The value of testicular sperm extraction (TESE) by microdissection was evaluated according to its physiological consequences compared with open, classic surgical biopsy in the same patient. A total of 100 patients with non-obstructive azoospermia and bilateral identical testicular histology underwent bilateral diagnostic TESE via the conventional method on one side and the microsurgical method on the other side. The spermatozoa recovery rate by microdissection TESE was significantly higher than by conventional TESE (47 and 30% respectively; P < 0.05). In order to assess the safety of this new procedure, 60 patients were followed-up ultrasonographically for 1, 3 and 6 months. Acute and chronic complications were significantly lower in the microsurgical side compared with the conventional side (15 and 58.3% respectively and 3 and 30% respectively; P < 0.05). Segmental devascularization was detected in seven testes operated on conventionally, and in two testes operated on microsurgically. However, permanent devascularization could not be detected in any patient after 6 months. These findings suggest that microdissection TESE is not devoid of complications, but that it is relatively safer than the conventional technique and improves sperm yield significantly in patients with non-obstructive azoospermia.

Introduction Penile fracture is described as a traumatic rupture of the tunica albuginea because of blunt injury of an erect penis. Aim To assess the etiology, treatment maneuvers, and late effects of penile fractures treated by surgical repair. Methods Thirty-three patients diagnosed provisionally as having fractured penises. Thirty patients were managed by immediate surgical repair and three by delayed repair. Main Outcome Measures International Index of Erectile Function-5 for married cases and Single-question Self-report of Erectile Dysfunction questionnaires and recording complications after 2, 3, and 6 months. Results The most common cause of fracture penis is self-inflicted acute bending (54.5%). The tear was visualized by ultrasound in 20/30 patients (66.7%) mostly on the right proximal third of the penis. All tears were unilateral with mean length 2.0 ± 0.9 cm (range 0.5–4 cm). All patients who completed their follow-up after 6 months (N=24) were able to achieve an adequate erection except two married cases who felt mild erectile dysfunction. Penile nodules were the most common postoperative complication (41.7%) after 6 months' follow-up. Patients treated with immediate or delayed repair had comparable complications. Conclusions Fracture penis is not uncommon as an emergency that must be repaired either immediately or delayed. Clinical diagnosis is more predictive than ultrasound in diagnosis and determining the site of the tear. Ultrasound may be of value in patients where there is clinical doubt.

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Aims and Methods The aim of this study was to evaluate the efficacy of aspiration and irrigation of the corpora cavernosa with cold saline as a simple outpatient method for treating prolonged penile erection after intracavernous injection of vasoactive agents. Results Aspiration and irrigation was needed in 70 out of 122 cases with iatrogenic priapism in whom cooling of the penis and perineum failed to achieve detumescence. According to the temperature of the saline used, patients were randomized into four different groups: A, B, C, and D with a saline temperature 10, 15, 20, and 37°C, respectively. Main Outcome We used a significantly larger volume of saline in groups C and D compared to group A. On the other hand there was no significant difference in the volume of saline used between groups A and B. Complete detumescence was achieved in 24/25 (96%) of cases in group A compared to 9/15 (60%) of cases in group D. Conclusion We recommend corporal aspiration and irrigation with 10°C saline for patients with prolonged penile erection who failed to respond to the noninvasive measures using ice-cold compresses and physical exercise.