1. health and fitness
2. disease
3. cancer

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Volume 1, Supplement 1
May 2007
www.europeanandrology.eu
ISSN 1802-4793
EUROPEAN
ANDROLOGY
Abstracts of the
2nd Czech and International
Congress of Andrology
May 3-5, 2007
Chateau Štiřín
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Congress of Andrology
www.andrologickykongres.cz
www.congressofandrology.eu
Andrological Section of the Czech Urological Society
www.andrologickasekce.cz
www.czechandrology.eu
European Andrology
www.europeanandrology.cz
www.europeanandrology.eu
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European Andrology Supplement, Vol. 1, No. 1, May 2007
ISSN 1802–4793 print version (on-line version ISSN 1802–4807)
EUROPEAN ANDROLOGY
CONTENTS
Editorial
3
Acknowledgement
5
Letter of Invitation
7
General Information
11
Map
14
Programme Schedule
15
Scientific Programme
16
Abstracts
25
List of Authors
59
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Legal Obligations
Photocopying
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be reproduced, transmitted or stored, in any form, or by any means, without first obtaining written
permission from the Publisher.
Single photocopies of single articles may be made only for personal use as allowed by national copyright
laws.
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Permission of the Publisher is required to store or use electronically any material contained in this journal,
including any article or part of the article. Except as described above, no part of this publication may be
reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, without prior written permission of the Publisher.
Notice
The Publisher takes no responsibility for any injury and/or damage to person or property as a matter of
products lability, negligence and otherwise, or from any use or operation of any methods, products,
instructions or ideas contained in the material herein.
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Editorial
European Andrology: introducing the new publication
Welcome to the first issue of the European Andrology, a new journal dedicated to all aspects of andrology.
This issue contains abstracts of the 2nd Czech and International Congress of Andrology which is held in
Chateu Štiřín in May 3-5, 2007.
The European Andrology will publish papers in field of andrology and related topics from urology,
endocrinology, sexuology, genetics, gynaecology, oncology and reproductive medicine.
The European Andrology will be the international forum for original papers and reviews in English ranging
from basic molecular research to the results of clinical investigations. Areas of interest include sexual
dysfunction, male factor infertility, reproductive technologies, genetics, contraception, reproductive
physiology and pathology, aging male, androoncology, surgery techniques and ethic and social issues.
Announcements of professional meetings, postgraduate courses, symposia and other events of interest to
andrologists will be also published. The highest scientific and editorial standard will be maintained
throughout the journal along with a rapid rate of publication.
Currently, the editorial board is beeing formed, will be constituted of scientists and clinicians not only from
Europe.
The regular issue will be published in October 2007, your articles may be submitted via journal homepage
from August 2007. We welcome not only your contributions but also your impulses, comments and
suggestions.
The journal of European Andrology will be available only in electronic format and freely accessible on
homepage at www.europeanandrology.eu.
I hope that we will make together worthwile journal of high professional standard.
Jiri Heracek
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Working session of the
Andrological Section
of the Czech Urological
Society
September 13–16, 2007
New York
Meeting with Czech compatriots
in the Bohemia National Hall
Visit to the Cornell University with scientific
programme
(lecture P. Schlegel, M. Goldstein, J. Mulhall,
M. Hardy, G. Hunnicut, A. Mielnik, D. Paduch)
Visit to the Czech Center New York
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Acknowledgement
The Organizers of the 2nd Czech and International Congress gratefully acknowledge the support
of the following companies:
Abbott Laboratories
Androgeos
Astellas Pharma
Astra Zeneca
DaimlerChrysler, Automotive Bohemia
Eli Lilly
Ferring – Léčiva
LaparoTech Instruments
Medesa
Medial
Nikon
Novartis
Organon
Pfizer
Sanatorium Pronatal
TEVA Pharmaceuticals CR
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The Chateau Štiřín
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Letter of Invitation
Dear Colleagues,
On behalf of the Scientific and Organizational Committees, we are proud and honoured to invite you to
attend the 2nd Czech and International Congress of Andrology which is held in flowery Chateau Štiřín in
May 3–5, 2007.
The scientific programme covers all the topics in the field of sexual dysfunction, male infertility, prostate
disorders and quality of medical care in reproductive medicine.
This congress is intended for all practitioners with an interest in the andrology, particularly clinicians and
researchers from the area of urology, sexuology, endocrinology, reproductive medicine, gyneacology,
genetics and general practice.
Our congress gather a lot of famous international experts from multidisciplinal backgrounds. We are very
pleased to invite again prof. Eberhard Nieschlag, the president of the German Society of Andrology, as well
the other speakers from Italy, Germany, Slovakia, Austria and France.
We invite you to visit our website www.congressofandrology.eu, which is regularly updated with all the
scientific and organisational information, and as well www.czechandrology.eu, which is the oficial website
of the Andrological Section of the Czech Urological Society.
The Chateau Štiřín is located near Prague in the romantic environment of a baroque chateau surrounded by
several ponds, its park currently belongs among the best historical gardens and parks in the Czech Republic
and at the beginning of May is all in bloom.
We look forward to welcoming you to the congress and hope that it will be a memorable experience for all
of you.
Prof. Dalibor Pacik, MD, PhD
Chairman of Scientific
Committee
Jiri Heracek, MD
President of Congress
Vladimir Sobotka, MD
Chairman of Organizational
Committee
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The 3rd Faculty of Medicine, Charles University Prague, in collaboration with private urological and
andrological centre Androgeos, Sanatorium Pronatal, University Hospital Kralovské Vinohrady and
Department of Urology of the Masaryk University and University Hospital Brno
holds in the Chateau Štiřín
from May 3rd to 5th, 2007
2nd Czech and International
Congress of Andrology
Patronage
Tomáš Hanuš
President of the Czech Urological Society
Václav Pačes
Chairman of The Academy of Science of the Czech Republic
Dean of the
3rd
Bohuslav Svoboda
Faculty of Medicine, Charles University Prague
Jan Žaloudík
Dean of the Faculty of Medicine, Masaryk University Brno
Congress President
Jiří Heráček
Congress Secretary
Vladimír Sobotka
Organizational Committee
Jiří Heráček, Vladimír Sobotka, Michael Urban
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Scientific Committee
Dalibor Pacík (chairman)
Faculty of Medicine, Masaryk University, Brno
1st
Petr Weiss, Libor Zámečník
Faculty of Medicine, Charles University, Prague
Pavel Hanek, Marta Šnajderová
2nd Faculty of Medicine, Charles University, Prague
Jiří Heráček, Václav Mandys, Michael Urban
3rd Faculty of Medicine, Charles University, Prague
Vladimír Študent
Faculty of Medicine, Palacky University, Olomouc
Marcela Kosařová, Tonko Mardešić, Vladimír Sobotka
Sanatorium Pronatal, Prague
Vladimír Gregor, Roman Zachoval
Thomayer’s University Hospital, Prague
Aleš Horák
University Hospital, Ostrava
Jiří Rubeš
Veterinary Research Institute, Brno
Aleš Roztočil
Regional Hospital Jihlava
Luboslav Stárka
Institute of Endocrinology, Prague
Invited Speakers
Friedrich Gagstaiger, Ulm, Germany
Luca Gianaroli, Bologna, Italy
Herfried Kohl, Nürnberg, Germany
Volkmar Lent, Andernach, Germany
Jozef Marenčák, Skalica, Slovakia
Eberhard Nieschlag, Münster, Germany
Dalibor Ondruš, Bratislava, Slovakia
Paul Palascak, Vesoul, France
Eugen Plas, Wien, Austria
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General Information
Accessibility
By car:
Štiřín Conference Centre and hotel Chateau Štiřín is 25 km southeast from the Capital. On the highway D1
from Prague to Brno turn towards Velké Popovice (Exit 15-Všechromy), Štiřín is about 3 km passed Velké
Popovice. It is also possible to turn from the Old Benešov road (rd. 603) in Želivec and than continue for
1 km further to Štiřín.
Shuttle bus will be available between Štiřín and Hotel S.E.N. for participants attending scientific and social
programs.
By bus:
From Prague metro station Budějovická take bus No. 334, 335, 337, 339, 369 to Želivec and from Želivec
change to bus No. 461 to Kamenice – Strančice.
By train:
Take train No. 221 from Hlavní nádraží or Hostivař train stations to Strančice. Change to bus No 461.
The distance from the Prague – Ruzyně Internation Airport is 38 km/40 min., from Prague centre
25 km/25 min. and from Strančice train station 12 km/15 minut.
Address:
Chateau Štiřín
Ringhofferova 711
Štiřín
251 68 Kamenice
Accommodation
The accommodation of participants is ensured in hotel Chateau Štiřín**** and in hotel S.E.N.****, which
is located about 10 km from hotel Chateau Štiřín. The accommodation will be ensured by Congress
organizer.
Car Parking
Car Parking is available at the Chateau Štiřín parking.
Cellular Phones
Participants are kindly requested to keep their mobile phones switched off during all sessions.
Certificate of Attendance
A Certificate of Attendance is available at registration desk.
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Congress Badge
Each participant and accompanying person receives at registration desk a name badge. All participants are
strongly requested to wear their name badge at all times during the congress. The badge is the pass for the
congress scientific and social programmes.
Congress Hour
Thursday May 3, 2007
Friday May 4, 2007
Saturday May 5, 2007
12 am – 7 pm
8 am – 7 pm
8 am – 12 am
CME Accreditation
Congress Guarantee is the Andrological Section of the Czech Urological Society, patronage is taken by the
Czech Urological Society of the Czech Medical Association of JEP.
Congress is accredited by the Czech Medical Chamber. Each active participant obtaines a Certificate.
Congress is accredited by the Czech Nurse Association. Each nurse obtaines a certificate granting 9 credits
for passive and 15 credits for active participation in a national system of the Continual Medical Education.
Currency, Banking, Credit Cards
The national currency unit in the Czech Republic is Czech crown (Kč). The main International credit cards
are widely accepted for payment in most hotels, restaurants and shops. Exchange Offices and ATM
machines are available. Hotel Štiřín accepts Visa, Visa Elektron, American Express, Mastercard, Maestro
and Diner Club cards.
Electricity
The electricity in the Czech Republic runs on 220 volts and the frequency is 50 Hz, sockets have the
European standard and plugs are three-prong grounded.
Exhibition
An Exhibition is opened alongside with the Congress in the Štiřín Congress Centre.
Insurance
The Congress Organizers are not taking responsibility for neither loss or damage of personal belongings,
financial loss nor injury, illness and death of participants of the Congress. Participants are advised to
arrange adequate cover for travel and health insurance befor departing.
Internet Access
Hotel Štiřín offers in each room an internet access via LAN, at lounges and restaurants via WiFi (available
at reception) – connection speed 256 kbps.
Management and Technical Support
Jiri Heracek, Androgeos, Na Valech 4/289, Prague 6, 160 00, Czech Republic, phone +420 233 325 636,
fax +420 233 325 641, email: [email protected]
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Vladimir Sobotka, Sanatorium Pronatal, Na Dlouhe Mezi 4/12, Prague 4, 147 00, Czech Republic,
phone +420 261 711 606, fax +420 261 711 585, email: [email protected]
Official Languages
Official languages of the Congress are Czech, Slovak, English (interpretation)
Participants Registration
Thursday May 3, 2007
Friday May 4, 2007
10 am – 6 pm
8 am – 6 pm
Registrated participant obtains Congress materials and name badge at registration desk.
Registration Fee
Doctors, accompanying person
Nurses
3000 CZK
1000 CZK
The registration fee includes:
admission to the lecture halls and participation in the scientific programme
admission to the exhibition areas
participation in the opening ceremony on May 3, 2007
participation in the social party on May 4, 2007
congress materials
morning and afternoon coffee breaks on May 3–5, 2007
lunch May 4, 2007
Social programme
Thursday May 3, 2007
Friday May 4, 2007
Opening ceremony, concert
Social evening, concert
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Map
French Garden
golf course
Chateau Terrace
Parking
parking
Golf
Salm’s Hall
Parking
Reconstruction
Chateau
Rural Hall
Baillifs House
Atis
House
Chval’s
Hall
Garage
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SCIENTIFIC PROGRAMME
THURSDAY May 3, 2007
from 10.00
REGISTRATION
SUK’s Parlour
12.00 – 13.00 MEETING OF ANDROLOGICAL SECTION OF THE CZECH UROLOGICAL SOCIETY
HUNTER’s Parlour
13.00
WELCOME DRINK
13.45 – 14.00 Coffee break
SALM’s Hall
14.00 – 15.00
I. GENETICS
Chairpersons: Gregor V., Minarik M.
14.00 I/1
Systematic genetic examination of men with severe fertility disorders
Macek M. sr.1, Vilimova S.1, Gromoll J.2, Müllerova M.1, Zamecnikova M.1, Diblik J.1, Paulasova P.1,
Panosova M.1, Macek M. jr.1, Cernikova J.1, Hrehorcak M.3
1Department of Medical Biology and Genetics, Charles University – 2nd School of Medicine and University
Hospital Motol, Prague, Czech Republic
2Institute of Reproductive Medicine, University of Münster, Germany
3Department of Obstetric and Adult and Paediatric Gynaecology, Charles University – 2nd School of Medicine
and University Hospital Motol, Prague, Czech Republic
14.15 I/2
DNA analysis of microdeletions in AZF regions (Yq) in man with reproductive failure – our results
Gaillyova R.1, Valaskova I.1, Crha I.2, Ventruba P.2, Beharka R.3, Pacik D.3
1Department of Medical Genetics, University Hospital Brno, Czech Republic
2Department of Obstetrics and Gynecology, University Hospital Brno, Czech Republic
3Department of Urology, University Hospital Brno, Czech Republic
14.30 I/3
Detection of inherited prostate cancer predisposition based on examination of polymorphic variants
in steroid 5-alpha-reductase gene (SRD5A2)
Minarik M.1, Loukola A.2, Fantova L.1, Urban M.3, Heracek J.3, Sachova J.3, Benesova L.1
1Laboratory for Molecular Genetics and Oncology, Genomac International, Prague, Czech Republic
2Finnish Genome Center, University of Helsinki, Finland
3Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
14.40 I/4
FISH diagnostics of Kallmann syndrome
Gregor V.1, Horacek J.1, Snajderova M.2, Hana V.3
1Department of Medical Genetics, Thomayer’s University Hospital, Prague, Czech Republic
2Department of Paediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
33rd Medical Department, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
14.50 I/5
Combined detection of sperm proteins and chromosomes
Diblik J.1, Koubek P.2
1Center of Reproductive Genetics, Institute of Biology and Medical Genetics, Charles University – 2nd School
of Medicine, University Hospital Motol, Prague, Czech Republic
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2Laboratory
of Diagnostics for Reproductive Medicine, Biotechnology Section, Institute of
Molecular Genetics, The Academy of Sciences of the Czech Republic, Prague, Czech Republic
15.00 – 16.00
II. HORMONES AND PROSTATE
Chairpersons: Starka L., Beharka L.
15.00 II/1
Dihydrotestosterone and inhibitors of steroid 5alpha-reductase
Starka L., Duskova M.
Institute of Endocrinology, Prague, Czech Republic
15.15 II/2
Aging male, hormonal and genetic alterations
Beharka R.
Department of Urology, University Hospital Brno, Medical School, Masaryk University Brno, Czech Republic
15.30 II/3
Endocrine therapy of prostate cancer and sexual dysfunction in men
Matouskova M., Hanus M.
Urocentrum, Prague, Czech Republic
15.38 II/4
The endocrine profiles in men with localized and locally advanced prostate cancer treated with radical
prostatectomy
Heracek J.1, Urban M.1, Sachova J.1, Kuncova J.2, Eis V.3, Mandys V.3, Hampl R.4, Starka L.4
1Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
2Department of Surgery, Division of Urology, St. Chiara Hospital, University of Pisa, Italy
3Department of Pathology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
4Institute of Endocrinology, Prague, Czech Republic
15.46 II/5
Finasteride treatment of premature androgenetic alopecia
Duskova M., Starka L.
Institute of Endocrinology, Prague, Czech Republic
15.54 II/6
Serum adiponectin as an auxilliary marker of prostate cancer progression
Housa D.1, Vernerova Z.1, Heracek J.2, Prochazka B.3, Housova J.4, Cechak P.5, Kuncova J.6, Haluzik M.4
1Department of Pathology, 3rd Medical Faculty and Teaching Hospital Kralovske Vinohrady, Prague,
Czech Republic
2Department of Urology, 3rd Medical Faculty and Teaching Hospital Kralovske Vinohrady, Prague,
Czech Republic
3Department of Biostatistics and Informatics, National Institute of Public Health, Prague, Czech Republic
43rd Department of Internal Medicine, 1st School of Medicine and General Faculty Hospital Prague,
Czech Republic
5Department of Biochemistry and Pathobiochemistry, 3rd Medical Faculty and Teaching Hospital Kralovske
Vinohrady, Prague, Czech Republic
6Department of Surgery, Division of Urology, St. Chiara Hospital, University od Pisa, Italy
16.00 – 16.45
III. PREIMPLANTATION GENETIC DIAGNOSIS
Chairpersons: Rubes J., Gianaroli L.
16.00 III/1
Implantation failure: The contribution of the spermatozoa
Gianaroli L.
SISMER, Bologna, Italy
16.15 III/2
Preimplantation genetic diagnosis in balanced translocation carriers
Rubes J.1,2,3, Musilova P.1,2,3, Oracova P.1,3, Rybar R.1,3, Vozdova M.1, Tauwinklova G.3, Vesela K.2,3
1Veterinary Research Institute, Brno, Czech Republic
2Genprogress, Brno, Czech Republic
3Repromeda, Brno, Czech Republic
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16.30 III/3
Preimplantation genetic diagnosis – numerical chromosome abnormalities in fertilized human oocytes
after TESA
Siruckova K., Kosarova M., Zudova D., Brachtlova T., Bürgerova E.
Sanatorium Pronatal, Prague, Czech Republic
16.37 III/4
Methods for detection of sperm chromatin integrity in men
Rybar R.1, Rubes J.1,2
1Veterinary Research Institute, Brno, Czech Republic
2Genprogress, Brno, Czech Republic
16.45 – 17.00 Coffee break
17.00 – 17.45
IV. ONCOLOGY
Chairpersons: Zachoval R., Ondrus D.
17.00 IV/1
Radical cystectomy and erectile dysfunction
Zachoval R., Zalesky M., Vik V., Jarabak J.
Department of Urology, Faculty Thomayer’s Hospital, Prague, Czech Republic
17.15 IV/2
Rehabilitaton of erectile function following radical prostatectomy
Khamzin A., Pacik D.
University Hospital Brno, Medical School, Masaryk University Brno, Czech Republic
17.30 IV/3
The role of a general practitioner in an early diagnosis of the testicular cancer
Hanek P., Chocholaty M., Dusek P., Kawaciuk I.
Department of Urology, Charles University and University Hospital Motol, Prague, Czech Republic
17.35 IV/4
Testicular oxidant and spermatogenic injury induced by atrazine in an experimental rat model
Abarikwu S.O.1, Farombi E.O.2, Oyeyemi M.O.3
1Department of Biochemistry, Redeemers University, Redemption City, Nigeria
2Drug Toxicology Laboratories, Department of Biochemistry, College of Medicine, University of Ibadan,
Nigeria
3Department of Veterinary Reproduction, Faculty of Veterinary Medicine, University of Ibadan, Nigeria
17.40 IV/5
Who is responsible for diagnostic delay of testicular cancer?
Chocholaty M., Dusek P., Hanek P., Kawaciuk I.
Department of Urology, Charles University and University Hospital Motol, Prague, Czech Republic
17.45 – 18.45 SYMPOSIUM ASTRA ZENECA
Prostate cancer – what’s new?
Prostate cancer – PSA and early detection, active treatment or Watchfull Waiting
Student V.
Department of Urology, University Hospital Olomouc, Czech Republic
Adjuvant hormonal therapy in patients with localized and locally advanced prostate cancer treated
by radical prostatectomy
Lukes M.
Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
SUK’s Parlour
19.30
CONCERT – NOSTIZ QUARTET
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Restaurant ATIS
from 20.30
OPENING CEREMONY, SOCIAL PARTY
FRIDAY May 4, 2007
SALM’s Hall
8.30 – 9.00
I. ANDROLOGY IN THE CZECH REPUBLIC – CURRENT STATUS AND FUTURE
Chairpersons: Pacik D., Heracek J., Sobotka V.
9.00 – 9.45
II. LECTURES OF INVITED SPEAKERS
Chairpersons: Pacik D., Heracek J.
9.00 II/1
Clinical relevance of androgen receptor polymorphism
Nieschlag E., Gromoll J., Zitzmann M.
Institute for Reproductive Medicine of the University, WHO Collaboration Centre for Research in Male
Reproduction, Münster, Germany
9.15 II/2
Damage of hormonal function and bone metabolism in long term survivors of testicular cancer
Ondrus D.1, Spanikova B.2, Ondrusova M.3,4, Mardiak J.5
11st Department of Oncology, Comenius University Medical School, St. Elisabeth Cancer Institute, Bratislava,
Slovak Republic
2Out Patient’s Department of Osteology, St. Elisabeth Cancer Institut, Bratislava, Slovak Republic
3National Cancer Registry, National Health Information Center, Bratislava, Slovak Republic
4Cancer Research Institute, Slovak Academy of Science, Bratislava, Slovak Republic
52nd Department of Oncology, Comenius University Medical School, National Cancer Institute, Bratislava,
Slovak Republic
9.30 II/3
Hypogonadotropic hypogonadism
Plas E.
Department of Urology, KH Hietzing, Vienna, Austria
9.45 – 10.00
Coffee break (sponsored by Organon)
10.00 – 11.00
III. CHRONIC PELVIC PAIN (SPONSORED BY ANDROGEOS)
Chairpersons: Urban M., Fügner D.
10.00 III/1
Chronic pelvic pain in male patients – joint view of an urologist and anatomist – impact on sexual
dysfunction
Urban M.1,2, Heracek J. 1,2, Baca V.3
1Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
2Androgeos, Prague, Czech Republic
3Centre for Integrated Studies of Pelvis, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
10.15 III/2
Integrated approach to the chronic pelvic pain – overcoming the mind – body split
Fügner D.
AGEL, Hospital Sumperk, Czech Republic
10.30 III/3
Chronic inflammatory diseases of small pelvis, their influence to fertility
Matouskova M., Hanus M.
Urocentrum, Prague, Czech Republic
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10.45 III/4
Importance evaluation of praesacral nerves block in the treatment of chronic prostatitis/chronic pelvic
pain syndrome
Maskova V.1, Urban M.1,2, Heracek J.1,2
1Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
2Androgeos, Prague, Czech Republic
10.52 III/5
Urological and sexual disorders after a severe pelvic injury
Grill R.1,2, Dzupa V.1,3, Maskova V.2, Baca V.1,6, Fric M.1,4, Otcenasek M.1,5, Urban M.2
1Centre for Integrated Studies of Pelvis (CISP), 3rd Faculty of Medicine, Charles University Prague,
Czech Republic
2Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Faculty Hospital Kralovske
Vinohrady, Prague, Czech Republic
3Department of Ortopaedics and Traumatology, 3rd Faculty of Medicine, Charles University Prague, Faculty
Hospital Kralovske Vinohrady, Prague, Czech Republic
4Department of Anaestesiology and Resuscitation, 3rd Faculty of Medicine, Charles University Prague,
Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
5Department for Mother and Child Care in Prague Podoli, Prague, Czech Republic
6Department of Anatomy, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
11.00 – 12.00
IV. MALE INFERTILITY (SPONSORED BY PRONATAL)
Chairpersons: Peknicova J., Kosarova M.
11.00 IV/1
Effect of endocrine disruptors on mammalian fertility
Peknicova J.1, Novakova V.1, Buckiova D.2, Boubelik M.1
1Institute of Molecular Genetics, v.v.i., Czech Academy of Sciences, Prague, Czech Republic
2Institute of Experimental Medicine, v.v.i., Czech Academy of Sciences, Prague, Czech Republic
11.15 IV/2
Genetic ethiology of infertility
Kosarova M.
Sanatorium Pronatal, Prague, Czech Republic
11.30 IV/3
Advanced age of the father – genetic risks and possibilities of genetic analysis
Gaillyova R.1, Kadlecova J. 1, Baxova A.2, Krepelova A.3
1Department of Medical Genetics, University Hospital Brno, Czech Republic
2Institute of Biology and Medical Genetics, 1st Faculty of Medicine, Charles University Prague,
Czech Republic
3Institute of Biology and Medical Genetics, 2nd Faculty of Medicine, Charles University Prague,
Czech Republic
11.45 IV/4
Cytogenetical and molecular genetical factors contributing to male infertility
Lonsky P., Maskova S., Burgerova E., Siruckova K., Gregor V.
Sanatorium Pronatal, Prague, Czech Republic
11.53 IV/5
Sperm chromatin damage in fertile men
Rubes J.1, 2, Rybar R.1, Markova P.3, Veznik Z.1, Svecova D.1, Zajicova A.1, Kunetkova M.1, Prinosilova P.1,
Kopecka V.1
1Veterinary Research Institute, Brno, Czech Republic
2Genprogress, Brno, Czech Republic
3Sanatorium ART, Ceske Budejovice, Czech Republic
12.00 – 13.00 Lunch
13.00 – 14.00
V. ERECTILE DYSFUNCTION I. (SPONSORED BY ELI LILLY)
Chairpersons: Pacik D., Zamecnik L.
13.00 V/1
Gene therapy and erectile dysfunction
Zamecnik L.
Department of Urology, 1st Medical School, Charles University Prague, Czech Republic
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13.15 V/2
The surgical correction of buried penis
Hartmann I., Smakal O., Student V., Vrana J.
Department of Urology, University Hospital Olomouc, Czech Republic
13.30 V/3
Erectile dysfunction and the partner’s role
Sramkova T.
Traumatological Hospital of Brno, Trauma centre, Department of Traumatology at the Medical Faculty
Masaryk University of Brno, Emergency service of Brno City, Czech Republic
13.45 V/4
Ejaculation praecox and cybersex
Spilkova J.
GONA – Sexuological centre, Prague, Czech Republic
13.50 V/5
Comorbidity of men with ED – is ED warning signal of weither disease in relatively healthy men?
Jarabak J., Zachoval R.
Department of Urology, Faculty Thomayer’s Hospital, Prague, Czech Republic
13.55 V/6
Effects of autoerotic penis stimulation – case report
Vidlar A., Hartmann I., Student V.
Department of Urology, University Hospital Olomouc, Czech Republic
14.00 – 15.00
VI. SPERMATOGENESIS
Chairpersons: Mandys V., Khazim A.
14.00 VI/1
Contribution of histomorphological evaluation of testicular biopsies to management of azoospermic
patients
Mandys V.1, Sobotka V.2
1Department of Pathology, 3rd Faculty of Medicine and Faculty Hospital Kralovske Vinohrady, Prague,
Czech Republic
2Sanatorium Pronatal, Prague, Czech Republic
14.15 VI/2
Inhalational anaesthetics and risks for human reproduction
Malek J.
Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University Prague
and University Hospital Kralovske Vinohrady, Prague, Czech Republic
14.30 VI/3
Nonhormonal methods of male contraception
Heracek J., Urban M.
Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
Androgeos, Prague, Czech Republic
14.45 VI/4
Paediatric varicocele – indications for early surgical repair: a prospective study
Kocvara R.1, Dolezal J.2, Dite Z.1, Sedlacek J.1, Dvoracek J.1, Stanek Z.2, Novak K.1
1General University Hospital and 1st Medical School, Postgraduate Medical School, Prague, Czech Republic
2Department of Urology, Hospital Ceske Budejovice, Czech Republic
14.53 VI/5
Protracted late autonomous dysreflection after TESE in a patient with high spinal lesion
Sutory M., Sramkova T.
Traumatological Hospital of Brno, Trauma centre, Department of Traumatology at the Medical Faculty
Masaryk University of Brno, Emergency service of Brno City, Czech Republic
15.00 – 15.15 Coffee break
15.15 – 16.00
VII. QUALITY IN REPRODUCTIVE MEDICINE (SPONSORED BY ORGANON)
Chairpersons: Sobotka V., Kohl H.
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15.15 VII/1
Work in the quality management, implements, benefits and impacts on a medical institution
Sobotka V., Mardesic T., Brokesova M., Dvorakova J.
Sanatorium Pronatal, Prague, Czech Republic
15.30 VII/2
International experiences in the certification of medical institutions
Kohl H.
CEO of LGA InterCert and TÜV Rheinland Cert, Nuremberg and Cologne, Germany
15.45 VII/3
Have the ISO standards overranged the ambit of Europe?
Gagsteiger F.
IVF-Zentrum Ulm, Germany
16.00 – 16.30
VIII. ANDROPAUSE (SPONSORED BY FERRING – LÉČIVA)
Transdermal testosterone therapy
Golkova M.
A2C Clinic, Czech Republic
16.30 – 17.30
IX. ERECTILE DYSFUNCTION II. (SPONSORED BY PFIZER)
Chairpersons: Horak A., Palascak P.
16.30 VIII/1
Conservative treatment for the Peyronie’s disease – use of low-power laser
Horak A.1, Fojtik P.2
1ANDROPHARM, Urologic – andrologic outpatients’ clinic, Ostrava – Poruba, Czech Republic
2Urological Department, University Hospital Ostrava, Czech Republic
16.45 VIII/2
Local application of verapamil in the treatment of Peyronie’s disease: our experience in 12 patients
Zamecnik L.
Department of Urology, 1st Medical School, Charles University Prague, Czech Republic
16.54 VIII/3
Our experiences in local application of the verapamil in patients with induratio plastica penis
Hrabec M., Student V.
Department of Urology, Teaching Hospital Olomouc, Czech Republic
17.03 VIII/4
Self-injection of foreign material under penile skin
Macek P., Zamecnik L., Pavlik I.
Department of Urology, General University Hospital and 1st Faculty of Medicine of Charles University,
Prague, Czech Republic
17.12 VIII/5
Congenital lateral penile curvature and primary erectile dysfunction
Palascak P.1, Gomez-Orozco W.1, Sauvain J.L.2, Nader N.1
1Urology Department, CHI Paul Morel, Vesoul, France
2Imaging medical center, Vesoul, France
17.21 VIII/6
Color and power Doppler sonography with 3D reconstruction: interest in vasculogenic causes of erectile
dysfunction
Sauvain J.L.1, Palascak P.2, Gomez-Orozco W.2
1Imaging medical center, Vesoul, France
2Urology Department, CHI Paul Morel, Vesoul, France
17.30 – 17.45 Coffee break
17.45 – 18.45 SYMPOSIUM NIKON/MEDESA
The recent microscopical and micromanipulation techniques for the IVF
The recent microscopical methods of the prenatal diagnostics
Kadlec D.
Laboratory Imaging, Prague, Czech Republic
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Biopsy from embryos
Cernohorsky D.
Medesa, Ricany, Czech Republic
Nikon Biostation – the closed and easy to use system for the microscopical observation of the cell cultures
Rozkosny I.
Nikon, Prague, Czech Republic
Hormon analysis in 20 minutes – simple and reliable (Testosterone, PSA, fPSA, Prolactin, LH etc.)
Cernohorsky D.
Medesa, Ricany, Czech Republic
SUK’s Parlour
8.30 – 15.00
SECTION OF NURSES
Restaurant ATIS
from 19.30
SOCIAL EVENING
CONCERT – TĚŽKEJ POKONDR
SATURDAY MAY 5, 2007
SALM’s Hall
8.15 – 9.00
I. LECTURES OF INVITED SPEAKERS
Chairpersons: Pacik D., Sobotka V.
8.15 I/1
Preservation of erectile function in patients with prostate carcinoma
Lent V.
Department of Urology, St. Nikolaus – Stiftshospital, Andernach, Germany
8.30 I/2
Androgen supplementation: potential risks for the prostate of aging male
Marencak J.
Department of Urology, Hospital with Policlinic Skalica, Slovakia
8.45 I/3
LUTS associated with BHP – is it a risk factor for sexual dysfunction?
Palascak P.1, Gomez-Orozco W.1, Sauvain J.L.2
1Urology Department, CHI Paul Morel, Vesoul, France
2Imaging medical center, Vesoul, France
9.00 – 9.45
II. CORRECTIVE SURGERY OF EXTERNAL GENITAL
Chairpersons: Heracek J., Roztocil A.
9.00 II/1
Corrective surgery of male external genital organs
Heracek J., Urban M.
Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
Androgeos, Prague, Czech Republic
9.15 II/2
Corrective surgery of female external genital organs
Roztocil A.
Department of Gynecology and Obstetrics, Jihlava Regional Hospital, Czech Republic
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9.30 II/3
Penile prosthesis implantation – patient’s evaluation in long term follow up
Pacik D., Khamzin A.
Department of Urology, University Hospital Brno, Medical School of Masaryk University, Czech Republic
9.45 – 10.00
Coffee break
10.00 – 11.00
III. PROSTATE CANCER
Chairpersons: Student V., Hanek P.
10.00 III/1
Early detection of prostate cancer (KAPROS II.) in Olomouc region – first results
Student V.
Department of Urology, University Hospital Olomouc, Czech Republic
10.15 III/2
Robotic-assisted radical prostatectomy (da Vinci prostatectomy – dVP)
Kocarek J., Köhler O.
Department of Urology, Central Military Hospital Prague, Czech Republic
10.30 III/3
Our first experience with preservation of the prostatic fascia (veil of Afrodita) during da Vinci robotic
laparoscopic radical prostatectomy
Kolombo I., Beno P., Toberny M., Cernohorsky S., Bartunek M., Tobias J.
Centre of Robotic Surgery and Urology, Hospital Na Homolce Prague, Czech Republic
10.45 III/4
Case report of prostatic cancer with metastasis and low PSA level (PSA, is it still a good marker
for prostate adenocarcinoma)
Yaghi M., Jirasek E.
Department of Urology, Hospital Chomutov, Czech Republic
10.52 III/5
Tissue and serum levels of principal androgens in benign prostatic hyperplasia and prostate cancer
Heracek J.1, Hampl R.2, Hill M.2, Starka L.2, Sachova J.1, Kuncova J.3, Eis V.4, Urban M.1, Mandys V.4
1Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
2Institute of Endocrinology, Prague, Czech Republic
3Department of Surgery, Division of Urology, St. Chiara Hospital, University of Pisa, Italy
4Department of Pathology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
11.00 – 11.30
IV. TAKE HOME MESSAGE
Chairpersons: Pacik D., Heracek J., Sobotka V.
11.30
THE BEST PRESENTATION ANNOUNCEMENT
11.45
CONGRESS CLOSING
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SYSTEMATIC GENETIC EXAMINATION OF MEN WITH SEVERE
FERTILITY DISORDERS
Macek M. sr.1, Vilimova S.1, Gromoll J.2, Müllerova M.1, Zamecnikova M.1, Diblik J.1, Paulasova P.1, Panosova M.1,
Macek M. jr.1, Cernikova J.1, Hrehorcak M.3
1Department
of Medical Biology and Genetics, Charles University – 2nd School of Medicine and University Hospital Motol, Prague,
Czech Republic
2Institute of Reproductive Medicine, University of Münster, Germany
3Department of Obstetric and Adult and Paediatric Gynaecology, Charles University – 2nd School of Medicine and University Hospital Motol,
Prague, Czech Republic
The verified and tested system is based on specialized genetic
counselling to detect genetic and environmental risk factors at
least in the last 3 generations and to indicate further laboratory and clinical examinations. Cytogenetic examination is indicated for the detection of heterochromosomal and autosomal
aberrations. In the case of unclear severe oligo- or azoospermia, FISH analysis of ejaculated sperm is recommended together with classical and CASA sperm analysis, accompanied
by Y chromosome microdeletion analysis of AZF a, b and c,
including the recently introduced Y subdeletion detection within AZFc. The detection of most frequent 38 CFTR gene mutations and variants IVS8(TG)/IVS8(Tn) and 1540 A/G are
performed in men with the nonobstructive azoospermia and
severe oligospermia. The androgene receptor is analysed to
elucidate disorders of sex development, as well as phenotypically unapparent males with XXY (Klinefelter) syndrome.
The detection of thrombophilic mutations is important to improve the strategy of early prenatal care, especially if female
partner is carrying alleles increasing thrombophilic disposition in developing embryo/fetus, that might endanger reproduction or their prenatal developement. This combined approach
of genetic counselling together with genetic testing will allow
the precise contribution of genetic factors causing male infertility.
Supported by VZ FNM 000064203.
DNA ANALYSIS OF MICRODELETIONS IN AZF REGIONS (YQ) IN MAN
WITH REPRODUCTIVE FAILURE – OUR RESULTS
Gaillyova R.1, Valaskova I.1, Crha I.2, Ventruba P.2, Beharka R.3, Pacik D.3
Department of Medical Genetics, University Hospital Brno, Czech Republic
Department of Obstetrics and Gynecology, University Hospital Brno, Czech Republic
3
Department of Urology, University Hospital Brno, Czech Republic
1
2
Introduction:
Male factor of infertility is the cause of reproductive failure in
approximately 50% pairs and in about 50% cases is the cause
of male infertility unknown.
Microdeletions of the regions AZF (Yp) occur in about 4-5%
men with oligospermia and in about 15–18% men with azoospermia.
Material and methods:
In pairs with reproductive failure we recommend genetic conselling and chromosomal analysis in both partners. Examination of microdeletions of AZF regions we performed in men
with severe oligo- or azoospermia.
Results:
In 2000–2005 we performed this analysis in 549 men with patological count of sperms and we foud the microdeletions in
19 men (3.46%), between 1.89 and 5.43 %. In all 16 positive
patients with microdeletion of AZF regions was azoopsermia,
in three oligospermia (max. 1.2 mil/ml).
Conclusions:
According to our experience and literaty data we clarify indications criteria to analysis of microdeletions of AZF regions in
men. We recommend this analysis in men with the count of
sperms less then 2 millions in ml.
Genetic counselling and genetic analysis is a very important
part of assisted reproduction. The information about possibility of transmition some genetic failure on the child should be
given before using the methods of asisted reproduction.
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DETECTION OF INHERITED PROSTATE CANCER PREDISPOSITION
BASED ON EXAMINATION OF POLYMORPHIC VARIANTS IN
STEROID 5-ALPHA-REDUCTASE GENE (SRD5A2)
Minarik M.1, Loukola A.2, Fantova L.1, Urban M.3, Heracek J.3, Sachova J.3, Benesova L.1
1Laboratory
for molecular genetics and oncology, Genomac International, Prague, Czech Republic
Genome Center, University of Helsinki, Finland
3Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
2Finnish
Introduction:
Genotyping of single-nucleotide polymorphisms (SNP) is becoming central in post-genome era of disease predisposition
assesment as well as in quest for individualised therapy. Subtle variations in coding as well as non-coding regions of major
genes involved in carcinogenesis are of major interest. Steroid 5-alpha-reductase (SRD5A2) is one of major genes involved in transformation of prostate cancer cells though its regulation of testosterone synthesis. Association studies involving
SRD5A2 polymorphisms were mostly directed at functional
substitutions in exons 1 and 4. The aim of this work was to investigate a set of less prominent SRD5A2 SNPs and their associations with prostate cancer incidence.
Material and methods:
A total of 339 unrelated patients with clinically confirmed prostate cancer (stages pT2 – 3) and 231 controls with confirmed
BHP were enrolled in the study. A total of 16 SNPs, mostly in
non-coding regions of SRD5A2 locus, was genotyped in each
proband using PCR and Cycling-gradient Capillary Electrophoresis technique.
Results:
We have identified 5 SNPs showing significant allele frequency and genotype distribution differencies between cases and
controls. In addition we have identified 5 haplotypes showing
strong association with prostate cancer status as well as with
the aggressivity of the disease (pT and Gleason score) with
p values between 0.001 and 0.005.
Conclusions:
Many of the significant SNP markers are from noncoding regions, therefore the haplotype association may mostly be related to alternate gene regulation. Haplotype analyses on a larger patient cohorts is desirable in order to evaluate potential of
the identified SNPs and haplotypes for identification of risk
groups.
This project was supported by Czech Ministry of Health grant
No. 8039-3.
FISH DIAGNOSTICS OF KALLMANN SYNDROME
Gregor V.1, Horacek J.1, Snajderova M.2, Hana V.3
1Department
of Medical Genetics, Thomayer’s University Hospital, Prague, Czech Republic
of Paediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
33rd Medical Department, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
2Department
Introduction:
Aim of study was to confirm a possibility of Fluorescence In
Situ Hybridization (FISH) diagnostics of putative Kallmann
syndrome (KS) patients using the Vysis LSI® KAL Region
Probe.
Material and methods:
FISH was carried out in totally 8 men (12–40 yrs, mean age
21.1) clinically diagnosed by endocrinologists as KS. All
cases were sporadic. Moreover, one putative female carrier of
KAL1 deletion was also diagnosed by this technique.
Results:
Using the FISH technique, we found one patient with a deletion of the KAL1 region out of the 8 men in our study, but no
deletion was confirmed in his mother.
Conclusions:
Kallmann syndrome etiology is highly heterogeneous. Our
findings on KAL1 region FISH detectable deletions mostly
conform with published data. We are planning to follow with
FISH diagnostics in further putative KS patients and to start
with molecular genetics diagnostics of Fibroblast Growth Factor Receptor 1 (FGFR1), which is supposed to be mutated in
about 10 % of KS patients.
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COMBINED DETECTION OF SPERM PROTEINS AND CHROMOSOMES
Diblik J.1, Koubek P.2
1Center
of Reproductive Genetics, Institute of Biology and Medical Genetics, Charles University – 2nd School of Medicine, University
Hospital Motol, Prague, Czech Republic
2Laboratory of Diagnostics for Reproductive Medicine, Biotechnology Section, Institute of Molecular Genetics, The Academy of Sciences
of the Czech Republic, Prague, Czech Republic
Introduction:
Qualitative aspects of spermatogenesis can be studied using
antibodies against sperm-specific proteins and by fluorescence in situ hybridization (FISH) with probes specific for individual chromosomes. It would be beneficial for clinical practice to combine these two methods to decide whether patients
with abnormalities of sperm proteins also have a higher risk of
sperm aneuploidy. Combined detection of the proteins and the
chromosomes can also elucidate the relation between disorders of meiosis and sperm maturation in individual spermatozoa.
B) Decondensation and FISH followed by the antigen detection.
Images and positions of individual spermatozoa were stored
using a digital camera and a motorized scanning stage.
Material and methods:
We have tested two approaches:
A) Detection of intraacrosomal antigen HS-8 by specific antibody that is visualized by secondary antibody labelled with
a fluorochrome followed by sperm nucleus decondensation
with dithiothreitol (DTT) and FISH.
Conclusions:
Our initial results show, that it is possible to perform the FISH
after the antigen detection by antibodies and thus analyze both
proteins and chromosomes in single spermatozoa.
Results:
A) FISH with decondensation of the nucleus does not destroy
the bound antibodies. The fluorescence of the secondary antibody is decreased, but it can be evaluated in all analyzed spermatozoa together with the FISH signals.
B) The antigen is not detectable after sperm head decondensation and FISH.
Supported by VZ FNM 64203.
DIHYDROTESTOSTERONE AND INHIBITORS OF STEROID
5ALPHA-REDUCTASE
Starka L., Duskova M.
Institute of Endocrinology, Prague, Czech Republic
Dihydrotestosterone (DHT) in man plays a key role in many
physiological and pathological events. As an example is the
Imperato-McGinley syndrome, in which mutations in type 2
isoenzyme of 5alpha-reductase cause male pseudohermaphroditism. The affected 46XY individuals have normal to elevated plasma testosterone levels with decreased DHT levels and
elevated testosterone/DHT ratios. They have ambiguous external genitalia at birth so that they are believed to be girls and
are often raised as such. However, Wolffian differentiation
occurs normally and they have epididymis, vas deferens and
seminal vesicles. Virilization occurs at puberty frequently
with a gender role change. The prostate in adulthood is small
and rudimentary, and facial and body hair is absent or decreased. Balding has not been reported. Partial deficiency of
5alpha-reductase presents with micropenis. It could be corrected by dihydrotestosterone treatment. In normal individuals
higher local concentrations of dihydrotestosterone play a key
role in benign prostate hyperplasia and carcinoma of prostrate
and also in androgenetic alopecia, hirsutism and acne. Finasteride was the first 5alpha-reductase type 2 inhibitor that received clinical approval for the treatment of human benign
prostatic hyperplasia and male pattern hair loss. Until now the
physiological effects of dihydrotestosterone on rat bone
growth zone chondrocytes, spermatogenesis, especially on
maturation of spermatozoa in epididymis, on sexual brain differentiation and its action as neuroactive steroid or association
of its higher levels with homosexuality are not well understood in detail and deserve further studies.
The study was supported by Internal grant agency of Ministry
of Health CR, grant No. NR/8525 – 5.
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AGING MALE, HORMONAL AND GENETIC ALTERATIONS
Beharka R.
Department of Urology, University Hospital in Brno, Medical School Masaryk University Brno, Czech Republic
Introduction:
The ageing process manifests itself within numerous organs.
Central nervous (particularly brain), immune, endocrine and
cardiovascular systems functioning are impaired with age.
Alternations in conjunctive and muscular tissues are other familiar ailments common to ageing humans.
Material and methods:
Presentation macromolecular processes
The endocrine system is particularly sensitive to age. Alterations may be due to the:
• diminution of the synthesis or turnover of most of hormones;
• impaired functioning of hormone receptors;
• defective binding between hormone and its receptor;
• premature programmed death (apoptosis) of hormone producing cells;
• auto-immune reactions;
• cancerous transformations.
Endocrine system alterations are linked to the apparition of several ageing related diseases such as diabetes, disorders in
thyroid gland functioning and sexual hormones deficiencies.
In ageing men, a progressive diminution of circulating levels
of androgens is observed (aging male).
With age, genetic material is altered at different levels. The
stability of DNA is decreased, the DNA transcription and the
translation of proteins are impaired. The alternation in the
transmission of the genetic information results in accumulation or abnormal, no functional proteins („error theory“), leading to cellular impairment, ageing and death. At each cell division the shortening in telomeres (protecting structures at the
ends of chromosomes) is observed. The progressive shortening of telomeres may be a cause (or the cause) of cellular
ageing. Telomeres shortening may appear to be the cellular
clock that determines the number of times cells could divide
and which weakens chromosomes to the point where cell division is no longer possible.
DNA methylation plays a central role in genomic imprinting
and embryonic development. Aberrations in DNA methylation
have been implicated in ageing and various diseases including
cancer.
Conclusion:
The ageing is conclusive process. At least this time.
ENDOCRINE THERAPY OF PROSTATE CANCER AND SEXUAL
DYSFUNCTION IN MEN
Matouskova M., Hanus M.
Urocentrum, Prague, Czech Republic
Introduction:
Pro-active approach to the diagnostics of prostate cancer leads
not only to the stages shift, but primarily to the recognition of
the diseases in younger-age categories. Unique biological behaviour of the prostate cancer is different from other solid tumours. Natural course of the disease (long doubling time and
slow progression) enables the patient with hormonally dependant tumour long-term stabilization of the disease and survival. Every therapy of prostate cancer (surgical-, radiation- and
drug therapies) shall significantly influence sexual life of the
patients and thereby also the quality of their life.
Material a methods:
We present a group of 36 males with average age of 63.2 years
<48;67> with locally advanced or generalised disease. Before
commencement of the therapy all these men lived sexual life.
Hormonal suppression had been incited with LH RH analogues or anti-androgens, in 29 men from the group in the form of
intermittent androgenic suppression, others were receiving
continual therapy. We were evaluating Life Quality Assessment Questionnaires and IIEF score (International Index of
Erectile Function), therapeutic response and its duration.
Results:
Before commencement of the therapy we had diagnosed erectile dysfunction in 21 pts (59%) patients, ejaculation disorder
in 50% and painful ejaculation in 11 pts (30%) of patients.
Progress of the sexual dysfunction depended on the kind of
pharmaceutical used. LH RH analogues lead to the quick loss
of libido and development of impotence in majority of patients. Administration of steroid anti-androgens is not followed
by development of sexual dysfunction, despite decrease of tes-
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tosterone levels. We have observed libido decrease only in
25% of patients. Erectile dysfunction worsened in patients
with already developed dysfunction. Non-steroid anti-androgens induced sexual dysfunction in 30% of patients. Intermittent androgenic suppression reduces incidence of symptoms
associated with lack of androgens; in the cycle without therapy comes to the increase of testosterone levels and improvement of sexual life.
Conclusion:
Sexual dysfunction (SD) is accompanied with prostate diseases. Depending on the level of symptoms of lower urinary
tract also the SD level gets worse. Moreover, in prostate cancer we influence development of SD also by selection of therapeutic regimen and anti-tumour pharmacotherapy. During
selection of therapeutic strategy we should take into consideration not only safety of oncological therapy but also the patient’s sexuality and preferences.
THE ENDOCRINE PROFILES IN MEN WITH LOCALIZED AND LOCALLY
ADVANCED PROSTATE CANCER TREATED WITH RADICAL
PROSTATECTOMY
Heracek J.1, Urban M.1, Sachova J.1, Kuncova J.2, Eis V.3, Mandys V.3, Hampl R.4, Starka L.4
1Department
of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
of Surgery, Division of Urology, St. Chiara Hospital, University of Pisa, Italy
3Department of Pathology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
4Institute of Endocrinology, Prague, Czech Republic
2Department
Introduction:
Prostate cancer is now recognized as one of the principal medical problems facing male population and the commonest
cancer in males in delevoped countries. The aim of this study
was to find out whether serum hormone levels differ significantly in localized (pT2) and locally advanced (pT3–pT4 or
N1) prostate cancer.
Material and methods:
In 250 men (mean age ± SEM: 63.8 ± 0.4) who underwent radical retropubic prostatectomy for histologically confirmed
prostate cancer were analyzed serum samples for total testosterone, dehydroepiandrosterone sulfate, estradiol, progesterone, prolactin, cortisol, sex hormone-binding globulin, luteinizing hormone and follicle stimulating hormone. Free
testosterone content was calculated from total testosterone and
SHBG concentrations.
Results:
Significantly lower serum level of FSH, i.e. 5.63 ± 0.31 vs.
7.07 ± 0.65 U/L was found in patients with localized prostate
cancer than in locally advanced (P<0.05). Significant correlation was found between serum levels of DHEAS and cortisol
in both groups (P<0.02), estradiol and prolactin in patients
with locally advanced prostate cancer, as well between LH
and prolactin (P<0.05). No differences were found in other observed hormones.
Conclusion:
The results point to importance of hormone status as possible
additional prognostic marker for patients with prostate cancer.
Considerable research is needed to further understand influence of hormones on prostate cancer.
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FINASTERIDE TREATMENT OF PREMATURE ANDROGENETIC
ALOPECIA
Duskova M., Starka L.
Institute of Endocrinology, Prague, Czech Republic
Introduction:
Androgenetic alopecia (AGA) is the most common cause of
balding in men. AGA is the risk factor of cardiovascular diseases, glucose metabolism disorders and also the risk of benign
prostate hyperplasia and prostate carcinoma.
Material and methods:
A group of 26 men (mean age: 31 years, mean BMI 25.58), in
which premature hair loss begun before 30 years of age was
involved in the present study. In all individuals, their hormonal profile involving total testosterone, androstenedione, dehydroepiandrosterone, epitestosterone, dihydrotestosterone,
cortisol, estradiol, SHBG, prolactin, TSH, LH, FSH and index
of free testosterone was determined and insulin tolerance test
before the treatment with finasterid was carried out. Finasteride in the daily dose of 1 mg was administered for 3 months.
After the treatment hormonal profile was determined again.
Wilcoxon robust test was used for statistic comparison of preand post-treatment results.
Results:
The hormonal levels before and after the finasteride treatment
were compared. The ratios of dihydrotestosterone/testosterone
before and after treatment differed significantly while in the
other hormonal levels no significant differences were found.
Among 26 men examined and treated 17 subjects described
the amelioration of hair quality and the stop of hair loss and no
side effects during the treatment period. They were satisfied
with treatment asking for the treatment to continue. Eight men
have observed no treatment effect after the 3 months of finasteride administration. One man has shown the discrete sign of
gynecomastia, and interrupted the treatment. No other side effects have been recorded. The insuline tolerance test before
treatment was normal.
Conclusions:
Finasteride in dose of 1 mg can present safe eventuality of the
androgenetic alopecia control experiencing discrete amelioration of problems with hair loss in prematurely balding men.
The study was supported by grant No. NR/8525 – 5 of the IGA
MZCR.
SERUM ADIPONECTIN AS AN AUXILLIARY MARKER OF PROSTATE
CANCER PROGRESSION
Housa D.1, Vernerova Z.1, Heracek J.2, Prochazka B.3, Housova J.4, Cechak P.5, Kuncova J.6, Haluzik M.4
1Department
of Pathology, 3rd Medical Faculty and Teaching Hospital Kralovske Vinohrady, Prague, Czech Republic
of Urology, 3rd Medical Faculty and Teaching Hospital Kralovske Vinohrady, Prague, Czech Republic
3Department of Biostatistics and Informatics, National Institute of Public Health, Prague, Czech Republic
43rd Department of Internal Medicine, 1st School of Medicine and General Faculty Hospital Prague, Czech Republic
5Department of Biochemistry and Pathobiochemistry, 3rd Medical Faculty and Teaching Hospital Kralovske Vinohrady, Prague,
Czech Republic
6Department of Surgery, Division of Urology, St. Chiara Hospital, University of Pisa, Italy
2Department
Introduction:
Adipocytokines – adipose tissue hormones – have been recognized among others as a potential link between obesity and
cancer development. The role of adiponectin in organ limited
and locally advanced prostate cancer was studied.
Material and methods:
Adiponectin ELISA assay, tissue immunohistochemistry and
selected biochemical, hormonal and metabolic parameters
were meausured in 25 patients with benign prostate hyperpla-
sia and 43 with prostate cancer (17 patients with organ-confined (pT2) and 26 patients with locally advanced disease
(pT3)).
Results:
Serum adiponectin levels did not differ between prostate benign hyperplasia and cancer, but was significantly higher in
pT3 in comparison to pT2 group (14.51 ± 4.92 vs. 21.41 ±
8.12, P = 0.003). Tissue immunohistochemistry showed enhanced staining in neoplastic prostate glands and intraepithe-
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lial neoplasia relative to benign prostate hyperplasia without
correlation to disease grade or stage.
viding futher improvement to PSA for preoperative discrimination between pT2 and pT3 stages.
Conclusions:
Serum adiponectin levels are increased in locally advanced
prostate cancer and may thus serve as an auxiliary marker pro-
This work was supported by Research Project of MHCR No.
64165 to M. Haluzik.
IMPLANTATION FAILURE: THE CONTRIBUTION OF THE
SPERMATOZOA
Gianaroli L.
SISMER, Bologna, Italy
Abstract not submitted at the time of printing.
PREIMPLANTATION GENETIC DIAGNOSIS IN BALANCED
TRANSLOCATION CARRIERS
Rubes J.1,2,3, Musilova P.1,2,3, Oracova P.1,3, Rybar R.1,3, Vozdova M.1, Tauwinklova G.3, Vesela K.2,3
1Veterinary
Research Institute, Brno, Czech Republic
Brno, Czech Republic
3Repromeda, Brno, Czech Republic
2Genprogress,
Congenital balanced structural aberrations of chromosomes
occur in about 0.3% of human population. Their presence in
karyotype often causes a significant reduction in fertility and
increased risk of birth of an affected offspring. Although preimplantation genetic diagnosis (PGD) for chromosomal translocations was introduced only 10 years ago it is currently one
of the most practical applications of PGD, which appeared to
have a major impact on the clinical outcome of carriers of balanced chromosomal translocations.
Initially PGD was done for maternally derived translocations
and performed by using 1st polar body (PB). At present, it is
mostly combined with 2nd PB analysis. However, this procedure is relatively complicated and therefore we routinely test
single cells obtained from preimplantation embryos for both
maternally and paternally derived translocations. For detection of chromosomally unbalanced embryos from reciprocal
translocation carriers, we use a combination of 3 to 4 DNA
probes distal (telomeric) and proximal (centromeric) to the
breakpoints. For detection of unbalanced embryos in Robertsonian translocation carriers, we use 2 probes that can detect
both chromosomes involved in translocation.
During last four years, we examined 13 couples with reciprocal translocation in 25 PGD cycles; translocation carriers were
women and men in 6 and 7 cases, respectively. Four other
couples with Robertsonian translocation were examined in
4 PGD cycles. The proportion of abnormal embryos varied depending on the type of translocation and their origin. The mean
percentage of chromosomally abnormal embryos in our group
of reciprocal translocation carriers was 78.7% (55–97.3%).
A higher frequency of chromosomally abnormal embryos is
found in couples where the woman is a translocation carrier:
81.7% versus 76.4%. Pregnancy rate was 20%. The prognosis
of couples with Robertsonian translocation is more favourable.
The mean percentage of chromosomally abnormal embryos is
64.7 (46–66.7) and the achieved pregnancy rate is 50%.
In human male carriers of balanced translocations, we also use
the FISH method for assessment of frequency of chromosomally unbalanced spermatozoa. We examined 23 men with various translocations so far. Frequencies of spermatozoa with
abnormal segregation of translocated chromosomes ranged
between 40.1–70.3% and 5.8–23.5% in the carriers of reciprocal translocations and the carriers of Robertsonian translocations, respectively.
PGD is an important tool that can help the carriers of balanced
translocations in their effort to overcome their reproductive
handicap. In the present group of patients, 7 healthy children
have already been born.
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PREIMPLANTATION GENETIC DIAGNOSIS – NUMERICAL
CHROMOSOME ABNORMALITIES IN FERTILIZED HUMAN OOCYTES
AFTER TESA
Siruckova K., Kosarova M., Zudova D., Brachtlova T., Bürgerova E.
Sanatorium Pronatal, Prague, Czech Republic
Introduction:
In sperms of infertile men is higher incidence of chromosome
aneuploidy. Consequently for embryos developed from these
sperms PGD is indicated.
Material and methods:
In our laboratory were made 331 PGD cycles. 25 of them were
counted among group of indication, in which embryos were
fertlized with sperm after TESA. PGD was performed on blastomeres from three-day old embryo in two hybridisation cycles. During this procedure we evaluated 8 chromosomes (13,
15, 16, 18, 21, 22, X, Y).
Results:
Total mean age of patients with spermatogenic failure was
32.24. This group contained 25 couples and 184 embryos were
evaluated. From this amount 75 preimplantation embryos did
not show numerical aberrations for detected chromosomes
and 22 of them were transferred. 31.8 % patients were pregnant (this number related to embryotransferr). On the other
side more than 59 % investigated blastomeres showed a numerical chromosomal abnormality. Monosomy chromosome
16 and aneuploidy of sex chromosomes were observed the
most frequently.
Conclusions:
The incidence of aneuploidies in sperm after TESA should
correlate with incidence of genetic abnormalities in embryo.
Our results are similar to literature, where sex chromosomes
aneuploidies the most frequently occur in sperms after TESA.
In these studies the chromosome 16 was not analysed. The
higher incidence of monosomy of this chromosome can be
caused by low number of evaluated blastomeres.
METHODS FOR DETECTION OF SPERM CHROMATIN INTEGRITY IN MEN
Rybar R.1, Rubes J.1,2
1Veterinary
Research Institute, Brno, Czech Republic
Brno, Czech Republic
2Genprogress,
Recently, alterations of the male reproductive system are more
and more discussed as one of the causes of infertility, spontaneous abortions and failure in assisted reproduction. Due to
development of molecular biology and genetic methods for infertility treatment, we can say that chromatin integrity assessment is a significant tool for evaluating fertility. Sperm chromatin integrity can be disturbed above all by presence of DNA
strand breaks and due to defective chromatin condensation.
Based on the results of various studies, there is no doubt that
sperm chromatin damage is one of factors causing infertility in
males. There are several ways to test for sperm chromatin integrity; these differ in the requirement on technical equipment,
speed, robustness, reliability and cost. The most common met-
hods employed for assessment of human sperm chromatin
quality, especially Sperm chromatin structure assay (SCSA),
Toluidine Blue test (TB), Aniline Blue staining (AB) and
chromomycin A3 staining (CMA3) are discussed. Sperm
chromatin integrity was measured by the SCSA method in
a total of 383 men from infertile couples and by TB, AB and
CMA3 methods in 100 men. The obtained results showed that
all these tests are suitable for chromatin integrity status detection in human sperm. While SCSA is a highly convenient, fast
and robust method, the other three methods give rough information and can be complementary to the results obtained by
the SCSA method.
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ERECTILE DYSFUNCTION AFTER RADICAL CYSTECTOMY
Zachoval R., Zalesky M., Vik V., Jarabak J.
Department of Urology, Faculty Thomayer’s Hospital, Prague, Czech Republic
Introduction:
The aim of the study was to evaluate influences of different
modifications of radical cystectomy on erectile dysfunction.
Material and methods:
Medline database has been searched for all publications with
key words: „radical cystectomy erectile dysfunction“. A research of incidence, ethiology and pathophysiology, diagnostic
and therapy of erectile dysfunction after different modifications of radical cystectomy has been performed in all abstracts
and all available full text articles in English, French, German
and Slovak language.
Results:
In the Medline database have been found 56 publications. Abstracts were available for 51 and a full text articles in chosen
languages were available for 28 of them.
Incidence o erectile dysfunction after traditional radical cystectomy is high and reaches up to 91 %. Incidence of erectile
dysfunction in case of additional urethrectomy reaches up to
100 %, pelvic lymph node dissection has no negative influence on erectile function. Incidence of erectile dysfunction after
uni or bilateral nerve sparing cystectomy or cystectomy with
sparing of seminal vesicles and prostate is significantly lower
and ranges from 40 to 83 %. Oncological outcomes of the spa-
ring procedures do not seem to be inferior to those of traditional radical cystectomy. However data with long term followup are not sufficient.
The most common cause of erectile dysfunction after radical
cystectomy is a neurological impairment. Vasculogenic (arteriogenic or/and venooclusive) and psychogenic mechanisms
also participate in the pathogenesis.
Common methods are used for the diagnosis of type and degree of erectile dysfunction in patients after radical cystectomy and additional neurological examinations i.e. EMG and latency of bulbocavernous reflex are performed in experimental
studies.
All types of erectile dysfunction treatment are employed in patients after radical cystectomy. The most successful therapies
seem to be intracavernous injections and penile prosthesis. Success rate of medical treatment is lower, however side effects
are significantly less frequent and serious.
Conclusion:
The incidence of erectile dysfunction after radical cystectomy
is high. Therefore in indicated cases nerve sparing procedures
are more often performed in the last decade. However more
data with long term follow-up are needed for the evaluation of
oncological outcomes.
REHABILITATON OF ERECTILE FUNCTION FOLLOWING RADICAL
PROSTATECTOMY
Khamzin A., Pacik D.
University Hospital Brno, Medical School, Masaryk University, Brno, Czech Republic
There is recently obvious increasing number of prostate cancer confined to prostate gland in men of relatively young age.
Unfortunately, the consequent definitive treatment could negatively affect patient’s quality of life. In spite of improved radical prostatectomy techniques, pretty common complication
today, besides quite rare urinary incontinence, is erectile dysfunction. Erection is according to different authors normalized
in 16%–85% of patients after 6–24 months. Rehabilitation of
erectile function is dependent on surgical technique, advancement of tumor, status of erectile function prior surgery and age
of patient. According to the literature, active attitude to that
problem enabled to higher percentage of patients faster rehabilitation of erectile function after radical prostatectomy. Authors try to bring overview of current possibilities of erectile
function rehabilitation.
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THE ROLE OF A GENERAL PRACTITIONER IN AN EARLY DIAGNOSIS
OF THE TESTICULAR CANCER
Hanek P., Chocholaty M., Dusek P., Kawaciuk I.
Department of Urology, Charles University and University Hospital Motol, Prague, Czech Republic
Introduction:
To investigate the role of general practitioner in an early diagnosis of the testicular cancer.
Material and methods:
A cross sectional survey was conducted in a random sample of
82 practitioners in Prague from January to December 2006.
A total of 78 practitioners (95%) volunteered to answer all
items of the questionnaire, administered by the telephone. The
mean age of responders was 52 years (range 32–78 years) and
the average length of their professional career was 23 years.
Results:
Almost every practitioner (97.5%) was persuaded that the testicular self-examination (TSE) is the best in prevention of the
late diagnosis of the testicular cancer. Seventy-one percent of
responders think that the optimal time for beginning with TSE
is between 15 and 20 years of age. Thirty-four percent suppose that TSE should be performed every two months and less
frequently. Less than half of practitioners (45%) teach patients
about TSE. Other practitioners (55%) don’t do it. They declared the lack of time (38%), shyness (20%), 26% of them forgot to inform the patients and 16% didn’t mention the reason.
Only 34% of the practitioners provided physical examination
of the testicles by the preventive examination or as a part of
the total examination, 61% only in case of the patient’s problems in this area and 5% of the practitioners didn’t examine
them at all.
Conclusions:
The majority of practitioners does not inform the patients
about TSE. Moreover, two thirds of them do not carry out the
investigation of testicles as a part of a total examination of
young male patients. Our results clearly indicate the need to
urge general practitioners to perform an examination of the
scrotum and to inform the patients about TSE together with
the risk of testicular cancer.
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TESTICULAR OXIDANT AND SPERMATOGENIC INJURY INDUCED
BY ATRAZINE IN AN EXPERIMENTAL RAT MODEL
Abarikwu S.O.1, Farombi E.O.2, Oyeyemi M.O.3
1Department
of Biochemistry, Redeemers University, Redemption City, Nigeria
Toxicology Laboratories, Department of Biochemistry, College of Medicine, University of Ibadan, Nigeria
3Department of Veterinary Reproduction, Faculty of Veterinary Medicine, University of Ibadan, Nigeria
2Drug
Introduction:
The extensively used herbicide, atrazine has been shown to
adversely affect reproductive tissues in animal models, although a specific mechanism or mechanisms of action remain
to be identified. In this context, we evaluated the potential for
atrazine to induce testicular injury and spermatogenic disturbance through tissue oxidant/antioxidant parameters, spermatological studies, and various germ cells at stage VII of spermatogenic cycle were quantified from testicular stained
sections.
Material and methods:
Atrazine was administered to wistar rats at a dose equivalent
to 0 mg/kg (control) or 120 mg/kg or 200 mg/kg b. wt for up
to 7 days.
Results:
The feed intake, body weights, and the weight of the epididymides, prostate and the seminal vesicles dropped significantly
(P<0.05) and dose dependently in atrazine-treated rats. Testicular MDA concentrations and the activity of GST in the atrazine exposed rats were increased (P<0.05), but the levels of
testicular reduced GSH and ascorbic acid were significantly
decreased. The activities of testicular antioxidant enzymes
such as catalase, superoxide dismutase were significantly decreased but those of marker enzymes such as γ-GT was significantly increased (P<0.05) in a dose-dependent manner.
Conclusions:
This particular pattern in the activity of γ-GT, testicular antioxidant enzymes and decrease in sperm motility, viability, epididymal and testicular sperm number, daily sperm production
and an increase in the frequency of sperms with abnormal
morphology mediated by atrazine suggest damage to germ
cells and sertoli cells and may be due to the potential for atrazine or its metabolites to induce testicular oxidant injury in the
rat testis.
WHO IS RESPONSIBLE FOR DIAGNOSTIC DELAY OF TESTICULAR
CANCER?
Chocholaty M., Dusek P., Hanek P., Kawaciuk I.
Department of Urology, Charles University and University Hospital Motol, Prague, Czech Republic
Introduction:
In testicular cancer, which is one of the highly curable cancers,
the beneficial effect of early diagnosis on survival has been
accepted for years. The aim of this study was to find out the
reasons of diagnostic delay of testicular cancer.
Material and methods:
A total of 126 patients with testicular cancer undergoing radical orchiectomy at our department between January 2000 and
December 2006 were included in this study. Mean age was
35.7 years (range 19–68). Diagnostic delay was defined as the
time period between the first appearance of any symptoms and
the date of the radical orchiectomy.
Results:
The scrotal mass was presented in more than 96% of the patients. The average time of diagnostic delay was 131 days (patients 122 days, practitioners 7 days, urologists 5 days). However, in 25% of the patients the diagnosis was established more
than a half year after the first relevant symptoms and 15 % of
the patients had stage III disease.
Conclusions:
There was not the significant diagnostic delay of testicular
cancer in practitioners and urologists, but the patients visited
the medical examination more than 4 months after the first appearance of any symptoms. Our results indicate the need to inform the patients about symptoms of testicular cancer and significance of early diagnosis of testicular cancer.
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CLINICAL RELEVANCE OF ANDROGEN RECEPTOR POLYMORPHISM
Nieschlag E., Gromoll J., Zitzmann M.
Institute for Reproductive Medicine of the University, WHO Collaboration Centre for Research in Male Reproduction, Münster, Germany
Testosterone (T) and its metabolite dihydrotestosterone
(DHT) are the key hormones for male sexual differentiation,
for turning males into men and for maintaining masculinity lifelong. This action is dependent on T production in the Leydig
cells of the testes, on total testosterone in circulation, on
SHBG determining the biologically active free T and on the
androgen receptor (AR) in the target tissues and cells. ARs are
present in almost all organs and cells, making T a universal
hormone influencing almost all body functions to various degrees. The AR encompasses of three major domains: the
COOH-terminal domain required for hormone binding, the
centrally located DNA-binding domain and the NH2-terminal
domain necessary for transactivation.
A defective AR caused by inactivating mutations may lead to
androgen insensitivity syndromes (AIS). Complete insensitivity causes testicular feminization of patients characterized by
normal male karyotype and gonads, but female phenotype.
Partial AIS is defined by a male genotype with gynecomastia,
maldescended testes and hypospadias (Reifenstein Syndrome). Over 600 different mutations of the AR have been described, but a clear genotype:phenotype correlation has not
emerged (www.mcgill.ca/androgendb/).
More subtle changes in T action are caused by the CAG repeat polymorphism in exon 1 of the AR. The length of the CAG
repeats determines the transactivation activity of the AR and
thus T-action. A shorter number of CAG repeats is responsible for higher T-activity, whereas longer CAG repeats cause
less T-activity. In cases of extreme CAG repeat length (e.g.
>37), a distinct clinical disorder results, i.e. spinal and bulbar
muscular atrophy (SBMA or Kennedy Syndrome). In normal
men the length of the CAG repeats co-determines bone density, lipid metabolism, body composition, vascular endothelial
function, hair pattern (balding), sperm production and personality traits. Klinefelter patients with a 47,XXY karyotype
bear two X-chromosomes; one is inactivated and the CAG repeat polymorphism of the other active X-chromosome determines several phenotypic traits. Patients with longer CAG repeats are taller, more often present with gynecomastia, have
lower bone density and often achieve a lower level of education and professional status than other family members; finally, they are less likely to live in a stable relationship and overall they tend to be less androgenised.
CAG repeats also appear to be responsible for pharmacogenetic aspects of T-action. In response to T-treatment prostate
growth and haemoglobin production are more pronounced in
hypogonadal patients with shorter CAG repeats than in those
with longer CAG repeats. In normal volunteers participating
in trials for hormonal male contraception based on testosterone administration, those with longer CAG repeats are more likely to suppress spermatogenesis to azoospermia than those
with shorter CAG repeats (von Eckardstein et al. 2002). The
CAG polymorphism may also explain ethnic differences in
response to T for male contraception, where Eastern Asians
show a higher rate of azoospermia than Caucasians.
DAMAGE OF HORMONAL FUNCTION AND BONE METABOLISM
IN LONG TERM SURVIVORS OF TESTICULAR CANCER
Ondrus D.1, Spanikova B.2, Ondrusova M.3,4, Mardiak J.5
11st
Department of Oncology, Comenius University Medical School, St. Elisabeth Cancer Institute, Bratislava, Slovak Republic
Patient’s Department of Osteology, St. Elisabeth Cancer Institut, Bratislava, Slovak Republic
3National Cancer Registry, National Health Information Center, Bratislava, Slovak Republic
4Cancer Research Institute, Slovak Academy of Science, Bratislava, Slovak Republic
52nd Department of Oncology, Comenius University Medical School, National Cancer Institute, Bratislava, Slovak Republic
2Out
Introduction:
Improved survival of testicular cancer patients during the last
years leads to rising of interest on the disease consequences of
whole the organism. Cancer and its treatment may have impact on patient's hormonal status and bone metabolism.
Material and methods:
In the period of 11/2005–3/2007 there were examined 510 followed-up patients with unilateral (group A) and 41 patients
with bilateral (group B) testicular cancer. Each patient has
evaluated serum testosterone and marker of bone resorption –
CTx. Osteodensitometry was performed on Holoxic Explorer
machine, focused on measurement of the hips and lumbar
spine bone mineral density (BMD).
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Results:
Testosterone deficiency was observed in 16/510 (3.1 %) patients in group A and in 29/41 (70.7 %) patients of the group B,
other patients have testosterone in normal range (5.7–28.1
nmol/l). This difference was statistically significant (P<0.001).
Increased S-CTx was observed in 269/510 (52.7 %) patients of
the group A and in 27/41 (65.8 %) patients of the group B,
other patients had S-CTx in normal range (1020–3750 pM),
despite the fact that difference between the group of patients
A and B was not statistically significant. Bone densitometry
(BMD) shows osteopenia or even osteoporosis in 253/510
(49.6 %) patients of group A and in 27/41 (65.8 %) patients of
group B, other patients had normal BMD. The difference was
statistically significant (P<0.01).
Conclusions:
Examination of hormonal profile and testosterone replacement therapy may be recommended as an important aspect of
patient’s follow-up not only in bilateral disease, but also in patients with unilateral testicular cancer. The important part of
standard examination algorithm should be also osteological
examination to prevent cancer-treatment-induced bone loss
(osteopenia or even osteoporosis).
HYPOGONADOTROPIC HYPOGONADISM
Plas E.
Department of Urology, KH Hietzing, Vienna, Austria
Hypogonadotropic hypogonadism is a rare disease associated
with male infertility but one of the view endocrine alterations
that can be treated effectively with a high chance of sperm recovery and fertility.
The etiology of hypogonadotropic hypogonadism with its
congenital or acquired forms will be covered. The clinical findings associated with hypogonadotropic hypogonadism are
presented recommending a diagnostic approach.
Since treatment of hypogonadotropic hypogonadism with pul-
satile GnRh or combination of recombinant FSH and HCG is
very effective, most patients do not require any form of assisted reproduction techniques. However, it is important to motivate patients to continue treatment at least for several months
since spermiogenesis will be induced by 80–90% of the patients after 5–24 months of treatment. Due to high chance of
spontaneous pregnancy induction the correct diagnosis and
management of hypogonadotropic hypogonadism in male infertility is mandatory.
CHRONIC PELVIC PAIN IN MALE PATIENTS – JOINT VIEW OF AN
UROLOGIST AND ANATOMIST – IMPACT ON SEXUAL DYSFUNCTION
Urban M.1,2, Heracek J. 1,2, Baca V.3
1Department
of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
Prague, Czech Republic
3Centre for Integrated Studies of Pelvis, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
2Androgeos,
Introduction:
Chronic pelvic pain (CHPP) in men is manifested by a chronic, non-malignat pain felt in the structures connected with the
Elvis-the organs, muscles of the pelvic floor, supportive ligamentous apparatus. The pain is either permanent or reccuring
at the interval of at least 6 months. It is often associated with
symptoms indicating a poor function of the lower urinary
tract, sexual problems, gastroenetrological or gynecological in
women. No infection or another pathological affection can be
proved. This is a definition of the International Continence
Society (ICS) and the Internal Association for the Study of
Pain (IASP).
Material and method:
The authors created a set of CHPP syndromes and performed
an anatomical retrieval relating to the distribution of nerve fibros in the area of the lesser pelvis. Subsequently, they compared clinical manifestations in patients with CHPPS with the
anatomical correlate of both superficial and deep inervation
regions contributing to the variety of the incidence and intensity of the pain.
Results:
The authors prepared a review comparing the clinical symptoms with the superficial and organ innervation projections
that may help explain localisation and penetration of the pain
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to remote regions. They also made a list of potential difficulties in distant areas on the basis of distribution of fibers from
individual nerve plexuses supplying the structures affected by
pain.
encing the chronic pelvic pain thus increasing the quality of
life of the patients stigmatised by chronic pain. Detailed anatomical knoweledge will allow the use of mini- and micro-invasive techniques (endoscopically assisted operations, surgeries controlled by direct mini electrode stimulation).
Conclusion:
Comparision of clinical symptoms and their anatomical substrate will help in future to identify new oportunities of influ-
INTEGRATED APPROACH TO THE CHRONIC PELVIC PAIN –
OVERCOMING THE MIND – BODY SPLIT
Fügner D.
AGEL, Hospital in Sumperk, Czech Republic
Not only urologists are urged to adopt new model of chronic
pelvic pain. The paradigm for chronic prostatitis has been
changing. Urologist has to appreciate a new key to understand
the pathogenesis of this, better these, chronic conditions. He
must abandon the old prostatocentric view and adopt alternative ways of medical thinking.
The result of the mind-body schism in the classic conception
has been to limit success in the treatment of many of disease.
So called chronic prostatitis has been the leader in urology in
this way.
Every experienced urologist can agrese. More that 75% of
their patiens not only with chronic prostatitis have „psychological problems“ causing or contributing to the disease process.
Today the amount of empirical evidence support the mindbody unification is overwhelming.
Changing paradigm is as follow: When we are looking at
chronic pain, it is not something damaged and malfunctioning
in the perifery, in the organ alone. When we are looking at
chronic pain, we are clearly looking at the disease of the nervous system, regardless of that the originating factor is.
Biopsychological model of pain is far superior to the old biomedical model.
What is the complexity of chronic pain? Speaker tries to explain the neural plasticity, the pain senzitisation, the gate theory, the pain behavoir, the role of cognition and internalisation of emotions in pain perception in his slideshow as well.
Autor stresses the concept of the myofascial and visceral pain
syndrome and he tries to coin the most simplified and broadest
term: The pelvic myoneuropathy.
CHRONIC INFLAMMATORY DISEASES OF SMALL PELVIS,
THEIR INFLUENCE TO FERTILITY
Matouskova M., Hanus M.
Urocentrum, Prague, Czech Republic
The most common urological diseases in younger males are
inflammatory diseases of small pelvis, as prostatitis, orchiepididymitis, urethritis and others. Their course significantly bothers the patient himself as well as his closest ones, encumbers
account in Health Insurance Company and doesn’t add any
peace to the patient’s attending physician either. Patient with
chronic inflammatory disease comes to the outpatient’s office
4-times more often than patient with BPH or prostate cancer.
Part of clinical diagnosis in patients with inflammatory disease of small pelvis is infertility of unknown ethiology in up to
37% and erectile dysfunction in 12%.
Uropathogenic flora (gram-negative or gram-positive microorganisms) is successfully proved as ethiologic agent only in
small part of patients. Thorough laboratory diagnostics can
discover inducer in major part of diseases, after all. Great majority of them belongs to the group of STIs (sexually transmitted infections). Besides that, even the above mentioned
“uropathogens” can be included among STIs. The most common of these are Chlamydia infections, which form, with annual incidence over 90 million cases, a real worldwide problem. Yet, they do not reach the incidence of the most frequent
STI, which is the HPV infection. For STI is characteristic po-
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lysymptomatic or asymptomatic course, and this is oftentimes
in both sexual partners. During anti-microbial therapy of
“banal” problems multi-resistance develops. Significant is
a rapid increase of virus and Chlamydia infections that are curable however only with difficulties. Part of those unambiguously relates to the development of tumour diseases (HPV,
HSV, and also Chlamydiosis). Tubular infertility of females is
almost in 100% based on Chlamydia infection.
The work presents view to the complex diagnostics of STIs
and inflammatory diseases of small pelvis, findings of micro-
biological testing and examination of ejaculate. On the results
of therapy of some of STIs we substantiate complicacy of treatment and inconsistency or total absence of therapeutic guidelines. It looks like that there could be possibly active prevention established by vaccination at least in one of the
diseases. But how the virus shall act and what can we expect
from the state economics (national vaccination) – these are the
questions for the future. The main emphasis therefore has to
be put on primary prevention.
IMPORTANCE EVALUATION OF PRAESACRAL NERVES BLOCK
IN THE TREATMENT OF CHRONIC PROSTATITIS/CHRONIC PELVIC
PAIN SYNDROME
Maskova V.1, Urban M.1,2, Heracek J.1,2
1Department
2Androgeos,
of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
Prague, Czech Republic
Introduction:
Evaluation of successfulness of new therapeutic strategy (biofeedback + praesacral nerves block) compared with still used
treatment.
Material and methods:
Prospective study of 20 patients who were examined according to our given protocol: laboratory and urodynamic examinations (P/Q study), subjective evaluation of live quality and
level symptoms severity-National Institutes of Health Chronic
Prostatitis Symptom Index (NIH-CPSI), duration period of
symptoms. Urinary infection and bacterial prostatitis were
exclusion criteria.
Results:
Medium term of follow up was (17 months, range 8–26). Duration period of symptoms was 1 year to 10 years. 3 patients
(15%) were found to have obstructive voiding disorders according to P/Q study, that was further treated, equally 3 patients
(15%) were found to have overactive bladder symptoms.
14 patients (70%) with normosenzitive stable detrusor praesacral nerves block + biofeedback was accomplished.
11 patients (78.57%) gave satisfactory effect, 3 patients
(21.43%) gave no effect. Start of effect was between 1 day and
1 week, duration of effect was from 3 months to 6 months.
There were no complications.
Conclusions:
Our given therapeutic strategy is miniinvasive method with
medium-term up to long-term effect. Results showed, that patients with initial milder intensity (severity) of symptoms evaluate treatment effect favourably that is by low index than patients with longstanding, severe symptoms. Nowadays is
obvious that urodynamic examination and NIH-CPSI will
play the determinantal role as for separation of patients as for
evaluation quality, severity and prognosis of disease. To identify treatments that might help prevent acute problems from
becoming chronic, it will be the subject of continuation that
study.
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UROLOGICAL AND SEXUAL DISORDERS AFTER A SEVERE PELVIC
INJURY
Grill R.1,2, Dzupa V.1,3, Maskova V.2, Baca V.1,6, Fric M.1,4, Otcenasek M.1,5, Urban M.2
1Centre
for Integrated Studies of Pelvis, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
of Urology, 3rd Faculty of Medicine, Charles University Prague, Faculty Hospital Kralovske Vinohrady, Prague,
Czech Republic
3Department of Ortopaedics and Traumatology, 3rd Faculty of Medicine, Charles University Prague, Faculty Hospital Kralovske
Vinohrady, Prague, Czech Republic
4Department of Anaestesiology and Resuscitation, 3rd Faculty of Medicine, Charles University Prague, Faculty Hospital Kralovske
Vinohrady, Prague, Czech Republic
5Department for Mother and Child Care in Prague Podoli, Prague, Czech Republic
6Department of Anatomy, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
2Department
Introduction:
The aim of the study is a retrospective evaluation of urological and sexual chronic sequelae in patients with a pelvic injury.
Material and methods:
The followed up group comprised 86 patients (33 women and
53 men) at the age between 16 and 89 years (women’s range,
16–89 years; men’s range, 17–87 years), the average age was
39 years (women – 41 years, men – 39 years).
Results:
As compared to the fractures associated with a primary injury
to the urogenital system, the incidence of urological and sexual disorders in severe pelvic injuries (Type B fractures with
a diastasis of the symphysis exceeding 2.5 cm and Type
C fractures according to the AO/ASIF classification) was higher and this difference was significant (P=0.002).
Conclusions:
Results of the study have confirmed that the number and severity of both temporary and chronic sequelae of the urological and sexual nature depend on the severity of the injury to
the anterior pelvic segment, rather than on the number of associated injuries to the urogenital system itself.
EFFECT OF ENDOCRINE DISRUPTORS ON MAMMALIAN FERTILITY
Peknicova J.1, Novakova V.1, Buckiova D.2, Boubelik M.1
1Institute
2Institute
of Molecular Genetics, v.v.i., Czech Academy of Sciences, Prague, Czech Republic
of Experimental Medicine, v.v.i., Czech Academy of Sciences, Prague, Czech Republic
Many chemicals released into the environment can interfere
with the action of the endocrine system through diverse mechanisms in animals and humans. This includes chemicals that
occur naturally in plants such as phytoestrogens and also manmade chemicals (xenoestrogens).
In our study we selected xenoestrogens (bisphenol-A (BPA),
p-nonylphenol (NP), diethylstilbestrol (DES)) and phytoestrogens (genistein (GEN), resveratrol (RES)).
All these pollutants represent of endocrine disruptors (ED).
The effect of BPA, NP, DES, GEN and RES on the body weight, weight of different organs, sperm acrosomal status and in
vivo fertility of CD1 mice was tested in a multigenerational
study. The adult parental generation of mice and F1 and F2 generations were exposed to selected drugs for all their life.
BPA and NP had a negative effect on offspring born of mice,
on reproductive organs, and acrosome integrity of mice sper-
matozoa. Different effect was found in P, F1 and F2 generations.
The fertility of mice exposed to DES was disrupted, especially in the first generation.
Contrary to that, treatment by GEN and RES had no effect on
fertility of CD1 mice but had some effect on reproductive parameters except of sperm integrity.
Monoclonal antibodies against intra-acrosomal sperm proteins
were used as biomarkers of sperm damage.
This study was supported by EUREKA grant No. OE211 and
grants No’s 1M06011 and 2B06151 from the Ministry of Education of the Czech Republic.
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GENETIC ETHIOLOGY OF INFERTILITY
Kosarova M.
Sanatorium Pronatal, Prague, Czech Republic
Causes of reproductive disorders are heterogenous in women
as well as in men. More and more genetic causes of reproductive disorders are being reported. They can be de novo or inherited. It is important not to overlook the cause of the reproductive failure, to enable efficient treatment to be given to the
couple, as well as information about possible genetic risks to
the offsprings.
In this presentation, the numerical chromosomal disorders,
structural aberrations (intra-or interchromosomal rearrangements, microdeletions), monogenic diseases (autosomal or
sex-linked), multifactorial genetic diseases, mitochondrial disorders and imprinting disorders related to reproduction are
discussed.
ADVANCED AGE OF THE FATHER – GENETIC RISKS AND POSSIBILITIES
OF GENETIC ANALYSIS
Gaillyova R.1, Kadlecova J.1, Baxova A.2, Krepelova A.3
1Department
of Medical Genetics, University Hospital Brno, Czech Republic
of Biology and Medical Genetics, 1st Faculty of Medicine, Charles University Prague, Czech Republic
3Institute of Biology and Medical Genetics, 2nd Faculty of Medicine, Charles University Prague, Czech Republic
2Institute
New mutations can develop in every mitotic or meiotic division during spermatogenesis and oogenesis. There is a big difference between both sexes in number and timing of meiotic
and mitotic divisions. Prenatal diagnostic in pregnat with age
over 35 years oriented on detection of numerical chromosomal
abnormalities in consequence on elevated risk of non-disjunction is very well-known and recommended. Spermatogenesis
is a continuous chain of cellular divisions runing during all
live of the men. The result is about a billion of sperms. These
cells are outcome of about 30 mitotic divisions from embryonic stage up to puberty and after puberty about 20 to 25 repli-
cations every year. This process conditiones a high risk of replication mistakes and new mutations in sperms. The number
of new mutations in sperm increase with the age of the father.
This fact is known in some inherited disorders, for example in
Achondroplasia or Neurofibromatosis. High number of new
mutations, paternal origin and advanced age of the father is in
these disorders well-known. Prenatal diagnosis is very limited
in this way. We can recommend genetic counselling, ultrasound examinations of the fetus and in suspicion of bone dysplasia DNA analysis of FGFR3 gene only.
CYTOGENETICAL AND MOLECULAR GENETICAL FACTORS
CONTRIBUTING TO MALE INFERTILITY
Lonsky P., Maskova S., Bürgerova E., Siruckova K., Gregor V.
Sanatorium Pronatal, Prague, Czech Republic
Introduction:
The aim of this study was to evaluate the type and frequency
of chromosomal aberrations, Y chromosome microdeletions
and CFTR gene mutations in infertile men examined in Sanatorium Pronatal between October 2002 and September 2006.
Material and methods:
Metaphase chromosomes of 1,389 infertile men, including
130 men with azoospermia and 449 with oligozoospermia
were analysed using Giemsa-trypsin-Giemsa banding. Y chromosome microdeletions were examined using multiplex PCR
method in 607 infertile men, including 116 with azoospermia.
Genetic analysis of CFTR locus was performed using combination of multiplex PCR kit Elucigene 29 and Slavic mutation
(CFTRdel21kb) examination. This approach comprises
92.47% of all CFTR mutations in population.
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Results:
Chromosome aberrations were found in 3.2% of infertile men.
Y chromosome microdeletions were detected in 1.6% infertile men. CFTR mutations were found in 3.0% examined patients. Strong association of all three investigated parameters
with azoospermia and severe oligoasthenozoospermia when
compared with normozoospermia was observed.
Conclusions:
The high rate of abnormalities observed in studied parameters
among infertile men suggests the need for routine genetic analysis prior to employment of assisted reproduction. The role of
clinical geneticist in treatment of infertile couples is irreplaceable.
SPERM CHROMATIN DAMAGE IN FERTILE MEN
Rubes J.1,2, Rybar R.1, Markova P.3, Veznik Z.1, Svecova D.1, Zajicova A.1, Kunetkova M.1, Prinosilova P.1, Kopecka V.1
1Veterinary
Research Institute, Brno, Czech Republic
Brno, Czech Republic
3Sanatorium ART, Ceske Budejovice, Czech Republic
2Genprogress,
Introduction:
The present knowledge concerning male infertility treatment
indicates that not only basic sperm parameters refer to the quality of ejaculates, but the genetic factor quality is important as
well. A normal function of genes involved in embryonic development is essential. Disturbed integrity of these genes leads
to a failure of embryonic or foetal progress and hence to infertility.
Material and methods:
A total of 235 men from infertile couples, 91 young fertile
men and 59 men from couples with idiopathic infertility were
examined. These men were not pre-selected. Sperm chromatin
integrity was measured by the Sperm chromatin structure
assay (SCSA), based on increased susceptibility of altered
DNA (strand breaks) in sperm nuclear chromatin to in situ denaturation measured by flow cytometry after staining with acridine orange (AO). The damage was then quantified by DNA
fragmentation index (DFI) and lower levels of chromatin condensation (population of immature forms of spermatozoa) by
HDS parameter.
Results:
The lowest sperm chromatin damage was detected in young
fertile men (DFI=12.4±7.2) in contrast to the highest levels
detected in men from couples with idiopathic infertility
(DFI=18.9±10.2; P<0.01). DFI and HDS in normospermic
men were lower than in men having at least one of the sperm
parameters outside the normal range (DFI=11.8±6.4 vs.
18.8±11.1; HDS=12.9±5.9 vs. 18.5±9.2; P<0.01). Correlation
analysis indicated a possible relationship between DFI and
other parameters such as morphology (r=0.361; P<0.001) and
motility (r=-0.333; P<0.001). Sperm chromatin integrity
seems to be associated with age. The effect of smoking on
chromatin integrity was not confirmed.
Conclusions:
It follows from the present results that chromatin damage is
higher in men from infertile couples. In men from couples
with idiopathic infertility, it can be the reason of postfertilization failure.
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GENE THERAPY AND ERECTILE DYSFUNCTION
Zamecnik L.
Department of Urology, 1st Medical School, Charles University Prague, Czech Republic
Current available treatment options for erectile dysfunction
(ED) are effective but not without failure and/or side effects.
Although the development of phosphodiesterase type 5
(PDE5) inhibitors (i.e. sildenafil, tadalafil and vardenafil) has
revolutionized the treatment of ED, these oral medications require on-demand is less efficacious in some hard-to-treat populations (diabetics, men after radical prostatectomy). Recent
trials have demonstrated that gene therapy strategies may be
feasible for these purposes. Improvement in the treatment of
ED is dependent on understanding the regulation of human
corporal smooth muscle tone and on the identification of relevant molecular targets. Tissue engineering and gene therapy
are currently investigated in animal studies for reconstructing
penile tissue or treating erectile dysfunction. Future ED therapies might consider the application of molecular technologies
such as gene therapy. As a potential therapeutic tool, gene the-
rapy might provide an effective and specific means for altering intracavernous pressure "on demand" without affecting
resting penile function. Gene therapy aims to cure the underlying conditions in ED, including fibrosis. Furthermore, gene
therapy might help prolong the efficacy of the PDE5 inhibitors
by improving penile nitric oxide bioactivity. It is feasible to
apply gene therapy to the penis because of its location and
accessibility, low penile circulatory flow in the flaccid state
and the presence of endothelial lined (lacunar) spaces. Gene
therapy approaches have focused on a number of signaling
pathways that are crucial for penile erection, such as nitric
oxide/cyclic guanosine monophosphate, RhoA/Rho-kinase,
growth factors, ion channels, peptides, and control of oxidative stress. This review provides a brief insight of the current
role of gene therapy in the management of ED.
THE SURGICAL CORRECTION OF BURIED PENIS
Hartmann I., Smakal O., Student V., Vrana J.
Department of Urology, University Hospital Olomouc, Czech Republic
Introduction:
A buried penis is a normally developed penis that is hidden by
the suprapubic fat pad with inadequate attachment of the skin
to the Buck's fascia. A modified surgical technique and the results are reported.
Material and methods:
Seven boys (aged 12 months to 4 years) with buried penis underwent the surgical procedure. A circumferential incision is
made at the junction of the outer and inner prepuce. After disection of subcutaneous tissue is the inner prepuce sutured directly to Buck's fascia. The procedure is completed by reapp-
roximation of the outer and the inner prepuce. Suprapubic catheter is inserted in all cases.
Results:
No major complications after the procedure was observed. All
patients achieved satisfactory results. No patiens required
a second operation.
Conclusions:
Congenital buried penis is a syndrome which may be successfully repaired with good cosmetic results.
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ERECTILE DYSFUNCTION AND THE PARTNER’S ROLE
Sramkova T.
Traumatological Hospital of Brno, Trauma centre, Department of Traumatology at the Medical Faculty Masaryk University of Brno, Emergency service of Brno City, Czech Republic
Introduction:
Sex is a necessary part of a fulfilling relationship. Erectile
dysfunction is a source of stress for the couple. The partner’s role in the treatment of ED is often overlooked. TED
Study, a Canadian non-intervention observational study from
2006, evaluated partner’s role and it was found that 75% of the
patients had informed their partners that they were taking inhibitors PDE5, but only 12% of the partners took part in the
study. EDITS questionnaire was administered to measure satisfaction. In our clinic, we focused on the partner’s role in treatment of ED in a specific group of patients with spinal cord
injury.
Material and methods:
The sample consists of 16 partners of 16 men with ED after
spinal cord injury. Effects of tadalafil in treatment of ED were
observed. Recommended frequency of sexual activity was
twice a week and each couple kept a “log book”. Partner’s satisfaction was measured with the relationship version of
EDITS questionnaire (Erectile Dysfunction Inventory of Treatment Satisfaction).
Results:
Tadalafil treatment improved erection (GAQ) in 94 % of the
men. The same number were SEP2. Realization of a satisfactory sexual intercourse (SEP3) was confirmed by 68% of the
patients and their partners (11 out of 16).
Two-sided satisfaction was reported by 9 out of 11 couples,
i.e. 81%. EDITS index score of all partners was between 50%
and 70%. 8 out of 11 couples continue with tadalafil treatment
one year later.
Conclusions:
Paraplegic couples form a specific client group in the treatment of ED. Cooperation of partners is usual, including their
active approach to treatment. In our sample of 16 paralyzed
patients, 100% got involved in the treatment without any problems. Effects of PDE5 inhibitors are lower in paraplegics
than in common clients. In spite of that, EDITS index of partners reached up to 70%, 81% of the couples reported twosided satisfaction. Cooperation with the couple increases motivation and compliance in men with erectile dysfunction.
EJACULATION PRAECOX AND CYBERSEX
Spilkova J.
GONA – Sexuological centre, Prague, Czech Republic
Introduction:
The aim of my presentation is to discuss case study of a man
who visited my practice and claimed problems in the relationship with his wife. He discovered her contacts with other
men on her PC. He kept referring particularly to her infidelity
and consequently felt very hurt. Up to that point he was convinced that there were no problems either in their relationship
or sex life. Only during the third visit he admitted that he has
suffered from EP since the very beginning of his active sex
life.
Material and methods:
A forty two years old men come for a first visit in January
2007, apparently full of tension and depression. Following
twenty years lasting relationship which he evaluated as ”nice“,
last week he discovered that his wife was chatting with other
men on line, she developed an emotional relationship with one
of them and was sending around her pornographic images. He
claimed that there were no problems in their sex life and that
he was always the one who initiated it. In October ’06 she had
moved to her own bedroom supposedly due to her back pain.
Retrospectively he saw as the main problem in the relationship the lack of communication.
During his next visit he rather dealt with the questions of the
future of the relationship and asked if he should be giving her
one more chance. It was suggested that his wife shall visit the
practice too.
During the third visit he gradually came to the conclusion that
there must be something wrong with him for he ejaculates too
early, sometimes already before he enters the vagina, sometimes a few seconds after the beginning of copulation. Along
with a continual psychotherapy the treatment by sertralin was
applied.
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Conclusions:
With these kind of patients what is most important is exploration and of course a complex examination. This particular patient claimed his merital problems as the first point. Late tre-
atment of his EP may not safe the marriage but certainly can
contribute to better communication of the couple. In order to
sucessfully resolve this case a cooperation of his wife would
be desireable.
COMORBIDITY OF MEN WITH ED – IS ED WARNING SIGNAL
OF WEITHER DISEASE IN RELATIVELY HEALTHY MEN?
Jarabak J., Zachoval R.
Department of Urology, Faculty Thomayer’s Hospital, Prague, Czech Republic
Introduction:
ED is a prevalent conditon in men. Numerous studies have documented the association of ED with various risk factors and
other diseases. ED may be used as an early clinical marker of
vascular health and underlying comorbid conditions, particullary cardiovascular disease.
Results:
162 patients reviewed, mean age of 52 years. In 70 cases the
investigation of ED resulted into a capture of some undiagnosed abnormalities, not so far diagnosted diseases, mostly some
of cardiovascular diseases. The incident of newly diagnose
cardiovascular diseases were increasing with age.
Material and methods:
The retrospective study which evaluate the first capture of
major disease which has occured by the men who had been
primarily examined in our andrological out-patient department due to the ED.
Evalution period: January 2005 – December 2006.
Conclusions:
Detailed and complete examination of the patient with ED in
the first line provide the best change for diagnosis of hidden
undiagnosed disease, well time to decrease the probability of
complications.
It cuts down the cost of the treatment including the ED and
provides better duality of life.
EFFECTS OF AUTOEROTIC PENIS STIMULATION – CASE REPORT
Vidlar A., Hartmann I., Student V.
Department of Urology, University Hospital Olomouc, Czech Republic
Young man, (27 years old) long-term unsatisfied with moderate penis deviation to the left side has decided that he would
correct his penis deviation with forceful bending. After that he
felt extreme pain and audible crack followed by hematoma of
the penis and scrotum. The patient was examined by the urologist near residence and after one week was sent to our department. We confirmed a traumatic rupture of corpora cavernosa with no evidence of urethral injury. The rupture was
cured without surgery. During two years worse deviation developed. Finally the deviation was 5 cm to the left side and the
patient suffered from problems with sexual intercourse.
The patient was examined at our department again and he was
recommended for surgery – correction of penis deviation sec.
Nesbit. Three months after surgery patient had minimal penis
deviation, normal erection and sexual intercourse with any
problems.
In western countries traumatic rupture of corpora cavernosa is
unusual and most of the time originated from effect of penis
impact on the perineum during sexual intercourse.
In some areas of the Middle East there is common reason of
rupture an attemp to fast achieve the detumescension after masturbation (taghaandan).
In our department we solved two fractures of corpora cavernosa resulting from the manual correction of penis deviation.
In literature we have not found any analogical case.
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CONTRIBUTION OF HISTOMORPHOLOGICAL EVALUATION OF
TESTICULAR BIOPSIES TO MANAGEMENT OF AZOOSPERMIC PATIENTS
Mandys V.1, Sobotka V.2
1Department
of Pathology, 3rd Faculty of Medicine Charles Universty Prague and Faculty Hospital Kralovske Vinohrady, Prague,
Czech Republic
2Sanatorium Pronatal, Prague, Czech Republic
Testicular biopsy is one of morphological approaches used to
evaluate alterations of testicular tissue in the infertile males. In
this study we demonstrate the results of evaluation of testicular biopsies performed at our Department of Pathology over
the past 6 years. The study was carried out on 164 infertile
men, mean age 31.4 years. Simultaneously, tissue samples for
TESE were taken from the same testis. Tissue samples were
fixed with Bouin solution. Paraffin-embedded blocks were cut
and the slides were stained with H&E, blue trichrom and PAS.
Histological changes were classified into 5 categories: normal
spermatogenesis (29 cases), hypospermatogenesis (46 cases),
maturation arrest (29 cases), germinal cell aplasia (40 cases),
and germinal cell aplasia with focal spermatogenesis (11
cases). In 9 cases, exceptional microscopic finding was disclosed: Germinal cell aplasia with persistent immature
tubules (3 cases), sclerosing Sertoli cell tumour (1 case), Kallmann’s syndrome (2 cases), Klinefelter’s syndrome (1 case),
intratubular germ cell neoplasia (1 case), and seminoma
(1 case). The results of histological evaluation were in all
cases compared with clinical and laboratory findings and with
the results of TESE. Our study give evidence testicular biopsies represent a useful method to classify pathologic changes
and to identify presence of spermatozoa and spermatids within
the testicular tissue.
INHALATIONAL ANAESTHETICS AND RISKS FOR HUMAN
REPRODUCTION
Malek J.
Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University Prague and University Hospital Kralovske
Vinohrady, Prague, Czech Republic
Millions of people are exposed to inhalational anaesthetics
(IA) either as patients or medical professionals. IAs are not
chemically inert and may impose deleterious effects on various functions including reproduction. Probably the most extensively studied agent is nitrous oxide (N2O) that may influence rapidly growing cells including sperm and fetal tissues.
N2O is still the most frequently used IA. Risk groups are patients in reproductive age, mainly pregnant women undergoing
surgery, medical staff and patients elicited for in vitro fertilisation.
Exposition to N2O has been studied in experimental animals
to simulate both occupational and surgical exposures. Very
high and long exposition resulted in increased incidence of
fatal abnormalities. On the other way extensive study performed in 1973–81 in pregnant patients confirmed only increased
early postnatal death when an operation occurred during 2nd
and 3rd trimester, but not during the 1st trimester with no particular type of anaesthetic identified.
Several studies in 60th and 80th identified increased risk of
abortion and difficulties with fertility not only in women working at surgical theatres, but also in women whose partners
were exposed to inhalational agents. Recently, the increasing
popularity of in vitro fertilisation has afforded to study the effects of anaesthetics in details. Various anaesthetic regimens
have been examined for their effect on rates of fertilisation
and cleavages of oocytes, pregnancy and carriage to term.
There was no difference among various types of inhaled anaesthetics, but in one study general anaesthesia resulted in significantly lower clinical pregnancy rate than local anaesthesia
methods. Several studies have examined the effect of inhaled
anaesthetics on sperm, but no significant differences were
found between exposed and non-exposed men. We can summarise, that with modern anaesthetics and scavenging systems
the risk of general anaesthesia for reproduction is extremely
low.
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NONHORMONAL METHODS OF MALE CONTRACEPTION
Heracek J., Urban M.
Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
Androgeos, Prague, Czech Republic
The methods devised for male contraception are seldom. The
authors summarize various nonhormonal methods of male
contraception which are currently available – vasectomy, noscalpel vasectomy, biomedical devices, intravasal thread, copper wire and electric device, Bionyx control valve, tantalum
clips, percutaneous injection of sclerotic and non-sclerotic
chemical agents and injectable or non-injectable plugs. The
authors evaluate essential criteria of methods – safety, efficacy, economy and complete reversibility.
PAEDIATRIC VARICOCELE – INDICATIONS FOR EARLY SURGICAL
REPAIR: A PROSPECTIVE STUDY
Kocvara R.1, Dolezal J.2, Dite Z.1, Sedlacek J.1, Dvoracek J.1, Stanek Z.2, Novak K.1
1General
University Hospital and 1st Medical School, Postgraduate Medical School, Prague, Czech Republic
of Urology, Hospital Ceske Budejovice, Czech Republic
2Department
Introduction:
Indications for paediatric varicocelectomy remain controversial. A project has been designed to determine indication criteria related to testicular hypoplasia, varicocele grade and pubertal stage.
Material and methods:
Between 1997–2004, 166 patients, 14.6 y of age, were ∅ with
varicocele grade II-III, 8.1 to 17.4 y prospectively assigned
into three research groups. Patients without significant testicular asymmetry (atrophy index AI < 4.3) were assigned to
∅ 25 %, surgery – Group 1 (41), or to conservative treatment
– Group 2 (55); patients with significant testicular asymmetry
(AI > 29.4) or bilateral ∅ 25 %, varicocele were assigned to
surgery – Group 3 (52) or assigned (retrospectively) to conservative group – Group 4 (18) if the planned surgery was not
performed. Laparoscopic varicocelectomy was performed
with lymphatic sparing (LS) or without (LNS). Mean followup: 3.6 y (range 1 to 8).
Results:
No differences in hormonal and sperm parameters were found
between the groups 1 and 2. After the LS repair in the group 1,
higher fast progressive motility (45.0 % versus 29.2 %;
P=0.02722) and better sperm morphology (57.0 % versus
45.4; P= 0.01549) were achieved in comparison with LNS repair. Higher sperm concentrations (73.8 versus 43.5 mil/mL;
P=0.02081) and higher fast progressive motility (38.3 versus
28.0 %; p= 0.02885) were found in the group 3 as against to
the group 4. After the LS repair in the group 3, higher stimulation LH levels (17.7 versus 9.1 IU; P=0,03455) were detected in varicocele grade III (versus grade II), better sperm
morphology was found in patients operated during pubertal
stage I–III in comparison with the pubertal stage IV–V (58.0
versus 49.8 %; P=0.01658).
Conclusions:
Paediatric varicocele with asymmetrical testes (especially
grade III) shows as serious and progressive disease already
during adolescence and should be indicated for early lymphatic-sparing repair; in symmetrical testes observation until reliable sperm analysis is appropriate.
Supported by grant IGA MHCR No 6983-4, 8817-4.
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PROTRACTED LATE AUTONOMOUS DYSREFLECTION AFTER TESE
IN A PATIENT WITH HIGH SPINAL LESION
Sutory M., Sramkova T.
Traumatological Hospital of Brno, Trauma centre, Department of Traumatology at the Medical Faculty Masaryk University of Brno,
Emergency service of Brno City, Czech Republic
Introduction:
Development of autonomic dysreflexia (AD) is described in
patients with high transversal spinal lesion – above the level
C6. While applying methods of assisted reproduction, AD is
described at performing artificial ejaculation – vibrostimulation or electroejaculation.
We have not found any references to occurence of AD in connection to TESE in the Medline database.
Material and methods:
A 32-year-old patient, 16 years after injury with a spinal lesion at the level C6, was admitted to have TESE performed
under spinal anesthesia. The procedure was without complications. A permanent urinary catheter was introduced, which the
patient had no problem torelating in the past.
Once the effects of anesthesia subsided, autonomic dysreflexia developed – anxiety and restlessness, profuse sweating on
the upper half of the body with gradual increase in blood pressure up to values of 220/130, massive macroscopic hematuria
appears. Upon introduction of complex pharmacotherapy re-
gimen, there is only partial stabilization of the condition. Final
normalization of the condition occurs 60 hours after extraction of the permanent urinary catheter, which had been left there
before due to danger of tamponade of the urinary bladder.
Further course was without complications.
Results:
Overall high reflex activity in a patient with a high spinal lesion, along with a long-term poor bladder emptying and a surgical procedure in an exceptionally strong reflexively active
area, lead to the development of AD, which was managed only
after removing all offending stimuli from the pelvic area and
after consistent complex pharmacotherapy, i.e. after consistent
administration of analgesics, anxiolytics and a combination of
antihypertensitives.
Conclusions:
Performing TESE on patients with high spinal lesion can be
accompanied by AD not only directly during the surgical procedure, but also in postoperative period.
WORK IN THE QUALITY MANAGEMENT, IMPLEMENTS,
BENEFITS AND IMPACTS ON A MEDICAL INSTITUTION
Sobotka V., Mardesic T., Brokesova M., Dvorakova J.
Sanatorium Pronatal, Prague, Czech Republic
The authors demonstrate on the Sanatorium Pronatal where
there has been working in the Quality Management System for
more than 7 years its positives, necessary implements with the
aim of functional system maintenancing and the negative impacts on a medical institution.
Furthermore, the authors explain basic conceptions – certification and accreditation – and demonstrate it on the documentation concerning to the individual standards.
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INTERNATIONAL EXPERIENCE IN THE CERTIFICATION OF MEDICAL
INSTITUTIONS
Kohl H.
CEO of LGA InterCert and TÜV Rheinland Cert, Nürnberg and Cologne, Germany
The certification of medical institutions of all kinds reaching
from university clinics over medical centres, care centres,
pharmacies etc. became a topic on the international market of
health care. The LGA InterCert deals with around one thousand clients in health care industry.
The talk will give an overview about current tendencies and
certification standards in the different medical areas. Specific
attention to the field of IVF will be stressed.
HAVE THE ISO STANDARDS OVERRANGED THE AMBIT OF EUROPE?
Gagsteiger F.
IVF-Zentrum Ulm, Germany
Abstract not submitted at the time of printing.
CONSERVATIVE TREATMENT FOR THE PEYRONIE’S DISEASE – USE
OF LOW-POWER LASER
Horak A.1, Fojtik P.2
1ANDROPHARM,
2Urological
Urologic–andrologic outpatients’ clinic, Ostrava – Poruba, Czech Republic
Department, University Hospital Ostrava, Czech Republic
Peyronie’s disease /PD/ is characterised by penile plaque formation, (which can be painfull at the beginning), by penile deviation and erectile dysfunction. Incidence is 66 in 100 000
men, aged 50–59 years, over 60% patients with PD are 40–60
years of age. Histologically it is classified as a benign fibromatosis belonging to those of Dupuytrene type. It is of unknown origin, a few theories come into account – traumatic,
genetic and infectious. Basic tools for establishing diagnosis
are case history, findings on palpation, picture or CIS-test,
USG (5–7.5 MHz). Conservative treatment consists of peroral, physical, alternative forms and of substances injected into
plaque. Modalities can either be a single therapy or combined.
Peroral drugs available in Czech Republic are tocopherol, tamoxifen, colchicin and POTABA. Drugs for injecting are corticosteroids, verapamil and interferon α-2b. Alternative treatment offers low-power laser /LPL/ in monotherapy or
combined with the above mentioned drugs. The effects of LPL
are analgesic, anti-inflammatory, vasodilating and biostimulating. Plaque reduction as high as 88% in monotherapy and
total remission in 74% of the patients with combined therapy
using verapamil, has been described. Evaluation of conservative treatment results for PD are still subject of controversy.
Different results stem from heterogenity of cases regarded as
PD. Better results are achieved in earlier stage of the disease.
Advantage of conservative treatment is low morbidity, possibility of combined models of treatment and ability to repeat
the procedures. Disadvantages are unsure final effect and treatment duration. LPL has its place in monotherapy or combined, as it is minimally invasive, repeatable and accessible. To
date there is no definite modality for PD treatment. Patient
should be offered as many conservative modalities as possible, and finally after failure, start to opt for surgery. Psychotherapeutic approach is also part of the treatment plan.
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LOCAL APPLICATION OF VERAPAMIL IN THE TREATMENT
OF PEYRONIE'S DISEASE: OUR EXPERIENCE IN 12 PATIENTS
Zamecnik L.
Department of Urology, 1st Medical School, Charles University Prague, Czech Republic
Introduction:
Induratio penis plastica – Peyronie's disease (PD) is characterized by presence of fibrous plaques in the tunica albuginea of
penis. Aim of study: To evaluate the role of intralaesional injections of verapamil in the treatment of PD and its success
rate.
the dosage of 5 mg directly into the plaque for 8–30 times
(average 17 times), in the interval of one week. The subjective condition and clinical finding following the application
were assessed. Change of curvature, pain improvements and
change of the plaque consistence and size as well as the degree
of seriousness of side effects were analyzed.
Material and methods:
From December 2005 to February 2007 a total of 12 patients
were treated with local intralaesional application of verapamil.
Patient's age was 37–62 years (average: 50.2 years) and the
average duration of the disease was 4.1 years. Indication for
the treatment was symptomatic penis plaque not responding to
previous oral medical therapy. Besides palpation, measurement of the size and localization of plaque and evaluation of
calcifications were carried out by means of ultrasound. Plaque
size was 1.0– 2.5 cm (average 1.4 cm) and calcifications were
in 2 cases. Verapamil (Lekoptin® 5 mg/2 ml) was injected in
Results:
Subjective improvement was noted in 9 patients (75%), penile curvature decreased in 8 patients (66.5%), pain during erection disappeared in 9 patients (75%) and change of the plaque
consistence and size was found in 7 patients (58.1%). Side effects were not recorded.
Conclusions:
Intralaesional application of verapamil in PD is relatively effective, safe and very well-tolerated approach for local treatment.
OUR EXPERIENCE IN LOCAL APPLICATION OF THE VERAPAMIL
IN PATIENTS WITH INDURATIO PLASTICA PENIS
Hrabec M., Student V.
Department of Urology, Teaching Hospital Olomouc, Czech Republic
Introduction:
The aim of the study is to evaluate our experience in local application of the verapamil in patients with induratio plastica
penis (IPP). Indication of the treatment was the IPP without
effectiveness of oral pharmacotherapy.
Material and methods:
Between November 2005 and March 2007 we have treated
9 patients with local applications of the verapamil into the le-
sion of the penis. Average age was 56 years (50–59 years). We
have instillated verapamil (Lekoptin) in dose of 5 mg (2 ml) in
1–2 weeks periods up to the maximal dose of 120 mg.
Results:
We have found pain relief in all 9 (100 %) patients. The lesion was softer in 6 patients (67 %), reduction of the curvature
of the penis was found in 2 (22 %) patients. There were no
local or general adverse events.
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SELF-INJECTION OF FOREIGN MATERIAL UNDER PENILE SKIN
Macek P., Zamecnik L., Pavlik I.
Department of Urology, General University Hospital and 1st Faculty of Medicine of Charles University, Prague, Czech Republic
Introduction:
Authors present 2 cases of self-injection of foreign material
under penile skin aimed to increase a diameter of penis.
Material and methods:
Patient 1, age 35. Three weeks before presentation he self-injected a liquid paraffin under the skin of the whole penis from
several punctures. Total amount was unknown. He presented
due to difficult voiding, swelling and mauve colour of a foreskin, pain and fever up to 38 degrees. US showed no obvious fluid collection, thickened subcutaneous tissues only,
erectile bodies intact. Patient was admitted, broad spectrum
ATB administed and suprapubic tube inserted. As no clear improvement was noted within 24 hours complete circumcision
was performed. Patient went well post-operatively, voided
spontaneously. Histology showed acute tisseue inflammatory
reaction.
Patient 2, age 25. He self-injected warmed Framykoin® ointment under the penile skin in 2002 without acute complications. He was complication free in 2006, but requested a remo-
val of a subcutaneous granuloma due to unattractive appearance. US showed several encapsulated deposits on the left lateral side in the middle of the penile shaft, erectile bodies intact. Surgical removal was carried out using a degloving
technique and uncomplicated post-operative course. Histology showed giant-cell granulomatous reaction.
Results:
Both patients required surgical management following a selfinjection of a foreign material under penile skin due to a complication or patient’s request. Postoperative course was uncomplicated in both cases.
Conclusions:
Self-injection of foreign material under the penile skin is usually followed by complications arising from a tissue inflammatory reaction or a granulomatous reaction to foreign bodies/material. These complications often lead to immediate or
delayed surgical intervention.
CONGENITAL LATERAL PENILE CURVATURE AND PRIMARY ERECTILE
DYSFUNCTION
Palascak P.1, Gomez-Orozco W.1, Sauvain J.L.2, Nader N.1
1Urology
2Imaging
Department, CHI Paul Morel, Vesoul, France
medical center, Vesoul, France
Introduction:
Lateral penile curvature is an uncommon situation in postadolescent males caused by disparity in the size of the corpora cavernosa with consecutive primary erectile dysfunction.
Methods:
A 24 year-old man was evaluated for lateral penile curvature
at the time of erection and unsatisfactory intercourse. Doppler
sonography showed a hypoplasia of the left corpora cavernosa. This detection led to correction of erectile deformity by
shortening the opposite side of the penis as described by Nesbit.
Results:
The results of surgical correction of this genital deformity
have been excellent without penile shortening and intercourse
was satisfactory.
Conclusion:
Normal elasticity of the tissue layers of the penis and the size
of the corpora cavernosa are critical for erectile function. In
our young patient congenital deformity causes more psychological distress than physical disability. The results of surgical
repair of lateral penile curvature by the excision of an ellipse
of tunica albuginea in our patient have been excellent without
formation of scar tissue, without penile shortening and with
satisfactory intercourse.
Everything would be fine, if it wasn’t for the penis.
Jean-Paul Aron
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COLOR AND POWER DOPPLER SONOGRAPHY WITH 3D
RECONSTRUCTION: INTEREST IN VASCULOGENIC CAUSES
OF ERECTILE DYSFUNCTION
Sauvain J.L.1, Palascak P.2, Gomez-Orozco W.2
1Imaging
2Urology
medical center, Vesoul, France
Department, CHI Paul Morel, Vesoul, France
Introduction:
To assess the role and information provided by color and
power Doppler sonography with 3D reconstruction in erectile
dysfunction.
Material and methods:
47 patients presenting erectile dysfunction and undergoing
Doppler evaluation with injection PGE1 20 mcg were included. In each patient corpus cavernosum and spongiosum with
their fascial layer and tunica albuginea were explored with 2D
imaging. Iliac, internal pudendal (penile) artery, intra cavernosal and dorsal vessels were studied with pulsed, color and
power Doppler with 3D reconstruction.
rial occlusion of intra cavernous artery found in 26 cases: in
these cases 3D vascular reconstruction provides interesting information about the quality of anastomosis as well as of dorsal-cavernosal perforators. 16 patients presented an abnormal
response: 9 with arterial insufficiency (4 proximal and 5 distal), 2 with venous leak, Peyronie‘s disease was diagnosed in
two patients. At lest, we found 1 post traumatic arterio venous
fistula and 1 unilateral congenital hypoplasia of corpus cavernosum.
Conclusion:
Color and power Doppler evaluation is an effective and as
well as cost-effective method to explore vasculogenic causes
of erectile dysfunction.
Results:
In all patients explorations were correctly performed. A normal response was noted in 37 patients in spite of partial arte-
PRESERVATION OF ERECTILE FUNCTION IN PATIENTS
WITH PROSTATE CARCINOMA
Lent V.
Department of Urology, St. Nikolaus – Stiftshospital, Andernach, Germany
Introduction:
In patients with prostate carcinoma erectile function is preserved best by early diagnosis in the stage of organ-confined carcinoma and by nerve-sparing prostatectomy avoiding potency
destroying procedures like radiotherapy and androgen blockade.
Results:
The earlier the diagnosis of the carcinoma of the prostate is
made and the better the patients are operated upon the better
success can be achieved concerning tumor control avoiding
potency destroying procedures and so preserving erectile
function.
Material and methods:
The patients of our institution were reviewed after early diagnosis using PSA-test (cut off ≥ 2.5 ng/ml or velocity per year
≥ 0.75 to 1.0 ng/ml) and after nerve-sparing retropubic prostatectomy using magnification loupes and power headlight. The
rates of tumor control, continence and potency were summarised by a new formula of success.
Conclusions:
Criteria of success in treatment of patients with prostate carcinoma are not only the mortality rate but also the chance of
early nerve-sparing prostatectomy avoiding primary or secondary potency destroying therapies like radiotherapy or androgen blockade.
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ANDROGEN SUPPLEMENTATION: POTENTIAL RISKS
FOR THE PROSTATE OF AGING MALE
Marencak J.
Department of Urology, Hospital with Policlinic Skalica, Slovakia
The elderly population is the fastest growing age group and
a considerable attention is needed. Androgen decline represents one of the most important medical aspects of elderly.
Testosterone Deficiency Syndrome (TDS) is a clinical and
biochemical syndrome which results in significant detriment
in the quality of life and adversely affects the function of multiple organ systems. The patophysiology of T decline in elderly is not yet completely defined. Potential mechanisms include reduced hypotalamic GnRH outflow, impaired testicular
steroidogenesis and altered sex – steroid negative feedback.
Androgen pharmaceutical worldwide marketplace is largely
changed during last years by indroduction of new oral and
transdermal formulations. T supplementation is safe and efficacious in improving symptoms associated with androgen deficiency. Risks of androgen replacement therapy (ART) are
mild and contraindications for T treatment well defined.
A close monitoring during T administration is needed and timing and modalities are very well indicated. One of the most
controversial aspects of the ART remain the effect of T on pro-
state functioning. To date, prospective studies have demonstrated a low frequency of prostate cancer in association with
T replacement therapy (TRP). Current standard of practice established categorically that the administration of androgen is
absolutely contraindicated in men suspected of or harbouring
prostate and breast cancer. This includes those with an abnormal digital rectal examination (DRE) and/or abnormal prostate specific antigen (PSA), in whom the diagnosis of carcinoma has not been excluded beyond doubt. The presence of
prostatic intraepithelial neoplasia (PIN) represents a major
controversial condition.
Conlusions:
There is not now – nor has there ever been – a scientific basis
for the belief that T causes prostate cancer to grow. Larger –
scale and longer – term data are needed on the effects of T treatment in the older population to confirm safety on specific
risk data on the prostate and cardiovascular systems.
LUTS ASSOCIATED WITH BHP – IS IT A RISK FACTOR FOR SEXUAL
DYSFUNCTION?
Palascak P.1, Gomez-Orozco W.1, Sauvain J.L.2
1Urology
2Imaging
Department, CHI Paul Morel, Vesoul, France
medical center, Vesoul, France
Introduction:
To produce a synthesis of data from several studies concerning
LUTS associated with BHP and sexual dysfunction consecutively.
Material and methods:
We evaluated the prevalence of sexual dysfunction from main
studies in a comprehensive number of randomized or
LUTS/BHP patients. Main studies involving large number of
patients and carried out by a cross-section method. Moreover
we analysed physio-pathological mechanisms common in
LUTS/BHP patients suffering from sexual dysfunction.
Results:
Epidemiological studies confirmed prevalent relations between LUTS/BHP and sexual dysfunction.
Conclusion:
LUTS/BHP, as a predictive factor of erectile insufficiency, is
largely described with a view to improving the strategy of diagnosis and treatment of this problem. The detection of prevalent physio-pathological mechanism common to those two
pathologies resulted in more effective and appropriate treatments.
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CORRECTIVE SURGERY OF MALE EXTERNAL GENITAL ORGANS
Heracek J., Urban M.
Department of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
Androgeos, Prague, Czech Republic
Surgery to the external genital is one of the most challenging
chapters of reconstructive urology. Authors review surgical
methods for correction of penile size and Peyronie’s disease.
Penile lengthening is performed for a variety of reasons, some
cosmetic and some medical. Surgical treatment of
Peyronie’s disease is reconstructive surgery by either lengthe-
ning the concave side (incision and grafting) or shortening the
convex side (Nesbit procedure or plication) of the penis, and
implantation of penile prosthesis with or without incision of
the plaque. The authors evaluate indication, results and complications of methods.
CORRECTIVE SURGERY OF FEMALE EXTERNAL GENITAL ORGANS
Roztocil A.
Department of Gynecology and Obstetrics, Jihlava Regional Hospital, Czech Republic
The defininition of the corrective surgery is the performance of
the surgical procedures that modify the form and the functions
of the tissues and organs. In the case of external genital organs
in women the delimitation of the area of interest is the upper limits of vulva cranialy, laterally fossae genitocruralis and dorsaly the perineum. From the visceral point of view the margin
is the hymen. This type of surgery is an interdisciplinary one as
what concerns the area of interest and the medical speciality.
The external genital organs in women neighbor with the distant
parts of the urinary system and the aboral end of the digestive
tract. The surgical procedures may be performed either by gynecologist or in collaboration with esthetic surgeon or urologist. The targets are the following: to reestablish the normal
functions of the external genitalia and the neighboring organs
namely the sexual functions and the the functions of the excretory organs, the elimination of the pathologic resistance, is the
part of the oncogynecological therapy, the esthetics of genital
organs and to reach the psychological well being of the patient.
Among the numerous surgical procedures performed on the female external genitals the following are the most frequent: enlargement of the hypoplastic vaginal outlet, surgical treatment
of condylomata accuminata, pseudocystis of the Bartolin
gland, sutura episiototomiae male sanata, descensus vaginae,
the hypotrophy of labia minora, adrenogenital syndrome, vaginal agenesis, hymen malformations, female genital mutilation
(FGM) in African women, and vulva tumors.
PENILE PROSTHESIS IMPLANTATION – PATIENT’S EVALUATION
IN LONG TERM FOLLOW UP
Pacik D., Khamzin A.
Department of Urology, University Hospital Brno, Medical School of Masaryk University, Czech Republic
Introduction:
Penile implantation is the most invasive but still the most effective choice of erectile dysfunction treatment. Its role is very
often not mentioned to patients suffering by erectile dysfunction who failed less invasive methods of treatment, because
physicians do not have enough experience with that therapy.
Material and methods:
Authors represent own series of 65 patients operated on in the
period 1992–2002 and followed up 5–15 years (mean 10.6
years). Patients have been questioned by specific questionnaire created by authors.
Results:
97% of patients answered that prosthesis fulfilled their expectations, ability of sexual intercourse has been in 100% better,
frequency of intercourse increased in 80% of patients, self-esteem improved (in sexual activities in 100% in social activities in 81% in professional activities in 74%), relationship with
partner improved in 93% of patients, sexual activities evalua-
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ted by partner are better in 90%. 97% of patients would recommend that procedure to the other patient and 97% would
undergo surgery again in the case of repeated decision making.
Conclusions:
Penile prosthesis implantation is invasive but very effective
treatment alternative and brings high satisfaction to properly
selected patients and their partners. Specialists should keep it
in mind and recommend as option to patients in whom less invasive treatment fails.
EARLY DETECTION OF PROSTATE CANCER (KAPROS II.)
IN OLOMOUC REGION – FIRST RESULTS
Student V.
Department of Urology, University Hospital Olomouc, Czech Republic
Introduction:
Secondary prevention of prostate cancer in Olomouc region in
age range 40–70 years. Similar study in Czech population was
not so far done.
Material and methods:
Prospective study with 362 respondents in Olomouc region
within July 2006 till March 2007. Men were informed by
a medial campaign in local press, they were given the oportunity of testing the PSA level free of charge and without any
medical recommendation at the dpt. of urology. After checking their PSA level, the basic urological examination was
done and according to the results the prostate biopsy was
eventually offered.
Results:
The data showed, that average age in tested men was 61.5
years (range 39–85 years) and average age of men with prostate cancer was 63.8 years (range 49–85 years).
Average PSA level of all tested men was 11.02 ng/ml
(1.3–258) and in men with PSA level under 50 ng/ml was
average PSA level 8.6 ng/ml (1.3–37.2).
Prostate biopsy was done in 243 men. Prostate cancer was
proved in 57 cases (23%).
PSA level in cases with positive prostate biopsy (table):
Conclusion:
Our results conclude advisibility of prostate cancer early detection, as a secondary prevention of prostate cancer. Male population is still not well informed about the risks of having
PSA level (ng/ml)
<3
3-4
4-5
5-10
10-20
20-30
>30
Positive biopsy cases
2
5
4
15
18
8
5
Gleason sum
2+3
3+2
3+3
3+4
3+5
4+3
4+4
4+5
5+4
No. of cases
9
1
13
19
1
3
1
8
1
a prostate cancer especially in population aged 50–60. The detection of prostate cancer in 7 cases with patients with PSA
level <4.0 ng/ml proves that “normal level” of PSA does not
exist. It is necessary to find out the PSA velocity (PSAV) in
lower levels of PSA.
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ROBOTIC-ASSISTED RADICAL PROSTATECTOMY (DA VINCI
PROSTATECTOMY – DVP)
Kocarek J., Köhler O.
Department of Urology, Central Military Hospital Prague, Prague, Czech Republic
Introduction:
The prostate cancer is significant cause of morbidity and mortality in the all advanced countries and in total the second most
common cancer in men. On the present is possible to treat
completely the patients suffering from localized prostate cancer. As the first way of treatment of localized prostate cancer
is usually accepted the radical prostatectomy (RP).
The aim of treatment is the radical tumor extirpation, the preservation of the erectile function and the urinary continence.
Radical retropubic approach is the most common form of prostatectomy performed today. The outcome of operation depends not only on the surgeon’s training, but also predominantly on the practical interpretation. Regarding lack of
operation space in retropubic approach, high vascularisation
of prostatic gland, importance of preserving of neurovascular
bundles, urinary bladder neck and urethral sphincter is the radical retropubic prostatectomy recognized as one of the most
difficult surgical operations.
Laparoscopic approach has been developed for better visualization, minimal invasivennes and decrease of post-operative
morbidity associated with open RP. Laparoscopic radical prostatectomy requires considerable skills and has a lengthy learning curve, with long initial operating times. A lot of limitations of conventional laparoscopic approach can be overcome
by the robotic surgical system da Vinci – da Vinci RP (dVP).
Aim: Presentation of therapeutic outcomes of 80 dVPs performed at the Department of Urology in the Central Military
Hospital Prague in the last year.
Material and methods:
dVP was performed in 80 patients with clinically localized
prostate cancer in the period from January 2006 to February
2007. In 76 patients we used extraperitoneal surgical approach
and in 4 patients transperitoneal approach. All procedures
were performed by the four-arm robotic system da Vinci (Intuitive Surgical, California, USA). dVP was done in the retrograde manner in twenty-degree oblique position of the patient
(Trendelenburg).
We make a preperitoneal space digital dissection throw the
small incision under the navel. Two robotic ports we set up
under the digital control in the right hypogastrium, third robotic port and the assistant port we set up in left hypogastrium. Robotic camera we set to under-navel incision. In case of
transperitoneal approach we set up all the port in the same
place directly into the peritoneal cavity under the visual con-
trol after insufflations of CO2. The fibroadipose tissue covering the prostate is carefully dissected away to expose the pelvic fascia, puboprostatic ligaments, and superficial branch of
the dorsal vein. We do the robot assisted endopelvic fascia incision in both sides of prostate, stitch the ligature through the
dorsal vein complex. After we open the bladder neck, identify the deferents and excise the seminal vesicles. The key
point is the identification and preservation of the neurovascular bundle. Lateral pedicles we clamp with the hemo-lock
clips and excise them. After division of the prostate and rectum we transect the urethra as close to the apex as possible.
The prostate we put into the extraction sack and we remove it
out via the under-navel port. Urethrovesical anastomosis was
closed by the continuous suture with the both side needles.
Procedure was finished by the drain insertion and suture of
the incisions.
Results:
In this study we compare the group of the initial 40 dVPs (1st)
and the group of the next 40 procedures (2nd). The operating
time in the 1st group was in average 260 minutes (150 – 450
min.) and the blood loss was 410 millilitres (100 – 4800 ml).
In the 2nd group was the average operating time 170 minutes
(110 – 230 min.) and the blood loss 70 millilitres (30 – 340 ml).
The preparation of the preperitoneal space takes at average
5 minutes, the wiring of robotic system and set up of robotic
arms 10 minutes in the 2nd group.
The main aims of radical robot assisted prostatectomy are the
reduction of blood loss, to decrease post-operative morbidity,
reduction of the in-patient period and markedly break short the
patient recovery including period of bladder catheterization.
This method is safe as well for patient with high body mass
index. The different outcomes in the first and the second group
are due to learning curve.
Conclusions:
In short staff-training period it is possible reach good surgical
outcomes by the da Vinci robotic system assistance comparable to open retropubic RP. The main advantages are lower
blood loss, shorter in-patient period and patient recovery and
shorter period of bladder catheterization.
Compared to laparoscopic RP the main benefit is much shorter learning curve. The main benefits of the preperitoneal surgical approach are a lack of blood and urine in the peritoneal
cavity and the lower chance of intraperitoneal organs injury.
The main drawback of the dVP is the cost.
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OUR FIRST EXPERIENCE WITH PRESERVATION OF THE PROSTATIC
FASCIA (VEIL OF AFRODITA) DURING DA VINCI ROBOTIC
LAPAROSCOPIC RADICAL PROSTATECTOMY
Kolombo I., Beno P., Toberny M., Cernohorsky S., Bartunek M., Tobias J.
Centre of Robotic Surgery and Urology, Hospital Na Homolce Prague, Czech Republic
Introduction:
Recovery of sexual function after anatomical nerve sparing radical prostatectomy is variable. New technique with preservation of the prostatic fascia (veil of Afrodita) can improve results of postoperative potency.
Material and methods:
5 potent patients underwent robot assisted laparoscopic radical prostatectomy with preservation of the prostatic fascia
from September to December 2006 for clinically localized
prostate cancer (PSA <10 µg/l, Gleason <7, IIEF >17, cT1c).
In the study group clips were used for control of vessels in the
prostatic fascia and prostatic pedicles. No coagulation was
used. Articulated cold da Vinci robotic scissors were used for
separating the prostatic fascia from the capsule of prostate. Perioperative data and first postoperative result were prospectively recorded. Early postoperative potency (defined as achievement of erections strong enough for penetration with or
without oral medications) after 3 months was assessed.
Results:
No intraoperative or postoperative complications occurred in
the study group. Positive margins were in 1 case (pT3). In
control 2 patients indicated that they achieved erection adequate for intercourse with/without PDE5I. Recovery of potency with improved erection but still not strong enough for penetration is observed for another 2 patients. One patient
remain impotent in spite of PDE5I oral medications.
Conclusions:
The prostatic fascia sparing da Vinci robotic radical prostatectomy is safe and feasible, and allows enhanced preservation of
cavernosal neurovascular tissue. This new technique is promising especially for potent patients with clinically localized
prostate cancer.
CASE REPORT OF PROSTATIC CANCER WITH METASTASIS AND LOW
PSA LEVEL (PSA, IS IT STILL A GOOD MARKER FOR PROSTATE
ADENOCARCINOMA)
Yaghi M., Jirasek E.
Department of Urology, Chomutov Hospital, Czech Republic
70 years old man was admitted to Internal medicine department for staging of colorectal Carcinoma and Colonoscopy,
on per rectum examination which was performed by surgent.
There was a huge mass obstructing the lumen of the rectum,
PSA level was 1.14 a year ago. On Computer Tomography,
dorsally to the urinary bladder there was a huge nonhomogenic mass sized 11 cm x 9 cm x 10 cm, prostate and seminal vesicles were not differentiated, the mass is leing on the dorsal
wall of the urinary bladder, the lumen of rectum is norrowed
irregularly and deviated to the right side, the wall of rectum is
filled by the patological mass. On Ultrasound there were enlarged retroperitoneal lymph nodes and expanding mass between the prostate and ampulla of rectum. Colonoscopy was
performed, there was a Cauliflower-like tumor, fragile and
bleeding, filling the ampulla of the rectum, 2 biopsies were
taken from the mass during colonoscopy, according to histo-
logy there were tumor cells growing into the rectum from the
Urogenital tract. Cystoscopy were recommended by the pathologist. Then the patient was transported to our department.
We have performed flexible Cystoscopy without distinctive
findings, sextant biopsy has been done later. Histology showed that it is prostatic tumorous cells, the PSA was 5.4 at time
of diagnosis, according to Imunohistochemistry. It was Desmoplastic Carcinoma of prostate, on Bone scan there were
suspecious pathological findings on the right shoulder joint
and the head of the left femur, the pacient was sent later to
Oncology department for Radiotherapy.
Examinations and Radiological findings
Abdominal Ultrasound:
1 – Slight Hepatomegaly
2 – Retroperitoneal lymphadenopathy – paraaortal
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Eur Androl Suppl 2007;1(1):58
3 – Parapelvic cysts on both kidneys
4 – Suspected diverticle of Urinary bladder
5 – Expanding mass in pelvis between prostate and ampulla of
rectum
Lungs x-ray: without pathological findings.
CT of pelvis:
1 – Huge Tumorous mass dorsally to the urinary bladder,
infiltrating nearby organs
2 – Pelvic and retroperitoneal lymadenopathy
3 – Suspected diverticle of the urinary bladder
2 – Internal Hemorrhoids
3 – Diverticulosis of sigmoidal colon
Bone Scan:
1 – suspected Tumorous changes in the region of right
shoulder joint and the head of left femur
2 – degenarative changes on the spine
Histology from rectum:
Tumorous cells growing in the rectum from the Urogenital
tract.
Colonoscopy:
1 – Cauliflower-like tumor, fragile and bleeding, filling the
ampulla of rectum
TISSUE AND SERUM LEVELS OF PRINCIPAL ANDROGENS IN BENIGN
PROSTATIC HYPERPLASIA AND PROSTATE CANCER
Heracek J.1, Hampl R.2, Hill M.2, Starka L.2, Sachova J.1, Kuncova J.3, Eis V.4, Urban M.1, Mandys V.4
1Department
of Urology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
of Endocrinology, Prague, Czech Republic
3Department of Surgery, Division of Urology, St. Chiara Hospital, University of Pisa, Italy
4Department of Pathology, 3rd Faculty of Medicine, Charles University Prague, Czech Republic
2Institute
Introduction:
Androgens are considered to play a substantial role in pathogenesis of both benign prostatic hyperplasia (BPH) and prostate cancer. The importance of determination of androgen levels in tissue and serum for cancer progression and prognosis
has been poorly understood. The aim of study was to find out
hormonal differences in both diseases, their correlations between intraprostatic and serum levels and predictotory value of
their investigation.
Material and methods:
Testosterone, dihydrotestosterone, androstenedione and also
epitestosterone were determined in prostate tissue from 57 patients who underwent transvesical prostatectomy for BPH and
121 patients after radical prostatectomy for prostate cancer. In
75 subjects with cancer and 51 with BPH the serum samples
were analyzed for testosterone, dihydrotestosterone and
SHBG.
Results:
Significantly higher intraprostatic androgen concentrations,
i.e 8.85 ± 6.77 vs. 6.44 ± 6.43 pmol/g, P<0.01 for dihydrotestosterone, and 4.61 ± 7.02 vs. 3.44 ± 4.53 pmol/g, P<0.05 for
testosterone, respectively, were found in patients with prostate cancer than in BPH. Higher levels in cancer tissue were
found also for epitestosterone. However, no differences were
found in serum levels. Highly significant correlations occurred between all pairs of intraprostatic androgens and also epitestosterone as well as between serum testosterone and dihydrotestosterone (P<0.001) in both BPH and cancer groups.
Correlation was not found between corresponding tissue and
serum testosterone and dihydrotestosterone, either in benign
or cancer samples.
Conclusion:
The results point to importance of intraprostatic hormone levels for evaluation of androgen status of patients, contrasting
to a low value of serum hormone measurement.
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LIST OF AUTHORS
Abarikwu S.O.
Baca V.
Bartunek M.
Baxova A.
Beharka R.
Benesova L.
Beno P.
Boubelik M.
Brachtlova T.
Brokesova M.
Buckiova D.
Bürgerova E.
Cechak P.
Cernikova J.
Cernohorsky S.
Crha I.
Diblik J.
Dite Z.
Dolezal J.
Dusek P.
Duskova M.
Dvoracek J.
Dvorakova J.
Dzupa V.
Eis V.
Fantova L.
Farombi E.O.
Fojtik P.
Fric M.
Fügner D.
Gagsteiger F.
Gaillyova R.
Gianaroli L.
Gomez-Orozco W.
Gregor V.
Grill R.
Gromoll J.
Haluzik M.
Hampl R.
Hana V.
Hanek P.
Hanus M.
Hartmann I.
Heracek J.
Hill M.
Horacek J.
Horak A.
Housa D.
Housova J.
Hrabec M.
Hrehorcak M.
Chocholaty M.
Jarabak J.
Jirasek E.
35
37, 40
57
41
25, 28
26
57
40
32
48
40
32, 41
30
25
57
25
25, 27
47
47
34, 35
27, 30
47
48
40
29, 58
26
35
49
40
38
49
25, 41
31
51, 52, 53
26, 41
40
25, 36
30
29, 58
26
34, 35
28, 38
43, 45
26, 29, 30, 37, 39, 47, 54, 58
58
26
49
30
30
50
25
34, 35
33, 45
57
Kadlecova J.
Kawaciuk I.
Khazim A.
Kocarek J.
Kocvara R.
Kohl H.
Köhler O.
Kolombo I.
Kopecka V.
Kosarova M.
Koubek P.
Krepelova A.
Kuncova J.
Kunetkova M.
Lent V.
Lonsky P.
Loukola A.
Macek M. jr.
Macek M. sr.
Macek P.
Malek J.
Mandys V.
Mardesic T.
Mardiak J.
Marencak J.
Markova P.
Maskova S.
Maskova V.
Matouskova M.
Minarik M.
Müllerova M.
Musilova P.
Nader N.
Nieschlag E.
Novak K.
Novakova V.
Ondrus D.
Ondrusova M.
Oracova P.
Otcenasek M.
Oyeyemi M.O.
Pacik D.
Palascak P.
Panosova M.
Paulasova P.
Pavlik I.
Peknicova J.
Plas E.
Prinosilova P.
Prochazka B.
Roztocil A.
Rubes J.
Rybar R.
Sachova J.
41
34, 35
33, 54
56
47
49
56
57
42
32, 41
27
41
29, 30, 58
42
52
41
26
25
25
51
46
29, 46, 58
48
36
53
42
41
39, 40
28, 38
26
25
31
51
36
47
40
36
36
31
40
35
25, 33, 54
51, 52, 53
25
25
51
40
37
42
30
54
31, 32, 42
31, 32, 42
26, 29, 58
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Eur Androl Suppl 2007;1(1):60
Sauvain J.L.
Sedlacek J.
Siruckova K.
Smakal O.
Snajderova M.
Sobotka V.
Spanikova B.
Spilkova J.
Sramkova T.
Stanek Z.
Starka L.
Student V.
Sutory M.
Svecova D.
Tauwinklova G.
Toberny M.
Tobias J.
Urban M.
Valaskova I.
Ventruba P.
Vernerova Z.
Vesela K.
Veznik Z.
Vidlar A.
Vik V.
Vilimova S.
Vozdova M.
Vrana J.
Yaghi M.
Zachoval R.
Zajicova A.
Zalesky M.
Zamecnik L.
Zamecnikova M.
Zitzmann M.
Zudova D.
51, 52, 53
47
32, 41
43
26
46, 48
36
44
44, 48
47
27, 29, 30, 58
43, 45, 50, 55
48
42
31
57
57
26, 29, 37, 39, 40, 47, 54, 58
25
25
30
31
42
45
33
25
31
43
57
33, 45
42
33
43, 50, 51
25
36
32
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Editor: Jiri Heracek
Published by: Androgeos, s.r.o., Na Valech 4/289, 160 00, Prague 6, Czech Republic
Printed by: TNM PRINT, s.r.o., Nové Město 14, 503 51, Chlumec nad Cidlinou, Czech Republic
Graphics: TNM PRINT, s.r.o., Šumavská 5, 120 00, Prague 2, Czech Republic
Volume 1, Supplement 1, May 2007
Number of pages: 64
Number of copies: 250 pc
ISSN 1802-4793 print version (on-line version ISSN 1802-4807)
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