Levels of Macro- and Trace Elements and Select Cytokines in the Semen of Infertile Men.

The current study evaluated levels of macro-/trace elements, select cytokines, and sperm quality, in the semen of men with abnormal spermograms. The study population of men with abnormal spermograms was divided into three groups, i.e., oligospermic, asthenozoospermic, and oligoasthenozoospermic. The control group was fertile men with normal semen parameters. Analyses showed that in comparison with that in the semen of the fertile men, levels of calcium, magnesium, and selenium were significantly lower in men with all three groups. Semen levels of zinc were significantly lower in men with asthenospermia as compared with that in control. GGT (gamma-glutamyltranspeptidase) activity in semen was significantly higher in men in any of the three states as compared with that seen in control semen. In contrast, semen ALT (alanine aminotransferase) activity was reduced in men with any of these abnormalities compared with that in the controls. Semen cholesterol levels were significantly lower in men with asthenospermia as compared with control semen. Of all the measured cytokines, only IL-5 levels were reduced in the semen of the men with any of the conditions as compared with control semen. The semen of infertile males is characterized by reduced levels of calcium, magnesium, and trace metals such as zinc and selenium. The study also indicated that measures of cholesterol and of GGT/ALT activities could serve as supplementary parameters indicative of semen quality. Further investigations are needed to clarify the role of the measured parameters in sperm physiology.

Mean platelet volume-to-lymphocyte ratio: a novel biomarker associated with overall survival in patients with nonmetastatic clear cell renal cell carcinoma treated with nephrectomy.

INTRODUCTION: Renal cell carcinoma is a highly aggressive malignancy that causes significant morbidity and mortality. The rising number of newly diagnosed renal tumors results in a great need to search for new preoperative markers to evaluate the course of the disease and to help select patients who would benefit the most from additional postoperative care. The aim of our study was to evaluate the prognostic value of mean platelet volume-to-lymphocyte ratio (MPVLR) in patients undergoing nephrectomy for nonmetastatic clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS: A total number of 344 patients with proven nonmetastatic ccRCC treated with radical or partial nephrectomy at our institution between January 2003 and December 2012 were included in our analysis. Based on the optimal cut-off value of MPVLR, which was determined by the receiver operating characteristic curve, our study population was divided into two groups, with low and high MPVLR. Differences in overall survival between groups were compared using the Kaplan-Meier method with log-rank testing. The Cox proportional hazards regression model was applied to perform univariate and multivariate analysis. RESULTS: Study subjects with high MPVLR were older and had more advanced tumors. Tumor necrosis and higher TNM stages were also more prevalent in this group of patients. Mortality in patients with high MPVLR was significantly higher than in patients with low MPVLR. In the multivariate analysis, after adjustment for pathological and clinical covariates, high MPVLR (≥ 3.61) was independently associated with higher long-term overall mortality in nonmetastatic ccRCC patients. CONCLUSION: MPVLR is an easily obtainable prognostic marker for overall survival in nonmetastatic ccRCC patients treated with nephrectomy.

The Role of Oxidative Stress, Selected Metals, and Parameters of the Immune System in Male Fertility.

The aim of the study was to investigate the associations between standard semen parameters and the parameters reflecting oxidative stress intensity, antioxidant defense functions, levels of selected macro and trace elements, and parameters characterizing immune system function. The study group consisted of 103 fertile males. Based on semen volume, sperm concentration, total sperm count, and percentage of motile sperm at 1 hour postcollection, the individuals were divided into two equal groups-those with excellent (EX) semen quality and those with mediocre (ME) semen quality. The remaining measured parameters characterizing motility and the percentage of normal morphology were higher in the EX group than in the ME group; however, the seminal plasma pH did not differ between the examined groups. The phosphate level was 31% lower in the EX group than in the ME group, whereas there was a tendency toward a 25% lower level of Fe in the EX group than in the ME group (p = 0.064). The activities of enzymes involved in antioxidant defense, CuZn-SOD, CAT, and G6PD, were 14%, 63%, and 39%, respectively, higher in the EX group than in the ME group. However, the level of alpha-tocopherol was 32% lower in the EX group than in the ME group. The other measured parameters characterizing antioxidant defense and the parameters of oxidative stress intensity and immune system function were not significantly different. The value of seminal plasma pH is not related to the semen quality of fertile males. Higher fertility potential estimated based on standard semen parameters in fertile males is associated with lower levels of Fe and higher activities of some antioxidant enzymes.

The Associations between Infertility and Antioxidants, Proinflammatory Cytokines, and Chemokines.

The aim of the study was to evaluate the parameters of oxidative stress and antioxidant defense in relation to the levels of proinflammatory cytokines and chemokines in patients diagnosed with oligozoospermia and asthenozoospermia. Based on the basic parameters of the spermogram, the examined group (n = 243) was divided into three groups: oligospermic group (sperm count less than 15 × 106/ml) consisting of 152 men, astenozoospermic group (less than 40% of progressively moving sperm cells) consisting of 142 men, and oligoastenozoospermic group (both criteria met) consisting of 90 men. The control group consisted of 103 males with normal semen profile according to the WHO criteria. Total superoxide dismutase (SOD) activity in seminal plasma and spermatozoa lysate was significantly lower by 12% and 22%, respectively, in males with oligospermia than in the control group. Analogically, Mn-SOD activity in spermatozoa lysate was significantly lower in males with oligospermia, asthenospermia, and oligoasthenospermia by 44%, 32%, and 45%, respectively. By contrast, CuZn-SOD activity in spermatozoa lysate was significantly higher in males with oligospermia by 60%. The activity of glutathione peroxidase (GPx) in seminal plasma was also significantly higher in males with oligospermia and oligoasthenospermia by 56% and 78%, respectively. The level of malondialdehyde (MDA) in seminal plasma was significantly higher in males with asthenospermia than in the control group by 12%. By contrast, the level of MDA in spermatozoa lysate was significantly lower in males with oligospermia, asthenospermia, and oligoasthenospermia by 26%, 20%, and 26%, respectively. The level of interleukin- (IL-) 8 in seminal plasma was significantly higher in males with asthenospermia and oligoasthenospermia by 64% and 67%, respectively. Abnormalities in spermogram, such as oligospermia, asthenospermia, and oligoasthenospermia, may be related to a decreased activity of Mn-SOD in spermatozoa and increased levels of chemokines in seminal plasma.

A non-inferiority study to analyze the safety of totally tubeless percutaneous nephrolithotomy.

BACKGROUND: Totally tubeless percutaneous nephrolithotomy (ttPCNL) becomes increasingly frequently utilized in the treatment of kidney stones. This procedure emerged as an answer for patients' needs to minimize hospitalization time, pain intensity and discomfort due to nephrostomy tube. However, ttPCNL may be less safe for patients, as without nephrostomy tube bleeding from renal vessels is potentially more severe. OBJECTIVES: The purpose of our study was to retrospectively evaluate the safety parameters of ttPCNL collected in a prospective manner. MATERIAL AND METHODS: This was a single tertiary care center, non-inferiority study with 2 arms (55 patients in each arm). The 1st group consisted of patients who underwent ttPCNL with the application of TachoSil® (Takeda, Osaka, Japan) as sealing material, while in the 2nd group, conventional PCNL with nephrostomy tube (cPCNL) was utilized. The primary goal was to prove that hemoglobin drop after surgery, as equivalent of safety, was not inferior than 1 g/dL. The secondary endpoints comprised visual analogue scale (VAS) of pain, additional pain treatment and hospital stay. RESULTS: The mean hemoglobin drop after ttPCNL was insignificantly lower in comparison with cPCNL group (mean: -0.35 g/dL; confidence interval (CI) = -0.8, 0.21). Visual analogue scale of pain and pain treatment were comparable between groups. Hospital stay was significantly shorter in the ttPCNL group. CONCLUSIONS: Totally tubeless PCNL can be considered a safe option after uncomplicated lithotripsy - what is important, it is characterized by a shorter hospitalization time. Postoperatively, pain intensity is comparable between both groups.

Sacrocolpopexy with polypropylene tape as valuable surgical modification during cystectomy with orthotopic ileal bladder: functional results.

Introduction. Urinary diversion is very often associated with urinary retention and urinary incontinence. In this study, a surgical modification during cystectomy with orthotopic ileal neobladder is presented. Material and Methods. Female patients enrolled in the study (n-24) were subjected to sacrocolpopexy during the operation. Apart from oncological control, the follow-up consisted of 1-hour inlay test and questionnaires (UDI-6 and IIQ-7) in the 3rd, 6th, and 12th month after the operation. In the 12th month after the surgery, the urodynamic pressure-flow test was performed. Outcomes were compared with the control group (n-18) in which sacrocolpopexy was not implemented. Results. The study group was characterised by reduced urinary retention and improved continence. Conclusion. Sacrocolpopexy during cystectomy with orthotopic ileal bladder is a valuable surgical method which provides patients with a better quality of life.

Ten-year treatment outcomes including blood cell count disturbances in patients with simple renal cysts.

BACKGROUND: The simple renal cyst is the most common benign kidney disease. It may cause pain and hypertension, especially if significantly enlarged. As in polycystic kidney disease, blood cell count disturbances are frequently observed in simple renal cysts. The aim of our study was to assess such disturbances, changes in blood pressure, and complication rate in our patients undergoing surgery due to simple renal cyst in the last 10 years. MATERIAL AND METHODS: 210 patients with simple renal cysts were underwent surgery between 2002 and 2012. Two different kinds of operation were conducted: aspiration of cyst fluid with injection of sclerosing agent, and laparoscopic/retroperitoneoscopic decortications of the cyst wall. A control group comprised 134 patients with benign prostate hyperplasia. The following data were obtained: cyst burden, hematocrit, hemoglobin, red blood cells, thrombocytes, occurrence of pain, and blood pressure before and after the operation. Complications were collected and presented in Clavien score. RESULTS: Hematocrit, hemoglobin, and red blood cells were significantly increased in the experimental group. A positive correlation was observed between cyst burden and the parameters mentioned above. Of 91 patients with hypertension, 56 (61.7%) had blood pressure reduction after the operation. Treatment relieved the loin pain in 132 (88%) patients. Complications occurred in 15 (7.4%) patients. CONCLUSIONS: Patients with simple renal cysts have high values of red blood cells, hematocrit, and hemoglobin. Treatment decreases blood pressure in patients with hypertension. Complications after treatment are rare and mild.

Testicular volume and fertility potential in men operated due to varicocele and testicular hypotrophy in adolescence.

INTRODUCTION: Failure to perform surgical repair of varicocele before puberty is among the common causes of male infertility. The purpose of this study was to evaluate the testicular volume and fertility potential in men after laparoscopic varicocelectomy conducted in adolescence due to varicocele and concomitant testicular hypotrophy. MATERIAL AND METHODS: From 1996 through 2011, eighty-two adolescents were operated on for unilateral primary varicocele with testicular hypotrophy. Sixty-eight patients were subject to the current analysis. The age of the patients was 13 to 17 years (mean 15.3 years). Clinical diagnosis was established on the basis of andrologic examination and ultrasonography with an assessment of testicular size and varicocele severity. Laparoscopic surgical repair was performed by a transperitoneal approach with division of testicular vein only. RESULTS: An increase in left testicular volume when compared with the contralateral testis was found in 25 (78.1%) young men with clinical grade 2 varicocele (p = 0.02) and in 32 (88.8%) subjects with grade 3 abnormality (p = 0.04). An increase in left testicular volume was found in 46 (85.1%) of 54 patients with unilateral varicocele and in 12 (85.7%) of 14 subjects operated on for bilateral disease. A left testicular volume increase was comparable independent of the use of uni- or bilateral repair. Fifty-eight (85.2%) of our 68 patients had normozoospermia. CONCLUSIONS: Laparoscopic varicocele repair resulted in a significant increase of hypotrophic testicular volume in 83.8% of our subjects.

Prognostic value of radical cystoprostatectomy in men with bladder cancer infiltrating prostate versus co-existing prostate cancer: a research study.

BACKGROUND: The aim of the following study is to evaluate the advancement of incidentally diagnosed prostate cancer in specimen after cystoprostatectomies caused by muscle-invasive bladder cancer. Secondly we assessed the survival in patients after radical cystoprostatectomy whose postoperative specimen was characterized by the presence of co-existing prostate cancer or prostate infiltration by urothelial bladder cancer. METHODS: Between 1993 and 2009 a total of 320 patients with muscle-invasive bladder cancer underwent cystoprostatectomy. The first analyzed group consisted of 52 patients with bladder cancer infiltrating prostate, while the second group consisted of 21 patients with co-existing prostate cancer. In all patients cancer specific survival and progression were analyzed. Average follow up was 75.2 months (range: 0 - 181). RESULTS: Cancer-specific survival was significantly shorter in group I (p = 0.03). Neoplastic progression in patients from group I was observed in 42.2% of patients, while in patients from group II in 23.6% of patients (p = 0.04). No statistical difference was observed in the percentage of positive lymph nodes between the groups (p = 0.22). The median Gleason score in patients with co-existing prostate cancer was equal to 5. The stage of prostate cancer pT2/pT3 was equal to 20 (96%)/1 (4%) patients. 12 (57%) prostate cancers were clinically insignificant. Biochemical recurrence occurred in 2 (9%) patients. CONCLUSIONS: 1. Incidentally diagnosed prostate cancer in specimen after cystoprostatectomies is frequently clinically insignificant and characterized by low progression.2. Patients with bladder cancer infiltrating prostate are characterized by higher percentage of progression and death in comparison with patients with co-existing prostate cancer.

[Comparison of testicular volume before and after laparoscopic varicocelectomy in children and adolescents]. / Ocena porównawcza objetosci jader przed i po laparoskopowej operacji zylaków powrózka nasiennego u dzieci i mlodzienców.

UNLABELLED: Male infertility is the most frequent consequence of late diagnosis of varicocoele and not performing surgical varicocelectomy before puberty. The etiopathogenesis is still obscure. The anatomical conditions in men are conducive to the development of left varicocoele. The aim of this study is the assessment of the results of varicocelectomy on increase of testicular volume in adolescents with the grade II and III varicocoele and on improvement of potential fertility of young men. MATERIAL AND METHODS: In the period between 1996-2004, 62 children and adolescents with varicocoele and with left small testis underwent laparoscopic varicocelectomy. Unilateral varicocelectomy was performed in 51 (83.3%) while bilateral varicocectomy was performed in 11 (17.7%) patients. The average age was 15.6 years (13-17 years). Clinical diagnosis was based on: general physical examination, andrologic and sonographic (colour Doppler) examination where testis volume and clinical degree were assessed according to Dubin and Amelar score. Laparoscopic transperitoneal procedure was carried out using two surgical techniques: testicular vein and artery ligation or only testicular vein ligation. RESULTS: Left testis volume increase i.e. comparable volume of both testies was observed in 22 (75.9%) young men with grade II (p<0.001) and in 29 (87.9%) with grade III of clinical advancement of varicocoele (p<0.003). The increase of testis volume was noted in 43 (84.3%) patients: among 51 patients with unilateral varicocoele and in 8 (72.7%) among 11 boys operated with bilateral varicocele (p<0.001). The increase of testis volume was not significantly greater in boys who underwent spermatic artery sparing technique (p=0.85). Out of 62 patients, in 53 (85.5%) normozoospermy was observed (p<0.005). CONCLUSIONS: Laparoscopic ligation of testicular vein produced significant increase of hypotrophic testicular volume in 82.3% operated children. The presence of hypotrophic testies in adults, after varicocelectomy before puberty is accompanied by oligoasthenoteratozoospermy and high plasma FSH, LH levels and low plasma testosterone level. Assessment of the results of the varicocelectomy in children should include in the procreation period semen analysis and the estimation of plasma FSH, LH and T levels.