Transperineal vesiculodeferentography under ultrasound control: first experiences.

Vesiculodeferentography (VDG) plays an important role in diagnosing male infertility and staging of prostatic cancer; the techniques of performing the examination are, today, well codified: 1) retrograde, by endoscopic cannulation of ejaculatory ducts; 2) anterograde, by cannulation of the deferent duct surgically prepared at the scrotum. In order to avoid the difficulties of the first method and the risks in the second (like stenosis and fibrosis of the deferent duct) we propose a new simple and safe method based on the direct transperineal puncture of the seminal vesicle under direct echographic control with a transrectal probe. We have studied 16 patients, mainly in order to stage prostatic cancer; the procedure was easy to perform, well tolerated and without consequences at seminal level. It required only 30 minutes, without anaesthesia and with a very low cost. The method permits a clear visualisation of anatomical structures and of possible pathologies with particular reference to vesicular invasion by a prostatic cancer.

A highly sensitive chemiluminescent assay for glycerylphosphorylcholine in human seminal plasma.

Glycerylphosphorylcholine (GPC), one of the major phosphorus-containing-choline compounds of seminal plasma, is secreted mainly by the epididymal epithelium under androgenic control. This study reports a new method that uses chemiluminescence to determine seminal GPC content, comparing it with a spectrophotometric technique. The results, obtained with both techniques studying 20 fertile patients (as control), 35 infertile patients with normospermia, 23 infertile patients with oligozoospermia and impaired motility and 9 patients with excretory azoospermia, demonstrate that the GPC chemiluminescent assay is more sensitive, simple and rapid than the spectrophotometric assay. Our data confirm that GPC may be used as a marker of vas deferens and ejaculatory duct perviousness, suggesting a possible role of this glycerophosphodiester in sperm motility.

Effect of lipid peroxidation upon human spermatic adenosinetriphosphate (ATP). Relationship with motility, velocity and linearity of the spermatozoa.

The aim of the present paper was to study the effect of forced lipid peroxidation upon human spermatozoa and its relation with motility, velocity, linearity and ATP content. Forty-three pools of semen samples were studied one hour after liquefaction. After washing, normal and pathological spermatozoa presented no variations in motility, velocity or linearity with respect to basal values. Forced peroxidation produced a significant decrease of motility, velocity and linearity (p less than 0.02) with respect to control. Spermatic ATP was not significantly different in control vs forced peroxidation groups in normozoospermic samples. In contrast, a significant decrease of ATP between control and peroxidation groups was observed in asthenozoospermia at 120 minutes of incubation (p less than 0.02). In the asthenozoospermic group, a significant LPO-p increase was observed in comparison with the normal group.

Adenosine 5 triphosphate (ATP) content and acrosin activity in polyzoospermic subjects.

The aim of this paper was to measure the concentration of spermatic ATP and acrosin in a group of patients with polyzoospermia, and to compare these values with those found in a group of normozoospermic men. The general characteristics of the semen, the ATP and the acrosin, were measured in a group of 46 men with polyzoospermia, who consulted in our clinic for sterility. The results were compared with those of 50 normozoospermic men in the control group. Statistically, no significant difference was found between the volume, motility and morphology of the samples in both groups; however, the concentration of spermatic ATP and acrosin decreased significantly in a group of polyzoospermic patients. This could be due to a functional defect of the spermatozoa in this group of patients.

Effects of kallikrein on the male reproductive system and its use in the treatment of idiopathic oligozoospermia with impaired motility.

A single-blind study on the effects of kallikrein in idiopathic oligozoospermia was carried out. 8 of the 16 patients admitted to the trial were treated with kallikrein 100 K.U. t.i.d., the remaining patients received vitamin E 100 mg t.i.d. Treatment lasted 120 days in both groups. Kallikrein led to an increase in sperm concentration, total sperm count and sperm penetration capacity. Patients receiving vitamin E failed to show any improvement. It is postulated that the increase in sperm concentration could be explained by the positive action of kallikrein on spermatogenesis, due to a stimulatory effect of the drug directly on the Sertoli cell function and on the circulation in the vascular system of the testis.

Glycerylphosphorylcholine in selected forms of male infertility.

GPC was studied in the seminal plasma of 35 normozoospermic men, 34 cases of azoospermia due to bilateral deferent obstruction, 34 cases of azoospermia due to bilateral ejaculatory duct obstruction, 10 vasectomized patients, 6 vasectomized patients after vasovasostomy and 118 cases of spermatogenetic arrest without obstruction of the seminal ducts. Values of GPC in azoospermia due to deferent or ejaculatory ducts obstruction and to vasectomy are significantly lower than in normozoospermic subjects (p less than 0.001). Levels of GPC increased (p less than 0.05) following vasovasostomy. Although GPC values in secretory azoospermia were higher than those in cases of duct obstruction, they were still lower than in normozoospermic (p less than 0.001). The most likely source of GPC is the epididymis. These results support the assumption that GPC originates mainly in the epididymis. The absence of germinal cells in the epididymis could explain the decreased levels of GPC in azoospermia due to arrest of spermatogenesis.

Further studies on the effects of pentoxifylline on sperm count and sperm motility in patients with idiopathic oligo-asthenozoospermia.

To further investigate the effectiveness of pentoxifylline (trental) treatment in male infertility, we studied 22 young men (mean age 28.4 years) with "idiopathic" oligo-asthenozoospermia treated for 6 months with the drug (1200 mg daily orally). Sperm concentration and sperm motility were determined before therapy, as well as after 3 and 6 months of pentoxifylline administration. Moreover, fructose concentrations in seminal fluid and sperm ATP levels were assayed before and at the end of the treatment in five semen samples. Pentoxifylline therapy significantly increased both sperm concentration and sperm motility. Sperm concentration showed a 1.5-fold increase (p less than 0.01) at the 3rd month of therapy, and a 2.0-fold increase (p less than 0.001) at the 6th month, whereas sperm motility increased by 1.8-fold (p less than 0.001) and by 2.8-fold (p less than 0.001) respectively. At the end of the treatment, fructose concentrations in seminal fluid were significantly higher (p less than 0.001) than pretreatment values; in contrast, sperm ATP levels showed a significant (p less than 0.05) fall. These results suggest that pentoxifylline, probably acting on the cAMP metabolism, may be an useful drug in the treatment of idiopathic oligo-asthenozoospermia.

Role of seminal prostaglandins in male fertility. II. Effects of prostaglandin synthesis inhibition on spermatogenesis in man.

The effect of prostaglandin biosynthesis inhibition has been studied in two groups of infertile oligozoospermic patients with high or normal-low seminal prostaglandin (PG) levels. PGE and 19-OH PGE were assayed by means of a gas chromatographic method and the most important seminal parameters (volume, concentration, motility and morphology of spermatozoa) were evaluated in basal conditions and at the end of indomethacin treatment, at a daily oral dose of 100 mg for thirty days. A drop in prostaglandin levels following indomethacin was observed in both groups of patients but only in the group with high concentrations of prostanoid derivates the prostaglandin inhibition was correlated with a significant improvement in sperm count and motility.

Relationships among pleasure, anxiety and physiological response patterns during the sexual sequence in normal and dispermic subjects.

We examined the reported subjective level of pleasure and anxiety usually perceived during the four phases of the sexual sequence by 18 dispermic patients and 18 normal subjects. Relevant differences exist between the two groups in their perception of both emotions. The role of pleasure and anxiety in modulating some reflexive biological responses of the sexual sequence is discussed.

Testicular transposition with right-to-left epididymo deferential anastomosis: a case report.

We report a case of azoospermia due to malformation that was treated successfully by epididymo-deferential anastomosis using only 1 deferens for both testicles.

Adenosinetriphosphate (ATP) in human spermatozoa. II. Concentrations in fertile men.

The Bucher's method was applied to establish normal values of ATP in the spermatozoa of fertile men. It was shown that the normal value is 6.5 +/- 0.34 S.E. microgram per 10(8) spermatozoa. Pools of spermatozoa showed that incubation in seminal plasma at room temperature produced a progressive loss of ATP in the gametes.

Role of seminal prostaglandins in male fertility. I. Relationship of prostaglandin E and 19-OH prostaglandin E with seminal parameters.

Prostaglandin (PG) E and 19-OH PGE, now considered to be the most important of the human seminal prostaglandins, were assayed in infertile and normal men. In the 15 volunteers PGE and 19-OH PGE levels were 23-89 microgram/ml, respectively. In the 4 groups of infertile patients in whom either PGE or 19-OH PGE levels were increased or decreased with respect to normal, sperm concentration and motility were significantly reduced. The negative effects of low levels of seminal prostaglandins on sperm concentration and motility might be correlated respectively with decreased adenylcyclase and testicular androgen activity. The negative effects of high levels of prostaglandins on the seminal fluid might be due either to an inhibition in testicular DNA synthesis or to a decreased sensitivity of the receptors to high titers of prostaglandins.

Relationship between seminal PGE and 19-OH PGE and seminal fructose in man.

Seminal PGE, 19-OH PGE and fructose were assayed in normal volunteers and in infertile patients. From data obtained it appears that seminal PGE are probably not synthesized exclusively at seminal vesicles level since no relationship was observed between PGE and fructose. On the other hand the seminal vesicles appear to be the preferential site of seminal 19-OH PGE production since a close relationship was observed between 19-OH PGE and fructose in those case in which these prostaglandins were below minimum normal values. Various hypotheses are advanced in order to interpret the lack of correlation in the presence of high 19-OH PGE levels.

Treatment and follow-up of patients with infertility due to spermagglutinins.

A therapeutic trial based on pharmacologically induced azoospermia followed by the administration of corticosteroids was carried out in 48 patients with infertility due to spermagglutinins. Three types of responses were observed: type A, no modifications in the blood and spermagglutinating (SA) titer (19 cases); type B, disappearance or significant decrease in SA titer during treatment, with return to normal values upon resumption of spermatogenesis (7 cases); and type C, disappearance or significant decrease in SA titer for at least 1 year after stopping treatment (22 cases). Within the 1st year after stopping therapy only men who responded in type C fashion were able to impregnate partners, three pregnancies ended in abortion and nine in normal births.