Umit Gul

Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study

OBJECTIVE To perform conventional and microdissection testicular sperm extraction (TESE) at the same session and compare their effectiveness. DESIGN Prospective comparative study. SETTING University hospital setting. PATIENT(S) The study included 335 patients with nonobstructive azoospermia. INTERVENTION(S) Microdissection TESE was performed to 77 patient with atrophic testes. An additional 258 patients underwent conventional TESE using three incisions on three quadrants of the testis (upper, middle, and lower). Microdissection TESE was performed by enlarging the middle incision vertically when no spermatozoa could be detected using the conventional technique. MAIN OUTCOME MEASURE(S) Sperm retrieval, fertilization, clinical pregnancy rate (PR), and live birth rate were evaluated. The relation between sperm retrieval rate and FSH level and testis volume was also investigated. RESULT(S) Spermatozoa was detected in 33.7% of patients using conventional TESE. The spermatozoa detected increased to 50.8% using microdissection TESE. The increase was statistically significant. In the primary microdissection TESE group, the surgical retrieval rate was 20.8%. The overall sperm retrieval rate was 43.9%. There was a significant relation between the sperm retrieval rate and testis volume, whereas there was no relation between sperm retrieval rate and FSH levels. The overall fertilization rate, clinical PR, and live birth rate were 57.1%, 50.4%, 36.4%, respectively. CONCLUSION(S) Conventional TESE combined with microdissection TESE can be used in selected patients. Sperm retrieval rate of TESE can be low in patients with atrophic testes.

The Effect of Prior Varicocelectomy in Patients With Nonobstructive Azoospermia on Intracytoplasmic Sperm Injection Outcomes: A Retrospective Pilot Study

OBJECTIVES To examine our retrospective data on the outcomes of intracytoplasmic sperm injection (ICSI) and to determine whether a history of varicocele repair in men with nonobstructive azoospermia (NOA) undergoing an ICSI cycle was optimizing or not. METHODS This retrospective study was conducted on Baskent University Department of Obstetrics and Gynecology, IVF Unit, and Department of Urology. Infertile couples suffering from NOA scheduled to an ICSI cycle, which was controlled ovarian hyperstimulation with a gonadotropin or gonadotrophin-releasing hormone-agonist protocol, selected for the study were divided into 2 groups: group 1 (n = 31) included NOA patients who had undergone prior varicocele repair, and group 2 (n = 65) included NOA patients who had not undergone varicocele repair. RESULTS There was a significant difference between the 2 groups considering the sperm retrieval rate, which was higher in the varicocele repair group (sperm retrieval rate 60.81% and 38.46% respectively, P = .01). The clinical pregnancy rate and live birth rate were significantly higher in the varicocelectomy group (74.2% vs 52.3% and 64.5% vs 41.5%, respectively, P <.05). CONCLUSIONS Varicocele repair in NOA might be considered in patients undergoing ICSI cycle.

Sperm retrieval and live birth rates in presumed Sertoli-cell-only syndrome in testis biopsy: a single centre experience

We aimed to investigate sperm retrieval rates (SRR) by testicular sperm extraction (TESE), factors affecting SRR, and fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR) and live birth rate (LBR) in patients with presumed Sertoli‐cell‐only syndrome in testis biopsy (SCOS). We retrospectively evaluated files of 134 patients with SCOS who underwent TESE. Group I were patients in whom spermatozoa were retrieved and Group II were patients in whom no spermatozoa could be retrieved. SRR, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), and testosterone levels, and the volume of testicles were compared between groups. In addition, FR, IR, CPR and LBR were determined. Sperm retrieval was achieved in 37 (27.6%) patients (Group I), and the remaining 97 (72.4%) patients made Group II. There were no significant differences in age, infertility time, testicular volume, serum FSH, LH and testosterone levels between Groups I and II (p > 0.05). Intracytoplasmic sperm injection (ICSI) was performed in 36 patients. FR, IR, and CPR were 60.86 ± 23.03, 36.53 ± 41.78 and 51.3% respectively. Cycle and patient based LBRs were 37.8 and 45.1% respectively. SRR in SCOS is lower than patients with non‐obstructive azoospermia (NOA) in general. No parameters to predict spermatozoa retrieval were determined. In patients with SCOS, ICSI achieves similar live birth rate to other patients with NOA.

Maspin Expression in Renal Cell Carcinoma and Its Correlation with Clinicopathologic Parameters

OBJECTIVES To investigate the relationship between maspin expression and prognostic parameters in renal cell carcinoma (RCC) with relevance to vascular endothelial growth factor (VEGF) expression and microvessel density. METHODS One-hundred twenty-four patients with RCC of varying histologic types who underwent radical or partial nephrectomy were studied. The mean age of the patients was 59.4 years (range, 28-84). Maspin, VEGF, and microvessel density were studied by the universal avidin-biotin complex peroxidase method. Sections of 5-μm thickness were taken from paraffin blocks for immunohistochemical study. Cytoplasmic and/or nuclear staining were scored for maspin as negative and positive for all tumor cells. RESULTS Cytoplasmic maspin expression was positive in 51 (41.1%) patients. Nuclear maspin expression was not seen in any of the materials. Maspin expression decreased as tumor size increased (P = .036) without any specific relation to tumor subtypes (P = .583), and decreased as the pathologic stages increased without reaching statistical significance (P = .053). There were no correlations between maspin positivity and either VEGF expression or microvessel density. CONCLUSIONS In RCC, maspin expression is reduced with increased tumor size. Studies with larger series may be contributory in defining the role of maspin expression in RCC. Moreover, regulation of maspin expression genes appears to have the potential to lead to new treatment approaches.

Isolated Tuberculous Epididymoorchitis Developing After Allogeneic Haematopoietic Stem Cell Transplantation: A Case Report

We report a case of isolated tuberculous epididymoorchitis developing in a patient after haematopoietic stem cell transplantation (HSCT). Forty-four-year-old male was admitted to the hospital with scrotal pain and swelling 6 months after an allogeneic HSCT using a fullymatched sibling donor because of his acute myeloid leukemia. There were scrotal tenderness, thickening and erythema on the right side. Brucella standard tube agglutination test was negative. Increased scrotal skin thickening, edema in the right epididymis and increased testicular vascularization were detected on ultrasonography. He was readmitted to our hospital with recurrent scrotal pain after 3 months of partial improvement with oral ciprofloxacin administered for a diagnosis of right epididymoorchitis. Pelvic magnetic resonance imaging revealed bilateral epididymoorchitis and scrotal abscess. Acid fast bacilli were detected on Ehrlich-Ziehl-Neelsen staining of the content of abscesses drained under local anesthesia. Mycobacterium tuberculosis complex was isolated on the 24th day of quadruple antituberculosis therapy. Scrotal fistula developed on the first month of therapy which healed spontaneously after discontinuation of immunosuppressive agents. Full recovery was achieved after six months of antituberculosis therapy. As a result, tuberculous epididymoorchitis should be kept in mind in the presence of chronic epididymoorchitis developing in patients receiving immunosuppressive therapy. Klimik Dergisi 2017; 30(2): 87-9.

Simultaneous laceration of external iliac artery and vein complicating anterior vaginal wall sling operation for stress urinary incontinence.

Case reportWe report a case of simultaneous injury of right external iliac artery and vein by a needle carrier that was inserted from the suprapubic area down to the vaginal lumen during anterior vaginal wall sling procedure.DiscussionThe risk factors and measures to be taken to avoid this life threatening complication are discussed.