Male Reproductive Dysfunction: Pathophysiology and Treatment PDF

Preface

Given the finite nature of the human lifespan, it is possible to argue that an individual man's most precious and lasting gift to the world is the legacy created by his offspring. It is no wonder, then, that the purely reproductive function of fertility has become inextricably tied to the human male's impression of his own masculinity. The fact of being childless is often an extremely emotional issue for patients and their families, and ameliorating such a cause is certainly worthy of our efforts. Each day, great strides are made in the ever-evolving body of knowledge that comprises the whole science and practice of medicine, allowing men to live longer, healthier lives; thus, retaining sexual and reproductive health even well into their later years has taken on increased importance for many men, and, consequently, for the physicians who treat them.

Yet, with the benefit of increased longevity, there must simultaneously exist an increased likelihood that the male reproductive tract will be subjected to greater levels of stress resulting from longer exposure to harmful environmental agents, poor lifestyle choices, and new diseases and infections. Additionally, the therapeutic drugs and regimens prescribed for these conditions frequently diminish sexual and reproductive capacities to an even greater degree. For example, a male patient who survives cancer and its treatment often falls victim to sexual, reproductive, and inter personal difficulties that may further compromise his quality of life.

Due to the wide range of impairments that may impact a man's reproductive health throughout his lifespan, by necessity, the field of reproductive medicine is a multidisciplinary specialty comprised of andrology, endocrinology, urology, gynecology, radio logy, psychology, and sociology. The vast array of data and the complexity of new technologies constantly being produced in so many different areas are often bewildering. Therefore, the chief goal in creating this first edition of Male Reproductive Dysfunction: Pathophysiology and Treatment has been to assimilate the most pertinent and important scientific knowledge gained from the complementary expertise of more than 70 individual leaders in all related disciplines into a single, comprehensive source, and to present this information from a clinical viewpoint, not only for the benefit of those actively involved in managing male patients with reproductive disorders, but also for the considerable numbers of physicians and healthcare providers who are likely to encounter and care for such men, regardless of etiology or precipitating factors. We hope to educate our readers with both the science behind these complex disorders and to equip them with practical tools for the effective and rational management of these conditions.

Based on the most recent data available, Male Reproductive Dysfunction: Pathophysiology and Treatment presents historical, psychosocial, behavioral, medical, and surgical perspectives in an unparalleled 43- chapter guide to the assessment and treatment of the male patient with reproductive dysfunction. Logically divided into five parts, the book begins with an extensive review of the normal anatomy and physiology of the male reproductive system, including a chapter on the effect of aging on testosterone production. Building on this foundation, the second part details the many etiologies, mechanisms, and clinical manifestations of male reproductive disorders. Both common and rare conditions of male reproductive dysfunction are covered, from genetic defects and child hood developmental abnormalities to other causes of hypogonadism, including the adverse effects of substance abuse, malnutrition, environmental toxins, and the iatrogenic effects of cancer treatments and other pharmaco therapies on the hypothalamic-pituitary- testicular axis. Also highlighted are problems that occur later in life, such as the complications of systemic diseases, obstructive and mass lesions of the repro ductive tract, and sperm allergy.

With this information well in hand, the third part invaluably outlines strategies for the complete assessment of the hypogonadal and/or infertile male patient, from obtaining the initial history and physical exam, to ordering bloodwork and semen analyses, to interpreting advanced imaging studies and performing testicular biopsies. The multitude of illustrations, images, algorithms, and tables elucidate these complex topics even more clearly. Of special note are the chapters dedicated to the evaluation of immunological factors that may be contributing to infertility and the effective use of imaging technology in the diagnosis of male reproductive tract pathology.

The fourth part then provides extensive guidelines for the treatment of male reproductive dysfunction depending on the individual pathology, including specialized situations such as patients who are cancer survivors or have spinal cord or other neurological injury. The details of various surgical sperm retrieval methods as well as assisted reproduction techniques (ART) are described step-by-step. Several chapters feature additional information that is unique to this book, such as the latest progress in male contraception, micromanipulation procedures for the treatment of the subfertile male, the psychological effects of infertility and its treatment, and the management of immunological factors in male infertility.

The final, fifth part is devoted to a full discussion of the mass lesions of the male reproductive tract, including testicular, penile, prostate, and male breast cancers. The problems of prostate hyperplasia, prostatitis, and gynecomastia are also addressed.

Most importantly, each chapter in this volume considers the future aims of its particular topic, opening the doorway for continued thought and discussion as new research is added to the current armamentarium. It is hoped that this book will become an essential, self-contained desk reference for both new and seasoned clinicians involved in the care of male patients with all forms of reproductive dysfunction, and that by enriching the current body of knowledge, our work will provide the starting point for future generations of medical professionals to learn, study, develop, and discover.