Tendências na contracepção masculina

Methods that are available for male contraception, namely coitus interruptus, condoms, and vasectomy, have been used since the 19th century. With the exceptions of a few improvements of these methods, no major progress has been made with respect to introducing new male contraceptives since then. It is extremely urgent to develop new, safe, effective, and reversible male contraceptive methods. Among all male contraceptive methods that are being investigated, the hormonal approach is the closest to clinical application. Hormonal contraception provides pregnancy protection by means of spermatogenic suppression. Androgen-progestin regimens currently represent the best available hormonal combination for induction of a profound suppression of spermatogenesis. Further development of new steroids is mandatory for increasing the choices of available contraceptive formulations and to optimize long-term safety of these regimens.Métodos disponíveis para contracepção como coito interrompido, preservativo e vasectomia são usados desde o século 19. Com exceção a alguma melhora nestes métodos, nenhum progresso maior tem sido feito com relação à introdução de novos contraceptivos masculinos desde então. É de extrema urgência o desenvolvimento de um novo método contraceptivo seguro, efetivo e reversível. Entre todos os métodos contraceptivos que estão sendo investigados, a abordagem hormonal é a que está mais perto para aplicação clínica. A contracepção hormonal fornece proteção contra a gravidez por meio da supressão na espermatogênese. Tratamentos que incluem andrógeno e progestágenos representam na atualidade a melhor combinação hormonal disponível para induzir uma profunda supressão na espermatogênese. O desenvolvimento futuro de uma nova formulação esteróide é mandatório para melhorar as chances de formulações contraceptivas disponíveis e otimizar o efeito a longo-prazo de tais regimes

Riscos e benefícios da terapia de reposição hormonal em homens idosos

O uso da testosterona em homens idosos, conhecido como Terapia de Reposição Hormonal no homem ou Terapia de Reposição com Androgênios, têm aumentado o interesse para as comunidades médica e leiga na última década. Muito embora o conhecimento a respeito dos potenciais benefícios e riscos da Terapia de Reposição Hormonal nos homens tem aumentado dramaticamente, ainda existe muito que precisa ser determinado. Embora existam vários benefícios potenciais da Terapia de Reposição com Androgênios e dados clínicos relacionados com o uso de tal terapia, não existem ainda nenhum estudo controlado, randomizado e multicêntrico avaliando o uso de tal terapia. O objetivo deste artigo é revisar os aspectos atuais sobre os possíveis riscos e benefícios da Terapia de Reposição com Androgênios discutindo os estudos clínicos publicados sobre o assunto.The use of testosterone in older men, known as male hormonal replacement therapy or androgen replacement therapy, has become of increasing interest to both the medical and lay communities over the past decade. Even though the knowledge of the potential benefits and risks of male Androgen Replacement Therapy has increased dramatically, there is still much that needs to be determined. Although there are a number of potential benefits of male Androgen Replacement Therapy and data concerning clinical effects of such replacement have accumulated, as yet there have not been any large multicenter randomized controlled trials of this therapy. It is the purpose of this article to review what is currently known about the possible risks and benefits of male Androgen Replacement Therapy by discussing the clinical trials to date

Melhor tratamento da infertilidade no homem vasectomizado: reprodução assistida ou reversão de vasectomia?

Reconstrução microcirúrgica do trato reprodutivo é preferível à captação de espermatozóides com Fertilização in vitro e Injeção intracitoplasmática de espermatozóides em homens vasectomizados quando o intervalo de obstrução for inferior a 15 anos e ausência de fatores de risco para infertilidade feminina. Se ocorrer uma obstrução epididimária ou se a mulher possuir uma idade avançada, a decisão para ou reconstrução microcirúrgica ou captação de espermatozóides com fertilização in vitro ou Injeção intracitoplasmática de espermatozóides deve ser individualizada. Captação espermática com fertilização in vitro e Injeção intracitoplasmática de espermatozóides é preferível ao tratamento cirúrgico quando o tratamento do fator feminino requer fertilização in vitro ou quando a chance de sucesso com a captação de espermatozóides e Injeção intracitoplasmática de espermatozóides são superiores às chances de sucesso com a captação de espermatozóides e Injeção intracitoplasmática de espermatozóides são superiores às chances com o tratamento cirúrgico.In men with prior vasectomy, microsurgical reconstruction of the reproductive tract is more cost-effective than sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection if the obstructive interval is less than 15 years and no female fertility risk factors are present. If epididymal obstruction is detected or advanced female age is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection should be individualized. Sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection is preferred to surgical treatment when female factors requiring in vitro fertilization are present or when the chance for success with sperm retrieval and intracytoplasmic sperm injection exceeds the chance for success with surgical treatment

Efeitos da terapia medicamentosa, àlcool, cigarros e substância deletérias para o sistema endócrino na infertilidade masculina

A infertilidade afeta até 15% da população sexualmente ativa e em 50% dos casos, o fator masculino está envolvido, como problema primário ou em combinação com causas de origem feminina. Como muitas drogas comumente encontradas e medicações podem ter efeitos deletérios na infertilidade masculina, a avaliação médica deve incluir uma discussão sobre o uso de drogas recreacionais e ilícitas, medicamentos e outras substâncias podem prejudicar a fertilidade. Com o conhecimento de quais drogas e medicamentos podem ser prejudiciais à fertilidade talvez seja possível mudar os hábitos ou a posologia das medicações para diminuir os efeitos adversos na fertilidade e aumentar as chances de engravidar com sucesso. Preocupações referentes ao desenvolvimento sexual masculino e reprodução tem mudado para a pior nos últimos 30-50 anos. Embora alguns relatos não demonstrem modificações, outros sugerem que a concentração espermática esteja diminuindo e que a incidência de anormalidades do desenvolvimento como hipospádia e criptorquidia parecem estar aumentando, assim como a incidência de câncer de testículo. Estas preocupações sobre a possibilidade do ambiente estar contaminado com substâncias químicas - naturais ou sintéticas - que podem interagir com o sistema endócrino.Infertility affects up to 15% of the sexually active population, and in 50% of cases, a male factor is involved, either as a primary problem or in combination with a problem in the female partner. Because many commonly encountered drugs and medications can have a detrimental effect on male fertility, the medical evaluation should include a discussion regarding the use of recreational and illicit drugs, medications, and other substances that may impair fertility. With the knowledge of which drugs and medications may be detrimental to fertility, it may be possible to modify medication regimens or convince a patient to modify habits to decrease adverse effects on fertility and improve the chances of achieving a successful pregnancy. Concern is growing that male sexual development and reproduction have changed for the worse over the past 30 to 50 years. Although some reports find no changes, others suggest that sperm counts appear to be decreasing and that the incidence of developmental abnormalities such as hypospadias and cryptorchidism appears to be increasing, as is the incidence of testicular cancer. These concerns center around the possibility that our environment is contaminated with chemicals - both natural and synthetic - that can interact with the endocrine system

Complicação urológica após enxerto aorto-ilíaco: relato de caso e revisão de literatura

CONTEXT: Ureteral stenosis and ureterohydronephrosis may be serious complications of aortoiliac or aortofemoral reconstructive surgery. CASE REPORT: A 62-year-old female patient presented with a six-month history of left lumbar pain. She was a smoker, and had mild chronic arterial hypertension and Takayasu arteritis. She had previously undergone three vascular interventions. In two procedures, Dacron prostheses were necessary. Excretory urography showed moderate left ureterohydronephrosis and revealed a filling defect in the ureter close to where the iliac vessels cross. This finding was compatible with ureteral stenosis, and the aortoiliac graft may have been the reason for this inflammatory process. The patient underwent laparotomy, which showed that there was a relationship between the ureteral stenosis and the vascular prosthesis. Segmental ureterectomy and end-to-end ureteroplasty with the ureter crossing over the prosthesis anteriorly were performed. There were no complications. The early and late postoperative periods were uneventful. The patient evolved well and the results from a new excretory urogram were normal. We concluded that symptomatic ureterohydronephrosis following aortoiliac graft is a real complication and needs to be quickly diagnosed and treated by urologists.INTRODUÇÃO: Estenose ureteral e ureterohidronefrose podem ser sérias complicações da cirurgia reconstrutiva aorto-femoral ou aorto-ilíaca. RELATO DE CASO: Uma paciente de 62 anos apresentou-se referindo história de dor lombar a esquerda há seis meses. Ela era fumante, portadora de hipertensão arterial crônica leve e arterite de Takayasu. Havia sido submetida a três intervenções vasculares. Em dois procedimentos o uso de prótese de Dacron foi necessário. Uma urografia excretora revelou moderada ureterohidronefrose à esquerda e falha de enchimento no ureter próximo ao cruzamento dos vasos ilíacos. Esse achado era compatível com uma estenose ureteral e o enxerto aorto-ilíaco poderia ser a causa do processo inflamatório. A paciente foi submetida a laparotomia, que evidenciou a relação entre estenose ureteral e a prótese vascular. Ureterectomia segmentar e uretroplastia término-terminal com o ureter passando anteriormente à prótese foram realizadas. Não ocorreram complicações. Os períodos de pós-operatório precoce e tardio transcorreram sem intercorrências. A paciente evoluiu bem e uma nova urografia excretora apresenta-se normal. Concluímos que ureterohidronefrose sintomática após enxerto aorto-ilíaco é uma complicação real e precisa ser rapidamente diagnosticada e tratada pelo urologista

Spontaneous Recanalization after Vasectomy

Vasectomy is the method most commonly used in men for voluntary sterilization purposes. We report two cases of early recanalization following vasectomies performed in 1085 men for sterilization purposes at a tertiary public institution between January 2000 and November 2003. Thus, the risk of 0.2% of failure due to early recanalization should be explained and the fertility implications stressed. Written documentation recording the clarification presented at consultation is essential. KEYWORDS: vasectomy, infertility, failure, sterile, sperm INTRODUCTION Of all the methods of contraception, vasectomy is the safest, easiest, cheapest, most effective, and most reliable. It is usually uncomplicated; the discomfort after surgery usually abates promptly and there are generally no sequelae. Further, few patients suffer from bleeding or infection at the vasectomy site. Testicular pain is the most common complication after vasectomy. Although these complications can be serious, the usual conservative management leads to spontaneous cure Vasectomy may fail to result in sterility for three reasons, i.e., by failure to divide either vas, by vasal recanalization caused by the formation of microchannels between the severed ends, and by unrecognized anatomic variation. Although definitions vary among investigators, early failure of the procedure is considered to have occurred when significant numbers of spermatozoa or any motile spermatozoa persist continuously later than 4 months after vasectomy The purpose of our study is to report our experience with vasectomy spontaneous recanalization among 1085 patients treated with vasectomy for sterilization purposes. METHODS Between January 2000 and November 2003, 1085 patients were submitted for vasectomy for sterilization purposes at a tertiary public institution. All patients were over 25 years old or had two or more children. Our institution has a standard protocol for the performance of vasectomy after referral that includes Lucon et al.: Spontaneous Recanalization after Vasectomy TheScientificWorldJOURNAL (2006) 6, 2366-2369 2367 counseling and informed consent. Vasectomy procedure was performed under local anesthesia by a single physician (EDSM). Two 1-cm transversal hemiscrotal incisions were made. A 1-cm vas deferens segment was excised, followed by ligature, but not cauterization, of the cut ends using polypropilene 4-0 transfixed suture. Interposition of fascia was not done. Although the segments excised were not sent for pathological confirmation, the surgeon confirmed it to be vas deferens by passing a suture through its lumen. After vasectomy, patients were advised to maintain their use of contraceptives until they were considered sterile. Sperm samples were obtained before and 2 months after the procedure, and at the 4 th month if the result was other than azoospermia. RESULTS Vasectomy early recanalization occurred in 2 out of 1085 patients (0.2%). The first patient was 40 years old, his wife was 38, and they had four children. The second was 34 years old, his wife 28, and they had two children. A seminal sample was obtained from each patient before the vasectomy procedure and two additional samples were taken 2 and 4 months, respectively, after the surgery. The data of the sperm analysis are summarized i

Urological complication following aortoiliac graft: case report and review of the literature

CONTEXT: Ureteral stenosis and ureterohydronephrosis may be serious complications of aortoiliac or aortofemoral reconstructive surgery. CASE REPORT: A 62-year-old female patient presented with a six-month history of left lumbar pain. She was a smoker, and had mild chronic arterial hypertension and Takayasu arteritis. She had previously undergone three vascular interventions. In two procedures, Dacron prostheses were necessary. Excretory urography showed moderate left ureterohydronephrosis and revealed a filling defect in the ureter close to where the iliac vessels cross. This finding was compatible with ureteral stenosis, and the aortoiliac graft may have been the reason for this inflammatory process. The patient underwent laparotomy, which showed that there was a relationship between the ureteral stenosis and the vascular prosthesis. Segmental ureterectomy and end-to-end ureteroplasty with the ureter crossing over the prosthesis anteriorly were performed. There were no complications. The early and late postoperative periods were uneventful. The patient evolved well and the results from a new excretory urogram were normal. We concluded that symptomatic ureterohydronephrosis following aortoiliac graft is a real complication and needs to be quickly diagnosed and treated by urologists