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The constant failure to control the orgasm and the following ejaculation is called premature ejaculation. After having excluded organic factors the reason for premature ejaculation is always worry. When the reason for this fear is found, a psychotherapeutic treatment can soon be successful.
From 38 patients, who had undergone retroperitoneal lymphadenectomy in the period between April 1980 and October 1983, reliable statements were obtained referring to pre- and postoperative erectile and ejaculatory abilities. The thoracolumbar outflow (Th12-L3) of the centers for emission and psychogenic erection is usually damaged in this procedure. About 12% of the radically lymph node dissected patients complained of permanent erectile disturbances; 85% of the radically lymph node dissected patients revealed ejaculatory disorders, 58% of them with a total loss of ejaculation. About 50% of them showed a considerable psychic involvement. In 12 patients a modified lymph node dissection procedure was performed with the intention to preserve ejaculatory capability. Nevertheless 6 (50%) of them revealed postoperative ejaculatory failure, 3 of them with a total loss of ejaculation. Thus our own experiences and a review of the literature indicate that this modified lymph node dissection often fails in its purpose and can not always be considered a valuable procedure for preservation of ejaculation. The administration of sympathomimetic drugs and/or imipramine is a promising approach in the treatment of ejaculatory failure.
The sub-cutaneous injection of physostigmine (Eserine), an indirect para-sympatheticomimetic by reversible anticholinesterase activity, is capable of provoking ejaculation. The result is therefore identical to that obtained with a spinal injection of neostigmine (Prostigmine), which is only effective by spinal injection. In 6 patients with lesions at T12, L1 and L2, the subcutaneous injection of physostigmine was always effective. When this injection does not provoke any adverse reactions, it can be repeated at home without medical supervision. When this injection results in ejaculation, the erection is improved in 80% of cases and the sexual act is made easier. The usual dose is 2 mg of Eserine. One woman is currently pregnant from such an ejaculation. This method can therefore be proposed in the outpatient treatment of sterility in couples in whom the man is paraplegic, until its oral administration has been perfected.
The distribution and fine structure of free immature germ cells and their degenerated forms in the human testis, epididymis, and ejaculate were investigated by means of semithin sections under the light microscope and by means of thin sections under the electron microscope. If spermatogenesis is normal, among the free immature germ cells, spermatids and spermatocytes I can be found in the testis. In cases of disorganized or very reduced germinal epithelium, in addition to all the normal cell forms of spermatogenesis, numerous morphologically altered and degenerated free immature germ cells are present. In these cells vacuoles, nuclear tubuli, and a special structure of the endoplasmic reticulum are particularly remarkable. Spermatocytes II and normal and aberrant forms of spermatids are present in the epididymis. Aberrations of the spermatids are especially numerous--for example multinucleated cells, abnormalities of nuclear condensation and acrosome vesicle, abundant cytoplasm in combination with a small nucleus, and a great number of lipid droplets in the cytoplasm. In comparison with the testis, the number of cell ghosts and anucleated components of cytoplasm is increased. The variety of cell types is decreased in the ejaculate. Only spermatids are distinctly demonstrable. Primary spermatocytes are characterized by exceptional abundant endoplasmic reticulum. Cells with eccentrically placed dense nuclei are not similar to any of the cell forms in spermatogenesis. The fine structure of many cells appears faded. Often the cells are degenerated or only recognizable as shadow forms. Two forms of anucleated components of the cytoplasm are distinguishable. These are interpreted as epididymal secretory blebs or cell fragments. Spermatophages are described in the rete testis, epididymis and ejaculate.
The intactness of bull spermatozoa was determined by exclusion of external succinate. This was oxygraphically measured in the presence of cytochrome c after inhibition of the cell respiration with rotenone. An addition of cytochrome c was necessary for a reproducible respiration of damaged cells. The portion of intact cells determined in this way correlated with that obtained by the fluorescent dye primuline. The content of adenine nucleotides and the percentage of ATP of washed fresh spermatozoa depended on the intactness of the sperm sample. The adenine nucleotide pattern of spermatozoa after deep freezing corresponded to that of washed fresh ejaculates with a high percentage of damaged cells. The major part of ejaculates tested showed only a small increase of damaged cells during substrate-free incubations at 38 degrees C up to 4 h under aerobic and anaerobic conditions. Ejaculates which had shown a drastic increase of damaged cells were not recognizable by the initial portion of damaged cells. Also a lowered content of ATP in the cells was no indicator of an increased fragility of the cell membrane. A remarkable loss of total adenine nucleotides was observed under conditions of cold shock. It indicates that the changes in the sperm membrane induced by cold shock were qualitatively different in comparison with changes caused by storage and by a slow decrease in temperature.
The phospholipids of porcine spermatozoa were analyzed by a hydrolytic procedure directly after ejaculation, and after incubation for 120 min in vitro or in ligated uterine segments of females with induced estrus. Total phospholipid content of ejaculated sperm was 65.7 micro g lipid P per 10(9) sperm, of which 41% was alkyl ether and 23% was alkenyl ether glycerophospholipid. All of the ether phospholipids were choline and ethanolamine glycerophospholipids. In order of decreasing amount (% of total phospholipid), the phospholipids were choline and ethanolamine glycerophospholipids (49.9 and 28.2), sphingolipid (10.6), cardiolipin (5.5), phosphatidylinositol (2.3), phosphatidic acid (1.5), phosphatidylserine (1.2), and phosphatidylglycerol (0.8). Phosphorus-containing sphingolipid separated into two components during thin-layer chromatography. Sphingosine was the only long-chain base identified in either band. Major fatty acids in the band with lower R(f) were 16:0 (56%), 20:0 (23%), and 18:0 (11%) plus smaller amounts of 14:0, 18:1, and 22:0, while those in the band with higher R(f) were 14:0 (30%), 16:0 (45%), and 18:1 (12%) plus smaller amounts of 18:0, 20:0, and 22:0. Choline was the only water-soluble base present in the lower R(f) sphingomyelin while ethanolamine was prevalent in the higher R(f) component. Incubation of washed spermatozoa in Ca(2+)-free Ringer-fructose at 37 degrees C for 2 hr produced no significant change in the level of any of the phospholipids. Incubation of washed sperm in the uterus for 2 hr, in the presence of oviductal secretions, produced an increase in phosphatidylcholine from 7.2 to 10.2 micro g lipid P per 10(9) sperm.-Evans, R. W., D. E. Weaver, and E. D. Clegg. Diacyl, alkenyl, and alkyl ether phospholipids in ejaculated, in utero-, and in vitro-incubated porcine spermatozoa.
A major drawback for many sexually active men who undergo a prostatectomy for benign prostatic hyperplasia, either via a transurethral resection or an open procedure, is the high incidence of retrograde ejaculation. Transurethral laser ablation of the prostate (TULAP) is a minimally invasive alternative to these procedures for prostatic outlet obstruction. We retrospectively reviewed 37 patients who underwent the TULAP procedure. Our data revealed that in addition to a significant improvement in voiding symptoms, 92% of sexually active patients retained both potency and antegrade ejaculation postoperatively. We conclude that this procedure is a viable alternative to transurethral prostatectomy, especially for the men who wish to remain sexually potent with antegrade ejaculation. A rationale for the mechanism of preservation of ejaculatory function is discussed.
OBJECTIVE: To determine the clinical significance of albumin determination in ejaculates by means of an easy office test to screen semen samples for subclinical infection-inflammation. PATIENTS: One hundred fifty-nine randomly chosen males of couples with longstanding infertility (median duration of infertility 4 years (range 1 to 19 years) without clinical signs or symptoms of genital tract infection. SETTING: Outpatient Infertility Clinic of the University of Heidelberg, Germany. MAIN OUTCOME MEASURES: Screening of ejaculates for subclinical infection-inflammation by means of a ready-to-use kit for semiquantitative detection of albumin in addition to determination of leukocytes rates by means of monoclonal antibodies for differentiation of round cells and measurement of granulocyte elastase concentration in semen samples. Evaluation of sperm quality by means of standard sperm analysis including determination of local antisperm antibodies with the mixed antiglobulin reaction, evaluation of sperm functional capacity in vitro with the standardized sperm-cervical mucus (CM) penetration test, and semen cultures. All tests were performed from aliquots of the same ejaculates. RESULTS: Screening of semen samples for elevated albumin with the modified paper strips proved to be very easy, quick, and suitable for routine use. Positive results were not related markedly to medical history and outcome of clinical examination as well as to standard parameters of sperm analysis and were not influenced by local antisperm antibodies of the immunoglobulin (Ig)G and/or IgA class and microbial colonization. However, albumin-positive semen samples were significantly less frequent in case of very good outcome of the sperm-CM penetration test. A significant relationship was found with high rates of leukocytes of the round cells in semen samples (total range 0% to 96%) and the concentration of granulocyte elastase (total range 1 to 880 micrograms/L). CONCLUSIONS: The results of this prospective study suggest that the determination of albumin in semen samples with ready-to-use test kits might be a valuable additional marker for subclinical infection-inflammation of the male genital tract and therefore suitable for screening during infertility investigation.
Premature ejaculation is a common male sexual dysfunction. Many kinds of medication have been used without great success. The start-stop technique is usually preferred. However, some patients and couples do not want to learn this kind of sexual therapy. One common adverse effect of the new selective serotonin re-uptake inhibitors is delayed ejaculation. This article discusses a patient with a premature ejaculation problem combined with minor depression and anxiety, who was successfully treated with paroxetine.
The study aimed at investigation of laser radiation effect on reproductive male function which has failed as a result of genital inflammation, versus the efficacy of routine chemotherapy. The treatment was given to 50 males of reproductive age who had been infertile for 1-12 years. 25 of them (group 1) were exposed to laser, the other 25 received standard drugs. The responses were assessed clinically and by ejaculate potency. Due to laser application clinical and ejaculate characteristics improved in the absence of side effects either on the reproductive system or the body as a whole. The author recommends laser application for treatment of ejaculate infertility in males with chronic genital inflammation.
With the aim of applying the technique of electro-ejaculation to paraplegics, the authors perfected an apparatus which permits stimulation with an intra-rectal electrode. Out of 27 electro-ejaculations carried out on 9 monkeys, there were 5 failures and 22 successes (but 3 of these only contained coagulum). The results improved at the same time as the technique. Although the motility and the number of spermatozoa were rather reduced in comparison with normal ejaculation, the semen obtained appeared to be utilizable. Observation of the animal, rectoscopy as well as the histological investigations carried out in 3 of the animals which were sacrificed showed no complication or lesion. The apparatus and technique which subsequently proved to be applicable in the paraplegic male should enable the improvement of his possibilities of procreation.
A 24-year-old man underwent right radical orchiectomy for testicular teratocarcinoma in May 1982, which was followed by retroperitoneal lymph node dissection. The patient showed no evidence of recurrent disease at followup examinations. The patient later reported a complete loss of ejaculation postoperatively. Erection and orgasm remained normal. Prior use of a sympathomimetic agent, imipramine hydrochloride, was unsuccessful in producing an antegrade ejaculation. Pregnancy was achieved following the fifth attempt at artificial insemination using semen retrieved from the bladder by the modified Hotchkiss method. A healthy male infant, weighing 3,150 g, was delivered. The treatment modality for male infertility due to retrograde ejaculation after retroperitoneal lymph node dissection for testicular cancer is discussed.
In this work we apply the Hoechst 33258 DNA staining, the TUNEL procedure and conventional electron microscopy to study the ejaculate of fertile and infertile men, in order to detect apoptosis in human sperm cells. We have observed that apoptosis is abnormally frequent in the sperm cells of the ejaculate of sterile men, and that it shows the classical biochemical and ultrastructural pattern in spermatozoa, spermatids and apoptotic bodies. These characteristics, involving the chromatin, the nuclear envelope, the plasma membrane, the presence of cytoplasmic vacuoles and the status of mitochondria, are consistent whatever the pathology of the patient is. What is varying is the percentage of the apoptotic sperm cells, that is about 0.1% in fertile controls, and increases up to about 10% in varicocele, infected (including AIDS), "round headed' patients, to 20% in cryptorchid men, to 25% in immature patients, and to 50% in testicular seminoma carriers. Obviously in each category the frequence of apoptotic cells increases concomitantly with the degree of the affection. The present demonstration not only extends to human spermiogenetic epithelium the natural presence of apoptosis, which starts in the testis and is revealed in the ejaculate, but also explains many abnormal ultrastructural sperum patterns hitherto unexplained in fertile and infertile individuals.
This study evaluated paroxetine as a possible treatment for premature ejaculation. Sixty two patients affected by primary premature ejaculation were randomly assigned to two groups. A and B, and treated with two different treatment schedules. Patients assigned to group A were treated with paroxetine 20 mg p.o. daily for six months; patients assigned to group B were treated with paroxetine 20 mg p.o. daily for fourteen days, and than dose was reduced to 10 mg for a total treatment period of six months. Only one patient reported significative side effects (weakness). Positive clinical results were obtained, at the end of the treatment, in 89 per cent of group A and 88 per cent of group B. In patients with primary premature ejaculation, paroxetine represents, in our opinion, the best therapeutic option for its efficacy and lack of significant side effects.
PURPOSE: We determined a rational strategy for treatment of patients with retrograde ejaculation in the era of modern assisted reproduction technology. MATERIALS AND METHODS: In 7 consecutive patients medical treatment or retrieval of spermatozoa from the bladder was performed at a male infertility clinic. RESULTS: Antegrade ejaculation was restored in 3 patients, and spermatozoa were retrieved from the bladder and used for assisted reproduction in 3. Spermatozoa with good oolemma penetrating ability were collected by seminal vesicle massage. CONCLUSIONS: Modern assisted reproduction technology is a powerful treatment option for retrograde ejaculation when combined with a technique to retrieve spermatozoa of good quality from the bladder.
Authors have presented results of vibratory stimulation in 20 anejaculatory spinal cord injury men. In 17 of 20 patients who had not ejaculated since their injuries, application of a vibrator to the penis caused ejaculation. Three of them had retrograde ejaculation. All patients with upper thoracic lesions received nifedipin. Side effects of vibratory stimulation were not reported. Semen can be used for assisted reproductive techniques.
The rat seminal vesicle produces large amounts of a protein-rich fluid that greatly contributes to semen volume. RSV IV, a protein abundantly secreted from this gland, binds in vitro to rat epididymal spermatozoa. However, there is no evidence that this protein may have an in vivo role as a sperm-coating antigen. We report in this paper that high-molecular-weight RSV IV immunologically related proteins can be detected on ejaculated spermatozoa, but not on epididymal spermatozoa. After incubation of purified RSV IV with ejaculated spermatozoa in freshly recovered semen or with epididymal spermatozoa in a medium containing the coagulating gland secretion, sperm-bound proteins with analogous properties were detected. These results support the hypothesis that RSV IV is modified at ejaculation to an high-molecular-weight, sperm-coating antigen.
Twenty-four healthy volunteers and 24 patients undergoing transurethral resection of the prostate received an oral dose of 200 mg of cefpodoxime as proxetil ester in a fasting state. At the same time 3.235 g of iohexol, a renal contrast medium, was injected intravenously to indicate possible urinary contamination of the prostatic fluid. The subjects were divided into three groups each. After 3, 6 and 12 h the cefpodoxime concentrations were measured in plasma, urine, prostatic fluid and ejaculate in volunteers and in plasma, prostatic fluid and prostatic adenoma tissue in patients by a bioassay as well as by an HPLC method. In general, the concentrations measured by bioassay were higher than those by HPLC. The median plasma concentrations (bioassay) in volunteers (patients) after 3, 6 and 12 h were 2.28 (2.34) mg/l, 0.95 (1.17) mg/l and 0.12 (0.28) mg/l, respectively. The median ejaculate concentrations after 6 and 12 h were 0.95 mg/l and 0.19 mg/l, respectively. Only in three volunteers and in one patient prostatic fluid concentration without urinary contamination could be measured after 3 h with a median fluid to plasma ratio of 0.10. The prostatic adenoma tissue concentrations (bioassay) after 3 and 6 h were 0.50 mg/kg and 0.24 mg/kg with tissue to plasma ratios of 0.30 and 0.26, respectively. After 3 h about half of the volunteers and after 12 h about half of the patients showed no detectable concentration in ejaculate (volunteers) and prostatic tissue (patients), respectively. It was concluded that the cefpodoxime should be administered 3 to 6 h prior to surgery if used for perioperative prophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)