Comparison of semen profile and frequency of chromosome aneuploidies in sperm nuclei of patients with varicocele before and after varicocelectomy.

Semen profile and meiotic segregation products are important for assessing aneuploidy risk and risk of resulting infertility. To determine the effect of varicocelectomy on semen profile and aneuploidy frequency, we investigated semen profile and aneuploidy frequency of selected chromosomes in patients with varicocele before and after varicocelectomy. Chromosomal aneuploidy for selected chromosomes was evaluated using chromosome-specific DNA fluorescence in situ hybridisation (FISH) probes. There was a significant difference in the level of normal sperm morphology before and after varicocelectomy (P > 0.007). There were no significant differences in aneuploidy frequency of chromosomes 1, 16, 17 and 18 in sperm nuclei obtained from patients before varicocelectomy compared with 6-7 months after varicocelectomy (P > 0.05), although FISH analysis with chromosomes 17 and 18 combination showed a higher aneuploidy frequency before varicocelectomy than after varicocelectomy (7.81 +/- 9.67 versus 4.03 +/- 1.46 respectively). In conclusion, varicocele seems to affect the semen profile but minimally affects aneuploidy frequency. Varicocelectomy demonstrates a repairing effect on the semen profile and contributes to a slight decrease in aneuploidy frequency in some but not all chromosomes.

Use of a laser to detect viable but immotile spermatozoa.

A prerequisite for the success of intracytoplasmic sperm injection (ICSI) is the use of viable sperm that will support oocyte activation and embryo development. Usually, spermatozoa are selected according to motility, which is a clear indication for viability. However, in cases with complete asthenozoospermia, it is impossible to select viable sperm by morphological means. Here we report for the first time on the use of a laser to discriminate between viable and dead immotile spermatozoa. The application of a single laser shot to the far end of the sperm tail causes a curling of the sperm tail only in viable sperm, similar to the reaction observed in the hypo-osmotic swelling test. Using this method for sperm selection prior to ICSI we achieved high fertilization and cleavage rates in cases with immotile sperm in fresh testicular biopsy material as well in cases with ejaculated immotile sperm. It is concluded that laser sperm interaction allows for the identification of viable but immotile spermatozoa.

Epididymo-orchitis as a complication of brucellosis.

A study of 84 patients who were diagnosed with epididymo-orchitis between July 1987 and September 1993 is presented. Brucellosis was a complication in 14 cases (17%). All 14 cases had elevated agglutination titers. Brucella blood culture was found to be positive in 4 of 14 cases (28.5%). Standard therapy regime (streptomycin plus tetracycline) was effective in 13 of 14 (93%) cases.

Intravesical mitoxantrone for superficial bladder tumors.

Thirty-five patients (33 males, median age 58) with stage T alpha (21 patients) or T1, grade 1 (17 patients) or grade 2 superficial bladder carcinoma, were treated with transurethral resection (TUR) followed by intravesical prophylactic therapy with 10 mg mitoxantrone administered weekly for 6 weeks and then monthly for 10 months. Twenty-five patients were newly diagnosed and 10 had relapsed after previous therapy. Diagnosis was confirmed with cytology and biopsy. The aim of the study was to evaluate the prophylactic effect (relapse rate, disease free interval) and toxicity of intravesical mitoxantrone in superficial bladder carcinoma. Relapses were established with biopsy. After a mean period of 12 months follow-up (median 8.3 months), 63% of patients in the whole group, 72% in the newly diagnosed group and 40% in the group of previously relapsed patients remained relapse free. These rates compare very favorably with the most effective prophylactic agents available. At the end of the follow-up period the median disease-free survival for the whole group was not reached. Therapy was well tolerated with no systemic toxicity and 14 patients reporting grade 1-2 local toxicity. In no patient was treatment discontinued due to toxicity. Mitoxantrone is an effective and safe agent for the post-TUR adjuvant intravesical therapy.

Selection of patients for intravesical therapy for superficial bladder cancer.

In a nonrandomized retrospective study, 133 patients with superficial transitional cell carcinoma of the bladder were evaluated to identify any clinical prognostic features which indicate the necessity of intravesical therapy (IVT). The risk factors taken into account were stage, grade and multiplicity of the tumour. All patients were treated initially by complete transurethral resection (TUR); 27 patients received no further treatment after resection of the tumour, 106 patients received adjuvant IVT over a period of 6 weeks. The mean follow-up was 23 and 18.8 months in the TUR-only group and TUR+IVT group, respectively. In the TUR-only group 7 and in the TUR+IVT group 29 recurrences were encountered. Patient group with no risk factors (Ta, GI, solitary tumour) or with only one risk factor revealed no statistical difference in terms of the recurrence rate from the identical control group. So it does not seem worthwhile to give additional therapy in the low-risk group. Another notable outcome of this study was that the higher the potential risk factors, the higher the likelihood of recurrence. The results suggest that T1 tumours, multifocal tumours, and high-grade tumours have poor prognosis, making additional treatment necessary.

Treatment of renal stones in a solitary functioning kidney with extracorporeal shock wave lithotripsy.

Forty extracorporeal shock wave lithotripsy (ESWL) sessions were performed in the treatment of 36 stones in 22 solitary functioning kidneys between October 1990 and October 1991. We inserted a double-J catheter in all patients preoperatively and no serious obstruction such as stone street formation was observed after treatments. Following ESWL therapy, at the end of 3 months follow-up, 14 patients (63.6%) were completely stone free while in 5 patients ESWL therapy was unsuccessful. ESWL became the treatment of choice for stones in solitary kidneys as a result of its highly effective, safe and encouraging outcome.

A rare scrotal mass: fibrous pseudotumor of epididymis.

Fibrous pseudotumor, also called multiple fibromata pseudofibromatous periorchitis, is a rare testicular fibromatous condition. It is a benign fibroproliferative lesion with dense hyalinization and sometimes focal calcification. Most of the cases occur in the testicular tunics, whereas a few originate from the epididymis.