Sperm extraction in nonmosaic Klinefelter syndrome patients: A case series and literature review of sperm extraction in Klinefelter syndrome patients.

Objectives: Klinefelter syndrome (KF) is a group of chromosomal disorders with at least one extra X chromosome in male individuals that leads to infertility and diminished hair growth in affected males. In this study, we present a case series of 16 nonmosaic KF and an extensive literature review. Patients and Methods: This is a retrospective study including 16 nonmosaic Klinefelter Syndrome patients that underwent micro-testicular sperm extraction (m-TESE) at our center between January 2016 and December 2022. Frequencies and percentages were used to present categorical variables, whereas continuous variables were presented as the median and interquartile range (IQR). The sperm retrieval rate (SRR) was assessed using a one-sample proportions test with continuity correction. Fisher's exact test was to assess the differences between patients with negative and positive retrieval in terms of the categorical variables. A Wilcoxon rank-sum test was applied to explore the between-group differences in the numerical variables. A literature search was performed for additional publications of discussing m-TESE among KF patients. Results: The median (IQR) age of patients was 40.0 years (34.5-47.0). All of the patients had nonobstructive azoospermia, and the majority of them (93.8%) had primary infertility. The most common histopathological findings were atrophic tubules (57.1%), followed by Sertoli cell-only (28.6%). Sperm retrieval was positive for two patients with a rate of 12.5% (95% confidence interval 2.2 to 39.6). Patients with positive sperm retrieval were significantly younger than their peers with negative retrieval (median = 28.0, IQR = 27.5 to 28.5 vs. median = 41.5, IQR = 35.8 to 47.0, P = 0.031). The successful conception rate was 100% (n = 2) using intracytoplasmic sperm injection with a birth rate of 100% (n = 2). Conclusion: Our observed SRR among nonmosaic KF patients was marginally lower than the reported literature. Younger-age patients were significantly more likely to benefit from the procedure.

Varicocelectomy outcomes among patients with azoospermia and severe oligasthenoteratozoospermia.

Background: Varicocele is a reversible cause of male infertility. However, there are conflicting data available concerning the benefit of varicocele repair for patients with nonobstructive azoospermia (NOA) and severe oligoasthenoteratozoospermia (OAT). Objective: To address the benefit of varicocelectomy in patients with severe OAT and NOA with regard to their semen parameters and surgical sperm retrieval rate in those who underwent testicular sperm extraction (TESE) or testicular sperm aspiration (TESA). Materials and Methods: This retrospective cohort study was conducted on a sample of 13 patients diagnosed with NOA and severe OAT who underwent varicocelectomy for infertility treatment with no prespecified exclusion criteria. Results: Thirteen patients were enrolled. Five patients were diagnosed with NOA; eight were diagnosed with severe OAT. For improvements in the semen parameters postoperatively, the semen concentration of all patients was significantly increased compared to the preoperative concentration (3.59 ± 10.0.8 vs. 0.25 ± 0.31, P = 0.02) and the remaining parameters were unchanged. Regarding sperm retrieval, three patients underwent TESE and two patients underwent TESA, in which all had positive results. Conclusion: Varicocele repair was found to improve the semen parameters in patients with NOA and severe OAT and produced a successful surgical sperm retrieval rate in all patients who underwent TESA or TESE.

Varicocelectomy for scrotal pain: Is it effective?

Introduction: Varicocelectomy is the prevailing management of scrotal pain secondary to varicocele. However, the literature is controversial on this topic. Some data showed that pain may persist after the surgery even if the varicocele is not detected postoperatively. Objectives: The objectives of the study were to identify the effect of varicocelectomy in patients with chronic scrotal pain, to report the association between the clinical grade and postoperative pain resolution, and to identify the need for a secondary procedure after varicocelectomy to control the pain. Materials and Methods: This was a retrospective study of 47 patients who underwent varicocelectomy between March 2016 and December 2018. Results: Postoperatively, the pain totally resolved after surgery in 64.3% of patients with scrotal pain; it improved in 21.4%, 11.9% have persistent pain, and the pain got worse in only 2.4%. Our study showed 100% complete resolution or improvement with Grade I, 85.7% in Grade II, and 81.3% in Grade III. In addition, all patients who underwent bilateral varicocelectomy had pain that either completely resolved or improved postoperatively. On the other hand, all patients who had persistent pain or pain worsening postoperatively had unilateral varicocelectomy. An additional intervention for postoperative pain control was needed in only 14% of patients, 7% of them underwent embolization, 4.7% had a cord block, and 2.3% were sent to a pain clinic. Conclusion: Varicocelectomy offers good outcomes in most patients with varicocele-related scrotal pain. The most significant predictor for success was low grade and bilaterality. However, there is a subset of patients whose symptoms will not improve postoperatively. Careful preoperative counseling and expectation management are crucial when discussing surgical options for those patients.

A duplicated Urethra with epispadias: An uncommon association.

Epispadias is a malformation of the urethra in which the urethral opening ends on the dorsum of the penis. It is considered a rare anomaly, especially when associated with urethral duplication. Urethral duplication is another congenital anomaly that has different clinical manifestations and a separate classification. In this case, we present a 4-year-old boy who underwent epispadias repair and was found to have an accidently duplicated urethra of Effiman's Type ⅡA during the operation. Excision of the accessory urethra was performed, and the patient tolerated the procedure well.

Renal abscess post ureteroscopic lithotripsy.

With the advancement of ureteroscopic equipment, it has become a safe and efficient technique that is widely used in our practice for wide variety of diseases. Here we present a 65-years old patient with 2cm right renal pelvic stone, who underwent uneventful right ureteroscopic lithotripsy. She developed symptomatic right renal abscess after one week time, which was treated with antibiotics and drainage successfully. Although ureteroscopic lithotripsy is safe and efficient technique in the management of urolithiasis, careful patient monitoring postoperatively is indicated as minor and major adverse events might be encountered.

Laparoscopic intraperitoneal bladder injury repair of a trauma patient: A case report.

The standard intraperitoneal bladder injury repair approach is an open technique; however, in some cases of isolated bladder injury, it can be alternatively repaired by laparoscopy. A 28-years-old male who sustained a motor vehicle accident found to have isolated intraperitoneal bladder injury which was repaired laparoscopically. Cystogram after 2 weeks confirmed the successful outcome. Although laparoscopic repair technique found to be safe and efficient, careful patient selection is mandatory.

Global Variations in the Mineral Content of Bottled Still and Sparkling Water and a Description of the Possible Impact on Nephrological and Urological Diseases.

Kidney stone disease (KSD) is a complex disease. Besides the high risk of recurrence, its association with systemic disorders contributes to the burden of disease. Sufficient water intake is crucial for prevention of KSD, however, the mineral content of water might influence stone formation, bone health and cardiovascular (CVD) risk. This study aims to analyse the variations in mineral content of bottled drinking water worldwide to evaluate the differences and describes the possible impact on nephrological and urological diseases. The information regarding mineral composition (mg/L) on calcium, bicarbonate, magnesium, sodium and sulphates was read from the ingredients label on water bottles by visiting the supermarket or consulting the online shop. The bottled waters in two main supermarkets in 21 countries were included. The evaluation shows that on a global level the mineral composition of bottled drinkable water varies enormously. Median bicarbonate levels varied by factors of 12.6 and 57.3 for still and sparkling water, respectively. Median calcium levels varied by factors of 18.7 and 7.4 for still and sparkling water, respectively. As the mineral content of bottled drinking water varies enormously worldwide and mineral intake through water might influence stone formation, bone health and CVD risk, urologists and nephrologists should counsel their patients on an individual level regarding water intake.

Small Ureteral Access Sheath in Treating Paediatric Urolithiasis: A Single Centre Experience.

INTRODUCTION: Urolithiasis is not commonly encountered in the pediatric population. The adoption of ureteral access sheaths (UAS) facilitates the passage to the pediatric ureter and limits the harm and ureteral injury. However, the debate continues regarding whether or not to use UAS in children. OBJECTIVE: To assess the safety and outcomes of using UAS in the treatment of pediatric renal and ureteral stones. STUDY DESIGN: This was a prospective cohort study of 14 pediatric patients who underwent flexible ureteroscopy (fURS) with the use of UAS for symptomatic renal and ureteric stones. RESULTS: Of the fourteen enrolled patients, nine (64.3%) were males, and five (35.7%) were females with an average age of 9.5 years. Eleven (78.6%) of the patients were rendered stone-free. The average operative time was 55.7 min. None of the patients developed any complications. The stone-free rate was significantly higher with stone burdens of ≤10 mm (p ≤ 0.05). CONCLUSION: The use of UAS in children facilitates the passage of a flexible ureteroscope without complications. The procedure is considered to be efficient and safe with minimal morbidity.

Submucosal stone formation after 14-years of polydimethylsiloxane (Macroplastique®) endoscopic subureteric injection for vesicoureteral reflux: Unusual presentation for a rare complication.

Polydimethylsiloxane (Macroplastique®) endoscopic subureteric implantation is considered to be safe and effective for vesicoureteral reflux (VUR) treatment. The Macroplastique® implantation is popular for its high success rate and minimal complications. A 22-years-old male who underwent prior subureteric endoscopic therapy with Macroplastique for VUR 14-years ago was investigated for microscopic hematuria. Renal ultrasound confirmed the presence stone that was retrieved by cystolitholapaxy. Although endoscopic subureteric implantation with Macroplastique has a high success rate for VUR resolution, caution during the follow-up period in order to prevent potential long-term complications is required.