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Resumen La mayor accesibilidad a los tratamientos de reproducción asistida (RA) y los avances de la criobiología produjeron cambios en los laboratorios de andrología. El objetivo de este trabajo fue analizar la demanda y evolución de las variables seminales en las últimas dos décadas, caracterizar el laboratorio andrológico actual, evaluar el impacto de la incorporación del aseguramiento de la calidad y la inclusión de los sistemas computarizados (CASA). Se utilizaron datos de las medias mensuales del control de calidad interno (n=22 528) y encuestas a profesionales de laboratorios andrológicos (n=65) y a médicos especialistas en fertilidad (n=33). La demanda global se redujo significativamente con el aumento de las solicitudes de primera vez. El volumen y recuento, variables dependientes de andrógenos, disminuyeron con los años. El criterio estricto en morfología disminuyó el porcentaje de normales; la mitad de los médicos encuestados recibieron resultados entre 0 y 10% y el 40% consideró que ponía en riesgo el valor clínico de la variable. El sistema CASA permitió objetivar la cinética espermática e incrementar el porcentaje de progresivos rápidos, pero pocos laboratorios lo incorporaron. El 66% de los médicos resuelven el factor andrológico severo por tratamientos clínicos y el 95% utiliza técnicas de RA. El análisis de semen es ejecutado fundamentalmente por bioquímicos especializados, con baja adhesión a la automatización y acreditación del laboratorio, pero con participación en programas de evaluación externa de calidad. La demanda disminuyó como consecuencia del aumento del tratamiento por RA. La reducción del porcentaje de formas normales compromete su utilidad clínica.

Abstract Increasing availability to assisted reproduction (AR) treatments in Argentina and advances in cryobiology resulted in changes in andrology laboratories. The aim of this study was to evaluate the demand and evolution of seminal variables in the last two decades, characterise the current andrology laboratory, evaluate the impact of the incorporation of quality assurance and the introduction of computer assisted semen analysis (CASA). Data were taken from internal quality control (IQC) monthly means (n=22 528) and professionals in charge of laboratories (n=65) and fertility physicians' (n=33) surveys. Overall demand decreased significantly while first-time orders increased. Sperm volume and sperm count -androgen dependent parameters- decreased over the years. Strict morphology criteria reduced the percentage of normal results; half of the physicians received results between 0 and 10% and 40% considered that it compromised the clinical value of the variable. The CASA system made it possible to objectify sperm kinetic, increasing the percentage of fast progressives, but few laboratories have incorporated it. Sixty-six percent of physicians resolve severe andrological factor by clinical treatments and 95% use AR techniques in those cases. Semen analysis is mainly performed by specialised biochemists, with low adherence to laboratory automatisation and accreditation, but with participation in external quality assessment programmes. The demand decreased because of the increase in AR treatment. The lower percentage of normal forms compromises their clinical utility.

Resumo O aumento do acesso aos tratamentos de reprodução assistida (RA) e os avanços na criobiologia levaram a mudanças nos laboratórios de andrologia. O objetivo deste trabalho foi analisar a demanda e a evolução das variáveis de sêmen nas últimas duas décadas, caracterizar o laboratório de andrologia atual, avaliar o impacto da incorporação da garantia da qualidade e a inclusão dos sistemas computadorizados (CASA). Foram utilizados dados das médias mensais do controle de qualidade interno (n= 22 528) e pesquisas a profissionais de laboratórios andrológicos e a médicos especialistas em fertilidade (n=33). A demanda geral diminuiu significativamente com o aumento das solicitações de primeira vez. O volume e a contagem de esperma, parâmetros dependentes de andrógenos, diminuíram ao longo dos anos. O critério morfológico rigoroso diminuiu a porcentagem de normais; metade dos médicos entrevistados recebeu resultados entre 0 e 10% e 40% considerou que isso comprometía o valor clínico do parâmetro. O sistema CASA, permitiu objetivar a cinética espermática e aumentar o percentual de progressões rápidas, mas poucos laboratórios o incorporaram. 66% dos médicos resolvem o fator andrológico grave por tratamentos clínicos e 95% utilizam técnicas de RA nesses casos. A análise do sêmen é realizada principalmente por bioquímicos especializados, com baixa aderência à automação e acreditação laboratorial, mas com participação em programas de avalação externa de qualidade. A demanda diminuiu como consequência do aumento do tratamento por RA. A diminuição em percentagem de formas normais compromete sua utilidade clínica.

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Introduction: The sexual life of a couple is a dynamic entity, in which the two influence each other mutually, thus the existence of female sexual dysfunction (FSD) can influence the treatment of the man who seeks clinical help. Identify sexual dysfunction in female partners of patients attending an andrology clinic may provide a therapeutic opportunity. The authors aim to assess proportion of FSD in this population by comparison with a control group. Material and methods: A longitudinal study over 12 months timespan. The female partners of patients attending the andrology clinic participating in the study (study group – SG) completed the Female Sexual Function Index (FSFI), as did the women serving as controls (control group – CG). Further data such as age, duration and quality of the relationship and previous relationships was also collected. Results: Of the 30 women included in the SG, 14 (46.6%) considered that their current sex life was worse than in previous relationships. Of the 20 women in the CG, 60% considered that their current sex life was better. In the SG, 22 (73.3%) had FSD, with a mean score in the FSFI of 20.5, whereas only 3 women in the CG (15%) had FSD, with a mean score of 30.7 (p<0.01). Conclusions: Our study demonstrated that the proportion of FSD in female partners of patients attending an andrology clinic is significantly higher than control group. FSD treatment should be considered as a therapeutic opportunity for the couple in this setting. (AU)

Introducción: La vida sexual de una pareja es una entidad dinámica, en la que ambos se influyen mutuamente, por lo que la existencia de disfunción sexual femenina (DSF) puede influir en el tratamiento del hombre que busca ayuda clínica. Identificar la disfunción sexual en las parejas femeninas de los pacientes que asisten a una Clínica de Andrología puede brindar una oportunidad terapéutica. Los autores pretenden evaluar la proporción de DSF en esta población comparándola con un grupo de control. Material y métodos: Estudio longitudinal durante 12 meses. Las parejas femeninas de los pacientes que asistieron a la Clínica de Andrología y que participaron en el estudio (grupo de estudio) completaron el Índice de Función Sexual Femenina, de la misma forma que las mujeres, que sirvieron como control (grupo de control). También se recopilaron datos adicionales como edad, duración, calidad de la relación y las relaciones entre los anteriores. Resultados: De las 30 mujeres incluidas en el grupo de estudio, 14 (46,6%) consideraron que su vida sexual actual era peor que en relaciones anteriores. De las 20 mujeres del grupo control, el 60% consideró que su vida sexual actual era mejor. En el grupo de estudio, 22 (73,3%) tenían DSF, con una puntuación media de Índice de Función Sexual Femenina de 20,5, mientras que solo 3 mujeres en el grupo control (15%) tenían DSF, con una puntuación media de 30,7 (p <0,01). Conclusiones: Nuestro estudio demostró que la proporción de DSF en parejas femeninas de pacientes que acuden a una Clínica de Andrología es significativamente mayor que en el grupo control. El tratamiento de la disfunción sexual femenina debe considerarse como una oportunidad terapéutica para la pareja en este escenario. (AU)

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INTRODUCTION: The sexual life of a couple is a dynamic entity, in which the two influence each other mutually, thus the existence of female sexual dysfunction (FSD) can influence the treatment of the man who seeks clinical help. Identify sexual dysfunction in female partners of patients attending an andrology clinic may provide a therapeutic opportunity. The authors aim to assess proportion of FSD in this population by comparison with a control group. MATERIAL AND METHODS: A longitudinal study over 12 months timespan. The female partners of patients attending the andrology clinic participating in the study (study group - SG) completed the Female Sexual Function Index (FSFI), as did the women serving as controls (control group - CG). Further data such as age, duration and quality of the relationship and previous relationships was also collected. RESULTS: Of the 30 women included in the SG, 14 (46.6%) considered that their current sex life was worse than in previous relationships. Of the 20 women in the CG, 60% considered that their current sex life was better. In the SG, 22 (73.3%) had FSD, with a mean score in the FSFI of 20.5, whereas only 3 women in the CG (15%) had FSD, with a mean score of 30.7 (p<0.01). CONCLUSIONS: Our study demonstrated that the proportion of FSD in female partners of patients attending an andrology clinic is significantly higher than control group. FSD treatment should be considered as a therapeutic opportunity for the couple in this setting.

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Introducción: El estado de alarma debido a la COVID-19 revolucionó la actividad asistencial y quirúrgica. Dentro de la enfermedad urológica, aquellas consideradas «demorables» como la andrológica y la reconstructiva sufrieron un retraso considerable en su atención. Material y métodos: En mayo de 2020, tras haber superado casi la primera ola de la pandemia y en pleno estado de alarma, se envió una encuesta con 24 ítems a 120 urólogos integrados en los Grupos de Cirugía Reconstructiva Urológica y Andrología de la Asociación Española de Urología (AEU) para conocer la repercusión asistencial sobre la actividad clínica y quirúrgica en ambas subespecialidades. Resultados: Se alcanzó una tasa de respuesta del 75,8% con 91 encuestas recibidas. Previo al estado de alarma, el 49,5% disponía de uno a 2 quirófanos semanales, el 71,4% afrontaba una lista de espera quirúrgica de entre 3 y 12 meses, y el 39,6% atendía entre 20 y 40 pacientes semanales en consulta. Durante el estado de alarma, el 95,6% recibió directrices sobre cirugías a realizar, priorizando la cirugía urgente y la oncológica. En el 85,7% de los centros no se realizó ninguna cirugía andrológica ni reconstructiva. Alrededor del 50% de las consultas no fueron presenciales, recurriendo a la telemedicina (teléfono o e-mail) en la mayoría de los casos. Conclusiones: Las repercusiones de la pandemia sobre las enfermedades andrológicas y las candidatas a cirugía reconstructiva fueron muy importantes. Tras casi 2 años del inicio de la pandemia, aún queda por determinar el verdadero impacto final en nuestro sistema sanitario (AU)

Introduction: In Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as «non-urgent» (andrology and reconstructive surgery) were postponed or even unattended. Material and methods: In May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties. Results: We observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails). Conclusions The negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined (AU)

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Introduction: Fertilin β is a sperm surface protein that can mediate sperm-egg membrane interaction. This study was conducted to determine whether the expression of fertilin β after intrauterine insemination (IUI) in donors with normal parameters after standard semen analysis is related to low success rate or failure of fertilization. Methods: We examined the sperm of 30 male donors who have normal as controls, oligozoospermia, and unexplained infertility as the clinically indication for IUI. Fertilin β has been labeled with the ADAM2 antibody by indirect immunofluorescence (IF) assay. To evaluate the reproducibility of the test, we selected four sperm samples scale of 0 to +++ according to the distribution of fluorescence label. Results: The results were highly correlated with the corrected total cell fluorescence (CTCF) (Rp=0.9972, P<0.05). We suggest that the relationship between infertility and fertilin β may be due to the distribution of this protein on the sperm surface. Male partners of couples with unexplained infertility showed a low distribution of fertilin β by a decrease of the fluorescence signal in the IF labeling (scale of +++ by 7.4±10.32%, P<0.0001, ±SD). Discussion: Abnormal fertilin β function may be a potential mechanism that could lead to fertilization failure. (AU)

Introducción: La fertilinβ es una proteína de la superficie del esperma que puede mediar entre la interacción del espermatozoide y la membrana del óvulo. Este estudio se realizó para determinar si la expresión de fertilinβ después de la inseminación intrauterina (IIU) en donantes con parámetros normales después del análisis estándar de semen está relacionada con una baja tasa de éxito o fracaso de la fertilización. Métodos: Examinamos los espermatozoides de 30 donantes masculinos que tenían controles normales, oligozoospermia e infertilidad inexplicable como indicación clínica de IIU. La fertilinβ ha sido etiquetada con el anticuerpo ADAM2 mediante un ensayo de inmunofluorescencia indirecta (IF). Para evaluar la reproducibilidad de la prueba, seleccionamos cuatro muestras de esperma en una escala de 0 a +++ según la distribución de la etiqueta de fluorescencia. Resultados: Los resultados estuvieron altamente correlacionados con la fluorescencia celular total corregida (Rp=0,9972, p<0,05). Sugerimos que la relación entre la infertilidad y la fertilinβ puede deberse a la distribución de esta proteína en la superficie del esperma. Los compañeros masculinos de parejas con infertilidad inexplicable mostraron una baja distribución de fertilinβ por una disminución de la señal de fluorescencia en el etiquetado IF (escala de +++ en 7,4 ±10,32%, p<0,0001, ±DE). Conclusión: La función anormal de la fertilinβ puede ser un mecanismo potencial que podría conducir al fracaso de la fertilización. (AU)

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INTRODUCTION: In Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as "non-urgent" (andrology and reconstructive surgery) were postponed or even unattended. MATERIAL AND METHODS: In May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties. RESULTS: We observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails). CONCLUSIONS: The negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined.

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INTRODUCTION: Fertilin ß is a sperm surface protein that can mediate sperm-egg membrane interaction. This study was conducted to determine whether the expression of fertilin ß after intrauterine insemination (IUI) in donors with normal parameters after standard semen analysis is related to low success rate or failure of fertilization. METHODS: We examined the sperm of 30 male donors who have normal as controls, oligozoospermia, and unexplained infertility as the clinically indication for IUI. Fertilin ß has been labeled with the ADAM2 antibody by indirect immunofluorescence (IF) assay. To evaluate the reproducibility of the test, we selected four sperm samples scale of 0 to +++ according to the distribution of fluorescence label. RESULTS: The results were highly correlated with the corrected total cell fluorescence (CTCF) (Rp=0.9972, P<0.05). We suggest that the relationship between infertility and fertilin ß may be due to the distribution of this protein on the sperm surface. Male partners of couples with unexplained infertility showed a low distribution of fertilin ß by a decrease of the fluorescence signal in the IF labeling (scale of +++ by 7.4±10.32%, P<0.0001, ±SD). DISCUSSION: Abnormal fertilin ß function may be a potential mechanism that could lead to fertilization failure.

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The aim of this work was to compare results of breeding soundness examination (BSE) of Nellore bulls (n=1257) according to evaluation criteria from two different classification tables (traditional-Table1 used since 1997 and an updated-Table2-proposed in 2020). Data were separated into 3 categories: questionable animals in Table1 and Table2 (Q1Q2), animals approved in Table1 and questionable in Table2 (A1Q2) and animals approved in Table1 and Table2 (A1A2). BSE parameters were submitted to ANOVA (P<005), according to age groups. Higher (P<0.0001) scrotal perimeter (PE) were observed in A1A2 category (18-24m=33.4±2.4cm; 24-36m=34.5±2.2cm; 36-48m=36.6±1.7cm; >48m=38.6±1.7cm) compared to A1Q2 (18-24m=29.05±0.98cm; 24-36m=30.3±0.6cm; 36-48m=32.9±1.0cm; >48m=34.8±1.0cm) and to Q1Q2 (24-36m=26.8±2.0cm; 36-48m=30.0±0.1cm; >48m=31.3±1.1cm), for all age groups. At the age of 36-48months (Q1Q2=2.7±0.3; A1Q2=3.2±0.3; A1A2=3.3±0.6) and >48months (Q1Q2=3.0±0.4; A1Q2=3.3±0.5; A1A2=3.4±0.5), animals with better andrological classifications presented higher (P<0.05) body condition score (BCS). Additionally, at age >48m, higher sperm Motility (P=0.0250) and Vigor (P=0.0335) were observed in animals A1Q2 (Mot=55.5±14.7%; V=3.21±0.82) and A1A2 (Mot=55.8±12.2%; V=3.23±0.81) compared to Q1Q2 (Mot=50.2±17.4%; V=2.77±0.82). It was concluded that bulls approved using strict selection criteria demonstrated higher PE and BCS, regardless of the age. The utilization of updated classification tables is highly recommended for further reproductive potential development of Nellore bulls in the field.(AU)

O objetivo deste estudo foi comparar os resultados obtidos no exame andrológico a campo de touros Nelore (n=1257) de acordo com os critérios de avaliação de duas tabelas de classificação (uma tabela tradicional - tabela 1 - proposta em 1997 e uma nova tabela atualizada - tabela 2 - proposta em 2020). Os dados foram separados em três categorias: animais questionáveis nas tabelas 1 e 2 (Q1Q2), animais aprovados na tabela 1 e questionáveis na tabela 2 (A1Q2) e animais aprovados nas tabelas 1 e 2 (A1A2). Os parâmetros foram submetidos à análise de variância (P<0,05), por faixa etária. Observou-se maior (P<0,0001) PE no grupo A1A2 (18-24m=33,4±2,4cm; 24-36m=34,5±2,2cm; 36-48m=36,6±1,7cm; >48m=38,6±1,7cm) em comparação ao grupo A1Q2 (18-24m=29,05±0,98cm; 24-36m=30,3±0,6cm; 36-48m=32,9±1,0cm; >48m=34,8±1,0cm) e este maior (P<0,0001) que Q1Q2 (24-36m=26,8±2,0cm; 36-48m=30,0±0,1cm; >48m=31,3±1,1cm) em todas as idades. Nas faixas etárias 36-48m (Q1Q2=2,7±0,3; A1Q2=3,2±0,3; A1A2=3,3±0,6) e >48m (Q1Q2=3,0±0,4;A1Q2=3,3±0,5; A1A2=3,4±0,5), animais com melhor classificação andrológica apresentaram melhor (P<0,05) escore de condição corporal (ECC). Adicionalmente, na idade >48m, maiores motilidade (P=0,0250) e vigor (P=0,0335) foram observados nos animais A1Q2 (Mot=55,5±14,7%; V=3,21±0,82) e A1A2 (Mot=55,8±12,2%; V=3,23±0,81) comparados aos animais Q1Q2 (Mot=50,2±17,4%; V=2,77±0,82). Concluiu-se que touros aprovados na tabela com critérios mais rigorosos de classificação (tabela 2) apresentaram maior PE e ECC, independentemente da idade. Assim, a utilização de tabelas classificatórias atualizadas é fundamental para maior desenvolvimento do potencial reprodutivo de touros Nelore a campo.(AU)

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Este estudo teve por objetivo comparar variações de parâmetros andrológicos e comportamentais de touros Nelore de diferentes faixas etárias, calcular seu potencial reprodutivo (PR) e propor uma nova tabela de classificação por pontos, de acordo com as médias atualmente alcançadas por eles nas características estudadas. Foram utilizados dados de 6162 exames andrológicos de touros da raça Nelore, entre 12 e 80 meses de idade, em regime de monta natural. O número de touros classificados como aptos consistiu em 88,9% dos animais avaliados (n=5480), sendo 51,6% desses considerados excelentes (n=2827), 41,2% muito bons (n=2257) e 7,2% considerados bons (n=394). Entre os animais questionáveis (n=682; 11,1%), 79,6% foram classificados como inaptos temporários (n=542) e 20,4% (n=139) como animais descarte, de acordo com o exame andrológico, independentemente do teste da libido. O número de touros classificados como excelentes se reduziu para 752 (12,2%) quando dados de comportamento sexual foram incluídos para definição do seu PR. Concluiu-se que o uso de tabelas de classificação andrológica por pontos com atualizações técnicas beneficia a seleção mais apurada de touros Nelore. O teste da libido é ferramenta importante para a determinação do PR, o qual permite melhor aproveitamento dos reprodutores.(AU)

This study aimed to compare variations of andrological and behavioral parameters from Nelore bulls of different ages, to calculate their reproductive potential (RP) and propose a new classification table by points, considering current averages in each reproductive trait studied. Data were collected from 6162 breeding soundness examinations of Nelore bulls aged between 12 and 80 months, under natural mating. According to andrological parameters, regardless of the libido test, the number of bulls classified as approved was 88.9% (n= 5480), being 51.6% considered as excellent (n= 2827), 41.2% very good (n= 2257) and 7.2% considered as good (n= 394). Among the animals considered as questionable (n= 682; 11.1%), 79.6% were classified as temporarily reproved (n= 542) and 20.4% (n= 139) as discarded animals. The number of bulls classified as excellent decreased to 752 (12.2%) when sexual behavior data were included to define their RP. It was concluded that the use of tables for andrological classification by points with technical updates improves the reproductive selection of Nelore bulls. The libido test is an important tool for RP determination which provides better utilization of the sires.(AU)

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Utilizaram-se quatro garanhões nos meses de janeiro, abril, julho e outubro de 2016, em dois protocolos, em que: GI (n=4; 5mL de solução salina, i.v.) e GII (n=4; 5000UI de hCG, i.v.) e subdividiram-se esses protocolos em ciclos (C1 e C2), seguindo o esquema crossover, sendo: CI=animais 1 (GI) e 2 (GII), avaliados nos dias D1, D3 e D5, e animais 3 (GI) e 4 (GII), em D2, D4 e D6; CII= animais 1 (GII) e 2 (GI), em D1, D3, D5, e animais 3 (GII) e 4 (GI), em D2, D4 e D6. Realizou-se o tratamento em D1 e D2 de cada ciclo e a ultrassonografia testicular no modo color Doppler e Doppler espectral, uma hora antes de cada coleta de sêmen e imediatamente após. Avaliou-se: número de reflexo de Flehmen, de montas sem ereção, início da monta, tempo de reação à ereção e total da monta e análises de qualidade seminal. Estatisticamente foram utilizados os testes de qui-quadrado e ANOVA. Não houve diferenças estatísticas (P>0,05) entre os parâmetros analisados. Concluiu-se que uma única dose de 5000UI de hCG em garanhões não causou alterações significativas nos parâmetros avaliados em diferentes estações do ano.(AU)

Four stallions were used in January, April, July and October 2016 in two protocols: GI (n=4; 5ml saline, iv) and GII (n=4; 5000 hCG, iv), and these protocols were subdivided into cycles (C1 and C2) following the cross over scheme, as follows: CI=animal 1 (GI) and 2 (GII) evaluated on days D1, D3 and D5 and animal 3 (GI) and 4 (GII) at D 2, D 4 and D 6; CII=animal 1 (GII) and 2 (GI) at D1, D3, D5 and animal 3 (GII) and 4 (GI) at D2, D4 and D6. Treatment was performed on D1 and D2 of each cycle and testicular ultrasound in color Doppler and spectral Doppler mode, one hour before each semen collection and immediately after. We evaluated: Flehmen's reflex number, mounts without erection, start of the mount, reaction time to erection and total mount and seminal quality analyzes. Statistically, the Chi-square and ANOVA tests were used. There were no statistical differences (P>0.05) between the analyzed parameters. It was concluded that a single dose of 5000IU hCG in stallions did not cause significant changes in the parameters evaluated in different seasons of the year.(AU)

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PURPOSE: The COVID-19 pandemic which has affected Spain since the beginning of 2020 compels us to determine recomendations for the practice of Andrology in present times. MATERIALS AND METHODS: A web search is carried out in English and Spanish and a joint proposal is defined by experts in Andrology from different regions of Spain. RESULTS: Most diagnostic and therapeutic procedures in Andrology can be safey postponed during the COVID-19 pandemic. Online consultations and outpatient surgeries must be encouraged. Andrologic emergencies and penile cancer management should be considered high priority, and should be diagnosed and treated promptly even in the most severe phases of the pandemic.

INTRODUCCIÓN: La pandemia COVID-19 que ha afectado a España desde comienzos de 2020 obliga a definir unas recomendaciones para la práctica de la Andrología en la actualidad.MATERIAL Y MÉTODOS: Se realiza una búsqueda web en inglés y español y se define una propuesta conjunta por parte de expertos en Andrología de distintas regiones de España.RESULTADOS: La mayor parte de los procedimientos diagnósticos y terapéuticos en Andrología pueden ser demorados con seguridad durante la pandemia COVID-19. Se debe fomentar la consulta telemática y la cirugía ambulatoria. Las urgencias andrológicas y el manejo del cáncer de pene deben considerarse una prioridad alta, diagnosticándose y tratándose con brevedadi ncluso en las fases más severas de la pandemia.

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Nowadays, sub-specialty expertise in andrology is required within the Urology training program. These practices -during the MIR (Medical Intern Residency) program and once the specialty studies are over- should be performed under supervision and have a multidisciplinary nature. In fact, the urologist's andrology training program does not finish with his residency period. The unceasingly increasing knowledge related to infertility, reproduction, sexual medicine and reconstructive surgery require a high level of dedication and engagement with continuing education. The field of Andrology has evolved significantly in Europe and in the United States in the past 30 years. Although the andrology training programs in these 2regions share some common aspects, there are also substantial differences between them. This chapter includes a review of the Spanish training programs and those in our international environment, with the objective to comprehend the importance of andrology medical-surgical training for Urology residents.

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La valoración subjetiva de la calidad seminal ha dado paso al uso de las técnicas objetivas de valoración por medio de la tecnología CASA (computer-assisted semen analysis). Se pueden aplicar una serie de pruebas cinéticas, morfométricas, morfológicas o de integridad del ADN para caracterizar y entender la biología reproductiva del espermatozoide. En los últimos años, se ha dado un cambio significativo de paradigma conceptual respecto de qué es un eyaculado. Cabe decir que, hasta tiempos recientes, se consideró que una población representativa (miles de millones) de espermatozoides estaba formada por células "equivalentes" con un objetivo común: ser el que finalmente pudiese fecundar el ovocito. La comprobación de que el conjunto de espermatozoides se agrupa en subpoblaciones bien definidas de acuerdo con sus características cinéticas y/o morfométricas, ha abierto el camino hacia una visión más cooperativa. Además, se ha visto que la distribución subpoblacional es diferente entre individuos, lo que parece indicar diferentes estrategias que se pueden entender dentro de otro paradigma: el de la competencia espermática entre diferentes eyaculados. A pesar de que aún no se conoce el papel de las diferentes subpoblaciones, se deben continuar los trabajos en esa dirección. En esta revisión, se caracterizó la evaluación de la fertilidad con la tecnología CASA y se examinaron los principales métodos multivariados en la evaluación de subpoblaciones de espermatozoides analizados mediante un sistema CASA.

In recent years, there has been a substantive change in the conceptual paradigm regarding what an ejaculate is. Until recently, it was considered that a representative population (billions) of sperm was made up of "equivalent" cells with a common goal: to be the one that could finally fertilize the oocyte. New data suggesting that a set of spermatozoa is grouped in distinct subpopulations, according to their kinematic and morphometric characteristics, has opened the way towards a more cooperative vision. In addition, recently, it has been established that the subpopulation distribution is different among males, which seems to indicate that there are different strategies that can be understood within another paradigm: sperm competition between different ejaculates. These heterogeneous subpopulations of spermatozoa in the ejaculate, that show kinematics and morphometric patterns, has been widely known for a while, but the biological meaning of these different sperm subpopulations is still not clear. For this reason, the subjective evaluation of seminal quality is being displaced by objective assessment techniques using CASA technology (computer-assisted semen analysis). Also, the application of principal components (PC) and clustering methods to reveal subpopulations of spermatozoa are complementary tools used to characterize raw semen and processed cell suspensions. Despite the advances in such powerful tools, researchers are not well versed on such techniques and its advantages. For instance, PC analysis is a multivariate statistical method that reduces the number of variables used in subsequent calculations for describing the data. By integrating the original data into new complex mathematical variables, homogenous subpopulations of spermatozoa can define clearly. Furthermore, kinematic, morphometric, morphological or DNA integrity tests can be also applied to characterize and understand the reproductive biology of the spermatozoon. Although the role of the different subpopulations of spermatozoa remains unknown, the work should continue by implementing novel technologies and coordinated tools. In this review, we characterize the fertility evaluation with CASA technology and examine the main multivariate methods in the assessment of sperm subpopulations analyzed by CASA systems.

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La acreditación de laboratorios especializados en Andrología tiene como objetivo promover, mejorar y asegurar la calidad del servicio. Las especialidades requieren de la participación de expertos que asesoren a los organismos autónomos que efectúan las auditorías de tercera parte. El objetivo del trabajo es comunicar la experiencia de trabajo cooperativo llevado a cabo por una sociedad científica, la Sociedad Argentina de Andrología (SAA) y el Programa de Acreditación de Laboratorios (PAL) de la Fundación Bioquímica Argentina (FBA) para el aseguramiento de la calidad de la prestación bioquímica en el área andrológica. Con tal fin se firmó un convenio marco y específico de colaboración para la acreditación de laboratorios especializados en Andrología. La FBA llevaría a cabo la logística del proceso, con su plantel de auditores, aplicando como instrumento el Manual de Acreditación MA3 y la SAA proveería asesoramiento científico. Junto con las autoridades del PAL se elaboró un documento que especifica los apartados correspondientes al MA3 capítulo Nº 4 Anexo Nº 4, "Estándares para la acreditación de laboratorios especializados". Se realizó capacitación para la elaboración de la documentación y formación de los auditores en la especialidad. Esta experiencia demuestra que el trabajo cooperativo entre organizaciones permite alcanzar logros a favor de la seguridad del paciente.

Laboratory accreditation aims to promote, improve and ensure the quality of the service. The specialties require the participation of experts who advise the autonomous bodies that carry out third-party audits. The objective is to communicate the experience of cooperative work carried out by a scientific society, the Sociedad Argentina de Andrología (SAA) (Argentine Society of Andrology) and the Laboratory Certification Programme (PAL for its name in Spanish) of Fundación Bioquímica Argentina (FBA) (Argentine Biochemistry Foundation) for quality assurance of the biochemical work in the andrology area. To reach this goal, a framework and specific collaboration agreement was signed for the certification of specialized laboratories in Andrology. The FBA will carry out the logistics of the process, with its auditors' staff, applying the MA3 Accreditation Manual as an instrument, and the SAA will provide scientific advice. Together with the PAL authorities, a document was drawn to specify the sections corresponding to the MA3 chapter No. 4 Annex No. 4, "Standards for the certification of specialized laboratories". Training was carried out to prepare the documentation and the auditors in the specialty were trained as well. This experience has proven that cooperative work between organizations can achieve results favouring the patient's safety.

O credenciamento dos laboratórios visa promover, melhorar e garantir a qualidade do serviço. As especialidades requerem a participação de profissionais que assessoram os órgãos autônomos que realizam auditorias de terceiros. O objetivo é comunicar a experiência do trabalho cooperativo realizado por uma sociedade científica, a Sociedade Argentina de Andrologia (SAA) e o Programa de Credenciamento (PAL) da Fundação Bioquímica Argentina (FBA) para garantir a qualidade do trabalho bioquímico na área andrológica. Para esse fim, foi assinado um acordo-quadro e específico de cooperação para o credenciamento de laboratórios especializados em Andrologia. A FBA iria executar a logística do processo, com a sua equipe de auditores, por meio do Manual de Credenciamento MA3 como instrumento e a SAA como um instrumento e a SAA forneceria assessoramento científico. Junto com as autoridades do PAL foi elaborado um documento especificando as seções relativas ao MA3 capítulo Nº 4 Anexo Nº 4, "Normas para a credenciamento de laboratórios especializados". O treinamento foi realizado para a elaboração da documentação e formação dos auditores na especialidade. Essa experiência tem demonstrado que o trabalho cooperativo entre organizações permite atingir resultados positivos para a segurança do paciente.

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This study aimed to evaluate the use of some testicular traits to identify boars with low sperm morphological quality. The consistency (scores from 1 to 5), tone with tonometry (mm), parenchyma echogenicity and heterogeneity with ultrasound (pixel) were assessed in 402 mature boars (18.5 months on average). Sperm abnormality thresholds (≤ 25% of total sperm abnormalities, ≤ 5% of heads, acrosome, neck or midpiece defects, ≤ 10% tail defects, and 15% cytoplasmic droplets) were used to classify boars as approved or disapproved. Three classes of testicular traits were formed (extremely low and high values, approximately 15% each, were kept in separated classes). When the traits were individually evaluated, fewer boars were approved if the echogenicity or heterogeneity were high, or if the tone was rigid. When evaluated in combination, the interaction between heterogeneity and tone, and between heterogeneity and echogenicity were significant. The high heterogeneity combined with soft tone or with hypo-echogenicity resulted in lower approval of boars. Tonometry and ultrasonography have a moderate potential to be included in breeding soundness examination of boars. When combined, they provide more reliable information about the impact of testicular parenchymal alterations on morphology of sperm cells.(AU)

O estudo objetivou avaliar o uso de características testiculares para identificar reprodutores com baixa qualidade de morfologia espermática. A consistência (escore de 1 a 5), o tônus por tonometria (mm), a ecogenicidade e a heterogeneidade do parênquima testicular por ultrassonografia (pixel) foram avaliados em 402 machos suínos maduros (18,5 meses, em média). Limiares máximos de anormalidades espermáticas (≤ 25% de defeitos totais, ≤ 5% de defeitos de cabeça, acrossoma, colo e peça intermediária, ≤ 10% de defeitos de cauda e 15% de gota citoplasmática) foram utilizados para classificar os machos como aprovados ou reprovados. Três classes de características testiculares foram formadas (valores extremamente baixos e altos, aproximadamente 15% em cada, foram mantidos em classes separadas). Quando as características testiculares foram avaliadas individualmente, menos machos foram aprovados se a ecogenicidade ou a heterogeneidade foram altas, ou se o tônus era rígido. Quando avaliadas em combinação, a interação entre heterogeneidade e tônus e a interação entre heterogeneidade e ecogenicidade foram significativas. A alta heterogeneidade combinada com testículos flácidos ou com testículos hipoecogênicos resultou em menor aprovação de cachaços. A tonometria e a ultrassonografia possuem potencial moderado para serem incluídas no exame andrológico de cachaços. Quando combinadas, as técnicas fornecem uma informação mais consistente do impacto das alterações do parênquima testicular na morfologia das células espermáticas.(AU)

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Este estudo teve o objetivo de demonstrar o efeito da idade sobre as características de circunferência escrotal, cor de pelagem e qualidade seminal, desde a puberdade até após a maturidade sexual. Foram utilizados dados de 6607 exames andrológicos de touros da raça Nelore criados a pasto. Os animais eram de diferentes faixas etárias, variando de 12 até 80 meses. O exame andrológico consistiu em exame clínico reprodutivo, perímetro escrotal (PE), avaliação do sêmen e nota para cor do pelame (COR; 1-4). Estabeleceram-se quatro faixas etárias, que foram comparadas pelo teste de Bonferroni. Os parâmetros seminais PE e COR variaram (P<0,05) conforme a faixa etária dos animais: A) 12-18m: COR=1,45±0,64a, PE=31,63±3,51cma, motilidade total (Mot)=67,73±17,99%a, total de defeitos espermáticos (TDE)=16,22±16,95%a; B) 18-24m: COR=1,50±0,57b, PE=32,00±3,47cma, Mot=69,60±29,13%a, TDE=14,49±15,00%b; C) 24-36m: COR=1,51±0,66b, PE=33,56±3,91cmb, Mot=69,46±15,52%a, TDE=12,29±12,92%c; D) 36-48m: COR=1,60±0,57c, PE=36,66±3,50cmc, Mot=71,04±16,19%b, TDE=10,87±12,97%d; E) >48m: COR=1,64±0,72c, PE=38,00±3,22d, Mot=71,54±15,30b, TDE=9,70±16,95d. Concluiu-se que a faixa etária influencia o tamanho testicular, a cor da pelagem e os parâmetros de qualidade seminal. Com o avançar da idade, ocorre escurecimento do pelo, aumento do perímetro escrotal, da motilidade e do vigor, e redução dos defeitos espermáticos de touros Nelores criados a pasto, avaliados a partir de 12 meses de idade.(AU)

This study aimed to demonstrate the effect of age on bull traits such as scrotal circumference, pelage color, and semen quality, from puberty to post sexual maturity. Data from 6607 breeding soundness examinations of pasture raised Nelore bulls were used. The animals presented different age groups ranging from 12 to 80 months. The andrological examination consisted in reproductive clinical evaluation, assessment of scrotal perimeter (PE). In addition, color of pelage (COR; 1-4) was recorded for each animal. Four age groups were established, which were compared by Bonferroni test. Semen parameters, scrotal circumference (PE) and color of the pelage (COR) varied (P< 0.05) according to the age range: A) 12-18m: COR=1.45±0.64 a , PE=31.63±3.51cm a , Total Motility (Mot)=67.73±17.99% a , Total os sperm defects (TDE)=16.22±16.95% a ; B) 18-24m: COR=1.50±0.57 b , PE=32.00±3.47cm a , Mot=69.60±29.13% a , TDE=14.49±15.00% b ; C) 24-36m: COR=1.51±0.66 b , PE=33.56±3.91cm b , Mot=69.46±15.52% a , TDE=12.29±12.92% c ; D) 36-48m: COR=1.60±0.57 c , PE=36.66±3.50cm c , Mot=71.04±16.19% b , TDE=10.87±12.97% d ; E) >48m: COR=1.64±0.72 c , PE=38.00±3.22 d , Mot=71.54±15.30 b , TDE=9.70±16.95 d . It was concluded that age influences testicular size, pelage color, and semen quality parameters. As the age progresses, there is an increase in scrotal perimeter, hair darkening, sperm motility and vigor, and reduction of sperm morphological defects of pasture raised Nelore bulls, assessed as from as 12 months of age.(AU)

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INTRODUCTION: Andrology focuses in male sexual and fertility diseases. Its referral should be thoughtful and tailored in order to select the correct cases. OBJECTIVES: The aim of this work was to evaluate the referral to our department and improvement points. MATERIAL AND METHODS: A retrospective analysis was performed of the Andrology consults between January 2014 and December 2015. RESULTS: We evaluated 96 of the 102 consults performed. About 60% of patients were referred with erectile dysfunction complaints, 15% with penile curvature and 8% with ejaculatory dysfunction. About 27% had previously tried phosphodiesterase 5 inhibitor, and 40% lacked recent metabolic workup. DISCUSSION: The high prevalence of sexual complaints coupled with a high number of naïve patients could be due to difficulties by the referral doctors when analyzing and characterizing male sexual dysfunction according to the current sexual response cycle model. The lack of patient categorization accordingly to Princeton criteria (III) shows the difficulties found when selecting patients to start the first line of treatment for erectile dysfunction. CONCLUSION: Sexual dysfunction are highly prevalent in the general population. Healthcare providers should improve diagnostic and treatment skills in this field of Urology.

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Introducción Pese a que se ha descrito la presencia de actividad sexual en el adulto mayor, ella tiende a menospreciarse. Al no contar con personas con quienes puedan hablar de sus dificultades o les facilite información, los adultos mayores pueden tener problemas para tener una vida sexual activa, así como mayor probabilidad de presentar conductas de riesgo. Objetivo Identificar las actividades sexuales y los problemas en ese campo más frecuentes en el adulto mayor. Métodos Se realizó una revisión en las bases de datos: Medline, Embase, Lilacs y Scielo. Se incluyeron estudios que brindaron información sobre la sexualidad en el adulto mayor al respecto de: Conductas sexuales más frecuentes, condiciones asociadas a una mejor o peor satisfacción sexual, y comunicación con el adulto mayor. Resultados Se revisaron 2.342 artículos por título y el resumen. En total se seleccionaron 27 referencias para revisión en texto completo. Se identificó la importancia de la sexualidad en el adulto mayor en la calidad de vida y cómo ella se ve afectada por la presencia de condiciones como: cáncer, diabetes y depresión; además de falta de deseo, disfunción eréctil en el hombre y la menopausia en la mujer. Dentro de las conductas sexuales más frecuentes se describen: los besos, el coito genital, el sexo oral y la masturbación. Conclusiones Es importante conocer las condiciones que afectan la sexualidad del adulto mayor y entender la forma en que ellos desean vivir su sexualidad para facilitar la comunicación en la consulta y ayudarlos a tener una vida sexual satisfactoria.

Introduction Although the presence of sexual activity in the elderly has been described, it tends to be underestimated. By not having people with whom they can talk about their difficulties or providing them with information, older adults may have problems to have an active sex life, as well as a greater probability of having risky behaviors. Aim To identify the most frequent sexual activities and problems in this field in the elderly. Methods A review was performed in the databases: Medline, Embase, Lilacs and Scielo. We included studies that provided information about sexuality in the older adult regarding: More frequent sexual behaviors, conditions associated with better or worse sexual satisfaction, and communication with the elderly. Results 2,342 articles were reviewed by title and abstract. In total, 27 references were selected for full-text review. The importance of sexuality in the elderly was identified in the quality of life and how it is affected by the presence of conditions such as: cancer, diabetes and depression; In addition to lack of desire, erectile dysfunction in men and menopause in women. Among the most frequent sexual behaviors are described: kissing, genital intercourse, oral sex and masturbation. Conclusions It is important to know the conditions that affect the sexuality of the older adult and to understand the way in which they want to live their sexuality, to facilitate the communication in the consultation and to help them to have a satisfactory sexual life

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Soluções hiposmóticas com diferentes concentrações (0, 50, 100, 150, 200mOsm/L) foram testadas para a avaliação funcional da membrana espermática de catetos (n=13). Foi verificado que o número de espermatozoides reagidos diminuía (P<0,05) de acordo com o aumento da osmolaridade do meio. A maior porcentagem (71,8%) de espermatozoides reagidos, bem como a menor variação nas respostas osmóticas, foi detectada com o uso de água destilada (0mOsm/L) (P<0,05), a qual também apresentou a menor variação nos resultados, de acordo com os erros padrão verificados. Em conclusão, a água destilada aparenta ser uma solução adequada para o uso no teste hiposmótico para sêmen de catetos.

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O objetivo deste estudo foi determinar o estádio de maturidade sexual e avaliar o perímetro escrotal e as características seminais de touros jovens da raça Nelore, puros de origem (PO), através da classificação andrológica por pontos (CAP). Trinta e oito touros, com média de 25,38 ± 2,16 meses, foram submetidos ao exame andrológico completo e a classificação andrológica por pontos (CAP). O valor médio observado para perímetro escrotal foi de 34,34 ± 2,17 cm. A média observada para turbilhonamento, vigor espermático e motilidade espermática progressiva retilínea foi de 4,03 ± 0,76, 4,35 ± 0,75 e 84,32 ± 7,18 %, respectivamente. Quanto às características morfológicas, foi observada média de 10,66 ± 5,26 e 16,78 ± 5,68 %, para os defeitos maiores e defeitos espermáticos totais, respectivamente. Com relação ao estádio de maturidade sexual, 97,37 % (n = 37) dos touros foram considerados maturos sexualmente (classes 1 e 2) e, somente um touro (2,63 %), foi considerado sexualmente imaturo (classe 3). Os touros avaliados pelo CAP foram classificados como muito bons (78,63 ± 9,38). As estimativas de correlações simples de Pearson entre o CAP e o perímetro escrotal e entre as características físicas do sêmen foram consideradas positivas e significativas. Já, para as características morfológicas do sêmen as correlações foram consideradas negativas e significativas.

The aim of this study was to determine the stage of sexual maturity and evaluate scrotal circumference and semen traits of in purebred Nelore young bulls, through the breeding soundness evaluation (BSE). Thirty-eight bulls, averaging 25.38 ± 2.16 months, underwent through breeding soundness evaluation (BSE). The average value observed for scrotal circumference was 34.34 ± 2.17 cm. The average observed for individual sperm motility, vigor e mass activity motility, were 4.03 ± 0.76, 4.35 ± 0.75 and 84.32 ± 7.18 %, respectively. A abnormal morphology was observed an average of 10.66 ± 5.26 and 16.78 ± 5.68% for major defects and total sperm defects, respectively. About the stage of sexual maturity, 97.37% (n = 37) bulls were considered sexually mature (classes 1 and 2) and only one bull (2.63 %) were considered sexually immature (class 3). Bulls assessed by BSE were classified as very good (78.63 ± 9.38). The estimated simple correlations by Pearson between the BSE and scrotal circumference and between the physical characteristics of semen were positive and significant. However, the morphological characteristics of semen correlations were negative and significant.

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