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In this triple-blind randomised clinical trial, we compared the effects of Withania somnifera and pentoxifylline on the sperm parameters in idiopathic male infertility. One hundred infertile male patients were randomly allocated into either W. somnifera or pentoxifylline groups. Patients in the herbal group received six capsules containing 5 g/daily of W. somnifera root, and subjects in the pentoxifylline group received six capsules containing 800 mg/daily of pentoxifylline and placebo for 90 days. Sperm parameters were analysed at the beginning and end of the study. W. somnifera increased mean sperm count (12.5%) and progressive motility (21.42%) and improved sperm morphology (25.56%) compared to the baseline (p = .04, p = .001 and p = .000 respectively). Moreover, pentoxifylline increased mean semen volume (16.46%), progressive motility (25.97%) and improved sperm morphology (13.28%) versus the baseline (p = .02, p = .003 and p = .01 respectively). Intergroup comparison showed no significant differences between the two groups regarding semen volume (p = .11), sperm count (p = .09), morphology (p = .12) and progressive motility (p = .77) after treatment. No major complication was reported in either of the two groups. W. somnifera, a traditional medicine remedy, improves sperms parameters in idiopathic male infertility without causing adverse effects. Therefore, this medication can be considered to be an alternative to pentoxifylline in this regard.

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BACKGROUND: After organ transplantation, many patients have diverse experiences; they face many changes in the physical and emotional aspects of their life. Patients' understandings of the post-transplantation period influence their adaptation to the changes. There is a need to improving the knowledge of patients' unique experiences of post-transplantation period and the changes occur in their life. OBJECTIVE: To explore the experiences of organ recipients in the post-transplantation period. METHODS: In a qualitative research using a hermeneutical phenomenological approach, data were collected from April 2015 to June 2016. Participants were consisted of 15 patients who received organ chosen using a purposive sampling method. In-depth semi-structured interviews were held with them. The collected data were analyzed using Diekelmann's hermeneutical analysis approach. RESULTS: The data analyses led to the development of 3 main themes and 17 subthemes as "back from the grave" with the subthemes of "organ as the God's deposit," "God as the source of life," and "new life"; "chapter of prosperity" with the subthemes of "the spring of the body," "recovery," "peace and joy," "benevolent and good behavior," "renewal," "opportunity of being together again," "golden age," "positive perspective," "the sense of normality," "the return of health," and "spiritual evolution"; and "the fall" with the subthemes of "a lack of energy," "the mirage of transplantation," and "hell on the earth." CONCLUSION: The patients had diverse experiences of the post-transplantation period, which varied from the feeling of exhilaration and youth to losing energy and the wish for not undertaking organ transplantation.

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To evaluate the effect of diuretics on ureteral stone fragmentation and clearance during therapy with extra corporeal shock wave lithotripsy (ESWL), we studied 87 patients with ureteral stone at different levels and treated with ESWL. The patients were randomized into two groups treated by standard ESWL; the treatment protocol included 3500 shock wave per patient in each session, energy of the shock in two groups was 13 to 9 kv per patient, and the number of sessions was 3 per patient. The first group included 43 patients who received only ESWL, while the second group of 44 patients received as well 40 mg of furosemide. Stone fragmentation rate was 81% and 93.1% and stone clearance rate was 68.2% and 88.4% for the first and the second groups, respectively. With diuretics, fragmentation was 18.8% more in the middle ureteral stones, 16.9% more in the upper tract stones, and 5.4% more in the distal stones. Moreover, clearance of fragmented stones was 38%, 28%, 15.4% more at middle and upper and distal ureteral stone, respectively. We conclude that the stone fragmentation and clearance were higher with ESWL and diuretics than without diuresis. Diuresis is safe and has some advantage at increasing the effect of ESWL on ureteral stones especially the middle ureteral calculi.

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BACKGROUND: Transplant nephrectomy has been reported to display a high morbidity (17% to 56%) and considerable mortality (13% to 14%). We used a debulking technique leaving an intact ureter with intracapsular instillation of betadine; it was associated with a low rate of complications. MATERIALS AND METHODS: A total of 25 patients (16 males, 9 females) with failed allografted kidneys underwent transplant nephrectomy between 1991 and 2006 (Group 1). All subjects had failed kidneys for 2 months or more posttransplantation. The surgical approach to allograft nephrectomy was via the same oblique incision in the iliac fossa as the original transplantation. The capsule of the allograft was exposed and incised from pole to pole for the renal parenchyma to be bluntly dissected free with an index finger. The kidney parenchyma was pulled outward, and then the pedicle was ligated with silk, and layer by layer the tissue was removed until reaching the pedicle. Again it was transfixed and carefully ligated. After homeostasis, diluted betadine was instilled into the capsule and a drain inserted. The allograft ureter and capsule were left intact. All cases were followed for at least 1 year. Postnephrectomy, small doses of immunosuppressive drugs were continued for at least 2 months. RESULTS: Intracapsular nephrectomy was not associated with a significant complication. CONCLUSION: Intracapsular debulking nephrectomy, leaving the ureter and capsule intact and with intracapsular instillation of betadine, was a safe technique to remove a delayed, failed allograft.

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INTRODUCTION: Sometimes in spermatic cord handling procedures like varicocelectomy, hernioraphy, and vasectomy, there is concern about perfusion of the testis. Herein we have presented our experience with retroperitoneal mass ligation of the cord in kidney recipients. Between 2001 and 2006, we performed mass ligation of the spermatic cord, including vas deferens and all spermatic vessels, in 15 kidney recipients (older than 55 years) who gave informed consent. During retroperitoneal preparation of the Iliac fossa for allografting, we performed this maneuver next to the internal ring of the inguinal canal. After performing a J incision in the right iliac fossa, separating fascia, and pushing the peritoneum medially, we isolated the spermatic cord at the internal ring of the inguinal canal for transfixation and placing the allografted kidney in retroperitoneal position with anastomoses of the iliac vessels. Posttransplantation the scrotum of patients was followed up by color Doppler ultrasound and physical examination. RESULT: Normal circulation was detected in the testis postoperation using color Doppler ultrasound evaluation. Six patients returned with hydrocoeles between 4 and 8 months after transplantation and 3 of them underwent hydrocoelectomy. CONCLUSION: Mass ligation of the spermatic cord (preinternal ring of inguinal canal) did not disturb the circulation to the testis severely nor did it induce ischemic problems (atrophy). This study suggested an unknown connection between vessels of the cord and other vessels that supply blood to the testis. This study questions the safety of cryo-biopsy of a testis mass by high clamping of the cord and also suggests that vasectomy may be safe in patients with a history of a standard Palomo varicocoelectomy.

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