Erectile dysfunction: anatomical parameters, etiology, diagnosis, and therapy.

Functional anatomy of the human penis involves various parameters: cavernous tissue, covering integument, prepuce foreskin, corpora cavernosa, corpus spongiosum, glans, facia, arterial supply, venous drainage, lymph drainage, musculature, and nerve supply. Several factors affect the expression/degree of erectile dysfunction (ED) endocrine profile, aging/senescence, demyelinating diseases, and surgery. Risk factors of ED are: age, vascular factors, metabolic diseases (diabetes mellitus), neurologic diseases, and HIV/AIDS. Several drugs are associated with ED: antiandrogenic, anticholinergic, antidepressants, antihypertensive, major tranquilizers, anxiolytics, and certain medicines/metabolites. The International Index of Erectile Function (IIEF) is a multidimensional scale for assessment of erectile dysfunction. The main structures mediating erection are the corpora cavernosa or "erectile bodies," which are fused distally for approximately three-quarters of their length. They separate proximally to fuse with each ischial tuberosity of the pelvis. On their ventral surface lies the corpus spongiosum, which surrounds the urethra. Coital dysfunction is classified into "erectile dysfunction" (psychosexual and endocrine/neuro-endocrine) and "ejaculatory dysfunction" (psychosexual, and genitourinary surgery). Vasculogenic impotence was evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Cavernosal, alpha-blockade is a technique used to evaluate and treat ED. Another diagnostic procedure for ED involves color floro and spectural Doppler imaging after papaverine-induced erection in impotent men. Color Doppler and duplex ultrasonography are used to evaluate Peyronie's disease. Sildenafil cilrate (Viagra) is an effective therapy of ED in men. Vardenavil is a highly selective phosphodiesterase 5 (PDE5) inhibitor which improved ED. Prostagland E1, vasoactive intestinal polypeptide (VIP), and phentolamine mesylate (administered by autoinjectors) have been applied to treat ED in patients resistant to other intracavernosal agents. Clinical trials were conducted on self-injection of vasoactive drugs, apomorphine SL, and tadalafil in diabetic men. Medical therapy of ED includes: medicated urethral system for erection (MUSE), intravenous pharmacotherapy, arterial revascularization, vacuum devices, two- and three-component inflatable penile prosthesis, semi-rigid penile prosthesis in situ, and inflatable one-piece penile prosthesis. Surgical therapy include procedures to correct Peyronie's penile deformity and penile deformity, procedures to avoid inevitable shortening accompanying Nesbit's disease, and for penile lengthening.

Stress/aging: endocrine profiles/reproductive dysfunction in men.

Extensive investigations have been carried out on the biology/physiology of stress [13, 18, 20, 25, 35, 48, 49, 53, 55], pathophysiology of aging [41], sexual dysfunction [7, 27] and adrenal insufficiency [4, 31].

Mammalian fertilization, IVF, ICSI: physiological/molecular parameters, clinical application.

Fertilization is associated with several phenomena: rearrangement of euplastic cytoskeleton, intra-cellular communication, cellular polarity, and the release of a variety of complex systems. Several criteria are used to score fertilization. On the day after fertilization, oocytes are cleaned of cumulus and examined for presence of 2 pronuclei and any possible cytological anomalies. Function tests to evaluate fertilization include SPA, ZBA, SCSA, AAA acrosome reaction and fluorescent probes. Fertilization failure, silent polyspermy, aster arrest, mitotic arrest, aster growth defect, or immuno-logical mechanisms cause infertility. Sperm-induced oocyte activation may be due to ligand-recep-tor-mediated interaction or a soluble sperm-derived factor that enters the oocyte at the time of fusion. Any abnormalities in transcription, translation, or any other significant molecular process responsible for producing the oocyte-activating ligand/effector molecule during spermatogenesis and/or spermatogenesis will ultimately cause fertilization failure. The centrosome is paternally derived. During the time course of fertilization the sperm centrosome is orchestrating producer mobilization, syngamy and, ultimately, early cleavage. Vesicle-associated membrane protein(VAMP) is typically lost at cell surface during sperm penetration. Understanding cytoskeletal motility during fertilization requires sophisticated digital imaging including conventional epifluorescence microscopy, laser scanning confocal microscopy and time lapse video microscopy. Clinical application of the recent finding is discussed with emphasis on timing of coitus or insemination, to coincide with time of monitored ovulation. Future research directions are outlined.

Andropause: endocrinology, erectile dysfunction, and prostate pathophysiology.

This review summarizes major biological aspects of andrology of andropause, deficiency in androgens/growth hormones, and molecular parameters; erectile dysfunction (ED), the use of malleable, mechanical, inflatable devices as well as the application of Viagra (Sildenafil), alprotadil (Caverject), Yohimbine, and other drugs not yet approved by FDA, such as Papaverine, phentolamine (Vasomax), and apormorphine (Uprima); osteopenia/osteoporosis: testosterone/osteoporesis; supplementation during andropause: administration of andiogens, possible risk factors of androgens, calcium supplement and muscle mass; prostate pathophysiology: consequences of prostatectomy, prostate cancer, benign prostatic hyperplasia (BPH), hormone-dependent cancers; bladder and urethral dysfunction: neurological parameter, urodynamics technology; models on aging in male animals: comparative physiology of prostate of laboratory animals/farm animals; future research: functional anatomy of male reproductive organs, pharmacokinetics of osteoporosis, endocrinology/neuroendocrinology/chromosome anomalies supplementation during andropause, experimental animal models and future multicenter multidisciplinary research.