Clinical Care Pathways in Andrology PDF
Preview Clinical Care Pathways in Andrology
John P. Mulhall Peter J. Stahl Doron S. Stember Clinical Care Pathways in Andrology 123 Clinical Care Pathways in Andrology John P. Mulhall • Peter J. Stahl Doron S. Stember Clinical Care Pathways in Andrology John P. Mulhall, MD, MSc, FECSM Peter J. Stahl, MD Sexual and Reprodictive Medicine Program Department of Urology Department of Surgery Columbia University College of Division of Urology, Department of Surgery Physicians & Surgeons Memorial Sloan-Kettering Cancer Center New York, NY, USA New York, NY, USA Doron S. Stember, MD Department of Urology Beth Israel Medical Center Albert Einstein College of Medicine of Yeshiva University New York, NY, USA ISBN 978-1-4614-6692-5 ISBN 978-1-4614-6693-2 (eBook) DOI 10.1007/978-1-4614-6693-2 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2013933340 © Springer Science+Business Media New York 2014 This work is subject to copyright. 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Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Preface Andrology is the medical specialty that deals with male health, especially as it pertains to problems of the male sexual and reproductive system. Andrological issues in urologic practice and indeed in general medical practice are commonly encountered, yet perplexing for many clinicians. In medical training, urologic or general medicine, there is generally minimal attention focused on these topics. Thus, clinicians are often left under-informed and under-trained. This is the impetus behind this book. It was my vision to develop a series of clinical care algorithms to aid the clinician in their medical practice. Whether you are a urologist or belong to another medical specialty or are a physician in training, a nurse or physician assistant, these algorithms have been designed to assist you in your decision-making regarding patient evaluation and treatment. To the best of our ability, we have designed algorithms that are evidence-based and where such evidence or society guidelines do not exist I have used my substantial clinical experience in sexual and reproductive medicine to generate these clinical care pathways. I have been ably assisted in the development of these pathways by two bright young stars in andrology, both trained by me, Doron Stember MD and Peter Stahl MD, without whose efforts this project would not have been possible. No doubt, there may be topics that you would have liked to see covered by us that have been omit- ted. We have tried to focus on the most frequent or important areas for clinical practice. Each chapter is organized in an identical fashion, with the algorithm presented with annotations to text that expands on the point in question. We have attached appendices where we believe these are of value, in par- ticular, specific questionnaires that may be of value to you in your daily practice. We have included numerous tables, listing definitions, key history and examination points, and medication doses and side effects. We have also included suggested reading lists, which are specifically designed not to be comprehensive and overwhelming, but rather functional. I hope you find this book of clinical utility to you. I welcome comments and suggestions with regard to specific algorithms in this book or future algorithms. John P. Mulhall, MD, MSc, FECSM Division of Urology, Department of Surgery Memorial Sloan-Kettering Cancer Center New York, NY, USA v Contents 1 Abnormal Semen Analysis ................................................................................................. 1 2 Anejaculation ....................................................................................................................... 11 3 Azoospermia ........................................................................................................................ 17 4 Azoospermia: Indeterminate Etiology .............................................................................. 25 5 Azoospermia: Surgical Sperm Retrieval ........................................................................... 31 6 Delayed Orgasm .................................................................................................................. 37 7 Erectile Dysfunction: Initial Evaluation ........................................................................... 41 8 Erectile Dysfunction: Extended Evaluation ..................................................................... 47 9 Erectile Dysfunction: Treatment ....................................................................................... 57 10 Hematospermia ................................................................................................................... 67 11 Hypogonadism: Evaluation ................................................................................................ 75 12 Hypogonadism: Treatment ................................................................................................. 85 13 Low Libido ........................................................................................................................... 97 14 Low Semen Volume ............................................................................................................. 101 15 Penile Deformity: Peyronie’s Disease ................................................................................ 109 16 Penile Fracture .................................................................................................................... 117 17 Penile Pain ........................................................................................................................... 123 18 Penile Rehabilitation ........................................................................................................... 129 19 Penile Sensory Loss ............................................................................................................. 135 20 Premature Ejaculation ....................................................................................................... 141 21 Priapism ............................................................................................................................... 151 22 Sexual Incontinence ............................................................................................................ 161 vii viii Contents 23 Varicocele ............................................................................................................................. 165 24 Vasectomy ............................................................................................................................ 171 25 Vasectomy Reversal ............................................................................................................ 177 Index ............................................................................................................................................. 183 Chapter 1 Abnormal Semen Analysis Reassurance I Global or non-specific abnormalities J Directed additional testing Modifiablemale factorModifiable factor presentnot present MNO EndocrineVaricoceleLifestyle orabnormalitymedicationadjustment VaricoceleEndocrinePligationtherapyConsiderempirictherapy Reassess semen quality Attempt spontaneous conception mal L Infection Antibiotics Nor AAbnormal semen analysis BHistory and physical examinationSerum T and FSH CRepeat semen analysis Abnormal D Specific abnormalities EFGSevereAbsoluteGlobozoospermiaoligozoospermiaasthenozoospermia Rule outcorrectable causes KGenetic testingSemen processingAntispermantibodies Zero motileSome motilespermspermSteroids Viability test No viableViable spermsperm presentpresent ElectronTESEmicroscopy HAssisted reproduction Lowsemenvolume See lowsemenvolumealgorithm mia miam Azoosper Seeazoosperalgorith J.P. Mulhall et al., Clinical Care Pathways in Andrology, DOI 10.1007/978-1-4614-6693-2_1, 1 © Springer Science+Business Media New York 2014
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