Infertility is defined by the International Committee for Monitoring Assisted Reproductive Technologies as the incapacity to conceive after at least one year of regular, unprotected, and well-timed intercourse, 1 and has become a global problem faced by one out of five couples. Although approximately 50% of these cases are associated with male infertility, 2 the etiology of male infertility is multifactorial and the average incidence of unexplained male infertility is approximately 15%. 2 Furthermore, approximately 40% of cases were unexplained in a recent survey on infertility among Japan males. 3 Many studies have reportedly revealed the pathophysiologies of unexplained male infertility, but the causes of most cases remain unknown. Many studies on the effect of seminal oxidative stress (OS) on male fertile capacity have been reported since Aitken et al first reported reactive oxygen species (ROS) in washed human semen in 1987 using a chemiluminescence assay. 4 OS results from a disturbance of homeostatic balance between ROS production and antioxidant capacity in seminal plasma in human semen 5 (Figure 1). It is well known that a small amount of ROS is vital for the steps involved in the essential physiological response of fertilization-sperm maturation, hyperactivation, capacitation, acrosome reaction of sperm, and

Infertility is defined as the inability to become pregnant after at least 1 year of regular intercourse without contraception. It is reported that approximately 8%-12% of couples in reproductive age are infertile, and male factors contribute to the infertility of those couples in approximately 50% of cases. 1 Azoospermia has been reported in approximately 1% of all men and in 10%-15% of infertile men. 2 According to this percentage, male infertility and azoospermia could be currently considered a common disease. Nonetheless, the majority of male infertilities are categorized as idiopathic, representing about 50% of all cases, and their causes are unknown. 3 Thus, one of the most important tasks for physicians and researchers engaged in reproductive medicine is to classify idiopathic male infertility based

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Although reactive oxygen species in semen are associated with unfavorable results with respect to assisted reproductive technology, their effects based on the detailed stages of embryo development are unclear. We investigated the relationship between reactive oxygen species in semen and the oocyte fertilization rate, cleavage rate, and blastulation rate of intracytoplasmic sperm injections. This retrospective study enrolled 77 couples who underwent intracytoplasmic sperm injection and analyzed 887 eggs from 141 cycles of intracytoplasmic sperm injection. The reactive oxygen species level in semen was compared between the fertilized and nonfertilized groups, between the good-cleavage-embryo and non-developed-embryo groups, and between the goodquality-blastocyst and poor-quality-blastocyst groups. The cut-off level of reactive oxygen species was calculated to predict good-cleavage-embryo and good-quality-blastocyst development. The fertilization rate was 65.4%, and the mean reactive oxygen species levels were not significantly different between the fertilized and nonfertilized groups. The reactive oxygen species level was significantly higher in the non-developed-embryo group than in the good-cleavage-embryo group (P = 0.0026) and was significantly lower in the good-quality-blastocyst group than in the poor-quality-embryo group (P = 0.015). Cleavage embryos and blastocysts were divided into highand low-reactive-oxygen-species groups using a cut-off value of 6601 and 4926 relative light units, as calculated from the receiver operating characteristic curve. The rates of good-cleavage embryos and good-quality blastocysts were lower in the high-reactive-oxygen-species group than in the low-reactive-oxygen-species group, which were both statistically significant. To conclude, reactive oxygen species in semen is considered to have an adverse effect on both the early and late stages of embryo development in intracytoplasmic sperm injection.

The number of involved calyces larger than four, stone surface area >500 mm(2) and a history of febrile urinary tract infection independently predicted the development of systemic inflammation response syndrome after endoscopic combined intrarenal surgery. This is the first study to identify the independent predictors of systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position.

Klinefelter syndrome is a condition in which a male patient has one Y chromosome and one or more extra X chromosomes. It is the most common sex chromosome disorder. Klinefelter syndrome is distinguished by many clinical features, such as infertility, high gonadotropin and low testosterone levels, increased height, and sparse body and facial hair. We report the case of a 32-year-old man who visited our hospital complaining of male infertility. Semen analysis showed azoospermia, and chromosomal analysis revealed a 47,XY,i(X)(q10) karyotype, which is a rare variant of Klinefelter syndrome. No spermatozoon was found on microdissection testicular sperm extraction, and the testis biopsy histology showed only Sertoli cells and hyalinised seminiferous tubules. 47,XY, i(X)(q10) has an additional isochromosome made of the long arm of the X chromosome, which shares some features of classical Klinefelter syndrome in many aspects, but patients are usually shorter than average height and have normal intelligence. In addition, to the best of our knowledge, no successful sperm extractions from 47,XY, i(X)(q10) patients were reported in the literature. The reports of patients who have undergone microdissection testicular sperm extraction are very rare. Further reports and studies of this chromosomal abnormality are needed.

Short-term post-stenting using overnight ureteral catheterization in uncomplicated cases after fURS for kidney stone was as effective as conventional long-term post-stenting in reducing postoperative complications. These preliminary data suggest the possibility that routine long-term post-stenting was unnecessary.

We report the case of a 46-year-old Chinese male patient who visited our clinic complaining of infertility. Semen analysis revealed azoospermia, and azoospermia factor c region partial deletion (b1/b3) was detected using Y chromosome microdeletion analysis. Testicular sperm extraction was performed after genetic counseling. The bilateral ductus deferens and a portion of the epididymis were absent, whereas the remaining epididymis was expanded. Motile intratesticular spermatozoa were successfully extracted from the seminiferous tubule. On histopathology, nearly complete spermatogenesis was confirmed in almost every seminiferous tubule. To our knowledge, this is the first case report of b1/b3 deletion with a congenital bilateral absence of the vas deferens and almost normal spermatogenesis.