Background and Objectives: Tubular ectasia is a rare, pathologically benign condition which initially may present as tiny cyst. Knowledge of typical ultrasound features of this condition helps to differentiate it from other malignant lesions of testis. This study was conducted to find out ultrasound spectrum of tubular ectasia of rete testis and epididymis. Methods: Patients undergoing scrotal ultrasound and doppler for various indications including scrotal pain, infertility, postvasectomy and prior to recanalisation of vas were studied. The history, clinical examination, semen analysis and ultrasound features were analyzed. Our emphasis was on early detection of this rare but benign entity involving testis and epididymis. Results: Scrotal ultrasound with colour doppler in these patients revealed the abnormalities ranging from early changes like specked appearance and tiny cysts to more severe forms involving rete testis and epididymis. Associated abnormalities like epididymal cyst, hydrocele and spermatocele were also found in addition to tubular ectasia in some cases. Conclusion: Tubular ectasia is a pathologically benign condition which can be reliably diagnosed on ultrasound and colour doppler. Familiarity with the ultrasound and doppler features of tubular ectasia will definitely help in early diagnosis which in turn will help in reducing patients' anxiety and prevent unnecessary interventions.

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Cell phones are a relatively novel and evolving technology. Mobile communication is now essentially ruling in our daily activities through better connectivity and intelligent, smart phone services. While the potential benefits of this technology continue to emerge, so do the potential health risks. There is increasing concern that the use of mobile phones may be associated with decreased semen quality and infertility. The most sensitive tissues to the damaging effects of cell phones are testicular tissues through increased oxidative stress, heating and radiation. Cell phone radiation may negatively affect sperm quality in men by decreasing the semen volume, sperm concentration, sperm count, motility, and viability, thus impairing male fertility. This should be supported by mass media to raise awareness among people regarding the possible health effects of radiofrequency emissions from mobile phones and to minimize its exposure. This study is a brief review of the recent data about the effect of cell phones in male infertility.

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Due to the increase in erectile dysfunction (ED) and infertility in world population, there is growing interest in the integrative treatment of these diseases. Therefore, it is raising a market with non-prescription natural supplements. Especially in menu of internet, online shops come increasingly to light new natural over the counter products. Recent sale and use of medicinal plants and their extracts in the treatment of ED are according to the declaration of the producers first of all on a number of the thousand-year-old traditions in some nations, based on the efficacy and safety of these plants, verified in the long-time healing practice. The aim of this article was to make an extensive review of the scientific and professional medical literature and to find out which medicinal plants, minerals and other active substances, sold in the natural products for ED, were evaluated in relevant clinical trials as statistically significant in their efficacy and safety. The review of the literature shows that some marketed medicinal plants and active substances lack clinical studies, the results of some clinical studies related to the same medicinal plant are controversial and some bring significantly positive effects, but their number is minimal (maximum two to five clinical studies). The future is therefore open to starting the number of new clinical trials testing the medicinal plants for the treatment of ED with possible inclusion of some of these plants in evidence-based medicine, if confirming their efficacy and safety.

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Primary hypothyroidism refers to a systemic hypometabolic status due to hypothyroxinemia or thyroid hormone resistance caused by pathologic changes to the thyroid gland. The main role of thyroid hormone is to promote energy metabolism and facilitate growth and development processes within the body. In a hypothyroidism state caused by thyroid hormone deficiency, the body's thermogenic effect is down-regulated and metabolisms of protein, sugar, and fat were slowed down, which might further lead to cardiovascular disease, hyperlipidemia, myocardial damage and myxedema, as well as other changes. Hypothyroidism tends to be neglected or misdiagnosed due to its trivial and nonspecific clinical manifestations, and a combined renal dysfunction is rarely reported. Herein a case of kidney dysfunction caused by hypothyroidism is reported and relevant literature was reviewed.

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The vacuum erectile device (VED) uses negative pressure to increase blood inflow and oxygen into the corpora cavernosum, with a ring at the base of the penis to maintain the erection for intercourse or without a ring for penile rehabilitation. As the limitation of phosphodiesterase 5 inhibitors (PDE5I) showed in the treatment of refractory erectile dysfunction (ED), the use of VED resurged and is becoming the first-line therapy in treatment of ED after radical prostatectomy. Currently, the combination therapy of VED and PDE5I and of VED and intracavernous injection are advocated. Furthermore, there has been increasing interest in the use of VED to preserve penile length in inflatable penile prosthesis preoperation procedure and Peyronie's disease. Hereby, we reviewed the underlying mechanisms, the status of VED in penile rehabilitation, the combination therapy and the expanded use of VED.

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Myoglobin is a heme protein present in muscle tissues and responsible for binding and delivery of oxygen in the muscle cells for oxidative metabolism. Whenever muscle tissue is injured, that is, rhabdomyolysis occurs free myoglobin enters into circulation along with other enzymes and electrolytes and myoglobinuria occurs when the renal threshold is crossed. There are many causes of rhabdomyolysis including physical damage, infective, inflammatory, toxic, and metabolic problems. Clinically, myoglobinuria presents as muscle pain, weakness, cola colored urine, and laboratory diagnosis is done by elevated serum creatine kinase, urine dipstick positive for blood without RBC in microscopy examination. These myoglobin molecules can cause renal injury by renal vasoconstriction, proximal tubular necrosis, and distal tubular obstruction. Early anticipation of myoglobinuria and aggressive fluid resuscitation during the initial stage of injury is the mainstay of management of myoglobinuric acute kidney injury (AKI). There is lesser role of forced alkaline diuresis and mannitol than diuresis by normal crystalloid solution in myoglobinuric AKI. Renal replacement therapy should be considered in cases with life-threatening dyselectrolytemia and acidosis.

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Peyronie's disease (PD) is an acquired fibrotic disease of the penile tunica albuginea accompanied by penile pain, curvature, erectile dysfunction, and psychosocial problems. Recent evidence suggests an increasing prevalence of PD with current uncertainty of its etiology and pathophysiology. According to the natural history of PD, the disease can be divided into acute phase and fibrotic phase that greatly determines the treatment plan. Oral, intralesional medication, and topical therapy are suitable for acute phase while surgical therapy is suggested only in fibrotic phase with the formation of stable plaques. Although a number of pharmacologic agents have been evaluated in preclinical and clinical studies, a few of them can be used in the clinic with satisfactory outcome. Recent studies showed promising results in improving symptoms and limiting disease progression, especially the only Food and Drug Administration-approved collagenase Clostridium histolyticum as well as some multimodal therapies. In this study, we reviewed currently available medications and focused on recent advances in PD pharmacotherapy. However, further high-quality studies are much needed to clarify the pathogenesis of PD and, more importantly, to find out effective and safe medicines for PD treatment.

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Although renal disease has been present for over 200 millennia of Homo sapiens' existence, knowledge of the causes and management of these disorders has only emerged during the last 4000 years. Brilliant insights into human disease probably emerged from time to time over the long period of human existence, but observations could only be advanced after writing began in 3200 BC. Humans could then make observations, record these thoughts, and have others in their present and future critique them leading to improvement in this information. This discussion selectively considers some of the medical giants who led the way to clinical nephrology of the 21^st century. It reflects on who taught us basic principles of renal disease that led to our current knowledge. Attention is given to the ancient Egyptians, Ancient Greeks, Galen of Pergamon, the Byzantine Greeks of the 5^th-9^th centuries, the Arab/Persian Physicians of the 9^th-12^th centuries, Moses Maimonides of the 12^th century, selective Renaissance Physicians, and the father of modern nephrology - Richard Bright MD. This reflection celebrates au courant renal sagacity by celebrating the past clinicians who led the way from their eras to ours.

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We report a 67-year-old woman with osteoarthritis (OA) of knees. She also had past histories such as dyslipidemia and hypertension. She was sometimes treated by hyaluronan-injection into the knees for OA at the nearby clinic. She was admitted to our hospital because of acute pyelonephritis in July 2014. We treated her successfully with ceftriaxone first empirically and de-escalated to cefazolin along with the results of urinary and blood cultures. Urinary and blood cultures revealed Escherichia coli. She recovered from pyelonephritis, however, began to complain pain and swelling of the right knee. Culture of the right knee-joint fluid also revealed E. coli. We diagnosed septic arthritis of the right knee and performed arthroscopic lavage, followed by continuous washout with saline for 7 days. She recovered from septic arthritis of the right knee and discharged from our hospital. Although rare, it is important that pyelonephritis-derived sepsis cause septic arthritis of the knee.

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Objectives: This study aimed to assess the role of varicocelectomy in the improvement of premature ejaculation (PE) in patients with clinical varicoceles and PE. Materials and Methods: In a prospective clinical study, it conducted on 85 male patients with clinical varicoceles and PE. Those patients were selected from whom attending the Outpatient Clinics of Andrology and General Surgery at Sohag University Hospital, Upper Egypt, between February 2015 and May 2016. All patients were subjected to preliminary assessment included a detailed medical and sexual history and general and genital examination. Patients were treated with open bilateral subinguinal varicocelectomy under spinal anesthesia. All patients were evaluated before and 6 months after the varicocelectomy by PE diagnostic tool (PEDT). The intravaginal ejaculatory latency times (IELTs) per minute and overall sexual satisfaction scores were evaluated before and 6 months after varicocelectomy. All patients were asked to indicate their sexual satisfaction on a scale of 0-5, with 0 being extremely dissatisfied and 5 being extremely satisfied. Results: The mean scores of the five questions of the PEDT measuring ejaculation control, frequency of inability of ejaculation control, ejaculation with minimal stimulation, feel of distress, and interpersonal difficulty owing to PE had statistically significant improvements at 6 months after varicocelectomy. The mean IELTs per minute and overall sexual satisfaction scores were significantly improved at 6 months after varicocelectomy. Conclusions: The study concluded that varicocelectomy improve PE in patients with bilateral clinical varicoceles and PE. Further prospective, controlled studies are needed to provide further characterization of this potential relationship.

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Congenital anorchia represents a rare form of testicular disorder. It classically refers to the absence of unilateral or bilateral testes in an otherwise normal genetic male. It is usually diagnosed in infancy due to the absence of testes with or without evidence of micropenis during routine health screening of the child. However, it can be identified at late stages while the person is being evaluated for delayed puberty and primary hypogonadism. Early identification and differentiation from cryptorchidism are essential from a therapeutic point of view. Apart from imaging studies, hormonal evaluation plays a crucial role in establishing the diagnosis.

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Background and objectives: Chronic kidney disease (CKD) is an important, chronic, noncommunicable disease epidemic that affects the world. Lack of registries precludes an accurate estimation of the number of patients with CKD. Only a few studies are done in our country to assess etiology of CKD in young patients. This study was aimed to assess the etiology of CKD in young patients. Materials and Methods: Data were collected from 50 patients of CKD between 15 and 40 years age who presented to Government General Hospital, Kurnool from July 2012 to June 2013. They were clinically evaluated and underwent relevant investigations including renal biopsy in indicated cases. Results: Of the 50 patients studied, there was an overall male preponderance over all age groups with a mean age of 27.6 ± 4.9 years. Small kidneys were seen in 70% of patients. 92% of patients had proteinuria. Most common symptoms of presentation were related to gastrointestinal disturbances, breathlessness, easy fatigability, and urinary disturbances. Pallor, pedal edema, and facial puffiness were major clinical features. Majority (62%) had CKD of unknown etiology. In this unknown etiology patients, majority were found to have glomerular disease (42%) based on clinical presentation and other supporting investigations. 92% presented in stage IV or stage V CKD. Histopathologically etiology was proven among 19 patients (38%) with renal biopsy. Conclusion: It is concluded that male patients in the third and fourth decades were in the majority requiring medical care. Chronic Glomerulonephritis of unknown causes constitutes a major etiology among the young presenting in late stages of CKD.

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Nephrotic syndrome is a common clinical type of glomerular diseases in the elderly and has its own characteristics in the pathological types, clinical manifestations, and diagnoses. Renal biopsy is an important diagnostic method for elderly patients with nephrotic syndrome. Membranous nephropathy is the most common primary pathology while amyloidosis and diabetic nephropathy are common secondary causes. Individualized treatments should be performed according to ages and physical characteristics of the elderly patients.

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Objective: To study and describe the utilization pattern of various classes of drugs including antibiotics in patients with chronic kidney disease (CKD). Materials and Methods: A total of 185 CKD patients were finally recruited after strictly obeying the selection criteria in this cross-sectional, observational study that was conducted over a period of 6 months in Nephrology Department of a tertiary care teaching hospital. Relevant data were extracted by interviewing the patients and from prescriptions, case records, and investigational reports. Results: Mean age of CKD patients was 45.81 ± 11.16 with male predominance (58%). CKD Stage III comprised of the maximum number (28%) of patients. Polypharmacy was executed in 83% of these patients. Hypertension (95%), diabetes (87%), and anemia (86%) are the most common co-morbidities. The five most frequently prescribed drugs were diuretics (100%), anti-ulcer agents like proton pump inhibitors and H ₂ blockers (98%), anti-hypertensives (95%), vitamins and minerals supplements including calcium (92%), and hematinics (85%). Infectious diseases like respiratory tract infection (37%) and urinary tract infection (34%) had shown to have a high prevalence in CKD patients. Cefoperazone, metronidazole, piperacillin + tazobactam were the most prescribed parenteral antibiotics. Azithromycin and levofloxacin were the extensively used oral antibiotics. Conclusion: This study demonstrates the variability of drug utilization in CKD patients. Drug utilization studies on a regular basis give a framework to pharmaceutical companies and healthcare providers and help to build management strategies. However, the right choice of drugs and inappropriate doses will reduce the incidence of nephrotoxicity and ultimately result better clinical outcomes. Managing infections and prescribing antibiotics in CKD are crucial and hence claim rationalization of the use of antibiotics to improve the quality of life of CKD patients.

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Bilateral subconjunctival hemorrhage is usually caused by conjunctivitis and trauma. Other causes are straining, sneezing, coughing, or vomiting. We report here two cases of severe stricture urethra who presented to us with bilateral subconjunctival hemorrhage. Both patients had to strain for more than half an hour to empty bladder once, since many months. On evaluation both patients were found to have very narrow segment stricture urethra, underwent subsequent augmented urethroplasty and in about 3 weeks subconjunctival hemorrhage resolved on its own. We conclude that bilateral subconjunctival hemorrhage could be potential presenting sign of stricture urethra in patients who strain severely to empty their bladder.

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Elevated uric acid (UA) levels has been shown to be associated with cardiovascular disease such as hypertension, coronary heart disease, heart failure, renal failure, peripheral vascular disease, metabolic syndrome, and stroke. In addition, in recent years various novel pathological entities such as endothelial dysfunction, oxidative stress, inflammation, activation of the renin angiotensin system (RAS) has been found to be associated with increased UA levels. Erectile dysfunction (ED) on the other hand has also been associated with cardiovascular risk. Besides, similar mechanisms such as endothelial dysfunction, oxidative stress and RAS have been found to be related with ED. Thus, the current hypothesis tried to explain why UA may be associated with ED.

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Diabetic nephropathy (DN) is a leading cause of end-stage renal disease worldwide. The mainstay of DN has been management of hyperglycemia, blood pressure and proteinuria using hypoglycemic agents, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Application of traditional Chinese medicine (TCM) for DN has received increasing attention due to its wide availability, low side-effects, proven therapeutic mechanisms and benefits. In this paper, we mainly focus on the recent studies of TCM including Tongxinluo, Chaihuang-Yishen granule, Shenyan Kangfu tablets, Danggui Buxue Tang, Gordon Euryale Seed, Cherokee Rose Fruit and Bawei Dihuang wan, and the effective components of TCM, including Astragalus and Astragalus polysaccharide. The aim of this study is to review the protection and treatment effect of TCM for treating DN in type 1 and type 2 diabetes mellitus. Meanwhile, the possible mechanisms of major compounds and active crude drugs are also summarized.

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The term acute kidney injury (AKI) appeared in the society of nephrology in 2004 mirroring a key station of the constant development of the whole entity of acute renal failure. The long route from “acute Bright's disease” in the 19^th century to modern “acute kidney stress” reflects the continuous effort of the society of nephrology to set the appropriate criteria and finally to formulate a precise and consensus definition in nomenclature of kidney injury. The most important definitions were the Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease in 2004, Acute Kidney Injury Network (AKIN) in 2007, and Kidney Disease Improving Global Outcomes (KDIGO) in 2012 which had been proposed by the committees of Acute Dialysis Quality Initiative, AKIN, and KDIGO, respectively. Common basis of the above definitions was the clinical-laboratory criteria of urine output and serum creatinine while the target of every newer attempt was to increase the sensitivity of AKI and to offer a globally unified perception in terms of diagnosis and prevention. Since the emersion of KDIGO definition, the interest in defining AKI has been focused on the stage that precedes renal damage by the detection of clinically reliable biomarkers. Subsequently, the concept of acute injury is being lately realized as an attack in correspondence with heart attack or even more as an acute stress which can only be witnessed by the appropriate biomarkers. Recent research is focusing on the discovery of the ideal biomarker which must meet the requirements of high specificity, low cost, and ease of application.

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Chronic kidney disease (CKD) is characterized by progressive loss of renal function. Although the burden of CKD in India cannot be assessed accurately, its approximate prevalence is believed to be 800 per million populations (pmp), and the incidence of end-stage renal disease (ESRD) is 150–200 pmp. Diabetic nephropathy is a leading cause of ESRD worldwide. Another cause of ESRD is dyslipidemia, which is one of the most common quantitative lipid abnormalities in patients with CKD. In diabetes, the total cholesterol and triglyceride levels rise as the albumin excretion rate increases, leading to renal injury. Oxidative stress generated by hyperglycemia increases reactive oxygen species production, which causes cellular dysfunction and damage, and ultimately results in diabetic micro- and macro-vascular complications. Therefore, lipids may represent a useful clinical tool for not only identifying patients at a high risk of developing CVD but also assessing the development and progression of renal disease. In this review, we summarize the effects of lipid abnormalities and oxidative stress in patients with diabetes and nephropathy.

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Background and Objectives: The high prevalence of thyroid dysfunction in chronic kidney disease (CKD) patients reveals significant association between CKD progression and thyroid dysfunction. The aim was to study the thyroid dysfunction in patients of CKD for the prevalence of subclinical hypothyroidism (SCH) and clinical hypothyroidism and study the correlation between thyroid dysfunction and severity of renal diseases. In view of the variability of thyroid profile in CKD patients in previous studies, a prospective study of various thyroid function has been undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases. Materials and Methods: A total of 100 patients with CKD on conservative management fulfilling the criteria for CKD who were admitted at the Department of Medicine, SNMC, Agra, Uttar Pradesh, India, during the period of July 2016–June 2017, were selected in this study. Descriptive analysis of the collected data was done and association of various parameters with the presence or absence of SCH or overt hypothyroidism was studied using Chi-square test and correlated. Results: Results showed that out of the 100 patients with CKD, 53 patients had thyroid dysfunction which accounted for 53%. The prevalence of SCH and clinical hypothyroidism was 33% and 20%, respectively. The number of patients with hypothyroidism progressively increased with increased severity of renal failure. Conclusions: We observed a high prevalence of thyroid dysfunction in our CKD patients and revealed significant association between CKD progression and thyroid dysfunction.

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Objectives: The objective of this study was to explore the values of prostate-specific antigen (PSA) before and after transurethral prostatic resection (TURP) surgery and the corresponding correlation with the resection extent through short and long-term changes of benign prostatic hyperplasia (BPH) of patient's serum PSA after TURP. Materials and Methods: Data were abstracted from a retrospective sampling study of 209 cases of BPH patients. The values of serum PSA level were measured preoperatively and at specified periods after TURP surgery; 5 days, 1 month, 3 months, and 6 months. These periods were correlated with the resection extent. Results: Quantitative PSA values were collected before and after the surgical procedure at the time periods. The decrease of PSA value was observed 5 days after surgery when compared with preoperative PSA value, which is about 4.42 ± 8.78 ng/mL while 35% decrease was reported following a month after surgery. Moreover, PSA levels in these five periods were significantly different (P < 0.01), and the value of PSA >4 ng/mL group is still higher than the group of PSA ≤4 ng/mL after the decrease. Resection extent of TURP: The mean differences between real removal quality and the quality, according to the prostate ultrasonography, should be removed, which is expressed in ± standard deviations. The value of the total sample is −0.941 ± 9.56 ng/mL. Values in the group of PSA ≤4 ng/mL and PSA >4 ng/mL are 0.13 ± 10.53 and −3.83 ± 5.41, respectively. There appears to be a positive correlation between the variations of PSA and the resection extent (P < 0.01, R = 0.91). In addition, a positive correlation was confirmed between the variations of PSA and the resection extent in the group of PSA ≤4 ng/mL and PSA >4 ng/mL (P < 0.01, R 1 = 0.986, R 2 = 0.924). Conclusion: A downward trend is demonstrated here in PSA after TURP. The PSA value lowered to a normal level in about 1 month. The interesting point is that there is an inverse relationship between the larger size of the resection and the decrease in PSA values. Thus, missed and misdiagnoses of prostate cancer could be reduced with the long-term follow-up of BPH patients' postoperative levels of serum after TURP. In regards to patients whose preoperative PSA >4 ng/mL, monitoring standards should be taken according to their postoperative PSA baseline when measuring their results of prostate needle biopsies and the diagnosis of prostatic cancer.

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Objective: The objectives of the study were to study etiology, manifestations, and outcome of acute kidney disease in the tropical region in a tertiary care center. Materials and Methods: In the present prospective study, patients with acute kidney disease admitted to JNMC, Wardha, India, between January 2017 and December 2017 were studied with a detailed history, general physical examination, and systemic examination. Data were collected and analyzed. Statistical analysis was performed using descriptive and inferential statistics using the Chi-square test and Student's unpaired t-test and software used in the analysis was SPSS 22.0 version and Graph Pad Prism 6.0 version. Results: This study showed male-to-female ratio of 1.8:1. Maximum incidence was seen in patients aged >60 years. As per the Kuppuswamy's scale, most of the patients belonged to lower-middle and upper lower class. The study showed various etiological factors associated with acute kidney injuries (AKIs) such as renal causes (most common), heart failure, respiratory failure, cirrhosis, malaria, snake bite, acute gastroenteritis, poisoning, drug nephrotoxicity, and sepsis. Common symptoms were oliguria followed by pedal edema and dyspnea. The most common comorbid illness was hypertension followed by diabetes mellitus which may have made them prone to AKI. About 81.42% of patients survived and 18.58% expired. Of 70, 56 patients were managed conservatively, whereas 14 underwent hemodialysis. Mean duration of hospitalization was 11.01 ± 8.60 days. Conclusion: Intrinsic renal causes followed by heart failure were the common causes of AKI as against infective causes a few years earlier. This shows the changing trend of AKI causes in a developing nation. Average duration of hospitalization was 11 days in the study.

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