Fujioka H

Surgical repair of varicocele at puberty: preventive treatment for fertility improvement.

In 40 pubertal boys with a varicocele a comparative followup study was performed to evaluate the efficacy of surgical correction of the varicocele in this age group in regard to improvement of fertility after completion of sexual maturation. The varicocele was corrected surgically in 24 patients and it was left uncorrected in 16. Testicular atrophy was noted in all cases at the initial visit and after followup. Of the 24 corrected patients 16 had atrophy of at least 1 testis before surgical treatment, whereas only 7 demonstrated atrophy after followup. Of the 16 uncorrected patients testicular atrophy was noted in 8 at the initial visit but 12 had atrophy after followup. Semen examination of 23 patients who had completed sexual maturation demonstrated a higher quality of routine seminal parameters, for example sperm density, sperm motility and percentage of morphologically normal spermatozoa, in the corrected group than in the uncorrected group.

Surgical Management of Undescended Testis: Retrospective Study of Potential Fertility in 274 Cases

To determine the fertility potential of men with an undescended testis a retrospective study was performed on 274 patients by evaluating sperm density and sperm motility, as well as histopathological findings of the seminiferous tubules. The patients, who had been treated surgically when they were 2 to 5 or 9 to 12 years old and who were examined when they were 18 to 39 years old, were divided into 4 groups: group 1 (61 patients) underwent bilateral orchiopexy, group 2 (149) underwent unilateral orchiopexy, group 3 (26) underwent unilateral orchiectomy and group 4 (38) received no surgical treatment for a unilateral undescended testis. Significant differences in the sperm density and motility were detected between group 1 (normal range 0 to 7 per cent) and group 2 or 3 (normal range 72 to 79 per cent), and between group 2 or 3 and group 4 (normal range 42 to 58 per cent). Histopathological differences were significant between group 1 or 2 (Johnsens score count 6.06 to 6.11) and group 4 (4.72) for the affected side, and between group 2 or 3 (9.09 to 9.20) and group 4 (8.60) for the unaffected side. The results suggest that surgical treatment may not significantly ameliorate the fertility potential of patients with bilateral undescended testes. On the other hand, in patients with unilateral undescended testis an operation not later than at early puberty is advisable to maintain the spermatogenic function in the unaffected testis. It is suggested that some unknown factors relating to the highly impaired unilateral undescended testis may in some way inhibit function of the contralateral unaffected testis.

Late recurrence of renal cell carcinoma after nephrectomy.

Late recurrence of renal cell carcinoma is unusual. Of 43 patients who underwent curative nephrectomy more than 10 years before, 2 cases (4.7%) had late recurrence. The 2 cases, both female patients, had late recurrence 12 and 19 years from the date of nephrectomy. The clinical aspects of late recurrence are discussed briefly.

Salvage Microdissection Testicular Sperm Extraction After Failed Conventional Testicular Sperm Extraction in Patients With Nonobstructive Azoospermia

PURPOSE TESE is considered the best procedure for identifying a tubule for spermatozoa retrieval. This technique improves the SRR to around 50%. However, it has been unclear whether it is useful in patients in whom conventional TESE has failed. We compared the outcome of microdissection TESE in patients in whom conventional TESE failed to that in patients who did not undergo conventional TESE. We also evaluated relations between the outcome of salvage microdissection TESE and the characteristics of previous conventional TESE. MATERIALS AND METHODS A total of 46 patients with nonobstructive azoospermia in whom salvage microdissection TESE was performed after failed conventional TESE were included. Patient characteristics and the SRR were compared between these patients and 134 in whom conventional TESE had not been performed previously. The previous TESE procedure, testicular histology and interval between TESEs were also evaluated. RESULTS Patient characteristics did not differ significantly between the groups. The microdissection TESE SRR also did not differ significantly between the groups (45.7% vs 44.0%). The possibility of successful spermatozoa retrieval by salvage microdissection TESE remained regardless of the previous failure of any other TESE procedure and regardless of testicular histology. The salvage microdissection TESE SRR was not related to the interval between TESEs. CONCLUSIONS Because salvage microdissection TESE is effective in patients in whom conventional TESE has failed, this option should be made available to them with the understanding that extended followup after salvage microdissection TESE is necessary due to the risk of hypogonadism.

Temperature Sensitivity of Human Spermatogonia and Spermatocytes in Vitro

To study the effect of temperature on human spermatogenesis, both the number and DNA synthesis of germ cells were investigated in tissue fragments of human testes cultured for 22 h at 31 degrees C and 37 degrees C. The number of differentiated germ cells such as spermatids and spermatozoa cultured at 37 degrees C was significantly smaller than that cultured at 31 degrees C. The number of spermatogonia and resting primary spermatocytes was not significantly different between these two temperatures, but the functional ability of DNA synthesis in these cells was significantly lower at 37 degrees C than at 31 degrees C. It seems that in normal body temperature (37 degrees C) differentiated germ cells such as spermatids and spermatozoa are fragile and the DNA synthesis of spermatogonia and resting primary spermatocytes is retarded.

Surgical repair of varicocele: effective treatment for subfertile men in a controlled study.

We performed a comparative study to evaluate the efficacy of surgical repair of varicoceles in improving fertility. A group of 224 subfertile men with varicoceles was divided into 141 patients who had their varicoceles surgically corrected and 83 who had not. A significant improvement in sperm density and percentage of progressive motile sperm was noted in the corrected group (p less than 0.01, p less than 0.05). Pregnancy rate was also higher in the corrected group (p less than 0.05). From this controlled study we conclude that the repair of a varicocele increases the chance of fertilization.

Hormone Receptor in Renal Cell Carcinoma and Correlation With Clinical Response to Endocrine Therapy

Analyses of hormone receptors in cytosols from 41 renal cell carcinoma specimens were performed by the dextran-coated charcoal technique, using estradiol, synthetic progestin R5020 and synthetic androgen R1881. Binding data were calculated according to the method of Scatchard. Of 41 renal cell carcinomas estradiol receptor was detected in 11, R5020 receptor in 11 and R1881 receptor in 13. No significant correlation between histopathological findings and hormone receptors was observed. Patients were classified into those positive and negative for receptors. The clinical response of endocrine therapy for 17 with advanced residual or metastatic lesions after nephrectomy was studied in regard to the survival rates. Although there was no complete or partial regression in tumor size, the survival rate of patients with 1 or more receptors was significantly higher than that of patients negative for receptors (p less than 0.01). In conclusion, hormonal manipulation in patients with renal cell carcinoma cannot induce an antitumor effect but seems to increase survival in patients with receptors.

Optimal Temperature for Synthesis of DNA, RNA, and Protein by Human Testis in Vitro

To determine the optimal temperature for DNA, RNA, and protein syntheses in the human testis, the levels of incorporation of 3H-thymidine, 14C-uridine, and 14C-leucine into testicular tissue were studied at 28 degrees C, 31 degrees C, 34 degrees C, and 37 degrees C in vitro. The results suggest that the DNA synthesis is at a maximum at 31 degrees C and shows delicate temperature sensitivity, whereas the RNA and protein syntheses are at a maximum at 34 degrees C or 37 degrees C and are temperature-dependent. It is concluded that the temperature sensitivity of DNA synthesis may be one of the primary causes of delicate thermal inhibition of human spermatogenesis.

SUSCEPTIBILITY TO IDIOPATHIC AZOOSPERMIA IN JAPANESE MEN IS LINKED TO HLA CLASS I ANTIGEN

PURPOSE Approximately 15 to 20% of infertile men have azoospermia. In the Y chromosome a deletion, termed the azoospermic factor, has been found in some cases of idiopathic azoospermia. We investigate the relationship of factors in autosomal chromosomes (HLA class I antigens) to spermatogenesis failure in idiopathic azoospermia. MATERIALS AND METHODS We evaluated 65 infertile Japanese men with idiopathic azoospermia. The frequency of the HLA allele reported in 1,216 healthy Japanese men was used as a control. HLA class I typing was performed by the National Institutes of Health standard serological method or polymerase chain reaction-sequence specific primer analysis. Allele frequencies were calculated. We determined statistical significance in the frequency of each allele in patients and controls using the chi-square test. The relationship of HLA antigens to idiopathic azoospermia was expressed as relative risk. RESULTS In Japanese men with idiopathic azoospermia the frequency of HLA-A33, B13 and B44 was significantly increased compared with controls. The relative risk of HLA-B44 was 8.4, an extremely high value compared with that of other diseases and HLA antigens. CONCLUSIONS We suggest that HLA class I antigens are important genetic markers that represent a risk factor for idiopathic azoospermia.

Induction of renin-angiotensin system in human testis in vivo.

To better understand the local renin-angiotensin system in Leydig cells of the human testis, the plasma renin activity (PRA) and plasma concentration of angiotensin II (PAII) in the left internal spermatic vein (ISV) and cubital vein (CV) were measured at the time of surgical repair of varicocele in 27 patients. Fourteen of the patients were given a single i.m. injection of hCG (10,000 IU/m2) 4 days before the operation, whereas the remaining 13 were not treated. Although the mean PRA or PAII levels in the CV in the treated and nontreated groups were similar, both levels in the ISV in the treated group were significantly higher than in the nontreated group (p less than 0.05). For PAII levels in the treated group, nine of 11 patients with an increased PRA level showed significantly higher levels than the normal peripheral PAII value. The serum testosterone levels in the same ISV were also much higher in the treated group than in the nontreated group (p less than 0.001). These results suggested the possibility that sex steroids might influence the renin-angiotensin system in Leydig cells.