RESUMEN
Objective: Varicocele, the dilation of the pampiniform plexus of the spermatic cord. It is discovered incidentally in most patients. Symptoms vary, but its impact is especially experienced in the field of fertility and reflected in semen parameters. Varicocelectomy is a surgical approach to correct the varicocele, however, reports are conflicting regarding its success. Our aim was to evaluate the efficacy of varicocelectomy on semen parameters and conception rates in patients who underwent surgery and its association with comorbidities such as diabetes, hypertension, and obesity. Materials and Methods: This cross-sectional study included the complete medical records of 86 patients. Data collection form included the patient's age, body mass index (BMI), chronic diseases, smoking, surgical history, medication usage, and the reason for performing surgery. Presurgical and postsurgical semen parameters were evaluated 3 months before surgery and an average of 6 months postoperatively. Data were analyzed with SPSS, Chi-square test, and independent and paired t-test. Results: No significant difference was found between primary and secondary infertility regarding semen analysis, postoperative semen analysis indicated an improvement in semen motility at 180 min with no effect on other parameters. Using spontaneous intercourse or in vitro fertilization (IVF) after varicocelectomy was significantly associated with increasing conception rates irrespective of the type of infertility. Diabetes, hypertension, BMI, and smoking did not appear to affect semen parameters. Conclusion: Patients who underwent varicocelectomy had improved sperm motility at 180 min and subsequently had a higher chance of successful conception either through spontaneous intercourse or IVF. Further studies are needed to understand the relationship between conception and sperm motility. Semen parameters were not affected if the patient had comorbidities such as diabetes and hypertension. Furthermore, smoking and BMI did not appear to affect the conception rate.
RESUMEN
INTRODUCTION: This study aimed to demonstrate the outcome of hypospadias repair in the pediatric population using the tubularized urethral plate technique and to compare the incidence of fistula between incised and unincised urethral plate. METHODOLOGY: This is a retrospective cohort study of pediatric patients who had hypospadias repair in a tertiary hospital in Jeddah, Saudi Arabia, between January 2000 and December 2012. They were divided into two main groups according to the status of the urethral plate: Group A included patients who had incision of the urethral plate just before tubularization, and Group B included patients who underwent tubularization without incision. RESULTS: After reviewing 310 medical records, 106 patients were included in the final analysis, with a median age of 2 years (interquartile range = 3 years). There was no statistically significant relationship between types of hypospadias and the development of fistula (P = 0.26). In Group A, we identified 87 patients (82%), and in Group B, there were 19 patients (18%). The overall incidence of fistula was 34.9% (n = 37). The incidence of fistula in Groups A and B was 36% (n = 31) and 32% (n = 6), respectively. This difference was not statistically significant. Despite a high fistula rate, only 12 patients (11%) were required to repeat surgery. CONCLUSION: Incision of the urethral plate did not affect the fistula rate. In comparison to international literature, the incidence of fistula was significantly higher which could be explained by the fact that one-third of those patients had a previous hypospadias repair.
