Azoospermia with known causes – a retrospective assessment of clinical data within a 1 year period

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Azoospermia, the absence of sperm in ejaculated semen, is the most severe form of male-factor infertility and is present in approximately 5% of all investigated infertile couples. This condition can be classified as non-obstructive azoospermia (NOA, associated with spermatogenesis failure), and obstructive azoospermia (OA, characterized by an obstruction in the seminal tract and normal spermatogenesis). Whereas NOA accounts for 60% of azoospermic patients, OA accounts for around 40%. A precise diagnosis of azoospermia and systematic evaluation of the patient to establish the disease aetiology are needed to guideappropriate management options and to determine the associated cost benefits, risks and prognosis for treatment success. Aim of the study. Assessment of clinical data of azoospermia males evaluated during 2019 to show aetiology factors distribution within included patients. Materials and methods.. A retrospective record review of data collected from 46 azoospermic males was done. The mean age of infertility patients was 31.3 ± 5.2 years. All participants were examined using a standardized andrology workup, accompanied by a structured medical interview. The hormonal analysis included serum FSH, LH and testosterone and genetic assessment (AZF, CFRT and Karyotyping) was done. The diagnosis of azoospermia it was confirmed by centrifugation of a semen specimen for 15 min at room temperature with highpowered microscopic examination of the pellet and a centrifugation speed of at least 3,000 rot/min. TESE outcome and histology investigation of biopsies it was used for final distribution of the patients. Results. 21 (45.65%) patients with normal testis size, normal hormonal profile and no genetic defects were diagnosed. In this group, TESE outcome it was successful for 16 (76.19%) patients with normal histology exam, 3 (6.52%) patients with unsuccessful TESE outcome and meiotic arrest on histological results, and 2 (4.34%) patients with unsuccessful TESE outcome and no data on histologic phenotype. 17 (36.95%) patients with bilateral or unilateral testis atrophy, abnormal hormonal profile and no genetic defects. In this group just for 5 (29.41%) patients it was performed TESE and all 5 patients were found with negative sperm extraction and histologic phenotype – mixed atrophy and Sertoli cell-only syndrome. In the same group 10 (21.73%) patients with the history of Mumps orchitis in the post-pubertal period, bilateral testis atrophy and hypergonadotropic hypogonadism. 8 (17.39%) patients with genetic defects: 4 (8.69%) with Klinefelter syndrome, 3 (6.52%) with AZF deletion (1 patient with AZFa deletion and 2 patients with AZFbc) and one patient with CFTR mutation. Conclusions. Patients with bilateral or unilateral testis atrophy and abnormal hormonal profile should be karyotyped and screened for Y chromosome microdeletions; these analyses lead to a diagnosis in more than 15% of cases and contraindicate a testicular biopsy when a full AZFa and/or AZFb microdeletion is present. Percentage of patients with the history of Mumps orchitis is much higher than in other populations because of mumps epidemic parotitis in 2008

Descriptive study of diagnostic findings in male with severe oat syndrome and azoospermia

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroduction. It has been established that one of the most prevalent causes of male subfertility is oligoasthenoteratozoospermia (OAT). About 1% of men in the general population and 10%– 15% of men who are infertile have azoospermia. Azoospermia exists in two forms: obstructive and non-obstructive. The diagnosis of male infertility, ranging from mild OAT to complete azoospermia, requires a comprehensive evaluation to ascertain the underlying causes. Aim of study. The aim of the study was to do the analytical description of diagnostic findings in male with severe OAT syndrome and azoospermia. Methods and materials. This retrospective analysis encompassed 90 patients diagnosed with severe OAT syndrome and azoospermia. Inclusion criteria were based on semen quality parameters: sperm concentration ≤5 million/mL, inclusive of azoospermia and cryptozoospermia. Evaluated factors included age, body mass index (BMI), comprehensive semen analysis, serum vitamin D3 levels, scrotal ultrasonography, and targeted genetic assessments (karyotyping, AZF microdeletions, and CFTR mutations). Participants were split into two subgroups, with 45 individuals in each, for the qualitative and quantitative analysis of seminal material in the study group: severe OAT and azoospermia. Results. The average age was 32.83±5, calculated BMI (27.1±4) indicating overweight. In the group with severe OAT, the average values for both the concentration and total sperm count were 1.77±2 and 5.59±8, respectively. The total motility (12.64±16), progressive motility (7.93±12), vitality (13.64±18), and morphology (1.02±2) were significantly reduced. In this group, agglutination was absent, and mild aggregation was present in 4.4% of cases. An elevated number of germ cells and leukocytes in semen (4.1±8 and 1.71±3.3, respectively) were observed. Vitamin D levels were deficient (29.37±9.3 ng/ml). The levels of FSH and LH were elevated (14.55±13.22 IU/L and 8.42±5.3 IU/L, respectively). The ultrasound evaluation of the scrotum was conducted, estimating the average volume of the right testicle (12.50±5.47) and the left testicle (12.30±5.09). Changes in echotexture and echogenicity of the right testicle were identified in 24.6% and 31.5%, respectively. For the left testicle, altered echotexture was present in 15.6% and abnormal echogenicity in 25.5%. Testicular calcifications were present on the right in 4.4% and on the left in 7.7%. Varicocele on the left of varying degrees was identified in 17.7%. Genetic evaluations revealed Y chromosome microdeletions in 4.4%, with 92.2% having a normal karyotype and 7.8% exhibiting karyotypic abnormalities. A single case of a CFTR gene mutation was identified. Conclusion. Males with severe OAT syndrome and azoospermia has higher BMI, FSH and LH levels comparable with normal range limit, but deficit of vitamin D being noticed. Genetic abnormalities were found in 13.3% of the cases. is oligoasthenoteratozoospermia (OAT). About 1% of men i n the general population and 10%– 15% of men who are infertile have azoospermia. Azoospermia exists in two forms: obstructive and non-obstructive. The diagnosis of male infertility, ranging from mild OAT to complete azoospermia, requires a comprehensive evaluation to ascertai n the underlying causes. Aim of study. The aim of the study was to do the analytical description of diagnostic findings in male with severe OAT syndrome and azoospermia. Methods and materials. This retrospective analysis encompassed 90 patients diagnos ed with severe OAT syndrome and azoospermia. Inclusion criteria were based on semen quality parameters: sperm concentration ≤5 million/mL, inclusive of azoospermia and cryptozoospermia. Evaluated factors included age, body mass index (BMI), com prehensive semen analysis, serum vitamin D3 levels, scrotal ultrasonography, and targeted gene tic assessments (karyotyping, AZF microdeletions, and CFTR mutations). Participants were spl it into two subgroups, with 45 individuals in each, for the qualitative and quantitative analy sis of seminal material in the study group: severe OAT and azoospermia. Results. The average age was 32.83±5, calculated BMI (27.1±4) indicating overweight. In the group with severe OAT, the average values for both the conc entration and total sperm count were 1.77±2 and 5.59±8, respectively. The total motility (12.64±16), progres sive motility (7.93±12), vitality (13.64±18), and morphology (1.02±2) were significantly reduc ed. In this group, agglutination was absent, and mild aggregation was present in 4.4% of cases. An elevated number of germ cells and leukocytes in semen (4.1±8 and 1.71±3.3, respect ively) were observed. Vitamin D levels were deficient (29.37±9.3 ng/ml). The levels of FSH a nd LH were elevated (14.55±13.22 IU/L and 8.42±5.3 IU/L, respectively). The ultrasound evaluation o f the scrotum was conducted, estimating the average volume of the right testicle ( 12.50±5.47) and the left testicle (12.30±5.09). Changes in echotexture and echogenicity of the right testi cle were identified in 24.6% and 31.5%, respectively. For the left testicle, altered echotexture wa s present in 15.6% and abnormal echogenicity in 25.5%. Testicular calcifications were prese nt on the right in 4.4% and on the left in 7.7%. Varicocele on the left of varying degrees was identif ied in 17.7%. Genetic evaluations revealed Y chromosome microdeletions in 4.4%, with 92.2% having a normal karyotype and 7.8% exhibiting karyotypic abnormalities. A single case of a CFT R gene mutation was identified. Conclusion. Males with severe OAT syndrome and azoospermia has hig her BMI, FSH and LH levels comparable with normal range limit, but deficit o f vitamin D being noticed. Genetic abnormalities were found in 13.3% of the cases

Histological outcome after conventional testicular sperm extraction vs microsurgical technics in patients with azoospermia

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroduction. The 2021 AUA/ASRM Guidelines on Diagnosis and Treatment of Infertility in Men recommend micro-TESE for men with NOA undergoing sperm retrieval. The 2021 European Association of Urology (EAU) Guidelines on Male Sexual and Reproductive Health recommend conventional or micro-TESE. Aim of study. The study aimed to perform a comparative analysis of the success sperm retrieval rate and histological outcome between tissue samples obtained through conventional and microTESE. Methods and materials. The study included 45 men with a mean age of 33.4±5.6 years. According to the internal protocol, patients with presumed obstructive azoospermia underwent conventional TESE (22 men), while those with non-obstructive azoospermia underwent microTESE (23 men). The criteria for presuming the type of azoospermia were: medical history, testicular volume, hormones and genetic findings. A comparative analysis of the success sperm retrieval rate and histological outcome was conducted in both groups. Results. In the group undergoing classical extraction intervention, the success sperm retrieval rate was 81.8% (18), respectively 18.2% (4) yielding a negative result. Histological analysis revealed normal spermatogenesis in 68.2% (15), reduced spermatogenesis in 22.7% (5), and maturation arrest in 9.1% (2). We observed that 9.1% (2) with reduced spermatogenesis had a negative success rate due to the classical method used. In the group subjected to micro-TESE methods, the success rate was 21.7% (5) versus 78.3% (18) where sperm cells were not identified. Histological examination identified mixed atrophy in 13.6% (3), hypo-spermatogenesis in 8.7% (2), Sertoli cell-only syndrome in 56.5% (13), and tubular fibrosis in 21.2% (5). Conclusion. Both conventional TESE and micro-TESE are effective methods when patients are pre-selected based on the presumed type of azoospermia. For better efficacy, the possibility of switching to the microsurgical method should be considered for patients planned for the classical method. recommend micro-TESE for men with NOA undergoing sperm retri eval. The 2021 European Association of Urology (EAU) Guidelines on Male Sexual and Repr oductive Health recommend conventional or micro-TESE. Aim of study. The study aimed to perform a comparative analysis of the success sperm retrieval rate and histological outcome between tissue samples obt ained through conventional and microTESE. Methods and materials. The study included 45 men with a mean age of 33.4±5.6 years. According to the internal protocol, patients with presumed o bstructive azoospermia underwent conventional TESE (22 men), while those with non-obstruc tive azoospermia underwent microTESE (23 men). The criteria for presuming the type of azo ospermia were: medical history, testicular volume, hormones and genetic findings. A compa rative analysis of the success sperm retrieval rate and histological outcome was conducted in bot h groups. Results. In the group undergoing classical extraction interventio n, the success sperm retrieval rate was 81.8% (18), respectively 18.2% (4) yielding a negative result. Histological analysis revealed normal spermatogenesis in 68.2% (15), reduced spermatogenesis in 22.7% (5), and maturation arrest in 9.1% (2). We observed that 9.1% (2) with reduced spe rmatogenesis had a negative success rate due to the classical method used. In the group subjected to micro-TESE methods, the success rate was 21.7% (5) versus 78.3% (18) where sperm cells were not ide ntified. Histological examination identified mixed atrophy in 13.6% (3), hypo-spermatogen esis in 8.7% (2), Sertoli cell-only syndrome in 56.5% (13), and tubular fibrosis in 21.2% ( 5). Conclusion. Both conventional TESE and micro-TESE are effective me thods when patients are pre-selected based on the presumed type of azoospermia. Fo r better efficacy, the possibility of switching to the microsurgical method should be considere d for patients planned for the classical method

Metastatic mature teratoma association with azoospermia due to bilateral cryptorchidism and testicular benign teratoma: case report

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroduction. Azoospermia, the most severe type of male infertility, is caused by numerous untreatable testicular problems. Approximately 10% to 15% of all male infertile individuals suffer from azoospermia, which affects approximately 1% of all men. The phenomenon known as growing teratoma syndrome is considered to be relatively uncommon. It is characterized by the enlargement of a residual mass that has been histologically confirmed to be a mature teratoma. Case statement. We present the case of a 37-year-old male with difficulty conceiving. The patient has a history of bilateral cryptorchidism, for which orchidopexy was performed at the age of 6. 4 years ago, the patient presented a testicular mass. Scrotal ultrasonography (sUSG) revealed an asymmetric enlargement of the right testicle with multiple microcalcifications and peripheral vascularity, measuring 3.2x3.0x2.2 cm, indicative of primary testicular cancer, with normal serum tumor markers. Semen evaluation revealed azoospermia. Subsequent chest and abdomen contrast enhanced CT (CECT) scans showed an unremarkable chest scan, while the abdomen CECT identified a thin-walled, well-circumscribed, cystic mass compressing the anterior aspect of the inferior vena cava, measuring up to 7 cm in diameter. Right orchiectomy was performed. The surgical pathology report (SPR) reveals benign teratomatous elements within the testis, a central cystic component containing necrotic material, that occupies ~75% of testicular volume. The remaining seminiferous tubules show absent spermatogenesis and Leydig cell hyperplasia. Afterwards, resection of the retroperitoneal mass was performed. The SPR confirms the diagnosis of a mature teratoma with metastasis to a precaval lymph node. Notably, paracaval, intra-aorto-caval, and para-aortic lymph nodes show no signs of metastasis. The patient maintained regular screening, undergoing abdomen and pelvis CECT scans biannually. The present patient examination involved the assessment of hormones, spermogram and sUSG. The relevant abnormal hormonal results: Tt-191, FSH-65, LH-25, Prolactin-732. The spermogram evidences azoospermia. sUSG reveals left testicle volume 3.4 cm3, irregular contour, inhomogeneous “geographic” echo structure. Doppler USG reveals increased vascularity. Micro-TESE was performed on left testis with negative sperm retrieval results, histology – tubular fibrosis and Sertoli cell-only syndrome. Discussions. Metastatic mature teratoma is frequently observed in both radiological and histopathological examinations following chemotherapy for metastatic non-seminomatous germ cell cancers. The primary explanation for these remaining tumors is the distinct resistance of teratomas to chemotherapy compared to the heightened sensitivity of the embryonal components. Resection of metastatic mature teratomas is recommended due to their malignant potential and occasional progression to growing teratoma syndrome, which involves the invasion of surrounding structures. Conclusion. Azoospermia due bilateral cryptorchidism is a common clinical situation. However, there’s no evidence of concomitant metastatic mature teratoma and testicular benign teratoma related to this condition. untreatable testicular problems. Approximately 10% to 15% of all male infertile individuals suffer from azoospermia, which affects approximately 1% of all men. The phenomenon known as growing teratoma syndrome is considered to be relatively uncommon. It is cha racterized by the enlargement of a residual mass that has been histologically confirmed to be a mature terat oma. Case statement. We present the case of a 37-year-old male with difficulty c onceiving. The patient has a history of bilateral cryptorchidism, for which orchidopexy w as performed at the age of 6. 4 years ago, the patient presented a testicular mass. Scrotal ultrasonograp hy (sUSG) revealed an asymmetric enlargement of the right testicle with multiple microcal cifications and peripheral vascularity, measuring 3.2x3.0x2.2 cm, indicative of primary testicular cancer, with normal serum t umor markers. Semen evaluation revealed azoospermia. Subsequent chest and abdomen contrast enhanced CT (CECT) scans showed an unremarkable chest scan, while the abdome n CECT identified a thin-walled, well-circumscribed, cystic mass compressing the anterior a spect of the inferior vena cava, measuring up to 7 cm in diameter. Right orchiectomy was performed. The surgi cal pathology report (SPR) reveals benign teratomatous elements within the testis, a central cy stic component containing necrotic material, that occupies ~75% of testicular volume. The remaining seminiferous tubul es show absent spermatogenesis and Leydig cell hyperplasia. Afterwards, resecti on of the retroperitoneal mass was performed. The SPR confirms the diagnosis of a mature teratoma with metastasi s to a precaval lymph node. Notably, paracaval, intra-aorto-caval, and para-aortic lymph nodes s how no signs of metastasis. The patient maintained regular screening, undergoing abdomen and pel vis CECT scans biannually. The present patient examination involved the assessment of hormone s, spermogram and sUSG. The relevant abnormal hormonal results: Tt-191, FSH-65, LH-25, Prolacti n-732. The spermogram evidences azoospermia. sUSG reveals left testicle volume 3.4 cm3, irregul ar contour, inhomogeneous “geographic” echo structure. Doppler USG reveals increased vascularity. Micro- TESE was performed on left testis with negative sperm retrieval results, histol ogy – tubular fibrosis and Sertoli cell-only syndrome. Discussions. Metastatic mature teratoma is frequently observed in both ra diological and histopathological examinations following chemotherapy for metasta tic non-seminomatous germ cell cancers. The primary explanation for these remaining tumors is th e distinct resistance of teratomas to chemotherapy compared to the heightened sensitivity of the embryonal components. Resection of metastatic mature teratomas is recommended due to their mali gnant potential and occasional progression to growing teratoma syndrome, which involves the invasion of surrou nding structures. Conclusion. Azoospermia due bilateral cryptorchidism is a common clinical situation. However, there’s no evidence of concomitant metastatic mature teratoma and testicular benign teratoma related to this condition

Criptorhidia la adult – cauza infertilitații masculine

Introducere: Criptorhidia-cea mai frecventă anomalie congenitală a organelor genitale masculine, întâlnită la adulți aproximativ 1% cazuri. Tratamentul chirurgical este indicat pînă la vîrsta de 1 an, postpubertal persistă riscul de dezvoltare al complicațiilor: cancerul testicular și infertilitatea. Scopul: Studierea fertilității la pacienți adilți cu criptorhidie. Materiale și metode: Pe baza clinicii de Urologie, a fost evaluat 27 pacienți adulți cu criptorhidie, tratați în perioada anilor 2015-2020. Vîrsta pacienților 16-50 ani, cu o medie de 24±7 ani. Evaluarea pacienților pre și postoperator a inclus examenul fizic, ecografic, spermograma, hormonii sexuali masculini, markerii tumorali. Rezultate și discuții: Au fost diagnosticați 15 pacienți cu criptorhidie unilaterală pe stânga (55%), 11 pacienți pe dreapta (41%) și doar 1 pacient (4%) bilaterală. Preoperator la 21 pacienți (77%) s-a depistat dereglări ale spermogramei, dintre care la 12 pacienți (44%) azospermie. Orhectomia s-a efectuat la 10 pacienți (37%), iar orhidopexia la 17 pacienți (63%). Rezultatul examenului histologic al testicolului înlăturat a relevat atrofia și scleroza țesutului testicular. Postoperator nici la un pacient nu s-a determinat ameliorarea parametrilor spermogramei. Concluzii: Infertilitatea masculină se întâlnește mai des la pacienți cu criptorhidie. Tratamentul chirurgical cu scop de prevenire a malignizării testicolului necoborît este mai mult recomandat, în peroada postoperatorie poate fi deteriorat parametrii spermogramei. Înainte de orhidopexie la adult este necesară crioconservarea materialului seminal

Comparative epidemiology and resistance trends of common urinary pathogens

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Urinary tract infections (UTIs) are some of the most common infections in human medicine, affecting a large patient population (around 150 million cases/year) to various extents, irrespective of age and gender. The principal cause of UTIs (>80%) are uropathogenic Escherichia coli and Klebsiella species both in the community and nosocomial settings. The assessment of local data on the prevalence and resistance is essential to evaluate trends over time and to make adjustments on the empirical treatment protocol. Aim of the study. Assessment of epidemiology and resistance trends of most common urinary pathogens in order to create a hospital-specific antibiogram and practical recommendation on first chose antibiotics for empirical and prevention treatment.Materials and methods.. A retrospective record review of data collected from laboratory results of 1299 patients admitted to the Urology Department of Republican Clinical Hospital between April 2019 and October 2019 was done. The outcome of interest was the antibiotic susceptibility of bacterial isolates from the patient’s urine probes, before or after planned surgery. Pathogens the selection was done according to the highest incidence observed: Escherichia Coli, Klebsiella pneumonia, Proteus Mirabilis and Pseudomonas aeruginosa. The isolates were analyzed for susceptibility and resistance to 4 antimicrobial groups (Cephalosporins, Carbapenems, Fluoroquinolones, Aminoglycosides) and 3 miscellaneous agents (Nitrofurantoin, Fosfomycin trometamol, Trimethoprim-sulfamethoxazole). Results. A total of 221 (17%) isolates from urines, of 4 selected bacteria were analyzed: Escherichia Coli (43.43%), Klebsiella pneumonia (33,48%), Proteus Mirabilis (12.66%) and Pseudomonas aeruginosa (5.88%). According to received data, the highest susceptibility for Escherichia Coli, Klebsiella pneumonia and Proteus Mirabilis it was for Fosfomycin with 92.7%, 63.51% and 89.28 respectively. Pseudomonas aeruginosa sensitivity it was highest for Amikacin followed by Carbapenems and Cefalosporins with 76.92%, 61.53% and 53.84% respectively. Klebsiella pneumonia was found with the lowest susceptibility to Cephalosporins (29.72%), Fluoroquinolones (27.02%) and Nitrofurantoin (18.91%) – those antibiotics that are most commonly used as prophylaxis and empirical treatment. If we consider the general impact of Amikacin on selected bacteria, we see that almost 75% of all isolates are sensitive to it. Conclusions. Statistically significant increases in resistance to commonly used antibiotics were observed. In this respect, we consider that the choice of empiric antibiotic therapy should be selected based on local susceptibility profiles. The choice of antimicrobial drugs should be reconsidered when it comes to prevention or empiric treatment, as most commonly used groups of antibiotics are no more effective. From this specific study, we can conclude that Amikacin and Fosfomycin trometamol should be considered as first chose antibiotics for empirical and prevention treatment

Criptorhidia la adult – cauza infertilității masculine

Department of Urology and Surgical Nephrology, Nicolae Testemitanu SUMPhBackground. Cryptorchidism - the most common congenital anomaly of the male genitals in children. Prevalence in adults up to 1%. Surgical treatment is indicated until the age of 1 year, but the risk of developing complications persists: testicular cancer and infertility. Objective of the study. Study of fertility in adult patients with cryptorchidism. Material and Methods. Evaluation of the data from specialized literature and the activity of the Urology Department, included 27adult patients with cryptorchidism, treated during 2015-2020. The age of patients was between 16-50years, with an average of 24±7years. Evaluation of pre- and postoperative patients included physical examination, ultrasound, spermogram, male sex hormones, tumor markers. Results. Were diagnosed 15 patients with unilateral cryptorchidism on the left side(55%), 11 patients on the right side (41%) and only 1 patient (4%) with bilateral cryptorchidia. Preoperative, sperm disorders were detected in 21 patients (77%), of which in 12 patients (44%) azospermia. Orhectomy was performed in 10 patients (37%) and orhidopexy was performed in 17 patients (63%). The result of the histological examination of removed testicle revealed atrophy and sclerosis of the testicular tissue. Postoperative, no improvement in sperm parameters was determined in one patient, in 8 patients (48%) with orhodopexy the spermogram was deteriorated. Conclusion. Male infertility is present in most adults with cryptorchidism. Surgical treatment in order to prevent malignancy of the undescended testicle, deteriorates the parameters of the spermogram. Cryopreservation of semen is required before adult orhidopexy.Introducere. Criptorhidia este cea mai frecventă anomalie congenitală a organelor genitale masculine la copii. Prevalența la adulți este sub 1%. Tratamentul chirurgical este indicat până la vârsta de 1 an, dar persistă riscul de dezvoltare al complicațiilor: cancerul testicular și infertilitatea. Scopul lucrării. Studierea fertilității la pacienții adulți cu criptorhidie. Material și Metode. Evaluarea datelor din literatura de specialitate și activitatea clinicii de Urologie, a inclus 27 de pacienți adulți cu criptorhidie, tratați în perioada anilor 2015-2020. Vârsta pacienților a variat între 16-50 ani, cu o medie de 24±7 ani. Evaluarea pacienților pre și postoperator a inclus examenul fizic, ecografic, spermograma, hormonii sexuali masculini, markerii tumorali. Rezultate. Au fost diagnosticați 15 pacienți cu criptorhidie unilaterală pe stânga (55%), 11 pacienți pe dreapta (41%) și doar 1 pacient (4%) cu criptorhidie bilaterală. Preoperator la 21 pacienți (77%) s-au depistat dereglări ale spermogramei, dintre care la 12 pacienți (44%) azoospermie. Orhiectomia s-a efectuat la 10 pacienți (37%), iar orhidopexia s-a efectuat la 17 pacienți (63%). Rezultatul examenului histologic al testiculului înlăturat a relevat atrofia și scleroza țesutului testicular. Postoperator nici la un pacient nu s-a determinat ameliorarea parametrilor spermogramei, la 8 pacienți (48%) cu orhidopexie -spermograma s-a deteriorat. Concluzii. Infertilitatea masculină este prezentă la mare majoritatea a adulților cu criptorhidie. Tratamentul chirurgical cu scop de prevenire a malignizării testicolului necoborât, deteriorează parametrii spermogramei. Înainte de orhidopexie la adult este necesară crioconservarea materialului seminal

Comparative resistance trends of common urinary pathogens at 2 years distance in the same population

Introduction. Urinary tract infections are some of the most common infections in human medicine, affecting a large patient population (around 150 million cases/year) to various extents, irrespective of age and gender. Among the reasons underlying this increased mortality associated with antimicrobial resistance, it should be mentioned that the high levels of antibiotic resistance strongly contribute to initial inappropriate empiric antibiotic treatments and the subsequent delay in the implementation of adequate treatments. The assessment of local data on the prevalence and resistance is essential to evaluate trends over time and to make adjustments to the empirical treatment protocol. Aim of study. Empirical treatment and prophylaxis of urinary tract infections at this stage is based on old principles that guide us to the use of first-line antibiotics and second-line, third-line antibiotics, etc. Due to the long and uncontrolled use of antibiotics according to these principles, the use of first-line antibiotics often has a statistical efficacy of less than 30%. Regular evaluation of antimicrobial resistance trends should be done in order to adjust the first-line preparations according to the highest rate of efficacy. Methods and materials. A retrospective record review of data collected from laboratory results of 1299 patients admitted to the Urology Department of Republican Clinical Hospital in 2019 vs 1250 patients in 2021 was done. It was selected and compared the highest incidence bacteria commonly found in bought groups: Escherichia Coli, Klebsiella pneumonia, Proteus Mirabilis and Pseudomonas aeruginosa. The isolates were analyzed for susceptibility and resistance to main antimicrobial groups and agents used for urinary tract infection treatment. Results. A total of 221 (17%) vs 154 (12.32%) of 4 selected bacteria was found in the 2019 group and in the 2021 group. From selected bacteria, Escherichia Coli were reported in 43.43% vs 39.61%, Klebsiella pneumonia 33,48% vs 37.01%, Proteus Mirabilis 12.66% vs 12.34% and Pseudomonas aeruginosa 5.88% vs 11.04%. In the 2019 group the Escherichia Coli, Klebsiella pneumonia and Proteus Mirabilis susceptibility to Fosfomycin was 92.7%, 63.51% and 89.28 respectively. In the 2021 group was found significant reduced susceptibility to Fosfomycin in Escherichia Coli (62.9%) and Klebsiella pneumonia (43.1%) but significant increase in Pseudomonas aeruginosa (94.5%). Pseudomonas aeruginosa sensitivity changed in time for Amikacin, Carbapenems and Cephalosporins with 76.92% vs 86.6%, 61.53% vs 33.3% and 53.84% vs 46.6%, respectively. Klebsiella pneumonia with the lowest susceptibility to Cephalosporins (29.72% vs 13.7%), Fluoroquinolones (27.02% vs 25.4%) and Nitrofurantoin (18.91% vs 31.3%) – those antibiotics that are most commonly used as prophylaxis and empirical treatment. The highest sensitivity of selected bacteria was found to Amikacin in bought groups with 75% and 80.53% respectively. Conclusion. Comparative data showed statistically significant changes over time in bacterial susceptibility to commonly used antibiotics. Two analyzed groups from the same population at two years distance showed low efficacy of empirically used antibiotics as treatment and prophylaxis (Cephalosporins, Fluroquinolones and Nitrofurantoin). In this respect, we consider that the choice of empiric antibiotic therapy should be selected based on local susceptibility profiles. From this specific study, we can conclude that Amikacin should be considered as the first chosen antibiotic for empirical and prevention treatment in this specific population

Comparative clinical aspects of unilateral vs bilateral acute mumps orchites

Introduction. Mumps is a contagious disease worldwide caused by the Mumps virus (MuV). In addition to the typical painful parotids in infected men, orchitis is the most common extra-salivary inflammation and an important etiological factor of male infertility caused by mumps. The data about evolution of the clinical manifestations in the acute phase of mumps orchitis is limited, thus making it more difficult to define the pathological mechanisms with a significant impact on post-mumps testicular dysfunction. Is not clear which of the unilateral or bilateral mumps orchitis disrupt the testicular function, that is why this study is focused on comparative data from mumps orchitis clinical evolution. Aim of study. Although mumps is a vaccine-preventable disease, sporadic outbreaks have occurred worldwide, even in highly vaccinated populations. In the Republic of Moldova vaccination of children 12 months old against Mumps was started in 1983. Second vaccination at 7 years was introduced in 2000. At the end of 2007 – beginning of 2008 it was an epidemic with 29,357 of mumps infections, 2/3 of infected were vaccinated with 1 dose, 1/3 – unknown status, just 4% with known 2 dosages. Methods and materials. A retrospective record review of the case files of 203 patients (15 to 44 years old; mean age 20 years) with unilateral (148 patients) and bilateral mumps orchites (55 patients) admitted to infectious diseases department between end of 2007 and 2008 was done. The following clinical manifestations were analyzed: testicular swelling, testicular pain, scrotal hyperemia and fever. The data on the time of onset and duration of maintenance of symptoms in unilateral and bilateral mumps orchitis were compared. Results. Testicular swelling was reported in the first 3 days, first 10 days and after 10 days of disease in 13 patients (23.63%), 50 patients (90.9%) and 5 patients (9.09%) respectively in those with bilateral orchites vs 34 patients (23.28%), 129 patients (88.35%) and 17 patients (11.64%) respectively in those with unilateral orchites (2 patients did not present testicular swelling). Testicular pain at 3, 10 and after 10 days of parotitis: 9 patients (16.36%), 50 patients (90.9%) and 5 patients (9.09%) respectively in bilateral vs 32 patients (22.53%), 124 patients (87.32%) and 18 patients (12.67%) respectively in unilateral (in unilateral group 6 patients - no testicular swelling). Scrotal hyperemia has been occurred in the first 7 days in 39 patients (70.9%) with bilateral vs 85 patients (60.71%) in unilateral (8 patients with no scrotal hyperemia in unilateral group). Fever at 3, 10 and after 10 days of parotitis: 29 patients (59.18%), 47 patients (95.91%) and 2 patients (4.08%) respectively in bilateral (6 patients – with no fever) vs 76 patients (55.07%), 128 patients (92.75%) and 10 patients (7.24%) respectively in unilateral (10 patients – with no fever). Conclusion. Testicular swelling, pain and scrotal hyperemia have no significant differences on the time of onset, with an average duration of symptoms of 8.5 days in bilateral orchites vs 7.2 in unilateral mumps orchites. The time of onset of fever was found in the first 3 days of parotitis in more than a half of the patients, with an average duration of 3.5 days in bought groups

Testosterone deficiency in men of reproductive age

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. La moment, observăm o adresabilitate tot mai mare a bărbaților tineri (18 – 49 de ani) cu simptome de nivel scăzut de testosteron (T), confirmate prin analize de laborator. Activitatea sexuală redusă, disfuncția erectilă, absența erecțiilor matinale și scăderea dorinței sexuale sunt cele mai predictive și frecvente simptome raportate. Scopul lucrării. Identificarea celor mai importante aspecte în diagnosticul, tratamentul și monitorizarea deficitului de testosteron la bărbații de vârstă fertilă. Material și metode. Analiza literaturii de specialitate utilizând bazele de date PubMed, Hinari, SpringerLink și Scopus, selectând articolele ce elucidează diagnosticul și tratamentul deficitului de testosteron la bărbații de vârstă reproductivă. Rezultate. O treime dintre bărbații infertili sub 50 de ani sunt hipogonadali. Corelarea spermogramei cu nivelul de testosteron a identificat deficitul la 16,7% dintre bărbații cu azoospermie obstructivă, 45% cu azoospermie non-obstructivă, 42,9% cu oligozoospermie și/sau astenozoospermie și 35,3% cu parametri normali ai spermei. În cazurile de afectare a SHBG seric, măsurarea T liber este necesară. Concluzii. Deficitul de testosteron la bărbații de vârstă fertilă este frecvent și asociat cu diverse forme de infertilitate. Terapia de substituție cu testosteron îmbunătățește simptomele hipogonadismului, dar necesită monitorizare pentru a evita efectele negative asupra funcției testiculare. O abordare integrată în diagnostic și tratament este esențială.Introduction. Currently, we observe an increasing number of young men (18 – 49 years) with symptoms characteristic of low testosterone (T) levels, subsequently confirmed by laboratory tests. Reduced sexual activity, erectile dysfunction, absence of morning erections, and decreased sexual desire are the most predictive symptoms for low T levels and the most frequently reported symptoms. Objective of the study. Identification of the most important aspects in the diagnosis, treatment, and monitoring of testosterone deficiency in men of reproductive age. Material and methods: A literature review was conducted using the databases PubMed, Hinari, SpringerLink, and Scopus (Elsevier), selecting articles that elucidate the aspects of diagnosis and treatment of testosterone deficiency in men of reproductive age. Results. It was found that one-third of infertile men under 50 years old are hypogonadal. Correlating sperm analysis results with testosterone levels identified a deficiency in 16.7% of men with obstructive azoospermia, 45% of men with non-obstructive azoospermia, 42.9% of men with oligozoospermia and/or asthenozoospermia, and 35.3% of men with normal sperm parameters. Given that serum SHBG concentration can be affected by liver or kidney disease, thyroid dysfunction, or other endocrine disorders, measuring free T, either calculated or by equilibrium dialysis, is necessary. Conclusions. Testosterone replacement therapy, although effective in addressing most symptoms of hypogonadism, requires careful monitoring to avoid negative effects on endogenous testicular function. An integrated approach in diagnosis and treatment is essential for effectively managing this deficiency