the Short Abstinence May Have Paradoxical Effects On Sperms With Different Level Of DNA Integrity: A Prospective Study.

PURPOSE: To investigate the effect of short abstinence on sperm function tests and semen parameters. MATERIALS AND METHODS: This prospective study included 65 male patients with increased DNA injury in their ejaculated sperm and a history of recurrent pregnancy loss and/or assisted reproductive techniques failures. The effects of antioxidants medical therapy and short abstinence on semen quality were assessed (TUNEL test and CMA3 staining). RESULTS: Antioxidants have statistically significant effects on mean sperm concentration (untreated, 67.51 ± 44.40 million/ml, vs. treated, 56.09 ± 37.85 million/ml; P-value=0.005) and mean TUNEL score (untreated, 24.56% ± 9.49%, vs. treated, 20.64% ± 10.28%; P-value = 0.013). Moreover, a short abstinence period might have positive effects as shown on the TUNEL assay (20.64% ± 10.28 vs. 17.38% ± 8.59 ; P-value = 0.028) and CMA3 staining (47.79% ± 20.78, vs. short 41.92% ± 18.49; P-value = 0.019), when considering all study subjects. However, different results were obtained using more precise analysis based on a TUNEL cutoff score of 20%. The analysis showed that short abstinence might improve sperm DNA integrity in patients with TUNEL score > 20% (mean TUNEL score from 27.85% ± 8.32% to 19.14% ± 8.90% ; P-value =0.001%). However, it might have deleterious effects on sperm DNA integrity in patients with TUNEL score < 20% (mean TUNEL score from 11.89% ± 3.21% to 15.17% ± 7.79%; P-value = 0.045%) Conclusion: Our results showed that short abstinence may not be beneficial in all infertile males, and it should only be used in selected patients with abnormal DNA integrity.

Management of Colon Perforation During Percutaneous Nephrolithotomy: 12 Years of Experience in a Referral Center.

INTRODUCTION: The management protocol for colon perforation during percutaneous nephrolithotomy (PCNL) is controversial because of the scarcity of reported cases and their management diversity. We present our management experience of colon perforation during PCNL. MATERIALS AND METHODS: All PCNL operations between April 2004 and September 2016 in our center (N = 11,376) were reviewed for the occurrence and management of colon perforation. We typically performed PCNL with insertion of nephrostomy tube before mid-2007. After mid-2007, we typically performed tubeless PCNL and inspected access tract for evidence of organ injury especially colon perforation during nephroscope removal. RESULTS: Seventeen colon perforations happened during the study period. The first three cases were diagnosed postoperatively and in two patients open surgery was employed for treatment. The next 14 cases were diagnosed intraoperatively (n = 12) or in the early postoperative period (n = 2) and were managed by broad spectrum antibiotics, bowel rest, and urinary Double-J and Foley's catheter insertion. Percutaneous retroperitoneal drain was inserted for only one patient after intraoperative diagnosis of colon perforation. The other 13 patients were managed without insertion of such drains. For one patient, postoperative insertion of retroperitoneal drain was attempted because of collection of urine. In other patients (n = 12), the management was effective with no need for an operation. Complications according to Clavien-Dindo grade in these 17 patients were grades II, IIIa, and IIIb in 13, 1, and 3 patients, respectively. CONCLUSIONS: Colon perforation during PCNL that is diagnosed intraoperatively or in the early postoperative period can be managed conservatively. It seems possible not to insert colostomy or retroperitoneal drains in stable patients with early or intraoperative diagnosis. In cases of delayed diagnosis, or deterioration of the patient on tubeless management, the standard protocol should be performed including insertion of colonic or retroperitoneal drain or surgery especially in patients with signs or symptoms of peritonitis or persistent fever.

Laser Treatment for Urethral Hemangiomas: Report of Three Cases.

To present our experience with coagulation/laser treatment of urethral hemangiomas. Three cases with small to medium sized urethral hemangiomas in penile and posterior urethra presented with hematuria or urethral bloody discharge. All patients were male. They were treated with thermal or Holmium-YAG laser coagulation in the first session. Recurrence of hematuria/bloody discharge happened in two patients within one month from the first treatment that was managed with a second session of laser coagulation. No third session of intervention for hematuria/bloody discharge was required in any patient during 10-39 months of follow up. In cases of relapse after thermal or laser coagulation of small to medium sized urethral hemangiomas, after appropriate consultation with the patient, a second session of laser coagulation can be successful before contemplating more invasive measures like open surgery.

Symptomatic lymphocele after kidney transplantation: a single-center experience.

INTRODUCTION: In a retrospective study, we evaluated the frequency, clinical presentation, and management of lymphocele in kidney transplant recipients operated on in a single center. MATERIALS AND METHODS: Between September 1984 and June 2005, we had 2147 kidney transplantations from living donors. During the follow-up period, ultrasonography was performed in symptomatic patients and those with elevated serum creatinine level postoperatively. Other radiological procedures were done in complicated cases. Patients with lymphocele were treated by percutaneous drainage with or without injection of sclerotizing agent (povidone iodine). If recurrence occurred, surgical intraperitoneal drainage was performed. In cases with multiloculated collection or inappropriate access for percutaneous drainage, the primary approach was surgical intraperitoneal drainage. RESULTS: Symptomatic lymphocele collection was seen in 17 kidney recipients of our series (0.8%; 95% confidence interval, 0.4% to 1.2%). It presented with elevation of serum creatinine concentrations (47.1%), pain and abdominopelvic swelling (29.4%), and lower extremity edema (23.5%). Percutaneous drainage was used for the treatment of lymphocele in 11 patients, but recurrence occurred in 7 (63.6%). These cases were treated with open surgical drainage. In 6 patients, the primary approach was surgical intraperitoneal drainage, because of multiloculated collection or inappropriate access for percutaneous drainage. All of the patients were treated successfully and no graft loss occurred during the follow-up period. CONCLUSION: Symptomatic lymphocele is an uncommon complication after kidney transplantation. Surgical intraperitoneal drainage is the most effective approach for the management of symptomatic lymphocele.

Radiofrequency-induced thermotherapy in benign prostatic hyperplasia.

INTRODUCTION: We evaluated the efficacy and safety of radiofrequency-induced thermotherapy of the prostate in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Radiofrequency-induced thermotherapy of the prostate was performed under local anesthesia in 24 patients (median age, 67 years) with BPH. The International Prostate Symptom Score (IPSS) score, maximum flow rate, postvoid residual urine volume, and prostate volume were measured preoperatively and 4 months postoperatively. RESULTS: Nine patients (37.5%) had urinary retention preoperatively. One patient (4.2%) required transurethral resection of the prostate due to retention despite improved symptoms, and 2 (8.3%) needed an alpha-blocker, postoperatively. The success rate was 87.5% after 4 months follow-up. All patients were catheter-free after the procedure. The mean IPSS score decreased from 26.08 +/- 3.9 to 13.33 +/- 4.69 (P < .001), and the mean maximum flow rate increased from 4.63 +/- 4.4 mL/s to 13.21 +/- 4.28 mL/s (P < .001). The mean prostate volume and mean residual urine volume were 46.38 +/- 16.8 mL and 160 +/- 57 mL, which decreased to 39.6 +/- 16 mL (P = .009) and 61.46 +/- 17.45 mL (P = .003), respectively. Fever, dysuria, and perineal pain (in 9 patients; 37.5%) were improved with conservative therapy. Retrograde ejaculation, erectile dysfunction, and urinary incontinence were not reported. CONCLUSION: Radiofrequency-induced thermotherapy of the prostate is a new, safe, and effective treatment for BPH. This technique is carried out under local anesthesia and mild sedation with little bleeding. It is especially appropriate for patients who present as high risk for general anesthesia.