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Cryptorchidism is the most frequent defect of the male urogenital tract at birth. It represents a risk factor for primitive testiculopathy associated with long-term complications (infertility, testicular neoplasia, and hormonal changes). An only consensus exists: "children with bilateral cryptorchidism who are not treated in early age are certainly set to become infertile". The majority of Authors agrees that the cryptorchid testicle will be in for structural and functional alterations and the rate of infertility is inversely proportional to the age at the time of orchidopexy. Cryptorchidism causes secretory primitive testicular pathology responsible for infertility. It is correlated to a non-specific severe histopathological pattern that can be useful to predict future infertility at the moment of orchidopexy. Also cryptorchidism represents the major risk factor associated with germ cell testicular neoplasia (5-10 times more probably than a normal testicle) due to genetic, hormonal, environmental factors. [ABSTRACT FROM AUTHOR]

The treatment of male factor infertility is a rapidly developing field. The introduction of microsurgical fertilization techniques allows assisted conception units to treat couples who previously would not have benefited from in−vitro fertilization techniques. However, these techniques are only used for the minority of subfertile men in andrological practice. Many subfertile men are still treated pharmacologically or by sperm selection methods to enhance sperm fertilizing ability. Numerous pharmacological compounds have been described that enhance sperm motility and thus, potentially, sperm fertilizing capacity. This paper attempts to review these compounds and assess their role in treatment of the subfertile male. [ABSTRACT FROM PUBLISHER]

Purpose: The aim of this study was to compare the technical success between left spermatic vein (LSV) scleroembolisation achieved with the injection of sclerosant through a diagnostic catheter and through an occluding balloon (OB), in the treatment of male varicocele., Materials and Methods: From January 2012 to September 2013, we prospectively enrolled 100 patients with left varicocele and an indication for LSV scleroembolisation related to symptoms or spermiogram anomalies; patients were randomised to two groups (we wrote a list of 100 lines assigned casually with A or B and each patient was consecutively allocated to group A or B on the basis of this list). Patients in group A underwent injection of the sclerosing agent through an angiographic diagnostic catheter (free catheter technique) and patients in group B through an OB catheter (OB technique). In cases of incomplete occlusion of the LSV, the procedure was completed with coils. Total occlusion of the LSV at post-treatment phlebography during a Valsalva manoeuvre before any coil embolisation was considered a technical success. The rate of complications was also evaluated. The Fischer's test was used for statistical analysis., Results: We evaluated a total of 90 patients because five patients for each group were not included in the statistical analysis owing to technical problems or complications. In group A we had a technical success of 75.6 versus 93.4 % in group B, and the difference was statistically significant (P = 0.003); in particular, we had to complete the embolisation with insertion of coils in 11 cases (24.4 %) in group A, and in three cases in group B (6.6 %). In group A, LSV rupture occurred in four cases (8 %) so the procedure was completed by sclerosant injection through the OB located distally to the lesion. These patients were not considered for evaluation. In another case, a high flow shunt towards the inferior vena cava was detected, so the patient underwent OB injection to stop the flow to the shunt, and was not included for statistical evaluation. In group B, vein rupture with contrast leakage was noted in six cases (12 %); nonetheless, all the procedures were completed because the OB was positioned distally to the vessel tear, obviating any retrograde leakage of sclerosant. In group B, in five cases (10 %), we were unable to advance the OB though the LSV ostium so the procedures were completed with the diagnostic catheter and not considered for statistical evaluation., Conclusion: On the basis of our data, the embolisation of the LSV obtained by injecting the sclerosant through an OB rather than through a diagnostic catheter seems to be more effective in achieving total vein embolisation, as well as allowing a controlled injection of sclerosant even in cases of vein rupture.

Aim: Different authors showed clear correlations between diabetic disease and male reproductive damage (es. rate of nuclear DNA fragmentation, mithocondrial DNA mutations, increased of enzymatic glication products, etc...). The aim of this observational study carried out on a selected group of diabetic patients (average age 36) with primary infertility was to determine reactive oxygen species (ROS) production in sperm in connection with duration of disease, glicemic control and seminal vescicular emptying in the post ejaculatory., Methods: All diabetic patients enrolled (20) were submitted to two consecutive spermiograms, ROS sperm analysis and transrectal ultrasound evaluation before and after ejaculation, performed according to standard conventional methods., Results: Diabetic patients with better glicometabolic compensation (HBAI C < 7%) and duration of disease <5 years showed spermatic rate of ROS production significantly lower regarding the group with worse glicemic control and greater duration of disease. Diabetic patients with altered vescicular emptying in the post ejaculatory showed spermatic rate of ROS production significantly higher regarding patients with normal vescicular emptying., Conclusion: The degree of oxidative stress in sperm of diabetic patients follows the course of the other chronic complications, getting worse in connection with duration of disease and glicemic control. Altered vescicular emptying in the post ejaculatory could be an important mechanism for initiation of this higher response.

Cryptorchidism is the most frequent defect of the male urogenital tract at birth. It represents a risk factor for primitive testiculopathy associated with long-term complications (infertility, testicular neoplasia, and hormonal changes). An only consensus exists: "children with bilateral cryptorchidism who are not treated in early age are certainly set to become infertile". The majority of Authors agrees that the cryptorchid testicle will be in for structural and functional alterations and the rate of infertility is inversely proportional to the age at the time of orchidopexy. Cryptorchidism causes secretory primitive testicular pathology responsible for infertility. It is correlated to a non-specific severe histopathological pattern that can be useful to predict future infertility at the moment of orchidopexy. Also cryptorchidism represents the major risk factor associated with germ cell testicular neoplasia (5-10 times more probably than a normal testicle) due to genetic, hormonal, environmental factors.

Aim: In the management of the chronic complications caused by diabetes mellitus, an important role is played to andrological problematics, which require a specialistic evaluation combined in order to concretely contribute to the improvement of quality of life of such patients. The erectile disfunction in the diabetic patient notoriously correlates with the main cardiometabolics risk factors, and recently it has been pointed out how after chronic use of inhibitors of the phospodiesterase-enzyme-5 (PDE5-I) it is possible to improve the vascular response profile, evaluated through ecolor doppler (ECD) penile dynamic. The incidence of the vascular extra-genital pathology in the patients with ED of organic arterial type has also been observed, underlining in particular the correlation with a low value of the systolic peak at penile level. Little attention has been paid to other andrologic pathologies that preliminary clinic evidences or less followed research points have individuated as real emerging problems; among them there are: 1) the hypogonadism in adult age (late onset hypogonadism); 2) the lower urinary tract symptoms (LUTS) correlated to the condition of prostatic hypertrophy; 3) the infections of the male genito-urinary tract with different characterization for imaging respect to the not diabetic population; 4) different sexual disorders; 5) implications over the male reproductive sphere., Methods: Retrospective analysis of the clinic, laboratory (spermatic, microbiologic and hormonal), ultrasonography integrated data, led on a diabetic population examined during the last 3 years; finalized at the estimation of the distribution of the andrological pathology characterizing such population, with the comparison of the data on the basis of years of duration disease, grade of glicometabolic compensation and levels of total testosterone., Results: ED was present in 16.36% of the examined population; 50% showed vascular arterial form; hypogonadism was present in 10% of the population. A very high prevalence of subfertility was observed 51.82%. The ultrasonographic characterization of the didimo-epididimary and prostatic-vesicular regions showed reduced testicular volume the 16.36% of cases, increase of the prostatic glandular volume in 45.45% of cases, altered thickness of the seminal vesicles in the 24.45% of cases. The microbiologic characterization evidences the contemporary positivity of the 3 prechosen indicators (spermiocolture, urinocolture, leukocytospermia) in 34.55% of patients., Conclusions: The study has contributed to enrich the data relative to the heterogeneity of the clinic-andrological presentation of the diabetic patient.

Aim: Recently, the clinic characterization of the gonadic male function has been put in tight correlation on the pathogenetic level with the main variables forming the condition of metabolic syndrome (MS); probably the serum testosterone (T) concentration in males is to be considered as an additional parameter completely related to the traditional clinical-metabolic findings. Currently the matter of the substitutive hormonal therapy with androgens is apparently influenced by some important unresolved aspects: 1) who really benefits from the T therapy? 2) are the actual dosage methods of T reliable? 3) which vascular and metabolic targets are to be monitored during the T therapy?, Methods: In an analytical longitudinal study, carried out 12 months long on 60 men (average age 58 years, range 54-63 years) affected by metabolic syndrome (MS) and combined hypogonadism late onset (LOH), authors have evaluated the clinical response (androgenic asset, non-invasive hospital monitoring of the arterial pressure, lipidic asset study, body composition and the biologic resistance to the insulinic action) after conventional medical therapy (insulin-sensibilizing and anti-hypertensive) and after substitutive hormonal therapy with testosterone (T) by transdermic way. A group of five patients with MS and LOH, not treated, was used as group of control., Results: The group of patients treated with T showed a profile of clinical response better than the group of controls., Conclusions: In conclusion, the seric determination of T is useful to better characterize the dismetabolic patient at the moment of the first level active medical therapy planning on the controls of the main risk factors constituting MS, expressing a potential role of conditioning.

A method has been developed for quantifying the residual cytoplasm present in the midpiece of human spermatozoa, based upon the imaging of NADH oxidoreductase activity. This procedure used NADH and nitroblue tetrazolium as electron donor and acceptor, respectively, and resulted in the discrete staining of the entire midpiece area, including the residual cytoplasm. Image analysis techniques were then used to generate binary images of the midpiece, from which objective measurements of this cellular domain could be undertaken. Such data were found to be highly correlated with biochemical markers of the cytoplasmic space, such as creatine kinase (CK) and glucose-6-phosphate dehydrogenase (G-6-PDH), in sperm populations depleted of detectable leukocyte contamination. Morphometric analysis of the sperm midpiece was also found to reflect semen quality in that it predicted the proportion of the ejaculate that would be recovered from the high-density region of Percoll gradients and was negatively correlated with the movement and morphology of the spermatozoa in semen. Variation in the retention of excess residual cytoplasm was also associated with differences in the functional competence of washed sperm preparations, both within and between ejaculates. Thus, within-ejaculate comparisons of high- and low-density sperm subpopulations revealed a relative disruption of sperm function in the low-density fraction. This disruption was associated with the presence of excess residual cytoplasm in the midpiece, high concentrations of cytoplasmic enzymes, and the enhanced-generation reactive oxygen species (ROS). Functional differences between individual high-density Percoll preparations were also negatively correlated with the area of the midpiece and the corresponding capacity of the spermatozoa to generate ROS. These findings suggest that one of the factors involved in the etiology of defective sperm function is the incomplete extrusion of germ cell cytoplasm during spermiogenesis as a consequence of which the spermatozoa experience a loss of function associated with the induction of oxidative stress.