Micheal J. Chehval

Deterioration of semen parameters over time in men with untreated varicocele: evidence of progressive testicular damage

Objective To report observations of semen parameters in men with untreated varicocele over time. Design Semen parameters in 13 men with varicoceles were obtained at initial presentation, and re-evaluated at a 9 to 96-month interval because of persistent infertility. Setting Outpatient male fertility clinic. Patients, Participants Thirteen men who presented for fertility evaluation and who were found to have varicocele(s) and normal semen parameters. Re-evaluation was performed because of continued fertility problems. Interventions None. Main Outcome Measure Semen parameters, especially sperm density, sperm mobility, and total sperm. Results Statistically significant deterioration was noted from normal to abnormal. Conclusion In males with varicocele(s), normal semen parameters should not routinely be expected to remain normal over time.

The Effect of Unilateral Injury to the Vas Deferens on the Contralateral Testis in Immature and Adult Rats

The relationship between alterations in testicular histology and antisperm antibodies in immature and mature Lewis rats subjected to unilateral vasectomy was studied. Forty percent of immature rats and 90% of mature rats (p < 0.01) demonstrated significant alterations in both the obstructed (vasectomy) testis and the contralateral testis. There were significant changes in antisperm antibodies (ELISA) in the animals which demonstrated histologic changes.

Chorionic Gonadotropins in the Treatment of the Subfertile Male

Sixty-four men with idiopathic subfertility were given human chorionic gonadotropin, 50,000 units in 10 divided doses. Sixty-nine per cent of the men demonstrated significant improvement in semen quality in response to the medication, and thirty-six per cent achieved a pregnancy. Eight patients have achieved a second pregnancy without additional therapy.

Adenocarcinoma of rete testis

Adenocarcinoma of the rete testis is a very rare malignant neoplasm originating in the epithelium of the rete testis. Histologically, it appears as a papillary adenocarcinoma. The first case was reported in the literature in 1853 and since that time only 16 additional cases have been reported. This report represents the eighteenth case.

A Clinical Evaluation of a New Silastic Seminal Fluid Collection Device

A new Silastic seminal fluid collection device has been tested clinically and comparison studies have been made with both the polyethylene sheath and commercial latex condoms. In a series of 100 patients, the Silastic seminal fluid device has been found to be superior to the polyethylene sheath with regard to patient comfort and also has had greater reliability. In comparison with the latex device, the Silastic seminal fluid collection device is nearly as comfortable and has been found to be far more reliable.

Human Chorionic Gonadotropin in the Treatment of the Infertile Man

We have treated 128 men with proved infertility with human chorionic gonadotropin. Excellent results were obtained in the patients who underwent varicocelectomy but who did not respond to the operation. Good results were obtained in the idiopathic oligospermic men, that is with sperm density less than 20 million. Indeterminate results were obtained in patients with sperm values more than 20 million. However, therapy was deemed inappropriate in those patients who either had elevation of follicle-stimulating hormone, an untreated varicocele or biopsy findings of hyalinization, or atrophy, which would preclude success of therapy.

Effect of vasovasostomy on contralateral testicular damage associated with unilateral vasectomy in mature and immature Lewis rats

OBJECTIVE We sought to determine if laser-assisted vasovasostomy could reverse the contralateral histologic testicular changes associated with unilateral vasectomy. DESIGN A prospective, randomized, blinded, controlled study. SETTING Animal microsurgical laboratory, St. Johns Mercy Medical Center, St. Louis, Missouri. PATIENT(S) Twenty mature and 20 immature male Lewis rats. INTERVENTION(S) Ten mature and 10 immature male Lewis rats underwent unilateral vasectomy. At 5 months, testicular biopsy and laser-assisted vasovasostomies were performed followed 2 months later by evaluation of vas patency and repeat testicular biopsy. Control animals consisted of 10 rats in each group, 5 that underwent sham operations and 5 that had halothane anesthesia alone. RESULT(S) In the immature and mature groups unilateral vasectomy resulted in marked contralateral testicular damage in 30% (3 of 10) and 50% (5 of 10), respectively. Vas patency determined 2 months after vasovasostomy was 80% (8 of 10) in the mature group and 89% (8 of 9) in the immature group. No animal that had contralateral testicular changes after vasectomy and a patent vas after vasovasostomy showed improvement in testicular histology. CONCLUSION(S) It appears that contralateral testicular damage associated with unilateral vasectomy is not improved 2 months after successful vasovasostomy in mature or immature Lewis rats.

Congenital megalourethra: report of a unique case.

Abstract Congenital megalourethra is a rare clinical entity of mesodermal origin. A unique case is presented, which demonstrates features of a fusiform and scaphoid megalourethra.

Nonoperative management of renal artery embolus

Two cases of renal artery emboli were treated nonsurgically with intravenous heparin. Both patients experienced prompt and total relief of the apparent embolization.

Perinephric Abscess 19 Years After an Intentional Ureteral Ligation

AbstractA case of a perinephric abscess as a result of intentional ureteral ligation 19 years previously is presented.