Practical Clinical Andrology

Preface
Contents
Contributors
1: Introduction: History of Sexual Medicine
1.1 Introduction
1.2 Andrologists, Sexual Physicians, Medical Sexologists, Sexologists, and Psychosexologists
1.3 Development of the Sexual Medicine
1.4 The Role of the Scientific Societies and Journals: The International Society of Sexual Medicine
1.5 The European Contribution to the History of Sexual Medicine: The European Society of Sexual Medicine and the European Academy of Andrology
1.6 The Psychosexological Societies in the Field of Sexual Medicine and Other Journals Which Contributed to Its Development
1.7 Forecast and Conclusion
References
2: Sexuality and Sexual Orientation in the Twenty-First Century
2.1 Definitions and Conceptualizations: Sexual Identity, Gender Identity, Gender Role, and Sexual Orientation
2.2 Determining Factors of Sexual Orientation
2.3 The Assessment of Sexual Orientation
2.4 Incidence in Sexual Orientation
2.5 Contemporary Issues on Sexual Orientation in Clinical and Research Fields
2.6 Conclusions: Toward a Sex-Positive Approach
References
3: Erectile Dysfunction: From Pathophysiology to Clinical Assessment
3.1 Penile Erection
3.1.1 Anatomy
3.1.2 Innervation
3.1.3 Vasculature
3.1.4 Erectile Process
3.2 Pathophysiology of Erectile Dysfunction
3.3 Diagnosis
References
4: Erectile Dysfunction: Medical Therapy and Rehabilitation
4.1 Introduction
4.1.1 Oral Pharmacotherapy: PDE-5Is
4.1.1.1 Pharmacokinetic and Pharmacodynamic Features
Sildenafil
Vardenafil
Tadalafil
Avanafil
4.1.1.2 The Right Molecule for the Right Patient
4.1.1.3 Pharmacological Interactions
4.1.1.4 Cardiovascular Safety
4.1.1.5 Non-responders
4.1.1.6 On-Demand Vs Daily Treatment
4.1.1.7 PDE5-I in Penile Rehabilitation
4.1.2 Vacuum Erection Devices
4.1.3 Alprostadil
4.1.3.1 Topical Route
4.1.3.2 Intraurethral Route
4.1.3.3 Intracavernous Injection
4.1.4 Extracorporeal Shockwave Therapy
4.1.4.1 Introduction
4.1.4.2 ESWT and Vascularization
4.1.4.3 ESWT and Stem Cells
4.1.4.4 ESWT and Erectile Dysfunction
4.1.4.5 ESWT Protocol
4.1.4.6 ESWT Adverse Effects
References
5: Erectile Dysfunction, Surgical and Regenerative Therapy
5.1 Erectile Dysfunction: Surgical Therapy
5.1.1 Introduction
5.1.2 History of Penile Prosthesis
5.1.3 Penile Prosthesis Implant
5.1.4 Types of Devices and Differences
5.1.5 Surgical Approach
5.1.6 Comparison Between the Three Techniques
5.1.7 Complications
5.1.7.1 Intraoperative Complications
5.1.7.2 Postoperative Complications
5.2 Regenerative Therapies for Erectile Dysfunction
5.2.1 Introduction
5.2.2 Li-SWT for Erectile Dysfunction
5.2.2.1 Mechanism of Action
5.2.2.2 Type of Li-SWT Machine
5.2.2.3 Efficacy
5.3 Platelet-Rich Plasma for Erectile Dysfunction
5.3.1 Mechanism of Action
5.3.2 Effectiveness
5.4 Stem Cells for Erectile Dysfunction
5.4.1 Introduction
5.4.2 Mechanism of Action
5.4.3 Efficacy
References
6: Peyronie’s Disease
6.1 Introduction
6.2 Pathophysiology
6.3 Epidemiology
6.4 Clinical Presentation and Medical Evaluation
6.5 Non-surgical Treatment for Peyronie’s Disease
6.5.1 Oral Medications
6.5.1.1 Phosphodiesterase Type 5 Inhibitors (PDE5is)
6.5.1.2 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
6.5.1.3 Coenzime Q10
6.5.1.4 Vitamin E
6.5.1.5 Colchicine
6.5.1.6 Para-aminobenzoacidic Potassium (POTABA)
6.5.1.7 Carnitine
6.5.1.8 Tamoxifen
6.5.2 Topical Medications
6.5.3 Extracorporeal Shock Wave Therapy (ESWT)
6.5.4 Mechanical Devices
6.5.4.1 Penile Traction Therapy
6.5.4.2 Vacuum Erection Device
6.5.5 Intraplaque Injection
6.5.5.1 Collagenase Clostridium Histolyticum (CCH)
6.5.5.2 Interferon Alpha
6.5.5.3 Calcium Channel Blockers (Verapamil, Nicardipine)
6.6 Surgical Treatment for Peyronie’s Disease
6.6.1 Tunical Shortening Procedure
6.6.2 Tunical Lengthening Procedure
6.6.3 Penile Prosthesis Implant
References
7: Orgasm and Ejaculation Disorders
7.1 Anatomy and Physiology of Orgasm and Ejaculation
7.2 Premature Ejaculation (PE)
7.2.1 Aetiology
7.2.1.1 Hereditary PE
7.2.1.2 Neurobiology of PE
7.2.1.3 Hormones and PE
7.2.1.4 Chronic Prostatitis and Chronic Pelvic Pain Syndrome (CPPS)
7.2.1.5 Psychological Factors
7.2.1.6 Pharmacology and PE
7.2.2 Diagnosis
7.2.2.1 History and Questionnaires
7.2.2.2 Physical Examination
7.2.3 Treatments
7.3 Delayed Ejaculation (DE)
7.3.1 Aetiology
7.3.2 Diagnosis of DE
7.3.3 Treatment
7.4 Retrograde Ejaculation
7.4.1 Aetiology
7.4.2 Diagnosis of RE
7.4.3 Treatment
7.5 Anejaculation and Anorgasmia
7.5.1 Aetiology
7.5.2 Diagnosis
7.5.3 Treatment
References
8: Female Sexual Dysfunctions: A Clinical Perspective on HSDD, FAD, PGAD, and FOD
8.1 Female Sexual Dysfunctions: A Clinical Perspective
8.1.1 Introduction
8.2 Sexual Interest/Desire Disorders
8.2.1 Pathophysiology of Low Desire
8.2.2 Nosology and Current Definitions
8.2.3 Prevalence and Leading Etiologies of HSDD
8.2.4 Diagnostic Algorithms and Tools
8.2.5 Key Therapeutic Approaches
8.3 Arousal Disorders
8.3.1 Pathophysiology of Genital Arousal Disorders
8.3.2 Nosology and Current Definitions
8.3.3 Prevalence and Leading Etiologies of Female Genital Arousal Disorder
8.3.4 Diagnostic Tools for Arousal Disorders
8.3.5 Key Therapeutic Approaches
8.4 Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia
8.5 Orgasm Disorders
8.5.1 Pathophysiology of Orgasm
8.5.2 Nosology and Current Definitions
8.5.3 Prevalence and Leading Etiologies of FOD
8.5.4 Diagnostic Tools for Orgasm Disorders
8.5.5 Key Therapeutic Approaches
8.6 Conclusion
References
9: Penile Diseases and Dysmorphisms (Phimosis, Frenulum, Micropenis, and Buried Penis)
9.1 Foreskin Disease: Balanitis and Balanoposthitis
9.1.1 Definition and Epidemiology
9.1.2 Pathophysiology
9.1.3 Skin Conditions
9.1.4 Clinical Findings and Diagnosis
9.1.5 Treatment
9.2 Foreskin Disease: Phimosis and Paraphimosis
9.2.1 Definition and Epidemiology
9.2.2 Pathophysiology
9.2.3 Clinical Findings and Diagnosis
9.2.4 Treatment
9.3 Paraphimosis
9.3.1 Definition, Epidemiology, and Treatment
9.4 Short Frenulum
9.4.1 Definition, Epidemiology, and Treatment
9.5 Micropenis
9.5.1 Definition and Epidemiology
9.5.2 Pathophysiology
9.5.3 Diagnosis
9.5.4 Treatment
9.6 Buried Penis
9.6.1 Definition and Epidemiology
9.6.2 Pathophysiology
9.6.3 Clinical Findings and Diagnosis
9.6.4 Treatment
References
10: Andrological Emergencies
10.1 Introduction
10.2 Paraphimosis
10.2.1 Clinical Presentation
10.2.2 Management
10.3 Penile Strangulation Injury
10.3.1 Clinical Presentation
10.3.2 Management
10.4 Penile Blunt Trauma
10.4.1 Clinical Presentation
10.4.2 Management
10.5 Penile Open Trauma
10.5.1 Clinical Presentation
10.5.2 Management
10.6 Testicular Trauma
10.6.1 Clinical Presentation
10.6.2 Management
10.7 Testicular Torsion
10.7.1 Clinical Presentation
10.7.2 Management
10.8 Penile Abscess
10.8.1 Clinical Presentation
10.8.2 Management
10.9 Fournier’s Gangrene
10.9.1 Clinical Presentation
10.9.2 Management
10.10 Penile Prosthesis Complications
10.10.1 Clinical Presentation
10.10.2 Management
10.11 Priapism
10.11.1 Clinical Presentation
10.11.2 Management
References
11: Andrological Aspects of Penile and Testicular Cancer
11.1 Penile Cancer
11.1.1 Epidemiology, Etiology, and Pathology
11.1.2 Diagnostic Evaluation
11.1.3 Treatment of the Primary Tumor
11.2 Treatment of Superficial Non-invasive Disease (PeIN)
11.3 Treatment of Invasive Disease Confined to the Glans (T1–T2)
11.4 Organ-Preserving Treatments
11.4.1 Laser Therapy
11.4.2 Moh’s Micrographic Surgery
11.4.3 Glans Resurfacing
11.4.4 Glansectomy
11.4.5 Radiotherapy
11.5 Treatment Recommendations for Invasive Penile Cancer (T2–T4)
11.6 Management of Regional Lymph Nodes
11.6.1 Lymphadenectomy
11.7 Andrological Aspects of Penile Cancer
11.7.1 Consequences after Penile Cancer Treatment
11.7.2 Sexual Activity and Quality of Life After Treatment for Penile Cancer
11.8 Testicular Cancer
11.8.1 Epidemiology, Etiology, and Pathology
11.8.1.1 Diagnostic Evaluation
11.8.1.2 Disease Management
11.8.2 GCNIS (Germinal Cell Neoplasia In Situ)
11.8.2.1 Stage I Germ Cell Tumors
Seminoma: Clinical Stage I
11.8.2.2 NSGCT (Non-seminoma Germ Cell Tumors): Clinical Stage I
11.8.2.3 Metastatic Germ Cell Cancer (Stage IIA–IIB)
Stage IIA-IIB Seminoma
Stage IIA-IIB NSGCT
11.9 Andrological Aspects of Testicular Cancer
11.9.1 Testicular Cancer and Gonadal Function
11.9.2 Fertility and Sexual Disfunction After Treatment for Testicular Cancer
References
12: Male Reproduction: From Pathophysiology to Clinical Assessment
12.1 PFAS Pollution and Male Fertility
12.2 HPV Infection and Male Infertility
12.3 Obesity and Male Infertility
12.4 Conclusions
References
13: Clinical Interpretation of Semen Analysis
13.1 Introduction
13.2 Semen Analysis: General Concepts
13.3 Macroscopic Evaluation of Semen
13.3.1 Liquefaction, Viscosity, and Appearance
13.3.2 Volume and pH
13.4 Microscopic Evaluation of Semen
13.4.1 Agglutination and Sperm Antibodies
13.4.2 Sperm Number, Motility, Vitality, and Morphology
13.4.3 How to Interpret the Three Principal Sperm Parameters
13.4.4 Round Cells
13.5 From Semen Analysis to Diagnosis
13.5.1 General Considerations on Azoospermia/Cryptozoospermia
13.5.1.1 Which Parameters May Help Clinicians to Distinguish Between NOA and OA?
13.5.1.2 Which Sperm Parameters are Informative in Quantitative and Qualitative Impairment of Spermatogenesis?
13.6 Value and Limits of the Semen Analysis
References
14: Therapy in Oligozoospermia (Varicocele, Cryptorchidism, Inflammation, and Seminal Tract Infections)
14.1 Varicocele
14.2 Cryptorchidism
14.3 Inflammation and Seminal Tract Infections
References
15: Therapy in Secretory and Obstructive Azoospermia
15.1 Introduction
15.2 Classification
15.3 Epidemiology
15.4 Etiology
15.4.1 Pre-Testicular Etiology
15.4.1.1 Hypogonadotropic Hypogonadism (HH)
15.4.2 Testicular Etiology
15.4.2.1 Genetic Mutations
15.4.2.2 Gonadotoxins
15.4.2.3 Undescended Testis
15.4.2.4 Varicocele
15.4.2.5 Idiopathic Cause
15.4.3 Post-testicular Etiology
15.4.3.1 Obstruction of the Seminal Pathway
Testicular Obstruction
Epididymal Obstruction
Vas Deferens Absence
Vas Deferens Obstruction
Ejaculatory Duct Obstruction
Ejaculatory Dysfunctions
15.5 Diagnosis
15.5.1 Medical History
15.5.2 Physical Examination
15.5.3 Lab Tests
15.5.4 Genetic Screening
15.5.5 Radiological Assessment
15.5.6 Invasive Diagnostic Tools
15.6 Surgical Treatment
15.6.1 Recanalization of the Proximal Seminal Pathways
15.6.1.1 Vasoepididymostomy
15.6.1.2 Vasovasostomy
15.6.2 Recanalization of the Distal Seminal Pathways
15.6.2.1 Trans Rectal Ultrasound-Guided Cyst Aspiration (TRUCA)
15.6.2.2 Transurethral Resection of Ejaculatory Duct (TURED)
15.6.3 Sperm Retrieval Techniques
15.6.3.1 MESA
15.6.3.2 TESA/TEFNA
15.6.3.3 PESA
15.6.3.4 TESE
15.6.3.5 MICRO-TESE
15.6.3.6 New Horizons
References
16: Pathophysiology of Female Reproduction and Clinical Management
16.1 Hypothalamic–Pituitary Axis [3–5]
16.2 Early Follicular Phase
16.2.1 Ovaries and Endometrium
16.3 Mid-Follicular Phase
16.3.1 Ovarian and Endometrial Changes
16.4 Late Follicular Phase
16.4.1 Ovarian, Endometrial, and Cervical Mucus Changes
16.5 Midcycle Surge and Ovulation
16.5.1 Ovarian Changes
16.5.2 Endometrium
16.6 Luteal Phase
16.6.1 Endometrial Changes
16.7 Puberty
16.8 Menopause
16.8.1 Clinic
16.8.2 Menopausal Endocrinology
16.8.3 Diagnosis
16.8.4 Treatment
16.9 Amenorrhea
16.9.1 Causes of Amenorrhea
16.9.2 Causes of Primary Amenorrhea
16.9.3 Causes of Secondary Amenorrhea
16.9.4 Differential Diagnosis
16.9.4.1 Diagnosis of Primary Amenorrhea
16.9.4.2 Diagnosis of Secondary Amenorrhea
16.9.5 Amenorrhea Complications
16.9.6 Treatment
16.9.6.1 Ovulation Induction in Patient Desiring Pregnancy
16.9.6.2 Patient Not Desiring Pregnancy Can Be Divided into Two Categories
16.10 Infertility
16.10.1 Definition
16.10.2 Timing of Infertility Evaluation
16.10.3 Most Common Female Factors of Infertility
16.10.3.1 Ovulatory Disorders
16.10.3.2 Pelvic Factor
16.10.3.3 Tubal Disease
16.10.3.4 Cervical Factors
16.10.3.5 Genetic Causes
16.10.3.6 Unexplained Infertility
16.10.4 Essentials of Infertility Diagnosis
References
17: Laboratory and Instrumental Diagnostics
17.1 Introduction
17.2 Laboratory Tests in Infertility
17.3 Imaging in Infertility
17.3.1 Hysterosalpingography
17.3.2 Ultrasounds
17.3.3 Laparoscopy
17.3.4 Hysteroscopy
References
18: Assisted Reproductive Technology
18.1 Introduction
18.2 Assisted Reproductive Technology
18.3 Art Techniques and Indications
18.3.1 First Level Technique: Intrauterine and Intracervical Insemination IUI/ICI
18.3.1.1 Sperm Preparation Techniques
18.3.2 Second Level Techniques: In Vitro Fertilization (IVF)
18.3.2.1 Indications
18.3.2.2 Controlled Ovarian Stimulation in IVF
18.3.2.3 Controlled Ovarian Stimulation and Ovarian Response
18.3.3 IVF—ICSI: Laboratory Phase
18.3.3.1 In Vitro Fertilization
18.3.3.2 Intracitoplasmatic Sperm Injection (ICSI)
18.3.4 Third Level Techniques: IVF in Azoospermic Patients
18.3.5 Genetic Diseases/Preimplantation Genetic Testing
18.3.6 IVF Outcomes in European Countries
18.4 Art Complications
18.4.1 Ovarian Hyperstimulation Syndrome (OHSS)
18.4.1.1 Prevention of OHSS: Effective Interventions
18.4.2 Multiple Pregnancies and Preterm Birth
18.4.3 Long-Term Effects of ART on Women
18.4.4 Long-Term Effects of ART on Offspring
18.5 Art Legislation and Regulation in European Countries
References
19: Male Sex Hormones in Andrology Today
19.1 Introduction
19.2 Steroids
19.2.1 Sexual Desire
19.2.2 Erectile Function
19.2.3 Ejaculation
19.3 Prolactin
19.3.1 Sexual Desire
19.3.2 Erectile Dysfunction
19.3.3 Ejaculation
19.4 Thyroid Hormones
19.4.1 Sexual Desire
19.4.2 Erectile Dysfunction
19.4.3 Ejaculation
19.5 Other Hormones
19.6 Conclusions
References
20: Gender Dysphoria: Overview and Psychological Interventions
20.1 Introduction
20.2 Basic Concepts: Sexual and Gender Identity
20.3 Symptoms
20.3.1 Children
20.3.2 Teenagers and Adults
20.3.3 DSM 5
20.3.3.1 Gender Dysphoria Criteria in Adults
20.3.3.2 Gender Dysphoria Criteria in Children
20.3.3.3 Gender Dysphoria Criteria in Adolescents
20.4 Causes: Etiological Theories
20.5 Treatment
20.5.1 Treatment for Children and Adolescents
20.5.2 Treatment for Adults
20.6 Conclusions
References
Link to Further Information
21: The Transgender: Endocrinological Assessment
21.1 Introduction
21.2 Initial Evaluation in Trans AFAB and AMAB People
21.3 Full Masculinization in Trans AFAB People
21.3.1 Hormonal Treatment Strategies
21.3.2 Virilizing Effects
21.3.3 Safety Concerns
21.3.4 Monitoring During Hormonal Treatment
21.4 Full Feminization and De-Masculinization in Trans AMAB People
21.4.1 Hormonal Treatment Strategies
21.4.2 Feminizing and De-Virilizing Effects
21.4.3 Safety Concerns
21.4.4 Monitoring During Hormonal Treatment
21.5 Partial De−/Masculinization and/or De-/Feminization
21.5.1 Partial Virilization and/or De-Feminization in Trans AFAB People
21.5.2 Partial Feminization and/or De-Virilization in Trans AMAB People
21.6 Conclusions
References
22: The Transgender: Legal Path to Surgery
22.1 The Right to Gender Identity
22.2 The Procedure for Rectification of the Attribution of Sex
23: MtF Sex Reassignment Surgery: Trombetta Technique
23.1 Introduction
23.2 Preoperative Procedures
23.3 Position of the Surgeons
23.4 Markings
23.5 Devices
23.6 Perineal Surgery
23.7 Penile Surgery
23.8 Tubularization of Penile-Scrotal Flap
23.9 Postoperative Care
23.10 Possible Side Effects and Complications
References
24: Gender Affirming Surgery: Assigned Female at Birth
24.1 Introduction
24.1.1 Definitions and Epidemiology
24.1.2 Guidelines and Regulations
24.1.3 Aim of the Treatment
24.1.4 Standards of Care Specific Criteria for Chest-Contouring Mastectomy and Genital Surgery
24.2 Chest-Contouring- Mastectomy
24.2.1 Surgical Planning
24.2.2 Surgical Techniques
24.2.3 Post-Operative Rehabilitation and Cancer Prevention
24.3 Penis Reconstruction
24.3.1 Surgical Planning
24.3.2 Surgical Techniques
24.3.2.1 Metoidioplasty
24.3.2.2 Phalloplasty
24.3.2.3 Vaginectomy
24.3.2.4 Scrotoplasty and Testicle Implants
24.3.2.5 Erection Implants
24.3.3 Pre-Operative Preparations
24.3.3.1 Post-Operative Rehabilitation
24.3.3.2 Ongoing Researches
References
25: Sexual Pain Disorders, Vestibulodynia, and Recurrent Cystitis: The Evil Trio
25.1 Introduction
25.2 Sexual Pain-Related Disorders and Comorbid Lower Urinary Symptoms
25.2.1 Nosology and Current Definitions
25.2.2 Methodology
25.2.3 Working Definitions in the Clinical Setting
25.2.4 Lower Urinary Tract Symptoms and Female Sexual Disorders: From Epidemiological Data to Clinical Meaning
25.2.5 FSD as Predisposing/Precipitating Factors for MSD
25.2.6 Epidemiology of Sexual Pain Disorders
25.2.7 Clinical Approach to Sexual Pain Disorders
25.2.8 Etiological Complexity of Sexual Pain
25.3 Pathogenic Biofilms, in the Shadow of LUTS and Sexual Pain Disorders
25.3.1 Clinical Approach to Recurrent Post-Coital Cystitis and Comorbid Vestibulodynia and Sexual Pain Disorders
25.3.2 Multimodal Treatment Strategy
25.3.3 Recurrent Cystitis and Sexual Pain: What Probiotics Have to Say
25.3.4 Probiotics to Address Dysbiosis: Which Ones, When, and Why?
25.3.5 Role of Topical Sexual Hormones to Address Cystitis Associated with GSM
25.4 Conclusions
References