Management of ureteral complications in renal transplantation: prevention and treatment.

Urinary anastomotic complications following renal transplantation cause significant patient morbidity. In ureteric reconstruction, different techniques are used to reduce complications (such as leakage or obstruction). In this study, we suggested two aspects of management of the complications of ureteral anastamosis: ureteral spatulation more than 10 mm for prevention and percutaneous nephrostomy and balloon dilatation as the first steps of treatment. A sequential double-blind random trial with 170 kidney transplant recipients was performed, dividing the patients into two groups: group 1 patients had ureteral spatulation length ≤ 10 mm (70 recipients) and group 2 patients had ureteral spatulation ≥ 10 mm (100 recipients). In patients with ureteral stenosis, percutaneous nephrostomy (PCN) and balloon dilatation were used as the first step of treatment. The mean age was 44 ± 4.2 years. Before and after removing the double J stent, ureteral complications that needed surgical intervention occurred in 16/70 recipients in group 1 (20.3%) and in eight/100 recipients in group 2 (8%). There is a significant difference between the two groups (P < 0.05). PCN and balloon dilatation were performed in 24 patients with ureteral stenosis. Eleven patients had a good response and 13 patients underwent surgical procedures (in four of theses patients, ileal interposition was used for repairing the ureteral defects). In conclusion, ureteral spatulation more than 10 mm in prevention of ureteral stenosis and use of PCN and balloon dilatation in the first step of treatment of ureteral obstruction should be the management choice for these patients.

Complications and the effect of varicocelectomy on semen analysis, fertility, early ejaculation and spontaneous abortion.

Varicocele is still an enigma. Its effects on semen analysis, fertility and, more recently, early ejaculation and spontaneous abortion in spouses are not yet fully understood. In this retrospective study, we evaluated these four parameters (semen analysis, fertility, early ejaculation and spontaneous abortion among spouses) in relation to varicocele and varicocelectomy during a 13-year period. A total of 1,711 patients with varicocele underwent varicocelectomy by high inguinal method (251 cases), subinguinal method (1,375 cases), scrotal method (34 cases), and subinguinal method with local anesthesia (38 cases). Our complication rate was acceptable. Sperm count, motility and morphology increased three months post operation in 55, 51, and 46%, respectively (P value 0.000, 0.000, and 0.015, respectively). Paternity was 56% after one year of post varicocelectomy follow-up. Only 7 out of 82 azoospermic men had sperm in their semen after varicocelectomy and only one of them with mild spermatogenic hypoplasia became a father. The spontaneous abortion rate in the spouses of respondents was 59%. Early ejaculation improved in 75% of the respondents. In conclusion, varicocelectomy does not improve sperm parameters in all men, but it improves pregnancy rate, early ejaculation, and scrotal pain.

Evaluation of Crocus sativus L. (saffron) on male erectile dysfunction: a pilot study.

In this study, the effect of Crocus sativus (saffron) was studied on male erectile dysfunction (ED). Twenty male patients with ED were followed for ten days in which each morning they took a tablet containing 200mg of saffron. Patients underwent the nocturnal penile tumescence (NPT) test and the international index of erectile function questionnaire (IIEF-15) at the start of the treatment and at the end of the ten days. After the ten days of taking saffron there was a statistically significant improvement in tip rigidity and tip tumescence as well as base rigidity and base tumescence. ILEF-15 total scores were significantly higher in patients after saffron treatment (before treatment 22.15+/-1.44; after treatment 39.20+/-1.90, p<0.001). Saffron showed a positive effect on sexual function with increased number and duration of erectile events seen in patients with ED even only after taking it for ten days.