Sperm concentration and semen volume increase after smoking cessation in infertile men.

Smoking has negative reproductive consequences. This study investigated the effect of smoking cessation on the main semen parameters. We included 90 participants who applied to our infertility clinic and smoked at least 20 cigarettes a day for at least 1 year. Of the 90 participants, 48 were in the study group and 42 were in the control group. Semen analysis was performed before and at least 3 months after quitting smoking in the study group. Semen analysis was repeated at baseline and at least 3 months later in the control group. Semen parameters such as volume, sperm concentration, total sperm count, morphology, and motility were evaluated according to the World Health Organization criteria. Patient characteristics as well as the duration of the smoking period, the number of cigarettes smoked per day and the time elapsed since smoking cessation were recorded. The mean age of the participants was 34.69 ± 5.3 years, and the duration of infertility was 34.12 ± 12.1 months (n = 90). The number of cigarettes smoked per day was 30.14 ± 6.69, and the smoking time was 8.31 ± 3.53 years. The average time to quit smoking was 104.2 ± 11.51 days (n = 48). A significant increase in semen volume, sperm concentration and total sperm count was observed 3 months after smoking cessation (2.48 ± 0.79 ml vs. 2.90 ± 0.77 ml, p = 0.002; 18.45 × 106/ml ± 8.56 vs. 22.64 × 106/ml ± 11.69, p = 0.001; 45.04 ± 24.38 × 106 vs. 65.1 ± 34.9 × 106, p < 0.001, respectively). This study showed that smoking cessation had a positive effect on sperm concentration, semen volume, and total sperm count. Although smoking cessation contributed positively to sperm motility and morphology, the difference was not statistically significant.

The impact of tumor invasion to muscularis mucosaevascular plexus on patient outcome in pT1 bladder urothelial carcinoma.

OBJECTIVES: T1 bladder cancer has a wide range of tumor behavior and lamina propria invasion depth has a high potential risk of disease progression. To evaluate the patient outcome according to the tumor invasion to the muscularis mucosae-vascular plexus (MM-VP) in pT1 bladder urothelial carcinoma (BUC). MATERIALS AND METHODS: This study is a retrospective analysis of patients consecutively recorded from 2007 to 2013. A total of 93 patients with a history of primary pT1 BUC and complete follow-up were included. We used a pathological substaging system according to the tumor invasion regarding the MM-VP: pT1a (invasion above MM-VP) and pT1b (MM-VP invasion). We evaluated recurrence-free survival (RFS), progression- free survival (PFS), disease-specific-survival (DSS) based on this sub-staging system. RESULTS: Pathological evaluation regarding the MM-VP invasion revealed 53 patients (57%) as pT1a BUC and 40 patients (43%) as pT1b BUC. The mean follow-up was 78.8 months. During the follow-up period; 60 patients (64.5%) had tumor recurrences, 32 patients (34.4%) had progression to invasive disease, 18 patients (19.4 %) died during follow-up related to the BUC. In 29 (54.7%) of pT1a and in 31(77.5%) of pT1b tumors, the recurrent disease was recorded during the followup period (p = 0.023). DSS rates at 5 years for pT1a and pT1b were 80.2% and 60.8%, respectively. PFS, RFS, and DSS rates were similar for pT1a/pT1b and did not reach statistical significance (p > 0.05). CONCLUSIONS: Sub-staging of pT1 BUC according to the MM-VP invasion showed a limited impact on the outcome in our patient cohort. However, the presence of pT1b disease caused a significantly higher rate of recurrence.

Do success rate, complications of transobturator tape procedure differ based on experienced surgeon or residents? / ¿Son diferentes las tasas de éxito y complicaciones de la malla transobturatriz entre cirujanos expertos y residentes?

OBJECTIVES: To investigate the postoperative surgical complications and patient satisfaction with the outside-in transobturator tape (TOT) procedure performed by an experienced surgeon compared to those performed by residents in training. METHODS: Patients who received TOT surgery performed by a resident under supervision of a faculty were included in group 1 (n = 31) whereas, patients operated by the same faculty were included in group 2 (n = 26). Both groups were compared for demographic data, procedure results, satisfaction rates as well as intraoperative and early postoperative (urinary retention, vaginal erosion, dyspareunia, infection, abnormal discharge) complications. Statistical Package for Social Sciences for Windows was used for statistical analyses. For continuous variables Mann-Whitney U test and for categorical variables Chi-square, Fishers exact tests were used. RESULTS: Stress incontinence in groups 1 and 2 were either completely cured or improved in 87.1% and 84.6%, respectively. The question" Would you like to have an operation like this again?" was answered positively by 26 (83.9%) of patients in group 1 and by 22 (84.6%) in group 2. There was no significant difference between two groups for the complication rates occurred within 90-days period. However, there was a significantly higher groin pain persisting more than three weeks in group 1 (38.7%) compared to group 2 patients (7.7%). CONCLUSIONS: There was statistically significant increased groin pain in the early period in TOT procedures performed by the residents. However, the complications observed in both groups did not affect the success rate or patient satisfaction.

OBJETIVOS: Investigar las complicaciones quirúrgicas postoperatorias y la satisfacción del paciente con la operacion de malla transonbturatriz fuera-adentro realizada por un cirujano experto en comparación con la realizada por residentes en formación.MÉTODOS: Las pacientes operadas de TOT por un residente bajo supervisión de un adjunto se incluyeron en el grupo 1 (n = 31) y las operadas por el mismo adjunto se incluyeron en el grupo 2 (n = 26). Se compararon los datos demográficos, resultados de la operación, tasas de satisfacción así como las complicaciones intraoperatorias y postoperatorias tempranas (retención urinaria, erosión vaginal, dispareumia, infeccion, flujo anormal). Para el análisis estadístico se utilizó el software SPSS para Windows. Se utilizaron el test de la U de Mann- Whitney para variables continuas y los de Chi cuadrado y Prueba exacta de Fisher para variables categóricas. RESULTADOS: La incontinencia urinaria de esfuerzo en los grupos 1 y 2 fue bien completamente curada, bien mejoró en 87,1% y 84,6%, respectivamente. La pregunta ¿volvería a someterse a la misma operación? fue respondida positivamente por 26 (83,9%) de los pacientes en el grupo 1 y 22 (84,6%) en el grupo 2. No había diferencias estadísticamente significativas entre los grupos en la tasa de complicaciones en los primeros 90 días. Sin embargo, el dolor en la ingle que persistía más de 3 semanas era significativamente mayor en el grupo 1 (38,7%) en comparación con las pacientes del grupo 2 (7,7%). CONCLUSIONES: Hay un aumento estadisticamente significativo del dolor en el muslo en el periodo postoperatorio temprano de las operaciones de TOT realizadas por residentes. Sin embargo, las complicaciones observadas en ambos grupos no afectaron a la tasa de éxitos o a la satisfaccion del paciente.

Effect of Autologous Fibrin Glue on Lymphatic Drainage and Lymphocele Formation in Extended Bilateral Pelvic Lymphadenectomy in Robot-Assisted Radical Prostatectomy.

Introduction: Postoperative lymphatic drainage and lymphocele formation is a common seen complication after extended pelvic lymph node dissection (ePLND) in robot-assisted radical prostatectomy (RARP) operation. The aim of this study was to evaluate autologous fibrin glue as an additional treatment option to reduce the volume of lymphatic drainage and prevent lymphocele development. Materials and Methods: A total of 75 patients undergoing transperitoneal RARP with ePLND between January and July 2018 were enrolled in this study. Thirty-five patients who received autologous fibrin glue enrolled to study group, another 40 patients who did not receive to control group. Autologous fibrin glue was applied over the PLND areas. Age, body mass index (BMI), pathologic stages, and number of removed lymph nodes (LNs) were compared. The main endpoint was to compare postoperative lymphatic drainage volume and lymphocele formation rate between groups. Results: There was not statistically significant difference between the groups with respect to age, BMI, Gleason score, T-stage, and number of removed LNs. Autologous fibrin glue resulted in 50% (110 mL vs 210 mL; p = 0.037) and 75% reduction of postoperative drainage volume (70 mL vs 270 mL; p = < 0.0001) in study group than control group at postoperative 2nd and 3rd days, respectively. The total drainage volume was also 50% reduced in study group (277 mL vs 577 mL; p = 0.004). The incidence of asymptomatic lymphocele was 20% (n = 7) and 37.5% (n = 15) in study and control groups, respectively (p = 0.112). One patient in control group developed symptomatic lymphocele. There were no immediate or late adverse effects in study group. Conclusion: Autologous fibrin glue application reduced postoperative lymphatic drainage, and also lymphocele formation rate after extended PLND in RARP operation.

Clinical and Urodynamic Results of Repeated Intradetrusor Onabotulinum Toxin A Injections in Refractory Neurogenic Detrusor Overactivity: Up to 5 Injections in a Cohort of Children With Myelodysplasia.

OBJECTIVE: To determine the efficacy and safety of repeated intradetrusor onabotulinum toxin A (onaBoNT-A) injections in children with neurogenic detrusor overactivity due to myelodysplasia. MATERIALS AND METHODS: The study group consisted of 19 children (4 boys and 15 girls) with a mean age of 10.3 ± 3.1 years old, who had received at least 2 injections of 10 U/kg onaBoNT-A for the treatment of urinary incontinence resistant to anticholinergic treatment and clean intermittent catheterization in our clinic, between 2010 and 2015. Controlled urodynamic studies were performed at the baseline and 3 months after each injection. RESULTS: Eight of the children received 3 injections, 5 children had 4 injections, and 2 children had 5 injections. From the baseline to the fifth injection, the detrusor compliance (1.3, 4.5, 10, 20.7, 18.8, and 16.6 mL/cm H2O), the maximum bladder capacity (82.0, 157.0, 191.0, 272.0, 299.0, and 210.5 mL), and the maximum detrusor pressure (55.0, 33.0, 22.0, 12.5, 16.0, and 12.5 cm H2O) were assessed. The findings significantly improved following the first, second, and third injections, when compared with the previous bladder dynamics (P <.05), but the differences with the fourth were not statistically significant (P >.05). The continence periods were similar under clean intermittent catheterization after all of the injections (P <.05), and no severe side effects were observed. CONCLUSION: Repeated onaBoNT-A injections are a safe treatment modality and can be offered as an effective alternative choice, instead of more invasive surgery, in children with neurogenic detrusor overactivity due to myelodysplasia.

Differentiation of ureteral stones and phleboliths using Hounsfield units on computerized tomography: a new method without observer bias.

To differentiate ureteral stones and phleboliths by measuring density [as Hounsfield unit (HU)] and volume (as mm3) of the opacities in the bony pelvis on unenhanced computerized tomography (U-CT). A total of 52 patients, who underwent semirigid ureteroscopy and laser lithotripsy for distal ureteral stone and had isochoronous phleboliths in U-CT, were included. Images were reviewed for density and volume of the opacities. Data were compared, and a cut-off value was defined with receiver operating characteristics curve analysis to differentiate the nature of the opacity. Using the cut-off values of 171 mm³ for volume (sensitivity 75 %, specificity 100 %) and 643 HU for density (sensitivity 75 %, specificity 93 %), differentiation between stone and phlebolith was achieved. Differentiation of pelvic opacities needs meticulous observation with certain signs on U-CT. On the other hand, our study offers a new method, with certain cut-off values, such as 643 HU and 171 mm3, which can be used to precisely predict the actual nature of opacities of interest.