Gil Raviv

A 20-Year Experience with Treatment of Ectopic Ureteroceles

Between 1970 and 1990 a total of 37 patients (female-to-male ratio 3.6:1) was diagnosed and treated at our institution for ectopic ureterocele. Urinary tract infection was the most frequent mode of presentation (59%). Of the patients 54% were less than 3 years old at operation. Transurethral incision of ectopic ureterocele served only as a decompressive procedure for acutely ill infants and was followed with a high incidence (80%) of resultant vesicoureteral reflux. The elective surgical policy was individualized based on renal function and presence of vesicoureteral reflux. Overall results within the various groups were generally satisfactory regarding eradication of urinary tract infections, preservation of renal function and continence or treatment of vesicoureteral reflux. Upper pole heminephrectomy and partial ureterectomy were performed in 14 patients with 3 (21%) requiring reoperation, including only 2 (14%) subsequent reimplantations. Thus, we believe that an expectant approach to the lower urinary tract is well recommended in the majority of the patients with a poorly functioning ipsilateral renal segment. A modified technique of total reconstruction, performing only partial ureterectomy with double barrel reimplantation, was successful in 7 patients.

Studies on sperm chromosomes in patients with severe male factor infertility undergoing assisted reproductive technology treatment

The aim of the study was to determine the rate of chromosome abnormalities in testicular sperm after intracytoplasmic sperm injection due to severe male factor infertility. The study groups included patient with non-obstructive azoospermia (n=9), obstructive azoospermia (n=10), Klinefelters syndrome (n=5) and normal controls (n=6, groups I-VI, respectively). The mean serum levels of FSH 17.5+/-8.2 (P<0.05), 3.5+/-2.6, 29.8+/-13.0 (P<0.05) and 3.1+/-0.4 mIU/ml, respectively. The rates of chromosome abnormalities were 19.6% (P<0.001), 8.2% (P<0.001), 6.3 and 1.6%, respectively. Chromosomes X and Y were significantly more involved in the aneuploidy than chromosome 18 in groups I and II. The present findings demonstrate a linkage between gonadal failure (high serum FSH levels) and sperm chromosome abnormalities. Our findings may explain the increased incidence of perinatal sex chromosome abnormalities found in severe male factor patients. Patients with non-mosaic Klinefelters syndrome have comparable risk for sex chromosomes aneuploidy as the rest of the patients with azoospermia. Therefore, genetic screening during pregnancy or before embryo replacement should be carefully considered in severe male factor patient following in vitro fertilization (IVF).

Cumulative pregnancy rate following IVF and intracytoplasmatic sperm injection with ejaculated and testicular spermatozoa.

The purpose of this study was to calculate the cumulative pregnancy rates of IVF cycles with ICSI using ejaculated or testicular spermatozoa. A computerized database for the IVF cycles with ICSI performed between January 1996 and December 1998 was utilized. Cycles with spermatozoa obtained after electro-ejaculation were excluded. A multifactorial analysis was performed to define the impact of different factors on the success rate of IVF and ICSI. During a 36-month period, 229 pregnancies were achieved by 643 couples using ejaculated spermatozoa, and 83 pregnancies by 167 couples who required testicular spermatozoa. The pregnancy rates (PR) per cycle, including all treatment cycles with ejaculated spermatozoa, remained similar during the first five consecutive cycles achieving a cumulative PR of 80.44%. The cumulative pregnancy rates for cycles with testicular spermatozoa showed a consistent rise during four consecutive treatments and reached 61.84%. The regression analysis of pregnancy rate showed that it was significantly positively correlated with oocyte fertilization rate (P = 0.02), and negatively correlated with maternal age (P = 0.03). Thus, according to the present results, couples with infertility who require IVF with ICSI should be offered at least five consecutive attempts if ejaculated spermatozoa are used, and at least four cycles whenever testicular spermatozoa are used.

Risk of prostate cancer in patients with schizophrenia

OBJECTIVESnTo examine the rate of prostate cancer in a cohort of schizophrenia in-patients in the PSA-era as compared to expected rates. There is conflicting evidence on the relative risk of prostate cancer in men with schizophrenia.nnnMETHODSnthe study sample was comprised of schizophrenia patients who had been admitted to a tertiary care mental health center between 1990 and 2011. The data for the sample was cross-referenced with the National Cancer Registry. Analyses of Standardized Incidence Rates (SIR) for prostate cancer and for lung cancer (representing an organ system not sensitive to sex hormones) were performed.nnnRESULTSnOf 4,326 schizophrenia patients included in the present study, 181 (4.2%) were diagnosed with cancer at any site. Only 10 of these patients were diagnosed with prostate cancer. This reflects a reduced risk; SIR of 0.56 (95% CI 0.27-1.03). In the same cohort, 33 schizophrenia patients were diagnosed with lung cancer presenting a SIR of 1.43 (95% CI 0.98-2.01) in this sample.nnnCONCLUSIONSnThe present study suggests a reduced rate of prostate cancer in patients admitted for schizophrenia. There are several possible explanations for this finding including chronic state of hyperprolactinemia induced by antipsychotic drugs.

Deformable registration of trans-rectal ultrasound (TRUS) and magnetic resonance imaging (MRI) for focal prostate brachytherapy.

PurposeFocal therapy in low-risk prostate cancer may provide the best balance between cancer control and quality of life preservation. As a minimally invasive approach performed under TRUS guidance, brachytherapy is an appealing framework for focal therapy. However, the contrast in TRUS images is generally insufficient to distinguish the target lesion from normal prostate tissue. MRI usually offers a much better contrast between the lesion and surrounding tissues. Registration between TRUS and MRI may therefore significantly improve lesion targeting capability in focal prostate brachytherapy. In this paper, we present a deformable registration framework for the accurate fusion of TRUS and MRI prostate volumes under large deformations arising from dissimilarities in diameter, shape and orientation between endorectal coils and TRUS probes.MethodsFollowing pose correction by a RANSAC implementation of the ICP algorithm, TRUS and MRI Prostate contour points are represented by a 3D extension of the shape-context descriptor and matched by the Hungarian algorithm. Eventually, a smooth free-form warping is computed by fitting a 3D B-spline mesh to the set of matched points.ResultsQuantitative validation of the registration accuracy is provided on a retrospective set of ten real cases, using as landmarks either brachytherapy seeds (six cases) or external beam radiotherapy fiducials (four cases) implanted and visible in both modalities. The average registration error between the landmarks was 2.49 and 3.20xa0mm, for the brachytherapy and external beam sets, respectively, that is less than the MRI voxels’ long axis length (

The impact of vaginal penetration difficulties on the sexual functioning of women and their male partners

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Enhanced cytologic detection of early stage mouse bladder tumor following induction of uroepithelial cell shedding.

=3.6mm). The overall average registration error (for brachytherapy and external beam datasets together) was 2.56xa0mm.ConclusionsThe proposed method provides a promising framework for TRUS–MRI registration in focal prostate brachytherapy.

Bulbocavernosus reflex testing: a preliminary study on the prognostic factors for potency and response to sildenafil citrate after bilateral nerve-sparing radical prostatectomy

Hematospermia is usually caused by nonspecific inflammation of the prostate and seminal vesicles. Transrectal ultrasound (TRUS) is a safe and inexpensive modality for evaluating patients with hematospermia. The aim of this study is to describe the findings of TRUS and its contribution to patients management. A total of 115 consecutive patients presented with hematospermia and evaluated with TRUS between 2006 and 2012. All patients exhibited an abnormality in the TRUS examination. A 12-core TRUS-guided biopsy of the prostate was taken from 10 patients, but none of these samples were positive for tumor. In the vast majority of cases, a benign cause can be identified using TRUS. These causes usually do not require treatment.