Treatment of posterior cruciate ligament tibial avulsion by a minimally-invasive open posterior approach.

OBJECTIVE: To assess the surgical technique and report the outcomes following fixation of PCL bony avulsions through mini-invasive posterior knee approach as described by Burks and Schaffer. METHODS: From June 2012 to July 2015, 27 patients enrolled in the study (21 males and 6 females). Fixation of tibial PCL avulsion fractures was done with one or two cannulated screws, or sutures through Burks and Schaffer's approach. The mean interval before surgery was 16days (1-70) .Patients was followed up for an average of 51 weeks. The outcome measures evaluated at final follow-up were (1) clinical stability as assessed by posterior drawer test, (2) radiologic union, (3) functional assessment by Lysholm score, and (4) gastrocnemius muscle strength as a measure of morbidity. RESULTS: Average operative time was 43min. Improvement of both subjective Lysholm score (mean 93) and objective stability testing by posterior drawer test (returns to normal in 81.1% of patients) at the final follow-up. Good radiographic union at average of 5.6 weeks. No morbidity of the gastrocnemius with few complications. CONCLUSIONS: The approach was fast and safe with excellent visualization. It allows surgeons to address other injuries in the same setting. It can be considered as a minimally-invasive open surgery without surgery-related morbidity. It is a reproducible technique that can be done at any trauma centre by surgeons with average experience. The subjective and objective results of the technique are excellent and comparable to the arthroscopic procedures that needs more specific centres with well-trained surgeons.

Single tubule biopsy: a new objective microsurgical advancement for testicular sperm retrieval in patients with nonobstructive azoospermia.

OBJECTIVE: The aim of this study was to measure the diameter of seminiferous tubules (ST) during microdissection testicular sperm extraction (TESE) using a micrometer fixed to one of the eyepieces of the operating microscope to find a correlation between the extracted ST diameter and TESE outcome. DESIGN: A prospective comparative study. SETTING: Adam International Andrology and Infertility Clinic, Giza, Egypt. PATIENT(S): Two hundred sixty-four patients with nonobstructive azoospermia (NOA) were included. INTERVENTION(S): Patients underwent TESE using the open surgical technique. The STs were measured using the micrometer, and the tubule with the largest diameter was excised and freshly examined under an inverted microscope. If no spermatozoa were found, another sample was taken from the second most dilated tubule area and then at random until sperm were found or a maximum six samples were harvested. If no spermatozoa were detected, the contralateral testis was operated upon. MAIN OUTCOME MEASURE(S): The TESE outcome in relation to ST diameter. RESULT(S): The total sperm recovery rate was 105 out of 264 (39.8%). When ST measured >or=300 microm the sperm retrieval rate was 16 out of 19 (84.2%). When ST diameter was <300 microm, the sperm retrieval rate was 36.3% (89 out of 245). CONCLUSION(S): During microdissection TESE, the best cutoff level of the ST diameter for harvesting testicular spermatoza is 110 microm with sensitivity 86.0% and specificity 74.4% (AUC 0.653, 95% confidence interval 0.608-0.663). When ST diameter is 300 microm or more a single tubule biopsy is usually sufficient to harvest enough testicular spermatozoa for intracytoplasmic sperm injection or sperm freezing with minimal tissue excision.

Intracavernosal irrigation by cold saline as a simple method of treating iatrogenic prolonged erection.

AIMS AND METHODS: The aim of this study was to evaluate the efficacy of aspiration and irrigation of the corpora cavernosa with cold saline as a simple outpatient method for treating prolonged penile erection after intracavernous injection of vasoactive agents. RESULTS: Aspiration and irrigation was needed in 70 out of 122 cases with iatrogenic priapism in whom cooling of the penis and perineum failed to achieve detumescence. According to the temperature of the saline used, patients were randomized into four different groups: A, B, C, and D with a saline temperature 10, 15, 20, and 37 degrees C, respectively. MAIN OUTCOME: We used a significantly larger volume of saline in groups C and D compared to group A. On the other hand there was no significant difference in the volume of saline used between groups A and B. Complete detumescence was achieved in 24/25 (96%) of cases in group A compared to 9/15 (60%) of cases in group D. CONCLUSION: We recommend corporal aspiration and irrigation with 10 degrees C saline for patients with prolonged penile erection who failed to respond to the noninvasive measures using ice-cold compresses and physical exercise.