Is there a relationship between varicocele and testosterone levels?

OBJECTIVES: The goal of this work was to study the relationship between presence of varicocele and testosterone serum levels in adulthood. METHODS: A comparative, cross-sectional study of 387 men who consulted for erectile dysfunction. Age, body mass index (BMI), diabetes (DM), and presence of varicocele were related to testosterone levels through uni- and multi-variate analysis. RESULTS: A total of 248 cases (70.8%) had no varicocele, 46 (13.1%) had grade I varicocele, 36 (10.3%) grade II, and 20 (5.7%) grade III. The mean total testosterone levels were 4.77 ng/mL in the non-varicocele group and 4.34 ng/mL in the varicocele group (p = .91), while free testosterone levels were 69.81 and 73.24 pg/mL (p = .18), respectively. In the multivariate analysis, BMI> = 30 was related to low total testosterone levels (OR: 2.94, p < .001) and low free testosterone (OR: 2.01, p = .01), while advanced age associated with low levels of free testosterone (OR: 1.04, p < .001). CONCLUSIONS: We were not able to establish a relationship between the presence of varicocele and decreased serum testosterone levels. Other factors already described, such as obesity and age, were related to low levels of total and free testosterone.

[Renal lithiasis, can we predict the need for retreatment in retrograde intrarenal surgery (RIRS)?] / Litiasis renales, ?podemos predecir la necesidad de retratamientos en cirugía retrógrada intrarrenal?.

OBJECTIVES: To analyze the predictive factors for retreatment in RIRS to achieve complete lithiasis resolution. METHODS: Retrospective comparative study analyzing 298 cases of RIRS performed in our center over a 3 year period. The cohort was divided in two groups: Resolution in one operation or more than one, evaluating homogeneicity for age and gender. We compared the folowing variables: Hounsfield units, body mass index (BMI), number of stones, size, (on the case of multiple stones, larger stone size), side, location in the kidney and stone biochemistry. Bivariant statistical analysis by Student's t and Chi square tests, and multivariate analysis by binary logistic regression. ROC curves were made to set cutting points for relationship between quantitative variables. RESULTS: The groups were homogeneous for both age and gender (p>0.05). 260 (87.25%) patients required one treatment only and 38 (12.75%) more than one. Among the study variables, the only one that showed differences between the groups wa stone size, being the mean size 18 mm in the single treatment group and 26 mm in the more than one treatment group (Difference between mean values -8.27, 95%CI: -5,91 - -10.63, p<0,001). CONCLUSIONS: RIRS with holmium laser is still an effective technique for the treatment of renal lithiasis. The largest stone size is related with the need of retreatments, so it must be taken into consideration specially over 2 cm. In our series, for every extra millimeter in size the probability of retreatment increased 1.14 times, demonstrating the importance of size in this context.

Litiasis renales, ¿Podemos predecir la necesidad de retratamientos en cirugía retrógrada intrarrenal? / Renal lithiasis, can we predict the need for retreatment in retrograde intrarenal surgery (RIRS)?

OBJETIVO: El objetivo de este trabajo fue analizar los factores predictivos de retratamientos para la resolución completa de la litiasis mediante cirugía retrógrada intrarrenal (CRIR). MÉTODOS: Estudio retrospectivo y analítico comparativo sobre 298 casos de CRIR realizados en nuestro centro a lo largo de 3 años. Se dividió a la muestra en dos grupos: resolución con una cirugía, o con más de una, estudiándose la homogeneidad para edad y sexo. Se compararon las siguientes variables pre e intraoperatorias entre cada grupo: Unidades Hounsfield (UHC), Índice de masa corporal (IMC), número de litiasis, tamaño de la litiasis (en caso de múltiples, tamaño mayor de la litiasis más grande), lateralidad, localización dentro del riñón, y bioquímica de la litiasis. Análisis estadístico bivariante mediante T-Student y chi-cuadrado, y multivariante mediante regresión logística binaria. Se realizaron curvas ROC para establecer puntos de corte en caso de relación con variables cuantitativas. RESULTADOS: Grupos homogéneos para edad y sexo (p > 0,05), 260 (87,25%) sujetos precisaron un solo tratamiento y 38 (12,75%) más de uno. Dentro de las variables estudiadas, la única con diferencias entre los dos grupos fue el tamaño de la litiasis, siendo la media en el grupo de un tratamiento de 18 mm, y de 26 mm en el de más de un tratamiento (diferencia de medias -8,27, IC 95%: -5,91 -- -10,63, p < 0,001). Por cada milímetro más de tamaño, la probabilidad de necesitar más de un tratamiento aumenta 1,14 veces (p < 0,001). En la curva ROC se observó que el punto con mayor sensibilidad y especificidad para el tamaño de la litiasis se estableció en 21mm, con ABC de 0,804 (IC 95%: 0,73 - 0,87, p < 0,001). CONCLUSIONES: La CRIR con láser holmio sigue siendo una técnica eficaz para el tratamiento de la litiasis renal. El tamaño mayor de la litiasis se relaciona con la necesidad de retratamientos, debiendo tenerse en cuenta este hecho sobre todo a partir de los 2 cm. En nuestra serie, por cada milímetro más de tamaño de la litiasis, aumentó 1,14 veces la probabilidad de retratamientos, lo cual demuestra la importancia e influencia del tamaño en este contexto

OBJECTIVES: To analyze the predictive factors for retreatment in RIRS to achieve complete lithiasis resolution. METHODS: Retrospective comparative study analyzing 298 cases of RIRS performed in our center over a 3 year period. The cohort was divided in two groups: Resolution in one operation or more than one, evaluating homogeneicity for age and gender. We compared the folowing variables: Hounsfield units, body mass index (BMI), number of stones, size, (on the case of multiple stones, larger stone size), side, location in the kidney and stone biochemistry. Bivariant statistical analysis by Student`s t and Chi square tests, and multivariate analysis by binary logistic regression. ROC curves were made to set cutting points for relationship between quantitative variables. RESULTS: The groups were homogeneous for both age and gender (p > 0.05). 260 (87.25%) patients required one treatment only and 38 (12.75%) more than one. Among the study variables, the only one that showed differences between the groups wa stone size, being the mean size 18 mm in the single treatment group and 26 mm in the more than one treatment group (Difference between mean values -8.27, 95%CI: -5,91 -- -10.63, p < 0,001). CONCLUSIONS: RIRS with holmium laser is still an effective technique for the treatment of renal lithiasis. The largest stone size is related with the need of retreatments, so it must be taken into consideration specially over 2 cm. In our series, for every extra millimeter in size the probability of retreatment increased 1.14 times, demonstrating the importance of size in this context

[Renal hemorrhage after ESWL: From small hematoma to renal blowout]. / Hemorragia renal tras LEOC: del pequeño hematoma al estallido renal.

OBJECTIVE: To report two cases of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL) and their therapeutic management. METHODS: Description of the clinical cases, together with the diagnosis and therapeutic management of these complications. RESULTS: We present two cases of patients with renal hemorrhage after ESWL, which were performed without immediate complications. One of the cases, after detecting an important laceration of the renal parenchyma, needed two embolization sessions for its short-term resolution; however, the patient finally passed away due to the complications derived from hemorrhage. The other case was solved through conservative management. CONCLUSIONS: Even though hemorrhage is an infrequent complication after ESWL, it should be suspected when the patient presents compatible clinical symptoms, since even though most cases are resolved in a conservative manner, on some occasions specific treatments for the hemorrhage are necessary. Old age and the presence of vascular comorbidities seem to be related to a higher risk of hemorrhage after ESWL.

Intrarenal pseudoaneurysm after percutaneous nephrolithotomy. Renal angiography and selective embolization.

OBJECTIVE: We present a case of intrarrenal pseudoaneuysm after percutaneous nephrolithotomy. The treatment was selective embolization of the pseudoaneurysm. We discuss the role of computerized angiotomography and angiography in these cases. We present a review of the related literature. METHODS: A computerized angiotomography (angio CT) was performed because of suspicion of a delayed vascular lesion after percutaneous nephrolithectomy. Faced with the findings of the angio CT an selective renal artery arteriography and selective embolization was performed. RESULTS: The angiotomography shows an enhanced nodular contrast in the lower third of the left kidney with a scarred area at this level suggestive of hemorrhage due to vascular lesion.Through puncture of the right common femoral artery, arteriography was performed on the left renal artery with, objectifying an amputated artery related to the bleeding situation in the calyx. After localization of the point of hemorrhage, the vessel was embolized with a 3 mm metallic microspiral GCD, 6 cm in length After embolization, the evolution of the patient was satisfactory. CONCLUSIONS: Intrarenal pseudoaneurysm is the most frequent cause of late bleeding after percutaneous nephrolithotomy. The most common symptom is hematuria that can be severe and require active treatment in order to inhibit the hemorrhage. In these cases, computerized angiotomography and angiography take on a very important diagnostic role, the latter offering the possibility to treat the hemorrhage through selective embolization of the pseudoaneurysm.

Pseudoaneurisma intrarrenal tras nefrolitotomía percutánea. Angiografía renal y embolización selectiva / Intrarenal pseudoaneurysm after percutaneous nephrolitotomy. Renal angiography and selective embolization

OBJETIVO: Presentamos un caso de pseudoaneurisma intrarrenal tras nefrolitotomia percutánea. El tratamiento en este caso fue la embolizacion selectiva. A partir de este caso discutimos la utilidad en el dignóstico de la angiotomografia computerizada y la angiografia renal. Realizamos una revisión de la literatura al respecto. MÉTODOS: Se realizó una angitomografía computerizada (angioTC) por sospecha de lesión vascular diferida tras la nefrolitectomía percutánea. Ante los hallazgos deangioTC, se realizó una arteriografía de la arteria renal izquierda y embolización selectiva de la lesión. RESULTADOS: La angiotomografía evidencia un realce nodular de contraste en el tercio inferior del riñón izquierdo con área hipocaptante a este nivel sugestiva de hemorragia por lesión vascular. Mediante punción de la arteria femoral común derecha, se realiza arteriografía de la arteria renal izquierda objetivando una arteria amputada que corresponde a la situación del sangrado al cáliz. Tras localización del punto de hemorragia se procedió a embolizar el vaso con una microespiral metálica GDC de 3mm y 6cm de longitud Tras la embolización, la evolución del enfermo fue satisfactoria. CONCLUSIONES: El pseudoaneurisma intrarrenal constituye la causa más frecuente de sangrado tardío tras nefrolitotomía percutánea. El síntoma más habitual es la hematuria que puede ser severa y precisar de tratamiento activo para cohibir la hemorragia. En estos casos, cobran un papel muy importante en el diagnostico, la angiotomografía computerizada y la angiografía, ofreciendo esta última la posibilidad de tratar la causa de la hemorragia mediante la embolización selectiva del pseudoaneurisma(AU)

OBJECTIVE: We present a case of intrarrenal pseudoaneuysm after percutaneous nephrolithotomy. The treatment was selective embolization of the pseudoaneurysm. We discuss the role of computerized angiotomography and angiography in these cases. We present a review of the related literature. METHODS: A computerized angiotomography (angio CT) was performed because of suspicion of a delayed vascular lesion after percutaneous nephrolithectomy. Faced with the findings of the angio CT an selective renal artery arteriography and selective embolization was performed. RESULTS: The angiotomography shows an enhanced nodular contrast in the lower third of the left kidney with a scarred area at this level suggestive of hemorrhage due to vascular lesion. Through puncture of the right common femoral artery, arteriography was performed on the left renal artery with, objectifying an amputated artery related to the bleeding situation in the calyx. After localization of the point of hemorrhage, the vessel was embolized with a 3 mm metallic microspiral GCD, 6 cm in length After embolization, the evolution of the patient was satisfactory. CONCLUSIONS: Intrarenal pseudoaneurysm is the most frequent cause of late bleeding after percutaneous nephrolithotomy. The most common symptom is hematuria that can be severe and require active treatment in order to inhibit the hemorrhage. In these cases, computerized angiotomography and angiography take on a very important diagnostic role, the latter offering the possibility to treat the hemorrhage through selective embolization of the pseudoaneurysm(AU)