Short anogenital distance is associated with testicular germ cell tumour development.

BACKGROUND: Testicular germ cell tumour is a multifactorial disease in which various genetic and environmental factors play a role. Testicular germ cell tumour is part of the testicular dysgenesis syndrome which includes also cryptorchidism, hypospadias, oligo/azoospermia and short anogenital distance. OBJECTIVES: The primary objective was to examine anogenital distance in testicular germ cell tumour cases and healthy fertile controls. The secondary objective was to assess the (CAG)n polymorphism of the Androgen Receptor gene in relationship with anogenital distances and testicular germ cell tumour development. MATERIAL AND METHODS: 156 testicular germ cell tumour patients and 110 tumour-free normozoospermic controls of Spanish origin. All subjects underwent full andrological workup (including semen and hormone analysis) and genetic analysis (Androgen Receptor (CAG)n). The main outcome measures were the anopenile distance (AGDap), the anoscrotal distance (AGDas) and AR(CAG)n. RESULT: We observed significantly shorter anogenital distances in the group of testicular germ cell tumour patients in respect to controls (P < .001) independently from sperm count and testis histology. Threshold values, applicable only to our cohort, were calculated for anogenital distances with the best sensitivity and specificity. Subjects with AGDap and AGDas below threshold showed a significantly increased risk for testicular germ cell tumour (OR = 4.97, 95% CI = 2.01-12.33, P = .001 and OR = 4.11, 95% CI = 1.89-8.92, P ≤ .001, respectively). No significant correlation was observed between AR(CAG)n polymorphism and anogenital distances. The median values of the AR(CAG)n were similar between cases and controls, excluding a major role for this polymorphism in the etiopathogenesis of these testicular dysgenesis syndrome components. CONCLUSIONS: Ours is the first study focusing on anogenital distances in testicular germ cell tumour patients. We identified short anogenital distances (which is a surrogate biomarker of androgen action during foetal life) as a significant risk factor for this disease. After further validation of our preliminary data, anogenital distance measurement could become part of testicular germ cell tumour screening in order to better define those individuals who would benefit from long-term active follow-up.

[Azoospermia should not be given as the result of vasectomy]. / La azoospermia no debería ofrecerse como resultado de la vasectomia.

OBJECTIVES: Vasectomy is a surgical method of male contraception. Azoospermia is offered as result of the technique and this is not always attained, resulting in legal matters. The purpose of this study is to know the number of semen samples needed to discharge a patient after intervention. To identify sperm count on semen analysis at time of discharge. METHODS: Retrospective study of men who underwent vasectomy in a 15-month period with a 2 year follow up. Consecutive semen analyses up to 5 samples were measured at 2 to 3 months interval in all men who had persistence of spermatozoa. RESULTS: 618 men were intervened, 106 did not bring semen to the laboratory (17%), 2 (0.39%) presented motile sperm and were considered a failure of the technique and excluded. 510 men completed controls. 316 (61.9%) were azoospermic in the first sperm analysis, 74 (14.5%) in the second, 27 (5.2%) in the third, 6 (1.2%) in the fourth and one (0,.%) in the fifth analysis. The remaining 86 men (16.8%) had persistence of immotile sperm in the ejaculate and were less than 100,000/ml. No pregnancy was reported during 2 years follow up or after. CONCLUSIONS: Five or more semen analysis can be made after the surgery. Persistence of immotile sperm in the ejaculate is frequent and may exist for a long period afterwards. Immotile sperm count of 100,000/ml or less should be accepted as result of the procedure. The patient should be informed about the fact that persistent immotile sperm can be found in his semen. In the informed consent azoospermia should not be a concern as it is frequent to find immotile sperm in the ejaculate and this is an acceptable issue. As with other contraceptive methods, vasectomy should be offered as a safe method although clearly stating that the possibilities of failure do exist.

Classification of cystic structures located at the midline of the prostate: our experience.

OBJECTIVES: Between January 1994 and February 2002, 9086 men underwent biplane TRUS at our institution for a variety of reasons. 781 of the 9086 men (8.6%) showed evidence of one or more intraprostatic cystic lesions. We propose a new classification of cystic structures located at the midline of the prostate. MATERIAL AND METHODS: We have designed a methodology that reclassifies cystic structures located at the prostate midline through the ultrasonically guided transrectal aspiration of the cystic structure, the analysis of the PSA level of the aspirated fluid and the presence of spermatozoa, radiological studies (cyst injection with contrast medium, vasography, retrograde and/or voiding cystourethrography and utricle injection with contrast medium) and endoscopic studies (cystourethroscopy). RESULTS: Upon completion of the methodology, we have classified and defined these structures as the following: simple prostatic cysts, cysts of the müllerian ducts, megautricle, megautricle with inclusion of the ejaculatory ducts, "pseudocystic" dilation of the ejaculatory ducts and utriculoceles. CONCLUSIONS: This new classification of cystic structures located at the prostate midline is simple, useful and steers one away from any possible confusion.

Regulation of human penile smooth muscle tone by prostanoid receptors.

We have characterized the prostanoid receptors involved in the regulation of human penile arterial and trabecular smooth muscle tone. Arachidonic acid induced relaxation of human corpus cavernosum strips (HCCS) that was blocked by the cyclo-oxygenase inhibitor, indomethacin, and augmented by the thromboxane receptor (TP) antagonist, SQ29548, suggesting that endogenous production of prostanoids regulates penile smooth muscle tone. TP-receptors mediate contraction of HCCS and penile resistance arteries (HPRA), since the agonist of these receptors, U46619, potently contracted HCCS (EC50 8.3+/-2.8 nM) and HPRA (EC50 6.2+/-2.2 nM), and the contractions produced by prostaglandin F(2alpha) at high concentrations (EC50 6460+/-3220 nM in HCCS and 8900+/-6700 nM in HPRA) were inhibited by the selective TP-receptor antagonist, SQ29548 (0.02 microM). EP-receptors are responsible for prostanoid-induced relaxant effects in HCCS because only prostaglandin E1 (PGE1), prostaglandin E2 and the EP2/EP4-receptor agonist, butaprost, produced consistent relaxation of this tissue (EC50 93.8+/-31.5, 16.3+/-3.8 and 1820+/-1284 nM, respectively). In HPRA, both prostacyclin and PGE1 (EC50 60.1+/-18.4 and 109.0+/-30.9 nM, respectively) as well as the selective IP receptor agonist, cicaprost, and butaprost (EC50 25.2+/-15.2 and 7050+/-6020 nM, respectively) caused relaxation, suggesting co-existence of IP- and EP-receptors (EP2 and/or EP4). In summary, endogenous production of prostanoids may regulate penile smooth muscle contractility by way of specific receptors. TP-receptors mediate contraction in HCCS and HPRA, while the relaxant effects of prostanoids are mediated by EP2- and/or EP4-receptors in HCCS and by EP- and IP-receptors in HPRA.