During the last few years, the general aging of the population and the growing knowledge about male hormonal changes in older age have lead the scientific community to focus on the clinical aspects of secondary hypogonadism in aging males. This syndrome is well defined by the term late-onset hypogonadism (LOH). LOH is a deficiency in gonadal function that results in low testosteron levels and variety of symptoms. The aim of the therapy is to establish a physiological concentration of serum testosterone in order to correct the androgen deficiency, relieve its symptoms and prevent long-term sequelae. The traditional benefits of testosterone on sexual function, mood, strength and quality of life remain the primary goals of treatment but possible beneficial effects on other parameters such as bone density, obesity, insulin resistance and angina are emerging and will be reviewed. Purpose of this article is to review author´s opinions with diagnosis and treatment and monitoring patients with LOH. Article reviews the advantages of available and investigational formulations of testosterone, admit recommendations of current guidelines for the treatment of hypogonadism. Potential concerns regarding the effects of testosterone on prostate disease especially in patients with risk of prostate cancer. The options available for treatment have increased in recent years with the availability of a number of testosterone preparations which can reliably produce physiological serum concentrations. Standardization of diagnostic procedures as well as emerging information concerning potential risks and benefits of testosteron therapy should increase extend of testosteron therapy also safe substitution therapy in patients at increased risk for prostate cancer.
Two distinct 5?-reductase isoenzymes, type I and type II, are known in mammals. They are differentially expressed in tissues during distinct developmental stages and the expression is species specific. The enzyme is responsible for the reduction of testosterone to dihydrostestosterone, progesterone to dihydroprogesterone and deoxycorticosterone to dihydrodeoxycorticosterone. These steroids and their metabolites (known as the neuroactive steroids) exhibit rapid non-genomic effects on brain function and behavior, primarily via an enhancement of ?-aminobutyric acid (GABAergic) inhibitory neurotransmission. Neuroactive steroids exert anticonvulsant, antidepressant and anxiolytic effects via GABA-A receptors. Finasteride is a 5?-reductase inhibitor which was originally used for the treatment of benign prostatic hypertrophy is also efficient for the treatment of male pattern hair loss (1 mg/day). There are some reports suggesting finasteride induction of depressive symptoms and anxiety in human. The steroid profile of patients treated by finasteride was followed only in urine. The profile was similar to that of male pseudohermaphrodites with inherited 5?-reductase deficiency. Material and methods: In our study a group of 20 men with bening prostatic hyperplasia was examined. In all individuals, their hormonal profile of steroid hormones in blood was determined. Finasteride in the daily dose of 5mg was administrated for 4 months. After the treatment the same hormonal profile was determined. Results: The results showed significant decrease in circulating 5?-reduced C19 steroids (androsterone (p<0.008), epiandrosterone (p<0.01), 5?-androstane-3ß,17ß-diol (p<0.01), and 5?-dihydrotestosterone (p<0.001). Surprisingly the levels of C19 3ß-hydroxy-5-ene steroids significantly decreased as well (DHEA, p<0.03; 5-androstene-3ß,17ß-diol, p<0.04). Conclusions: In addition to the decrese of dihydrotestosterone level after treatement, the alteration in other 5 alfa steroids metabolites was found, which could explain the depresive symptomatology.
The aim of the study was study the prevalence of ED, TDS, and MS in patients with BMI over 30 or waist circumference over 94 cm. TDS significantly decreased quality of life and occurrence is 38.7% in men over 45 years. MS is defined by the presence of at least three of the following: “abdominal obesity“ (waist circumference over 94 cm), arterial hypertension, hypercholesterolemy, hypertriglyceridemy, diabetes mellitus or disorder of blood sugar tolerance. Metabolic syndrome increase risc of diabetes mellitus and heard disease. It is suspected that TDS can be next component of MS. This can be basis for treatment MS with testosteron. Material and methods: We have examined 79 patients over 50 years of age with body mass index (BMI) over 30 or with waist circumference over 94 cm. Hormonal evalutation as well as a complete urological evaluation (including PSA) and medical evaluation were carried out in every patient. To assess subjective symptoms related to TDS and 5 domains of sexaul health, the Androgen Deficiency Questionaire and Sexual Health Questionaire were utlized. In all patients, the presence of prostate cancer was ruled out. Normal ranges of testosterone are 10-28 nmol/l. When results were in range 10-14 we examined free testosterone. Results: Total serum testosterone values decreased in 55/79, 32 below 10 nmol/l and 23 betwen 10-14. Free testosterone was 22-51%. Symptoms of TDS have 48 (87%) patients. ED had 50 (91%) and MS had 46 (83.6%) patients. Discussion Tsai et al. shows that all this 3 factors: obesity, insulin resistency or hypogonadismus can be introduction which leads to MS. Conclusions: Conclusion Symptomatic complex caused by the lack of androgens mainly in men over 50 years, is gradually becoming the topic of interest for urologists, andrologist and general practitioners. In respect to longer life expectancy and prolonged survival, the diagnosis and treatment of ED, TDS and MS may significantly improve the quality of life of the affected men. In patients with abdominal obesity we find out increased number of patients with TDS, ED and MS.
The prognosis of patiens with Hodgkin's lymphoma (HL) has improved over the last decades. Depending on stage of disease, more than 80% of patients can be cured, but they are at higher risk for secondary malignancies and other late effects such as infertility. Even if the most HL patients are young, several studies have shown they have inadequate sperm quality even before cytostatic treatment. Material and methods: We evaluated semen and hormonal analysis in newly diagnosed patients with HL to demonstrate the fertility status at the time of diagnosis. We examined a total of 80 male patients, with median age 26 years (16-42). Most patients were in early clinical stage (33 patients; 41%), followed by the group of patients in advanced stage (28 patients; 35%) and in intermediate stage (19 patients; 24%). The semen samples parameters were compared with a reference set of 89 healthy men interested in sperm donation, with median age of 23 years (18-35). The t-test was used for statistical evaluations. Results: In 95% (N=76) of the patients, inadequate semen quality was established, with low sperm cell count and/or defective sperm morphology. Severe defects such as azoospermia and OAT were found in 14% (n=11) and 26% (n=21) patients respectively. In other patients, combined damages such as asthenospermia in 14% (n=11) and asthenoteratospermia in 41% (n=33) were identified. Normal findings were only established in 4 patients. In comparison with the control set of healthy men, statistically significant differences were found (p=0.05) in the average concentration (31.6 vs 55.7 mil/ml) and in the presence of progressively motile sperm cells (14.2% vs 43.6%). No deviation from the normal reference range of serum levels of FSH, LH and testosterone could be established in anyone of the patients. Conclusions: The majority of patients in our study had inadequate semen quality before treatment. The underlying mechanism is still unknown. Suspected factors include damage in the germinal epithelium, disturbance in the hypothalamic-hypophysial axis and the impact of the disease-related cytokines on spermatogenesis.
Varicocelectomy is the most common procedure for male infertility. The introduction of microsurgical techniques has revolutionized the treatment of male infertility. Material and methods: Over a 4-year period, 217 patients underwent microsurgical varicocelectomy at our center. Pre-operative semen values were compared with the post-operative values. Results: Significant improvement of spermiogram occurs in 70.35%. Pregnancy rate 41%. Conclusions: Microsurgical varicocelectomy is a safe and effective option for the management of varicocele-induced male infertility. It leads to improvement in all semen parameters and increases the possibility of spontaneous pregnancies.
The main condition for good results after surgical repairs of traumatic dysruption of corpora cavernosa is early detection and reconstruction of tunica albuginea. Pre-requisite for keeping of good quality erection is preservation of blood perfusion in all parts of corpora cavernosa. Material and methods: We treated 42 years old man with penile fracture injury during the sexual intercourse (a´la cheval position). Because of horrible looking bleeding from the urethra he decided to insert a rough bandage around the radix penis. Time delay to investigation in our departement was 45 minuts. He did not void spontaneously, drainage of the urin from the bladder was attached per epicystostomiam. Urethrography verified total urethral disruption and injury of corpora cavernosa. Surgical repair was done 70 minuts past penile trauma. We utilized knowledge about location of trauma and incised penis skin under defects. Boths corpora cavernosas were completely devided and conected only in dorsal parts of tunica albuginea. Urethra was completely disrupted with lenght of dystraction defect 2.5 cm. First were reconstructed boths corpora cavernosa using single sutures. After spatulization we provided end to end urethroplasty. Results: Two months past procedure was reached normal uroflowmetry. Voiding now is as good as before traumatic epizode. Patient is able to attach very good quality of erection, but we recommended him 2 months of sexual abstinence. Four months past procedure is visible light penile curvature without any influence to quality of erection. Conclusions: Extension of injury in this case is not typical for majority of penile fractures. In most cases is visible rupture of only one side corpora cavernosa and urethral injury is present occasionally. For good result it is necessary early surgical repair and a very good patient compliance in postoperative period.
Partial deletions in the AZFc and AZFb region of the Y chromosome are linked to subfertility, whereas AZFa is linked to complete infertility in the syndrome of Y chromosome microdeletions. The aim of this study is to determine the frequency of specific AZFc subdeletions (nanodeletions) - gr/gr, b1/b3 and b2/b3 in Czech fertile men. Material and methods: These types of AZFc/AZFb subdeletions were analyzed in 262 Czech fertile men by multiplex polymerase chain reaction (PCR) of specific markers in the AZFc region: gr/gr - sY1291; b2/b3 - sY1191; b1/b3 - sY1161, sY1191, sY1291. Moreover, the following markers, sY1206 and sY1201 from AZFc region were analyzed. The PCR products were made visible on 3% agarose gel. Results: The gr/gr deletions were found in 1.91 % in normal fertile Czech men population; other deletions b1/b3 and b2/b3 were found in 0.76 % and 2.29 % respectively. No other tested Y chromosome subdeletions in AZFc were found. These findings are not different from other Caucasian populations reported so far. Conclusions: These data provide the basis for further studies of male infertility associated with increased prevalence of the studied Y chromosome nanodeletions.
The aim of this study was the determination of the genotype characteristics of FSH-R polymorphism in position -29 (A/A, A/G, G/G) and exon 10 N680S in fertile males in families indicated for prenatal diagnosis, or with risk of cystic fibrosis, risk of trombophilic disorders and chronic pancreatitis dispositon in Czech males. Material and methods: Polymorphism -29 (A/A, A/G, G/G) was examined in 303 males, exon 10 N680S in 304 males. The exon 10 and promotor polymorphisms were analyzed by allelic discrimination on ABI Prism 7000 detection system (Applied Biosystems). Results: The promotor polymorphism A/A was in 6.93%; A/G in 35.31%; G/G in 57.76%. Exon 10 polymorphism Asn/Asn was 27.96%; Asn/Ser in 50.33% and Ser/Ser in 21.71%. The genotype 680 exon 10 polymorphism Asn/Asn, Asn/Ser, Ser/Ser are not different from so far published prevalence in Caucasian population and from prevalence in females. Conclusions: These data provide possibility to compare the genotype characteristic of FSH-R polymorphisms for association studies in male reproductive disorders and for the pharmacogenetic strategy in hormonal treatment of male patients with regard to the highest FSH-R sensitivity of Asn/Asn genotype.
Recent years have seen an increasing tendency for the development of certification schemes for practically all kinds of medical institutions and their departments, some of these schemes being even prescribed by law or other regulations. The talk is about these trends. Focus is on international standards as the ISO 9001, which is currently under revision - planned changes of this standard will be sketched. Detailed focus will be on the german experience with specific certification schemes for acute and rehabilitation clinics as well as for medical centers as breast cancer centers, stroke units and others. Schemes for sterilization departments and pharmacies will be presented as well. The presentation will be critical in nature and discuss frankly the positive and negative aspects in the field which became to be an industry on its own.
The aim of the study was to review present problems and recent findings in andrological endocrinology. Present guidelines for testosterone treatment of hypogonadism, especially in aging males, and for the methodology of androgen determination are discussed. Important andvances higlighted mechanisms for internalisation of SHBG-bound testosterone into the target cell, therapeutic possibilities for paternity of men with Klinefelter´s syndrome, secular trends in decline of testosterone levels, prevention of prostate diseases of aging men, male hormonal contraception, andrological aspect of other diseases, especially of disturbed thyroid function, and the role of human feromones for gender identity.
