The prognostic value of the neutrophil-to-lymphocyte ratio in patients with testicular cancer.

OBJECTIVES: To evaluate the potential prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in testicular cancer. MATERIALS AND METHODS: 80 patients with testicular cancer treated at our institution from 2005 to 2018 were retrospectively reviewed. Age, tumor markers, stage and histotype at final pathology, eventual medical treatment, tumor recurrence and follow-up data were extracted. The NLR was retrospectively calculated from blood tests. Data were analyzed by medians comparison, linear correlation, univariate and multivariate Cox regression and survival curve analysis. RESULTS: Population's median age was 33 years and median follow-up was 40.5 months. Overall, the median NLR was significantly reduced after orchiectomy (2.2 [1.55-3.09] vs. 1.77 [1.34-2.46], M-W P<0.001). Post-orchiectomy NLR was higher in patients who had disease recurrence (2.51;IQ 1.84-3.74 vs 1.59; IQ 1.10-2.24; M-W P=0.001), regardless of disease's stage: HR=1,85 (95%CI 0,99-3,46) and HR=1,91 (95%CI 0,96-3,78) for stage disease I or stage II, respectively. After stratification of patients by post-orchiectomy NLR (optimal cut-off: 2.255), patients with lower NLR had significantly longer recurrence-free survival (107.7 months [95%CI 97,7-119,2] vs. 57.65 months [95%CI 48,2-81,1], P<0.001). Univariable and multivariable Cox proportional hazard analyses, showed post-orchiectomy NLR, histotype at final pathology and disseminated disease at diagnosis as predictors of recurrence. CONCLUSION: NLR is a simple and wildly available biomarker. Higher post-orchiectomy NLR was found independently correlated to higher risk of recurrence, regardless of disease stage, which could potentially lead to a worse prognosis.

Abordaje perineal de fístulas rectouretrales tras prostatectomía radical laparoscópica / Perineal approach for rectourethral fistulae after radical laparoscopic prostatectomy

Objetivo: Describir nuestra experiencia con el abordaje perineal para el tratamiento de las fístulas rectouretrales (FRU) tras prostatectomía radical laparoscópica. Materiales y métodos: Realizamos un estudio retrospectivo desde el año 2012 al 2015 presentando 5 casos de FRU tras prostatectomía radical laparoscópica. Todos los casos requirieron cirugías abdominales mayores entre la prostatectomía radical laparoscópica y el tratamiento de la FRU a causa de complicaciones varias. En ningún caso se indicó radioterapia previa o posterior a la reparación. Se realizó abordaje perineal en los 5 casos como primera opción. Un caso requirió una segunda intervención con abordaje combinado (abdominal y perineal) por persistencia de la fístula. Resultados: Tras un mínimo de 12 meses de seguimiento en los 5 casos se ha resuelto la FRU. 2 pacientes presentaron incontinencia urinaria y uno estenosis de la anastomosis que requirió uretrotomía interna. El resto no ha mostrado complicaciones a largo plazo. Conclusión: El abordaje perineal permite un campo quirúrgico sano en pacientes multioperados, obteniendo altas tasas de resolución de la fístula

Objective: To describe our experience with the perineal approach to treat rectourethral fistulae (RUF) after radical laparoscopic prostatectomy. Materials and methods: We performed a retrospective study from 2012 to 2015 presenting 5 cases of RUF after radical laparoscopic prostatectomy. All cases required major abdominal surgery between the radical laparoscopic prostatectomy and the RUF treatment due to various complications. In no case was radiation therapy indicated prior to or after the repair. A perineal approach was performed in the 5 cases as the first option. One case required a second operation with a combined approach (abdominal and perineal) due to persistent fistulae. Results: After a minimum of 12 months of follow-up, 5 cases had resolved the RUF. Two patients presented urinary incontinence, and one patient had an anastomotic stricture that required internal urethrotomy. The other patients had no long-term complications. Conclusion: The perineal approach provides a healthy surgical field in patients who undergo multiple operations, achieving high rates of resolution of the fistulae

Perineal approach for rectourethral fistulae after radical laparoscopic prostatectomy.

OBJECTIVE: To describe our experience with the perineal approach to treat rectourethral fistulae (RUF) after radical laparoscopic prostatectomy. MATERIALS AND METHODS: We performed a retrospective study from 2012 to 2015 presenting 5 cases of RUF after radical laparoscopic prostatectomy. All cases required major abdominal surgery between the radical laparoscopic prostatectomy and the RUF treatment due to various complications. In no case was radiation therapy indicated prior to or after the repair. A perineal approach was performed in the 5 cases as the first option. One case required a second operation with a combined approach (abdominal and perineal) due to persistent fistulae. RESULTS: After a minimum of 12 months of follow-up, 5 cases had resolved the RUF. Two patients presented urinary incontinence, and one patient had an anastomotic stricture that required internal urethrotomy. The other patients had no long-term complications. CONCLUSION: The perineal approach provides a healthy surgical field in patients who undergo multiple operations, achieving high rates of resolution of the fistulae.

Factores predictivos de recuperación espermática en las azoospermias / Predictive Factors of Successful Sperm Retrieval in Azoospermia

Introducción: El tratamiento estándar de las azoospermias es la recuperación espermática del testículo para inyección intracitoplásmica. El objetivo de este estudio es identificar factores predictivos de recuperación espermática. Material y métodos: Intentamos recuperar espermatozoides mediante extracción espermática del testículo (TESE) en 74 pacientes azoospérmicos. Se estudiaron los niveles séricos de FSH einhibina B (INHB), la histología testicular, la genética, la criptozoospermia y el tamaño testicular. Resultados: La recuperación espermática fue del 47,2% para el total de pacientes, del 36% para las azoospermias no obstructivas y del 100% para las obstructivas. La INHB baja y la FSH alta se correlacionaron con el fracaso en la recuperación espermática. Los puntos de corte obtenidos mediante curvas ROC fueron de 67 pg/ml para la INHB y de 12,2 mUI/ml para la FSH. En ningún paciente con microdeleción Y en AZF a, b se recuperaron espermatozoides. En el 100% de los pacientes con mutaciones CFTR se obtuvieron espermatozoides. La mayor tasa de recuperación espermática fue para las hipoespermatogénesis, seguidas de los bloqueos madurativos y de los solo Sertoli. En todos los pacientes con criptozoospermia se recuperaron espermatozoides. Se encontró una relación entre el tamaño testicular y la recuperación espermática, pero no resultó estadísticamente significativa. Conclusiones: Salvo las microdeleciones en AZF a, b ningún factor predictor descarta a un paciente para TESE. La INHB baja se relaciona mejor que la FSH alta con el fracaso en la recuperación espermática. La recuperación es posible en todos los casos de mutaciones CFTR. La ausencia de células germinales se correlaciona con una alta probabilidad de fracaso en la recuperación espermática. La presencia de criptozoospermia se vincula a una alta probabilidad de éxito en la recuperación espermática (AU)

Introduction: Testicular sperm extraction with intracytoplasmic sperm injection is the standard treatment for azoospermia. The objective of this study is to identify predictive factors of successful sperm retrieval. Materials and methods: Between June 2003 and May 2011, we tried testicular sperm extraction(TESE) in 74 azoospermic patients in the Reproductive Medicine Unit of Son Espases Hospital (Palma de Mallorca). Serum follicle stimulating hormone (FSH) and inhibin B levels, testicular histology, genetic study, presence or not of cryptozoospermia and testicular volume were examined. Results: Spermatozoa were successfully recovered in 47.2% of the total patients, in 36% of nonobstructiveazoospermic patients and in 100% of obstructive azoospermic patients. Low inhibin B and high FSH were correlated to sperm retrieval failure. The cutoff points were determined using ROC curves that were 67 pg/mL for inhibin B and 12.2 mUI/mL for FSH. Spermatozoa were not successfully retrieved in any patient with Y microdeletions in AZF a, b regions. Spermatozoa were successfully retrieved in 100% of the patients with CFTR mutations. The highest spermretrieval rate was for hypospermatogenesis, followed by maturation arrest and Sertoli-cellonly. Spermatozoa were successfully retrieved in all cryptozoospermic patients. Although usinga non-significant test, there seems to be a correlation between higher testicular volume and a higher probability of successful sperm retrieval. Conclusions: Except for Y microdeletions in AZF a, b regions, there is no predictive factor of testicular sperm retrieval to rule out a patient for TESE. Lower inhibin B is more related to spermretrieval failure than higher FSH. Sperm retrieval is possible for all cases of CFTR mutations but in any case of microdeletion Y in AZF a ,b. The lack of germ cells is correlated with a high probability of sperm retrieval failure. The presence of cryptozoospermia is correlated with a high probability of sperm retrieval success. We do not find a statistically significant relation between testicular volume and successful sperm retrieval (AU)

Predictive factors of successful sperm retrieval in azoospermia.

INTRODUCTION: Testicular sperm extraction with intracytoplasmic sperm injection is the standard treatment for azoospermia. The objective of this study is to identify predictive factors of successful sperm retrieval. MATERIALS AND METHODS: Between June 2003 and May 2011, we tried testicular sperm extraction (TESE) in 74 azoospermic patients in the Reproductive Medicine Unit of Son Espases Hospital (Palma de Mallorca). Serum follicle stimulating hormone (FSH) and inhibin B levels, testicular histology, genetic study, presence or not of cryptozoospermia and testicular volume were examined. RESULTS: Spermatozoa were successfully recovered in 47.2% of the total patients, in 36% of non-obstructive azoospermic patients and in 100% of obstructive azoospermic patients. Low inhibin B and high FSH were correlated to sperm retrieval failure. The cutoff points were determined using ROC curves that were 67 pg/mL for inhibin B and 12.2 mUI/mL for FSH. Spermatozoa were not successfully retrieved in any patient with Y microdeletions in AZFa,b regions. Spermatozoa were successfully retrieved in 100% of the patients with CFTR mutations. The highest sperm retrieval rate was for hypospermatogenesis, followed by maturation arrest and Sertoli-cell-only. Spermatozoa were successfully retrieved in all cryptozoospermic patients. Although using a non-significant test, there seems to be a correlation between higher testicular volume and a higher probability of successful sperm retrieval. CONCLUSIONS: Except for Y microdeletions in AZFa,b regions, there is no predictive factor of testicular sperm retrieval to rule out a patient for TESE. Lower inhibin B is more related to sperm retrieval failure than higher FSH. Sperm retrieval is possible for all cases of CFTR mutations but in any case of microdeletion Y in AZFa,b. The lack of germ cells is correlated with a high probability of sperm retrieval failure. The presence of cryptozoospermia is correlated with a high probability of sperm retrieval success. We do not find a statistically significant relation between testicular volume and successful sperm retrieval.