DOCSLIB.ORG

Complications After Surgery for Benign Prostatic Enlargement: a Population-­ Based Cohort Study in Ontario, Canada

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Open access Original research BMJ Open: first published as 10.1136/bmjopen-2019-032170 on 30 December 2019. Downloaded from Complications after surgery for benign prostatic enlargement: a population- based cohort study in Ontario, Canada Rano Matta ,1,2 Erind Dvorani,3 Christopher Wallis,1,2 Amanda Hird,1,2 Joseph LaBossiere,4 Girish Kulkarni,1,5 Ronald Kodama,1,6 Lesley Carr,1,6 Sidney B Radomski,1,5 Refik Saskin,2,3 Sender Herschorn,1,6 Robert K Nam1,2,3,6 To cite: Matta R, Dvorani E, ABSTRACT Strengths and limitations of this study Wallis C, et al. Complications Objectives To examine the complication rates after after surgery for benign benign prostatic enlargement (BPE) surgery and the effects ► A major strength of this study includes population- prostatic enlargement: a of age, comorbidity and preoperative medical therapy. population- based cohort study level data with the ability to follow patients after Design A retrospective, population- based cohort study in Ontario, Canada. BMJ Open their index procedure irrespective of where compli- using linked administrative data. 2019;9:e032170. doi:10.1136/ cations are managed within the province. Setting Ontario, Canada. bmjopen-2019-032170 ► There is potential for misclassification using admin- Participants 52 162 men≥66 years undergoing first BPE istrative data to identify outcomes. ► Prepublication history and surgery between 1 January 2003 to 31 December 2014. ► Although we adjust for geography and income, the additional material for this Intervention Medical therapy preoperatively and surgery paper are available online. To regional variations within Ontario might limit the for BPE. view these files, please visit generalisability of our results to other jurisdictions. Primary and secondary outcome measures The the journal online (http:// dx. doi. ► We do not have data on prostate size, urinary symp- primary outcome was overall 30- day postoperative org/ 10. 1136/ bmjopen- 2019- toms, extent of resection during the index procedure complication rates. Secondary outcomes included BPE- 032170). and the specific technology used for resection be- specific event rates (bleeding, infection, obstruction, yond electrical, laser or open surgery. Received 11 June 2019 trauma) and non- BPE specific event rates (cardiovascular, ► We were unable to evaluate postoperative functional Revised 09 November 2019 pulmonary, thromboembolic and renal). Multivariable outcomes besides urinary obstruction. Accepted 04 December 2019 analysis examined the association between preoperative medical therapy and postoperative complication rates. Results The 30- day overall complication rate after http://bmjopen.bmj.com/ BPE surgery was 2828 events/10 000 procedures and progression of their disease as the severity © Author(s) (or their increased annually over the study period. Receipt of of LUTS,4 the size of the prostate5 and the employer(s)) 2019. Re- use preoperative -blocker monotherapy (relative rate (RR) α cumulative incidence of urinary retention6 permitted under CC BY- NC. No 1.05; 95% CI 1.00 to 1.09; p=0.033) and antithrombotic commercial re- use. See rights medications (RR 1.27; 95% CI 1.22 to 1.31; p<0.0001) increase with time and age. When medical and permissions. Published by was associated with increased complication rates. or conservative therapy for patients eventu- BMJ. ally becomes ineffective, surgery is offered. 1 Among the ≥80- year- old group, the rate of complications Surgery, Division of Urology, increased by 39% from 2003 to 2014 (RR 1.39; 95% CI The recommended surgical treatments for University of Toronto, Toronto, 1.21 to 1.61; p<0.0001). The mean duration of medical patients with urinary symptoms secondary to on September 29, 2021 by guest. Protected copyright. Ontario, Canada 2Institute of Health Policy and conservative management increased by a mean of 2.1 BPE are either endoscopic resection, vapouri- Management and Evaluation, years between 2007 and 2014 (p<0.0001 for trend). sation or enucleation or simple prostatec- University of Toronto, Toronto, Conclusions Thirty-day complication rates after BPE tomy.7 By this point, patients are often older Ontario, Canada surgery have increased annually between 2003 and 2014. 8 9 3 and more frail, which may increase the rate Institute for Clinical Evaluative Preoperative medical therapy with alpha blockers or of perioperative complications.10 Sciences, Toronto, Ontario, antithrombotics was independently associated with higher Studies evaluating surgical therapy for BPE Canada rates of complications. Over this time, the duration of 4 Division of Urology, University conservative therapy also increased. have reported rates of postoperative morbidity of Alberta, Edmonton, Alberta, greater than 10%.10–12 However, there are Canada 5 few clinical studies evaluating the effects of Division of Urology, University INTRODUCTION medical therapy on perioperative outcomes, Health Network, Toronto, Ontario, Canada Medical therapy as first- line treatment for and these have been highly controlled with 8 9 13 6Division of Urology, Sunnybrook patients with lower urinary tract symptoms small sample sizes. To our knowledge, Health Sciences Centre, Toronto, (LUTS) from benign prostatic enlargement there are no large, population-based studies Ontario, Canada (BPE) has enabled men to delay or avoid examining the effect of medical management 1 2 Correspondence to surgery. Watchful waiting (conservative on surgical complications. Thus, we evaluated Dr Rano Matta; management) is also a reasonable manage- the trends in 30- day complications and re- op- rano. matta@ mail. utoronto. ca ment option.3 Some men with BPE will develop eration following BPE surgery, and the factors Matta R, et al. BMJ Open 2019;9:e032170. doi:10.1136/bmjopen-2019-032170 1 Open access BMJ Open: first published as 10.1136/bmjopen-2019-032170 on 30 December 2019. Downloaded from Table 1 Baseline characteristics of men undergoing benign legal status under Ontario’s health information privacy prostatic enlargement (BPE) surgery from 2003 to 2014 in law allows it to collect and analyse healthcare and demo- Ontario, Canada graphic data, without consent, for health system evalu- ation and improvement. Each of the data sources used Total cohort has been validated previously (online supplementary data Variable n=52 162 sources). All analyses were performed between June 2018 Mean age (years; SD) 75.76 ±6.41 and January 2019 and were consistent with Strengthening Intervention type (N, %) the Reporting of Observational Studies in Epidemiology TURP 45 463 87.2% reporting guidelines. Laser 5925 11.4% Study subjects Open 774 1.5% All individuals≥66 years old who had BPE surgery from 1 Preoperative urinary obstruction* (N, %) 25 779 49.4% January 2003 to 31 December 2014 were eligible (supple- 5ARI medication (only) in year prior to 2378 4.6% mentary eTable 1 for cohort selection). We included only surgery (N, %) the first procedure (index procedure) for each patient, which included transurethral resection of the prostate -blocker medication (only) in year prior 20 600 39.5% α (TURP) using electrocautery, transurethral laser surgery to surgery (N, %) (including enucleation or vapourisation using any laser 5ARI and α-blocker in year prior to 14 450 27.7% modality) or simple prostatectomy. These were captured surgery (N, %) using intervention codes during their hospitalisation (see No BPE medications prior to surgery (N, 14 734 28.2% supplementary eTable 2). Individuals were followed from %) the date of index procedure to 30 days post procedure. Antithrombotic in year prior to surgery 12 837 24.6% To determine the duration of time between initiating (N, %) BPE medication and surgical therapy, we restricted the Charlson Comorbidity Index (N, %) cohort to men≥80 years old to ensure a 15-year look- back 0 40 694 78.0% period to age 65, since the cost of prescription medica- 1 3961 7.6% tion in Ontario is covered for all patients starting at this age and therefore dispensing records are available. 2+ 7507 14.4% Income quintile (N, %) Exposure Missing 167 0.3% The primary independent variable was receiving a prescription for medical therapy for BPE. We captured 1 9553 18.3% this using prescription claims for 5α-reductase inhibitors 2 10 728 20.6% (5ARI) and α-blockers indicated for BPE, in the year http://bmjopen.bmj.com/ 3 10 263 19.7% prior to surgery (see supplementary eTable 3 for list of 4 10 689 20.5% medications). 5 10 762 20.6% Covariates Rural residence (N, %) 7264 13.9% We collected information on important covariates that *Preoperative urinary obstruction events include: urinary retention, may confound the association between medication use bladder neck obstruction or obstructive uropathy. and postoperative outcomes including age at surgery, ARI, α-reductase inhibitor; TURP, Transurethral resection of the year of surgery, Charlson Comorbidity Index- based hospi- on September 29, 2021 by guest. Protected copyright. prostate. talisations in the 5 years preceding the index procedure, prescription claims for antithrombotics (see supplemen- tary eTable 3 for list of medications), geographical region associated with these outcomes, in a population- based of residence (Local Health Integration Network) and sample of patients≥66 years old in Ontario, Canada. income quintile. We also identified patients who had a urinary obstruc- tion event (urinary catheterisation, bladder neck obstruc- METHODS tion or obstructive uropathy) in the 2 years prior to their Data sources and setting index surgery (see
Recommended publications
  • Chapter 99 – Urological Disorders Episode Overview Urinary Tract Infections in Adults 1

    Chapter 99 – Urological Disorders Episode Overview Urinary Tract Infections in Adults 1

    Crack Cast Show Notes – Urological Disorders – August 2017 www.crackcast.org Chapter 99 – Urological Disorders Episode Overview Urinary Tract Infections in Adults 1. Differentiate between the three major causes of dysuria in women? (ddx of dysuria) 2. List 3 common UTI pathogens, and list 3 additional pathogens in complicated UTIs 3. Define uncomplicated UTI and antibiotic options 4. Define complicated UTI and antibiotic options 5. List two antibiotic options for uncomplicated and complicated pyelonephritis. 6. How is pyelonephritis managed in pregnancy? What are safe antibiotic options for bacteriuria in pregnancy? Prostatitis 1. Describe the diagnosis and management of prostatitis Renal Calculi 1. Name the areas of narrowing in the ureter 2. Name 6 risk factors for urolithiasis 3. List 8 alternative diagnoses (other than renal colic) for pain associated with urolithiasis 4. What are indications for hospitalization of patients with urolithiasis Bladder (Vesical) Calculi 1. Describe this condition and its management Acute Scrotal Pain 1. List causes of acute scrotal swelling by age groups (infant, child, adolescent, adult) 2. Describe the physiology, diagnosis and management of testicular torsion 3. Describe the treatment for sexually vs. non-sexually acquired epididymitis Acute Urinary Retention 1. Describe the physiology of urination 2. List 10 causes of acute urinary retention in adults 3. List 6 causes of urinary retention in women Hematuria 1. List causes of red-coloured urine without hematuria 2. List risk factors for urinary tract malignancy Wisecracks: 1. When is a urine culture indicated (box 89.1) 2. What is a CAUTI and how is it managed? 3. What are two medication classes of drugs for prostatic enlargement? 4.
  • A Clinical Case of Fournier's Gangrene: Imaging Ultrasound

    A Clinical Case of Fournier's Gangrene: Imaging Ultrasound

    J Ultrasound (2014) 17:303–306 DOI 10.1007/s40477-014-0106-5 CASE REPORT A clinical case of Fournier’s gangrene: imaging ultrasound Marco Di Serafino • Chiara Gullotto • Chiara Gregorini • Claudia Nocentini Received: 24 February 2014 / Accepted: 17 March 2014 / Published online: 1 July 2014 Ó Societa` Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2014 Abstract Fournier’s gangrene is a rapidly progressing Introduction necrotizing fasciitis involving the perineal, perianal, or genital regions and constitutes a true surgical emergency Fournier’s gangrene is an acute, rapidly progressive, and with a potentially high mortality rate. Although the diagnosis potentially fatal, infective necrotizing fasciitis affecting the of Fournier’s gangrene is often made clinically, emergency external genitalia, perineal or perianal regions, which ultrasonography and computed tomography lead to an early commonly affects men, but can also occur in women and diagnosis with accurate assessment of disease extent. The children [1]. Although originally thought to be an idio- Authors report their experience in ultrasound diagnosis of pathic process, Fournier’s gangrene has been shown to one case of Fournier’s gangrene of testis illustrating the main have a predilection for patients with state diabetes mellitus sonographic signs and imaging diagnostic protocol. as well as long-term alcohol misuse. However, it can also affect patients with non-obvious immune compromise. Keywords Fournier’s gangrene Á Sonography Comorbid systemic disorders are being identified more and more in patients with Fournier’s gangrene. Diabetes mel- Riassunto La gangrena di Fournier e` una fascite necro- litus is reported to be present in 20–70 % of patients with tizzante a rapida progressione che coinvolge il perineo, le Fournier’s Gangrene [2] and chronic alcoholism in regioni perianale e genitali e costituisce una vera emer- 25–50 % patients [3].
  • Urologic Disorders

    Urologic Disorders

    Urologic Disorders Abdulaziz Althunayan Consultant Urologist Assistant professor of Surgery Urologic Disorders Urinary tract infections Urolithiasis Benign Prostatic Hyperplasia and voiding dysfunction Urinary tract infections Urethritis Acute Pyelonephritis Epididymitis/orchitis Chronic Pyelonephritis Prostatitis Renal Abscess cystitis URETHRITIS S&S – urethral discharge – burning on urination – Asymptomatic Gonococcal vs. Nongonococcal DX: – incubation period(3-10 days vs. 1-5 wks) – Urethral swab – Serum: Chlamydia-specific ribosomal RNA URETHRITIS Epididymitis Acute : pain, swelling, of the epididymis <6wk chronic :long-standing pain in the epididymis and testicle, usu. no swelling. DX – Epididymitis vs. Torsion – U/S – Testicular scan – Younger : N. gonorrhoeae or C. trachomatis – Older : E. coli Epididymitis Prostatitis Syndrome that presents with inflammation± infection of the prostate gland including: – Dysuria, frequency – dysfunctional voiding – Perineal pain – Painful ejaculation Prostatitis Prostatitis Acute Bacterial Prostatitis : – Rare – Acute pain – Storage and voiding urinary symptoms – Fever, chills, malaise, N/V – Perineal and suprapubic pain – Tender swollen hot prostate. – Rx : Abx and urinary drainage cystitis S&S: – dysuria, frequency, urgency, voiding of small urine volumes, – Suprapubic /lower abdominal pain – ± Hematuria – DX: dip-stick urinalysis Urine culture Pyelonephritis Inflammation of the kidney and renal pelvis S&S : – Chills – Fever – Costovertebral angle tenderness (flank Pain) – GI:abdo pain, N/V, and
  • Paraffin Granuloma Associated with Buried Glans Penis-Induced Sexual and Voiding Dysfunction

    Paraffin Granuloma Associated with Buried Glans Penis-Induced Sexual and Voiding Dysfunction

    pISSN: 2287-4208 / eISSN: 2287-4690 World J Mens Health 2017 August 35(2): 129-132 https://doi.org/10.5534/wjmh.2017.35.2.129 Case Report Paraffin Granuloma Associated with Buried Glans Penis-Induced Sexual and Voiding Dysfunction Wonhee Chon1, Ja Yun Koo1, Min Jung Park3, Kyung-Un Choi2, Hyun Jun Park1,3, Nam Cheol Park1,3 Departments of 1Urology and 2Pathology, Pusan National University School of Medicine, 3The Korea Institute for Public Sperm Bank, Busan, Korea A paraffinoma is a type of inflammatory lipogranuloma that develops after the injection of an artificial mineral oil, such as paraffin or silicon, into the foreskin or the subcutaneous tissue of the penis for the purpose of penis enlargement, cosmetics, or prosthesis. The authors experienced a case of macro-paraffinoma associated with sexual dysfunction, voiding dysfunction, and pain caused by a buried glans penis after a paraffin injection for penis enlargement that had been performed 35 years previously. Herein, this case is presented with a literature review. Key Words: Granuloma; Oils; Paraffin; Penis A paraffinoma is a type of inflammatory lipogranuloma because of tuberculous epididymitis [1,3]. that develops after the injection of an artificial mineral oil, However, various types of adverse effects were sub- such as paraffin or silicon, into the foreskin or the subcuta- sequently reported by several investigators, and such pro- neous tissue of the penis for the purpose of penis enlarge- cedures gradually became less common [3-6]. Paraffin in- ment, cosmetics, or prosthesis [1]. In particular, as this pro- jections display outcomes consistent with the purpose of cedure is performed illegally by non-medical personnel in the procedure in early stages, but over time, the foreign an unsterilized environment or with non-medical agents, matter migrates from the primary injection site to nearby cases of adverse effects, such as infection, skin necrosis, tissues or even along the inguinal lymphatic vessel.
  • Non-Certified Epididymitis DST.Pdf

    Non-Certified Epididymitis DST.Pdf

    Clinical Prevention Services Provincial STI Services 655 West 12th Avenue Vancouver, BC V5Z 4R4 Tel : 604.707.5600 Fax: 604.707.5604 www.bccdc.ca BCCDC Non-certified Practice Decision Support Tool Epididymitis EPIDIDYMITIS Testicular torsion is a surgical emergency and requires immediate consultation. It can mimic epididymitis and must be considered in all people presenting with sudden onset, severe testicular pain. Males less than 20 years are more likely to be diagnosed with testicular torsion, but it can occur at any age. Viability of the testis can be compromised as soon as 6-12 hours after the onset of sudden and severe testicular pain. SCOPE RNs must consult with or refer all suspect cases of epididymitis to a physician (MD) or nurse practitioner (NP) for clinical evaluation and a client-specific order for empiric treatment. ETIOLOGY Epididymitis is inflammation of the epididymis, with bacterial and non-bacterial causes: Bacterial: Chlamydia trachomatis (CT) Neisseria gonorrhoeae (GC) coliforms (e.g., E.coli) Non-bacterial: urologic conditions trauma (e.g., surgery) autoimmune conditions, mumps and cancer (not as common) EPIDEMIOLOGY Risk Factors STI-related: condomless insertive anal sex recent CT/GC infection or UTI BCCDC Clinical Prevention Services Reproductive Health Decision Support Tool – Non-certified Practice 1 Epididymitis 2020 BCCDC Non-certified Practice Decision Support Tool Epididymitis Other considerations: recent urinary tract instrumentation or surgery obstructive anatomic abnormalities (e.g., benign prostatic
  • Evaluation and Treatment of Acute Urinary Retention

    Evaluation and Treatment of Acute Urinary Retention

    The Journal of Emergency Medicine, Vol. 35, No. 2, pp. 193–198, 2008 Copyright © 2008 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/08 $–see front matter doi:10.1016/j.jemermed.2007.06.039 Technical Tips EVALUATION AND TREATMENT OF ACUTE URINARY RETENTION Gary M. Vilke, MD,* Jacob W. Ufberg, MD,† Richard A. Harrigan, MD,† and Theodore C. Chan, MD* *Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California and †Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania Reprint Address: Gary M. Vilke, MD, Department of Emergency Medicine, UC San Diego Medical Center, 200 West Arbor Drive Mailcode #8676, San Diego, CA 92103 e Abstract—Acute urinary retention is a common presen- ETIOLOGY OF ACUTE URINARY RETENTION tation to the Emergency Department and is often simply treated with placement of a Foley catheter. However, var- Acute obstruction of urinary outflow is most often the ious cases will arise when this will not remedy the retention result of physical blockages or by urinary retention and more aggressive measures will be needed, particularly caused by medications. The most common cause of acute if emergent urological consultation is not available. This urinary obstruction continues to be benign prostatic hy- article will review the causes of urinary obstruction and pertrophy, with other obstructive causes listed in Table 1 systematically review emergent techniques and procedures (4). Common medications that can result in acute
  • Phimosis Table of Contents

    Phimosis Table of Contents

    Information for Patients English Phimosis Table of contents What is phimosis? ................................................................................................. 3 How common is phimosis? ............................................................................. 3 What causes phimosis? ..................................................................................... 3 Symptoms and Diagnosis ................................................................................. 3 Treatment ................................................................................................................... 4 Topical steroid .......................................................................................................... 4 Circumcision .............................................................................................................. 4 How is circumcision performed? .................................................................. 4 Recovery ...................................................................................................................... 5 Paraphimosis ........................................................................................................... 5 Emergency treatment ....................................................................................... 5 Living with phimosis ........................................................................................... 5 Glossary ................................................................................... 6 This information
  • Brucellar Epididymo-Orchitis Van Tıp Dergisi: 17 (4):131-135, 2010

    Brucellar Epididymo-Orchitis Van Tıp Dergisi: 17 (4):131-135, 2010

    Brucellar epididymo-orchitis Van Tıp Dergisi: 17 (4):131-135, 2010 Brucellar Epididymo-orchitis: Report of Fifteen Cases Mustafa Güneş*, İlhan Geçit**, Salim Bilici*** , Cengiz Demir****, Ahmet Özkal*****, Kadir Ceylan**, Mustafa Kasım Karahocagil***** Abstract Aim: To discuss brucellar epididymo-orchitis cases in our clinic in terms of clinical and laboratory findings, treatment, and prognosis. Materials and methods: Our diagnostic criteria for the patients having epididymo-orchitis clinical findings are Standard Tube Agglutination (STA) or STA with Coombs test ≥1/160 titer or increase of STA titers four times and more in their serum samples in two weeks. Results: Ten of our cases (66%) had herb cheese eating history and five of them (33%) were dealing with animal husbandry. The most frequently observed symptom in our cases was testicular pain, and the most frequent clinical and laboratory finding was scrotal swelling and the alteration of the C-reactive protein (CRP). The diagnosis was made with STA test in 14 cases (93%), STA with Coombs test in one case (7%). Epididymo-orchitis was diagnosed on the right side in nine cases, on the left in five cases and bilateral in one case on physical examination. The patients were treated with rifampicin+doxycycline. Orchiectomy was done in one case who applied late to our clinic. Conclusion: Brucellar epididymo-orchitis should be thought first in patients applied with orchitis in brucellosis endemic regions, and should not be ignored in nonendemic regions also. It was shown that with early and appropriate medical treatment cases could be cured without surgery. Key words: Brucella spp., epididymo-orchitis, orchiectomy.
  • The Management of Acute Testicular Pain in Children and Adolescents

    The Management of Acute Testicular Pain in Children and Adolescents

    BMJ 2015;350:h1563 doi: 10.1136/bmj.h1563 (Published 2 April 2015) Page 1 of 8 Clinical Review CLINICAL REVIEW The management of acute testicular pain in children and adolescents 1 2 1 Matthew T Jefferies specialist registrar in urology , Adam C Cox specialist registrar in urology , 1 3 Ameet Gupta specialist registrar in urology , Andrew Proctor general practitioner 1Department of Urology, University Hospital of Wales, Cardiff, UK; 2Institute of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK; 3Roath House Surgery, Cardiff, UK Sudden onset testicular pain with or without swelling, often aspect of the testes to the tunica vaginalis. Consequently the referred to as the “acute scrotum,” is a common presentation in testis is free to swing and rotate within the tunica vaginalis of children and adolescents, and such patients are seen by the scrotum. This defect is referred to as the “bell-clapper urologists, paediatricians, general practitioners, emergency deformity,” occurring in 12% of all males; of those, 40% of doctors, and general surgeons. Of the many causes of acute cases are bilateral 7 (figure⇓). This type of abnormality mainly scrotum, testicular torsion is a medical emergency; it is the one occurs in adolescents. In contrast, extravaginal torsion occurs diagnosis that must be made accurately and rapidly to prevent more often in neonates (figure), occurring in utero or around loss of testicular function. the time of birth before the testis is fixed in the scrotum by the This review aims to cover the salient points in the history and gubernaculum. Consequently, both the spermatic cord and the clinical examination of acute scrotum to facilitate accurate tunica vaginalis undergo torsion together, typically in or just diagnosis and prompt treatment of the most common below the inguinal canal.
  • EAU Guidelines on Male Infertility$ W

    EAU Guidelines on Male Infertility$ W

    European Urology European Urology 42 (2002) 313±322 EAU Guidelines on Male Infertility$ W. Weidnera,*, G.M. Colpib, T.B. Hargreavec, G.K. Pappd, J.M. Pomerole, The EAU Working Group on Male Infertility aKlinik und Poliklinik fuÈr Urologie und Kinderurologie, Giessen, Germany bOspedale San Paolo, Polo Universitario, Milan, Italy cWestern General Hospital, Edinburgh, Scotland, UK dSemmelweis University Budapest, Budapest, Hungary eFundacio Puigvert, Barcelona, Spain Accepted 3 July 2002 Keywords: Male infertility; Azoospermia; Oligozoospermia; Vasectomy; Refertilisation; Varicocele; Hypogo- nadism; Urogenital infections; Genetic disorders 1. Andrological investigations and 2.1. Treatment spermatology A wide variety of empiric drug approaches have been tried (Table 1). Assisted reproductive techniques, Ejaculate analysis and the assessment of andrological such as intrauterine insemination, in vitro fertilisation status have been standardised by the World Health (IVF) and intracytoplasmic sperm injection (ICSI) are Organisation (WHO). Advanced diagnostic spermato- also used. However, the effect of any infertility treat- logical tests (computer-assisted sperm analysis (CASA), ment must be weighed against the likelihood of spon- acrosome reaction tests, zona-free hamster egg penetra- taneous conception. In untreated infertile couples, the tion tests, sperm-zona pellucida bindings tests) may be prediction scores for live births are 62% to 76%. necessary in certain diagnostic situations [1,2]. Furthermore, the scienti®c evidence for empirical approaches is low. Criteria for the analysis of all therapeutic trials have been re-evaluated. There is 2. Idiopathic oligoasthenoteratozoospermia consensus that only randomised controlled trials, with `pregnancy' as the outcome parameter, can accepted Most men presenting with infertility are found to for ef®cacy analysis. have idiopathic oligoasthenoteratozoospermia (OAT).
  • Epididymo-Orchitis-Leaflet Epididymo-Orchitis

    Epididymo-Orchitis-Leaflet Epididymo-Orchitis

    Page 1 of 4 View this article online at: patient.info/health/epididymo-orchitis-leaflet Epididymo-orchitis Epididymo-orchitis is an inflammation of the epididymis and/or testicle (testis). It is usually due to infection, most commonly from a urine infection or a sexually transmitted infection. A course of antibiotic medicine will usually clear the infection. Full recovery is usual. Complications are uncommon. What is epididymo-orchitis? Epididymitis means inflammation of the epididymis (the structure next to the testicle (testis) that is involved in making sperm). Orchitis means inflammation of a testicle. As the epididymis and testis lie next to each other, it is often difficult to tell if the epididymis, the testis, or both are inflamed. Therefore, the term epididymo-orchitis is often used. What causes epididymo-orchitis? Most cases are due to an infection. Causes of infection include the following: A complication from a urine infection Germs (bacteria) such as E. coli that cause urine infections can sometimes track down the vas deferens to cause an epididymo-orchitis. This can happen at any age and is the most common cause of epididymo-orchitis in men aged over 35 years. This is because partial blockage of urine flow becomes more common with increasing age, due an enlarged prostate or narrowing of the urethra (urethral stricture). The urethra is the tube that urine flows out of from the bladder. Partial blockage of urine makes you more prone to develop urine infections. A complication of a urine infection is also the usual cause of epididymo-orchitis in young boys. Page 2 of 4 Sexually transmitted infection A sexually transmitted infection is the most common cause of epididymo-orchitis in young men (but can occur in any sexually active man).
  • Male Factor Infertility

    Male Factor Infertility

    2 Male Factor Infertility SECTION CONTENTS 3 Evaluation and Diagnosis of Male Infertility 4 Hormonal Management of Male Infertility 5 Immunology of Male Infertility 6 Surgical Management of Male Infertility 7 Genetics and Male Infertility 3 Evaluation and Diagnosis of Male Infertility Sandro C Esteves, Alaa Hamada, Ashok Agarwal to the andrological armamentarium. Today, it is possible CHAPTER CONTENTS to correctly classify some cases which were previously ♦ Definition and Epidemiology of Male Infertility believed to be idiopathic. The initial evaluation of com- ♦ Pathophysiology, Etiology and Classification of Male mon infertility complaint comprises the meticulous his- Infertility tory taking, as well as conducting a thorough physical ♦ Probabilities of Conception for Fertile and Infertile examination along with proper laboratory and imaging Couples studies as needed. ♦ Goals and the Proper Timing for Fertility Evaluation ♦ Approaching the Subfertile Male DEFINITION AND EPIDEMIOLOGY OF MALE INFERTILITY The infertility is defined as failure of the couples to INTRODUCTION conceive after 12 months of unprotected regular inter- course.2 Infertility is broadly classified into primary t is well known that the motivation to have children infertility, when the male partner has no previous history Iand the formation of a new family unit are essential of fertility, and secondary infertility, when there was components of the individual instinct for existence and previous man’s history of successful impregnation of well-being. Fertility problems may represent a stressful a woman. Subfertility refers to a reduced but not unat- situation to the individual’s life with important nega- tainable potential to achieve pregnancy, while sterility tive psychological consequences.1 The experienced cli- is denoted by permanent inability to induce or achieve nician should realize and comprehend the burdensome pregnancy.3 Fecundity, on the other hand, indicates the bearings and frustrated mood of the infertile individual.