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Biomedical subjects

I H Hirsch

Publications and source records attributed to I H Hirsch.

51 records · Page 3Linked to original sources
PubMed1993

Transurethral balloon dilation of the external urinary sphincter: effectiveness in spinal cord-injured men with detrusor-external urethral sphincter dyssynergia.

The authors investigated balloon dilation as a minimally invasive alternative to transurethral external sphincterotomy for the treatment of detrusor-external urethral sphincter dyssynergia (DESD). Seventeen spinal cord-injured men with voiding pressures greater than 60 cm H2O underwent balloon dilation of the external sphincter to 90 F at 4 atm of pressure for 10 minutes. The mean voiding pressures before and 12 months after dilation were 83 cm H2O +/- 35 and 37 cm H2O +/- 15, respectively (P = .008). There was a significant decrease in residual urine volume, from 163 mL +/- 162 to 68 mL +/- 59 (P = .05), whereas bladder capacity remained relatively unchanged at 253 mL +/- 181 and 230 mL +/- 97 (P = .30). Complications included one case of postoperative bleeding necessitating transfusion, two treatment failures, and one bulbous urethral stricture. Fourteen of the 17 patients (82%) now void without the aid of an indwelling catheter or alternative therapy. Balloon dilation has no detrimental effect on erectile function and may improve fertility.

Adult↗
PubMed1992

Antisperm antibodies in seminal plasma of spinal cord-injured men.

Central to the problem of reproductive rehabilitation of spinal cord-injured men treated by assisted ejaculatory techniques is the consistent observation of deficient semen quality. Most studies have reported asthenospermia despite the presence of normal sperm concentration in most men undergoing these procedures. To date little attention has been given to the incidence and relevance of sperm autoimmunity in this group. In 9 anejaculatory spinal cord-injured men, electroejaculation was performed. Antegrade ejaculates were obtained in 7 men and analyzed. Mean sperm antegrade concentration was 74.4 +/- 113 x 10(6)/mL with a mean motile sperm concentration of 28.6 +/- 54.0 x 10(6)/mL. Enzyme-linked immunosorbent assay (ELISA)-determined antisperm antibody response was positive in the seminal plasma of 5 of 7 patients. Because of the disproportionately high incidence of an immunologic factor in men with neurogenic infertility, sperm autoimmunity should be considered among the important causes underlying their seminal dysfunction.

Adult↗
PubMed1992

Technique of external sphincter balloon dilatation.

We report on our technique and early experience with balloon dilatation of the external sphincter in 7 spinal cord-injured men with detrusor external sphincter dyssynergia and elevated voiding pressure. Following dilatation, bladder emptying into condom catheters was achieved in all patients without dribbling incontinence.

Adult↗
PubMed1992

The relative distribution of viable sperm in the antegrade and retrograde portions of ejaculates obtained after electrostimulation.

OBJECTIVE: To determine the relative concentration, motility, and viability of spermatozoa in the antegrade and retrograde portions of the ejaculate after electroejaculation in spinal cord injured men. DESIGN: Retrospective. SETTING: University outpatient clinic providing tertiary care in reproductive rehabilitation. PATIENTS: The antegrade and retrograde portions of 22 ejaculates obtained from five spinal cord-injured men were analyzed for sperm density, mean sperm motility, and percentage of total motile and viable sperm yield. RESULTS: The number of spermatozoa were uniformly distributed between the antegrade (54.4%) and retrograde (45.6%) ejaculates. However, of the total sperm yield in both compartments, 66.3% of the motile spermatozoa and 71% of the viable sperm were found in the antegrade compartment (P less than 0.05). Additionally, mean sperm motility was significantly higher in the antegrade ejaculate (P less than 0.05). CONCLUSIONS: Significantly impaired sperm motility and viability are noted in the retrograde ejaculate. Efforts should therefore be directed to maximizing the antegrade portion of the electro-ejaculate and optimizing the technique of preserving functional sperm in the intravesical compartment.

Cell Survival↗
PubMed1991

Quantitative testicular biopsy in spinal cord injured men: comparison to fertile controls.

Spermatogenic abnormalities have been reported in the majority of spinal cord injured men on routine testicular biopsy. However, given the interim advances in their urological and rehabilitative care, a quantitative assessment of the germinal epithelium after spinal cord injury and comparison of these parameters to normal controls are warranted. Incisional testicular biopsy was performed in 14 spinal cord injured men. Quantitative micrometric techniques were applied to assess spermatogenesis and the results were compared to a normative data base of testicular biopsies previously obtained from a group of 15 fertile volunteers. From a minimum of 10 randomly selected round seminiferous tubules per subject the mean number of Sertoli cells, mature spermatids, tubular diameter and tubular wall thickness were determined in both groups and statistically analyzed. In the spinal cord injury group the mean number of spermatids per tubule was significantly lower and the mean number of Sertoli cells per tubule was significantly higher than in fertile controls (p less than 0.05). Moreover, the mean Sertoli cell-to-spermatid ratio per seminiferous tubule was significantly higher in the spinal cord injury group and discriminated between spinal cord injured men and controls, with a sensitivity of 93% and specificity of 100% (p less than 0.0001). Half of the spinal cord injury group showed a mean tubular spermatid density of less than 10. Compared to the fertile population, spinal cord injured men show significant differences in quantitative parameters of the germinal epithelium that may contribute to the reproductive dysfunction.

Adolescent↗
PubMed1991

Biochemical analysis of electroejaculates in spinal cord injured men: comparison to normal ejaculates.

To address the consistent finding of asthenospermia in spinal cord injured men we compared the biochemical constituents of antegrade fractions of electroejaculates of 6 such patients with the manual ejaculates of 6 volunteers. Semen samples in each group were analyzed for 19 biochemical parameters, pH and osmolality. Organic components included triglycerides, glucose, fructose, uric acid, creatinine, urea, total protein, albumin and cholesterol. Metabolic enzymes, including glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase, lactate dehydrogenase and alkaline phosphatase, were measured. Inorganic constituents included chloride, sodium, potassium, zinc and phosphorous. Although not significant, higher levels of blood urea nitrogen and creatinine were demonstrated in most electroejaculates suggesting urinary contamination of the antegrade specimens. In electroejaculates significantly lower levels (p less than 0.05) of fructose, albumin, GOT and alkaline phosphatase as well as significantly higher levels (p less than 0.05) of chloride were noted. No significant difference in osmolality or pH was found. Moreover, in the electroejaculates the levels of glucose, uric acid and all inorganic constituents approached their corresponding levels in serum. We conclude that biochemical abnormalities of the seminal plasma may contribute to seminal dysfunction of spinal cord injured men and may result from neurological injury to the accessory sex glands or from the electroejaculation procedure itself.

Adult↗
PubMed1990

Quantitative testicular biopsy in congenital and acquired genital obstruction.

To determine if congenital obstruction of the genital tract is associated with significant testicular histopathological conditions compared to acquired forms of obstruction we performed testicular biopsy in 8 vasectomized men and 5 men with vasal agenesis. Quantitative analysis of the seminiferous tubular and epithelial parameters demonstrated a statistically significant increase in tubular wall thickness in the vasectomized group. There was no significant difference among the groups with reference to the mean number of late spermatids per seminiferous tubules, mean number of Sertoli cells per seminiferous tubules, mean number of seminiferous tubules per field (100 times) or mean seminiferous tubular diameter. We conclude that despite a lifelong duration of obstruction, men with vasal agenesis demonstrate a more favorable testicular histological status compared to men after vasectomy. This finding may have therapeutic implications when considering assisted pregnancy techniques as a method of treatment of male genital tract atresia.

Adult↗
PubMed1990

Systemic sperm autoimmunity in spinal-cord injured men.

Historically, spinal-cord injured men have been considered virtually sterile because of ejaculatory dysfunction commonly resulting from their injury. Assisted ejaculatory techniques, however, have overcome the problem of sperm transport and have allowed both the establishment of pregnancy through artificial insemination and the assessment of their semen quality. Most studies have noted the presence of asthenozoospermia in the setting of normal sperm concentration following electroejaculation or vibratory stimulated ejaculation. Thus far, little attention has been given to the basis for the frequent finding of asthenozoospermia, and the possibility of sperm autoimmunity in this group has not been adequately studied. In nine spinal-cord injured men, reproductive evaluation was performed consisting of hormonal measurements, testicular biopsy, and indirect immunobead tests for sperm autoimmunity. A mean sperm concentration was 144 +/- 185 x 10(6)/ml. However, the mean motile concentration was 33 +/- 62 x 10(6)/ml. Indirect serum immunobead showed positive IgG or IgA titers in 3 of 8 patients. Because of the disproportionately high incidence of an immunologic factor in spinal-cord injured men compared to able-bodied infertile men, sperm autoimmunity should be considered among the important causes underlying seminal dysfunction following spinal cord injury.

Autoantibodies↗
PubMed1990

Electroejaculatory stimulation of a quadriplegic man resulting in pregnancy.

Reproductive rehabilitation of men after spinal cord injury has been made possible by the application of assisted ejaculatory techniques such as electroejaculation. Although this technique may predictably overcome the barrier of semen recovery, the problem of seminal dysfunction still remains. This report describes one of the few pregnancies established by a quadriplegic man using electroejaculatory stimulation for semen acquisition and standard in vitro semen preparation methods for intrauterine insemination.

Adult↗
PubMed1989

Pharmacologic therapy of male infertility: specific treatment.

Pharmacotherapy of male reproductive disorders is applicable to the majority of men seeking treatment for infertility. Since a favorable prognosis is associated with specific medical measures directed toward enhancing sperm quality, a comprehensive clinical and laboratory assessment of the infertile male is essential. This treatment may consist of replacement therapy for pituitary or hypothalamic dysfunction (i.e., exogeneous gonadotropins or GnRH), suppression of prolactin excess, antimicrobial therapy, sympathomimetic agents for ejaculatory disorders, or immunosuppressive treatment of sperm autoimmunity. Finally, the possibility of multiple causes of male reproductive dysfunction and their specific forms of treatment should be considered.

Humans↗
PubMed1987

Endourological reconstruction of posterior urethral disruption.

While conventional methods of urethroplasty for posterior urethral disruption usually are successful technically, they may be associated with complications and often require the expertise of a specialist. Therefore, the option of an endourological approach to the treatment of the obliterated posterior urethra would be highly desirable if a comparable surgical outcome could be achieved. We describe a closed controlled method of posterior urethral reconstruction following traumatic avulsion of the posterior urethra. Urethral continuity was re-established by endoscopic identification of the true prostatic outlet, its fixation with an angiography wire and a Goodwin sound, retrograde visual urethrotomy through the fibrotic segment and balloon dilation of the entire posterior channel. Postoperative anatomical and functional results were excellent, and were achieved with much less risk and cost to the patient than those of a perineal or transpubic urethroplasty.

Adult↗
PubMed1987

Medical treatment of male infertility.

After an appropriate clinical and laboratory assessment of a patient's fertility status, the clinician must often decide whether specific and empiric treatment is indicated. Specific treatment may take the form of replacement therapy (exogenous gonadotropins or GnRH) for pituitary or hypothalamic failure, inhibition of prolactin secretion, antimicrobial therapy, or immunosuppressive therapy for demonstrable immunologic infertility. Finally, ejaculatory dysfunction often requires sympathomimetic agents. Alternatively, in the normogonadotropic oligospermic patient, the major form of empiric therapy relies on the enhancement of physiologic hormone levels that influence spermatogenesis. Such "stimulation" therapy may be achieved by GnRH analogues, antiestrogens, exogenous gonadotropins, or androgens.

Autoimmune Diseases↗
PubMedDate not supplied

Spermatogenesis in early and chronic phases of experimental spinal cord injury in the rodent model.

A rodent model was used to study the degree and dynamics of potential spermatogenic alterations during both acute and chronic phases after experimental spinal cord injury (SCI). Sexually mature Sprague-Dawley rats underwent controlled impact SCI by exposure of the thoracic spine, T-10 laminectomy, and intraoperative somatosensory-evoked potential latency and amplitude. A 50 gm-cm SCI was produced in 35 experimental subjects. Sham surgery was performed on 16 control subjects through exposure of the dura without weight drop. SCI was verified by obliteration of the somatosensory-evoked potential following injury and subsequent neurologic assessment (modified hindlimb Tarlov scale) 4 weeks after injury. Flow cytometry with acridine orange as the DNA probe was used to measure potential spermatogenic alterations in testicular cell development and integrity of epididymal sperm chromatin structure between 2 and 20 weeks following SCI. Flow cytometric analysis revealed that nine of the 35 SCI animals demonstrated altered spermatogenesis; it is not clear whether these effects are specific or nonspecific stress related. These responder animals contributed to dramatic differences in relative percent testicular haploid cells (spermatids) and concurrent differences in percent diploid cells at 2, 4, 8, 12, and 16 weeks. Percentages within the three spermatid populations (round, elongating, and elongated) also differed at these time points. The sperm chromatin structure assay (SCSA) revealed significant epididymal sperm nuclear structure differences at 2, 4, and 12 weeks (P < 0.001). These findings are in concordance with our clinical observations of spermatogenesis in spinal cord injured men and suggest that significant spermatogenic deficit may occur, even in the early phase of injury.

Acute Disease↗
PubMedDate not supplied

Soluble Fc gamma RIII (CD16) and immunoglobulin G levels in seminal plasma of men with immunological infertility.

Receptors for the Fc region of the immunoglobulin G (IgG) (Fc gamma R) have been recognized as a link between humoral and cellular immune responses. A soluble form of Fc gamma RIII (CD16) has been found in seminal plasma (SP), which may modulate immunosuppression of antisperm immune responses in the male and female reproductive tracts. SP from some individuals apparently have lower levels of Fc gamma RIII, but it is not known whether the diminished activities are due to low receptor concentration or steric interference from IgG. To test the hypothesis that different levels are due to steric interference, relative levels of Fc gamma RIII were measured in SP using monoclonal antibody 3G8 in an amplified enzyme-linked immunosorbent assay (ELISA) system. Men who were positive for antisperm antibodies (ASA) by Sperm Mar and direct immunobead assay (N = 26) and negative for ASA (N = 26) were tested. Individuals who were ASA positive had lower detectable levels than those who were ASA negative (t = 1.99, P = 0.05). Therefore, variation in Fc gamma RIII levels may be due to steric interference from IgG. IgG subclass concentrations in SP of both groups were determined using an ELISA method and compared to Fc gamma RIII levels. Slight correlations were seen for IgG1 (r2 = 0.237, P < 0.001), IgG2 (r2 = 0.204, P < 0.001), and total IgG (r2 = 0.299, P < 0.001) in relation to Fc gamma RIII levels in ASA-negative SP specimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Autoantibodies↗