Archivio italiano di urologia, nefrologia, andrologia : organo ufficiale dell'Associazione per la ricerca in urologia = Urological, nephrological, and andrological sciences最新文献

Spermatic cord torsion happens rather frequently in young men. It must be discovered early on, to allow for the possibility of removal by surgery. It appears from recently written medical articles that the endocrine function of the testis is protected following several hours of torsion and the risk of immunological damage to the contralateral testis is subsequently reduced.

What is the cause for impotence? In the recent years psychological studies have accredited some insights and modern neurological and vascular technologies have identified some previously idiopathic or misdiagnosed causes. The postulated ratio of psychogenic to organic dysfunction varies from 20:1 to 1:7 and this ratio may vary form one cultural area to the next. The authors underline that the main characteristic of the groups of males complaining of erectile dysfunction is heterogeneity and that the diagnostic procedure for finding the correct etiology may be rather cumbersome. Of primary importance is the patient's history to obtain a precise description of the dysfunction. Graber has suggested a more systematic approach to create a scientific nosology in the area of erectile failure. The phenomenon of morning erections must be inquired as well as the evaluation of the genital reflexes. A series of new diagnostic procedures has been developed but the Authors underline that it is preferable to use noninvasive techniques.

Several abdomino-Pelvic surgical procedures can cause ejaculatory failure or impotence. Retroperitoneal lymph node dissection for testis cancer is followed by loss of ejaculation if bilateral. In low stage cancers, monolateral procedure is associated with maintenance of ejaculation in most patients. Evaluation of seminal fluid before surgery is essential for cryopreservation and artificial insemination erectile impotence is consequent to section of "nervi erigentes" in pelvic surgery for cancer. Careful anatomic dissection can spare these nerves but oncologic radicality should be always kept in mind.

The Authors report the results of a study on 87 patients; among them some were drug dependent and others were already drug-free. This study has in object the consequences of some drugs use (psycoanaleptics, psycoleptics, psychodysleptics) in the sexual behavior and male fertility. Abuse of these drugs seems to be able to cause impotence by psychologic and organic factors. As it concerns the drugs effects on male fertility, we have observed O.T.A. during the dependence period, that seems to be reversible after detoxification. Our purpose is to further investigate the andrological aspects of drug dependence.

Diagnosis in cryptorchidism should be as early as possible for therapeutical purposes and for the achievement of most positive results. Early but also exact diagnosis allows a selective therapy concerning type of procedure and age of performance. Aims of early diagnosis and selected treatment are: prevention of infertility and eventual decrease of androgenic endocrinal function in the adult; prevention of torsion in retractile testis; prevention of trauma in perineal ectopic situation; prevention of cancer especially in cryptorchidism of the adult; prevention of psychogenic defects of the empty scrotum. Those goals can be obtained by different approaches: pharmacological (hormonal stimulation), surgical (orchidopexy) or by their association. If hormonal administration is not suitable or without results surgical approach will be adopted. Which is now the most suitable age for surgery? Testicular damages begin at the second year of life. Therefore operation should be acted in advance. However, up to date international acknowledgement is in favour of surgical management around the fourth year for the advantages of a more mature anatomical situation without reducing quality of results. Purpose of early diagnosis and selective therapy in cryptorchidism is to avoid irreversibility of severe histological alteration able to compromise gonadal, especially germinal, function. It is never to forget that the high level of infertility in cryptorchidism can be depending not only on evident alteration in number, motility and morphology of spermatozoa but also on morphofunctional defects escaping from the routine seminal examination. All that is in tight connection with the intrinsic dysmorphism in cryptorchism where the abnormal position of the testis is only a partial aspect.(ABSTRACT TRUNCATED AT 250 WORDS)

Andrologic problems were considered as nutrition is concerned: vitamin and oligo-element deficiencies, metabolic alterations, and toxic intake. Ethanol role was examined and discussed for its relevance in psychological and organic impairment due to both chronic abuse and acute intake, mainly for its role on hypothalamic-pituitary-gonadal axis. Rational nutrition is a clue in sexual disturbance prevention, correction and integrated care.

The authors report their experience in the surgical treatment of scrotal trauma and underline the diagnostic importance of ultrasound as well as the necessity of an early surgical control, in order to prevent permanent damage of the testicle.

Sexual impotence is the main andrological complication of diabetes mellitus and is the consequence of nervous, vascular and psychological factors which act either separately or in association. An attempt to prevent this complication will be successful if performed early before impotence has became irreversible. Neuropathy-induced impotence can be prevented by obtaining a good metabolic control of diabetes and/or by using some specific drugs such as gangliosides and aldose reductase inhibitors. The vascular causes of erectile failure can be prevented by reducing or removing associated risk factors such as smoking, hypertension, obesity, hypercholesterolemia, sedentariness and insulin-resistance. Finally, correct information and reassurance of the patient and his partner can prevent the negative role played by psychological factors on the sexual dysfunctions complained by the diabetic subject.

Up to date general tendency in diagnostic procedure is to check the pathology directly under vision. In all sciences technology has provided means of investigation with high resolution, which can detect alterations of few millimeters in size. However the direct vision of the disease is always preferred by the physician. In this program Cavernoscopy is perfectly inserted as the andrologist expected an examination able to provide direct informations on erectile tissue under physiological and pathological points of view. Cavernoscopy is simple, repeatable, atraumatic and effective in its purposes and even if it requires a minimum of training its practice is to be recommended because the direct vision of erectile tissue is surely the first step towards operative performances inside corpus cavernosum.