Evaluation of Azoospermic Patients to Distinguish Obstructive from Non-Obstructive Azoospermia, and Necessity of Diagnostic Testis Biopsy: A Retrospective Study.

BACKGROUND: Accurate etiology of azoospermia is required for optimal management of patients. The aim of this
study was the determination of serum hormonal levels and testicular long axis cut off points to distinguish obstructive
azoospermia (OA) from non-OA (NOA) in Iranian patients as well as the evaluation of the necessity of diagnostic
testis biopsy in azoospermic patients.
Materials and Methods: In this retrospective study, data of 471 azoospermic patients such as history and physical
examination, serum hormonal level, semen fluid parameter, and testicular long axis based on ultrasound were
evaluated from 2016 to 2020. All patients were examined by a single urologist and underwent a diagnostic testis
biopsy for a definite diagnosis. The diagnostic parameters were analyzed using Statistical Package for the Social
Sciences (SPSS) version 16 with t test and chi-square test and receiver operating characteristic (ROC) curves to
distinguish NOA from OA.
Results: A total of 127 patients with OA and 284 with NOA were included in this study. The mean serum testosterone
level was significantly higher in OA than NOA (4.2 vs. 3.4 ng/ml), whereas the mean serum follicular stimulating hormone
(FSH, 5.3 vs. 19.1 mIU/ml) and luteinizing hormone (LH, 5.3 vs. 11 mIU/ml) were lower in OA. ROC curve analysis
showed that FSH and testicular long axis were the best diagnostic predictors. Using a combination of serum FSH (8.9
mIU/ml) and testicular long axis (39 mm), the positive predictive value for NOA was 97.02% and for OA was 78.8%.
Conclusion: Combination of serum FSH higher than 8.9 mIU/ml and testicular long axis lower than 39 mm were
strong predictors to distinguish NOA from OA in Iranian participants in this study. In addition, diagnostic testicular
biopsy seems to be necessary for patients with OA and NOA characteristics.

Organ yield from deceased donors: initial experience of an organ procurement unit in Iran.

To promote organ transplantation in Iran, organ procurement from deceased donors should be supported. For this policy, some organ procurement units have been established in university hospitals. Further researches in these activities are warranted to better elucidate the role of cadaveric organ transplantation in Iran.We retrospectively studied deceased organ donation from June 2005 through December 2007 in Organ Procurement Unit of Shariati Hospital in Tehran. We analyzed a total of 141 organs that were retrieved from 46 brain-dead organ donors.The median age of all donors was 29 years (min: six, max: 63). Two third of them were males. The average of harvested organs was 3.06 per donor and four organs per month. The main cause of brain death was head trauma (n=33, 72%). Organ yield per donor was correlated to the time of the organ procurement unit activity and increased during the three years (r=0.261, P=0.017). Other variables were not changed during this period. Donor characteristics such as age, sex, blood group, and causes of brain death impacted on the organ yield. This study showed that organ procurement units can improve organ yield and both experience and donor characteristics influence on the number of harvested organs.

Bladder neck preservation during radical retropubic prostatectomy and postoperative urinary continence.

INTRODUCTION: Bladder neck-sparing modification of radical retropubic prostatectomy has been reported to lower the risk of urinary incontinence after prostatectomy. We reviewed the outcomes in men with prostate cancer who had undergone prostatectomy with either bladder neck preservation or bladder neck reconstruction. MATERIALS AND METHODS: In this retrospective study, a total of 103 patients who had undergone radical retropubic prostatectomy were assessed. The patients were divided into two groups of bladder neck preservation (51 patients) and bladder neck reconstruction (52 patients). We compared frequency of biochemical failure, bladder neck stricture, and urinary incontinence between these two groups. Biochemical failure was defined as a serum prostate-specific antigen level higher than 0.2 ng/mL and its rising trend in at least 2 postoperative subsequent measurements. Continence was defined as no need to use sanitary pads or diapers. RESULTS: The two groups were comparable in terms of age, serum prostate-specific antigen level, Gleason score, and prostate volume. After a mean follow-up period of 32.5 months, all patients with bladder neck preservation and 46 (88.5%) with bladder neck reconstruction were continent (P = .03). There were no significant differences in the frequency of biochemical failure and bladder neck stricture that required dilation between the two groups of patients. CONCLUSION: Bladder neck preservation during radical retropubic prostatectomy may improve long-term results of urinary continence and be effective in eradicating prostate cancer without increasing recurrence rate.

Influence of hypernatremia and polyuria of brain-dead donors before organ procurement on kidney allograft function.

INTRODUCTION: Polyuria and hypernatremia are common problems during the pretransplant care of brain-dead donors. They have not only important role in hemodynamic stability, but also may influence organ transplantation outcomes. The influence of donor hypernatremia in liver transplantation was reported. This study aimed to determine these effects on kidney allograft. MATERIALS AND METHODS: We retrospectively studied on 57 transplanted kidney allografts from cadaveric donors. The effects of the urine output volume and serum level of sodium of the donors were on the recipients' serum creatinine levels 1 week after transplantation and at the last follow-up visit were assessed. RESULTS: Of the donors, 58% had polyuria and 45% had hypernatremia. The median pretransplant urine output of the donors was 130 mL/h (range, 35 mL/h to 450 mL/h), and their mean serum sodium level was 152.0 +/- 13.0 mEq/L. Serum creatinine concentrations in the recipients at the 1st posttransplant week correlated significantly with the recipients' age (r = 0.355, P = .02) and the donors' urine output volume (r = 0.329, P = .04). The serum creatinine measured in the last follow-up visit significantly correlated only with the donors' serum sodium levels (r = 0.316, P = .02) and the donors' age (r = 0.306, P = .02). Multivariate regression analysis showed that the donors' serum levels of sodium and potassium were the predictors of the last measured serum creatinine level. CONCLUSION: Polyuria and hypernatremia in brain-dead donors are frequent. Elevated serum level of sodium and polyuria in the donor can have adverse effects on kidney allograft function.

Transanal repair of rectourethral and rectovaginal fistulas.

INTRODUCTION: We evaluated the efficacy and safety of repair of the rectourethral and rectovaginal fistulas with transanal approach using the Latzko technique. MATERIALS AND METHODS: We repaired 8 fistulas with transanal approach. Fistulas were rectourethral in 5 patients, and in the only woman of the series, they were rectovaginal and vesicovaginal. In 3 patients, The fistulas had been diagnosed following prostatectomy, urethral stricture repair, and colonic resection and radiotherapy due to rectosigmoid cancer in 3, 2, and 1 patients, respectively. Complying with Latzko technique, the fistula orifice was exposed and a fusiform incision was made with the orifice in its center. The mucosa lying between the incision and the orifice was excised in the direction of the incision to the orifice, leaving the fistula edges to meet. Then, the edges were closed, followed by closure of the muscular layers above it. Finally, the edges of the rectal mucosa were closed. RESULTS: Two patients had 2 fistulas and 4 had 1 fistula who were all managed by transanal approach. During a median follow-up period of 44 months, no serious complication was noted, except for recurrence of deep vein thrombosis in 1 patient with a positive history for this complication. Hospitalization period was 1 to 7 days. CONCLUSION: It seems that transanal repair is a simple and effective technique with minimal complication rate in the treatment of rectourethral fistulas. Regardless of the etiology, this method can be used as the preferred therapeutic technique. Further studies are necessary to confirm our findings.

Distribution of hepatitis C virus genotypes among hemodialysis patients in Tehran--a multicenter study.

Hepatitis C virus has substantial heterogeneity of genotypes throughout the world. The aim of this study was to determine the frequency of HCV genotypes, risk factors and clinical implications in cases of hemodialysis living in Tehran. A total of 155 patients treated by hemodialysis, who had been identified to be anti-HCV positive at 45 medical centers in Tehran, were enrolled. Genotyping was using restriction fragment length polymorphism (RFLP) on HCV-RNA positive samples. HCV-RNA was detected in 66 (42.6%) patients. Genotyping of HCV-RNA positive serum samples demonstrated that subtypes 3a and 1a were predominant accounting for 30.3 and 28.8%, respectively. The distribution of other HCV genotypes showed genotype 1b, 18.2%; genotype 4, 16.7%; mixed genotypes 1a and 1b, 3%; and genotype 3b, 3%. Genotype 2 was not detected in this study. Statistically significant differences were identified between HCV infected and non-HCV infected patients regarding history of hemodialysis unit changes more than two times (P = 0.01), and history of hemodialysis for more than 20 years (P = 0.02). However, blood transfusion, mean duration of hemodialysis therapy and the history of solid organ transplantation did not differ between these two groups. This study indicates that the dominant HCV genotypes among patients treated by hemodialysis living in Tehran were 3a and 1a, and considering previous reports from the general population, genotype 4 was strongly associated with hemodialysis. The duration of treatment by hemodialysis and, in turn, more hemodialysis unit changes will lead to more frequent HCV infections.