Erectile dysfunction: anatomical parameters, etiology, diagnosis, and therapy.

Functional anatomy of the human penis involves various parameters: cavernous tissue, covering integument, prepuce foreskin, corpora cavernosa, corpus spongiosum, glans, facia, arterial supply, venous drainage, lymph drainage, musculature, and nerve supply. Several factors affect the expression/degree of erectile dysfunction (ED) endocrine profile, aging/senescence, demyelinating diseases, and surgery. Risk factors of ED are: age, vascular factors, metabolic diseases (diabetes mellitus), neurologic diseases, and HIV/AIDS. Several drugs are associated with ED: antiandrogenic, anticholinergic, antidepressants, antihypertensive, major tranquilizers, anxiolytics, and certain medicines/metabolites. The International Index of Erectile Function (IIEF) is a multidimensional scale for assessment of erectile dysfunction. The main structures mediating erection are the corpora cavernosa or "erectile bodies," which are fused distally for approximately three-quarters of their length. They separate proximally to fuse with each ischial tuberosity of the pelvis. On their ventral surface lies the corpus spongiosum, which surrounds the urethra. Coital dysfunction is classified into "erectile dysfunction" (psychosexual and endocrine/neuro-endocrine) and "ejaculatory dysfunction" (psychosexual, and genitourinary surgery). Vasculogenic impotence was evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Cavernosal, alpha-blockade is a technique used to evaluate and treat ED. Another diagnostic procedure for ED involves color floro and spectural Doppler imaging after papaverine-induced erection in impotent men. Color Doppler and duplex ultrasonography are used to evaluate Peyronie's disease. Sildenafil cilrate (Viagra) is an effective therapy of ED in men. Vardenavil is a highly selective phosphodiesterase 5 (PDE5) inhibitor which improved ED. Prostagland E1, vasoactive intestinal polypeptide (VIP), and phentolamine mesylate (administered by autoinjectors) have been applied to treat ED in patients resistant to other intracavernosal agents. Clinical trials were conducted on self-injection of vasoactive drugs, apomorphine SL, and tadalafil in diabetic men. Medical therapy of ED includes: medicated urethral system for erection (MUSE), intravenous pharmacotherapy, arterial revascularization, vacuum devices, two- and three-component inflatable penile prosthesis, semi-rigid penile prosthesis in situ, and inflatable one-piece penile prosthesis. Surgical therapy include procedures to correct Peyronie's penile deformity and penile deformity, procedures to avoid inevitable shortening accompanying Nesbit's disease, and for penile lengthening.

Stress/aging: endocrine profiles/reproductive dysfunction in men.

Extensive investigations have been carried out on the biology/physiology of stress [13, 18, 20, 25, 35, 48, 49, 53, 55], pathophysiology of aging [41], sexual dysfunction [7, 27] and adrenal insufficiency [4, 31].

Mammalian fertilization, IVF, ICSI: physiological/molecular parameters, clinical application.

Fertilization is associated with several phenomena: rearrangement of euplastic cytoskeleton, intra-cellular communication, cellular polarity, and the release of a variety of complex systems. Several criteria are used to score fertilization. On the day after fertilization, oocytes are cleaned of cumulus and examined for presence of 2 pronuclei and any possible cytological anomalies. Function tests to evaluate fertilization include SPA, ZBA, SCSA, AAA acrosome reaction and fluorescent probes. Fertilization failure, silent polyspermy, aster arrest, mitotic arrest, aster growth defect, or immuno-logical mechanisms cause infertility. Sperm-induced oocyte activation may be due to ligand-recep-tor-mediated interaction or a soluble sperm-derived factor that enters the oocyte at the time of fusion. Any abnormalities in transcription, translation, or any other significant molecular process responsible for producing the oocyte-activating ligand/effector molecule during spermatogenesis and/or spermatogenesis will ultimately cause fertilization failure. The centrosome is paternally derived. During the time course of fertilization the sperm centrosome is orchestrating producer mobilization, syngamy and, ultimately, early cleavage. Vesicle-associated membrane protein(VAMP) is typically lost at cell surface during sperm penetration. Understanding cytoskeletal motility during fertilization requires sophisticated digital imaging including conventional epifluorescence microscopy, laser scanning confocal microscopy and time lapse video microscopy. Clinical application of the recent finding is discussed with emphasis on timing of coitus or insemination, to coincide with time of monitored ovulation. Future research directions are outlined.

Andropause: endocrinology, erectile dysfunction, and prostate pathophysiology.

This review summarizes major biological aspects of andrology of andropause, deficiency in androgens/growth hormones, and molecular parameters; erectile dysfunction (ED), the use of malleable, mechanical, inflatable devices as well as the application of Viagra (Sildenafil), alprotadil (Caverject), Yohimbine, and other drugs not yet approved by FDA, such as Papaverine, phentolamine (Vasomax), and apormorphine (Uprima); osteopenia/osteoporosis: testosterone/osteoporesis; supplementation during andropause: administration of andiogens, possible risk factors of androgens, calcium supplement and muscle mass; prostate pathophysiology: consequences of prostatectomy, prostate cancer, benign prostatic hyperplasia (BPH), hormone-dependent cancers; bladder and urethral dysfunction: neurological parameter, urodynamics technology; models on aging in male animals: comparative physiology of prostate of laboratory animals/farm animals; future research: functional anatomy of male reproductive organs, pharmacokinetics of osteoporosis, endocrinology/neuroendocrinology/chromosome anomalies supplementation during andropause, experimental animal models and future multicenter multidisciplinary research.

Reproductive parameters of male dromedary and bactrian camels.

Functional anatomy of male reproductive organs and reproductive physiology of dromedary and bactrian camels are quite similar except for some differences in the seasonal pattern of reproductive events: left testes bigger than right; scrotum not pendulous; vas deferens very convoluted with 2 mm diameter; prostate divided into 2 parts by septum, with many ducts; bulbourethral (Cowper's) glands well developed and seminal vesicle absent; fibroelastic penis has "prescrotal" sigmoid flexure and the glans resembles crochet needle; triangular-shaped prepuce directed posteriorly to open to the rear, and can move cranially or caudally during erection or urination, respectively; semen ejaculate, 1-12 mL in volume with little gelatinous material, coagulates and liquifies within minutes; total sperm/ejaculate 6 x 10(9) sperm/mL; semen contains PGE1, PGE(2x,LH), estradiol progesterone/other metabolites; semen collected by AV used for bulls with long copulation time; ovulation induced 36-48 h after mating or insemination; sperm of a short life of 1-6 h at 0.4 degrees C, is prolonged in presence of mucopolysaccharide gel; fresh semen inseminated. Topics of future research on endocrinology of reproduction, gonadal physiology, semen biology assisted reproductive technology, and gene transfer to germ cells of camels are outlined. The prevention and control of STD is an important component of camel stud management to improve reproductive performance in this species.

The Norplant system: an effective, long term contraceptive of the 20th century.

PIP: The Norplant system (levonorgestrel implants) provides excellent protection against pregnancy (typical failure rates, 0.2% for Norplant vs. 0.4% for female sterilization and 3% for oral contraceptives [OCs]). Women may choose to have the capsules removed before the end of the 5-year period. The pregnancy rate in former Norplant users is similar to that of women who have not used Norplant. Active thrombophlebitis or thromboembolic disorders, abnormal genital bleeding, known or suspected pregnancy, acute liver disease, benign or malignant liver tumors, and breast cancer are contraindications to Norplant. Trained providers should insert Norplant capsules within the 1st 7 days of the menstrual cycle. The most common side effect is change in menstrual bleeding, particularly irregular and/or prolonged bleeding during the 1st year. Norplant's cost is about 50% lower than that of OCs (US$11 vs. $21.40 per month; $133 vs. $278 per year; and $665 vs. $1391 over 5 years). Norplant-1 and Norplant-2 are comparable. This article provides step-by-step instructions, including photographs, on how to insert and remove the implant capsules and to remove a hard-to-retrieve capsule.^ieng

Medicinal plants: conception / contraception.

PIP: Researchers have conducted considerable experiments on the effectiveness and therapeutic values of Chinese herbs and parts of plants. We should not ignore the significance of natural medicine. The Chinese have been perfecting medicinal therapy based on the raw ingredients of plants/herbs and their derivatives for thousands of years. Chinese practitioners of traditional medicine prescribe medicines based on yin and yang. Traditional medicine is communicated in a verb or written form. Natural resources used in traditional medicine to treat diseases are not limited to just medicinal plants but also include animals, shell fish, and minerals. Parts of plants used in traditional medicine are leaves, stems, flowers, bark, and root. Chinese medicine is the world's oldest continuous surviving tradition. The Chinese experimented with local plants, often resulting in mild to violent reactions. This process allowed them to become familiar with poisonous plants and those that could relieve pain or successfully treat illness. Current allopathic medicines are composed of synthetic compounds copied from natural chemical derivatives, which tend to be more potent than the original compound. Some medicinal plants used to effect conception/contraception include Striga astiatica (contraceptive); Eurycoma longifolia (male virility); and a mixture of lengkuas, mengkudu masak, black pepper seeds, ginger, salt, and 2 eggs (increase libido). Women in Malaysia take jamu to preserve their body shape and to provide nutrition during pregnancy. Praneem causes local cell-mediated immunity in the uterus. Clinical trials of Praneem with or without the hCG vaccine are planned.^ieng

HIV / STD interactions immunosuppression and future research development.

PIP: Screening for HIV in China began in 1984, with the first AIDS case appearing in 1985. 305,280 sera were tested as of 1992, of which 379 were seropositive for antibodies to HIV. Of these 379 individuals, there were 4 hemophiliacs identified in 1985, 1 homosexual male, 4 individuals returning from Africa, 365 drug addicts and 2 spouses. 68 foreigners and 1 Chinese hemophiliac from Hong Kong also tested seropositive. Concern is expressed over the psychosomatic trials of infected women who feel unable to discuss their HIV status with family members for fear of influencing their role as primary caregivers and sex partners. Without access to medical therapy and support groups, these women no doubt feel isolated. Non-directive counseling is recommended for seropositive women during pregnancy. AIDS patients have reduced natural killer cell cytotoxicity. Seminal plasma also suppresses several immune responses. The pathogenicity of HIV, however, has yet to be determined. Fatty acid metabolism and Beta-endorphin are discussed in the context of therapeutic approaches. HIV/STD interactions are finally considered with individual attention given to bacterial vaginosis, hepatitis B, Chlamydia trachomatis, Herpes Simplex virus, microbiological contaminants of the vagina bacterial vaginosis, syphilis, mycoplasmas/epididymitis, bacterial prostatitis, and IVF culture media infections.^ieng

Histochemistry of human urethral glands.

Human urethral glands were reacted histochemically and immunohistochemically to identify glycoproteins, some androgen metabolic enzymes, and VIP-like immunoreactivity. Neutral/acid mucosubstances were detected mainly in the apical cytoplasm of the principal cells. 3 beta-, 17 beta-, and 3 alpha-hydroxysteroid dehydrogenase, G6PD, and 6PGD reactivity were intense in all the glandular epithelium. Small amounts of VIP-positive fibers were noted around the secretory elements.

Conception control and HIV/STD infections.

PIP: The basic clinical aspects of contraception, fertility regulation, family planning, and family health are described as they relate to parameters of human immunodeficiency virus (HIV), AIDS Related Complex (ARC), and sexually transmitted diseases (STD) in man. Special emphasis is placed on: the biology/pathology of HIV; microbiology/immunology of human semen; condoms/spermicides; IUDS and HIV infections; STDs; heterosexual/homosexual transmission of HIV; risk factors/cofactors and HIV; prevention of HIV; clinical manifestations and opportunistic infections; and the integration of family planning programs with STD/HIV services. Human semen contains a wide variety of cellular elements and microbiological contaminants. THe major leukocyte subpopulations in the semen include: granulocytes, monocytes/macrophages, B lymphocytes, helper and suppressor/cytotoxic T lymphocytes, and antibodies. HIV penetrates several types of cells: macrophages, antibody-producing B cells, endothelial cells of blood vessels, and non-neuronal brain cells. Sperm-specific moieties have a high potential of immunogenicity. Condoms have been recommended to HIV carriers, both to prevent sexual transmission of HIV to uninfected sexual partners and to avoid repeated contact with HIV which influences clinical outcome of AIDS. Fluctuations in sales of condoms are due to the removal of IUDs from the American market; homosexual fear of HIV infection; and the discontinuation of oral contraceptive use among older women. The FDA has authorized anti-AIDS benefits in advertising/labelling of condoms. With the use of IUDs, a local infection of susceptible cervical cells from infected semen precedes systemic spread of HIV. Multiple sex partners increase the risk of HIV/STD infections. Further complications may also involve immunopathological interactions among multiple viral infections. With copper IUDs there may be urticarial eruptions and eczematous dermatitis and such cases with exposure of subcutaneous areas of the skin are considered as cofactors for HIV infection. HIV-infected women should avoid pregnancy and be given the highest priority for family planning services.^ieng

Immuno-andrology/IVF/AID/HIV.

PIP: Several research projects are suggested related to artificial insemination by donor (AID), rectal insemination, autoimmunity in the male reproductive system and isoimmunity in the female tract and HIV transmission. The mixed antiglobulin reaction test is suggested as an early indicator of whether semen for donor insemination is free of HIV. Such semen should also be screened for hepatitis B. The immune responses to rectal insemination should be explored, as evidence from laboratory animals and homosexual men suggests that this practice may compromise the immune system. The possibility that the high titer of HIV in semen could adversely affect women using IUDs, via the exposed tail of the device, should be investigated. A protocol for insuring that semen for artificial insemination is free of HIV is presented. 21 other research experiments are suggested by title only, including 13 types of testing for studies of the immune response in malignancy.^ieng

Condoms replacing IUDs: integrated family planning with STD/AIDS.

PIP: This editorial overview is an update of recent research advances in the interrelationships between 1) contraception and family planning and 2) sexually transmitted diseases and acquired immunodeficiency syndrome (AIDS). In both developed and developing countries, family planning services should be integrated with the most urgent public health services, such as 1) clinics for sexually transmitted diseases, including AIDS; 2) centers of maternal and infant care; and 3) special local public health services, such as improved nutrition and parasite control. Special programs have been developed to serve teenaged parents and their children, including 1) recruitment, 2) organization of services, 3) technical assistance to service providers, 4) measures to help teens delay 1st births, and 5) program evaluation. In the US, approximately 1 million adolescents become pregnant each year, or 96/1000 girls aged 15-19. Some 50% of US adolescents have had sexual intercourse by age 17, but more than 25% have never used contraception. During the last decade, extensive research has identified potentially serious complications of IUDs. Recently, it was established that there are significant relationships between AIDS and IUDs. The association between IUD use and pelvic inflammatory disease is well established. In 1985-1986 in the US, condoms have been replacing IUDs. Except for Japan and China, condoms are not commonly used for contraception, but are greatly needed to prevent the spread of AIDS.^ieng

Interdisciplinary andrology. STDs. AIDS research.

Multidisciplinary andrology deals with clinical application and modern technology for the evaluation and differential diagnosis of male infertility with emphasis on morphological, anatomical, biochemical, immunological, hereditary, and microbiological parameters. Little is known about the effects of diet, disease, stress, environmental, and drugs on male-related unexplained infertility of couples. Regional, national, and international centers of multidisciplinary andrology should provide (1) extensive and unique clinical services; (2) a computerized "patient referral center," (3) self-learning packages (slides/tape programs) for patients; and (4) a computer link to the National Library of Medicine and the Drug Information Center. Specialized laboratories and clinics can be served by expert consultants, visiting professors, bilingual and well-trained clinicians, nurses, laboratory technologists, computer operators, and related allied health personnel. Patient education pamphlets, updated every few years, can be distributed during training workshops when an extensive network of remote teleprinters can be utilized. Qualified client location may install a printer to allow on-site printing of reports in the shortest possible time. Special mailing containers are provided to clients who wish to mail their laboratory specimens. Other clinical services may include the following: 1. Central source of communication and information in andrology; 2. International roster of multidisciplinary andrology centers; 3. Patient referral to centers and consultations for developing countries; 4. Screening of husbands and wives for in vitro fertilization/embryo transfer (IVF/ET); 5. Screening of couples with unexplained infertility for sexually transmitted diseases (STDs) including AIDS; 6. Exchange of research material and methodology; 7. Coordination of multicenter research; 8. Organizing training workshops for clinicians, nurses, and laboratory technicians; 9. Establishing a repository of films, video tapes, slides, catalogs, instrumentation, books, SEM photos, and atlases; 10. Publication and editorial assistance; 11. Consultation for the appropriate selection, purchase, and quality control of instrumentation (all on one computer system); 12. Evaluation of new diagnostic tools for idiopathic infertility and fertility regulation; 13.(ABSTRACT TRUNCATED AT 400 WORDS)

[Scanning electron microscopy of the IUD tail]. / Examen des fils de D.I.U. au microscope electronique a balayage.

PIP: The surface ultrastructure of over 40 IUDs including Multiload, Copper 7, Copper-T, Nova-T, FDI, Lippes Loop, and Dalkon Shields, in place for periods ranging from less than 1 month to over 9 years was studies with the scanning electron microscope to assess the influence of various factors on the etiology of pelvic inflammatory disease (PID). Strings of IUDs in place for less than 1 month showed few changes. 3 sections of strings cooresponding to intravaginal, intracervical, and intrauterine location were easily distinguishable after 3 months of use and were comparable in all types of IUDs regardless of type of string. IUDs with relatively smooth strings became contaminated less rapidly the 1st few months of use, but all strings eventually began to acquire coatings which served as substrates for adhesion of exfoliated epithelial cells, blood cells, uterine and cervical secretions, and other matter. The deposits were usually invaded by bacteria. There appeared to be a correlation between the length of the intravaginal string and the quantity of vaginal epithelial cells, but not of bacteria. The surfaces of intravaginal segments appeared identical regardless of whether the wearer suffered from PID. After 3-6 months of use, the intracervical segments contained large deposits with a globular structure. The deposits, unlike those in the other 2 sections, were very hard and appeared to contain little water. The intracervical sections appeared to contain age rings resulting apparently from variations in the composition of materials deposited, although they were largely composed of cellular debris, mucus, and occasionally trapped bacterial residues. No calcium was seen under X-ray, but copper was usually observed in IUD strings in place at least 9 months. The thickness of the intracervical deposits depended more on such factors as the quantity and composition of cervical and vaginal secretions than on the duration of use of the IUD. Bacteria were found in most intracervical string sections, but no relationship was established between presence of bacteria and PID. The intrauterine string segment was usually more homogeneous and contained more water than either of the other sections. Bacteria were sometimes observed, particularly in devices in place for more than 2 years, although they were not necessarily associated with signs of inflammation. Coatings of material seemed to form more rapidly on strings with 2 strands than on those with just 1 strand, and on strings with irregular surfaces or knots. The thicker the coating of materials on the intracervical and intravaginal segments, the greater the likelihood of bacteria on the intrauterine segments. Since the thickness of the coating increased with time, it does not seem advisable to leave an IUD in place for longer than about 18 months.^ieng

Zona-free hamster egg-sperm penetration assay: I. Testing of human semen fertilizability.

The zona-free hamster egg penetration test was performed on semen samples from 21 fertile donors, 57 infertile patients with normal semen parameters, and 63 infertile patients with subnormal spermiogram, as well as on 19 frozen semen samples. In the donor group 100% of the samples gave a positive range of penetration (PRP) of 20-96% with a mean penetration rate (MPR) of 53%, while 84% of the frozen samples showed a PRP of 18-44% and an MPR of 31%. Although 74% of the samples from infertile patients with normal spermiograms gave a PRP of 11-92% and an MPR of 34%, only 46% of the semen samples from the infertile patients with subnormal spermiogram showed a PRP of 21-100% but an MRP of 43%.