Andrological Patients Research Articles

Organizational issues of surgical treatment of urological and andrological patients in the conditions of COVID-19: literature review

The COVID-19 pandemic has made adjustments to the management of patients in many medical areas, including urological ones, and the transition of the priorities of the healthcare system to the treatment of patients with a new coronavirus infection has led to a decrease in the quality and intensity of care for patients with other pathologies.

Historical and modern aspects of vascular andrology

Vascular andrology, or angioandrology, was formed on the principle of an interdisciplinary approach in medicine. The object of study were pelvic varicose veins, arteriovenous conflicts, chronic pelvic pain syndrome, erectile dysfunction, prostatic hyperplasia and lower urinary tract symptoms. New approaches developed within this scientific and clinical direction have significantly improved the results of treatment of urological and andrological patients.

(510) Do Patients with Peyronie’s Disease Perceive Penile Curvature Differently than the General Population?

Abstract Introduction Perception of penile curvature (PC) varies widely, and correction of PC is in the eye of the beholder. Objective We sought to investigate if patients with Peyronie’s Disease (PD) had differing opinions on correction of PC compared to general andrology (AD) patients without PD and general urology (URO) patients. Methods A cross-sectional survey was administered to adult patients in andrology and general urology clinics at 3 geographically separate institutions. Patients were grouped with having PD vs AD vs URO conditions. The survey consisted of unlabeled images of penis models with varying degrees of PC (range 10-90°). Respondents were asked to select the images they would want surgically corrected. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to consider correction. Results Ninety-four PD, 106 AD, and 302 URO patients were recruited. When comparing the 3 groups, besides obvious gender differences with PD patients, PD patients were less in 25-34 age range and more in 55-64 age range (p=0.01 and p=0.007). PD was less represented in Mid-Atlantic (p<0.001). 8% of PD, 12% of AD, and 20% of URO patients chose not to surgically correct any degree of PC (p=0.001). Among those who endorsed willingness to surgically correct PC, the average threshold for correction was 52.5° (SD 13) for PD, 37.2° (SD 29.5) for AD, and 51.0° (SD 19.9) for URO patients. When comparing PD patients with AD patients, no difference in the decision to surgically correct was found (p=0.42). This was also found to be the case when comparing PD with URO (p=0.46) and PD+AD patients vs URO (p=0.67). On univariable analysis, among AD patients, those ages 55-64 were more willing to undergo PC correction at lower degrees of PC (p=0.03) but did not hold up on multivariable analysis (p=0.40). No other demographic factors among PD and AD groups were found to have an impact on willingness to undergo PC correction (Table 1). Conclusions No significant differences were seen in the decision to surgically correct PC when comparing the perspectives of patients with PD, AD, and URO. Roughly 10% of all of these patients would defer on surgical management of any degree of PC. Despite having PC, no demographic differences were seen among PD patients’ willingness to correct PC. Disclosure No

(319) The Pandemic, Telemedicine, and Andrology: What Have We Learned?

Abstract Introduction Telemedicine has gained wide acceptance during the COVID-19 pandemic. It was critical for patient care when lockdowns were implemented worldwide. While there has been evidence to suggest that urology patients were receptive to telemedicine, no systematic review has been done to date on andrology patients and their perception of telemedicine. Objective To assess the perception of andrology patients to telemedicine during the COVID-19 pandemic Methods Three electronic databases: PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients “wishing for telemedicine consultation”, “preferring telemedicine over in person”, “accepting the current telemedicine arrangement”, “having needs addressed with teleconsultation”, or “willingness to do a teleconsultation”. Results Of the 1128 retrieved abstracts, 56 underwent full-text review and 11 were included in the final analysis, comprising a total cohort of 2195 cases. Video visits were used in 7 studies, 2 used only telephone encounters, and one used both methods. 3 studies showed andrology and sexual medicine are compatible with telemedicine with a few 30 and 90-day in-person revisit rates. Telemedicine was shown to save an average cost of $149-252 per patient. All 8 studies that assessed the perception of andrology patients to telemedicine showed that most patients had a “positive perception”. Pooled analysis of the positive response to telemedicine was 73.7% (Figure 1) and that of patients who recommended telemedicine was 58.5%. While the percentage of patients (97%) recommending telemedicine is high among studies using videoconference, the percentage drops to 26.3% in studies using telephone visits only. In the latter group, up to 27.1% of patients preferred in-person visits, with security and privacy of either mode of telecommunication being a concern. Conclusions Most patients have a positive perception of telemedicine, particularly with videoconferencing, and less so with telephone visits. These results suggest that telemedicine will likely continue to play a pivotal role in andrology and sexual medicine practices. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus, Hims & Hers Health, Inc.

The pandemic, telemedicine, and andrology: what have we learned?

Telemedicine gained wide acceptance during the COVID-19 pandemic, as it was deemed critical for patient care when lockdowns were implemented worldwide. While there is evidence to suggest that urology patients were receptive to telemedicine, no systematic review has been done to date on andrology patients and their perception of telemedicine. Three electronic databases, PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients "wishing for telemedicine consultation", "preferring telemedicine over in person", "accepting the current telemedicine arrangement", "having needs addressed with teleconsultation", or "willingness to do a teleconsultation". Of the 1128 retrieved abstracts, 56 underwent full-text review and 12 were included in the final analysis, comprising a total cohort of >4021 cases. Video visits were evaluated in 5 studies, telephone encounters were analyzed in 2 studies, and both methods were examined in 1 randomized control study. Three studies showed that andrology and sexual medicine are compatible with telemedicine, with few 30- and 90-day in-person revisit rates. Telemedicine was shown to save an average cost of US$149-$252 per patient, and 8 studies that directly assessed andrology patient perceptions of telemedicine showed that most patients had a "positive perception."Pooled analyses of the positive responses to telemedicine were 68.7% (95% CI, 49.4%-83.1%, P = 0.057), and those of patients who recommended telemedicine were 65.1% (95% CI, 18.4%-93.9%, P = 0.577). While the percentage of patients recommending telemedicine was high among studies using videoconferencing, the percentage dropped in studies using telephone visits only. The difference between recommending video and telephone practices was statistically significant, with 84.6% pooled proportion for recommending video practice compared to 38.9% pooled proportion for recommending telephone practice, P = 0.035. In the telephone-only encounters, up to 27.1% of patients preferred in-person visits, as security and privacy of any mode of telecommunication were of concern. Most patients have a positive perception of telemedicine, particularly with videoconferencing and less so with telephone visits. These results suggest that telemedicine will likely continue to play a pivotal role in andrology and sexual medicine practices.

MP45-15 THE PANDEMIC, TELEMEDICINE, AND ANDROLOGY: WHAT HAVE WE LEARNED?

You have accessJournal of UrologyCME1 Apr 2023MP45-15 THE PANDEMIC, TELEMEDICINE, AND ANDROLOGY: WHAT HAVE WE LEARNED? Muhammed A. Moukhtar Hammad, Adnan El-Achkar, Tuan Nguyen, David W. Barham, Lawrence Jenkins, and Faysal Yafi Muhammed A. Moukhtar HammadMuhammed A. Moukhtar Hammad More articles by this author , Adnan El-AchkarAdnan El-Achkar More articles by this author , Tuan NguyenTuan Nguyen More articles by this author , David W. BarhamDavid W. Barham More articles by this author , Lawrence JenkinsLawrence Jenkins More articles by this author , and Faysal YafiFaysal Yafi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Telemedicine has gained wide acceptance during the COVID-19 pandemic. Worldwide lockdowns made this interface an indispensable one for patient care. Recent evidence suggests that urology patients were receptive to telemedicine; however, no systematic review has been done to date on andrology patients in particular and their perception of telemedicine. METHODS: Three electronic databases: PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients “wishing for telemedicine consultation”, “preferring telemedicine over in person”, “accepting the current telemedicine arrangement”, “having needs addressed with teleconsultation”, or “willingness to do a teleconsultation”. RESULTS: Of the 1128 retrieved abstracts, 56 underwent full-text review and 12 were included in the final analysis, comprising a total cohort of >4021 cases. All 8 studies that assessed perception of andrology patients to telemedicine showed that most patients had “positive perception”. Telemedicine was shown to save an average cost of $149-252/patient. Pooled analyses of positive response to telemedicine were 68.7% (95% CI = 49.4 – 83.1%, p=0.057) and of patients who recommended telemedicine were 65.1% (95% CI = 18.4 – 93.9%, p=0.577). 84.6% pooled proportion for recommending video compared to 38.9 % pooled proportion for recommending telephone practice, p=0.035. In the telephone-only encounters, 27.1% of patients preferred in-person visits as security and privacy of any mode of telecommunication were of concern. CONCLUSIONS: Most patients have a positive perception of telemedicine, particularly with videoconferencing and less so with telephone visits. Telemedicine will plausibly continue to be integral in andrology practice. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e627 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muhammed A. Moukhtar Hammad More articles by this author Adnan El-Achkar More articles by this author Tuan Nguyen More articles by this author David W. Barham More articles by this author Lawrence Jenkins More articles by this author Faysal Yafi More articles by this author Expand All Advertisement PDF downloadLoading ...

Fluctuations in Seminal Quality throughout the Year: How do Temperature, Humidity and Atmospheric Pressure Impact on Human Sperm Quality?

Most studies evaluating the possible seasonal variation of semen quality have considered temperature as the only causal factor. To assess possible seasonality in sperm quality and associations between semen parameters and several meteorological variables (temperature, humidity, apparent temperature and atmospheric pressure) in a large cohort of andrological patients. This was a retrospective, cross-sectional and correlational/descriptive study. Patients (n: 15665) were categorised into four groups (summer, winter, spring and autumn) according to the date of assistance at the fertility centre. Daily values of temperature, apparent temperature, humidity and atmospheric pressure were provided by the National Weather System and were calculated as the average of the 74 days previous to semen collection (spermatogenic cycle). As appropriate, the results were analysed by analysis of variance/Kruskal-Wallis, Chi-square test, t-test/Mann-Whitney, forward conditional regression model and Spearman/Pearson's correlations. We detected seasonality effects on sperm count, total sperm count and total motile sperm count, with the highest values in winter and the lowest in summer. Correlation analysis showed that temperature, apparent temperature and humidity negatively correlated with semen parameters, being humidity the most powerful predictive meteorological variable. Sperm quality is influenced by seasons; increased environmental temperature and humidity negatively affect semen quality.

Impact of lifestyle and environmental factors on male reproductive health

The identification of potential environmental hazards is of clinical relevance for the diagnosis of male infertility. Knowledge about these factors will improve prevention of fertility disorders. Apart from drugs or factors related to lifestyle such as alcohol and tobacco smoke, various environmental and occupational agents, both chemical and physical, may impair male reproduction. Reproductive toxicity may evolve at the hypothalamic-pituitary, testicular, or posttesticular level; endpoints comprise deterioration of spermatogenesis and sperm function as well as endocrine disorders and sexual dysfunction. However, due to the complex regulation of the male reproductive system, information regarding single exogenous factors and their mechanisms of action in humans is limited. This is also due to the fact that extrapolation of results obtained from experimental animal or invitro studies remains difficult. Nevertheless, the assessment of relevant exposures to reproductive toxicants should be carefully evaluated during diagnostic procedures of andrological patients.

A rat study model of depression-driven chronic prostatitis by modulating the PI3K/Akt/mTOR network.

Depression and chronic prostatitis (CP) are two common diseases that affect the human population worldwide. Clinically, it has been demonstrated that andrological patients often simultaneously suffer from depression and CP. Prior investigations have established that depression acts as an independent risk factor for CP. Herein, we explored the correlation between depression and CP using bioinformatics tools and through animal experiments. The potential targets and signalling pathways involved in depression and CP were predicted using bioinformatics tool, while depression in the rat model was established through chronic restraint stress. The expression of the related proteins and mRNA was assessed by Western blotting and real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-qPCR). Relative to those in the control rats, the protein contents of PI3K, p-Akt, and p-mTOR were lower in the model rats (p < 0.05). Similarly, the transcript levels of PI3K, Akt, and mTOR was also relatively lower in the model rats (p < 0.05). And PI3K/Akt agonists reduced inflammation in rat prostate tissue, accompanied by significant increases in the transcript and protein expression levels of PI3K, Akt, and mTOR. Thus, we proposed that depression model rats may induce CP as a result of mediation by the negative regulation of the PI3K/Akt/mTOR signalling network.

Evaluation of Online Andrology Medical Services in Central Regions of China During the COVID-19 Pandemic: A Cross-Sectional Data Analysis Study.

To provide an overview of the current situation, challenges, and trends in online medical services from the perspective of andrology and promote the development of online medical services. Users of the Learning Alliance of Urology, who mainly worked in central regions of China, were invited to complete the questionnaire that included information on the participants and their institutions and their involvement in and concerns for online medical services. We received 875 complete responses. The percentage of online andrology patients at most institutions was less than 30%. The most common services were online appointment registration (92.7%) and online payment (81.8%). Online chat consultation (77.7%) was the most common form of consultation. Only 1 in 5 of the institutions had constructed their Internet hospital. Factors related to the percentage of online andrology patients included specialized andrology clinics and wards, sufficient time for doctors to provide online services, more diversified services, and online clinic training. The biggest challenge for online medical services was diagnosis and treatment safety. It is essential to raise awareness of online medical services for hospitals and patients and strengthen standardized management and training of online medical services, especially applicable to central regions of China. However, online medical services cannot wholly replace offline services due to insufficient diagnosis and treatment.

Clinical and Laboratory Assessment of Androgenic Status and Principles of Hormone Therapy in Sexological and Andrological Patients

The article considers the main clinical manifestations and diagnostic approaches to sexual and andrological disorders in men, the principles of hormone therapy in sexopathology and andrology. Treatment and diagnosis of any form of sexual disorder involves an individual approach, phasing, complexity, taking into account the fact that sexual function and its disorders are always a traumatic factor that deepens and self-fixes as it progresses. The formation and state of sexual function are influenced by ethical and moral attitudes, as well as personal characteristics of the patient. Creating a trusting relationship between the patient and the doctor, tact, attention of the doctor, his compliance with the rules of deontology – the necessary conditions for successful treatment. Given that sexual function in men has several levels of regulation, in which the leading role is played by a higher (cortical) level, when prescribing treatment it is necessary to assess the level and extent of damage, determine the role of damaged levels of regulation in the genesis of sexual dysfunction. ways to eliminate disorders of sexual function and determine the role of sexual partners in the development of sexual disorders. Based on modern ideas about the stages and components of the copulatory cycle, in the treatment of sexological and andrological patients it is recommended to adhere the principles that fully affect all its parts. In sexual dysfunction, drug therapy is more often used, which includes the appointment of hormonal, sedative, vegetotropic, vasoactive and stimulant drugs. Advances in modern pharmacology have made it possible to synthesize and isolate from tissues steroid and protein hormones used in the treatment of disorders of the reproductive system, thus allowing real care to sexological and andrological patients.

Modern Approaches to Examination of Andrological and Sexological Patients During Covid-pandemia

Rapid increase in the overall incidence of pathologies of the reproductive and genitourinary systems in the conditions of a covid epidemic is predictable and requires certain medical and social steps (the formation of a preventive direction of treatment, the restoration of dispensary observation measures, the introduction of social health programs, the ability of citizens to receive qualified and timely specialized medical care etc.). The global spread of the SARS-CoV-2 coronavirus has led to a restriction in the provision of specialized urological care at the time of lockdown, which also negatively affected the dynamic examination of patients, due to a decrease in scheduled examinations. Remotely provided medical recommendations are not always correct due to the lack of the possibility of direct examination of the patient by a doctor. Significant assistance in the classification of patient complaints with the indicated clinical groups of symptoms is provided by questionnaires using generally recognized questionnaires, which must be used when interviewing each patient to establish a clinical syndrome, and it is possible to get a general idea of the state of human health only through a comprehensive analysis of the questionnaire data. The diagnosis by a doctor is established according to the anamnesis in 50% of cases, on the basis of clinical observation – in 30% and according to laboratory data – in 20%. The first remote contact of such patients with a doctor should include a detailed questioning of complaints, a review of the medical history, a review of his own medical, sometimes auto photographic, materials. Such men should always be examined on a second visit. In conditions of remote examination with lockdown, all the above examinations of patients with androgen deficiency are difficult to carry out, therefore, a less short diagnostic protocol can be applied, which will include the data: 1) ultrasound scan of the thyroid gland, abdominal organs, retroperitoneal space, small pelvis, scrotum; 2) data from clinical and laboratory tests. It is mandatory to provide medical information about the somatic and mental (psychological) state of the patient. Andrological patients usually do not have emergency conditions, but diagnostics, especially prescribing treatment, is a painstaking and individually directed process, therefore remote medical procedures are not the best option and require direct contact between the doctor and the patient.

18 F-FDG PET/CT use in functional assessment of the testes: A systematic review.

Our study analysed previous studies employing positron emission tomography with co-registered computer tomography (PET/CT) in andrological patient evaluation and assessed the differences in 2-[18 F]F-fluoro-2'-deoxyglucose (FDG) uptake between three groups: healthy testes, benign and malignant testicular pathology. Medline and Embase were systematically searched for studies involving FDG-PET/CT imaging of testes with results expressed as mean standardised uptake value (SUVmean ). A one-way ANOVA was used to compare SUVmean between three groups. All papers assessing andrological parameters were pooled to compare fertility data. Seventeen studies, including three relating to fertility diagnosis, with a total of 830 patients, were included in the review. One-way ANOVA showed a statistical difference between mean values of tracer SUVmean in healthy and malignant testes (Dif.=-2.77, 95% CI=-4.32 to 1.21, p<0.01) as well as benign and malignant (Dif.=-2.95, 95% CI=-4.33 to -1.21, p<0.01) but no difference between healthy and benign (Dif.=0.19, 95% CI=-0.96 to 1.33, p=0.90). There is some evidence to suggest that FDG uptake and testicular volume are positively correlated to total sperm count, sperm concentration and sperm motility and that germ cells are likely to account for the majority of testicular FDG accumulation. Our findings indicate that malignant testicular lesions demonstrate a significantly higher FDG uptake than benign testicular lesions or healthy testes. Some evidence also suggests that FDG-PET could visualise metabolic activity and thus spermatogenesis; however more studies are required to determine whether FDG-PET could also be used to diagnose infertility. Further studies should focus on correlating both sex hormone-serum levels and semen analysis results with imaging data.

Italian experiences in the management of andrological patients at the time of Coronavirus pandemic.

The SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) was first reported in December 2019, then its rapid spread around the world caused a global pandemic in March 2020 recording a high death rate. The epicenter of the victims moved from Asia to Europe and then to the United States. In this Pandemic, the different governance mechanisms adopted by local health regional authorities made the difference in terms of contagiousness and mortality together with a community strong solidarity. This document analyzes the andrological urgencies management in public hospitals and in private practice observed in Italy and in particular in the most affected Italian Regions: Emilia-Romagna and Marche.

When technological innovations do not reach consensus: the case of tele-consultation of andrological patients.

When technological innovations do not reach consensus: the case of tele-consultation of andrological patients.

The clinical case of infertility treatment caused by male factor (globozoospermia type 1) by the intracytoplasmic morphologically normal sperm injection with activation of the oocytes by Ca2+-ionophore

A case of infertility treatment in couple with a male factor, the severe form of teratozoospermia (total globozoospermia (type 1)) was presented. This pathology is extremely rare (0.1 % at andrological patients). Globozoospermia (type 1) is an insufficiently studied disease and is a severe disorder of spermatogenesis that leads to 100 % of male infertility. Assisted reproductive technologies with using of intracytoplasmic morphologically normal sperm injection and the activation of oocytes – by Ca2+-ionophore A23187 in a man with globozoospermia (type 1) helped in the treatment of infertility in matrimony. Pregnancy and childbirth proceeded favorably.

Testicular ultrasound inhomogeneity is an informative parameter for fertility evaluation.

Testicular volume (TV) is proposed to be a positive predictor of male fertility status, because of the relation known between the TV and the seminiferous tubule content. Independently of the measurement methodology, the role of TV and testicular ultrasound (US) assessments is still debated in andrological clinical practice. In this retrospective cohort study, we evaluated TV and testis US role in the diagnostic workup of andrological patients. All consecutive outpatients undergoing single-operator testis US (Modena, Italy) from March 2012 to March 2018 were enrolled, matching sonographic, hormonal, and seminal data. A total of 302 men were referred and evaluated for gynecomastia, suspected hypogonadism, couple infertility (CI), or sexual dysfunction. In the hypogonadal group, TV was lower compared to that in other groups (P < 0.001), and a significant, direct correlation between TV and testosterone level was observed in nonandrogen-treated patients (R = 0.911, P < 0.001), suggesting that testicular size could be related to the testosterone-secreting compartment. In the CI group, normozoospermic patients showed higher TV compared to men with impaired semen quality (P = 0.003) and azoospermia (P = 0.003). However, TV was not able to discriminate between patients presenting normal and altered semen quality. On the contrary, testis US inhomogeneity was more frequent in patients with impaired sperm quality (55.0%; P = 0.007) and azoospermia (40.0%; P = 0.012), compared to patients with normozoospermia (5%), identifying thereby the sonographic pattern as an informative parameter of the fertility status. Therefore, in the CI workup, US evaluation seems to be more informative than the TV assessment alone.

Einfluss von Lebensstil und Umweltfaktoren auf die reproduktive Gesundheit des Mannes

The identification of potential environmental hazards may be clinically relevant in the diagnosis of male infertility. Knowledge about these factors will improve prevention of fertility disorders. Apart from drugs or factors related to lifestyle such as alcohol and tobacco smoke, various environmental and occupational agents, both chemical and physical, may impair male reproductive function. Reproductive toxicity may evolve at the hypothalamic-pituitary, testicular, or post-testicular level; endpoints comprise deterioration of spermatogenesis and sperm function as well as endocrine disorders and sexual dysfunction. With regard to the complex regulation of the male reproductive system, the available information concerning single exogenous factors and their mechanisms of action in humans is limited. This is also due to the fact that extrapolation of results obtained from experimental animal or in vitro studies remains difficult. Nevertheless, the assessment of relevant exposure to reproductive toxicants should be carefully evaluated during diagnostic procedures of andrological patients.

The great opportunity of the andrological patient: cardiovascular and metabolic risk assessment and prevention

Andrologists, cardiologists and diabetologists (and general practitioners) have the great opportunity to collaborate and find shared clinical workup for the benefit of a large number of men. Several evidence established a link between erectile dysfunction (ED), cardiovascular disease (CVD), diabetes, and metabolic syndrome. Not only these conditions share many risk factors and pathophysiological mechanisms but also an emerging paradigm indicates that ED is, in fact, an independent marker of cardiovascular disease risk, CV events and CV mortality. However, there is no consensus on the best cardiologic investigation in men with ED with no known CVD and, on the contrary, on what is the clinical and prognostic role of detecting ED during cardiovascular investigation and CVD risk assessment. Only vasculogenic ED, which represents the most common type of organic ED, indeed represents a harbinger of CVD, especially for younger patients, and might be diagnosed by dynamic penile color doppler ultrasonography, which represents a real cardiovascular imaging technique that give evidence on the presence of systemic endothelial dysfunction and atherosclerosis. Furthermore, assessment of glucose and lipid metabolism is warranted as first step workup in all ED patients, and diabetologists should ask their patients for erectile function, address ED patients to andrologists, and consider vasculogenic ED in the context of the cardiovascular and metabolic workup and in the context of diabetic complications. Sexual symptoms (and testosterone levels) should sound as harbinger for cardiovascular and metabolic investigation and cardiologists and diabetologists have the opportunity to have a symptom (erectile dysfunction) and a vascular test (penile color doppler) that help them in better management of patients, their comorbidities and complications.

Leydig cell clustering and Reinke crystal distribution in relation to hormonal function in adult patients with testicular dysgenesis syndrome (TDS) including cryptorchidism.

Testicular dysgenesis syndrome (TDS) comprises testicular germ cell cancer, cryptorchidism and some cases of male infertility and hypospadias, which can be linked to impairment of intrauterine gonadal development. Among histological signs of TDS, large Leydig cell (LC) clusters (micronodules) are frequently present. This study aimed to investigate possible associations of LC micronodules with the presence of Reinke crystals and hormonal function of LCs, the latter primarily reflected by serum concentrations of luteinising hormone (LH) and testosterone, in patients with TDS. A retrospective study of 101 andrological patients with TDS (infertility with and without a history of cryptorchidism or presence of germ cell neoplasia in situ) and 20 controls with normal testis histology and LC-function. Archived testicular biopsies were re-evaluated for the presence of LC micronodules and Reinke crystals and the findings were correlated with testis size and serum concentrations of LH, follicle-stimulating hormone (FSH), testosterone, inhibin B, estradiol and sex hormone binding globulin (SHBG). TDS patients with bilateral LC micronodules had significantly lower concentrations of LH, FSH and inhibin B, a lower testosterone/LH-ratio and smaller testis sizes compared to TDS-patients lacking this feature. Presence of LC micronodules was correlated with a lower number of Reinke crystals, while cryptorchid testes had a significantly higher number of crystals than normally descended TDS testes. LC micronodules appear to be a compensatory mechanism caused by androgenic failure and are presumably driven by high concentrations of LH. A relative paucity of Reinke crystals in LCs within micronodules in normally descended TDS testes may be a feature of recently renewed immature Leydig cells. The increased number of Reinke crystals in LCs in testes that were either undescended at birth or are persistently undescended could indicate an impairment of LC renewal in cryptorchidism.