The Influence of Varicocelectomy Age on Semen Parameters and Fertility Rates

Objective: Varicocele is the most frequently observed correctable cause of infertility in men. In this study, we aimed to evaluate the influence of age at the time of varicocelectomy on semen parameters and fertility. Methods: Infertile men who underwent microsurgical varicocelectomy between January 2012 and December 2019 were retrospectively evaluated. Patients were divided into 4 age groups as follows: group 1 including patients aged ≤25 years old, group 2 including patients aged ≥26 and ≤30 years old, group 3 including patients aged ≥31 and ≤35 years old, and group 4 including patients aged ≥36 years old. Results: A total of 138 infertile men were divided into 4 groups. There were 18 men in group 1, 58 men in group 2, 44 men in group 3, and 18 men in group 4. There were significant improvements in the mean sperm concentration, progressive motility, and total motile sperm count values in all groups after surgery. Significant improvement in sperm morphology was detected only in groups 1 and 2 (p=0.007 and p=0.005, respectively). There was no significant difference between the groups in terms of preoperative and postoperative sperm parameters. Total fertility rate and the number of patients having children with natural conception or assisted reproductive techniques were lower in group 4 but these differences were not statistically significant (p=0.083 and p=0.454, respectively). Conclusion: Varicocelectomy can be recommended for all infertile men regardless of age. There was no difference in postoperative semen parameters and fertility rates between the age groups

Volunteer Surgical Camp at Gombe Hospital in Uganda

Background: The Islamic University Habib Medical School in Uganda (IUIU), in collaboration with Doctors Worldwide (DWW) from Turkey, organized a surgical camp in April 2014. In this camp, different types of hernia repair, among other general surgical procedures were conducted. The target population was the population within the Gombe hospital serving districts.Methods: The defined area for the surgical camp was Butambala and neighboring districts including Mpigi; Gomba, Mityana, and parts of Wakiso district. The IUIU team and Gombe hospital team were respectful to the sensitivities of the community, district and government officials. The surgical team composed of 4 surgeons (three from DWW-Turkey and one from Uganda), 3 Anesthesiologists, (two from DWW-Turkey and one from Uganda), 2 nurses and 2 intern doctor, (one from DWW-Turkey and one from Uganda).Results: The total number of patients operated was 115; however the total number of operations performed was 130. One hundred and fourteen operations were different types of hernia repair. The ages of hernia patients ranged between 1 and 80 years (mean±SD is 27.46±24.55). Hemoglobin values ranged between 9.2 and 17 (mean±SD is 12.5±1.48). Only two (1.8%) of 114 hernia patients had positive results on HIV serology. Sixteen patients underwent circumcision. Of those, only two (12.5%) patients had positive results on HIV serology.Conclusion: Hernia is a common surgical problem in all age groups. It is more common in men. In addition to the operations conducted, the need for surgery for 187 patients was detected. This condition shows that the hernia operation is commonly accepted as a negligible condition.Keywords: Global surgery; Provincial; Hernia; World Wide Doctors; Ugand

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Age May Be the Only Variable Effecting Microhematuria Prevalance in Pelvic Organ Prolapse

Objective: We aimed to estimate the prevalence of microscopic hematuria in women with pelvic organ descent and compare the results in terms of severity and accompanying urinary symptoms. We hypothesized that microhematuria incidence would be higher in advanced prolapse and accompanying urinary symptoms. Study Design: Women who presented to our clinic from January 2013 to July 2016 were analyzed using our electronic medical record system. Those who were classified in the system under the "N81: female genital prolapse" code were included. Records were checked to certify that samples were acquired properly. Urogynecological examinations were performed by specialist gynecologists and documented according to the international continence society classification system. After ruling out urinary tract infections urinalysis was performed by an integrated system composed of an urine strip analyzer and a sediment autoanalyzer. Results: Gravidity, parity, menopause onset, smoking status and presence of systemic disease were similar for both groups. Women in the hematuria group were older (p<0.001). Hematuria prevalance was greater ininternational continence society Stage 3-4 anterior prolapse and total prolapse (p=0.03) compared to early stage prolapse. However after logistic regression analysis; age was the only factor left in association with hematuria. Conclusions: Women who were older and with advanced stage prolapse ( ≥ international continence society stage 3) were more likely to have microscopic hematuria. Urine tests are requested routinely in the work-up of urogynecological patients. As the prevalance is microhematuria is high in this population; we believe that evidence based algorithms should be set as guidelines when hematuria is encountered in patients with organ prolapse

Comparison of Scoring Systems in Predicting Success of Percutaneous Nephrolithotomy

Background: Scoring systems are useful to inform the patients about the success and complication rates of the operation prior the surgery. Aims: To determine the applicability of the popular scoring systems (Guy’s, stone size, tract length, obstruction, number of involved calices, and essence/stone density and Clinical Research Office of the Endourological Society) by means of examining preoperative data of patients treated with percutaneous nephrolithotomy. Study Design: Cross sectional study. Methods: We retrospectively reviewed files of the patients who had undergone percutaneous nephrolithotomy in our center between 2011 and 2015. Excluded from the study were patients aged <18 years, and those who were not assessed preoperatively with computed tomography. Preoperative computed tomography images of all patients were assessed by a single observer, and patients were graded based on three scoring system. Demographic data were analyzed along with perioperative data (operation, fluoroscopy, length of hospital stay, changes in hematocrit values, location, and number of access sites, stone-free and complication rates). Results: A total of 298 patients who had been treated with 300 procedures were enrolled into the study. Mean age, stone burden, number of stones, and density were 48.1±12.9 years, 663.5±442.8 mm2, 1.8±1.1 and 888.3±273 HU respectively. Scores of the cases based on Guy’s, stone size, tract length, obstruction, number of involved calices, and essence/stone density, and Clinical Research Office of the Endourological Society scoring system were calculated as 2, 7.6, and 222.1 points respectively. 81.6% of the patients were stone-free. Complications were detected in 30 (9.9%) patients. Based on receiver operating characteristic curve analysis a positive correlation was detected between success rate and scoring systems, i.e., Guy’s (p=<0.001, r=-0.309), stone size, tract length, obstruction, number of involved calices, and essence/stone density (p=<0.001, r=-0.295), and Clinical Research Office of the Endourological Society (p=<0.001, r=0.426). The Clinical Research Office of the Endourological Society scoring system had the highest predictive value. The sensitivity rates rates for Guy’s, Clinical Research Office of the Endourological Society and Stone scoring system were as 78.78%, 80% and 82.34% respectively. Conclusion: All of scoring systems predicted correctly the success of the percutaneous nephrolithotomy procedures. The Clinical Research Office of the Endourological Society scoring system had the highest predictive value