Endocrine effects of testosterone undecanoate as a supplementary treatment to menopausal gonadotropins or tamoxifen citrate in idiopathic oligozoospermia.

OBJECTIVE: To evaluate the effects of T undecanoate given as a supplementary treatment with tamoxifen citrate (TAM) or hMG on pituitary and Leydig cell function in men with idiopathic oligozoospermia. DESIGN: A total of 48 normogonadotropic men with idiopathic oligozoospermia were allocated in to six groups (n = 8 per group) treated with placebo, 40 mg T undecanoate three times per day, 10 mg TAM two times per day, T undecanoate and TAM, 75 IU/d hMG, and T undecanoate and hMG. All groups were evaluated with standard GnRH, thyrotropin-releasing hormone, and hCG tests before and on the final day of 3 months on treatment with measurements of FSH, LH, thyroid-stimulating hormone (TSH), PRL, T, E2, 17-hydroxyprogesterone, sex hormone-binding globulin, and seminal analyses (at least twice each time). RESULTS: Basal and stimulated concentrations and incremental FSH and LH values showed no differences among TAM or hMG and TAM + T undecanoate or hMG + T undecanoate treated groups. Basal, stimulated, and incremental values for TSH and PRL were elevated markedly during treatment in most groups in comparison to placebo. Basal, stimulated, and incremental T and E2 values were similar in active treatment groups except that higher T concentration was found in TAM + T undecanoate as compared with T undecanoate only treated men. Finally, significant improvements were noted in important seminal parameters and particularly in the functional sperm fraction of the TAM + T undecanoate group as compared with single treatment with TAM. CONCLUSION: These results indicate that T undecanoate in combination with TAM or hMG not only had no adverse effects on pituitary and Leydig cell activity but also seemed to improve important seminal parameters and signify that androgens may be tried as a supplementary treatment to conventional regimes in idiopathic oligozoospermia.

Effects of induced peripheral anosmia on gonadal maturation in prepubertal male rabbits.

The effect of induced peripheral anosmia on gonadal development and maturation was investigated in sexually immature male rabbits. Furthermore, the effect of agents promoting gonadal maturation (LHRH, hMG or methyl testosterone) on testicular development was examined in anosmic rabbits. Peripheral anosmia was induced by spraying the olfactory mucosa with 5% ZnSO4 solution; its effects were evaluated after a 45-day period, corresponding to the duration of spermatogenesis. Evaluation was based on measurement of body-weight, testicular size, testicular biopsy score count (TBSC) and a standard LHRH test (0 and 30 min) involving measurement of the blood levels of FSH, LH and testosterone before and at the end of the test. Markedly lower final and incremental values were noted in anosmic, compared to intact, animals for body-weight (P less than 0.001), TBSC (P less than 0.001), FSH (P less than 0.01) and LH (P less than 0.05). On the other hand, treatment of the anosmic rabbits with 0.9% saline, resulted in lower FSH, TBSC and testicular size increments than in rabbits treated with LHRH, hMG or testosterone, while testosterone levels and body-weight increments were similar in all groups. These findings indicate that induced peripheral anosmia is probably responsible for the inadequate gonadal maturation in prepubertal anosmic male rabbits. This relationship was confirmed by the observed stimulatory effect of administration of agents activating pituitary gonadotrophin secretion or gonadal function in anosmic animals.

Germinal epithelium changes in sexually immature rabbits treated with intratesticular testosterone implants.

The effect of testosterone (T) on germinal epithelium development and maturation was studied in prepubertal male rabbits. For this purpose, implants of free T (50 mg) or placebo (PL) were placed intratesticularly in 55-60-day-old animals. Each group was divided into sub-groups additionally treated with 0.9% NaCl, FSH/LH (3.0 IU) or cyproterone acetate (CA, 2.5 mg) over a 45-day period. Initial and final evaluations included measurements of testicular volume, testicular biopsy score count (TBSC) and plasma T, FSH and LH concentrations. At the end of the experiment, increment values (final-initial evaluation) of the parameters examined showed the following differences: (1) mean TBSC in T-implanted, irrespective of additional treatment, was higher than that of PL-implanted rabbits (P less than 0.01); (2) mean plasma T, FSH and LH values were significantly different in T- and PL-implanted rabbits, with higher T (P less than 0.05) but lower FSH and LH increments (P less than 0.01 for both) in the former group; (3) marked differences amongst types of additional treatment, irrespective of the implant used, were found for TBSC, T, FSH and LH (P less than 0.01 for all); animals treated with CA had markedly lower increments than other treatment groups. From these findings, it may be concluded, that in the prepubertal rabbit T plays an important role in development and maturation of the testis, but this effect probably requires the synergistic action of endogenous gonadotrophins.

Raised sodium, potassium, and urea concentrations in spermatic venous blood: an additional causative factor in the testicular dysfunction of varicocele?

The concentrations of Na, K, Cl, HCO3, LA, and urea, with calculation of the AG, as indirect indices of electrolyte balance and metabolic conditions prevailing in testicular environment, were determined in PB and SVB of 24 men with varicocele and 15 men with inguinal hernia. Significantly higher concentrations of Na, K, and urea were found in SVB as compared with PB values (P less than 0.001 for all) of patients with varicocele, but not in control subjects. The SVB concentrations of Na, K, and urea in varicocele patients were higher than SVB and PB concentrations of the control group (P less than 0.001 for all). It is concluded that urea, Na, and K concentrations are raised in SVB of patients with varicocele; this imbalance may be related, among other factors, to the pathogenesis of dyspermia in varicocele.

Hormone levels in the reproductive system of normospermic men and patients with oligospermia and varicocele.

The endocrine milieu on which spermatogenesis and sperm maturation mainly depend was evaluated quantitatively with simultaneous measurements of FSH, LH, PRL, testosterone, estrone, estradiol (E2), and sex hormone-binding globulin concentrations in spermatic venous plasma, antecubital plasma, seminal fluid, and wash fluid from vas deferens in 16 normospermic men and 24 oligospermic patients. Anesthesia and surgical stress caused a rise of only PRL and E2 (P less than 0.001-0.01). Mean FSH, LH, and PRL levels were comparable in antecubital and spermatic venous plasma, and antecubital values were higher in oligospermic patients for FSH and LH (P less than 0.05-0.001). Mean (+/- SD) T levels were similar for normospermic and oligospermic men in spermatic venous plasma (473 +/- 75 and 439 +/- 270 ng/ml), in antecubital plasma (6.5 +/- 1.3 and 6.6 +/- 1.8), and in seminal fluid (0.3 +/- 0.1 for both). Minute quantities of testosterone were detected in pooled wash fluid (0.08 ng). For E2, similar concentration gradients from high to low levels were found in normospermic and oligospermic men (spermatic venous plasma = 926 +/- 205 pg/ml and 1090 +/- 262; antecubital plasma = 31.0 +/- 12.0 and 28.4 +/- 1.9; seminal fluid = 14.3 +/- 2.3 and 12.0 + 2.8). Estrone was also high in spermatic venous and low in antecubital plasma but higher in seminal fluid than in antecubital plasma. Sex hormone-binding globulin levels were slightly though not significantly lower in spermatic venous (23 +/- 10 nmol/liter) than in antecubital plasma (28 +/- 6), but not measurable in seminal fluid. These results define important aspects of the endocrine milieu prevailing in the male reproductive tract and demonstrate a change of the relative activity of androgens and estrogens from the testis to the seminal fluid.

An unusual case of rectourethral fistula. Restoration by using a flap from the bladder.

A rare case of rectourethral fistula is described, with tunnelization of a flap from the anterior bladder wall in order to produce a new posterior urethra after excising the original one. The excellent result obtained by this technique introduced by Tanagho et al. is stressed.

The effect of clomiphene citrate on sex hormone binding globulin in normospermic and oligozoospermic men.

The effect of clomiphene citrate (CG) on sex hormone binding globulin (SHBG) was studied in 10 oligozoospermic patients with varicocele and 6 normospermic men. Plasma SHBG, testosterone (T), oestradiol (E2), FSH, LH, Prolactin (Prl), thyroxine (T4) and 17-OH-progesterone (17-OH-P) were determined before and during medication. SHBG concentration rose from 38.1 +/- 18.3 to 54.3 +/- 16.0 nmol/l (P less than 0.01), while T and E2 showed significant increases from 31.2 +/- 10.8 nmol/l and 24.6 +/- 5.4 pg/ml to 52.0 +/- 3.6 and 43.3 +/- 14.9, respectively in the oligozoospermic patients, with similar rises noted in the normospermic men. FSH, LH and 17-OH-P were markedly elevated while on CC, but Prl and T4 remained unchanged. The findings of this study indicated the CC causes an increase of SHBG concentration, which is probably related to the rise of E2 concentration. This SHBG change, combined with the intrinsic oestrogenic activity of CC might be one of the factors responsible, through a decrease of free T and a T to E2 imbalance, for the lack of significant effect on parameters of seminal quality in so treated patients.

Urethral diverticulum with lithiasis.

Urethral diverticulum, either congenital or acquired, is very rare and becomes symptomatic when complicated by infection and lithiasis. This paper reports on such a case that was cured by radical excision of the lesion.

Testosterone concentration in different functional compartments of the male reproductive tract.

The concentration of testosterone in testicular tissue (TT), spermatic vein blood (SVB), cubital blood (CB), and seminal fluid (SF) was estimated using a radioimmunoassay technique in a total of 50 normospermic, oligozoospermic, and azoospermic men. Testosterone was also determined in cauda epididymis-vas deferens ductus wash fluid (WF) in 6 normospermic men. In 2 oligozoospermic men the testosterone concentration in TT was 556 and 725 ng/g tissue, respectively. In 9 normospermic men the mean SVB testosterone concentration was 473 ng/ml. CB and SF concentrations of this steroid were 6.8 and 0.4 ng/ml in normospermic, 6.4 and 0.5 ng/ml in oligozoospermic, and 4.9 and 0.4 ng/ml in azoospermic men, respectively; the difference among the three groups was not significant. The SVB:CB and SVB:SF ratios in normospermic men were 71 and 1549, respectively, while the CB:SF ratio was 18 in normospermic, 18 in oligozoospermic, and 16.6 in azoospermic men. Testosterone could not be detected in individual specimens of WF, but after pooling of samples a concentration of 0.08 ng/ml WF was estimated. These results demonstrate the relative concentrations of testosterone in the different functional compartments of the reproductive tract in man and facilitate a better understanding of its function.

[Traumatic rupture of the isthmus of a horseshoe kidney (author's transl)]. / Rupture traumatique de l'isthme d'un rein en fer-à-cheval.

In the light of an extremely rare case of rupture of the isthmus of a horseshoe kidney, the author described the operative technique used and the postoperative complications which, despite their gravity, could be controlled by conservative operative measures.

[Sigmoid kidney accompanied by the absence of uterine tubes, uterus and vagina (author's transl)]. / Rein sigmoïde accompagné d'absence de trompes, d'utérus et de vagin.

The author reports a rare case of sigmoid kidney accompanied by the absence of uterine tubes, uterus and vagina, and stresses the importance of thorough investigation of both the urinary and genital systems in the presence of a malformation affecting one or the other.