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Aim: It was the aim of this study to investigate the effect of a low testosterone/estradiol (T/E2) ratio and the normalization of this ratio by an aromatase inhibitor, anastrozole, on the treatment results of tamoxifen citrate (TAM) in idiopathic oligoasthenoteratozoospermic patients with a normal T/E2 ratio., Patients and Methods: 127 normogonadotropic men were included in this study. TAM (10 mg twice daily) was applied to 103 of the patients (group 1). The control group consisted of 25 patients who did not receive any treatment (group 2). After 3 months, TAM therapy was continued in 42 of the patients with a normal T/E2 ratio (group 1A). Of the remaining 61 patients with low ratios, 30 continued with TAM (group 1BTAM), while the remaining 31 patients underwent additional anastrozole therapy (1 mg/day) to TAM (group 1BANA)., Results: In the 3rd month of the study, while the sperm concentration and motility were found significantly improved in group 1 (p < 0.05), they were significantly lower in groups 1BTAM and 1BANA than in group 1A (p < 0.01). In the 6th month of the study, the mean T/E2 ratio was normal in group 1A and group 1BANA, but was lower than normal ranges in group 1BTAM. The sperm concentration and motility significantly increased in groups 1A and 1BANA (p < 0.05)., Conclusions: A significant decrease in the T/E2 ratio was seen in the majority of the patients during TAM treatment. Normalization of this ratio by addition of anastrozole to the treatment regimen improved the treatment outcomes. However, a placebo-controlled study is needed to confirm our results., (Copyright 2009 S. Karger AG, Basel.)

Aims: To investigate the relation between the findings of physical examination and ultrasonography and to evaluate whether venous diameter (VD) and retrograde flow volume (RFV) have any additional benefit to the diagnosis of suspected low-grade varicoceles., Methods: Five hundred and fifty-two patients who applied to our outpatient clinic due to infertility were assessed by physical examination (PE) and B-mode and color Doppler ultrasonography (CDUS). The correlation of VD and RFV with clinical grade and with each other was investigated in cases diagnosed as unilateral left varicocele., Results: Unilateral left varicocele was detected in 184 (33.3%) of 552 patients: mean VD of the subjects was 3.17 +/- 1.02 mm and mean RFV in 160 patients with a reflux was 24.01 +/- 13.76 ml/min. There was a correlation of clinical grade both with VD and RFV (r = 0.669, p < 0.001 and r = 0.603, p < 0.001, respectively). Considering VD and RFV, there was a significant difference between grade (G)1-G2 and G2-G3 (p < 0.001, p < 0.001, respectively) except between subclinic-G1 varicocele groups (p = 0.626, p = 0.529, respectively). The best cut-off point predicting the palpable varicocele on physical examination was 3.1 mm (sensitivity 58.2%) for VD and 14.5 ml/min (sensitivity 83.8%) for RFV., Conclusions: Measurement of RFV is more sensitive than that of VD in predicting palpable varicocele. However, neither of them seem to have any additional benefit to PE in clarifying the diagnosis of suspected low-grade varicoceles., (Copyright 2009 S. Karger AG, Basel.)

Introduction: Isolated teratozoospermia is rarely encountered in patients with clinically palpable varicocele, and the consequences of varicocelectomy remain unclear in these cases. In the current study, we assessed the effect of varicocelectomy on sperm morphology in a series of patients with infertility., Materials and Methods: The data obtained from 52 primary subfertile men with isolated teratozoospermia and clinical palpable varicocele were reviewed retrospectively. Varicocelectomy was performed on 29 patients, and the remaining 23 patients did not undergo any treatment (control group). The differences in sperm morphology assessed by using Kruger's strict criteria 3 months before and 12 months after varicocelectomy were taken into consideration for statistical analysis., Results: One patient who underwent varicocelectomy was excluded from the study due to varicocele recurrence. Thus, data obtained from the remaining 28 patients were evaluated. Following varicocelectomy, significant improvement was detected in the ratio of normal sperm forms (p < 0.001). While there was significant improvement in the ratio of sperm cells with head defects, tail defects and immature forms (p < 0.001), the ratio of sperm with acrosome and mid-piece defects was not changed (p > 0.05). While an overall spontaneous pregnancy was achieved in 5 of the 28 (17.8%) couples in the varicocelectomy group within 12 months after operation, neither improvement in sperm morphology nor pregnancy in the patients' partners was detected in the control group., Conclusion: Varicocelectomy caused a significant improvement in sperm morphology, particularly in immature forms and forms with head and tail defects evaluated by Kruger's classification.

Aims: Two-stage Fowler-Stephens orchiopexy has been accompanied by testicular atrophy in some cases but neither of the mechanisms responsible for testicular injury are clear, nor is there an effective agent that might prevent this injury. In this study we aimed to investigate the long-term effects of naloxone, a morphine antagonist, on testicular histopathology and oxidative stress after spermatic vessel ligation (SVL) in rats., Methods: 32 prepubertal rats were randomly divided into four equal groups: group 1: control (only bilateral orchiectomies were performed); group 2: sham-operated group; group 3: SVL, and group 4: SVL+naloxone (1 mg/kg twice daily for 1 month). One month postoperatively, bilateral orchiectomies were performed to evaluate histopathologic findings and measurement of malondialdehyde (MDA) and nitric oxide (NO) levels., Results: Considering group 3, left SVL resulted in significant tissue damage in both testes, more severe in the ipsilateral testis. The SVL resulted in a significant increase in testicular MDA levels of both testes in this group (p < 0.05). While the ipsilateral testicular NO levels of groups 2 and 3 were significantly lower than of group 1 (p < 0.05), the contralateral testicular NO levels of all these groups were similar. After naloxone therapy, while there was no significant improvement in ipsilateral testicular histopathology (p > 0.05), the contralateral testicular histopathology improved significantly (p < 0.05). However, naloxone did not change either testicular MDA or NO levels., Conclusions: The SVL led to bilateral testicular injury, and oxidative stress may be a reason for this injury. Naloxone significantly improved contralateral testicular injury without showing any antioxidative effect., (2008 S. Karger AG, Basel)