This prospective randomized study was performed in order to investigate the effects of interventive treatment or counselling on pregnancy rates in infertile couples in whose male partners a varicocele was diagnosed. The present report extends a previous study using the same design. A total of 125 couples were included in the current study while the previous report comprised 95 couples. Couples fulfilling the inclusion criteria were allocated randomly either to interventive treatment (surgical ligation or angiographic embolization of the spermatic vein) (n = 62) or to counselling as the sole treatment (n = 63). Couples were followed over the subsequent 12 months and seen at 3-monthly intervals. At the end of the 12 month period pregnancy rates, as the main outcome measure, were 29% in the group given interventive treatment and 25.4% in the counselled group and were not significantly different. The only significant difference found, regardless of treatment modality, was the wives' age at admittance: the 34 wives achieving a pregnancy were 28.8 +/- 0.6 years (mean +/- SE) old while the 91 non-pregnant wives were 31.2 +/- 0.3 years old (P < 0.05). The study suggests that regular counselling of the infertile couples is as effective as interventive treatment of varicoceles in achieving pregnancies.

Amitriptyline therapy for 4 months is safe and effective for treating IC. A statistically significant change in the symptom score and statistically significant improvement of pain and urgency intensity compared with placebo were observed. Anticholinergic side effects constitute the major drawback of amitriptyline treatment for IC.

mean (range) follow-up of 44.3 (15-115) months. RESULTSThe MCDK was removed in 17 children; the follow-up of 75 children (five lost to followup) showed total involution of the MCDK in 25%, shrinkage in 60% and a stable size in 15%. None had any sign of malignancy . The contralateral kidney showed anomalies in 19 of 97 children (20%); 12 had a dilated renal pelvis (two with megaureter), six had a high echogenicity of the contralateral kidney (one had reflux, and two also pelvic dilatation). In only four of the 89 children was reflux found by VCUG; 16 of the 19 anomalies were detected by US. Five children needed surgery on the contralateral urinary tract (three a pyeloplasty, and one each a pyeloplasty plus ureteroneocystostomy, and an antireflux procedure). Of the contralateral kidneys 43% showed compensatory hypertrophy. There was mild renal insufficiency in three children; renal function seemed to be slightly impaired in many. Five infants had hypertension (four with spontaneous resolution) caused by renal scarring after pyelonephritis or inborn dysplasia of the contralateral kidney. There were symptomatic urinary tract infections in seven children. CONCLUSIONUS can be used safely to diagnose unilateral MCDKs and malformations of the contralateral urinary tract and kidney. In cases where US of the dysplastic kidney remains uncertain renal scintigraphy is necessary to detect the lack of renal function. The low rate of reflux makes routine VCUG unnecessary if the contralateral upper urinary tract and kidney appear to be normal on US. Nephrectomy of the dysplastic kidney in typical cases is also unnecessary. A long-term nephro-urological follow-up of children with MCDK is recommended.

The development of hypothyroidism during treatment might be useful as a predictor of PFS for mRCC patients undergoing treatment with targeted agents.