Heavy cigarette smoking and alcohol consumption are associated with impaired sperm parameters in primary infertile men

We assessed the concomitant impact of cigarette smoking and alcohol con sumption in men presenting for primary couple's infertility.Data from 189 in fertile men were an a lyzed.Semen analysis,serum hormones,and sperm DNA fragmentation(SDF)were obtained.Smoking status was categorized as follows:current nonsmoker(-S),moderate smoker(+MS),and heavy smoker(+HS).Alcohol consumption was categorized as follows:abstainer(-D),moderate drinker(+MD),and heavy drinker(+HD).Descriptive statistics and logistic regression models were applied.Among all the participants,132(69.8%),30(15.9%),and 27(14.3%)patients were-S,+MS,and+HS,respectively.In addition,67(35.4%),77(40.7%)and 45(23.8%)men were-D,+MD and+HD,respectively.Regarding concomitant habits,52(27.5%)patients were nonsmokers and abstainers(-S/-D:Group 1),91(48.1%)had at least one recreational habit(-S/+D or+S/-D:Group 2),and 46(24.3%)were both smokers and drinkers(+S/+D:Group 3).Sperm concentration and progressive motility were lower in+HS and+HD,compared with-S and-D(all P<0.05),respectively.Similarly,both parameters were significantly lower in Group 3 than Groups 1 and 2(all P<0.05).SDF values were higher in Group 3 than Groups 1 and 2(both P<0.05).In multivariate analysis,follicle-stimulating hormone(FSH)levels and concomitant+S/+D status were independent predictors of impaired sperm concentration and progressive motility(all P<0.05).Heavy smoking and heavy drinking were associated with worse seminal parameters than moderate smoking/drinking and nonsmoking/abstaining.When concomitant,+S/+D status has an even greater detrimental effect on semen parameters.

Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction:outcomes of a tertiary referral center and predictors of early prosthetic infection

We aimed to evaluate ten-year outcomes of penile prosthesis(PP)implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection(EPI).We identified 549 men who underwent 576 PP placements between 2008 and 2018.Univariate and multivariate analyses were used to identify potential predictors of EPI.An EPI predictive nomogram was developed.Thirty-five(6.1%)cases of EPI were recorded with an explant rate of 3.1%.In terms of satisfaction,82.0%of the patients defined themselves as“satisfied,”while partner’s satisfaction was 88.3%.Diabetes(P=0.012),longer operative time(P=0.032),and reinterventions(P=0.048)were associated with EPI risk,while postoperative ciprofloxacin was inversely associated with EPI(P=0.014).Rifampin/gentamicin-coated 3-piece inflatable PP(r/g-c 3IPP)showed a higher EPI risk(P=0.019).Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients,redo surgeries,or when a r/g-c 3IPP was used(all P<0.03).We showed that diabetes,longer operative time,and secondary surgeries were the risk factors for EPI.Postoperative ciprofloxacin was associated with a reduced risk of EPI,while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant.After further validation,the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.

L.ong-term recovery of normal sexual function in lesticular cancer survivors

Testicular cancer （TC） is the most common solid cancer in men between the third and fourth decade of life. Due to successful treatment approaches, TC survivors （TCSs） have long life expectancy, but with numerous potential long-term sequelae, including sexual dysfunction. We investigated predictors of long-term normal sexual function （SF） recovery in TCSs. Sociodemographic, medical, and psychometric data were analyzed in 143 Caucasian-European TCSs, who underwent orchiectomy at a single institution. Health-significant comorbidities were scored with the Charlson Comorbidity Index （CCI）. Patients completed the International Index of Erectile Function （IIEF）. Statistical models tested the association between predictors （including age at surgery, body mass index, CCI, and adjuvant therapy： radiotherapy [RT], chemotherapy [CT], CT followed by retroperitoneal lymph node dissection [RPLND] and RPLND alone） and the long-term recovery of normal SF （defined as IIEF-erectile function [EF] ≥26, and sexual desire [SD], intercourse satisfaction [IS] orgasmic function [OF], and overall satisfaction [OS] domain scores in the upper tertiles）. At a mean follow-up of 86 months, 35 （25.5%） TCSs had erectile dysfunction （ED）, with 16 （11.2%） experiencing severe ED. Median time of EF recovery was 60, 60, and 70 months after CT, RT, and RPLND, respectively. Only adjuvant RT emerged as an independent predictor of nonrecovery of normal EF （HR： 0.55, P = 0.01）. Neither adjuvant CT nor CT plus RPLND or RPLND alone significantly impaired the recovery of normal erections. Adjuvant therapy was not associated with impaired recovery of normal sexuality as a whole, considering the IIEF-SD, -OF, -IS, and OS domains.

Testicular volume in infertile versus fertile white-European men: a case-control investigation in the real-life setting

Testicular volume(TV)is considered a good clinical marker of hormonal and spermatogenic function.Accurate reference values for TV measures in infertile and fertile men are lacking.We aimed to assess references values for TV in white-European infertile men and fertile controls.We analyzed clinical and laboratory data from 1940(95.0%)infertile men and 102(5.0%)fertile controls.Groups were matched by age using propensity score weighting.TV was assessed using a Prader orchidometer(PO).Circulating hormones and semen parameters were investigated in every male.Descriptive statistics,Spearman's correlation,and logistic regression models tested potential associations between PO-estimated TV values and clinical variables.Receiver operating characteristic(ROC)curves were used to find TV value cutoffs for oligoasthenoteratozoospermia(OAT)and nonobstructive azoospermia(NOA)status in infertile men.The median testicular volume was smaller in infertile than that of fertile men(15.0 ml vs 22.5 ml;P<0.001).TV positively correlated with total testosterone,sperm concentration,and progressive sperm motility(all P≤0.001)in infertile men.At multivariable logistic regression analysis,infertile status(P<0.001)and the presence of left varicocele(P<0.001)were associated with TV<15 ml.Testicular volume thresholds of 15 ml and 12 ml had a good predictive ability for detecting OAT and NOA status,respectively.In conclusion,infertile men have smaller testicular volume than fertile controls.TV positively correlated with total testosterone,sperm concentration,and progressive motility in infertile men,which was not the case in the age-matched fertile counterparts.

Substances of abuse consumption among patients seeking medical help for uro-andrological purposes:a sociobehavioral survey in the real-life scenario

Substances of abuse(SoA),as well as smoking and alcohol consumption,are well known for their impact on male fertility status,erectile function,and ejaculation.We assessed SoA consumption habits in a cohort of men seeking medical attention for uro-andrological purposes.Data from 7447 men seeking medical attention for the first time for uro-andrological purposes were analyzed.A complete medical and sexual history was collected for each patient.Smoking,alcohol,and SoA consumption were investigated.Descriptive statistics was used to describe the whole cohort.The primary motivations for their evaluation were lower urinary tract symptoms(LUTS),erectile dysfunction(ED),and infertility in 1912(25.7%),2944(39.5%),and 2591(34.8%)men,respectively.Previous use of SoA was reported by 378(5.1%)men,and 190(2.6%)individuals were current users.Patients seeking medical attention for infertility were more frequently current SoA users(107;4.1%)than men with ED(66;2.2%)and LUTS(17;0.9%)(both P<0.001).Current users of SoA were younger than those with past or no SoA history(P<0.001).Current SoA users were more frequently smokers(P<0.001)and alcohol consumers(P<0.001)than those with a previous history or those who had never tried SoA.In conclusion,approximately 3%of men seeking medical attention for uro-andrological purposes were current SoA consumers.Infertile men reported a higher use of SoA than those with ED or LUTS.Current SoA users were younger and more frequently concomitant smokers and alcohol consumers compared to those who did or had never used SoA.

Metabolic syndrome in White-European men presenting for secondary couple＇s infertility： an investigation of the clinical and reproductive burden

We aimed to determine the impact of metabolic syndrome （MetS） on reproductive function in men with secondary infertility, a condition that has received relatively little attention from researchers. Complete demographic, clinical, and laboratory data from 167 consecutive secondary infertile men were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index （CCI; categorised 0 vs I vs 2 or higher）. NCEP-ATP III criteria were used to define MetS. Semen analysis values were assessed based on the 2010 World Health Organization （WHO） reference criteria. Descriptive statistics and logistic regression models tested the association between semen parameters and clinical characteristics and MetS. MetS was found in 20 （12%） of 167 men. Patients with MetS were older （P 〈 0.001） and had a greater BMI （P 〈 0.001） compared with those without MetS. MetS patients had lower levels of total testosterone （P = 0.001）, sex hormone-binding globulin, inhibin B, and anti-MOIlerian hormone （all P 〈 0.03）, and they were hypogonadal at a higher prevalence （P = 0.01） than patients without MetS. Moreover, MetS patients presented lower values of semen volume, sperm concentration, and sperm normal morphology （all P≤0.03）. At multivariate logistic regression analysis, no parameters predicted sperm concentration, normal sperm morphology, and total progressive motility. Our data show that almost 1 of 8 White-European men presenting for secondary couple＇s infertility is diagnosed with MetS. MetS was found to be associated with a higher prevalence of hypogonadism, decreased semen volume, decreased sperm concentration, and normal morphology in a specific cohort of White-European men.