The relationship of angiogenic factors to maternal and neonatal manifestations of early-onset and late-onset preeclampsia.

OBJECTIVE: An imbalance between angiogenic and antiangiogenic factors has been implicated in the pathogenesis and severity of preeclampsia. In this study, we evaluated serum levels of an angiogenic factor and an antiangiogenic factor - placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1), respectively - in pregnant women with preeclampsia, as well as evaluating the impact of those factors on maternal and fetal outcomes. METHOD: We studied 44 pregnant women diagnosed with preeclampsia and admitted to an intensive care unit (ICU). The preeclampsia was classified (by weeks of gestation at delivery) as early-onset (<34 weeks) or late-onset (≥34 weeks). We analyzed serum PlGF and sFlt-1, as well as urinary PlGF at admission to the ICU. RESULTS: In the early-onset preeclampsia group, the sFlt-1/PlGF ratio was higher, as was serum sFlt-1, whereas serum PlGF was lower. Serum sFlt-1 and the sFlt-1/PlGF ratio correlated positively with proteinuria and length of maternal hospital stay and correlated negatively with birth weight. The sFlt-1/PlGF ratio correlated positively with length of newborn stay in the neonatal ICU. CONCLUSION: Angiogenic imbalance is more pronounced in patients with early-onset preeclampsia and correlates with worse clinical outcomes, especially for the neonates.

Trans-scrotal varicocelectomy in adolescents: clinical and surgical outcomes.

BACKGROUND: The gold standard to treat varicocele in adolescents is still under discussion. The aim of this study is to evaluate the role of trans-scrotal varicocelectomy and show the results obtained by using local anesthesia in combination with preoperative sedation. MATERIALS AND METHODS: Between January 2010 and January 2012, this surgical and anesthesiology procedure was proposed to study patients. Inclusion and exclusion criteria were created. Patients received trans-scrotal varicocelectomy with lymphatic and artery sparing technique under local anesthesia with mild sedation anesthesia. Patients were followed for 6 months after surgery, and complications were recorded. RESULTS: Eighteen patients were treated with this technique. Three patients required additional sedation with propofol. None had recurrence of varicocele, and one patient showed post-operative hydrocele. All patients were discharged within 24h following surgery. Three patients used ibuprofen and paracetamol for two days after surgery. CONCLUSIONS: Local anesthesia in the pediatric age group could be used for varicocelectomy with mild sedation anesthesia.

Thromboses of the pampiniform plexi after subinguinal varicocelectomy.

PURPOSE: To present the Authors' experience with spermatic vein thrombosis after varicocelectomy. MATERIALS AND METHODS: The medical charts of patients treated for varicocele at the Authors' Institution between January 2008 and January 2013 were reviewed; inclusion and exclusion criteria were created. Data were analyzed focusing on the clinical diagnosis of spermatic vein thrombosis after varicocelectomy performed using two different techniques. RESULTS: After revision of the medical charts and in compliance with the inclusion criteria previously established, 188 patients underwent varicocelectomy: 112 with laparoscopic technique and 76 patients with subinguinal technique. A total of five cases of spermatic vein thrombosis (2.6%) were diagnosed between 6 and 12 days after surgery. All these patients had received the subinguinal technique (6.5%). All the patients were managed conservatively. DISCUSSION: Spermatic vein thrombosis after surgery is a rare complication but its onset should be considered as a possible event in patients with inguinal and scrotal pain. To manage this condition after diagnosis surgeons may opt for a surgical or clinical approach, either with drugs or local heat, rest and scrotal support.

Relationship between testicular sperm extraction and varicocelectomy in patients with varicocele and nonobstructive azoospermia.

OBJECTIVE: To evaluate the effect of varicocelectomy on sperm retrieval at testicular sperm extraction (TESE) and at spermiograms in patients with nonobstructive azoospermia. MATERIALS AND METHODS: An observational study was conducted from April 2008 to December 2011. The study included men with a clinical diagnosis of nonobstructive azoospermia with a history of clinical unilateral varicocele (only grade III). After providing consent, the patients were treated with 2 different strategies according to the timing of varicocelectomy: group 1, varicocelectomy before microsurgical TESE (3 months); and group 2, varicocelectomy during microsurgical TESE. At 6 months after varicocelectomy, we evaluated the semen analysis findings for all patients. All patients underwent subinguinal microsurgical varicocelectomy. We also evaluated the percentage of sperm retrieval during TESE. RESULTS: During the study period, 35 patients were enrolled. Group 1 included 19 patients and group 2, 16 patients. The sperm retrieval rate during the spermiograms was significantly greater in group 1 (57.8%) than in group 2 (37.5%). The percentage of sperm retrieval during TESE between the 2 groups was significantly greater in group 1 (57.8%) than in group 2 (27%; P <.05). CONCLUSION: Our results have suggested that varicocele repair significantly increases the sperm retrieval rate in patients with clinical varicocele and nonobstructive azoospermia at both TESE and spermiogram.