BackgroundCryptozoospermia (CO) is a situation in which spermatozoa cannot be observed in a fresh semen sample unless an extended centrifugation and microscopic search are performed. CO patients are suggested to use only intracytoplasmic sperm injection (ICSI) as infertility treatment. But still there is debate about the choice of sperm source in cryptozoospermic men candidate for ICSI.ObjectivesThis study was conducted to evaluate fertility outcomes in men with idiopathic cryptozoospermia who were treated using ICSI with freshly ejaculated sperm and testis sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA).MethodsIn this prospective cohort study carried out in an academic institution, 83 out of 92 couples with cryptozoospermia undergoing their first ICSI cycle were recruited. These patients were randomly allocated to two groups: group one (n = 42) who produced freshly ejaculated sperm and, group two (n = 41) who produced a sample by TESE or PESA. The groups were analyzed and compared in terms of fertilization rate, cleavage rate, embryo quality, implantation rate, and clinical pregnancy rate.ResultsThere was a significant difference in fertilization rate, embryo quality, implantation rate, and pregnancy rates between the group of surgically extracted sperm and those of naturally ejaculated sperm using conventional ICSI (P < 0.05).ConclusionsSperm quality extracted by percutaneous PESA and TESE procedures increases fertility outcomes compared to naturally ejaculated sperm in men with idiopathic CO. More specifically, embryo quality, which is most relevant to fertility outcome, improved when surgically extracted sperm was used for ICSI.

Purpose To compare balloon with Amplatz for tract dilation in totally ultrasonographically guided PCNL (UPCN). Methods We randomized 66 patients candidate for sonographically guided PCNL in the flank position in two study groups. In the first group, we used single step Amplatz dilation (AG) technique in which the 28- or 30-French Amplatz dilator is used for tract dilation. In the other group, we dilated the tract using balloon dilator (BG). We compared procedure time, success rate of dilation, and postoperative clinical outcomes and cost between two groups. ResultsThe rate of short dilation was higher in the Amplatz group (57.6%) compared with Balloon group (36.4%) (P=0.08). When using Amplatz for lower pole access, short dilation occurred in 81% of cases compared with 44% in the BG (P=0.02). Overall operation was longer in the AG (80±21 versus 65±20 minutes P=0.02). Stone free rate was 87.9% in the AG compared with 72.7% in the BG (p=0.12). Mean cost of the surgery was 603±85 USD and 718±78 USD in the AG and BG, respectively (P=0.0001). Hemoglobin drop, transfusion rate, renal function alteration, duration of hospitalization, and complication rate based on Clavien classification were similar in both groups. Conclusions AG showed a higher rate of short dilation compared with BG; consequently, overall operating time was significantly longer in the AG whereas BG was significantly more expensive than AG. Bleeding and other complications were similar in two groups. We observed an advantage for balloon dilation over Amplatz when approaching the lower pole calyxes.

Background:Tamsulosin is an α-1A-specific blocker which induces selective relaxation of ureteral smooth muscle with subsequent inhibition of ureteral spasms and dilatation of the ureteral lumen and facilitates stone expelling.Objectives:In this study we aimed to assess the efficacy of tamsulosin for improving the success rate of ureteroscopic lithotripsy (URS) for lower ureteral stones.Patients and Methods:In a prospective study by a randomized controlled clinical trial, which was performed from June 2008 to December 2010, we enrolled one hundred and forty-two subjects and eventually 102 patients completed the clinical trial. All the patients underwent ureteroscopic lithotripsy with the pneumatic wolf lithotripsy. The patients were randomly divided into 2 groups: the study group including 52 patients, received tamsulosin with our traditional treatment (hydration and analgesic when required), and the control group with 50 patients who received placebo with traditional treatment. The number of colic episodes, lower urinary tract symptoms, analgesic dosage, and days of spontaneous passage of the stones through the ureter were recorded in a diary after lithotripsy.Results:The results showed that tamsulosin treatment group had low expulsion time (P = 0.011), low urinary tract symptoms, least analgesic needs and low adverse effects, all with statistically significant differences comparable with the control group (P < 0.05).Conclusions:Administration of α-1A-specific blocker reduced analgesic dosage and colic episodes and rate of adverse effects after ureteroscopic lithotripsy of lower ureteral stones and decreased gravel expulsion time after URSL.

Objectives: To evaluate the effect of acupuncture on the semen quality of patients with clinical varicocele and their fertility outcomes. Methods: A total of 158 men, with the primary infertility and clinical varicocele were randomized into two groups. The study group underwent a subinguinal microscopic varicocelectomy, and control group without operation. Then, each group was randomized to two sub groups; the first subgroups from them (sub group study 1 and sub group control 1) underwent acupuncture treatment twice a week for 2 months, the next subgroups (sub group study 2 and sub group control 2) underwent sham acupuncture. All subgroups were evaluated by performing spermogramms after 6 months and notifications were made by phone call for the results of their wives pregnancy. Results: The pre-treatment sperm parameters were statistically similar in all groups, however, post treatment results were significantly improved in varicocelectomized and acupuncture subgroups in comparison to control sub groups. The pregnancy rate after 24 months follow up in study subgroups were significantly better than control subgroups. Conclusions: According to our results, in this study acupuncture procedures in primary infertile clinical varicocele patients with semen abnormalities was effective, especially if combined by varicocelectomy.

BackgroundTransurethral resection of the prostate (TURP) is the most common surgical treatment for benign prostatic hyperplasia.ObjectivesThe aim of the present study was to compare the conventional bipolar transurethral resection of prostate (TURP) with a modified transurethral resection of the prostate (M-TURP) in men with mild to moderate symptoms of benign prostatic hyperplasia.Patients and MethodsTo compare and evaluate the clinical outcomes of M-TURP, a new electrosurgical suggested method, with the standard treatment, transurethral resection of prostate (TURP), 200 patients with benign prostatic enlargement causing moderate to severe clinical lower urinary symptoms were selected and divided into two equal groups of A and B. Patients of group A underwent M-TURP (incomplete bladder neck resection), resecting only from 1 to 11 O'clock position and group B underwent conventional TURP. These patients were evaluated between Jun 2008 and April 2011, after excluding 24 patients, finally 176 men were studied, 98 in the conventional monopolar transurethral resection of prostate (TURP) group and 78 in the (M-TURP) group. Postoperative follow up to assess the results of the surgeries and the complication rates, began from the operation and continued with postoperative visits of the patient at 24 hour after the catheter remove, two weeks, three months and finally six months.ResultsThe age range of both groups were the same (65-82 years old), preoperative IPSS score in study and control groups were 18 ± 3.3, 17 ± 4.6 (nonsignificant P value = ns) respectively. The size of prostate gland was 58 ± 3.5 g in study and 78 ± 1.2 g in control (ns) preoperatively. Intra and postoperative complications including hematuria (need for transfusion), urine retention (need for catheterization), fever after operation in study and control groups were 2.04%, 6.41%, 1.02% and 0.0%, 3.06%, 6.41% respectively. ISI score (stress incontinence score index) were 7 ± 2.5 and 19 ± 3.6 and UR (urge ratio) were %26 and %70 for study and control groups respectively; P < 0.05. IIEF (international index of erectile function) in study group was better than control (23 ± 3.2 vs. 11 ± 1.7), P < 0.05.ConclusionsThe results of this study showed that the support of anterior fibro muscular zone (anterior lobe) of prostate after TUR-P has a significant role in postoperative complications, especially in postoperative stress incontinence. So, we strongly recommend to preserve this segment of prostate for prevention of incontinence and other intra and postoperative complications.

Background: Circumcision is the most common surgical procedure throughout the world today and is usually performed in children for medical, cultural, or religious reasons. In most countries, nonsurgeons or traditional circumcisers perform this procedure, however, there is still a debate regarding the proper age of circumcision. Objectives: To determine the best and appropriate time for circumcision, we compared the late complications of this procedure between patients who are circumcised in different age groups. Methods: This is a retrospective and descriptive study that was performed on patients who were referred for late circumcision complications. The patients were divided according to the age range of circumcision as well as the performed age, which were divided into 4 groups (neonate, infant, child, and adolescent) by the author, during the period of May 2010 to December 2013 at an urology clinic. All late complications that were obtained were analyzed and compared between these groups.

Background:Premature ejaculation (PE) is the inability to delay ejaculation, occurring sooner than they or their partner would like during sexual activities. PE is a challenging problem that can affect sexual enjoyment and may harm relationships of couples and affect their quality of life. In idiopathic PE, several helpful techniques and medicines are recommended, but none of them has yielded satisfactory results.Objectives:Our objective in this study was to evaluate the efficacy and safety of clomiphene as a selective estrogen receptor modulator on the treatment of idiopathic PE.Patients and Methods:In a randomized clinical trial, 178 married men with idiopathic PE defined according to the Diagnostic and Statistical Manual of Mental Disorders Third Revised Version (DSM-III-R) who referred to urology clinics over a 10-month period in 2012 were randomized into two groups, namely the study (clomiphene) and control (placebo) groups. They completed self-administered questionnaires that included intravaginal ejaculatory latency time (IELT), erectile dysfunction indexes, quality of life (QOL), sociodemographic characteristics, lifestyle, and medical illness. After 6 months of intervention, all data were compared with the baseline data and between the groups.Results:Within the 10-month study course, 126 patients (70.8%) completed this study. After intervention and comparison of the results between the two groups, IELT, sexual indexes, and QOL improved in the study group, but significant differences were observed only in the IELT and QOL findings.Conclusions:Clomiphene seems to be useful in the pharmacological treatment of PE compared to the placebo.

Objective. The general objective of this study was to analyze the perception and attitude of Clinical varicocele patients treated for infertility at the Shafa Hospital of Kerman, Iran. Method. This is a case control study of 62 infertile patients with Clinical varicocele, they invited to participate to a survey by demographic and Hamilton Depression Rating Scale (HDRS) questionnaires prior to the surgical procedure and compared the results with a control group (50 age matched healthy men), from April 2009 to May 2010 at the Shafa Hospital of Kerman, Iran. Results. In the study group 45% of patients (28/62) said that they used to isolate themselves from the public. 32% (n = 20) patients have doubt about the results of operation, 20% (n = 12) believed operation will cause erectile dysfunction; 16% (n = 10) declared that their infertility problem is mainly due to their wife infertility not themselves; 17.7% (n = 11) of them divorced (regarding to infertility). Hamilton Depression Rating Scale were respectively (28.8 +/-6.5) and (15.6 +/-1.7) in the study and control groups (p = 0.001). Conclusions. Clinical varicocele patients have a very negative perception about their condition specially whose primary infertility and in comparing to general population have more depression grades. So, it is strongly recommended that for improve their psychological status by detailing their problem and changing negative perception and attitude to encourage them to follow and continue treatment options.