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Article
Sub- Inguinal Varicocelectomy in the Treatment of Infertile Males with Varicoceles

Author: Murtadha M.S.Majeed Al-Musafer
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 323-327
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Varicocele is an abnormal dilatation of pampiniform plexus within the spermatic cord. Varicoceles are present in 15% of the normal male population and in up to 35-40% of patients with infertility. In approximately 70-81% of patients with secondary infertility, a varicocele is an underlying cause. It is a disease of puberty and is only rarely detected in boys less than ten years of age.OBJECTIVE:Is to evaluate the sub inguinal approach of varicocelectomy in infertile males with grade II and III varicoceles.METHODS:A total of 150 patients were included in the study from 2004 to May 2010. Their ages ranged from 18 to 42 years. Fifty patients (33.3%) had grade II while 100 (66.6%) patients had grade III varicoceles. All the patients had history of more than one year infertility (ranging from 14 to 36 months) and all of them were sexually competent. Physical examination was performed with no apparent other clinical cause of infertility. Although varicoceles were diagnosed primarily by physical examination, color Doppler ultrasound was done for further documentation of the patient's condition. Only patients with grade II and grade III primary varicoceles were included in the study with exclusion of those with grade I varicoceles. Seminal fluid analysis and hormonal assay were done for all patients. Any patient with sperm concentration below 10 millions / milliliter was also excluded. Sub inguinal varicocelectomy was done for each patient. The operative time ranged from 20-25 minutes. The patients were followed for one year.RESULTS:The overall pregnancy rate at one year was 66, 6 % .The time from the operation till pregnancy was ranged from 4 to 12 months. Ten patients ( 6.6% ) developed recurrence , 2 patients ( 1.3% ) developed scrotal pain for 3 weeks postoperatively and then disappeared , and only 4 patients ( 2.6 % ) developed hydrocele .CONCLUSION:Whereas most male infertility surgeons now use the microsurgical approach, varicocele repairs can be achieved with successful results and minimal complications without microsurgery as long as they are carefully performed. Although microscopic sub inguinal varicocelectomy is better than non microscopic one, the later can be done successfully with shorter operative time


Article
Extracorporeal Shock Waves in the Treatment of Peyronie's Disease

Author: Murtadha M.S.Majeed Al-Musafer
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2012 Volume: 9 Issue: 2 Pages: 362-368
Publisher: Babylon University جامعة بابل

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Abstract

Background: Peyronie's disease is an acquired disorder of the tunica albuginea characterized by the formation of a plaque of fibrous tissue that may be associated with erectile dysfunction and pain on erection. There may be difficulty of penetration as a result of the curvature. The aim of the study is to evaluate the effectiveness of extracorporeal shock waves in the treatment of patients with stable Peyronie's disease .Methods: A total of 30 male patients were included in the study from December , 2007 till October, 2010. The mean age ±SD was 42.77 years ±9.38. Detailed medical and sexual history was obtained. Five patients ( 16.66 % ) were diabetics and other 5 patients ( 16.66 % ) had hypertension as well as diabetes mellitus. Thorough physical examination including local examination was performed. All the patients had dorsal plaques. Twenty patients (66.7 %) were presented with dorsal plaques , curvature and erectile dysfunction . The remaining 10 patients ( 33.3 % ) had pain in addition to these features. Extracorporeal shock wave therapy was performed in all cases with low energy shock waves using Wolf lithotripsy machine in Basrah General Hospital. Results: No serious complications occurred . The average decrease of the plaque length was ( 0. 14 centimeters ) . Pain relief obtained in 6 out of 10 patients who were presented with pain ( 60% ) . Improvement in the sexual function occurred in 15 out of 30 patients ( 50 % ). Improvement in the psychological status obtained in 20 out of 30 patients ( 66.7 % ). No definite cure occurred in the current study in terms of disappearance of the plaque and symptoms.Conclusion :Extracorporeal shock wave therapy in Peyronie's disease seems to be a safe procedure without severe side effects. It seems to have an effect on penile pain during erection , sexual function and the psychological status of patients with no statistically significant decrease in the plaque length.

إن الهدف من إجراء هذا البحث هو تقييم فعالية العلاج بموجات الصدم الموجهة إلى التليف الحاصل في الأجسام ألكهفيه للقضيب والمسمى بمرض بيروني لدى 30 مريضا 0 لقد تم الاستنتاج بان هذه الموجات لها تأثير ايجابي على الألم الحاصل أثناء الانتصاب وعلى الوضع النفسي للمريض مع وجود نقصان (غير مهم إحصائيا) في طول التليف علما بأنه لم يتم الحصول على حالات شفاء تام من المرض باستخدام هذه الطريقة . لم تحدث أثناء هذه ألدراسة أية مضاعفات مهمة0

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