[Ethical aspects]. / Aspetti etici.

The relation is considered between ethical choices, morals and deontology in plastic surgery of the male external genitals. Ethics dictates the behavioural model applied by an individual or group in their actions. Professional ethics--deontology--is the collection of duties governing the exercise of a certain profession. Morals are the set of rules governing an individual's life in society. Ethics, deontology and morals do not always convey the same message, since environmental, racial and religious situations, custom, and even fashion can influence a patient's demands, reflecting his desire to improve his quality of life, even only from the purely hedonistic viewpoint, and the specialist's attitude. Surgeons are increasingly tending to bend to these demands or--much worse--even encourage and foster them, with a view to financial considerations. The attitude and ethical choices available are examined in relation to surgery to lengthen or enlarge the penis.

[Role and current significance of EDVG (epididymography plus vasography) in obstructive azoospermia]. / Ruolo e significato attuale della EDVG (epididimovesciculodeferentografia) nelle azoospermie ostruttive.

The Authors present their 20 years experience about 612 EDVG (epididymography plus vasography). We will here discuss indications, complications and future prospects of EDVG and refer data arising from 55 andrology units: we can appreciate as this methodic is up to date in selected cases, i.e. obstructive azoospermia associated with normal FSH levels and lower or absent fructose, in presence of clearly pathological TRUS.EDVG is also indicated when on obstructive pathology is suspected to be the cause of an oligospermia or before vaso-vasostomy.

[Impotence: non-hormonal drug therapy. Old and new drugs]. / Impotenza: farmacoterapia non ormonale. Vecchi e nuovi farmaci.

The treatment for male impotence has undergone a radical change during these last years. This change is due mainly to the use of vasoactive drugs and more and more sophisticated prosthesis. The Authors discuss old and new drugs used, considering that often pharmacotherapy for impotence doesn't require the giving of a drug, but its suspension. The Authors mention, among the most active drugs, trazodone, yohimbine, pentoxifylline and L-arginine hydrochloride. However these pharmacological agents found only application to well defined and unfortunately limited cases. To day the ideal therapeutic agent is still not available. There is a need for continued research in this field; the initial results, like the ones on the erective mechanisms NO-dependents, give hope for the future.

[Spontaneous pregnancy in "sterile couples"]. / Le gravidanze spontanee nelle "coppie sterili".

The aim of the study is to evaluate the results of tests performed in "infertile" couples that have obtained spontaneous pregnancy. 953 couples were studied from 1986 to 1991; 108 spontaneous pregnancies occurred (11.1%). All patients were evaluated according to standard procedures recommended by literature. "Female factor" as cause of infertility was present in 41.5%; "cervical factor" was present in 19.4%; "male factor" was present in 48.1% while in 14.8% of the couples evaluated no pathology was showed. In this series, spontaneous pregnancy occurred within 4 year of infertility in more than 90%; no significant difference was present between primary and secondary infertility. A considerable incidence of pathologies was observed in couples that obtained spontaneous pregnancy. Our data suggest that common investigation for infertility may have not a real prognostic value.

[Induction of puberty and maintenance of secondary sexual characteristics in males with thalassemia major]. / Induzione della pubertà e mantenimento delle caratteristiche sessuali secondarie in maschi portatori di talassemia major.

18 males with beta-thalassaemia major were studied; mean age was 17.6 flAF 4.3, 8 of 18 males evaluated were prepubertal (Tanner 1), 5 were early and mid pubertal (Tanner 2-3) and 5 were full pubertal (Tanner 5). All patients (pts) underwent GnRH test and 61% showed positive response. 8 pts. were treated with hCG; 2 were azoospermic, 6 were aspermic. The starting dose was 1000 IU twice weekly; dose adjustments were made basing on testosterone levels and clinical features. Clinical examination, testosterone assays, semen analysis were performed every 3 months during the treatment period. Therapy was started 18-48 months ago and it is still in progress. Within 12 months of treatment 4 pts progressed to Tanner stage 4, 3 pts to Tanner stage 5, 1 showed no response. Semen analysis showed an improvement in 6 pts: after 12 months of therapy 1 pts was aspermic, 5 were azoospermic, 1 was oligozoospermic. Our data showed that hCG administration is effective in inducing and maintaining secondary sexual character.

[The retained testicle: our experience]. / Il testicolo ritenuto: la nostra esperienza.

In our experience the undescended testis has an occurrence rate of 3-4% on the total of males born. The rate decreases to 0.3% when the occurrence is observed on males aged 1 year. The first step of treatment is hormonal followed by a surgical second step in case of failure. The Author stresses the need of the treatment as early as possible to prevent the damage of both exocrine and endocrine testicular functionality.

[Cryptorchism: long-term results in subjects evaluated in a conjugal infertility service (monolateral cryptorchism fertility)]. / Il criptorchidismo: esiti a distanza in soggetti depistati in servizi di sterilità matrimonaiale (la fertilità di criptorchidi monolaterali).

Infertile male subjects because of cryptorchidism have an overall rate of 0.5-1%. Undescended testis even if treated by surgery and/or hormonal therapy have a bad seminal map. However in Author's experience, the hormonal treatment give a significant improvement in terms of fertility. Biopsies carried out on undescended testis demonstrated an early cellular damage of the testis.

[Testicular biopsy in cryptorchism: prognostic parameters]. / La biopsia testicolare nel criptorchidismo: parametri prognostici.

470 testicular biopsies performed in prepuberal cryptorchides has been reviewed in order to assess the relationship, if any, between the morphological parameters and the prognosis of future fertility. The main parameter is the presence and the number of germinal cells, which are progressively decreasing in the following groups of patients: descended testis in monocryptorchid patients, monolateral undescended testis, bilateral undescended testis. The results observed are similar to those reported by various Authors. The age of the patients biopsied was irrelevant with respect to the results of the predictability of fertility. Other parameters than germinal cells are of no practical interest.

[Ultrastructural analysis of human ejaculate from infertile subjects]. / Analisi dell'ultrastruttura dell'eiaculato umano in soggetti infertili.

It has been demonstrated that the semen of infertile patients contains at high percentage of abnormal forms and no clear answer has been so far provided to the questions of which malformations are compatible with male fertility, which malformations are responsible for the infertility and which is the percentage of defective cells that gives rise to infertility. In this study the eiaculates of 56 patients of suspected male infertility were used as material. The semen samples were fixed for 2 hr at room temperature in 4% glutaraldehyde in 0.05 M cacodilate buffer + 0.018% CaCl2 + 6.6% sucrose, post-fixed in 1.5% OsO4 in same buffer + 6.6% sucrose, dehydrated and embedded in Spurr. The samples were sectioned with Reichert OMu3 ultratome. The sections, contrasted with uranyl acetate and lead citrate, were examined in a Feol M T8 E.M. The varieties of sperm malformations are described and classificated into morphological categories based upon the type of alteration and the cellular portion in which the malformation appeared. From this research we have got the following conclusions: 1) an absolute correlation between microscopical, ultrastructural defects and functionality of spermatozoa does not exists; 2) the submicroscopic analysis contributes to a more accurate definition of the eiaculate; 3) the high variability of the ultrastructural defects needs that the submicroscopical analysis of the human semen must be supplemented by a quantitative evaluation.

Testicular biopsy of azoospermic men with vas deferens malformation using two different techniques.

A morphological analysis was carried out on testicular biopsies of men with obstructive azoospermia as consequence of vas deferens malformations as compared with biopsies from fertile men. For each case the biopsies were processed with two different techniques: routine histological procedure, and semithin sections of specimens processed for electron microscopy. Four parameters were considered: tubular morphology, testicular biopsy score count (TBSC), tubular diameter, and germinal cell density. The data were quantified and analyzed by statistical tests. The biopsies of azoospermic men present a higher frequency of tubular sections with "tubular blockage," "sloughing" and cellular degeneration, lower values of TBSC, and lower germinal cell density. The results appear to be of relevant interest in relation to the existence of long-term testicular alteration following vasectomy.

The morphology of seminiferous tubules of human testicular biopsies. Analysis of the data obtained with two different techniques.

Testicular biopsies of fertile men and of azoospermic patients for vas deferens agenesis were processed with two different techniques, i.e. routine histological procedure and semithin sections of electron microscopy preparations. Tubular morphology, testicular biopsy score count and tubular diameter were analyzed in comparison. The two techniques give rise to a different qualitative and quantitative evaluation of all tubular parameters considered. Otherwise they confirm the real existence of the so-called 'tubular blockage' situation with central tubular cellular mass and cell degeneration.

[Ultrastructure of Sertoli cells of the human testis in agenesis of the vas deferens]. / Ultrastrucutre des cellules de Sertoli du testicule humain chez des sujets atteints d'une agénésie du canal déférent.

Ten testicular biopsies from adult males with agenesis of the vas deferens have been investigated with light and electron microscopy. The ultrastructural study of SERTOLI cells has demonstrated that: (a) the junctions between SERTOLI cells and between SERTOLI and germinal cells retain their normal ultrastructural features. (b) Lanthanum permeates SERTOLI cells tight junctions, but its diffusion towards the adluminal compartment is prevented. (c) SERTOLI cells present unusual amounts of cytoplasmic inclusions, especially lipofuscin granules. A relationship between these inclusions and phagocytosis has not been demonstrated. (d) "Dark" SERTOLI cells which show alterations of their typical junctional complex have been frequently observed, although their frequency varies among the different patients. The results are discussed in relation to diagnostic significance of the ultrastructural study of testicular biopsies.