Andrology for the Clinician (eBook)

Foreword 5
Preface 6
Contents 7
List of Contributors 18
Introduction 23
Andrology: Definition, Clinical Issues and Prevalence 23
Layout and How to Use the Book 26
General Considerations 27
Evidence-Based Medicine in Reproductive Medicine and Andrology 27
Economic Cost and Cost-Effectiveness 29
Ethics of Reproductive Research and Treatment 31
Human Tissue for Research 36
I Diagnosing and Solving Clinical Problems 38
Problem: Gender Dysphoria and Disorders of Sexual Differentiation 39
I.1.1 Gender Dysphoria 39
I.1.2 Disorders of Sexual Differentiation 43
Problem: Abnormal Pubertal Development 47
Male Factor Fertility Problems 49
I.3.1 The Consensus-Based Approach to Standardized Diagnosis and Management of the Infertile Male 49
I.3.2 The WHO Recommended Diagnostic Flow Chart 51
I.3.3 Implications of Multifactorial Aetiology in the Diagnosis and Management of Male Infertility 53
I.3.4 Sexual Dysfunction and Male Fertility 55
I.3.5 Reference Values of Semen Variables and Their Interpretation 60
I.3.6 Normal Spermatozoa and Isolated Abnormalities of Seminal Plasma 64
I.3.7 Immunological Causes 67
I.3.8 Iatrogenic Causes of Abnormal Spermatozoa 73
I.3.9 Systemic Causes of Male Infertility 77
I.3.10 Congenital Disorders and Male Infertility 83
I.3.11 Acquired Testicular Damage 86
I.3.12 Cause: Varicocele 88
I.3.13 Infection/Inflammation of the Accessory Sex Glands 92
I.3.14 Endocrine Factors 95
I.3.15 Oligo-Astheno-Teratozoo-Spermia with No Demonstrable Cause ( Idiopathic O- A- T) 97
I.3.16 Azoospermia 101
Problem: Sexual Dysfunction 105
I.4.1 Erectile Dysfunction 105
I.4.2 Erectile Deformity, Including Peyronie’s Disease 113
I.4.3 Ejaculatory Dysfunction: Premature Ejaculation, Delayed Ejaculation, Anejaculation, Low- Volume Ejaculation, Retrograde Ejaculation and Painful Ejaculation 119
I.4.4 Orgasm Dysfunction 125
I.4.5 Abnormal Libido 127
I.4.6 Sexual Deviation and Paraphilias 131
Problem: Male Contraception 134
I.5.1 Controversies Regarding Postvasectomy Management 134
I.5.2 Vasectomy Reversal 139
I.5.3 Male Contraception 141
I.5.4 Traditional Methods 142
Problem: Reproductive Tract Infections 145
I.6.1 Reproductive Tract Infections/ Sexually Transmitted Diseases 145
I.6.2 HIV Infection 151
Problem: Emergencies in Andrology 154
I.7.1 Testicular Torsion 154
I.7.2 Blunt Testicular Trauma 182
I.7.3 Penile Fractures 184
I.7.4 Priapism 186
I.7.5 Testicular Pain and Related Pain Syndromes 190
Benign Lesions and Malignant Tumours of the Male Genital Tract 199
I.8.1 Scrotal Benign Lesions, Epididymal Cysts, Epididymal Tumours 199
I.8.2 Testicular Cancer, CIS, Microcalcifications, TNM Classification 203
I.8.3 Penile Inflammations 210
I.8.4 Penile Cancer 221
I.8.5 Circumcision 223
Problem: Diseases of the Prostate ( Infection, Benign Prostatic Hyperplasia, Cancer) 233
I.9.1 Benign Prostatic Hyperplasia and Prostatic Cancer 233
I.9.2 Prostatitis 237
Problem: Male Breast Disorder 245
I.10.1 Gynaecomastia and Benign Breast Hyperplasia Including Iatrogenic Causes 245
I.10.2 Skin Diseases of the Male Nipple 252
I.10.3 Male Breast Cancer 257
Problem: Male Ageing 261
I.11.1 Neuroendocrine Regulation of Testicular Function 261
I.11.2 Male Ageing: Wear and Tear 269
I.11.3 Organ Failure and Common Disease of the Ageing Male 271
II Rationale 277
Understanding Normal Anatomy and Function 278
II.1.1 Anatomy and Histology of the Male Genital Tract 278
II.1.2 Sexual Differentiation and Development 285
II.1.3 Physiology of Spermatogenesis 291
II.1.4 Physiology of Sexual Function 300
II.1.5 Endocrine Regulation 307
II.1.6 Immunology of the Testis and Excurrent Ducts 311
II.1.7 Male Contributions to the Biology of Conception and Fertilization 319
Mechanisms of Dysfunction and Pathology 324
II.2.1 Disorders of Prenatal Sexual Development 324
II.2.2 Endocrine Disorders and the Role of Hormone Disrupters 332
II.2.3 Infection/Inflammation of the Male Genital Tract as Cause of Abnormal Spermatozoa 341
II.2.4 Urethritis, Sexually Transmitted Diseases (STD), Acquired Immunodeficiency Syndrome ( AIDS) 346
II.2.5 Disorders of Blood Flow: Arterial and Venous/ Sexual Dysfunction and Varicocele 357
II.2.6 Effects of Lifestyle and Toxicants 367
II.2.7 Influence of Systemic Diseases and Iatrogenic Factors on Sexual and Reproductive Functions 377
II.2.8 Mechanisms of Pathogenesis of Uro- Genital Cancers 381
Diagnostic Tools 390
II.3.1 History and Examination for Andrological Problems 390
II.3.2 Semen Analysis and Sperm Function Tests 400
II.3.3 Cytomorphological Semen Analysis 414
II.3.4 Clinical Microbiology 420
II.3.5 Hormonal Evaluation in Infertility and Sexual Dysfunction 427
II.3.6 Tumour Markers in Andrology 434
II.3.7 Technical Investigations Including Imaging Procedures: Doppler, MRI, PET, Echo for Tumours 444
II.3.8 Technical Investigations Including Imaging Procedures: Colour Flow Doppler and Thermography for the Detection of Reflux in Varicocele 466
II.3.9 Evaluation of Testicular Biopsy Samples from the Clinical Perspective 473
II.3.10 Genetics and Male Infertility 481
II.3.11 Tumour Genetics (Prostate/Testis/Penis) 500
Therapeutic Options 503
II.4.1 Introduction to Surgical Section 503
II.4.2 Surgical Procedures in Andrology 503
II.4.3 Vasectomy Technique 514
II.4.4 Vasovasostomy and Vasoepididymostomy 519
II.4.5 Nonsurgical Cure of Varicocele by Transcatheter Embolization of the Internal Spermatic Vein( s) with a Tissue Adhesive 529
II.4.6 Hormonal Treatment of Infertility 535
II.4.7 Hormonal Male Contraception 539
II.4.8 Treatment of Gender Dysphoria 543
II.4.9 Treatment of Sexual Dysfunction 547
II.4.10 Therapeutic Options for Benign Prostate Hyperplasia ( BPH) and Prostatic Cancer 554
II.4.11 Partial Androgen Deficiency of the Ageing Male ( PADAM) and Testosterone Supplementation: Use, Misuse or Abuse? 570
II.4.12 Abuse of Androgens 574
II.4.13 Exotic Hormones 580
II.4.14 Anti-Ageing Nutrition and Food Supplements 584
II.4.15 Nutriceuticals and Food Supplements in the Treatment of the Infertile Man 591
II.4.16 Assisted Reproductive Techniques 597
II.4.17 Cryopreservation of Spermatozoa and Testicular Tissue Including Autotransplantation of Germinal Epithelium 604
II.4.18 Current Research and Future Prospects for Gene Therapy in Andrology 611
II.4.19 Behavioural Therapy and Counselling 617
II.4.20 Donor Insemination, Egg and Embryo Donation 626
II.4.21 Aesthetic Andrology: Surgical Interventions 636
II.4.22 Aesthetic Andrology: Skin Care for Men – Male Cosmetics and Cosmetic Dermatologic Procedures 640
Subject Index 653