[Influence of COVID-19 on male fertility. What is already known?]

A new coronavirus infection caused by SARS-CoV-2 was first identified in December 2019. It has spread quickly and caused a global pandemic. Analysis of demographic factors reveals a disproportionately large number of men with severe forms of the disease. Moreover, mortality rate is also higher in men. The currently available data regarding potential risks to the male reproductive system, including pathophysiological basics, detection of viral RNA in the reproductive tract, risk of orchitis, hypogonadism, possible influence of oxidative stress, etc. are described in the review.

[Why are recommendations on the study of ejaculate not updated?]

In recent years, the quality of germinal cells has been recognized as the main factor determining reproductive potential. Standard sperm analysis is of limited value for predicting both the achievement of a pregnancy and the outcomes of assisted reproductive technologies, which raises the question of the additional significance of functional testing. Most current guidelines recommend to perform additional studies from a scientific point of view, recognizing their importance, but dont include men in the basic diagnostic schemes. In this review, we try to discuss of the relevance of special sperm testing.

[The role of tadalafil in the management of sexual dysfunctions].

Erectile dysfunction (ED) has a significant negative impact on the quality of life of the patients and their partners. The sequence and regimens of ED therapy have become quite evident since the advent of phosphodiesterase type 5 inhibitors (PDE-5). However, there have been continued basic research of the efficacy and safety of these agents and studies aimed at new therapeutic goals. In recent years, the attention of researchers has shifted into a wider range of issues related to the personalized PDE-5 therapy, including sexual satisfaction, psychosocial variables (e.g., confidence, self-esteem, quality of relationships) and other potentially related factors. In particular, there are more and more new data on male sexual dysfunction. This review focuses on the relationship between erectile dysfunction and concomitant conditions: depressive symptoms, libido and sexual satisfaction disorders, ejaculation and orgasm abnormalities. The authors outline the possibilities and potential benefits of PDE-5 for patients with comorbid sexual dysfunction and depression with a special focus on tadalafil.

[Isolated teratozoospermia: is there a role for antioxidant therapy?]

Recently, literature has emerged that offers contradictory findings of idiopathic forms of isolated teratozoospermia that may confuse clinicians. Some researchers argue that at 0-1% of normal forms of spermatozoa, morphology itself cannot be a prognostic indicator of fertility, either in the planning of natural pregnancy, or when used in assisted reproduction. In this connection, the possible causes of teratozoospermia and alternative therapies are being actively sought, in addition to known invasive and costly procedures. There is convincing evidence that reactive oxygen species overproduction is associated with the occurrence of abnormal spermatozoa in the ejaculate. An abnormal morphology can be accompanied by damage to the sperm DNA, impaired chromatin condensation, and associated unsuccessful pregnancy outcomes. Most of the studies show that using antioxidants results in positive changes. This literature review highlights the role of oxidative stress and DNA fragmentation in the formation of morphologically abnormal spermatozoa. The authors discuss drug interventions to treat teratozoospermia and present their own recommendations for antioxidant therapy in the clinical management of idiopathic forms of male infertility.

[PDE-5 inhibitors: patients preferences].

To date, multidisciplinary approach is commonly used to treat erectile dysfunction (ED), and the first line of ED pharmacotherapy, despite its multiple causes, is phosphodiesterase inhibitors of type 5 (PDE-5). They are considered an effective and well tolerated treatment option [1-4]. Concurrently, sildenafil has the largest evidence base for efficacy and safety [5]. The satisfaction of patients with ED therapy is a complex and personal matter, and there are no clearly established and reliable criteria for showing preferences when choosing a PDE-5. Adherence of patients to the PDE-5 therapy is determined not only by the erectile response and side effects, but also by how well the treatment meets the needs and expectations of patients and how it affects the relationship between the partners. This review examines the tolerability and efficacy of the various types of PDE-5 available for treating ED, with a special emphasis on the patient's preferences, and in particular on the new sildenafil orodispersible films. As an alternative route of drug administration, films quickly dissolve in the mouth [6] and have several advantages, improve sexual health and the sense of psychological well-being of patients and their partners.

[Contemporary aspects of using sildenafil].

Sildenafil has been thoroughly studied in 74 registered double-blind, placebo-controlled clinical trials assessing the efficacy and safety of the drug in a total of more than 16 000 men with erectile dysfunction (ED). However, practicing urologists have some questions regarding administering the drug in patients with multiple comorbidities. In this review, on a par with the now "classic" research, we outline the latest updates of meta-analyzes and comparative studies relating to the use of sildenafil in different groups of patients. We also discuss the problem of self-discontinuation of sildenafil therapy and the possible risks of using counterfeit phosphodiesterase type 5 inhibitors (PDE-5i).

[MALE PRECONCEPTION CARE].

Planning pregnancy is very important to ensure the most comfortable and optimal conditions for conception, gestation and the subsequent birth of a healthy child. This review examines the effects and mechanisms of the damaging effect of external factors, social habits and certain diseases on the ejaculate quality, as well as ways to overcome them aiming to optimum preparation of a man to conceive. Several studies have shown an inverse relationship between semen quality and common diseases. Unfavorable environmental conditions, varicocele, endocrine causes, such as diabetes, obesity, and metabolic syndrome, are thought to be among the factors that could adversely affect the quality of sperm. Oxidative stress in the testicular microenvironment may lead to suppression of spermatogenesis and sperm DNA damage resulting in a decrease of their mobility and causing morphological abnormalities.

[USE OF SILDENAFIL CITRATE FOR TREATMENT OF ERECTILE DYSFUNCTION OF VARIOUS ETIOLOGY].

Erectile dysfunction is closely linked to the general state of both physical and psychological wellness. Among the major risk factors are heart disease, arterial hypertension, diabetes, hyperlipidemia, as well as sedentary lifestyle, smoking and alcohol abuse. Also, the disease is more frequently found in men undergoing radiation therapy or surgery for prostate cancer. Psychological correlates include anxiety, depression and irritability. Despite a higher prevalence among older men, erectile dysfunction is not considered an inevitable part of aging. Due to polyetiology of the disease, sildenafil is regarded as the gold standard of treatment, and new high quality generic drugs are marketed. The article covers the use of sildenafil in patients with diseases of the cardiovascular system, diabetes, hypogonadism. Effectiveness of sildenafil in patients on chronic hemodialysis as well as in patients undergoing radical prostatectomy is discussed. The issue of addiction to sildenafil is outlined.