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Hariri MK, Rajabalian MB, Narouie B, Ahmadaghayi S, Rostami G, Ezoji K, Momeni H, Radpour N. Semen parameter enhancement after varicocelectomy: Insights into varicose vein diameter and BMI influence: A cross-sectional study. Urologia 2024:3915603241247290. [PMID: 38634553 DOI: 10.1177/03915603241247290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Varicocele is a condition in which the veins in the spermatic cord become enlarged and twisted. Varicocele is widely recognized as the leading cause of male infertility due to its significant impact on reproductive health in men. The aim of this study was to investigate the relationship between the diameter of the varicose vein and the recovery rate of the spermogram after varicocelectomy. Also, the effect of body mass index (BMI) on sperm parameters after varicocelectomy. METHODS This descriptive and analytical cross-sectional study was conducted in Valiasr Hospital's urology clinic in Qaemshahr, Iran from August 2018 to August 2019 and involved 27 men with unilateral left varicocele who met the inclusion criteria for surgical repair. Before the operation, we recorded demographic information, the maximum diameter of varicose veins in the pampiniform plexus, and spermogram results. We repeated semen analysis 3 months after the operation and analyzed the data using Statistical Package for the Social Sciences version 21 software. RESULTS Our findings showed that the diameter of the varicose vein before varicocelectomy was not significantly associated with the improvement of main semen parameters after the operation. Furthermore, our study suggested that a lower body mass index might contribute to a greater improvement in sperm motility, as individuals with lower BMI showed more significant improvement. DISCUSSION There is a significant inverse relationship between BMI and sperm motility improvement after surgery. Patients with a lower BMI showed greater improvement in sperm motility.
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Affiliation(s)
- Mohammad Kazem Hariri
- Department of Urology, Islamic Azad University of Medical Sciences, Sari Branch, Sari, Iran
| | | | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Ahmadaghayi
- Islamic Azad University of Medical Sciences, Sari Branch, Sari, Iran
| | - Ghasem Rostami
- Department of Urology, Babol University of Medical Sciences, Babol, Iran
| | - Khadijeh Ezoji
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hamidreza Momeni
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Radpour
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Maimaitiming A, Muhemaiti A, Mulati Y, Li X. Nomograms for Predicting Postoperative Sperm Improvements in Varicocele Patients. EUR UROL SUPPL 2024; 59:40-48. [PMID: 38264086 PMCID: PMC10804247 DOI: 10.1016/j.euros.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 01/25/2024] Open
Abstract
Background Varicocele is a condition that seriously affects male fertility. It can cause pathological changes in the testicles and affect their spermatogenesis and endocrine function. Objective To formulate nomograms to predict sperm improvements after microscopic varicocelectomy. Design setting and participants A retrospective analysis was conducted on varicocele patients who met the research criteria and were enrolled from March 2020 to June 2022. They were divided into a development and a validation cohort in a 2:1 ratio. Outcome measurements and statistical analysis Data on preoperative testicular atrophy index, bilateral testicular elastic modulus, testosterone, pre- and postoperative 6-mo total sperm count, sperm concentration, and sperm vitality were collected. An increase of ≥25% is considered a postoperative improvement in sperm parameters. Predictive nomograms were constructed through forward stepwise LR regression, based on independent risk factors filtered by univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis, calibration curve, and decision curve analysis were employed to assess the performance of the models. Results and limitations The areas under the curve of nomograms for predicting the postoperative improvement of total sperm count, sperm concentration, and sperm vitality were 0.915, 0.986, and 0.924 respectively. The nomogram models demonstrated good predictive performance. The single-center sample size was a limitation of this study. Conclusions In this study, we developed effective predictive nomogram models for anticipating postoperative improvements in sperm quality among varicocele patients. These models offer a significant value in providing accurate predictions of surgical outcomes. However, it is crucial to conduct further external validation. Patient summary In this study, a predictive nomogram model was constructed for assessing the improvement of sperm quality in varicocele patients after surgery. The model offered satisfactory results.
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Affiliation(s)
- Abulaiti Maimaitiming
- Urology Department, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi, China
| | - Aidibai Muhemaiti
- Ultrasound Department, Medical Imaging Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yelisudan Mulati
- Urology Department, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi, China
| | - Xiaodong Li
- Urology Department, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi, China
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Santi D, Lotti F, Sparano C, Rastrelli G, Isidori AM, Pivonello R, Barbonetti A, Salonia A, Minhas S, Krausz C, Vignozzi L, Maggi M, Corona G. Does an increase in adipose tissue 'weight' affect male fertility? A systematic review and meta-analysis based on semen analysis performed using the WHO 2010 criteria. Andrology 2024; 12:123-136. [PMID: 37226894 DOI: 10.1111/andr.13460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Obesity negatively impact on the metabolism of sex hormones, leading to reduced testosterone serum levels. However, how the obesity could negatively impact on the overall gonadal function, particularly on male fertility, remained unclear so far. OBJECTIVE To systematically review evidences regarding the influence of body weight excess on the sperm production. METHODS A meta-analysis was conducted, searching all prospective and retrospective observational studies reporting male subjects older than 18 years old, with body weight excess from overweight to severe obesity were considered. Only studies using the V edition of the World Health Organization (WHO) manual for semen analysis interpretation were considered. No specific interventions were considered. Search was focused on studies comparing overweight/obese to normal weight subjects. RESULTS Twenty-eight studies were considered. Total sperm count and sperm progressive motility were significantly lower in overweight compared to normal weight subjects. Meta-regression analyses demonstrated that patients' age impacted on sperm parameters. Similarly, obese men showed lower sperm concentration, total sperm number, progressive and total motilities, and normal morphology lower than normal weight subjects. Reduced sperm concentration in obese men was influenced by age, smoking habit, varicocele, and total testosterone serum levels at meta-regression analyses. CONCLUSIONS The male potential fertility is reduced in subjects with increased body weight, compared to normal weight men. The higher was the increased body weight, the worst was the sperm quantity/quality. This result comprehensively included obesity among non-communicable risk factor for male infertility, shedding new lights on the negative impact of increased body weight on overall gonadal function.
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Affiliation(s)
- Daniele Santi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Unit of Endocrinology, Department of Medical Specialties, AziendaOspedaliero-Universitaria of Modena, Modena, Italy
| | - Francesco Lotti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Center for Prevention, Diagnosis and Treatment of Infertility, Careggi Hospital, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Clotilde Sparano
- Endocrinology Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Giulia Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Center for Prevention, Diagnosis and Treatment of Infertility, Careggi Hospital, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Centre for Rare Diseases (Endo-ERN accredited), Policlinico Umberto I Hospital, Rome, Italy
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile, Università Federico II di Napoli, Naples, Italy
- UNESCO, Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Suks Minhas
- Department of Urology, Imperial College NHS Healthcare, London, UK
| | - Csilla Krausz
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Center for Prevention, Diagnosis and Treatment of Infertility, Careggi Hospital, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Center for Prevention, Diagnosis and Treatment of Infertility, Careggi Hospital, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Glick H, Claflin J, Heximer A, Fiestan GO, Varon D, Daignault-Newton S, Van Til M, Wan J, Kraft KH. Testicular catch-up growth in the non-operative management of the adolescent varicocele. J Pediatr Urol 2023; 19:652.e1-652.e6. [PMID: 37394305 DOI: 10.1016/j.jpurol.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/05/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Adolescent varicocele is a common urologic condition with a spectrum of outcomes, leading to variations in management. Testicular hypotrophy is a common indication for surgery Routine monitoring may be an appropriate form of management for many adolescents with testicular hypotrophy, as studies have shown that a large proportion of these patients may experience catch-up growth of the ipsilateral testis. Furthermore, there are few longitudinal studies which have correlated patient specific factors to catch-up growth. We aimed to determine the frequency of testicular catch up-growth in adolescents with varicocele while also examining if patient specific factors such as BMI, BMI percentile, or height correlated with testicular catch-up growth. METHODS A retrospective chart review found adolescent patients who presented to our institution with varicocele from 1997 to 2019. Patients between the ages of 9 and 20 years with left-sided varicocele, a clinically significant testicular size discrepancy, and at least two scrotal ultrasounds at least one year apart were included in analysis. Testicular size discrepancy of greater than 15% on scrotal ultrasound was considered clinically significant. Testicular size was estimated in volume (mL) via the Lambert formula. Statistical relationships between testicular volume differential and height, body mass index (BMI), and age were described with Spearman correlation coefficients (ρ). RESULTS 40 patients had a testicular volume differential of greater than 15% at some point during their clinical course and were managed non-operatively with observation and serial testicular ultrasounds. On follow-up ultrasound, 32/40 (80%) had a testicular volume differential of less than 15%, with a mean age of catch up growth at 15 years (SD 1.6, range 11-18 years). There were no significant correlations between baseline testicular volume differential and baseline BMI (ρ = 0.00, 95% CI [-0.32, 0.32]), baseline BMI percentile (ρ = 0.03, 95% CI [-0.30, 0.34]), or change in height over time (ρ = 0.05, 95% CI [-0.36, 0.44]). DISCUSSION The majority of adolescents with varicocele and testicular hypotrophy exhibited catch-up growth with observation, suggesting that surveillance is an appropriate form of management in many adolescents. These findings are consistent with previous studies and further indicate the importance of observation for the adolescent varicocele. Further research is warranted to determine patient specific factors that correlate with testicular volume differential and catch up growth in the adolescent varicocele.
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Affiliation(s)
- Hannah Glick
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Jake Claflin
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Alisha Heximer
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - David Varon
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Monica Van Til
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Julian Wan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Marquardt N, Ros CTD. Can we recommend varicocele surgery for men with hypogonadism? Int Braz J Urol 2023; 49:637-643. [PMID: 37506035 PMCID: PMC10482463 DOI: 10.1590/s1677-5538.ibju.2023.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/23/2023] [Indexed: 07/30/2023] Open
Affiliation(s)
- Nilson Marquardt
- Pontifícia Universidade Católica do Rio Grande do SulDepartamento de UrologiaPorto AlegreRSBrasilDepartamento de Urologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Carlos Teodósio Da Ros
- Pontifícia Universidade Católica do Rio Grande do SulDepartamento de UrologiaPorto AlegreRSBrasilDepartamento de Urologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Universidade Luterana do BrasilDisciplina de UrologiaCanoasRSBrasilDisciplina de Urologia, Universidade Luterana do Brasil – ULBRA, Canoas, RS, Brasil
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Samplaski MK, Rodman JCS, Perry JM, Marks MBF, Zollman R, Asanad K, Marks SF. Sperm granulomas: Predictive factors and impacts on patency post vasectomy reversal. Andrologia 2022; 54:e14439. [PMID: 35524153 PMCID: PMC9541413 DOI: 10.1111/and.14439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/06/2022] [Accepted: 03/18/2022] [Indexed: 12/04/2022] Open
Abstract
The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post-VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.
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Affiliation(s)
- Mary K. Samplaski
- Institute of UrologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - John C. S. Rodman
- Southern California Clinical and Translational Science InstituteUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | | | - Robert Zollman
- International Center for Vasectomy ReversalTucsonArizonaUSA
| | - Kian Asanad
- Institute of UrologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Kandevani NY, Namdari F, Hamidi M, Dialameh H, Behzadi A. Developing a novel prediction model for the impact of varicocelectomy on postoperative fertility. Eur J Transl Myol 2022; 32. [PMID: 35502854 PMCID: PMC9295180 DOI: 10.4081/ejtm.2022.10411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to evaluate inflammatory markers as predictors of fertility after varicocelectomy and to develop a prediction model. This prospective cohort was conducted on patients with varicoceles who were presented to the clinic of Imam Reza hospital of Tehran during 2019-2020. Semen analysis, complete blood count (CBC), and scrotal ultrasonography was requested. Patients with abnormalities of semen analysis were chosen as candidates for varicocelectomy. 6 months after the operation, semen analysis was repeated. Hematologic and semen analysis parameters were recorded at baseline and follow-up visits. Treatment success was defined as 50% increase in total motile sperm count (TMSC) in cases with preoperative TMSC> 5 million/cc or 100% increase in TMSC in cases with preoperative TMSC< 5 million/cc. Patients were then categorized into two groups based on treatment success and statistical analysis was performed on these two groups. 124 infertile patients with varicocele were evaluated in our study. 52 patients (41.93%) showed improvements in semen analysis after varicocelectomy. After univariate and multivariate analysis three parameters were used in our predictive model as body mass index (BMI)>23.70 kg/m2 (4 scores), neutrophil-lymphocyte ratio (NLR) >1.80 (3 scores), and TMSC<14.69 million (2 scores). A cut-off value of 5 was associated with an 87.5% sensitivity and an 84.6% specificity for the prediction of failure of varicocelectomy. Varicocelectomy can improve semen analysis parameters in almost all infertile men with varicocele. Using BMI, NLR, and baseline TMSC as the suggested scoring system can predict the success of varicocelectomy for improving fertility and determine the appropriate infertile candidates for surgery.
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Hu X, Yang X, Zhao J, Guan T, Dai Q, Yang J, Zhang H, Zhang D, Zhang Y, Shang L, Ma X. Association between body mass index and varicocele among 211 989 Chinese reproductive-age males. Int J Urol 2022; 29:853-859. [PMID: 35483962 PMCID: PMC9546267 DOI: 10.1111/iju.14915] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/12/2022] [Indexed: 12/01/2022]
Abstract
Objectives To explore the relationship between body mass index and varicocele, the range of body mass index that leads to increased odds of varicocele, and the association between body mass index with the position and grade of varicocele. Methods We conducted a cross‐sectional study of 211 989 Chinese males aged 18–65 years participated in the National Free Pre‐conception Check‐up Projects from January 2013 to December 2018. Univariate and multivariate logistic regression models were constructed to assess the association between body mass index and varicocele. Results Overweight and obese males had 13.1% (odds ratio 0.869, 95% confidence interval 0.838–0.902) and 32.3% (odds ratio 0.677, 95% confidence interval 0.632–0.725) lower odds of varicocele than those with normal body mass index, respectively. The association between them was non‐linear, and males with body mass index of 17.74 to 23.09 kg/m2 had an increased odds of varicocele. The overweight and obese males had lower odds of left and bilateral varicocele, but the right varicocele odds was increased by 63.3% in obese males. Conclusion Body mass index was associated with the odds of varicocele among reproductive‐age males, but the odds varied by position. The effects of weight management and varicocele on fertility should be taken into account in fertility guidance.
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Affiliation(s)
- Xuhuai Hu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, China
| | - Xueying Yang
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China
| | - Jun Zhao
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China
| | - Ting Guan
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, China
| | - Qiaoyun Dai
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China
| | - Juan Yang
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China
| | - Dongmei Zhang
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, China
| | - Yue Zhang
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China
| | - Li Shang
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China
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Esteves SC, Cocuzza MS. The obesity paradox in varicocele - is the protective effect real? Int Braz J Urol 2021; 47:20-22. [PMID: 33047910 PMCID: PMC7712690 DOI: 10.1590/s1677-5538.ibju.2019.0210.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, SP, Brasil.,Departamento de Cirurgia, Divisão de Urologia, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.,3 Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Marcello S Cocuzza
- Centro de Reprodução Humana, Divisão de Urologia, Universidade de São Paulo, SP, Brasil
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Favorito LA. A decisive year to International Brazilian Journal of Urology. Int Braz J Urol 2020; 47:1-3. [PMID: 33047907 PMCID: PMC7712705 DOI: 10.1590/s1677-5538.ibju.2021.01.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil.,Serviço de Urologia, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
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