Objective:To evaluate the relationship between preoperative grade and postoperative changes of semen parameters following left inguinal varicocelectomy.Methods:This study included 44 patients undergoing left microsurg...Objective:To evaluate the relationship between preoperative grade and postoperative changes of semen parameters following left inguinal varicocelectomy.Methods:This study included 44 patients undergoing left microsurgical inguinal varicocelectomy.Internal spermatic veins were classified as large(4 mm or more in diameter),medium(2-4 mm),or small(2 mm or less).Changes in sperm activity,morphology and count were estimated perioperatively.The introperative findings and semen parameters were compared between varicocele groups of grades 2 and 3.Results:Both sperm motility and count improved significantly postoperatively(from(31.9±16.3)%to(47.3±15.5)%,from(28.1±28.1)106/mL to(52.1±74.2)×10^6/mL).In varicoceles with grade 2 and 3,significant differences were found in the number of large veins(0.4±0.6 vs.1.2±0.7,p<0.001)and ultrasonographic maximum diameters of spermatic vein in supine and standing positions(2.3±0.4 cm vs.2.8±0.6 cm,3.1±0.7 cm vs.3.9±0.7 cm,p=0.001 and 0.001 respectively).However no difference of changes in sperm motility and count was detected((16.3±13.5)%vs.(14.4±12.6)%,(30.5±84.4)×10^6/mL vs.(12.9±20.6)×10^6/mL respectively,p=0.65 and 0.40 respectively).Conclusion:Preoperative varicocele grade might not predict postoperative semen changes regardless of possible existence of anatomic and ultrasonographic associations.展开更多
The benefit of androgen-deprivation therapy （ADT） in combination with dose-escalated radiotherapy （DERT） for localized prostate cancer has not been determined in randomized studies. In this study, the benefit of A...The benefit of androgen-deprivation therapy （ADT） in combination with dose-escalated radiotherapy （DERT） for localized prostate cancer has not been determined in randomized studies. In this study, the benefit of ADT was assessed in patients uniformly treated with dose-escalated intensity-modulated radiation therapy （IMRT） to the prostate and seminal vesicles but not pelvis. In all, 419 patients with localized prostate adenocarcinoma underwent definitive IMRT （cumulative dose 78 Gy）, with 32.6%, 33.1%, 32.1%, and 2.1% having T1 through T4 disease, respectively, and 51.2% having high-risk disease. ADT was given to 76.1% of patients. With a median follow-up of 60 months, 5-year biochemical failure-free, disease-free, and overall survival rates were 87%, 86%, and 87%, respectively. T stage was an independent predictor of all three rates. Five-year pelvic nodal recurrence rate was 2.9%. ADT improved biochemical failure-free and disease-free survival but not overall survival. ADT showed benefit in high-risk disease but not intermediate-risk disease. Late gastrointestinal and genitourinary toxicities ≥ grade 2 occurred in 11.0% and 6.7%, respectively. In conclusion, DERT with 78 Gy yields good disease control and low rate of pelvic nodal recurrence. ADT improves disease-free survival in patients with high-risk but not intermediate-risk disease.展开更多
文摘Objective:To evaluate the relationship between preoperative grade and postoperative changes of semen parameters following left inguinal varicocelectomy.Methods:This study included 44 patients undergoing left microsurgical inguinal varicocelectomy.Internal spermatic veins were classified as large(4 mm or more in diameter),medium(2-4 mm),or small(2 mm or less).Changes in sperm activity,morphology and count were estimated perioperatively.The introperative findings and semen parameters were compared between varicocele groups of grades 2 and 3.Results:Both sperm motility and count improved significantly postoperatively(from(31.9±16.3)%to(47.3±15.5)%,from(28.1±28.1)106/mL to(52.1±74.2)×10^6/mL).In varicoceles with grade 2 and 3,significant differences were found in the number of large veins(0.4±0.6 vs.1.2±0.7,p<0.001)and ultrasonographic maximum diameters of spermatic vein in supine and standing positions(2.3±0.4 cm vs.2.8±0.6 cm,3.1±0.7 cm vs.3.9±0.7 cm,p=0.001 and 0.001 respectively).However no difference of changes in sperm motility and count was detected((16.3±13.5)%vs.(14.4±12.6)%,(30.5±84.4)×10^6/mL vs.(12.9±20.6)×10^6/mL respectively,p=0.65 and 0.40 respectively).Conclusion:Preoperative varicocele grade might not predict postoperative semen changes regardless of possible existence of anatomic and ultrasonographic associations.
文摘The benefit of androgen-deprivation therapy （ADT） in combination with dose-escalated radiotherapy （DERT） for localized prostate cancer has not been determined in randomized studies. In this study, the benefit of ADT was assessed in patients uniformly treated with dose-escalated intensity-modulated radiation therapy （IMRT） to the prostate and seminal vesicles but not pelvis. In all, 419 patients with localized prostate adenocarcinoma underwent definitive IMRT （cumulative dose 78 Gy）, with 32.6%, 33.1%, 32.1%, and 2.1% having T1 through T4 disease, respectively, and 51.2% having high-risk disease. ADT was given to 76.1% of patients. With a median follow-up of 60 months, 5-year biochemical failure-free, disease-free, and overall survival rates were 87%, 86%, and 87%, respectively. T stage was an independent predictor of all three rates. Five-year pelvic nodal recurrence rate was 2.9%. ADT improved biochemical failure-free and disease-free survival but not overall survival. ADT showed benefit in high-risk disease but not intermediate-risk disease. Late gastrointestinal and genitourinary toxicities ≥ grade 2 occurred in 11.0% and 6.7%, respectively. In conclusion, DERT with 78 Gy yields good disease control and low rate of pelvic nodal recurrence. ADT improves disease-free survival in patients with high-risk but not intermediate-risk disease.
