The link between varicoceles and male infertility has been a matter of debate for more than half a century. Varicocele is considered the most common correctable cause of male infertility, but some men with varicoceles are able to father children, even without intervention. In addition, improvements in semen quality after varicocelectomy do not always result in spontaneous pregnancy. Studies regarding possible pathophysiological mechanisms behind varicocele-induced infertility have tried to address these controversies. Oxidative stress seems to be a central mechanism; however, no single theory is able to explain the differential effect of varicoceles on infertility. As a consequence, careful patient selection for treatment based on couple fertility status, varicocele grade, and semen quality is critical for achieving a chance of a subsequent pregnancy. A substantial amount of data on the effects of varicocelectomy has been gathered, but inadequate study design and considerable heterogeneity of available studies mean that these data are rarely conclusive. Current evidence suggests a beneficial effect of varicocelectomy on semen quality and pregnancy outcomes in couples with documented infertility only if the male partner has a clinically palpable varicocele and affected semen parameters.

Varicocele and male infertility

Background
This is an updated version of the original Cochrane review published in Issue 10, 2011. Paracetamol (acetaminophen) is the most commonly prescribed analgesic for the treatment of acute pain. It may be administered orally, rectally, or intravenously. The efficacy and safety of intravenous (IV) formulations of paracetamol, IV paracetamol, and IV propacetamol (a prodrug that is metabolized to paracetamol), compared with placebo and other analgesics, is unclear.

Objectives
To assess the efficacy and safety of IV formulations of paracetamol for the treatment of postoperative pain in both adults and children.

Search methods
We ran the search for the previous review in May 2010. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 1), MEDLINE (May 2010 to 16 February 2016), EMBASE (May 2010 to 16 February 2016), LILACS (2010 to 2016), a clinical trials registry, and reference lists of reviews for randomized controlled trials (RCTs) in any language and we retrieved articles.

Selection criteria
Randomized, double-blind, placebo- or active-controlled single dose clinical trials of IV paracetamol or IV propacetamol for acute postoperative pain in adults or children.

Data collection and analysis
Two review authors independently extracted data, which included demographic variables, type of surgery, interventions, efficacy, and adverse events. We contacted study authors for additional information. We graded each included study for methodological quality by assessing risk of bias and employed the GRADE approach to assess the overall quality of the evidence.

Main results
We included 75 studies (36 from the original review and 39 from our updated review) enrolling a total of 7200 participants.

Among primary outcomes, 36% of participants receiving IV paracetamol/propacetamol experienced at least 50% pain relief over four hours compared with 16% of those receiving placebo (number needed to treat to benefit (NNT) = 5; 95% confidence interval (CI) 3.7 to 5.6, high quality evidence). The proportion of participants in IV paracetamol/propacetamol groups experiencing at least 50% pain relief diminished over six hours, as reflected in a higher NNT of 6 (4.6 to 7.1, moderate quality evidence). Mean pain intensity at four hours was similar when comparing IV paracetamol and placebo, but was seven points lower on a 0 to 100 visual analog scale (0 = no pain, 100 = worst pain imaginable, 95% CI -9 to -6, low quality evidence) in those receiving paracetamol at six hours.

For secondary outcomes, participants receiving IV paracetamol/propacetamol required 26% less opioid over four hours and 16% less over six hours (moderate quality evidence) than those receiving placebo. However, this did not translate to a clinically meaningful reduction in opioid-induced adverse events.

Meta-analysis of efficacy comparisons between IV paracetamol/propacetamol and active comparators (e.g., opioids or nonsteroidal anti-inflammatory drugs) were either not statistically significant, not clinically significant, or both.

Adverse events occurred at similar rates with IV paracetamol or IV propacetamol and placebo. However, pain on infusion occurred more frequently in those receiving IV propacetamol versus placebo (23% versus 1%). Meta-analysis did not demonstrate clinically meaningful differences between IV paracetamol/propacetamol and active comparators for any adverse event.

Authors' conclusions
Since the last version of this review, we have found 39 new studies providing additional information. Most included studies evaluated adults only. We reanalyzed the data but the results did not substantially alter any of our previously published conclusions. This review provides high quality evidence that a single dose of either IV paracetamol or IV propacetamol provides around four hours of effective analgesia for about 36% of patients with acute postoperative pain. Low to very low quality evidence demonstrates that both formulations are associated with few adverse events, although patients receiving IV propacetamol have a higher incidence of pain on infusion than both placebo and IV paracetamol.

Single dose intravenous paracetamol or intravenous propacetamol for postoperative pain

Authors' conclusions The body of the reviewed literature on cryptorchidism comprise primarily fairand poor-quality studies, which limits our ability to draw definitive conclusions. No specific imaging technique is able to completely identify anorchia or position of the undescended testicles and thus eliminate the need for further surgical evaluation. Accuracy of imaging is related to location of the testicles, with less invasive methods demonstrating poor accuracy for abdominally located testicles and those that are atrophied. Hormonal stimulation testing may predict anorchia, but evidence is insufficient, with only two studies of fewer than 50 participants. Hormonal treatment is marginally effective relative to placebo, but it is successful in some children and has minimal side effects, suggesting that it may be an appropriate trial of care for some patients. Surgical options are effective, with high rates of testicular descent (moderate strength of evidence for Fowler-Stephens procedures, high for primary orchiopexy). Comparable outcomes occur with laparoscopic and open approaches.

Evaluation and Treatment of Cryptorchidism

Objectives: To determine the effect of surgical varicocele repair in improving testicular Leydig cell function as shown by increased testosterone production.



Methods:  Eligible studies were searched in Medline and the Pubmed database, and cross-referenced as of 31 May 2011 using the terms “varicocele,”“testosterone” and “surgery.” The database search, quality assessment and data extraction were independently carried out by two reviewers. Only studies including patients with testosterone evaluation before and after surgery were considered for the analysis. A systematic review and meta-analysis was carried out for continues variables using random effect models.



Results:  Out of 125 studies, a total of nine were selected, including 814 patients. The combined analysis showed that mean serum testosterone levels after surgical treatment increased by 97.48 ng/dL (95% confidence interval 43.73–151.22, P = 0.0004) compared with preoperative levels.



Conclusions:  Surgical treatment of varicocele significantly increases testosterone production and improves testicular Leydig cell function.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1442-2042.2011.02890.x

Effect of surgical repair on testosterone production in infertile men with varicocele: a meta-analysis.

The aim of the present paper was to review the literature on all available ureteral access sheaths (UASs) with their indications, limitations, risks, advantages and disadvantages in current modern endourological practice. Two authors searched Medline, Scopus, Embase and Web of Science databases to identify studies on UASs published in English. No time period restriction was applied. All original articles reporting outcomes or innovations were included. Additional articles identified through references lists were also included. Case reports, editorials, letters, review articles and meeting abstracts were excluded. A total of 754 abstracts were screened, 176 original articles were assessed for eligibility and 83 articles were included in the review. Based on a low level of evidence, UASs increase irrigation flow during flexible ureteroscopy and decrease intrapelvic pressure and probably infectious complications. Data were controversial and sparse on the impact of UASs on multiple reinsertions and withdrawals of a ureteroscope, stone-free rates, ureteroscope protection or damage, postoperative pain, risk of ureteral strictures, and also on its cost-effectiveness. Studies on the benefit of UASs in paediatrics and in patients with a coagulopathy were inconclusive. In the absence of good randomized data, the true impact of UASs on surgery outcome remains unclear. The present review may contribute to the evidence-based decision-making process at the individual patient level regarding whether or not a UAS should be used.

Systematic review of ureteral access sheaths: facts and myths.

Introduction: We evaluated the relation between ischemic priapism (IP) and blood count parameters in IP patients. We especially wanted to examine the contribution of eosinophil count (EC), platelet count (PC), and mean platelet volume (MPV) values, which are suspected predictive parameters for vascular endothelium damage and venoocclusive pathogenesis and etiopathogenesis, particularly in IP. Methods: A total of 40 IP patients fulfilled the study criteria. Forty healthy volunteers in a similar age group were included as the control group. Complete blood count values were compared between the two groups. Intergroup comparisons were performed using the Mann-Whitney U test, and the chi-square test was used to assess the relationship between categorical variables in the patient groups. The area under the curve was calculated by receiver operating characteristic (ROC) regression analyses. Epidemiological diagnosis percentages were calculated by finding cutoff values. Results: The IP group’s high MPV, PC, and EC values compared to those of the control group were detected to be statistically significant (p<0.001, p=0,03, p=0.001, respectively). No statistically significant difference was observed between the two groups for other blood count parameters. Statistically significant values for IP were measured as MPV: positive predictive value: 84%; EC: positive predictive value: 71.4%; and PC: positive predictive value: 61.4%. Conclusions: High MPV, PC, and EC values are significant positive predictive factors in IP etiopathogenesis. No proof was detected for other blood count

/pdf/ischemic-priapism-can-eosinophil-count-and-platelet-31i9oyfqbb.pdf

Ischemic priapism: Can eosinophil count and platelet functions be positive predictive factors in etiopathogenesis.

Background: The aim of this study was to calculate the radia on amount exposed during percutaneous nephrolithototomy (PCNL) and to make the urologists and other staff sensi ve about the radia on risk they were exposed to. Materials and Methods: We measured the radia on exposure during 114 cases of PCNL performed. Thermoluminescent dosimeters (TLD) were placed between the opera on table and the pa ent at the loca on of kidney and gonads of pa ents to measure the radia on exposure of pa ents. TLD were placed at the head, neck, finger and the legs of the opera ng surgeon to measure the occupa onal exposure of the urologist. And also two dosimeters were placed to the inner wall of the opera ng room and two dosimeters were placed to the hall. Results: The mean fluoroscopy screening me was 2.18 minutes (0.15 6.12) and the mean opera on me was 49 minutes (10-150). The mean radia on exposure for pa ents was 1.307 milisievert (mSv) at kidney loca on and 0.562 mSv at gonad loca on per procedure. Surgeon exposure was 0.021 and 0.003 mSv per procedure for hand and leg, respec vely. Radia on amounts exposed inside the room and by the surgeon were sta s cally significantly lower than measured radia on results compared to pa ent kidney. Conclusion: According to our findings radia on exposure of the pa ent and the surgeon is below the annual occupa onal dose limit recommenda ons. However, for protec ng from stochas c effects of radia on, fluoroscopy should be used as low as possible and lead aprons and thyroid shields must be worn to minimize the

Radiation exposure during percutaneous nephrolithotomy; Is there a risk of the patient and the operating team?

Üreter alt uç taşlarının tedavisinde üreteroskopi ile vücut dışı şok dalga litotripsinin karşılaştırılması

A 53-year-old female patient with long-standing hypertension was evaluated for left flank pain. Abdominal CT scan revealed a 2,8 cm left adrenal mass. Metanephrine, normetanephrine and vanylmandelic acid levels in a 24-hour urine sample were increased. The levels of serum cortisol, renin, aldosteron, calcitonin, parathormone, calcium and phosphate were normal. Left adrenalectomy was performed. There was a nodular mass with a red cut surface in medullary region. The medulla was enlarged in other parts. On microscopic examination, the mass was composed of mature adipose tissue admixed with hematopoietic cells. The medulla was hyperplastic with a corticomedullary ratio of 1:5. After surgery, blood pressure and catecholamine levels normalized. Although myelolipomas are incidental findings, they can rarely present with endocrine dysfunction. In conclusion, surgical excision should be considered in adrenal incidentalomas with characteristic radiographic features of myelolipoma, presenting with biochemical abnormalities. Turk Jem 2009; 13: 84-6

Combined Adrenal Medullary Hyperplasia and Myelolipoma: A Mimicker of Pheochromocytoma Adrenal Medüller Hiperplazi ve Myelolipom Kombinasyonu: Bir Feokromositoma Taklitçisi

Mesane taslari tum uriner sistem taslarinin %5’ini olusturmaktadir. Siklikla ileri yasli erkeklerde gorulurler ve prostat hiperplazisi, norojenik mesane gibi infravezikal obstruksiyonlara sekonder olusurlar. Enfeksiyonlar, yabanci cisim, kadinlarda anti inkontinans cerrahisi ve nadiren gebelik mesane taslari icin predispozan faktor olabilmaktedir. Endemik mesane taslari ise, cocuklarda ve herhangi bir predispozan faktor olmaksizin saglikli genclerde gorulebilmektedir. Bu olgu sunumunda dev endemik mesane tasi olan ve sistolitotomi yaptigimiz 23 yasindaki bir erkek hastayi sunduk. Tasin agirligi 102 gr, boyutlari ise 53x52x43 mm olarak olculdu. Tas analiz sonucu ise kalsiyum oksalat tasi olarak rapor edildi. Bu dev mesane tasi icin hicbir predispozan faktor yoktu. Bu olgu sunumuyla hicbir predispozan faktor olmaksizin genc ve saglikli erkeklerde de mesane tasi olusabilecegi ve DUS grafi ve/veya uriner sistem USG ile kolaylikla tani konulabilecegini vurgulayi amacladik

/pdf/genc-saglikli-erkekte-dev-mesane-tasi-olgu-sunumu-2rvh22es86.pdf

Cengiz Kara

Papers

Ischemic priapism: Can eosinophil count and platelet functions be positive predictive factors in etiopathogenesis.

Radiation exposure during percutaneous nephrolithotomy; Is there a risk of the patient and the operating team?

Üreter alt uç taşlarının tedavisinde üreteroskopi ile vücut dışı şok dalga litotripsinin karşılaştırılması

Combined Adrenal Medullary Hyperplasia and Myelolipoma: A Mimicker of Pheochromocytoma Adrenal Medüller Hiperplazi ve Myelolipom Kombinasyonu: Bir Feokromositoma Taklitçisi

Genç Sağlıklı Erkekte Dev Mesane Taşı: Olgu Sunumu