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.

Purpose Blood count parameters of patients referring with penile vasculogenic erectile dysfunction (ED) were examined in this study. It was investigated whether eosinophil count (EC), platelet count (PC) and mean platelet volume (MPV), values among the suspected predictive parameters which may affect vascular functions, have a contribution on ED pathology or not. Materials and methods Patients referring erectile dysfunction complaint were evaluated. Depending on the medical story, ED degree was determined by measuring International Index of Erectile Function (IIEF). Values such as hormones, complete blood count and other laboratory markers were examined. Penile doppler ultrasonography (PDU) was performed in patients suspected to have vasculogenic ED. According to PDU result, patients with vascular deficiency were included in the penile vasculogenic ED group and patients with normal results were included in the control group. 49 patients participated in the study from the penile vasculogenic ED group and 30 patients from the control group. Intergroup comparisons were performed using the Mann–Whitney U test and the chi-square (χ2) test was used to assess the relationship between categorical variables within the patient groups. Results Low IIEF score in vasculogenic ED group compared to the control group and high EC, MPV and PC values were detected to be statistically significant (p  Conclusion High MPV value and platelet count showing the platelet functions and high eosinophil count are important factors which may play a role in penile vasculogenic ED etiopathogenesis.

Is there a relationship between penile vasculogenic erectile dysfunction, platelet functions and eosinophil count?

Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience

Öz What’s known on the subject? and What does the study add? There are studies showing that low-intensity linear shockwave treatment (LI-ESWT) was effective and successful in erectile dysfunction (ED) due to vascular disorders, especially in arteriogenic ED. It has been claimed that LI-ESWT caused neovascularization by stimulating angiogenesis and increased endothelial cell proliferation. The efficacy of LI-ESWT + phosphodiesterase type 5 inhibitors (PDE5i) was compared with PDE5i treatment only in patients with severe ED who were diagnosed with penile arteriogenic ED based on penile Doppler ultrasonography. Ağır Arteriyojenik Erektil Disfonksiyonlu Hastalarda Düşük Dansiteli Linear Şok Dalga Tedavisinin Etkinliği Efficacy of Low Density Linear Shockwave Treatment in Severe Arteriogenic Erectile Dysfunction Patients Doi: 10.4274/jus.1431 Journal of Urological Surgery, 2017;4(4):189-194

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Efficacy of Low Density Linear Shockwave Treatment in Severe Arteriogenic Erectile Dysfunction Patients

OZET The aim of using vaccine in the treatment of prostate cancer (Pca) is to activate immune response against malignant cells by overcoming the tolerance triggered by the tumor. Vaccine therapies are effective by using the immune response against cancer. The first oncological vaccine therapy ever published in the literature belongs to Coley dating back to 1893. In that study, it has been demonstrated that inoperable soft tissue sarcomas were regressed by stimulating non-specific immune response with streptococcal toxins. Not every type of cancer is suitable for vaccine therapy. For a vaccine therapy to be implemented, the cancer should have a slow progression, it should be immunogenic, and contain tissue-specific proteins. For that reason, studies regarding urological cancers, most of which are phase 1/2 and phase 3, are focused on the kidneys and the prostate. Although vaccine therapy in oncological diseases dates back to old times, studies have only been intensified recently. In this compilation, we will discuss vaccine therapies that are being used in prostate cancer, which urologists are not so familiar with, in the light of the up-to-date literature.

Prostat Kanserinde Aşi Tedavileri Vaccine Therapy for the Prostate Cancer

OZ A 26-month-old boy, who was misdiagnosed with urinary tract infection, was admitted to our hospital with increasing complaints of uneasiness, vomiting and nausea. On physical examination, a urethral stone was suspected and was confirmed by plain urinary tract x-ray. In children, the clinical features of a urethral stone may be overlooked because children are not able to express their complaints fully. Therefore, a detailed and careful physical examination is of great importance. In this paper, we present the rare case of urethral stone in a child and a review of the literature.

Yirmi Alti Aylik Erkek Çocukta Üriner Enfeksiyonu Taklit Eden Üretra Taşi An Urethral Stone Mimicking Urinary Tract Infection in a Twenty-six-month-old Boy

Cengiz Kara

Papers

Is there a relationship between penile vasculogenic erectile dysfunction, platelet functions and eosinophil count?

Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience

Efficacy of Low Density Linear Shockwave Treatment in Severe Arteriogenic Erectile Dysfunction Patients

Prostat Kanserinde Aşi Tedavileri Vaccine Therapy for the Prostate Cancer

Yirmi Alti Aylik Erkek Çocukta Üriner Enfeksiyonu Taklit Eden Üretra Taşi An Urethral Stone Mimicking Urinary Tract Infection in a Twenty-six-month-old Boy