Hypogonadism and urologic surgeries: a narrative review.

Background and Objective: Previous studies indicated that the treatment of male hypogonadism can be beneficial for intraoperative and postsurgical outcomes. In this study, we aimed to determine the impact of male hypogonadism on urologic surgeries. We provided an overview of the key studies in the field with the focus on the outcomes of urologic surgeries in hypogonadal men with/without testosterone replacement therapy (TRT). Methods: We performed a literature review in PubMed and Google Scholar databases for the most relevant articles pertaining to the outlined topics without placing any limitations on publication years or study designs. We included full-text English articles published in peer reviewed journals between January 1970 and March 2022. Key Content and Findings: Androgen deficiency is a common finding after major urologic surgeries. Although guidelines recommend against TRT in men with prostate carcinoma, recent investigations showed no association between TRT and disease progression and recurrence. Indeed, recent evidence suggested that low androgen levels could be related to high grade prostate carcinoma and increased risk of upgrading from low to high grade disease. Investigations on the application of TRT in benign prostatic hyperplasia (BPH) patients also revealed contrasting results. While some studies suggested higher rates of prostate-related events in men who received TRT, others showed that TRT could alleviate urinary symptoms in hypogonadal men with BPH. Decreased testosterone level is commonly seen in bladder cancer patients. The treatment of perioperative androgen deficiency can reduce postoperative morbidities and lower the risk of recurrence in these patients. Low testosterone levels are observed in approximately half of the men who undergo artificial urinary sphincter (AUS) placement and can increase the risk of complications. Conclusions: The role of testosterone treatment in patients with urologic diseases such as prostate carcinoma and BPH is controversial. Further investigations are needed to determine the impact of hypogonadism and TRT on the outcomes of urologic surgeries in patients with androgen deficiency.

Best time to wait for the improvement of the sperm parameter after varicocelectomy: 3 or 6 months?

OBJECTIVE: To estimate the duration of time required following varicocelectomy to wait for the improvements of semen parameters. Therefore, we characterized the changes with the time in sperm parameters in men after varicocelectomy. MATERIALS AND METHODS: In this prospective cohort study we included consecutively observed men who underwent varicocelectomy between September 2017 and September 2018 in a referral academic hospital. Clinical data of the patients, as well as their semen parameters, were measured before surgery and at 3 and 6 months afterward. RESULTS: In this study, a total of 100 men with average age of 29.5 ± 6.2 years were included. Mean sperm concentration and sperm motility significantly improved by 3 (p < 0.05), but not by 6 months following varicocelectomy. The semen volume and sperm with normal morphology were the same before and after surgery (p > 0.05). There was no statistically significant difference in the improvement of semen parameters when comparing 6 months to 3 months postoperatively (p > 0.05). CONCLUSIONS: Sperm parameters (concentration and motility) improve by 3 months after varicocelectomy without further improvements. Consequently, physicians should decide quickly after 3-month of varicocelectomy if surgery has been not helpful and then plan other therapies, like assisted reproductive technology (ART) for managing infertility in couples.

Huge renal epithelioid angiomyolipoma - A case report of a giant, benign renal mass.

INTRODUCTION: Renal angiomyolipoma (also called renal hamartoma) is a benign Tumor, composed of adipose tissue, smooth muscle tissue, and blood vessels. Tumors more than 10 cm (referred to as "giant" AMLs) are infrequent and a very small number of reported cases were measured more than 20 cm. Epithelioid angiomyolipoma (EAML), is a rare variant of angiomyolipoma with malignant potential. There are less than 10 cases of huge EAML reported in English literature, that were all associated with recurrence and complications. CASE PRESENTATION: Here we report a rare case of renal EAML in a 48-year-old male patient that was not associated with tuberous sclerosis. He was admitted to our hospital with a complaint of severe abdominal pain. Computer Tomography Scan (CT-scan), revealed two masses attached to the left kidney with a size of 32 × 22 × 8 cm and 20 × 10 × 3 cm. The patient underwent a radical left nephrectomy. Postoperative histopathological examination confirmed the diagnosis of an EAML. The two-year follow-up CT-scan showed no recurrence. CONCLUSION: Malignant EAML, although rare, does exist. Thus, besides evaluations required for ruling out the diagnosis of renal sarcomas, surgeons must follow patients after total nephrectomy for possible recurrence. Benign cases can be completely cured by surgery and do not show recurrence at the end of the follow-up period.

The First Report of Triple Advanced Synchronous Cancer: Bladder Transitional Cell Carcinoma and Clinically Silent Adenocarcinoma of Prostate and Colon.

Multiple synchronous malignancies are believed to be quite rare and their diagnosis and treatment are very challenging for physicians. Co-presence of synchronous bladder and prostate cancers in an elderly individual is not uncommon; however, the simultaneous occurrence of the third cancer - colon cancer - is extremely outlandish. In the present study, the case of an 82-year-old man with a complaint of hematuria is reported who was eventually diagnosed with three synchronous cancers: stage-3 transitional cell carcinoma of the bladder, stage-4 prostate mucinous adenocarcinoma, and stage-3 glandular adenocarcinoma of the colon. The patient underwent total colectomy and radical cystoprostatectomy followed by chemotherapy and radiotherapy. The 2-year follow-up showed promising results with no major complications and the patient's general condition was satisfactory. Although synchronous cancers are not so common, they should not be disregarded in elderly patients especially in those with multiple symptoms.

Cystoscopic removal of a migrated intrauterine device to the bladder; a case report.

BACKGROUND: An intrauterine device (IUD) is a well-accepted means of reversible contraception. Migration of IUD to the bladder through partial or complete perforation has been rarely reported. This phenomenon could be strongly associated with history of prior cesarean sections (C-section) or early insertion of the device in the postpartum period. CASE PRESENTATION: In this study, a case of copper IUD migration through cesarean scar defect is presented, in such a way that was successfully managed by cystoscopic removal. A 31-year-old female with a history of lower urinary symptoms referred to the clinic for her secondary infertility work-up. A copper IUD outside the uterus in the bladder was found using hysterosalpingraphy. A plain abdominal radiography also confirmed the presence of a T-shaped IUD in the pelvis. According to ultrasound, the copper IUD was partly in the bladder lumen and within the bladder wall. The patient had a history of an intrauterine device insertion eight years ago followingher second cesarean delivery. Three years later, her IUD was expelled, and another copper IUD was inserted. Thesecond copper IUD was alsoremoved while she decided to be pregnant. The patient finally underwent a hysteroscopic cystoscopy. The intrauterine device with its short arms embedded in the bladder wall was successfully extracted through the urethra. CONCLUSIONS: IUD insertion seems to be more challenging in women with prior uterine incisions and requires more attention. Cystoscopic removal should be considered as a safe and effective minimally invasive approach tomanage a migrated intrauterine device in the bladder.

First Experience of Inserting a Metallic Mesh Stent (Uventa Stent) in Malignant Ureteral Obstruction in Iran.

Malignant ureteral obstruction is usually caused by an extrinsic compression including intra-abdominal cancers. One of the treatment modalities decompressing the obstruction is applying stent to open the ureter. Metallic Stent is an effective instrument which we used for the first time in Iran in our patient who had a metastatic colon cancerwith a single kidney and we used a Novel, Double-Layered, Coated, Self-expandable Metallic Mesh Stent (Uventa Stent) to keep the ureter open. After six months of follow up with ureteroscopy, there was no obstruction any more.

Is modified retroperitoneal lymph node dissection alive for clinical stage I non-seminomatous germ cell testicular tumor?

PURPOSE: To evaluate efficacy of modified retroperitoneal lymph node dissection (RPLND) in the management of patients with pathological stage (PS) I non-seminomatous germ cell testicular tumor (NSGCT) in a retrospective study. MATERIALS AND METHODS: Between April 2002 and April 2012, 55 patients with clinical stage (CS) I NSGCT had undergone modified RPLND according to Sloan-Kettering modified RPLND template. Clinicopathological parameters, retroperitoneal relapse, and antegrade ejaculation rate were evaluated in patients with PS I. RESULTS: Of 55 patients, 41 (74.5%) and 14 (25.5%) subjects were in PS I and II, respectively. In PS I group, the mean patients' age was 32.8 years (range, 19 to 51 years) at the end of the follow-up period. Three patients missed the follow-up; hence, were excluded from the study. Mean follow-up duration was 56 months (range, 6 to 120 months). Tumor recurrence was identified in no subjects at the end of the follow-up period. Overall peri and postoperative complication rate was 18% (7 patients). Out of 38 patients, 23 (61%) had post RPLND antegrade ejaculation at the end of the study. CONCLUSION: Modified template RPLND is a safe, effective, and sufficient treatment for patients with no retroperitoneal micrometastasis after the procedure. Furthermore, this strategy may obviate the need for close, expensive, and potentially harmful follow-up protocol in patients with PS I NSGCT.

Feasibility and safety of laparoscopic nephrectomy for nonfunctioning kidney in patients with previous renal surgery.

PURPOSE: Performing laparoscopic nephrectomy in the setting of previous renal surgery may be challenging and associated with a higher complication rate. We conducted this study to assess the feasibility and safety of laparoscopic nephrectomy among patients with a history of ipsilateral renal surgery. PATIENTS AND METHODS: We reviewed the chart of 193 patients who underwent transperitoneal laparoscopic nephrectomy for nonfunctioning kidney between April 2007 and March 2011. The study population was divided into two groups: Group 1 comprised 37 patients with a history of ipsilateral renal surgery, and Group 2 consisted of 156 patients with no history of previous renal surgery. RESULTS: Baseline characteristics and preoperative variables were similar in both groups. Mean operative time, complication rate, and hospital stay were comparable between the two groups. A nonstatistically significant trend toward a higher transfusion rate was noted in Group 1 patients. The operation was converted to open nephrectomy in 1 (2.7%) and 3 (1.9%) patients of Groups 1 and 2, respectively (P=.765). CONCLUSIONS: Laparoscopic nephrectomy of the nonfunctioning kidney is a feasible and safe procedure in the setting of previous renal surgery and is not associated with a significant increase in operative time and complication rate compared with patients with no prior ipsilateral renal surgery.