Prevalence of Hypogonadism in a Male Population below 60 Years of Age with Metabolic Syndrome

Introduction. A high prevalence of hypogonadism (H) has been demonstrated in patients with metabolic syndrome (MetS). There are no studies in Latin America showing the prevalence of H in MetS in men below 60 years of age. The objective of this study was to determine the association between the MetS and levels of testosterone (T) and calculated free testosterone (cfT) in men under 60 years of age. Methodology. 101 men were included between 18 and 60 years who met the IDF MetS criteria. The diagnosis of H was considered <70 pg/mL of cfT and <10.4 nmol/L (300 ng/dL) of T. Results. H with T was 17.8% and 20.7% with cfT. The H according to T had higher BMI, waist circumference, visceral fat, markers of insulin resistance, SHBG, LH, and E2. We find an inverse but weak significant correlation between T, visceral fat, and HOMA index. The linear regression analysis showed that E2 and visceral fat are determinants in H. Conclusion. We found a high prevalence of H using T and cfT in Chilean patients with MetS below 60 years of age, who turned out to be more insulin-resistant and have more visceral fat, waist, and E2 than non-H.

Outcome of Varicocelectomy with Different Degrees of Clinical Varicocele in Infertile Male

Aim. To evaluate the prevalence and effect of varicocele repair on sperm motility, sperm concentration, testicular volume, and pregnancy rate in different degrees of clinical varicocele. Material and Methods. The case records were retrospectively evaluated for 482 infertile patients with varicocele who underwent varicocelectomy from December 2008 to December 2013. Semen analysis of patient at preoperative and 3-, 6-, and 12-month postoperative period was done. Varicocele was graded as per the World Health Organization grading (WHO 1993) system and included in the study. Testicular volume was noted by ultrasonography in pre- and postoperative period in one-year follow-up. Pregnancy rate was calculated at 3, 6, and 12 months of follow-up. Results. Significant differences were seen in sperm motility and concentration of patients with Grade 3 varicocele as compared with Grade 1 and Grade 2 varicocele. Significant increase in testicular volume was present after one year in Grade 3 varicocele in the postoperative period. There was significant correlation between the testicular volume and the sperm concentration. Percentage of spontaneous pregnancy in 1 year after varicocele treatment was 32 to 41% of cases. Conclusion. Varicocelectomy significantly improved sperm motility, concentration, and testicular volume. There were 32 to 41% of infertile patients who achieved pregnancy spontaneously.

Complications of Inflatable Penile Prostheses Implantation Classified according to the Modified Clavien System

Introduction. In patients with erectile dysfunction (ED), inflatable penile prosthesis (IPP) surgery is regarded as the gold standard treatment in medically refractory cases or where its conservative treatment options are contraindicated. Despite improvements in surgical technique and implanted materials, IPP surgery retains a substantial complication rate. The aim of the study was to record and grade the postoperative complications of IPP implantation according to a modified Clavien system. Methods. A total of 60 three-piece IPP implantations were performed between 2007 and 2013 by a single surgeon. The primary outcome was to stratify the early (first 30 days) complications into five categories using the modified Clavien-Dindo classification system. A secondary aim was to record the long-term adverse events and to identify possible factors related to complication occurrence. Results. Overall, there were 21 (35%) postoperative complications in 17 of 60 men (28.3%), with 15 adverse events occurring early after surgery. In terms of late complications, there were six (10%) major complications managed by either revision surgery or removal of the prosthesis. Conclusion. This study utilizes a validated morbidity scale thus overcoming problems of previous studies reporting IPP surgery complications. The modified Clavien classification system easily aids in assessing and comparing accurately patients’ postoperative complications, thus improving management and prevention.

Role of Membrane Lipid Fatty Acids in Sperm Cryopreservation

Lipid is an important constituent of cell membrane. Membrane lipid composition of spermatozoa has been correlated to different function. Many researchers have related membrane lipid with survival success after cryopreservation or cold shock. Sperm maturation and acrosome reactions are natural phenomenon, but cryopreservation or cold shock is not. Therefore, sperm cells are not programmed for such change and undergo stress. So the change in membrane lipid composition due to cold shock or cryopreservation may be looked upon as response of spermatozoa to a certain stressed condition. A significant body of research worked on the relationship between membrane lipid and fatty acid composition and ability of cell to tolerate adverse change in temperature. However, as the approach of different research groups was different, it is very difficult to compare the changes. Studies have been done with different species, ejaculated/seminal or epididymal sperm. Lipid analyses have been done with whole cell membrane isolated by different methods. Fatty acids estimated were from whole cell, plasma membrane, head membrane, or phospholipids. The cryopreservation condition, media composition, and diluents/cryoprotectants were also different. At this onset a comprehensive review is needed to cover changes of sperm membrane lipid composition of different species under different cryopreservation conditions.

A Personal Reflection of Greenlight 532 nm Laser for BPH Treatment

Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia are a bothersome symptom set that affect approximately one in every four males above the age of 50. First line treatment is typically medication, but when medications fail surgical therapy is the next option. Technological advances have made surgical therapy safer and more effective. One area that our group has particular interest and focus in is the application of the 532 nm laser in surgical therapy. The high power 532 nm laser is used to remove obstructive prostatic tissue and the laser energy is selectively absorbed by hemoglobin in the prostate tissue, resulting in effective tissue vaporization and removal. We review our experience with Greenlight laser system and its evolution from the original 60-watt laser to the most recent 180-watt Greenlight system with MoXy fiber.

The Enzymatic Antioxidant System of Human Spermatozoa

The ejaculated spermatozoon, as an aerobic cell, must fight against toxic levels of reactive oxygen species (ROS) generated by its own metabolism but also by other sources such as abnormal spermatozoa, chemicals and toxicants, or the presence of leukocytes in semen. Mammalian spermatozoa are extremely sensitive to oxidative stress, a condition occurring when there is a net increase in ROS levels within the cell. Opportunely, this specialized cell has a battery of antioxidant enzymes (superoxide dismutase, peroxiredoxins, thioredoxins, thioredoxins reductases, and glutathione s-transferases) working in concert to assure normal sperm function. Any impairment of the antioxidant enzymatic activities will promote severe oxidative damage which is observed as plasma membrane lipid peroxidation, oxidation of structural proteins and enzymes, and oxidation of DNA bases that lead to abnormal sperm function. Altogether, these damages occurring in spermatozoa are associated with male infertility. The present review contains a description of the enzymatic antioxidant system of the human spermatozoon and a reevaluation of the role of its different components and highlights the necessity of sufficient supply of reducing agents (NADPH and reduced glutathione) to guarantee normal sperm function.

Chlamydial Infection and Its Role in Male Infertility

Introduction. Chlamydia trachomatis is an established cause of tubal factor infertility; however its role in male fertility is not as clear. We sought to determine the prevalence of Chlamydia in infertile men and evaluate its impact on male reproductive potential. Materials and Methods. We compared the incidence of Chlamydia in our infertile male population with that reported in the literature. We then reviewed the impact of Chlamydia infection on male fertility. Results. The incidence of Chlamydia infection in our population of infertile men was 0.3%. There is considerable variability in the reported incidence, likely due to variation in the population studied, and detection technique. The optimal testing method and sample are presently unclear. The effect of Chlamydia on male reproductive function is also variable in the literature, but appears to be relatively minimal and may be related primarily to sperm DNA fragmentation or female partner transmission. Conclusions. The prevalence of Chlamydia in the infertile male population is low and routine testing is not supported by the literature. For high-risk infertile men, nucleic acid testing of urine +/− semen is the most sensitive method to detect Chlamydia. A validated testing system for semen needs to be developed, so that a standardized methodology can be recommended. In this way the full implications of Chlamydia on male fertility can be elucidated.

Functional Importance of 1α,25(OH)2-Vitamin D3 and the Identification of Its Nongenomic and Genomic Signaling Pathways in the Testis

The 1α,25(OH)2-vitamin D3 (1,25-D3) is known by its classic effects on Ca2+ metabolism and regulation of cellular proliferation and differentiation. The hormone 1,25-D3 acts in the testis through nongenomic and genomic events being implicated in the success of spermatogenesis in rats and in human being. The aim of this review was to highlight the effect and intracellular pathways of 1,25-D3 to modulate the spermatogenesis. The pivotal role of 1,25-D3 in male reproduction is reinforced by the presence of VDR and 1α-hydroxylase in reproductive tract. Also, the marked expression of VDR and the VD metabolizing enzymes in human testis, ejaculatory tract, and mature spermatozoa implicates the 1,25-D3 in spermatogenesis and maturation of human spermatozoa. Among genomic events, 1,25-D3 influences the expression of calcium binding protein and stimulates aromatase gene expression through a nongenomic activation of the membrane-bound VDR receptor involving the PKA pathway in the testis. Also, 1,25-D3 stimulates amino acid transport and exocytosis in testis by nongenomic events coupled to ionic currents triggered at plasma membrane. All together, the demonstration that 1,25-D3 regulates both Sertoli cell and sperm function may be useful for the study and development of new therapeutic strategies for the male reproductive disorders.

Looking beyond Androgen Receptor Signaling in the Treatment of Advanced Prostate Cancer

This review will provide a description of recent efforts in our laboratory contributing to a general goal of identifying critical determinants of prostate cancer growth in both androgen-dependent and -independent contexts. Important outcomes to date have indicated that the sustained activation of AR transcriptional activity in castration-resistant prostate cancer (CRPC) cells results in a gene expression profile separate from the androgen-responsive profile of androgen-dependent prostate cancer (ADPC) cells. Contributing to this reprogramming is enhanced FoxA1 recruitment of AR to G2/M phase target gene loci and the enhanced chromatin looping of CRPC-specific gene regulatory elements facilitated by PI3K/Akt-phosphorylated MED1. We have also observed a role for FoxA1 beyond AR signaling in driving G1/S phase cell cycle progression that relies on interactions with novel collaborators MYBL2 and CREB1. Finally, we describe an in-depth mechanism of GATA2-mediated androgen-responsive gene expression in both ADPC and CRPC cells. Altogether these efforts provide evidence to support the development of novel prostate cancer therapeutics that address downstream targets of AR activity as well as AR-independent drivers of disease-relevant transcription programs.

Advances in Stem Cell Therapy for Erectile Dysfunction

Stem cell (SC) therapy for erectile dysfunction (ED) has been investigated in 35 published studies, with one being a small-scale clinical trial. Out of these 35 studies, 19 are concerned with cavernous nerve (CN) injury-associated ED while 10 with diabetes mellitus- (DM-) associated ED. Adipose-derived SCs (ADSCs) were employed in 18 studies while bone marrow SCs (BMSCs) in 9. Transplantation of SCs was done mostly by intracavernous (IC) injection, as seen in 25 studies. Allogeneic and xenogeneic transplantations have increasingly been performed but their immune-incompatibility issues were rarely discussed. More recent studies also tend to use combinatory therapies by modifying or supplementing SCs with angiogenic or neurotrophic genes or proteins. All studies reported better erectile function with SC transplantation, and the majority also reported improved muscle, endothelium, and/or nerve in the erectile tissue. However, differentiation or engraftment of transplanted SCs has rarely been observed; thus, paracrine action is generally believed to be responsible for SC’s therapeutic effects. But still, few studies actually investigated and none proved paracrine action as a therapeutic mechanism. Thus, based exclusively on functional outcome data shown in preclinical studies, two clinical trials are currently recruiting patients for treatment with IC injection of ADSC and BMSC, respectively.