The Role of Vasography in Obstructive Azospermia : A Report of 26 Patients
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male patients referred with obstructive azospermia were selected for bilateral vasography. The F.S.H. was normal in 84.6 % of patients. testicu- lar biopsy showed normal spermatogenesis in all biopsied normal sized testes. Obstructions were epididymal in 6 patients, vasal in 6 patients and at the level of ejaculatory ducts in 4 patients. Congenital absence of the vas was unilateral in 6 patients and bilateral in 2 patients. Iatrogenic post- operative obstruction was present in 6 patients and post- inflammatory obstruction was found in 8 patients. The seminal vesicles were dilated uni- laterally in 4 patients and bilaterally in 2 patients. They were absent in 4 patients on both sides and in 2 patients on one side. They showed atrophy in 2 patients and were normal in the remaining 8 patients. Vasography proved to be an essential and reliable technique in the diagnosis of the level of obstructive azospermia as well as the underlying etiologic cause of obstruction.Cite
Selective phleborenotesticulography, ++tensiometry of the left iliac, right and left renal veins, vena cava inferior, duplex scanning of the left renal vein were performed in 356, 296 and 57 patients, respectively, of a total of 356 examinees aged 8-17 years with left-side varicocele. Among other tests were measurements of hormones in the blood from the left and right testes (n = 24), pO2, pCO2. Stenosis, aortomesenteric compression (AMC) of the left renal vein, left-side venous renotesticular hypertension (RTH) of the left renal vein were diagnosed in 12, 342 and 158 patients, respectively. Secondary genesis of left varicocele has been proved. The diagnosis of left-side phlebohypertensive nephropathy was made preoperatively. Estradiol content in the blood of the left testis was 1.7 times higher than from the right one. 4 groups of patients were formed: group 1 patients (n = 142) had stenosis, AMC, dilatation of the testicular vein (DTV) and RTH; group 2 patients (n = 18) had AMC, DTV, borderline high pressure; group 3 patients (n = 18) had AMC, RTH, multiple thin testicular veins; group 4 patients (n = 174) had moderate AMC without hypertension. 160 patients of group 1 and 2 have undergone two-direction venous testiculo-iliac anastomosis operation. 193 patients of groups 3 and 4 have undergone Ivanissevich's operation. After Ivanissevich's operation 2 patients with secondary varicocele of the third degree retained varicocele of the first degree. After establishment of anastomoses, neither varicocele recurrences nor anastomosis thrombosis were registered.
Renal vein
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Objective:To improve the level of early diagnosis and treatment in patients with spermatic cord torsion and to prevent testicular loss.Method:The clinical data of 67male adolescents with spermatic cord torsion from August 2003to December 2011were analyzed retrospectively.The average age of the patients was 14.6(range,13-16)years.During of symptoms was less than six hours in 23cases,less than 24hours in 39cases and more than 24hours in five cases.Fifty-three patients underwent color Doppler ultrasonography.Surgical treatments were performed for 63patients,and the rest underwent non-surgical treatment.We calculated rate of diagnosis,misdiagnosis and testicular salvage.Result:The initial diagnosis rate of the disease was 72%(48/67)and the initial misdiagnosis rate was 28%(19/67).Misdiagnosed diseases included epididymis-orchitis 52%(10/19),hydrocele 16%(3/19),inguinal hernia 16%(3/19),ureteral calculi 11%(2/19)and testicular hematoma 5%(1/19).Sixty-three of 67patients whose testes with a range of 360°to 1 080°intrathecal torsion were performed open surgery.The rate of salvage testes was 84%(16/19)within six hours period of disease,but it was 23%(10/44)for during of symptoms more than six hours.The difference between two groups was statistically significant(P0.05,the median degree of testicular torsion in two groups was 540°).All 63patients underwent contralateral orchiopexy and ipsilateral orchiectomy for testicular torsion with necrosis intraoperatively.The resected testes in pathology demonstrated haemorrhagic necrosis.On the other hand,four patients received non-surgical treatment(two patients with successful manual detorsion,one patient with testicular atrophy and one patient with spontaneous remission).There were 16patients in all 26salvaged testes who followed up for 6to 18months.Testicular atrophy was found in 11patients.Conclusion:The rate of misdiagnosis of testicular torsion is high.Sudden,severe scrotal pain in pubertal males should be considered as possible testicular torsion.Doppler ultrasonography should be used as the first-line examination.The degree of testicular torsion and ischemic time are significant factors affecting testicular function.Orchidectomies can be reduced by timely surgical exploration.Therefore,early diagnosis and treatment are crucial to avoid testicular loss.
Spermatic cord
Hydrocele
Spermatic Cord Torsion
Orchiopexy
Scrotal Pain
Orchiectomy
Orchitis
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OBJECTIVE To investigate the clinical features and outcome of hydronephrosis induced by retroperitoneal fibrosis (RPF), and to evaluate the effect of corticosteroid based therapy combined with surgical intervention of ureteral obstruction. METHODS A total of 17 RPF patients with hydronephrosis hospitalized in Peking University International Hospital from May 2016 to December 2019 were analyzed retrospectively. RESULTS The median age was 56 (53, 65) years, the male to female ratio was 2.4 : 1, and the disease duration was 4.00 (0.83, 8.00) months. The initial symptoms included back pain (9 cases), abdominal pain (6 cases), oliguria (2 cases) and lower limb edema (3 cases). Eight patients presented left hydronephrosis, 1 right hydronephrosis and 8 bilateral hydronephrosis. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were both elevated in 13 patients (76.5%, n=17). Immunoglobin (Ig) G4 increased in 5 cases (29.4%, n=17). IgG, IgE and IgA increased in 4 cases (30.8%, n=13), 4 cases (30.8%, n=13) and 1 case (7.7%, n=13), respectively. Among 12 patients who underwent biopsy, 3 patients were diagnosed with IgG4-relate disease. The level of IgG4 in the tissues varied, 6 cases expressed less than 10 per high power field (HPF) or no expression (50.0%). Only 2 cases expressed 10-30/HPF (16.7%), and 4 cases revealed more than 30/HPF (33.3%). Among the 17 patients with ureteral obstruction, no urinary drainage procedure was needed in 4 patients who had mild ureteral obstruction, whereas, ureteral stenting was carried out in the other 13 cases before drug treatment. Time was too short to evaluate the effect of urinary drainage procedures in 4 patients. For the rest, ureterolysis had to be performed in 3 cases after failed ureteral stent insertion. Successful drain removal was accomplished in all of these 9 patients and the mean time to drain removal was (6.7±3.0) months. In addition, 10 patients had complete medical records after an average follow-up time of 5 (3-13) months. Levels of ESR, CRP, IgG4, IgG, IgE, IgA were 54.0 (36.3, 98.5) mm/h, 26.8 (8.7, 53.0) mg/L, 1.34 (0.55, 3.36) g/L, 16.3 (13.0, 21.1) g/L, 40.5 (31.4, 203.0) IU/mL, 2.51 (1.82, 3.25) g/L at baseline, which all decreased predominantly after treatment. ESR, CRP, IgG4, IgG, IgE and IgA dropped by 38.5 (23.5, 54.3) mm/h (P < 0.01), 23.0 (5.5, 52.0) mg/L (P < 0.05), 0.92 (0.40, 2.85) g/L (P < 0.01), 6.5 (1.7, 9.1) g/L (P < 0.05), 23.7 (4.8, 162.0) IU/mL (P < 0.05) and 0.77 (0.32, 1.26) g/L (P < 0.05), respectively. Size of mass measured by CT/MRI imaging became smaller significantly and hydronephrosis relieved. CONCLUSION Onset of RPF is insidious and lack of specific initial symptoms. Corticosteroid based therapy combined with surgical intervention of relieving obstruction is effective.
Oliguria
Urinary tract obstruction
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Vasovasostomy
Vasectomy reversal
Vasectomy
Vas deferens
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The condition in infants showing the characteristic facial abnormalities, limb deformities, and pulmonary hypoplasia induced by oligohydramnios is termed Potter sequence (PS). In addition to bilateral renal agenesis, Potter sequence could be caused by other urological abnormalities such as cystic dysplasia and obstructive uropathy. Although lethal in most of the patients with PS, some exceptional infants were reported to survive in spite of the antenatal demonstration of oligohydramnios from renal abnormalities. These surviving patients put new questions to us regarding the management of both respiratory and renal failure starting from the newborn periods. The diversity of clinical courses in patients with antenatally detected PS may imply that this entity has a spectrum of severity. Our study of infants autopsied on the diagnosis of PS was undertaken to determine various histological grade of the kidneys and the lungs.Thirty-two autopsy cases of PS (19 males and 13 females) diagnosed by the presence of the characteristic stigmata, oligohydramnios, and renal or urological abnormalities were studied retrospectively. Patients were divided according to the urological abnormalities into 3 groups; renal hypodysplasia, urinary obstruction, and polycystic kidney disease (PCKD). Renal histology was evaluated by two parameters; renal glomerular count (RGC), and dysplastic grade. Developmental aspects of the lung were judged by lung/body-weight ratio (L/ B ratio) and radial alveolar count (RAC) proposed by Emery.The underlying urological disorders included renal hypodysplasia in 22 patients, obstruction in 7, and polycystic kidney disease in 3. Dysplastic grade of 29 patients with hypodysplasia and obstruction consisted of grade 4 in 12 patient, grade 3 in 9, and grade 2 in 8. In 10 kidneys from 8 patients with grade 2-dysplasia, RGC was significantly fewer than that of normal fetuses for the gestational age. The term patient with PS showed the glomerular count equivalent to normal fetus of around 25 weeks of gestation. L/B ratio indicated definite pulmonary hypoplasia in 25 of 29 patients. The ratio was much smaller than normal in another 4 patients. RAC was calculated in 24 patients; of these only 2 had normal count for gestational age. In another 22, the number of air space stopped to increase at about 20 to 25 weeks of gestation. There was a tendency for L/B ratio to decrease according to dysplastic grade (1.3% for grade 2 vs. 0.9% for grade 3 and 4).The primary urological abnormalities leading to PS included bilateral renal hypodysplasia, obstructive uropathy, and PCKD. Histological study of the kidneys indicates that PS is the spectrum disease with various degree of nephron formation. The development of the lung depends, in part, on the grade of renal dysplasia.
Sequence (biology)
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Epididymitis
Orchitis
Concomitant
Hydrocele
Testicular atrophy
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Objective:To evaluate the early diagnosis and treatment of testicular torsion,and to improve the survival rate of testicular torsion. Methods:Clinical data of 18 patients with testicular torsion were analyzed retrospectively. All patients were examined with color Doppler ultrasonography and underwent surgical exploration,8 patients underwent testectomy,10 patients underwent testicular reduction and fixation,and all patients underwent surgical exploration and fixation of contralateral testis. Results:Of the 18 patients with testicular torsion,11 cases were definitely diagnosed at first visit,and the other 7 cases were misdiagnosed as acute testicular epididymitis,the conformity rate of diagnosis of color Doppler ultrasonography was 100%,all patients were cured. Of 6 patients with episode time 12 h,their testes were retained and all the testes survived; of 5 patients with episode time 12 ~ 24 h ,testes of 4 cases were retained,one patient's testis was excised due to testicular necrosis; of 7 patients with episode time 24 h,their testes were excised due to testicular necrosis. According to follow-up of 1 to 5 years,of the 10 patients with retained testes examined with color Doppler ultrasound,6 cases showed normal testicular morphology and blood flow supply; 3 patients's testes occurred mild atrophy,but the contralateral testicular blood flow was normal; one patient's testis occurred marked atrophy. Contralateral testicular blood flow of the 8 patients with one testis resected was normal according to color Doppler ultrasonography. Conclusion:Color Doppler ultrasonography is the preferred examination of testicular torsion,early diagnosis and timely surgical exploration are key to improve the survival rate. Of the treatment of testicular torsion,reduction and fixation of twisted testis indicates to patient with episode time 12 h,retention of twisted testis indicates to patient with episode time 12 ~ 24h,and orchiectomy indicates to patient with episode time 24 h.
Epididymitis
Testicular atrophy
Spermatic Cord Torsion
Color doppler
Orchitis
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Multicystic dysplastic kidney
Megaureter
Ureterocele
Nephrology
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The aim of this study is to evaluate effective prognostic factors in the evolution of patients with retroperitoneal fibrosis and to establish the validity of fractal analysis in determining the disease severity in these patients.This study included 19 patients (M/F: 5/14) treated for idiopathic retroperitoneal fibrosis and bilateral obstructive renal failure between Jan 2004-Dec 2008. Patients were identified retrospectively, searching for patients diagnosed with IRF, after retroperitoneal biopsy or, in most cases the diagnosis rested on radiological findings, especially CT, with identification of a retroperitoneal mass, the absence of other demonstrable renal or ureteric disease or any other pathology that could explain the findings. CT was very useful in describing the retroperitoneal mass around the aorta and inferior vena cava, the extent of the lesion and for monitoring the response to surgical treatment during the follow-up. The data were evaluated about medical history, physical examination findings, laboratory tests (serum urea and creatinine, blood sugar, sodium, potassium, bicarbonate levels, serum pH, uric acid, haematocrit, white blood cell count), imaging methods (renal ultrasound, abdominal CT-scan, MRI). At admission all patients had active disease with obstructive renal failure and underwent bilateral ureteric stenting in order to normalize the BUN levels. After normalizing of BUN levels, ureterolysis and omental wrapping was performed. Postoperatively, ureteric stents were removed after 1 month and remission of renal disfunction was obtained in approximately 5 months (range 2-10 months). All patients were followed for at least 1 year. Patients were regularly checked every 3 months.Of the 19 patients, there were 5 men and 14 women. The median age at diagnosis of RF was 50 years (range 42-64 years). The most frequent presenting symptoms were back or abdominal pain, weakness, weight loss, oligoanuria, arterial hypertension and mild fever. The duration of symptoms before diagnosis ranged from 6 to 18 months. At presentation all patients had active disease, presenting renal dysfunction with a median serum creatinine of 5.18 mg/dl (range 1-15.4 mg/dl). Most of the patients had moderate bilateral hydronephrosis (2nd degree hydronephrosis). In our study, all patients had excellent prognosis, with full recovery of renal function in 78% of cases (15 patients). The fractal dimension of the fibrosis mass contour correlates with level of renal function impairment. Even more, the fractal dimension seems to slightly variate between CT evaluations (1.30 +/- 0.1), suggesting a non aggressive pattern of extension of the fibrotic mass characteristic for benign lesions.The imaging parameters did not predict the disease severity, except the increase in fractal dimension of fibrosis surface area. Efficacy of bilateral ureteric stenting in improving renal function is limited in most of the cases. Dispite the level of renal function impairment at admission, full recovery can be achieved after bilateral ureteric stenting/nephrostomy and ureterolisis.
Ureterolysis
Retroperitoneal space
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