The relevance of neutral alpha-glucosidase activity in andrology.

To assess the usefulness of routine determination of neutral alpha-glucosidase (NAG) in andrology, 216 ejaculates were analyzed for NAG activity and semen quality. A correlation between NAG activity and semen volume and sperm concentration was determined; however, no correlation was observed between NAG activity and sperm motility or sperm morphology. The number of azoospermic ejaculates that had NAG activity below acceptable levels was significantly higher than the number of non-azoospermic ejaculates with similarly low NAG levels. Routine determination of NAG activity is not practical; however, when an epididymal pathology leading to a physiological or anatomical functional alteration is suspected, the determination of NAG activity is a valuable tool in the diagnosis, and would also aid in the prognosis.

Vasculogenic erectile dysfunction in teenagers: a 5-year multi-institutional experience.

OBJECTIVE: To report the experience of three highly specialized centres in the vascular evaluation of erectile dysfunction (ED) in teenagers, as there is little information on this topic, and although clinical guidelines support the use of vascular studies in selected cases, our experience is that vascular evaluation aimed at diagnosing organic ED is uncommon in teenagers, and most are designated as having psychogenic ED. PATIENTS AND METHODS: In a retrospective multi-institutional analysis of three ED databases (1998-2003) we assessed males aged < or =19 years presenting with ED. The review of these databases focused on demographic characteristics, risk factors for ED, erectile function, results of vascular evaluation, and the causes of ED. RESULTS: In all, 40 males aged 14-19 years were identified. The mean (range) duration of ED at presentation was 22.6 (4-84) months. The major risk factors for ED were antecedent perineal trauma (37%) and penile trauma or surgery (15%). The mean (sd) International Index of Erectile Function 'erectile function' domain score was 15 (4). Information obtained by history taking was not predictive of the cause of ED. Vascular studies were performed in 62% of the patients and 48% of these patients were found to have an underlying vascular pathology; 42% of the latter group were found to be possible candidates for surgical intervention and another 16% needed further angiographic evaluation. CONCLUSION: ED in teenagers should not be routinely categorized as psychogenic without an adequate vascular evaluation, as a significant percentage have abnormal erectile haemodynamics consistent with vasculogenic ED.

Cryopreservation of human sperm in a lecithin-supplemented freezing medium.

The use of egg yolk and serum albumin as additive diluents for human sperm cryopreservation is routine. But because both diluents are of animal origin, they potentially may introduce microbial agents to the sample. To reduce the risk of contamination, the cryoprotective property of phospholipids extracted from lecithin was evaluated and found to be effective when supplemented with dimethyl sulfoxide and glycerol.

The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function.

PURPOSE: It has been suggested that postradical prostatectomy (RP) erectile function outcomes are improved by early use of erectogenic medications. This analysis was designed to assess the ability of a post-RP vasoactive drug program to improve long-term spontaneous erectile function. METHODS: Men with functional preoperative erections who underwent RP were challenged early postoperatively with oral sildenafil. Nonresponders were switched to intracavernosal injection therapy (ICI). Patients were instructed to inject three times a week. Only patients who presented within 6 months post RP, who completed the International Index of Erectile Function (IIEF) questionnaire on at least three separate occasions after surgery, and who had been followed for at least 18 months were included. Data from men who were committed to rehabilitation were compared with those of men who did not follow the protocol but continued to be followed serially following RP. RESULTS: There were 58 patients in the rehabilitation (R) group and 74 in the nonrehabilitation (NR) group. No differences existed in mean patient age, comorbidity profile, intraoperative nerve sparing status, or postoperative erectile hemodynamics between the two groups. At 18 months post RP, there were statistically significant differences between the two groups in the percentage of patients who were capable of having medication-unassisted intercourse (R=52% vs. NR=19%, P<0.001); mean erectile rigidity (R=53+/-21% vs. NR=26+/-43%, P<0.01); mean IIEF erectile function (EF) domain scores (R=22+/-6 vs. NR=12+/-14, P<0.01); the percentage of patients with normal EF domain scores (R=22% vs. NR=6%, P<0.01); the percentage of patients responding to sildenafil (R=64% vs. NR=24%, P<0.001); the time to become a sildenafil responder (R=9+/-4 vs. NR=13+/-3 months, P=0.02); and the percentage of patients responding to ICI (R=95% vs. NR=76%, P<0.01). CONCLUSIONS: The data generated from this nonrandomized study indicate that a pharmacologic penile rehabilitation protocol results in higher rates of spontaneous functional erections and erectogenic drug response after RP.

Posthumous reproduction: current and future status.

Posthumous reproduction became possible with the technologies of sperm cryopreservation and ART. The legal and social status of children born as a result of these technologies continue to evolve. The proper disposition of unwanted stored gametes and embryos remains unknown. Physicians are increasingly asked to make quick judgments on posthumous gamete retrieval. The procedures for gamete harvest are technically simple; however, one must carefully select cases with definitive prior intent to have children. There is a need for standardized legal protocols to protect the physician and the patient. The physician must use sound judgment and comply with accepted standards, when present, before performing any service for posthumous sperm retrieval and reproduction.