Decisional Conflict and Knowledge Among Patients With Varicocele Seeking Treatment for Infertility.

OBJECTIVE: To study disease-specific knowledge and decisional quality in men with varicocele being counseled for infertility. MATERIALS AND METHODS: An instrument designed to measure decisional quality by evaluating disease-specific knowledge, decisional conflict, and the impression that shared decision-making was administered to 92 men identified to have a varicocele seeking their initial infertility consultation. Mean scores on disease-specific knowledge questionnaire, prevalence of decisional conflict, and impact of consultation on preferred infertility treatment were analyzed. RESULTS: Fifty-five percent of patients were found to have decisional conflict. Compared to those with decisional conflict, men without decisional conflict scored higher on the infertility knowledge assessment (63% vs 53% correct) and were more likely to feel that they discussed treatment options with their physician in detail (98% vs 82%) (all P <0.01). Prior to consultation, 28% of all patients preferred assisted reproductive technologies and 2% preferred varicocelectomy as the primary treatment for infertility. Following consultation, 12% and 17% preferred assisted reproductive technologies and varicocelectomy, respectively. The increase in preference for varicocelectomy was greater in men without decisional conflict (5%-31%) than those with conflict (0%-8%) (P = 0.03). CONCLUSION: Infertile men with varicocele have limited knowledge of their disease and high rates of decisional conflict. Before consultation, men with varicoceles showed preference for assisted reproductive technology over varicocele surgery; this trend reversed after consultation. Men with decisional conflict were less likely to prefer varicocelectomy, even after consultation.

Massive Renal Intratubular Hemorrhage With Herniations into Renal Veins: Report of a Case.

A 30-year-old woman suffered intractable gross hematuria of renal origin, which required nephrectomy after failed conservative management. Pathological examination revealed massive intratubular hemorrhage and frequent deposition of an amorphous and homogenous material positive for Periodic Acid-Schiff (PAS) stain in the corticomedullary junction. This substance is frequently herniated into the lumen of thin-walled veins of arcuate size. There was no apparent cause for the bleeding. To the best of our knowledge this is the fourth reported case with these peculiar histopathological findings associated with hematuria. We discuss some hypotheses as to the etiopathogenesis of this rare and interesting condition.