1 male infertility and impotence
TRANSCRIPT
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MALE INFERTILITY AND IMPOTENCE
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INCIDENCE OF INFERTILITY
50% are due to the female factor.
30% are due to the male factor.
20% are due to combined factors.
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MALE FACTOR EVALUATION
History.Physical
examination.Laboratory evaluation.
Imaging.
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HISTORY
Infertility history
Sexual history
Childhood and development
Medical history
Surgical history
Drug history
Environmental history
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PHYSICAL EXAMINATION
Inguinal scars
varicocele
Presence of vas deferens
Epididymal examination
Testicular examination
Digital rectal examination
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ENDOCRINE EVALUATION
FSH
LH
Prolactin
Testosterone.
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SEMEN ANALYSIS
Ejaculate volume: 1.5-5 cc
Sperm density (count): >20 million/cc
Motility>60%
Forward progression>2(scale 1-4)
Insignificant sperm agglutination
Insignificant pyospermia or hematospermia
No hyperviscosity.
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ULTRASOUND EVALUATION
Paratesticular evaluation
Testicular evaluation
Evaluation of the seminal
vesicle,ejaculatory ducts and vasal ampulla
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ETIOLOGY OF MALE INFERTILITY
Pretesticular causes (endocrine)
Testicular (genetic)
Post-testicular (obstruction)
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TREATMENT OF MALE INFERTILITY
•Specific therapy•Replacement hormonal therapy.•Empirical therapy•Antiestrogens•HCG•HCG and FSH•Steroids•Kallikrein•Pentoxyfylline•antioxidants
Medical
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SURGICAL TREATMENT
Varicocelectomy
Vasovasostomy
TUI of the ejaculatory ducts
ICSI
ICSI/TESE
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ERECTILE DYSFUNCTION
Incidence: 52% of adult males between 40-70 years.
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ANATOMY OF ERECTION
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PHYSIOLOGY OF ERECTION
Sexual stimulation
NO
Increase in blood flow
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ETIOLOGY OF ERECTILE DYSFUNCTION
Psychogenic
Arteriogenic
Venogenic
Hormonal
Systemic
drugs
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DIAGNOSIS OF ERECTILE DYSFUNCTION
History•Medical history•Sexual history
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PHYSICAL EXAMINATION General Local
Penis Testes DRE
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INVESTIGATIONS Laboratory Imaging
Penile duplex study Cavernosometry Arteriography
Others rigiscan Intracavernosal injection
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TREATMENTManaging modifiable causes
Oral drugs
Vacuum erection devices
Intracavernosal injection of vasoactive substance
Intrathecal injection of a vasodilator pillet
Penile implants(prosthesis)
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VACUUM ERECTION DEVICE
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PENILE PROSTHESIS