Testosterone levels in patients with varicocele and azoospermia / 北京大学学报(医学版)

OBJECTIVE@#Androgen deficiency is common in aging males and may have unfavourable health consequences. Large-scale studies suggested low testosterone level might increse mortality and morbidity in ageing males. However, young men with low testosterone level might be neglected. Recent studies reported young men with infertility may have reduced testosterone level. To investigate the incidence of androgen deficiency in males with infertility and possible factors affecting the low testosterone level.@*METHODS@#Between January 2011 and December 2012, 407 men with infertility caused by varicocele (VC), obstructive azoospermia (OA) and nonobstructive azoospermia (NOA) in our center were included. The number of men in each group of OA, NOA and VC was 141, 97 and 169, respectively. All the eligible patients underwent a serum testosterone assessment by a single morning blood draw (between 8:00 to noon) to test for concentration of the total testosterone. All serum samples were determined by radioimmunoassay in our andrology laboratory. Androgen deficiency was defined as having a total testosterone level less than 300 ng/dL.@*RESULTS@#The mean age was (30.4±5.8) years. The mean testosterone level was (4.18±1.64) ng/dL (range 0.30 to 11.32 ng/dL). The overall incidence of androgen deficiency was 26.5% (108/407). The incidences of androgen deficiency in NOA, OA and VC groups were 40.2% (39/97), 19.1% (27/141) and 24.9% (42/169), respectively, which were significantly higher in the NOA than in the VC and OA groups (P < 0.001). The incidences had no difference between the VC and OA groups (P=0.229). Univariate analysis revealed the cause of infertility, FSH and the mean testis volume as possible affecting factors for androgen deficiency. However, on multivariate analysis the only cause of infertility was an independent predictor. The incidence of androgen deficiency was the highest in the NOA group [OR 0.492 (95% confidence interval 0.288-0.840)].@*CONCLUSION@#NOA and varicocele might be risk factors of androgen deficiency. Young men with NOA may have a higher possibility of low testosterone level. Testosterone level should be followed up after NOA and varicocele treatment. Androgen deficiency should be assessed in males with infertility in clinical practice.

Appllication of human acellular dermal matrix in surgical treatment of genitourinary disease / 北京大学学报(医学版)

Humanacellular dermal matrix (HADM) is widely used in the field of burn wound repair and tissue engineering plastic surgery. HADM is manufactored by physical and chemical decellular process to remove the antigenic components that might cause immune rejection in dermis.The extracellular matrix of three-dimensional cell scaffold structure with collagen fibers had been used for wound repair and tissue regeneration, while HADM characterized with low absorption rate after implantation and strong ability to induce angiogenesis in host tissue. Studies reported that after the HADM was implanted into the patient, the host cells, such as fibroblasts and myofibroblasts, as well as lymphocytes, macrophages, granulocytes and mast cells, rapidly infiltrated the graft. The connective tissue and neovascularization were then formed within the HADM three-dimensional cell scaffold, the lymphatic system also appears after vascular reconstruction. Traditional urethral reconstruction using autologous skin flaps has some defects, such as complexity of the technology, risk of necrosis of the skin flaps after transplantation, and failure to achieve functional repair of the urethral epithelium. It has been reported that using HADM to reconstruct the urethra in patients with urethral stricture, hypospadias and bladder-vaginal fistula, showed promising results. Others have reported the experience of using HADM to repair and reconstruct congenital classic bladder exstrophy. HADM has also been used for tissue repair in patients with penile skin defect caused by Fonier's gangrene and hidradenitis suppurativa, and implanted under Bucks' fascia to enlarge the penis. The report of HADM implantation for treating premature ejaculation also deserves attention. Researchers found that HADM implantation can form a tissue barrier between the skin and corpus cavernosum, which can effectively reduce penile sensitivity and treat premature ejaculation. The safety and effectiveness of HADM implantation in the treatment of premature ejaculation need to be further standardized by data from multi-center, large-sample clinical studies. In summary, HADM is the extracellular matrix and three-dimensional cell scaffold of human dermis. As a new type of tissue repair material, new blood vessels are formed actively after implantation, which shows good histocompatibility. HADM has shown increasingly broad application prospects in treatment of genitourinary diseases including penis, urethra and bladder diseases. HADM has also been used in the treatment of premature ejaculation in recent clinical studies, and its long-term safety and efficacy need to be further investigated.

Daily low-dose tadalafil for erectile dysfunction induced by pelvic fracture urethral disruption / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of daily low-dose tadalafil on erectile dysfunction (ED) induced by pelvic fracture urethral disruption (PFUD).</p><p><b>METHODS</b>This study included 46 cases of PFUD-induced ED treated from Jan 2008 to Dec 2011. The patients were aged 33.9 +/- 7.2 years (range 25 -51 yr), and the interval between injury and treatment was 19.6 +/- 12.7 months (range 3 - 72 mo), all with normal erectile function before PFUD. Based on the nocturnal penile tumescence and rigidity (NPTR) recorded by erectometry without medication of phosphodiesterase type 5 inhibitor (PDE-5I), the patients were divided into an abnormal nocturnal erection group and a non-nocturnal erection group, and treated with tadalafil 10 mg once daily for 3 months. The therapeutic effect was evaluated by IIEF-5 scores and the rate of yes responses to questions 2 and 3 of the Sexual Encounter Profile (SEP).</p><p><b>RESULTS</b>Totally 38 (82.6%) of the patients accomplished the treatment and follow-up, 26 (68.4%) in the abnormal nocturnal erection group and 12 (31.6%) in the non-nocturnal erection group. After 3 months of daily tadalafil treatment at 10 mg, the IIEF-5 scores were significantly improved in the abnormal nocturnal erection group than in the non-nocturnal erection group (P < 0.05), and the rate of yes responses to SEP2 and SEP3 was remarkably higher in the former than in the latter (76.9% vs 41.7% and 65.4% vs 25.0%, P < 0.05).</p><p><b>CONCLUSIONS</b>Daily low-dose tadalafil can effectively improve the erectile function of PFUD-induced ED patients, particularly in those with nocturnal erection.</p>

Idiopathic Scrotal Calcinosis / 대한남성과학회지

Idiopathic scrotal calcinosis is a rare benign disease of scrotal skin, characterized by multiple asymptomatic nodules on the scrotum. The lesions are asymptomatic, round, firm, and yellowish nodules with variable size. Herein, we report a case of idiopathic scrotal calcinosis and a short review of the literature. A 42-year old man presented multiple painless, firm, nodules on his scrotum for about ten years. After excision of the nodules, mixture of calcified material was observed as a typical histological feature of idiopathic scrotal calcinosis.

Effect of Microsurgical Bilateral Varicocelectomy on Patients with a Left Varicocele Diagnosed by Color Doppler Ultrasonography / 대한남성과학회지

PURPOSE: The objective of this study was to evaluate the accuracy of color Doppler ultrasonography (CDU) and to assess the effects of microsurgical bilateral varicocelectomy on patients diagnosed with a left varicocele by CDU. MATERIALS AND METHODS: 69 patients with varicocele were enrolled between March 2005 and May 2007. The patients were randomized into 2 groups: group I-preoperative bilateral varicoceles were diagnosed by color CDU, and group II-only a left varicocele was diagnosed by CDU. All patients underwent an inguinal microsurgical varicocelectomy bilaterally. Statistical analysis was performed by paired Student's t-test and one way ANOVA. RESULTS: Mean age of the patients was 27.5+/-7.9 years. After surgery, semen parameters were significantly improved in sperm number in group I (p=0.002) and semen volume in group II (p<0.005). At the time of surgery, we found that 16 (88.9%) of 18 patients had bilateral varicoceles in group II. The accuracy of CDU to diagnose varicoceles was not perfect. CONCLUSIONS: The bilateral microsurgical varicocelectomy in patients with only a left varicocele diagnosed by CDU significantly increased their semen volume. Most (88.9%) patients diagnosed with a left varicocele actually had bilateral varicoceles. Therefore, microsurgical bilateral varicocelectomy may be appropriate for infertile men with a left varicocele diagnosed by CDU.

Effect of Microsurgical Bilateral Varicocelectomy on Patients with a Left Varicocele Diagnosed by Color Doppler Ultrasonography / 대한남성과학회지

PURPOSE: The objective of this study was to evaluate the accuracy of color Doppler ultrasonography (CDU) and to assess the effects of microsurgical bilateral varicocelectomy on patients diagnosed with a left varicocele by CDU. MATERIALS AND METHODS: 69 patients with varicocele were enrolled between March 2005 and May 2007. The patients were randomized into 2 groups: group I-preoperative bilateral varicoceles were diagnosed by color CDU, and group II-only a left varicocele was diagnosed by CDU. All patients underwent an inguinal microsurgical varicocelectomy bilaterally. Statistical analysis was performed by paired Student's t-test and one way ANOVA. RESULTS: Mean age of the patients was 27.5+/-7.9 years. After surgery, semen parameters were significantly improved in sperm number in group I (p=0.002) and semen volume in group II (p<0.005). At the time of surgery, we found that 16 (88.9%) of 18 patients had bilateral varicoceles in group II. The accuracy of CDU to diagnose varicoceles was not perfect. CONCLUSIONS: The bilateral microsurgical varicocelectomy in patients with only a left varicocele diagnosed by CDU significantly increased their semen volume. Most (88.9%) patients diagnosed with a left varicocele actually had bilateral varicoceles. Therefore, microsurgical bilateral varicocelectomy may be appropriate for infertile men with a left varicocele diagnosed by CDU.

A Case of Growth Hormone Deficiency that Induced Erectile Dysfunction / 대한남성과학회지

Growth hormone deficiency is the medical condition of inadequate production of growth hormone. Growth hormone deficiency in adults is not common, but it may feature a diminished, lean body mass, poor bone density and a number of physical and psychological symptoms, including poor memory, social withdrawal and even depression. Abnormally low growth hormone levels in adults typically result in a diminished quality of life and it can even be disabling. The physical symptoms include loss of strength, stamina, and musculature. Growth hormone deficiency can also impair the biological and physiological/functional substrate of penile erection, which can be, at least in part, restored by the normalization of the plasma levels of growth hormone. This is a report on a 63-year-old man who suffered with severe erectile dysfunction and loss of libido due to growth hormone deficiency. Upon growth hormone administration, his erectile function improved dramatically.