Andrology Flashcards
how common is varicocele?
15% in general population
30% in infertile men
what is the classification for varicocele?
Hudson grade 3 visible 2 palpable on standing 1 palpable with valsalva 0 subclinical
why does OAT occur in varicocele?
higher intrascrotal temp
ROS
reflux
evidence for varicocelectomy for subfertility
pregnancy rate
Ficarra: 20 -> 36%
Marmar: odds 2.6
what are the techniques for varicocelectomy?
high retro Palomo
inguinal Ivanissevich
subinguinal Marmar
Lap
Hydrocele and failure rate of microscopic subinguinal varicocelectomy
hydrocele 0%
failure 1.4%
types of priapism
ischemic
non-ischemic
stuttering
name the corporoglandular shunts for priapism
percutaneous: Winter, Ebbehoj, T-shunt
open: Al-Ghorab, Burnett
name the proximal shunts for priapism
Quackels/Sacher: corporospongiosal
Grayhack: corporosaphenous
Barry: dorsal vein shunt (corporo-)
what blade is used for T-shunt?
what dilator size is used for tunnelling?
#10 Fr 20 - 24
what are the stages of spermatogenesis?
neonatal gonocyte, adult dark spermatogonia, pale meiosis 1: primary spermatocyte meiosis 2: secondary spermatocyte spermatid spermatozoa
what is retrograde ejaculation
failure bladder neck contraction
propulsion of sperm back
what is Liverpool solution?
NaCl NaHCO3
alkalinize post-orgasmic urine
what are the methods of sperm retrieval for anejaculation?
Above T10/intact bulbocavernosus reflex: penile stimulation
Below T10: Seager electro-ejaculator to stimulate perirectal and periprostatic sympathetic nerves
Most common mode of inheritance for Kallmann syndrome
X-linked recessive
How common is =
Obstructive azoospermia
Obstruction at epididymis, ejaculatory duct?
20%
epididymis 50%
ejaculatory duct < 3%
CTFR gene
Ch =?
Ch 7
WHO 2010 lower limit wrt sperm parameters: volume total sperm conc total motility vitality morphology
1.5ml 39 15 40 58 4
what is Cap-score?
Ganglioside localization pattern (apical = good)
calcium influx and capacitation
what is Johnsen score?
1 - 10
1 = fibrosis
10 = complete spermatogensis
Risks of chromosomal abnormalities and congenital malformation associated with ART?
3X
OR 1.29
what ART technique will you choose for:
Irreversible OA
Reversible OA
NOA
PESA
MESA / ART
mTESe
what is mTESE
microdissection
seminiferous tubules
identify enlarged tubules
Failure rate of various vasal occlusion techniques = ?
Mucosal cautery: 0.28%
Suture ligation: 0.51%
Marie Stopes: 0.64%
Post-vasectomy semen analysis Mx
One azoopsermic
after 12wk , 20 eja
Special clearance for post-vasectomy
One SA
< 100,000/ml, immotile
12 wk
Factors related to successful vasectomy reversal
interval expertise length vasal fluid sperma granuloma young female partner
Pregnancy rate post-vasectomy reversal (VVSG)
< 3: 76%
3 - 8: 53%
9 - 14: 44%
> 15: 30%
Neurology wrt erection:
somatosensory
somatomotor
parasympathetic
pudendal S2 - 4
Onuf S2 - 4
cavernosal nerve
serum testosterone components
free + alb-bound + SHBG-bound
T 1/2
Viagra
Cialis
4h
18h
how common is hypogonadism
18% in > 70y
Absolute and relative contraindications of T replacement
2 + 5
regarding ejaculation and their spinal levels:
secretory centre
mechanical centre
T10 - L2
S2 - 4
what is Dapoxetine?
efficacy
Priligy
SSRI
3 fold increase in IELT
Peyronie’s disease
___ over-expression
TGF-B1
Peyronie:
most common location
dorsal 78%
Peyronie: natural history
48% worse
40% stable
12% better
Peyronie: postulated mechanisms:
Colchicine
vit E
POTABA
anti-inflam/stimulate collagenase/down-reg TGF-a
antioxidant
potassium para-aminobenzoate, enhanced O2 uptake
Peyronie: efficacy of LiESWT
pain relief only
what is Nesbit procedure?
plication
excision of elliptical portion of TA
