Does Clomiphene citrate administration increase the success rate of microdissection testicular sperm extraction in non-obstructive azoospermic men? A cross-sectional study.

Background: Clomiphene citrate (CC) has been suggested to increase the chance of sperm retrieval withmicrodissection testicular sperm extraction (micro-TESE). Objective: This study aimed to evaluate the effect of CC on micro-TESE results, due to the great controversy in this regard. Materials and Methods: 112 participants were included in this cross-sectional study and were divided into a case (n = 54) and a control group (n = 58) diagnosed with non-abstractive azoospermia. The case group received 25 mg of CC daily for 3 months, while the control group did not receive anything. All participants underwent micro-TESE by an andrologist, and at the end, the results were compared between groups. Hormone tests, including follicle-stimulating hormone, luteinizing hormone, testosterone, and prolactin were analyzed. Results: The mean age of participants was the same in the case and the control groups, and no significant relationship was observed between the 2 groups (p = 0.16). 25.9% of sperm and 31.0% of sperm were observed and extracted in the CC-treated and the control group, respectively. Conclusion: Our findings showed that after receiving CC, the number of sperm extraction did not increase but it rather decreased. However, the initial level of hormones such as testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin, and the men's age, testicle size, smoking, and opium addiction, underlying diseases had no significant relationship in the 2 groups and did not affect the results.

Benign cystic Teratoma and Gonadoblastoma developed in bilateral abdominal undescended testis.

Cryptorchidism is one of the most common congenital malformations in humans and one of its most important consequences is the development of testicular cancer. While germ cell tumors (GCTs) and sex cord-stromal tumors are major testicular tumors. Gonadoblastoma is a rare neoplasm composed of a combination of germ cells and gonadal stromal elements. In this study we present a patient with bilateral abdominal undescended testis with gonadobelastoma in the left and benign cystic teratoma in the right testicle.

Effect of Coronavirus Disease (COVID-19) on Human Semen: No Evidence of Coronavirus in Semen of Patients.

Background: In December 2019, a severe acute respiratory syndrome (SARS-COV-2) was found in China. The coronavirus can impact different organs, as shown by the virus having been detected in urine, blood, oropharyngeal, and feces. This study was done to assess the impact of COVID-19 on semen analysis and to evaluate the existence of the virus in the semen of infected men. Methodology. Forty fertile men with COVID-19 were confirmed by an oropharyngeal sample. The men were divided into two groups. The semen of twenty men in the acute stage of COVID-19 and twenty men in the clinical recovery stage was analyzed, and the parameters of semen were compared between two groups. In addition, a PCR test of patients' semen was done. Result: The analysis showed that all patients' semen specimens tested negative. Semen analysis revealed no significant difference in sperm count, concentration, or motility, and the sperm of both groups was found to be normal. However, viability and morphology parameters were significantly lower in men with the acute disease. Conclusion: Coronavirus (COVID-19) was not secreted in the semen of infected men but had a negative effect on the morphology and viability of the sperm of men in the acute stage.

Impact of COVID-19 Pandemic on Emergency Department Referrals with Urologic Complaints; a Retrospective Cross-Sectional Study.

Introduction: Medical and surgical priorities were dramatically changed during the COVID-19 pandemic. This study aimed to evaluate the impact of this pandemic on presentation to emergency department (ED) with urologic complaint. Method: This cross-sectional study was conducted at a tertiary urology referral center in Tehran, Iran. The data of all ED admissions were collected and the frequency of admissions with urologic complain and their outcomes were compared between two 90-day periods (before and during COVID-19 era). Results: 480 ED admissions were studied. The number of patients visiting the ED with urologic complaint during COVID-19 era was significantly lower than the same period in the pre-COVID-19 period (125 vs. 355 admissions; p = 0.01). The mean hospitalization days for patients in the pre-COVID-19 period were significantly higher (5.6 ± 4.4 vs. 3.2 ± 4.2 days; p <0.001). The most common patient complaints before and during COVID-19 period were flank pain (32.7%) and gross hematuria (32.8%), respectively. The number of patients discharged against medical advice in the COVID-19 period was significantly higher than before (22 (17.6%) vs. 10(2.8%); p < 0.001). The number of patients who developed severe complications was significantly higher in the COVID-19 period than in the pre-COVID-19 period (p = 0.001). Conclusion: During the COVID-19 pandemic we were faced with decreasing frequency of admission with urologic complaint, change in the pattern of referrals, decrease in the duration of hospitalization, increase in the number of patients discharged against medical advice, and increase in the number of cases with irreversible urologic complications or complications requiring surgery due to deferred treatment.

Percutaneous extraction of big kidney stone without fragmentation: The novel technique in percutaneous nephrolithotomy (EN BLOC PCNL).

PCNL is gold standard treatment of pelvis stone more than 2 cm. Since 1970 that PCNL was introduced, multiple methods including mini PCNL, Lap assisted PCNL etc. were used to increase the efficacy and decrease the complications of PCNL in different patients. We describe a new method of PCNL for the first time for extracting 7 cm renal stone without fragmentation, and we called it EN BLOC PCNL. Our technique had no complication and caused lower operative time.

Case report: Removal of a big sewing needle from a boy's urethra from the skin for the first time.

Self-insertion of foreign bodies into the urethra is uncommon urologic emergency which is rarely reported in children. Based on the size and the location of the foreign body, different methods have been introduced for its removal. We removed a big sewing needle from the urethra through the skin without any complication for the first time.

An Overnight Stay Versus three Days Admission after Uncomplicated Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

PURPOSE: To evaluate the safety and efficacy of discharging patients on the first postoperative day after an uncomplicated percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: after an uncomplicated successful PCNL without significant residual stone (>5mm) or any complication up to the first postoperative day, we randomly assigned patients into two groups-Group 1: overnight surgery, and Group 2: routine discharge after three days. Patients with significant residual stone on control fluoroscopy were excluded. Ninety eight and 102 patients were assigned to groups 1 and 2, respectively. Serum Hemoglobin and Cr were evaluated before the operation as well as the first postoperative day. Stone free status was evaluated using ultrasound and KUB radiography at the first postoperative day. RESULTS: The stone and patient characteristics were not different in two groups. The preoperative and change in the hemoglobin and creatinine levels were not significantly different between the two groups. Nine patients (9.2%) in Group 1 and five (4.9%) in Group 2 were readmitted because of complications (mainly hematuria) (p=.23). Of the readmitted patients, five in Group 1 (55%), and three in Group 2 (60%) received blood transfusion (p=.87). in these patients, group 1 received 1.6±0.51 units of blood compared with 1.93±0.25 in group 2 (p=.07). All the readmitted patients did well with conservative therapy with no need for angioembolization. CONCLUSION: In uncomplicated PCNL with no significant residual stone, discharging the patient on the first postoperative day is safe. The outcome is comparable to a routine three-day hospital stay.

A Short Review on the Relationships Between Nephrolithiasis and Myocardial Infarction.

The interaction between organs is a crucial part of modern medicine. As a very prerequisite to manage a disease, practitioners should have a full awareness of the related organs. Kidney and heart are two vital organs that are closely interconnected in various fields. These two organs have a lot of common risk factors for making a person unhealthy; therefore, if you prevent the disease in one of them, the other's morbidity might be alleviated as well. Among them, nephrolithiasis and myocardial infarction (MI) have more risk factors in common, and both could be fatal. Also, these two diseases are important regarding the prevalence, incidence, and burden of disease. Some studies confirm the relationship between MI and nephrolithiasis; however, further researches are needed to discover the exact direction of their relationship. The present review aims to explain the mechanism of MI and nephrolithiasis; clarify the relationship between these two disease based on physiological, pathological, and clinical studies; and propose some solutions for the prevention and treatment of such diseases.

Assessment of meatal stenosis in neonates undergoing circumcision using Plastibell Device with two different techniques.

PURPOSE: It was intended to compare meatal stenosis (MS) as a late complication of neonatal circumcision by using two different methods of Plastibell Device circumcision. MATERIALS AND METHODS: A total of 2,307 healthy term newborns (6-36 hours) who were born between 2007 and 2009 in Niknafs Medical Center of Rafsanjan, Iran, were simply randomized into two groups in a controlled, nonblinded clinical trial. In group A (1,102 neonates), the frenulum was maintained intact without any manipulation, and in group B (1,205 neonates) frenular hemostasis was performed in all cases by thermal cautery. MS was assessed by follow-up visits that were made for all cases at the 24-72 hours, 60th day, 12th month, and 16th month after circumcision. RESULTS: At 2 months follow-up visit, the rate of MS in group A was 4.9% (54) and in group B was 5.9% (71), which was not statistically significant. After 12 months, MS in group A was 8.5% (94) and in group B was 13.7% (165), which was statistically significant (P<0.001). At 16 months after circumcision, in the frenulum intact group, MS was 13.8% (152) and in the cautery group, it was 18.9% (228), which was compatible with significant difference (P=0.001). CONCLUSION: Our experience with large group of cases revealed that neonatal circumcision by using Plastibell Device with intact frenulum technique decreases the rate of delayed MS.

Laparoscopic Versus Open Partial Nephrectomy for Stage T1a of Renal Tumors.

PURPOSE: Partial nephrectomy is the gold standard treatment for small kidney masses. Data on the comparison oflaparoscopic (LPN) versus open partial nephrectomy (OPN) are based on retrospective studies. Thus, we plannedto compare these two techniques in a prospective trial. MATERIALS AND METHODS: The study population consisted of patients over 18 years old with single renal mass of≤ 4 cm. Patients were divided into two groups considering their preference. Study arms were matched accordingto age, gender, tumor size and location and renal nephrometry score. Mean operation time, warm ischemia time,hospital stay, peri-operative complications and changes in glomerular filtration rate (GFR) after 1 month were recordedand compared in two groups. Patients' satisfaction score, visual analogue scale and narcotics use to controlpost-operative pain were also studied. RESULTS: 34 and 31 patients underwent LPN and OPN, respectively. There was no significant difference betweenOPN and LPN regarding hospital stay (4.1 versus 4.6 days; P = .37), mean hemoglobin drop (2.17 and 1.96 g/dL;P = .62), changes in GFR and positive margin (1 versus 3 p=.40). LPN was accompanied with longer mean surgerytime (180 min versus 127 minutes; P < .001) and higher rate of urologic complications (P = .04); nevertheless,patient satisfaction rate was higher (P = .02) and dose of narcotics necessary for controlling post-operative painwas lower (P = .04) in LPN. CONCLUSION: This clinical trial shows that LPN has some benefits over OPN, including decreased post-operativepain and higher patient satisfaction. However, extra caution should be considered in the issue of tumor margin andurinary leakage in LPN.

Percutaneous Nephrolithotomy Using Split Amplatz Sheath: A Randomized Clinical Trial.

PURPOSE: To compare the outcome of percutaneous nephrolithotomy (PCNL) using split or intact Amplatz sheath. MATERIALS AND METHODS: Seventy two patients who underwent PCNL were randomly divided into two groups; PCNL using intact (group 1) and split (group 2) Amplatz sheath. Preoperative data, operative time, largest extracted stone size, fluoroscopy and lithotripsy time, and serum biochemistry tests before and after PCNL were evaluated. RESULTS: Preoperative features and stone size were not significantly different between the groups. There were no significant differences in complications and postoperative changes in hemoglobin and serum electrolytes. Stone free rate in group 2 (88.1%) was insignificantly higher than group 1 (83.3%) (p = .05), but in staghorn stones and stones larger than 1000 mm2, stone free rate in group 2 was significantly higher than group 1 (82% vs. 72%). The mean extracted stone size in group 2 (150 ± 49) was significantly larger than group 1 (40 ± 16 mm2) (p < .005). The mean operative, lithotripsy and fluoroscopy times were significantly longer in group 1. CONCLUSION: Using split Amplatz sheath in PCNL facilitates extraction of larger stone fragments which could contribute to shorter fluoroscopy, lithotripsy and operative times. .

Association between MTHFR C677T Polymorphism and Risk of Prostate Cancer: Evidence from 22 Studies with 10,832 Cases and 11,993 Controls.

BACKGROUND: The MTHFR C677T polymorphism is a genetic alteration affecting an enzyme involved in folate metabolism, but its relationship to host susceptibility to prostate cancer remains uncertain. The aim of this study was to investigate the association between MTHFR C677T polymorphism and prostate cancer by performing a meta-analysis. MATERIALS AND METHODS: Pubmed and Web of Science databases were searched for case-control studies investigating the association between MTHFR C677T polymorphism and prostate cancer. Odds ratios (OR) and 95% confidence intervals (95%CI) were used to assess any link. RESULTS: A total of 22 independent studies were identified, including 10,832 cases and 11,993 controls. Meta-analysis showed that there was no obvious association between MTHFR C677T polymorphism and risk of prostate cancer under all five genetic models. There was also no obvious association between MTHFR C677T polymorphism and risk of prostate cancer in the subgroup analyses of Caucasians. In contrast, MTHFR C677T polymorphism was associated with increased risk for prostate cancer in Asians with the allele model (C vs G: OR=1.299, 95 %CI =1.121-1.506, P=0.001, Pheterogeneity =0.120, I2=45%), additive genetic model (CC vs TT: OR =1.925, 95 % CI= 1.340-2.265, P=0.00, Pheterogeneity =0.587, I2=0.00%), recessive model (CC vs TT+TC: OR= 1.708, 95 % CI= 1.233-2.367, P=0.001, Pheterogeneity =0.716, I2=0.00%), and heterozygote genetic model (CT vs TT: OR=2.193, 95 % CI =1.510-3.186, P=0.000, Pheterogeneity =0.462, I2=0.00%). CONCLUSIONS: These results suggest that the MTHFR C677T polymorphism does not contribute to the risk of prostate cancer from currently available evidence in populations overall and Caucasians. However, the meta analysis indicates that it may play a role in prostate cancer development in Asians.

S100A12 and RAGE expression in human bladder transitional cell carcinoma: a role for the ligand/RAGE axis in tumor progression?

BACKGROUND: Transitional cell carcinoma (TCC) and prostate cancer are the most frequent cancers in the male genitourinary tract. Measurement of biological biomarkers may facilitate clinical monitoring and aid early diagnosis of TCC. The aim of the present investigation was to detect the mRNA levels of S100A12 and RAGE (receptor for advanced glycation end products) in patients suffering from bladder TCC. MATERIALS AND METHODS: To explore the involvement of S100A12 and RAGE genes, total RNA was harvested from cancer tissues and samples obtained from normal non-tumorized urothelium of the same patients. Quantitative PCR (qPCR) was subsequently employed to determine the mRNA levels of S100A12 and RAGE. RESULTS: The results showed that mRNA expression of S100A12 and RAGE was significantly up-regulated in the cancer tissue. CONCLUSIONS: According to the results presented in the current study, mRNA expression of S100A12 and RAGE might be as a useful biomarker for TCC. Therefore, this ligand-receptor axis possibly plays important roles in the development of TCC and may serve either as an early diagnostic marker or as a key factor in monitoring of response to treatment. More research is required concerning inhibition of the S100A12-RAGE axis in different cancer models.

The frequency of prostatic involvement in radical cystectomy specimens for transitional cell carcinoma of the bladder.

OBJECTIVE: To evaluate the frequency of prostatic involvement in pathologic samples of the patients who had undergone radical cystectomy due to transitional cell carcinoma (TCC) of the bladder. MATERIALS: The files of the patients who had been subjected to radical cystectomy due to bladder TCC between 1998 and 2004 were evaluated retrospectively. A total of 164 radical cystectomies had been done during this period. Seventeen cases were excluded because the primary tumour was not TCC or the patient had previously undergone prostatectomy. RESULTS: Of 147 patients, 36 (24/4%) had prostate TCC and 19 (12.9%) had prostate adenocarcinoma. Two patients had both TCC and prostate adenocarcinoma. Twenty-one cases had superficial bladder cancer (T1) and prostatic involvement was detected in TCC cases but in 9.5% of those with adenocarcinoma. The prevalence of prostate adenocarcinoma in radical cystectomy samples (due to bladder TCC) is much lower in Iranian patients in comparison with the European and American patients (vs 12.9 and 17.5 to 45%, respectively). CONCLUSION: Prostatic involvement by TCC had a direct relation with the stage (P = .01) and grade (P = .008) of the bladder tumour. If we try to preserve the prostate or its capsule during the radical cystectomy procedure, attention to these findings is worthwhile

Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a randomized clinical trial.

PURPOSE: Achieving access to the pyelocaliceal system in percutaneous nephrolithotomy (PCNL) is routinely performed using fluoroscopic guidance. We compared ultrasonography-guided access for PCNL with conventional fluoroscopy-guided access. PATIENTS AND METHODS: In a clinical trial, 100 patients with no abnormality of the upper urinary tract were selected from among candidates for PCNL and randomly assigned to two 50-patient groups: ultrasonography-guided access (group 1) versus fluoroscopy-guided access (group 2). In group 1, location of the target calix was identified in the transverse and sagittal planes by real-time ultrasonography when patients were in the prone position. Puncture of the target calix was attempted with a Chiba needle attached to the side of the ultrasound probe. If access to the collecting system was achieved, the site of puncture was controlled using fluoroscopy. In group 2, access was achieved using fluoroscopy guidance. Tract dilatation and stone extraction were the same in both groups. The mean age of patients was 40.7 +/- 12 years and 41.6 +/- 13.7 years in groups 1 and 2, respectively (P = 0.4). The male to female ratio in groups 1 and 2 was 34/16 and 31/19, respectively (P = 0.5). RESULTS: On average, duration of access was 11 +/- 3.5 minutes and 5.5 +/- 1.7 minutes in groups 1 and 2, respectively (P = 0.0001). Duration of radiation exposure, on average, was 0.69 +/- 0.26 minutes and 0.95 +/- 0.44 minutes in groups 1 and 2, respectively (P = 0.0001). CONCLUSION: Access for PCNL using ultrasonography guidance is an acceptable alternative to fluoroscopy and decreases radiation hazards.