Uptonbonner0849

Following consultation, 12% and 17% preferred assisted reproductive technologies and varicocelectomy, respectively. The increase in preference for varicocelectomy was greater in men without decisional conflict (5% to 31%) than those with conflict (0% to 8%) (p=0.03). Conclusions Infertile men with varicocele have limited knowledge of their disease and high rates of decisional conflict. Before consultation, men with varicoceles showed preference for assisted reproductive technology over varicocele surgery; this trend reversed after consultation. Men with decisional conflict were less likely to prefer varicocelectomy, even after consultation.Introduction and objective Application of the Single Port (SP) robotic platform [Intuitive®] is expanding. Using two illustrative examples of bladder diverticula (BD) resulting from bladder outflow obstruction (BOO), we describe in this video our techniques utilising SP to treat BD via Extravesical (EV#1) and Transvesical (TV#2) approaches. Methods In EV#1, a 56 year old, with BOO due to benign prostate enlargement (BPE) of a 30ml prostate, and a 5cm BD, was treated with RABD-SP. A sub-umbilical SP access was used to approach and excise the BD in an EV fashion. The BPE was treated with Rezum®. A 16Fr urethral catheter was placed. In TV#2, a 67 year old, with urinary retention due to a 55ml BPE and a 6cm BD in the right posterolateral aspect adjacent the ureteric orifice (UO), was treated with RABD-SP using a Gelport® (no additional assistant ports). An open cut-down was performed onto a pre-filled bladder and secured onto the abdominal wall with stay sutures. After draining the bladder, a Gelport was introduced into the bladder for SP docking with pneumo-vesical insufflation. Intravesical (inside-out) excision of the BD was performed with protection of the adjacent right UO with an open access ureteral catheter. Utilising the TV access, a simple prostatectomy was performed. A 22Fr, 3-way catheter was placed at the end. Results For EV#1 and TV#2, estimated blood loss (EBL) were 5ml and 100ml, length stay was 1 day in both, without any immediate peri-operative complications. Both patients had successful trials of void on post-operative day 7 and 9 respectively. selleckchem Conclusions RABD-SP can be customised to treat bladder diverticula, via transabdominal (extravesical) or transvesical (with bladder pneumo-insufflation) approaches, and combined with different BOO treatments (Rezum® or simple prostatectomy, for instance), in a patient-specific personalised manner.Nitrous oxide (N2O) is underutilized in ambulatory urology. Here, we review available data regarding application, efficacy, and side effect profile of N2O in ambulatory urologic procedures. Data were available from 11 studies. N2O has been described in the setting of transrectal ultrasound-guided prostate biopsies, flexible cystoscopy, ureteral stent placement, and extracorporeal shockwave lithotripsy in adult patients and catheterization in children. Studies showed significant improvements in peri-procedural pain and anxiety relative to alternative (or none) forms of analgesia. Adverse effects were rare and self-limited. More widespread use of N2O may result in cost savings and better patient tolerance with outpatient procedures.Objective To compare two techniques-trocar and Seldinger-for performing percutaneous suprapubic cystostomy (SPC). Materials & methods 125 patients, mean age 71.8 ± 16.5 years (range, 15-102 years), underwent primary SPC from January 2013 - December 2018. Trocar access (N=60) was performed as a single step using a puncture cannula without guidewire access. Seldinger access (N=65) involved needle puncture, guidewire placement, and serial dilation. A retrospective review of patient records was conducted. Results All procedures were technically successful. Mean catheter size was 13.1 ± 2.0 and 13.9 ± 2.0 French for trocar and Seldinger, respectively (p=0.044). Mean procedure time was significantly reduced using trocar technique, 12.4 ± 7.7 versus 25.7 ± 12.1 minutes (p less then 0.001), and was associated with lower anxiolytic dose, 1.2 ± 0.8 versus 1.9 ± 1.1 mg midazolam (p=0.003), and less radiation exposure, 20.2 ± 59.5 versus 100.7 ± 98.5 mGy (p less then 0.001). Catheter occlusion was the most common complication (28.8%), followed by UTI (13.6%) and bladder spasm (8.0%). All but two complications were classified as Clavien-Dindo grade I or II. Catheter occlusion was more frequent in the trocar group (41.7% versus 16.9%, p=0.003), while bladder spasms were more frequent in the Seldinger group (13.8% versus 1.7%, p=0.018). Conclusion Suprapubic cystostomy via trocar is associated with faster procedure time, lower anxiolytic dose, and less radiation. While major complications are rare, catheter occlusion is a common occurrence that may be overlooked. Although we detected more occlusions with trocar technique, this may be confounded by a catheter-tract size discrepancy.Aims Skeletal muscle diseases have become to be the most common complication in patients with type 2 diabetic mellitus (T2DM). However, the effective therapies against skeletal muscle diseases are not yet available. Sulforaphane (SFN) is an organic isothiocyanate found in cruciferous plants. Our aim was to explore whether SFN could attenuate the skeletal muscle diseases in spontaneous type 2 diabetic db/db mice. Materials and methods The db/m and littermate db/db mice were treated with SFN or dimethyl sulfoxide. The grip strength of mice was measured by a grasping forcing machine. The electron transmission microscopy was used to perform the skeletal muscle. The western blot was used to detect the nuclear factor E2-related factor 2/heme oxygenase 1 (Nrf2/HO-1) signal pathway related proteins, and inflammatory and apoptotic associated proteins. The mRNA levels of anti-inflammatory and anti-oxidative relative genes were detected by RT-QPCR. Key findings We found that SFN could significantly increase the grip strength of the db/db mice. The lean mass and gastrocnemius mass were increased in the db/db mice after administration with SFN. Additionally, the db/db mice restored the skeletal muscle fiber organization after SFN treatment. Mechanistically, SFN could activate the Nrf2/HO-1 signal pathway, and downregulate the expression of inflammatory and apoptotic associated proteins. Furthermore, SFN could also regulate the mRNA levels of anti-inflammatory and anti-oxidative related genes. Significance Our results demonstrated that SFN can protect against skeletal muscle diseases in db/db type 2 diabetic mice and provide a potential drug to prevent skeletal muscle dysfunction in T2DM patients.