Prospective analysis of factors predicting feasibility & success of longitudinal intussusception vasoepididymostomy in men with idiopathic obstructive azoospermia.

BACKGROUND & OBJECTIVES: : Microsurgical reconstruction for idiopathic obstructive azoospermia is a challenging procedure, and selection of appropriate patients is important for successful outcomes. This prospective study was done to evaluate the ability of scrotal ultrasound measurements to predict the surgical feasibility and determine factors that could predict a patent anastomosis following vaso-epididymal anastomosis (VE) in men with idiopathic obstructive azoospermia. METHODS: : In this prospective study, men diagnosed with idiopathic obstructive azoospermia, scheduled for a longitudinal intussusception VE, underwent a scrotal ultrasound measurement of testicular and epididymal dimensions. During surgery, site and type of anastomosis, presence of sperms in the epididymal fluid and technical satisfaction with the anastomosis were recorded. All men where VE could be performed were followed up for appearance of sperms in the ejaculate. Ultrasound parameters were compared between men who had a VE versus those with negative exploration. Predictive factors were compared between men with or without a patent anastomosis. RESULTS: : Thirty four patients were included in the study conducted between September 2014 and August 2016 and a VE was possible in only 19 (55%) patients. Of these 19 patients, six had a patent anastomosis with one pregnancy. Preoperative ultrasound measurements could not identify patients where a VE could not be performed. Motile sperm in the epididymal fluid was the only significant predictor of a successful anastomosis. INTERPRETATION & CONCLUSION: : Forty five per cent of men planned for a VE for idiopathic obstructive azoospermia could not undergo a reconstruction. Ultrasound assessment of testicular and epididymal dimensions could not predict the feasibility of performing a VE. The presence of motile sperms in the epididymal fluid was the only significant predictor of a patent VE in our study.

Prospective randomized placebo-controlled study to assess the safety and efficacy of silodosin in the management of acute urinary retention.

OBJECTIVE: To determine the safety and efficacy of silodosin in the management of acute urinary retention (AUR) related to benign prostatic hyperplasia (BPH). METHODS: From January 2011 to May 2012, 60 men over 50 years of age with AUR were equally randomized to either silodosin 8 mg once daily or placebo for 3 days followed by trial without catheter (TWOC). If the patient re-experienced urinary retention or if postvoid residual urine volume was >150 mL, he was re-catheterized and considered to have a failed TWOC. All patients with a successful TWOC on day 3 were started on silodosin regardless of which arm they had belonged initially. Uroflowmetry, postvoid residual volume and International Prostate Symptom Score (IPSS) were noted at TWOC and after 2 weeks. RESULTS: Baseline patient demographics and clinical characteristics were similar in both groups (P >.1). The success rate of TWOC was 76.7% in the silodosin group and 36.7% in the placebo group (P = .002). On multivariate analysis, patients in silodosin group had lesser odds of having a failure (0.13) when compared to those not given treatment (P = .008). Among the clinical parameters, a retention volume more than 800 mL (P = .038) and an IPSS score more than 25 (P = .042) had significantly greater odds of failure. There were no adverse effects related to the use of silodosin. CONCLUSION: Silodosin significantly increases the chances of successful TWOC after AUR.