Retrospective analysis of factors affecting sperm retrieval with microscopic testicular sperm extraction in infertile men with Klinefelter syndrome: A multicentre study.

The aim of this study was to evaluate the data currently available on predictors of sperm retrieval (SR) in infertile men with Klinefelter syndrome (KS). The data of infertile patients with KS who were evaluated for primary infertility in the andrology outpatient clinics of six centres were retrospectively reviewed. SR, fertilization and pregnancy rates were evaluated. While SR was achieved with microscopic testicular sperm extraction (mTESE) in 57.7% of the cases, the positive pregnancy rate was 22%. While mosaicism was significantly associated with achieving pregnancy, it was not significant for SR (p = 0.002 and p = 0.136 respectively). However, receiving medical treatment prior to mTESE was a positive factor for both achieving pregnancy (p = 0.010) and successful SR (p = 0.032). Unsurprisingly, fertilization rate was a variable that increased the pregnancy rate (p = 0.001). In addition, total testosterone value correlated with SR (p < 0.001). For patients with KS, pregnancy can be achieved by obtaining sperm through mTESE, especially in those with mosaic karyotype, normal partner fertility, a high fertilization rate and who receive appropriate medical treatment before mTESE.

Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation.

INTRODUCTION: No study has compared surgical outcomes and couples' satisfaction among the 3 types of implants, with all brands available on the markets. AIMS: To compare long-term complications, mechanical reliability, and couples' satisfaction with penile implant types and brands in patients who underwent penile prosthesis implantation. We also investigated whether there are risk factors that might predict couples' dissatisfaction. METHODS: This retrospective study included 883 patients with erectile dysfunction who underwent penile prosthesis implantation. Of the patients, 349 had malleable penile implant, 26 had 2-piece implants, and 508 had 3-piece implants. MAIN OUTCOME MEASURE: Couples' satisfaction after surgery was evaluated with the modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Surgical outcomes, mechanical reliability, and couples' satisfaction were compared according to type and brand of the penile implants in all patients. RESULTS: The mean age and follow-up period of the patients were 57.74 ± 9.59 years and 67.81 ± 49.11 months, respectively. The couples' satisfaction rates were significantly higher in the 3-piece implant group than in the malleable group (P < .001), but there was no significant difference between the 2-piece and 3-piece implant groups. There was no difference in terms of couples' satisfaction according to the brand of the implants. Of the patients who had malleable implants, 27 (7.7%) underwent 3-piece penile prosthesis implantation due to dissatisfaction; however, only 1 (0.2%) of the patients with a 3-piece implant was switched to a malleable implant (P < .001). The highest rate of revision surgery due to penile corporal perforation was in the malleable group (2.6%), whereas the highest rate of revision surgery due to penile implant malfunction occurred in the 3-piece implant group (5.5%) (P = .021 and .001, respectively). To analyze risk factors, using multivariate analysis, presence of complication was the only predictor that might cause couples' dissatisfaction (P = .003). CONCLUSIONS: 3-piece and 2-piece implants have higher couples' satisfaction rates than the malleable implant. Brands of implants did not have any effect on the couples' satisfaction. Regarding detail of the complications, the 3-piece implant has a lower rate of penile corporal perforation and a higher rate of penile implant malfunction than the malleable implant. Patients with erectile dysfunction who need a penile implant should be informed about surgical outcomes, brands, and types of penile implants. Prosthesis choice should be customized to individual patient's expectations/conditions and tailored accordingly. Çayan S, Asci R, Efesoy O, et al. Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation. J Sex Med 2019;16:1092-1099.

Efficacy of low-intensity shockwave therapy with different tadalafil regimens in patients with PDE5 inhibitor-resistant erectile dysfunction: a retrospective cohort study.

PURPOSE: Currently, there is a lack of research comparing tadalafil treatment protocols recommended during low-intensity shock wave therapy (LI-SWT) for patients with erectile dysfunction (ED) who are unresponsive to phosphodiesterase type 5 inhibitors (PDE5i). The objective of this study is to compare the efficacy of only LI-SWT versus LI-SWT plus 5 mg tadalafil daily versus LI-SWT plus 20 mg tadalafil alternate-day in PDE5i -resistant ED. MATERiALS AND METHODS: In this study, a cohort of 105 patients with PDE5i-resistant ED was recruited and divided into three groups labeled as A (only LI-SWT), B (LI-SWT plus 5 mg tadalafil daily), and C (LI-SWT plus 20 mg tadalafil alternate-day), comprising 27, 42, and 36 patients, respectively. The patients' International Index of Erectile Function-5 (IIEF-5) scores and the Erection Hardness Score (EHS) were evaluated at the baseline, three months and six months following the treatment. RESULTS: After three months post-treatment, the IIEF-5 scores in group A, B, and C increased by 4.1 ± 0.6, 7.3 ± 0.6, and 8.2 ± 0.6, respectively. These improvements were maintained at six months with IIEF-5 scores increasing by 3.7 ± 0.6, 7.3 ± 0.6, and 8.5 ± 0.7 in groups A, B, and C, respectively. At 3 and 6 months post-treatment, groups B and C showed significant improvement in IIEF-5 scores and EHS values compared to group A (p < 0.001). The rate of patients with EHS ≥ 3 and IIEF-5 ≥ 17 was significantly higher in groups B and C compared to group A, while there was no significantly different between groups B and C. CONCLUSiON: In patients with PDE5i-resistant ED, PDE5i combined with LI-SWT is superior to LI-SWT monotherapy. The statistical analysis failed to demonstrate any difference between two distinct tadalafil regimens when administered with LI-SWT treatment.

Testicular sperm retrieval for intracytoplasmic sperm injection: when to consider it after unsuccessful intracytoplasmic sperm injection with ejaculated sperm?

BACKGROUND: The question of whether patients are more likely to succeed with testicular sperm intracytoplasmic sperm injection (T-ICSI) after unsuccessful ICSI with ejaculated sperm (Ej-ICSI) remains unknown. OBJECTIVE: The study aimed to identify potential predictors of successful T-ICSI in men with idiopathic infertility and oligozoospermia (sperm concentration < 15 × 106/mL, non-azoospermic) who had previously experienced unsuccessful Ej-ICSI. MATERIALS AND METHODS: In total, 154 couples with male partners who had oligozoospermic conditions after two unsuccessful cycles of Ej-ICSI switched to T-ICSI. Before initiating T-ICSI, the sperm DNA fragmentation index (DFI) was assessed in ejaculated specimens. Participants were divided into two groups: group A (live birth (+), n = 60) and group B (live birth (-), n = 94). RESULTS: Fertilization, clinical pregnancy, live births, and miscarriages had rates of 72.7%, 44.2%, 39%, and 5.2%, respectively. The total motile sperm (TMS) count in group A was significantly higher (3.8 ± 1.5 million) than in group B (3 ± 1.6 million; p = 0.002). DFI was significantly higher in group A (24.2 ± 12.3) than in group B (18.1 ± 11; p = 0.001). Hormone levels and oocyte counts showed no statistically significant differences between groups. Multivariate regression analysis revealed that TMS (odds ratio [OR]: 1.46; 95% CI, 1.14-1.87, p = 0.003) and DFI (OR: 1.04; 95% CI, 1.01-1.08, p = 0.009) were found to be significant predictors of live birth outcomes. At a cutoff point of 2.55 (area under the curve [AUC] = 0.65), the optimal sensitivity and specificity values for TMS were 78% and 48%, respectively. At a cutoff point of 25.8 (AUC = 0.65), DFI had a maximum sensitivity of 51.7% and a specificity of 78.7%. CONCLUSIONS: TMS and DFI were found to be significant predictors of live birth outcomes in couples with oligozoospermic male partners undergoing T-ICSI. These findings may help clinicians tailor treatment strategies for this specific patient population.

Pilot feasibility study of transscrotal near infrared spectroscopy in the evaluation of adult acute scrotum.

PURPOSE: We investigated the usefulness of transscrotal near infrared spectroscopy that measures testicular oxygen saturation (StO2%) in the diagnosis of testicular torsion vs other causes of the acute scrotum in adults. MATERIALS AND METHODS: Between January and May 2009, 16 adult males presenting with acute scrotum underwent StO2% measurement of the affected and unaffected testis using near infrared spectroscopy followed by color Doppler ultrasound. If surgically explored, near infrared spectroscopy was performed at surgery and on postoperative day 1. Data were presented as means ± SD and/or normalized to the internal control. Cutoff value was generated for the StO2% difference between the affected testis and control side. RESULTS: Sixteen males with acute scrotum of mean duration 12 hours were enrolled. Of 11 patients with abnormal Doppler undergoing surgical exploration, mean StO2% of the affected testis at presentation and at surgery decreased from 40.09 ± 2.66 (range 36 to 44) to 37.18 ± 3.31 (range 32 to 42), respectively, while StO2% of the unaffected testis remained 63.09 (range 55 to 69) both at presentation (SD 4.72) and at surgery (SD 4.98). Of the 11 surgically explored, 4 had orchiectomy and 7 patients underwent surgical detorsion. At presentation and at surgical exploration of the detorsed group, the mean normalized difference between the StO2% values of the affected and unaffected sides was -16.12 and -25.9, respectively. A cutoff value of -11.5 was measured for the StO2% difference between the affected testis and control side at presentation in patients who underwent surgery. CONCLUSIONS: Near infrared spectroscopy identified all surgically confirmed cases of testicular torsion when affected testis StO2% was more than 11.5 units lower than the contralateral testis. In pilot testing, near infrared spectroscopy is a rapid, noninvasive, easy and safe method for the differential diagnosis of adult human testicular torsion.

A pumpless monolayer microfluidic device based on mesenchymal stem cell-conditioned medium promotes neonatal mouse in vitro spermatogenesis.

BACKGROUND: Childhood cancer treatment-induced gonadotoxicity causes permanent infertility/sub-infertility in nearly half of males. The current clinical and experimental approaches are limited to cryopreservation of prepubertal testicular strips and in vitro spermatogenesis which are inadequate to achieve the expanded spermatogonial stem/progenitor cells and spermatogenesis in vitro. Recently, we reported the supportive effect of bone marrow-derived mesenchymal cell co-culture which is inadequate after 14 days of culture in static conditions in prepubertal mouse testis due to lack of microvascular flow and diffusion. Therefore, we generated a novel, pumpless, single polydimethylsiloxane-layered testis-on-chip platform providing a continuous and stabilized microfluidic flow and real-time cellular paracrine contribution of allogeneic bone marrow-derived mesenchymal stem cells. METHODS: We aimed to evaluate the efficacy of this new setup in terms of self-renewal of stem/progenitor cells, spermatogenesis and structural and functional maturation of seminiferous tubules in vitro by measuring the number of undifferentiated and differentiating spermatogonia, spermatocytes, spermatids and tubular growth by histochemical, immunohistochemical, flow cytometric and chromatographic techniques. RESULTS: Bone marrow-derived mesenchymal stem cell-based testis-on-chip platform supported the maintenance of SALL4(+) and PLZF(+) spermatogonial stem/progenitor cells, for 42 days. The new setup improved in vitro spermatogenesis in terms of c-Kit(+) differentiating spermatogonia, VASA(+) total germ cells, the meiotic cells including spermatocytes and spermatids and testicular maturation by increasing testosterone concentration and improved tubular growth for 42 days in comparison with hanging drop and non-mesenchymal stem cell control. CONCLUSIONS: Future fertility preservation for male pediatric cancer survivors depends on the protection/expansion of spermatogonial stem/progenitor cell pool and induction of in vitro spermatogenesis. Our findings demonstrate that a novel bone marrow-derived mesenchymal stem cell-based microfluidic testis-on-chip device supporting the maintenance of stem cells and spermatogenesis in prepubertal mice in vitro. This new, cell therapy-based microfluidic platform may contribute to a safe, precision-based cell and tissue banking protocols for prepubertal fertility restoration in future.

Near infrared spectroscopy to diagnose experimental testicular torsion: comparison with Doppler ultrasound and immunohistochemical correlation of tissue oxygenation and viability.

PURPOSE: Near infrared spectroscopy measures tissue oxygenation even when there is complete cessation of blood flow. We evaluated near infrared spectroscopy to diagnose testicular torsion and blindly compared its accuracy with that of Doppler ultrasound. We also compared it by immunohistochemical evaluation of hypoxia and cell viability. MATERIAL AND METHODS: Rats were randomized to 4 groups, including group 1-720-degree unilateral torsion, group 2-360-degree unilateral torsion, group 4-sham operation and group 4-720-degree unilateral torsion followed by surgical torsion reduction at minute 180. Near infrared spectroscopy and Doppler ultrasound were done blindly at minutes 0, 5, 30, 60, 180 and 400. All torsed and contralateral testicles were excised for pathological examination using hypoxia inducible factor-α for hypoxia and the TUNEL test for apoptosis. We compared all groups with the contralateral testis and the sham operated group. RESULTS: All blinded, near infrared spectroscopy measurements correctly identified the torsed testis after minute 5. Median oxygen saturation in groups 1 and 2 was significantly different compared to that in the sham operated group after minute 5. In group 4 near infrared spectroscopy detected detorsion with the loss of a significant oxygen saturation difference between the affected and the contralateral testicle after detorsion. At minute 400 median oxygen saturation in group 4 was not statistically different compared to that in the sham operated group (p = 0.09) but it was significantly different compared to that in groups 1 and 2 (p <0.001). In each torsed testis oxygen saturation was at least 18.75% lower than in the contralateral testis. In groups 1 and 2 hypoxia inducible factor-α staining in torsed testicles was significantly greater than that in the contralateral organ and the sham operated group. In group 4 hypoxia inducible factor-α staining after detorsion was significantly decreased compared to that in groups 1 and 2. There was no significant difference in the apoptotic index between the experimental and the contralateral testis or the sham operated group. CONCLUSIONS: Near infrared spectroscopy is as effective but quicker than Doppler ultrasound for detecting testicular torsion without a radiologist. Near infrared spectroscopy accurately reveals oxygen saturation, which is more vital than blood flow, on which Doppler ultrasound focuses.

Can PCNA and LIM15 gene expression levels predict sperm retrieval success in men with non-obstructive azoospermia?

INTRODUCTION AND OBJECTIVES: It is necessary to be able to predict sperm retrieval before microdissection testicular sperm extraction (mTESE) in azoospermic men. This study established the importance of proliferating cell nuclear antigen (PCNA) and LIM15 gene expression levels in predicting the success of sperm retrieval by mTESE. MATERIALS AND METHODS: One hundred and forty-three men who were diagnosed with non-obstructive azoospermia (NOA) were included in the study. Patients' age, total testosterone and follicle stimulating hormone values, testicular volume and testicular histology were recorded by prospectively. PCNA and LIM15 gene expression levels were determined by real-time PCR in the materials from both ejaculate and testicular specimens. RESULTS: Testis volume and histology were the most important factors in predicting the sperm retrieval rate (SRR). The PCNA and LIM15 gene expression levels measured in testicular tissues and the LIM15 gene expression levels measured in ejaculate significantly correlated with the SRR in mTESE (p=0.038, p=0.022, and p=0.004, respectively). Although the PCNA gene expression level measured in ejaculate was higher in men with successful sperm retrieval, the difference was not statistically significant (p=0.061). According to the multivariate logistic regression analysis, testicular volume and LIM15 gene expression level in ejaculate were independent predictive parameters for sperm retrieval. CONCLUSION: The data showed that LIM15 gene expression level in ejaculate is a useful molecular marker to predict the SRR before mTESE.

The comparison of premature ejaculation assessment questionnaires and their sensitivity for the four premature ejaculation syndromes: results from the Turkish society of andrology sexual health survey.

INTRODUCTION: In addition to the previously defined "lifelong" and "acquired" premature ejaculation (PE), the existence of two more subtypes of PE, namely "natural variable PE" and "premature-like ejaculatory dysfunction," has been proposed. AIMS: To evaluate the diagnostic value of the Premature Ejaculation Diagnostic Tool (PEDT) and Arabic Index of Premature Ejaculation (AIPE) in a population-based study, in relation to their sensitivity across these four different PE syndromes and to assess the Premature Ejaculation Profile (PEP) scores of patients with lifelong, acquired, natural variable PE and premature-like ejaculatory dysfunction. METHODS: Between June 2009 and December 2009, couples were randomly selected from 17 provinces of Turkey. Subjects with the complaint of ejaculating prematurely were classified as lifelong, acquired, natural variable PE, and premature-like ejaculatory dysfunction according to the medical and sexual history they described. PE status was also assessed with PEDT, AIPE and PEP. The sensitivity, specificity, positive predictive value and negative predictive value were calculated for PEDT and AIPE in the study population whereas detection rates of these two questionnaires were also compared among the four PE syndromes. Moreover, PEP scores of patients with lifelong, acquired, natural variable PE and premature-like ejaculatory dysfunction were compared. Significance level was considered as P < 0.05. MAIN OUTCOME MEASURES: Scores obtained from PEDT, AIPE, and PEP questionnaires. RESULTS: A total of 2,593 couples were enrolled where 512 (20.0%) male subjects reported PE. PEDT, AIPE, and PEP measures of the PE patients indicated worse sexual function (P < 0.001 each). Mean scores obtained from questionnaires were significantly better in patients with premature-like ejaculatory dysfunction and they were the worst in patients with acquired PE (P < 0.001 each). The sensitivity values of PEDT and AIPE were 89.3 and 89.5, whereas their specificity values were 50.5 and 39.1, respectively. There were statistically significant differences in detection rates of PEDT and AIPE among the four PE syndromes (P = 0.006 and P < 0.001). They were higher in acquired and lifelong PE and lower in premature-like ejaculatory dysfunction. CONCLUSION: PEDT and AIPE can diagnose PE with high sensitivity, especially in patients with lifelong and acquired PE. The complaint of patients with acquired PE seems to be more severe than those complaining of lifelong, natural variable PE and premature-like ejaculatory dysfunction patients.

Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes: results from the Turkish Society of Andrology Sexual Health Survey.

INTRODUCTION: In addition to the previously known lifelong and acquired premature ejaculation (PE) syndromes, the existence of two more PE syndromes has been suggested: natural variable PE and premature-like ejaculatory dysfunction. However, epidemiological studies investigating the prevalence of these four PE syndromes have yet to be conducted. AIM: To determine the prevalence of the complaint of ejaculating prematurely across the four PE syndromes. METHODS: This study, conducted between June 2009 and December 2009, was designed as a non-interventional, observational cross-sectional field survey. Participating couples were randomly selected from 17 provinces of Turkey. All participants were asked to complete a questionnaire including data regarding demographics, socioeconomic status, social and cultural factors, medical and sexual history, current medications, and ejaculation time. Subjects with a complaint of ejaculating prematurely were classified as lifelong, acquired, and natural variable PE, or premature-like ejaculatory dysfunction. MAIN OUTCOME MEASURES: The main outcome measures were prevalence of complaint of ejaculating prematurely in the general population and across the four PE syndromes. RESULTS: A total of 2,593 couples (mean age, 41.9±12.7 years for males and 38.2±12.1 years for females) were enrolled. Five-hundred twelve subjects (20.0%) complained of ejaculating prematurely. Fifty-eight (2.3%), 100 (3.9%), 215 (8.5%), and 131 (5.1%) subjects were classified as lifelong, acquired, and natural variable PE, and premature-like ejaculatory dysfunction, respectively. CONCLUSIONS: The prevalence of the complaint of ejaculating prematurely among Turkish men was 20.0%, with the highest PE syndrome being natural variable PE (8.5%) and premature-like ejaculatory dysfunction (5.1%).

Tadalafil rehabilitation therapy preserves penile size after bilateral nerve sparing radical retropubic prostatectomy.

OBJECTIVE: To evaluate the change in penile size r bilateral nerve sparing retropubic radical prostatectomy (BNSRRP) and possible effect of Tadalafil. MATERIALS AND METHODS: A total of 65 patients underwent BNSRRP and they were evaluated prospectively for a whole year of follow-up. The patients were randomized to control without rehabilitation (Group 1) or Tadalafil rehabilitation group (Group 2). The patients were evaluated at months 3, 6 and 12 postoperatively for erectile function, penile measurements (flaccid penile length, penile length at maximum erection, penile circumference at flaccid status, and penile circumference at maximum erection), penile abnormalities and general health status. Statistical analysis was performed by Chi-Square test and significance was defined as p value < 0.05. RESULTS: In Group 1 there was significant decrease in penile measurements at month 3 compared to preoperative measurements. There was decrease in all parameters at month 6 compared to month 3 but only the decrease in penile length at maximum erection was significant. There were no significant differences between postoperative months 6 and 12 for all measurements. In Group 2 there was a tendency to decrease in all measurements at month 3 compared to baseline. There was no significant difference for penile measurements between postoperative 3rd and 6th months and between 6th month and the first year. CONCLUSION: Although further large sampled trials are needed to describe the possible positive effect of tadalafil or other PDE5-I 's on penile size after BNSRRP, tadalafil rehabilitation is effective in preserving penile size especially in the early postoperative period after BNSRRP.

Administration of Pharmaceutical Agents Prior to Testicular Sperm Extraction Procedures: A Meaningful or Meaningless Approach?

BACKGROUND: To date, no randomized and controlled study has demonstrated the effect of adjuvant medical therapy on testicular sperm production before the sperm retrieval procedures in men with non-obstructive azoospermia (NOA). OBJECTIVES: To present the available data on the administration of pharmaceutical agents prior to testicular sperm extraction (TESE) procedures in order to obtain better sperm retrieval results in men with NOA. METHODS AND RESULTS: Various pharmaceutical agents were used empirically to induce spermatogenesis in the treatment of NOA. The rationale for adjuvant hormonal treatment has been to increase intratesticular testosterone levels with different dosages of gonadotropins, anti-estrogen agents, or aromatase inhibitors. CONCLUSION: Based on the published studies, in the presence of a normal range of peripheral serum total testosterone levels, no medical treatment is advised, and TESE procedures should be performed directly in men with NOA. Further well-designed and randomized, placebo-controlled trials are needed to support the potential benefit of pretreatment prior to TESE procedures.

Potassium citrate vs. hydrochlorothiazide to reduce urinary calcium excretion in calcium oxalate stone patients with hypercalciuria: a prospective randomized study.

PURPOSE: Calcium oxalate (Ca-Ox) is the most common stone composition and one of the most common 24-h urine anomalies is hypercalciuria. The purpose of this study was to evaluate the efficacy of potassium citrate (K-CIT) for prevention of hypercalciuria in comparison with hydrochlorothiazide (HCT) in patients with calcium oxalate stones and hypercalciuria. MATERIALS AND METHODS: In this prospective randomized study, patients were randomized to receive either HCT (50 mg/day) or K-CIT (40 mEq/day) following achieving stone-free status. Treatment was continued for 6 months. 24 h urine analysis was performed prior to treatment and repeated at third month and measured parameters were volume, calcium, oxalate, citrate, sodium, and uric acid. Stone recurrence was evaluated with KUB and ultrasonography at 6th and 12th months. RESULTS: Data of 40 patients in each arm were evaluated. Mean 24 h urine calcium levels decreased to 205 ± 54.5 mg/day and 220.6 ± 96.3 mg/day in the K-CIT and HCT groups, respectively, and difference was not significant (p = 0.931). The reduction compared to pretreatment values was statistically significant in both groups. Urinary citrate levels also significantly increased in both groups and level of increase was significantly higher in K-CIT group. At 12th month, ultrasonography revealed stones in two patients in HCT group, and in one patient in the K-CIT group. CONCLUSIONS: K-CIT provided significantly reduced calcium and increased citrate excretion in patients Ca-Ox stone patients with hypercalciuria. The efficacy in decreasing calcium excretion was comparable to HCT treatment. K-CIT can be used for medical prophylaxis of Ca-OX stone patients with hypercalciuria.

Hematospermia is rarely related to genitourinary cancer: lessons learned from 15 years of experience with 342 cases.

We investigated the prevalence of hematospermia among the 161,258 men with ≥18 years old, presenting to outpatient clinics with urologic complaints, between January 2003 and December 2017. We also recorded underlying causes of hematospermia to determine frequency of genitourinary cancer in 342 men who presented with hematospermia. Further evaluations such as urine/semen culture, Meares-Stamey four glass test, transrectal/scrotal ultrasound, pelvic magnetic resonance imaging (MRI), cystourethroscopy, and prostate biopsy were performed in the presence of additional symptoms and findings or recurrence of hematospermia after treatment of patients with monosymptomatic hematospermia. The prevalence of hematospermia was detected as 0.21% (342/161,258) among the urological patients. The mean age of the patients was 45.05 ± 14.04 years (range 18-85), and the median duration of hematospermia was 15 days (range 1-7200). In 306 (89.5%) of the patients, hematospermia was resolved after medical therapy for infections/inflammations, surgery for ductal obstruction and cysts, prostate and testicular cancer. However, 36 (10.5%) had persistent hematospermia. The most relevant etiologic cause of hematospermia was inflammation/infections in 169 patients (49.4%), and genitourinary cancers were detected in only 11 patients (3.2%) as prostate cancer in 8 and testicular cancer in 3. Hematospermia is seen frequently due to inflammatory or infectious causes, and is rarely associated with genitourinary cancer. However, genitourinary cancers should be kept in mind in the differential diagnosis of patients with recurrent/persistent hematospermia and associated symptoms, such as hematuria, lower urinary tract symptom, and scrotal pain/swelling.

Fertility outcomes and predictors for successful sperm retrieval and pregnancy in 327 azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction.

BACKGROUND: Although few studies have reported fertility outcomes, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series. OBJECTIVES: To investigate fertility outcomes and predictors for successful sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction (mTESE). MATERIALS AND METHODS: This retrospective observational study included 327 azoospermic men with a history of cryptorchidism who underwent mTESE. Fertility outcomes including sperm retrieval, fertilization rate, number of transferred embryos, pregnancy, miscarriage, and live birth rates were recorded. RESULTS: Sperm retrieval was observed in 172 (52.6%) of the patients. The mean fertilization, pregnancy, and live birth rates were 55.2%±20.5, 53.5%, and 44.8%, respectively. The sperm retrieval rate was significantly higher at the orchidopexy age of ≤ 9.5 years (70.8%) than the orchidopexy age of > 9.5 years (42.1%) (P = .000). Patients with total testicular volume of ≥ 13.75 mL had significantly higher sperm retrieval rate (65.2%) than the patients with total testicular volume of < 13.75 mL (45.5%) (P = .001). Patients with total testosterone level of ≥ 300.5 ng/dL had significantly higher sperm retrieval rate (65.6%) than the patients with total testosterone level of < 300.5 ng/dL (40.3%) (P = .000). Patients with follicle-stimulating hormone (FSH) level of ≤ 17.25 mIU/ml had significantly higher sperm retrieval rate (72.3%) than the patients with FSH level of > 17.25 mIU/mL (44.4%) (P = .000). Younger male and female ages, and higher fertilization rates were the parameters that might predict pregnancy. CONCLUSIONS: Infertile azoospermic men with a history of cryptorchidism have high sperm retrieval rate with mTESE. Patients who had orchidopexy at the age of ≤ 9.5 years, and having total testicular volumes of ≥ 13.75 mL with total testosterone level of > 300.5 ng/dL and FSH level of ≤ 17.25 mIU/mL have higher success rate for sperm retrieval.

Effect of lesion diameter and prostate volume on prostate cancer detection rate of magnetic resonance imaging: Transrectal-ultrasonography-guided fusion biopsies using cognitive targeting.

OBJECTIVE: This study aimed to evaluate the effect of prostate volume and lesion size on the clinically significant prostate cancer (csPCa) detection rates of transrectal ultrasonography (TRUS)-guided prostate biopsies, performed by a cognitive targeting method for sampling peripheral zone lesions. MATERIAL AND METHODS: We retrospectively enrolled 219 consecutive patients, who underwent multiparametric magnetic resonance imaging with a 3-T scanner and had peripheral zone lesions suspected for prostate cancer. All of these patients underwent combined cognitive targeted biopsy of suspicious lesions and TRUS-guided systematic biopsy. The detection rates of csPCa according to different lesion diameters (<5 mm, 5-9.9 mm, and ≥10 mm) and prostate volumes (<30 mL, 30-49.9 mL, 50-79.9 mL, and ≥80 mL) were calculated per lesion basis. In addition, subgroup analysis of csPCa detection rates was performed according to Prostate Imaging Reporting and Data System scores of lesions. RESULTS: The csPCa detection rates according to lesion diameters <5 mm, 5-9.9 mm, and ≥10 mm were 4%, 9.8%, and 33.1%, respectively, and were significantly lower for lesions <10 mm (p<0.001). The csPCa detection rates were 61.5%, 24.1%, 16.2%, and 6.9%, respectively, for prostate volumes <30 mL, 30-49.9 mL, 50-79.9 mL, and ≥80 mL, and were significantly higher for prostate volumes <30 mL (p<0.001). CONCLUSIONS: Clinicians should be very careful when they prefer cognitive targeted prostatic biopsy in patients with periferal zone lesions less than 10 mm and with prostate volumes greater than 30 mL, because of significantly low csPCa detection rates.

Trends in benign prostatic hyperplasia surgery over the years: A multicenter 14-year retrospective study.

OBJECTIVE: The aim of this study is to show the surgical trend over the past 14 years using the data from five major centers in Turkey with accumulated experience in benign prostatic hyperplasia (BPH) surgery. MATERIAL AND METHODS: This study included 94,954 patients with low urinary tract symptoms (LUTSs) secondary to BPH. By using electronic databases, we identified 7,163 patients who underwent BPH surgery, including monopolar transurethral prostate resection (M-TURP), bipolar transurethral prostate resection (BTURP), transurethral incision of the prostate (TUIP), open prostatectomy (OP), and holmium laser enucleation of the prostate (HoLEP) from 2006 to 2019. The years were grouped as 2006-2010, 2011-2015, and 2016-2019. RESULTS: The total number of outpatient treatments for BPH increased by 72.9% from 5,379 in 2006 to 9,302 in 2019. Until 2019, the annual number of surgeries increased from 375 to 937 (increasing 150%). All surgical approaches for BPH, except TUIP, were most frequently performed between the ages of 60 and 69. The rate of surgery including M-TURP, B-TURP, and TUIP was statistically different between 2006 and 2010, 2011 and 2015, and 2016 and 2019 (P < .001), except OP (P » .071). The highest increase was observed in HoLEP in the first half of the 2010s compared to the second half of the 2010s. The rate of M-TURP decreased from 77.9% to 17.9% from 2016 to 2019. CONCLUSION: With the aging population, the number of patients diagnosed and treated with BPH is increasing. B-TURP as a resection technique and HoLEP as an enucleation technique replace M-TURP. Healthcare services and government spending should be organized according to these data.

Comparison of 3 Different Enucleation Techniques of Holmium Laser Enucleation of Prostate (HoLEP).

PURPOSE: To evaluate the effect of different enucleation techniques on operation time, enucleation efficacy and postoperative results. MATERIALS AND METHODS: 178 HoLEP cases performed by two senior surgeons were evaluated retrospectively. All patients were evaluated for age, IPSS, preoperative PSA, prostate size, maximum flow rate (Qmax) postvoid residual volume (PVR), enucleation time, morcellation time, enucleated tissue weight, enucleation ratio (enucleated tissue weight/prostate volume) and enucleation time efficacy (enucleated weight/enucleation time). Patients were categorized into three groups according to performed enucleation techniques; Retrograde Low Tension (RLT) two-lobe, traditional three-lobe, and en bloc techniques. IPSS, Qmax, PVR and transient urine leakage (TUL) were evaluated during postoperative follow up. All preoperative, intraoperative and postoperative results were compared between 3 groups. RESULTS: Mean age was 70.52 (52-85) years. Baseline data were comparable between groups. Enucleation time was significantly shorter in RLT two-lobe (median; 50, 60 and 60 min; RLT two-lobe, traditional three-lobe, and en bloc HoLEP techniques, respectively. (P = .031). Morcellation time was comparable between groups (P = .532). No significant difference was observed between morcellated prostate weights (P = .916) Significant improvements in IPSS, Qmax, and PVR were noted in all groups (P < .001). TUL was significantly increased in en bloc technique (P = .034). Postoperative stricture rates were similar between groups. (P = .769) Conclusion: Shorter enucleation time was observed in the RLT HoLEP technique and increased TUL rate was observed in the en bloc technique.

Histomorphological differences of spermatic cords regarding subinguinal versus inguinal levels: a cadaveric study.

AIM: Varicocele is a common disorder among male population and is the most common cause of secondary infertility. Microsurgical inguinal or subinguinal operations are the preferred approaches but the two differ in technical difficulty. Therefore, we examined the histomorphological differences of spermatic cords at both subinguinal and inguinal levels in this cadaveric study. METHODS: Spermatic cords from 9 adult male cadavers were examined at both the inguinal and subinguinal levels using a light microscope with an image analysis program in the anatomy and histology laboratories of Ankara University Medical School between July 15, 2006 and February 15, 2007. RESULTS: In terms of number and wall thickness, we did not observe any significant histomorphological differences in spermatic cord veins and arteries between the subinguinal and inguinal levels. CONCLUSION: We conclude that the subinguinal approach is not a harder technique than the inguinal approach concerning vessel dissection, but more studies must be made to compare subinguinal versus inguinal varicocelectomy.