Reconstructive surgery in male infertility: The technique and predictive parameters

İnfertil erkeğin değerlendirilmesinde amaç, infertilite etiyolojisinin açıklanması ve etiyolojiye spesifik tedavinin planlanmasıdır. Spesifik tedavi yapılamadığında üremeye yardımcı tekniklere başvurulmaktadır. Ancak erkek infertilitesinin etiyolojiye spesifik tedavisi, üremeye yardımcı tekniklere göre hem maliyet/fayda açısından daha avantajlı, hem de oluşan gebelikler üremeye yardımcı tekniklerin riskinden uzak olmaktadır. Sperm taşıyan kanalların obstrüksiyonu, erkek infertilitesinin düzeltilebilir sebepleri arasında yer alır ve tedavi seçenekleri, obstrüksiyonun lokalizasyonuna göre değişmektedir. Distal ejakülatör kanal patolojilerinde TUR-ED, proksimal obstrüksiyonlarda ise rekonstrüktif cerrahi (vazovazostomi/epididimovazostomi) birinci seçenek tedavilerdir. Operasyon sonrasında tekrar obstrüksiyon gelişebilme ihtimali bulunduğundan hastalara perop sperm dondurma önerilmektedir. Duktal sistemin rekonstrüktif cerrahisi yıllar içinde teknik olarak gelişme gösterirken, bu gelişmeye paralel olarak ameliyat başarısında da artış sağlanmıştır. Ameliyatın başarısı duktal açıklığın (patens) ve gebeliğin sağlanmasıdır. Cerrahi tekniklerdeki dönüm noktası, ameliyat mikroskobunun kullanılmasıdır. Ameliyat mikroskobu ile obstrüksiyon daha iyi yerleştirilebilirken, anatomiye uygun anastomozlar yapılabilmektedir. Sonuçta ameliyat başarısı da artmaktadır. Ameliyatın başarısı, tekniklerdeki gelişmenin yanında ameliyat için doğru hastanın seçilebilmesine bağlıdır. Yapılan çalışmalarda ameliyat başarısını öngörebilmek için ölçütler belirlenmeye çalışılmış, ameliyat öncesinde ve ameliyat sırasında bazı ölçütlerin prediktif önemi olduğu belirtilmiştir.Introduction: The aim of infertile male evaluation is to unveil the etiology of infertility and plan the specific treatment according to the etiology. In case there is not a specific treatment the aim is to refer to assisted reproductive techniques. However the etiology specific treatment of male infertility, compared to the assisted reproductive techniques is more cost effective and it does not have the risks of assisted reproductive techniques. Materials and Methods: The obstruction of the sperm ducts is one of the correctable causes of male infertility and the treatment varies according to the localization of obstruction. When there is distal ejaculatory duct pathology the treatment choice is TUR-ED while in proximal ejaculatory duct patologies reconstructive treatment is the preferred choice (vasovasostomy/epididymovasostomy). Peroperative semen freezing is offered to the patient as there is a risk of recurrence. Results: The reconstructive surgery of ductal system has been improved through years and so has the operation success. The success of the operation is to provide a ductal patency and pregnancy. The milestone of operative technique is the use of the microscope. With the use of the microscope the obstruction is localized more effectively and the anastomoses are made according to the anatomy. Consequently, the success of the operation is higher. Conclusion: The success rate of the operation, on behalf of the development of the operational technique, depends on the choice of the right patient. In order to predict the success of the operation some parameters were tried to be established in some studies. It was stated that some preoperative and peroperative parameters have predictive importance

Effects of Ivabradine on 6-Minute Walk Test and Quality of Life in Patients With Previously Implanted CRT-D

Background: We aimed to evaluate clinical effects of additional heart rate control by ivabradine on life quality score and 6-minute walking test in patients with previously implanted biventricular cardiac resynchronization therapy defibrillator (CRT-D) with ischemic heart failure under regular treatment. Background: &nbsp; We aimed to evaluate clinical effects of additional heart rate control by ivabradine on life quality score and 6-minute walking test in patients with previously implanted biventricular cardiac resynchronization therapy defibrillator (CRT-D) with ischemic heart failure under regular treatment. Methods: &nbsp; Fifteen men and 14 women with a median age of 63 years (range, 48 &nbsp; Y79 years) were studied. Twenty-one patients were in New York Heart Association class II (8 patients were in class III), CRT-D implanted previously, and with resting heart rates greater than 70 beats per minute with sinus rhythm despite conventional medication. Patients were given 2.5- to 7.5-mg ivabradine orally twice a day, and drug dosage was titrated to decrease the patients&rsquo; average heart rate to 70 beats per minute. Before and 3 months after ivabradine treatment, all patients underwent extensive clinical, echocardiographic, and laboratory evaluation. Results: &nbsp; Ivabradine treatment produced dose-dependent reductions in heart rate at rest and at peak exercise (91.9 &nbsp; T 6.3 to 71.7 T 4.8 and 114.4 T 7.6 to 96.8 &nbsp; T 4.8; P = 0.001 and P = 0.001, respectively). There were also significant improvements in life quality score (52.4 &nbsp; T 9.5 to 37.9T7.8; P &nbsp; = 0.001) and 6-minute walking distance (278.7 T 85.8 to 373.3 T 94.0; P &nbsp; = 0.001) of patients. All patients with New York Heart Association class III became class II after 3 months of ivabradine treatment. Conclusion: &nbsp; Heart rate reduction in a short-term period by ivabradine produced significant improvements in exercise capacity and life quality in patients with CRT-D and conventional therapy.</p

Epidemiological, Clinical, and Laboratory Features of Children With COVID-19 in Turkey

Objectives: The aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children

Consensus and diversity in the management of varicocele for male infertility: Results of a global practice survey and comparison with guidelines and recommendations

Purpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men