Kazukiyo Miura

Cytogenetic Survey of 1,007 Infertile Males

The aim of this study was to investigate the influence of a chromosome abnormality on male infertility. The subjects consisted of 1,007 males with the chief complaint of infertility. Karyotyping was conducted mainly by G banding. Major chromosome abnormalities were observed in 62 patients (6.2%) in total and consisted of sex chromosome abnormalities were observed in 62 patients (6.2%) in total and consisted of sex chromosome abnormalities in 38 patients (3.8%) and autosomal chromosome abnormalities in 24 (2.4%). Among the patients with sex chromosome abnormalities, 28 cases were 47, XXY, 3 were 47,XYY, and 7 cases had a Y chromosome abnormality. Autosomal chromosome abnormalities comprised 10 cases of reciprocal translocation, 8 cases of Robertsonian translocation, 5 cases of inversion, and 1 case of ring chromosome. In patients with a sperm density < 5 x 10(6)/ml, a total motile sperm count < 1 x 10(6), a follicle-stimulating hormone value > or = 30.1 mIU/ml, a luteinizing hormone value > or = 8.9 mIU/ml, a testosterone value < or = 2.69 ng/ml, or an average testis volume < or = 8 ml, the incidence of major chromosome abnormalities was significantly higher. These findings suggest that patients who need microinsemination should undergo chromosome analysis. We should counsel patients about obtaining adequate information on each chromosome abnormality.

Evaluation of seminiferous tubule scores obtained through testicular biopsy examinations of nonobstructive azoospermic men

OBJECTIVE To evaluate the seminiferous tubules of nonobstructive azoospermic men, a modified version of the Johnsen score known as the seminiferous tubule score was used. DESIGN Retrospective clinical study. SETTING University-based urology center. PATIENTS One hundred twenty-eight infertile men with nonobstructive azoospermia who underwent open testicular biopsy. INTERVENTION(S) Categorization as follows of various seminiferous tubule characteristics according to the modified seminiferous tubule score parameters: [1] a total absence of cells within the seminiferous tubule, [2] Sertoli cell only, [3] a few spermatogonia, [4] many spermatogonia, [5] a few primary spermatocytes, [6] many primary spermatocytes, [7] a few secondary spermatocytes, [8] many secondary spermatocytes, [9] a few round spermatids, [10] many round spermatids, [11] a few late spermatids and/or spermatozoa, and [12] many late spermatids and/or spermatozoa. MAIN OUTCOME MEASURE(S) Seminiferous tubule score. RESULT(S) In terms of maximum seminiferous tubule score, scores of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 corresponded with total patient numbers of 9, 90, 0, 0, 3, 10, 0, 0, 3, 1, 11, and 1, respectively. CONCLUSION(S) It was discovered that intracytoplasmic sperm injection (ICSI) of round spermatids could be performed in 3.1% of the patients in this study and that ICSI using late spermatids or spermatozoa could be performed in 9.4% of the patients in order to achieve fertilization.

Cushing syndrome associated with prostatic tumor adrenocorticotropic hormone (ACTH) expression after maximal androgen blockade therapy.

Abstract:  We report a patient with adenocarcinoma of the prostate, who eventually developed Cushing syndrome due to ectopic adrenocorticotropic hormone (ACTH) secretion from the tumor. At first, maximal androgen blockade (MAB) therapy was effective for the prostate carcinoma, which was positive for prostate‐specific antigen (PSA) and negative for ACTH on the biopsy specimen. However, 3 years later, the patient complained of bilateral leg edema. A chest computed tomographic (CT) scan showed bilateral pleural effusion and inflammatory changes, focused on the right upper‐lobe. While his PSA was not elevated, and there were no obvious tumor metastases, his serum cortisol and ACTH levels were elevated, without any evidence of lesions that could release ectopic ACTH. Two weeks later, the patient complained of dyspnea and bilateral pleural effusion, and inflammatory changes were worse. Although the patient was administered inhibitors of adrenocorticoid synthesis‐metyrapone, they did not have enough clinical efficiency. Steroid pulse therapy was also administered but the patients severe pneumonia and pleural effusion did not improve and he finally died of respiratory failure. In contrast to the initial biopsy specimen findings, on autopsy, the tumor was negative for PSA but positive for ACTH. Thus, it would appear that the tumor began to produce and release ectopic ACTH after therapy, which resulted in the development of Cushing syndrome in this patient with prostate carcinoma.

Endoscopic management of a traumatic disruption of the bulbous urethra using a thin trocar puncture.

Abstract A case is reported in which complete disruption of the bulbous urethra resulted in a straddled‐type injury, which was managed by endoscopic realignment with a thin trocar needle. The endoscopic urethroplasty consisted of: (i) direct observation of the proximal end of the obliterated urethra by an antegrade flexible cystoscope; (ii) adjustment of the direction of trocar penetration under fluoroscopy and direct vision; (iii) confirmation of the exact trocar position and penetration by antegrade flexible cystoscope; and (iv) placement of the guidewire following the trocar penetration as guidance for urethrotomy. A Foley catheter was left in place for 6 weeks. To date, no further endoscopic revision has been required. Although long‐term follow up and more experience are required, this technique is reported because it appears to be safe, reproducible, simple and minimally invasive.

Hyperactivation of Human Spermatozoa: Measurement of Motility before and after Incubation

Summary:  The motility rate of sperm during capacitation process was determined by calculating a sperm motile efficiency index (SMEI) using a hemocytometer. The SMEI values for the sperm from 100% of normal fertile men and 64% of infertile patients increased significantly by the fourth hour of incubation, while for 36% of infertile patients there was no increase. A correlation between the increase of SMEI and original motility, original SMEI and original semen amount was not possible. In addition, a decrease of the SMEI value was observed after sperm incubated for 3 hours were added to the seminal plasma of the donor. It is concluded that in human spermatozoa “hyperactivation and dehyperactivation” can be measured by SMEI.

One-day penile prosthesis surgery by penile block.

Since penile prosthesis surgery is conducted under general, spinal, epidural and other forms of anesthesia, it is a highly invasive procedure. Consequently, many elderly patients decline treatment. Furthermore, because hospitalization is required, many patients refuse to have penile prosthetic surgery treatment, particularly if they are resistant to hospital admission or have severe time-related restrictions. This surgical modality is not covered by the national medical insurance system, which places a heavy financial burden on the patient as the hospitalization and treatment are expensive. For these reasons, in order to reduce the physical, psychological and economic burden on the patient, we have been conducting non-inflatable penile prosthesis surgery by means of a penile block (local anesthesia) since April 1993.

An azoospermic male with an unbalanced autosomal-Y translocation

SummaryAn azoospermic male with an unbalanced translocation between the Y chromosome and chromosome 15 was examined in the present study. Testicular biopsy found only Sertoli cells only within the seminiferous tubules of the 35-year-old patient. Chromosome analysis, using the techniques of G and C banding and fluorescent in situ hybridization revealed an abnormal karyotype of 46,XY,der(15)t(Y;15)(q12;p11). Deoxyribonucleic acid (DNA) analysis confirmed the presence of the genes such as DAZ and YRRM1 which are known to control spermatogenesis. The cause of spermatogenetic dysfunction in this particular patient therefore.

Epigenetics in assisted reproductive technology

It has been reported that the rates of epigenetic disorders such as Angelman syndrome (AS) and Beckwith-Wiedemann syndrome (BWS) are high in offspring conceived by assisted reproductive technology (ART). Angelman Syndrome is characterized by intellectual disability and BWS is known as large offspring syndrome (LOS). Weight abnormalities have also been reported in cloned animals. Possible factors underlying these findings include inherent gamete characteristics, influence of in vitro culture and peculiarity of ART methods. It is important to conclusively determine whether such epigenetic abnormalities are present in children conceived by ART, so as to consider the health of next generations.

Is Diabetic Neuropathy Responsible for Diabetic Impotence

It is well known that diabetes mellitus is accompanied by complications of sexual dysfunction and it is believed that diabetic neuropathy may cause impotence. In our study, we found that not all the patients who visited our center with the chief complaint of diabetic impotence were suffering from organic impotence, and diabetes mellitus per se served as a means of psychological stress in a substantial number of cases. Probably because no method has been available to provide precise information on the state of the penile-controlling nerves, we found that a larger number of patients than expected were suffering from a vascular disorder.

Clinical Experience and Successful Impregnation Using an Artificial Spermatocele

We have to date installed artificial spermatoceles made of silicone in a total of 33 patients. Artificial insemination of husband (AIH) was performed in 1-9 times using semen collected from 11 of the 33 patients in whom spermatocele was installed, and pregnancy was achieved in 2 cases. Reported cases of pregnancy achieved using semen collected from artificial spermatoceles are few in number; indeed, our successful cases were the fifth and sixth reported so far. The key point for success in achieving pregnancy by means of the artificial spermatocele is considered to be attempting AIH as soon as possible after collecting the sperm, because collection of sperm soon becomes impossible, due to early obstruction of the incised region at the epididymis by degeneration of fibrous tissue. 3% HSA-TMPA medium was found to be useful for sperm collection.