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Biomedical subjects

G M Colpi

Publications and source records attributed to G M Colpi.

At least 19 recordsLinked to original sources
PubMed2007

High prevalence of testicular cancer in azoospermic men without spermatogenesis.

BACKGROUND: An increased risk of testicular cancer in men with infertility and poor semen quality has been reported. Our aim was to investigate the prevalence of testicular nodules and cancer in azoospermic subjects with different spermatogenetic patterns. METHODS: A total of 1443 consecutive infertile men were investigated, out of which 145 (10.0%) were found to be azoospermic. By using clinical examination and testicular ultrasound, 11 out of the 145 patients showed testicular nodules (2.8-26 mm). To obtain spermatozoa for assisted reproduction, 97 subjects required testicular sperm extraction (TESE) and biopsy, including the 11 patients with nodules. They were divided into two groups according to biopsy results: Group A (n = 38) with complete Sertoli cell-only syndrome (SCOS) and Group B (n = 59) with varying spermatogenetic patterns. Ten nodules were found in Group A and one in Group B. RESULTS: In azoospermic men, the overall prevalence of nodules was 7.5%. In complete SCOS, the prevalence of nodules and cancer was 10/38 (26.3%) and 4/38 (10.5%), respectively. Amongst the cancers, one embryonal carcinoma, one seminoma and two in-situ carcinomas were found. CONCLUSION: The prevalence of testicular nodules and cancer in azoospermic men with complete SCOS is very high. In these subjects, the role of clinical evaluation, ultrasound and biopsy should be emphasized.

Adult↗
PubMed2005

Immunophenotypical characterization of contractile cells in caput epididymidis of men affected by congenital or post-inflammatory obstructive azoospermia.

Myoid cells of the human caput epididymidis are replaced by large cells with ultrastructural features of smooth muscle cells (SMC) in chronic obstruction of the male genital tract. To evaluate whether these cellular changes are associated with different functional phenotypes we analysed the immunohistochemical expression of myosin heavy chain isoforms and of extracellular matrix (EM) components in the human caput epididymidis contractile cells in normal and in obstructed epididymides. Normal caput epididymidis myoid cells expressed a scattered immunostaining for SM2, marker of differentiated contractile SMC, while no staining was detected for SMemb (the non-muscle-type myosin heavy chain isoform) and for its transcription factor BTEB2, markers of undifferentiated proliferating SMC. A faint immunoreaction (IR) for EM was observed in the peritubular wall of the normal caput. In the contractile wall of the obstructed caput epididymidis a strong IR was detected for all myosin heavy chain isoforms as well as for collagen type IV and for fibronectin, markers for a secretory function of SMC. These findings, unknown in other models of SMC pathophysiology, suggest that myoid cells resume the molecular machinery of both mature SMC and of differentiating/secretory cells in the chronic obstruction of the human caput. Contractile cells of the epididymal duct represent a unique model to study the plasticity of SMC.

Chronic Disease↗
PubMed2005

Sperm retrieval for intra-cytoplasmic sperm injection in non-obstructive azoospermia.

Surgical testicular sperm retrieval for intra-cytoplasmic sperm injection (ICSI) purposes is the only possibility of biological fathering in case of non-obstructive azoospermia (NOA). Successful retrieval only correlates with histology, not with FSH values or testicular volume. Concurrent AZFa and AZFb microdeletion predict unsuccessful recovery. Testicular sperm extraction (TESE) (mean of successful retrievals in literature: 52.7%) is the technique of choice: we had successful retrievals in 100% of cases of hypospermatogenesis with > 5 spermatids/tubule (spd/tub), 81.8% of cases of hypospermatogenesis with < 4 spd/tub, 50% of cases of maturation arrest, and 25% of cases of histologically pure Sertoli cell-only syndrome. Microsurgical TESE (mTESE) has been reported to increase successful retrievals: from 16.7-45% for standard TESE to 42.9-63.6% for mTESE, depending on the distribution of testicular histology in the various case studies; from 9 to 14 cases out of 22, respectively, in the only study in which TESE and mTESE were performed simultaneously on the same testis. Improvements in biological procedures for TESE retrievals can increase positive findings. TeFNA does not appear to be indicated in NOA, both because of its low success rates--which, in practice, are only positive in hypospermatogenesis--and because it is unable to detect any carcinomas in situ. Previous surgery of left varicocele in NOA could increase the chances of subsequent recovery. ICSI from TESE has lower birth rates in NOA than in obstructive azoospermia (OA) (19% vs 28%). Abortion rates are significantly higher following ICSI from NOA (11.5%) than from OA (2.5%) (P=0.001). Therefore, the prognostic fertility of a couple with an NOA male is quite lower than for a couple with an OA male.

Humans↗
PubMed2004

Testicular function following chemo-radiotherapy.

Improvements in cancer survival raise infertility issues in young patients suffering from malignancies. The aim of the study is to review current knowledge on the effect of chemotherapy (CT) and radiotherapy (RT) for testis and hematological neoplasms on testicular function. Cisplatin-based regimens for testis neoplasm induce temporary azoospermia; permanent damage can occur with high doses (400-600 mg/m(2)). Alkylating agents are very effective for hematological neoplasm therapy but extremely dangerous to germinal epithelium. Damage can be irreversible. Spermatozoa cannot tolerate irradiation doses higher than 6 Gy. Leydig cells are damaged by doses higher than 15 Gy. A-Spermatogonia have been shown to survive after CT and RT and their recovery for post-treatment graft has been recently developed in animal models. Infertility counselling before treatment in young oncological patients is mandatory. Cryopreservation is the best option for fertility protection.

Animals↗
PubMed2004

Semen cryopreservation from oncological patients: the Italian experience.

The aim of the study is to summarize official data on semen cryopreservation for oncological patients in Italy. The first private semen bank for oncological patients in Italy was founded by Colpi in 1983 in Milan. In 1987, the first public semen bank was established in "Macedonio Melloni" Hospital (Milan) by Ragni. Normal semen samples are usually present in only 40% of oncological patients. The rate of semen sample use for assisted reproduction techniques is similar to international data (5%). At present, semen cryopreservation is possible only in about 20 Italian centers.

Cryopreservation↗
PubMed2004

Sildenafil citrate vs intracavernous alprostadil for patients with arteriogenic erectile dysfunction: a randomised placebo controlled study.

We compared the effectiveness of sildenafil citrate and alprostadil in improving arterial penile inflow (peak systolic velocity (PSV)) and penile rigidity in 55 patients with erectile dysfunction caused by atherosclerosis. A total of 35 patients with pure vasculogenic impotency were randomly assigned to alprostadil (Av group; n=11), sildenafil (Sv group; n=12), or placebo (P group; n=12), and 20 patients with nonvasculogenic impotency were randomly assigned to alprostadil (A group; n=10) or Sildenafil (S group; n=10): Av and A used alprostadil injection (capable of giving a full erection) once a week for 1 month, Sv and S took daily oral sildenafil (25 mg) for 1 month, and P took daily oral placebo for one month. The PSV was measured with Duplex sonography and penile rigidity was assessed using the IIEF-15 questionnaire, both of which were administered before and after treatment. Although both treatments improved penile rigidity, they increased PSV only in the Av and Sv groups. Our results suggest that alprostadil and oral therapy should be the starting therapy in men with vasculogenic impotency, whereas alprostadil should be avoided as the first-line approach in men with nonvasculogenic impotency.

Adult↗
PubMed2000

[Management of infertility following treatment of testicular tumors].

Testis cancer mainly affects patients in a reproductive age. Since at the present time recovery can be achieved in 84% of cases within ten years, there has been an increasing demand for paternity by these patients. In most cases, the preventive cryopreservation of spermatozoa and their subsequent use for assisted reproductive techniques can solve the problems connected with secretory infertility (no always reversible) caused by chemotherapy or radiotherapeutic treatment. Cryopreservation also allows to avoid the surgical taking of germinal cells either from testes or from seminal ducts in cases of anajeculation due to retroperineal lymphoadenectomy (present in 23.5-80% of cases). Failing the preventive cryopreservation, the surgical or microsurgical extraction of testis spermatozoa can be performed with success rates equal to 50%. Their use for intracytoplasmic sperm injection (ICSI) procedures presently seems to provide some encouraging results both for fertilization and pregnancy rates.

Antineoplastic Agents↗
PubMed2000

[Doppler color ultrasonography in the diagnosis of erectile dysfunction of vascular origin].

The aim of this paper is to evaluate whether echo-color Doppler diagnostics allows to detect the different evolutionary stages of arteriopathy affecting the cavernous arteries of the penis. 124 patients with erectile deficiency were examined. All of them were evaluated by andrologic and psychologic anamnesis. An echo-color Doppler examination was performed on cavernous arteries before (basal) and after (dynamic) an injection of Prostaglandin E1 (10 micrograms). The penile circulation has been observed for twenty minutes after the injection to detect anomalous collateral vessels of the cavernous arteries. The population was divided into 4 groups according to the basal and dynamic peak systolic velocity (PSV). Cardiovascular risk factor incidence in patients with normal basal and dynamic PSV values (group A) and in patients with pathologic basal and dynamic PSV values (group C) is 10% and 44% respectively (p < 0.002). Psychologic disorder in group A and C is 41% and 26% respectively (p < 0.05). Patients with pathologic basal PSV and normal dynamic PSV (group B) show an intermediate (26%) incidence of cardiovascular disorders as compared to A and C. Anomalous side branches are equally represented in A and B (41% and 38%) and to a lesser extent in C (26%). Based on anamnestic and instrumental data, Group B ranges at an intermediate position between A and C. In this group, the presence of incipient arteriopathy affecting the penile circulation may be suspected. The ability to detect patients with vascular diseases still at a subclinical stage, as it already happens for other organs, would allow a prompt therapeutic action.

Adult↗
PubMed1999

Perineal floor efficiency in sexually potent and impotent men.

Given the knowledge that the ischiocavernous and bulbocavernous muscles are involved in the erection of the penis, we studied the voluntary contractile activity of the perineal floor muscles in sexually potent and impotent men to investigate whether or not a different muscular efficiency can be found in these subjects. The activity of perineal floor muscles was studied in 76 sexually potent men and in 97 impotent men matched by age. A further group of 217 older impotent men was also studied to verify the impact of age on the efficiency of perineal floor contraction. The average myoelectrical activity of 24 maximized contractions of the perineum was measured in microV by anal plug electromyography. Perineal floor muscle contraction was significantly higher (P = 0.0007) in potent than in impotent men matched by age. In addition, in older impotent men the less perineal floor efficiency was also negatively correlated to age (r = -0.21, P = 0.002). Our results clearly demonstrated that a reduction of contractile activity of perineal muscles may be related to erectile dysfunction in younger men and an additional influence of age on perineal floor efficiency can be present in older impotent men.

Adolescent↗
PubMed1997

Is transrectal ultrasonography a reliable diagnostic approach in ejaculatory duct sub-obstruction?

We studied the diagnostic predictive power of transrectal ultrasonography (TRUS) coupled with semen volume in cases of distal seminal tract sub-obstruction. As a gold standard for diagnosis we used seminal tract washout (STW). Non-azoospermic subjects (n = 112) were submitted to transrectal ultrasonography because of suspected excretory infertility or other andrological pathologies, before performing STW. STW indicated ejaculatory duct sub-obstruction in 36.6% of the patients. Seminal vesicle enlargement (anterior-posterior diameter > or = 15 mm) and seminal vesicle roundish anechoic areas (stasis) were the ultrasonographic anomalies more often associated with ejaculatory duct sub-obstruction. Stepwise logistic regression (SLR) analysis revealed that the ultrasonographic evidence of stasis was highly diagnostic only in the presence of a low semen volume (< or = 1.5 ml) and that ejaculatory duct sub-obstructions may be present but with no evidence of ultrasonographic anomalies. Therefore, TRUS is a useful approach for the treatment of suspected ejaculatory duct sub-obstruction, but is not a reliable diagnostic tool and, before performing transurethral surgery, STW should be mandatory.

Adult↗
PubMed1995

Fertility restoration by seminal tract washout in ejaculatory duct obstruction.

A complex case of secondary sterility due to excretory azoospermia-dry ejaculation is reported. Transrectal ultrasonography and vaso-vesiculography revealed post-inflammatory total obstruction of the right ejaculatory duct. Excluding small radiolucent concrements in the seminal vesicle, no anatomical anomalies were identified on the left side. By performing antegrade seminal tract washout with saline solution it was possible to clear both seminal ducts and restore fertility in our patient. In select cases seminal tract washout may be a valid alternative to the conventional transurethral surgical approach for acquired obstruction of the ejaculatory ducts.

Ejaculatory Ducts↗
PubMed1994

Epididymal ultrasonographic findings in case of obstructive pathology.

Epididymal ultrasonography has proved effective in finding anatomic obstructive alterations affecting the epididymis. The authors investigated two groups: 1. Bilateral vas agenesia (20 epididymis)--(sensitivity of EUS--100%) 2. Normozoospermic noninfertile patients (before different surgical exploration)--(45 epididymis) EUS resulted "ideal" epididymis in 36 out of 45. EUS was "altered" in 9 cases. They call the attention for the impotence of EUS investigation in andrology.

Adolescent↗
PubMed1991

Nerve conduction velocity of dorsal nerve of penis: a modified technique.

The dorsal nerve of the penis is involved in sexual function. Until now, the nerve conduction velocity (NCV) of the dorsal nerve of the penis has been measured by dividing the distance between the stimulating and the recording electrodes by the latency to the negative peak of the action potential. With the penis stretched with a 1 lb weight, the NCV in normal men was 33 m/sec +/- 3.8. Measuring the NCV in this way, we became aware that when we decreased the distance between the stimulating and the recording electrodes, the velocity decreased. Furthermore these different measurements were linearly related. Taking this into account, we calculated the NCV with mathematical formula. In normal people, it turned out to be faster than reported previously.

Action Potentials↗
PubMed1990

Linear and non-linear relationships between the 'swelling test' and conventional semen variables in men suspected of primary infertility.

The relationship and degree of association between the percentage of sperm swelling (HOS-test) and conventional semen variables was investigated in 263 consecutive ejaculates. The semen samples were exclusively obtained from men suspected of primary infertility. It was found that the correlation coefficients (Spearman's rho) followed the order: percentage of progressive motility at 3 h greater than count/ml greater than percentage of total motility at 3 h greater than percentage of normal spermatozoa. Of the three morphology sub-classes considered (sperm head, mid-piece and tail abnormalities), only mid-piece abnormalities correlated with the outcome of the HOS-test (rho = -0.409). Linear relationships between HOS-test results and sperm motility and morphology, but not sperm count, were indicated by LOWESS-smoothing. However, a linear relationship between the HOS-test, sperm count and a 'functional index' combining the conventional semen variables could be demonstrated after normalization of the data. Our findings suggest that the HOS-test may be of value in assessing the functional integrity and viability of spermatozoa; however, its prognostic power for fertility is probably not different from that of conventional semen variables.

Fertilization↗
PubMed1990

Semen anomalies due to voiding defects of the ampullo-vesicular tract. Infertility due to ampullo-vesicular voiding defects.

Anatomical (congenital or postinflammatory) or functional anomalies of the uroseminal intersection can induce a voiding dysfunction of the deferential ampullae and seminal vesicles, leading to infertility. In case of azoospermia or OAT-syndrome with poor semen volume and decreased vesicular markers, some clinical history and examination data can cause suspect of one of such anomalies. The transrectal ultrasonographic findings of anechoic area(s) inside the prostate and/or seminal vesicle (even after recent ejaculation), the peculiar vasovesiculographic pictures (especially after ejaculation following the contrast medium injection into the vasa deferentia), plus the evaluation of the "deferential-ampullary sperm reserve", will permit a detailed diagnosis of the voiding dysfunction of the uroseminal crossing. A successful appropriate treatment of these pathologies can be done. Ultrasonically-guided transrectal puncture, or transurethral incision upstream of (or resection of) the ejaculatory duct orifices, or prolonged sexual abstinence, or artificial spermatocele of the vas deferens, or sperm recovering from urine for GIFT or IVF/ET after washing-out of the seminal tract by vas puncture are all methods, which can be selectively used depending on the individual case, to treat these forms of infertility. The authors present some paradigmatic clinical cases, and report that this pathology presumably occurs in up to 9% of non-selected infertile patient population.

Adult↗