RESUMO
BACKGROUND: The effect of bariatric surgery on impaired semen parameters, hormonal profile and sexual function remains controversial to some extent. THE CONTEXT AND PURPOSE OF THE STUDY: To look at the long-term effects of sleeve gastrectomy on hormonal profiles, sperm parameters, and sexual function in infertile men with severe obesity. This prospective study included fifty-four obese patients with primary or secondary infertility who were scheduled for sleeve gastrectomy between February 2018 and March 2021. All participants were given a sperm analysis and a serum hormone profile before, 12, and 18 months after surgery. We used the International Index of Erectile Function questionnaire to assess sexual function. RESULTS: There was a significant correlation between weight loss after sleeve gastrectomy and improvement in lipid profile (p < 0.05). No significant detectable effect of post-gastrectomy weight loss on patients with diabetes mellitus, hypertension, or obstructive sleep apnea. As regards the hormonal profile, sex hormone binding globulin, total and free testosterone improved significantly after 12- and 18-months following sleeve gastrectomy. There was a significant increase in sperm count and total sperm number during the follow-up after sleeve gastrectomy (p < 0.05), however, there were no significant changes in other semen parameters. Concerning sexual function, sexual desire, erectile function, and satisfaction improved significantly at 12 and 18 months after surgery. CONCLUSION: Weight loss through sleeve gastrectomy surgery significantly improves testosterone deficiency, sexual performance, and Sperm count in obese infertile men.
RéSUMé: CONTEXTE: L'effet de la chirurgie bariatrique sur l'altération des paramètres du sperme, du profil hormonal et de la fonction sexuelle, reste controversé dans une certaine mesure. Le contexte et le but de l'étude : examiner les effets à long terme de la gastrectomie longitudinale sur les profils hormonaux, les paramètres du sperme et la fonction sexuelle chez les hommes infertiles souffrant d'obésité sévère. Cette étude prospective comprenait 54 patients obèses, atteints d'infertilité primaire ou secondaire, qui devaient subir une gastrectomie longitudinale entre février 2018 et mars 2021. Tous les participants ont eu une analyse de sperme et un profil hormonal sérique avant, puis 12 et 18 mois après la chirurgie. La fonction sexuelle a été évaluée au moyen du questionnaire de l'indice international de la fonction érectile. RéSULTATS: Une corrélation significative était présente entre la perte de poids après la gastrectomie longitudinale et l'amélioration du profil lipidique (p < 0,05). Aucun effet significatif détectable de la perte de poids post-gastrectomie n'a été retrouvé chez les patients atteints de diabète, d'hypertension ou d'apnée obstructive du sommeil. En ce qui concerne le profil hormonal, la globuline liant les hormones sexuelles, la testostérone totale et la testostérone libre se sont significativement améliorées à 12 et 18 mois après la gastrectomie longitudinale. Il y eut une augmentation significative de la numération de spermatozoïdes et du nombre total de spermatozoïdes au cours du suivi après la gastrectomie longitudinale (p < 0,05) ; sans, toutefois, de changements significatifs pour les autres paramètres du sperme. En ce qui a concerné la fonction sexuelle, le désir sexuel, la fonction érectile et la satisfaction se sont considérablement améliorés 12 et 18 mois après la chirurgie. CONCLUSION: La perte de poids due à la chirurgie par gastrectomie longitudinale améliore significativement le taux de testostérone, la performance sexuelle et le nombre de spermatozoïdes chez les hommes infertiles obèses.
RESUMO
PURPOSE: To compare the rate of post-flexible ureteroscopy urinary tract infection (UTI) in patients subjected to the standard antibiotic prophylaxis alone versus enhanced prophylactic measures. METHODS: A prospective randomized controlled study included 256 patients subjected to flexible ureteroscopy (FURS) for ureteral or renal stones from March 2018 to July 2022. Treatment groups included the standard antibiotic prophylaxis group (group 1, n=128) and the enhanced prophylaxis group (group 2, n=128). Patients in group 1 were injected with intravenous fluoroquinolone one hour preoperatively, and oral antibiotics were used for 24 h postoperatively. Patients in group 2 had urine culture ten days before the procedure; antibiotic-culture based was given for positive asymptomatic cases, while the procedure was deferred for active UTI. RESULTS: The study groups were comparable regarding patient demographics, stone characteristics, operative time, and intraoperative complications. The overall hospitalization time was 1.68 ± 0.81 days. Postoperative, and overall complications were significantly higher in group 1 (15.6% vs. 6.3%, p = 0.04 and 26.6% vs. 17.2%, p = 0.047), respectively. Twenty patients (15.6 %) in the standard prophylaxis group were diagnosed with UTI in comparison to 8 patients (6.3 %) in the enhanced prophylaxis group (p = 0.047). CONCLUSIONS: Urinary tract infection after FURS could be reduced significantly by utilizing the suggested enhanced prophylactic approach.