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Tauber R, Johnsen N.Antegrade scrotal sclerotherapy for the treatment of varicocele: Technique and late results. J Urol 1994; 151: 386-390. Thon W F, Sigmund G, Bahren W, Steimann J. Perkutane Sklerotherapie bei Vena testikularis Insuffiziens. Akt Urol 1986; 17: 240-243. Seyferth W, Jecht E, Zeitler E. Percutaneous sclerotherapy of varicocele. Radiology 1981; 139: 335-340. Sigmund G, Bahren W, Gall H, Lenz M, Thon W. Idiopathic varicoceles: feasibility of percutaneous sclerotherapy. Radiology 1987; 164: 161-168. Lenk S, Fahlenkamp D, Gliech V, Lindeke A. Comparison of different methods of treating varicocele. J Androl 1994; 15 (Suppl): 34S-37S. Feneley MR, Pal MK, Nockler IB, Hendry WF. Retrograde embolisation and causes of failure in the primary treatment of varicocele. BrJ Urol 1997; 80:642-646. Lenz M, Hof N, Kersting-Sommerhoff B, Bautz W. Anatomic variants of the spermatic vein: importance for percutaneous sclerotherapy of idiopathic varicocele. Radiology 1996; 198: 425-431. Bassi R, Radice F, Bergami G, De-Grazia F, Papa B. Surgical treatment of varicocele. Our experience in the last 10 years. Minerva Chir 1996; 51: 533-536. 30. Wallijn E,Desmet R. Hydrocele: a frequently overlooked complication after high ligation of the spermatic vein for varicocele. Int J Androl 1978; 1:411-415. 31. Goldstein M, Kim FY, Mathews GJ.
Goldstein M. Varicocelectomy: General considerations; in Goldstein M (ed): Surgery of Male Infertility. Philadelphia, Saunders, 1995, pp 169-172.
Minimally invasive therapy. J Urol 1995; 153: 712-713. Miersch WD, Schoeneich G, Winter P, Buszello H. Laparoscopic varicocelectomy: indication, technique and surgical results. Br J Urol 1995; 76: 636-638. Tan SM, Ng FC, Ravintharan T, Lim PH, Chng HC. Laparoscopic varicocelectomy: technique and results. Br J Urol 1995; 75: 523-528. Tulloch WS. Varicocele in subfertility: results of treatment. Br Med J 1955; 2: 356-358. HYPOGONADISM Introduction Men with hypogonadism usually present with symptoms of androgen deficiency (see above Andrological investigations and spermatology).
? Idiopathic hypogonadotrophic hypogonadism (including Kallmann's syndrome) ? Delay of puberty ? Hyperprolactinaemia Hypergonadotrophic syndromes = primary hypogonadism (= testicular origin) ? Anorchia (+ acquired) ? Klinefelter's syndrome ? Leydig cell tumours ? General diseases, e.g. liver cirrhosis Target organ resistance to androgens ? Testicular feminization ? Reifenstein syndrome
Aetiology, diagnosis and therapeutic management Hypogonadotrophic hypogonadism is caused either by hypothalamic or pituitary diseases. The failure of hormonal regulation can easily be determined [3]. Endocrine deficiency leads to a lack of spermatogenesis and testosterone secretion due to decreased secretion patterns of LH and FSH. The therapy of choice is human chorionic gonadotrophin (hCG) treatment, with the later addition of human menopausal globulin (hMG), dependent on initial testicular volume [4]. If hypogonadotrophic hypogonadism is hypothalamic in origin, a 1-year therapy with pulsatile gonadotrophin releasing hormone (GnRH) is as effective as gonadotrophins in stimulating spermatogenesis [5]. Once pregnancy has been induced, patients will go back to testosterone substitution (see below). Conclusion
Aetiology, diagnosis and therapeutic management Common conditions associated with hypergonadotrophic hypogonadism in younger men include injury to and loss of the testicles (e.g. after bilateral testicular cancer) (Table 11). More recently it has been recognized that hypogonadism may occur after extensive testicular biopsy to recover sperm for IVF/ICSI [6]. Men with Klinefelter's syndrome are at risk for spontaneous hypogonadism with ageing. Those undergoing extensive testicular biopsy in the context of IVF/ICSI will almost certainly have an exacerbated risk [7]. Hypergonadotrophic hypogonadism may occur spontaneously in the elderly, in patients with erectile dysfunction [8], and after LHRH treatment or surgical castration for prostatic cancer [9]. All these conditions are not clinically significant for infertile men. Hypogonadism may be associated with osteoporosis [10]. The laboratory diagnosis of hypergonadotrophic hypogonadism is based on decreased serum testosterone and increased LH levels [2]. Additional prolactin measurement is suggested.
Conclusion There is general agreement that patients with primary or secondary hypogonadism should receive testosterone substitution therapy. References Date: 2016-06-12; view: 320
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