs while maintaining quality of care in patients undergoing radical retropubic prostatectomy. METHODS: This program initially involved identification of factors that contribute to patient costs after radical prostatectomy and elimination or control of items that were deemed unnecessary. Patient care was standardized with a collaborative care pathway coordinated by a clinical nurse specialist and that served as a goal for each case. RESULTS: Length of total hospital stay was reduced from a mean of 5.7 days to 3.6 days after full implementation of the program (p < 0.0001). A reduction in operating room time, material utilization, antibiotic use, routine laboratory studies, and refinements in postoperative pain management contributed significantly to cost savings. Overall, the average adjusted total hospital charges were reduced from $13,783 to $7741 (p < 0.0001) by the implementation of this program, with no discernible adverse effect on morbidity rates. CONCLUSIONS: Careful analysis of the critical components of medical care and implementation of a standardized pathway with emphasis on a collaborative approach can substantially increase the cost efficiency of medical care.

Urinary solute transport by gastric mucosa: a comparison with ileum using a rat model.

OBJECTIVES: This study was conducted to quantitate and compare urinary solute transport by stomach and ileum using an in vivo rat model. METHODS: An artificial urine solution was perfused through isolated gastric and ileal segments in the anesthetized rat. Concentrations of solutes and a volume marker were periodically determined in the perfusate and net solute flux was calculated. RESULTS: The stomach secretes less sodium and very little bicarbonate in comparison with ileum. Hydrogen ion and chloride are absorbed by ileum but secreted in large quantities by the stomach. Ammonium, potassium, and urea are absorbed by both segments but to a much lesser degree in the stomach. Overall, there was a net osmolar absorption by ileum, and a net secretion by the stomach. Both segments secrete water to a similar degree. CONCLUSIONS: These findings both suggest the mechanism of the hypochloremic metabolic alkalosis seen after urinary reconstruction with the stomach and provide insight into potential therapeutic approaches. Solute fluxes in both the stomach and the ileum are consistent with the known physiology of these segments.

Exposure of intestinal segments to hemiacidrin: analysis of metabolic and histological effects using a rat model.

Using a previously reported rat model, we examined the effects of intestinal perfusion with hemiacidrin on calcium and magnesium homeostasis, and inspected the intestinal segments for histological alterations following exposure to the solution. Intestinal irrigation with hemiacidrin resulted in a significant increase in serum magnesium. Urinary excretion rates of calcium increased 8-fold and magnesium excretion rates increased 5-fold over control values. Hemiacidrin appeared to have detrimental effects on the integrity of the intestinal mucosa, and irrigation should be done with caution in patients whose urinary tract has been reconstructed with intestinal segments.

Ureteral reimplantation: postoperative management without catheters.

We reviewed the medical records of 34 consecutive children with reflux who underwent simple ureteroneocystostomy at our institution and an affiliated hospital between 1991 and 1992. Fourteen patients were managed with ureteral and urethral catheters during the initial postoperative period, and 20 patients were managed with a "catheterless" technique employing neither of these devices. The latter group had a 50 percent decrease in length of hospital stay with 20 percent decrease in hospital costs when compared with the former. They also seemed to have less postoperative discomfort as evidenced by a 50 percent decrease in administered pain medicine. Complete follow-up was obtained in all cases, and there were no complications or failures.