Role of varicocele treatment in assisted reproductive technologies.

OBJECTIVE: In this review, we investigate the advantage of varicocele repair prior to assisted reproductive technologies (ART) for infertile couples and provide cost analysis information. MATERIALS AND METHODS: We searched the following electronic databases: PubMed, Medline, Excerpta Medica Database (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL). The following search strategy was modified for the various databases and search engines: 'varicocele', 'varicocelectomy', 'varicocele repair', 'ART', 'in vitro fertilisation (IVF)', 'intracytoplasmic sperm injection (ICSI)'. RESULTS: A total of 49 articles, including six meta-analyses, 32 systematic reviews, and 11 original articles, were included in the analysis. Bypassing potentially reversible male subfertility factors using ART is currently common practice. However, varicocele may be present in 35% of men with primary infertility and 80% of men with secondary infertility. Varicocele repair has been shown to be an effective treatment for infertile men with clinical varicocele, thus should play an important role in the treatment of such patients due to the foetal/genetic risks and high costs that are associated with increased ART use. CONCLUSION: Varicocele repair is a cost-effective treatment method that can improve semen parameters, pregnancy rates, and live-birth rates in most infertile men with clinical varicocele. By improving semen parameters and sperm structure, varicocele repair can decrease or even eliminate ART requirement.

Intravenous paracetamol for relief of pain during transrectal-ultrasound-guided biopsy of the prostate: A prospective, randomized, double-blind, placebo-controlled study.

Transrectal-ultrasound-guided prostate biopsy (TRUS-PBx) is the standard procedure for diagnosing prostate cancer. The procedure does cause some pain and discomfort; therefore, an adequate analgesia is necessary to ensure patient comfort, which can also facilitate good-quality results. This prospective, randomized, double-blinded, placebo-controlled study aimed to determine if intravenous (IV) paracetamol can reduce the severity of pain associated with TRUS-PBx. The study included 104 patients, scheduled to undergo TRUS-PBx with a suspicion of prostate cancer, that were prospectively randomized to receive either IV paracetamol (paracetamol group) or placebo (placebo group) 30 minutes prior to TRUS-PBx. All patients had 12 standardized biopsy samples taken. Pain was measured using a 10-point visual analog pain scale during probe insertion, during the biopsy procedure, and 1 hour postbiopsy. All biopsies were performed by the same urologist, whereas a different urologist administered the visual analog pain scale. There were not any significant differences in age, prostate-specific antigen level, or prostate volume between the two groups. The pain scores were significantly lower during probe insertion, biopsy procedure, and 1 hour postbiopsy in the paracetamol group than in the placebo group. In conclusion, the IV administration of paracetamol significantly reduced the severity of pain associated with TRUS-PBx.

Help-seeking interval in erectile dysfunction: analysis of attitudes, beliefs, and factors affecting treatment-seeking interval in Turkish men with previously untreated erectile dysfunction.

In this study, we report data on attitudes, beliefs, and factors affecting the help-seeking interval among Turkish men with erectile dysfunction to determine whether they are different from those previously published in the literature. Out of 279 Turkish men complaining of erectile dysfunction attending our clinic between December 2006 and March 2008 without the need for referral, 202 were interviewed from a standardized questionnaire covering demographic details, relationships, help-seeking intervals, and attitudes and beliefs. Eleven patients interrupted the questionnaire and only 191 individuals who had never sought medical help for their erectile dysfunction completed the study. The mean age of the study population was 50.1 (20-80) years. Overall, 93.7% of participants had engaged in sexual intercourse during the year preceding the interview. The mean help-seeking interval and the mean estimated time elapsed since last satisfactory sexual intercourse were 24.5 (1-360) and 10.5 (1-180) months, respectively. Patients with low household income and education level had a relatively longer help-seeking interval than the remaining sample. No statistical correlation was seen between treatment-seeking interval and patient age, duration of marriage or continued relationship, and presence of premature ejaculation. Main reasons for delayed consultation included embarrassment (n = 63, 33%) and thinking of erectile dysfunction as a natural process of aging (n = 51, 26.7%). To enable earlier diagnosis and management of erectile dysfunction, emphasis should be put into the provision of affordable health care and wide public education about erectile dysfunction as an entity requiring prompt medical consultation.