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Objectives: To investigate the association between androgen deficiency symptoms and sexual function, serum testosterone, and therapy in testicular cancer survivors (TCS). Methods: A total of 83 patients treated for testicular cancer were investigated. All patients completed the International Index of Erectile Function-15 and the Aging Males Symptoms scale. Age, months of follow-up, treatment modality, and serum testosterone levels were measured. Scores for the erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction subdomains of the International Index of Erectile Function-15 were calculated. Results: Overall, almost half (47.0%) of TCS experienced clinical symptoms of androgen deficiency, 28.9% had erectile dysfunction, and 25.3% had laboratory-proven hypogonadism. TCS with clinical symptoms of androgen deficiency were significantly older (median age 45.0 vs 37.5 years, P = .001) and had a longer follow-up (median follow-up 48.0 vs 39.5 months, P = .985, respectively) than TCS without symptoms. TCS with clinical symptoms had significantly lower scores for erectile function (P = .004), orgasmic function (P = .05), sexual desire (P = .001), intercourse satisfaction (P = .005), and overall satisfaction (P = .001) than those without symptoms. The aging males'' symptoms correlated significantly with erectile dysfunction (r = −0.410, P = .001). In TCS with symptoms, age (r = −0.457, P = .003), but not treatment modalities (r = 0.223, P = .173) or testosterone levels (r = 0.205, P = .210), correlated with sexual function. Conclusions: Clinical symptoms of androgen deficiency were associated with sexual problems and increasing age, but not with serum testosterone or treatment. [Copyright &y& Elsevier]

Objectives: High-grade prostate cancer is associated with low serum testosterone levels, which generally recover after radical prostatectomy. The cause of this low testosterone level is unclear, and it has been hypothesized that cancer cells produce a factor that disturbs the pituitary-gonadal axis. Inhibin is a hormone that has a negative feedback effect on this axis. The aim of this study was to investigate the role of serum inhibin in patients with prostate cancer. Methods: The serum hormone levels of the pituitary-gonadal axis, including inhibin levels, in patients with prostate cancer were compared with those in patients with benign prostatic hyperplasia. Testosterone levels of less than 3 ng/mL were classified as hypogonadal. Prostate cancer was classified according to Gleason score as high grade (Gleason score 7 to 10) or low grade (Gleason score 2 to 6). Results: A total of 196 men (126 with prostate cancer and 70 with benign prostatic hyperplasia) were entered into the study. The serum inhibin levels did not differ significantly between the patients with benign prostatic hyperplasia and those with prostate cancer (150.0 versus 131.75 pg/mL, P = 0.062), between men with hypogonadal and eugonadal disease (143.0 versus 146.5 pg/mL, P = 0.573), or between those with low-grade and high-grade cancer (151.5 versus 146.0 pg/mL, P = 0.830). Men with high-grade cancer had lower levels of serum testosterone than did those with low-grade cancer (3.49 versus 4.09 ng/mL, P = 0.056). Conclusions: The results of our study have shown that although high-grade prostate cancer is associated with low serum testosterone levels, inhibin does not appear to be the cause of this phenomenon. [Copyright &y& Elsevier]

Objective: To investigate the spontaneous variation of leukocytospermia (>1 million/mL) in semen samples from infertile men. Design: Prospective cohort study. Setting: Andrologic clinic at university hospital. Patient(s): Ninety-nine men evaluating for infertility causes. Intervention(s): Two semen analyses according the World Health Organization criteria combined with urologic investigation without any treatment. Main Outcome measure(s): Spontaneous (downward/upward) variation in leukocyte count, sperm concentration, total motility, and morphology between the two semen samples. Result(s): In the first semen analysis, 21% of men had leukocytospermia. By the second analysis, leukocyte concentrations were within the normal range in 9 of these 21 men, corresponding to a downward variation of 43%. In contrast, 7 of 78 patients with normal leukocyte levels at the first analysis had leukocytospermia at the second analysis, corresponding to an upward variation of 9%. The upward variation rates for sperm concentration, total motility, and morphology were 4%, 17%, and 4%, respectively. Downward variation rates were considerably higher for total motility and morphology (30% and 28%, respectively). Conclusion(s): The rate for spontaneous downward variation of leukocytospermia in the absence of treatment was 43% in this study. This rate should be taken into consideration when treating infertile men with leukocytospermia, because effective medical therapy is still lacking. [Copyright &y& Elsevier]

Objective: To assess the quality and activity of spermatogenesis in the contralateral healthy testicle at the time of orchiectomy and to assess whether any tumor-related factor such as tumor type or vascular invasion is a risk factor for impaired spermatogenesis. Design: Retrospective cohort study. Setting: University hospital. Patient(s): Seventy-six patients undergoing orchiectomy for seminoma or nonseminomatous germ cell tumor (NSGCT). Intervention(s): Open biopsy of contralateral healthy testicle at the time of orchiectomy. Main Outcome Measure(s): Quality of spermatogenesis using median and highest Johnsen score in correlation with histopathologic tumor type, vascular invasion, and serum tumor markers and hormone levels. Result(s): Contralateral spermatogenesis is reduced in seminomas and in NSGCTs, with median Johnsen scores of 8.9 and 8.6, respectively. Similar results were seen in tumors with vascular invasion (median Johnsen score 8.8 [range 8.2–9.5]) and without vascular invasion (median Johnsen score 8.8 [range 8.1–9.2]). Areas with good-quality spermatogenesis were found in 88.9% of seminoma and 92.5% of NSGCT biopsies. Conclusion(s): Testicular cancer is associated with impaired spermatogenesis, but neither the histopathologic tumor type nor the presence of vascular invasion correlated with significantly reduced spermatogenesis. [Copyright &y& Elsevier]

Objectives: To investigate the prevalence of hypogonadism in correlation with androgen deficiency symptoms in testicular cancer survivors. Methods: Luteinizing hormone, follicle-stimulating hormone, serum testosterone, dehydroepiandrosterone, and sex hormone binding globulin levels were determined in patients who had undergone treatment for unilateral testicular cancer. Patients with serum testosterone levels less than 3.0 ng/mL were classified as hypogonadal; all other testosterone levels signified eugonadism. Additionally, all patients completed the Aging Males’ Symptoms scale: scores of less than 26 indicated no androgen deficiency symptoms and scores greater than 27 indicated symptoms. Results: According to testosterone level, 18 (26.5%) of 68 patients were hypogonadal and 50 (73.5%) were eugonadal (P = 0.456). According to the Aging Males’ Symptoms scale, 23 (33.8%) of the 68 patients had androgen deficiency symptoms and 45 (66.2%) had no symptoms (P = 0.267). The median testosterone level was 3.6 ng/mL in all patients with androgen deficiency symptoms, 2.4 ng/mL in patients with androgen deficiency symptoms who were hypogonadal, and 4.7 ng/mL in those with androgen deficiency symptoms who were eugonadal. Conclusions: Testicular cancer survivors are at risk of developing hypogonadism and androgen deficiency symptoms. However, no specific testosterone threshold could be detected at which symptoms start, indicating that each patient has an individual testosterone threshold for androgen deficiency symptoms. [Copyright &y& Elsevier]

Objective: To investigate the correlation between leukocytospermia, bacteriospermia, and clinical signs of infection and to evaluate antiinflammatory therapy. Design: Prospective nonrandomized study. Setting: Andrologic clinic at university hospital. Patient(s): A total of 56 patients were evaluated, and 12 of them received further treatment with a Cox-2 inhibitor. Intervention(s): Semen analysis and clinical investigation were done according to World Health Organization guidelines. Serum levels of leukocytes, C-reactive protein (CRP), and prostate-specific antigen (PSA) were measured from blood samples. Main Outcome Measure(s): Sperm concentration, leukocyte concentration, serum leukocyte count, CRP, PSA, bacterial growth. Result(s): Leukocytospermia (>1 × 106/mL) was present in 60.7% of the semen samples, significant pathogenic bacterial growth was detectable in 35.7%, and 14.3% of the samples fulfilled the criteria for ejaculate signs of infection. All serum parameters were within the normal range. In abacterial leukocytospermia, treatment with a Cox-2 inhibitor decreased leukocytospermia from 5.5 × 106/mL to 1.0 × 106/mL (P=.001) and increased sperm concentration from 22.5 × 106/mL to 48.0 × 106/mL (P=.02). Conclusion(s): There was no evidence of an immune response in the peripheral blood system. In abacterial leukocytospermia, treatment with a Cox-2 inhibitor seems to be able to reduce leukocytospermia and increase sperm count. [Copyright &y& Elsevier]

Objective: To investigate semen quality in infertile men from an urban population over an 18-year period. Design: Retrospective study. Setting: Andrology clinic at a city university hospital. Patients: A total of 9,327 men were referred to the clinic for infertility investigation. After excluding those with azoospermia, 7,780 samples were evaluated. Intervention(s): Semen samples were analyzed within half an hour of production using computer-automated semen analysis and phase microscopy. Main Outcome Measure(s): Sperm concentration, morphology, and motility; semen pH and leukocyte concentration; and patient age. Result(s): The median patient age over the study period was 31.6 years, with an increase from 30.8 years in 1986 to 34.4 years in 2003. The median sperm concentration was 10.25 million/mL for the entire period, with a decline from 27.75 million/mL in 1986 to 4.60 million/mL in 2003. The median proportion of normally shaped spermatozoa was 15%, and the proportion of motile spermatozoa was 21%. The pH increased from 7.4 in 1986 to 7.9 in 2003, and the median leukocyte concentration was 1.50 million/mL. Conclusion(s): A constant decline in median sperm concentration was found in the infertile men. The reason for this remains unclear, although the high pH and leukocyte concentration indicates the involvement of infection. [Copyright &y& Elsevier]

Abstract: Objectives: To investigate the influence of treatment for testicular cancer on the pituitary-gonadal axis and sexual function in long-time survivors after unilateral orchiectomy. Methods: Blood was drawn from patients treated for testicular cancer during routine oncologic follow-up for measurement of luteinizing hormone, follicle-stimulating hormone, sexual hormone-binding globulin, testosterone, and bioavailable testosterone. Sexual function was evaluated using the International Index of Erectile Function 15-item (IIEF-15) questionnaire. Patients were grouped according to treatment: group 1 followed a surveillance strategy, group 2 received two cycles of carboplatin monotherapy, and group 3 underwent cisplatin, etoposide, and bleomycin chemotherapy. Results: No statistically significant difference was found in the serum hormonal levels among the three groups, and all hormonal levels were within the 95% confidence range, except for follicle-stimulating hormone. The median serum testosterone level was 3.5 ng/mL in group 1, 3.9 ng/mL in group 2, and 4.2 ng/mL in group 3. In group 1, the median IIEF-15 score was 64.0, and the median Erectile Function (EF) domain score was 28. The median scores in groups 2 and 3 were 62.5 for IIEF-15 and 27.5 for EF and 65.0 for IIEF-15 and 30.0 for EF, respectively. No correlation was found between testosterone level and IIEF-15 or EF score. Conclusions: None of the treatments investigated had a significant influence on the serum hormonal levels in long-time survivors of testicular cancer. Patients undergoing chemotherapy have no greater risk of developing a hormonal disorder than those following a surveillance strategy, and therapy for testicular cancer is not a risk factor for erectile dysfunction. [Copyright &y& Elsevier]

The aim of this study was to investigate the fertilization and pregnancy rates of artificial reproductive technologies using semen samples without (<1 × 106/mL) and with (≥1 × 106/mL) leukocytospermia. The overall fertilization rate was 63.4% (range, 44.4–87.5%) in nonleukocytospermic couples and 64.3% (range, 45.3–100.0%) in leukocytospermic couples, whereas the corresponding pregnancy rates were 34.5% and 50%, respectively. These results show that leukocytospermia may not necessarily have a negative effect on outcome after either in vitro fertilization or intracytoplasmic sperm injection. [Copyright &y& Elsevier]

Summary: Background & aims: Nearly 50% of male infertility is idiopathic and to date there still is no proven therapy. We evaluated the effect of a non prescription nutraceutical containing eight micronutrients on sperm quality in males with idiopathic sub-fertility. Methods: This open comparative pilot study was carried out at the Fertility Center IMI, Vienna, Austria. A total of 132 sub-fertile males (active treatment group) were invited to participate and take two daily capsules of the active compound for a three month period between the first and the follow-up semen analysis. Each capsule contained L-carnitine, L-arginine, zinc, vitamin E, glutathione, selenium, coenzyme Q10 and folic acid. Sub-fertile men receiving no active treatment served as controls (n = 73). Main outcome measure was the standardized semen analysis. Results: All parameters evaluated by semen analysis significantly increased after 3 months of treatment with the active compound. Median ejaculatory volume, sperm cell density, sperm motility (progressive and total) and normal morphology rate increased by 33.3%, 215.5%, 83.1%, 36.4% and 23.0%, respectively. These increments were significantly higher than those observed among controls. In the active treatment group no side effects were encountered and a total of 34 pregnancies were reported after 6 months follow-up whereas 11 were reported in the control group. Conclusion: Semen analysis significantly improved in sub-fertile men after treatment with an active micronutrient compound, leading to pregnancies without any adverse effects. [ABSTRACT FROM AUTHOR]

Objective: To examine simultaneously the levels of hydrogen peroxide (H2O2) and superoxide (O2 −•) using chemiluminescence and flow cytometry. Design: Prospective laboratory study. Setting: Reproductive research lab in a tertiary hospital. Patient(s): Semen samples from 18 healthy male volunteers. Intervention(s): Sperm preparation and measurement of reactive oxygen species (ROS) by chemiluminescence using luminol and lucigenin before and after H2O2 exposure and by flow cytometry using dichlorofluorescin diacetate (DCFH-DA) for H2O2 and dihydroethidium (DHE) for O2 −•. Main Outcome Measure(s): Sperm count, motility, viability, and ROS levels. Result(s): Immature sperm fractions showed significantly higher levels of ROS measured by either luminol or lucigenin compared with the neat and mature fraction. ROS levels were detectable by flow cytometry in chemiluminescence-negative samples. Both mature and immature sperm fractions had a significantly higher percentage of cells positive for H2O2 compared with neat semen. On the other hand, the percentage of O2 −•-positive cells in neat semen was significantly higher compared with the percentage found in mature fractions but significantly lower than that in the immature sperm fractions. Conclusion(s): We recommend ROS measurement by flow cytometry on the basis that it requires a lower sperm count, is comparable to chemiluminescence, and has higher specificity for intracellular ROS in viable spermatozoa. Samples tested negative by chemiluminescence still may have high intracellular H2O2 generation that can be detected by flow cytometry. [Copyright &y& Elsevier]

Objectives: To evaluate a new method for differentiating inflammatory from noninflammatory prostatitis using the simple and rapid quantification of seminal macrophages and monocytes. Methods: Patients affected with chronic pelvic pain syndrome (CPPS) were classified as having the IIIA (n = 11) and IIIB (n = 30) subtypes according to the peroxidase positive leukocyte concentration in semen; 18 healthy individuals served as controls. Seminal inflammatory markers, including polymorphonuclear elastase, interleukin (IL)-6 and IL-8, and numbers of macrophages/monocytes (MMs) per 50 fields of 1000× magnification (high-power field [hpf]), were determined for all patients. Results: The numbers of MMs/50 hpf correlated significantly with the peroxidase positive leukocyte counts and IL-8, IL-6, and polymorphonuclear elastase levels (all P < .001). Data from the analysis of receiver operating characteristic curves (area under the curve 0.912 ± 0.073; P < .001) showed a sensitivity of 90.9% and specificity of 86.7% at a cutoff value of 5 MMs/50 hpf. The positive and negative predictive value was 71.4% and 96.3%, respectively. The median concentrations of IL-6, IL-8, and elastase in the patients with CPPS with ≥5 MMs/50 hpf differed significantly (P ≤ .002) from those in the patients with <5 MMs/50 hpf. Conclusions: The results of our study have shown that the quantification of seminal macrophages and monocytes is a simple, rapid, and reproducible technique by which to differentiate chronic prostatitis/CPPS IIIA from IIIB. [ABSTRACT FROM AUTHOR]

Objectives: To compare the results of preoperative scrotal color Doppler ultrasonography (CDS) and final diagnosis of subsequent surgical exploration in cases of suspected testicular torsion (TT). Methods: This retrospective study included 298 boys with acute scrotum whose clinical presentation was suspicious of TT and who subsequently underwent emergency surgery regardless of CDS results. Results: Mean patient age was 11.4 ± 4.1 years. The mean time of duration of symptoms up to surgical exploration was 26.4 ± 37.3 hours. All patients had standardized CDS of the scrotum. At surgery, 62 boys (20.9%) were diagnosed with TT, 168 (56.4%) with torsion of a testicular appendage (TA), and 24 (8.1%) with epididymitis. In 34 patients (11.4%), the cause of pain could not be identified during surgery. Overall CDS sensitivity, specificity, positive predictive value, and negative predictive value for TT diagnosis was 96.8%, 97.9%, 92.1%, and 99.1%, respectively. The mean age for the occurrence of TA and TT was 11.2 and 13.4 years, respectively (P <.0001). The peak incidence of TT was between age 14 and 16. Boys with TT sought medical attention statistically significantly earlier than those with TA or epididymitis obviously because of more severe pain (P <.0001). At the time of exploration for TT the affected testicle could be preserved in 32 boys (85.5%). In the remaining 9 boys the testis was considered nonviable and removed. Conclusions: About 20% of boys presenting with an acute scrotum actually have TT. CDS is a reliable tool to identify TT. [Copyright &y& Elsevier]