ObjectivesTo evaluate the long-term efficacy and safety of transobturator four-arm mesh for treating cystoceles.Patients and methodsIn this prospective study, 105 patients had a cystocele corrected between January 2004 and December 2008. All patients had a symptomatic cystocele of stage ⩾2 according to the Baden–Walker halfway stratification. We used only the transobturator four-arm mesh kit (Surgimesh®, Aspide Medical, France). All surgical procedures were carried out by the same experienced surgeon. The patients’ characteristics and surgical variables were recorded prospectively. The anatomical outcome, as measured by a physical examination and postoperative stratification of prolapse, and functional outcome, as assessed by a questionnaire derived from the French equivalents of the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire and the Pelvic Organ Prolapse–Urinary Incontinence-Sexual Questionnaire, were considered as the primary outcome measures. Peri- and postoperative complications constituted the secondary outcome measures.ResultsAt 36 months after surgery the anatomical success rate (stage 0 or 1) was 93%. On a functional level, all the scores of quality of life and sexuality were improved. The overall satisfaction score (visual analogue scale) was 71.4%. There were no perioperative adverse events. Mesh erosion was reported in 7.6% and mesh retraction in 5.7% of the patients.ConclusionsIf the guidelines and precautions are followed, vaginal prosthetic surgery for genitourinary prolapse has shown long-term benefits. It provides excellent results both anatomically and functionally. However, complications are not negligible and some are specific to prosthetic surgery.

Antenatal renal vein thrombosis is a rarely described diagnostic finding, with variable consequences on kidney function. We present the case of an affected fetus, born at 35-week gestation, with intrauterine oligohydramnios and two small kidneys. A renal ultrasound carried out after birth confirmed the presence of prenatal abnormalities. Renal vein thrombosis was not diagnosed at the time. The baby died 20 days later of kidney failure, metabolic acidosis, and polypnea with severe hypotrophy. Autopsy revealed atrophied kidneys and adrenal glands. The vena cava had thrombosis occupying most of its length. The right renal vein was normal, while the left renal vein was threadlike and not permeable. Histologically, there was necrosis of the left adrenal gland with asymmetrical bilateral renal impairment and signs of ischemic and hemorrhagic lesions. A review of thrombophilia was carried out and a heterozygous mutation in Factor V was found in both the mother and the child.

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Abstract:Objectives. Intrauterine insemination (IUI) is frequently used as a first line strategy in the treatment of male and unexplained infertility. Threshold levels of sperm parameters associated with IUI success are controversial. The aim of this study was to evaluate the influence of sperm parameters on the outcome of IUI. Study Design. A prospective observational study. Patients and methods. This study included 295 IUI cycles. All IUI cycles were preceded by ovarian superovulation with clomiphene citrate 50 mg tablets orally twice daily for 5 days starting on the second day of menses and recombinant FSH 150 units IM on the 6th, 8th, and 10th day. Cycles were monitored by transvaginal ultrasound. The IUI was performed with a catheter 36 ± 4 hours after hCG injection. Sperm parameters before and after semen treatment for IUI were evaluated and correlated with pregnancy outcome. Results. A total of 29 clinical pregnancies were obtained, for a pregnancy rate per cycle of 9.83%. No pregnancy was obtained when less than one million spermatozoa were inseminated (p = 0.022). A statically significant increase in pregnancy rate was observed when normal sperm morphology was > 20% before semen treatment (p = 0.01) and> 25% after semen treatment (p = 0.034). NTSI (number of typical spermatozoa inseminated) and NTMSI (number of typical and mobile spermatozoa inseminated) significantly influence the clinical pregnancy rate. A 65% decrease in pregnancy rate was observed when the NTSI <2 106 compared to the NTSI ≥ 2 106 (5.16% vs 15%, p =0.004). Similarly, a 54% decrease in pregnancy rate was observed when the NTMS <106" compared to the NTMS ≥ 106 (6.12% vs 13.5%, p =0.026). Conclusion. IUI used for treating male factor infertility seems to have little chance of success when NMSI <1 × 106, NTSI < 2 million, NTMSI < 1 million. If theses thresholds cannot be obtained, IVF should be recommended.

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Aim: Chromosome abnormalities evaluation and Y chromosome microdeletions screening prior to assisted reproduction have an important interest in preserving future generations of genetic risks. The primary aim of this study was to establish the prevalence of chromosomal abnormalities and microdeletions on Yq chromosome in Tunisian infertile men with severe oligozoospermia or non obstructive azoospermia. Secondary to correlate Yq microdeletions with testicular sperm extraction results and cytological evaluation. Methods: In this prospective study, Eighty-four infertile patients and 52 controls were screened for karyotypic abnormalities and Yq chromosome microdeletions. Results: No chromosome abnormalities and no microdeletions were detected in controls. Seven infertile males (8.3%) carried chromosomal abnormalities and 8 (9.5%) presented Y chromosome microdeletions. The frequency of chromosome abnormalities in azoospermic patients was 11.1% vs 3.3% in severe oligozzospermic group. The frequency of microdeletions was 11.1% in the azoospermic group and 6.7% in the severe oligozoospermic group. Six out of 84 (71.4%) of the infertile patients had microdeletions in the AZFc region (4 azoospermic and 2 severe oligozoospermic males), 1 azoospermic male (10%) in the AZFb,c regions and one in AZFb, no deletions in the AZFa region were detected. Among the 6 azoospermic patients with microdeletions: 4 had Sertoly cell only syndrome (SCOS) and 2 had maturation arrest (MA). Conclusion: Genetic abnormalities and Yq microdeletions in infertile Tunisian patients are frequent and similar to those reported in other countries. The knowledge of the existence of genetic abnormalities and microdeletions is useful to provide a correct diagnosis of male infertility, it allows the physician to refer the patient to adequate assisted reproduction technique and examine the value of testicular biopsy pertinence.

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