[Testicular microlithiasis: is there a relationship with malignant tumour?]. / Microlitiasis testicular: existe relación con patología maligna?

The aim of this revision is to assess the relationship between testicular microlithiasis and malignant tumours. We reviewed 98 charts of patients with pathological diagnosis of testicular malignant tumour. Diagnosis of testicular tumour was made by ultrasound, and 6.02% (6 pts.) presented testicular lithiasis, and this finding makes us conclude that this is not a characteristic feature of this entity. We also reviewed bibliography related to this theme, and conclude that the management of microlithiasis remains being controversial.

[Patient response to and assessment of intracavernous drug injection and vacuum]. / Respuesta y valoración por parte del paciente de la farmacoinyección intracavernosa y del vacuum.

One of the various therapeutic options currently used in erectile dysfunction (ED), vacuum is a procedure that should not be ruled out as it can benefit certain types of patient. To understand each patient's response and usage readiness, a vacuum test is routinely performed by the andrology service as part of the diagnostic study. The present study conducted on 200 patients with ED of different etiologies, included the vacuum test and the intracavernous injection of vasoactive drugs. The assessment included the response to each methodology; which of the two systems offered better response; and initial usage readiness to each system. Positive response was 93% in the vacuum test, and 40% in the intracavernous injection. Improved erection was reported by 73% with vacuum and only 13% with the intracavernous injection. With regard to usage readiness 60.5% favoured vacuum and only 14.5% the intracavernous injection. It was apparent that vacuum is a highly effective methodology with very high initial usage readiness, although ultimate use may be limited for different reasons.

[Our clinical experience with the use of ++sildenafil citrate to treat erectile dysfunction]. / Nuestra experiencia clínica con el uso del citrato de sildenafilo para tratar la disfunción erectil.

OBJECTIVE: To evaluate the response and adverse effects to treatment with Sildenefil in those patients with an erectile dysfunction who, according to our protocol, were considered as candidates for this therapeutic option. MATERIALS AND METHODS: We reviewed the clinical histories of 180 patients seen in our service from november 1988 to February 1999 as a result of an erectile dysfunction. Those patients in whom the use of Sildenefil was not contraindicated were prescribed this product at does of 50 mg. The response to treatment was subjectively evaluated based on the option of the patient when comparing his quality of life before and after treatment. RESULTS: Out of 180 patients, 144 started treatment as indicated. Of these, 67% expressed a positive response, while 33% did not respond to treatment. Adverse effects were notice by 26% of patients, but in 97% of them they were not severe enough to withdraw the medication. CONCLUSIONS: Two-thirds of 144 patients with erectile dysfunctions of heterogeneous origin responded positively to treatment with Sildenefil. One fourth of them reported some ort of adverse effect, but almost none of them stopped the medication for this reason.

[Value of the vacuum test in the clinic of erectile dysfunction]. / Valor del test de vacuum en la clínica de la disfunción eréctil.

Among the few therapeutic alternatives currently available in erectile dysfunction (ED), vacuum is a procedure from which a considerable number of patients may benefit. To know the response and usage availability in each patient, the routine performance of the vacuum test is proposed in order to compare it with other therapeutic methodologies. This study was conducted in 272 patients with ED of various etiologies, with favourable results in 93.3%. 94% presented no complications, which were otherwise minimal (pain, haematoma) in the rest, 94% were in favour to using vacuum as therapy. This study demonstrates that vacuum is an effective methodology free from complications which allows application in most ED patients, its inclusion as a routine study of signs and symptoms of ED appearing to be very useful. This approach makes patient's knowledge of the system easier also facilitating the choice of the most appropriate therapeutic alternative.

[Mechanisms of vacuum erection]. / Mecanismos de erección por vacío.

OBJECTIVES: To analyze the vacuum erection devices utilized in the treatment of erectile dysfunction. METHODS: The different devices used for vacuum therapy are described. The indications, contraindications, complications, management and patient acceptance of vacuum erection devices are discussed. RESULTS: The preliminary data from our study show good patient acceptance of and satisfaction with this type of therapy. CONCLUSIONS: Treatment of some forms of erectile dysfunction with vacuum devices has achieved encouraging results. Some cases that require higher pressures may benefit from the new electronic vacuum devices that are currently being developed.

Critical evaluation of the present experience on microsurgical sperm aspiration.

Microsurgical epididymal sperm aspiration (MESA) and IVF techniques are indicated in those cases of bilateral congenital absence of the vas deferens (BCAVD) and in cases of epididymal obstruction (EO) of other aetiologies were vasoepididymostomy is not possible or has failed. Microsurgical deferential sperm aspiration (MDSA) is indicated in those cases where spermatogenesis and epididymal permeability are conserved but spermatozoa, for different causes, cannot reach the ejaculate and other therapies have failed. We have performed this procedure in 70 patients by two different human reproduction teams. Both teams achieved very similar results regarding fertilization rate: 5.5 and 7.2% in cases of BCAVD, 6.5 and 8.8% in cases of EO and 33.3 and 26.7% in cases of non-epididymal pathology (NEP). However, the fertilization rate per patient presents differences between both teams: 27 and 44.4% in BCAVD, 31 and 11% in EO and 80 and 100% in NEP. In spite of a better fertilization rate per patient in team two, it was in the other where pregnancies were achieved (7% in BCAVD, 15% in EO and 20% in NEP). One pregnancy in EO group was achieved by intracytoplasmatic sperm injection. The pregnancy rates per transfer were 25% in BCAVD, 50% in EO and 25% in NEP.

[Penile erection using vacuum devices: our experience with 100 impotent patients with organic etiology]. / Erección peneana por sistemas de vacío: nuestra experiencia en cien pacientes impotentes de etiología orgánica.

The aim of this study was to determine the efficacy and acceptability of the erection suction device in patients with erectile dysfunction from organic causes. One hundred patients suffering from impotence due to different organic etiologies were evaluated following a protocol which included patient history, physical examination, general blood tests, hormonal tests, erection (Rigiscan) study and vascular and neurological tests. In 87% of the patients, a correct erection was achieved when the suction device was used for sexual intercourse. However, only 28.7% accepted to use this method routinely.

[Pregnancy via spermatozoa aspirated from the ductus deferens and fertilization in vitro]. / Gestación mediante espermatozoides aspirados del conducto deferente y fertilizacion in vitro.

The possibility of aspirating sperm from the first segments of the seminal tract by microsurgical techniques has permitted in vitro fertilization of the oocytes of the partners of men with obstructive azoospermia and ejaculation disorders. Sperm can be aspirated from the epididymis by microsurgical techniques in those cases with deferent duct agenesis or other obstructive pathologies, or from the deferent duct if spermatogenesis is unimpaired and there is no epididymal obstruction, but spermatozoa do not reach the ejaculate. We previously reported a pregnancy achieved by in vitro fertilization using sperm aspirated from the epididymis and the present article reports the first pregnancy achieved in our country using sperm aspirated from the deferent duct of the spouse with aspermia of psychogenic origin. A micropipette was utilized to obtain the sample, which was prepared using the mini-Percoll method. A total of 10 million motile spermatozoa were obtained and 6 of the 15 oocytes aspirated from the spouse were fertilized. The 3 embryos transferred to the fallopian tube resulted in a twin pregnancy that was carried to term.