Varicocelectomy outcomes among patients with azoospermia and severe oligasthenoteratozoospermia.

Background: Varicocele is a reversible cause of male infertility. However, there are conflicting data available concerning the benefit of varicocele repair for patients with nonobstructive azoospermia (NOA) and severe oligoasthenoteratozoospermia (OAT). Objective: To address the benefit of varicocelectomy in patients with severe OAT and NOA with regard to their semen parameters and surgical sperm retrieval rate in those who underwent testicular sperm extraction (TESE) or testicular sperm aspiration (TESA). Materials and Methods: This retrospective cohort study was conducted on a sample of 13 patients diagnosed with NOA and severe OAT who underwent varicocelectomy for infertility treatment with no prespecified exclusion criteria. Results: Thirteen patients were enrolled. Five patients were diagnosed with NOA; eight were diagnosed with severe OAT. For improvements in the semen parameters postoperatively, the semen concentration of all patients was significantly increased compared to the preoperative concentration (3.59 ± 10.0.8 vs. 0.25 ± 0.31, P = 0.02) and the remaining parameters were unchanged. Regarding sperm retrieval, three patients underwent TESE and two patients underwent TESA, in which all had positive results. Conclusion: Varicocele repair was found to improve the semen parameters in patients with NOA and severe OAT and produced a successful surgical sperm retrieval rate in all patients who underwent TESA or TESE.

Recurrent Scrotal Arteriovenous Malformation as a Slowly Increasing Left Testicular Swelling: A case report.

Arteriovenous malformations (AVMs) are benign vascular lesions. Although, the majority of AVMs occur in the central nervous system, there are published reports of AVMs involving all systems including the scrotum, kidney, and uterus. We report a 37-year-old male patient who presented to the urology clinic of a tertiary care hospital in Riyadh, Saudi Arabia, in 2021 with recurrent gradual scrotal swelling for four years attributed to scrotal AVM. Embolisation was performed; however, one year later his symptoms reoccurred. As a result, left partial scrotal wall excision was carried out without complications.

Varicocelectomy for scrotal pain: Is it effective?

Introduction: Varicocelectomy is the prevailing management of scrotal pain secondary to varicocele. However, the literature is controversial on this topic. Some data showed that pain may persist after the surgery even if the varicocele is not detected postoperatively. Objectives: The objectives of the study were to identify the effect of varicocelectomy in patients with chronic scrotal pain, to report the association between the clinical grade and postoperative pain resolution, and to identify the need for a secondary procedure after varicocelectomy to control the pain. Materials and Methods: This was a retrospective study of 47 patients who underwent varicocelectomy between March 2016 and December 2018. Results: Postoperatively, the pain totally resolved after surgery in 64.3% of patients with scrotal pain; it improved in 21.4%, 11.9% have persistent pain, and the pain got worse in only 2.4%. Our study showed 100% complete resolution or improvement with Grade I, 85.7% in Grade II, and 81.3% in Grade III. In addition, all patients who underwent bilateral varicocelectomy had pain that either completely resolved or improved postoperatively. On the other hand, all patients who had persistent pain or pain worsening postoperatively had unilateral varicocelectomy. An additional intervention for postoperative pain control was needed in only 14% of patients, 7% of them underwent embolization, 4.7% had a cord block, and 2.3% were sent to a pain clinic. Conclusion: Varicocelectomy offers good outcomes in most patients with varicocele-related scrotal pain. The most significant predictor for success was low grade and bilaterality. However, there is a subset of patients whose symptoms will not improve postoperatively. Careful preoperative counseling and expectation management are crucial when discussing surgical options for those patients.

Plasmacytoid Variant Urothelial Cell Carcinoma: A Case of a Histological Variant of Urinary Bladder Cancer With Aggressive Behavior.

This paper presents a case report of plasmacytoid variant urothelial carcinoma (PVUC), a rare form of transitional cell carcinoma. PVUC is known for its unique clinical features, aggressive behavior, and poor survival rates. PVUC comprises less than 3% of all bladder tumors, and its diagnosis is often difficult due to its resemblance to other forms of bladder cancer. It requires a staging workup to rule out metastasis, relies heavily on immunostaining and histopathological analysis for diagnosis, and requires a multidisciplinary approach with early aggressive treatment, including cisplatin-based chemotherapy following surgery. This report highlights the importance of understanding rare variants of bladder cancer to ensure timely and accurate diagnosis and appropriate treatment planning. We report here a case of a 75-year-old male with multiple comorbidities who presented with hematuria and was diagnosed with urothelial carcinoma plasmacytoid type, which was initially treated with transurethral resection but later found to be unresectable and treated with palliative chemotherapy and radiation therapy. Eventually, the patient passed away three years after the diagnosis.

Classical Seminoma With Secondary Undescended Testis in an Elderly Patient: An Incidental Finding With a Penile Fracture.

Cryptorchidism is a common condition among children; however, it is rare in adults and is associated with an increased risk of malignancy. The development of secondary undescended testes is recognized as a complication following inguinal surgeries such as hernia repair and orchidopexy. Herein, we describe the case of a 64-year-old male with a known past surgical history of right indirect inguinal hernia repair complaining of penile swelling. The patient was diagnosed with a penile fracture, and a genital examination further revealed a right undescended testis. The patient underwent penile fracture repair and right orchiectomy. Histopathology examinations showed classic seminoma. These findings show that the position of each testis should always be documented before, during, and after inguinal hernia repair due to the increased risk of undescended testis. Histopathological confirmation is necessary for such patients so that malignancy can be identified in its early stages and cured subsequently.

Chronic pelvic pain syndrome symptoms significantly affect medical students' well-being.

Aims: This study aims to determine the prevalence of chronic pelvic pain syndrome (CPPS) symptoms among male-medical students in Riyadh, Saudi Arabia. Settings and Design: It is a cross-sectional study at King Saudi Bin Abdulaziz University for Health Sciences, College of Medicine at Riyadh, Saudi Arabia. Subjects and Methods: A total of 300 male medical students were given a hardcopy questionnaire to be filled anonymously that includes demographic characteristics, several questions regarding the health status, habits of the participants, and the National Institutes of Health Chronic Prostatitis Symptom Index for evaluating CPPS symptoms. Statistical Analysis Used: SPSS (v21) was used for the analysis. Qualitative data presented by frequencies and percentages and quantitative data presented by median and interquartile range (Q1 to Q3). The Chi-square test and binary logistic regression were used to assess the relationship between the outcome variables with demographical data. Results: In total 300 male medical students were surveyed, 245 medical students returned the questionnaire giving a response rate of 81.6%. The prevalence of CPPS symptoms among all participants was 57.9%. Majority of the participants does not have any associated medical/psychological conditions 152 (62%). Students with irritable bowel syndrome (IBS) or/and anxiety have statistically significant association with CPPS symptoms (P < 0.05). A total of 23% of students with CPPS reported being impaired with their quality of life (QOL), while 77% are satisfied. Conclusions: The prevalence of CPPS symptoms among male medical students is high. Anxiety, IBS, and lack of activity might be associated with CPPS symptoms, which have a significant negative impact on the QOL. For the future direction, a large-scale global study should be conducted to link the effects of CPPS symptoms on male medical students well-being.

Effect of COVID-19-Induced Stress among Males on the Partner Relationship and Sexual Activity during COVID-19 Pandemic: A Cross-Sectional Study.

Introduction: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, there have been some reports regarding the impact of COVID-19 on male psychosexual health. Aims and Objectives: To assess the severity of stress during COVID-19 and to determine the association of stress levels with partner relationships and sexual activity. Methodology: A cross-sectional study was conducted in Saudi Arabia through social media platforms via an online questionnaire between 1 December 2020 and 31 January 2021 among 871 participants after a pilot study among 20 participants, of which 497 were included in the study. Stress levels were assessed using the Arabic version of the Depression, Anxiety, and Stress Scale (DASS-21). Statistical analysis was conducted using SPSS version 20.0. Responses were presented as frequencies and percentages, and associations were studied using the Chi-squared test/Fisher's exact test. A value of p ≤ 0.05 was considered significant. Results: A total of 497 participants who had been infected with COVID-19 completed the survey. In total, it was found that 203 (40.8%) had severe stress scores (severe and extremely severe scores merged), while 131 (26.4%) had moderate stress scores. About 84 (16.9%) participants agreed that their sexual desire decreased, 91 (18.1%) confirmed their sexual intercourse frequency decreased, and sexual satisfaction decreased in 76 (15.3%). A significant positive correlation was found in that those who disagreed with having a good sexual relationship tended to have severe stress (p < 0.001). Conclusion: There were increased levels of stress during the lockdown period, which impacted psychosexual health.

Salvage of an iatrogenic partial allograft nephrectomy during caesarean section-a case report.

Since transplanted kidney allografts are standardly placed in a heterotopic pelvic position, any surgical intervention in the pelvis carries the potential risk for allograft injury. A 41-year-old female G4P2 with history of prior kidney transplants presented for an elective cesarean sections (CS). During the CS, profound bleeding was encountered and was later realized to be from the transplanted kidney allograft. A complete transection of the upper pole with the injury extending to the hilar structures was noted. Careful intraoperative evaluation led to the decision favoring a salvage attempt of the remaining part of the allograft. The patient continues to enjoy sufficient allograft function 6 months after the incident. To conclude, although CS after kidney transplantation is considered safe, the risk of allograft injury remains possible with potentially catastrophic consequences. This case highlights the importance of rapid surgical expertise and appropriate preoperative evaluation, preparation and planning.

Renal abscess post ureteroscopic lithotripsy.

With the advancement of ureteroscopic equipment, it has become a safe and efficient technique that is widely used in our practice for wide variety of diseases. Here we present a 65-years old patient with 2cm right renal pelvic stone, who underwent uneventful right ureteroscopic lithotripsy. She developed symptomatic right renal abscess after one week time, which was treated with antibiotics and drainage successfully. Although ureteroscopic lithotripsy is safe and efficient technique in the management of urolithiasis, careful patient monitoring postoperatively is indicated as minor and major adverse events might be encountered.

Ureteropelvic junction obstruction causing a spontaneous collecting system rupture: A case report and review of the literature.

Stones are the most common cause of collecting system ruptures. There are few reported cases of a ruptured collecting system without an underlying pathological cause. We report a case of a 15-year-old female patient who presented with left flank pain that was associated with nausea and vomiting. Computed tomography revealed a large, left retroperitoneal fluid collection, which was associated with severe hydronephrosis without an obvious pathological cause. The patient was treated with the insertion of a left double-J stent, and a retrograde pyelography confirmed the cessation of extravasation. At follow up, she was treated surgically with left robotic-assisted pyeloplasty without complications.

Empirical therapy for male factor infertility: Survey of the current practice.

BACKGROUND: Empirical therapy is sometimes used by urologists who desire to improve the outcomes for infertility patients. However, the literature on empirical therapies is scarce. Therefore, we aimed to assess the clinical practice of urologists regarding the use of empirical therapy in the treatment of infertility patients. METHODOLOGY: An online survey using Google Forms was used to collect data during the Saudi Urological Association Annual Meeting, February 2019. Additional data were gathered electronically in March and April 2019 and sent to respondents. The study was closed in May 2019. No incentives were provided to the respondents. RESULTS: A total of 96 (80%) urologists participated in the survey, of whom 69.8% were consultants, and 20.8% were andrology-trained urologists. Empirical therapy was used by 86.5% of urologists for patients with idiopathic oligoasthenoteratozoospermia. The most commonly used empirical therapies were zinc, L-canitine, clomiphene citrate, and L-arginine. The main factors that influenced the selection of empirical therapy were follicle-stimulating hormone, total testosterone, and luteinizing hormone levels. CONCLUSION: Empirical therapy was used by more than three-quarters of the participants for idiopathic male infertility. There were no clear guidelines for the ideal therapy to be considered for individual patients while treating empirically. Our concern is that urologists use a wide variety of medications without significant data to support these medications.

Successful Laparoscopic Management of Retroperitoneal Necrotizing Fasciitis: A Case Report.

Necrotizing fasciitis is a soft tissue infection characterized by rapid progression caused by gas-forming organisms. Retroperitoneal necrotizing fasciitis is a rare and fatal condition posing a diagnostic and management challenge. We present a case of a 28-year-old man who presented to the emergency department with a two-day history of diarrhea, right lower quadrant abdominal pain, dysuria, and a history of tender perianal swelling. A CT scan of the abdomen and pelvis showed extensive emphysema involving abdominopelvic retroperitoneal spaces. The patient underwent incision and drainage of the perianal area initially followed by diagnostic laparoscopy and drainage of retroperitoneal space. Early detection and extensive debridement of devitalized tissue are the cornerstones of the successful management of necrotizing fasciitis. This is the first case to report laparoscopic management of retroperitoneal necrotizing fasciitis.

Current surgical procedures for benign prostatic hyperplasia and impression of new surgical modalities.

BACKGROUND: Surgery is considered the most effective treatment for Benign prostatic hyperplasia (BPH) and Transurethral resection of prostat (TURP) is considered the gold standard. The goal of this study is to assess the surgical interventions used in Saudi Arabia, the difference in surgical procedures done depending on age and years of experience and the participant's impression on the new modalities in the management of BPH. METHODOLOGY: An online survey using Google Forms was sent to the participants. The data were collected during Saudi Urological Association Annual Meeting February 2019. Additional data were gathered 2 months later. The study was closed in May 2019. No incentives were provided to participants. RESULTS: A total of 65 (54.1% response rate) urologist participated in the survey, of whom 41.5% of respondents were aged <40 years, while 40% of them aged between 40 and 60 years. Forty-seven (72.3%) out of 65 were consultants. The essential investigations used by most participants prior to surgical interventions are prostate specific antigen, urine culture, urinalysis, and abdominal ultrasound. The most used surgical interventions are unipolar transurethral resection (TURP), Bipolar TURP, and open prostatectomy. About 50% of respondents preferred open prostatectomy for prostate size above 100 g. In general, 40%-50% of participants believe that urethral lift, Rezum, Aquablation, prostate artery embolization, and robotic simple prostatectomy are useful options. CONCLUSION: TURP continues to be the main intervention for prostate sizes <100 g. Open prostatectomy is widely used intervention for prostate sizes more than 100 g. New modalities gained little acceptance among urologist practicing in Saudi Arabia. Hands on workshops may help in educating urologists and introduce these new modalities for the future use.

Testicular chondrosarcoma.

Only 5% of all urological tumors are accounted as Testicular tumors. Furthermore, a well differentiated chondrosarcoma of the testis is extremely rare. Thus, we are representing a rare case of testicular chondrosarcoma. A 43-year-old male with right scrotal swelling did Doppler Ultrasonography demonstrating a large heterogenous hypervascular mass. Patient has had uneventful radical inguinal orchiectomy. The histopathology of the resected tumor reveled 50% seminoma - 50% teratoma with somatic type malignancy (well differentiated chondrosarcoma). Only few cases were reported in the medical literature for testicular chondrosarcoma. Thus, reporting such cases will add to the literature and shall help in establishing a management strategy.

Can the Body Mass Index Predict Varicocele Recurrence Post-Intervention?

Purpose In this study, we investigated the association between the body mass index (BMI) and varicocele recurrence post-intervention in our local Saudi population. We also explored the association between recurrence and other predictors such as age, laterality, indication for surgery, type of intervention, clinical grade, testicular delivery, and method of ligation. Methods We conducted a retrospective cohort study, including all patients who had microscopic varicocelectomy surgery or radiographic embolization for varicoceles over a five-year period. The data included demographic information and intervention-related variables. Descriptive and analytical statistics were used to analyze the data. Results We included 147 patients who had microscopic varicocelectomy surgery or radiographic embolization. We categorized the patients according to their BMI as underweight, normal, overweight, and obese. We found no statistical association between any BMI group and the recurrence of varicocele (P>0.05). However, there was a significant association between the clinical grade and recurrence (P<0.05). Conclusion This study did not show any significant correlation between height, weight, BMI, and varicocele recurrence after an intervention. The only predictor of varicocele recurrence was the clinical grade.

Testicular fibrothecoma: A case report and literature review.

Sex cord Stromal are neoplasms containing granulosa, Sertoli, and Leydig cells. The problem usually occurs among females that are hormonally active and is associated to Gorlin-Goltz syndrome. The present study reports a 37-year-old male was referred to Urologist due to a firm right testicular mass for which orchiectomy was performed. Tumor markers were all within normal range. Histopathological examination revealed compact spindle tumor involving the rete-testis in keeping with pure fibrothecoma. The results of the given study are valuable for medical professionals related to the field of urology and pathology.

Study Habits of Urology Residents in Saudi Arabia: Identifying Defects and Areas for Curricular Development - A Trainee-Based Survey.

PURPOSE: This study evaluated the study habits of Saudi urology residents throughout their residency training. It examines the study time and quality of study materials used by Saudi urology residents and identifies ways to maximize study benefits. PATIENTS AND METHODS: An online questionnaire was distributed to 152 registered residents in regions throughout Saudi Arabia (response rate: 93.4%). The questionnaire addressed study habits throughout training, motivations for studying, preferred study resources, impressions on teaching quality, study preparation methods, and exam preparedness among junior and senior residents. RESULTS: Among all residents, 37.3% read for 2-5 hours weekly. Juniors read significantly more than seniors (P = 0.034). Marital status affects seniors' study habits (P = 0.029). For most seniors, preparation for the final board exam is the greatest motivation for studying (P = 0.006). The AUA/EAU guidelines were useful information source for seniors (P = 0.001). Fifty-four percent (54.4%) of residents felt that their residency program did not provide protected study time prior to the board exams. Moreover, the majority (64.8%) felt that the training program did not adequately prepare them for the board exams. CONCLUSION: We recommend that local program directors implement more effective teaching methods. Structured reading habits and specific study materials were found to be positive predictors of successful performance. Residents should also be educated in balancing working hours, social life, and study.

Congenital unilateral absence of vas deferens with contralateral testicular atrophy.

We present a case report of a 25-year-old obese man complaining of primary infertility for 2 years. After a thorough examination and investigation were done, he had congenital unilateral absence of vas deferens with ipsilateral renal agenesis and a palpable vas deferens in the contralateral side with testicular atrophy. Semen analysis showed low semen volume (0.5 mL) with azoospermia. Hence, a scrotal exploration and a crossover transseptal vasoepididymostomy to relocate the vas deferens were done. After 6 months, the sperm concentration reached 5 × 106/mL with good motility (40%) and volume (1.5 mL).

Adult urethral stricture: Practice and expertise of urologists in Saudi Arabia.

OBJECTIVE: The aim of this study is to determine the methods used to evaluate and manage urethral strictures by urologists practicing in Saudi Arabia. MATERIALS AND METHODS: This is a cross-sectional study based on a validated questionnaire directed to all urologists and senior residents practicing in Saudi Arabia. Categorical data reported as frequencies and percentages. A Chi-square test was used for inferential analysis. P < 0.05 was considered statistically significant. RESULTS: We received 112 responses, of which 78% were from board-certified urologists. The majority were working in government hospitals. The rate of endoscopic procedures performed exceeded open urethroplasty. Direct Vision Internal Urethrotomy was the most common procedure performed as stated by 85% of the responses. Uroflowmetry with postvoid residual was the most common investigation requested to assess strictures before and after the operation usually in adjunction with retrograde urethrogram and or cystoscopy. Most of the urologists believed in a step-wise approach in the management of strictures and that urethroplasty is indicated only after repeated trials of endoscopic management. CONCLUSION: Our results revealed a preference, and perhaps misuse, of endoscopy which might raise a concern regarding patients' prognosis with repeated endoscopic management. Most of the urologists seem to be reluctant to proceed to a definitive treatment on the time of diagnosis either due to a lack of experience or knowledge. The results showed no difference between practice in government and private hospitals.

Intra-scrotal testicular torsion of a classical seminoma in an elderly patient: a case report and literature review.

Intra-scrotal testicular torsion of a seminoma is extremely rare and has been reported scarcely in literature. On the other hand testicular torsion by itself is rare in old age as well. We report a 63-year-old male who was presented to our Emergency Department with a right scrotal swelling and pain for 1 week. The patient had intra-scrotal testicular torsion of a seminoma which was overlooked initially by Doppler ultrasound, progression of symptoms led to a computed tmomgraphy scan which showed a testicular torsion. Intra-operative findings showed a torsed right testis with completely engorged cord. Right radical orchiectomy was done and indecently histopathology revealed a classical seminoma. Urologist should be aware and more vigilant of testicular torsion as a presentation of malignancy in old age especially with the presence of diagnostic limitations.