Expression of proapoptotic receptors Fas/Fas-L on sperm cells and levels of their soluble forms in seminal fluid from patients with varicocele.

Varicocele is a condition in which the pampiniform venous plexus in the scrotum dilates abnormally during puberty, affecting testicular growth and semen parameters, and is thought to be a major cause of male infertility. The findings of researches on the presence of the Fas system in sperm are controversial. As the main triggers of apoptosis in the semen of patients with varicocele, in this study, we examined the expression of Fas/Fas-L on sperm cells and also the levels of their soluble forms in seminal plasma. Semen samples were taken from 45 patients with varicocele (study group) and 45 healthy subjects without varicocele (control group) after 3-5 days of ejaculatory abstinence. Flow cytometry was used to examine the expression of Fas and Fas ligand (Fas-L) on Sperm cells. Furthermore, soluble Fas (sFas) and soluble Fas-Ligand (sFas-L) levels in the seminal fluid were determined using an ELISA (enzyme-linked immunosorbent assay). The presence of Fas and Fas-L proteins on the sperm ejaculation surface was not found in the patients with varicocele or the control groups. However, in the case group (3.32 ± 0.31 ng/mL), sFas seminal concentrations were slightly lower than in the control group (5.50 ± 0.36 ng/mL) (p < 0.001). In varicocele patients, there was a strong negative association between seminal sFas and sperm motility. Apoptosis effects through this system on key sperm parameters were not found based on our findings. In varicocele, a reduction in sperm count and motility does not seem to be due to Fas-related mechanisms, but rather to other mechanisms.

Amplatz versus Balloon for Tract Dilation in Ultrasonographically Guided Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

PURPOSE: To compare balloon with Amplatz for tract dilation in totally ultrasonographically guided PCNL (UPCN). METHODS: We randomized 66 patients candidate for sonographically guided PCNL in the flank position in two study groups. In the first group, we used single step Amplatz dilation (AG) technique in which the 28- or 30-French Amplatz dilator is used for tract dilation. In the other group, we dilated the tract using balloon dilator (BG). We compared procedure time, success rate of dilation, and postoperative clinical outcomes and cost between two groups. RESULTS: The rate of short dilation was higher in the Amplatz group (57.6%) compared with Balloon group (36.4%) (P=0.08). When using Amplatz for lower pole access, short dilation occurred in 81% of cases compared with 44% in the BG (P=0.02). Overall operation was longer in the AG (80±21 versus 65±20 minutes P=0.02). Stone free rate was 87.9% in the AG compared with 72.7% in the BG (p=0.12). Mean cost of the surgery was 603±85 USD and 718±78 USD in the AG and BG, respectively (P=0.0001). Hemoglobin drop, transfusion rate, renal function alteration, duration of hospitalization, and complication rate based on Clavien classification were similar in both groups. CONCLUSIONS: AG showed a higher rate of short dilation compared with BG; consequently, overall operating time was significantly longer in the AG whereas BG was significantly more expensive than AG. Bleeding and other complications were similar in two groups. We observed an advantage for balloon dilation over Amplatz when approaching the lower pole calyxes.

Intracytoplasmic Sperm Injection Outcomes with Freshly Ejaculated Sperms and Testicular or Epididymal Sperm Extraction in Patients with Idiopathic Cryptozoospermia.

BACKGROUND: Cryptozoospermia (CO) is a situation in which spermatozoa cannot be observed in a fresh semen sample unless an extended centrifugation and microscopic search are performed. CO patients are suggested to use only intracytoplasmic sperm injection (ICSI) as infertility treatment. But still there is debate about the choice of sperm source in cryptozoospermic men candidate for ICSI. OBJECTIVES: This study was conducted to evaluate fertility outcomes in men with idiopathic cryptozoospermia who were treated using ICSI with freshly ejaculated sperm and testis sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA). METHODS: In this prospective cohort study carried out in an academic institution, 83 out of 92 couples with cryptozoospermia undergoing their first ICSI cycle were recruited. These patients were randomly allocated to two groups: group one (n = 42) who produced freshly ejaculated sperm and, group two (n = 41) who produced a sample by TESE or PESA. The groups were analyzed and compared in terms of fertilization rate, cleavage rate, embryo quality, implantation rate, and clinical pregnancy rate. RESULTS: There was a significant difference in fertilization rate, embryo quality, implantation rate, and pregnancy rates between the group of surgically extracted sperm and those of naturally ejaculated sperm using conventional ICSI (P < 0.05). CONCLUSIONS: Sperm quality extracted by percutaneous PESA and TESE procedures increases fertility outcomes compared to naturally ejaculated sperm in men with idiopathic CO. More specifically, embryo quality, which is most relevant to fertility outcome, improved when surgically extracted sperm was used for ICSI.

Clomiphene Effects on Idiopathic Premature Ejaculation.

BACKGROUND: Premature ejaculation (PE) is the inability to delay ejaculation, occurring sooner than they or their partner would like during sexual activities. PE is a challenging problem that can affect sexual enjoyment and may harm relationships of couples and affect their quality of life. In idiopathic PE, several helpful techniques and medicines are recommended, but none of them has yielded satisfactory results. OBJECTIVES: Our objective in this study was to evaluate the efficacy and safety of clomiphene as a selective estrogen receptor modulator on the treatment of idiopathic PE. PATIENTS AND METHODS: In a randomized clinical trial, 178 married men with idiopathic PE defined according to the Diagnostic and Statistical Manual of Mental Disorders Third Revised Version (DSM-III-R) who referred to urology clinics over a 10-month period in 2012 were randomized into two groups, namely the study (clomiphene) and control (placebo) groups. They completed self-administered questionnaires that included intravaginal ejaculatory latency time (IELT), erectile dysfunction indexes, quality of life (QOL), sociodemographic characteristics, lifestyle, and medical illness. After 6 months of intervention, all data were compared with the baseline data and between the groups. RESULTS: Within the 10-month study course, 126 patients (70.8%) completed this study. After intervention and comparison of the results between the two groups, IELT, sexual indexes, and QOL improved in the study group, but significant differences were observed only in the IELT and QOL findings. CONCLUSIONS: Clomiphene seems to be useful in the pharmacological treatment of PE compared to the placebo.

The effect of tamsulosin, an alpha-1 receptor antagonist as a medical expelling agent in success rate of ureteroscopic lithotripsy.

BACKGROUND: Tamsulosin is an α-1A-specific blocker which induces selective relaxation of ureteral smooth muscle with subsequent inhibition of ureteral spasms and dilatation of the ureteral lumen and facilitates stone expelling. OBJECTIVES: In this study we aimed to assess the efficacy of tamsulosin for improving the success rate of ureteroscopic lithotripsy (URS) for lower ureteral stones. PATIENTS AND METHODS: In a prospective study by a randomized controlled clinical trial, which was performed from June 2008 to December 2010, we enrolled one hundred and forty-two subjects and eventually 102 patients completed the clinical trial. All the patients underwent ureteroscopic lithotripsy with the pneumatic wolf lithotripsy. The patients were randomly divided into 2 groups: the study group including 52 patients, received tamsulosin with our traditional treatment (hydration and analgesic when required), and the control group with 50 patients who received placebo with traditional treatment. The number of colic episodes, lower urinary tract symptoms, analgesic dosage, and days of spontaneous passage of the stones through the ureter were recorded in a diary after lithotripsy. RESULTS: The results showed that tamsulosin treatment group had low expulsion time (P = 0.011), low urinary tract symptoms, least analgesic needs and low adverse effects, all with statistically significant differences comparable with the control group (P < 0.05). CONCLUSIONS: Administration of α-1A-specific blocker reduced analgesic dosage and colic episodes and rate of adverse effects after ureteroscopic lithotripsy of lower ureteral stones and decreased gravel expulsion time after URSL.

Combination effect of Pentoxifylline and L-carnitine on idiopathic oligoasthenoteratozoospermia.

BACKGROUND: Pentoxifylline (PX) is a methyl xanthine derivative that influences the sperm motion characteristics and L-carnitine (L-C) is an amino acid that is naturally produced in the body. In general, separate administration of PX and L-C has been reported to be effective on preserving sperm motility in vitro, and also when is consumed orally by the Idiopathic oligoasthenoteratozoospermia (IOAT) patients. OBJECTIVE: The aim of this study was to evaluate any possible effect of a combination of L-C and PX on sperm characteristics and improving the type of assisted reproductive techniques (ART) in a group of patients with unexplained oligoasthenoteratozoospermia. MATERIALS AND METHODS: Two hundred twelve infertile men with IOAT in a double-blind, placebo-controlled, randomized clinical trial were allocated for this study. They randomized to four groups. Group I received PX/ and L-C (each one, twice daily), group II, PX and placebo, group III, L-C with the placebo, and group IV, received placebo tablets. Finally, we compared pre and post intervention sperm parameters and ART procedures between groups. RESULTS: While the use of PX and L-C are only improved sperm motility, but their combined uses improved all sperm parameters, especially the sperm count. Also the combination of PX and L-C was effective on improving the ART procedures (p<0.01). CONCLUSION: Our results demonstrate that the combination use of PX and L-C is useful in improving of sperm parameters in IOAT patients and also, improve ART procedures in this group of patients.

The Effect of Modified TURP (M-TURP) in Intra and Postoperative Complications.

BACKGROUND: Transurethral resection of the prostate (TURP) is the most common surgical treatment for benign prostatic hyperplasia. OBJECTIVES: The aim of the present study was to compare the conventional bipolar transurethral resection of prostate (TURP) with a modified transurethral resection of the prostate (M-TURP) in men with mild to moderate symptoms of benign prostatic hyperplasia. PATIENTS AND METHODS: To compare and evaluate the clinical outcomes of M-TURP, a new electrosurgical suggested method, with the standard treatment, transurethral resection of prostate (TURP), 200 patients with benign prostatic enlargement causing moderate to severe clinical lower urinary symptoms were selected and divided into two equal groups of A and B. Patients of group A underwent M-TURP (incomplete bladder neck resection), resecting only from 1 to 11 O'clock position and group B underwent conventional TURP. These patients were evaluated between Jun 2008 and April 2011, after excluding 24 patients, finally 176 men were studied, 98 in the conventional monopolar transurethral resection of prostate (TURP) group and 78 in the (M-TURP) group. Postoperative follow up to assess the results of the surgeries and the complication rates, began from the operation and continued with postoperative visits of the patient at 24 hour after the catheter remove, two weeks, three months and finally six months. RESULTS: The age range of both groups were the same (65-82 years old), preoperative IPSS score in study and control groups were 18 ± 3.3, 17 ± 4.6 (nonsignificant P value = ns) respectively. The size of prostate gland was 58 ± 3.5 g in study and 78 ± 1.2 g in control (ns) preoperatively. Intra and postoperative complications including hematuria (need for transfusion), urine retention (need for catheterization), fever after operation in study and control groups were 2.04%, 6.41%, 1.02% and 0.0%, 3.06%, 6.41% respectively. ISI score (stress incontinence score index) were 7 ± 2.5 and 19 ± 3.6 and UR (urge ratio) were %26 and %70 for study and control groups respectively; P < 0.05. IIEF (international index of erectile function) in study group was better than control (23 ± 3.2 vs. 11 ± 1.7), P < 0.05. CONCLUSIONS: The results of this study showed that the support of anterior fibro muscular zone (anterior lobe) of prostate after TUR-P has a significant role in postoperative complications, especially in postoperative stress incontinence. So, we strongly recommend to preserve this segment of prostate for prevention of incontinence and other intra and postoperative complications.

Opium dependency in recurrent painful renal lithiasis colic.

BACKGROUND: The main goal of this study is to determine the relationship between opium dependency and frequency of urolithiasis renal colics. METHODS: In a cross sectional study we compared opium dependency in urolithiasis patients (case group) with non-urolithiasis patients (control group) and assessed urolithiasis related renal colics as risk factor to opium dependency prevalence. Dependency was defined as the diagnostic criteria specified in DSM-IV questionnaire and Urolithiasis was diagnosed by standard methods (imaging modalities as US, X-Ray). FINDINGS: From 450 urolithiasis adult patients (120 female and 370 male with the age range of 18-67 years) 157 (34.88%) were opium addicts, however from the 340 non-urolithiasis patients (matched age group and gender ratios) only16 (4.70%) were opium addicts (P < 0.001). 56.68% of urolithiasis patients (who had a history of more than 15 renal colics (related to stone forming frequencies) were addicts for more than 10 years (P < 0.05). A strong positive correlation between the duration of dependency and renal colic rate was detected in these patients (P < 0.001, r = 0.999). CONCLUSION: This study showed that the risk of opium dependency is higher among urolithiasis patients. Moreover, there was a relation between urolithiasis frequencies (renal colics) and the duration of dependency. Other factors such as severity of pain, perception and faith of patients in the therapeutic effects of opium or local availability of opium were also effective in opium dependency.

Prevalence of symptomatic urinary calculi in Kerman, Iran.

INTRODUCTION: In a cross-sectional study, we evaluated the prevalence of symptomatic urinary calculi in Kerman, Iran. MATERIALS AND METHODS: A total of 2431 citizens of Kerman were surveyed from September of 2005 to April 2006. The study population was selected by cluster method from 5 different areas, and 100 houses in each area were randomly approached. Questions on the urinary symptoms consisted of flank pain, urogenital pain, dysuria or any difficulty in urination, and alterations in urine color. Individuals with a suspicion of urinary calculi based on their symptoms were evaluated by physical examination, laboratory investigations, and plain abdominal radiography. Ultrasonography and intravenous urography were done if required to confirm the diagnoses. RESULTS: Of 2431 individuals, 196 (8.1%) had symptoms in favor of urinary calculus diagnosis, of whom 47 (24.0%) had urinary calculi (prevalence of symptomatic urolithiasis was 1.9%). Of the patients, 35 (74.5%) were underweight. Compared to the other participants, the patients with urinary calculus were younger (P = .001) and a larger proportion of them had a positive family history of urinary calculi (14.9% versus 6.5%; P = .02) and were rug weavers and office employees. Dependency on opium and its derivative was significantly more frequent in patients with urinary calculi (25.5% versus 0.2%; P = .001). CONCLUSION: This study showed that the prevalence of symptomatic urinary calculi in this hot and dry area is relatively high. According to our findings, the other factors including specific occupations, malnutrition, and substance use may also have influence on the rate of urinary calculus formation. Therefore, to prevention and early treatment of urinary calculi, evaluation of potential predisposing conditions should be considered with special attention to regional factors.