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Ugeskrift For Laeger Nov 2021Impaired male fertility contributes to at least 50% of cases of couple infertility. Azoospermia is found in 1-2% of the male population. In the diagnostic workup,... (Review)
Review
Impaired male fertility contributes to at least 50% of cases of couple infertility. Azoospermia is found in 1-2% of the male population. In the diagnostic workup, genetic and endocrine as well as lifestyle factors may be considered. Spermatozoa can be retrieved surgically in many cases of azoospermia, aspermia and difficult cases of retrograde ejaculation. Such spermatozoa can be used for injection into the oocytes of the female partners by intracytoplasmic sperm injection. Treatment with follicle stimulating hormone is only indicated in hypogonadotrophic hypogonadism. This review is a summarisation of the current male infertility treatment modalities.
Topics: Azoospermia; Female; Humans; Hypogonadism; Infertility, Male; Male; Sperm Injections, Intracytoplasmic; Spermatozoa; Testis
PubMed: 34852902
DOI: No ID Found -
Military Medical Research Apr 2022Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an...
Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline "2018 Standard Edition". However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons' surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons' skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.
Topics: Aged; Humans; Male; Prostate; Prostatic Hyperplasia; Quality of Life; Transurethral Resection of Prostate; Urethral Stricture
PubMed: 35361280
DOI: 10.1186/s40779-022-00371-6 -
Translational Andrology and Urology Aug 2016Although there has been an increased interest on premature ejaculation in the recent years, our understanding regarding the disorders of retrograde ejaculation, painful... (Review)
Review
Although there has been an increased interest on premature ejaculation in the recent years, our understanding regarding the disorders of retrograde ejaculation, painful ejaculation and hematospermia remain limited. All three of these conditions require a keen clinical acumen and willingness to engage in thinking outside of the standard established treatment paradigm. The development of novel investigational techniques and treatments has led to progress in the management of these conditions symptoms; however, the literature almost uniformly is limited to small series and rare randomised trials. Further investigation and randomised controlled trials are needed for progress in these often challenging cases.
PubMed: 27652230
DOI: 10.21037/tau.2016.06.05 -
Biology Apr 2022Ejaculation is a reflex and the last stage of intercourse in male mammals. It consists of two coordinated phases, emission and expulsion. The emission phase consists of... (Review)
Review
Ejaculation is a reflex and the last stage of intercourse in male mammals. It consists of two coordinated phases, emission and expulsion. The emission phase consists of secretions from the vas deferens, seminal vesicle, prostate, and Cowper's gland. Once these contents reach the posterior urethra, movement of the contents becomes inevitable, followed by the expulsion phase. The urogenital organs are synchronized during this complete event. The L3-L4 (lumbar) segment, the spinal cord region responsible for ejaculation, nerve cell bodies, also called lumbar spinothalamic (LSt) cells, which are denoted as spinal ejaculation generators or lumbar spinothalamic cells [Lst]. Lst cells activation causes ejaculation. These Lst cells coordinate with [autonomic] parasympathetic and sympathetic assistance in ejaculation. The presence of a spinal ejaculatory generator has recently been confirmed in humans. Different types of ejaculatory dysfunction in humans include premature ejaculation (PE), retrograde ejaculation (RE), delayed ejaculation (DE), and anejaculation (AE). The most common form of ejaculatory dysfunction studied is premature ejaculation. The least common forms of ejaculation studied are delayed ejaculation and anejaculation. Despite the confirmation of Lst in humans, there is insufficient research on animals mimicking human ejaculatory dysfunction.
PubMed: 35625414
DOI: 10.3390/biology11050686 -
Fertility and Sterility Sep 2021Ejaculatory dysfunction is not only psychologically distressing but can become a significant obstacle for men who wish to conceive. Dysfunction comes in the form of... (Review)
Review
Ejaculatory dysfunction is not only psychologically distressing but can become a significant obstacle for men who wish to conceive. Dysfunction comes in the form of anejaculation, reduced ejaculation, retrograde ejaculation, painful ejaculation, or premature ejaculation. Most treatments for lower urinary tract symptoms related to benign prostatic hyperplasia, which commonly occurs in aging men, carry significant risks of absent, reduced, or retrograde ejaculation. This review focuses on such risks that accompany both the medical and surgical management of lower urinary tract symptoms/benign prostatic hyperplasia and how these risks impact male fertility.
Topics: 5-alpha Reductase Inhibitors; Adrenergic alpha-Antagonists; Ejaculation; Fertility; Humans; Infertility, Male; Lower Urinary Tract Symptoms; Male; Premature Ejaculation; Prostatectomy; Prostatic Hyperplasia; Recovery of Function; Risk Factors; Treatment Outcome
PubMed: 34462095
DOI: 10.1016/j.fertnstert.2021.07.1199 -
Ugeskrift For Laeger Jan 2020This review summarises the current knowledge of ejaculatory dysfunction, which is a group of prevalent sexual disorders with a substantial impact on sexual health of men... (Review)
Review
This review summarises the current knowledge of ejaculatory dysfunction, which is a group of prevalent sexual disorders with a substantial impact on sexual health of men and their partners. A thorough medical history is the most important evaluation tool. Several treatments for premature ejaculation are available; however, a successful treatment outcome depends on pre-treatment alignment of expectations. Infertility due to delayed ejaculation, retrograde ejaculation or anejaculation can be treated effectively.
Topics: Ejaculation; Humans; Male; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Treatment Outcome; Urologic Diseases
PubMed: 32052738
DOI: No ID Found -
Reproductive Medicine and Biology Oct 2019Ejaculatory dysfunction (EjD) is a complex pathological condition compared to erectile dysfunction (ED). A definitive classification of EjD is not established, and... (Review)
Review
BACKGROUND
Ejaculatory dysfunction (EjD) is a complex pathological condition compared to erectile dysfunction (ED). A definitive classification of EjD is not established, and treatment is often delayed. Owing to its association with infertility, EjD is a serious concern, particularly in men of reproductive age.
METHODS
The authors performed a literature search to identify the latest articles and overseas guidelines for review.
RESULTS
Our new classification categorizes men into two groups as follows: (1) men with inability to ejaculate (retrograde ejaculation, anejaculation, intravaginal ejaculatory dysfunction) and (2) men requiring an abnormal time for ejaculation (premature ejaculation, delayed ejaculation). In Japan, the number of men presenting with an inability to ejaculate is greater than those presenting with premature ejaculation. Pharmacotherapy is the first-line treatment for the management of these EjD patients. Behavioral therapy is added to pharmacotherapy depending on the case. Penile vibratory stimulation or electroejaculation is indicated in some men with retrograde ejaculation and anejaculation. In cases who hope for a baby, assisted reproductive technology should be simultaneously considered not to waste time.
CONCLUSION
It is important to distinguish between EjD and ED and accurately diagnose the type of EjD for optimal treatment of this condition.
PubMed: 31607793
DOI: 10.1002/rmb2.12289 -
Translational Andrology and Urology Aug 2016A large body of literature on diminished ejaculatory disorders has been generated without the use of a clear diagnostic definition. Many studies have not distinguished... (Review)
Review
A large body of literature on diminished ejaculatory disorders has been generated without the use of a clear diagnostic definition. Many studies have not distinguished between the orgasm and ejaculation disorders leading to doubtful results. Delayed ejaculation (DE) is one of the diminished ejaculatory disorders, which range from varying delays in ejaculatory latency to a complete inability to ejaculate. The present review is aimed at providing a comprehensive overview of the current knowledge on the definition and epidemiology of diminished ejaculatory disorders. We focus on the acquired diseases, such as benign prostatic hyperplasia (BPH) and specific drug regimens that may cause an iatrogenic form of ejaculatory disorder. In addition, the impact of aging is discussed since the prevalence of DE appears to be moderately but positively related to age. Finally, we also focus on the importance of the hormonal milieu on male ejaculation. To date, evidence on the endocrine control of ejaculation is derived from small clinical trials, but the evidence suggests that hormones modulate the ejaculatory process by altering its overall latency.
PubMed: 27652226
DOI: 10.21037/tau.2016.05.10 -
Translational Andrology and Urology Aug 2018Although erectile dysfunction is the most common disorder of male sexual health, ejaculatory dysfunction is the most common form of sexual dysfunction experienced by... (Review)
Review
Although erectile dysfunction is the most common disorder of male sexual health, ejaculatory dysfunction is the most common form of sexual dysfunction experienced by men. Ejaculatory dysfunction covers a broad range of disorders that we have divided into four main categories: premature ejaculation, delayed ejaculation (DE)/anorgasmia, unsatisfactory sensation of ejaculation (including painful ejaculation and ejaculatory anhedonia), and absent ejaculate (including retrograde ejaculation and aspermia). We also cover several special scenarios including hematospermia, spinal cord injury and fertility with anejaculation. In this paper, we will review the anatomy and pathophysiology of normal ejaculation to establish the baseline knowledge of how this pathway can go awry. We will then briefly review the critical diagnostic criteria, pertinent steps in evaluation, risk factors, and causes (if known) for each of the ejaculatory disorders. Finally, the bulk of the paper will discuss current management strategies of each disorder.
PubMed: 30211060
DOI: 10.21037/tau.2018.06.20 -
Fertility and Sterility May 1987
Topics: Ejaculation; Humans; Male; Sperm Count; Sperm Motility
PubMed: 3569569
DOI: 10.1016/s0015-0282(16)59189-4