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Although extracorporeal shockwave lithotripsy (SWL) is the treatment of choice for symptomatic urinary calculi, it has been shown in number of studies that adverse effects of high-energy shockwaves may be encountered in short- and long-term follow-up. To evaluate the possible protective effect of verapamil administration on renal tissue, both magnetic resonance imaging (MRI) and histopathologic examination were performed after SWL in rabbits. Thirty-five animals were divided into three groups. The 15 animals in the first group were fed verapamil (0.1 mg/kg) for 3 days. Another 15 animals received no medication but underwent SWL, and the remaining 5 animals received anesthesia alone (sham group). The animals were then subdivided into three groups according to the shockwave number applied (1000, 15,000, or 2000) and the aforementioned evaluations were performed 24 hours and 3 months after the procedure. We found prominent histopathologic alterations in animals not receiving any medication before SWL. Persistence of these pathologic alterations during 3 months of follow-up indicated the importance of preservation of renal architecture during high-energy shockwave application. On the other hand, animals under verapamil medication prior to SWL demonstrated only a limited degree of histopathologic alteration. Demonstration of a normal histologic pattern after 3 months supported the preservation of tissue structure by such medication. No significant histopathologic alteration could be observed in the sham-group animals, as expected. Our study demonstrates that verapamil is protective against shockwave-induced renal tubular damage. Such medications may be useful to avoid the proven histopathologic and functional side effects of high-energy shockwaves.

Background Although few studies have reported fertility outcomes, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series. Objectives To investigate fertility outcomes and predictors for successful sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction (mTESE). Materials and methods This retrospective observational study included 327 azoospermic men with a history of cryptorchidism who underwent mTESE. Fertility outcomes including sperm retrieval, fertilization rate, number of transferred embryos, pregnancy, miscarriage, and live birth rates were recorded. Results Sperm retrieval was observed in 172 (52.6%) of the patients. The mean fertilization, pregnancy, and live birth rates were 55.2%±20.5, 53.5%, and 44.8%, respectively. The sperm retrieval rate was significantly higher at the orchidopexy age of ≤ 9.5 years (70.8%) than the orchidopexy age of > 9.5 years (42.1%) (P = .000). Patients with total testicular volume of ≥ 13.75 mL had significantly higher sperm retrieval rate (65.2%) than the patients with total testicular volume of < 13.75 mL (45.5%) (P = .001). Patients with total testosterone level of ≥ 300.5 ng/dL had significantly higher sperm retrieval rate (65.6%) than the patients with total testosterone level of < 300.5 ng/dL (40.3%) (P = .000). Patients with follicle‐stimulating hormone (FSH) level of ≤ 17.25 mIU/ml had significantly higher sperm retrieval rate (72.3%) than the patients with FSH level of > 17.25 mIU/mL (44.4%) (P = .000). Younger male and female ages, and higher fertilization rates were the parameters that might predict pregnancy. Conclusions Infertile azoospermic men with a history of cryptorchidism have high sperm retrieval rate with mTESE. Patients who had orchidopexy at the age of ≤ 9.5 years, and having total testicular volumes of ≥ 13.75 mL with total testosterone level of > 300.5 ng/dL and FSH level of ≤ 17.25 mIU/mL have higher success rate for sperm retrieval.

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