Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?

OBJECTIVE: Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia. METHODS: We reviewed 167 patients with varicocele-associated male infertility over a 7-year period (December 1999-November 2005). Pre- and post-varicocelectomy seminal fluid analyses, assessed using the World Health Organization criteria, were obtained at intervals of 4-6 months. Wilcoxon signed rank tests were used to evaluate for statistical significance and P < or = 0.05 was considered significant. RESULTS: The mean age of the patients and their spouses were 35 and 28 years, respectively. The mean duration of infertility was 3.2 years (range, 1.5-7.5). Oligospermia, teratospermia, asthenospermia, oligospermia, asthenospermia and teratospermia (OAT) syndrome and azoospermia were found preoperatively in 106 (63.5%), 58 (34.7%), 154 (92%), 118 (71%) and 15 (9%) patients, respectively. Overall, significant improvements in semen volume (P < 0.001), sperm density (P < 0.001), sperm motility (P < 0.001) and sperm vitality (P < 0.001) were obtained after varicocelectomy. There was, however, no significant improvement in sperm morphology after varicocelectomy (P = 0.220). When patients with preoperative oligospermia (sperm density, <20 million/mL) were considered separately, varicocelectomy led to significant improvement in all the semen parameters except the sperm morphology (P = 0.183). Conversely, when varicocele patients with a sperm density of > or =20 million/mL (normospermia) associated with asthenospermia and/or teratospermia were considered separately, they did not show significant improvement in any of the semen parameters after varicocelectomy (P > 0.05). In addition, azoospermic patients did not show significant improvement in any of the semen parameters (P > 0.05) CONCLUSION: No significant improvement in semen parameters may be obtained in patients with clinical varicocele and preoperative normospermia. It is possible that only patients with preoperative oligospermia may benefit from varicocelectomy. Larger multi-institutional studies are needed to determine more definitively if asthenospermia or teratospermia in normospermic subfertile males with clinical varicoceles are in fact indications for varicocelectomy.     

Management of Acute and Chronic Retention in Men

Urinary retention is complex and may present in various ways as a result of a myriad of pathologic processes. Retention is >10 times more common in men than in women, and acute urinary retention (AUR) is rare in younger men; men in their 70 s are at five times more risk of AUR than men in their 40 s. Most of the epidemiologic data referred to in the literature are for AUR; data for chronic urinary retention (CUR) are sparse. Management of urinary retention must begin with modifying risk factors for developing AUR by using 5α-reductase inhibitors, follow-up, and early surgical intervention for those who may benefit. Once retention occurs, delay of surgery when possible must be the aim to reduce the risk of perioperative morbidity and mortality as well as to allow the bladder to recover its contractility. Finally, perhaps it is time to use suprapubic catheterisation for retention patients as a first-line approach.     

Management of penile cancer patients during the COVID-19 pandemic: An eUROGEN accelerated Delphi consensus study

ObjectivesTo develop an international consensus on managing penile cancer patients during the COVID-19 acute waves. A major concern for patients with penile cancer during the coronavirus disease 2019 (COVID-19) pandemic is how the enforced safety measures will affect their disease management. Delays in diagnosis and treatment initiation may have an impact on the extent of the primary lesion as well as the cancer-specific survival because of the development and progression of inguinal lymph node metastases.Materials and methodsA review of the COVID-19 literature was conducted in conjunction with analysis of current international guidelines on the management of penile cancer. Results were presented to an international panel of experts on penile cancer and infection control by a virtual accelerated Delphi process using 4 survey rounds. Consensus opinion was defined as an agreement of ≥80%, which was used to reconfigure management pathways for penile cancer.ResultsLimited evidence is available for delaying penile cancer management. The consensus rate of agreement was 100% that penile cancer pathways should be reconfigured, and measures should be developed to prevent perioperative nosocomial transmission of COVID-19. The panel also reached a consensus on several statements aimed at reconfiguring the management of penile cancer patients during the COVID-19 pandemic.ConclusionsThe international consensus panel proposed a framework for the diagnostic and invasive therapeutic procedures for penile cancer within a low-risk environment for COVID-19.     

Medicinal Plants Useful for Malaria Therapy in Okeigbo, Ondo State, Southwest Nigeria

There is increasing resistance of malaria parasites to chloroquine, the cheapest and commonly used drug for malaria in Nigeria. Artemisin, a product from medicinal plant indigenous to China, based on active principle of Artemisia annua, has been introduced into the Nigerian market. However not much has been done to project antimalaria properties of indigenous medicinal plants. This study thus, has the main objective of presenting medicinal plants used for malaria therapy in Okeigbo, Ondo State, South west Nigeria. Focus group discussions and interview were held about plants often found useful for malaria therapy in the community. Fifty species (local names) including for example: Morinda lucida (Oruwo), Enantia chlorantha (Awopa), Alstonia boonei (Ahun), Azadirachta indica (Dongoyaro) and Khaya grandifoliola (Oganwo) plants were found to be in use for malaria therapy at Okeigbo, Southwest, Nigeria . The parts of plants used could either be the barks, roots, leaves or whole plants. The recipes also, could be a combination of various species of plants or plant parts. This study highlights potential sources for the development of new antimalarial drugs from indigenous medicinal plants found in Okeigbo, Nigeria.     

Risk factors for malnutrition among rural Nigerian children

Protein Energy Malnutrition (PEM) remains a major public health problem in the developing world. The aim of this study was to determine the current nutritional status and the influence of feeding practices and family characteristics on the nutritional status of under-five rural Nigerian children. It was conducted using a cross sectional, community based survey design. From 344 households, 420 children were studied. Using the modified Wellcome Classification, the prevalence of PEM was 20.5 percent whereas the prevalence of underweight, wasting and stunting using the World Health Organization/ National Centre for Health Statistics (WHO/NCHS) standards were 23.1 percent, 9 percent and 26.7 percent respectively. Young age was significantly associated with a higher prevalence of underweight (P = 0.004). Overcrowding, low maternal income and the use of infant formula feeds in children who have attained the age of 6 months and above were associated with a higher prevalence of wasting (P = 0.029, P = 0.031 and P = 0.005 respectively). Improved living standard of families, empowerment of mothers with the aim of augmenting family income and parental education on appropriate feeding practices may help in reducing the incidence of under-five malnutrition in communities. The low prevalence rate of malnutrition was probably due to activities of the NGO in this community. This method of intervention is similarly achievable in any other community.