Purpose. To determine the mechanisms predisposing penile fracture as well as the rate of long-term penile deformity and erectile and voiding functions. Methods. All fractures were repaired on an emergency basis via subcoronal incision and absorbable suture with simultaneous repair of eventual urethral lesion. Patients' status before fracture and voiding and erectile functions at long term were assessed by periodic follow-up and phone call. Detailed history included cause, symptoms, and single-question self-report of erectile and voiding functions. Results. Among the 44 suspicious cases, 42 (95.4%) were confirmed, mean age was 34.5 years (range: 18–60), mean follow-up 59.3 months (range 9–155). Half presented the classical triad of audible crack, detumescence, and pain. Heterosexual intercourse was the most common cause (28 patients, 66.7%), followed by penile manipulation (6 patients, 14.3%), and homosexual intercourse (4 patients, 9.5%). “Woman on top” was the most common heterosexual position (n = 14, 50%), followed by “doggy style” (n = 8, 28.6%). Four patients (9.5%) maintained the cause unclear. Six (14.3%) patients had urethral injury and two (4.8%) had erectile dysfunction, treated by penile prosthesis and PDE-5i. No patient showed urethral fistula, voiding deterioration, penile nodule/curve or pain. Conclusions. “Woman on top” was the potentially riskiest sexual position (50%). Immediate surgical treatment warrants long-term very low morbidity.
Finasteride is a potent and specific inhibitor of the 5α-reductase enzyme in men. Clinical studies have shown that finasteride 1mg/day is effective for promoting hair growth in men with male pattern hair loss. However, there is a concern about the use of finasteride, especially in young fertile patients, because of its action on testosterone metabolism. This paper describes 3 cases of young patients who had very poor seminal quality during finasteride treatment (1 mg/day), and their seminal quality greatly improved after cessation of finasteride treatment. Two of them presented with a left varicocele and the other was obese. We hypothesize that finasteride may not dramatically change the spermatogenesis process in healthy men, but in patients with conditions related to infertility, an amplification of the negative influence of finasteride could occur. Future studies should be done to clarify the extent of the effect of finasteride in patients fertility problems. Finasteride is a potent and specific inhibitor of the 5α-reductase enzyme. 1 It inhibits the conversion of testosterone to dihydrotestosterone (DHT). 2 Dihydrotestosterone is the most potent androgen, and its level directly affects prostate development.It is known that the use of 5α-reductase enzyme inhibitors like finasteride, when administered at 5 mg/ day, reduce the prostatic size around 20% to 30%. 3 Finasteride has been used for the treatment of benign prostate hyperplasia. Clinical studies have shown that finasteride 1 mg/day is also effective in promoting hair growth in men with male pattern hair loss. 4 There has been a concern regarding the use of finasteride, especially in young patients, because of its action on testosterone metabolism. Overstreet et al. (1999) demonstrated in a prospective clinical trial that treatment with finasteride 1 mg/day does not affect spermatogenesis or the spermatozoa production in young healthy men. 1 However, Kinniburg et al. (2001) showed that the use of finasteride promotes a significant reduction of the serum level of DHT, decrease of the plasma seminal volume, and the suppression of gonadotropin secretion, resulting in impairment of spermatogenesis. 2 O'Donnel et al. (1999) showed in an animal model that the use of finasteride promoted partial inhibition of spermatogenesis. 2 A Medline review searching with the key words finasteride and fertility produced 3 papers related to the positive influence of finasteride on the fertility, but none of them were performed with humans. Cukierski et al. (1991) and Wise et al. (1991) showed that in rats the administration of 80 mg/kg/day of finasteride decreased fertility. 5,6 According to Iguer-Ouada et al. (1997), finasteride (1 mg/kg) promoted an increase in sperm concentration and decrease in volume of prostatic secretion in male beagle dogs. 7 The effects on the fertility of a long period of finasteride treatment are not completely defined.The aim of this study was describe 3 cases of young male patients who consulted for infertility and showed severe decrease of spe...
Spermatozoa were obtained from all groups. All animals showed significant histological alterations in the epididymides from the second puncture and thereafter except with regard to necrosis. The cumulative effect of percutaneous epididymal sperm aspiration was only shown by lymphoplasmacytic infiltrate and fibrosis. Stereological analysis showed increased conjunctive tissue volumetric density from the second puncture and thereafter.
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