Prevalence of Y chromosome microdeletions in oligospermic and azoospermic candidates for intracytoplasmic sperm injection.

OBJECTIVE: To determine the prevalence and type of Y chromosome microdeletions in 136 consecutively seen intracytoplasmic sperm injection (ICSI) candidates and in 50 consecutively seen azoospermic men attending an infertility clinic. DESIGN: Controlled clinical study. SETTING: Genetics laboratory and infertility clinic at a University hospital. PATIENT(S): One hundred eighty-six men who were seen at an infertility clinic and who were referred to a genetics counseling service for genetic assessment before ICSI. INTERVENTION(S): Collection of semen and blood samples. MAIN OUTCOME MEASURE(S): Semen analysis; serum FSH, LH, and T levels; karyotype analysis; and presence or absence of several single tagged site markers along the Y chromosome (sY274, sY238, sY276, sY84, sY102, sY143, sY153, sY254, sY269, sY202, sY158, sY160). RESULT(S): Yq chromosome microdeletions were detected in 10 (5.4%) of 186 consecutively seen ICSI candidates. The number of microdeletions was much higher in azoospermic patients (16%; 8 of 50) than in oligospermic patients (1.5%; 2 of 136). Two of the azoospermic patients with a Yq microdeletion also had sex chromosome aneuploidy mosaicism. No microdeletions were detected in 100 consecutively seen fathers who were included as controls. CONCLUSION(S): The prevalence of Yq microdeletions in the azoospermic group was much higher than in the oligospermic group and was consistent with the prevalence of Yq microdeletions detected in other series of azoospermic men in different geographic areas. All Yq microdeletions found in our patients belong to the AZFc region, indicating that microdeletions of the AZFa and AZFb regions are infrequent among oligospermic ICSI candidates or azoospermic males in our population.

Transposition of iliac vessels in implantation of right living donor kidneys.

BACKGROUND: The rate of right laparoscopic living-donor nephrectomy (RLLDN) is low among kidney transplantations due to the short renal vein and presumed higher risk of thrombosis. Our objective was to describe a surgical technique to compensate for the shorter veins of these grafts. METHODS: Between January 2004 and July 2010, we prospectively collected data from all transplantations using RLLDN-harvested kidneys at our center. Recipient iliac vein transposition was performed in all patients. We reviewed the indications, surgical techniques, and postoperative courses. RESULTS: The 43 included cases showed a 2.1 +/- 0.6 cm, average length of the right renal vein as measured on abdominal computed tomography (CT). The mean extraction and implantation times were 109 +/- 33 and 124 +/- 31 minutes, respectively; the mean warm ischemia time was 151 +/- 29 seconds. Two recipients required postsurgical blood transfusions. In 97.6% of cases, there was immediate urine flow. Postoperative echo-Doppler revealed good arterial and venous flows in all patients. No venous thromboses were detected. The recipients' average hospital stay was 8 +/- 5 days. With a mean follow-up of 57 months, 86% of recipients maintain a glomerular filtration rate (GFR) >50 mL/min and creatinine levels <1.5 mg/dL. CONCLUSIONS: Transposition of the recipient iliac vein during implantation is a good technical solution to compensate for the short length of the right renal vein. The use of iliac vein transposition allowed us to perform safe implants of RLLDN-harvested kidneys with good short-term and long-term results.

[Delayed bleeding after partial nephrectomy. Management with selective embolization]. / Sangrado diferido después de nefrectomía parcial. Manejo mediante embolización selectiva.

INTRODUCTION: Bleeding after partial nephrectomy can be immediate or delayed and may have severe consequences. The incidence of this complication is low. The most frequent cause of delayed bleeding is arterial pseudoaneurysm. Superselective embolization is a feasible therapeutic option that has shown good results. OBJECTIVE: To evaluate treatment and outcomes of delayed bleeding in our series of patients with partial nephrectomy. MATERIAL AND METHODS: We performed a retrospective study of our database of partial nephrectomies. Patients who developed delayed bleeding (after discharge) were identified. Clinical histories were reviewed and data on presentation, diagnosis, treatment and outcomes were analyzed. RESULTS: Among our series of patients undergoing partial nephrectomy, three developed delayed bleeding (1.3%). Symptom onset occurred 17 to 25 days after surgery and consisted of hematuria or lumbar pain. Diagnosis was provided through ultrasound, abdominal computed tomography and renal angiography. In all three patients, a complicated pseudoaneurysm was diagnosed and all patients underwent renal artery catheterization with selective renal artery embolization. In all patients, immediate control of bleeding was achieved. Outcome after a follow-up of 61 to 92 months was favorable. CONCLUSIONS: Selective vascular embolization is the treatment of choice of renal pseudoaneurysm after partial nephrectomy in hemodynamically stable patients.

Sangrado diferido después de nefrectomía parcial. Manejo mediante embolización selectiva / Delayed Bleeding after Partial Nephrectomy. Management with Selective Embolization

Introducción: El sangrado después de una nefrectomía parcial es una complicación con posibles consecuencias graves. Puede ser inmediato o diferido y su incidencia es baja. La causa más frecuente del sangrado diferido es el pseudoaneurisma arterial. La embolización supraselectiva vascular es una opción terapéutica posible que ha demostrado buenos resultados. Objetivo: Evaluar la evolución y el tratamiento del sangrado diferido en nuestra serie de pacientes con nefrectomías parciales. Material y métodos: Realizamos un estudio retrospectivo de nuestra base de datos de nefrectomías parciales. Identificamos los pacientes que presentaron sangrado diferido (después del alta). Se revisó la historia clínica, analizando datos sobre la presentación, el diagnóstico, el tratamiento y la evolución de los pacientes. Resultados: De nuestra serie de nefrectomías parciales tres pacientes presentaron sangrado diferido (1,3%). La clínica se inició después de 17 a 25 días de la cirugía por la aparición de hematuria o dolor lumbar. El diagnóstico se realizó mediante ecografía, TAC abdominal y angiografía renal. En todos los pacientes se diagnosticó un pseudoaneurisma arterial complicado, siendo sometidos a cateterismo arterial renal con embolización selectiva del mismo. La evolución fue correcta en todos los pacientes con control inmediato del sangrado. Documentamos un seguimiento posterior favorable de 61 a 92 meses. Conclusiones: La embolización selectiva vascular es el tratamiento de elección del pseudoaneurisma renal sintomático después de nefrectomía parcial en el paciente hemodinámicamente estable (AU)

Introduction: Bleeding after partial nephrectomy can be immediate or delayed and may have severe consequences. The incidence of this complication is low. The most frequent cause of delayed bleeding is arterial pseudoaneurysm. Superselective embolization is a feasible therapeutic option that has shown good results. Objective: To evaluate treatment and outcomes of delayed bleeding in our series of patients with partial nephrectomy. Material and methods: We performed a retrospective study of our database of partial nephrectomies. Patients who developed delayed bleeding (after discharge) were identified. Clinical histories were reviewed and data on presentation, diagnosis, treatment and outcomes were analyzed. Results: Among our series of patients undergoing partial nephrectomy, three developed delayed bleeding (1.3%). Symptom onset occurred 17 to 25 days after surgery and consisted of hematuria or lumbar pain. Diagnosis was provided through ultrasound, abdominal computed tomography and renal angiography. In all three patients, a complicated pseudoaneurysm was diagnosed and all patients underwent renal artery catheterization with selective renal artery embolization. In all patients, immediate control of bleeding was achieved. Outcome after a follow-up of 61 to 92 months was favorable. Conclusions: Selective vascular embolization is the treatment of choice of renal pseudoaneurysm after partial nephrectomy in hemodynamically stable patients (AU)