The number of spermatozoa collected with testicular sperm extraction is a novel predictor of intracytoplasmic sperm injection outcome in non-obstructive azoospermic patients.

The purpose of this study was to determine the relationships between monitors of spermatogenesis and predictors of the intracytoplasmic sperm injection (ICSI) outcome in patients with non-obstructive azoospermia (NOA) undergoing testicular sperm extraction (TESE). Seventy-nine patients with NOA (mean age: 43.6±5.2 years), each of whom yielded (97 000±3040) spermatozoa with conventional TESE, were considered in our analysis. Their partners (mean age: 35.8±5.1 years) underwent a total of 184 ICSI cycles; 632 oocytes were collected, 221 oocytes were injected, 141 oocytes were fertilized, 121 embryos were obtained, 110 embryos were transferred, 14 clinical pregnancies were achieved and only one miscarriage occurred. Multivariate regression analysis indicated relationships between the percentage of fertilized oocytes, transferred embryos and clinical pregnancies with the following variable values: female partner's age, number of spermatozoa collected, testicular volume, male partner's levels of follicle stimulating hormone (FSH), number of oocytes collected, number of oocytes injected and number of ICSI cycles. A significant inverse relationship was found between female partner's age or male partner's FSH levels and biochemical pregnancies. A significant direct relationship emerged between the number of ICSI cycles and the percentage of oocytes fertilized, embryos transferred and biochemical pregnancies, and between the number of spermatozoa collected per testicular biopsy and biochemical pregnancies. The number of spermatozoa was positively linked to the number of clinical pregnancies, independent of the number of ICSI cycles and the number of oocytes collected/injected. The number of spermatozoa collected, FSH level and testicular volume are monitors of spermatogenesis linked to ICSI success.

Open preliminary randomized prospective clinical trial of efficacy and safety of three different verapamil dilutions for intraplaque therapy of Peyronie's disease.

OBJECTIVES: To investigate the efficacy and safety of three different dilutions of verapamil used in intraplaque injections in an attempt to reduce Peyronie's disease symptoms. METHODS: A total of 77 patients (age 48 +/- 9 years) with chronic Peyronie's disease were randomized into three groups, each receiving 12 intraplaque injections (1 injection every 2 weeks) of 10 mg verapamil in different dilutions. Group 1 (27 patients) received verapamil 10 mg/4 mL, group 2 (24 patients) received verapamil 10 mg/10 mL, and group 3 (26 patients) received verapamil 10 mg/20 mL. The variables, assessed before and 8 months after therapy, were erectile function (assessed by semistructured interview), plaque size, peak systolic velocity, end-diastolic velocity, left and right cavernosal arteries (assessed with dynamic Duplex ultrasonography), pain (assessed with a pain scale), penile curvature (measured using a photograph of a pharmacologically induced full erection), and side effects. Analysis of variance and the chi-square test were used to analyze the differences among the groups. RESULTS: No significant differences were found in the baseline values among the groups. The peak systolic velocity of the left and right cavernosal arteries was never significantly modified. The plaque area, penile curvature, erectile function, end-diastolic velocity of the left and right cavernosal arteries, and pain improved more significantly in group 3 than in groups 1 and 2. The side effects were ecchymosis, with no significant differences among the groups. CONCLUSIONS: The dilution of verapamil significantly improved its efficacy in improving Peyronie's disease symptoms.

Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy.

OBJECTIVES: To determine whether propionyl-L-carnitine (PLC) plus acetyl-L-carnitine (ALC) improves the effectiveness of sildenafil in restoring sexual potency after bilateral nerve-sparing radical retropubic prostatectomy. METHODS: We analyzed the data from 96 patients who had undergone bilateral nerve-sparing radical retropubic prostatectomy: 33 were given placebo (group 1), 32 used PLC 2 g/day plus ALC 2 g/day plus sildenafil 100 mg when needed (group 2), and 35 used sildenafil alone (group 3). The studied variables were sexual function (assessed through sexual behavior interviews and the International Index of Erectile Function), peak systolic velocity and end-diastolic velocity of cavernosal arteries (assayed by dynamic echo-color Doppler), the percentage of patients able to achieve a positive intracavernous injection test, and side effects. RESULTS: Placebo proved ineffective and sildenafil and sildenafil plus ALC and PLC proved effective. The International Index of Erectile Function-15 scores of the group 2 patients were significantly greater than those of group 3 in the following domains: erectile function, sexual intercourse satisfaction, orgasm, and general sexual well-being. The drugs did not significantly modify the score in the sexual desire domain or in the peak systolic velocity or end-diastolic velocity of the cavernosal arteries. Sexual behavior interviews revealed that 2 of 29 in group 1, 28 of 32 in group 2, and 20 of 39 in group 3 attained satisfactory sexual intercourse (P <0.01). Only group 2 had a significantly increased percentage of patients with a positive intracavernous injection test after therapy (36.4% versus 63.6%; P <0.01). ALC plus PLC did not significantly improve the side effects of sildenafil. CONCLUSIONS: PLC and ALC proved to be safe and reliable in improving the efficacy of sildenafil in restoring sexual potency after bilateral nerve-sparing radical retropubic prostatectomy.

Cinnoxicam and L-carnitine/acetyl-L-carnitine treatment for idiopathic and varicocele-associated oligoasthenospermia.

The objective of this study was to detect a therapy for idiopathic and varicocele-associated oligoasthenospermia (OAT). Idiopathic and varicocele OAT patients were randomized into 3 groups. Each group was composed of varying degrees of left varicoceles (graded into 5 grades with echo-color Doppler) and of idiopathic OATs. Group 1 used a placebo, group 2 used oral L-carnitine (2 g/d) + acetyl-L-carnitine (1 g/d), group 3 used L-carnitine/acetyl-L-carnitine + 1 x 30-mg cinnoxicam suppository every 4 days. Drugs were administered for 6 months. The groups were composed as follows: group 1, 71 varicoceles and 47 idiopathic OATs; group 2, 62 varicoceles and 39 idiopathic OATs; group 3, 62 varicoceles and 44 idiopathic OATs. Sperm concentration, motility, and morphology before during and after treatments were assessed. Pregnancy rates and side effects were recorded. Group 1 did not have modified sperm patterns during treatment. Group 2 had significantly increased sperm patterns at 3 and 6 months into therapy in idiopathic patients and in patients with grades I, II, and III varicocele, but not in grades IV and V. Group 3 had significantly increased sperm parameters in all patients, with the exception of grade V varicocele. Group 3 sperm patterns proved significantly higher during therapy than group 2. All sperm patterns fell to baseline after therapy suspension. Minor side effects occurred. Pregnancy rates were 1.7% (group 1), 21.8% (group 2), and 38.0% (group 3) (P <.01). L-carnitine/acetyl-L-carnitine + cinnoxicam suppositories proved a reliable treatment for low-grade varicoceles and idiopathic OATs.

Fertility in male patients treated with neoadjuvant chemotherapy for osteosarcoma.

PURPOSE: To evaluate fertility in male patients with osteosarcoma after chemotherapy including high doses of alkylating agents. PATIENTS AND METHODS: Postchemotherapy fertility was evaluated in 96 male patients who received chemotherapy at the authors' institution from 1976 to 1996 for localized bone osteosarcoma of the extremities. Four drugs were administrated (doxorubicin, cisplatin, methotrexate, ifosfamide) at different doses according to six different protocols. Eleven patients were prepubertal and 85 were postpubertal at the time of chemotherapy. The median age of these patients at the time of chemotherapy was 17 years (range 10-42), the median age at the time of the interview was 27 years (range 19-53), and the median follow-up from the end of chemotherapy was 9 years (range 4-17). RESULTS: Of the 96 patients, 26 underwent sperm analysis and 20 showed oligo- or azoospermia. Patients who received high-dose ifosfamide showed a higher incidence of azoospermia. Six patients were normospermic and received no ifosfamide or lower doses of ifosfamide. Eight patients fathered a total of 12 children. No birth defects or congenital anomalies were observed in their offspring. CONCLUSIONS: The rate of sterility was related to ifosfamide dosage. It appears that pubertal maturation is not affected by chemotherapy. No congenital malformations were seen in the children of the few patients who fathered children.

Dyspermia and testicular artery peak systolic velocity.

OBJECTIVE: To compare reliability of peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI) of testicular arteries, folliculostimulating hormone (FSH) and testicular volume in the differential diagnosis of dyspermias. PATIENTS AND METHODS: Testicle volume, FSH, PSV, EDV, and RI were compared with analysis of variance among the following patients or controls: 9 obstructive azoospermic (OA), 20 non obstructive (NOA), 17 oligoasthenospermic varicoceles + male accessory glands inflammation (MAGI), 38 undetermined oligoasthenospermic, 19 MAGI, 11 varicoceles, 32 subjects with normal sperm analysis who recently fathered (fertile controls), and 15 subjects with normal sperm analysis with varicocele who recently fathered. RESULTS: Only PSV and RI proved to be selective for the different classes of patients, while EDV, FSH and testicle volume did not. Varicoceles, varicoceles + MAGI and fertile varicoceles showed the highest PSV and RI; fertile controls, OAs and MAGIs displayed similar PSV and RI; undetermined patients displayed significantly lower PSV and RI, NOAs' PSV and RI proved to be the lowest. CONCLUSIONS: RI and PSV proved to be a reliable tool to be routinely used in the clinical study of infertile/dyspermic males, whereas EDV, FSH and testicle volume did not.