Development and in vitro testing of a new method of urine preparation for retrograde ejaculation; the Liverpool solution.

OBJECTIVE: To design a new method for oral preparation of urine for sperm retrieval after retrograde ejaculation (RE) and to test the motility of sperm exposed to prepared and unprepared urine. DESIGN: In vitro testing of urine conditions and sperm motility. SETTING: Assisted conception unit at a teaching hospital in the United Kingdom. PATIENT(S): Ten healthy volunteers to provide urine and sperm specimens from men attending the unit for semen analysis. INTERVENTION(S): Various solutions of sodium bicarbonate and sodium chloride were drunk by a single subject until a suitable regimen was achieved. This regimen (called the Liverpool solution) was then tested on 10 volunteers. Samples of sperm were then added to prepared urine, unprepared urine, and culture medium, and the motility was analyzed. MAIN OUTCOME MEASURE(S): Urinary pH and osmolarity, sperm motility. RESULT(S): Urine produced by the 10 volunteers had a mean pH of 7.47 (range, 7.23-7.79) and a mean osmolarity of 289 mOsmol/L (range, 225-412 mOsmol/L), similar to that of medium. The progressive motility of sperm exposed to the unprepared urine was reduced (42.4% of sperm in medium), whereas that in the prepared urine was similar to that in the control medium. CONCLUSION(S): Liverpool solution can be used in any unit treating couples with RE, and it is a noninvasive and inexpensive regimen that may optimize urine pH and osmolarity for sperm survival after RE.

Immunohistochemical localization of androgen receptors in the urogenital tracts of human embryos.

The aim of this study was to investigate androgen receptor (AR) expression in the developing human urogenital tract. The distribution of AR was examined in paraffin-embedded tissue sections of the lower urogenital tract using 55 human embryos of 8-12 weeks of gestation. Immunohistochemistry was performed for AR detection and gender was determined by polymerized chain reaction. There were no differences in the distribution of AR in male and female embryos at any stage of gestation. AR was present only in the mesenchymal tissues of the urogenital sinus at 8 weeks whilst the epithelium was negative, but after 9 weeks the epithelium also showed progressively more positive staining. In the phallus, AR staining was prominent. There was far less staining in the epithelium of the urethral groove from 8 to 10 weeks, whilst the mesenchyme of the urethral folds showed positive staining. At 11 and 12 weeks, both the urethral groove and folds showed uniform staining. The genital tubercle, genital swelling and bulbourethral gland precusors were also positively stained, although paramesonephric ducts were negative. Staining was observed in the mesonephric duct from 9 weeks. There was an absence of staining in the rectum at all stages of gestation. The expression of AR in an epithelium may be dependent upon the mesenchyme. Mesenchymal-epithelial interactions played an important role in development, as has been described in experimental animals. AR expression could play a part in the growth of the genital organs.

Retrograde ejaculation and male infertility.

Incompetence of the internal urethral sphincter causes semen to pass into the bladder. Infertility can be successfully treated by restoring normal ejaculation or by sperm retrieval techniques.