EAU17: Breakthroughs in andrology

New insights into the gold standards, developments and controversies within andrology were deliberated today in the state-of-the-art lectures of the “Hot topics in andrology” session chaired by Prof. Dr. Francesco Montorsi (IT) and Prof. Hein Van Poppel (BE).

The Plenary Session commenced with the presentation of Dr. Peter B. Østergren (DK) on testosterone therapy in men with prostate cancer (PCa). He stated that high endogenous T levels are not associated with an increased risk of PCa, and that testosterone replacement therapy (TRT) is not associated with an increased risk of aggressive PCa but may increase the risk of being diagnosed with low-risk PCa due to more vigorous monitoring. He added that TRT appears safe in men curatively treated for low-risk PCa but there are only few available studies with small sample sizes. Østergren emphasised that TRT is not recommended in men with untreated PCa.

According to Dr. Yacov Reisman (NL), large multicentre, well-conducted trials are essential for establishing evidence to facilitate a standard algorithm to approach scrotal pain. He said that reversible causes should be ruled out before any treatment, and testicles should be spared whenever possible. A multidisciplinary approach that includes psychological, sexual and physical therapy modalities, should be considered.

Mr. David John Ralph (GB) discussed that as priapism duration increases, the success for conservative therapy decreases and surgical management increases. Early insertion of a penile prosthesis in priapism maintains penile length, aids easy insertion, and treats the condition. Alternatively, late insertion of penile prosthesis result in penile shortening and difficult implantation.

Ralph mentioned the pre-requisites of penile implants for patients with Peyronie’s disease such as refractory erectile dysfunction, distal flaccidity, significant hinge effect, ossified/calcified plaque or, for example, those who cannot have a grafting procedure due to vascular disease.

Dr. Ulla N. Joensen (DK) stated that male reproductive development depends on normal early feotal testicular function. She said normal germ cell development in feotal life determines later reproductive capacity, and that timing is everything with reference to the masculinization programming window. Joensen said translation to clinical recommendations of the advancements in understanding how these processes work are difficult because this is a system that cannot be interventionally studied.

Men should not be considered infertile until they have a microTESE and are found to be infertile according to Mr. Majid Shabbir (GB). MicroTESE should be the gold standard survival sperm retrieval (SSR) technique for patients with irreversible non-obstructive azoospermia (NOA). Compared to the conventional TESE, microTESE almost doubles the chance of successful SSR.

Dr. Ferdinando Fusco (IT) discussed that male contraception remains an important area of research, and introduction of new forms of male contraception based on both hormonal and non-hormonal paradigms are wanted and needed.