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Biomedical subjects

M G Royle

Publications and source records attributed to M G Royle.

7 recordsLinked to original sources
PubMed1992

Irrigation or no irrigation after transurethral prostatectomy?

Urologists remain divided as to the need for routine irrigation following transurethral prostatectomy (TURP). This randomised prospective study compared a policy of irrigation with that of no irrigation in a consecutive group of 200 patients undergoing TURP. In the irrigation group, a mean of 15 litres of irrigating fluid was used in each patient and one-third of patients required at least one bladder washout. In the no irrigation group, although two-thirds of the patients required at least one bladder washout, only one-third required more than one washout. No significant difference in blood loss, electrolyte balance, infection rate or recovery was seen in the 2 groups. This study led to a local change in practice, converting from a policy of routine irrigation to one of no irrigation.

Humans↗
PubMed1990

Testicular obstruction: clinicopathological studies.

Genital tract reconstruction has been attempted in subfertile men with obstructive azoospermia (370 patients) or unilateral testicular obstruction (80 patients), and in vasectomised men undergoing reversal for the first (130 patients) or subsequent (32 patients) time. Histopathological changes in the obstructed testes and epididymes, and immunological responses to the sequestered spermatozoa have been studied to gain insight into possible causes of failure of surgical treatment. The results of surgery have been assessed by follow-up sperm counts and occurrence of pregnancies in the female partners. The best results were obtained with vasectomy reversal (patency 90%, pregnancy 45%), even after failed previous attempts (patency 87%, pregnancy 37%). Epididymovasostomy gave good results with postinfective caudal blocks (patency 52%, pregnancy 38%), while postinfective vasal blocks were better corrected by total anatomical reconstruction (patency 73%, pregnancy 27%) than by transvasovasostomy (patency 9%, no pregnancies). Poor results were obtained with capital blocks (patency 12%, pregnancy 3%), in which substantial lipid accumulation was demonstrated in the ductuli efferentes; three-quarters of these patients had sinusitis, bronchitis or bronchiectasis (Young's syndrome). There is circumstantial evidence to suggest that this syndrome may be a late complication of mercury intoxication in childhood. After successful reconstruction, fertility was relatively reduced in those men who had antibodies to spermatozoa, particularly amongst the postinfective cases. Similarly, impaired fertility was found in men with unilateral testicular obstruction and antibodies to spermatozoa. Mononuclear cell infiltration of seminiferous tubules and rete testis was noted occasionally, supporting a diagnosis of autoimmune orchitis; although rare, this was an important observation as the sperm output became normal with adjuvant prednisolone therapy.

Autoantibodies↗
PubMed1985

Why does vasectomy reversal fail?

The scrotum was explored in 32 patients who had vasectomy reversal which failed to restore their fertility. Twenty-three patients were azoospermic and nine had severe or persistent oligozoospermia. Amongst the 23 azoospermic cases, the vasa were found to be blocked in 12; following repeat vaso-vasostomy, normal sperm counts were produced in 10 patients; 8 of these patients followed up for 6 months or more successfully impregnated their wives. In four cases there was a secondary epididymal block: following epididymo-vasostomy, three of four patients obtained normal sperm counts and two wives became pregnant. In seven patients there was a very high antisperm antibody titre (greater than 1024 by tray agglutination test) and despite reparative surgery and prednisolone therapy, no pregnancies were obtained. The overall pregnancy rate for this group was 7 of 19 (37%). Amongst nine oligozoospermic cases, unilateral obstruction was found in eight. The block was found in the vas in five and in the epididymis in two, and in two there were very high antisperm antibody titres. After reconstructive surgery, four patients had normal sperm counts and one pregnancy has been obtained.

Adult↗
PubMed1983

Use of Jonas Silicon-Silver prosthesis in erectile impotence.

Eleven patients presenting over the last three years with erectile impotence who have been treated by the insertion of the Jonas Silicon-Silver penile prosthesis are reviewed. The insertion of this prosthesis is a minor procedure. It has a simple design, low cost, no permanent erection or mechanical problems and an excellent cosmetic and functional result.

Adult↗
PubMed1981

Reversal of vasectomy: the effects of sperm antibodies on subsequent fertility.

Antisperm antibodies were measured in serum and seminal plasma in 130 males before and after vasectomy reversal and the occurrence of pregnancy was analysed in the partners of 77 who were followed for more than one year. Sperm-agglutinating antibodies were found in the serum of 79% of patients; seminal plasma antibodies were present in only 9.5% before reversal and this rose to 26% afterwards. Pregnancies occurred in the partners of 53% of those men who were trying to produce children. A pregnancy was significantly less likely when the pre-operative serum antisperm antibody titre was 512 or more, but no decrease in fertility was seen with titres below this. Several pregnancies were produced by patients with seminal plasma antibodies, but numbers and follow-up are too small to permit detailed analysis. A randomised controlled trial of per-operative steroids showed that they produced no benefit. The antisperm antibodies associated with vasectomy reversal appear to differ fundamentally from those occurring in naturally subfertile males.

Agglutination Tests↗
PubMedDate not supplied

The effects of sperm antibodies on fertility after vasectomy reversal.

Antisperm antibodies have been measured in serum and in seminal plasma in 130 males before and after vasectomy reversal, and the occurrence of pregnancy has been analyzed in those partners who were trying to produce a pregnancy. All patients have been followed for at least one year. Sperm-agglutinating antibodies were found in the serum of 79% of patients; seminal plasma antibodies were present in only 9.5% before reversal, and this rose to 29.5% afterwards. Overall, pregnancies occurred in the partners of 44.6% of those men who were trying to produce children. Production of pregnancy was significantly less likely when the preoperative serum antisperm antibody titer was 512 or more, but no decrease in fertility was seen with titers below this. Similar numbers of pregnancies were produced by patients with or without seminal plasma antibodies in titers of up to 16; there are too few patients with titers above this level to permit further analysis. A randomized controlled trial of perioperative steroids showed that they produced no benefit. It appears that the antisperm antibodies associated with vasectomy reversal may differ fundamentally from those occurring in naturally subfertile males.

Autoantibodies↗