Comparison of macroscopic one-layer over number 1 nylon suture vasovasostomy with the standard two-layer microsurgical procedure.

OBJECTIVE: To compare the outcomes of macroscopic one-layer vasovasostomy (MOLVV) with those of two-layer microsurgical vasovasostomy (TLMVV). METHODS: Standard TLMVV was performed in 112 men (Group 1), while MOLVV was performed in 94 patients. All of the MOLVVs were performed with number 1 nylon suture as a temporary stent. The outcome measures were as follows: patency rate, pregnancy rate, operation time, total procedure cost, and complications. RESULTS: The mean operation duration was 114 ± 10 min for the TLMVV technique, and 74 ± 5 min for the MOLVV procedure (P = 0.024). In patients who underwent vasal patency at 6-month postoperative period, the median sperm density (106/mL) was 28.3 and 27.7 in Groups 1 and 2, respectively (P = 0.62). At the same time, the median total motile sperm count (× 106) was 39.4 and 32.6 in two-layer microsurgical and one-layer macroscopic groups, respectively (P = 0.47). Patency rates were 82.1% in Group 1 and 77.7% in Group 2, which were not significantly different (P = 0.21). The pregnancy rate was 28.4% for patients in Group 1 and 26.7% for patients in Group 2 (P = 0.38). CONCLUSIONS: There were no significant differences in terms of patency and pregnancy rates between MOLVV and TLMVV methods, but the MOLVV technique offers a decreased cost and operative time, and a simplified procedure.

Opium consumption is negatively associated with serum prostate-specific antigen (PSA), free PSA, and percentage of free PSA levels.

Addiction to opium continues to be a major worldwide medical and social problem. The study addressing the association between opium consumption and serum prostate-specific antigen (PSA) level is lacking. We determined the effects of opium consumption on serum PSA levels in opium-addict men. Our study subjects comprised 438 opium-addict men with a mean age of 52.2 ± 6.4 years (group 1). We compared these men with 446 men who did not indicate current or past opium use (group 2). Serum total PSA (tPSA), free PSA (fPSA), % fPSA, and sex hormones were compared between the 2 groups. The mean serum tPSA level was significantly lower in group 1 (1.05 ng/mL) than in controls (1.45 ng/mL) (P = 0.001). Opium consumption was also associated with lower fPSA (P = 0.001) and % fPSA (P = 0.001). Serum free testosterone level in opium-addict patients (132.5 ± 42 pg/mL) was significantly lower than that in controls (156.2 ± 43 pg/mL) (P = 0.03). However, no significant correlation existed between tPSA and free testosterone levels (r = 0.28, 95% CI, -0.036 to 0.51, P = 0.34). Among the patients with cancer in group 1, 35% were found to have high-grade tumor (Gleason score ≥ 7) compared with 26.7% in group 2 (P = 0.02). Total PSA and fPSA were strongly correlated with duration of opium use (r = -0.06, 95% CI, -0.04 to -0.08, P = 0.0001; and r = -0.05, 95% CI, -0.03 to -0.07, P = 0.0001, respectively). Opium consumption is independently and negatively associated with serum tPSA, fPSA, and % fPSA levels.

The effects of opiate consumption on serum reproductive hormone levels, sperm parameters, seminal plasma antioxidant capacity and sperm DNA integrity.

We evaluated the effects of opiate consumption on semen quality, sperm function, seminal plasma antioxidant capacity, and sperm DNA integrity. A total of 142 opiate addict men (group 1) were enrolled in the study and 146 healthy age matched male volunteers (group 2) served as controls. Two semen analyses were performed in all participants. Sperm chromatin structure assay (SCSA) was used to identify sperm DNA integrity. The mean±SD sperm concentration in opiate users and in control subjects was 22.2±4.4 and 66.3±8.3 million per ml, respectively (P=0.002). A significant increase in the amount of fragmented DNA was found in opiate consumers compared with that in controls (36.4±3.8% vs. 27.1±2.4%, P=0.004). Significantly decreased levels of catalase-like and superoxide dismutase-like (SOD) activity were observed in group 1 compared with group 2. Opiate consumption has significant adverse effects on semen quality. In cases of unexplained infertility in men, opium consumption should be considered as a possible factor.

Effects of varicocele repair on spontaneous first trimester miscarriage: a randomized clinical trial.

PURPOSE: To evaluate the effects of varicocelectomy on semen parameters, pregnancy rates, and live birth in couples with first term recurrent miscarriage. MATERIALS AND METHODS: One hundred and thirty-six women with recurrent miscarriage were recruited into this study. All of the husbands had normal semen parameters according to World Health Organization criteria and clinical varicocele. In order to evaluate the causes of recurrent pregnancy loss, we looked for chromosomal abnormalities and endocrine, chronic inflammatory, and infectious diseases. Both groups were well matched according to male/female age, varicocele grade, and smoking history. These couples were assigned randomly into two groups: group one (n = 68), in which male partners underwent varicocele repair, and group two (n = 68), which underwent expectant therapy. All of the couples were followed up monthly up to 12 months. All of the women who conceived were followed up until delivery. In each 3-month follow-up visits, two semen analyses were performed. RESULTS: Mean sperm concentration, sperm progressive motility, and sperm with normal morphology improved significantly after elapsing 6 months from varicocelectomy by 75.0%, 15.9%, and 14.3%, respectively, versus the expectant group (P < .01). The overall pregnancy rate was 44.1% and 19.1% within a 12-month period in groups 1 and 2, respectively (P = .003). Of women who conceived in groups 1 and 2, 13.3% and 69.2% developed miscarriage (P = .001). Sperm density/mL (r = 0.072; P = .001), time elapsed from varicocelectomy (r = 0.068; P = .001), and female age (r = -0.062; P = .002) were three most significantly related independent factors to pregnancy rate by multiple regression analysis. CONCLUSION: Varicocelectomy improves semen quality, increases pregnancy rate, and decreases miscarriage rate significantly. Further controlled studies to confirm our results seem warranted.

Kidney displacement in complete supine PCNL is lower than prone PCNL.

To compare the amount of the kidney displacement in the complete supine percutaneous nephrolithotripsy (PCNL) to the prone PCNL during getting renal access. Thirty-three patients were randomly divided into two groups. The patients in group A were placed in the complete supine position and the patients in group B in the prone position. Amounts of the kidney displacement in three states and other data were analyzed. The mean amount of the kidney displacement in the complete supine PCNL was 10.1 ± 7.9 mm in stage 1, 10.7 ± 8.28 mm in stage 2 and 12.2 ± 10.4 mm in stage 3. The mean amount of the kidney displacement in prone PCNL was 16.6 ± 5.8 mm in stage 1, 16.2 ± 6.3 mm in stage 2 and 17.6 ± 6.7 mm in stage 3. In stages 1 and 2, a significant difference between the two groups derived from the mean amount of the kidney displacement, but the difference was not statistically significant in stage 3. Adjusted for age, gender, BMI, stone burden and position of PCNL, prone position was a predictor caused significantly more displacement in all three stages. Among other predictors, only BMI had a significant effect on the amount of the kidney displacement (in stages 2 and 3). Performing PCNL in the complete supine position is safe and effective and leads to less kidney displacement during getting renal access and therefore, it may be considered in most patients requiring PCNL.

Diagnostic accuracy of C-reactive protein and erythrocyte sedimentation rate in patients with acute scrotum.

INTRODUCTION: Our aim was to investigate the diagnostic accuracy of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in patients with acute scrotum. MATERIALS AND METHODS: One hundred and twenty patients with acute scrotum were evaluated and divided into 3 groups: 46 with acute epididymitis (group 1), 23 with spermatic cord torsion (group 2), and 51 with other noninflammatory causes of acute scrotum (group 3). Serum levels CRP and ESR were measured at the time of admission. RESULTS: Of the patients in group 1, 44 (95.6%) had elevated serum levels of CRP (mean, 67.77 +/- 47.80 mg/L). In contrast, only 1 patient in group 2 had a significant increase in the serum level of CRP (mean, 9.0 +/- 4.90 mg/L), and the patients in group 3 did not have any significant increase in the CRP levels (mean, 7.0 +/- 2.2 mg/L) (P < .001). The mean ESR values were 45.9 +/- 21.4 mm/h, 14.2 +/- 11.2 mm/h, and 8.8 +/- 7.5 mm/h, in groups 1 to 3, respectively (P < .001). The cutoff points for distinguishing between epididymitis and noninflammatory causes of acute scrotum were 24 mg/L for CRP and 15.5 mm/h for ESR. The sensitivity and specificity values were 93.4% and 100% for CRP and 95.6% and 85.1% for ESR, respectively. CONCLUSION: Based on our findings, serum levels of CRP and ESR can provide helpful information for differentiation between epididymitis and other causes of acute scrotum. We recommend CRP and ESR measurements before making a decision of surgical intervention.

Acute urinary retention in children.

PURPOSE: Acute urinary retention in children is a relatively rare entity. There are a variety of causes that are poorly defined in the literature. We review our cases of acute urinary retention in children at three major pediatrics centers in Iran. MATERIALS AND METHODS: Between 1996 and 2003, children (up to 14 years old) who had been referred due to acute urinary retention were examined. Urinary retention was defined as inability to empty the bladder volitionally for more than 12 hours with a urine volume greater than expected for age or a palpably distended bladder. All data from the patients' past medical history, physical examination, and laboratory and radiographic assessments were collected. Also, cystourethroscopy and urodynamic procedures had been carried out according to patient's conditions. Patients with secondary urinary retention, including those with surgical history, immobility or chronic neurological disorders, mental retardation, and drugs or narcotics consumption were excluded from study. RESULTS: There were 86 patients meeting the inclusion criteria, consisting of 58 males with a median age of 4 years (range 1 month to 14 years) and 58 females with a median age of 4 years (range 4 month to 14 years). Etiologies were lower urinary tract stone in 27.9%, neurological disorders in 10.4%, trauma in 10.4%, local inflammatory causes in 9.1%, urinary tract infection in 7.4%, ureterocele in 7.4%, benign obstructing lesions in 5.8%, iatrogenic in 5.8%, constipation in 4.6%, imperforated hymen in 3.5%, and large prostate utricle, urethral foreign body, and rhabdomyosarcoma each in 1 case (1.1%). CONCLUSION: The most common cause of acute urinary retention was lower urinary tract stone in our pediatric cases. Ureterocele and stone were the main findings in girls and boys, respectively, and urinary retention in boys was twice as prevalent as that in girls.