Andrology for the clinician 120 tables

Andrology for the clinician 120 tables

Gespeichert in:
Bibliographische Detailangaben
Format: Buch
Sprache:English
Veröffentlicht: Berlin [u.a.] Springer 2006
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Andrologie
Aufsatzsammlung
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Datensatz im Suchindex

_version_ 1819728118171041792
adam_text CONTENTS LIST OF CONTRIBUTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . XXI INTRODUCTION ANDROLOGY: DEFINITION, CLINICAL ISSUES AND PREVALENCE W.-B. SCHILL, F. COMHAIRE, T.B. HARGREAVE . . . . 1 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 LAYOUT AND HOW TO USE THE BOOK F. COMHAIRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 GENERAL CONSIDERATIONS EVIDENCE-BASED MEDICINE IN REPRODUCTIVE MEDICINE AND ANDROLOGY F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . . . . . . . . . 5 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ECONOMIC COST AND COST-EFFECTIVENESS F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . . . . . . . . . 7 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ETHICS OF REPRODUCTIVE RESEARCH AND TREATMENT T.B. HARGREAVE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 BASIC PRINCIPLES UNDERLYING ETHICAL CONSIDERATIONS 10 CONSENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 APPLYING THE PRINCIPLES TO REPRODUCTIVE MEDICINE 11 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 HUMAN TISSUE FOR RESEARCH T.B. HARGREAVE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 I DIAGNOSING AND SOLVING CLINICAL PROBLEMS I.1 PROBLEM: GENDER DYSPHORIA AND DISORDERS OF SEXUAL DIFFERENTIATION I.1.1 GENDER DYSPHORIA G.G.R. T*SJOEN . . . . . . . . . . . . . . . . . . . . . . . . 19 I.1.1.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 I.1.1.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . . 19 I.1.1.3 CLINICAL FINDINGS . . . . . . . . . . . . . . . . . . . . . . 19 I.1.1.4 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 I.1.1.5 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 I.1.2 DISORDERS OF SEXUAL DIFFERENTIATION G.G.R. T*SJOEN . . . . . . . . . . . . . . . . . . . . . . . . 23 I.1.2.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 I.1.2.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . . 23 I.1.2.3 CLASSIFICATION OF INTERSEX . . . . . . . . . . . . . . . . 23 I.1.2.4 CLINICAL FINDINGS . . . . . . . . . . . . . . . . . . . . . . 24 I.1.2.5 MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . 24 I.1.2.6 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 I.2 PROBLEM: ABNORMAL PUBERTAL DEVELOPMENT S.A. WUDY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 I.2.1 PHYSIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 I.2.2 PRECOCIOUS PUBERTY . . . . . . . . . . . . . . . . . . . . 27 I.2.3 DELAYED PUBERTY . . . . . . . . . . . . . . . . . . . . . . 28 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 I.3 MALE FACTOR FERTILITY PROBLEMS I.3.1 CONSENSUS-BASED APPROACH TO STANDARDIZED DIAGNOSIS AND MANAGEMENT OF THE INFERTILE MALE F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . . 29 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 I.3.2 WHO RECOMMENDED DIAGNOSTIC FLOW CHART F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . . 31 I.3.3 IMPLICATIONS OF MULTIFACTORIAL AETIOLOGY IN THE DIAGNOSIS AND MANAGEMENT OF MALE INFERTILITY F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . . 33 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 I.3.4 SEXUAL DYSFUNCTION AND MALE FERTILITY T.B. HARGREAVE . . . . . . . . . . . . . . . . . . . . . . . 35 I.3.4.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . . . 35 I.3.4.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . . 35 I.3.4.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAMINATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . . . 36 I.3.4.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . . . 37 I.3.4.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 I.3.4.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . . 37 I.3.4.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I.3.5 REFERENCE VALUES OF SEMEN VARIABLES AND THEIR INTERPRETATION F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . . 40 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 I.3.6 NORMAL SPERMATOZOA AND ISOLATED ABNORMALITIES OF SEMINAL PLASMA F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . . 44 I.3.6.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 I.3.6.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . . 44 I.3.6.3 CLINICAL AND LABORATORY FINDINGS . . . . . . . . 45 I.3.6.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . . . 45 I.3.6.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 I.3.6.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . . 46 I.3.6.7 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 I.3.6.8 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 I.3.6.9 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 I.3.7 IMMUNOLOGICAL CAUSES A. MAHMOUD, F. COMHAIRE . . . . . . . . . . . . 47 I.3.7.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . 47 I.3.7.2 MECHANISMS OF MALE IMMUNITY TO SPERMATOZOA . . . . . . . . . . . . . . . . . . . . . . . . . . 47 I.3.7.3 DETECTION OF ANTISPERM ANTIBODIES . . . . . . . 48 I.3.7.4 ANTISPERM ANTIBODIES IN MALE INFERTILITY 49 I.3.7.5 CLINICAL ASPECTS OF MEN WITH ANTISPERM ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 I.3.7.6 PERSPECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . 50 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 I.3.8 IATROGENIC CAUSES OF ABNORMAL SPERMATOZOA G. HAIDL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 I.3.8.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 I.3.8.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . . 53 I.3.8.3 CLINICAL AND LABORATORY FINDINGS . . . . . . . . 55 I.3.8.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . . . 55 I.3.8.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 I.3.8.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . . 55 I.3.8.7 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 I.3.8.8 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 I.3.8.9 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 I.3.9 SYSTEMIC CAUSES OF MALE INFERTILITY A. MAHMOUD, F. COMHAIRE . . . . . . . . . . . . 57 I.3.9.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . 57 I.3.9.2 SYSTEMIC CAUSES . . . . . . . . . . . . . . . . . . . . . . . 57 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 I.3.10 CONGENITAL DISORDERS AND MALE INFERTILITY T.B. HARGREAVE . . . . . . . . . . . . . . . . . . . . . . 63 I.3.10.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . . 63 I.3.10.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 63 I.3.10.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAMINATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . . 63 I.3.10.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . . 64 I.3.10.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 I.3.10.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . 65 I.3.10.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 I.3.11 ACQUIRED TESTICULAR DAMAGE G. HAIDL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 I.3.11.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 I.3.11.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 66 I.3.11.3 CLINICAL AND LABORATORY FINDINGS . . . . . . . 67 I.3.11.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . . 67 I.3.11.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 I.3.11.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . 67 I.3.11.7 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 I.3.11.8 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 I.3.11.9 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 I.3.12 CAUSE: VARICOCELE F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . . 68 I.3.12.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 I.3.12.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 68 I.3.12.3 CLINICAL FINDINGS, TECHNICAL INVESTIGATIONS AND LABORATORY FINDINGS . . . . . . . . . . . . . . . 69 I.3.12.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . . 70 I.3.12.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 I.3.12.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . 70 I.3.12.7 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 I.3.12.8 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 I.3.12.9 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 I.3.13 INFECTION/INFLAMMATION OF THE ACCESSORY SEX GLANDS F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . . 72 I.3.13.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 I.3.13.2 AETIOLOGY AND PHYSIOPATHOLOGY . . . . . . . . . 72 I.3.13.3 CLINICAL AND LABORATORY FINDINGS . . . . . . . 72 I.3.13.4 DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS . . . . 73 I.3.13.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 I.3.13.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . 73 I.3.13.7 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 I.3.13.8 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 I.3.14 ENDOCRINE FACTORS R. WEBER . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 I.3.14.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 I.3.14.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 75 I.3.14.3 CLINICAL FINDINGS . . . . . . . . . . . . . . . . . . . . . 76 X CONTENTS I.3.14.4 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 I.3.15 OLIGO-ASTHENO-TERATOZOOSPERMIA WITH NO DEMONSTRABLE CAUSE (IDIOPATHIC O-A-T) F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . . 77 I.3.15.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . . 77 I.3.15.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 78 I.3.15.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAM- INATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 I.3.15.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . . 78 I.3.15.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 I.3.15.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . 79 I.3.15.7 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 I.3.15.8 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 I.3.15.9 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 I.3.16 AZOOSPERMIA G.R. DOHLE . . . . . . . . . . . . . . . . . . . . . . . . . . 81 I.3.16.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 I.3.16.2 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . 81 I.3.16.3 INVESTIGATIONS . . . . . . . . . . . . . . . . . . . . . . . . 82 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 I.4 PROBLEM: SEXUAL DYSFUNCTION I.4.1 ERECTILE DYSFUNCTION T.B. HARGREAVE . . . . . . . . . . . . . . . . . . . . . . 85 I.4.1.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . . 85 I.4.1.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 85 I.4.1.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAM- INATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 I.4.1.4 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 I.4.1.5 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . 91 I.4.1.6 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 I.4.2 ERECTILE DEFORMITY, INCLUDING PEYRONIE*S DISEASE T.B. HARGREAVE . . . . . . . . . . . . . . . . . . . . . . 93 I.4.2.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . . 93 I.4.2.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 93 I.4.2.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAM- INATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 I.4.2.4 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 I.4.2.5 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . 97 I.4.2.6 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 I.4.3 EJACULATORY DYSFUNCTION. PREMATURE EJACULATION, DELAYED EJACULATION, ANEJACULATION, LOW-VOLUME EJACULATION, RETROGRADE EJACULATION AND PAINFUL EJACULATION T.B. HARGREAVE . . . . . . . . . . . . . . . . . . . . . . . 99 I.4.3.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . . . 99 I.4.3.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 100 I.4.3.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAMINATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . . 101 I.4.3.4 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 I.4.3.5 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 I.4.3.6 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 REFERENCES I.4.4 ORGASM DYSFUNCTION . . . . . . . . . . . . . . . . . . 105 T.B. HARGREAVE . . . . . . . . . . . . . . . . . . . . . . 105 I.4.4.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . . 105 I.4.4.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . . . . I.4.4.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAM- INATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 I.4.4.4 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 I.4.5 ABNORMAL LIBIDO B. BROSIG . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 I.4.5.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 I.4.5.2 EPIDEMIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . 108 I.4.5.3 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 108 I.4.5.4 CLINICAL FINDINGS . . . . . . . . . . . . . . . . . . . . . 109 I.4.5.5 THERAPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 I.4.5.6 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 I.4.6 SEXUAL DEVIATION AND PARAPHILIAS M. BEUTEL . . . . . . . . . . . . . . . . . . . . . . . . . . 111 I.4.6.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 I.4.6.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 111 I.4.6.3 PAEDOPHILIA AS AN EXAMPLE OF PARAPHILIA 112 I.4.6.4 DIAGNOSIS AND TREATMENT . . . . . . . . . . . . . . 112 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 I.5 PROBLEM: MALE CONTRACEPTION I.5.1 CONTROVERSIES REGARDING POST-VASECTOMY MANAGEMENT J. SHAH, H. FISCH . . . . . . . . . . . . . . . . . . . . . 114 I.5.1.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . 114 I.5.1.2 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 I.5.1.3 PREVALENCE . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 I.5.1.4 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 I.5.1.5 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . 115 I.5.1.6 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . 117 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 CONTENTS XI I.5.2 VASECTOMY REVERSAL A. BELKER . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 I.5.2.1 INDICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . 119 I.5.2.2 CONTRAINDICATIONS . . . . . . . . . . . . . . . . . . . . 119 I.5.2.3 VASECTOMY REVERSAL TECHNIQUES . . . . . . . . . 119 I.5.2.4 POSTOPERATIVE CARE . . . . . . . . . . . . . . . . . . . . 120 I.5.2.5 COMPLICATIONS . . . . . . . . . . . . . . . . . . . . . . . 120 I.5.2.6 RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 I.5.2.7 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . 120 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 I.5.3 MALE CONTRACEPTION D. HANDELSMAN, G. WAITES . . . . . . . . . . . 121 I.5.3.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . 121 I.5.3.2 HORMONAL METHODS . . . . . . . . . . . . . . . . . . . 121 I.5.3.3 NONHORMONAL METHODS . . . . . . . . . . . . . . . . 121 I.5.3.4 VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 I.5.3.5 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . 122 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 I.5.4 TRADITIONAL METHODS D. HANDELSMAN, G. WAITES . . . . . . . . . . . 122 I.5.4.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . 122 I.5.4.2 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . 124 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 I.6 PROBLEM: REPRODUCTIVE TRACT INFECTIONS I.6.1 REPRODUCTIVE TRACT INFECTIONS/SEXUALLY TRANSMITTED DISEASES F.R. OCHSENDORF . . . . . . . . . . . . . . . . . . . . 125 I.6.1.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . . 125 I.6.1.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 125 I.6.1.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAM- INATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 I.6.1.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . . 129 I.6.1.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 I.6.1.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . 129 I.6.1.7 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 I.6.1.8 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 I.6.1.9 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 I.6.2 HIV INFECTION F.R. OCHSENDORF . . . . . . . . . . . . . . . . . . . . 131 I.6.2.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . . 131 I.6.2.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . . 131 I.6.2.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAM- INATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 I.6.2.4 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 I.6.2.5 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . . 132 I.6.2.6 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 I.6.2.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 I.6.2.8 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 I.7 PROBLEM: EMERGENCIES IN ANDROLOGY I.7.1 TESTICULAR TORSION C.F. HEYNS, A.J. VISSER . . . . . . . . . . . . . . . 134 I.7.1.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . 134 I.7.1.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . 136 I.7.1.3 CLINICAL FINDINGS . . . . . . . . . . . . . . . . . . . . 138 I.7.1.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . 145 I.7.1.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . 146 I.7.1.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . 150 I.7.1.7 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 I.7.1.8 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . 155 I.7.1.9 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . 156 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 156 I.7.2 BLUNT TESTICULAR TRAUMA J. VALE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 I.7.2.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . 162 I.7.2.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . 162 I.7.2.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 I.7.2.4 TREATMENT * CONSERVATIVE VERSUS SURGICAL 163 I.7.2.5 POSTOPERATIVE FOLLOW-UP . . . . . . . . . . . . . . 163 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 163 I.7.3 PENILE FRACTURES W.D. AIKEN . . . . . . . . . . . . . . . . . . . . . . . . . 164 I.7.3.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . 164 I.7.3.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . 164 I.7.3.3 CLINICAL FINDINGS . . . . . . . . . . . . . . . . . . . . 164 I.7.3.4 PHYSICAL EXAMINATION . . . . . . . . . . . . . . . . 165 I.7.3.5 INVESTIGATIONS . . . . . . . . . . . . . . . . . . . . . . . 165 I.7.3.6 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . 165 I.7.3.7 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . 165 I.7.3.8 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . 166 I.7.3.9 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 I.7.3.10 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . 166 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 166 I.7.4 PRIAPISM P. KUMAR, D.J. RALPH . . . . . . . . . . . . . . . . 166 I.7.4.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . 166 I.7.4.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . 166 I.7.4.3 CLINICAL FINDINGS, TECHNICAL INVESTIGATIONS AND LABORATORY FINDINGS . . . . . . . . . . . . . . 167 I.7.4.4 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . 168 I.7.4.5 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . 169 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 169 I.7.5 TESTICULAR PAIN AND RELATED PAIN SYNDROMES T.B. HARGREAVE, L. TURNER-STOKES . . . 170 I.7.5.1 DEFINITION OF THE DISEASE . . . . . . . . . . . . . . 170 I.7.5.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . 170 I.7.5.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAM- INATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 I.7.5.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . 174 I.7.5.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . 174 XII CONTENTS I.7.5.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . 176 I.7.5.7 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 I.7.5.8 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . 177 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 177 I.8 BENIGN LESIONS AND MALIGNANT TUMOURS OF THE MALE GENITAL TRACT I.8.1 SCROTAL BENIGN LESIONS, EPIDIDYMAL CYSTS, EPIDIDYMAL TUMOURS K. TURNER . . . . . . . . . . . . . . . . . . . . . . . . . . 179 I.8.1.1 HYDROCELE . . . . . . . . . . . . . . . . . . . . . . . . . . 179 I.8.1.2 EPIDIDYMAL CYSTS . . . . . . . . . . . . . . . . . . . . 181 I.8.1.3 EPIDIDYMAL TUMOURS . . . . . . . . . . . . . . . . . 181 I.8.1.4 OTHER BENIGN EPIDIDYMAL LESIONS: SPERM GRANULOMA . . . . . . . . . . . . . . . . . . . . . . . . . 182 I.8.1.5 OTHER BENIGN EPIDIDYMAL LESIONS: TUBERCULOSIS OF THE EPIDIDYMIS . . . . . . . . 182 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 182 I.8.2 TESTICULAR CANCER, CIS, MICROCALCIFICATIONS, TNM CLASSIFICATION O. STAHL, J. EBERHARD, A. GIWERCMAN 183 I.8.2.1 TESTICULAR CANCER . . . . . . . . . . . . . . . . . . . . 183 I.8.2.2 CARCINOMA-IN-SITU OF THE TESTIS . . . . . . . . 187 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 188 I.8.3 PENILE INFLAMMATIONS F.-M. KOEHN . . . . . . . . . . . . . . . . . . . . . . . . . 190 I.8.3.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 190 I.8.3.2 PEARLY PENILE PAPULES . . . . . . . . . . . . . . . . . 190 I.8.3.3 SCLEROSING LYMPHANGITIS OF THE PENIS . . . 191 I.8.3.4 BALANITIS AND BALANOPOSTHITIS . . . . . . . . . . 191 I.8.3.5 LICHEN SCLEROSUS ET ATROPHICUS . . . . . . . . . 193 I.8.3.6 BALANITIS CIRCUMSCRIPTA PLASMACELLULARIS (ZOON*S BALANITIS) . . . . . . . . . . . . . . . . . . . . 193 I.8.3.7 BALANITIS CIRCINATA . . . . . . . . . . . . . . . . . . . 194 I.8.3.8 PSORIASIS VULGARIS . . . . . . . . . . . . . . . . . . . . 195 I.8.3.9 LICHEN PLANUS . . . . . . . . . . . . . . . . . . . . . . . 196 I.8.3.10 FIXED DRUG ERUPTION . . . . . . . . . . . . . . . . . 197 I.8.3.11 OTHER DRUG-INDUCED LESIONS OF THE PENIS 198 I.8.3.12 ALLERGIC AND IRRITANT CONTACT DERMATITIS OF THE PENIS . . . . . . . . . . . . . . . . . . . . . . . . . 198 I.8.3.13 ATOPIC DERMATITIS . . . . . . . . . . . . . . . . . . . . 199 I.8.3.14 SEBORRHOEIC DERMATITIS . . . . . . . . . . . . . . . 199 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 200 I.8.4 PENILE CANCER I.D.C. MITCHELL . . . . . . . . . . . . . . . . . . . . 201 I.8.4.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . 201 I.8.4.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . 201 I.8.4.3 CLINICAL FINDINGS . . . . . . . . . . . . . . . . . . . . 201 I.8.4.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . 202 I.8.4.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . 202 I.8.4.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . 203 I.8.4.7 PROGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 I.8.4.8 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . 203 I.8.4.9 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 I.8.5 CIRCUMCISION C.F. HEYNS, J.N. KRIEGER . . . . . . . . . . . . . 203 I.8.5.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 204 I.8.5.2 EPIDEMIOLOGY OF CIRCUMCISION . . . . . . . . . 204 I.8.5.3 EMBRYOLOGY AND FUNCTION OF THE FORESKIN 204 I.8.5.4 INDICATIONS FOR CIRCUMCISION . . . . . . . . . . 205 I.8.5.5 CONTRAINDICATIONS FOR CIRCUMCISION . . . . 206 I.8.5.6 COMPLICATIONS OF CIRCUMCISION . . . . . . . . 207 I.8.5.7 CURRENT CONTROVERSIES ABOUT CIRCUMCISION . . . . . . . . . . . . . . . . . . . . . . . 208 I.8.5.8 ALTERNATIVES TO CIRCUMCISION . . . . . . . . . . 210 I.8.5.9 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . 210 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 211 I.9 PROBLEM: DISEASES OF THE PROSTATE (INFECTION, BENIGN PROSTATIC HYPERPLASIA, CANCER) I.9.1 BENIGN PROSTATIC HYPERPLASIA AND PROSTATIC CANCER S.A. MCNEILL, S.K.W. LEUNG . . . . . . . . . . 213 I.9.1.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 213 I.9.1.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . 213 I.9.1.3 PROSTATE CANCER . . . . . . . . . . . . . . . . . . . . . . 214 I.9.1.4 SYMPTOMS, DIAGNOSIS AND TREATMENT . . . 214 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 216 I.9.2 PROSTATITIS M.C. BISHOP . . . . . . . . . . . . . . . . . . . . . . . . 217 I.9.2.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 217 I.9.2.2 DIAGNOSIS OF PROSTATITIS . . . . . . . . . . . . . . . 218 I.9.2.3 AETIOLOGY OF CHRONIC PROSTATITIS . . . . . . . . 220 I.9.2.4 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . 221 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 223 I.10 PROBLEM: MALE BREAST DISORDER I.10.1 GYNAECOMASTIA AND BENIGN BREAST HYPERPLASIA INCLUDING IATROGENIC CAUSES W. KRAUSE . . . . . . . . . . . . . . . . . . . . . . . . . 225 I.10.1.1 DEFINITION, EPIDEMIOLOGY . . . . . . . . . . . . . 225 I.10.1.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . 226 I.10.1.3 CLINICAL FEATURES . . . . . . . . . . . . . . . . . . . . . 227 I.10.1.4 HISTOPATHOLOGY . . . . . . . . . . . . . . . . . . . . . . 227 I.10.1.5 GENETIC RISK FACTORS . . . . . . . . . . . . . . . . . 228 I.10.1.6 DIAGNOSTIC PROCEDURES . . . . . . . . . . . . . . . . 228 I.10.1.7 PREVENTION AND TREATMENT . . . . . . . . . . . . . 230 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 231 I.10.2 SKIN DISEASES OF THE MALE NIPPLE W. KRAUSE . . . . . . . . . . . . . . . . . . . . . . . . . 232 I.10.2.1 GENERAL SKIN DISEASES . . . . . . . . . . . . . . . . 232 I.10.2.2 LOCALIZED INFLAMMATORY DISEASES . . . . . . 232 I.10.2.3 TUMOURS . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 I.10.2.4 MALFORMATIONS . . . . . . . . . . . . . . . . . . . . . . 235 I.10.2.5 SURGICAL INTERVENTIONS . . . . . . . . . . . . . . . . 236 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 236 CONTENTS XIII I.10.3 MALE BREAST CANCER P.S.H. SOON, J.M. DIXON . . . . . . . . . . . . . . 237 I.10.3.1 INCIDENCE . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 I.10.3.2 RISK FACTORS . . . . . . . . . . . . . . . . . . . . . . . . 237 I.10.3.3 PATHOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . 238 I.10.3.4 PRESENTATION . . . . . . . . . . . . . . . . . . . . . . . . 238 I.10.3.5 INVESTIGATION . . . . . . . . . . . . . . . . . . . . . . . . 239 I.10.3.6 MANAGEMENT OF EARLY BREAST CANCER . . . . 239 I.10.3.7 MANAGEMENT OF METASTATIC BREAST CANCER . 240 I.10.3.8 FOLLOW-UP . . . . . . . . . . . . . . . . . . . . . . . . . . 240 I.10.3.9 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . 240 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 240 I.11 PROBLEM: MALE AGEING I.11.1 NEUROENDOCRINE REGULATION OF TESTICULAR FUNCTION J.M. KAUFMAN . . . . . . . . . . . . . . . . . . . . . . 241 I.11.1.1 DEFINITION . . . . . . . . . . . . . . . . . . . . . . . . . . 241 I.11.1.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . 241 I.11.1.3 CLINICAL FINDINGS, TECHNICAL INVESTIGATIONS AND LABORATORY FINDINGS . . . . . . . . . . . . . . 246 I.11.1.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . 246 I.11.1.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . 246 I.11.1.6 RESULTS OF TREATMENT . . . . . . . . . . . . . . . . . 246 I.11.1.7 SUMMARY AND CONCLUSIONS . . . . . . . . . . . . 246 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 246 I.11.2 MALE AGEING: WEAR AND TEAR F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . 249 I.11.2.1 DEFINITION AND PATHOGENESIS . . . . . . . . . . . 249 I.11.2.2 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAMINATION, TECHNICAL INVESTIGATIONS, LABORATORY FINDINGS . . . . . . . . . . . . . . . . . 249 I.11.2.3 TREATMENT AND PREVENTION . . . . . . . . . . . . . 250 I.11.2.4 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 250 I.11.3 ORGAN FAILURE AND COMMON DISEASE OF THE AGEING MALE E.J.H. MEULEMAN, F. COMHAIRE . . . . . . . 251 I.11.3.1 INTRODUCTION AND DEFINITION OF THE DISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 I.11.3.2 AETIOLOGY AND PATHOGENESIS . . . . . . . . . . . 251 I.11.3.3 CLINICAL FINDINGS: HISTORY, PHYSICAL EXAMINATIONS AND LABORATORY FINDINGS 253 I.11.3.4 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . 254 I.11.3.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . 254 I.11.3.6 PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . 255 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 255 II RATIONALE II.1 UNDERSTANDING NORMAL ANATOMY AND FUNCTION II.1.1 ANATOMY AND HISTOLOGY OF THE MALE GENITAL TRACT A. MEINHARDT . . . . . . . . . . . . . . . . . . . . . . 259 II.1.1.1 TESTIS AND SCROTUM . . . . . . . . . . . . . . . . . . . 259 II.1.1.2 EPIDIDYMIS . . . . . . . . . . . . . . . . . . . . . . . . . 260 II.1.1.3 SPERMATIC CORD AND DUCTUS DEFERENS . . 261 II.1.1.4 PROSTATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 II.1.1.5 SEMINAL VESICLE, BULBOURETHRAL GLAND . . 263 II.1.1.6 PENIS AND URETHRA . . . . . . . . . . . . . . . . . . . 263 SUGGESTED READING . . . . . . . . . . . . . . . . . . 266 II.1.2 SEXUAL DIFFERENTIATION AND DEVELOPMENT Y.L. GIWERCMAN, A. NORDENSKJOELD . . . 266 II.1.2.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 266 II.1.2.2 GENES INVOLVED IN MALE SEX DIFFERENTIATION . . . . . . . . . . . . . . . . . . . . . . 268 II.1.2.3 DIAGNOSIS OF SEXUAL AMBIGUITY . . . . . . . . 271 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 271 II.1.3 PHYSIOLOGY OF SPERMATOGENESIS M. BERGMANN . . . . . . . . . . . . . . . . . . . . . . 272 II.1.3.1 SPERMATOGENESIS . . . . . . . . . . . . . . . . . . . . 272 II.1.3.2 SEMINIFEROUS TUBULES . . . . . . . . . . . . . . . . 272 II.1.3.3 SPERMATOGONIA . . . . . . . . . . . . . . . . . . . . . 274 II.1.3.4 SPERMATOCYTES/MEIOSIS . . . . . . . . . . . . . . 274 II.1.3.5 SPERMATIDS/SPERMIOGENESIS . . . . . . . . . . 274 II.1.3.6 SPERMATOZOON . . . . . . . . . . . . . . . . . . . . . . 276 II.1.3.7 SERTOLI CELL . . . . . . . . . . . . . . . . . . . . . . . . . 276 II.1.3.8 APOPTOSIS AND SPERMATOGENESIS . . . . . . . 278 II.1.3.9 KINETICS OF SPERMATOGENESIS . . . . . . . . . . 278 II.1.3.10 PATHOPHYSIOLOGY OF SPERMATOGENESIS AND INFERTILITY . . . . . . . . . . . . . . . . . . . . . . 279 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 280 II.1.4 PHYSIOLOGY OF SEXUAL FUNCTION O. BALDO, I. EARDLEY . . . . . . . . . . . . . . . 281 II.1.4.1 PENILE ERECTION . . . . . . . . . . . . . . . . . . . . . 282 II.1.4.2 EJACULATION AND ORGASM . . . . . . . . . . . . . . 285 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 288 II.1.5 ENDOCRINE REGULATION F. COMHAIRE, A. MAHMOUD . . . . . . . . . . 288 II.1.5.1 HYPOTHALAMO*PITUITARY*TESTICULAR AXIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 290 II.1.6 IMMUNOLOGY OF THE TESTIS AND EXCURRENT DUCTS H.-C. SCHUPPE, A. MEINHARDT . . . . . . . 292 II.1.6.1 IMMUNE PRIVILEGE OF THE TESTIS . . . . . . . . 292 II.1.6.2 IMMUNE CELLS IN THE TESTIS . . . . . . . . . . . . 292 II.1.6.3 BLOOD*TESTIS BARRIER . . . . . . . . . . . . . . . . . 293 II.1.6.4 MECHANISMS OF IMMUNE TOLERANCE IN THE TESTIS . . . . . . . . . . . . . . . . . . . . . . . . 294 II.1.6.5 LOCAL FACTORS OF TESTICULAR IMMUNO- REGULATION * THE DUAL ROLE OF CYTOKINES 294 II.1.6.6 INFLAMMATION OF THE TESTIS . . . . . . . . . . . . 296 II.1.6.7 IMMUNOBIOLOGY AND PATHOLOGY OF THE EXCURRENT DUCTS . . . . . . . . . . . . . . . . . . . . 297 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 298 XIV CONTENTS II.1.7 MALE CONTRIBUTIONS TO THE BIOLOGY OF CONCEPTION AND FERTILIZATION H.J. TOURNAYE . . . . . . . . . . . . . . . . . . . . . . 300 II.1.7.1 THE FOREPLAY . . . . . . . . . . . . . . . . . . . . . . . . 300 II.1.7.2 PATERNAL CONTRIBUTIONS TO CONCEPTION . . . 301 II.1.7.3 OTHER SPERMATOZOAL ATTRIBUTES . . . . . . . . . 303 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 303 II.2 MECHANISMS OF DYSFUNCTION AND PATHOLOGY II.2.1 DISORDERS OF PRENATAL SEXUAL DEVELOPMENT P. WIEACKER . . . . . . . . . . . . . . . . . . . . . . . . 305 II.2.1.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 305 II.2.1.2 PRIMARY DISORDERS OF GONADAL DEVELOPMENT . . . . . . . . . . . . . . . . . . . . . . . . 305 II.2.1.3 DISORDERS OF STEROID HORMONE BIOSYNTHESIS . . . . . . . . . . . . . . . . . . . . . . . . 309 II.2.1.4 ANDROGEN INSENSITIVITY . . . . . . . . . . . . . . . 310 II.2.1.5 DISORDERS OF AMH ACTION . . . . . . . . . . . . . 311 II.2.1.6 DISORDERS OF THE HYPOTHALAMIC * PITUITARY * GONADAL AXIS . . . . . . . . . . . . . . . . . . . . . . . 311 II.2.1.7 HYPOSPADIA AND UNDESCENDED TESTIS . . . . 311 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 311 II.2.2 ENDOCRINE DISORDERS AND THE ROLE OF HORMONE DISRUPTERS A. MAHMOUD, FRANK COMHAIRE . . . . . . 313 II.2.2.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 313 II.2.2.2 ENDOCRINE DISORDERS . . . . . . . . . . . . . . . . . 313 II.2.2.3 THE ROLE OF HORMONE DISRUPTERS . . . . . . . 315 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 319 II.2.3 INFECTION/INFLAMMATION OF THE MALE GENITAL TRACT AS CAUSE OF ABNORMAL SPERMATOZOA C. DEPUYDT, A. MAHMOUD, K. EVERAERT . . . . . . . . . . . . . . . . . . . . . . . . 322 II.2.3.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 322 II.2.3.2 CAUSAL FACTORS AND THE ROLE OF CYTOKINES 323 II.2.3.3 WHITE BLOOD CELLS AND REACTIVE OXYGEN SPECIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325 II.2.3.4 OBSTRUCTION OF SPERM TRANSPORT AND ANTI-SPERM ANTIBODIES . . . . . . . . . . . . . . . 325 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 326 II.2.4 URETHRITIS, SEXUALLY TRANSMITTED DISEASES (STD), ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) F.R. OCHSENDORF . . . . . . . . . . . . . . . . . . . 327 II.2.4.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 327 II.2.4.2 URETHRITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . 328 II.2.4.3 STD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 II.2.4.4 HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 334 II.2.5 DISORDERS OF BLOOD FLOW: ARTERIAL AND VENOUS/SEXUAL DYSFUNCTION AND VARICOCELE G.M. COLPI, M. MANCINI, G. PIEDIFERRO, F.I. SCROPPO . . . . . . . . . . . . . . . . . . . . . . . . 338 II.2.5.1 ERECTILE DYSFUNCTION AND VASCULAR DISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339 II.2.5.2 VARICOCELE . . . . . . . . . . . . . . . . . . . . . . . . . . 340 II.2.5.3 TESTICULAR TORSION . . . . . . . . . . . . . . . . . . . . 342 II.2.5.4 UNDESCENDED TESTIS . . . . . . . . . . . . . . . . . . 343 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 345 II.2.6 EFFECTS OF LIFESTYLE AND TOXICANTS J. P. BONDE . . . . . . . . . . . . . . . . . . . . . . . . . 348 II.2.6.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 348 II.2.6.2 LIFESTYLE FACTORS . . . . . . . . . . . . . . . . . . . . . 349 II.2.6.3 WORKPLACE FACTORS . . . . . . . . . . . . . . . . . . . 350 II.2.6.4 ENVIRONMENTAL EXPOSURES . . . . . . . . . . . . . 354 II.2.6.5 MALE-MEDIATED DEVELOPMENTAL TOXICITY 354 II.2.6.6 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . 354 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 355 II.2.7 INFLUENCE OF SYSTEMIC DISEASES AND IATROGENIC FACTORS ON SEXUAL AND REPRODUCTIVE FUNCTIONS R. BORNMAN . . . . . . . . . . . . . . . . . . . . . . . . 358 II.2.7.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 358 II.2.7.2 SEXUAL AND REPRODUCTIVE FUNCTION . . . . . 358 II.2.7.3 SYSTEMIC DISEASES AND FERTILITY . . . . . . . . 362 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 362 II.2.8 MECHANISMS OF PATHOGENESIS OF URO-GENITAL CANCERS T.F. *AHO, D.E. NEAL . . . . . . . . . . . . . . . . . 362 II.2.8.1 PATHOGENESIS OF CANCER IN GENERAL . . . . . . 362 II.2.8.2 PATHOGENESIS OF PROSTATE CANCER . . . . . . . . 366 II.2.8.3 PATHOGENESIS OF TESTIS CANCER . . . . . . . . . . 368 II.2.8.4 PATHOGENESIS OF PENILE CANCER . . . . . . . . . 369 II.2.8.5 FUTURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 370 II.3 DIAGNOSTIC TOOLS II.3.1 HISTORY AND EXAMINATION FOR ANDROLOGICAL PROBLEMS T.B. HARGREAVE . . . . . . . . . . . . . . . . . . . . . 371 II.3.1.1 HISTORY TAKING . . . . . . . . . . . . . . . . . . . . . . 371 II.3.1.2 SCHEME FOR HISTORY TAKING . . . . . . . . . . . . 371 II.3.1.3 PROBLEM-SPECIFIC SPECIAL HISTORY TAKING 372 II.3.1.4 CLINICAL EXAMINATION FOR ANDROLOGICAL CONDITIONS . . . . . . . . . . . . . . . . . . . . . . . . . 376 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 380 II.3.2 SEMEN ANALYSIS AND SPERM FUNCTION TESTS F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . 381 II.3.2.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 381 II.3.2.2 SAMPLE COLLECTION AND DELIVERY . . . . . . . . 381 II.3.2.3 INITIAL MACROSCOPIC EXAMINATION . . . . . . . 382 II.3.2.4 INITIAL MICROSCOPIC INVESTIGATION . . . . . . . 382 II.3.2.5 EVALUATION OF MORPHOLOGICAL CHARACTERISTICS . . . . . . . . . . . . . . . . . . . . . . 385 II.3.2.6 TESTING FOR ANTIBODY-COATED SPERMATOZOA . . . . . . . . . . . . . . . . . . . . . . . . 386 II.3.2.7 COUNTING OF SPERMATOZOA . . . . . . . . . . . . . 387 CONTENTS XV II.3.2.8 SEMEN CULTURE . . . . . . . . . . . . . . . . . . . . . . 388 II.3.2.9 SUMMARY OF BASIC TESTING . . . . . . . . . . . . 388 II.3.2.10 ADVANCED ASSESSMENT OF BASIC SPERM CHARACTERISTICS . . . . . . . . . . . . . . . . . . . . . . 388 II.3.2.11 SPERM FUNCTION TESTS . . . . . . . . . . . . . . . . 389 II.3.2.12 BIOLOGICAL AND BIOCHEMICAL TESTS ON SEMEN . . . . . . . . . . . . . . . . . . . . . . . . . . 390 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 392 II.3.3 CYTOMORPHOLOGICAL SEMEN ANALYSIS G. HAIDL, H.-C. SCHUPPE . . . . . . . . . . . . 395 II.3.3.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 395 II.3.3.2 METHODOLOGICAL ASPECTS . . . . . . . . . . . . . . 395 II.3.3.3 PREDICTIVE VALUE OF SPERM MORPHOLOGY IN VIVO AND IN VITRO . . . . . . . . . . . . . . . . . 397 II.3.3.4 CLINICAL RELEVANCE OF CYTOMORPHOLOGICAL SEMEN ANALYSIS . . . . . . . . . . . . . . . . . . . . . 398 II.3.3.5 SPERM MORPHOLOGY AND ICSI . . . . . . . . . . 399 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 399 II.3.4 CLINICAL MICROBIOLOGY H.G. SCHIEFER, A. VON GRAEVENITZ . . . 401 II.3.4.1 NORMAL FLORA OF THE MALE UROGENITAL TRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401 II.3.4.2 DIAGNOSIS OF PATHOGENS IN THE MALE UROGENITAL TRACT . . . . . . . . . . . . . . . . . . . . 401 II.3.4.3 MICROBIOLOGICAL EXAMINATIONS IN THE DIAGNOSIS OF MALE UROGENITAL INFECTIONS 404 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 407 II.3.5 HORMONAL EVALUATION IN INFERTILITY AND SEXUAL DYSFUNCTION D. KLINGMUELLER, N. BLIESENER, G. HAIDL . . . . . . . . . . . . . . . . . . . . . . . . . . 408 II.3.5.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 408 II.3.5.2 TOTAL TESTOSTERONE . . . . . . . . . . . . . . . . . . . 409 II.3.5.3 FREE TESTOSTERONE . . . . . . . . . . . . . . . . . . . 409 II.3.5.4 LUTEINIZING HORMONE (LH) AND FOLLICLE- STIMULATING HORMONE (FSH) . . . . . . . . . . 409 II.3.5.5 INHIBIN B . . . . . . . . . . . . . . . . . . . . . . . . . . 410 II.3.5.6 ANTI-MUELLERIAN HORMONE . . . . . . . . . . . . . 410 II.3.5.7 OESTRADIOL . . . . . . . . . . . . . . . . . . . . . . . . . 410 II.3.5.8 SEX HORMONE BINDING GLOBULIN (SHBG) 411 II.3.5.9 PROLACTIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 II.3.5.10 DIHYDROTESTOSTERONE . . . . . . . . . . . . . . . . . 411 II.3.5.11 HORMONAL EVALUATION OF SEXUAL DYSFUNCTION . . . . . . . . . . . . . . . . . . . . . . . . 411 II.3.5.12 HUMAN CHORIONIC GONADOTROPHIN (HCG) STIMULATION TEST . . . . . . . . . . . . . . . . . . . . 412 II.3.5.13 GONADOTROPHIN RELEASING-HORMONE (GNRH) STIMULATION TEST . . . . . . . . . . . . . 412 II.3.5.14 STIMULATION TESTS . . . . . . . . . . . . . . . . . . . . 413 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 413 II.3.6 TUMOUR MARKERS IN ANDROLOGY M. E. BRACKE . . . . . . . . . . . . . . . . . . . . . . . 415 II.3.6.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 415 II.3.6.2 MARKERS FOR PROSTATIC CARCINOMA: PROSTATE-SPECIFIC ANTIGEN (PSA) AND OTHERS . . . . . . . . . . . . . . . . . . . . . . . . . 415 II.3.6.3 MARKERS FOR TESTICULAR CARCINOMA: [ -FETOPROTEIN, HUMAN CHORIONIC GONADOTROPHIN AND OTHERS . . . . . . . . . . . . 418 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 421 II.3.7 TECHNICAL INVESTIGATIONS INCLUDING IMAGING PROCEDURES: DOPPLER, MRI, PET, ECHO FOR TUMOURS E.L.F. NIJS, R.H. OYEN . . . . . . . . . . . . . . . . 425 II.3.7.1 ULTRASOUND (US) . . . . . . . . . . . . . . . . . . . . . 425 II.3.7.2 DOPPLER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437 II.3.7.3 MRI (MAGNETIC RESONANCE IMAGING) . . . . 439 II.3.7.4 PET (POSITRON EMISSION TOMOGRAPHY) . . 441 II.3.7.5 EMERGENCIES IN ANDROLOGY . . . . . . . . . . . . 442 II.3.7.6 TUMOURS . . . . . . . . . . . . . . . . . . . . . . . . . . . 445 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 446 II.3.8 TECHNICAL INVESTIGATIONS INCLUDING IMAGING PROCEDURES: COLOUR FLOW DOPPLER AND THERMOGRAPHY FOR THE DETECTION OF REFLUX IN VARICOCELE Y. GAT, M. GORNISH . . . . . . . . . . . . . . . . . . 447 II.3.8.1 INTRODUCTION ON THE BILATERALITY OF THE DISEASE . . . . . . . . . . . . . . . . . . . . . . . 447 II.3.8.2 HOW TO USE CONTACT SCROTAL THERMOGRAPH . . . . . . . . . . . . . . . . . . . . . . . 448 II.3.8.3 MEDICAL IMPORTANCE OF THE COMPLETE AND ACCURATE DIAGNOSIS OF VARICOCELE . . . . . . . 449 II.3.8.4 IS THERE A RELATIONSHIP BETWEEN VARICOCELE AND MALE INFERTILITY? . . . . . . . . . . . . . . . . . . 450 II.3.8.5 IS SUBCLINICAL VARICOCELE RELEVANT TO MALE INFERTILITY AND DOES IT REQUIRE TREATMENT? . . . . . . . . . . . . . . . . . . . . . . . . . . 450 II.3.8.6 IS ULTRASONOGRAPHY A BETTER DIAGNOSTIC TOOL BECAUSE VENOGRAPHY IS SUBJECT TO TECHNICAL VARIATIONS? . . . . . . . . . . . . . . . . . 451 II.3.8.7 WHY RIGHT VARICOCELE COULD NOT BE DETECTED . . . . . . . . . . . . . . . . . . . . . . . . . . . 451 II.3.8.8 GOREN-GAT TECHNIQUE FOR DETECTION AND TREATMENT OF RIGHT AND LEFT VARICOCELE 451 II.3.8.9 *RECURRENT* VARICOCELE AFTER LEFT HIGH LIGATION IS ACTUALLY *SURVIVED* VARICOCELE 452 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 453 II.3.9 EVALUATION OF TESTICULAR BIOPSY SAMPLES FROM THE CLINICAL PERSPECTIVE M. BERGMANN . . . . . . . . . . . . . . . . . . . . . . 454 II.3.9.1 INDICATION . . . . . . . . . . . . . . . . . . . . . . . . . . 454 II.3.9.2 PREPARATION . . . . . . . . . . . . . . . . . . . . . . . . . 455 II.3.9.3 EVALUATION . . . . . . . . . . . . . . . . . . . . . . . . . . 455 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 461 II.3.10 GENETICS AND MALE INFERTILITY T.B. HARGREAVE, D.J. ELLIOTT . . . . . . . . . 462 II.3.10.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 462 XVI CONTENTS II.3.10.2 BASIC INFORMATION ABOUT THE HUMAN GENETIC CODE . . . . . . . . . . . . . . . . . . . . . . 462 II.3.10.3 CHROMOSOMAL ABNORMALITIES AND MALE FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . 463 II.3.10.4 GENETIC DEFECTS AND MALE FERTILITY . . . . 465 II.3.10.5 DNA METHYLATION AND GENE IMPRINTING AND AGEING CHANGES . . . . . . . . . . . . . . . . 473 II.3.10.6 MITOCHONDRIAL ABNORMALITIES . . . . . . . . 473 II.3.10.7 INHERITED CYTOPLASMIC DISORDERS AND MALE FERTILITY . . . . . . . . . . . . . . . . . . . . . . 473 II.3.10.8 CHROMOSOMAL AND DNA ABNORMALITIES IN SPERM . . . . . . . . . . . . . . . . . . . . . . . . . . 474 II.3.10.9 CHROMOSOMAL ABNORMALITIES IN SPERM 474 II.3.10.10 RISKS OF INTRACYTOPLASMIC SPERM INJECTION . . . . . . . . . . . . . . . . . . . . . . . . . . 475 II.3.10.11 ETHICAL CONSIDERATIONS, GENETIC COUNSELLING AND INTRACYTOPLASMIC SPERM INJECTION . . 475 II.3.10.12 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . 475 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . 476 II.3.11 TUMOUR GENETICS (PROSTATE/TESTIS/PENIS) O. TATAROV, D. KIRK . . . . . . . . . . . . . . . . 481 II.3.11.1 GENETIC ASPECTS OF PROSTATE CANCER . . . 481 II.3.11.2 GENETICS OF TESTICULAR CANCER . . . . . . . . 481 II.3.11.3 GENETICS OF PENILE CANCER . . . . . . . . . . . . 482 II.3.11.4 GENETIC TESTING . . . . . . . . . . . . . . . . . . . . 482 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . 482 II.4 THERAPEUTIC OPTIONS II.4.1 INTRODUCTION TO SURGICAL SECTION . . . . . 484 II.4.2 SURGICAL PROCEDURES IN ANDROLOGY C. EVANS . . . . . . . . . . . . . . . . . . . . . . . . . . 484 II.4.2.1 SCROTAL SURGERY . . . . . . . . . . . . . . . . . . . . 484 II.4.2.2 ANAESTHESIA FOR SCROTAL, INGUINOSCROTAL AND PENILE SURGERY . . . . . . . . . . . . . . . . . 485 II.4.2.3 SURGICAL PROCEDURES ON THE SCROTUM . . . 485 II.4.2.4 SURGERY FOR ADULT HYDROCELE . . . . . . . . . 486 II.4.2.5 EXCISION OF EPIDIDYMAL CYST/ SPERMATOCELE . . . . . . . . . . . . . . . . . . . . . . 487 II.4.2.6 UNDESCENDED TESTIS IN THE ADULT . . . . . . 488 II.4.2.7 CIRCUMCISION IN ADULTS . . . . . . . . . . . . . . 489 II.4.2.8 INSERTION OF PENILE PROSTHESIS . . . . . . . . 491 SUGGESTED READING . . . . . . . . . . . . . . . . . 494 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . 494 II.4.3 VASECTOMY TECHNIQUE T.B. HARGREAVE . . . . . . . . . . . . . . . . . . . 495 II.4.4 VASOVASOSTOMY AND VASOEPIDIDYMOSTOMY A.M. BELKER . . . . . . . . . . . . . . . . . . . . . . 500 II.4.4.1 INDICATIONS . . . . . . . . . . . . . . . . . . . . . . . . 501 II.4.4.2 CONTRAINDICATIONS . . . . . . . . . . . . . . . . . . 501 II.4.4.3 ALTERNATIVE PROCEDURES . . . . . . . . . . . . . . 501 II.4.4.4 FACTORS THAT INFLUENCE CHOICE OF VASO- VASOSTOMY OR VASOEPIDIDYMOSTOMY . . . 501 II.4.4.5 SURGICAL TECHNIQUES . . . . . . . . . . . . . . . . 502 II.4.4.6 POSTOPERATIVE CARE . . . . . . . . . . . . . . . . . 508 II.4.4.7 COMPLICATIONS . . . . . . . . . . . . . . . . . . . . . . . 508 II.4.4.8 RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508 II.4.4.9 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . 509 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 509 II.4.5 NONSURGICAL CURE OF VARICOCELE BY TRANSCATHETER EMBOLIZATION OF THE INTERNAL SPERMATIC VEIN(S) WITH A TISSUE ADHESIVE J. KUNNEN, M. KUNNEN . . . . . . . . . . . . . . . 510 II.4.5.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 510 II.4.5.2 DIAGNOSTIC VENOGRAPHY . . . . . . . . . . . . . . . 510 II.4.5.3 TREATMENT BY EMBOLIZATION . . . . . . . . . . . . 510 II.4.5.4 GENERAL INFORMATION . . . . . . . . . . . . . . . . . 510 II.4.5.5 SPECIFIC INFORMATION ON SUPERSELECTIVE, CO- AXIAL CATHETERIZATION AND EMBOLIZATION . . 512 II.4.5.6 DATA ON TISSUE ADHESIVES AND SCLEROSING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 514 II.4.5.7 RESULTS IN 3043 CONSECUTIVE PATIENTS . . . . 514 II.4.5.8 EFFECT ON SEMEN AND PREGNANCIES . . . . . . 515 II.4.5.9 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . 515 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 515 II.4.6 HORMONAL TREATMENT OF INFERTILITY F. COMHAIRE, A. MAHMOUD . . . . . . . . . . . 516 II.4.6.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 516 II.4.6.2 ANDROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . 516 II.4.6.3 GONADOTROPHINS . . . . . . . . . . . . . . . . . . . . . 517 II.4.6.4 LUTEINIZING HORMONE RELEASING HORMONE (LHRH) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517 II.4.6.5 TREATMENTS INTERFERING WITH OESTRADIOL . . 517 II.4.6.6 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . 519 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 519 II.4.7 HORMONAL MALE CONTRACEPTION D.J. HANDELSMAN, G.M.H. WAITES . . . . . 520 II.4.7.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . 520 II.4.7.2 ANDROGENS ALONE AS HORMONAL CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . 521 II.4.7.3 PHARMACOKINETIC CONSIDERATIONS . . . . . . . 521 II.4.7.4 SAFETY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521 II.4.7.5 COMBINATION REGIMENS AS HORMONAL CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . 521 II.4.7.6 EFFICACY OF COMBINATION REGIMENS . . . . . 522 II.4.7.7 GONADOTROPHIN BLOCKADE: GNRH ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . 522 II.4.7.8 IMMUNONEUTRALIZATION AS A CONTRACEPTIVE APPROACH . . . . . . . . . . . . . . . . . . . . . . . . . . . 522 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 522 II.4.8 TREATMENT OF GENDER DYSPHORIA L.J.G. GOOREN . . . . . . . . . . . . . . . . . . . . . . . 524 II.4.8.1 REAL LIFE TEST . . . . . . . . . . . . . . . . . . . . . . . . 524 II.4.8.2 HORMONAL SEX REASSIGNMENT . . . . . . . . . . 525 II.4.8.3 SIDE-EFFECTS OF HORMONAL SEX REASSIGNMENT . . . . . . . . . . . . . . . . . . . . . . . 526 II.4.8.4 JUVENILE GENDER DYSPHORIA . . . . . . . . . . . . 527 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 527 CONTENTS XVII II.4.9 TREATMENT OF SEXUAL DYSFUNCTION L.J.G. GOOREN . . . . . . . . . . . . . . . . . . . . . 528 II.4.9.1 ERECTILE DYSFUNCTION . . . . . . . . . . . . . . . . 528 II.4.9.2 RETARDED EJACULATION . . . . . . . . . . . . . . . 531 II.4.9.3 RAPID EJACULATION . . . . . . . . . . . . . . . . . . 531 II.4.9.4 TESTOSTERONE TREATMENT . . . . . . . . . . . . . 531 II.4.9.5 PUBERTAL DEVELOPMENT . . . . . . . . . . . . . . 532 II.4.9.6 SEXUAL FUNCTION AND AGEING . . . . . . . . . 532 II.4.9.7 HYPERPROLACTINAEMIA . . . . . . . . . . . . . . . 532 II.4.9.8 PARAPHILIAS AND THEIR PHARMACOLOGIC TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . 533 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . 533 II.4.10 THERAPEUTIC OPTIONS FOR BENIGN PROSTATE HYPERPLASIA (BPH) AND PROSTATIC CANCER S.K.W. LEUNG, S.A. MC NEILL . . . . . . . . 535 II.4.10.1 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . 536 II.4.10.2 MANAGEMENT OF BPH . . . . . . . . . . . . . . . . 539 II.4.10.3 WATCHFUL WAITING . . . . . . . . . . . . . . . . . . . 539 II.4.10.4 PHARMACOLOGIC THERAPY . . . . . . . . . . . . . 539 II.4.10.5 MINIMALLY INVASIVE THERAPIES . . . . . . . . 541 II.4.10.6 SURGICAL TREATMENT . . . . . . . . . . . . . . . . . 542 II.4.10.7 COMPLICATIONS OF SURGICAL TREATMENTS 542 II.4.10.8 THERAPEUTIC OPTIONS FOR PROSTATE CANCER . . . . . . . . . . . . . . . . . . . . . . . . . . . 543 II.4.10.9 MANAGEMENT OF LOCALIZED PROSTATE CANCER . . . . . . . . . . . . . . . . . . . . . . . . . . . 544 II.4.10.10 MANAGEMENT OF LOCALLY ADVANCED PROSTATE CANCER AND METASTATIC DISEASE . . . . . . . . 546 II.4.10.11 TREATMENT OF HORMONE RELAPSED PROSTATE CANCER . . . . . . . . . . . . . . . . . . . . 547 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . 548 II.4.11 PARTIAL ANDROGEN DEFICIENCY OF THE AGEING MALE (PADAM) AND TESTOSTERONE SUPPLEMENTATION: USE, MISUSE OR ABUSE? D. VANDERSCHUEREN . . . . . . . . . . . . . . . 551 II.4.11.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . 551 II.4.11.2 WHO IS TO BENEFIT FROM T REPLACEMENT? WHAT IS THE TARGET POPULATION? . . . . . . . 551 II.4.11.3 WHAT IS THE EXPECTED BENEFIT FROM T REPLACEMENT IN ELDERLY MEN? . . . . . . . . . 552 II.4.11.4 WHAT ARE THE RISKS/SIDE-EFFECTS OF T REPLACEMENT? . . . . . . . . . . . . . . . . . . 553 II.4.11.5 WHAT TYPE OF T REPLACEMENT SHOULD BE USED IN ELDERLY MEN? . . . . . . . . . . . . . . . 554 II.4.11.6 HOW LONG SHOULD WE ADMINISTER T IN THE ELDERLY? . . . . . . . . . . . . . . . . . . . . . . . . . . . 554 II.4.11.7 CONCLUSIONS AND RESEARCH AGENDA . . . . 554 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . 554 II.4.12 ABUSE OF ANDROGENS H.-C. SCHUPPE, A. JUNG, W.-B. SCHILL 555 II.4.12.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . 555 II.4.12.2 ANABOLIC-ANDROGENIC STEROIDS . . . . . . . 555 II.4.12.3 PATTERNS OF ABUSE . . . . . . . . . . . . . . . . . . 557 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . 559 II.4.13 EXOTIC HORMONES F. COMHAIRE, A. MAHMOUD . . . . . . . . . . 561 II.4.13.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 561 II.4.13.2 HORMONAL CHANGES IN AGEING MEN . . . . . 561 II.4.13.3 TREATMENT OPTIONS . . . . . . . . . . . . . . . . . . 562 II.4.13.4 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . 563 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 563 II.4.14 ANTI-AGEING NUTRITION AND FOOD SUPPLEMENTS F. COMHAIRE, A. MAHMOUD . . . . . . . . . . 565 II.4.14.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 565 II.4.14.2 COMPONENTS OF NUTRICEUTICALS . . . . . . . . . 565 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 569 II.4.15 NUTRICEUTICALS AND FOOD SUPPLEMENTS IN THE TREATMENT OF THE INFERTILE MAN F. COMHAIRE, A. MAHMOUD . . . . . . . . . . 572 II.4.15.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 572 II.4.15.2 ROLE OF LIFE STYLE AND NUTRITIONAL FACTORS 572 II.4.15.3 PIVOTAL ROLE OF INHIBIN B . . . . . . . . . . . . . 573 II.4.15.4 FOOD SUPPLEMENTATION . . . . . . . . . . . . . . . 573 II.4.15.5 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . 575 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 576 II.4.16 ASSISTED REPRODUCTIVE TECHNIQUES W. OMBELET . . . . . . . . . . . . . . . . . . . . . . . 578 II.4.16.1 IUI AND MALE INFERTILITY . . . . . . . . . . . . . . 579 II.4.16.2 MALE INFERTILITY: IUI VERSUS IVF/ICSI . . . 579 II.4.16.3 IVF AND ICSI . . . . . . . . . . . . . . . . . . . . . . . 581 II.4.16.4 AZOOSPERMIA: MESA, PESA, TESE AND TESA . . . . . . . . . . . . . . . . . . . . . . . . . . 581 II.4.16.5 ART: PREVENTION OF MULTIPLE PREGNANCIES 583 II.4.16.6 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . 583 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 584 II.4.17 CRYOPRESERVATION OF SPERMATOZOA AND TESTICULAR TISSUE INCLUDING AUTOTRANS- PLANTATION OF GERMINAL EPITHELIUM F.-M. KOEHN . . . . . . . . . . . . . . . . . . . . . . . . 585 II.4.17.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 586 II.4.17.2 BASIC PRINCIPLES OF CRYOBIOLOGY . . . . . . . 586 II.4.17.3 INDICATIONS FOR HUMAN SPERM CRYOPRESERVATION . . . . . . . . . . . . . . . . . . . 586 II.4.17.4 SPERM PREPARATION TECHNIQUES BEFORE CRYOPRESERVATION . . . . . . . . . . . . . . . . . . . 587 II.4.17.5 EFFECTS OF FREEZING ON SPERM QUALITY . . . 588 II.4.17.6 FERTILIZATION RATES WITH CRYOPRESERVED SPERMATOZOA . . . . . . . . . . . . . . . . . . . . . . . 588 II.4.17.7 CRYOBANKING OF SEMEN FOR FERTILITY PROTECTION FROM RADIATION OR CYTOTOXIC TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . 588 II.4.17.8 AUTOTRANSPLANTATION OF GERMINAL EPITHELIUM . . . . . . . . . . . . . . . . . . . . . . . . . 589 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 589 XVIII CONTENTS II.4.18 CURRENT RESEARCH AND FUTURE PROSPECTS FOR GENE THERAPY IN ANDROLOGY Y. KOJIMA, S. SASAKI, K. KOHRI . . . . . . . 592 II.4.18.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 592 II.4.18.2 ETHICAL ISSUE IN GENE THERAPY . . . . . . . . . 593 II.4.18.3 GENE TRANSFER VECTORS . . . . . . . . . . . . . . . 593 II.4.18.4 GENE THERAPY FOR PROSTATE CANCER . . . . . 593 II.4.18.5 GENE THERAPY FOR MALE INFERTILITY . . . . . . 595 II.4.18.6 GENE TRANSFER FOR TREATMENT OF ERECTILE DYSFUNCTION 596 II.4.18.7 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . 597 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 597 II.4.19 BEHAVIOURAL THERAPY AND COUNSELLING E.A. JANNINI, A. LENZI, G. WAGNER . . . . 598 II.4.19.1 FERTILITY PROBLEM COUNSELLING . . . . . . . . . 598 II.4.19.2 SEXUAL DYSFUNCTION . . . . . . . . . . . . . . . . . . 599 II.4.19.3 GENETIC COUNSELLING . . . . . . . . . . . . . . . . . 602 II.4.19.4 CANCER COUNSELLING . . . . . . . . . . . . . . . . . . 603 II.4.19.5 GENDER DYSPHORIA . . . . . . . . . . . . . . . . . . . 605 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 605 II.4.20 DONOR INSEMINATION, EGG AND EMBRYO DONATION G.T. KOVACS, A. TROUNSON, K. DAWSON . . . . . . . . . . . . . . . . . . . . . . . . . 607 II.4.20.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 607 II.4.20.2 DONOR INSEMINATION . . . . . . . . . . . . . . . . . 607 II.4.20.3 OOCYTE DONATION . . . . . . . . . . . . . . . . . . . . 610 II.4.20.4 EMBRYO DONATION . . . . . . . . . . . . . . . . . . . 612 II.4.20.5 INFORMING THE CHILDREN OF THEIR ORIGIN 613 II.4.20.6 LOOKING TO THE FUTURE . . . . . . . . . . . . . . . . 614 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 614 II.4.21 AESTHETIC ANDROLOGY: SURGICAL INTERVENTIONS R. PONCHIETTI . . . . . . . . . . . . . . . . . . . . . 617 II.4.21.1 NORMAL SIZE MEASUREMENTS OF THE PENIS 617 II.4.21.2 INDICATIONS AND CONTRAINDICATIONS FOR PENIS ENLARGEMENT SURGERY . . . . . . . . . . . 618 II.4.21.3 PREFERRED TECHNIQUES OF PENIS ENLARGEMENT SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 618 II.4.21.4 PHALLOPLASTY . . . . . . . . . . . . . . . . . . . . . . . . 619 II.4.21.5 TESTICULAR PROSTHESIS . . . . . . . . . . . . . . . . . 619 II.4.21.6 SCROTAL SKIN REDUNDANCY . . . . . . . . . . . . . 620 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 620 II.4.22 AESTHETIC ANDROLOGY: SKIN CARE FOR MEN * MALE COSMETICS AND COSMETIC DERMATO- LOGIC PROCEDURES C. MUELLER, W.B. SCHILL . . . . . . . . . . . . . 621 II.4.22.1 TRENDS IN MALE SKIN CARE . . . . . . . . . . . . . 621 II.4.22.2 BASIC CONCEPTS OF MALE SKIN SCIENCE . . . 622 II.4.22.3 COSMETIC DERMATOLOGIC PROCEDURES . . . . 624 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . 632 SUBJECT INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 635 CONTENTS XIX
any_adam_object 1
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spellingShingle Andrology for the clinician 120 tables
Andrologie (DE-588)4001968-8 gnd
subject_GND (DE-588)4001968-8
(DE-588)4143413-4
title Andrology for the clinician 120 tables
title_auth Andrology for the clinician 120 tables
title_exact_search Andrology for the clinician 120 tables
title_full Andrology for the clinician 120 tables W.-B. Schill ... (eds.)
title_fullStr Andrology for the clinician 120 tables W.-B. Schill ... (eds.)
title_full_unstemmed Andrology for the clinician 120 tables W.-B. Schill ... (eds.)
title_short Andrology for the clinician
title_sort andrology for the clinician 120 tables
title_sub 120 tables
topic Andrologie (DE-588)4001968-8 gnd
topic_facet Andrologie
Aufsatzsammlung
url http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014790475&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA
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