Impact of overactive bladder on retrograde ejaculation

ABSTRACT Purpose: To evaluate the impact of overactive bladder disorder on patients diagnosed with retrograde ejaculation. Materials and Methods: Retrospective analysis of prospective collected database made. Questionnaires conducted in urology polyclinics in five different centers. Main Outcome Measure(s): International Index of Erectile Function - 5 (IIEF - 5), Overactive Bladder 8 - Question Awareness Tool (OAB - V8), urodynamics, semen analysis. The participants of the study were n = 120 patients. There was retrograde ejaculation (RE) in only n = 47 patients (non / minimal symptomatic patients), n = 73 patients had RE and overactive (OAB) complaints (symptomatic patients) and received anticholinergic treatment (trospium), n = 37 control group patients who only had OAB and received an anticholinergic. Results: While no difference was observed in overactive bladder examination and urodynamic values between the non / minimal symptomatic group and the symptomatic group (p > 0.05), sperm was detected and identified as fructose positive in post - ejaculation urine in the symptomatic group. Thus, it was possible to demonstrate the differences between symptomatic patients and non - symptomatic patients. Consequently, following three - month daily treatment with trospium 30 mg 2 x 1 in the control group and the symptomatic group, it was observed that an evident increase was observed in the sperm count and ejaculate volume in the symptomatic group and that no change was observed in the control group (p < 0.05). Conclusion: This clinical study is the first of its kind in terms of revealing the coexistence of RE with OAB upon performing urodynamics and showing that treatment is possible in selected patients.

Impact of overactive bladder on retrograde ejaculation.

PURPOSE: To evaluate the impact of overactive bladder disorder on patients diagnosed with retrograde ejaculation. MATERIALS AND METHODS: Retrospective analysis of prospective collected database made. Questionnaires conducted in urology polyclinics in five different centers. MAIN OUTCOME MEASURE(S): International Index of Erectile Function - 5 (IIEF - 5), Overactive Bladder 8 - Question Awareness Tool (OAB - V8), urodynamics, semen analysis. The participants of the study were n = 120 patients. There was retrograde ejaculation (RE) in only n = 47 patients (non / minimal symptomatic patients), n = 73 patients had RE and overactive (OAB) complaints (symptomatic patients) and received anticholinergic treatment (trospium), n = 37 control group patients who only had OAB and received an anticholinergic. RESULTS: While no difference was observed in overactive bladder examination and urodynamic values between the non / minimal symptomatic group and the symptomatic group (p > 0.05), sperm was detected and identified as fructose positive in post - ejaculation urine in the symptomatic group. Thus, it was possible to demonstrate the differences between symptomatic patients and non - symptomatic patients. Consequently, following three - month daily treatment with trospium 30 mg 2 x 1 in the control group and the symptomatic group, it was observed that an evident increase was observed in the sperm count and ejaculate volume in the symptomatic group and that no change was observed in the control group (p < 0.05). CONCLUSION: This clinical study is the first of its kind in terms of revealing the coexistence of RE with OAB upon performing urodynamics and showing that treatment is possible in selected patients.

[Extent of sperm DNA damage in spermatozoa from men examined for infertility. Relationship with oxidative stress]. / Aumento del daño en el ADN y estrés oxidativo en espermatozoides de pacientes con oligozoospermia idiopática y antecedentes de criptorquidismo.

BACKGROUND: Cryptorchidism and oligozoospermia are clinical conditions closely associated with impaired fertility. Oxidative stress and related sperm DNA damage have been identified as significant causes of male infertility. AIM: To determine the extent of sperm nuclear DNA damage in patients affected with idiopathic oligozoospermia or undescended testes and to examine its relationship with oxidative stress. PATIENTS AND METHODS: We studied 20 patients with idiopathic oligozoospermia and 18 with undescended testes (who previously underwent orchiopexy) and 25 normozoospermic healthy controls. All subjects underwent semen analysis. Sperm DNA damage was evaluated by the sperm chromatin structure assay/flow cytometry (SCSA-FCM) and by the dUTP-biotin nick end labeling (TUNEL) assay. Levels of reactive oxygen species (ROS) and total antioxidant capacity (TAC) were assessed by a chemiluminescence assay. RESULTS: DFI (percentage of sperm with denatured DNA) values and percentage of TUNEL positive cells were significantly greater in patients with oligozoospermia (DFI: 28.8+/-5.6; TUNEL+: 26.9+/-3.0) or cryptorchidism (DFI: 26.4+/-10.1; TUNEL+: 29.1+/-3.9), compared with controls (DFI: 7.1+/-0.9; TUNEL+: 14.2+/-1.2). Similarly, both groups of patients had significantly higher (p<0.01) levels of ROS. TAC levels did not differ between control and patient groups, suggesting that the DNA damage occurs before spermiation. CONCLUSIONS: Sperm DNA damage is significantly increased in men with idiopathic oligozoospermia and in cryptorchid subjects. The finding of increased ROS levels may indicate that seminal oxidative stress may be involved in the pathogenesis of sperm DNA damage in these patients.

Aumento del daño en el ADN y estrés oxidativo en espermatozoides de pacientes con oligozoospermia idiopática y antecedentes de criptorquidismo / Extent of sperm DNA damage in spermatozoa from men examined for infertility. Relationship with oxidative stress

Background: Cryptorchidism and oligozoospermia are clinical conditions closely associated with impaired fertility. Oxidative stress and related sperm DNA damage have been identified as significant causes of male infertility. Aim: To determine the extent of sperm nuclear DNA damage in patients affected with idiopathic oligozoospermia or undescended testes and to examine its relationship with oxidative stress. Patients and methods: We studied 20 patients with idiopathic oligozoospermia and 18 with undescended testes (who previously underwent orchiopexy) and 25 normozoospermic healthy controls. All subjects underwent semen analysis. Sperm DNA damage was evaluated by the sperm chromatin structure assay/flow cytometry (SCSA-FCM) and by the dUTP-biotin nick end labeling (TUNEL) assay. Levels of reactive oxygen species (ROS) and total antioxidant capacity (TAC) were assessed by a chemiluminescence assay. Results: DFI (percentage of sperm with denatured DNA) values and percentage of TUNEL positive cells were significantly greater in patients with oligozoospermia (DFI: 28.8±5.6; TUNEL+: 26.9±3.0) or cryptorchidism (DFI: 26.4±10.1; TUNEL+: 29.1±3.9), compared with controls (DFI: 7.1±0.9; TUNEL+: 14.2±1.2). Similarly, both groups of patients had significantly higher (p <0.01) levels of ROS. TAC levels did not differ between control and patient groups, suggesting that the DNA damage occurs before spermiation. Conclusions: Sperm DNA damage is significantly increased in men with idiopathic oligozoospermia and in cryptorchid subjects. The finding of increased ROS levels may indicate that seminal oxidative stress may be involved in the pathogenesis of sperm DNA damage in these patients.

[Frequency and etiology of azoospermia in the study of infertile couples]. / Frecuencia y etiología de azoospermia en el estudio de parejas infértiles.

UNLABELLED: One out of ten couples seek some kind of treatment for infertility of which males are infertile between 30-50%. Azoospermia has been reported in the range of 10 to 20% of cases. MATERIAL AND METHODS: We reviewed 331 cases seen at the clinic of Reproductive Biology of the Hospital Juárez de México, SSA, from January 1993 through February 2000. 66 patients were found with azoospermia (19.93%). Studies performed were: seminogram, testicular and transrectal ultrasonography, cariotype, deferentovesiculography and testicular biopsy. Radioimmunoassay of gonadotropins (FSH, LH) and testosterone was also practiced. RESULTS: Twelve patients (18.18%) were excluded either for desertion or incompletion of studies. The etiology of azoospermia of remainder 54 cases was: secretory (85.19%) of which 41.3% was idiopathic, 10.9% had germ cells aplasia, 10.9% varichocele, 10.9% Klinefelter syndrome. Secondary secreting azoospermia was found in two cases with Kallman's syndrome one patient had excretory and 7 obstructive azoospermia. CONCLUSIONS: Azoospermia was diagnosed in 19.93% (n = 54) with a mean age of 30 years. 85.19% had primary secretory azoospermia with FSH & LH hypergonadotropism in 85.8 and 56.4% respectively (p < 0.05). Obstructive azoospermia was seen in 12.96% and only one case (1.85%) presented excretory azoospermia.

[Effect of Palomo procedure on the quality of the semen in infertile patients with varicocele and oligoastenospermia]. / Efecto de la operación de Palomo en la calidad del semen de pacientes infértiles con varicocele y oligoastenospermia.

OBJECTIVE: To evaluate the effect of Palomo's surgery on the semen quality from oligospermic infertile men with varicocele. STUDY DESIGN: Retrolective cohort. SETTING: Hospital General Regional No. 1, IMSS, Culiacán, Sinaloa. PATIENTS: 39 oligospermic infertile men with varicocele. INTERVENTIONS: Palomo's surgery. MEASUREMENTS: A spermatobioscopy before the Palomo's surgery was performed, and after the surgery two spermatobioscopies in different times of six months. RESULTS: Spermatobioscopy before the surgery: Concentration/mL = 8.8 +/- 4.1 millions, Motility = 19.5 +/- 10.0%, Vitality = 66.2 +/- 14.4%. First spermatobioscopy after surgery: Concentration/mL = 29 3 +/- 18 3 Motility = 41 5 +/- 19 1, Vitality = 74.7 +/- 14.5. Second spermatobioscopy after surgery: Concentration/mL = 14.6 +/- 10.3, Motility = 28.0 +/- 14.8, Vitality = 78.7 +/- 16.8. All differences from the spermatobioscopy before the surgery were significant. CONCLUSION: Palomo's surgery has a favorable effect on the quality of the semen, with a diminishing trend in concentration and motility in the second semester after the surgery. The pregnancy rate was 15%.

In vitro fertilization. The Jamaican experience.

In June 2000, twenty-eight infertile couples were treated by in vitro fertilization and embryo transfer at our initial assisted reproduction programme carried out in conjunction with Midland Fertility Services, Aldridge, Birmingham, England. A pre-requisite for treatment was that on day 3 of the menstrual cycle the levels of follicle stimulating hormone (FSH) and oestradiol (E2) should be < 10 i mu/l and < 100 pg/ml respectively in the female partner. The ages of the women ranged from 26 to 42 years with a mean age of 35.5 years. Down regulation was carried out by using buserelin acetate 0.5 microgram subcutaneously from day 21 of the cycle for 21 days. This process was completed when the ovaries and pituitary gland were quiescent and the endometrial thickness < 4 mm in diameter. On completion of down regulation the gonadotrophin hormone, pergonal (dosage of 150-450 units) was used for ovarian hyperstimulation. A total of 294 oocytes (mean of 10.5, range 2-45) were retrieved of which 138 were fertilized (mean of 4.9, range of 0-28). Twenty-four patients each received a mean of two embryos. Five patients (20.8%) had positive pregnancy tests. Three patients (0.1%) developed ovarian hyperstimulation syndrome (OHSS), one had the severe, and two, the mild form of the syndrome. All three cases were treated successfully. The success at the initial IVF controlled ovarian hyperstimulation augers well for the future of infertile couples seeking treatment at the Fertility Management Unit, The University of the West Indies, Jamaica.

[Young's syndrome: recurrent respiratory tract infections and azoospermia]. / Síndrome de Young: infecções respiratórias de repetição e azoospermia.

INTRODUCTION: Young's syndrome is part of primary ciliary dyskinesia, characterized by repeated airway infections and congenital epididymis obstruction. CASE REPORT: The authors present the case of a 28-year old male with recurrent rhinosinusitis and pneumonia. Sweat and immunologic tests fell within the normal range. Sperm analyses revealed absence of spermatozoa although spermatogenesis was normal according to the findings in testis biopsy. DISCUSSION: The final diagnosis was Young's syndrome the first case of the disease reported in Brazilian literature. CONCLUSIONS: The authors emphasize the need for appropriate diagnosis and genetic counselling as well as differential diagnosis with cystic fibrosis in these cases.

[Male sterility and its association with genital disease and environmental factors]. / Esterilidad masculina y su asociación con patología genital y factores ambientales.

Semen quality may be affected by many factors, as there is evidence that conditions as varicocele, criptorquidia, orchitis and bacterian infections; as well as to exposure to physical agents as heat, or chemical substances, or ingestion of alcohol and drugs, may affect semen quality. The objective of this study is to investigate the risk implied in the exposure to these factors on the semen quality. The study was carried out in a prospective way in a group of males at Clínica de Infertilidad, Unidad de Biología de la Reproducción del Hospital Universitario Dr. J.E. González. Ninety nine males were studied, they received an intentioned questionnaire about antecedents of exposure to environmental factors, and urologic resolved pathology. Espermatobioscopy was done and it was classified according to OMS. Two groups were formed, one with the individuals with normal espermatobioscopy (n = 25); and the abnormal ones (n = 74). The statistical Incidences Reason, square Xi and Atributable Risk, were applied in order to determine the impact that different factors may have on semen quality. The found alterations in semen were astenozoospermia (n = 58); hypospermia (n = 22); oligozoospermia (n = 18); teratozoospermia (n = 7); polizoospermia (n = 7); and azoospermia (n = 6). The results of the mentioned statistical tests, show that in these alterations there is an associated risk factor to the use of tobacco, exposure to chemical substances, to physical aggresors; and anatomic anomalies previously corrected. It is considered that obtention of this information is a great help because once the unfavorable factors are eliminated, the environment is improved in order to obtain an espermatogenesis in optimal conditions.

Familial bilateral vas deferens agenesis.

Two brothers with bilateral vas deferens agenesis are described, one of them with a chromosome mosaicism (46,XX/47,XXY). To our knowledge, there are not any previous reports of both conditions existing simultaneously. The patients consulted us because of infertility; they have normal sexual function, normal physical examination, but typical semen analyses with azoospermia, low semen volume, low pH, and negative fructose test. It appears to us that bilateral vas deferens agenesis may be genetic in origin in some patients.

Cinética de la respuesta esteroidogénica a la estimulación testicular con gonadotrofina coriónica: aplicación clínica en hombres con infertilidad asintomática / Kinetics the steroidogenic response to the testicular stimulation whit gonadotrophin chorionic: clinical application in asymptomatic infertile man

En el presente trabajo, hemos desarrollado una prueba de estimulación testicular simplificada y de aplicación clínica. Además, se correlacionó la respuesta esteroidogénica a la hCG, con las alteraciones espermatogénicas en hombres con infertilidad asintomática. Los niveles circulantes de testosterona (T), estradiol (E2), 17OH-Progesterona (17OHP) fueron determinados en condiciones basales (3 muestras de sangre tomadas en intervalos de 15 min) y a las 2, 4, 24 y 48 h después de la inyección i.m. de 5.000 UI de hCG, en 420 pacientes oligoastenospérmicos normoprolactinémicos con niveles normales de LH y FSH. Las respuestas de T y 17OHP a la hCG, en el grupo control, mostraron un patrón bifásico con un pico agudo a las 4 h y un pico más sostenido y retrasado luego de las 24 h. Los pacientes infértiles mostraron 2 tipos de respuesta de la T a la hCG: grupo 1) (n = 290), con una respuesta disminuida entre las 2 y 4 h, pero en el rango de los valores de los hombres normales entre las 24 y las 48 h, y un grupo 2 (n = 130) con una respuesta de T similar al grupo control. Las respuestas de E2 en los pacientes del grupo 1 y 2 fueron similares a las del grupo control. La hCG indujo un crecimiento significativo en la relación 170HP/T en los pacientes del grupo 1. En 22 pacientes: 16 del grupo 1 y 6 del grupo 2, se administró aminoglutetimida-hidrocortisana (AGT-HC), un inhibidor de la aromatasa, durante 90 días. Díez pacientes del grupo 1 normalizaron el espermograma (5 de los cuales lograron embarazos, en 5 se obtuvo un incremento significativo de los espermatozoides grado 3 y en 1 no se observaron cambios. Por otro lado, sólo 1 paciente del grupo 2 presentó una leve mejoría en la calidad del semen. La AGT disminuyó la concentración de E2 y aumentó las gonadotrofinas y la relación T/E2. En los pacientes del grupo 1 se incrementó la respuesta aguda de T a la hCG, durante el tratamiento. Nuestros resultados sugieren que 1), el E2 podría estar involucrado, tanto en la etiología de algunos casos de oligoazoospermia, como en la falta de respuesta aguda de T a la hCG, induciendo, posiblemente, un bloqueo parcial de la 17,20 desmolasa; 2) la mejoría de la calidad del semen inducida por el AGT-HC podría estar relacionada a un incremento en la relación T:E2, a una disminución intratesticular de E2, a un incremento de gonadotrofinas o a la suma de cambios hormonales; 3) solamente los pacientes con una respuesta aguda disminuidas de T a la hCG serían posibles para el tratamiento

Cinética de la respuesta esteroidogénica a la estimulación testicular con gonadotrofina coriónica: aplicación clínica en hombres con infertilidad asintomática / Kinetics the steroidogenic response to the testicular stimulation whit gonadotrophin chorionic: clinical application in asymptomatic infertile man

En el presente trabajo, hemos desarrollado una prueba de estimulación testicular simplificada y de aplicación clínica. Además, se correlacionó la respuesta esteroidogénica a la hCG, con las alteraciones espermatogénicas en hombres con infertilidad asintomática. Los niveles circulantes de testosterona (T), estradiol (E2), 17OH-Progesterona (17OHP) fueron determinados en condiciones basales (3 muestras de sangre tomadas en intervalos de 15 min) y a las 2, 4, 24 y 48 h después de la inyección i.m. de 5.000 UI de hCG, en 420 pacientes oligoastenospérmicos normoprolactinémicos con niveles normales de LH y FSH. Las respuestas de T y 17OHP a la hCG, en el grupo control, mostraron un patrón bifásico con un pico agudo a las 4 h y un pico más sostenido y retrasado luego de las 24 h. Los pacientes infértiles mostraron 2 tipos de respuesta de la T a la hCG: grupo 1) (n = 290), con una respuesta disminuida entre las 2 y 4 h, pero en el rango de los valores de los hombres normales entre las 24 y las 48 h, y un grupo 2 (n = 130) con una respuesta de T similar al grupo control. Las respuestas de E2 en los pacientes del grupo 1 y 2 fueron similares a las del grupo control. La hCG indujo un crecimiento significativo en la relación 170HP/T en los pacientes del grupo 1. En 22 pacientes: 16 del grupo 1 y 6 del grupo 2, se administró aminoglutetimida-hidrocortisana (AGT-HC), un inhibidor de la aromatasa, durante 90 días. Díez pacientes del grupo 1 normalizaron el espermograma (5 de los cuales lograron embarazos, en 5 se obtuvo un incremento significativo de los espermatozoides grado 3 y en 1 no se observaron cambios. Por otro lado, sólo 1 paciente del grupo 2 presentó una leve mejoría en la calidad del semen. La AGT disminuyó la concentración de E2 y aumentó las gonadotrofinas y la relación T/E2. En los pacientes del grupo 1 se incrementó la respuesta aguda de T a la hCG, durante el tratamiento. Nuestros resultados sugieren que 1), el E2 podría estar involucrado, tanto en la etiología de algunos casos de oligoazoospermia, como en la falta de respuesta aguda de T a la hCG, induciendo, posiblemente, un bloqueo parcial de la 17,20 desmolasa; 2) la mejoría de la calidad del semen inducida por el AGT-HC podría estar relacionada a un incremento en la relación T:E2, a una disminución intratesticular de E2, a un incremento de gonadotrofinas o a la suma de cambios hormonales; 3) solamente los pacientes con una respuesta aguda disminuidas de T a la hCG serían posibles para el tratamiento

Determinaciones hormonales y biopsia de testículo en el varón estéril / Testicular biopsy and hormonal studies in sterile males

Se estudiaron 25 varones que fueron referidos por esterilidad. Estos pacientes tenian un mínino de 2 espermatobioscopías que mostraron oligospermia severa o azoospermia. Se realizaron determinaciones hormonales basales de hormonas luteinizante (LH), folículo-estimulante (FSH), prolactina (PRL) y testosterona (T), sometiéndolos posteriormente a biopsia unilateral de testículo. Como grupo control , se hicieron determinaciones basales de FSH, LH, PRL y T en 35 varones normales de 18-35 años de edad con fertilidad comprobada en los 3 años previos al estudio. La imagen histológica más frecuente fue detención de la maduración (DM) que se encontró en 6/8 oligospérmicos y en 10/17 azoospérmicos, asociada con mínimas alteraciones del patrón hormonal. En 5 pacientes se encontró ausencia de células germinales en 1/8 oligospérmicos y en 4/17 azoospérmicos, y sólo un paciente azoospérmico presentó un incremento de FSH mayor que el doble de la máxima normal de la concentración basal. Cuatro pacientes, 1/8 oligospérmicos y 3/17 azoospérmicos tuvieron esclerosis tubular y peritubular (ETP), los 4 pacientes tuvieron FSH elevada y 2 de los pacientes azoospérmicos tuvieron también niveles elevados de LH y bajos de testosterona. En ambos grupos, oligospérmicos y azoopérmicos, las determinaciones de PRL estuvieron dentro de límites normales. Se concluye que la hiperprolactinemia no es una causa frecuente de oligospermia o azoospermia; las determinaciones basales de FSH, LH y T son útiles para estimar el grado de lesión y las líneas celulares afectadas. La biopsia de testículo constituye un auxiliar útil en la evaluación del pronóstico de algunos pacientes

In vitro Fertilization: the Jamacian experience

In June 2000, twenty-eight infertile couples were treated by vitro fertilization and embryo transfer at our initial assisted reproduction programme carried out in conjunction with Midland Fertility Services, Aldridge, Birmingham, England. A pre-requisite for treatment was that on day 3 of the menstrual cycle the levels of follicle stimulating hormone (FSH) and oestradiol (E2) should be <10iu/l and <100pg/ml respectively in the female partner. The ages of the women ranged from 26 to 42 years with a mean age of 35.5 years. Down regulation was carried out by using buserelin acetate 0.5 ug subcutaneously from day 21 of the cycle for 21 days. This process was completed when the ovaries and pituitary gland were quiescent and the endometrial thickness <4 mm in diameter. On completion of down regulation the gonadotrophin hormone, pergonal (dosage of 150-450 units) was used for ovarian hyperstimulation. A total of 294 oocytes (mean of 10.5, range 2-45) were retrieved of which 138 were fertilized (mean of 4.9, range of 0-28). Twenty-four patients each received a mean of two embryos. Five patients (20.8 percent) had positive pregnancy tests. Three patients (0.1 percent) developed ovarian hyperstimulation syndrome (OHSS), one had the severe, and two, the mild form of the syndrome. All three cases were treated successfully. The success at the initial IFV controlled ovarian hyperstimulation augers well for the future of infertile couples seeking treatment at the Fertility Management Unit, The University of the West Indies, Jamaica (AU)