All three treatments were equally effective in restoring testosterone levels. Single-agent CC is simple, cheap and may be used as treatment for hypogonadism when maintenance of fertility is desired. This approach seems to be as effective as either hCG alone or a combination of hCG and CC.

Clinical examination of the scrotum remains the most commonly used technique to diagnose varicoceles. However, scrotal anatomy (eg, thick scrotum, scarring, hydrocele) in some men may make physical examination alone unreliable. In these situations, imaging (eg, ultrasound, Doppler imaging, venography) may be used to diagnose a varicocele. The dilemma is that there are no widely accepted or used criteria to diagnose a varicocele based on imaging. This paper reviews the different imaging techniques used and the accuracy of each in diagnosing a varicocele.

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Uncontrolled DM is associated with increased risk of infection after penile implant surgery. The risk is directly related to the HbA1c level. A threshold HbA1c level of 8.5% is suggested for clinical use to identify patients at increased infection risk.

The objective of the study was to evaluate the differences in psychosocial distress and coping mechanisms among infertile men and women in Saudi Arabia (SA). We performed a cross-sectional study of infertile patients (206 women and 200 men) attending infertility clinics in three referral hospitals in Riyadh, SA. A semi-structured questionnaire was developed to assess socio-demographic, clinical and psychosocial variables. Infertility-related psychosocial pressures were reported in 79 (39.7%) male and 97 (47.3%) female participants (p = 0.123). Males suffered more from intrusive questions and pressure to conceive, remarry or get divorced, while females were stressed more from psychological and emotional exhaustion, marital discord, attitudes of mothers-in-law or society, and persistent desire by the husband to have children. To cope with infertility, females engaged more in religious activities (p < 0.001) and spoke more to someone regarding their problems (p < 0.001). To solve their infertility problems, 50% tried to find solutions via the internet, and 38.5% of males and 51% of females reported using alternative medicines (p = 0.012). The patients with infertility in SA face multiple psychosocial stressors related to their infertility, and cope differently based on the gender and culture-specific knowledge of infertility. The female participants were significantly more affected from psychosocial stressors and the persistent desire by their spouse to have children.

Laparoscopic nephrectomy for ADPKD is technically feasible and clinically safe. In addition to its low morbidity, other advantages of laparoscopic surgery are the ability to remove the dissected kidney through a small incision, short hospital stay, excellent cosmesis, and fast recovery.

ObjectivesThe educational environment plays a crucial role in the learning process. We aimed to evaluate the educational-environment perceptions of Saudi urology residents using the postgraduate hospital educational environment measure (PHEEM) inventory, and to investigate associations of their perception with stages of residency program, regions of Saudi Arabia, and main sectors of the health care system.MethodsWe used PHEEM to measure the educational environment of Saudi urology residents. Respondents’ perception was compared regarding different levels of residency training, regions of Saudi Arabia, and sectors of the health care system. Internal reliability of the inventory was assessed using Cronbach’s alpha coefficient.ResultsOut of 72 registered residents, 38 (53%) completed the questionnaire. The residents did not perceive their environment positively (77.7±16.5). No significant differences in perception were found among residents of different program stages or Saudi regions. Residents from different health care sectors differed significantly regarding the total PHEEM score (P=0.024) and the teaching subscale (P=0.017). The inventory showed a high internal consistency with Cronbach’s alpha of 0.892.ConclusionSaudi urology residents perceived the educational environment as less than satisfactory. Perception of the educational environment did not change significantly among different stages of the program or different regions of Saudi Arabia. However, some sectors of the health care system are doing better than others.

Ureteral stones disease is among the most painful and prevalent among urologic disorders that can substantially impact health-related quality of life (HRQoL), particularly in patients with a history of recurrent stones. The aim of the study is to assess the QoL in patients with ureteral calculi after surgical intervention and identifying the most significant factors that could impact their QoL. The target population included two groups: post-lithotripsy patients and comparator group comprising healthy individuals selected from the general population. Both groups were matched for age and gender. The study continued through a period of 9 months. An observation period of 4-10 months following the last surgical intervention was applied before interviewing patients. Information regarding socio-demographics, medical data and presence of co-morbidities were recorded. The Medical Outcome Study Short-Form 36-item survey (SF-36) was used to assess HRQoL for both groups. Based on the SF-36 questionnaire, there were no significant differences between patients and healthy volunteers in the mean scores for eight of the HRQoL domains, except for pain and social functioning subscales. Patient's age, distal ureteral stones and ureteral stent, in addition to DM and low back pain appeared to significantly affect the HRQoL of patients. In conclusion, the promising end point in the management of urolithiasis is improvement of HRQoL. The results of the current study support the notion that urinary stone disease is not a life threatening disease and patients can return to normal life after surgical intervention. Prospective studies are warranted for elucidating the factors influencing HRQoL in ureteral stone patients to optimize patient care.