Staged Laboratory Processing of Testicular Tissue in Non-Obstructive Azoospermia May Rescue Retrieving an Existing Sperm: A Case Report and Literature Review.

Non-obstructive azoospermia (NOA) is the most difficult form of male infertility to manage. It usually requires sperm retrieval from the testis, which is most challenging due to sperm rarity. Here, we describe the recovery of testicular sperms that had been missing and whose original retrieval results were negative. Salvage microsurgical testicular sperm extraction and sperm testing were performed on a 36-year-old male with NOA. Neither in the operation room nor after an inspection in the embryology laboratory were any sperm detected. The obtained tissue was advised to be frozen because the patient data and surgical microscopy predicted a favorable outcome, and the tissue processing was done in an inappropriate environment. About 1 month later, the specimen was thawed, crushed, and re-examined. Successful oocyte fertilization resulted from an effective detection of sperms and their direction to intra-cytoplasmic sperm injection. This is the first case report that, to the best of our knowledge, describes the stepwise laboratory processing of testicular tissue and its capacity to recover lost sperms in challenging NOA cases and under less-than-ideal working conditions.

Acute Epididymo-Orchitis Complicated With Abscesses in Testis and Seminal Vesicles: A Case Report.

Epididymo-orchitis is a common intra-scrotal inflammation among males that causes swelling of the epididymis and testis. In the era of modern antibiotics, complications associated with this condition are now rare. Herein, we report a 28-year-old man with acute epididymo-orchitis complicated by the formation of several abscesses involving the left testis and seminal vesicles. The literature review showed this patient as the first case with such extensive complications following epididymo-orchitis. Initial antimicrobial therapy was unable to resolve the condition. The management necessitated surgical intervention, which included MRI-guided aspiration of the seminal vesicle abscesses and testicular sparing drainage of the testicular abscess.

A Post-Aspiration Giant Spermatocele in a Young Man: A Case Report and Literature Review.

We report a case of a post-aspiration giant unilocular spermatocele in a young man. A 27-year-old man sought medical advice for a huge right scrotal swelling. The swelling first appeared following scrotal trauma and was aspirated. Shortly after, it reappeared and persisted for several years with a sense of heaviness, infrequent periods of right scrotal pain, and cosmetic concerns. Ultrasonography of the scrotum revealed a huge fluid cyst pushing the testis antero-inferiorly in the right hemi-scrotum. Scrotal exploration suggested the spermatocele nature of the cyst that emerged from the head of the epididymis. The cyst was excised, and its fluid content and wall underwent pathological examination for confirmation.

COVID-19 and Male Sexual Functioning: A report of 3 Recovered Cases and Literature Review.

COVID-19 is a new global pandemic. It can affect multiple body systems and functions. However, the relationship between COVID-19 and male sexual activity did not yet get much consideration. Herein, we report the impact of COVID-19 on sexual function in 3 men who recovered from the disease. Compared with their condition before catching the infection, the men showed, in different degrees, a decline in all aspects of sexual function as assessed by the international index of erectile function. They started to develop premature ejaculation or exacerbate an already existing condition according to the premature ejaculation diagnostic tool scoring. Beck's depression inventory revealed deterioration of the men's moods up to severe depression. The sex-related hormones (testosterone-total and free, luteinizing hormone, follicle-stimulating hormone, prolactin, and estradiol) of these men were within normal levels. To the best of our knowledge, this is the first case report documenting deleterious changes in mood and several aspects of sexual functioning in males after recovery from the COVID-19 using validated measurement tools. Follow-up and psychological support of the recovered men may help mend their moods and consequently upgrade their sexual functioning.

Serum estradiol levels in infertile men with non-obstructive azoospermia.

PURPOSE: To report the different patterns of estradiol levels in infertile men with non-obstructive azoospermia and correlate these levels with their clinical and laboratory findings. MATERIALS AND METHODS: A retrospective study was launched, and a retrieval of data for infertile men with non-obstructive azoospermia (n = 166) and fertile controls (n = 40) was performed. The retrieved data included demographics, clinical findings, scrotal duplex, semen analysis, and hormonal assay (testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, and estradiol). RESULTS: Our findings showed a wide spectrum of estradiol concentrations. The patients were arranged into three groups (high, normal, and low estradiol groups). The normal estradiol group was the most prevalent (71.1%). Testosterone, gonadotrophins, testicular volumes, and the number of patients with jobs in polluted workplaces showed significant differences among the study groups (p = 0.001, <0.001, <0.001, and 0.004, respectively). Age, body mass index, varicocele prevalence, prolactin, and smoking habits did not show any significant differences among the groups. Obesity was lacking in the low estradiol group, but it had significantly higher prevalence in the normal (p = 0.013) or high group (p = 0.023) compared with the controls. CONCLUSION: Serum estradiol, in infertile men with non-obstructive azoospermia, may be present at different levels. It is recommended that estradiol be measured in infertile men with non-obstructive azoospermia when there is an alteration in testosterone concentration, obesity, a polluted workplace occupation, or before trying hormonal therapy. Extended studies are highly recommended to provide a clear clue whether alterations in estradiol concentrations in men with non-obstructive azoospermia are the cause or a consequence of the condition.

Normal Male Reproductive Hormones And Sperm Parameters In Adult-Onset Still's Disease- A Case Report And Literature Review.

Adult-onset Still's disease (AOSD) is an uncommon systemic auto-inflammatory disease. It can affect multiple body organs. Herein, we report the reproductive hormone and semen profiles in a male with AOSD. A 23-year-old male with already diagnosed and controlled AOSD requested a premarital check-up on his fertility potential. He was kept on a maintenance treatment protocol for the disease including prednisolone, methotrexate, folic acid, and vitamin D3. His reproductive hormones and semen profiles were found normal. The questionable enhancing effects of the different elements of the treatment protocol on the tested reproductive indices were discussed and refuted. To the best of our knowledge, this is the first case report describing the impact of AOSD on male fertility potential which was not deleterious in the reported case.

Evaluation of Normal and Varicocele-Bearing Testes Using Real-time Strain Elastography.

OBJECTIVES: To evaluate testes in patients with varicocele using real-time strain elastography and to correlate the results with the patients' clinical, seminal, and hormonal profiles. METHODS: Fifty patients with left varicocele and 20 age-matched control participants were included in the study. All participants were evaluated via a historical interview, clinical examination, including testicular volume and varicocele grade, hormonal assay (total and free testosterone, luteinizing hormone, and follicle-stimulating hormone), computer-assisted semen analysis, and testicular assessment using real-time strain elastography to define the strain ratio and elasticity score. RESULTS: Testicular volume and sperm parameters were significantly lower (P < .001), whereas the follicle-stimulating hormone level, strain ratio, and elasticity score were significantly higher (P < .01; P < .001; P < .001, respectively), in the varicocele group. Other hormone levels in the endocrine profile were not significantly different between the groups. Significant negative correlations were found between the elasticity score and testicular volume and the percentage of normal forms (P = .029; P = .005). The varicocele grade showed significant positive correlations with both the strain ratio and elasticity score (P < .001). CONCLUSIONS: Strong correlations were found between real-time strain elastography and the testicular volume, varicocele grade, and sperm morphologic characteristics. Real-time strain elastography is a simple, noninvasive investigative modality that can potentially be used to study the structure and function of the testicular tissue in varicocele.

Penile Dimensions of Diabetic and Nondiabetic Men With Erectile Dysfunction: A Case-Control Study.

This study aimed to report penile dimensions in diabetic and nondiabetic men with erectile dysfunction (ED) and correlate their dimensions with other study variables. A case-control study was designed through retrospective data analysis of diabetic and nondiabetic patients consulting for ED and a control group ( n = 105, each group). Study data retrieved included history, clinical evaluation, and penile dimensions (pendulous length [PL], total length [TL], and circumference [CF]) at flaccid and erect states. Results identified that patients had lower values (mean, cm) for almost all penile dimensions. The diabetic patients identified significant differences in most dimensions, whether in flaccid (PL: 7.46 vs. 7.51 and 7.81, p = .11; TL: 11.8 vs. 12.77 and 12.88, p = .000; CF: 8.84 vs. 9.1 and 9.14, p = .016) or erect state (PL: 9.66 vs. 9.61 and 10, p = .092; TL: 13.96 vs. 14.88 and 15.04, p = .000; CF: 11.56 vs. 12.06 and 11.92, p = .018) as compared with the nondiabetic patients and controls, respectively. No significant correlation was detected between the dimensions and age, durations of diabetes and ED, or erectile function scores. In conclusion, diabetic and nondiabetic patients with ED presented, in varying degrees, significant decline in their penile dimensions, and this was more prevalent in diabetic patients. As changes in penile size could be a silent corollary of comorbidities, monitoring the changes in penile dimensions should be an important component of the clinical checkup of any patient with ED, especially a diabetic patient.

Increased prevalence of premature ejaculation in men with metabolic syndrome.

This prospective study aimed to investigate the relationship between metabolic syndrome (Met S) and premature ejaculation (PE) among men. The study included 300 consecutive male patients (53.6 y ± 8.7) who attended the urology clinic (December 2013-September 2014), mostly complaining of renal/ureteric calculi. A diagnostic approach was undertaken to include demographics, clinical features and laboratory investigations of the study subjects. Both erectile function and PE were evaluated using the International Index of Erectile Function (abridged form, IIEF-5) and Premature Ejaculation Diagnostic Tool (PEDT) questionnaires, respectively. Results identified 182 (60.7%) men had Met S. Prevalence of PE was significantly higher in the subjects with Met S than the controls (35.2% vs 7.6%, p < 0.001). Patients with Met S and PE had significantly higher PEDT scores (15.4 vs 6.7), smaller waist circumference (108.3 cm vs 111.5 cm) and higher fasting blood sugar (187 mg% vs 161 mg%) than those with no PE (p < 0.001, 0.047 and 0.019, respectively). The other variables including IIEF-5 score, body mass index, serum triglycerides and high-density lipoprotein (14.98 vs 16.8, 30.6 vs 31.5, 192.9 mg% vs 178.1 mg% and 37.4 mg% vs 36.2 mg%, respectively) did not reveal significant differences. Both systolic hypertension and erectile dysfunction (ED) had significant associations (p = 0.047 and <0.001, respectively) with PE in Met S. In conclusion, PE has a high prevalence in Met S. Patients with Met S should be questioned about PE. Both ED and systolic hypertension may be associated with PE. Prevention of Met S should be considered, and this may be of help to decrease the prevalence of PE.

Kallmann syndrome and deafness: an uncommon combination: A case report and a literature review.

BACKGROUND: Kallmann syndrome (Kal S) is an isolated form of hypogonadotrophic hypogonadism in combination with a defect in smell sensation. Depending on the genetic form of the disease, a number of non-reproductive, non-olfactory abnormalities may also be existent. In the present report, we describe a male with Kal S associated with hearing loss, and the successful treatment of his sexual and reproductive defects. CASE: A 23-year-old Caucasian man presented with a lifelong lack of erection and ejaculation. The patient reported also anosmia combined with loss of hearing ability. A diagnostic work-up identified the presence of Kal S associated with sensorineural hearing loss. Administration of gonadotrophins regained the erection and a viable-sperm containing ejaculation. CONCLUSION: Lack of erection and ejaculation are important components of delayed puberty which could lead to diagnosis of Kal S. The existence of a hearing impairment in the reported patient makes the recommendation to screen the hearing ability in Kal S of utmost importance.

Consultation for Small-Sized Penis in the Egyptian Males: A Case Control Study.

This study aimed to report penile dimensions in adult Egyptian males consulting for small-sized penis (SSP) and describe their demographics and andrological profile. A case control study was designed through retrospective data analysis of patients (n = 239) seeking advice for SSP and a control group (n = 59). This included sociodemographics, other andrological complaints, and penile dimensions (pendulous length [PL], penopubic or total length [TL], and circumference [CF]) at flaccid and erect states and the size of the prepubic fatty pad. The results reported that most patients were single, students, and smokers and had not completed a university education. Several patients reported falsely premature ejaculation (PE), penile curvature (PC), and small-sized testes. Most penile dimensions of the patients (mean, cm) were significantly lower than those of the controls, whether in flaccid (PL: 7.4 vs. 8.05, p = .008; CF: 8.7 vs. 8.98, p = .026) or erect state (PL: 11.8 vs. 13, p = .000; TL: 14.2 vs. 15, p = .000; CF: 11.3 vs. 11.8, p = .003). However, no patient presented with a pendulous penile length <4 cm in flaccid or <7 cm in erect state. In conclusion, Egyptian men consulting for SSP did not have true small organs, but their penile dimensions were slightly smaller than those of men without such complaint. The proper sexual education program is highly advisable in these situations to avoid the myths and misconceptions about sexuality.

Light-emitting diode exposure enhances sperm motility in men with and without asthenospermia: preliminary results.

OBJECTIVE: To evaluate the effect of light-emitting diode (LED) on sperm motility in men with and without asthenospermia. MATERIAL AND METHODS: Semen samples from 27 men were assessed and washed. An aliquot was taken from each sample as a control. The remaining amount was exposed to red LED for 2, 5 and 10 minutes. Sperm motility from the test and control tubes were re-checked at the end of each time interval. In 11 of these 27 samples, the same protocol was repeated without sperm washing. Evaluation of sperm creatine kinase (CK) activity, hypoosmotic swelling (HOS) test and aniline blue staining (ANBS) were undertaken after phototherapy in additional 15 samples. RESULTS: Progressive sperm motility increased significantly after LED treatment at the different time intervals whether in washed (p = 0.000) or non-washed (p = 0.003) samples. The amount of the increase in motility in washed aliquots was significantly more (p = 0.000) than in naive semen. Sperm CK activity increased, but was not significant whilst there were no changes regarding HOS and ANBS. CONCLUSION: Red LED is a promising safe tool to boost sperm motility in vitro. This may have a great implication on maximizing the possibilities and outcomes of intrauterine insemination trials.

Immediate development of post-varicocelectomy hydrocele: a case report and review of the literature.

INTRODUCTION: Hydrocele development is the most common complication after varicocele repair. The beginning of this kind of hydrocele is variable. The shortest reported onset is one week. In the present report we describe an unusual immediate onset of hydrocele formation following varicocele repair. This represents the first report of a harsh hydrocele onset in the literature. CASE PRESENTATION: A 29-year-old Caucasian male noticed the development of a big hydrocele just a few hours after inguinal varicocelectomy. The hydrocele remained stable in size throughout 12 years until a hydrocelectomy was done. CONCLUSION: Mass ligation and division of the spermatic cord structures during varicocele surgery should be avoided. Instead, lymphatic sparing is highly recommended. Differentiation between testicular edema and hydrocele should be confirmed as early as possible to assure the patient properly. This case study highlights the importance of our knowledge about the surgical anatomy of the spermatic cord structures. It definitely advances our understanding of a post-varicocelectomy hydrocele etiology and development. It is an original case report of interest to andrologists, urologists and general surgeons.

Isolated low follicle stimulating hormone (FSH) in infertile males - a preliminary report.

OBJECTIVES: High levels of follicle stimulating hormone (FSH) in infertile males received a significant attention and exploration. Studies investigating the isolated deficiency of FSH in males are few, and its real prevalence is still unknown. Therefore, the objectives of the current study was to report the prevalence of isolated low FSH in infertile males and highlight their demographics and standard sperm parameters. METHODS: Records of 3335 infertile men were retrospectively checked. Patients with isolated low FSH were retrieved. FSH levels were categorized into 3 groups based on the number of affected sperm parameter (s). Study variables were also arranged into 2 groups in relation to smoking history. A control group was included to document the changes in sperm morphology. RESULTS: Isolated low FSH (1.146 ± 0.219 mIU/mL) was found in 29 (0.87%) patients. All patients showed at least one abnormal sperm parameter. The abnormal parameters were present in different combinations within the same patient but with no significant correlations with the FSH levels. The FSH levels got lower as the number of the affected sperm parameters increased although the decline was insignificant. The most frequent abnormal parameter presented was sperm morphology (86.2%). Anomalous sperm morphology was highly and significantly demonstrated in the head; specifically in acrosome. Abnormal sperm parameters were present in both smoking and nonsmoking groups but with no significant differences in between. CONCLUSIONS: Isolated low FSH among infertile males has a low prevalence. This may be associated with abnormality in semen parameters; particularly sperm morphology. These patients are suggested to be found as a primary entity. However, an additional work-up is highly recommended to validate this hypothesis.

Effects of exposure to a mobile phone on testicular function and structure in adult rabbit.

The accumulating effects of exposure to electromagnetic radiation emitted by a conventional mobile phone (standby position) on the testicular function and structure are not yet fully investigated. To study these effects longitudinally, a total of 24 adult male rabbits were randomly and equally divided into three groups. Rabbits in the first (phone) group were exposed, in specially designed cages, to radio frequency emitted from the mobile phone (800 MHz) in a standby position opposite to that of testes for 8 h daily for 12 weeks. The second group consisted of the stress controls which were kept in the same kind of cages to appreciate any cage-induced anxiety. The third group included the ordinary controls which were kept in the conventional roomy cages. Semen analysis and sperm function tests (viability, hypo-osmotic swelling and acridine orange) were conducted weekly. Histological testicular sections and serum total testosterone were also evaluated. A drop in the sperm concentration appeared in the phone group at week 6. This became statistically significant at week 8, compared with the two control (stress and ordinary) groups (133, 339 and 356 x 106/mL, respectively) and to the initial sperm count (341 x 106/mL) of this group. Motile sperm population showed similarity amongst the three study groups until week 10 when it declined significantly, and thereafter in the phone and stress control groups, with more significant decline in the phone animals (50, 61 and 72.4%, respectively). Histological examination showed also a significant decrease in the diameter of seminiferous tubules in the phone group vs. the stress and ordinary controls (191 microm vs. 206 and 226 microm, respectively). The other study points did not show any difference. In conclusion, low intensity pulsed radio frequency emitted by a conventional mobile phone kept in the standby position could affect the testicular function and structure in the adult rabbit.

The mobile phone decreases fructose but not citrate in rabbit semen: a longitudinal study.

The negative impact of mobile phones on sperm motility has been previously described. Both fructose and citrate are important components in semen that facilitate sperm motility. To date, no studies have investigated the effect of exposure to electromagnetic radiation emitted from the mobile phone on their levels.. Therefore, a longitudinal study using the adult rabbit as a model was undertaken. A total of 30 adult male rabbits were randomly divided into three groups. The first (phone) group was placed in specially designed cages, and exposed to radio frequency emitted from a mobile phone (900 MHz) kept in standby mode and positioned adjacent to the genitalia for 8 h daily for 12 weeks. The other two groups served as controls; the stress group which was housed in the same kind of cages to evaluate any cage-induced anxiety, and the control group which was housed in the conventional roomy cages. Semen samples were retrieved weekly. Sperm motility and viability, semen fructose and citrate, and serum testosterone were measured. Histological sections from the prostatic complex, ampulla, and vesicular gland were evaluated. A significant drop in both fructose levels (257 +/-11.6 vs. 489 +/- 8.4 mg %, the baseline level) and number of motile sperms (50 vs. 72%) was observedin the phone group at the 10th week. However, no correlation was found between the two values. The stress control animals showed a similar but significantly less decline in motility No significant changes in citrate levels or other study parameters were seen in the three animal groups throughout the study. In conclusion, the pulsed radio frequency emitted by the mobile phone kept in the standby position longitudinally affected sperm motility and fructose but not citrate levels in rabbit semen.

Unusual trivial trauma may end with extrusion of a well-functioning penile prosthesis: a case report.

BACKGROUND: Diabetes mellitus (DM) is the most common indication for insertion of a penile prosthesis and is a risk factor for infection of such prostheses. CASE PRESENTATION: Two patients presented with infected prostheses following unusual trivial penile trauma. Both patients underwent exploration and removal of the prostheses with uneventful recovery. CONCLUSION: Appropriate sizing of the prosthesis should be taken into account to ensure good concealment and avoid easy exposure of the penis to unexpected trauma. Use of the newly designed antibiotic-coated prostheses appears preferable. As soon as signs of prosthesis infection appeared, extrusion of the device should be expedited.

Proliferating cell nuclear antigen in testes of infertile men with varicocele--preliminary results of interrelationship with sperm count before and after varicocelectomy.

OBJECTIVE: This study was conducted to assess germ cell kinetics and correlate them with sperm counts before and after varicocelectomy. MATERIAL AND METHODS: Forty-three testicular biopsy specimens were obtained from 47 patients with varicocele during varicocelectomy. Similar specimens were obtained from 8 fertile volunteers. All specimens were immunostained using anti-proliferating cell nuclear antigen (anti-PCNA) antibody. PCNA expression was evaluated by assessing its staining intensity (SI) and labeling index (LI). RESULTS: The varicocele specimens revealed significantly lower SI and LI than the controls. There was a significant correlation between initial sperm concentration and LI but not SI. Coexistence of LI > or = 31 and preoperative sperm count > 1 million/ml correlated with a significant rise in the postoperative sperm count. CONCLUSIONS: PCNA is a useful molecular marker for assessing germ cell kinetics in varicocele patients. The decline in DNA synthesis, as suggested by the lower PCNA SI and LI in varicocele specimens, could be a reason for the disordered spermatogenesis in these patients. PCNA LI may also be considered as a beneficial clinical marker and may help to predict the surgical outcome after varicocele repair.

The changes in testicular vascular permeability during progression of the experimental varicocele.

OBJECTIVES: The vascular permeability of testicular capillaries which play a role in controlling the formation of testicular interstitial fluid was studied during the progressive course of experimental varicocele. MATERIALS AND METHODS: The pathology was developed through partial ligation of left renal vein in four groups of rats. Controls of each group were subjected to sham surgery. After different periods of varicocele creation (1, 3, 6 and 14 weeks), animals' testes per one of the study groups were extirpated and weighed. The volume density percentages of polymorphnuclear leukocytes (PMN) per testicular blood vessels; which are markers of the increase in vascular permeability, were also estimated in both testes. To further verify the obtained findings, another group of animals received human chorionic gonadotrophin (hCG) treatment 6 weeks after varicocele creation and their histopathological sections were examined. RESULTS: Animal testes' of (1 and 3 weeks) groups were found to be significantly heavier (p<0.05) than their controls. PMN showed accumulation in testicular blood vessels and their volume density percentages per these blood vessels in both testes were significantly higher in each study group than in those of its controls. However, these percentages showed gradual significant decline as the duration of varicocele bearing gradually increased. The hCG-treated animals revealed more accumulation of the PMN in their histopathological sections. CONCLUSION: The present results suggest that experimental varicocele may induce an increase in testicular vascular permeability, which then decreases gradually with time. It is supposed that parallel changes in the rate of formation of testicular interstitial fluid may be accompanied. The results have also showed that the vasculature of the testis with experimental varicocele can still respond to hCG.