Are predictive factors in sperm retrieval and pregnancy rates present in nonobstructive azoospermia patients by microdissection testicular sperm extraction on testicle with a history of orchidopexy operation?

The aim in this study is to evaluate predictive factors on sperm retrieval and pregnancy rates by microdissection testicular sperm extraction in non obstructive azoospermia patients with a history of orchidopexy operation. A total of 148 patients were included, and their medical files were evaluated. Data related to possible predictive factors on sperm retrieval and pregnancy rates such as age at orchidopexy operation, unilateral or bilateral presence of undescended testis before orchidopexy, testis volumes and hormone levels were statistically analysed. It revealed that the mean ages in patients with unilateral and bilateral orchidopexy operations were 35.37 (±4.84) and 33.94 (±5.91) respectively. Mean testis volume in the unilateral orchidopexy group was 7.59 (±3.12) ml on the right testis and 7.37 (±2.86) ml on the left testis. Mean FSH levels were detected as 22.71 (±11.86) mIU/ml in the unilateral group and 28.19 (±12.40) mIU/ml in the bilateral group. In our study, we have shown that the age at which patients undergo orchidopexy and the unilateral or bilateral presence of cryptorchidism has no correlation with sperm retrieval and pregnancy rates.

Aging may adversely affect testicular sperm recovery in patients with Klinefelter syndrome.

OBJECTIVES: To investigate the clinical parameters or laboratory analyses that may have a predictive value for successful sperm retrieval in Klinefelter syndrome (KS). METHODS: A total of 74 patients with nonmosaic KS were included in this study. All patients were azoospermic and underwent microdissection testicular sperm extraction for sperm recovery. The predictive values of patient age, testicular volume, serum follicle-stimulating hormone, luteinizing hormone, and testosterone levels were assessed for successful sperm recovery. RESULTS: Testicular sperm recovery was successful in 42 (56.7%) of 74 men. The serum follicle-stimulating hormone, luteinizing hormone, and total testosterone levels did not show any difference between the patients with successful and those with unsuccessful sperm recovery. However, the patients with successful sperm recovery were significantly younger (31.6 +/- 4.3 years) than those with failed attempts (35 +/- 5.1 years, P = 0.002). In the receiver operating characteristics curve analysis, a cutoff of 30.5 years of age had a sensitivity of 78% and a specificity of 48% for successful sperm retrieval. Logistic regression analysis showed that sperm recovery was inversely related to patient age (odds ratio 0.854, 95% confidence interval 0.76 to 0.95). CONCLUSIONS: Microdissection testicular sperm extraction is an effective sperm recovery technique in patients with KS. Our data have demonstrated that aging might adversely affect the sperm recovery rate in men with KS. These results suggest that earlier infertility assessment and testicular sperm extraction in men with KS might play a critical role in their treatment.

Intratunical bupivacaine and methylprednisolone instillation for scrotal pain after testicular sperm retrieval procedures.

AIM: To investigate the effect of intratunical instillation of bupivacaine and methylprednisolone for scrotal pain, swelling and peritesticular fibrosis due to testicular sperm retrieval procedures. METHODS: A total of 65 patients were randomly divided into two groups. In the instillation group (GI), 34 patients were administered 2.5 mL of 0.5 % bupivacaine combined with 10 mg/ml methylprednisolone before closure of the tunica vaginalis. In the control group (GC), 31 patients only received analgesics postoperatively by intramuscular route. The pain (by visual analogue scale, VAS) and duration of pain-free period after surgery between the two groups were evaluated at 2 and 4 h and at days 2 and 7 postoperatively. RESULTS: The mean pain scores were significantly lower in the GI than in the GC group at 2 and 4 h after surgery (P<0.05 and P<0.01, respectively). The mean duration of pain free interval after the procedure was 47.8 +/-16.9 (12-72) h in GI, which was significantly longer than that in GC [(9.9 +/-3.6; 4-20) h]. Besides, in the GI, 29 % of patients were completely free from pain and 67 % had no scrotal swelling, but in the GC, all the patients required additional NSAID injection due to pain and only 3 % had no scrotal swelling. CONCLUSION: This study confirms that direct intratunical instillation of bupivacaine and methylprednisolone around the testis reduces the postoperative pain, scrotal swelling and peritesticular fibrosis.

Predictive role of non-contrast spiral computerized tomography on spontaneous passage of ureteral stones.

PURPOSE: We assessed the role of non-contrast spiral computerized tomography (CT) for prediction of a favorable clinical outcome in patients with ureterolithiasis, presenting with acute flank pain. MATERIALS AND METHODS: Consecutive 185 patients having acute flank pain were prospectively evaluated with physical examination, urinalysis and hemogram, and non-contrast spiral CT. Size (greatest width in mm), location, perinephric fat stranding, the degree of hydronephrosis, tissue rim sign and perinephric fluid were assessed with spontaneously passed and unpassed stones. RESULTS: Urinary stone disease was investigated in 173 (93.5%) patients out of 185 (mean age = 41.1 years) by non-contrast spiral CT in whom ureterolithiasis was diagnosed in 96 (94 unilateral, 2 bilateral). Spontaneous passage was assumed in 79 patients with ureterolithiasis. Only 38 patients spontaneously passed ureteral stones with less than 7.4mm diameter. The greatest width difference was statistically significant between passed and unpassed group [(2.0-7.4mm; mean 4.37+/-1.63) vs. (4.0-10.0mm; mean 7.35+/-1.81), p<0.05]. CONCLUSIONS: Spiral CT seems to be a sensitive imaging modality for the detection of ureteral calculi. In addition, size and location of the ureteral stones and its effects on ureteral wall, as periureteral inflammation and edema, demonstrated by the rim sign, present an important predictive value on spontaneous passage of uretreral stones.