Male Infertility and Sexual Dysfunction

639 Pages·1997·24.56 MB·English

by  Kenneth P. Roberts

Male Infertility and Sexual Dysfunction
Springer Science+Business Media, LLC
Wayne J.G. Hellstrom
Editor
Male Infertility and
Sexual Dysfunction
With 236 Illustrations, 38 in Full Color
Springer
Wayne lG. Hellstrom
Associate Professor of Urology
Chief, Section of Andrology and Male Infertility
Department of Urology
Tulane University School of Medicine
1430 Tulane Avenue SL 42
New Orleans, LA 70112-2699, USA
Library of Congress Cataloging-in-Publication Data
Male infertility and sexual dysfunction/Wayne l.G. Hellstrom,
editor.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-4612-7310-3 ISBN 978-1-4612-1848-7 (eBook)
DOI 10.1007/978-1-4612-1848-7
1. Andrology. 2. Infertility, Male. 3.- Impotence.
1. Hellstrom, Wayne l.G.
[DNLM: 1. Infertility, Male. 2. Sex Disorders. Wl 709 M24532
1997]
RC875.M35 1997
616.6'9--dc20 96-32477
Printed on acid-free paper.
© 1997 Springer Seienee+Business Media New York
Originally published by Springer-VerlagNew York, !ne. in 1997
Softeover reprint ofthe hardeover Ist edition 1997
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ssion of the publisher (Springer Science+Business Media, LLC), except for brief excerpts in connection with
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9 8 7 6 5 432 1
ISBN 978-1-4612-7310-3
This book is dedicated to Blackwell B. Evans, Sr., M.D., who was a friend, an
inspiration, and a mentor in urology; and to my family-lohn Erik, loshua,
Kyle, and Gina-for their continuing support.
Foreword
This comprehensive volume fills a need for information on current methods of diagno
sis and new means of treatment of both male infertility and sexual dysfunction. These
fields have expanded so rapidly that for practicing physicians it has become somewhat
impossible to keep up with the latest advances merely by reading the journals. Here,
the editor-in-chief has assembled a first-rate crew of experts from around the world
and assigned topics in their areas of expertise. The resulting chapters range from basic
principles and tests to newest diagnostic and therapeutic methods. Each chapter is
limited to a discussion of a specific aspect of andrology. This focus on specific disorders
allows the reader to quickly secure the diagnostic tools and a plan for treatment.
Although andrology has become a specialty of its own, general practitioners and
general urologists still diagnose and treat the majority of these patients. Thus, they
need a source of practical, current information on which to base their management. In
addition, the information laid out in this text will suggest what problems should be
referred to the specialist.
This is a book to keep at hand in the office or clinic for ready reference when a
patient is seen with a complaint of infertility or impotency.
Frank Hinman, Jr., M.D., FAC.S., F.AAP., FR.C.S. (Hon.)
University of California School of Medicine
San Francisco, California
vii
Preface
Infertility is more common than most would imagine. One in seven couples will have
difficulty conceiving during their reproductive lives, and the male factor is implicated
as the cause in up to 50% of these cases. The landmark birth of Denise Brown by in
vitro fertilization in 1978 was matched in significance in 1992 by the introduction of
intracytoplasmic sperm injection (ICSI) in humans. Although ICSI is now a main
stream topic in discussions about assisted reproductive techniques, it needs to be
considered as an adjunct in the treatment of male infertility. To treat only the sperm
and not do a complete history and physical examination as we were taught in medical
school is unconscionable. The field of male infertility crosses more than one discipline,
with a knowledge of urology, endocrinology, immunology, and even gynecology
needed for the physician to address many of the common clinical presentations. Infer
tility may well be the presentation of a serious medical condition, and the emotional
and financial impact on the couple undergoing any assisted reproductive technique
should never be underestimated.
Male sexual dysfunction, like male infertility, is receiving greater public attention.
According to recent estimates, between 20 and 30 million American men suffer from
some degree of sexual dysfunction. Comparative figures generally apply worldwide.
Surprisingly, only a small proportion of men experiencing impotence have undergone
evaluation or received treatment, often because of either their own reluctance or their
physician's lack of comfort in dealing with the subject of sexuality. Some critics have
commented that with the prevailing level of managed care and the introduction of
effective oral medications, the necessity for knowing about the mechanics and
psychogenics of male sexual dysfunction is no longer required. Nothing can be further
from the truth. Despite the logic of goal-directed therapy, most patients are dissatisfied
with this form of care. And, for the inquisitive physician, a knowledge of the underlying
mechanisms of causation and prevention is intellectually fulfilling and a driving force
for improved patient care. In no way has the introduction of oral agents for treatment
of impotence brought an end to the necessity of investigation. New knowledge, unfore
seen complications, and innovative treatment lie ahead.
These projections and anticipations are significant and worthy of our attention. To
this end, Male Infertility and Sexual Dysfunction combines discussions of the latest
advances in basic research with the recent innovations in the disciplines of male
infertility and sexual dysfunction.
Similar to the progress witnessed in other academic domains, the field of andrology
continues to evolve, perhaps at an even more rapid pace than certain other areas of
ix
x Preface
medicine. Nonetheless, it would be impossible to discuss every issue in andrology in a
single volume, and it would be unlikely that a single individual could comprehensively
cover all the latest developments in every specific area. For this reason, select interna
tional authorities have contributed in-depth coverage of their areas of expertise.
Part I begins with a discussion of male infertility and continues to the basic sciences,
office evaluation, laboratory and imaging techniques, use of testicular biopsy, and the
basic information that an andrologist should have about the female partner. Next is a
group of specialized chapters dealing with immunologic infertility, genital inflamma
tion, and reactive oxygen species, followed by clinically applicable chapters on medical
management, sperm processing, and surgical techniques that aid or ensure the union
of healthy gametes. Adolescent andrology and future concerns about genetics and
gonadotoxicity are included in this section on male infertility.
Part II reflects a more diverse format in coverage of sexual dysfunction. The basics
of office evaluation, androgen insufficiency, and duplex and nocturnal penile tumes
cence (NPT) studies are covered. Attention is then given to more abstract subjects on
neurotransmission, penile neurology, premature ejaculation, and psychogenic impo
tence. Finally, the medical, noninvasive, and surgical techniques are detailed.
The study of andrology is indeed a moving target. The dogma of today will be the
history of tomorrow. The goal of this volume is to provide a base of current knowledge
and set standards of clinical care to assist andrology researchers and clinicians of today.
These will in tum lay the foundations for the discoveries of tomorrow.
I would like to take this opportunity to thank June Banks Evans, Ann Morcos, and
Michon Breisacher Shinn for their tireless efforts and invaluable support in collecting,
correcting, and processing the many manuscripts that went into this volume. My
sincere appreciation to Raju Thomas, M.D., for his continued support and to Esther
Gumpert and Anne Fossella at Springer-Verlag for their professional guidance and
good cheer through all phases of the writing of this book.
Wayne J.G. Hellstrom
Contents
Foreword ............................................................ vii
Preface ......................................... '" . ... . . ... . . ... . . ... IX
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
1 Anatomy and Physiology of the Male Reproductive System . . . . . . . . . . . . . 1
Kenneth P. Roberts and Jon L. Pryor
2 Office Evaluation of the Infertile Man. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
R. Dale McClure
3 Semen Analysis and Other Tests for Male Infertility 39
James W. Overstreet
4 Treating the Sperm: Selection, Stimulation,
and Cryopreservation Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Erma Z. Drobnis
5 What Every Andrologist Should Know About Female Reproduction .... 83
Gloria Richard-Davis and P. Ronald Clisham
6 Leukocytospermia, Oxidative Stress, and Sperm Function. . . . . . . . . . . . . .. 100
R. John Aitken
7 Imaging the Reproductive Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 110
Brett C. Mellinger
8 Immunologic Infertility ........................................ , . . .. 128
John E. Gould
9 Genetics for the Clinician. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 143
Robert D. Oates
10 Medical and Endocrine Therapy of the Infertile Male .................. 166
Rebecca Z. Sokol
11 Testicular Biopsy and Vasography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 174
Ira D. Sharlip and Seck L. Chan
12 Evaluation and Treatment of Ejaculatory Duct Obstruction
in the Infertile Male. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 189
Randall B. Meacham and Julia A. Drose
xi
xii Contents
13 Varicocele........................................................ 201
Armand Zini, Sarah K. Girardi, and Marc Goldstein
14 Penile Vibratory Stimulation and Electroejaculation 219
Dana A. Ohl and Jens Sonksen
15 Vasovasostomy ................................................... 230
Arnold M. Belker
16 Obstructive Azoospermia and Vasoepididymostomy ................... 244
Anthony J. Thomas, Jr. and Osvaldo F. Padron
17 Micromanipulation of the Male Gamete ... . . . . . . . . . . . . . . . . . . . . . . . . . .. 258
Sarah K. Girardi and Peter N. Schlegel
18 Fertility Issues in the Patient with Testis Cancer . . . . . . . . . . . . . . . . . . . . . .. 276
Dana A. Ohl and Jens Sonksen
19 Infections and Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 284
Durwood E. Neal, Jr.
20 Gonadotoxicity.................................................... 292
Suresh C. Sikka
21 Cryptorchidism and Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 307
Manoj Monga and Wayne J.G. Hellstrom
22 The Effects of Testicular Torsion on Fertility. . . . . . . . . . . . . . . . . . . . . . . . .. 323
Manoj Monga and Wayne J.G. Hellstrom
23 Office Evaluation of the Impotent Man 335
David F. Mobley and Neil Baum
24 Androgen Deficiency .............................................. 340
Glenn R. Cunningham and Max Hirshkowitz
25 Premature Ejaculation ............................................. 356
Allen D. Sefiel and Stanley E. Althof
26 The Normal Penis and Augmentation Surgery in Adult Males. . . . . . . . . .. 362
Claudio Teloken
27 Color Duplex Doppler Ultrasound: Penile Blood Flow Study. . . . . . . . . . .. 367
Gregory A. Broderick
28 The Role of the Cavernosal Biopsy and Studies on Penile Innervation. . .. 396
Eric Wespes
29 Priapism ......................................................... 401
Farhad Parivar and Tom F. Lue
30 Vacuum Constriction Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 409
Joel L. Marmar
31 Nitric Oxide and Other Neurotransmitters of the Corpus Cavernosum . . .. 425
Nestor F. Gonzalez-Cadavid and Jacob Rajfer
32 Pharmacotherapy of Erectile Dysfuction . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 440
Martina Manning and Klaus Peter Juenemann