Hatsuki Hibi

THE TREATMENT WITH TRANILAST, A MAST CELL BLOCKER, FOR IDIOPATHIC OLIGOZOOSPERMIA

Although many drug treatments have been reported to theoretically improve semen parameters in male infertility, a standard method has not been established. The authors examined whether tranilast, a mast cell blocker, improves fertility and/or semen parameters in severe oligozoospermia. Seventeen patients with a sperm density of less than 10 2 10 6 sperm/mL and their fertile partners were enrolled in this study. Patients were prescribed tranilast 300 mg/day for at least 12 weeks. Semen and blood samples were collected before and after the prescription of tranilast for 12 weeks. Semen parameters, serum gonadotropins, luteinizing hormone, follicle-stimulating hormone, serum testosterone, and testicular size were evaluated. One patient complained of mild drowsiness during treatment. The sperm count was significantly increased after administration of tranilast in 7 patients (41.1%), although sperm motility was not altered. Semen volume and normal morphology were also unaltered. Three pregnancies were achieved. Endocrine profile and testicular size were unchanged. Tranilast, a mast cell blocker, is clinically useful for the treatment of severe idiopathic oligozoospermic men.

Treatment of Oligoasthenozoospermia with Tranilast, a Mast Cell Blocker, After Long-Term Administration

The authors retrospectively examined whether long-term administration of tranilast improves semen parameters in severe oligoasthenozoospermia. Fifty-two patients presenting with sperm concentration of less than 10 2 10 6 sperm/mL were enrolled. Subjects were partitioned into 3 groups as follows: patients displaying an atrophic testis with elevated (FSH) (group 1), patients exhibiting normal testicular volume with elevated FSH (group 2), and patients with normal testicular volume and normal FSH levels (group 3). Tranilast (300mg/day) was administered until pregnancy was achieved or for a period of up to 12 months. Sperm concentration was significantly increased at 3 months in 16 subjects (44%) in groups 1 and 3. In group 2, sperm concentration was increased at 12 months (5 of 16 subjects; 31%). Total sperm count was obviously elevated at 3 months in groups 1 and 2, and at 6 months in group 3. Six pregnancies were achieved via natural intercourse. Tranilast, a mast cell blocker, demonstrates a certain clinical benefit in terms of improvement of semen parameters involving severe oligoasthenozoospermia, but it does not appear to afford clinical benefit in long-term administration.

PROBABILITY OF SPERM RECOVERY IN NON-OBSTRUCTIVE AZOOSPERMIC PATIENTS PRESENTING WITH TESTES VOLUME LESS THAN 10 ml/FSH LEVEL EXCEEDING 20 mIU/ml

We evaluated the sperm recovery rate in non-obstructive azoospermia (NOA) patients presenting with bilateral testicular atrophy characterized by testes volume of less than 10 ml and FSH levels exceeding 20 mIU/ml (group NOA-1), and compared the results to those NOA cases displaying unilateral testis volume exceeding 10 ml or FSH levels less than 20 mIU/ml (group NOA-2). Sperm retrieval was conducted in 261 azoospermic patients from April 1995 to December 2002. Forty-six NOA-1 and 37 NOA-2 individuals underwent microdissection TESE or 3–4 standard biopsies. Sperm recovery was achieved in 11 (24%) and 12 (32%) cases in NOA-1 and NOA-2, respectively. All couples received ICSI. Four clinical pregnancies (36.3%) in NOA-1 and two (17%) in NOA-2 resulted. Five subsequent healthy deliveries were obtained. NOA patients presenting with bilateral severe atrophic testes volume and obviously elevated FSH levels exhibited approximately 24% probability of sperm recovery. On the other hand, NOA characterized by testicular atrophy or elevated FSH levels displayed probability of approximately 32%. Differences in sperm recovery were not evident between NOA-1 and NOA-2. No successful pre-operative predictors of sperm recovery were identified.

Retrograde ureteroscopic endopyelotomy using the holmium:YAG laser

Abstract Background : We report our experience of retrograde ureteroscopic endopyelotomy using the holmium laser for ureteropelvic junction (UPJ) obstruction not associated with upper tract stones.

Endoscopic ureteral incision using the holmium:YAG laser

Abstract Background: We reviewed the results of endoscopic ureteral incision for benign ureteral stricture, ureteropelvic junction obstruction and ureteroenteroanastomotic stricture using the holmium laser.

Clinical study of transitional cell carcinoma of the prostate associated with bladder transitional cell carcinoma.

Abstract Background: Transitional cell carcinoma of the prostate in patients with bladder cancer appears to influence the prognosis and affects the decision about therapeutic modality. Therefore, it is important to characterize transitional cell carcinoma associated with bladder cancer.

Microsurgical vasoepididymostomy with sperm cryopreservation for future assisted reproduction

Abstract Background Although obstructive azoospermia is treatable with microscopic seminal reconstruction, the number of patients who choose to undergo vasoepididymostomy is limited because of recent advances in assisted reproductive technology (ART). We attempted to define the outcome of surgical reconstruction in patients with suspected epididymal obstruction and no previous history of vasectomy.

Human Chorionic Gonadotropin Adjuvant Therapy for Patients with Leydig Cell Dysfunction After Varicocelectomy

The authors treated 135 men who underwent varicocelectomy, but had sustained Leydig cell dysfunction disclosed by LHRH test with human chorionic gonadotropin (hCG). hCG was administered for 10 weeks: 50,000 units were given in 10 divided doses intramuscularly. Semen analysis and measurement of serum hormone level were obtained 8 weeks after the completion of treatment, and every 3 months after that. All patients were followed up for 2 years to confirm pregnancy. Fifty-five percent of patients achieved pregnancy and they showed significant increase in sperm density, percentage of sperm motility, normal form sperm, and serum testosterone level. It is recommended that hCG be administered to patients who undergo varicocelectomy but have persistent subtle Leydig cell dysfunction disclosed by LHRH test to stimulate the intratesticular testosterone production.

Vesicourethral Anastomotic Suture Placement during Radical Prostatectomy Using Maniceps

Introduction: A new method of using a semiautomatic device (Maniceps) for precise vesicourethral anastomosis during radical retropubic prostatectomy is described. Methods: A total of 15 patients underwent radical retropubic prostatectomy with this technique. The follow-up period ranged from 6 to 16 months. The retrograde urethrocystography was performed at 2 weeks. Patients were evaluated specifically for anastomotic time, anastomotic obstruction and urinary continence. Results: The average anastomotic time was 8.1 (range 5–12) min. The catheter of all patients could be removed at 2 weeks. Anastomotic obstruction occurred in 1 patient (6.7%), and 14 patients (93.3%) were completely continent of urine. Conclusion: Maniceps is a useful procedure to carry out vesicourethral anastomosis safely, easily and surely, and it has provided good surgical results in our experience.

Testicular Sperm Extraction and ICSI in Patients with Post-Chemotherapy Non-Obstructive Azoospermia

146 MD-TESE procedures were performed in 74 patients presenting with non-obstructive azoospermia (NOA). Five of the 74 patients displayed a history of chemotherapy. Etiology of chemotherapies included testicular cancer, osteosarcoma, Ewing sarcoma, and malignant lymphoma of the stomach. Post-chemotherapy duration was 2.5-18 years. All patients underwent MD-TESE using local anesthesia with spermatic block and sedation. Extracted sperm was cryopreserved for ICSI. Histopathologic examination revealed Sertoli cell-only syndrome in all five patients; however, sperm were retrieved in 3 subjects. Post-chemotherapy MD-TESE and ICSI can be applied successfully in some patients with NOA. However, freezing semen prior to chemotherapy is recommended.