DOCSLIB.ORG

Male Infertility

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Male Infertility FEATURE Male infertility BY ROZH JALIL AND SUKS MINHAS Figure 1: The Hypothalamus-Pitutary-Gonadal axis Definitions Infertility is the inability of a sexually -ve active, non-contracepting couple to HYPOTHALAMUS achieve spontaneous pregnancy in one year [1]. About 15% of couples do not achieve LHRH pregnancy within one year and seek -ve -ve ANTERIOR PITUTARY medical treatment for infertility. Semen GLAND parameters are standardised by the World Health Organization (WHO) and defined LH FSH according to standardised values discussed Testes in the investigation section below. Azoospermia is defined as the absence of Interstitial cells Seminiferous tubules (Leydig cells) (Sertoli cells) sperm in the ejaculate and is identified in 10% to 15% of infertile males [2]. Oligospermia is defined as a sperm density of less than 15 million/ml. Unlike the situation with azoospermia, causes Testosterone Sperm Inhibin of oligospermia can be quite vast and the aetiology is often idiopathic. Figure 1. The hypothalamic-pituitary-gonadal (HPG) axis. Asthenospermia is decreased sperm motility (<32% motile spermatozoa [3]). Teratospermia is abnormal forms of sperm (<4% normal forms [3]). albumin and 2% is free. Testosterone is (AZF) gene on the Y chromosome. Sperm abnormalities of oligospermia, converted into a more potent androgen, Microdeletions of region AZFa has asthenospermia and teratospermia usually dihydrotestosterone, by 5-alpha reductase been associated with Sertoli cell only occur together; this is called oligo-astheno- at the target tissues. syndrome; AZFb with maturation teratozoospermia (OAT) syndrome. Sertoli cells line the seminiferous arrest and AZFc with azoospermia or In 50% of infertile couples, a male tubules, which surround developing severe oligozoospermia. associated factor is found together with germ cells (spermatogonia) and provide abnormal semen parameters [3]. nutrients and stimulating factors as well Testicular causes: as secreting androgen-binding factor • Varicoceles are found in 40% of infertile Physiology and inhibin. Primordial germ cells divide men [4]. Varicoceles may be associated The hypothalamic-pituitary-gonadal (HPG) to form primary spermatocytes. These with failure of testicular growth, axis is responsible for reproductive tract undergo two meiotic divisions to form hypogonadism or symptoms of pain and formation and development, maturation spermatids and a further differentiation discomfort. of fertility potential at puberty, and into spermatozoa. This process takes 72 • Idiopathic 30-40% [1]. the maintenance of sexual function in days. The non-motile spermatozoa leave • Undescended testes (cryptorchidism). the adult. The HPG axis is illustrated in the seminiferous tubules and pass to the • Functional sperm disorder e.g. Figure 1. epididymis for storage and maturation. antisperm antibodies; Karatagener’s The hypothalamus secretes syndrome. gonadotrophin-releasing hormone Aetiology • Testicular injury e.g. testicular torsion. (GnRH). This causes the release of follicle • Infection e.g. post pubertal mumps stimulating hormone (FSH) and luteinising Pre-testicular causes: orchitis. hormone (LH) from the anterior pituitary • Endocrinopathy / hormonal, • Radiation. gland, which act on the testis. LH acts on hypogonadotropic hypogonadism. • Cancer. Leydig cells to produce testosterone. FSH • Systemic disease e.g. renal failure; liver • Post surgery e.g. hernia repair. stimulates the seminiferous tubules to cirrhosis; cystic fibrosis (CF). secrete inhibin and produce sperm. • Environmental factors e.g. hot baths. Post-testicular (obstructive causes): Testosterone is secreted by the • Drugs, alcohol, smoking and cannabis. • Male genital tract obstruction e.g. interstitial Leydig cells. It promotes • Genetic abnormalities e.g. obstruction / absence of vas deferens the development of the male - Klinefelter’s syndrome (47 XXY) (may be associated with CF). CF is an reproductive system and secondary characterised by small firm testes, autosomal recessive disorder that sexual characteristics. Sixty percent of gynaecomastia and high serum affects multiple organs. Most men with testosterone is bound to sex hormone gonadotrophins. azoospermia with congenital bilateral binding globulin (SHBG), 38% bound to - Deletions in the azoospermic factor absence of vas deferens (CBAVD) have urology news | MAY/JUNE 2018 | VOL 22 NO 4 | www.urologynews.uk.com FEATURE genetic mutation in cystic fibrosis • Decreased body hair, absence of temporal Special investigations: transmembrane conductance regulator pattern balding areas – document • Genetic evaluation for Y microdeletion, (CFTR) on chromosome 7p. secondary sexual characteristics. karyotype and CF transmembrane • Erectile or ejaculatory problems e.g. • Low androgen levels at the time of conductance regulator (CFTR) gene. retrograde ejaculation. puberty will lead to disproportionately • Testicular biopsy: In selected cases, • Infection e.g. prostatitis. long extremities due to delayed closure of testicular biopsy may be indicated to the epiphyseal plates. exclude spermatogenic failure (non- Furthermore, the level of obstruction in • Examination of thyroid gland obstructive causes). Testicular biopsy obstructive azoospermia (OA) varies: may exclude nodules suggesting should be performed at the time of • Intratesticular obstruction 15%. hyperfunction or hypofunction, which can testicular sperm extraction and be part • Epididymal obstruction 30-67%. affect fertility. of intracytoplasmic sperm injection • Vas deferens obstruction: most common • Hepatomegaly on abdominal (ICSI) treatment in patients with clinical cause of acquired obstruction following examination raises suspicion for hepatic evidence of non obstructive azoospermia vasectomy. dysfunction, which may induce altered (NOA). Microdissection testicular sperm • Ejaculatory duct obstruction: 1-3% sex steroid metabolism. extraction (TESE) is the technique of choice. Spermatogenesis may be focal, Assessing male infertility Genital examination which means that in about 50% of men • Penis: curvature, Peyronie’s plaque, with NOA, spermatozoa can be found and History phimosis, hypospadias. used for ICSI. A thorough history is key in successful • Testes: assessment of testicular • Post-orgasmic urine analysis to confirm diagnosis of male infertility. Many specific consistency, tenderness and volume retrograde ejaculation in men with low factors can affect subsequent fertility or (using an orchidometer or by sonographic ejaculatory volume. sexual function (Table 1). measurement; normally >20ml) and • Sperm function tests, which are not to exclude the presence of testicular commonly performed, include: Table 1. Factors can affect subsequent fertility or sexual masses. 1. Post coital test function. • Epididymis: tenderness and fullness. 2. Sperm penetration test Infertility history Surgical • Spermatic cord: presence or absence of 3. Sperm-cervical mucus test Duration Orchidopexy vas deference, varicocele. Prior conceptions Retroperitoneal / pelvic Current or previous partner surgery Radiological investigations: Outcome Herniorrhaphy Investigations • Ultrasound scan of the scrotum: assess Previous fertility evaluation Vasectomy There are a number of available tools to testicular abnormality (e.g. mass) and the and treatment Bladder neck / prostatic surgery further evaluate the infertile male, ranging presence of varicocele, information on from the basic semen analysis to testicular which should include venous diameter Sexual history Medications Erectile function Gonadotoxins biopsy, as well as imaging studies. and evidence of venous reflux. Lubricants Environmental exposures Basic investigations: Appropriate • Transrectal ultrasound if seminal volume Frequency / timing of (pesticides, heavy metals) laboratory testing of semen plays a key is low to exclude obstructive causes e.g. intercourse Radiation Habits (tobacco, recreational role in evaluation of men presenting with Müllerian duct cyst. Past history drugs, anabolic steroids) Cryptorchidism infertility. • Vasography: This is to diagnose Onset of puberty • Semen analysis: specimens should be and evaluate level of obstruction if Testicular pathology collected over a period of a few weeks obstructive azoospermia is suspected Torsion after two to five days of sexual abstinence. to confirm distal patency prior to Trauma Midline defects (cleft palate) The specimen should be delivered within reconstruction e.g. vaso-epididymostomy. Medical Family history one hour to the laboratory. The normal Diabetes mellitus Infertility values for semen parameters are shown Management Neurologic disease Cystic fibrosis in Table 2. Treatments vary according to the underlying Spinal cord injury Androgen receptor deficiency • Hormonal assessment: these include cause and the degree of the impairment of Multiple sclerosis Infection LH, FSH and testosterone. Increased the male fertility. Urinary infections prolactin levels can be associated with Sexually transmitted disease sexual dysfunction and may indicate Pre-testicular conditions and idiopathic Epididymitis / prostatitis pituitary disease. Men with testicular Tuberculosis cases may respond to medical therapy: Mumps orchitis deficiency have high levels of FSH and LH, • Gonadotropin-releasing hormone Recent viral / febrile illness and sometimes low levels of testosterone agonists: These agents are effective Renal disease secondary to hypergonadotropic for treatment of hypogonadotropic Cancer hypogonadism. Generally, the levels Chemotherapy / radiotherapy
Load more

Recommended publications
  • Infertility.Pdf
    Harvard-MIT Division of Health Sciences and Technology HST.071: Human Reproductive Biology Course Director: Professor Henry Klapholz IN SUMMARY INFERTILITY INFERTILITY Defined as 1 year of unprotected intercourse during which a pregnancy is not achieved • United States - 15% to 20% of all couples are infertile • Higher in older couples • Rate has remained relatively stable since the early 1980s • Primary - neither partner has achieved a successful pregnancy • Secondary - couples who have achieved a pregnancy previously but are having difficulty currently with conception Estimated 25% of women will experience infertility during their childbearing years • Societal trend toward delayed marriage and childbirth • Greater awareness of treatment options • Increased societal acceptance of infertility as a medical condition Fecundability is the probability of achieving a pregnancy within 1 menstrual cycle • Fecundability of a “normal” couple (<35 years) is approximately 25% • 3 months, 57% of couples achieved pregnancy • 6 months, 72% • 12 months, 85% • 24 months, 93% Initial assessment - thorough patient history and physical examination Evaluate for evidence of systemic disease, genetic abnormalities, or androgen dysfunction. Female partner - specific areas requiring extra attention • Body mass index • Distribution of body fat • Breast formation and galactorrhea, • Hair pattern (hirsutism or virilization) • Focal neurologic findings (anosmia, visual field impairments) • Assessment of the pelvis o Anomalies of the external genitalia, vagina, or
    [Show full text]
  • Impact of Infection on the Secretory Capacity of the Male Accessory Glands
    Clinical�������������� Urolo�y Infection and Secretory Capacity of Male Accessory Glands International Braz J Urol Vol. 35 (3): 299-309, May - June, 2009 Impact of Infection on the Secretory Capacity of the Male Accessory Glands M. Marconi, A. Pilatz, F. Wagenlehner, T. Diemer, W. Weidner Department of Urology and Pediatric Urology, University of Giessen, Giessen, Germany ABSTRACT Introduction: Studies that compare the impact of different infectious entities of the male reproductive tract (MRT) on the male accessory gland function are controversial. Materials and Methods: Semen analyses of 71 patients with proven infections of the MRT were compared with the results of 40 healthy non-infected volunteers. Patients were divided into 3 groups according to their diagnosis: chronic prostatitis NIH type II (n = 38), chronic epididymitis (n = 12), and chronic urethritis (n = 21). Results: The bacteriological analysis revealed 9 different types of microorganisms, considered to be the etiological agents, isolated in different secretions, including: urine, expressed prostatic secretions, semen and urethral smears: E. Coli (n = 20), Klebsiella (n = 2), Proteus spp. (n = 1), Enterococcus (n = 20), Staphylococcus spp. (n = 1), M. tuberculosis (n = 2), N. gonorrhea (n = 8), Chlamydia tr. (n = 16) and, Ureaplasma urealyticum (n = 1). The infection group had significantly (p < 0.05) lower: semen volume, alpha-glucosidase, fructose, and zinc in seminal plasma and, higher pH than the control group. None of these parameters was sufficiently accurate in the ROC analysis to discriminate between infected and non- infected men. Conclusion: Proven bacterial infections of the MRT impact negatively on all the accessory gland function parameters evaluated in semen, suggesting impairment of the secretory capacity of the epididymis, seminal vesicles and prostate.
    [Show full text]
  • CUA Guideline: the Workup and Management of Azoospermic Males
    Originalcua guideline research CUA Guideline: The workup and management of azoospermic males Keith Jarvi, MD, FRCSC;* Kirk Lo, MD, FRCSC;* Ethan Grober, MD;* Victor Mak, MD, FRCSC;* Anthony Fischer, MD, FRCSC;¥ John Grantmyre, MD, FRCSC;± Armand Zini, MD, FRCSC;+ Peter Chan, MD, FRCSC;+ Genevieve Patry, MD, FRCSC;£ Victor Chow, MD, FRCSC;§ Trustin Domes, MD, FRCSC# *Department of Urology, Mount Sinai Hospital, University of Toronto, Toronto, ON; ¥Division of Urology, McMaster University, Hamilton, ON; ±Department of Urology, Dalhousie University, Halifax, NS; +Division of Urology, McGill University Health Centre, Montreal, QC; £Hôtel-Dieu De Lévis, Lévis, QC; §Department of Urologic Sciences, University of British Columbia, Vancouver, BC; #Saskatoon Health Region, Saskatoon, SK Cite as: Can Urol Assoc J 2015;9(7-8):229-35. http://dx.doi.org/10.5489/cuaj.3209 A further group of men have a failure to ejaculate. These Published online August 10, 2015. may be men with spinal cord injury, psychogenic failure to ejaculate, or neurological damage (sympathetic nerve committee was established at the request of the damage from, for example, a retroperitoneal lymph node Canadian Urological Association to develop guide- dissection). A lines for the investigation and management of azo- To understand the management of azoospermia, it is ospermia. Members of the committee, all of whom have important to also understand the role of assisted reproduc- special expertise in the investigation and management of tive technologies (ARTs) (i.e., in-vitro fertilization) in the male infertility, were chosen from different communities treatment of azoospermia. Since the 1970s, breakthroughs across Canada. The members represent different practices in the ARTs have allowed us to offer potentially successful in different communities.
    [Show full text]
  • Original Article Severe Teratozoospermia Associated with Severe Oligospermia Affects Clinical Outcome in Human ICSI Cycles
    Int J Clin Exp Med 2019;12(7):9324-9334 www.ijcem.com /ISSN:1940-5901/IJCEM0094152 Original Article Severe teratozoospermia associated with severe oligospermia affects clinical outcome in human ICSI cycles Yuan Xu1*, Di Sun1*, Wei Chen1, Jian Sun1, Yi-Xia Yang1, Yu Wu1, Zheng Li1, Zhen-Bo Zhang1,2 1The Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China; 2Department of Obstetrics and Gynecology, Shanghai First People’s Hospital, Baoshan Branch, Shanghai 201900, China. *Equal contributors. Received March 20, 2019; Accepted May 13, 2019; Epub July 15, 2019; Published July 30, 2019 Abstract: This study retrospectively investigated the effects of obvious head shape defect in sperm on embryo development and pregnancy outcome. Couples with severe oligospermia (total sperm count was less than several hundred, thus not enough for morphological assessment) were divided into two groups based on morphological ob- servation of sperm head. Group 1 (N=45): sperm with obvious head shape defects (large or small, tapered, pyriform and amorphous head defects). Group 2 (N=166): sperm with “good looking head shape”. The parameters of em- bryo development and pregnancy outcome were compared between the two groups. There were lower fertilization rates, availablity rate, high-quality embryo rate and cumulative live birth rate and higher miscarriage rate in Group 1 when compared with Group 2. No birth defects in the two groups were reported in the clinic. Embryo development and pregnancy outcome with fresh versus frozen-thawed sperm were similar in two groups. However, poor embryo development and pregnancy outcome were found in the obvious head shape defect sperm group regardless of us- ing fresh or frozen-thawed sperm.
    [Show full text]
  • GERONTOLOGICAL NURSE PRACTITIONER Review and Resource M Anual
    13 Male Reproductive System Disorders Vaunette Fay, PhD, RN, FNP-BC, GNP-BC GERIATRIC APPRoACH Normal Changes of Aging Male Reproductive System • Decreased testosterone level leads to increased estrogen-to-androgen ratio • Testicular atrophy • Decreased sperm motility; fertility reduced but extant • Increased incidence of gynecomastia Sexual function • Slowed arousal—increased time to achieve erection • Erection less firm, shorter lasting • Delayed ejaculation and decreased forcefulness at ejaculation • Longer interval to achieving subsequent erection Prostate • By fourth decade of life, stromal fibrous elements and glandular tissue hypertrophy, stimulated by dihydrotestosterone (DHT, the active androgen within the prostate); hyperplastic nodules enlarge in size, ultimately leading to urethral obstruction 398 GERONTOLOGICAL NURSE PRACTITIONER Review and Resource M anual Clinical Implications History • Many men are overly sensitive about complaints of the male genitourinary system; men are often not inclined to initiate discussion, seek help; important to take active role in screening with an approach that is open, trustworthy, and nonjudgmental • Sexual function remains important to many men, even at ages over 80 • Lack of an available partner, poor health, erectile dysfunction, medication adverse effects, and lack of desire are the main reasons men do not continue to have sex • Acute and chronic alcohol use can lead to impotence in men • Nocturia is reported in 66% of patients over 65 – Due to impaired ability to concentrate urine, reduced
    [Show full text]
  • Management of Male Lower Urinary Tract Symptoms (LUTS), Incl
    Guidelines on the Management of Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO) M. Oelke (chair), A. Bachmann, A. Descazeaud, M. Emberton, S. Gravas, M.C. Michel, J. N’Dow, J. Nordling, J.J. de la Rosette © European Association of Urology 2013 TABLE OF CONTENTS PAGE 1. INTRODUCTION 6 1.1 References 7 2. ASSESSMENT 8 3. CONSERVATIVE TREATMENT 9 3.1 Watchful waiting - behavioural treatment 9 3.2 Patient selection 9 3.3 Education, reassurance, and periodic monitoring 9 3.4 Lifestyle advice 10 3.5 Practical considerations 10 3.6 Recommendations 10 3.7 References 10 4. DRUG TREATMENT 11 4.1 a1-adrenoceptor antagonists (a1-blockers) 11 4.1.1 Mechanism of action 11 4.1.2 Available drugs 11 4.1.3 Efficacy 12 4.1.4 Tolerability and safety 13 4.1.5 Practical considerations 14 4.1.6 Recommendation 14 4.1.7 References 14 4.2 5a-reductase inhibitors 15 4.2.1 Mechanism of action 15 4.2.2 Available drugs 16 4.2.3 Efficacy 16 4.2.4 Tolerability and safety 17 4.2.5 Practical considerations 17 4.2.6 Recommendations 18 4.2.7 References 18 4.3 Muscarinic receptor antagonists 19 4.3.1 Mechanism of action 19 4.3.2 Available drugs 20 4.3.3 Efficacy 20 4.3.4 Tolerability and safety 21 4.3.5 Practical considerations 22 4.3.6 Recommendations 22 4.3.7 References 22 4.4 Plant extracts - Phytotherapy 23 4.4.1 Mechanism of action 23 4.4.2 Available drugs 23 4.4.3 Efficacy 24 4.4.4 Tolerability and safety 26 4.4.5 Practical considerations 26 4.4.6 Recommendations 26 4.4.7 References 26 4.5 Vasopressin analogue - desmopressin 27 4.5.1
    [Show full text]
  • This Document Was Released in November 2020. This Document Will Continue to Be Periodically Updated to Reflect the Growing Body of Literature Related to This Topic
    MEDICAL STUDENT CURRICULUM This document was released in November 2020. This document will continue to be periodically updated to reflect the growing body of literature related to this topic. Help: Andrew Gusev - [email protected] MALE INFERTILITY KEYWORDS: infertility, azoospermia, oligospermia, semen analysis, varicocele LEARNING OBJECTIVES: At the end of medical school, the medical student will be able to… 1. Describe the hypothalamus-pituitary-gonadal (HPG) axis 2. Describe the workup for male infertility, including the importance of the physical exam 3. Restate the limitations of the semen analysis 4. List some common reversible causes of infertility and their treatments 5. Recognize when to refer a patient for ART Introduction Approximately 15% of couples will be unable to conceive after attempting unprotected intercourse for one year. Of these couples, about 50% of them will have some male factor to that is contributing to their infertility (a male factor is the sole reason in approximately 20% of infertile couples). (Thonneau P, 1991) Male infertility can be due to a variety of genetic, anatomic, and environmental conditions, many of which will be briefly discussed below. When a cause for an abnormal semen analysis cannot be found, it is termed idiopathic. When a man is infertile with a normal semen analysis and workup, the term unexplained infertility is used. As the word suggests, these men do not have a known cause for their infertility but it is thought to likely be due genetic defects that have not been described yet. The purpose of evaluation is to identify possible conditions causing infertility and treating reversible conditions which may improve a man’s fertility potential.
    [Show full text]
  • Handbook of Urology Urology Edited by J
    HANDBOOK OF Urology Urology Edited by J. Kellogg Parsons, John B. Eifler and Misop Han Handbook of Urology Handbook of Urology Edited by J. Kellogg Parsons, MD, MHS, FACS Associate Professor of Urology Moores Comprehensive Cancer Center UC San Diego Health System La Jolla, CA, USA John B. Eifler, MD Resident, Urological Surgery The James Buchanan Brady Urological Institute and Department of Urology The Johns Hopkins School of Medicine Baltimore, MD, USA Misop Han, MD, MS Associate Professor of Urology and Oncology The James Buchanan Brady Urological Institute and Department of Urology The Johns Hopkins School of Medicine Baltimore, MD, USA This edition first published 2014 © 2014 by John Wiley and Sons, Ltd Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
    [Show full text]
  • A Clinical Case of Fournier's Gangrene: Imaging Ultrasound
    J Ultrasound (2014) 17:303–306 DOI 10.1007/s40477-014-0106-5 CASE REPORT A clinical case of Fournier’s gangrene: imaging ultrasound Marco Di Serafino • Chiara Gullotto • Chiara Gregorini • Claudia Nocentini Received: 24 February 2014 / Accepted: 17 March 2014 / Published online: 1 July 2014 Ó Societa` Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2014 Abstract Fournier’s gangrene is a rapidly progressing Introduction necrotizing fasciitis involving the perineal, perianal, or genital regions and constitutes a true surgical emergency Fournier’s gangrene is an acute, rapidly progressive, and with a potentially high mortality rate. Although the diagnosis potentially fatal, infective necrotizing fasciitis affecting the of Fournier’s gangrene is often made clinically, emergency external genitalia, perineal or perianal regions, which ultrasonography and computed tomography lead to an early commonly affects men, but can also occur in women and diagnosis with accurate assessment of disease extent. The children [1]. Although originally thought to be an idio- Authors report their experience in ultrasound diagnosis of pathic process, Fournier’s gangrene has been shown to one case of Fournier’s gangrene of testis illustrating the main have a predilection for patients with state diabetes mellitus sonographic signs and imaging diagnostic protocol. as well as long-term alcohol misuse. However, it can also affect patients with non-obvious immune compromise. Keywords Fournier’s gangrene Á Sonography Comorbid systemic disorders are being identified more and more in patients with Fournier’s gangrene. Diabetes mel- Riassunto La gangrena di Fournier e` una fascite necro- litus is reported to be present in 20–70 % of patients with tizzante a rapida progressione che coinvolge il perineo, le Fournier’s Gangrene [2] and chronic alcoholism in regioni perianale e genitali e costituisce una vera emer- 25–50 % patients [3].
    [Show full text]
  • Urologic Disorders
    Urologic Disorders Abdulaziz Althunayan Consultant Urologist Assistant professor of Surgery Urologic Disorders Urinary tract infections Urolithiasis Benign Prostatic Hyperplasia and voiding dysfunction Urinary tract infections Urethritis Acute Pyelonephritis Epididymitis/orchitis Chronic Pyelonephritis Prostatitis Renal Abscess cystitis URETHRITIS S&S – urethral discharge – burning on urination – Asymptomatic Gonococcal vs. Nongonococcal DX: – incubation period(3-10 days vs. 1-5 wks) – Urethral swab – Serum: Chlamydia-specific ribosomal RNA URETHRITIS Epididymitis Acute : pain, swelling, of the epididymis <6wk chronic :long-standing pain in the epididymis and testicle, usu. no swelling. DX – Epididymitis vs. Torsion – U/S – Testicular scan – Younger : N. gonorrhoeae or C. trachomatis – Older : E. coli Epididymitis Prostatitis Syndrome that presents with inflammation± infection of the prostate gland including: – Dysuria, frequency – dysfunctional voiding – Perineal pain – Painful ejaculation Prostatitis Prostatitis Acute Bacterial Prostatitis : – Rare – Acute pain – Storage and voiding urinary symptoms – Fever, chills, malaise, N/V – Perineal and suprapubic pain – Tender swollen hot prostate. – Rx : Abx and urinary drainage cystitis S&S: – dysuria, frequency, urgency, voiding of small urine volumes, – Suprapubic /lower abdominal pain – ± Hematuria – DX: dip-stick urinalysis Urine culture Pyelonephritis Inflammation of the kidney and renal pelvis S&S : – Chills – Fever – Costovertebral angle tenderness (flank Pain) – GI:abdo pain, N/V, and
    [Show full text]
  • Non-Certified Epididymitis DST.Pdf
    Clinical Prevention Services Provincial STI Services 655 West 12th Avenue Vancouver, BC V5Z 4R4 Tel : 604.707.5600 Fax: 604.707.5604 www.bccdc.ca BCCDC Non-certified Practice Decision Support Tool Epididymitis EPIDIDYMITIS Testicular torsion is a surgical emergency and requires immediate consultation. It can mimic epididymitis and must be considered in all people presenting with sudden onset, severe testicular pain. Males less than 20 years are more likely to be diagnosed with testicular torsion, but it can occur at any age. Viability of the testis can be compromised as soon as 6-12 hours after the onset of sudden and severe testicular pain. SCOPE RNs must consult with or refer all suspect cases of epididymitis to a physician (MD) or nurse practitioner (NP) for clinical evaluation and a client-specific order for empiric treatment. ETIOLOGY Epididymitis is inflammation of the epididymis, with bacterial and non-bacterial causes: Bacterial: Chlamydia trachomatis (CT) Neisseria gonorrhoeae (GC) coliforms (e.g., E.coli) Non-bacterial: urologic conditions trauma (e.g., surgery) autoimmune conditions, mumps and cancer (not as common) EPIDEMIOLOGY Risk Factors STI-related: condomless insertive anal sex recent CT/GC infection or UTI BCCDC Clinical Prevention Services Reproductive Health Decision Support Tool – Non-certified Practice 1 Epididymitis 2020 BCCDC Non-certified Practice Decision Support Tool Epididymitis Other considerations: recent urinary tract instrumentation or surgery obstructive anatomic abnormalities (e.g., benign prostatic
    [Show full text]
  • Role of Nutrition and Associated Factors in Oligospermia (Low Sperm
    The Pharma Innovation Journal 2019; 8(3): 68-72 ISSN (E): 2277- 7695 ISSN (P): 2349-8242 NAAS Rating: 5.03 Role of nutrition and associated factors in oligospermia TPI 2019; 8(3): 68-72 © 2019 TPI (Low sperm count) www.thepharmajournal.com Received: 09-01-2019 Accepted: 13-02-2019 Neelesh Kumar Maurya Neelesh Kumar Maurya Department of Home Science, Abstract Bundelkhand University, Jhansi, Prevalence of infertility gravitates to increase due to different factors. Causes of male infertility could be Uttar Pradesh, India varicocele, idiopathic infertility, testicular insufficiency, obstruction, ejaculation disorder, medicine- radiation effect, undescended testis, immunological mechanisms, endocrine dysfunction such as diabetes, excessive taking of alcohol, smoking and environmental toxins such as pesticides, mercury and lead. It is furthermore understood that person, obesity, be deficient in of nutrition and habits of utilizing time for example too much use of, laptop, mobile phones, computers and sauna, etc., as for women, age, smoking, too much consumption of alcohol, having a skinny or overweight body and having been exposed to physical or mental stress fruition in amenorrhea might be the causes of infertility. The progress in infertility prevalence draws attention to the effects of factors such as lifestyle, dietetic habits and environmental factors. Male infertility originates from mostly as a result of the association between oxidative stress and antioxidants. A review of these areas will provide researchers with a more noteworthy understanding of the compulsory participation of these nutrients in male reproductive processes. This review also caustic out gaps in recent studies which will require further investigations. Keywords: Nutrition; spermatogenesis, oligospermia, infertility, antioxidants, reproductive Introduction An approximately six per cent of adult males are thought to be infertile.
    [Show full text]