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