Seminal Tract Research Articles

FSH Therapy in Male Factor Infertility: Evidence and Factors Which Might Predict the Response.

Follicle-stimulating hormone (FSH) administration is applied in the management of subjects affected by hypogonadotropic hypogonadism. Whilst this application is widely recognized and established alone or in combination with human chorionic gonadotropin (hCG), a similar strategy is empirically advocated in idiopathic male factor infertility (MFI). In this setting, FSH therapy has been used to increase sperm quantity, quality, and pregnancy rate when FSH plasma concentrations are below 8 IU/L and when the seminal tract is not obstructed. In the literature, several studies suggested that giving FSH to patients with idiopathic MFI increases sperm count and motility, raising the overall pregnancy rate. However, this efficacy seems to be limited, and about 10-18 men should be treated to achieve one pregnancy. Thus, several papers suggest the need to move from a replacement approach to an overstimulating approach in the management of FSH therapy in idiopathic MFI. To this aim, it is imperative to determine some pharmacologic markers of FSH efficacy. Furthermore, it should be useful in clinical practice to distinguish, before starting the treatment, among patients who might respond or not to FSH treatment. Indeed, previous studies suggest that infertile men who have normal levels of gonadotropins in plasma might not respond to FSH treatment and about 50% of patients might be defined as "non-responders". For these reasons, identifying predictive markers of FSH action in spermatogenesis and clinical markers of response to FSH treatment is a fascinating area of study that might lead to new developments with the aim of achieving personalization of the treatment of male infertility. From this perspective, seminal parameters (i.e., spermatid count), testicular cytology, genetic assessment, and miRNA or protein markers in the future might be used to create a tailored FSH therapy plan. The personalization of FSH treatment is mandatory to minimize side effects, to avoid lost time with ineffective treatments, and to improve the efficacy, predicting the most efficient dose and the duration of the treatment. This narrative review's objective is to discuss the role of the different putative factors which have been proposed to predict the response to FSH treatment in idiopathic infertile men.

Secondary infertility due to necrospermia in men with autosomal-dominant polycystic kidney disease: a report of two cases.

Autosomal-dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease characterized by the formation of numerous cysts in organs other than the kidneys. Although female patients with ADPKD do not have direct fertility problems, infertility in male patients may arise following the formation of cystic lesions in the lower seminal tract, which impair the function of spermatozoa. Generally, the treatment strategy for necrospermia depends on the severity of sperm viability, and intracytoplasmic sperm injection may be offered to patients with necrospermia. We report two cases of secondary infertility in men with ADPKD. These men experienced an inability to reproduce naturally after the previous birth of a child, suggesting a progressive deterioration of semen quality. Semen analysis showed necrospermia in both patients, and transrectal ultrasound revealed marked dilatation of the seminal vesicles bilaterally. The main cause of secondary infertility in male patients with ADPKD is sperm death resulting from progressive dilatation of seminal vesicles. Further research is needed on the appropriate follow-up schedule for men with ADPKD who desire to reproduce naturally.

Challenges in differential diagnosis between obstructive and non‐obstructive azoospermia

AbstractBackgroundSome cases of non‐obstructive azoospermia (NOA) are characterized by normal clinical parameters, including testicular volume and levels of reproductive hormones, mimicking obstructive azoospermia (OA).MethodsWe performed a retrospective review of a consecutive series of 1417 patients undergoing primary surgical sperm retrieval between 2014 and 2023. Follicle‐stimulating hormone (FSH) level below 7.6 IU/l and normal testicular size with a long axis measurement >4.6 cm were used as criteria to suspect OA.ResultsFour hundred and eighteen patients with normal testicular volume and FSH levels had an initial diagnosis of OA. Among them, 243 (58.1%) had histological signs of spermatogenic dysfunction, and 175 (41.9%) had true OA. One hundred eleven patients had long‐standing obstruction (median: 16.5 years) with a median Bergmann–Kliesch score (BKS) of 5 (interquartile range [IQR]: 4–6) and 100% sperm retrieval rate (SRR), though some required microdissection testicular sperm extraction (microTESE). Fifty‐eight patients with a history of epididymo‐orchitis had a median BKS of 4 (IQR: 2–6) and 100% SRR. Twenty patients with a history of unjustified medical treatment for male infertility had a median BKS of 3 (IQR: 1–4) and 80% SRR. Fifty‐four patients had uniform maturation arrest with a 5.5% SRR on microTESE.ConclusionMen with normal testicular volume and FSH level may have evidence of spermatogenic failure on pathology. Patients with complicated seminal tract obstruction commonly have hypospermatogenesis, but true NOA caused by uniform maturation arrest may also be observed. Patient counseling for suspected OA should not be overly optimistic, and couples should be warned about possibility of conversion to microTESE and risks of negative sperm retrieval.

Partial Epididymal Obstruction as a Cause of Idiopathic Oligozoospermia: A Reproductive Urologist's Perspective following 35 Years of Surgical and Clinical Experience.

The role of partial epididymal obstruction as contributing to the development of oligozoospermia has been neglected for decades. In the early 1970s, however, Robert Schoysman, a gynecological surgeon devoted to the surgical and medical management of male factor infertility, dedicated many efforts to study such a pathology and its possible effects on male fertility. Following the studies of this pioneer in the field, we concentrated our attention to the patterns of partial and complete epididymal obstruction during surgical scrotal exploration, once made possible even in oligozoospermic men by diagnostic and therapeutic interventions, such as vasovesciculography or seminal tract washout test, at present considered obsolete and no longer feasible in light of the current guidelines. Interestingly, we found signs of partial epididymal obstruction in about 30% of oligozoospermic men with normal testicular volume and serum FSH level as well as normal spermatogenesis at testis biopsy. We, then, compared the findings of scrotal ultrasound with those of scrotal exploration and found that the ultrasound abnormalities of the epididymis were highly predictive of anatomic alteration of the gland. In the present study, we report our experience, together with a historical review of the literature, on this topic.

Efficacy of various surgical approaches in treating hematospermia using transurethral seminal vesiculoscopy

PurposeTo explore the efficacy of different approaches of seminal vesiculoscopy surgery and the predictive factors of good treatment outcome.Materials and MethodsA retrospective analysis of 68 patients who underwent seminal vesiculoscopy for hematospermia in our hospital from January 2015 to January 2021. According to different surgical approaches, they were divided into three groups: natural ejaculatory ducts (method A, 45 cases), assisted transurethral resection/incision of ejaculatory ducts (method B, 14 cases), fenestration in prostatic utricle (method C, 9 cases). We analyzed the recurrence rate of the three surgical approaches and the predictive factors of treatment efficacy.ResultsThe total recurrence rate after the seminal vesiculoscopy for hematospermia in this group was 32.35%. The postoperative recurrence rates of the three methods were 24.44% for method A, 50.00% for method B and 44.44% for method C, and there was no significant difference among the three methods (P > 0.05). The data of five predictors of 45 cases in method A group were included in the Univariate Logistic analysis, the results suggest that whether complicated with seminal tract stones/cysts was an effective predictor (OR 0.250, P = 0.022), which was still an effective predictor in the Multivariate Logistic analysis model (OR 0.244, P = 0.010).ConclusionsThe Transurethral seminal vesiculoscopy technique demonstrates a low postoperative recurrence rate in treating hematospermia. Among the various approaches, the intraoperative use of natural orifices through the ejaculatory duct exhibits the lowest recurrence rate. Additionally, seminal tract stones/cysts effectively predict favorable postoperative outcomes.

Value of MRI in the Evaluation of Azoospermia

Abstract Background Azoospermia is defined as the absence of spermatozoa in the ejaculate and is present in about 10%–20% of infertile men. It is classified as obstructive azoospermia (OA) or nonobstructive azoospermia (NOA). OA is caused by obstruction of sperm delivery route at any level (rete testis, efferent ducts, epididymis, vas deferens, and ejaculatory duct). NOA is caused by testicular failure to produce sperm due to various factors. Aim of the Study In the current study we aimed to show the usefulness of magnetic resonance imaging (MRI) in the evaluation of infertile men and its ability to distinguish obstructive from nonobstructive azoospermia. Patients and Methods We included 20 azoospermic men (8 with OA & 10 with NOA), diagnosed after at least two semen analyses & confirmed by testicular biopsy, MRI was done to each patient with same protocol with measurement of both volume & ADC value for every testis. Results Our study revealed that Patients with NOA usually have atrophic testicles with high ADC values, whereas patients with OA have testicles of normal size with low ADC values based on testicular volume & ADC values, using a cutoff of ≥ 13.17 ml & ≤1.05 ×10-3 mm2/s respectively, we were able to make a diagnosis of OA with a sensitivity of 100% and specificity of 83%. Also we find that abnormalities typical for the obstruction of the seminal tract (e.g., prostatic cysts, the absence of vas deferens, dilatation of ejaculatory ducts or vasa deferentia) are found in patients with OA which may be amenable to surgical correction. Conclusion On the basis of our preliminary data, TV and ADC might represent useful MRI parameters in the workup of patients with NOA by helping to predict the presence of spermatozoa after mTESE.

Factors of Infertility among the Males in Selected Hospitals of Dhaka City

Background: Infertility is a global health issue affecting approximately 8-10% of couples and has multidimensional problem with social, economic and cultural implications, which can take threatening proportions in countries with strong demographic problems. Reproductive health in Bangladesh focused mainly on women health and ignoring the role of men, in spite of the important role that men are playing in reproduction and fertility which impact his family and environment. Objective: To find out the factors of infertility among the males in selected hospitals of Dhaka city. Methods: A convenience sample of 112 medical records for males diagnosed with infertility in Shaheed Suhrawardi Medical College Hospital, National Institute of Kidney Diseases and Urology, Sher-E-Bangla Nagar, Dhaka, Fertility center Mohammedpur Dhaka, Infertility care and Research Center Mohammedpur Dhaka were retrospectively reviewed for the cause of their infertility. Four months duration of study from May 2016 to August 2016. After completion of data collection, the collected data was checked and verified on regular basis for accuracy, consistency and completeness. Data was edited and coded. The results were presented into the form of tables and figures. Data was processed in computer by using the software SPSS, version 22 and statistical analysis was done. Results: Male factor alone was accounted for 52% of infertility among couples of these 90 had primary infertility and 22 had secondary infertility. The mean duration of infertility was 4.98±3.99 years and the mean age for male cases was 33.5±7.24 years The most common causes among infertile men were, idiopathic infertility 36.6%, varicocele 32.1%, obstruction of the seminal tract 18.8%, and hormonal problems 5.4%. Least common causes found were, medication 1.8%, spinal cord injury 1.8%, cryptorchidism 1.8%, and testicular failure 1.8%. Conclusion: More than half of the infertile couples were from an idiopathic cause. Study results confirm that understanding about male reproductive function and the environmental factors that affect it is insufficient. Provide education to infertile men by doctors in charge about potential risk factors that may affect fertility and not just provide treatment because simple changes in lifestyle can improve fertility. Bangladesh J. Urol. 2021; 24(1): 37-45

A systematic review of monogenic mutations responsible of sertoli cell-only syndrome

ABSTRACT Introduction Sertoli-cell only syndrome (SCOS) is the severe form of non-obstructive azoospermia, in which only the Sertoli cells line the wall of seminiferous tubules. Y chromosome microdeletions are the obvious cause of SCOS in men, but conclusive and summarized data is lacking on the monogenic mutations. Objective To systematically review published data on monogenic mutations causing SCOS. Methods Medline was searched without publication date restriction for all the genetic association studies on SCOS by using keywords: genetics of Sertoli cell-only syndrome, genetics of azoospermia secondary to SCOS and, genes of Sertoli cell-only syndrome. Quality evaluation and data extraction were done by two authors Studies included in the systematic review were presenting original clinical data, human male cases and patients with confirmed SCOS by histopathology or MD-TESE. The genetic evidence of SCOS was included even if the reported case and genetic testing were published separately. Non-English language studies, descriptive reviews, articles of gene expression in SCOS, and articles related to the other chromosomal abnormalities as a cause of SCOS were also excluded. Any dispute on exclusion and inclusion of a study was resolved by discussion and consensus between all authors. Results The initial database search identified 489 articles, after evaluation according to the defined criteria, only 15 studies matched the inclusion criteria for systematic review. Articles included in the systematic review were published from 2005 to 2020. Only 13% (n=2) of articles were published before 2012. From 2012 to 2020, there have been 87% (n=13) publications. Most of the studies (66.7%, n=10) were carried out on Asian populations (Japanese population) and the rest were on Caucasians. The 15 publications included a total of 1513 cases of SCOS, originating from 7 different countries. However, 151 cases appeared in 2 articles. Extracted data show that 40% of studies exclude patients with a history of infections, seminal tract obstruction, pituitary gland disorder or any other cause of testicular damage, and 27% of studies only recruit patients with no chromosomal abnormalities. Approximately 13% of eligible studies exclude the patients based on congenital abnormalities, past cryptorchidism, orchitis, cancer and other systemic illnesses. In addition, 13% of studies included patients who were diagnosed with SCOS. Only 7% of studies include the patient with unknown cause of male infertility. In all the studies only patients with normal karyotype and without Y-chromosome microdeletions were included. In all the studies semen analysis and confirmatory tests MD-TESE or histopathology were for SCOS. Most of the studies used the technique of direct sequencing and only one study performed whole-exome sequencing. Altogether approximately 51 variations in 13 genes (USP26, RAD21L, SEPTIN12, PAPOLB, PLK4, H3t, ETV5, GILZ, SIN3A, CUL4B, DMRT1, SPATA17 and, LRWD1) were identified from which only 7 variations showed a statistically significant association, but others showed rare or no association. Conclusion Comprehensive large-scale studies on monogenic causes of SCOS still lacking. Altogether approximately 51 variations in 13 genes were identified from which only 7 variations showed statistically significant association. Further studies are required to determine the monogenic causes of SCOS. Disclosure Work supported by industry: no.

A review of intravaginal ejaculatory dysfunction and unconsummated marriage cases in the outpatient clinic for male infertility at the University of Tsukuba Hospital

ABSTRACT Introduction Male infertility can be classified into three categories of causes: testicular factors, seminal tract obstruction, and sexual disorders. Sexual disorders, in particular, have been increasing in recent years, as people now marry later in life, and lifestyles have become more diverse. This study focused on erectile dysfunction (ED) and ejaculation dysfunction (EjD) because they are direct causes of sexual disorders and infertility. The most serious sexual disorders are intravaginal ejaculation dysfunction (IVEjD), which indicates a lack of ability to ejaculate during sexual intercourse, and unconsummated marriage (UM), which means no experience of sexual intercourse after marriage. In this study, we reviewed the actual statuses of IVEjD and UM in male infertility patients who were consulted at our clinic. Objective To examine the characteristics of IVEjD and UM by comparing them with other male infertility patients. Methods This study was approved by the relevant ethical review board. We obtained data on 83 male infertility patients diagnosed from 2018–2020 at our clinic. We extracted information on IVEjD and UM patients, which were defined as serious sexual disorders (SSD). We analyzed the factors of SSD cases related to infertility. Results Of 83 male infertility cases, 26 cases had either ED or EjD. We found nine SSD cases; seven cases had IVEjD, and two cases had UM. The mean age was 38.8 years (IQR: 30–50), and the mean age of the wives was 33.6 years (IQR: 2–43). All SSD cases had never had ejaculatory intercourse with a woman including their wives. Seven cases possibly had ED or EjD, but all SSDs were able to ejaculate by masturbation. One case had premature ejaculation, and six cases had delayed ejaculation during masturbation. Three cases had poor semen findings (oligozoospermia or asthenozoospermia), one case had an organic abnormality (after phimosis surgery), and one case had active depression, but there were no abnormalities in the testicular volume or endocrine findings. The causes of SSDs were inappropriate methods of masturbation in three cases (push method in two cases, strong grip in one case), a lack of sexual experience in two cases, and sexual aversion in one case. In three cases, the wives were able to conceive, but all had undergone fertility treatments without sexual intercourse. Conclusion In this study, 31.3% of male infertility patients had sexual disorders, which is higher than the figure in the national survey. In addition, 10.8% of men had never had sexual intercourse with ejaculation in their lives, and even if we consider the fact that these are patients who visit specialized outpatient clinics, it is clear that there are more patients suffering from SSD than expected. Although sexual disorders can be caused by physical abnormalities such as neurological disorders, vascular disorders, and endocrine disorders, all nine cases examined in this study were able to ejaculate by masturbation, suggesting that lifestyle and psychological problems are the major factors of infertility. Given the difficulty in providing medical interventions for these factors, only a small percentage of cases with severe sexual dysfunction resulted in pregnancy, suggesting the difficulty involved in treating sexual dysfunctions. Disclosure Work supported by industry: no.

PD36-02 HISTOLOGICAL EVIDENCE OF SPERMATOGENIC FAILURE IN MEN WITH HIGH SPERM DNA FRAGMENTATION INDEX

You have accessJournal of UrologyCME1 May 2022PD36-02 HISTOLOGICAL EVIDENCE OF SPERMATOGENIC FAILURE IN MEN WITH HIGH SPERM DNA FRAGMENTATION INDEX Taras Shatylko, Inessa Telezhnikova, Safar Gamidov, Alikhan Tambiev, Alina Popova, and Vlada Kometova Taras ShatylkoTaras Shatylko More articles by this author , Inessa TelezhnikovaInessa Telezhnikova More articles by this author , Safar GamidovSafar Gamidov More articles by this author , Alikhan TambievAlikhan Tambiev More articles by this author , Alina PopovaAlina Popova More articles by this author , and Vlada KometovaVlada Kometova More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002594.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent pregnancy loss and IVF failures may be attributed, among other factors, to sperm DNA fragmentation (SDF). Many conditions and lifestyle factors potentially cause sperm DNA damage, but it is currently unknown where exactly this damage occurs – in testis, epididymis or other portion of seminal tract. Various studies have demonstrated lower SDF index in testicular sperm when compared to ejaculated sperm. Intracytoplasmic testicular sperm injection (Testi-ICSI) is a controversial technique using surgically retrieved sperm from non-azoospermic men to improve IVF outcomes. We sought to evaluate histopathology of seminiferous tubules obtained during sperm retrieval for Testi-ICSI. METHODS: This is an ongoing prospective study. The inclusion criteria are: recurrent pregnancy loss or at least 2 IVF failures, elevated DNA fragmentation index (TUNEL >15%). The exclusion criteria are: known female factor causing pregnancy loss or IVF failures, abnormal karyotype, oligozoospermia (concentration <15 × 106; total sperm count <39 × 106), treatable causes of increased SDF index, history of hormone therapy. Eighteen patients underwent testicular sperm extraction (TESE) for Testi-ICSI. A portion of extracted tissue was sent to pathology. Specimens taken from 5 patients undergoing TESE for obstructive azoospermia (duration of obstruction less than 5 years) were used as controls. Bergmann-Kliesch score (BKS) was used to assess seminiferous tubules histology. Fisher’s exact test and Mann-Whitney test were used as a part of statistical analysis. RESULTS: Median DNA fragmentation index for ejaculated sperm was 26% (interquartile range [IQR]: 23-30). Median percentage of seminiferous tubules containing elongated spermatids was 74% (IQR: 61-89), while in control specimens it was 92% (IQR: 90-95), which was a statistically significant difference (p=0.0251). Median BKS in Testi-ICSI specimens was 7 (IQR: 6-9), which was significantly lower than in control specimens (median: 9; IQR: 9-10; p=0.0271). Hypospermatogenesis was a dominant histological pattern in 10 of 18 Testi-ICSI specimens (55.5%), while all control specimens had features of normal spermatogenesis (p=0.0457). CONCLUSIONS: High prevalence of hypospermatogenesis in non-oligozoospermic patients was an unexpected finding. In theory, Testi-ICSI should work better in cases of post-testicular sperm DNA damage. However, we have found histological evidence of spermatogenic failure in some patients, which hints at probable testicular origin of SDF, which is yet to be correlated with Testi-ICSI outcomes. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e633 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Taras Shatylko More articles by this author Inessa Telezhnikova More articles by this author Safar Gamidov More articles by this author Alikhan Tambiev More articles by this author Alina Popova More articles by this author Vlada Kometova More articles by this author Expand All Advertisement PDF DownloadLoading ...

Imaging methods for seminal tract obstruction

Differential diagnosis between obstructive and non-obstructive azoospermia is an important task in clinical management of infertile patients. Chances of extracting sperm in obstructive azoospermia are high enough to inform the couple about favorable outcome of assisted reproductive technologies without resorting to donor sperm. Some forms of seminal tract obstruction can be corrected by microsurgical interventions or endoscopic resection of the ejaculatory ducts. Therefore, one of the objectives standing before imaging methods in reproductive andrology is the detection of these cases. In this literature review we present a detailed analysis of how to suspect and diagnose this form of azoospermia using imaging.

Multiple vas deferens with polyorchidism and many congenital malformations in a symptomatic 11-year-old male patient: a rare case report

BackgroundDuctus deferens may manifest in a variety of anomalies such as its absence, duplication, ectopy, or diverticulum. Ectopic seminal tract opening has two main types, ectopic ejaculatory duct opening, and ectopic vas deferens opening. Generally, ductus deferens anomalies affect approximately 0.05% of the population. Patients may be asymptomatic or complaining of urinary tract infections and/or epididymitis. Most of these cases are associated with renal dysplasia. To confirm the diagnosis Cystourethroscopy catheterization and retrograde urethrogram should be performed, but the definitive diagnosis is done by vasography. The definitive treatment is complete surgical resection of the pathological urogenital connection. This case is commonly discovered while exploring other findings such as testicular torsion and inguinal hernia.Case presentationWe report a rare case of an 11-year-old male who presented with gross hematuria and numerous congenital malformations including a left polydactyly clubfoot, polyorchidism, with several surgical procedures, and left kidney dysgenesis. Surgery was performed for a left inguinal hernia, during which a third undescended testicle was discovered incidentally and was eradicated. A retrograde urethrogram was performed to establish the diagnosis. A fistula- that is connected with the left ureter- was resected. The histopathologic findings confirmed the diagnosis of true duplication of the Vas deferens, with communication between the ureter and the vas deferens. By follow-up, the kidney function tests were within normal limits.ConclusionsThis case report aims to highlight the early diagnosis and management of the duplicated vas deferens and the associated congenital malformations to improve the prognosis and kidney function and to avoid long-term complications.

Study on the effect of completely preserving the ejaculatory duct during prostatectomy on reducing postoperative retrograde ejaculation in benign prostatic hyperplasia patients.

Preserving the sexual function of benign prostatic hyperplasia (BPH) patients and reducing the incidence of postoperative retrograde ejaculation are critical for BPH patients with sexual needs. To explore the effect of complete preservation of the seminal tract during transurethral prostatectomy (TURP) on reducing retrograde ejaculation in BPH patients. BPH patients meeting the inclusion criteria were randomly divided into the Control group (traditional TURP) and the Experimental group (complete reserved ejaculatory duct) in a ratio of 1 : 1. Finally, data of 64 BPH patients - 34 in the Control group and 30 in the Experimental group - were analyzed. We measured the preoperative and postoperative maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), Quality of Life (QOL) score, semen volume, and ejaculation function. Compared with pre-operation values, patients in the two groups exhibited increased Qmax and decreased IPSS and QOL scores after the operation. However, there was no significant difference in Qmax, IPSS, or QOL between the Control and Experimental groups after the operation. The two groups of patients had a significant reduction in postoperative ejaculation. Compared with the Control group, the semen volume of patients was higher, and the incidence of retrograde ejaculation was lower in the Experimental group. Prostatectomy with complete preservation of the seminal tract is not different from conventional electrosurgical resection in improving urination symptoms, while the incidence of retrograde ejaculation is significantly lower.

Localized Amyloidosis of the Seminal Tract is not Associated With Subsequent Development of Systemic Amyloidosis

ObjectiveTo investigate if localized amyloidosis of the seminal tract (LAST) is associated with subsequent development of systemic amyloidosis. Prior reports recorded no systemic amyloidosis at the time of LAST diagnosis. However, no follow-up studies exist to confirm that LAST is not a risk factor for subsequent development of systemic amyloidosis. MethodsOur study cohort included patients whose prostate biopsy (PB) or radical prostatectomy (RP) specimen demonstrated LAST between 2014–2021. Clinical variables including age, race/ethnicity, prostate specific antigen (PSA), and prostate weight were analyzed. Patients were assessed for clinical and laboratory evidence of systemic amyloidosis and lymphoproliferative conditions during the follow-up period. ResultsThirty-six men (26 RPs, 9 PBs, and 1 cystoprostatectomy) had LAST. Our study cohort included 18 white Hispanic, 9 white non-Hispanic, 7 black, and 1 Asian men. Median age was 67 years, mean PSA was 9.8 ng/mL. Over a median follow-up period of 20 months (mean, 30) in 27 men, none developed systemic amyloidosis. Frequency of LAST in RP specimens was 1.2% (26/2,135) and corelated with age (67 vs 63 years, P-value = .004). Race/ethnicity, PSA, and prostate weight were not associated with the incidence of LAST. ConclusionsLAST is not a harbinger of systemic disease. The incidence of LAST in a contemporary RP cohort is significantly lower than in previously published studies. While patient age positively corelates with LAST, PSA and prostate weight are not associated with the condition. There is no difference in the frequency of LAST between white Hispanic, white non-Hispanic, and black men.

Association of sexually transmitted infection with semen quality in men from couples with primary and secondary infertility

This study aims to compare the prevalence of sexually transmitted infections (STIs) with semen quality in men from couples with primary and secondary infertility. Semen samples were collected from 133 men who requested fertility evaluation. Seminal tract infection with Ureaplasma spp. (UU), Mycoplasma hominis (MH), Mycoplasma genitalium (MG), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and herpes simplex virus-2 (HSV-2) was assessed by PCR-based diagnostic assays. Among all patients, the prevalence of STIs was higher in men from couples with primary infertility than that in men from couples with secondary infertility (39.7% vs 21.7%, P = 0.03). The prevalence of UU was 28.8% and 13.3% in men from couples with primary and secondary infertility, respectively. Men from couples with primary infertility were more likely to be positive for UU than men from couples with secondary infertility (P = 0.04). Regarding the UU subtype, the prevalence of Ureaplasma urealyticum (Uuu) and Ureaplasma parvum (Uup; including Uup1, Uup3, Uup6, and Uup14) did not differ between the two groups. No associations between the prevalence rates of MH, MG, and CT were found in men from either infertility group. A lower sperm concentration was associated with STI pathogen positivity in men with primary infertility according to the crude model (P = 0.04). The crude and adjusted models showed that semen volume (both P = 0.03) and semen leukocyte count (both P = 0.02) were independently associated with secondary infertility. These findings suggest the importance of classifying the type of infertility during routine diagnosis of seminal tract infections.

Transurethral seminal vesiculoscopy for intractable hematospermia: experience from 144 patients

Purposeto describe the methodology of transurethral seminal vesiculoscopy and the anatomy of the area of the verumontanum, and to determine the safety of this procedure, especially in terms of postoperative complications.MethodsThis retrospective observational study enrolled 144 patients with intractable hematospermia from May 2011 and August 2019. A 4.5/6.5-Fr vesiculoscope was inserted into the seminal vesicle to deal with the positive findings. The solution of quinolones was used to rinse each seminal vesicle.ResultsIn this study, Transurethral seminal vesiculoscopy was successfully performed in 139 patients (96.53%). Hematospermia was alleviated or disappeared in 116 (80.56%) patients by less than half a year after surgery. Common intraoperative manifestations were hemorrhage, stones, utricle polyps and cysts. The surgical approach in our study were categorized into four types, including 24 (16.7%), 73 (50.7%), 42 (29.2%), and 5 (3.5%) cases in Type A (natural opening of the ejaculatory duct), B (trans-duct fenestration), C (trans-utricle fenestration), and D (not founded), respectively. Sexual function change was recorded in 12 patients of 111 patients, all by the method of trans-utricle fenestration, including 8 (7.21%), 3 (2.70%), and 1 (0.90%) patients in shorter intravaginal ejaculatory latency time, worse erection hardness and loss of orgasm, respectively.ConclusionTransurethral seminal vesiculoscopy is an effective and safe procedure for the management of hematospermia. The anatomy of the distal seminal tract should be understood more deeply and Wu’method (uncover-curtain method) needs to be promoted to verify its universality and safety. Besides, the complications of the function dysfunction should be discussed in the future in multi-center clinical trials.

Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia: A single-center, prospective, observational study.

This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy (TSV) guided by real-time transrectal ultrasonography (TRUS) in managing persistent hematospermia. A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center, prospective, observational study. The median follow-up period was 36.5 (range: 8.0–97.5) months. TSV was successfully performed in 272 (96.8%) patients. The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum. Seven (2.6%), 74 (27.2%), 64 (23.5%), and 127 (46.7%) patients had Types I (through the ejaculatory duct in the urethra), II (through the ejaculatory duct in the prostatic utricle), III (transutricular fenestration through a thin membrane), and IV (real-time transrectal ultrasound-guided transutricular fenestration) approach, respectively. In patients who successfully underwent surgery, bleeding occurred in the seminal vesicle in 249 (91.5%) patients. Seminal vesiculitis, calculus in the prostatic utricle, calculus in the ejaculatory duct, calculus in the seminal vesicle, prostatic utricle cysts, and seminal vesicle cysts were observed in 213 (78.3%), 96 (35.3%), 22 (8.1%), 81 (29.8%), 25 (9.2%), and 11 (4.0%) patients, respectively. Hematospermia was alleviated or disappeared in 244 (89.7%) patients 12 months after surgery. Fifteen patients had recurrent hematospermia, and the median time to recurrence was 7.5 (range: 2.0–18.5) months. TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.

Guiding role of seminal tract anatomical study in transurethral seminal vesiculoscopy.

IntroductionThere have been problems with low qualification operator-related complications and failures of transurethral seminal vesiculoscopy (TSV) in China.AimTo study the guiding role of seminal tract anatomical study (STAS) in TSV.Material and methodsWe performed STAS to study the structure, morphology, duct trajectory, and anatomical relationships between the seminal vesicles and the adjacent tissue in pelvic specimens from 12 adult cadavers. Then the surgical effects and complications of 82 cases of TSV performed by 3 doctors were retrospectively studied to compare the difference between the two groups of before and after the anatomical study.ResultsThe anatomical studies of the 12 adult cadaveric pelvis specimens identified the lengths and widths of the right- and left-side seminal vesicles and tracts. The TSV can treat lesions located in the distal seminal tract and vesicle, but proximal lesions cannot be reached, which is an anatomical limitation of this technique. There were significant differences in the surgical times and the surgical validity rates between the 2 groups.ConclusionsOur anatomical study of the seminal tract and seminal vesicles is valuable for guiding TSV in clinical practice.

A 30-year retrospective study of rare ectopic seminal tract opening cases.

Ectopic seminal tract opening is a rare congenital malformation. Until recently, there has been a lack of comprehensive reporting on the condition. The purpose of this retrospective study is to summarize the experience of diagnosis and treatment of this condition based on 28 clinical practice cases throughout the past 30 years. We conducted auxiliary examinations on such patients including routine tests, imaging examinations, and endoscopy. Among these 28 cases, there were ectopic opening of vas deferens into enlarged prostatic utricles (6 cases); ejaculatory ducts into enlarged prostatic utricles, Müllerian ducts cysts, and urethras (18 cases, 2 cases, and 1 case, respectively); and ectopic opening of the unilateral vas deferens and the contralateral ejaculatory duct into enlarged prostatic utricle (1 case). The size of the enlarged prostatic utricle, the type of ectopic seminal tract opening, and the opening's location effectively assisted in the selection of clinical treatment methods, including transurethral fenestration of the utricle, transurethral cold-knife incision, open operation, laparoscopic operation, and conservative treatment. Satisfactory effect was achieved during follow-up. In conclusion, a definite diagnosis and personalized treatment are especially important for patients with ectopic seminal tract opening.

Relationship between leukocytospermia, reproductive potential after assisted reproductive technology, and sperm parameters: a systematic review and meta-analysis of case-control studies.

The association of leukocytospermia with male fertility is still under debate. To evaluate the impact of leukocytospermia (≥1×106 white blood cells/mL of semen, according to the World Health Organization) in men attending a fertility clinic for couple subfertility, on fertility outcomes after assisted reproductive technology (ART) and on semen quality. A systematic review with meta-analysis of case-control studies reporting mean±standard deviation for values of different seminal parameters (sperm concentration, progressive motility, sperm morphology, sperm DNA fragmentation, semen volume, and Ph) and fertilization rate (FR), or the odds ratio (OR) for clinical pregnancy rate (PR) per cycle after ART in leukocytospermic and non-leukocytospermic patients was performed. A literature search was carried out in MEDLINE and SCOPUS for English-language studies published till June 2018. Twenty-eight case-controlled retrospective studies met the inclusion criteria, comparing fertility outcomes after ART or semen parameters in men with or without leukocytospermia. FR and PR after ART were not significantly different in the two groups. Leukocytospermic samples showed a lower sperm concentration (pooled SMD=-0.14; 95% CI: -0.28, -0.01, I2 =71%, pfor heterogeneity <0.00001) and a lower progressive motility (pooled SMD=-0.18; 95% CI: -0.29, -0.06; I2 =59%, pfor heterogeneity <0.0001). However, the significant differences disappeared, along with the large inter-study heterogeneity, when analyses were restricted to studies clearly reporting the inclusion of men without clinical evidence of seminal tract infection. Leukocytospermia in men seeking consultation for couple subfertility is not associated with a reduced fertility after ART and with altered semen quality in populations asymptomatic for genital tract infection. Therefore, the current clinical criteria for definition of leukocytospermia should be re-assessed in subfertile couples attending a fertility clinic.