Igael Madgar

Controlled trial of high spermatic vein ligation for varicocele in infertile men

OBJECTIVE To determine whether high ligation is an effective treatment for infertile men with clinical varicocele. DESIGN A randomized, controlled trial of high spermatic vein ligation was carried out. The patients were treated and observed for 3 years. SETTING Infertility treatment clinic and andrology laboratory in a hospital. PATIENTS Infertile men with abnormal semen analysis because of varicocele only. INTERVENTION High ligation 1 year postrecruitment (group A) and at the beginning of the study (group B). RESULTS Among the 20 couples in group A, 2 pregnancies (10%) were achieved within the 1st year of observation period. During the year after high ligation, there were 8 pregnancies (44.4%), and during the 2nd year after high ligation, there were 4 more pregnancies (22.2%). In group B, 15 pregnancies (60%) occurred within the 1st year after operation. Three pregnancies (12%) and 1 pregnancy (4%) occurred during the 2nd and 3rd year, respectively. After operation in all patients of both groups, there was significant improvement in semen parameters, regardless of pregnancy occurrence. The difference in pregnancy rate (PR) between the operated group B and nonoperated group A during the 1st year of study was found to be highly significant. CONCLUSIONS It is concluded that in a population of infertile men presenting varicocele as the only demonstrable factor of infertility, the varicocele is clearly associated with infertility and reduced testicular function, and its correction by ligation improves sperm parameters and fertility rate. Furthermore, the highest PR in both groups occurred during the 1st year postoperation.

Prognostic value of the clinical and laboratory evaluation in patients with nonmosaic Klinefelter syndrome who are receiving assisted reproductive therapy

OBJECTIVE To characterize clinical and laboratory findings in nonmosaic 47,XXY patients that may help to predict spermatogenetic activity in their testicles. DESIGN Prospective study. SETTING Assisted reproductive technology program. PATIENT(S) Twenty patients with nonmosaic Klinefelter syndrome who underwent testicular sperm retrieval for IVF. MAIN OUTCOME MEASURE(S) The correlation between basal FSH, LH and testosterone levels, mean testicular volume, and results of the hCG test and presence or absence of sperm after testicular sperm extraction (TESE). RESULT(S) Sperm was found in nine patients (45%). The mean testicular volume was 7.8 +/- 2.5 mL in men with sperm after TESE and 5.6 +/- 1.2 mL in those without sperm after TESE; corresponding testosterone levels were 3.5 +/- 1.2 ng/mL and 1.7 +/- 0.8 ng/mL. Serum levels of FSH and LH did not significantly differ between groups. After the hCG test, the mean serum testosterone level was 16.0 +/- 6.3 ng/mL in men with sperm after TESE and 6.7 +/- 5.6 ng/mL in those without sperm. CONCLUSION(S) Testicular volume, testosterone levels, and results of the hCG test are important predictive factors of spermatogenesis in patients with nonmosaic Klinefelter syndrome.

The human Pim-2 proto-oncogene and its testicular expression

In this study we describe the cloning of a human gene, encoding a protein that shares 90% identity and 93% similarity at the primary structure level, with the mouse Pim-2 gene. The gene was designated hPim-2. Structural features suggest that like the mouse Pim-2, hPim-2 is also a serine threonine kinase. At the RNA level, two hPim-2 transcripts were identified. The first, 2.2 kb, is highly expressed in hematopoietic tissues and in leukemic and lymphoma cell lines (K-562, HL-60 and RAJI). It also shows considerable high levels in testis, small intestine, colon and human colorectal adenocarcinoma cells (SW480). A second transcript, 5.0 kb in size, could be detected only in spleen, thymus, small intestine and colon and in the K-562 and RAJI cell lines. In situ hybridization analysis of biopsies taken from testes of men with complete or partial spermatogenesis revealed that the gene is expressed in primary spermatocytes. In the absence of germ cells, signal could be detected over specific cells in the well developed interstitial region. These results suggest a role for hPim-2 in proliferating cells as well as during meiosis. A possible connection between hPim-2 and apoptosis is discussed.

Long-term followup of patients less than 30 years old with transitional cell carcinoma of bladder.

A review of our records between 1970 and 1986 identified 22 patients with transitional cell carcinoma of the bladder who were less than 31 years old. Of these patients 7 were less than 20 years old (group 1) and 15 were 20 to 30 years old (group 2). The tumors usually were of low grade and low stage. Patients in group 1 had no recurrences, whereas 6 patients (40 per cent) in group 2 had recurrences. Upstaging occurred in 2 patients with tumor recurrence. It would appear that while transitional cell carcinoma of the bladder in patients less than 20 years old has a more favorable prognosis, in patients 20 to 30 years old the prognosis is poorer and similar to that observed in older patients.

Outcome of In Vitro Fertilization and Intracytoplasmic Injection of Epididymal and Testicular Sperm Extracted from Patients with Obstructive and Nonobstructive Azoospermia

OBJECTIVE To evaluate IVF outcome after epididymal and testicular sperm retrieval in patients with obstructive or nonobstructive azoospermia. DESIGN Retrospective clinical analysis. SETTING Public university-affiliated IVF unit. PATIENT(S) One hundred twenty-three azoospermic patients (178 cycles). INTERVENTION(S) Sixty-three patients (103 cycles) with obstructive azoospermia (group 1) underwent either epididymal or testicular sperm retrieval, and 60 patients (75 cycles) with nonobstructive azoospermia (group 2) underwent testicular sperm retrieval combined with IVF treatment. Mature oocytes were fertilized using intracytoplasmic sperm injection. After sperm preparation, supernumerary spermatozoa were cryopreserved. MAIN OUTCOME MEASURE(S) Oocyte fertilization rate and clinical pregnancy rate (PR). RESULT(S) The oocyte fertilization rate was 48.4% (534/1,104) in group 1 and 41.5% (312/751) in group 2 (not significant [NS] difference). A total of 100 cycles (97.1%) and 62 cycles (82.7%) in the obstructive and nonobstructive groups, respectively, had embryos for replacement (NS difference). The clinical PRs per ET cycle were 24% (24/100) and 17.7% (11/62) in the two groups, respectively. Oocyte fertilization rates, when fresh (46.4%) or frozen-thawed (41.8%) spermatozoa were used, were not significantly different in the two groups. The PR when fresh sperm were used was 23.6% (30/127), versus 14.3% (5/35) when frozen sperm were used (NS difference). The PR for women aged < or = 35 years was similar to that for women >35 years of age (20.7% or 29/140 and 18.2% or 4/25, respectively). CONCLUSION(S) Epididymal and testicular sperm obtained in azoospermic patients can fertilize oocytes successfully and may lead to high fertilization rates and PRs. Freezing of these spermatozoa does not reduce the outcome of treatment significantly.

Urodynamic Aspects of Continent Urinary Diversion: Review

Continence following urinary diversion depends on factors related to the reservoir and outlet. The reservoir should possess good compliance and no or atmost low pressured phasic contractions. The outlet should provide adequate outflow resistance to allow expulsion of urine under voluntary control and at convenient intervals. Overcoming high intra-reservoir pressures by producing high outlet resistance may endanger the upper urinary tracts. There is evidence that a low pressure reservoir may be constructed from any part of the bowel as long as detubularization of the segment is performed. All types of intussuscepted valves possess an inherent tendency to dessuscept despite various techniques which are employed to stabilize them. The causes are discussed and a recently described technique to overcome this problem is reviewed.

Intratesticular Doppler flow, seminal plasma nitrites/nitrates, and nonobstructive sperm extraction from patients with obstructive and nonobstructive azoospermia.

OBJECTIVE To prospectively evaluate the role of intratesticular vascular flow in modulating sperm function in men with obstructive and nonobstructive azoospermia. The correlation of testicular Doppler values with nitric oxide and testicular sperm extraction was further evaluated. DESIGN Prospective study. SETTING Assisted reproduction unit at a university center. PATIENT(S) Twenty-eight men with azoospermia undergoing sperm extraction for intracytoplasmic sperm injection. INTERVENTION(S) Ultrasound and color Doppler scanning of the testes. Testicular sperm retrieval and nitrite/nitrate assay. MAIN OUTCOME MEASURE(S) Doppler analysis of testicular transmediastinal artery, plasma and seminal plasma nitrite/nitrate values, and sperm extraction histopathology. RESULT(S) The pulsatility index (PI) of the transmediastinal artery was higher in patients with nonobstructive azoospermia (PI = 1.40 +/- 0.13) than in those with obstructive azoospermia (PI = 1.09 +/- 0.15; P=.011). Seminal plasma nitrite/nitrate concentrations were more elevated in cases of obstructive azoospermia than in gonadal failure. Unsuccessful sperm recovery was observed in four patients who showed the worst indices of gonadal failure. In this subgroup, a transmediastinal PI value >1.50 was always observed. CONCLUSION(S) Doppler analysis of the transmediastinal artery and nitrite/nitrate seminal plasma concentrations are useful for distinguishing between obstructive and nonobstructive azoospermia and allow the identification of the presence of spermatozoa within the testes.

Imipramine for the treatment of sterility in patients following retroperitoneal lymph node dissection

Imipramin zur Behandlung der Infertilität bei Männern nach retroperitonealer Lymphknoten‐Entfernung

Urethral strictures in boys

While common in adult males, urethral strictures are comparatively rare in boys. We report our experience with this condition in 19 boys. Ten of the strictures were iatrogenic, seven traumatic, and three inflammatory in origin. Dilation is reportedly unsatisfactory for the management of most urethral strictures in children. In our series, however, 9 patients (47.3%) underwent urethral dilation as the only definitive form of treatment, while urethroplasty was successfully performed in the other 10 cases.

Sperm preservation by electroejaculation in adolescent cancer patients.

The increasing prevalence of cancer survivors who are infertile due to gonadal failure highlights the importance of fertility preservation prior to gonadotoxic treatments. Adolescent cancer patients may not be mature enough to produce sperm by masturbation, leading to the use of alternative methods for obtaining sperm for cryopreservation. The aim of the current study was to evaluate the safety and efficacy of electroejaculation (EEJ) for cryopreservation among adolescent cancer patients.