Clinical Andrology PDF
Preview Clinical Andrology
Clinical Andrology Björndahl Clinical Giwercman EAU/ESAU Course Guidelines Tournaye Edited by Published in association with the European Weidner Andrology Association of Urology Lars Björndahl, MD, PhD Centre for Andrology and Sexual Medicine With a Foreword from Per-Anders Abrahamsson Clinic for Endocrinology, Department of Medicine, Huddinge A major new international reference work on and Karolinska University Hospital and andrology from the EAU Section of Andrological C EAU/ESAU Course Karolinska Institutet Urology – covering such issues as male infertility, Stockholm, Sweden erectile dysfunction, late-onset hypogonadism, l Guidelines and reproductive cancers – that engages i Aleksander Giwercman, MD, PhD n with contemporary concern for evidence- Reproductive Medicine Centre based practice, minimizing interventions, and Skåne University Hospital Malmö i promoting male reproductive health. c Lund University Malmö, Sweden a Herman Tournaye, MD, PhD Centre for Reproductive Medicine l University Hospital of the Dutch-speaking A Brussels Free University Brussels, Belgium n Wolfgang Weidner, MD d Department of Urology, Pediatric Urology and Andrology r University of Giessen o Giessen, Germany l o g y Edited by Lars Björndahl Aleksander Giwercman Herman Tournaye Wolfgang Weidner Published in Association with Telephone House, 69-77 Paul Street, London EC2A 4LQ, UK Published in Association with 52 Vanderbilt Avenue, New York, NY 10017, USA Published in Association with www.informahealthcare.com IHBK064-FM IHBK064-Bjorndahl April30,2010 21:42 Trim:246mm×189mm CharCount= Clinical Andrology IHBK064-FM IHBK064-Bjorndahl April30,2010 21:42 Trim:246mm×189mm CharCount= IHBK064-FM IHBK064-Bjorndahl April30,2010 21:42 Trim:246mm×189mm CharCount= Clinical Andrology EAU/ESAUCourseGuidelines Edited by LarsBjo¨rndahl,MD,PhD CentreforAndrologyandSexualMedicine EndocrinologyClinic,DepartmentofMedicine,Huddinge KarolinskaUniversityHospitalandKarolinskaInstitutet Stockholm,Sweden AleksanderGiwercman,MD,PhD ReproductiveMedicineCentre Ska˚neUniversityHospitalMalmo¨ LundUniversity Malmo¨,Sweden HermanTournaye,MD,PhD CentreforReproductiveMedicine UniversityHospitaloftheDutch-speakingBrusselsFreeUniversity Brussels,Belgium WolfgangWeidner,MD DepartmentofUrology,PediatricUrologyandAndrology UniversityofGiessen Giessen,Germany PublishedinassociationwiththeEuropeanAcademyofUrology IHBK064-FM IHBK064-Bjorndahl April30,2010 21:42 Trim:246mm×189mm CharCount= Publishedin2010byInformaHealthcare,TelephoneHouse,69-77PaulStreet,LondonEC2A4LQ,UK. SimultaneouslypublishedintheUSAbyInformaHealthcare,52VanderbiltAvenue,7thfloor,NewYork,NY10017,USA. (cid:1)c 2010InformaUKLtd,exceptasotherwiseindicated. NoclaimtooriginalU.S.Governmentworks. Reprintedmaterialisquotedwithpermission.Althougheveryefforthasbeenmadetoensurethatallownersofcopyrightmaterialhavebeen acknowledgedinthispublication,wewouldbegladtoacknowledgeinsubsequentreprintsoreditionsanyomissionsbroughttoourattention. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmitted,inanyformorbyanymeans, electronic,mechanical,photocopying,recording,orotherwise,unlesswiththepriorwrittenpermissionofthepublisherorinaccordancewiththe provisionsoftheCopyright,DesignsandPatentsAct1988orunderthetermsofanylicencepermittinglimitedcopyingissuedbytheCopyright LicensingAgency,90TottenhamCourtRoad,LondonW1P0LP,UK,ortheCopyrightClearanceCenter,Inc.,222RosewoodDrive,Danvers,MA 01923,USA(http://www.copyright.com/ortelephone978-750-8400). 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ACIPrecordforthisbookisavailablefromtheBritishLibrary. ISBN-13:978-1-8418-4680-4 Ordersmaybesentto:InformaHealthcare,SheepenPlace,Colchester,EssexCO33LP,UK Telephone:+44(0)2070175540 Email:[email protected] Website:http://informahealthcarebooks.com/ Forcorporatesalespleasecontact:[email protected] Forforeignrightspleasecontact:[email protected] Forreprintpermissionspleasecontact:[email protected] TypesetbyAptara,Inc. PrintedandboundintheUnitedKingdom IHBK064-FM IHBK064-Bjorndahl April30,2010 21:42 Trim:246mm×189mm CharCount= Foreword I am very honored to have the opportunity to include a few skillsathis/herdisposal,andtheevaluationofmanypatients, words in this edition of Clinical Andrology. At first glance moreoftenthannot,willinvolveateamofexperts(reproduc- onemaythink“Yetanotherbookonandrology,”albeitavery tive endocrinologist, geneticists, gynecologists, sex therapists, comprehensiveone.Butthisis,inmanyways,atrulyunique oncologists,etc.).Alsoinoncologysettingsweseereproductive publication:notonlybecauseitprovidesverycomprehensive health problems, including sexual dysfunction and impaired coverage of this difficult and multidisciplinary field, but also fertility,whichshouldbedealtwithinamultidisciplinaryset- becauseitrepresentsauniquecollaborationbetweenascientific ting. publisherandtopexpertsfromanumberofsocietiesoperating Theabilitytocoordinatealleffortstoensurecentralizedman- inthischallengingmedicalarea.ClinicalAndrology willbean agementandoversighttoguaranteecontinuityofpatientcare importantreferencepublicationforouryoungcolleaguestak- requiresahighlevelofcompetency. ingpartinajointtrainingprogramorganizedbytheEuropean We need to set, unify, and raise the standards in all areas Academy of Andrology (EAA), the European Federation of of care, but andrology will definitely be a field that will be Endocrine Societies (EFES), the European Society of Human taxed heavily in the years to come. Changing demographics, Reproduction and Embryology (ESHRE), and the European withthefirstwaveoftheBabyBoomergenerationapproaching Association of Urology (EAU). Aside from this direct link to 60 years of age will greatly affect the demands on healthcare aspecializationprogram,ClinicalAndrologyoffersthestateof professionals. Additionally,changesinsocialpatternsinfluence theartinallaspectscoveredbywhatwenowadaysconsiderto thedemandonexpertswithparticularandrologicalexpertise: beintherealmofandrologicalurology,anditwillsurelyprove delayedparenthood,secondmarriages,agreateracceptanceof avaluablereferencedocumentalsoforexperiencedcolleagues. diversefamilyunits,andmoreopennessaboutgender-related Overthepastdecennia,agreatprogresshasbeenmadeinthe problemsarejustafewfactorsthatwillaffectpracticepatterns. understandingofboththephysiologyandthepathophysiology Thetrendoffurtherspecializationisvisibleinmostmedical ofthemalereproductivesystem,anditisgenerallyrecognized fields,andcleardivisionlinesbetweenresponsibilitiesrelating nowthatspecializedtraininginclinicalandrologyisneededto to patient care seem to fade. Education of young colleagues keeppacewiththeemergingtechniquesforassistedreproduc- shouldremainacentralactivityifwe,asmedicalassociations, tion.Thecurriculaofthevariousmedicalspecialtiesinvolved fullycommittooptimizingpatientcare. havebeenlaggingbehind.Sustainablehigh-qualitystructuresto Icannotcommendtheeditors—LarsBjo¨rndahl,Aleksander trainprofessionalsareneededandthisfirstcollaborativetrain- Giwercman, Herman Tournaye, and Wolfgang Weidner— ing effort is an enormous step forward and all collaborators enough for bringing together this wealth of information and consideritasolidfoundationtofurtherbuildon. motivateandengagesomanyeminentexpertsinthisareato Oneonlyneedstolookatthetableofcontentstounderstand providehigh-qualitycontributions.Itakethelibertytospeak the complexity of this field and the range of skills involved alsoonbehalfoftheallcolleaguesdirectlybenefitingfromall toappropriatelytreatthedifferentpatientsgroups.Themost these efforts: it has most certainly paid off—my sincere con- important attributes for a clinical andrologist would be the gratulations. ability to take a clinical history and carry out a competent clinical examination. This may sound straightforward, but it Per-AndersAbrahamsson clearlyisnot.Aclinicalandrologistwillneedtohavearangeof Secretary-General,EuropeanAssociationofUrology v IHBK064-FM IHBK064-Bjorndahl April30,2010 21:42 Trim:246mm×189mm CharCount= Preface YouareholdinginyourhandsthefirsteditionofClinicalAndrol- Theaimofthistextbookistocoverallthesefourfieldsandto ogy.Aseditors,wewouldshortlyexplaintheintentionsbehind provideacomprehensiveevidencebasedandclinicallyoriented thistextbookandalsoaskforyourhelpinimprovingtheedi- toolfortrainingclinicalandrologists.However,itcanalsobe tionsweareexpectingtofollowtheopusone. used in teaching at the pregraduate level as well as an aid in Duringtherecentyears,ithasbecamemoreandmoreevident the daily life of more experienced andrologists. According to thatdiseasesofmalereproductivesystemrepresentaseriousand thesequiteambitiousgoals,wehaveapproachedsomeofthe common health problem. At least 15% of all couples experi- highest ranked experts within the field of clinical andrology enceinfertilityproblems,thecontributionofmale-relatedfac- to contribute to this book. The authors were asked to focus tors assumed to be as frequent as the female ones. Together ontheclinicalaspectsofandrologybasinganddocumenting withsexualdysfunction,fertilityproblemsrepresentoneofthe theirrecommendationsbystatingproperlevelsofevidence.We mostcommondisordersinoursociety.Anotherissuereceiving thankalltheauthorsfortheirinvaluableefforts. increasingattentionisage-relatedandrogendeficiencyandthe Weareawareofthefactthatthefirsteditionofatextbook linkbetweenlowtestosteronelevelsandtheriskofmetabolic willnotbeperfect.However,wehopethatthereaders,trainees, andcardiovasculardisorders.However,properandevidence- studentswillfinditvaluableintheirworkwithclinicalandrol- basedmanagementoftheseconditionsisseriouslyhampered ogy.Wewouldalsoappreciateconstructivefeedback—negative bylackofclinicalandrologists—specialistsindisordersofmale orpositive—sincethiswillbeanimportanttoolforimproving reproductivesystem.Duringthepastfewyears,collaboration theforthcomingeditions.Therefore,donothesitatetoletus betweenEuropeanAcademyofAndrology(EAA)andEuropean knowyouropinionaboutClinicalAndrology. AssociationofUrology(EAU),aimingtoestablishajointtrain- ing program within the field of clinical andrology, has been LarsBjo¨rndahl established. Four different subareas of this clinical discipline AleksanderGiwercman havebeendefined:(a)infertility,(b)hypogonadism,(c)sexual HermanTournaye dysfunction,and(d)maleaccessorysexglandinfections. WolfgangWeidner vi IHBK064-FM IHBK064-Bjorndahl April30,2010 21:42 Trim:246mm×189mm CharCount= Contents Foreword v Preface vi Contributors xi PARTI MALEINFERTILITY 1. Definingmalefactorinfertility 1 DimitriosA.Adamopoulos,GiorgiosMitios,andStamatinaS.Nicopoulou 2. Clinicalinvestigationoftheinfertilemale 9 GertR.Dohle 3. Thefemalefactor 18 LynneRobinsonandMasoudAfnan 4. Basicsemenanalysisandlaboratoryqualityforclinicians 28 LarsBjo¨rndahl 5. Geneticcausesofmaleinfertilityandtheirimpactonfuturegenerations 39 CsillaKrausz 6. Conventionaltreatmentofthemaleininfertilecouples 49 HermanTournayeandAleksanderGiwercman 7. Nonsurgicalmethodsforspermretrievalinpatientswithanejaculationand retrogradeejaculation 52 AxelKamischke 8. SpermpreparationforARTandIUI 65 KerstiLundin 9. Intrauterineinseminationformalesubfertility 73 AstridE.P.CantineauandBenJ.Cohlen 10. IVFandICSIfortreatingmaleinfertility 79 HermanTournaye 11. Surgeryformaleinfertility:surgicaltreatmentofobstructiveazoospermia 85 LaurentVaucherandPeterN.Schlegel 12. Surgeryformaleinfertility:surgicalspermretrievals 95 GiovanniM.Colpi,GuidoPiediferro,FabrizioI.Scroppo,ElisabettaM.Colpi, andPatriziaSulpizio 13. Surgeryformaleinfertility—varicocelectomyanditsalternatives 105 HowardH.KimandMarcGoldstein vii IHBK064-FM IHBK064-Bjorndahl April30,2010 21:42 Trim:246mm×189mm CharCount= contents 14. Assistedreproductionwithsurgicallyretrievedsperm 116 Val´erieVernaeveandHermanTournaye 15. Therapeuticspermcryopreservation 124 MathewTomlinson 16. TesticulartissueforICSI 134 GretaVerheyen 17. Donorinsemination:Past,present,andfuturechallenges 149 VanessaJ.KayandChristopherL.R.Barratt 18. Malecontraception 159 AhmedMahmoudandGuyT’Sjoen 19. Preventionofmaleinfertility:Environmentalandsystemicdiseaseeffects onmalefertility 164 JensPeterBondeandJormaToppari 20. Infertilityandtestiscancer 176 PatrickdeGeeterandPeterAlbers 21. Maleagingandreproduction 186 SabineKliesch PARTII ANDROLOGICALENDOCRINOLOGY 22. Sexsteroidsinmen:Biosynthesis,transport,metabolism,interactionwith receptors,andcellular(GenomicandNongenomic)andbiologicalactions 193 JemimaGaytant,KatrienVenken,andDirkVanderschueren 23. Gonadotropinsandgonadotropinreceptors 201 IlpoHuhtaniemiandMariaAlevizaki 24. Androgeneffectsinreproductiveandnonreproductiveorgans 216 MichaelZitzmann 25. Clinicalaspectsofmalesexdifferentiation 226 JohanSvenssonandYvonneLundbergGiwercman 26. Disturbancesinmalepubertaldevelopment 237 OlleSo¨der 27. Clinicalinvestigationandlaboratoryanalysesinmalehypogonadism 245 GianniForti,GiovanniCorona,andMarioMaggi 28. Testosteronedeficiencysyndrome 260 StefanArver 29. Androgenreplacement—indicationsandprinciples 269 FotiosDimitriadis,EvlaliaVlachopoulou,StavrosGratsias,DimitriosBaltogiannis,DimitriosGiannakis, PanagiotaTsounapi,MichaelRimikis,NikolaosPardalidis,TakeshiWatanabe,MotoakiSaito, IkuoMiyagawa,andNikolaosSofikitis 30. Androgendeficiencyincancer-treatedmen 282 JakobEberhard,PatrikRomerius,andAleksanderGiwercman viii IHBK064-FM IHBK064-Bjorndahl April30,2010 21:42 Trim:246mm×189mm CharCount= contents 31. Gynecomastia 286 NielsJørgensen,NielsKroman,Jens-JørgenElberg,andAndersJuul PARTIII UROGENITALINFECTIONANDSTD 32. Maleinfertilityinchronicurogenitalinfectionsandinflammationwithspecial referencetoejaculatefindings 293 WolfgangWeidner,ThorstenDiemer,andFlorianM.E.Wagenlehner 33. Inflammatoryparametersoftheejaculate 301 ZsoltKopaandMiha´lyBer´enyi 34. Spermmorphologyinmaleurogenitaltractinfections 309 RoelofMenkveld 35. Immunologicalaspectsofmaleaccessoryglandinfection 317 LucianoAdorini,MarioMaggi,andMauroGacci 36. ROSandDNAintegrity—implicationsofmaleaccessoryglandinfections 324 RalfHenkel PARTIV MALESEXUALDYSFUNCTION 37. Hematospermia(Hemospermia) 329 NadjaEngelandHubertJohn 38. Prostaticdiseaseandmalesexualdysfunction 336 FrancescoMontorsi 39. Sexualdysfunctionandtheprostate:andrologicalimplicationsofPCa,BPH, andprostatitis 345 WolfgangWeidnerandRichardBerges 40. Psychologicalabnormalitiesofmalesexualfunction 351 EmmanueleA.JanniniandAndreaLenzi 41. Ejaculatorydisorders 359 NancyL.Brackett,CharlesM.Lynne,DanaA.Ohl,andJensSønksen 42. Diagnosticmanagementoferectilefunction—clinicalandrology 372 Chi-YingLi,GiulioGaraffa,andDavidJ.Ralph 43. Conservativetreatmentoferectiledysfunction 380 ThomasC.Stadler,UweHartmann,ArminJ.Becker,andChristianG.Stief 44. Surgeryforerectiledysfunction 387 LeventGurkan,MathewC.Raynor,andWayneJ.G.Hellstrom 45. Peyronie’sdiseaseandpenilecurvature 396 EkkehardW.Hauck,ThorstenDiemer,andWolfgangWeidner ix
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