Female anterior wall onlay urethroplasty with lower lip buccal mucosal graft: Importance of the laterally extended incision.

Objective: To describe the outcome of female anterior wall (pubic side) onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques. Methods: From January 2016 to April 2018, 17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study. The diagnosis of urethral stricture was confirmed based on a combination of patients' symptoms, post-void residual urine, video-urodynamics, and cystoscopy. Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection. Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score, post-void residual urine, and maximum flow rate. Results: Despite the previously failed minimally invasive procedures, urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes (success rate=94%). The mean±standard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up (25.82±3.97 to 10.88±5.57); so did postvoid residual urine (71.12±74.98 mL to 15.00±28.30 mL), and maximum flow rate (7.88±1.72 mL/s to 25.82±5.59 mL/s) with all statistically significant (p<0.05). Conclusion: The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands. An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate. A laterally extended incision may improve visualization and better graft placement by providing wider working space. The results should be evaluated in the future studies with larger sample size.

Comparison of zeta potential and physiological intracytoplasmic sperm injection in obtaining sperms with a lower DNA fragmentation index: A cross-sectional study.

Background: The sperm DNA fragmentation index (DFI) is one of the men's reproductive health criteria that affects assisted reproductive technique outcomes. Efforts in obtaining high-quality mature sperms seem to be necessary. Advanced sperm selection techniques (including physiological intracytoplasmic sperm injection [PICSI], zeta potential, microfluidic, etc.) have gained popularity in this regard. Objective: The study aimed to compare the efficacy of zeta potential and PICSI sperm selection in obtaining sperms with better DNA integrity. Materials and Methods: In this cross-sectional study, 48 couples were enrolled where the male partner had increased sperm DFI in his ejaculated sample and the female was in normal reproductive health. For each male partner, the semen sample was processed with zeta potential and PICSI techniques, then the sperm DFI of neat semen was compared to zeta and PICSI samples by the sperm chromatin dispersion test. Results: Data showed that both the zeta potential and PICSI technique decreased sperm DFI in comparison with the neat semen sample (p < 0.001 for both). In addition, there was a statistically significant difference in sperm DFI between the PICSI and zeta potential samples (p < 0.01). Conclusion: The current study showed that both zeta potential and PICSI could result in sperm with a lower DFI. However, PICSI seems to be superior to zeta potential in this regard.

Associations of MTHFR rs1801133 (677C>T) and rs180113 (1298A>C) Polymorphisms with Susceptibility to Bladder Cancer: A Systematic Review and Meta-Analysis.

The effects of the MTHFR rs1801133 (677C>T) and rs180113 (1298A>C) polymorphisms on bladder cancer risk have been evaluated in some studies. However, the results were conflicting and ambiguous. Therefore, we aimed to perform a comprehensive meta-analysis to investigate the association of these polymorphisms with risk of bladder cancer from all eligible case-control studies. PubMed, Web of science, Scopus, SID, CNKI and SciELO databases were searched to identify all relevant studies published up to 1 January, 2021. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the strength of associations. A total of 20 case-control studies including 11 studies with 3463 cases and 3927 controls on MTHFR rs1801133 (677C>T) and 9 studies with 3177 cases and 3502 controls on rs180113 (1298A>C) polymorphism were selected. Pooled data revealed that the MTHFR rs1801133 (677C>T) and rs180113 (1298A>C) polymorphisms were not associated with risk bladder cancer in overall. Stratified analysis by ethnicity revealed that the MTHFR rs1801133 (677C>T) and rs180113 (1298A>C) polymorphisms were associated with bladder cancer risk in Asians, but not in Caucasians. There was no publication bias. The current meta-analysis revealed that the MTHFR rs1801133 (677C>T) and rs180113 (1298A>C) polymorphisms were not risk factor for development of bladder cancer globally. However, large sample size, well-designed, and population-based studies should be performed to verify the association of the MTHFR polymorphisms with bladder cancer risk.

Comparison of intracytoplasmic sperm injection outcomes in azoospermic men who underwent testicular sperm extraction vs. microdissection testicular sperm extraction: A cross-sectional study.

BACKGROUND: Outcomes of intracytoplasmic sperm injection (ICSI) may be different in azoospermic men who undergo testicular sperm extraction (TESE) vs. microdissection-TESE (micro-TESE). OBJECTIVE: This study was conducted to compare the ICSI outcomes in men who underwent TESE vs. micro-TESE due to obstructive azoospermia and nonobstructive azoospermia, respectively. MATERIALS AND METHODS: A total of310azoospermic men who underwent ICSI from September 2016 to September 2020 were enrolled in this cross-sectional study and divided into two groups (172 cases in the TESE and 138 cases in the micro-TESE group). The paternal and maternal age, and the fertilization, biochemical pregnancy, abortion and live birth rates were compared between the two groups. RESULTS: Maternal mean age was significantly higher in the TESE group (34.9 ± 4.2 yr vs. 32.3 ± 5.7 yr). The fertilization and biochemical pregnancy rates were significantly higher in the TESE group, but the abortion rate was similar in the two groups. The live birth rate was higher in the TESE group, but this difference was not significant (p = 0.06). Also, the maternal and paternal age did not affect ICSI outcomes. CONCLUSION: Individuals who underwent TESE had higher fertilization and biochemical pregnancy rates than those who underwent micro-TESE, but the live birth rate was not significantly different.

the Short Abstinence May Have Paradoxical Effects On Sperms With Different Level Of DNA Integrity: A Prospective Study.

PURPOSE: To investigate the effect of short abstinence on sperm function tests and semen parameters. MATERIALS AND METHODS: This prospective study included 65 male patients with increased DNA injury in their ejaculated sperm and a history of recurrent pregnancy loss and/or assisted reproductive techniques failures. The effects of antioxidants medical therapy and short abstinence on semen quality were assessed (TUNEL test and CMA3 staining). RESULTS: Antioxidants have statistically significant effects on mean sperm concentration (untreated, 67.51 ± 44.40 million/ml, vs. treated, 56.09 ± 37.85 million/ml; P-value=0.005) and mean TUNEL score (untreated, 24.56% ± 9.49%, vs. treated, 20.64% ± 10.28%; P-value = 0.013). Moreover, a short abstinence period might have positive effects as shown on the TUNEL assay (20.64% ± 10.28 vs. 17.38% ± 8.59 ; P-value = 0.028) and CMA3 staining (47.79% ± 20.78, vs. short 41.92% ± 18.49; P-value = 0.019), when considering all study subjects. However, different results were obtained using more precise analysis based on a TUNEL cutoff score of 20%. The analysis showed that short abstinence might improve sperm DNA integrity in patients with TUNEL score > 20% (mean TUNEL score from 27.85% ± 8.32% to 19.14% ± 8.90% ; P-value =0.001%). However, it might have deleterious effects on sperm DNA integrity in patients with TUNEL score < 20% (mean TUNEL score from 11.89% ± 3.21% to 15.17% ± 7.79%; P-value = 0.045%) Conclusion: Our results showed that short abstinence may not be beneficial in all infertile males, and it should only be used in selected patients with abnormal DNA integrity.

An Infertile Azoospermic Male With 45, X T(Yp;15) Karyotype.

Objective: 45, X is a very rare condition that usually results from Y/autosomal translocations or insertions. Here we present an infertile azoospermic man who had 45, X t(Yp;15) karyotype and deletion of AZF (azoospermia factor) gene region. Case report : A 35-year-old infertile azoospermic man with a typical male appearance came for infertility genetic counseling. He was infertile for more than ten years and had short height. High-resolution of metaphase chromosomes of 50 peripheral white blood cells were analyzed for karyotyping. Fluorescence in situ hybridization (FISH) analysis and Polymerase chain reaction (PCR) were done for SRY and AZF gene localization. Karyotyping and FISH analysis revealed 45, X t(Yp;15) karyotype and no mosaicism. More investigation on the Y chromosome revealed no deletion in the SRY region, but AZF a/b/c were deleted. It was revealed that Yp's subtelomeric region but not Yq was translocated to chromosome 15. Conclusion: This study shows that despite the lack of a complete Y chromosome in this person, the occurrence of secondary male traits is a result of the short arm translocation of the Y chromosome, which contains the (ex-determining region Y) SRY gene. Infertility is also due to the Y chromosomes long arm's deletion containing the AZF gene region.

Upregulation of the RNF8 gene can predict the presence of sperm in azoospermic individuals.

OBJECTIVE: In this study, specimens from testicular biopsies of men with nonobstructive azoospermia (NOA) were used to investigate whether RNF8 gene could serve as a biomarker to predict the presence of sperm in these patients. METHODS: Testicular biopsy specimens from 47 patients were classified according to the presence of sperm (positive vs. negative groups) and investigated for the expression of RNF8. The level of RNF8 gene expression in the testes was compared between these groups using reverse-transcription polymerase chain reaction. RESULTS: The expression level of RNF8 was significantly higher in testicular samples from the positive group than in those from the negative group. Moreover, the area under the curve of RNF8 expression for the entire study population was 0.84, showing the discriminatory power of RNF8 expression in differentiating between the positive and negative groups of men with NOA. A receiver operating characteristic curve analysis showed that RNF8 expression had a sensitivity of 81% and a specificity of 84%, with a cutoff level of 1.76. CONCLUSION: This study points out a significant association between the expression of RNF8 and the presence of sperm in NOA patients, which suggests that quantified RNF8 expression in testicular biopsy samples may be a valuable biomarker for predicting the presence of spermatozoa in biopsy samples.

Iranian temporal changes in semen quality during the past 22 years: A report from an infertility center.

BACKGROUND: Despite numerous reports about temporal changes in semen quality from all over the world, the debates continue. The latest systemic review has shown an overtime decrease in semen quality worldwide. OBJECTIVE: To assess the temporal changes in the semen quality among Iranian population referred to an infertility center. MATERIALS AND METHODS: In this retrospective cross-sectional study, semen parameters including concentration, motility, and morphology were compared between Iranian men reffered to Research and Clinical Center for Infertility, Yazd between 1990 to 1992 (group 1, n = 707) and 2010 to 2012 (group 2, n = 1108). Demographic characteristics and semen analysis were collected from the records. The effect of age on semen parameters was also investigated. RESULTS: Despite the increase in sperm concentration l in group 2, sperm with normal morphology decreased significantly (p < 0.001). Grade-A motility decreased (p < 0.001), grade B motility increased (p < 0.001), and grade C and D motile sperm remained constant (p = 0.303 and p = 0.315, respectively). Also, no significant correlation between the age and semen parameters were observed. CONCLUSION: This study showed inconsistent temporal changes in the participant semen quality. Significant temporal decline were obtained between various semen parameters, sperm morphology and grade A motility. These results should be further evaluated by larger studies in the future.

Glandular amputation by strangulating tied suture: a case report of late-onset complication in the Plastibell circumcision technique.

BACKGROUND: Circumcision is considered to be a procedure with minimal morbidity but may be associated with catastrophic complications in inexpert hands. CASE PRESENTATION: We presented a 9-year-old boy with a past medical history of circumcision at the age of one year with Plastibell clamp who was referred with severe chronic penile injury due to neglected plastibell string. After string removal under a loupe magnification (4×), we saw a deep circular injury at distal penile shaft which led to painless glandular autoamputation 45 days later. The patient was managed conservatively with daily urethral self-dilation until future reconstructive surgery. CONCLUSION: This complication emphasized the importance of the follow-up visit by a physician for any probable string remnant.

Effects of microsurgical varicocelectomy on semen analysis and sperm function tests in patients with different grades of varicocele: Role of sperm functional tests in evaluation of treatments outcome.

It seems that varicocele play a role in male infertility, as such, their prevalence increases from 15% in the normal population to 80% in secondary infertility subjects. Varicoceles may have negative effects on semen quality. Our goal was to assess the effects of microsurgical varicocelectomy on semen analysis and sperm functional tests in men with different grades of varicoceles. Thirty infertile men with different grades of varicoceles (grades 1 to 3) were enrolled in our study. Semen quality was assessed by semen analysis according to the WHO guideline (WHO, 1999) and four different sperm functional tests (aniline blue, toluidine blue, chromomycin A3 and TUNEL test) were carried out before and 3 months after microsurgical varicocelectomy (M-varicocelectomy). When considered all three grades together, we showed that M-varicocelectomy had statistically significant effects on all four types of sperm functional tests (p value<0.05). It also had positive effects on conventional semen parameters, although the effects were not statistically significant for some parameters (for example sperm count). When analysed separately (based on varicocele grades) the surgery, although caused improvements in semen quality, but may have more statistically significant effects on patients with varicocele of higher grade. In addition, in varicocele of lower grade (for example grade 2), sperm function test may be a better predictor of surgical success than the conventional semen analysis. Thus, we show that not only M-varicocelectomy has significant positive effect on semen quality but also if sperm functional tests become more affordable in the future, because they yield more precise results, their use in daily practice may increase significantly in patients with varicoceles.

Deep neck infections: a retrospective review of 112 cases.

The purpose of this study was to review our recent experience with deep neck infections and compare it to the experiences in the available literature. A total number of 112 charts of patients treated for deep neck infections at the department of otolaryngology of our hospital between August 1996 and September 2007 were retrospectively reviewed. All the relevant clinical charts including presentation, origin and site of deep neck infection, radiological, and bacteriological studies and interventions along with demographic profile, details of hospital stay, and outcomes were evaluated. The findings were compared to those in the available literature. Until 2002, we had nearly constant number of patients annually but since then we have found an increasing number of them. The most common presenting symptom was neck swelling (88.4%). Fever was present in 63.4 and 78% had leukocytosis. The most common known cause was dental infection (31.3%) and in 32.1% of them origin remained unknown. The most commonly encountered site was the submandibular space and 23.2% of patients had two or more involved spaces. Exactly 20.5% were treated with intravenous antibiotic therapy alone whereas 79.5% had surgical procedures with successful results in 98.2% of them. Diabetes mellitus was diagnosed in 20.5% of cases. There was no case of known primary or acquired immunodeficiency. We had two deaths from septic shock but there was not any other complication. Mean hospitalization time was 7 days. Deep neck infections remain potentially lethal infections if they are not diagnosed early and treated promptly. Widespread diffusion of empirical broad-spectrum oral antibiotic and anti-inflammatory treatments may cause masked presentations of deep neck infections without swelling, fever, or leukocytosis. Our tailored approach (medical or medical and surgical) based on clinical and radiological evidence was successful in 98.2% of the patients with a short mean hospitalization time.