Giovanni Chiriacò

Penile fracture: Retrospective analysis of our case history with long-term assessment of the erectile and sexological outcome

OBJECTIVES To review the cases of patients with suspected penile fracture and asses erectile and sexological outcomes. MATERIALS AND METHODS from 1987 to 2013 presented to the Urology Clinic of Trieste and at the AIED of Pordenone a total of 41 cases that were divided into two groups according to the timing of treatment: 18 patients with anamnestic diagnosis of penile fracture treated nonimmediately and 23 patients treated immediately after the trauma. For all patients we evaluated the type of treatment adopted, the occurrence of complications and reoperations and the follow-up. The erectile function was also evaluated through the IIEF, as well as the psychological impact of the trauma on social and sex life, using a psycho- sexological questionnaire. RESULTS Among patients treated immediately after the trauma 14 were subjected to surgery. About a year after surgery, penile curvature was reported in 1 patient, pain in 3 patients, urinary disorders in 1 patient, while none reported erectile dysfunction (ED). Out of these, only 3 patients underwent reoperation. Among those treated conservatively 1 patient reported curvature, 1 patient reported pain and none reported ED. Among patients who were admitted at a later date, 14 reported curvature and 4 reported pain whereas urinary disorders were reported in 1 and ED in 4 patients. From a psychological point of view, the trauma caused in most cases a fear of new trauma and of repercussions on erectile function and sensitivity. CONCLUSIONS The diagnosis is mainly clinical; however, radiological investigation is essential to confirm the diagnosis, assess the site and extent of the trauma and possible urethral involvement, so as to plan the most appropriate treatment. In addition, immediate treatment leads to better long-term results, with a lower incidence of ED and penile curvature. Psychologically, penile trauma intensifies the fear of reoccurrence; it decreases, however, with the passage of time.

Androgen Receptor (AR) Gene (CAG)n and (GGN)n Length Polymorphisms and Symptoms in Young Males With Long-Lasting Adverse Effects After Finasteride Use Against Androgenic Alopecia

Introduction Long-term adverse symptoms of men who used oral finasteride against androgenic alopecia have been recently described as post-finasteride syndrome (PFS). Aim To determine whether (CAG)n-rs4045402 and (GGN)n-rs3138869 polymorphisms in the androgen receptor (AR) gene are implicated in PFS. Methods AR polymorphisms were studied according to PFS symptoms in 66 white participants (31.8% Italian, 28.8% American, and 39.4% other). Main Outcome Measures Symptoms were investigated by an ad hoc 100-item questionnaire and the Arizona Sexual Experience Scale and Aging Male Symptom Scale (AMS). (CAG)n and (GGN)n repeats were categorized as short ([CAG]9–19, [GGN]<23), medium ([CAG]20–24, [GGN]23), or long ([CAG]25–37, [GGN]>23). Results Median age was 32 years, duration of finasteride use was 360 days, and time from finasteride discontinuation was 1,053 days. We observed several frequency differences in symptoms according to (CAG)n and (GGN)n repeat numbers. Three AMS items were worse for medium (GGN)23 than for long (GGN)>23 carriers and one item was worse for short (GGN)<23 carriers. The AMS item for decrease in sexual desire or libido was worse for short (CAG)9–19 carriers than for medium (CAG)20–24 carriers. Through the ad hoc questionnaire, significant findings in (CAG)n and/or (GGN)n repeats were obtained for penile discomfort, loss of scrotal sensitivity, scrotal discomfort, less pubic hair, loss of perceived perineal fullness, increased sperm density, involuntary muscle spasms, loss of muscle tone, increased weight (>2 kg), increased skin dryness, and onset of symptoms after finasteride use. Conclusion This study showed that short and/or long (CAG)n and (GGN)n repeats had different frequencies according to symptoms reported by patients with PFS, likely reflecting the vast array of genes modulated by the AR. This study showed a U-curvilinear profile of (CAG)n repeats for skin dryness symptoms, where the two extremes exhibited a worse condition than medium repeats. Further studies are necessary to investigate the PFS pathophysiology using a precision medicine approach.

MP89-13 PRESENTATION AND TREATMENT OUTCOMES OF EJACULATORY DUCT OBSTRUCTION

the 8 patients with partial retrograde ejaculation, 5 (62.5%) had a 50% increase in the antegrade total sperm count. The mean total motile count in this group increased from 6.6 3.2 million before treatment to 31.6 13.9 million after treatment, while the percentage of sperm in the urine declined from 41.9 11.2% to 17 10%, respectively (both p < 0.05). Overall, some improvement in seminal parameters occurred in 14 (70%) patients, with 10 patients (38.5% of all patients) achieving antegrade total sperm counts over 39 million. CONCLUSIONS: In men with retrograde ejaculation, a pseudoephedrine regimen prior to ejaculation confers some improvement in ejaculated semen parameters for approximately two thirds of patients and an ejaculated total motile count of greater than 20 million for approximately one third of patients.

MP89-09 SALVAGE MTESE AFTER PREVIOUS FAILED MTESE: RESULTS AND PREDICTORS FOR SUCCESS.

INTRODUCTION AND OBJECTIVES: Ultrasonographically guided puncture (UGUP) of the rete testis (RT) has been proven to be an efficient method for sperm recovery in obstructed azoospermic men (Andrologia 35:85, 2003). In the current study we evaluated the role of UGUP of the RT in sperm recovery from non-obstructed azoospermic (NOA) men. METHODS: Bilateral UGUP of the RT was performed in 83 NOA-men. Under local anesthesia and ultrasonographical control (mode B, frequency of 7.50 MHz), the hyperdense tip of a 30-gauge needle approached and reached the RT of each NOA-man. When ultrasonographical control demonstrated that the tip of the needle had reached the hyperdense line of the RT negative pressure was applied and cells from the RT were aspirated. All the aspirated samples from the RT were observed via confocal scanning laser microscope and some of them after fluorescent in situ hybridization (FISH) techniques. Men who were negative for spermatozoa after UGUP of the RT underwent microsurgical therapeutic testicular biopsy (MTTB). Recovered spermatozoa subpopulations either from UGUP-RT samples or from MTTBsamples were frozen. RESULTS: UGUP of the RT resulted in sperm recovery in 19 men (22.89%). The remaining 64 NOA-men underwent MTTB. Twenty nine men out of the 64 men (45.31%) who underwent MTTB demonstrated testicular spermatozoa. Thus in total, 48 men (57.83%) were positive for spermatozoa either in the UGUP-RT-samples or in the MTTB-samples. There was not a significant difference between the mean value of peripheral serum testosterone three months after UGUPRT and the respective mean value prior to UGUP-RT. FISH techniques in UGUP-RT samples demonstrated in each of the 19 men at least 81% haploid spermatozoa. Hematomas were not demonstrated by ultrasonography one, three, and nine weeks post-UGUP-RT. Nine couples from the above mentioned 19 NOA-couples participated in assisted reproductive technology programs. Three clinical pregnancies were achieved. Four offspring were delivered. CONCLUSIONS: Considering that UGUP-RT puncture a) does not reduce the volume of testicular parenchyma, b) is less invasive than MTTB, and c) apparently causes less detrimental effect on testicular vasculature than MTTB, UGUP-RT is recommended as first line approach for the treatment of NOA-men. If UGUP-RT is negative for spermatozoa in non-obstructed men, biopsy is indicated.

The Testicles: Trauma, Inflammation and Testicular Torsion

The majority of cases of acute scrotum are due to one of these three causes: trauma, torsion and inflammation.

Congenital and Acquired Penile Curvature: Relationships and Differences

Introduction Acquired penile curvature and congenital penile curvature are the most frequent causes of penile deformity. The correspondence between patients’ opinion of the degree of penile curvature and objective measures is inadequately studied. The primary objective of the current study was to correlate patient estimates of the degree of penile angulation with objective measures performed by trained specialists. The secondary objective was to study if there are any differences in the real and perceived magnitude of curvature among patients affected by acquired penile curvature (APC) versus patients with congenital penile curvature (CPC).