Nephrectomy as Salvage Treatment After an Unsuccessful Embolization of a Huge Incidental Renal Artery Aneurysm With an Arteriovenous Fistula.

Renal artery aneurysms (RAA) with a concomitant renal arteriovenous fistula (RAVF) are rare entities with a reported incidence of less than 1%. An 86-year-old man was admitted to the urology department after an incidental finding of a left RAA on an abdominal ultrasound. A computed tomography angiography (CTA) revealed a saccular aneurysm measuring 54x42mm in the distal part of the left renal artery, along with a huge arteriovenous fistula measuring 45mm. The patient was asymptomatic at admission. Given the radiologic findings, an unsuccessful attempt at transcatheter arterial embolization was conducted. Therefore, a radical nephrectomy was recommended for the patient, which was performed without major intraoperative or postoperative complications. Microscopic examination depicted arteriosclerotic lesions and arterionephrosclerosis with 30% sclerotic glomeruli. The patient at his last visit remained free of symptoms. This case highlights the role of nephrectomy as a feasible option in cases of endovascular treatment failure.

COVID-19 and Male Infertility: Is There a Role for Antioxidants?

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), jeopardizes male fertility because of the vulnerability of the male reproductive system, especially the testes. This study evaluates the effects of the virus on testicular function and examines the potential role of antioxidants in mitigating the damage caused by oxidative stress (OS). A comprehensive PubMed search examined exocrine and endocrine testicular function alteration, the interplay between OS and COVID-19-induced defects, and the potential benefit of antioxidants. Although the virus is rarely directly detectable in sperm and testicular tissue, semen quality and hormonal balance are affected in patients, with some changes persisting throughout a spermatogenesis cycle. Testicular pathology in deceased patients shows defects in spermatogenesis, vascular changes, and inflammation. Acute primary hypogonadism is observed mainly in severely infected cases. Elevated OS and sperm DNA fragmentation markers suggest redox imbalance as a possible mechanism behind the fertility changes. COVID-19 vaccines appear to be safe for male fertility, but the efficacy of antioxidants to improve sperm quality after infection remains unproven due to limited research. Given the limited and inconclusive evidence, careful evaluation of men recovering from COVID-19 seeking fertility improvement is strongly recommended.