1 male infertility and impotence

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1 male infertility and impotence

  1. 1. MALE INFERTILITY AND IMPOTENCE
  2. 2. INCIDENCE OF INFERTILITY50% are due to the female factor.30% are due to the male factor.20% are due to combined factors.
  3. 3. MALE FACTOR EVALUATIONHistory.Physicalexamination.Laboratoryevaluation.Imaging.
  4. 4. HISTORYInfertility historySexual historyChildhood and developmentMedical historySurgical historyDrug historyEnvironmental history
  5. 5. PHYSICAL EXAMINATIONInguinalscarsvaricocelePresence ofvasdeferensEpididymalexaminationTesticularexaminationDigital rectalexamination
  6. 6. ENDOCRINE EVALUATIONFSHLHProlactinTestosterone.
  7. 7. SEMEN ANALYSISEjaculate volume: 1.5-5 ccSperm density (count): >20 million/ccMotility>60%Forward progression>2(scale 1-4)Insignificant sperm agglutinationInsignificant pyospermia or hematospermiaNo hyperviscosity.
  8. 8. ULTRASOUND EVALUATIONParatesticularevaluationTesticularevaluationEvaluation of theseminalvesicle,ejaculatoryducts and vasalampulla
  9. 9. ETIOLOGY OF MALE INFERTILITYPretesticularcauses(endocrine)Testicular(genetic)Post-testicular(obstruction)
  10. 10. TREATMENT OF MALE INFERTILITY• Specific therapy• Replacement hormonal therapy.• Empirical therapy• Antiestrogens• HCG• HCG and FSH• Steroids• Kallikrein• Pentoxyfylline• antioxidantsMedical
  11. 11. SURGICAL TREATMENTVaricocelectomyVasovasostomyTUI of the ejaculatory ductsICSIICSI/TESE
  12. 12. ERECTILE DYSFUNCTION Incidence: 52% of adult males between 40-70 years.
  13. 13. ANATOMY OF ERECTION
  14. 14. PHYSIOLOGY OF ERECTIONSexualstimulationNOcGMPSinusoidal wallrelaxationIncrease inblood flowTrapping of theemissary veinsRigid erection
  15. 15. ETIOLOGY OF ERECTILE DYSFUNCTIONPsychogenic Arteriogenic VenogenicHormonal Systemic drugs
  16. 16. DIAGNOSIS OF ERECTILE DYSFUNCTION• Medicalhistory• Sexual historyHistory
  17. 17. PHYSICAL EXAMINATIONGeneralLocalPenisTestesDRE
  18. 18. INVESTIGATIONS LaboratoryImagingPenile duplex studyCavernosometryArteriography OthersrigiscanIntracavernosal injection
  19. 19. TREATMENTManaging modifiable causesOral drugsVacuum erection devicesIntracavernosal injection of vasoactive substanceIntrathecal injection of a vasodilator pilletPenile implants(prosthesis)
  20. 20. VACUUM ERECTION DEVICE
  21. 21. PENILE PROSTHESIS

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