Androgen receptor polymorphisms and testicular cancer risk

Testicular cancer (TC) is currently the most common malignant solid tumour in Caucasian males aged 15-39 years. Epidemiological evidence suggests that its onset may be due to an imbalance in the action of steroidal sex hormones and their receptors. A faulty androgen receptor signalling pathway can, in fact, cause various male reproductive disorders. The androgen receptor (AR) gene has two polymorphic segments consisting of CAG and GGC repeats. The length of CAG repeats has been shown to affect the regulation of AR activity. In our study, we used fragment analysis to evaluate the AR gene repeats of 302 TC patients and 322 controls, to establish if there is any association between repeat number and TC. This study of the largest Italian caseload investigated to date highlighted three particularly significant aspects. First, a CAG repeat number of ≥25 may be considered a risk factor for the onset of TC, given its greater frequency in patients in comparison with controls. This difference became significant for the non-seminoma group. Second, men with CAG repeats below 21 or above 24 were found to have a, respectively, 50 and 76% higher risk of TC than those with CAG 21-24, suggesting that these too can be considered a risk factor for TC. Finally, stage II patients were more likely to have a CAG repeat number 24 than stage I patients. © 2014 American Society of Andrology and European Academy of Andrology

Cryoprotectant-free vitrification of human spermatozoa in new artificial seminal fluid

Vitrification is a new method that has been recently introduced in Assisted Reproduction Technique programs. The aim of this study was to design a new medium similar to normal human seminal fluid (SF), formulation artificial seminal fluid (ASF), and to compare the cryoprotective potency of this medium with SF and human tubal fluid (HTF) medium. Thirty normal ejaculates were processed with the swim-up technique and sperm suspensions were divided into four aliquots: (i) fresh sample (control); (ii) vitrification in HTF medium supplemented with 5 mg/mL human serum albumin and 0.25 mol sucrose (Vit HTF); (iii) vitrification with patients' SF (Vit SF); and (iv) vitrification in ASF (Vit ASF). After warming, sperm parameters of motility, viability, and morphology were analyzed using WHO criteria. Also, sperm pellets were fixed in 2.5% glutaraldehyde and processed for scanning electron microscopy and transmission electron microscopy observations. The results showed that progressive motility (46.09 ± 10.33 vs. 36.80 ± 13.75), grade A motility (36.59 ± 11.40 vs. 16.41 ± 11.24), and normal morphology (18.74 ± 8.35 vs. 11.85 ± 5.84) and viability (68.22 ± 10.83 vs. 60.86 ± 11.72) of spermatozoa were significantly higher in Vit ASF than in Vit HTF. All parameters were better in Vit ASF than in Vit SF, but only viability was significantly different (p = 0.006). After cryopreservation, deep invagination in cytoplasm and mechanically weak point sites and folded tail were commonly observed. But, this phenomenon was more significant in Vit HTF and Vit SF than in ASF (p < 0.05). In transmission electron microscopy evaluation, acrosome damage, plasma membrane loss, chromatin vacuolation, and disruption of mitochondria arrangement and structures were observed in all vitrified groups. Adherence of several tail sections together was also seen in all cryo groups. But this was seen more in Vit HTF and Vit SF than in ASF (p < 0.05). In conclusion, vitrification of human spermatozoa with ASF can effectively preserve the quality of sperm motility in comparison with Vit HTF. © 2016 American Society of Andrology and European Academy of Andrology

Genomic biomarkers in prostate cancer.

Prostate cancer is the most common non-cutaneous cancer among men in the United States. In the last decade there has been a rapid expansion in the field of biomarker assays for diagnosis, prognosis, and treatment prediction in prostate cancer. The evidence base for these assays is rapidly evolving. With several commercial assays available at each stage of the disease, deciding which genomic assays are appropriate for which patients can be nuanced for physicians. In an effort to help guide these decisions in clinical practice, we aim to give an update on the current status of the biomarker field of prostate cancer

Neuromodulation in neurogenic bladder.

While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction

Late-onset hypogonadism (LOH) : an emerging pathophysiological entity requiring the physician's attention

Late-onset hypogonadism (LOH) is an emerging pathophysiological entity. Not everybody is familiar with LOH or even recognizes its existence. Since the 19th century women's life expectancy has become progressively greater than that of men and therefore their ailments associated with aging from the climacteric onwards attracted medical attention much earlier than male aging health problems. In addition, male aging problems start at a later age than the climacteric occurs in women. However, men's life expectancy is also continuously increasing: in Europe a newborn male now has a life expectancy of about 75 years, and a 60-year-old man has a statistical possibility of reaching 80 years of age. The increasing number of aging men forces physicians to focus on their health problems.peer-reviewe

Comparison of five different methods to assess the concentration of boar semen

Both for research and practical purposes, accurate and repeatable methods are required to assess the concentration of boar semen samples. Since the method which is used may influence the results considerably, the aim of the present study was to compare 5 frequently used techniques to determine boar semen concentration. Fifty ejaculates were collected from 37 different boars at an artificial insemination centre. Subsequently, each ejaculate was analyzed for sperm concentration by means of 2 different types of colorimeters (Colorimeter 1: Model 252, Sherwood Scientific Ltd, Cambridge, UK; Colorimeter 2: Ciba-Corning, Schippers, Bladel, The Netherlands), the Burker counting chamber (golden standard), and the Hamilton Thorne Analyzer (Ceros 42.1) using 2 types of Leja chambers (the 'former' and the 'recently developed'). Each ejaculate was assessed 5 times with each of the 5 methods, and the repeatability, expressed by coefficient of variation (CV), was determined for each method. The different methods were compared using Pearson's correlations and limits of agreement. The colorimeters yielded the lowest CV's (both 3.7%), while the former Leja chamber resulted in the highest CV (12.4%). Moreover, significant (P0.71) were found between the results obtained by the different methods. The limits of agreement plots showed that none of the methods consistently over- or underestimated the sperm concentrations when compared to the Burker chamber, although there was a tendency toward higher over- or underestimation in highly concentrated sperm samples. Based on our results, there were no major differences in the assessment of sperm concentration between the evaluated methods. The choice of method used in a laboratory could therefore be based on factors such as cost, number of samples to be assessed and practical use, without thereby negatively affecting the validity of the results thus obtained

Long-term complications of continent catheterizable channels: a problem for transitional urologists.

A majority of the transitional urology patient population have neurogenic bladder and many of these patients have undergone creation of continent catheterizable channels (CCCs) to facilitate bladder emptying. Transitional urologists will be faced with revision of these channels due to a variety of possible complications. We performed a comprehensive literature review to the data regarding the incidence, timing, and predisposing factors that lead to complications of CCCs as well as surgical revision techniques and their outcomes. Long-term channel complications and related revisions are common (25-30%) and likely underestimated. While many predictors for revision have been posited, the only predictor that has been significant in robust multivariable analysis is channel type, with appendicovesicostomies having a lower chance of requiring revision compared to Monti channels. Channels created in adults have high likelihood of requiring revision, even within a relatively short follow-up period. We review techniques for management of channel complications and their outcomes. As patients with congenital urologic conditions requiring CCCs are gaining longer lifespans, transitional urologists will be faced with revision and/or replacement of these channels. While some of these patients may require supravesical diversion in the future, data show that revision is feasible with good outcomes. Longer-term follow-up data is needed to understand the life-span and best practices of new CCCs created among the transitional population

Multiparametric magnetic resonance imaging of the prostate-a basic tutorial.

Prostate cancer is the second most common cause of cancer related death in the United States and the most commonly diagnosed malignancy in men. In general, prostate cancer is slow growing, though there is a broad spectrum of disease that may be indolent, or aggressive and rapidly progressive. Screening for prostate is controversial and complicated by lack of specificity and over diagnosis of clinically insignificant cancer. Imaging has played a role in diagnosis of prostate cancer, primarily through systemic transrectal ultrasound (TRUS) guided biopsy. While TRUS guided biopsy radically changed prostate cancer diagnosis, it still remains limited by low resolution, poor tissue characterization, relatively low sensitivity and positive predictive value. Advances in multiparametric magnetic resonance imaging (mpMRI) have allowed more accurate detection, localization, and staging as well as aiding in the role of active surveillance (AS). The use of mpMRI for the evaluation of prostate cancer has increased dramatically and this trend is likely to continue as the technique is rapidly improving and its applications expand. The purpose of this article is to review the basic principles of mpMRI of the prostate and its clinical applications, which will be reviewed in greater detail in subsequent chapters of this issue

Update on male reproductive endocrinology.

Practitioners of male reproductive and sexual medicine must have an intimate understanding of the physiology of male reproductive endocrinology, as such a knowledge is the cornerstone on which hormonal treatments are based. In this review, we highlight what is known about male reproductive endocrine physiology and the various control mechanisms for the system. We also discuss the limitations of our current understanding of the reproductive physiology. We hope that this review is helpful for male reproductive medicine practitioners in understanding the principles on which hormonal treatments are based

Readability and understandability of andrology questionnaires

Objective: Medical questionnaires, which enable collection, comparison and analysis of appropriate data as a means of written communication between a patient and a doctor, must be easily readable, and understandable. Here, we measure the readability and understandability of questionnaires used in andrology and examine the relationship between the educational status of the patients and the understandability of the forms. Material and methods: Seven questionnaires used to diagnose andological diseases were selected from the European Association of Urology guidelines. The number of syllables per word, the number of words in a sentence, and the average word and sentence lengths were calculated for each Turkish validated form. Readability scores were calculated, and closet tests were used to measure the understandability of the texts. Results: Three hundred and twenty-seven male volunteers participated in the study. Two hundred and sixteen of the participants (66%) had a high school or college education. The readability level of the seven forms was determined to be ''Difficult'' or ''Very Difficult,'' and at least a high school education level was required to understand the forms. As education level and monthly income increased, the understandability of the forms increased; as the readability of the forms became more difficult, their understandability decreased (p<0.001). Conclusion: The readability levels of questionnaires used in andrology are well above the reading level of Turkey. Health providers can help patients to fill out forms to increase doctor-patient communication