[Treatment of infertility in nonobstructive azoospermia using the TESE method (testicular sperm extraction)--clinical results]. / Lécba neplodnosti u neobstrukcní azoospermie metodou TESE (Testicular Sperm Extraction)--klinické výsledky.

Sperm was found in 56.6% of TESE cycles in 27 men with non-obstructive azoospermia. Using testicular sperm, 30% oocytes were fertilized. Embryos were transferred in 11 cycles. Twins were delivered in the 34th week of pregnancy. Two further pregnancies are ongoing. The pregnancy rate was 27% per ET. Testicular biopsy in all azoospermic men is recommended in special IVF centers not only for histological examination but also for ICSI procedure with testicular sperm which could be provided at the same time.

[Treatment of male infertility after oncologic therapy: preventive autologous sperm preservation versus testicular biopsy and oocyte fertilization with testicular spermatozoa]. / Lécba neplodnosti muzu po onkologické lécbe: preventivní autokonzervace versus biopsie varlete a oplodnení oocytu testikulárními spermiemi (TESE).

The prognosis of oncological therapy of some malignancies is favourable. Unfortunately the majority of young patients remain sterile. Sperm cryopreserved before treatment was successfully used in IVF-ICSI (in vitro fertilization-intracytoplasmic sperm injection) cycles. Testicular biopsy (TESE) was performed after successful oncological treatment in three men without previous sperm cryopreservation. No spermatozoa were found for oocyte fertilization. TESE could not ensure sperm recovery in all patients after oncological treatment. Sperm cryopreservation should be highly recommended to all patients before any treatment is offered.

[Treatment of infertility in non-obstructive azoospermia using the TESE (testicular sperm extraction) method--clinical study]. / Lécba neplodnosti u neobstrukcní azoospermie metodou TESE--klinická vysetrení.

Testicular sperm extraction (TESE) was performed in 27 men in 30 cycles. All men were examined for genetics, serum hormonal status, biochemical status of semen samples. All men were examined by an urologist. No prognostic evaluation able to provide information about the prognosis of TESE procedure was found. Even a high FSH level, testicular hypotrophy or previous histological examination cannot exclude any patient from testicular biopsy.

Infertility treatment of men with non-obstructive azoospermia.

Male infertility can be treated by several methods with varying degree of success. We present evidence that "open" testicular biopsy is favorable for men suffering from non-obstructive azoospermia (NOA). Moreover, any NOA patient may be subjected to this treatment even though his past histopathological examinations suggest that it is likely no sperm will be found in the testicular tissue. Thus, we recommend the testicular sperm extraction (TESE) procedure for NOA patients.

Testicle hemodynamics in patients after laparoscopic varicocelectomy evaluated using color Doppler sonography.

OBJECTIVES: Testicular blood supply and semen quality were compared in two groups of patients undergoing laparoscopic varicocelectomy: group I (n = 27) with spermatic artery ligation and group II (n = 48) with spermatic artery preservation. METHODS: Laparoscopic varicocelectomy was performed on 75 patients divided on the basis of whether ligation took place during surgery or not. The blood flow parameter (resistance index-RI) measured using color Doppler sonography was the index of vascular efficiency selected. RESULTS: Mean RI was 0.69 in group I and 0.65 in group II. The difference was not significant. Both groups showed improvements in sperm density and motility but there was no significant difference between groups for either parameter. CONCLUSION: Using color Doppler sonography confirms that ligation of the testicular artery during varicocelectomy does not lead to major changes in testicular blood supply or sperm quality.

[Surgical treatment of hydronephrosis]. / K moznostem operacního resení hydronefróz.

The objective of the study was to find the most suitable method of surgery of primary hydronephrosis and congestive horseshoe kidney, based on the authors own experience. The result was the finding that plastic resection operations according to Anderson-Hynes and flap operations in long stenoses and horseshoe kidneys meet the demands which are the prerequisite of favourable therapeutic results.

Familial hydronephrosis unlinked to the HLA complex.

Clinical findings, management, and possible linkage of congenital hydronephrosis caused by ureteropelvic junction stenosis to the HLA complex were studied in four families. These families provide evidence of possible autosomal dominant inheritance. HLA class I antigen studies in all four and class II (HLA-DR) in three families were performed. These studies failed to show close linkage to the chromosome 6 markers in two families but there was consistent inheritance in the other two. Although formal linkage calculations are not presented, it is apparent that in some families HLA haplotyping is not useful in predicting prevence of renal obstruction.

[Personal experience in treatment of urolithiasis using the MEDILIT M6 extracorporeal lithotriptor]. / Nase zkusenosti s lécbou urolitiázy extrakorporálním litotryptorem MEDILIT M6.

The authors report on their experience with the destruction of kidney stones with the lithotriptor MEDELIT M6 of Medipo Co. BRNO on the development of which they participated. They checked 878 patients where the instrument was used and where the condition of a half-year interval after the operation had been met. In these patients 119 operations were made 87% of which were successful. No serious complications occurred; after operation they observed in 17% of the patients complications ensuing from a block of the ureter by the passing stones. The extracorporeal lithotriptor MEDELIT M6 is a reliable instrument with a low rate of defects and cheap operation which makes accurate X-ray and sonographic focusing on the stone possible as well as adequate disintegration of the concrement without damaging surrounding tissues. It is comparable with instruments of the same generation manufactured abroad.

[Transvaginal urethrovesicopexy]. / Príspevek k problematice transvaginální uretrovezikopexe.

The authors present their own modification of Stamey's operation of female stress incontinence. Using a two-needle applicator of their own design, they introduce by transvaginal punction fibres next to the cervix of the bladder into the epigastrium. By tightening the fibres they elevate the cervix of the bladder. The elevation is checked by endoscopy. Using this method they operated 25 women. They did not observe any serious complications of the operation. Previous operations in the pelvis minor did not affect the duration of the operation.

A comparison of various methods for cooling the kidney.

Various methods for achieving preoperative renal hypothermia were tested and evaluated. A kidney immersed in an oil bath solution at 4 degrees C resulted in the highest rate of contact hyperthermia at a determined safe temperature of cooling medium. The acquired basic temperature curve served as a model for the comparison of other methods tested. The results showed that perfusion hypothermia is most rapid but this method is limited by the number and state of the renal arteries and displays all the risks associated with cannulation of arteries. Covering the kidney with crushed ice led to a sufficiently rapid decrease in temperature but lack of regulation carries the danger of renal damage caused by excessive temperature reduction. The disadvantages of these methods were eliminated using a device developed and tested by the authors.

Kidney temperature measurement. Thermistors for temperature measurement.

During a study of the protective effects of cold on kidney cells under conditions of interrupted blood circulation, it was found that attention must be paid to the temperature of kidney tissue in order to prevent cell damage caused by an excessively reduced temperature. The authors correspondingly developed an instrument for the measurement of kidney tissue temperature where thermal sensors located in a needle are able to measure deep temperature in live tissue under conditions of external hypothermia. Thermal sensors were also placed in a hypothermal coil for contact measurement of surface temperature of a cooled kidney and in a duct for supply of cooling medium into a coil. Construction of these devices is described and basic the characteristics of the thermistor and thermocouple sensors for temperature measurement are presented. After evaluation of advantages of the tested sensors, indications regarding their application are given.

A revised instrument for the regulated external cooling of the kidney.

The authors describe the instrument they have developed for the regulated external cooling of the kidney. This consists of a cooling thermostat fitted with a circulating pump, coils of their own construction for the surface cooling of the kidney and equipped with sensors for the measurement of kidney surface temperature, tube connectors, and a sensor for the measurement of the cooling medium temperature. A cooling liquid is supplied by means of a circulating pump from a thermostat through elastic tubes into the flow channels of the cooling coils. The temperature of the coolant is recorded by means of a thermistor sensor built into the system of tubes while the temperature of the kidney surface itself is monitored by a sensor installed in a coil. This permits the regulation of both the rate and depth of temperature reduction in order to prevent possible damage to the kidney caused by excessive temperature reduction. The efficiency and safety of this instrument were verified both experimentally and clinically.

A revised coil for the external cooling of the kidney.

The authors describe a coil they have developed for contact peroperative hypothermia of the kidney. This new type of coil eliminates the disadvantages of existing cooling coils, namely slow thermal transfer from kidney to cooling agent due to imperfect contact between the coil and the concave surface of the kidney, use of an inadequately conductive material and thermal losses from the outer surface of the coil. Special features of the coil described here include its construction to match the contours of the kidney, isolation of external shell to reduce thermal losses and continuous monitoring of renal tissue to reduce the danger of overcooling.

Protection of kidney cell against ischaemic damage by decreased kidney temperature.

At normal body temperature, kidney cells are highly sensitive to hypoxia. However, a bloodless operative field is advantageous in some interventions on the kidney. Kidney cells can be protected against the damage that might occur once blood flow has been interrupted pharmacologically or physically by reducing their temperature. The authors compare several methods for achieving renal hypothermia, including a method based on a device they developed themselves to eliminate defects found in existing equipment. The thermal curve obtained when the kidney is immersed in an oil bath cooled to 5 degrees C served as a model for other methods. Using the revised coil developed by the authors, renal hypothermia was achieved safely and efficiently. A combination of pharmacological and physiological methods is preferrable however in order to potentiate the effect of decreased temperature. This method was tested experimentally and then successfully applied in clinical practice.

The initial experience with doppler diagnosis of scrotum disease abstract.

Blood flow parameters in the scrota of 83 men with acute and chronic infra scrotal disease were compared with values from a sample of 70 healthy controls, using doppler ultrasonography. The results confirm the validity of this method in the diagnoses of scrotum disease when combined with other methods of examination. Technical difficulties are discussed.

Contribution to the clarification of heterogeneous foci within the prostate.

The determination of the nature of heterogeneous foci within the prostate is up till now insufficient. With the help of a standard method using a scanner with a changeable plane of cut and frequency of 7.0 MHz, 292 patients were examined with an enlarged or standard size of prostate and with morphologically proved prostate cancer. A high level of sensitivity and quite a low specification of examinations were found out. To distinguish the kind of heterogeneous foci within the prostate is of decisive importance for the carcinoma diagnostics. In 152 patients, the following characteristics were evaluated: the size, shape and contour of the focus, its localisation, echogenicity and homogeneity of echostructure. 70 patients were examined using a method evaluating the vascularisation of a tumour with CFM and the frequency analysis according to Furier. The results of examinations performed with the help of the above mentioned methods yielded some new experience, however, they did not contribute to the qualitative determination of heterogeneous intracapsular foci within the prostate. Their character can be defined only by punctual or aspirational biopsy.