Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS).

The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (QMAX), while the second group of patients exhibited significant improvement in both PVR and QMAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.

A correlation between selenium and carnitine levels with hypo-osmotic swelling test for sperm membrane in low-grade varicocele patients.

OBJECTIVE: The hypo-osmotic swelling (HOS) test predicts membrane integrity by determining the ability of the sperm membrane to maintain equilibrium between the sperm cell and its environment. The aim of our study was to determine the correlation between selenium and carnitine levels in the seminal fluid with HOS test for sperm membrane in low-grade varicocele patients. PATIENTS AND METHODS: Study numbered 64 examinees who suffered from low-grade varicocele and were divided into two groups, according to fertility potential and HOS test outcome. The study also included a control group of 64 healthy subjects, with no varicocele. RESULTS: From the Shapiro-Wilk's test, it is clear that carnitine distribution differs significantly from normal (0.938, p = 0.03). In distribution of selenium, Kolmogorov-Smirnov test clearly shows statistically significant deviation from the normal curve (z = 0.225, p < 0.000), likewise Shapiro-Wilk's statistic (0.787, p < 0.000). According to the results, the second group had significantly higher levels of carnitine and selenium than the first group of examinees (p < 0.05); therefore, when we compared epididymal markers with HOS tests outcomes, we found significant differences between the two groups. There were no significant differences between second group and healthy subjects (p > 0.05). CONCLUSIONS: HOS test outcome in varicocele patients is directly proportional to the carnitine and selenium levels, which could play a major role in both determining fertility parameters and in the treatment of its impairment. This result is important for sub-clinical varicocele in infertile patients with normal semen analysis, since there is no evidence of benefit from any treatment so far.

Advantages of microsurgical varicocelectomy over conventional techniques.

OBJECTIVE: Varicocelectomy is the only effective method of treating varicocele. Nowdays, many techniques for varicocelectomy include retroperitoneal, inguinal, and subinguinal varicocele repairs with or without magnification and laparoscopic repair. The advantages of the microsurgical approach to varicocele repairs are reliable identification and preservation of the vascular structures. Thus, our aim is to compare the efficiency of microsurgery over conventional techniques of varicocele repairs. PATIENTS AND METHODS: We have evaluated 105 man divided into three groups of 35 patients surgically treated with open varicocelectomy in the first group, microsurgical varicocelectomy in the second, and laparoscopic varicocelectomy in the third group. Sperm test improvement and complications were then compared. RESULTS: The testicular volume shows a significant increase after all three types of surgery, the highest one being after the laparascopic varicocelectomy (14.47 ± 6.76 vs. 21.8 ± 7.52), whereas the lowest increase was recorded in open varicocelectomy (14.90 ± 6.26 vs. 17.46 ± 5.89). Regarding motility of spermatozoids, the highest postoperative increase of values is after microsurgical varicocelectomy (4.30 ± 2.19 vs. 15.88 ± 3.13). CONCLUSIONS: Our study shows the lowest degree of postoperative complications among patients treated with microsurgical varicocelectomy, and the most frequent complications in those treated by open varicocelectomy. Sperm test outcomes after microsurgical varicocelectomy was better than those after other conventional techniques: significantly higher improvement of sperm quality, shoter postsurgical clinical treatment, and the lowest rate of postsurgical complications.