Taha A. Abdel-Meguid

Botulinum Toxin-A Injections Into Neurogenic Overactive Bladder—To Include or Exclude the Trigone? A Prospective, Randomized, Controlled Trial

PURPOSE The short-term outcomes of initial detrusor injections vs combined detrusor-trigone botulinum toxin-A injections were determined in patients with spinal cord injury-neurogenic detrusor overactivity. MATERIALS AND METHODS Adults with refractory spinal cord injury-neurogenic detrusor overactivity who strictly discontinued anticholinergics were recruited for the study. At a 1:1 ratio patients randomly received 300 U botulinum toxin-A intradetrusor injections excluding the trigone (detrusor arm) or 200 U intradetrusor plus 100 U intratrigonal injections (combined arm). Study end points were determination of the impact on incontinence episodes, complete dryness, quality of life, reusing anticholinergics, maximum detrusor pressure, reflex volume, maximum cystometric capacity, vesicoureteral reflux and adverse events. Patients were evaluated at baseline, and 2, 8, 12 and 18 weeks after injection. Statistical significance was considered at p<0.05. RESULTS Analysis included 18 patients per arm with no significant baseline differences. On within group analysis all parameters improved significantly compared to baseline. On between group analysis in the detrusor vs the combined arm at week 8 incontinence decreased by 52.4% vs 80.9% (number needed to treat 1.91 vs 1.23 patients, p<0.001), complete dryness was achieved in 33.3% vs 66.7% of patients (number needed to treat 3 vs 1.5, p<0.001) and quality of life score was decreased by 46.76% vs 48.13% (number needed to treat 2.14 vs 2.08, p<0.44). The absolute difference was 60% vs 82.5% for reflex volume (p<0.001), 66.2% vs 68.4% for maximum cystometric capacity (p<0.22) and -42.3% vs -41.9% for maximum detrusor pressure (p<0.21). At week 18 anticholinergics were needed again in 9 (50%) and 4 patients (22.2%) patients, respectively. No patient showed new or upgraded vesicoureteral reflux or reported significant adverse events. CONCLUSIONS In the short term all parameters improved significantly in each arm. The superiority of including rather than excluding the trigone was significant.

Predictors of Sperm Recovery and Azoospermia Relapse in Men With Nonobstructive Azoospermia After Varicocele Repair

PURPOSE In this study we determined the recoverability and sustainability of motile sperm in semen of men with nonobstructive azoospermia after varicocelectomy as related to different variables. MATERIALS AND METHODS Men with documented infertility for more than 1 year, with nonobstructive azoospermia and clinically palpable varicoceles were included in this prospective noncontrolled study. Participants underwent simultaneous subinguinal microsurgical varicocelectomy and testicular biopsies. Preoperative as well as initial and late followup semen analyses were performed. Outcomes of sperm recovery and relapse of azoospermia were correlated with the variables of patient age, infertility duration, varicocele grade, laterality, follicle-stimulating hormone, testicular volume and testicular histology. RESULTS The study included 31 men with a mean ± SD age of 34.9 ± 8.7 years and mean followup of 19.3 ± 3.3 months. Hypospermatogenesis, late maturation arrest, early maturation arrest and Sertoli-cell-only were observed in 13, 6, 2 and 10 patients, respectively. Overall, sperm recovery was evident in 10 of 31 (32.3%) patients (persistent recovery 19.4%, intermittent recovery 6.5%, relapse 6.5%). Sperm were recovered in patients with hypospermatogenesis (7 of 13, 53.8%) and late maturation arrest (3 of 6, 50%). No sperm were recovered in those with early maturation arrest or Sertoli-cell-only. Among the variables only histological patterns demonstrated a significant correlation with recovery (rho = 0.504, p = 0.004). None of variables was significantly correlated with relapse. Bilateral varicocele repair demonstrated a strong yet nonsignificant negative correlation with relapse (rho = -0.612, p = 0.06). CONCLUSIONS Varicocelectomy could recover motile sperm in men with nonobstructive azoospermia, palpable varicoceles and hypospermatogenesis or late maturation arrest. No sperm was recovered with early maturation arrest or Sertoli-cell-only. Recovery might be persistent or intermittent, or involve relapse of azoospermia. Testicular histology was the sole parameter significantly correlated with recovery and no predictors of relapse could be identified. This prognostic role of testicular biopsy is imperative in couple counseling.

Novel augmentation ileocystoplasty technique to manage non- compliant bladders in the presence of obstructed megaureters: The "fez procedure"

To show the efficacy and safety of a novel modification of Studers neobladder, herein defined as the “fez procedure.”