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Varicocele is a common disease that occurs in 35–40% of men with primary infertility and in 80% of men with secondary infertility Disturbance of microcirculation in the testicles, which occurs during varicocele, lead to ischemia and hypoxia of the testicles, which provoke degenerative changes in all testicular cell populations. Retrograde blood flow from the testicular vein and the external spermatic vein into pampiniform venous plexus leads to an increase of hydrostatic pressure in the testicular vascular system and rise of temperature, and it also contributes to the development of sterile inflammation. Oxidative stress, nitrosative stress, and hypoxia are generally recognized elements of the pathogenesis of infertility associated with varicocele. It is known that when the supraphysiological level of reactive oxygen species in the ejaculate is reached, their concentration disrupts the structure and function of spermatozoa. Nitric oxide (NO) is involved in the regulation of body temperature, NO-dependent mechanisms may contribute to the increased scrotal temperature during varicocele. The physiological concentration of NO pro duced by testicular macrophages stimulates steroidogenesis in Leydig cells. However, in the presence of certain reactive oxygen species, NO can transform into peroxynitrite and other strong cytotoxic metabolites, which lead to dysregulation of testosterone synthesis involved in spermatogenesis. Also, manifestations of varicocele among infertile men have decreased expression levels of the testis-specific heat-shock protein, HSPA2, and abnormal methylation of sperm DNA. Therefore, the use of combined anti oxidant supplements as part of adjuvant therapy after surgical treatment or as an independent application in some clinical cases appears to be an adequate strategy to optimize fertility in patients with varicocele. In this review, we evaluated the importance of various antioxidants, such as vitamin E, folic acid, carnitine, inositol, arginine, acetylcysteine, zinc, selenium in spermatogenesis and their effect on reproductive function during varicocele.

Introduction. According to research, seminal plasma is a rich source of biomarkers in male infertility including biomarkers of residual spermatogenesis in males with azoospermia. In many cases, extraction of seminal plasma does not require invasive procedures. Therefore, non-invasive test for identification of males with azoospermia and residual focal spermatogenesis can improve selection of patients for microdissection testicular sperm extraction (microTESE) and become a useful tool for patient consultation.The study objective is to evaluate capabilities of proteomic analysis of seminal plasma for identification of males with azoospermia and residual focal spermatogenesis in the testes who have higher chance for sperm extraction using the microTESE procedure.Materials and methods. Samples of seminal plasma of 36 males between 21 and 45 years of age (mean age 33.3 ± ± 3.9 years) were tested for proteomic composition. For proteomic analysis, proteins were hydrolyzed with trypsin. The obtained peptides were analyzed using chromatography-mass spectrometry complex composed of liquid chromatograph nano-HPLC Agilent 1100 and high-resolution mass spectrometer 7Т LTQ-FT Ultra. Proteomic analysis data were compared with results of the microTESE procedure.Results. In this study, proteomic composition of seminal plasma in azoospermia was assessed. Semi-quantitative analysis without markers using bottom-up approach identified 405 different proteins, and 174 of them were detected in all samples. The obtained quantitative parameters were sufficient to identify patients with focal spermatogenesis.Conclusion. Seminal plasma is a potential source of biological markers for prediction of sperm extraction success in patients with azoospermia. The presented results are preliminary, and further studies are needed to confirm the identified protein panel.

Relevance. During the pandemic and large-scale vaccination against COVID-19, studies of the effect of various types of vaccines on human reproductive function have become particularly important. Vaccination may have a negative impact on the reproductive organs and tissues due to the development of an autoimmune process involving the gonads. Currently, there are some studies on the effect of vaccination against coronavirus infection caused by SARS-CoV2 on the male and female reproductive function. The absence of a negative effect of vaccination on spermatogenesis in men has already been demonstrated in the results of three studies. Objective. To evaluate the effect of the Gam-COVID-Vac (Sputnik V) vaccine on spermatogenesis and the level of antiphospholipid antibodies in men. Materials and methods. The prospective study included 45 men who were vaccinated against COVID-19 with Gam-COVID-Vac (Sputnik V). The criteria for inclusion in the study were the age from 18 to 55 years, the absence of a previous history of COVID-19, a negative RT-PCR result in SARS-CoV-2 testing, negative SARS-CoV-2 IgG results prior to vaccination, and the absence of severe somatic diseases. The patients were examined twice: immediately before vaccination and 90 days after the first dose was injected. We evaluated spermogram parameters, determined the levels of FSH, LH, TSH and total testosterone, and analyzed blood for IgM and IgG antiphospholipid antibodies (aPL) to cardiolipin (aCL), β2-glycoprotein-1 (as2-GP1), annexin V (aAnV), phosphatidylserine (aPS), as well as IgG antibodies to SARS-CoV-2 using enzyme immunoassay. Results. There were no significant changes in the parameters of spermogram and hormone levels before and after vaccination;men with moderate impairment of spermatogenesis (oligoasteno-and/or teratozoospermia) did not show considerable changes either. The level of aPL after vaccination did not increase compared to the baseline level. Besides, there was no correlation between the dynamics of the level of antisperm antibodies, aPL and spermogram parameters. These findings indirectly indicate that there are no changes in the reproductive function associated with this autoimmune factor after vaccination in men. Conclusion. This is one of the first studies that has revealed the effect of the Gam-COVID-Vac vaccine on spermatogenesis, hormonal profile and aPL level in men. The obtained results demonstrate that the Gam-COVID-Vac vaccine does not have a negative effect on the reproductive function in men.

Novel coronavirus infection 2019 (COVID-19), which is caused by SARS-CoV-2 (severe acute respiratory syndrome related coronavirus-2), leads to a growing concern for public healthcare worldwide. Question about whether SARS-CoV-2 is able to penetrate into testicular tissue and/or seminal fluid remains unanswered. Fertility specialists also encounter many issues regarding prevention and treatment of infertility in patients with a history of COVID-19. There is an increasing number of publications which demonstrate anti-inflammatory, antiviral and antioxidant properties of socalled adaptogenic plants. This was the reason to analyze published articles on the effects of antioxidants and adaptogens on reproductive function in males with a history of COVID-19.

Oxidative stress is one of the leading causes of sperm dysfunction. Excessive amounts of reactive oxygen species can damage sperm membranes and disrupt their DNA integrity, which affects not only the likelihood of getting pregnant naturally, but also the clinical outcomes of assisted reproductive technologies and the risk of miscarriage. Sperm cells are extremely vulnerable to oxidative stress, given the limited functional reserve of their antioxidant systems and the DNA repair apparatus. Lifestyle factors, most of which are modifiable, often trigger generation of reactive oxygen species. Both the lifestyle modification and use of antioxidant dietary supplements are adequate and compatible ways to combat male oxidative stress-associated infertility. The search for other internal and external sources of reactive oxygen species, the identification of the etiology of oxidative stress and treatment of respective diseases are necessary for the successful regulation of redox processes in the male reproductive system in clinical practice, which is required not only to overcome infertility, but also to prevent induced epigenetic disorders in subsequent generations. The article presents the analysis of the molecular mechanisms of male idiopathic infertility. The authors provide an overview of how to prevent oxidative stress as one of the causes of subfebrile fever. The article provides an overview of modern therapeutics, as well as the options for eliminating the consequences of the effect of reactive oxygen species on spermatogenesis and male reproductive system in general.

Purpose of the study. To determine the practical value of puncture methods for obtaining spermatozoa in azoospermia. Patients and methods. The results of 127 puncture biopsies of testis (TESA) and testicular appendage (PESA) in patients with azoospermia of presumably obstructive origin were analyzed. The sperm production frequency (SPF) was calculated, as well as the frequency of transition to an open testicular biopsy. Was built a logistic regression model to analyze factors influencing the result, TESA / PESA, which included as independent variables the following parameters: patient age, duration of involuntary infertility, the level of sex hormones (testosterone, estradiol, luteinizing hormone, follicle-stimulating hormone, prolactin, progesterone, inhibin B), the total volume of testes, presence of varicocele, the presence of chemotherapy or radiation therapy, a history of alcohol abuse, Smoking, regular violation of the thermal mode, surgery in the inguinal and scrotal region. Indicators of the probability ratio (PR) with a 95% confidence interval (95% CI) were obtained. Results. 92 biopsy attempts out of 127 were successful, and the NPV was 72.4%. Independent statistically significant predictors of PESA / TESA success were testicular volume (PR = 1.113; 95% CI = 1.026–1.207) and inhibin b level (PR = 1.026; 95% CI = 1.011–1.041). In 35 patients whose spermatozoa were not found during the puncture biopsy, conversion to open microsurgical biopsy was performed. Conclusion. PESA and TESA have only limited effectiveness in azoospermia. We believe that puncture biopsy of the testicles and epididymis is justified only in patients with normal testicular volume and high levels of inhibin B. PESA / TESA should be performed in conditions that allow immediate transition to an open biopsy in case of failure.

Immediate outcomes of surgery for Peyronie’s disease (PD) are fairly easy to analyze. However, it is the patient-reported long-term outcomes which eventually determine the success of PD treatment. The goal of this observational study was to evaluate patients’ satisfaction with results of surgical treatment for PD at long-term follow-up. The primary outcome was the proportion of patients who were completely satisfied with their erectile function and penile appearance. We retrospectively identified 374 patients who underwent surgery for PD (median follow-up: 9.5 years) and attempted to invite them for follow-up visit; 342 patients were available for follow-up. Only 285 (83.3%) were sexually active. Among all patients, 197 (57.6%) were completely satisfied with penile appearance; among sexually active patients, 139 (40.6%) were completely satisfied with their erections. Only 101 patients (29.5%) were completely satisfied with penile appearance and erectile function. Logistic regression analysis revealed preoperative IIEF-EF score (OR = 1.668 per 1 point; 95% CI 1.469–1.894), tunica albuginea plication (OR = 5.599; 95% CI = 1.014–30.92), use of saphenous vein (OR = 8.517; 95% CI = 2.491–29.115), and cadaveric pericardium (OR = 61.388; 95% CI = 7.674–491.11) as significant predictors of satisfaction with erectile function. Severity of curvature (OR = 0.926 per 5°; 95% CI = 0.907–0.946) and tunica plication (OR = 0.117; 95% CI = 0.019–0.738) were negative predictors of satisfaction with penile appearance. Preoperative IIEF-EF (OR = 1.497 per 1 point; 95% CI = 1.322–1.694), severity of penile curvature (OR = 0.967 per 5°; 95% CI = 0.95–0.983), and use of pericardium allograft (OR = 10.728; 95% CI = 1.363–84.46) were predictors of both endpoints (satisfaction with erectile function and cosmesis). Despite excellent surgical outcomes in PD, patients’ satisfaction with penile appearance and erectile function is far from absolute and depends on many patient-related and treatment-related factors.

Empirical therapy of male infertility is used as a stand-alone type of treatment in idiopathic infertility, and in other situations can complement basic therapy. There are well-known pathogenetic methods of male infertility treatment applied in case of reproductive gland infection, hypogonadotropic hypogonadism, ejaculation disorders. However, the prospects of empirical treatment of male infertility are not fully clear. Combined antioxidant drugs are very popular, which include a wide range of similar substances. However, their molecules significantly differ from each other in structure, chemical properties and set of biological functions, therefore, there is a number of questions that deserve separate discussion regarding their compatibility with each other. Antioxidants such as various water-soluble and fat-soluble vitamins, coenzyme Q10, zinc and carnitines are widely used in its composition to reduce sperm damage caused by oxidative stress. They are widely available and inexpensive compared to other methods of treatment. Although there are no results of large randomized controlled trials yet, there is some evidence that taking oral antioxidoidants improves the basic parameters of sperm and increases the frequency of childbirth. There are many antioxidant supplements in different dosage forms, with different compositions and modes of use. In this article, we have analyzed the effect of the main antioxidant substances used on semen parameters, the need for their combined use and the role of these substances in the body.

INTRODUCTION AND OBJECTIVE:There is a general consensus today that subclinical varicocele should not be treated, which is reflected in current guidelines. However, this term originates from 1979 ar...

Obesity may present as a significant medical problem for any person, regardless of age or gender. In men obesity causes considerable psychological stress, sexual dysfunction, subfertility, hypogonadism and cardiovascular conditions. These problems may form numerous pathological associations between each other, creating a vicious circle. The main factors which influence male fertility and sexual function in obesity and metabolic syndrome are imbalance of sex hormones and systemic inflammation. In many patients symptomatic treatment is necessary for above-mentioned manifestations, but it is always rational to act on their pathophysiology and to recommend to lower the body mass by diet and lifestyle modification. When it proves impossible for the patient to follow such recommendations and when behavioral approach fails, central-acting and peripheral-acting medications may be used, including orlistat, sibutramine and liraglutide. Bariatric surgery should be offered to patients with high body mass index in whom conservative management fails. Without elimination of excess body mass it is difficult to solve problems regarding sexual dysfunction, hypogonadism and subfertility in obese males. All these issues and available modes of pharmacological treatment are described in this review.

This paper addresses the background of phosphodiesterase-5 inhibitors use in erectile dysfunction and lower urinary tract symptoms, as well as a special position which is held by tadalafil as an only drug from its class suitable for daily intake. Tadalafil pharmacodynamics and hypotheses concerning its mechanism of action on prostatic tissue are discussed. Special attention is paid to drug»s efficacy and safety in elderly men, who often require therapy for benign prostatic hyperplasia with lower urinary tract symptoms. It is mentioned that tadalafil may be used in penile rehabilitation programs in men who underwent radical prostatectomy.

Climacturia is a rarely discussed functional complication of radical prostatectomy. Various methods of medical and surgical treatment of climacturia have been described. In this article we present two clinical cases of successful surgical treatment of climacturia which involved three-piece penile prosthesis implantation and placement of compression graft made of porcine dermal collagen on urethra.

Background. Idiopathic male infertility remains an important problem in andrology and reproduction, despite steady advances in diagnostics and treatment of conditions associated with impaired fertility in men. Only available option of conservative treatment for idiopathic male infertility is an empiric antioxidant therapy. Materials and methods. Fifty five men from infertile couples without any identifiable cause of male infertility who received “BESTFertil” supplement were enrolled in this study. Semen analysis parameters (sperm density, percentage of sperm with progressive motility (categories A and B), sperm morphology, leukocyte concentration), MAR-test results, reactive oxygen species concentration as measured by chemiluminescence assay and sperm DNA fragmentation index evaluated using TUNEL method were registered and compared with baseline values after 90 days of treatment. Patient compliance was assessed by a number of capsules taken throughout the study period. Results. There was a significant difference in percentage of sperm with normal morphological features (median 2 % vs 4 %; p

Patients with erectile dysfunction require special approach. Any therapy should be prescribed with patient’s individual features, comorbidities and concominant medication in mind. Considering good efficacy and safety profile of tadalafil, together with appearance of its generic forms on the market, making such treatment more accessible for our patients, soon it may become the most commonly prescribed drug from phosphodiesterase-5 inhibitors class. Therefore, evidence on its use in special groups of men with specific anamnestic features should be systematized. In this article we discuss the use of 20 mg tadalafil on demand in specific categories of patients suffering from erectile dysfunction: in men with metabolic syndrome, benign prostate diseases, neurological conditions and, finally, in men who express wish to become fathers.

Varicocele-related infertility is traditionally considered an indication for surgery. At the same time in some specific clinical settings, especially with subclinical varicocele, conservative therapy using hormonal or antioxidant drugs is also possible. The potential role of drug therapy in this patient category remains controversial. The article discusses the options and treatment regimens for men with varicocele-related infertility. Given the difficulties in interpreting the results of studies and the heterogeneity of the data, it is not yet possible to recommend abandoning varicocelectomy in favor of drug therapy. The most promising option for drug therapy is adjuvant antioxidants after surgical treatment of varicocele.

This literature review is dedicated to surgical sperm retrieval techniques, such as percutaneous and microsurgical epididymal sperm aspiration, testicular sperm aspiration, testicular sperm extraction (standard, microdissection, multifocal). Those methods allow men with azoospermia to achieve biological parenthood, because gametes retrieved from testis or epididymis are usable for assisted reproduction. After laboratory processing of surgical specimen the sperm may be used for intracytoplasmic injection and/or cryopreservation. In this article we discuss historical and technical aspects of such procedures and provide critical analysis of their advantages, disadvantages and limitations. Existing laboratory techniques for processing of surgically retrieved sperm are mentioned. We discuss possible future directions for development of testicular biopsy technique aimed at improving sperm retrieval outcomes.

OBJECTIVE To study the survival rate of patients without biochemical recurrence according to the Stuttgart and Phoenix criteria in terms of their correlation with four different PSA nadir values as predictors of clinical recurrence in patients with localized prostate cancer who underwent total HIFU prostate ablation. MATERIAL AND METHODS The object of the study was patients with morphologically proven localized RP by biopsy results, who were treated with prostate cancer by HIFU ablation on the Ablatherm Integrated Imaging apparatus (EDAP TMS, France). The study included 658 patients in whom HIFU ablation was used as primary treatment of localized prostate cancer (stages T1 - T2) without previous use of other methods (hormonal, radiation therapy) For the analysis, a continuous sample of patients was selected, which were divided into four groups depending on the PSA nadir level: less or equal 0.2 ng / ml (1 group), 0.21-0.5 ng / ml (group 2), 0.51-1 ng / ml (group 3) and> 1 ng / ml (group 4). sensitivity, specificity, predictive value, and 5-year biochemical relapse-free survival according to the Stuttgart definition and the Phoenix definition in the PSA nadir groups. RESULTS The median (range) of the observation period for the patients was 5.3 (3-7) years, the mean time to reaching PSA nadir was 14.5+/-2.6 weeks. PSA nadirs less or equal 0.2, 0.21-0.5, 0.51-1.0 and > 1 ng/ml were achieved in 231 (35.1%), 132 (20.0%), 105 (15, 9%) and 190 (28.8%) patients, respectively. Survival without biochemical relapse in accordance with the Stuttgart definition in the four groups allocated for the PSA nadir was 82, 65, 43 and 32%, respectively (p