ABSTRACT
Objetivo El objetivo de esta revisión sistemática es identificar el tratamiento óptimo para la infertilidad masculina derivada del abuso de esteroides anabólicos androgénicos (EAA). Métodos Se llevó a cabo una revisión sistemática según la declaración Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Se incluyeron estudios que comparaban distintos protocolos para la recuperación de la espermatogénesis tras el uso de EAA. Resultados Un total de 13 estudios que investigaban diferentes protocolos para recuperar la espermatogénesis en pacientes con abuso de EAA cumplieron los criterios de inclusión. Entre los agentes disponibles que demostraron eficacia en el reestablecimiento de la espermatogénesis se encuentran las gonadotropinas inyectables, los moduladores selectivos de los receptores de estrógenos (SERM) y los inhibidores de la aromatasa (AI), pero su uso apenas ha sido descrito en la literatura. Conclusiones Los médicos deben conocer los efectos adversos que los EAA pueden tener sobre la espermatogénesis. La infertilidad asociada a estos agentes puede ser de carácter reversible, pero la producción de espermatozoides puede tardar más de un año en normalizarse. Tanto el tratamiento conservador como el agresivo pueden estimular la espermatogénesis con resultados satisfactorios. Se requiere una mayor comprensión de la endocrinología reproductiva masculina y datos de alta calidad sobre la recuperación de la espermatogénesis tras el abuso de EAA. (AU)
Objective This systematic review aims to evaluate the optimal treatment for male infertility resulting from Anabolic Androgenic Steroids (AAS) abuse. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies that compared different protocols for the recovery of spermatogenesis in patients after AAS use were included. Results 13 studies investigating different protocols to restore spermatogenesis in patients with AAS abuse met the inclusion criteria. The available agents that showed restoration of spermatogenesis include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their use is still poorly described in the literature. Conclusions Clinicians need to be aware of the detrimental effects of AAS on spermatogenesis. AAS-associated infertility may be reversible, but sperm production may take over a year to normalize. Both conservative and aggressive treatment can boost spermatogenesis with positive results. Further understanding of male reproductive endocrinology and high-quality data on the field of restoration of spermatogenesis after AAS abuse are warranted. (AU)
Subject(s)
Infertility, Male , Spermatogenesis , /adverse effects , Testosterone , GonadotropinsABSTRACT
OBJECTIVE: This systematic review aims to evaluate the optimal treatment for male infertility resulting from Anabolic Androgenic Steroids (AAS) abuse. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies that compared different protocols for the recovery of spermatogenesis in patients after AAS use were included. RESULTS: 13 studies investigating different protocols to restore spermatogenesis in patients with AAS abuse met the inclusion criteria. The available agents that showed restoration of spermatogenesis include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their use is still poorly described in the literature. CONCLUSIONS: Clinicians need to be aware of the detrimental effects of AAS on spermatogenesis. AAS-associated infertility may be reversible, but sperm production may take over a year to normalize. Both conservative and aggressive treatment can boost spermatogenesis with positive results. Further understanding of male reproductive endocrinology and high-quality data on the field of restoration of spermatogenesis after AAS abuse are warranted.
Subject(s)
Anabolic Agents , Androgens , Humans , Male , Anabolic Androgenic Steroids , Anabolic Agents/adverse effects , Semen , Testosterone Congeners/adverse effects , SpermatogenesisABSTRACT
BACKGROUND: Scrotal color Doppler ultrasound (CDUS) still suffers from lack of standardization. Hence, the European Academy of Andrology (EAA) has promoted a multicenter study to assess the CDUS characteristics of healthy fertile men (HFM) to obtain normative parameters. OBJECTIVES: To report and discuss the scrotal organs CDUS reference ranges and characteristics in HFM and their associations with clinical, seminal, and biochemical parameters. METHODS: A cohort of 248 HFM (35.3 ± 5.9years) was studied, evaluating, on the same day, clinical, biochemical, seminal, and scrotal CDUS following Standard Operating Procedures. RESULTS: The CDUS reference range and characteristics of the scrotal organs of HFM are reported here. CDUS showed a higher accuracy than physical examination in detecting scrotal abnormalities. Prader orchidometer (PO)- and US-measured testicular volume (TV) were closely related. The US-assessed TV with the ellipsoid formula showed the best correlation with the PO-TV. The mean TV of HFM was ~ 17 ml. The lowest reference limit for right and left testis was 12 and 11 ml, thresholds defining testicular hypotrophy. The highest reference limit for epididymal head, tail, and vas deferens was 12, 6, and 4.5 mm, respectively. Mean TV was associated positively with sperm concentration and total count and negatively with gonadotropins levels and pulse pressure. Subjects with testicular inhomogeneity or calcifications showed lower sperm vitality and concentration, respectively, than the rest of the sample. Sperm normal morphology and progressive motility were positively associated with epididymal head size/vascularization and vas deferens size, respectively. Increased epididymis and vas deferens sizes were associated with MAR test positivity. Decreased epididymal tail homogeneity/vascularization were positively associated with waistline, which was negatively associated with intratesticular vascularization. CDUS varicocele was detected in 37.2% of men and was not associated with seminal or hormonal parameters. Scrotal CDUS parameters were not associated with time to pregnancy, number of children, history of miscarriage. CONCLUSIONS: The present findings will help in better understanding male infertility pathophysiology, improving its management.
Subject(s)
Scrotum/diagnostic imaging , Ultrasonography , Adult , Fertility , Humans , Male , Middle Aged , Reference Values , Testis/anatomy & histology , Ultrasound, High-Intensity Focused, Transrectal , Young AdultABSTRACT
A retrospective observational study was undertaken to gain new insight into the relationship between total testicular volume and levels of serum testosterone, luteinising hormone, follicle-stimulating hormone, prolactin and clinical variables. A total of 312 men with sexual dysfunction or infertility were divided into groups A and B (156 each) on the basis of basal plasma testosterone ≤5 nmol/L of ≥12 nmol/L respectively. Group A was subclassified in A1 (primary hypogonadism) and A2 (secondary hypogonadism). There were significant differences in total testicular volume between group A (15.33 ± 11.94 ml) and group B (36.74 ± 6.9; p < .001) and also between subgroup A1 (11.07 ± 8.49 ml) and subgroup A2 (23.62 ± 13.04 ml; p < .001). Only 13.5% of patients in group B had a total testicular volume <30 ml. Differences in all studied parameters were found between group A and group B. There were no variations when comparing age, body mass index and testosterone in groups A1 and A2 . The use of total testicular volume and body mass index together for predicting testosterone levels yields a sensitivity and specificity of 85.3% and 86.5% respectively. Logistic regression analysis, univariate and multivariate models, using the measurement of total testicular volume resulted in a high capacity to predict testosterone levels.
Subject(s)
Hypogonadism/pathology , Infertility, Male/pathology , Testis/pathology , Testosterone/blood , Adolescent , Adult , Aged , Body Mass Index , Follicle Stimulating Hormone/blood , Humans , Hypogonadism/blood , Infertility, Male/blood , Luteinizing Hormone/blood , Male , Middle Aged , Organ Size/physiology , Retrospective Studies , Young AdultABSTRACT
Introducción: El objetivo fue estudiar la relación entre la rigidez peneana nocturna (RPN) con el síndrome metabólico (SM) y la testosterona en varones que consultan por trastornos de erección (DE). Material y método: Se incluyeron 234 varones en un estudio piloto prospectivo y transversal. Se midieron los niveles séricos de testosterona total y biodisponible y otros parámetros bioquímicos relacionados con el SM y con las RPN. Los pacientes se agruparon según la rigidez de las erecciones: normales (alta rigidez, componente predominante psicológico de la disfunción) o anormales (baja rigidez, posible componente orgánico o físico de la DE) y por la presencia o ausencia de SM. Resultados: El modelo de regresión logística para la rigidez del pene como variable dependiente demostró que el riesgo de rigidez anormal es menor en individuos con mayor testosterona total (OR=0,96; 95% CI=0,92-0,99) o biodisponible (OR=0,91; 95% CI=0,84-0,99). Pacientes con niveles de testosterona entre 8 y 12 mmol/L presentaron un riesgo cuatro veces mayor de tener rigidez anormal comparados con aquellos con niveles superiores a 12 mmol/L (OR=3,96; 95% CI=1,89, 8,31). Si se consideraban únicamente aquellos varones sin SM, solo la edad y el índice de masa corporal (IMC) aparecían como factores de riesgo asociados a la rigidez anormal. La edad aumentó el riesgo de rigidez anormal en un 8% (OR=1,08; 95% CI=1,03-1,13) y el IMC lo aumentó en un 18% (OR=1,18; 95% CI=1,01-1,38). Conclusión: La asociación de niveles de testosterona con la rigidez del pene fue baja y desaparece si se asocia con SM (AU)
Introduction: The aim was to study whether nocturnal penile rigidity (NPTR) correlates with metabolic syndrome (MetS) and testosterone in men consulting for erectile dysfunction (ED). Material and methods: 234 men were included in a prospective, cross-sectional pilot study. Serum total and bioavailable testosterone and other biochemical constituents were measured and compared with NPTR. Patients were classified by normal or low/abnormal penile rigidity (abnormal meaning predominant organic component of ED) and presence or absence of MetS to test the hypothesized correlations. Results: Application of the logistic regression model to rigidity as the dependent variable showed the risk of low penile rigidity to be significantly lower for patients with higher total (OR=0.96, 95% CI=0.92-0.99) or bioavailable testosterone (OR=0.91, 95% CI=0.84-0.99). Patients with testosterone levels between 8 and 12 mmol/L had a quadrupled risk of low penile rigidity compared with patients with higher levels (>12 mmol/L) (OR=3.96, 95% CI=1.89-8.31). Considering men without MetS, age and body mass index were associated as significant factors for low penile rigidity: age increased risk by 8% (OR=1.08, 95% CI=1.03-1.13) and BMI increased it by 18% (OR=1.18, 95% CI=1.01-1.38). Conclusion: Testosterone levels are weakly associated with penile rigidity and disappear when associated with MetS (AU)
Subject(s)
Humans , Male , Testosterone/pharmacokinetics , Metabolic Syndrome/complications , REM Sleep Parasomnias/complications , Prospective Studies , Penile Erection , Erectile Dysfunction/physiopathology , Hypogonadism/complications , Body Mass IndexABSTRACT
INTRODUCTION: The aim was to study whether nocturnal penile rigidity (NPTR) correlates with metabolic syndrome (MetS) and testosterone in men consulting for erectile dysfunction (ED). MATERIAL AND METHODS: 234 men were included in a prospective, cross-sectional pilot study. Serum total and bioavailable testosterone and other biochemical constituents were measured and compared with NPTR. Patients were classified by normal or low/abnormal penile rigidity (abnormal meaning predominant organic component of ED) and presence or absence of MetS to test the hypothesized correlations. RESULTS: Application of the logistic regression model to rigidity as the dependent variable showed the risk of low penile rigidity to be significantly lower for patients with higher total (OR=0.96, 95% CI=0.92-0.99) or bioavailable testosterone (OR=0.91, 95% CI=0.84-0.99). Patients with testosterone levels between 8 and 12 mmol/L had a quadrupled risk of low penile rigidity compared with patients with higher levels (>12 mmol/L) (OR=3.96, 95% CI=1.89-8.31). Considering men without MetS, age and body mass index were associated as significant factors for low penile rigidity: age increased risk by 8% (OR=1.08, 95% CI=1.03-1.13) and BMI increased it by 18% (OR=1.18, 95% CI=1.01-1.38). CONCLUSION: Testosterone levels are weakly associated with penile rigidity and disappear when associated with MetS.
Subject(s)
Metabolic Syndrome/complications , Penile Induration/blood , Penile Induration/complications , Testosterone/blood , Adult , Cross-Sectional Studies , Humans , Male , Middle Aged , Pilot Projects , Prospective StudiesABSTRACT
The aetiopathogenesis of isolated cryptorchidism remains largely unknown. Mutation screenings in the most relevant candidate genes for testicular maldescent lead to controversial data in the literature. In particular, the role of the T222P genetic variant of the RXFP2 gene is still debated. Given the controversies, the aim of this study was to provide further data on this genetic variant in two Mediterranean populations. A total of 577 subjects from Spain and 550 from Italy (with and without a history of cryptorchidism) were analysed. The T222P substitution was found in both unilateral and bilateral cases and in a total of 12 controls. These data exclude a clear-cut cause-effect relationship between T222P variant and testicular maldescent. The T222P variant was found at a similar frequency in both cases and controls in the Spanish population, whereas in Italy, the frequency of T222P resulted significantly higher in the cryptorchid group (p = 0.031). The observed difference between the two countries and the highly variable phenotypic expression of the T222P variant may depend on the genetic background or on environmental conditions. The haplotype analysis of the RXFP2 gene in T222P carriers and their parents showed that this variant is linked to the previously inferred C-C-G-A-13 haplotype and consequently provides further support to the 'founder effect' hypothesis. In conclusion, our data indicate that T222P is a frequent variant in the Spanish population with no pathogenic effect. Although in Italy it seems to confer a mild risk (odds ratio = 3.17, 95% confidence interval: 1.07-9.34) to cryptorchidism, the screening for this variant for diagnostic purposes is not advised because of the relatively high frequency of control carriers (1.4% of Italian men without a history of cryptorchidism).
Subject(s)
Cryptorchidism/genetics , Receptors, G-Protein-Coupled/genetics , Base Sequence , DNA Primers , Exons , Female , Founder Effect , Haplotypes , Humans , Male , Mediterranean Region , Pedigree , PhenotypeABSTRACT
In 32 men (mean age 54.94 years, range 25-70 years), thresholds for penile thermal and vibratory sensation were recorded before and 3 months after surgery using a genital sensory analyser. The following significant changes were found postoperatively. The cold threshold decreased in the glans from 27.24 to 25.33 degrees C (P<0.001) in men older than 60 years, and in the ventral penile shaft from 28.54 to 25.46 degrees C (P<0.001) in men aged 35-59 years. The warm threshold increased in the glans from 38.31 to 40.61 degrees C (P=0.002) in men aged 35-59 years, and from 39.20 to 40.58 degrees C in men older than 60 years (P=0.023). The warm threshold also increased in the ventral penile shaft in men aged 35-59 years, from 36.62 to 37.82 degrees C (P=0.023). For all three age groups combined, the vibratory threshold changed in the glans from 2.33 to 2.93 mum (P<0.001). It is concluded that penile sensitivity changed significantly after surgery for penile curvature treatment, regardless of whether a ventral or dorsal surgical approach is used.
Subject(s)
Penis/abnormalities , Penis/surgery , Postoperative Complications/physiopathology , Sensation/physiology , Adult , Aging/physiology , Cold Temperature , Hot Temperature , Humans , Linear Models , Male , Middle Aged , Penis/innervation , Physical Stimulation , Sensory Thresholds/physiology , Thermosensing , VibrationABSTRACT
OBJECTIVE: To compare patient preference for sildenafil citrate (sildenafil) vs. tadalafil and for their respective dosing instructions in a cohort of Spanish patients with erectile dysfunction (ED). MATERIAL AND METHODS: Sixty four Spanish patients from a multicenter, two period, cross-over, double-blind study (265 patients enrolled in total) were randomized to receive on-demand sildenafil 50 mg or tadalafil 20 mg for 12 weeks and afterwards were crossed over to the alternate regimen for another 12 weeks to assess drug preference in an extension period of the study. Similarly, to evaluate preference for their respective dosing instructions, 30 patients were randomized to one of the 2 arms treated with tadalafil: one with sildenafil (S) dosing instructions and the other with tadalafil (T) dosing instructions. RESULTS: Seventy percent of 56 patients completing the study chose to receive tadalafil treatment versus sildenafil treatment (30%) in the extension period (p<0.01). Correspondingly, 73% of 13 evaluating each drug dosing instructions preferred T dosing instructions (p>0.05). Preference did not vary with age, concomitant diseases and previous use of sildenafil. CONCLUSIONS: In this study, 7 out of 10 patients preferred tadalafil and its dosing instructions to sildenafil, for the treatment of their ED.
Subject(s)
Carbolines/therapeutic use , Erectile Dysfunction/drug therapy , Patient Satisfaction , Phosphodiesterase Inhibitors/therapeutic use , Piperazines/therapeutic use , Adult , Aged , Double-Blind Method , Europe , Humans , Male , Middle Aged , Purines , Sildenafil Citrate , Sulfones , Tadalafil , United StatesABSTRACT
Fundamento y objetivo: Comparar la preferencia por sildenafilo vs. tadalafilo, y por sus instrucciones de administración en una cohorte de pacientes españoles con disfunción eréctil (DE). Material y método: 64 pacientes españoles participantes en un estudio multicéntrico, de 2 periodos, cruzado y doble-ciego (con 265 pacientes en total) se distribuyeron aleatoriamente para recibir sildenafilo (50 mg) o tadalafilo (20 mg) a demanda durante 12 semanas, tras lo cual se cruzaron para recibir el régimen alternativo otras 12 semanas, para valorar la preferencia por uno de los dos tratamientos en una fase de extensión del estudio. Igualmente, para valorar la preferencia por las respectivas instrucciones de administración, 13 pacientes se distribuyeron en 2 brazos de tratamiento con tadalafilo 20 mg: uno con las instrucciones de administración de sildenafilo (S) y otro con las de tadalafilo (T). Resultados: De los 56 pacientes que finalizaron el estudio, un 70% eligieron recibir tratamiento con tadalafilo frente a sildenafilo (30%) en la extensión (p0,05). La preferencia no varió con la edad, enfermedades concomitantes o uso previo de sildenafilo. Conclusiones: En este estudio, aproximadamente 7 de cada 10 pacientes prefirieron tadalafilo y sus instrucciones de administración frente a sildenafilo, como tratamiento para su DE
Objective: To compare patient preference for sildenafil citrate (sildenafil) vs. tadalafil and for their respective dosing instructions in a cohort of Spanish patients with erectile dysfunction (ED). Material and methods: Sixty four Spanish patients from a multicenter, two period, cross-over, double-blind study (265 patients enrolled in total) were randomized to receive on-demand sildenafil 50 mg or tadalafil 20 mg for 12 weeks and afterwards were crossed over to the alternate regimen for another 12 weeks to assess drug preference in an extension period of the study. Similarly, to evaluate preference for their respective dosing instructions, 30 patients were randomized to one of the 2 arms treated with tadalafil: one with sildenafil (S) dosing instructions and the other with tadalafil (T) dosing instructions. Results: Seventy percent of 56 patients completing the study chose to receive tadalafil treatment versus sildenafil treatment (30%) in the extension period (p0.05). Preference did not vary with age, concomitant diseases and previous use of sildenafil. Conclusions: In this study, 7 out of 10 patients preferred tadalafil and its dosing instructions to sildenafil, for the treatment of their ED