PURPOSE: We evaluated the effects of a pubovaginal sling (PVS), with a Martius labial fat pad interposition (MLFI), on patients with a female urethral diverticulum. MATERIALS AND METHODS: 23 consecutive cases with a female urethral diverticulum were retrospectively reviewed. The pre-operative evaluations included the history, physical examination, voiding cystourethrogram, cystoscopy, transperineal ultrasound and urodynamic studies to investigate the urethral function and the concomitant stress urinary incontinence. The treatment consisted of a transvaginal diverticulectomy alone, or with a PVS only, or combined with a MLFI. RESULTS: A transvaginal diverticulectomy only was performed, using a 3-layer closure, in nine patients (39.1%) and a concomitant PVS with a diverticulectomy in eight (34.8%) with stress urinary incontinence. A MLFI, combined with the above procedure, was performed in six patients (26.1%) with large defects of the urethra following the resection of diverticulum. No women having undergone a diverticulectomy with, or without, a PVS and MLFI had an urethrovaginal fistula, recurrent diverticulum or postoperative incontinence. CONCLUSIONS: In complicated cases, a simultaneous transvaginal diverticulectomy, pubovaginal sling and Martius labial fat pad interposition can be performed safely and effectively.
Adipose Tissue* ; Cystoscopy ; Diverticulum ; Female* ; Fistula ; Humans ; Physical Examination ; Retrospective Studies ; Ultrasonography ; Urethra ; Urinary Incontinence ; Urodynamics

Male infertility, due to pituitary or hypothalamic disease, which results in a deficiency of luteinizing hormone, follicle-stimulating hormone, or both, is less common than that due to primary testicular damage, but should be eminently treatable by replacement of either or both of these hormones. Exogenous gonadotropin, or pulsatile gonadotropin-releasing, hormone is now commonly used to treat male infertility due to hypogonadotropic hypogonadism. Here, we report on a male patient with an acquired hypogonadotropic hypogonadism, which developed after puberty, who underwent successful treatment with human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG).
Adolescent ; Chorionic Gonadotropin ; Fertility* ; Follicle Stimulating Hormone ; Gonadotropins ; Humans ; Hypogonadism* ; Hypothalamic Diseases ; Infertility ; Infertility, Male ; Luteinizing Hormone ; Male ; Puberty

OBJECTIVE: We investigated whether serum testosterone to estradiol ratio was decreased in infertile men and whether this condition can be corrected with oral aromatase inhibitor. METHOD: The serum testosterone to estradiol ratio of 26 men with testicular failure were compared with those of normal semen analysis parameter, 89 control reference group. All of 26 testicular failure group were diagnosed with the previous testicular biopsy. Then 46 men with oligospermia and/or asthenospermia were selected and treated with 1 mg of the aromatase inhibitor anastrozole (Arimidex(R)) orally once daily for 3 months. Testosterone to estradiol ratio and semen analyses were evaluated during anastrozole therapy. RESULTS: The testosterone level of testicular failure group was significantly lower and the testosterone to estradiol ratio was more decreased than normal semen parameter group. Forty six on-anastrozole group had significantly lower testosterone (4.6 versus 5.7 ng/ml, p<0.01) and higher estradiol (15.9 versus 23.4 pg/ml, p<0.01) than pre-anastrozole group, resulting in a decreased testosterone to estradiol ratio (0.21+/-0.07 versus 0.39+/-.15, p<0.01). Semen analyses before and during anastrozole treatment revealed significant increases in sperm count (35.5 versus 52.2 million sperm per ml, p<0.01) and motility (22.9% versus 29.3%, p<0.01). CONCLUSIONS: We identified infertile men with testicular failure had hormonal changes characterized by a decreased serum testosterone to estradiol ratio. The ratio can be corrected with aromatase inhibitor, resulting in a significant improvement in semen parameters.
Aromatase* ; Biopsy ; Estradiol ; Humans ; Infertility ; Male* ; Oligospermia ; Semen ; Semen Analysis ; Sperm Count ; Spermatozoa ; Testosterone

OBJECTIVE: We investigated whether serum testosterone to estradiol ratio was decreased in infertile men and whether this condition can be corrected with oral aromatase inhibitor. METHOD: The serum testosterone to estradiol ratio of 26 men with testicular failure were compared with those of normal semen analysis parameter, 89 control reference group. All of 26 testicular failure group were diagnosed with the previous testicular biopsy. Then 46 men with oligospermia and/or asthenospermia were selected and treated with 1 mg of the aromatase inhibitor anastrozole (Arimidex(R)) orally once daily for 3 months. Testosterone to estradiol ratio and semen analyses were evaluated during anastrozole therapy. RESULTS: The testosterone level of testicular failure group was significantly lower and the testosterone to estradiol ratio was more decreased than normal semen parameter group. Forty six on-anastrozole group had significantly lower testosterone (4.6 versus 5.7 ng/ml, p<0.01) and higher estradiol (15.9 versus 23.4 pg/ml, p<0.01) than pre-anastrozole group, resulting in a decreased testosterone to estradiol ratio (0.21+/-0.07 versus 0.39+/-.15, p<0.01). Semen analyses before and during anastrozole treatment revealed significant increases in sperm count (35.5 versus 52.2 million sperm per ml, p<0.01) and motility (22.9% versus 29.3%, p<0.01). CONCLUSIONS: We identified infertile men with testicular failure had hormonal changes characterized by a decreased serum testosterone to estradiol ratio. The ratio can be corrected with aromatase inhibitor, resulting in a significant improvement in semen parameters.
Aromatase* ; Biopsy ; Estradiol ; Humans ; Infertility ; Male* ; Oligospermia ; Semen ; Semen Analysis ; Sperm Count ; Spermatozoa ; Testosterone