Obstructive uropathy following aortofemoral graft surgery.

Fifty patients who had undergone aorto-bifemoral bypass with a bifurcated Dacron graft for aortoiliac arteriosclerotic obliteration were examined with real-time sectorial ultrasound to screen for the presence of hydronephrosis. Hydronephrosis was detected in only 1 case. The low incidence of this complication in our cases may be due to the fact that all our patients were explored at least 1 year after surgery. Some may have developed hydronephrosis early, but this may have resolved spontaneously during the first year after the operation, thus remaining undiagnosed. Pathogenic mechanisms suggested for the development of hydronephrosis and therapeutic approaches are discussed. We conclude tha…

It is time to abandon “Expected bladder capacity.” Systematic review and new models for children's normal maximum voided volumes

Background There is an agreement to use simple formulae (expected bladder capacity and other age based linear formulae) as bladder capacity benchmark. But real normal child's bladder capacity is unknown. Aims To offer a systematic review of children's normal bladder capacity, to measure children's normal maximum voided volumes (MVVs), to construct models of MVVs and to compare them with the usual formulae. Methods Computerized, manual and grey literature were reviewed until February 2013. Epidemiological, observational, transversal, multicenter study. A consecutive sample of healthy children aged 5–14 years, attending Primary Care centres with no urologic abnormality were selected. Particip…

Reflux nephropathy: a clinico-pathological study of 16 cases.

The pathologic features of 16 nephrectomy specimens obtained from patients with a radiological diagnosis of reflux nephropathy were analyzed. Chronic pyelonephritis was diagnosed in 7 cases, renal dysplasia in 5 and segmental atrophy in 4. Clear correlations between pathologic pictures and pathogenic mechanisms involved in the development of renal lesions in kidneys with reflux are difficult to establish. These results show, however, that 'reflux nephropathy' is a broad term, which encompasses both congenital and acquired renal lesions.

Analysis of chromosomal abnormalities in testicular and epididymal spermatozoa from azoospermic ICSI patients by fluorescence in-situ hybridization

BACKGROUND: An increased incidence of numerical chromosomal abnormalities has been reported in the ejaculated spermatozoa of infertile patients. However, there are few cytogenetic studies of testicular and epididymal spermatozoa, and their results are still controversial. METHODS: Fluorescence in-situ hybridization (FISH) analysis of chromosomes 13, 18, 21, X and Y was performed on seven testicular samples and two epididymal samples from patients with obstructive azoospermia (OA), and on 13 testicular samples from patients with non-obstructive azoospermia (NOA). Five ejaculated sperm samples from normozoospermic fertile donors were evaluated as a control group. RESULTS: Both epididymal sper…

Effect of Intraperitoneal Sterile Urine Injection on Abdominal Myoelectrical Activity in the Spinal Rat Model

The abdominal muscle reflex contractions in response to intraperitoneal injection of homologous sterile urine and acid, alkaline, hypo- and hyperosmolar solutions are studied in an acute spinal rat model by conventional and integrated electromyographic techniques. Intraperitoneal injection of homologous sterile urine causes a powerful and almost immediate abdominal muscle contracture of relative short duration. This response seems not to be related to urine pH or osmolarity, since only when solutions with extreme variations in these parameters are injected intraperitoneally are significant abdominal muscle contractions observed.

First report of the absence of viral load in testicular sperm samples obtained from men with hepatitis C and HIV after washing and their subsequent use.

Human immunodeficiency virus and hepatitis C infections are sexually transmitted diseases that require sperm samples to be pretreated to eliminate the viral presence before their safe use in assisted reproduction treatments. In this report we describe our experience with sperm washing protocols applied to sperm cells from testicular biopsies as well as the results obtained in subsequent assisted reproduction treatments on seropositive males that are also azoospermic.

Behavior of Epithelial Differentiation Antigens (Carcinoembryonic Antigen, Epithelial Membrane Antigen, Keratin and Cytokeratin) in Transitional Cell Carcinomas of the Bladder

Results of an immunohistochemical study in normal urothelium and transitional cell carcinomas of the bladder are presented. Paraffin-embedded material was confronted with immunoantisera against carcinoembryonic antigen (CEA), keratin (K), cytokeratin (CK) and epithelial membrane antigen (EMA). Immunohistochemical findings confirm the changes in reactivity of dysplastic urothelium and carcinoma in situ for CEA, CK and EMA, in comparison with normal urothelium. Statistically significant differences were also found, depending upon tumor stage, in staining of transitional cell carcinomas for K and CK. Expression of CK correlated with the tumor differentiation grade: normal urothelium and well-d…

Testicular Sperm Extraction (TESE) and Intracytoplasmic Sperm Injection (ICSI) in Hypogonadotropic Hypogonadism with Persistent Azoospermia After Hormonal Therapy

Purpose: We aimed to retrieve testicular sperm to be employed on intracytoplasmic sperm injection (ICSI) cycles on a male affected of hypogonadotropic hypogonadism (HH) that remained azoospermic after long-time hormonal treatment. Methods: Design. We initially performed hormonal therapy using gonadotropins to achieve spermatogenesis. After several semen analyses, we weighed the possibility of looking for testicular spermatozoa for ICSI. Setting. A private university-affiliated setting. Patient. A 30-years-old man diagnosed 10 years ago to suffer from idiopathic, prepubertal HH. Interventions. Gonadotrophin treatment was initiated with hCG and follicle stimulating hormone (FSH). Testicular s…

Fertilization after intracytoplasmic sperm injection with cryopreserved testicular spermatozoa.

Objective To assess the possibility of cryopreserving testicular tissue extracted sperm for intracytoplasmic sperm injection (ICSI). Design A report of two cases. Our study was approved by the Ethical Committee at the Instituto Valenciano de Infertilidad. Setting In vitro fertilization program at the Instituto Valenciano de Infertilidad. Patients Two azoospermic patients with severe spermatogenic failure but with focal spermatogenesis on testicular biopsies. In both cases, a first ICSI attempt with fresh testicular biopsy extracted sperm was unsuccessful. Interventions Cryopreservation of testicular spermatozoa in 100-µL "pills." Intracytoplasmic sperm injection with thawed testicular sperm…

Nephro-broncho-cutaneous Fistula

High incidence of chromosomal abnormalities in large-headed and multiple-tailed spermatozoa

Rodrigo Vivo, Lorena, lorovi@alumni.uv.es ; Prados Dodd, Nicolas, Nicolas.Prados@uv.es ; Gil Salom, Manuel Luis, Manuel.Gil-Salom@uv.es ; Remohi Gimenez, Jose Alejandro, J.Alejandro.Remohi@uv.es

Intracytoplasmic Testicular Sperm Injection: An Effective Treatment for Otherwise Intractable Obstructive Azoospermia

AbstractPurpose: We evaluated the efficacy of intracytoplasmic sperm injection with testicular spermatozoa.Materials and Methods: Intracytoplasmic sperm injection was performed with spermatozoa obtained from testicular biopsy specimens in 15 patients with obstructive azoospermia, in whom standard microsurgical procedures were not feasible or had previously failed.Results: Fertilization was achieved in 14 to 15 cycles. Mean fertilization rate per cycle was 63.6 percent. Four clinical pregnancies occurred, for a pregnancy rate of 26.7 percent per started cycle and 28.6 percent per transfer.Conclusions: Intracytoplasmic testicular sperm injection is followed by high fertilization rates, and of…

Sperm DNA fragmentation levels in testicular sperm samples from azoospermic males as assessed by the sperm chromatin dispersion (SCD) test.

Objective To analyze sperm DNA fragmentation (SDF) in testicular sperm samples from patients with azoospermia either from spermatogenic failure or from duct obstruction. Several technologies can be applied in the evaluation of SDF, but given the ease and low costs, the sperm chromatin dispersion test (SCD) has emerged as a promising standard. Design Prospective blind observational cohort study. Setting University-affiliated private IVF setting. Patient(s) Azoospermic patients from couples undergoing intracytoplasmic sperm injection cycles. Intervention(s) Testicular sperm extraction (TESE). Main Outcome Measurement(s) We determined testicular SDF, and a basic comparison between nonobstructi…

DNA-Ploidy, Morphometric-Stereological and P-Glycoprotein Study of Superficial Bladder Carcinomas

We carried out a DNA-ploidy, morphometric-stereologic and P-glycoprotein study on 40 newly diagnosed superficial bladder cancer patients (G1-G2), correlating the results with histological grade and clinical outcome. Variations in the number of patients who present recurrences, progression or remain tumor-free during the whole follow-up period (at least 5 years) were not significant when related to nuclear size, proliferative diploid index, presence of aneuploidy and expression of P-glycoprotein. It is striking how the majority of disease-free subjects showed a proliferative diploid index higher than 10%. Moreover, 3 of them presented an aneuploid cell population. In our study, only histolog…

Cytokeratin expression patterns in low-grade papillary urothelial neoplasms of the urinary bladder.

BACKGROUND The differential expression patterns of cytokeratin 20 (CK20) and 34βE12 antigen in low-grade papillary urothelial tumors of the bladder are discussed. METHODS A retrospective study of 120 patients with low-grade papillary bladder tumors (45 neoplasms of low malignant potential and 75 low-grade WHO G1 carcinomas) was performed. All tumors were graded in accordance with the 1998 World Health Organization/International Society of Urological Pathology (WHO/ISUP) and 1999 WHO classifications. The mean follow-up was 76.6 months (range, 36–168 mos), considering for prognostic purposes the time to first recurrence, or relapse-free interval (RFI), and the total number of recurrent patien…

Presence of human papillomavirus DNA in testicular biopsies from nonobstructive azoospermic men.

Abstract Context.—Human papillomavirus (HPV) plays a major role in the etiology of many malignancies of diverse localization, such as uterine cervical carcinoma and its precursors. Human papillomavirus sequences have been detected throughout the male lower genitourinary tract, but the role of men as transmitters remains unclear. Objective.—To investigate the relationship between azoospermia and the presence of HPV DNA in testicular cells. Design.—One hundred eighty-five patients with azoospermia undergoing testicular biopsy were studied. Histologic study was done on formalin-fixed, paraffin-embedded samples from testicular biopsies, stained with hematoxylin-eosin. Molecular study to detect …

Multiple Mucosal Biopsies and Postoperative Urinary Cytology in Patients with Bladder Cancer

Seventy-one patients with bladder tumors of stage Ta, T1 or T2 were studied by bladder mucosal biopsies. In 34 (48%) patients abnormal histology was found in at least one of the biopsies. The occurrence and severity of mucosal abnormalities were related to tumor grade and stage. Urinary cytology after complete tumor resection was positive in 18 of 19 patients with abnormal biopsies and in 6 of 12 patients with normal biopsies. Postoperative urinary cytology seems to be a good indicator for the presence of urothelial atypia.

Testicular sperm from patients with obstructive and nonobstructive azoospermia: aneuploidy risk and reproductive prognosis using testicular sperm from fertile donors as control samples.

Objective To establish a baseline incidence of chromosomal abnormalities in testicular sperm of fertile men and to determine the best control sample for comparisons with azoospermic males to estimate their reproductive prognosis. Design Prospective study. Setting Infertility clinic. Patient(s) Sixteen obstructive azoospermic (OA) and 19 nonobstructive azoospermic patients (NOA). Control samples were ejaculated sperm from ten fertile donors and testicular sperm from ten other fertile donors. Intervention(s) Fluorescence in situ hybridization (FISH) in sperm. Main Outcome Measure(s) Sperm numerical abnormalities for chromosomes 13, 18, 21, X, and Y; ongoing implantation and pregnancy rates in…

TESTICULAR SPERM EXTRACTION AND INTRACYTOPLASMIC SPERM INJECTION

We evaluate the efficacy of testicular sperm extraction and results of intracytoplasmic sperm injection in cases of nonobstructive azoospermia. In addition, we define predictive parameters for successful testicular sperm extraction in these patients.A total of 154 patients with nonobstructive azoospermia underwent multiple testicular biopsies to obtain testicular spermatozoa and for histopathological diagnosis. Results of testicular sperm extraction were related to suspected etiology of azoospermia, patient age, maximal testicular volume, serum follicle-stimulating hormone and histopathology. When testicular sperm extraction was successful, intracytoplasmic sperm injection was performed.Spe…

Pregnancy in an azoospermic patient with markedly elevated serum follicle-stimulating hormone levels

Objective To assess the possibility of achieving a pregnancy in an azoospermic patient with markedly elevated serum FSH level. Design A case report. Setting In vitro fertilization program at the Instituto Valenciano de Infertilidad. Patient An azoospermic patient with small testes and serum FSH level (38.7 mlU/mL) higher than three times normal. Testicular biopsy revealed Sertoli cell-only syndrome with focal spermatogenesis. Interventions Intracytoplasmic microinjection of testicular tissue-extracted spermatozoa. Main Outcome Measurements: Fertilization rate, cleavage rate, clinical pregnancy. Results Eight of 11 (73%) intact oocytes showed two pronuclei. All of them cleaved normally. Four…

Intracytoplasmic sperm injection: a treatment for extreme oligospermia.

AbstractPurpose: We evaluated the efficacy of intracytoplasmic sperm injection in patients with extreme oligospermia.Materials and Methods: A total of 67 intracytoplasmic sperm injection cycles was attempted in 58 infertile couples in which the husbands had extreme oligospermia (less than 100,000 spermatozoa per ml. ejaculate).Results: Fertilization was achieved in 65 of 67 cycles. Mean fertilization rate per cycle was 66.4 percent. A total of 18 clinical pregnancies was obtained, for a pregnancy rate of 26.8 percent per started cycle. There were 4 miscarriages and 8 live births from 5 deliveries. Nine pregnancies are ongoing.Conclusions: Intracytoplasmic sperm injection in patients with ex…