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Huyghe E, Boitrelle F, Methorst C, Mieusset R, Ray PF, Akakpo W, Koscinski I, Chalas C, Rives N, Plotton I, Robin G, El Osta R, Hennebicq S, Eustache F, Marcelli F, Lejeune H. [AFU and SALF recommendations for the evaluation of male infertility]. Prog Urol 2020; 31:131-144. [PMID: 33309127 DOI: 10.1016/j.purol.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/20/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of these Association Française d'Urologie (AFU) and Société d'Andrologie de Langue Française (SALF) common recommendations are to provide practice guidelines for the French Urological and Andrological community regarding the evaluation of infertile men. MATERIAL AND METHODS Literature search in PubMed using the keywords "male infertility", "diagnosis", "management" and "evaluation" limited to clinical articles in English and French prior to 1/01/2020. To inform the level of evidence, the HAS grading system (2013) was applied. RESULTS Concerning the evaluation of infertile men, the AFU and the SALF recommend : (1) a systematic interview exploring the family history, the fertility history of the man outside the couple, the patient's personal history that may have an impact on his fertility, lifestyle habits, treatments, symptoms and possible sexual difficulties of the couple; (2) a general physical examination to assess signs of hypogonadism and secondary sexual characters; (3) a scrotal physical examination performed by an urologist or andrologist to assess (i) the testes for volume and consistency, (ii) vas deferens and epididymes for total or partial absence or nodules, and (iii) presence of varicoceles; (4) Performing two semen analyses, according to World Health Organization guidelines, if the first one has at least one abnormaly; (5) a scrotal ultrasound as part of routine investigation, that can be completed with an endorectal pelvic ultrasound according to the clinic; (6) an endocrine evaluation with at least a Testosterone and FSH serum determination; (7) Karyotype analysis in infertile men with a sperm concentration ≤10 106/mL; (8) assessment of Yq microdeletions in infertile men with a sperm concentration ≤1 106/mL; (9) Cystic fibrosis transmembrane conductance regulator gene evaluation in case of suspicion for bilateral or unilateral congenital agenesis of vas deferens and seminal vesicles. The interest of tests analyzing DNA fragmentation (TUNEL, SCSA) is still under investigation. CONCLUSION These guidelines can be applied in routine clinical practice in all infertile men.
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Affiliation(s)
- Eric Huyghe
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU de Toulouse, site de Rangueil, Toulouse, France; Médecine de la Reproduction, CHU de Toulouse, site de Paule de Viguier, Toulouse, France.
| | - Florence Boitrelle
- Service de gynécologie-obstétrique, CHI Poissy/Saint-Germain-en-Laye, Poissy, France
| | | | - Roger Mieusset
- Médecine de la Reproduction, CHU de Toulouse, site de Paule de Viguier, Toulouse, France
| | - Pierre F Ray
- Service de Biologie, Génétique de la reproduction, CHU de Grenoble, France
| | - William Akakpo
- Service d'Urologie, Hôpital universitaire de la Pitié Salpêtrière, APHP, Paris, France
| | | | - Céline Chalas
- Service d'Histologie, embryologie, cytologie, Hôpital Cochin, APHP, Paris, France
| | - Nathalie Rives
- Laboratoire de Biologie de la Reproduction, CECOS, CHU de Rouen, France
| | - Ingrid Plotton
- Service de médecine de la reproduction, Hôpital Femme Mère Enfant, HCL, Bron, France
| | - Geoffroy Robin
- Service de gynécologie, Médecine de la reproduction, Hôpital Jeanne de Flandres, CHRU de Lille, France
| | | | | | | | | | - Hervé Lejeune
- Service de médecine de la reproduction, Hôpital Femme Mère Enfant, HCL, Bron, France
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Lotti F, Maggi M. Ultrasound of the male genital tract in relation to male reproductive health. Hum Reprod Update 2014; 21:56-83. [DOI: 10.1093/humupd/dmu042] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Mohseni MG, Hosseini SR, Alizadeh F, Rangzan N. Serum testosterone and gonadotropins levels in patients with premature ejaculation: A comparison with normal men. Adv Biomed Res 2014; 3:6. [PMID: 24592360 PMCID: PMC3928961 DOI: 10.4103/2277-9175.124633] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 06/20/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To investigate the role of testosterone (T) in the pathogenesis of ejaculatory symptoms, particularly premature ejaculation (PE). MATERIALS AND METHODS A total of 41 male patients with PE as well as 41 controls with no sexual dysfunction were recruited in this cross-sectional study. We used the stopwatch measurement to monitor the intravaginal ejaculatory latency time (IELT). Patients with mean IELT values lower than 60 s were considered to have PE. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), total testosterone (TT) and free testosterone (FT) were measured in patients as well as controls. Patients with thyroid dysfunction, hypogonadism, hypertension and dyslipidemia were excluded from the study. RESULTS The serum levels of FT and FSH were significantly higher in cases (P = 0.036 and 0.003, respectively). There was no significant difference between TT, LH and PRL levels of the two groups. CONCLUSION Patients with PE have higher FT and FSH levels compared with normal men. The causative relationship between these entities and also the clinical importance of this finding has to be determined by more comprehensive studies.
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Affiliation(s)
- Mohammad G Mohseni
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Hosseini
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Alizadeh
- Isfahan Urology and Kidney Transplantation Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazir Rangzan
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Yilmaz O, Yilmaz S, Kisacik B, Aydogdu M, Bozkurt Y, Erdem H, Pay S, Saglam M, Dinc A. Varicocele and epididymitis in Behcet disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:909-913. [PMID: 21705723 DOI: 10.7863/jum.2011.30.7.909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Behçet disease is a systemic disease with protean manifestations. Vasculitis is a hallmark of the disease and may involve arteries, veins, and capillaries. Varicocele is dilatation of the pampiniform plexus veins. We aimed to investigate the incidence of varicocele in patients with Behçet disease. METHODS The study included 47 male patients with Behçet disease and 31 healthy control participants. All underwent a clinical evaluation including a medical history and systemic and scrotal examinations. Subsequently, 2 investigators blinded to the clinical data performed sonographic examinations and measured pampiniform plexus vein diameters. RESULTS The mean age of the patients ± SD was 23.4 ± 3.2 years; disease durations ranged from 3 to 120 months (46 ± 31 months). Scrotal pain or a palpable mass was detected by clinical examination in 24 patients with Behçet disease (51.1%) and 5 healthy participants (16.1%; P = .002). By color Doppler examination, left varicocele was diagnosed in 26 patients with Behçet disease (55.3%) and 9 healthy participants (29%; P = .02). All patients with right varicocele also had left varicocele; that condition was detected in 10.6% (5 patients) of the Behçet disease group and 6.4% (2 patients) of the control group (P > .05). Eight patients with Behçet disease (17%) had epididymitis, whereas none of the healthy participants did (P = .019, Fisher exact test). Genital ulcers and erythema nodosum lesions were more common among patients with varicocele (P = .034 and .058, respectively). There were no differences in smoking, epididymitis, arthritis, uveitis, or other clinical parameters for distinguishing varicocele in patients with Behçet disease. CONCLUSIONS The incidence of varicocele was increased in Behçet disease. Whether varicocele confers fertility problems in patients with Behçet disease and the underlying mechanism for a possible association are yet to be determined.
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Affiliation(s)
- Omer Yilmaz
- Division of Radiology, Gulhane School of Medicine, Etlik, 06018 Ankara, Turkey.
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Lotti F, Corona G, Mancini M, Biagini C, Colpi GM, Innocenti SD, Filimberti E, Gacci M, Krausz C, Sforza A, Forti G, Mannucci E, Maggi M. The Association between Varicocele, Premature Ejaculation and Prostatitis Symptoms: Possible Mechanisms. J Sex Med 2009; 6:2878-87. [DOI: 10.1111/j.1743-6109.2009.01417.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ghabili K, Shoja MM, Agutter PS, Agarwal A. Hypothesis: intracellular acidification contributes to infertility in varicocele. Fertil Steril 2009; 92:399-401. [DOI: 10.1016/j.fertnstert.2008.05.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 05/15/2008] [Accepted: 05/16/2008] [Indexed: 10/21/2022]
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Huyghe E, Izard V, Rigot JM, Pariente JL, Tostain J. Évaluation de l’homme infertile : recommandations AFU 2007. Prog Urol 2008; 18:95-101. [DOI: 10.1016/j.purol.2007.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2007] [Accepted: 12/04/2007] [Indexed: 10/22/2022]
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Fischietti G, Di Crosta G. Effects of surgery, medical therapy and combined therapeutical approach on spermatogenesis in patients suffering from varicocele: a prospective and comparative analysis. Urologia 2008. [DOI: 10.1177/039156030807500106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The definite mechanisms through which varicocele affects spermatogenesis are still not completely understood, and consequently the exact role of the various approaches available for its treatment is still under debate. In this study a comparison of medical treatment, surgery and combined approach is reported. Material and Methods. The study was conducted as a prospective evaluation of 189 patients suffering from varicocele and oligoasthenospermia. Patients were randomized in three groups on the basis of the different therapeutic approach: group A, treated only with varicocelectomy; group B, treated with varicocelectomy associated with hormonal therapy; group C, treated only with hormonal therapy. Randomization criteria were based on patient's preference. Spermiogram tests were carried out at baseline and after 3, 6 and 12 months from therapy. Results. Our results show that patients undergoing a combined therapeutical approach (surgery associated with hormonal therapy) and medical therapy alone achieve a greater improvement of seminal parameters than patients treated by surgery only. Conclusion. Data reported in this study are in accordance with Literature review. Furthermore, the association between varicocelectomy and early use of hormonal therapy seems to improve testis functional rehabilitation with a early evidence of sperm parameters improvement. In the light of these results of ours, we should conclude that surgical treatment is not effective for the spermatogenesis improvement.
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Affiliation(s)
- G. Fischietti
- Istituto di Urologia, Università “La Sapienza”, Polo Pontino (Latina)
| | - G. Di Crosta
- Istituto di Urologia, Università “La Sapienza”, Polo Pontino (Latina)
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Corona G, Jannini EA, Mannucci E, Fisher AD, Lotti F, Petrone L, Balercia G, Bandini E, Chiarini V, Forti G, Maggi M. Different testosterone levels are associated with ejaculatory dysfunction. J Sex Med 2007; 5:1991-8. [PMID: 18399946 DOI: 10.1111/j.1743-6109.2008.00803.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The role of testosterone (T) in pathogenesis of ejaculatory symptoms has not been completely clarified. AIM To evaluate the possible contribution of T and hypogonadism in the control of the ejaculatory reflex, comparing subjects with premature ejaculation (PE) or delayed ejaculation (DE) to those without ejaculatory dysfunction. METHODS A consecutive series of 2,437 (mean age 51.9 +/- 13.0 years) male patients with sexual dysfunction was studied. MAIN OUTCOME MEASURE Several hormonal and biochemical parameters were studied, along with the structured interview on erectile dysfunction (SIEDY) structured interview. Hypogonadism were defined when total testosterone (TT) was lower than 10.4 nmol/L. RESULTS Among the patients studied, 714 (25.9%) and 121 (4.4%) reported PE and DE, respectively. In the youngest age band (25-40 years), subjects with PE reported higher TT and free testosterone (FT) levels when compared to the other groups (subjects with DE or those without PE and DE; P < 0.05 for both). Conversely, in the oldest age band (55-70 years), lower TT and FT levels were observed in DE subjects. Accordingly, patients with PE showed the lowest (12%) and subjects with DE the highest (26%) prevalence of hypogonadism. These differences were confirmed even after adjustment for confounders such as age and libido (HR = 0.75 [0.57-0.99] and 1.83 [1.14-3.94] for PE and DE, respectively; both P < 0.05). CONCLUSIONS Our data seem to suggest that T plays a facilitatory role in the control of ejaculatory reflex. Both central and peripheral mechanisms have been advocated to explain this association. Clinical studies are currently in progress to further establish the role of T in the ejaculatory dysfunction, attempting to revert DE by androgen administration.
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Affiliation(s)
- Giovanni Corona
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Corona G, Mannucci E, Petrone L, Ricca V, Mansani R, Cilotti A, Balercia G, Chiarini V, Giommi R, Forti G, Maggi M. Psychobiological correlates of smoking in patients with erectile dysfunction. Int J Impot Res 2006; 17:527-34. [PMID: 15931232 DOI: 10.1038/sj.ijir.3901351] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although it is clear that cigarette abuse is closely linked to sexual dysfunction, it is still unclear which are the psychobiological correlates of smoking among individuals with sexual dysfunction. The aim of the present study is the assessment of the organic, psychogenic and relational correlates of erectile dysfunction (ED) in outpatients with different smoking habits. We studied the psychobiological correlates of smoking behaviour in a consecutive series of 1150 male patients, seeking medical care for ED. All patients were investigated using a Structured Interview (SIEDY), which explores the organic, relational and intra-psychic components of ED, and a self-administered questionnaire for general psychopathology (MHQ). In addition, several biochemical and instrumental parameters were studied, to clarify the biological components underlying ED. Current smokers (CS) showed a higher activation of the hypothalamus-pituitary-testis axis (higher LH, testosterone and right testicular volume) and lower levels of both prolactin and TSH. Hormonal changes were reverted after smoking cessation. CS showed a higher degree of somatized anxiety and were more often unsatisfied of their occupational and domestic lifestyle. Smoking, as part of a risky behaviour, was significantly associated with abuse of alcohol and cannabis. Both CS and past smokers (PS) showed an impairment of subjective and objective (dynamic peak systolic velocity at penile duplex ultrasound) erectile parameters. This might be due to a direct atherogenic effect of smoking, a cigarette-induced alteration of lipid profile (higher triglyceride and lower HDL cholesterol in CS than in non-smokers or PS), or due to a higher use of medications potentially interfering with sexual function. This is the first comprehensive evaluation of the biological and intrapsychic correlates to the smoking habit. Our report demonstrates that smoking has a strong negative impact on male sexual life, even if it is associated at an apparently more sexual-favourable hormonal milieu.
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Affiliation(s)
- G Corona
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Pajović B, Radović M, Radunović M, Vasić D. Varicocele and male infertility. SCRIPTA MEDICA 2006. [DOI: 10.5937/scrimed0602069x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Unsal A, Yilmaz B, Turgut AT, Taşkin F, Alaca R, Karaman CZ. Evaluation of varicocele frequency of patients with spinal cord injury by color Doppler ultrasonography: a new etiological factor for varicocele? Eur J Radiol 2005; 57:154-7. [PMID: 16162396 DOI: 10.1016/j.ejrad.2005.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 08/10/2005] [Accepted: 08/10/2005] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the varicocele frequency of patients with spinal cord injury by color Doppler ultrasonography. MATERIALS AND METHODS Sixty patients {48 patients with upper motor neuron injury (U-MNI) and 12 patients with lower-MNI} with traumatic spinal cord injury and age matched 48 healthy volunteers were enrolled in this prospective study. Testis volumes and varicocele grades were determined. Presence of varicocele was also classified according to clinical significance. RESULTS Testis volumes of U-MNI sub-group (14.81 +/- 4.74 ml) were significantly smaller than the control group (18.20 +/- 4.52 ml, p = 0.000) and L-MNI sub-group (17.88 +/- 3.23 ml, p = 0.008). No left-sided clinical varicocele was found in L-MNI sub-group (0/12, 0%), whereas there were 14 patients in control group (14/48, 29%) and 7 patients in U-MNI sub-group (7/47, 15%), and the difference was statistically significant (p = 0.000, 0.007, respectively). CONCLUSION Clinical varicocele frequency of U-MNI patients, who have spastic paralysis of abdominal and lower extremity muscles, is similar to the control group. This finding inspires that increased intra-abdominal pressure via normal to increased abdominal muscle tonus may have a role in the varicocele etiology, beside the classical factors. Absence of clinical varicocele in L-MNI patients, who have flaccid paralysis of the same muscle groups, supports this observation.
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Affiliation(s)
- Alparslan Unsal
- Adnan Menderes University, Faculty of Medicine, Department of Radiology, Aydin, Turkey.
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