RESUMO
Background: Varicocele is a condition that seriously affects male fertility. It can cause pathological changes in the testicles and affect their spermatogenesis and endocrine function. Objective: To formulate nomograms to predict sperm improvements after microscopic varicocelectomy. Design setting and participants: A retrospective analysis was conducted on varicocele patients who met the research criteria and were enrolled from March 2020 to June 2022. They were divided into a development and a validation cohort in a 2:1 ratio. Outcome measurements and statistical analysis: Data on preoperative testicular atrophy index, bilateral testicular elastic modulus, testosterone, pre- and postoperative 6-mo total sperm count, sperm concentration, and sperm vitality were collected. An increase of ≥25% is considered a postoperative improvement in sperm parameters. Predictive nomograms were constructed through forward stepwise LR regression, based on independent risk factors filtered by univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis, calibration curve, and decision curve analysis were employed to assess the performance of the models. Results and limitations: The areas under the curve of nomograms for predicting the postoperative improvement of total sperm count, sperm concentration, and sperm vitality were 0.915, 0.986, and 0.924 respectively. The nomogram models demonstrated good predictive performance. The single-center sample size was a limitation of this study. Conclusions: In this study, we developed effective predictive nomogram models for anticipating postoperative improvements in sperm quality among varicocele patients. These models offer a significant value in providing accurate predictions of surgical outcomes. However, it is crucial to conduct further external validation. Patient summary: In this study, a predictive nomogram model was constructed for assessing the improvement of sperm quality in varicocele patients after surgery. The model offered satisfactory results.
RESUMO
BACKGROUND: Traumatic amputation of the penis is a rare surgical emergency, usually caused by self-mutilation, accidents, circumcision, assault and animal attacks. This study aimed to summarize our treatment experience involving penile reconstruction in a rare case of a self-strangulation induced chronical penile partial amputation. CASE SUMMARY: A 22-year-old man presented with self-strangulation induced chronical penile partial amputation for 3 mo where the penile proximal part was 1 cm far from the pubis. Reconstruction methods included end-to-end anastomosis of the urethral mucosa, proximal anastomosis of the corpus cavernosum and tunica albuginea of the penis, anastomosis of the deep dorsal vein, dorsal artery, and superficial dorsal vein. Patient urinated smoothly after the catheter was removed on day 21. 3 mo after the surgery, the patient's penile preliminary cosmetic appearance was satisfactory, with occasional morning erections. Distal penile sensation was preserved, yet erection hardness of the distal penis was not satisfactory. CONCLUSION: Complete preoperative assessment and prompt surgical intervention decreases loss of residual penile functions.