Microsurgical treatment of obstructive azoospermia: a report of 76 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of microsurgical vasoepididymostomy and/or vasovasostomy in the treatment of obstructive azoospermia.</p><p><b>METHODS</b>This study included 76 patients with obstructive azoospermia, 53 treated by bilateral vasoepididymostomy (8 involving the epididymal head, 18 involving the epididymal body, 5 involving the epididymal tail, and 22 involving the epididymal head, body and tail), 14 by unilateral vasoepididymostomy, and the other 9 by unilateral vasoepididymostomy + unilateral vasovasostomy (including cross anastomosis). We followed up the patients for 2 to 16 months for the patency rate, routine semen parameters, and pregnancy outcomes.</p><p><b>RESULTS</b>The success rate of bilateral vasoepididymostomy, unilateral vasoepididymostomy, and unilateral vasoepididymostomy + unilateral vasovasostomy (including cross anastomosis) were 62.26% (33/53), 35.71% (5/14), and 77.78% (7/9), respectively. The average sperm concentrations in the three groups of patients were (27.9 +/- 5.74), (11.8 +/- 8.33), and (19.9 +/- 7.53) x 10(6)/ml, the average total sperm counts were (65.6 +/- 13.71), (28.0 +/- 15.86), and (69.2 +/- 28.59) x 10(6), and the mean rates of progressively motile sperm were (22.3 +/- 3.18), (11.0 +/- 9.77), and (15.8 +/- 5.05)%, respectively. The success rates of bilateral vasoepididymostomy that involved the epididymal head, body, tail, and all the three parts were 62.5, 72.22, 60, and 54.55%, respectively. Natural pregnancy was achieved in 8 (10.53%) of the total number of cases.</p><p><b>CONCLUSION</b>Microsurgery is effective for the treatment obstructive azoospermia. Unilateral vasoepididymostomy + unilateral vasovasostomy is superior to the other procedures, followed by bilateral vasoepididymostomy. Bilateral vasoepididymostomy involving the epididymal body may achieve a slightly better effect than that involving the other epididymal parts.</p>

Establishing a mouse model of Sertoli-cell-only syndrome by administration of busulfan / 中华男科学杂志

<p><b>OBJECTIVE</b>To establish a stable and reliable model of Sertoli-cell-only syndrome in mice.</p><p><b>METHODS</b>We randomly divided 60 NIH mice into two groups of equal number to receive intraperitoneal injection of busulfan (30 mg/kg) and 30 or 60 minutes of testis cooling. At 2, 4 and 8 weeks after treatment, we recorded the survival rate of the mice, weight of the testis and Johnsen scores, and conducted quantitative analysis on the degrees of spermatogenetic failure.</p><p><b>RESULTS</b>There were no significant differences in the baseline body weight and survival rate between the intervention and control groups (P > 0.05). At 4 and 8 weeks, the testis weight and Johnsen score were significantly lower in the intervention group than in the control ([0.04 +/- 0.01] g and [0.05 +/- 0.01] g vs [0.09 +/- 0.03] g and [0.11 +/- 0.02] g, P < 0.05; 3.86 +/- 0.50 and 2.70 +/- 0.67 vs 9.60 +/- 0.25 and 9.76 +/- 0.43, P < 0.01). At 2, 4 and 8 weeks, the testis weights were (0.07 +/- 0.02) g, (0.06 +/- 0.01) g and (0.09 +/- 0.01) g, respectively, in the 30-min cooling group and (0.05 +/- 0.01) g, (0.04 +/- 0.02) g and (0.04 +/- 0.02) g in the 60-min cooling group, significantly lower than in the control side at the same time points ([0.11 +/- 0.01] g, [0.11 +/- 0.01] g and [0.12 +/- 0.00] g) (P < 0.05), and the Johnsen scores were 4.70 +/- 0.67, 2.70 +/- 0.84 and 6.10 +/- 1.14 in the 30-min and 1.67 +/- 0.58, 1.20 +/- 0.45 and 1.00 +/- 0.00 in the 60-min cooling group, remarkably lower than in the control side (9.60 +/- 3.23, 9.60 +/- 0.55 and 9.70 +/- 0.45) (P < 0.01). Histopathological examination of the cooled testes revealed considerable atrophy of seminal tubules, necrosis of seminiferous epithelia and peritubular fibrosis.</p><p><b>CONCLUSION</b>Administration of busulfan has no obvious influence on the survival of mice, and is a reliable method for constructing a mouse model of Sertoli-cell-only syndrome.</p>

Efficacy of natural vitamin E on oligospermia and asthenospermia: a prospective multi-centered randomized controlled study of 106 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the therapeutic effect of natural vitamin E (VitE) on oligospermia and asthenospermia in in- fertile men.</p><p><b>METHODS</b>We conducted a prospective multi-centered randomized controlled study on 64 infertile men with oligospermia (31 as controls treated with Tamoxifen 10 mg bid and 33 as experimental cases treated with Tamoxifen 10 mg bid + VitE 100 mg tid) and 42 cases of asthenospermia (20 as controls treated with Levocarnitine oral solution 1 bottle bid and 22 as experimental cases treated with Levocarnitine oral solution 1 bottle bid + VitE 100 mg tid). We compared the control and experimental groups in sperm concentration and percentage of progressively motile sperm before and 3 months after medication, as well as the rate of clinical pregnancy and adverse events.</p><p><b>RESULTS</b>Among the oligospermia patients, the average sperm concentrations in the control and experimental groups were 8.00 x 10(6)/ml and 10.66 x 10(6)/ml before medication (P > 0.05). After medication, the numbers of cases evaluated as with no, slight, moderate and marked improvement in sperm concentration were 10 and 9 (P > 0.05), 16 and 14 (P > 0.05), 5 and 4 (P > 0.05) and 0 and 0 (P >0.05); and the numbers of natural pregnancies were 0 and 6 in the control and experimental groups (P < 0.01). Among the asthenospermia patients, the average rates of progressively motile sperm were 17.00% and 18.10% in the control and experimental groups before medication (P > 0.05). After medication, the numbers of cases evaluated as with no, slight, moderate and marked improvement in the percentage of progressively motile sperm were 7 and 2 (P < 0.01), 4 and 8 (P < 0.01), 3 and 2 (P > 0.05) and 1 and 1 (P > 0.05), and the numbers of natural pregnancies were 5 and 9 in the two groups (P < 0.01), but no adverse events were observed.</p><p><b>CONCLUSION</b>As a safe and effective adjuvant agent for the treatment of oligospermia and asthenospermia, vitamin E can improve sperm concentration, the percentage of progressively motile sperm, and finally the rate of natural pregnancy.</p>

Expression of heme oxygenase enzyme in the testis tissue and azoospermia / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the location of heme oxygenase (HO) enzyme in the human testis, and explore the correlation of the expression of HO enzyme with azoospermia by analyzing its different expression levels in the testes of nonobstructive azoospermia, obstructive azoospermia and normal men.</p><p><b>METHODS</b>We detected the location of the cells expressing HO enzyme in the human testis tissue using immunohistochemistry, determined the mRNA and protein expression levels of HO-1 and HO-2 in the testes of azoospermia patients and normal healthy men by RT-fluorescence quantitative PCR (RT-FQ-PCR) and Western blot, and explored the correlation of HO expressions with the pathogenesis of azoospermia.</p><p><b>RESULTS</b>HO-1 enzyme was expressed mainly in the Sertoli cells and HO-2 enzyme chiefly in the germ cells of the testis tissue. RT-FQ-PCR showed that the expression of HO-1 in the testis tissue was significantly lower in the nonobstructive azoospermia than in the normal and obstructive azoospermia groups (P < 0.05), with no significant difference between the latter two. Western blot revealed no obvious difference between the expression level of HO-1 protein and that of HO-1 mRNA. There were no differences in the expression level of HO-2 protein among the three groups.</p><p><b>CONCLUSION</b>The expression level of HO enzyme is significantly decreased in the testis tissue of nonobstructive azoospermia patients, and the expression of HO-1 protein is consistent with that of HO-1 mRNA. As HO-1 protects the testis tissue against various stress injuries through its antioxidant, anti-inflammatory and anti-apoptotic effects, its decreased expression level may be correlated with spermatogenic dysfunction, and therefore considered as a possible mechanism of nonobstructive azoospermia.</p>

Type V phosphodiesterase inhibitor erection-provoking test with audio-visual sexual stimulation for the diagnosis of erectile dysfunction / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the type V phosphodiesterase (PDE-5) inhibitor erection-provoking test with audio-visual sexual stimulation in the diagnosis of erectile dysfunction.</p><p><b>METHODS</b>A total of 853 out-patients diagnosed with erectile dysfunction were divided into an injury and a non-injury group. After scored on IIEF-5 questionnaires, all the patients received oral administration of PDE-5 inhibitors and, 30 minutes later, audio-visual sexual stimulation. The data on penile erection were recorded with Rigiscan Plus.</p><p><b>RESULTS</b>The patients with mild, moderate and severe ED accounted for 18.8, 31.9 and 49.3% in the injury group, and 50.6, 39.8 and 9.6% in the non-injury group, with statistic differences between the two groups in the mild and severe parts (P < 0.05). The rates of conspicuous effectiveness, effectiveness, ineffectiveness and total effectiveness of the combined method were 13.0, 14.5, 72.5 and 27.5% in the injury group, but 55.7, 20.7, 23.6 and 76.4% in the non-injury group, with significant differences (P < 0.05).</p><p><b>CONCLUSION</b>The PDE-5 inhibitor erection-provoking test with audio-visual sexual stimulation is a simple, practical, safe and effective method for the differentiation of organic from psychological erectile dysfunction.</p>

Prevention and treatment of the complications of inflatable penile prosthesis implantation / 中华男科学杂志

<p><b>OBJECTIVE</b>To report the amelioration of the three-piece inflatable penile prosthesis (IPP) implantation and the prevention of its complications.</p><p><b>METHODS</b>Thirty-two patients with moderate to severe erectile dysfunction (ED) irresponsive to conservative treatments received the implantation of the three-piece IPP. The surgical techniques were ameliorated in the course of operation. The patients were guided in using the IPP after operation. The effects and complications of the implantation were observed based on IIEF of the patients before and after operation.</p><p><b>RESULTS</b>Sexual life was resumed and no complication was found in 28 of the patients. The complications that developed in the other 4 were pump failure (2 cases), urethral perforation (1 case), and penis contraction (1 case). The former 3 achieved normal sexual intercourse after the second operation. Comparison between the IIEF scores before and after operation showed a very remarkable difference (P < 0.01). The occurrence rate of complications was 12.5%. The satisfaction rate of sexual intercourse was 87.5% and the total satisfaction rate of sexual life was 84.4%.</p><p><b>CONCLUSION</b>The complications of the three-piece IPP implantation were obviously reduced by ameliorating operation techniques. The implantation of the three piece-IPP is safe and effective for advanced ED patients.</p>

Clinical study of recombinant human growth hormone for male climacteric syndrome / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the effect and safety of the recombinant human growth hormone (rhGH) in the treatment of male climacteric syndrome and to investigate the specificity and sensitivity of insulin-like growth factor-1 (IGF-1) and serum total testosterone as the curative effect index.</p><p><b>METHODS</b>Forty patients aged 40-75 with male climacteric syndrome were divided into two groups randomly and injected with rhGH 4 IU (Group A) or 8 IU (Group B). The patients were followed up for about 12 weeks after 12-week treatment and then asked the questions of the assessed index of male climacteric syndrome at the 4th, 8th and 12th week of the treatment and 12 weeks after the treatment. The serum IGF-1, total testosterone (TT) and prostatic specific antigen(PSA) were measured before and after the treatment. The data were analysed by the software of SPSS 12.0 for Windows.</p><p><b>RESULTS</b>The scores of the 4th, 8th and 12th week and the follow-up significantly declined compared with the baseline (P < 0.01), but did not differ significantly between Groups A and B (P > 0.05). After the treatment, serum total testosterone, PSA and prostate volume had no obvious change (P > 0.05), and the IGF-1 level was markedly higher than the baseline and the normal public. No obvious side effect was found during the treatment and follow-up.</p><p><b>CONCLUSION</b>Small dosage of rhGH(4 IU/week) for 12 weeks can effectively treat male climacteric syndrome. The value of IGF-1 was parallel with the treatment effects. Short-time and small-dosage treatment with rhGH is safe and has little side effect.</p>