Influence of sickle cell disease and treatment with hydroxyurea on sperm parameters and fertility of human males.

BACKGROUND: Recent progress in the treatment of sickle cell disease, in particular the use of hydroxyurea, has considerably modified the prognosis of this disease. Many more patients now reach reproductive age. The objective of this study was to assess the potential impact of hydroxyurea on the semen of patients. DESIGN AND METHODS: In this retrospective multicenter study, we evaluated the sperm parameters and fertility of 44 patients and analyzed the potential impact of hydroxyurea. RESULTS: We report data from the largest series so far of semen analyses in patients with sickle cell disease: 108 samples were analyzed, of which 76 were collected before treatment. We found that at least one sperm parameter was abnormal in 91% of the patients before treatment, in agreement with published literature. All sperm parameters seemed to be affected in semen samples collected during hydroxyurea treatment, and this impairment occurred in less than 6 months, later reaching a plateau. Furthermore, after hydroxyurea cessation, while global results in 30 patients were not statistically different before and after hydroxyurea treatment, in four individuals follow-up sperm parameters did not seem to recover quickly and the total number of spermatozoa per ejaculate fell below the normal range in about half the cases. CONCLUSIONS: The observed alterations of semen parameters due to sickle cell disease seem to be exacerbated by hydroxyurea treatment. Until prospective studies reveal reassuring findings, we suggest that a pre-treatment sperm analysis be performed and sperm cryopreservation be offered to patients before hydroxyurea treatment.

[Management of priapism in patients with sickle-cell anaemia]. / Prise en charge du priapisme chez les patients drépanocytaires.

Sickle-cell anaemia is an autosomal recessive hereditary haemoglobinopathy. Patients with sickle-cell anaemia present a high risk of priapism. At least 40% of sickle-cell patients report episodes of priapism. Priapism in patients with sickle-cell tend to start during childhood and rapidly threaten the erectile prognosis. Apart from specific treatment of sickle-cell anaemia, the urologist must be able to recognize forms of intermittent priapism and promote medical prevention. The urologist must also be able to distinguish low-flow priapism from the rarer high-flow priapism, as the treatments differ. Treatment strategies are increasingly well defined, with an increasingly limited place for surgery.

[Scrotal reconstruction by inguinal flap after Fournier's gangrene]. / La reconstruction du scrotum après gangrène de Fournier par lambeau inguinal.

OBJECTIVES: The authors propose the use of a pedicle inguinal flap for reconstruction of the scrotal region after wide tissue resection following gangrene of the perineum. MATERIAL AND METHODS: Between 1998 and 2002, the authors treated 14 patients by surgical debridement following Fournier's perineo-perianal cellulitis. The authors used a pedicle inguinal flap in two patients with complete resection of the scrotal sac. RESULTS: Clinical examination at 3 years showed a good functional and aesthetic result. The trophicity and sensitivity of the neo-scrotum and testes were normal. CONCLUSIONS: The inguinal flap proposed by that authors allows cover of the scrotal region with relatively thick, sensitive tissue with limited scarring and functional sequelae.