1,721,483 research outputs found
Work-up of male infertility
No full textMany health conditions can affect male fertility, thus highlighting the need for a thorough evaluation of patients to identify treatable or reversible lifestyle factors or medical conditions. The initial step in evaluating infertility is obtaining a thorough medical and reproductive history, with specific focus on health comorbidities and lifestyle factors. A comprehensive physical examination is compulsory in the evaluation of every infertile male, including presence of adequate secondary sexual characteristics. Semen analysis, as for World Health Organization recommendations, is the cornerstone for evaluating male infertility. However, more complex testing than semen analysis may be required in particular cases. In men with oligozoospermia or azoospermia a hormonal evaluation should be performed, at least including total testosterone, follicle stimulating hormone, and luteinizing hormone. Genetic testing should be offered to azoospermic men and those with severe oligozoospermia. Ultrasound of the genitourinary tract can enrich the physical examination in many cases
PDE5i therapy
No full textPhosphodietserases-5 inhibitors (PDE5is) are currently the first line oral treatment for erectile dysfunction (ED) even though they can have potential role in slowing down plaque formation in Peyronie’s disease (PD). Several studies on animal models showed that PDE5is have anti-fibrotic properties that might help to relieve fibrotic plaques along with diffused corpora cavernosa fibrosis. Moreover, clinical studies using PDE5is alone or in combination with other medical treatments have shown promising results in reducing plaque fibrosis in patients with PD. Additionally, PDE5is play a fundamental role in patients developing ED after PD onset due to penile deformity, pain, narrowing, shortening and, curvature upon erections. Likewise, ED can occur after surgery for PD; in this context PDE5is are vital to restore proper erectile function
Gonadotropin Treatment For The Male Hypogonadotropic Hypogonadism
No full textHypogonadotropic hypogonadism (HH) is caused by a dysfunction in the hypothalamus and/or the pituitary gland and it can be congenital or acquired. This condition is biochemically characterized by low or inap-propriately normal gonadotropin levels along with low total testosterone levels. If fertility is not an issue, testosterone therapy is the treatment of choice to induce and maintain secondary sexual characteristics and sexual func-tion. Spermatogenesis is frequently impaired in patients with HH, but usually responsive to hormonal therapy such as gonadotropin therapy or GnRH supplementary/replacement therapy. When gonadotropins are the choice of treatment, conventional therapy includes human chorionic gonadotropin (hCG) along with different FSH for-mulations: human menopausal gonadotropins (hMG), highly purified urinary FSH preparations (hpFSH) (e.g., urofollitropin) or recombinant FSH (rFSH). The combination of FSH and hCG demonstrated to be associated with better outcomes than single compounds, whereas similar results were obtained with different FSH preparations in male individuals; both regarding the ability to stimulate spermatogenesis and eventually inducing physiology pregnancy. Gonadotropins can be administered either subcutaneously or intramuscularly. The combination therapy with hCG and FSH for a period of 12-24 months was found to promote testicular growth in almost all patients, spermatogenesis in approximately 80% and pregnancy rates in the range of 50%. Gynecomastia is the most common side effect of gonadotropin therapy and is due to hCG stimulation of aromatase causing increased secretion of estradiol. The therapeutic success is higher in patients with post-pubertal HH, in those without previ-ously undescended testes, in patients with higher baseline testicular volume, who underwent repeated cycles of therapy and in patients with higher baseline inhibin B serum concentrations. Reversal of hypogonadism can occur in up to 10% of patients but its physiopathologic mechanism has yet to be elucidated. In conclusion, gonadotropin therapy is effective in promoting puberty and in supporting spermatogenesis onset and preservation in HH patients with either hypothalamic or pituitary conditions
Anatomical Radical Retropubic Prostatectomy in Patients with a Preexisting Three-Piece Inflatable Prosthesis: A Series of Case Reports
No full textOnly few reports addressed the outcome of patients submitted to anatomical radical retropubic prostatectomy (RRP) with an indwelling inflatable penile prosthesis (IPP). To assess the feasibility and safety of RRP in patients with clinically localized prostate cancer and a previously implanted with an IPP. We evaluated the surgical parameters and the follow-up functional results in this particular patient population. Four patients previously submitted to IPP implant for severe erectile dysfunction underwent RRP for organ-confined prostate cancer. Patients' charts were carefully reviewed to investigate pre- and perioperative details. Patients were evaluated by the International Index of Erectile Function (IIEF) preoperatively and at 6 months postoperatively. Patients were then contacted to assess long-term functional and oncological outcome. The outcome of the procedures was comparable to a normal population in terms of operating time, estimated blood loss, hospitalization time, and pathological outcome. No injury to the preexisting penile implant was reported. Continence was obtained in 3 (75%) patients at catheter removal, and in 1 (25%) patient at the 1-month follow-up. No major intra- and postoperative complications were reported. All patients were able to use their prosthesis after RRP. No statistical difference in pre- and post-RRP EF domain scores was found. The presence of an IPP in patients with prostate cancer is not a contraindication to perform an anatomical RRP. Surgery can be performed safely without injuring the implant and the clinical outcome in these patients is satisfactory. Postoperative implant use is not affected by RRP. Deho' F, Salonia A, Briganti A, Zanni G, Gallina A, Rokkas K, Guazzoni G, Rigatti P, and Montorsi F. Anatomical radical retropubic prostatectomy in patients with a preexisting three-piece inflatable prosthesis: A series of case reports. J Sex Med 2009;6:578-583. OI Guazzoni, Giorgio Ferruccio/0000-0002-5713-8313; Gallina, Andrea/0000-0002-4540-956
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
AESTHETIC NEO-GLANS RECONSTRUCTION FOLLOWING PENIS-SPARING SURGERY FOR BENIGN, PREMALIGNANT OR MALIGNANT PENILE LESIONS
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Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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