The aim of this study was to evaluate the predictive value of preoperative hormonal levels and pathology, as well as the outcome of microsurgical testicular sperm extraction in patients with non-obstructive azoospermia (NOA), presenting to our clinic for treatment of infertility. The records of 145 men with NOA who underwent microdissection testicular sperm extraction (micro-TESE) between March 2013 and November 2016 were studied. The patient's age, testicular volume, hormonal profile for follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (TT), and testicular pathology were recorded. The sperm retrieval, the clinical pregnancy and live birth delivery rates were noted. Our testicular sperm retrieval rate was 65.5%. There was no statistical difference in age, testicular volume, or hormonal levels in the TESE-positive and negative groups. Hypospermatogenesis was found in testicular histopathology in 57 of 117 patients (48.7%) who underwent testicular biopsy. Sertoli Cell-Only (SCO) syndrome was seen in 20.5%, Germ Cell Maturation Arrest (MA) in 16.3%, and Atrophy-hyalinization in 14.5%. Seven men had Klinefelter's syndrome (KS), four of whom were TESE-positive. There were no adverse effects of the procedure except for infection at the incision site in one patient. Single intracytoplasmic sperm injection (ICSI) cycles were performed in 92 couples leading to 41 clinical pregnancies and 26 live birth deliveries. Micro-TESE is a safe procedure in experienced hands and provides infertile men with NOA an opportunity to father children. However unselected candidates with NOA should be counselled at the outset that only 17.9% will eventually become biological fathers.
Emphysematous cystitis is a relatively rare disease characterized by the presence of gas in the bladder wall and/or lumen. The primary risk factor is diabetes mellitus. Emphysematous cystitis should be considered in cases of urinary tract infections in diabetic patients with unusual presentations. Imaging studies are necessary to detect emphysematous cystitis. Accurate diagnosis of the disease and appropriate treatment typically results in a favourable prognosis and can improve the outcome. We present a case of emphysematous cystitis diagnosed by a computed tomography scan in a diabetic woman with poor glycemic control. IntroductionEmphysematous cystitis is a relatively rare and complicated urinary tract infection (UTI) primarily observed in diabetic middle-aged women. This disease is often characterized by non-specific clinical symptoms, with little or no diagnostic clues. It is defined by the presence of air within the bladder wall and/or the bladder lumen in imaging studies.1 Diabetes mellitus (DM) is the major risk factor of emphysematous cystitis. Other risk factors include neurogenic bladder, urinary tract outlet obstruction, chronic UTIs, indwelling urethral catheters, and immune-deficiency.2 Successful management of the disease and appropriate treatment with broad-spectrum antibiotics usually result in a favourable prognosis. 1,2 Case reportA 65-year-old female was admitted to our department with a 2-day history of fever. She complained of nausea, vomiting and mild right flank pain for 3 hours and symptoms of urgency and dysuria for 7 days; she denied using antibiotics for these symptoms. She had a medical history of DM for 14 years and extracorporeal shock wave lithotripsy (ESWL) for a kidney stone 2 years ago. Despite using oral antidiabetics, she had poor diabetic control (fasting blood glucose was between 250 and 350 mg/dL). She was conscious and interactive during the physical examination, which revealed an axillary temperature of 38.7ºC, arterial blood pressure of 130/70 mmHg, respiratory rate of 22 breaths per minute and oxygen saturation of 97%. There was no guarding or rebound to abdominal palpation, but minimal suprapubic tenderness and right side costovertebral angle tenderness was noted.Laboratory testing revealed the following abnormal results: serum white blood count 22,000/µL; erythrocyte sedimentation rate 60 mm/h; C-reactive protein 30.2 mg/dL; blood urea nitrogen 95 mg/dL; creatinine 2.4 mg/dL; initial blood glucose level 380 mg/dL and HbA1C 9.2%. The urine analysis revealed 60 to 80 red blood cells per field, significant leukocyturia and bacteriuria. Ketones, leukocyte esterase, nitrite and urine sugar were also positive ( Table 1). Because of her kidney stone history and right flank pain, abdominopelvic non-contrast CT was performed; abdominal CT revealed a right kidney stone (Fig. 1), and pelvic images showed the presence of intraluminal gas, diffuse thickening of the bladder wall and gas in the bladder lumen (Fig. 2, Fig. 3). There were no findings of ureteral obstruction or...
Aim:The aim of this study was to investigate the relationship between obesity and lower urinary tract symptoms and prostate volume in patients who underwent prostate biopsies.Materials and Methods:Between December 2008 and November 2009, transrectal ultrasound-guided prostate biopsy was performed on patients who had elevated prostate-specific antigen levels or abnormal digital rectal examination findings. A total of 211 patients were included in this study. Prostate volumes, International Prostate Symptom Score (IPSS) values, and the patient's height and weight were all recorded during the biopsy. Body mass index (BMI) <18.5 was determined as underweight, 18.5–23.0 normal, 23.0–27.5 overweight, and >27.5 obese.Results:The mean age of the patients was 68.0 ± 6.3 years, and the mean BMI was 28.0 ± 4.9 kg/m2. The mean prostate volume of the normal, overweight, and obese groups was 30, 50, and 70 ml, respectively. The positive and statistically significant correlation between BMI and prostate volume was determined (P < 0.001). According to BMI, the mean IPSS was 8.0, 16.5, and 20.0 in the groups, respectively. Similarly, a statistically positive correlation between BMI and IPSS was demonstrated (P < 0.001).Conclusions:As the result of a rise in BMI, prostate volumes and IPSS increase in patients. Prostate volume and IPSS decrease due to weight loss, and hence that fewer urinary symptoms occur, and the quality-of-life of patients may increase.
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