Sexual function after surgery and combination chemotherapy in men with disseminated nonseminomatous testicular cancer

Between 1978 and 1982 the sexual functions of 54 patients with a nonseminomatous testicular tumor stage II or III were assessed before and after treatment with surgery and combination chemotherapy. Two years after completing therapy 54% of the patients experienced sexual functional disorders. Greatly reduced or absent antegrade ejaculation was reported by 26 patients; 18 of them had been treated with more or less extensive retroperitoneal lymph node dissection, whereas 8 had not. This means that the chemotherapy might be responsible for ejaculatory disorders in 30% of the patients. Only two patients reported a change in the quality of erection; seven patients experienced a decidedly diminished libido, and five patients noticed their orgasm had changed in a negative sense. The appearance of the contralateral testis changed in 21 patients, who showed "atrophy" of this testis. The findings of this study indicate that sexual and ejaculatory disorders in particular are quite common in men treated for a disseminated nonseminomatous testicular tumor. Many of these disorders seem to be owing to causes other than surgical intervention.

Sperm-cervical mucus interaction, in particular in the presence of antispermatozoal antibodies

Disturbances of the interaction between spermatozoa and cervical mucus can cause subfertility or infertility. The diagnosis of such a disturbed interaction is possible with simple laboratory tests. Oligomucorrhoea and dysmucorrhoea are the most frequent causes of a disturbed sperm--cervical mucus interaction. Antispermatozoal IgA plays a quantitatively limited, but qualitatively important role. Sophisticated time-consuming laboratory investigations have mostly only additional value for the diagnosis.

A fertile man with a high sperm agglutination titer in the seminal plasma: a case report

A fertile man had sperm-agglutinating activity in his serum (titers 1:16-1:128) and in his seminal plasma (titers 1:128-1:2048). The antibodies in the seminal plasma could be absorbed with anti-IgA antiserum but not with anti-IgG antiserum. A fresh ejaculate showed strong auto-agglutination of the spermatozoa. With mixed antiglobulin reaction tests (MART) and/or immunobead tests (IBT), IgA and IgG were detected on almost all motile spermatozoa; the erythrocytes, in the MART, and the latex spheres, in the IBT, adhered mainly to the tip of the tail. After mixing the fresh semen with cervical mucus, only 40% of the spermatozoa were locally shaking. The spermatozoa showed excellent penetration of cervical mucus in vitro. This case shows that IgA coating of the tails of the spermatozoa does not necessarily lead to adherence of these spermatozoa to the micelles of the cervical mucus and that the sperm cervical mucus contact test has a better predictive value than the sperm agglutination titer in the seminal plasma.

A simplified method for freezing and storage of human semen

The use of 10-cm-long plastic tuberculin syringes for freezing and storage of human semen is introduced. This new method reduces the number of prefreezing and postthawing manipulations to a minimum. Postthawing motility, penetration of spermatozoa into cervical mucus, and results of the hamster ovum test were similar for spermatozoa stored-frozen in tuberculin syringes and for spermatozoa stored-frozen in french straws. The results of the postinsemination test performed in six women were slightly better with fresh semen than with semen stored-frozen in tuberculin syringes. Donor insemination with fresh semen resulted in eight pregnancies per 24 insemination cycles; with semen stored-frozen in tuberculin syringes five pregnancies were achieved in 22 insemination cycles.

Gonadal function after surgery and chemotherapy in men with stage II and III nonseminomatous testicular tumors

The gonadal functions were studied in 54 patients with disseminated nonseminomatous testicular tumors who had been subjected to combination chemotherapy (cisplatin, vinblastine, and bleomycin [PVB]) and surgery (hemiorchiectomy, retroperitoneal lymph node dissection or removal of retroperitoneal residual tumor after chemotherapy) and in 17 patients with a stage I tumor subjected to hemiorchiectomy exclusively. In the patients treated with chemotherapy, the plasma testosterone levels remained at the lower limit of normal and the luteinizing hormone (LH) levels remained elevated for 2 years after completion of treatment. The follicle-stimulating hormone (FSH) levels also remained significantly elevated, but showed a tendency to decrease after 2 years. Semen analysis was performed in 25 patients; of the other patients, 18 had no antegrade ejaculation, eight had undergone a vasectomy and three patients did not cooperate. Before treatment, 72% of the patients showed azoo- or oligozoospermia; 2 years after discontinuation of the chemotherapy, 48% had azoo- or oligozoospermia while 28% had more than 60 X 10(6) spermatozoa/mL. However, interestingly the proportion of patients with azoospermia had increased from 4% to 28%. In the course of this study, eight pregnancies occurred; one ended in an early spontaneous abortion; the other seven pregnancies ran an uncomplicated course. Seven healthy children were born. In 17 patients with a stage I tumor treated by hemiorchiectomy only, the testosterone, LH and FSH levels were also observed for 2 years; until 2 years after treatment, the testosterone levels remained lower and the FSH levels remained higher than normal. Insufficiency of the Leydig's cells in the unaffected gonad appeared to be responsible for the altered hormone concentrations in the blood.

Antibody and complement-binding activity of viable and nonviable human spermatozoa

Antibody and complement fixation by viable and nonviable spermatozoa were studied by means of immunofluorescence and a hemolytic assay (CH-50). Spermatozoa were incubated in sera from fertile male and female donors and in peritoneal fluid from fertile women undergoing laparoscopy. Nonviable spermatozoa were able to bind antibody or complement from sera and peritoneal fluid. There was no evidence of antibody or complement fixation by viable spermatozoa. The antibodies present in the serum that bind to spermatozoa belong to the IgG and IgM class; in peritoneal fluid, only IgG could be found. Complement fixation occurred via the classical (antibody-mediated) and alternative pathway. Viable spermatozoa possess antigenic properties different from nonviable spermatozoa. The lack of immunological reaction of women to viable spermatozoa and a possible mechanism for immunological infertility is considered.

Sexual function after bilateral retroperitoneal lymph node dissection for nonseminomatous testicular cancer

This study concerns the sexual functions of 101 patients who had undergone bilateral retroperitoneal lymph node dissection for stage I or II nonseminomatous testicular cancer between 1969 and 1982. All patients were without evidence of disease after at least 4 years of follow-up. Antegrade ejaculation was present in 12 patients, while 89 patients experienced "dry ejaculation." Urine collected after intercourse or masturbation from 75 patients with dry ejaculation showed retrograde ejaculation in 55 and lack of ejaculatory emission into the urethra in 20 patients. Regarding other sexual functions, 17 patients had a diminished sexual desire (especially those patients who had received radiotherapy), 12 experienced difficulty reaching organism, and 6 complained of erectile dysfunction. The incidence of a contralateral hydrocele developing after retroperitoneal lymph node dissection seems to correlate with ligation of the contralateral spermatic vessels and their lymphatics. A review of the literature is presented comparing the types of dissection with the incidence of sexual disorders after retroperitoneal lymph node dissection. Since preserving normal ejaculation and fertility is important, a modified or unilateral retroperitoneal lymph node dissection, when required, is advocated. In patients, with stage I disease the therapy may be limited to an orchiectomy without lymph node dissection. In patients with retroperitoneal lymph node metastases combination chemotherapy with cisplatin and tumor excision gives good results. Patients with true retrograde ejaculation can be treated with alpha-sympathomimetic drugs such as imipramine HCl, and thus be offered the chance of fatherhood by coitus.

Hemodynamics of the varicocele. Part I. Correlation among the clinical, phlebographic and scintigraphic findings

To determine whether the varicocele results from collateral circulation partially replacing an obstructed left renal vein, we developed a scintigraphic technique that provides not only information about the velocity of retrograde flow in the testicular veins but also quantitative information about the size of the varicocele. The reliability of this method was assessed by comparison with the results of phlebography and the clinical diagnosis in 104 patients. Furthermore, the diameter of the left testicular vein was determined on the phlebogram. Good correlation was found among the velocity of the retrograde flow in the left testicular vein, the size of the varicocele and the diameter of the left testicular vein.

Hemodynamics of the varicocele. Part II. Correlation among the results of renocaval pressure measurements, varicocele scintigraphy and phlebography

Left renal vein compression occurring mainly with the patient in the upright position, and being less severe or absent in the supine position, was considered to be the main cause of varicoceles. We show that left renal vein compression is, indeed, more severe with the patient in the upright than in the supine position and that it produces a left renocaval pressure gradient that is responsible for the retrograde blood flow in the left testicular vein. This pressure gradient, which was determined in the supine and semierect positions in 34 patients, increased from a mean of 3.8 mm. Hg in the supine position to a mean of 7.8 mm. Hg in the semierect position. On the basis of the assumption that the renocaval pressure gradient measured with the patient in the semierect position determines the presence and velocity of a retrograde flow in the left testicular vein, as shown by the dynamic portion of the varicocele scintigram (see part I), these variables were analyzed and the correlation coefficient proved to be good. Therefore, we conclude that the varicocele occurs when the left testicular vein lacks valves or there is a renogonadal bypass, and the severity of the left renal vein compression in the (semi) upright position determines the velocity of the retrograde flow in the left testicular vein and the size of the varicocele.

Fertility and hormonal function in patients with a nonseminomatous tumor of the testis

Semen quality and serum testosterone, LH, and FSH levels were studied in 54 patients with a unilateral nonseminomatous tumor of the testis--14 before and 40 after orchiectomy. Semen analyses before and after orchiectomy gave essentially no different results: a poor semen quality was found in most men. The additional effect of a recent orchiectomy on semen quality was not demonstrable in the patients described here. Before orchiectomy, increased testosterone levels were found in patients with a beta-hCG-producing tumor. After orchiectomy serum testosterone levels were decreased, and LH and FSH levels increased. With beta-hCG-producing tumors FSH was suppressed after orchiectomy, and testosterone levels did not exceed those in patients with a tumor not producing beta-hCG. The results of semen analysis and of hormonal studies after orchiectomy suggest a dysfunction of the remaining "normal" testis. Diminished spermatogenesis and insufficient testosterone production by the Leydig cells clearly indicate anomalies already present before orchiectomy.

Sexual disturbances arising from multiple sclerosis

Multiple sclerosis patients under the age of 50 with only a slight handicap were very often found to have disturbances of sexual functions (among male patients 71.4%; among female patients 73.9%; control group 18.7%). In 19.6% of the cases, the disturbances were of a serious nature. These disturbances, as well as disturbances of function of bladder and colon, were found to be mainly brought about by separate damage in the lumbosacral region of the spinal cord. The incidence of these disturbances bore no relationship to the degree of motor disturbances, age of the patient or duration of the disease.