Comparison of Tumor Enucleation and Standard Partial Nephrectomy According to Trifecta Outcomes: A Multicenter Study by the Turkish Academy of Urology, Uro-Oncology Working Group.

INTRODUCTION: We aimed to evaluate the impact of the resection technique (tumor enucleation (TE) or standard partial nephrectomy (SPN)) on trifecta outcomes in patients having undergone partial nephrectomy (PN). MATERIALS AND METHODS: We retrospectively analyzed the clinical and pathologic parameters in patients with localized renal cell carcinoma (pT1-2N0M0) who had undergone PN between January 2001-December 2018 at one of 15 different tertiary referral centers. Multivariable logistic regression analysis was applied to investigate independent predictors of trifecta failure, decreased postoperative renal functions (decreased estimated glomerular filtration rate (eGFR) > 10%), perioperative complications (Clavien-Dindo > 1), and positive surgical margins. RESULTS: A total of 1070 patients with a mean age 56.11 ± 11.88 years were included in our study. PN was performed with TE in 848 (79.25%) and SPN in 222 (20.75%) patients. Trifecta failure rate was 56.2% for TE and 64.4% for SPN (p = 0.028). On multivariable analysis, TE was associated with less trifecta failure (p = 0.025) and eGFR decrease >10% rates (p = 0.024). On the other hand, there was no statistically significant difference between TE and SPN according to positive surgical margins (p = 0.450) and complication > Clavien-Dindo grade 1 (p = 0.888) rates. The only independent predictive factor for complications > Clavien-Dindo 1 was the Charlson comorbidity index (CCI) (p = 0.001). CONCLUSION: TE is associated with less trifecta failure than SPN. This result is mainly due to better preservation of renal function with TE.

Analysis of factors affecting repeat microdissection testicular sperm extraction outcomes in infertile men.

OBJECTIVE: There is no clear consensus on which patients and how many of microscopic testicular sperm extraction (mTESE) procedures will be successful. In this study, we aimed to evaluate the sperm retrieval rates and factors affecting these rates in men who underwent repeat mTESEs. MATERIAL AND METHODS: A total of 346 patients who underwent mTESE for sperm retrieval were included in the study. Patients were divided into groups according to the number of mTESE operations. Patients' karyotype, follicle-stimulating hormone (FSH) and testosterone levels, varicocele presence, and testis volumes were recorded from patient files. The sperm retrieval rates were compared between groups, and predicting factors for successful sperm retrieval were evaluated. RESULTS: Microscopic TESE was applied for the first time in 244 patients, 1-2 times in 73 patients, and 3-4 times in 29 patients. There was a significant difference between groups in preoperative FSH values and postoperative testicular histopathology (p=0.004 and p<0.001). The sperm retrieval rate in the group of patients who had not undergone previous TESE was higher than the group of patients that had undergone TESE for 1-2 times and 3-4 times (p=0.028). In addition, testicular volume, histology, karyotype, and Y-chromosome microdeletion were predicting factors for successful sperm retrieval (p=0.011, p=0.039, p=0.002, and p<0.001, respectively). CONCLUSION: Our results confirm the necessity for repeat mTESE operations to be performed by experienced surgeons in reference centers to optimize the chance of reduced sperm retrieval rates with recurrent biopsies.

Comparison of long-term outcomes of laparoscopic and robot-assisted laparoscopic partial nephrectomy.

In this study, we compared the long-term oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) and robot-assisted laparoscopic partial nephrectomy (RAPN) performed in the treatment of renal tumors. The data of 142 patients (RAPN = 71, LPN = 71) were evaluated. Demographic data, perioperative and postoperative outcomes, long-term (5-year) overall survival (OS) and cancer-specific survival (CSS) rates of the patients were compared between the two groups. A P value of less than 0.05 was considered statistically significant. The mean follow-up time was 61.38 months. There were more complex tumors in the RAPN group (P = 0.014). The duration of warm ischemia time (WIT) was shorter in the RAPN group (P = 0.019). Perioperative and postoperative outcomes were similar. There were no differences between the groups in terms of 5-year metastasis-free survival, OS, and CSS rates. Hypertension, diabetes, and preoperative estimated glomerular filtration rate (eGFR) were the predictive factors for renal insufficiency; and preoperative eGFR, WIT, and positive surgical margin were the predictive factors for 5-year CSS. We concluded that RAPN is an important minimally invasive treatment method for partial nephrectomy with long-term favorable results, especially in complex tumors. Comparisons of two methods should be made with comparative, prospective, randomized, high case number studies, and the place of RAPN in the treatment of these tumors should be clarified.

The effect of percutaneous nephrostomy implementation on the outcome of ureteroscopic stone treatment.

PURPOSE: We aimed to investigate the effect of percutaneous nephrostomy (PCN) implementation on the second ureteroscopy (URS) outcomes after a failed URS. MATERIALS AND METHODS: The data of four hundred forty-eight patients with an unsuccessful URS history were evaluated. Patients were divided into two groups; patients who underwent PCN before second URS (Group A) and patients who did not (Group B). We compared the stone access rate in the second URS between the two groups according to patient and stone characteristics and operative data. Then, group A was subdivided into two groups according to stone access as; access succeeded (Group A1) and access failed (Group A2). We also compared stone access rates between these two groups in terms of gender, age, body mass index, stone size, side, location, grade of hydronephrosis and PCN duration.  All data were available immediately after surgery and obtained from patient files and the outcome assessment was performed during the study period. RESULTS: Stone access rate was higher in group A than group B (143/196 vs 41/252, P = .0018). Mean nephrostomy duration and mean hydronephrosis grade were significantly higher and mean stone size was significantly lower in group A1 than group A2 (18.74 vs 9.62 days, P < .001; grade 3.25 vs 1.21, P = .038; and 7.286 vs 12.631 mm P < .001, respectively). CONCLUSION: PCN is a favourable intervention after a failed URS and increases the success rate of the second operation with ease of implementation and minimal morbidity.

Do body mass index, hormone profile and testicular volume effect sperm retrieval rates of microsurgical sperm extraction in the patients with nonobstructive azoospermia?

OBJECTIVE: We aimed to evaluate the effect of body mass index (BMI), follicle stimulating hormone (FSH), and luteinizing hormone (LH) levels and the mean testicular volume on sperm retrieval rates in microsurgical sperm extraction (microTESE) in the patients with nonobstructive azoospermia (NOA). MATERIAL AND METHODS: The data of 282 infertile patients with NOA were analysed retrospectively. The patients with normal karyotype and no Y microdeletions were included in the study. The patients were classified according to their BMI scores and the medical history, physical examination and hormonal parameters were evaluated. The overall data were processed statistically with chi-square and logistic regression analysis and the relation between preoperative findings and sperm retrieval rates was investigated. RESULTS: The sperm retrieval rate of 282 patients after microTESE was found as 41.1%. There was no statistically significant difference in sperm retrieval rates among the subgroups classified according to BMI. FSH and LH levels and the mean testicular volume and pathologic findings were significantly correlated with sperm retrieval rates. CONCLUSION: Finally significant correlation was determined between sperm retrieval rates and FSH, and LH levels and testicular volumes but no statistically significant difference was found in sperm retrieval rates among BMI groups.

Comparison of percutaneous nephrostomy and double J stent in symptomatic pregnancy hydronephrosis treatment

Background/aim: We aimed to compare the success rate of percutaneous nephrostomy (PCN) and double J stenting (DJS) in the treatment of symptomatic pregnancy hydronephrosis. Materials and methods: Diagnosis and grading of hydronephrosis were performed by urinary ultrasound (USG) and Doppler mode was used for evaluation of renal arterial resistivity index (RI). Patients were divided into two groups according to the method used for the treatment of hydronephrosis: group A (PCN, n = 38) and group B (DJS, n = 46). A P value < 0.05 was considered significant. Results: The number of patients requiring second intervention was higher in group B (P = 0.0018) and time to secondary intervention was significantly earlier in group B also (P = 0.0025). The number of tertiary intervention was again higher in group B (5/16 vs. 1/6) and the need for tertiary intervention was higher in patients who underwent DJS implantation as a secondary intervention than those who underwent PCN (5/11 vs. 1/11, P = 0.0012). The time to tertiary intervention was longer in patients with PCN than in those with DJS (P = 0.0048). Conclusion: PCN may be preferred to DJS in symptomatic pregnancy hydronephrosis because it requires fewer re-interventions after longer times.

The relationship between lipoprotein-associated phospholipase A2 with cardiovascular risk factors in testosterone deficiency.

OBJECTIVE: Lipoprotein-associated phospholipase A2 (Lp-PLA2) which is believed to play a role in atherosclerotic inflammatory process due to its function in hydrolysis of phospholipids and release of pro-inflammatory products, is considered as a novel biomarker for vascular risk. In this study we aimed to investigate the alterations in Lp-PLA2 and its relationship with other cardiovascular risk factors in patients with testosterone deficiency. MATERIAL AND METHODS: Forty hypogonadic male and 30 healthy male aged between 18-50 years were enrolled in this study. Height-weight, waist-to-hip circumference, body mass index (BMI) blood pressure, and body fat measurements were performed in all subjects. Blood glucose, albumin, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, high sensitive C-reactive protein (hs-CRP), apo-A1, apo-B, fibrinogen, insulin, total testosterone, sex hormone binding globulin (SHBG), small dense low-density lipoprotein (sd-LDL), paraoxonase 1, oxidized low-density lipoprotein (ox-LDL) and Lp-PLA 2 values were measured. Free and bioavailable testosterone levels were calculated. Data management was carried out with the statistical program SAS Version 9.2. Statistical evaluations were performed using Analysis of Variance (ANOVA), Kruskal-Wallis test, Wilcoxon test, correlation analysis and chi-square analysis. P values <0.05 were considered statistically significant. RESULTS: In patients with hypogonadism, significant increase in Lp-PLA2 levels were accompanied with risk factors of atherosclerosis, such as increase in total cholesterol, apo-B, sd-LDL, weight, BMI, body fat percentage, and decrease in paraoxonase 1 levels. Although the differences were not significant, similarly ox-LDL, hs-CRP, triglyceride, LDL-cholesterol levels were found to be higher in patients with hypogonadism compared to the control group. The mean level of Lp-PLA2 was the highest when compared with the group of secondary hypogonadism with the lowest testosterone level. CONLUSION: Our study has demonstrated that the testosterone deficiency increases cardiovascular risk via its effects on lipid metabolism and Lp-PLA2 can be used to assess this risk.

Relationship between erectile dysfunction and silent coronary artery disease: detection with multidetector computed tomography coronary angiography.

AIM: Our aim was to determine the relationship between erectile dysfunction (ED) and silent coronary artery disease (CAD) by multidetector computed tomography (MDCT) coronary angiography. METHODS: Thirty consecutive men with nonhormonal and nonpsychogenic ED and with no cardiac symptoms were evaluated. Medical history, physical examination and laboratory investigation were performed. The five-item brief form of the International Index of Erectile Function (IIEF-5) was performed for evaluation of ED. The Agatston score (AS) was determined from MDCT images under beta blockade to induce bradycardia. The MDCT coronary angiography findings were evaluated by two radiologists blinded to the clinical findings. Patients were classified into three categories (mild, moderate and severe ED) according to IIEF-5 scores and into five categories (very low, low, moderate, moderately high and high CAD risk) according to the AS. RESULTS: Mean age was 58.3 ± 8.7 years (46-79). 6 patients had hypertriglyceridemia, 4 had hypercholesterolemia and 4 had hyperglycemia. All patients had normal early morning testosterone levels. Regarding IIEF-5 scores, none of them had mild ED, 14 had moderate ED and 16 had severe ED. Of the 14 patients with moderate ED, 21.4% had low and 28.5% had moderate CAD risk regarding AS. Of the 16 patients with severe ED, 25% had moderate, 31.2% had moderately high and 25% had high CAD risk regarding AS. Increasing age was a risk factor for high AS (p = 0.045). There was a significant correlation between AS and ED severity (p = 0.01). CONCLUSIONS: ED and CAD often coexist. MDCT coronary angiography can detect coronary lesions and allow appropriate medical intervention.

Identification of Y chromosome microdeletions in infertile Turkish men.

OBJECTIVE: The aim of this study was to determine the frequencies of Y chromosome microdeletions in infertile azoospermic and oligozoospermic Turkish men and in healthy control subjects. MATERIAL AND METHODS: Sixty-four azoospermic and 51 oligozoospermic patients infertile patients, and 70 healthy men who had a child without the aid of assisted reproductive technologies were included in this study. DNA was extracted from peripheral blood samples collected from the patients. Following multiplex PCR performed with 15 different primer sequences, Y chromosome AZFa, AZFb, AZFc and AZFd region microdeletions were determined by agarose gel electrophoresis. RESULTS: Y chromosome microdeletions were detected in 8 (12.5%) patients in the azoospermia group and 3 (5.9%) patients in the oligozoospermia group. The overall frequency of Y chromosome microdeletions in all infertile cases was 9.6%. Y chromosome microdeletions were not found in the healthy control group. Among the infertile cases, there were 4 (3.48%) AZFa, 2 (1.74%) AZFb, 3 (2.61%) AZFc and 7 (6.09%) AZFd region microdeletions. Y chromosome microdeletions were not found among healthy men in the control group. CONCLUSION: The presence of Y chromosome microdeletions among azoospermic and oligozoospermic infertile males suggests that routine genetic testing and genetic counseling prior to the use of assisted reproduction techniques are necessary.

Biochemical recurrence after radical prostatectomy: is the disease or the surgeon to blame?

PURPOSE: The PSA recurrence develops in 27 to 53% within ten years after radical prostatectomy (RP). We investigated the factors (disease grade and stage or the surgeon's expertise,) more likely to influence biochemical recurrence in men post-radical prostatectomy for organ-confined prostate cancer by different surgeons in the same institution. MATERIALS AND METHODS: A total of 510 patients that underwent radical prostatectomy were investigated retrospectively. Biochemical recurrence was defined as detection of a PSA level of ≥ 0.20 ng/mL by two subsequent measurements. The causes, which are likely to influence the development of PSA recurrence, were separated into two groups as those related to the disease and those related to the surgical technique. RESULTS: Biochemical recurrence was detected in 23.5% (120 cases) of 510 cases. The parameters most likely to influence biochemical recurrence were: PSA level (p < 0.0001), T stage (p < 0.0001), the presence of extracapsular invasion prostate (p < 0.0001), Gleason scores (p = 0.042, p < 0.0001) and the presence of biopsy with perineural invasion (p = 0.03). The only surgical factor that demonstrated relevance was inadvertent capsular incision during the surgery that influenced the PSA recurrence (p < 0.0001). CONCLUSION: The PSA recurrence was detected in 21.6% of patients who had been treated with radical prostatectomy within 5 years, which indicates that the parameters related to the disease and the patient have a pivotal role in the PSA recurrence.

Biochemical recurrence after radical prostatectomy: is the disease or the surgeon to blame?

PURPOSE: The PSA recurrence develops in 27 to 53 percent within ten years after radical prostatectomy (RP). We investigated the factors (disease grade and stage or the surgeon's expertise,) more likely to influence biochemical recurrence in men post-radical prostatectomy for organ-confined prostate cancer by different surgeons in the same institution. MATERIALS AND METHODS: A total of 510 patients that underwent radical prostatectomy were investigated retrospectively. Biochemical recurrence was defined as detection of a PSA level of > 0.20 ng/mL by two subsequent measurements. The causes, which are likely to influence the development of PSA recurrence, were separated into two groups as those related to the disease and those related to the surgical technique. RESULTS: Biochemical recurrence was detected in 23.5 percent (120 cases) of 510 cases. The parameters most likely to influence biochemical recurrence were: PSA level (p < 0.0001), T stage (p < 0.0001), the presence of extracapsular invasion prostate (p < 0.0001), Gleason scores (p = 0.042, p < 0.0001) and the presence of biopsy with perineural invasion (p = 0.03). The only surgical factor that demonstrated relevance was inadvertent capsular incision during the surgery that influenced the PSA recurrence (p < 0.0001). CONCLUSION: The PSA recurrence was detected in 21.6 percent of patients who had been treated with radical prostatectomy within 5 years, which indicates that the parameters related to the disease and the patient have a pivotal role in the PSA recurrence.

The comparison of premature ejaculation assessment questionnaires and their sensitivity for the four premature ejaculation syndromes: results from the Turkish society of andrology sexual health survey.

INTRODUCTION: In addition to the previously defined "lifelong" and "acquired" premature ejaculation (PE), the existence of two more subtypes of PE, namely "natural variable PE" and "premature-like ejaculatory dysfunction," has been proposed. AIMS: To evaluate the diagnostic value of the Premature Ejaculation Diagnostic Tool (PEDT) and Arabic Index of Premature Ejaculation (AIPE) in a population-based study, in relation to their sensitivity across these four different PE syndromes and to assess the Premature Ejaculation Profile (PEP) scores of patients with lifelong, acquired, natural variable PE and premature-like ejaculatory dysfunction. METHODS: Between June 2009 and December 2009, couples were randomly selected from 17 provinces of Turkey. Subjects with the complaint of ejaculating prematurely were classified as lifelong, acquired, natural variable PE, and premature-like ejaculatory dysfunction according to the medical and sexual history they described. PE status was also assessed with PEDT, AIPE and PEP. The sensitivity, specificity, positive predictive value and negative predictive value were calculated for PEDT and AIPE in the study population whereas detection rates of these two questionnaires were also compared among the four PE syndromes. Moreover, PEP scores of patients with lifelong, acquired, natural variable PE and premature-like ejaculatory dysfunction were compared. Significance level was considered as P < 0.05. MAIN OUTCOME MEASURES: Scores obtained from PEDT, AIPE, and PEP questionnaires. RESULTS: A total of 2,593 couples were enrolled where 512 (20.0%) male subjects reported PE. PEDT, AIPE, and PEP measures of the PE patients indicated worse sexual function (P < 0.001 each). Mean scores obtained from questionnaires were significantly better in patients with premature-like ejaculatory dysfunction and they were the worst in patients with acquired PE (P < 0.001 each). The sensitivity values of PEDT and AIPE were 89.3 and 89.5, whereas their specificity values were 50.5 and 39.1, respectively. There were statistically significant differences in detection rates of PEDT and AIPE among the four PE syndromes (P = 0.006 and P < 0.001). They were higher in acquired and lifelong PE and lower in premature-like ejaculatory dysfunction. CONCLUSION: PEDT and AIPE can diagnose PE with high sensitivity, especially in patients with lifelong and acquired PE. The complaint of patients with acquired PE seems to be more severe than those complaining of lifelong, natural variable PE and premature-like ejaculatory dysfunction patients.

Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes: results from the Turkish Society of Andrology Sexual Health Survey.

INTRODUCTION: In addition to the previously known lifelong and acquired premature ejaculation (PE) syndromes, the existence of two more PE syndromes has been suggested: natural variable PE and premature-like ejaculatory dysfunction. However, epidemiological studies investigating the prevalence of these four PE syndromes have yet to be conducted. AIM: To determine the prevalence of the complaint of ejaculating prematurely across the four PE syndromes. METHODS: This study, conducted between June 2009 and December 2009, was designed as a non-interventional, observational cross-sectional field survey. Participating couples were randomly selected from 17 provinces of Turkey. All participants were asked to complete a questionnaire including data regarding demographics, socioeconomic status, social and cultural factors, medical and sexual history, current medications, and ejaculation time. Subjects with a complaint of ejaculating prematurely were classified as lifelong, acquired, and natural variable PE, or premature-like ejaculatory dysfunction. MAIN OUTCOME MEASURES: The main outcome measures were prevalence of complaint of ejaculating prematurely in the general population and across the four PE syndromes. RESULTS: A total of 2,593 couples (mean age, 41.9±12.7 years for males and 38.2±12.1 years for females) were enrolled. Five-hundred twelve subjects (20.0%) complained of ejaculating prematurely. Fifty-eight (2.3%), 100 (3.9%), 215 (8.5%), and 131 (5.1%) subjects were classified as lifelong, acquired, and natural variable PE, and premature-like ejaculatory dysfunction, respectively. CONCLUSIONS: The prevalence of the complaint of ejaculating prematurely among Turkish men was 20.0%, with the highest PE syndrome being natural variable PE (8.5%) and premature-like ejaculatory dysfunction (5.1%).

Determination of nitric oxide synthase activity and apoptosis of germ cells in different obstruction models.

We aimed to determine the changes of inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) immunoreactivity and apoptosis after proximal and distal obstruction models on ipsilateral and contralateral testicular tissues. Male albino Wistar rats were randomly divided into three groups (n=30): a control group which underwent sham operations (n=10), a unilateral vasal ligation (n=10) and a unilateral epididymal ligation group (n=10). iNOS and eNOS distribution and apoptosis were studied in both ipsilateral and contralateral testes using quantitative immunohistochemistry. Nitric oxide synthase activity was significantly affected in ipsilateral and contralateral testes cells after vasal and epididymal ligation. eNOS immunoreactivity increased markedly after ipsilateral vasal ligation (ILVL). Degeneration-related changes were also associated with changes in apoptotic rate. Analysis using the terminal dUTP nick end-labeling TUNEL method revealed that apoptotic cell numbers significantly increased after ILVL. p53 and bcl-2 immunoreactivity increased in both experimental groups compared with the sham-operated group. Changes in iNOS and eNOS immunolocalisation were strongly associated with cell damage, because germ cell degeneration was more prominent in the ILVL group. Altered p53 immunolocalisation was also associated with cell degeneration, and a rise in bcl-2 immunoreactivity might be considered to reflect a protective mechanism in the testis. These cellular changes could enlighten understanding of the interaction between testicular functioning and damage.

Immunohistochemical expression of connexin 43 and occludin in the rat testis after epididymal and vasal ligation.

OBJECTIVE: To describe the effects of epididymal and vasal ligation, in an experimental rat model, by using connexin 43 and occludin immunohistochemistry as well as transmission electron microscopy. DESIGN: Comparative and controlled experimental research study. SETTING: University animal research and histology laboratories in Turkey. ANIMAL(S): Wistar male rats in experimental and control groups. INTERVENTION(S): The control group underwent sham operation (n = 7). The first experimental group (n = 7) underwent unilateral epididymal ligation, whereas the second experimental group (n = 7) underwent unilateral vasal ligation to induce experimental epididymal and vasal obstruction models, respectively. All animals were then killed at 90 days. MAIN OUTCOME MEASURE(S): Immunohistochemical expression of connexin 43 and occludin for testicular tissues was determined after epididymal and vasal obstruction models. Ultrastructural morphological changes were examined by electron microscopy. RESULT(S): Results of the semiquantitative analysis revealed that expressions of both occludin and connexin 43 in the rat testis were decreased in the experimental groups compared with in the sham-operated group. However, changes after vasal ligation were more prominent. Ultrastructural examination confirmed decreased intercellular communication as well as increased cellular degeneration among the ipsilateral and contralateral testicular tissues. CONCLUSION(S): Immunohistochemical expression of occludin and connexin 43 were decreased in the testis after vasal and epididymal ligation when compared with the sham-operated group. Ultrastructural changes indicating cell degeneration were more prominent after vasal ligation.

Comparative study of extracorporeal shock wave lithotripsy outcomes for proximal and distal ureteric stones.

OBJECTIVE: To assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated proximal ureteral calculi and compare it to that for isolated distal calculi. PATIENT AND METHODS: We treated 68 patients with isolated ureteral stones using MPL 9000. Stones were located in the proximal and distal ureters in 44 and 24 patients, respectively. Patients were stratified according to stone burden and degree of obstruction. Data of all patients were prospectively collected for stone burden, stone localization, number of sessions, number of shock waves, stone-free rates (SFRs), complications, re-treatment rates and auxiliary procedures. Outcomes regarding ureteral localization were compared. RESULTS: The overall SFR was 85.3% with a 41.2% re-treatment and 17.6% auxiliary procedure rate. The mean number of shock waves applied for each stone was not different among the two ureteral locations. The SFRs were 86.3% and 79.1% for proximal and distal ureteral stones, respectively (P=0.17). For the group with stones <100 mm(2), the SFR was 85.4% and 89.5% for the proximal and distal ureter, respectively. Although the degree of obstruction did not affect SFR of the entire group (P=0.12) and the proximal ureter group (P=0.96), it adversely affected SFR in the distal ureter (P=0.017). CONCLUSIONS: ESWL outcomes for the ureteral calculi support the use of lithotripsy particularly for stones <100 mm(2). Treatment efficacy was not significantly different among stones localized in proximal and distal ureters. Degree of obstruction did not affect the ESWL outcomes in the proximal ureter, but it adversely affected SFR in the distal ureter.

Streptozotocin-induced diabetic effects on spermatogenesis with proliferative cell nuclear antigen immunostaining of adult rat testis.

OBJECTIVE: To examine the histopathological effects of diabetes on spermatogenesis and to detect the proliferation of germ cells with proliferative cell nuclear antigen (PCNA). DESIGN: Controlled experimental study. SETTING: The animal laboratory of the Experimental Surgery Center of Ege University, Izmir, Turkey. ANIMAL(S): Ten nondiabetic (control) and 20 diabetic adult male albino rats. INTERVENTION(S): The rats were IP injected with 40 mg/kg streptozotocin for 5 days to create a diabetic condition that was confirmed by testing blood glucose levels 5-7 days after the first injection. MAIN OUTCOME MEASURE(S): Mean testicular diameter, mean semniferous tubuli diameter (MSTD), and PCNA index. RESULT(S): Six weeks after the streptozotocin injection, both the mean testicular and the seminiferous tubuli diameters were significantly decreased in diabetic rats compared with the control group. CONCLUSION(S): The effects of diabetes on spermatogenesis can be clearly detected as a decrease in testicular diameter, MSTD, and PCNA index.

The effects of female age on the outcome of testicular sperm extraction and intracytoplasmic sperm injection in infertile patients with azoospermia.

INTRODUCTION: Testicular sperm extraction (TESE) is well-defined procedure for surgical sperm retrieval in obstructive and non-obstructive azoospermia. This study was focused on the effectiveness of testicular sperm extraction and intracytoplasmic sperm injection (ICSI) for azoospermic men with different female age subgroups. MATERIALS AND METHODS: A total of 107 men with azoospermia underwent TESE and ICSI treatment. The women were examined in three groups 20-29, 30-34 and 35 years or older. The main outcome in this study was fertilization and pregnancy rates with TESE and ICSI. RESULTS: Spermatozoa were successfully retrieved during 97 of 107 (90.7%) TESE attempts, resulting in the fertilization of 286 of 563 (50.4%) injected metaphase II oocytes. Two hundred and fifty-five of them were transferred (89.8%). The clinical pregnancy rate and ongoing pregnancy rate per embryo transfer were 22.5% and 20.6% respectively. When comparing the fertilization and pregnancy rates, it was observed that women between the ages of 20-29 years had significantly higher pregnancy rates than women over 34 years of age (p < 0.05). CONCLUSION: The female age is a major factor in determining successful implantation in ICSI.