Ultrasonographic characteristics of the testes, epididymis and accessory sex glands and arterial spectral indices in peri- and post-pubertal Nelore and Caracu bulls.

Ultrasonography can provide information about the integrity of organs; however, rarely is applied to the reproductive organ evaluation of bulls. The objective of the present study was to characterize and compare values for variables and ultrasonographic characteristics of the testes, epididymis and accessory sex glands, as well as spectral Doppler indices of the testicular and internal iliac arteries, between peri- and post-pubertal Nelore and Caracu bulls. Nelore (n = 203) and Caracu (n = 79) bulls were assigned by age class: peri-pubertal (12-15 months) and post-pubertal (> 22 months). Data were analyzed using SAS's PROC MIXED procedure (P < 0.05). The biometric variables of the testes and cauda epididymis differed between peri- and post-pubertal Nelore and Caracu bulls. There was a difference between breeds for the vesicular glands, ampulla of vas deferens, disseminate portion of the prostate, and craniocaudal dimension of the bulbourethral glands. Echogenicity of the testicular parenchyma differed between breeds and age classes. The pulsatility and resistive indices of the testicular arteries differed between Nelore and Caracu bulls. The biometric and ultrasonographic characteristics of the testes, epididymis and accessory sex glands, as well as of the arterial indices in bulls are affected by genetic group and age class, and when assessed there is useful information regarding the progression of sexual maturation.

Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction.

INTRODUCTION: Male and female sexual dysfunction (SD) is considered a multifactorial condition. Numerous studies have shown the involvement of inflammatory processes in this pathological condition. Sexual intercourse requires healthy and functioning vessels to supply the pelvic region in both males and females, generating penile erection and clitoral and vaginal lubrication, respectively. Cardiovascular diseases and associated risk factors may contribute negatively to pelvic blood flow, possibly through immune system activation. AIM: The study aimed to address the correlation between vascular inflammation driven by immune system activation and SD in males and females. METHODS: A literature review was performed to identify articles addressing male and female SD and vascular inflammation. Key words included "male and female sexual dysfunction," "vascular inflammation," "iliac and pudendal arteries dysfunction," "genitourinary tract," and "blood flow." MAIN OUTCOME MEASURES: Management of systemic and local inflammation may be a useful alternative to improve SD and reduce the risk of cardiovascular diseases in the future. RESULTS: Increased levels of cytokines and chemokines have been detected in humans and animals with hypertension, obesity, and diabetic conditions. Chronic activation of the innate immune system, especially by pathogen- or damage-associated molecular patterns, and metabolic-related disorders may act as triggers further contributing to an increased inflammatory condition. Due to the reduced size of vessels, SD and retinal vascular impairments have been shown to be predictive factors for cardiovascular diseases. Therefore, considering that blood flow to the genitalia is essential for sexual function, endothelial dysfunction and vascular remodeling, secondary to chronic immune system activation, may be implicated in male and female vasculogenic SD. CONCLUSIONS: Several conditions appear to play a role in SD. In the present review, we have identified a role for the immune system in generating vascular and tissue impairments contributing to erectile dysfunction and female SD. Calmasini FB, Klee N, Webb RC, et al. Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction. Sex Med Rev 2019;7:604-613.

Prevalence of accessory pudendal artery.

This study investigated the frequency of an accessory pudendal artery in 15 adult cadavers fixed with formaldehyde solution. The prevalence of accessory pudendal artery varies between 7 and 75% according to the method of identification (imaging studies, microstereoscopic cadaveric dissection, and open and laparoscopic surgeries). Currently, under discussion is the role of this artery in postprostatectomy erectile dysfunction. Accordingly, it is important to know the true prevalence to appreciate its clinical significance. The internal pudendal system was examined through direct dissection, and findings were compared with the different methods of identification published.

[Multi-slice spiral computed tomography angiography of internal pudendal arteries: imaging and value].

OBJECTIVE: To investigate the feasibility and value of multi-slice spiral computed tomography angiography (CTA) in 3D imaging of internal pudendal arteries and their branches. METHODS: Using 64-slice spiral computed tomography, we performed hypogastric CTA for 156 twenty to seventy years old males without vascular diseases. We assigned them to groups A (n = 83, 20 to 55 yr old) and B (n = 73, 56 to 70 yr old), and included 7 male patients with arterial erectile dysfunction (AED) aged 43 to 70 years in group C. We conducted maximum intensity projection (MIP), volume rendering (VR) and vascular analysis on the internal pudendal arteries and their branches, divided the MIP and VR images into 3 levels according to the resolution and continuity of the internal pudendal arteries and their branches for blind evaluation, and measured their diameters at various positions. RESULTS: VR images of the internal pudendal arteries and their branches revealed significant differences between groups A and B (P<0.05), but not MIP images (P>0.05). There were no dramatic differences between MIP and VR in displaying internal pudendal arteries and their branches (P>0.05), nor any remarkable differences in the diameters of bilateral internal pudendal arteries and their branches at different levels in groups A and B (P>0.05). VR and MIP showed the 7 AED cases at grade III, and clearly revealed the degree and position of stenosis and occlusion in the internal pudendal arteries and their branches. CONCLUSION: CTA can display clear 3D images of internal pudendal arteries and their branches, and has a valuable role in the diagnosis and treatment of ED induced by internal pudendal artery diseases.

Vascular anomalies of the male genitalia.

PURPOSE: Vascular tumors and malformations of the male genitalia can affect urinary, sexual, reproductive, and emotional function. METHODS: Male patients with a genital lesion evaluated or treated at our center from 1995 to 2010 were reviewed to analyze presentation, diagnosis, treatment modalities, and outcome. RESULTS: Of the 3889 male patients, 117 had a vascular anomaly of the genitalia: 12 tumors and 105 malformations. The referring diagnosis was accurate in 72.7% of patients with a tumor, whereas 46.3% of malformations were misdiagnosed. Tumors included infantile hemangioma (n = 10) and kaposiform lymphatic anomaly (n = 2). Common vascular malformations were lymphatic (n = 46), venous (n = 33), and capillary-lymphatic-venous (n = 16). Presenting signs for tumors included ulceration (33.0%) and ambiguous genitalia (25.0%). Malformations manifested with swelling (40.0%), fluid leakage (16.2%), and pain (16.2%). Treatment was necessary for 69.9% (79/113) of patients. The remaining lesions (34/113) were observed. Tumor management included observation, pharmacotherapy, and excision. Malformations were largely treated with sclerotherapy and/or surgical procedures. CONCLUSIONS: Vascular anomalies of the male genitalia are uncommon and frequently misdiagnosed. Accurate diagnosis can be made and appropriate treatment can be instituted based on presentation, natural history, and radiographic imaging. Observation and pharmacotherapy are the mainstays of tumor management. Malformations require sclerotherapy and/or resection. Interdisciplinary care optimizes outcomes for males with these often-disfiguring vascular lesions.

Idiopathic high-flow priapism in a pediatric patient.

High-flow priapism is a very rare condition in children. The most common cause is perineal trauma, which is a major cause of arterio-cavernosal fistula. A few pediatric patients have high-flow priapism without an obvious cause. There are many therapeutic modalities for this condition, depending on the etiology. We report a case of idiopathic high-flow priapism in a 6-year-old boy who underwent repeated superselective embolization.

[Intrauterine development, functions and diseases of male reproductive organs]. / A férfi nemi szervek intrauterin fejlôdése, funkciója és betegségei. Andrologia foetalis.

This article discusses the role of the central nervous system and testosterone hormone and its derivatives in the intrauterine development of male reproductive organs. The characteristics that define male personality first emerge in fetal stage of human development. Thereafter they continue to evolve during childhood. They become increasingly apparent after puberty and then remain prevalent throughout the individual's life time. The cited process affects both male phenotype and masculine behavior. Testosterone and its derivatives control the development of male reproductive organs. Their absence leads to predominance of female sexual characteristics even in the presence of a male chromosome pattern. The clinical entity of testicular feminization is a typical example for this phenomenon. The presented study pays special attention to those abnormalities of male reproductive organs that are identifiable by ultrasound during the fetal period. Most of these anomalies cannot be treated effectively before birth. Those conditions that are also incurable in extra uterine life, may serve as indication for pregnancy termination if they can be detected by ultrasound examination in early gestation.

[Gangrene of Fournier, treatment, classification].

The experience of treatment with favorable outcome of 3 patients, in whom gangrene of Fournier was diagnosed, was summarized.The necessity of application of "agressive" surgical tactics in early terms of the disease was stressed.

Aetiology and management of injuries to male external genitalia in Nigeria.

OBJECTIVE: The recent increase in road traffic accidents and civil violence has resulted in a significant rise in injuries to male external genitalia, hence the need to document this new trend. METHODS: All men and boys who presented to our institution with injuries to the external genitalia between 1996 and 2005 were evaluated for the cause, type and severity of injury. Treatment and factors determining outcome were also evaluated. Patients were followed up with regular clinical examination and investigations to detect late complications. RESULTS: The mean age of the 131 patients was 28 (+/-3.2) years. Road traffic accidents and gunshot accounted for 68% and 16% of injuries, respectively. Avulsion injuries occurred in 25 cases, including complete avulsion of the penis, scrotum and testes in 2 cases; 7 cases involved penile amputation. Overall, there were 89 penile, 42 scrotal and 17 testicular injuries. About 22% of cases were managed non-operatively. Complications of treatment included wound infection and urethral stricture, seen in 42 (32%) and 12 (9.4%) cases, respectively. Associated injuries were seen in 41% of cases. CONCLUSION: Genital injuries resulted mainly from road traffic accidents and gunshot. Some injuries were associated with severe tissue loss. However, for the majority, function and cosmetic acceptability of the external genitalia were restored.

Anatomy and preservation of accessory pudendal arteries in laparoscopic radical prostatectomy.

OBJECTIVE: The incidence of laparoscopically diagnosed accessory pudendal arteries (APAs) varies depending on how proactive the surgeon is to find them. Their preservation depends on their calibre and location. Our objective was to provide a detailed description of how to identify, dissect, and preserve APAs during laparoscopic radical prostatectomy (LRP). METHODS: Between January 2003 and January 2005, we treated 377 men with LRP; 325 met inclusion criteria for this study. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex and extending caudally towards the anterior perineum, other than cavernous arteries, corona mortis, and satellite arteries to the superficial and deep vascular complex. Two distinct varieties of APAs were identified: (1) lateral APAs course along the lateral aspect of the prostate and branch off any of the terminal branches of the hypogastric artery; and (2) apical APAs emerge through the levator ani fibres near the apical region of the prostate and most likely branch off the pudendal artery or corresponds to an aberrant course of the pudendal artery itself. We present a video depicting the laparoscopic anatomy of APAs and the technique to preserve them. RESULTS: Ninety-six of 325 men (30%) were found to have 125 separate APAs. Using the depicted surgical technique, we were able to preserve 83% of all APAs. Forty-nine of 55 lateral APAs (89%) and 55 of 70 apical APAs (79%) were preserved. Thirty-five of 38 large-calibre APAs (92%) and 70 of 87 small-calibre APAs (80%) were spared. The side-specific incidence of PSMs were 3% and 6% when APAs were preserved and not preserved, respectively (p=0.5). CONCLUSIONS: APAs are frequently identified during laparoscopic prostatectomy. Their preservation is feasible in LRP without increasing the risk of causing a PSM. It is reasonable to integrate APA preservation as part of the modern radical prostatectomy, although their role in functional outcomes still needs to be prospectively established.

Aorta-left renal vein fistula complicating an aortic aneurysm: preoperative and postoperative multislice CT findings.

Fistulas complicating an abdominal aortic aneurysm (AAA) are rare, and fistulas involving the left renal vein are particularly uncommon. We highlight here a fistula between an infrarenal aortic aneurysm and a retroaortic left renal vein, revealed by left flank pain associated with hematuria and acute renal failure. The multislice CT angiography performed in this 68-year-old patient revealed communication and equal enhancement between the aorta and the left gonadic vein, suggesting the presence of a fistula. The three-dimensional VRT reconstructions presented in this case were of great value in the preoperative planning, enabling immediate visualization of this unusual feature. Alternative diagnoses to consider when encountering this clinical presentation are reviewed.

Radiation dose to the internal pudendal arteries from permanent-seed prostate brachytherapy as determined by time-of-flight MR angiography.

PURPOSE: To determine the feasibility of time-of-flight magnetic resonance (MR) angiography to visualize the internal pudendal arteries (IPAs) in potent men undergoing permanent-seed prostate brachytherapy and to calculate the radiation dose received by these arteries. METHODS AND MATERIALS: Prostate brachytherapy is performed at the University Health Network/Princess Margaret Hospital by use of transrectal ultrasound (TRUS) preplanning and preloaded needles. All patients received (125)I, with a mean seed activity of 0.32 mCi/seed (0.41 U). Postplan evaluation is performed at 1 month by magnetic resonance-computed tomography fusion. Twenty consecutive potent men had time-of-flight MR angiography as part of their postplan evaluation. RESULTS: The mean V100 was 96.5%, and the mean D90 was171.5 Gy. The IPAs were easily visualized for 18 of the 20 men. The mean peak dose received by the IPA was 17 Gy. The highest peak dose received by any patient was 38.2 Gy, with only 1 other patient receiving a peak dose greater than 30 Gy. Eleven of 18 had a measurable portion of at least 1 IPA that received 10% of the prescribed dose (V10 = 14.5 Gy). Only 2 patients had nonzero values for V25. The distal third of the IPA received the highest dose for 16 of the 18 patients. CONCLUSIONS: The IPAs can be well visualized in the majority of potent men by use of time-of-flight MR angiography 1 month after brachytherapy. The IPAs receive a low but calculable dose from permanent-seed (125)I brachytherapy. Further research is needed to determine if this outcome has any correlation with subsequent potency.

[Levitra in the treatment of patients with chronic prostatitis associated with sexual dysfunction].

Sixty patients with chronic prostatitis and sexual dysfunction were divided into two groups. All the patients received one-month standard course of physiotherapy. In addition, group I (n = 30) was given levitra (vardenafil; 5 mg per os each other day), the control group was not given this drug. Follow-up covered 6 months to 1.5 years. General urological examination, questionnaire survey, ultrasound investigation of male genital organs were made before, 1 and 6 months after treatment. The results were processed statistically. Levitra improves circulation in male sexual organs promoting increased arterial inflow to the prostate and penis. Aftertreatment effect persisted for half a year. Regular levitra intake (2-3 times a week) is recommended to correct circulation in the sexual system, including prostatic gland, but not only for correction of erectile dysfunction as a result of psychogenic and vascular disorders in the penis accompanying chronic prostatitis.

Occurrence of nonpersistent hematospermia after a prolonged period of daily ejaculatory intensity longer than 3 weeks.

A prolonged period of daily ejaculations via masturbation may result in an episode of hematospermia, possibly due to stress applied to the vasculature of the reproductive system.

Endothelial cell proliferation in male reproductive organs of adult rat is high and regulated by testicular factors.

Endothelial cells in the intact adult are, apart from those in the female reproductive organs, believed to be quiescent. Systematic examination of endothelial cell proliferation in male reproductive organs has not been performed and was therefore the aim of the present study. Intact adult rats were either pulse labeled or long-term labeled with bromodeoxyuridine to label proliferating cells. The roles of Leydig cells and testosterone were examined after castration or treatment with the Leydig cell toxin ethane dimethane sulfonate (EDS) and testosterone substitution. After perfusion fixation, all blood vessels remained open and were easily identified. In all male reproductive organs studied, particularly in the testis and epididymis, endothelial cell proliferation was considerably higher than in other tissues such as the liver, brain, and muscle. Proliferating endothelial cells were observed in all types of blood vessels in male reproductive organs, but other characteristics of new blood vessel formation were not seen. High endothelial cell proliferation may reflect a continuous high turnover of endothelial cells rather than classical angiogenesis. In the epididymis, the ventral and dorsolateral prostate lobes, and the seminal vesicles, endothelial cell proliferation decreased after testosterone withdrawal and increased following testosterone treatment. In the testis, endothelial cell proliferation was decreased after Leydig cell depletion but remained low after testosterone substitution. High, hormonally regulated endothelial cell proliferation is not unique to the female but is also seen in the male reproductive organs.

A historical survey of scintigraphic methodology for evaluation of the reproductive tract.

Scintigraphic techniques have contributed to many aspects of our understanding of genital and reproductive physiology and pathophysiology. Few of these methods have become mainstream diagnostic techniques; nonetheless, their flexible, physiologic, and intrinsically quantitative nature have contributed information and insights not readily available by other means. The techniques discussed in this review measure various dynamic processes within the body, including blood flow, variation of blood volume, and lymphatic and fallopian tube transport. Dynamic measurement of these processes exploits nuclear medicine's ability to radiolabel and monitor substances while preserving normal physiologic behavior. Consideration of these methods will potentially stimulate future development and application of radionuclide techniques to emerging questions in the fields of reproductive and genital physiology.

Male perineogenital anatomy and clinical applications in genital reconstructions and male-to-female sex reassignment surgery.

To determine the possibility of providing alternative surgical techniques for male genital reconstruction and for male-to-female sex reassignment surgery, the authors undertook an anatomic investigation of the perineogenital region in male cadavers. Anatomic dissection was performed on 14 male adult human cadavers (fresh and formalin-preserved) studying the main afferent vessels to the anterior perineal region and their mean internal diameters: deep external pudendal artery (0.60 mm), superficial perineal artery (0.50 mm), and funicular artery (0.37 mm). We established their exact topography, together with vascular anatomic variations, main vascular anastomosis circuits (base of the penis, scrotal septum, and perineal fat and lateral spermatic-scrotal fascia), angiosomes, anatomy of the rectovesical septum cavity, and their "critical" key points of dissection. The authors discuss the clinical possibility of elevation of a "tree" of previously described paragenital-genital flaps including mainly those based on the terminal branches of the internal pudendal vascular system, the erectile tissue pedicled flaps, and finally, flaps of the external pudendal system. The authors indicate the concrete vascularization system for each flap.