Scrotal pain: Evaluation and management

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.

Prophylactic Phenylephrine for Iatrogenic Priapism: A Pilot Study With Peyronie's Patients

PURPOSE: Although penile duplex Doppler ultrasonography (PDDU) is a common and integral procedure in a Peyronie's disease workup, the intracavernosal injection of vasoactive agents can carry a serious risk of priapism. Risk factors include young age, good baseline erectile function, and no coronary artery disease. In addition, patients with Peyronie's disease undergoing PDDU in an outpatient setting are at increased risk given the inability to predict optimal dosing. The present study was conducted to provide support for a standard protocol of early administration of phenylephrine in patients with a sustained erection after diagnostic intracavernosal injection of vasoactive agents to prevent the deleterious effects of iatrogenic priapism. MATERIALS AND METHODS: This was a retrospective review of Peyronie's disease patients who received phenylephrine reversal after intracavernosal alprostadil (prostaglandin E1) administration to look at the priapism rate. Safety was determined on the basis of adverse events reported by subjects and efficacy was determined on the basis of the rate of priapism following intervention. RESULTS: Patients with Peyronie's disease only had better hemodynamic values on PDDU than did patients with Peyronie's disease and erectile dysfunction. All of the patients receiving prophylactic phenylephrine had complete detumescence of erections without adverse events, including no priapism cases. CONCLUSIONS: The reversal of erections with phenylephrine after intracavernosal injections of alprostadil to prevent iatrogenic priapism can be effective without increased adverse effects.

Hypogonadism in Human Immunodeficiency Virus-Positive Men

In recent years, the life expectancy for those living with human immunodeficiency virus (HIV) with access to combined antiretroviral therapy (cART) has increased. As men live longer, the role testosterone plays in sexual function as well as in general well-being is becoming increasingly important. Here we discuss the available literature concerning androgens and HIV disease. A review was undertaken by using a PubMed search with the umbrella terms HIV or AIDS and testosterone or androgens spanning 1985 to 2011. Significant articles found in references in the primary search were also included. The reported prevalence of androgen deficiency appears to be greater in HIV-infected males than in the general population. Androgen deficiency is usually associated with low luteinizing hormone and follicle-stimulating hormone and is sensitive to the type of measurement of testosterone used. Rates of hypogonadism may be falling since the advent of cART. Causes of low testosterone levels have been attributed to chronic illness, HIV replication, cART, opportunistic infections, comorbidities and coinfections, wasting, and normal age-related declines. Studies of testosterone treatment in HIV-positive men are lacking in standardization and outcome measures.

Sexually Transmitted Infections and Sexual Function in Relation to Male Fertility

Infertility affects about 8% to 12% of couples, with male infertility being responsible for about 30% of cases. Sexually transmitted infections (STIs) are known to cause complications of pregnancy and are associated with tubal infertility in females, but the association with male fertility is still controversial. The prevalence of curable STIs has risen to an estimated 448 million a year with the number of people living with human immunodeficiency virus (HIV) at 34 million. This review looks at the evidence available to date, regarding the effect of STIs and male accessory gland infections on markers of male fertility and the evidence that STIs negatively affect sexual functioning, thus adversely affecting the ability to conceive. The review will also cover new developments in the use of medications and fertility treatments as an aid to conception in couples serodiscordant for HIV.

Genetics of azoospermia: current knowledge, clinical implications, and future directions Part I

We reviewed the most recent advances in the genetics of male infertility focusing on karyotypic abnormalities, obstructive azoospermia, and idiopathic hypogonadotropic hypogonadism. To update our previous review, we searched the literature using PubMed and skimmed articles published from January 1998 to November 2006. There were 52, 30, and 41 relevant articles to our subject on karyotypic abnormalities, obstructive azoospermia, and idiopathic hypogonadotropic hypogonadism. The full texts of these articles and their bibliographic information were reviewed and a total of 93 were used to contribute this review. The frequency of sperm aneulpoidy in karyotypic abnormalities such as 47,XXY and 47,XYY is higher than that in the healthy individuals, but transmission of the abnormalities to the offspring is rare and the outcomes of assisted reproductive techniques are encouraging. Mutations in the cystic fibrosis gene are detectable in up to 80% of men with congenital bilateral absence of the vas deferens. However, there is a considerable diversity among different populations and the role of other potential causes is not ruled out yet. Autosomal and X-linked genetic aberrations in men with idiopathic hypogonadotropic hypogonadism are now well known. As hormone replacement therapy can provide the chance of fathering in these patients, the risk of mutations' transmission, especially the autosomal dominant ones, is high. In the recent decade, a parallel progress has been made in the genetics of men with azoospermia and the treatment modalities for these patients. Assisted reproductive techniques can help most of the patients, but there are several genetic abnormalities that must be considered before decision making for treatment of their infertility