Main description:

Impending famine and a terrifying rate of consumption of natural resources are vital issues which have focussed public interest in the ecologic, social and political problems of ever increasing overpopulation in many countries of the world. As well as the vast material and intellectual expenditure lavished on family planning and birth control, the past decade has seen an immense research effort in the elaboration of improved methods of fertility control, both for men and for women. During the same period, however, research into the causes of male fertility disorders has proceeded with equal intensity, and a number of promising therapeutic approaches have become the subject of clinical trials. The wish of an individual or of a couple to have offspring is an absolute which requires no further justification, and there can be few challenges to a physician as essential as the spouses' predicament in a childless marriage. Only with a special knowledge of the function, pathology and pathophysiology of the reproductive system is he properly equipped to meet that challenge.

Contents:

Anatomical and Functional Aspects of the Male Reproductive Organs.- A. Testis.- I. Development.- II. General Anatomy.- III. Cytological Features.- 1. Seminiferous Tubules.- a) Replication of Stem Cells.- b) Meiosis.- c) Spermiogenesis.- ?) Formation of the Acrosome.- ss) Development of the Flagellum.- ?) Nuclear Changes.- ?) Reorganization of Cell Organelles and Cytoplasm.- ?) Spermiation.- d) Sertoli Cells.- e) Seminiferous Cycle.- 2. Intertubular Tissue.- a) Lamina Propria of the Seminiferous Tubules.- b) Interstitial Cells.- c) Vasculature.- IV. Function.- 1. Control of Testicular Function.- 2. Spermatogenic Function.- 3. Steroidogenic Function.- B. Anatomy of the Male Reproductive Tract and Accessory Glands.- I. Introduction.- II. Embryogenesis of the Male Reproductive Tract.- III. Intratesticular Ducts.- 1. Transitional Distal Segment of Seminiferous Tubule.- 2. Rete Testis.- a) Septal Rete.- b) Mediastinal Rete.- c) Extratesticular Rete.- d) Cytological Features.- IV. Epididymis.- 1. Derivation and Development.- 2. General Anatomy.- a) Anatomical Relationships.- b) Vasculature.- ?) Arterial.- ss) Venous.- ?) Lymphatics.- c) Innervation.- 3. Cytological Features.- a) Ductuli efferentes.- ?) Epithelium.- ss) Lamina Propria and Muscularis.- b) Ductus Epididymidis.- ?) Epithelium.- ss) Lamina Propria.- ?) Muscularis.- 4. Function.- a) Absorption.- b) Secretion.- c) Androgen Dependence.- V. Ductus Deferens.- 1. Development.- 2. General Anatomy.- a) Anatomical Relationships.- b) Vasculature.- c) Innervation.- 3. Cytological Features.- a) Epithelium.- b) Lamina Propria.- c) Muscularis.- VI. Seminal Vesicles.- 1. Development.- 2. General Anatomy.- a) Anatomical Relationships.- b) Vasculature.- c) Innervation.- 3. Cytological Features.- a) Epithelium.- b) Lamina Propria.- c) Muscularis.- VII. Prostate.- 1. Development.- 2. General Anatomy.- a) Anatomical Relationships.- b) Vasculature.- c) Innervation.- 3. Cytological Features.- a) Epithelium.- b) Lamina Propria.- c) Muscularis.- VIII. Bulbo-urethral and Urethral Glands.- 1. Derivation and Development.- 2. General Anatomy.- 3. Cytological Features.- References.- Quantitative Morphology of the Prostate and Epididymis.- A. Introduction.- B. Theoretical Basis of Stereology.- I. Symbols and Definitions.- II. Basic Stereological Equations.- 1. Volume Density.- 2. Surface Density.- 3. Numerical Density.- III. Preconditions for Stereological Analysis.- IV. Stereological Procedure.- 1. General Stereological Model.- 2. Morphological Criteria.- 3. Sampling.- 4. Multistage Sampling.- 5. Test Systems (Point and/or Line Sets).- 6. Stereological Model of the Prostatic Gland.- V. Stereological Calculations.- 1. Level I.- 2. Level II.- 3. Level III.- 4. Absolute Values.- C. Ventral Prostatic Lobe of the Rat.- I. Light-Microscopic Analysis.- II. Ultrastructural Findings.- III. Stereological Data.- IV. Experimental Applications on the Ventral Prostatic Lobe.- V. Discussion of the Experimental Applications.- D. Dog Prostate (Normal and Spontaneous Hyperplasia).- I. Light-Microscopic Analysis.- II. Electron Microscopy.- III. Stereological Analysis.- E. Human Prostate.- I. Materials.- 1. Normal Human Prostate.- 2. Benign Prostatic Hyperplasia.- II. Results.- 1. Light-Microscopic Analysis.- 2. Ultrastructural Findings.- 3. Ultrastructural-Microscopic Analysis.- F. Epididymis.- I. Stereological Model.- II. Epididymal Head of the Rat.- III. Experimental Applications.- IV. Discussion of the Experimental Applications.- G. Conclusion and Outlook.- References.- Etiology of Fertility Disturbances in Man.- A. Introduction.- B. Primary Testicular Failure.- I. Genetic Abnormalities.- 1. Sertoli-Cell-Only Syndrome.- 2. Maturation Arrest.- 3. Structural Defects of Spermatozoa.- II. Chromosomal Abnormalities.- 1. Additional X Chromosomes (Klinefelter's Syndrome).- 2. Additional Y Chromosomes and Y Chromosome Abnormalities.- 3. Noonan's Syndrome (Male Turner's Syndrome).- 4. Autosomal Abnormalities and Translocations.- III. Developmental Abnormalities.- 1. Congenital Anorchism.- 2. Cryptorchidism.- 3. Intersexuality.- IV. Defective Androgenization.- 1. Inadequate Androgen Synthesis.- 2. Inadequate Androgen Utilization (Androgen Insensitivity) 180 V. Acquired "Primary" Testicular Failure.- C. Secondary Testicular Failure.- I. Hypothalamic Failure.- II. Pituitary Failure.- D. Extratesticular Disturbances of Male Fertility.- I. Infections.- 1. Gonorrhea.- 2. Tuberculosis.- 3. Smallpox.- 4. Viral Infections.- 5. T Mycoplasma Infections.- 6. Trichomonas vaginalis.- 7. Candida albicans.- 8. Reiter's Syndrome.- II. Stress.- III. Radiation.- IV. Drugs.- V. Ejaculatory Problems.- 1. Anorgasmy.- 2. Retrograde Ejaculation.- References.- Male Fertility Disorders - History and Clinical Examination.- A. History.- I. Past History.- II. Sexual History.- III. Drug History.- IV. Urinary Symptoms.- B. Clinical Examination.- I. Genital Tract.- II. General Examination.- 1. Typical Alterations of Physical Habit with Related Disorders of Spermatogenesis.- a) Early (Prepubertal) Castration.- b) Late (Postpubertal) Castration.- c) Congenital Hypogonadism: Werner's Syndrome.- d) Rothmund's Syndrome.- e) Lawrence-Moon-Biedel Syndrome.- 0 Prader-Labhardt-Willi Syndrome.- g) Klinefelter's Syndrome.- h) "Pseudo-"Klinefelter's Syndrome.- References.- Semen Analysis.- A. Introduction.- B. Collection of the Ejaculate.- C. Sexual Abstinence Before Collection of the Ejaculate.- D. Examination of the Ejaculate.- I. Coagulation and Liquefaction.- II. Volume.- III. Biochemical Analysis.- E. Microscopic Examination.- I. Motility.- II. Count.- III. Morphology.- IV. Supravital Staining.- F. Normal Values.- G. Outlook.- References.- Testicular Biopsy.- A. Introduction.- B. Technique.- C. Histologic Evaluation of the Testicular Biopsy.- References.- Radiologic Investigation of Male Fertility Disorders.- A. Demonstration of Patency in the Spermatic Tract.- I. Indications.- II. Technique.- III. Complications.- B. Imaging of Glandular Structures.- C. Assessment of Urethral Abnormalities.- D. Phlebography of Varicoceles.- References.- Endocrine Evalution of Male Fertility Disorders.- A. Introduction.- B. Hormone Base Levels.- I. Testosterone.- II. Prolactin.- III. Follicle-Stimulating Hormone (FSH).- IV. Luteinizing Hormone (LH).- C. Dynamic Tests.- I. Clomiphene Citrate Test.- II. GNRH Test.- III. Human Chorionic Gonadotropin (HCG) Test.- D. Usefulness of Hormonal Tests for Selection of Patients for Gonadotropin Therapy.- References.- Neurology of Male Fertility Disorders.- A. Anatomic and Physiologic Basis.- I. Spinal Centers Involved in Genital Function.- II. Peripheral Innervation of the Genitalia.- III. Genital Function: Erection, Emission and Ejaculation, Orgasm.- 1. Erection.- 2. Emission.- 3. Ejaculation.- 4. Orgasm.- 5. Synopsis: Sexual Function and Spinal Segments.- IV. Centripetal Spinal Pathways of Genital Function.- V. Centrifugal Spinal Pathways of Genital Function.- VI. Pathways Connecting Spinal Centers.- VII. Genital Function and the Brain.- B. Neurologic Disturbances of Genital Function.- I. Spinal Transections and Their Significance for the Function of the Genital Organs.- 1. General Considerations on Spinal Transection: the Phase of Spinal Areflexia and the Phase of Increased Reflex Activity.- 2. Destruction of the Lumbar Sympathetic Centers (L2-4).- 3. Destruction of the Sacral Parasympathetic Centers (S2-4).- 4. Cauda Equina Lesions.- 5. Supralumbar Cord Lesions.- II. Peripheral Nerve Lesions and Genital Function.- III. Cerebral Causes of Impotence.- C. Neurologic Assessment.- I. History.- 1. Interpretation of the History.- II. Neurologic Status.- 1. Important Intrinsic Reflexes Bearing on Neurologic Fertility Disorders, According to Segmental Level.- 2. Chief Extrinsic Reflexes of Importance for the Neurologic Aspects of Fertility, According to Spinal Segments.- III. Special Investigations.- D. Synopsis of Neurologic Disturbances of Potency.- I. Synopsis According to Functional Impairment.- 1. Absence of Libido.- 2. Total Impotence.- 3. Impotentia Generandi.- 4. Impotentia Coeundi.- 5. Erection.- 6. Absence of Psychogenic Erection in the Presence of Reflex Erection.- 7. Absence of Psychogenic and Reflex Erections.- 8. Priapism (Semierection).- 9. Ejaculation.- 10. Absence of Ejaculation or Disordered Ejaculation (Dripping) with or without Disturbance of Erection (Pollutio Flaccida).- 11. Absence of Ejaculation in the Presence of Reflex Erection.- 12. Retrograde Ejaculation.- 13. Anorgasmia.- II. Synopsis According to Localization in the Central or Peripheral Nervous Systems.- 1. Cerebral Lesions.- 2. Supralumbar Spinal Transection.- 3. Lumbar Transection Involving the Sympathetic Genital Centers L2-4.- 4. Lesions of the Sacral Automic Center S2-5.- a) Conus Syndrome (S3-5 and Coccygeal Segment Cocc. 1).- b) Epiconus Syndrome (L4-5 and S1-2).- 5. Cauda Equina Syndrome (Below Vertebral Level L1/2).- 6. Peripheral Paralysis.- References.- Immunologic Causes of Male Fertility Disorders.- A. Antigenicity.- I. Blood Group Antigens in Seminal Fluid.- II. Antigenic Fractions of Seminal Fluid.- III. Antigens of Spermatozoa.- IV. Antigenic Properties of the Testes.- V. Allergic Orchitis.- VI. Antigenic Properties of the Seminal Vesicles.- VII. Antigenic Properties of the Prostate.- B. Antibodies in Male Fertility Disorders.- I. Humoral Antibodies.- II. Cellular Antibodies.- C. Diagnosis of Immunologic Fertility Disorders.- I. Sperm Agglutination Tests.- 1. Antisperm Antibodies Assay: Gelatin Agglutination Test (GAT) (Kibrick).- 2. Microscopic Sperm Agglutination Test.- II. Immobilization Tests.- III. Cytotoxin Tests.- IV. Immunofluorescence.- D. Generation of Antibodies.- I. Testes as Portal of Entry for Sperm Autoantigens.- II. Epididymis as Portal of Entry for Sperm Autoantigens.- III. Sperm Autoantigens Entering via the Seminal Vesicles and the Prostate.- E. Vasectomy and Sperm Antibodies.- I. Clinical Significance of Sperm Antibodies for Male Fertility.- F. Treatment of Immunologic Fertility Disorders in Men.- References.- Treatment of Male Infertility.- A. Hormonal Treatment of Male Infertility.- I. Gonadotropin-Releasing Hormone (GnRH).- II. Human Gonadotropins.- 1. Human Chorionic Gonadotropin (HCG).- 2. Human Menopausal Gonadotropin (HMG/HCG Therapy).- III. Prolactin Inhibitors.- IV. Androgens.- 1. Androgen Replacement Therapy.- 2. Androgens as Contraceptive Agents.- 3. Androgens as Spermatogenetic Agents.- V. Antiestrogens.- 1. Clomiphene Citrate.- 2. Tamoxifen.- VI. Various Hormonal Compounds.- B. Nonhormonal Treatment of Male Infertility (Excluding Surgical Interventions).- I. General Measures.- II. Split Ejaculate.- III. In Vitro Treatment of the Ejaculate.- 1. Problem: High Viscosity.- 2. Problem: Nonliquification of the Ejaculate.- 3. Problem: Contamination of the Ejaculate with "Debris".- 4. Problem: Asthenospermia.- IV. Antibiotic Treatment.- V. Various Compounds.- References.- Operative Therapy of Male Infertility.- A. Varicocele.- I. Methods of Treatment.- 1. The Ivanissevich Technique.- 2. Palomo Technique.- 3. High Ligature of the Vena Spermatica.- II. Complications.- B. Vas-Epididymis Anastomosis.- I. Indications.- II. Etiology.- 1. Congenital Anomalies.- 2. Infections.- 3. Cystic Changes.- 4. Trauma.- III. Diagnosis.- IV. Surgical Technique.- V. Postoperative Care.- C. Artificial Spermatocele.- D. Vas-Vas Anastomosis.- I. Problems.- 1. Reversibility.- 2. Frequency of Sperm-Immobilizing and Sperm-Agglutinating Antibodies After Vasectomy.- II. Immunologic Considerations.- III. Technique.- 1. Schoysman Technique (1976).- 2. Schmidt Techniques.- 3. Silber Technique.- 4. Friek Technique.- IV. Complications.- V. Results.- References.- Artificial Insemination and Semen Preservation.- A. Artificial Homologous Insemination.- I. Indications.- 1. Female Indications.- 2. Male Indications.- II. Timing of Insemination.- III. Technique.- IV. Results of Artificial Homologous Insemination.- B. Artificial Donor Insemination.- I. Indications for AID.- II. Selection of Donors.- III. Technique of Insemination.- IV. Results of AID.- V. Legal Aspects of AID.- C. Semen Preservation.- References.- Male Contraception.- A. Introduction.- B. The Need for Fertility Control.- C. Different Methods of Male Fertility Control.- I. Coitus Interruptus.- 1. Side Effects.- 2. Extent of Use.- II. Condom.- 1. Failure Rate.- 2. Side Effects.- III. Vasectomy.- 1. General Comments.- 2. Factors to be Considered Before Vasectomy is Performed.- a) Reversibility.- b) Frequency of Sperm-Immobilizing and Sperm-Agglutinating Antibodies After Vasectomy.- 3. Information to be Given to Patients and Preliminary Examinations.- 4. Surgical Technique.- 5. Complications.- 6. Side Effects.- IV. New Concepts in Vas Occlusion and Vasectomy.- 1. Occlusion by a Filament.- a) Procedure for Insertion.- b) Clinical Studies.- 2. Reversible Intravasal Device (R-IVD).- 3. Plugging of the Vas.- a) Technique.- b) Results.- 4. Reversible Intravasal Occlusive Device (RIOD).- 5. Spermatozoa Controller (SPACER).- 6. Injection of Sclerosing Chemicals.- 7. A Possible Reversible Vasectomy Procedure (Frick).- a) Technique.- b) Results.- V. Pharmacologic Male Contraception.- 1. Steroidal Effects on Spermatogenesis.- a) Orally Administered Steroids.- b) Steroid Implants.- c) Other Pharmacologic Methods of Sperm Suppression.- 2. Side Effects in all Studies of Sperm Suppression Reviewed.- a) Studies with TE only in Different Regimens.- b) Studies with Estrogen and Testosterone in Combination.- c) Studies with Progestins Alone or in Combination with Androgen.- D. New Aspects for the Future.- References.- Impotence.- A. Abnormalities of Erection.- I. Congenital Abnormalities of the Penis Interfering with Erection.- 1. Epispadias.- 2. Phimosis.- II. Acquired Abnormalities of the Penis Associated with Impotence.- 1. Peyronie's Disease (Induratio Penis Plastica).- 2. Abnormal Erection Following Priapism.- 3. Posttraumatic Change in the Penis.- 4. Impotence Following Pelvic Fracture.- III. Vascular Causes of Impotence.- IV. Diabetes Mellitus and Disorders of Erection.- V. Drugs, Poisons, and Disorders of Erection.- VI. Blood Pressure and Impotence.- B. Abnormalities of Ejaculation.- I. Premature Ejaculation.- II. Failure of Emission.- III. Retrograde Ejaculation.- References.- Functional Sexual Disorders in the Male.- References.- Male Climacteric?.- A. Introduction.- B. Diagnosis and Management.- References.