Renal leiomyosarcoma treated with partial nephrectomy.
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Female↗
Biomedical subjects
Sami Arap
Publications and source records attributed to Sami Arap.
Ocular metastasis as first presentation of renal cell carcinoma: report of 2 cases.
Authors report the cases of 2 patients who had an ocular lesion as the first sign leading to diagnosis of renal cell carcinoma, an uncommon presentation of this neoplasm. The first patient was a 59-year-old man presented with a mass in the right eye. The histological and immunohistochemical profile of the biopsy showed a probable renal cell carcinoma. A CT scan showed a solid mass in the left kidney. The patient underwent radical nephrectomy and excision of the ocular lesion and had an uneventful evolution. The second patient was a 72-year-old man presenting with an ulcerated lesion on the right inferior tarsal conjunctiva. An excisional biopsy of the lesion showed histological and immunohistochemical patterns of a clear cell carcinoma. Abdominal tomography disclosed a right peripheral renal tumor. A right radical nephrectomy was performed. Renal cell carcinoma may present atypically with metastases to quite uncommon organs. Nephrectomy may be of value in selected cases; the ocular metastases are usually excised for aesthetic and functional reasons.
Aged↗
Effects of medical therapy, alcohol, smoking, and endocrine disruptors on male infertility.
Infertility affects up to 15% of the sexually active population, and in 50% of cases, a male factor is involved, either as a primary problem or in combination with a problem in the female partner. Because many commonly encountered drugs and medications can have a detrimental effect on male fertility, the medical evaluation should include a discussion regarding the use of recreational and illicit drugs, medications, and other substances that may impair fertility. With the knowledge of which drugs and medications may be detrimental to fertility, it may be possible to modify medication regimens or convince a patient to modify habits to decrease adverse effects on fertility and improve the chances of achieving a successful pregnancy. Concern is growing that male sexual development and reproduction have changed for the worse over the past 30 to 50 years. Although some reports find no changes, others suggest that sperm counts appear to be decreasing and that the incidence of developmental abnormalities such as hypospadias and cryptorchidism appears to be increasing, as is the incidence of testicular cancer. These concerns center around the possibility that our environment is contaminated with chemicals--both natural and synthetic--that can interact with the endocrine system.
Alcoholism↗
Is it worthwhile to operate on subclinical right varicocele in patients with grade II-III varicocele in the left testicle?
PURPOSE: To determine whether repair of subclinical varicoceles in the right testicle results in significant seminal improvement in patients with clinical left varicocele. METHODS: Patients were divided into two groups: Group I (unilateral varicocelectomy) and Group II (bilateral varicocelectomy-subclinical left varicocele). The mean sperm concentration before treatment was higher in Group I (21.01 +/- 19.1) compared to Group II (5.7 +/- 10.7) (p = 0.04). RESULTS: An increase in volume was detected in the left testicle of patients in Group I (17 +/- 7.9 vs. 22.81 +/- 8.2; p = 0.04) and in the right testicle of patients in Group II (18.4 +/- 6.2 vs. 22.3 +/- 6.5; p = 0.04). Although the mean postoperative sperm concentration in Group I increased slightly (25.7 +/- 22.8), the mean sperm concentration in Group II increased significantly (30.32 +/- 9.8; p = 0.03). Pregnancy rate was higher in Group II (66.7%) compared to Group I (33.3%). CONCLUSIONS: Even a small, subclinical unrepaired varicocele continues to have a detrimental effect on bilateral testis function in a patient with grade II-III left varicocele.
Adult↗
Relationship between the number of veins ligated in a varicocelectomy with testicular volume, hormonal levels and semen parameters outcome.
PURPOSE: Correlate semen analysis, hormones, and testicular volume with the number of veins ligated. METHODS: Patients were divided into three groups: Group 1 (< or = 5 veins), Group 2 (6-10 veins), and Group 3 (> 10 veins). We evaluated testicular volume, hormonal levels, sperm concentration, and motility before and after the surgical procedure. RESULTS: In Group 1, even though there was an improvement in both testicular volume and sperm concentration; testosterone levels and sperm motility did not improve with surgery. In Group 2, no changes were detected in the both testicular volumes, in sperm concentration, motility, and testosterone levels. In Group 3, an improvement was seen in the right testicle volume, testosterone levels, and sperm concentration. Follicle-stimulating hormone levels decreased following the surgical procedure in all groups. CONCLUSION: Patients with more than 10 ligated veins have better chances to improve sperm concentration. FSH levels decreased in all groups of patients.
Follicle Stimulating Hormone↗
Semen profile, testicular volume, and hormonal levels in infertile patients with varicoceles compared with fertile men with and without varicoceles.
OBJECTIVE: To assess semen analysis, testicular volume, and hormone levels in fertile and infertile patients with varicoceles and fertile men without varicoceles. DESIGN: Retrospective study. SETTING: Academic medical center. PATIENT(S): Patients were divided into three groups: fertile men with varicoceles (n = 79), infertile men with varicoceles (n = 71), and fertile men without varicoceles (n = 217). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Levels of LH, FSH, and total T and testicular volume in fertile and infertile men with varicoceles and fertile controls without varicoceles. RESULT(S): LH (IU/L) and T (ng/dl) levels were not statistically different across the three groups. FSH levels were significantly higher in infertile men with varicoceles (7.8 +/- 7.6 IU/L) than in the fertile men with varicoceles (3.5 +/- 2.1 IU/L) or in fertile men without varicoceles (3.5 +/- 1.9 IU/L). The right testicle was smaller in infertile patients with varicoceles (18.7 +/- 8.3 cm(3)) than in fertile men with varicoceles (25.2 +/- 13 cm(3)) or in fertile men without varicoceles (24.9 +/- 10.7 cm(3)). In addition, the left testicle was smaller in infertile men with varioceles (17.6 +/- 8.9 cm(3)) than in fertile men with varicoceles (21.6 +/- 7.8 cm(3)) or in fertile men without varicoceles (23.4 +/- 8.3 cm(3)). Sperm concentration was lower in infertile men with varicoceles (33.7 +/- 23.3 x 10(6)/mL) than in fertile men with varicoceles (101.8 +/- 76.6 x 10(6)/mL) or in fertile men without varicoceles (111.8 +/- 74.2 x 10(6)/mL). In addition, sperm motility was lower in infertile men with varicoceles (37.2% +/- 23.9%) than in fertile men with varicoceles (53.9% +/- 17.4%) or fertile men without varicoceles (58.9% +/- 15.8%). CONCLUSION(S): Infertile patients with varicoceles have higher levels of FSH, smaller testes, and lower sperm concentration and motility compared with controls with or without varicoceles. No statistical differences were seen in the variables evaluated among the fertile men with incidental varicoceles detected at physical examination and those without varicoceles.
Adult↗
Testicular growth, sperm concentration, percent motility, and pregnancy outcome after varicocelectomy based on testicular histology.
OBJECTIVE: To evaluate the outcome following surgery in two different patterns of testicular histology in patients with varicocele. DESIGN: Prospective study. SETTING: Academic medical center. PATIENT(S): Sixty patients underwent varicocelectomy and had a testicular histology diagnosis of germ-cell aplasia (group I, n = 28) or maturation arrest (group II, n = 32). INTERVENTION(S): Varicocelectomy. MAIN OUTCOME MEASURE(S): Preoperative hormone levels, testicular size, and sperm parameters. After varicocelectomy, variations in testicular size, semen parameters, and pregnancy rates were evaluated. RESULT(S): The mean volume of the right and left testicle was smaller in group I patients than in group II. In addition, the mean sperm concentration before treatment was lower in group I than in group II. The mean volume of the left and right testicle increased in group I after the intervention. The mean postoperative sperm concentration and motility in group II showed no increase, whereas the mean sperm concentration in group I did increase. The pregnancy rate was higher in group II (14/26, 53.8%) than in group I (4/16, 25%) (P=.02). CONCLUSION(S): Patients with germ-cell aplasia present a postoperative increase in testicular size but the pregnancy rate is higher in patients with maturation arrest following surgery.
Adult↗
The laparoscopic management of intersex patients: the preferred approach.
UNLABELLED: In the world's largest series of patients with intersex treated by laparoscopy, authors from Sao Paulo found that this technique allowed easy identification and removal of gonads. They also found that other organs could be removed and genitoplasty performed. OBJECTIVE: To present possibly the largest series of the use of laparoscopy for treating intersex patients. PATIENTS AND METHODS: Fifty intersex patients (34 with male and two with female pseudohermaphroditism, nine with gonadal dysgenesis, four with true hermaphroditism, and one with complex hypospadias), aged 0.5-46 years (mean 18.3), underwent laparoscopy to remove gonads and/or ductal structures incompatible with the social gender, or for gonadal tumour or a potential risk for malignancy. When necessary, genitoplasty was performed concomitantly. RESULTS: At the laparoscopic evaluation, 10 gonads of six patients were absent, while four were identified as 'vanishing'; 72 gonads (46 dysgenetic, 17 normal testes, one normal ovary, one ovotestis, seven gonadoblastomas or dysgerminomas) were removed; two ovotestes were replaced in the scrotum after removing the ovarian segment, as was one normal testis. Twelve patients with a urogenital sinus had its vaginal component removed, 11 including a hysterectomy. Three of these patients had a combined perineal approach to complete its removal, together with masculinizing genitoplasty. There were no intraoperative complications or conversions; two patients had complications after surgery. CONCLUSIONS: Laparoscopy allows the straightforward identification and removal of gonads. All abnormal ductal structures must be removed, as this increases the chance of resecting unidentified gonads. Removing the uterus and vaginal component of the urogenital sinus in patients with male social sex is feasible, with low morbidity. Genitoplasty, according to the social sex, can be performed in the same procedure.
Adolescent↗
The best infertility treatment for vasectomized men: assisted reproduction or vasectomy reversal?
In men with prior vasectomy, microsurgical reconstruction of the reproductive tract is more cost-effective than sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection if the obstructive interval is less than 15 years and no female fertility risk factors are present. If epididymal obstruction is detected or advanced female age is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection should be individualized. Sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection is preferred to surgical treatment when female factors requiring in vitro fertilization are present or when the chance for success with sperm retrieval and intracytoplasmic sperm injection exceeds the chance for success with surgical treatment.
Female↗
Voiding dysfunction and urodynamic abnormalities in elderly patients.
Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in elderly men and women. With the progressive aging of the population, it is important to understand common micturitional disorders that may occur in this population. Most urinary problems in the elderly are multifactorial in origin, demanding a comprehensive assessment of the lower urinary tract organs, functional impairments, and concurrent medical diseases. Urodynamics is a highly valuable tool in the investigation of elderly patients with lower urinary tract symptoms. Urodynamic tests are not always necessary, being indicated after excluding potentially reversible conditions outside the urinary tract that may be causing or contributing to the symptoms. Although urodynamic tests may reveal common diagnoses such as bladder outlet obstruction and stress urinary incontinence in the elderly population, findings such as detrusor overactivity and impaired detrusor contractility are common and have important prognostic and therapeutic implications. The purpose of this article is to describe common urologic problems in the elderly and review the indications for and clinical aspects of urodynamic studies in these conditions.
Age Factors↗
Risks and benefits of hormone replacement therapy in older men.
The use of testosterone in older men, known as male hormonal replacement therapy or androgen replacement therapy, has become of increasing interest to both the medical and lay communities over the past decade. Even though the knowledge of the potential benefits and risks of male Androgen Replacement Therapy has increased dramatically, there is still much that needs to be determined. Although there are a number of potential benefits of male Androgen Replacement Therapy and data concerning clinical effects of such replacement have accumulated, as yet there have not been any large multicenter randomized controlled trials of this therapy. It is the purpose of this article to review what is currently known about the possible risks and benefits of male Androgen Replacement Therapy by discussing the clinical trials to date.
Aged↗
Comprehensive surgical treatment of prune belly syndrome: 17 years' experience with 32 patients.
OBJECTIVES: To describe the results of comprehensive surgical management of prune belly syndrome. METHODS: Thirty-two patients were evaluated and treated for abdominal and genitourinary abnormalities. The surgical procedure, including simultaneous abdominoplasty, bilateral orchiopexy, and urinary tract reconstruction, was performed according to individual needs. At follow-up, the urinary tract, abdominal, and genital anatomy and function were evaluated. RESULTS: The upper urinary tract anatomy and function were stabilized in 30 patients, and no vesicoureteral reflux was found postoperatively. The bladder drainage was adequate in 29 patients, and 4 presented with recurrent bacteriuria. Abdominoplasty improved flaccidity in 29 patients. Adequate testicular position and consistency were obtained in 54 testes. Complications included acute tubular necrosis (1 patient) and ureterovesical obstruction (3 patients). CONCLUSIONS: Individualized comprehensive surgical management of prune belly syndrome is effective, with an acceptable incidence of complications and excellent long-term results.
Abdominal Wall↗
Clinical and urodynamic evaluation after ureterocystoplasty and kidney transplantation.
PURPOSE: We assessed clinical and surgical results in renal transplantation candidates with voiding dysfunction and end stage renal disease who underwent bladder augmentation. MATERIALS AND METHODS: We analyzed 8 patients 3 to 30 years old with dilated ureters, voiding dysfunction and end stage renal disease who underwent renal transplantation following bladder augmentation from 1995 to 2003. The etiology of bladder dysfunction was neurogenic bladder in 3 patients, posterior urethral valves in 3 and vesicoureteral reflux in 2. All cases were assessed by ultrasonography, voiding cystourethrography and urodynamic studies. RESULTS: Mean followup was 50 months (range 4 to 93). Previous urodynamic evaluation revealed a bladder capacity of 75 to 294 ml (mean +/- SD 167.38 +/- 77.32) and an intravesical pressure of 28 to 100 mm H2O (mean 51.25 +/- 22.17). Urodynamic study after augmentation and kidney transplantation showed a bladder capacity of 191 to 400 ml (mean 335.25 +/- 99.01) and an intravesical pressure of 15 to 35 mm H2O (mean 28 +/- 9.45). Mean serum creatinine was 1.65 mg/dl (range 0.8 to 2.5). All patients remained continent. Three patients with neurogenic bladder empty the bladder by clean intermittent catheterization and the others empty by the Valsalva maneuver. None of the grafts were lost and the most common complication was asymptomatic urinary tract infection. CONCLUSIONS: Bladder augmentation is a well-known procedure for low capacity and poorly compliant bladders even in candidates for a renal transplant. Ureterocystoplasty combines the benefits common to all enterocystoplasties without adding to complications or risks.
Adolescent↗
Laparoscopic nephrectomy for wilms tumor after chemotherapy: initial experience.
PURPOSE: We describe 2 cases of laparoscopic nephrectomy for unilateral Wilms tumor in children who underwent preoperative chemotherapy. MATERIALS AND METHODS: Two children with unilateral nonmetastatic Wilms tumor included in the International Society of Pediatric Oncology 2001 protocol were preoperatively treated with vincristine/actinomycin D and subsequently underwent laparoscopic nephrectomy and lymph node sampling. A 5 and 10 mm trocar transperitoneal approach was used in each case. The tumor was extracted without morcellation through a 4 cm Pffannensteil incision. RESULTS: The 2 tumors were completely removed as well as lymph node samples. Intraoperative bleeding was minimal (50 ml). The postoperative period was free of complications and patients were discharged home after 3 days. CONCLUSIONS: Laparoscopic nephrectomy for Wilms tumor is feasible in children after chemotherapy. It is a safe procedure and it allows the complete surgical approach required to treat this tumor. Longer followup is necessary to evaluate long-term results and more cases are necessary to compare the results of laparoscopic techniques with those of open surgical procedures.
Antineoplastic Combined Chemotherapy Protocols↗
Surgery for adrenal tumours with thrombus in the supra-diaphragmatic infra-atrial inferior vena cava, with no cardiopulmonary bypass.
OBJECTIVES: To assess the result of surgery for adrenal neoplasia with thrombus in the supra-diaphragmatic infra-atrial inferior vena cava. PATIENTS AND METHODS: Five patients with adrenal cortex carcinoma and three with phaeochromocytoma were reviewed. All the thrombi were removed through a right thoracophrenolaparotomy in the fifth intercostal space, with clamping of the intrathoracic portion of the inferior vena cava, with no cardiopulmonary bypass. In the first two cases the thrombi were removed in a second surgical procedure after resecting the tumours. In the other six the complete procedure was done in one surgical stage. RESULTS: There were no surgery-related deaths. The major complications after surgery were pulmonary atelectasis, acute renal failure, a large retroperitoneal collection, deep vein thrombosis and pulmonary embolism, each in one patient. Of the five patients with adrenal cortex carcinoma one is still alive after 15 years with no evidence of disease, one is alive with pulmonary metastases 15 months after surgery and the other three died from widespread disease after 5, 12 and 15 months. Of the three patients with phaeochromocytoma, two show no evidence of the disease 2.5 and 11 years later and one died from myocardial infarction, with no evidence of the disease, 9 years later. CONCLUSION: Thrombi from adrenal neoplasia in the supra-diaphragmatic infra-atrial inferior vena cava may be removed with no need for cardiopulmonary bypass and cardiac arrest, thus avoiding the associated morbidity and high cost.
Adenocarcinoma↗
A single relaxing incision to correct different types of penile curvature: surgical technique based on geometrical principles.
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Anatomy, Artistic↗
Trends in male contraception.
Methods that are available for male contraception, namely coitus interruptus, condoms, and vasectomy, have been used since the 19th century. With the exceptions of a few improvements of these methods, no major progress has been made with respect to introducing new male contraceptives since then. It is extremely urgent to develop new, safe, effective, and reversible male contraceptive methods. Among all male contraceptive methods that are being investigated, the hormonal approach is the closest to clinical application. Hormonal contraception provides pregnancy protection by means of spermatogenic suppression. Androgen-progestin regimens currently represent the best available hormonal combination for induction of a profound suppression of spermatogenesis. Further development of new steroids is mandatory for increasing the choices of available contraceptive formulations and to optimize long-term safety of these regimens.
Androgens↗
Measuring male infertility: epidemiological aspects.
Evidence suggests that human semen quality may have been deteriorating in recent years. Most of the evidence is retrospective, based on analysis of data sets collected for other purposes. Measures of male infertility are needed if we want to monitor the biological capacity for males to reproduce over time or between different populations. We also need these measures in analytical epidemiology if we want to identify risk indicators, risk factors, or even causes of an impaired male fecundity-that is, the male component in the biological ability to reproduce. The most direct evaluation of fecundity is to measure the time it takes to conceive. Since the time of conception may be missed in the case of an early abortion, time to get pregnant is often measured as the time it takes to obtain a conception that survives until a clinically recognized pregnancy or even a pregnancy that ends with a live born child occurs. A prolonged time required to produce pregnancy may therefore be due to a failure to conceive or a failure to maintain a pregnancy until clinical recognition. Studies that focus on quantitative changes in fecundity (that does not cause sterility) should in principle be possible in a pregnancy sample. The most important limitation in fertility studies is that the design requires equal persistency in trying to become pregnant and rather similar fertility desires and family planning methods in the groups to be compared. This design is probably achievable in exposure studies that make comparisons with reasonable comparable groups concerning social conditions and use of contraceptive methods.
Female↗