The Status of Spermatogenesis in Germ Cell Tumor Bearing Testis and Its Association with Metastatic Disease

INTRODUCTION

We aimed to evaluate the status of spermatogenesis detected by histological examination of non-tumoral testicular tissues in tumor bearing testis and its association with advanced stage disease.

PATIENTS AND METHODS

We retrospectively reviewed patients with testicular germ cell tumors (TGCTs) that undergone radical orchiectomy. All non-tumoral areas of the orchiectomy specimens were examined for the status of spermatogenesis. Patients were divided into two groups as localized (stage I) and metastatic (stage II-III) disease and analyzed separately for seminomatous (SGCT) and nonseminomatous germ cell tumors (NSGCT).

RESULTS

Four hundred fifty-four patients were included in our final analysis. Of those, 195 patients had SGCT, and 259 patients had NSGCT. Three hundred and six patients had localized disease at the time of diagnosis. Median (Q1-Q3) age was 31 (26 - 38) years and 102 (22.5%) patients had normal spermatogenesis, 177 (39.0%) patients had hypospermatogenesis and 175 (38.5%) patients had no mature spermatozoa. On multivariate logistic regression analysis, embryonal carcinoma >50% (1.944, 95 %CI 1.054-3.585, P = .033) and spermatogenesis status (2.796 95% CI 1.251-6.250, P = .012 for hypospermatogenesis, and 3.907, 95% CI 1.692-9.021, P = .001 for absence of mature spermatozoa) were independently associated with metastatic NSGCT. However, there was not any variables significantly associated with metastatic SGCT on multivariate logistic regression analysis.

CONCLUSION

Our study demonstrated that only 22.5% of patients with TGCTs had normal spermatogenesis in tumor bearing testis. Impaired spermatogenesis (hypospermatogenesis or no mature spermatozoa) and predominant embryonal carcinoma are associated with advanced stage NSGCT.

Introducing a New Smartphone Applied Semen Analyzer, SpermCell™: A Cross-Sectional Validation Study with a Comparative Analysis and a Mini Patient Questionnaire on a Large Sample Cohort

(1) Background: Standard semen analysis methods may exhibit variability between observers and/or human error; therefore, additional methods are needed to overcome these handicaps. We aimed to present a new smartphone-applied semen analyzer, Sperm Cell™, investigate its diagnostic efficacy by comparing it with the standard analysis method, and determine its user-friendly nature. (2) Methods: A cross-sectional study was conducted on a large sample cohort, including 102 men. Three semen analyses were performed for each semen sample. The first employed the standard manual method, whereas the others were smartphone-based analyses performed by technicians and patients. We compared major semen parameters between the three semen analyses. The user-friendly nature of the analyzer was also evaluated with a mini-questionnaire completed by the participants. (3) Results: The determined median sperm count, motile sperm count, and percentage of motile sperms, on standard manual semen analysis, were 50.00 × 106/mL (0-160 × 106/mL), 23.94 × 106/mL (0-108 × 106/mL) and 50.00% (0-73.00%), respectively. Median sperm count and motile sperm count were 50.52 × 106/mL (<1-150 × 106/mL) vs. 55.77 × 106/mL (<1-160 × 106/mL) and 23.34 × 106/mL (0-105 × 106/mL) vs. 23.53 × 106/mL (0-104 × 106/mL) for SpermCell™-based semen analysis performed by a technician and patients themselves, respectively. The percentages of motile sperms were 47.40% (0-67.00%) vs. 47.61% (0-80.20%), respectively. All the parameters were statistically similar between the three semen analysis methods (p > 0.05 for each). The SpermCell™ analysis results were correlated with the standard manual method with up to 0.85 correlation coefficients. Moreover, substantial diagnostic accuracy, sensitivity and specificity were obtained in determining the oligospermia and asthenozoospermia via the device-based analyses performed by technician and patients. The mini-questionnaire results revealed that the analyzer is useful. (4) Conclusions: The novel smartphone-applied semen analyzer is a helpful tool with acceptable diagnostic accuracy in determining the major semen parameters. It can be used as an efficient at-home point-of-care testing method in the initial assessment of couples with infertility concerns.

High visceral adiposity index is associated with female orgasmic disorder in premenopausal women: a cross-sectional study

This study aimed to evaluate the association between the visceral adiposity index (VAI) and female sexual dysfunction (FSD). This cross-sectional study included 165 premenopausal, sexually active women admitted to the gynaecology outpatient clinic between January 2021 and April 2021. Female Sexual Function Index (FSFI) was used to assess the sexual function of the women. After measuring body mass index (BMI) and waist circumference (WC), biochemical serum analysis was performed. The VAI was calculated for all participants. The relationship between VAI and total FSFI and subdomain scores was investigated. Of the participants, FSD was detected in 65.5%. There was no relationship between the total FSFI scores and age, BMI, WC and VAI (p = .126, p = .675, p = .790, p = .220, respectively). Increased VAI levels were associated with dysfunction in orgasm (p = .008). Although VAI seems not to be directly related to FSD, it may predict the orgasmic disorder in women.Impact StatementWhat is already known on this subject? Obesity and female sexual dysfunction (FSD) are common health problems which adversely affect the biopsychosocial well-being. Although the relationship between FSD and obesity, body mass index (BMI) and waist circumference (WC) has been widely discussed in the literature to date, there is not enough evidence for the link between FSD and visceral adiposity index (VAI) which is a reliable indicator of visceral fat dysfunction.What do the results of this study add?The results of this study showed that none of the factors indicating obesity such as BMI, WC and VAI were correlated with the total FSFI scores. However, a significant positive correlation was found between the VAI and female orgasmic disorder (FOD).What are the implications of these findings for clinical practice and/or further research? The VAI may be a useful tool for detecting FOD patients. Diagnosis and treatment of orgasmic disorder would significantly improve the patient's quality of life and general well-being. Further large-scale and high-evidence studies are needed to clarify the impact of obesity on FSD and the relationship between VAI and FOD.

De Ritis ratio: how effectively can we use in bladder cancer management?

Background: This study aims to determine the relationship between the pre-operative De Ritis ratio (DRR) and bladder cancer (BCa) pathological subtypes. Results & methodology: A total of 248 patients with primary BCa were included. Univariate and multivariate analyses were performed to identify whether DRR can be a risk factor for the presence of carcinoma in situ (CIS). There was a statistically significant difference between the nonmuscle invasive BCa risk groups and the muscle-invasive BCa group according to the median DRR levels (p < 0.001). DRR was an independent risk factor for the presence of CIS in multivariate analysis (OR: 1.909; 95% CI: 0.030-0.196; p = 0.008). Discussion & conclusion: DRR can be considered as an independent risk factor for the presence of CIS in patients with primary BCa.

Comparison of the complications and the cost of open and laparoscopic radical nephrectomy in renal tumors larger than 7 centimeters

PURPOSE

To compare the complications and the cost analysis of open radical nephrectomy (ORN) versus laparoscopic radical nephrectomy (LRN) in patients with renal tumors larger than 7 centimeters (cm).

MATERIALS AND METHODS

A retrospective analysis was performed in 173 patients (ORN group, n = 140; LRN group, n = 33) who underwent surgery for kidney tumors between 2008 and 2011. Patients' age, tumor size, pre-operative surgical risk score (American Society of Anesthesiologists score), duration of hospitalization, complications and the costs of hospitalization were recorded. The complications in ORN group and LRN group were specified with Modified Clavien System in five grades.

RESULTS

The mean age was found 58.52 ± 13.74 years in ORN group, and 58.15 ± 12.81 years in LRN group (P = .847). Post-operative pain necessitating analgesics was observed in all patients (100%) after early post-operative period in both groups (Grade 1 complications). Blood transfusions were required in 51 patients (36.42%) in the ORN group, and 7 (21.21%) patients in the LRN group (Grade 2 complications) (P = .185). Grade 3 complication was not observed in each groups. Grade 4 complications were occurred in 6 (4.28%) patients [aortic injury, acute tubular necrosis, the need for dialysis, respiratory arrest (2), atrial fibrillation] in the ORN group, and in 1 (3.03%) patient (pulmonary embolism) in the LRN group. Grade 5 complication was occurred in 1 (0.71%) patient (death) in the ORN group. By the cost analysis, the average cost of ORN group was €1328, whereas €1508 in LRN group (P < .05).

CONCLUSION

Laparoscopy is used in many clinics with an increasing frequency because of the improved patient comfort, better cosmetic results, less post-operative pain, lower transfusion rates, and early return to the daily activities. Besides these advantages, the negligible difference in the costs compared to the open surgery (mean difference = €180 per case) makes it even more attractive.