Microdissection TESE (mTESE) following adult orchidopexy for undescended intra-abdominal and inguinal testicles - surgical techniques and outcomes from a single-centre cohort.

INTRODUCTION AND OBJECTIVES: Adult undescended testicles (UDTs) often present to fertility specialists with subfertility or azoospermia and with either an intra-abdominal or inguinal testicle(s). Performing an orchidopexy followed by a surgical sperm retrieval (SSR) is a potential option to retrieve spermatozoa. A microdissection TESE (mTESE) procedure is performed to retrieve mature spermatozoa for use in ICSI. This paper reviews the outcomes of mTESE in adults following an orchidopexy. MATERIAL AND METHODS: A cohort of azoospermic patients underwent adult orchidopexy over a 10-year period at a single specialist centre. Data were collected retrospectively from the patient records retrieved from an institutional database. All patients underwent pre-operative imaging to localize the testicles, serum testosterone levels and a semen analysis. Separate intraoperative testicular biopsies were performed to exclude intratubular germ cell neoplasia (ITGCN) and to analyse the Johnsen score. RESULTS: Twelve patients (age range 18-36 years) underwent orchidopexy procedures for either intra-abdominal or inguinal testicles. Mean follow-up was 34 months (range 13-58). Ninety per cent of patients had bilateral UDT with azoospermia. Pre-operative testosterone levels were within the normal range (mean 13.9 nmol/L; range 9.1-24.2). Five pelvic testicles (from four patients) were brought down and underwent a delayed mTESE. A total of nine inguinal orchidopexy procedures were carried out in eight men, and spermatozoa were found and preserved in three patients. None of the men with intra-abdominal testicles had mature spermatozoa present following a delayed mTESE. Overall, SSR was successful in 37.5% of the patients. Histological analysis showed no cases of ITGCN and the Johnsen scores ranged from 1 to 3.3. CONCLUSIONS: Microdissection TESE following orchidopexy for inguinal testicles can result in a successful SSR in over 1/3rd of patients. Intra-abdominal testicles appear to lack spermatogonia although the testicles can still be preserved for endogenous hormone production. Adult orchidopexy allows preservation of endogenous testosterone, easier self-examination and an immediate or delayed mTESE in azoospermic patients.

The association of abdominal muscle with outcomes after scheduled abdominal aortic aneurysm repair.

Sarcopenia is the degenerative loss of core muscle mass. It is an aspect of frailty, which is associated with increased rates of peri-operative harm. We assessed the association of the cross-sectional areas of abdominal muscles, including psoas, with survival during a median (IQR [range]) follow-up of 3.8 (3.2-4.4 [0.0-5.1]) years after scheduled endovascular (132) or open (5) abdominal aortic aneurysm repair in 137 patients. In multivariate analysis, mortality hazard (95%CI) was independently associated with: age, 1.06 (1.01-1.13) per year, p = 0.03; and the adjusted area of the left psoas muscle, 0.94 (0.81-1.01) per mm2 .kg-0.83 , p = 0.08. Shortened hospital stay was independently associated with haemoglobin concentration and adjusted left psoas muscle area, hazard ratio (95%) 1.01 (1.00-1.02) per g.l-1 and 1.05 (1.02-1.07) per mm2 .kg-0.83 , p = 0.04 and 0.001, respectively.

Organochlorine and organophosphoric insecticides, herbicides and heavy metals residue in industrial wastewaters in Cyprus.

Most industries in Cyprus possess permits either for disposal at central wastewater treatment plants (the treated effluent of which is reused or disposed into the sea), or discharge on soil, or reuse either for irrigation or groundwater recharge or discharge into the sea. A preliminary investigation undertaken by the University of Cyprus in regards to dangerous substances was the first step towards establishing a new licensing and monitoring system. Liquid-liquid extraction was used for the extraction of the selected pesticides from wastewaters. Gas chromatography with two different detection methods (ECD and FTD) was applied for the determination of 17 pesticides (12 organochlorine insecticides, 3 organophosphoric insecticides and 2 herbicides). In addition ICP and a mercury evaporation unit were used to determine the concentrations of heavy metals in the samples. The results revealed the presence of several priority substances in wastewaters, in most cases at concentrations well below the regulatory limits. Non-compliance was observed for a limited number of metals. Sixteen out of 17 organic substances that were monitored for 1-year period time were traced in different wastewater streams. What was found out is that there is a need to expand the analytical determinations and the monitoring to more wastewater streams and more priority substances, in order to safeguard the water resources in Cyprus.