Introduction: We determine the preoperative identifiable risk factors during staging that predict stricture recurrence after urethroplasty. Methods: We conducted a retrospective review of all urethroplasties performed at a Canadian tertiary referral centre from 2003 to 2012. Failure was defined as a recurrent stricture <16 Fr on cystoscopic assessment. Multivariate analysis was calculated by Cox proportional hazard regression. Results: In total, 604 of 651 (93%) urethroplasties performed had adequate data with a mean follow-up of 52 months. Overall urethral patency was 90.7% with failures occurring between 2 weeks and 77 months postoperatively. The average time to recurrence was 11.7 months, with most patients with recurrence within 6 months (42/56; 75%). Multivariate regression identified Lichen sclerosus, iatrogenic, and infectious etiologies to be independently associated with stricture recurrence with hazard ratios (HR) (95% confidence interval) of 5.9 (2.1-16.5; p ≤ 0.001), 3.4 (1.2-10; p = 0.02), and 7.3 (2.3-23.7; p ≤ 0.001), respectively. Strictures ≥5cm recurred significantly more often (13.8% vs. 5.9%) with a HR 2.3 (1.2-4.5; p ≤ 0.01). Comorbidities, smoking, previous urethroplasty, stricture location and an age ≥50 were not associated with recurrence. Conclusion: Urethroplasty in general is an excellent treatment for urethral stricture with patency rates approaching 91%. While recurrences occur over 6 years after surgery, most (75%) recur within the first 6 months. Long segment strictures (≥5 cm), as well as Lichen sclerosus, infectious and iatrogenic etiologies, are associated with increased risk of recurrence. Limitations include the retrospective, single-centre nature of the study and the 7% loss to follow-up due to the centre being a regional referral one.
Most giant pheochromocytomas do not present with classic symptoms, as documented by published case reports. Given this, clinicians have to consider a wide differential diagnosis for any retroperitoneal mass and perform screening tests to rule out a pheochromocytoma. We describe the largest pheochromocytoma reported in Canada, where the patient presented with a palpable abdominal mass and dyspnea. The 19 × 18 × 12-cm right retroperitoneal mass was biochemically active and was radiologically and pathologically consistent with a giant pheochromocytoma. We present this case and review the relevant current literature.
The presence of an ovulation-inducing factor (OIF) in the seminal plasma of llamas and alpacas (reflex ovulators) and cattle (spontaneous ovulators) has been reported previously (Ratto MH et al. 2006 Theriogenology 66, 1102–1106). The presence of this protein in unrelated species supports the hypothesis that OIF is a conserved factor among species. The objectives of this study were to determine if OIF was present in equine and porcine seminal plasma, and whether the proportion of test animals (llamas) that ovulated in response to treatment with seminal plasma was related to dose. In Experiment 1, female llamas were assigned randomly to four groups (n = 8 or 9 per group) and treated intramuscularly with 1 mL llama seminal plasma (positive control), 3 mL equine seminal plasma, 3 mL porcine seminal plasma, or 2 mL saline (negative control). Ovulation and maximum corpus luteum diameter were compared using ultrasonography and confirmed with blood samples taken on Day 7 (Day 0 = day of treatment) to determine plasma progesterone concentration. The diameter of the preovulatory follicle at the time of treatment did not differ among groups. Equine seminal plasma induced ovulations in 3/8 (38%) llamas compared to 0/8 (0%) llamas treated with saline or porcine seminal plasma (P = 0.1). The proportion of females that ovulated was lower in the equine group (P < 0.01) compared with those animals treated with llama seminal plasma (9/9; 100%). Of the animals that ovulated, maximum CL diameter did not differ between llama and equine seminal plasma-treated groups (mean ± SEM; 11.1 ± 1.1, 11.5 ± 1.5, respectively). Similarly, progesterone concentrations were not different among llamas treated with llama seminal plasma or equine seminal plasma (mean ± SEM; 3.1 ± 0.4, 3.7 ± 1.2, respectively). The design of Experiment 2 was the same, but the dose of equine and porcine seminal plasma was increased to 8 mL and 10 mL, respectively. The proportion of females that ovulated was less (P < 0.05) in equine (2/9) and porcine (3/9) seminal plasma groups compared with the group treated with llama seminal plasma (9/9). There were no ovulations detected in llamas treated with saline (0/8). Although differences between equine, porcine, and negative control groups did not reach significance, results provide some evidence for the presence of OIF in equine and porcine seminal plasma. The effect of dose of equine and porcine seminal plasma is equivocal, suggesting that the concentration of OIF in the seminal plasma of these species may be very low and the optimal dose for inducing ovulation in test animals had not been reached. Research supported by the Natural Sciences and Engineering Council of Canada.
As part of a project involving reproductive biotechnology as a method of preserving Canada’s threatened wood bison population, an experiment was designed to test the effectiveness of steroid-induced ovarian synchronization and fixed-timed AI. The experiment was performed in the early ovulatory season (September) with female wood bison (4 years old, n = 13) and plains bison (2 years old, n = 4, and 8 years old, n = 3). Based on results of a preceding study, progesterone was combined with estradiol as a synchronization treatment to mitigate against untimely ovulation. The bison were blocked by subspecies and assigned randomly to a control group (no treatment; n = 10) or given estradiol 17β (2.5 mg) + progesterone (50 mg) in canola oil i.m. and a progesterone-releasing intravaginal device (Cue-mate™, Bioniche, Belleville, Ontario, Canada) on Day 0 (n = 10). On Day 8, the Cue-mate™ device was removed and PGF (500 mg Estrumate®, Mallinckrodt Vet GmbH, Friesoythe, Germany) was given to induce luteolysis. On Day 10, all bison were given 5 mg of LH (Lutropin®-V, Bioniche) and artificially inseminated 12 h later with semen collected and frozen previously from wood bison of the same herd. The ovaries were examined daily by transrectal ultrasonography beginning 5 days before treatment and thereafter until the first post-treatment ovulation. Ultrasonographic pregnancy diagnosis was done 30 days post-insemination. No differences were detected between wood and plains bison for any end point, and data were combined for further statistical analyses. Ovarian follicular wave emergence occurred on Day 4.1 ± 0.8 (mean ± SEM) and 4.1 ± 0.3 in the control and treatment groups, respectively (P = 99.3). The interval to new wave emergence was less variable in bison treated with estradiol + progesterone than in untreated controls (residuals, 0.7 ± 0.2 and 1.9 ± 0.5 days, respectively; P < 0.05). The interval from LH administration to ovulation was 2.7 ± 0.6 and 5.4 ± 1.9 days for the treatment and control groups, respectively, and was less variable in the treatment group than in controls (residuals, 1.2 ± 0.4 and 5.3 ± 0.8 days, respectively; P < 0.05). The diameter of the preovulatory follicle was not different between groups and was, on average, 15.2 ± 1.1 mm. Pregnancy was diagnosed in 3 bison in the treatment group and 2 in the control group. In conclusion, treatment with estradiol and progesterone effectively synchronized the interval to wave emergence, and subsequent LH treatment resulted in a synchronous ovulatory response necessary for fixed-time AI in bison. Although the pregnancy rate was modest, perhaps because of issues with semen quality, timing of AI, or quality of the ovulated oocyte, this represents the first report of pregnancy in bison from fixed-time insemination. Supported by grants from the Advancing Canadian Agriculture and Agri-Food Fund, the Agri-Food Innovation Fund, Parks Canada, the World Wildlife Fund, and the Northwest Territories.
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