Interrelationships of cigarette smoking, testicular varicoceles, and seminal fluid indexes.

Data on cigarette smoking, testicular varicoceles, seminal fluid indexes, and oligospermia were examined in 160 young men without known disease and in 94 husbands in infertile couples. The combination of smoking and testicular varicoceles is strongly related to the incidence of oligospermia, defined as sperm count less than or equal to 20 X 10(6)/ml, in each sample. Smokers with testicular varicoceles, in each sample, had a disproportionately high incidence of oligospermia. In the combined sample of 254 men, the smokers with testicular varicoceles had an incidence of oligospermia approximately ten times greater than that in nonsmokers with testicular varicoceles and approximately five times greater than that in men who smoked but were without testicular varicoceles. This relationship of cigarette smoking and testicular varicoceles to oligospermia has not been previously reported. The pathophysiologic basis of the interaction between smoking and varicoceles was theorized to be due to an increased secretion of catecholamines from the adrenal medulla, induced by cigarette smoking. The elevated catecholamine concentrations in the renal vein would then reach the testes via retrograde flow down the internal spermatic vein in men with testicular varicoceles, resulting in seminiferous tubule damage.

Cryoprecipitate coagulum pyelolithotomy.

Coagulum pyelolithotomy is a useful adjunct in the extraction of renal calculi. Unfortunately, a superior coagulum (pooled fibrinogen) is no longer available in the United States. Experience has shown that the better coagula have a high fibrinogen content. A suitable alternate source of fibrinogen is present in cryoprecipitate. Experience with this new coagulum and its use are presented.

Periprostatic abscess. Unusual complication of transurethral prostatectomy.

Many large series analyzing the results and complications of transurethral prostatectomy have failed to mention the occurrence of periprostatic abscess. A case is described which followed perforation of the posterior capsule at the time of transurethral prostatic resection. This complication was successfully managed by transperineal needle aspiration and high-dosage antibiotic therapy.