MALE REPRODUCTION AND UROLOGY ... - Fertility and Sterility

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Oct 23, 2000 - increased during menstruation in women with endometriosis, but ... laparoscopy and they underwent endometrial ablation (EA) and the second.
[follicular (n54), luteal (n57), menstrual phase (n54)] was fixed with CytoRich, processed and thinlayers were prepared with the Autocyte-Prep. A Papanicolaou-stain and immunocytochemical stains were performed using monoclonal antibodies CK 7 (Dako), CK 8/18 (Novocastra), Ber-Ep4 (Dako), vimentin (Dako), calretinin (Swant) and CD68 (Kp1; Dako). Results: In comparison with the nonmenstrual phase of the cycle (n535), analysis of PF during menstruation (n58) showed an increased concentration of leucocytes (3.3 3 109/L vs 0.8 3 109/L, P50.03), eosinophilic (0.1 3 109/L vs 0.04 3 109/L, P50.09) and basophilic (0.2 3 109/L vs 0.04 3 109/L, P50.002) granulocytes, erythrocytes (0.3 3 1012/L vs 0.02 3 1012/L, P50.006), hematocrit (0.03 L/L vs 0.003 L/L, P50.01) and hemoglobin (0.8 g/dL vs 0.1 g/dL, P50.01). In the 36 women with endometriosis, the PF concentration of erythrocytes was high during menses (n58, 0.3 3 1012/L) and decreased significantly (P50.001) during follicular (n57, 0.1 3 1012/L) and luteal (n521, 0.02 3 1012/L) phase. During menstruation, no correlation was found between the stage of endometriosis and the PF concentration of leucocytes or erythrocytes. Peritoneal fluid contained sheets of mesothelial cells as well as single cells with a reniform nucleus (mesothelial cells? monocytes/macrophages? stromal endometrial cells?). Mesothelial cells stained positively with CK7, CK8/18, vimentin, calretinin and sometimes weakly with CD68. Cells positive for epithelial marker Ber-Ep4 were not observed, except in 2 patients investigated during menses who had a few positive cells. In some patients, the single cell population contained 10 –50% cells with very weak, probably nonspecific staining for calretinin. In all patients 50 –98% of single cells were strongly positive for both vimentin and CD68. Conclusions: The PF concentration of leucocytes and erythrocytes was increased during menstruation in women with endometriosis, but not related to the degree of endometriosis. Most of the single cells present in all peritoneal fluids belong to the monocyte/macrophage lineage. However, the presence of a small number of stromal endometrial cells cannot be excluded. In 2 menstrual cases, very few epithelial cells, possibly of endometrial origin, were present.

P-076 Endometriosis. Absence of Recurrence Rate in Patients with Endometrial Ablation. C. Bulletti, D. De Ziegler*, M. Stefanetti, E. Giacomucci, V. Polli, L. Diotallevi, C. Flamigni. Department of Obstetrics, Gynecology and Physiopathology of Reproduction, Rimini’s Hospital and University of Bologna, Italy, *Nyon Medical Center, Nyon, Switzerland. **Columbia Laboratories, Paris, France. Objectives: Abnormal Uterine Contractility was found in close relationship with endometriosis and retrograde bleeding; tubal efflux of endometrial debris into the pelvic cavity may cause recurrence of this disease. The present study was undertaken to evaluate differences between patients with and without eutopic endometrium in the recurrence of ectopic endometriotic implants. Design: 28 women with at least 1 child, age 24 to 40, who underwent laparoscopy twice during menses for unacceptable dysmenorrhea, with diagnosis of endometriosis stage II to IV and retrograde bleeding were recruited for the study. All patients did not received benefit from the first laparoscopy and they underwent endometrial ablation (EA) and the second laparoscopy after 18 –24 months (n514) or a second laparoscopy without EA after 18 to 36 months (n514) from the first laparoscopy. Materials and Methods: The first and the second laparoscopy was done to remove endometriotic implants by using bipolar instruments or by excision of the implants themselves. Endometrial ablation was performed with resectoscopical procedure. Endometrial implants were carefully identified as well as the retrograde bleeding during the first and the second laparoscopy. The cul de sac’s blood was collected and endometrial cells were identified and counted by cytofluximetry. The scores of pain was detected and compared between the two groups. Analysis of data was performed with paired T-Student Test. Results: Nine of the 14 patients underwent endometrial ablation reported a disappearance and 3 a significant reduction of the pain during menses while only 3 of the other group did have significant amelioration of the symptom (p,0.05). Patients who underwent EA procedures did not exhibit recurrence rate of endometriosis while 9 patients without the procedure had significant recurrence rate of the disease (p,0.002). The endometrial cell founded in the debris of the cul de sac of 8 patients who did not undergo EA were both stromal and epithelial cells; two patients without dysmenorrhea

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had significant amount of blood and cells. No blood or blood cells were found in the cul de sac of patients who underwent EA. Conclusions: Human uterus, in vitro and in vivo, exhibits spontaneous during menstrual cycle and abnormal uterine contractility were previously described. The present study is supporting the crucial role of endometrial contractility in the recurrence rate of this disease. The abnormal uterine contractility may account for several other gynecological pathologies, such as sterility and infertility.

P-077 Predictive Value of Anti-Ovarian Antibodies for Endometriosis. J. G. Donahue. Department of Obstetrics and Gynecology, Community Hospital, Indianapolis, IN. Objective: Anti-ovarian antibodies have been associated with endometriosis (Clin Exp Immunol 1982; 50: 259 –266). Some studies have suggested that auto-immunity may play a role in the pathogenesis of endometriosis (Fertil Steril 1996; 65: 1135– 40, Int J Gynecol Obstet 1993; 40: S21–27). The present study examines the predictive value of anti-ovarian antibodies for endometriosis. Design: Case-control study. Setting: Private office based infertility practice. Patients(s): One-hundred and sixty-four women with diagnostic laparoscopy for infertility between March, 1997 and November, 1999. Intervention(s): Diagnostic laparoscopy as part of infertility evaluation. Blood sample collection to detect the presence of anti-ovarian antibodies. Main Outcome Measure(s): Serum anti-ovarian antibodies were determined using an ELISA to human ovarian membranes. Endometriosis was staged according to AFS Revised Classification. Result(s): Anti-ovarian antibody levels were similar in patients with and without endometriosis. The antibodies did not correlate with stage of disease. The sensitivity was 71/13650.522; specificity, 18/2850.643; positive predictive value, 71/8150.876; and negative predictive value, 18/8350.216. Receiver Operating Characteristics were not favorable to predict any stage of endometriosis, AUC50.572 (95% CI; 0.492, 0.649). Conclusion(s): Anti-ovarian antibody determination may not be useful to predict the presence of endometriosis in infertility patients. The role of ovarian auto-immunity in endometriosis is uncertain.

MALE REPRODUCTION AND UROLOGY Monday, October 23, 2000 P-078 Sexual Function and Patient Satisfaction with Testosterone Supplementation. M. Kamarei, M. Monga. Division of Urology, University of California, San Diego, CA. Objective: The impact of hypogonadism on sexual function is controversial. Outcome analysis of testosterone supplementation for erectile dysfunction (ED) is limited. Our objective was to evaluate long-term efficacy of testosterone supplementation using modern standardized questionnaires and compare results between different testosterone delivery systems. Methods: We identified all men at the VAHCS San Diego who received testosterone supplementation for ED between 1/96 –3/98. Patients received depo-testosterone (DPT, Pharmacia & Upjohn, 400 mg IM q2–3 weeks) Testoderm scrotal patches (TSD, Alza, 4 – 6mg/24 hr) or Testoderm-TTS non-scrotal patches (TTS, Alza, 5mg/24 hr). The erectile dysfunction inventory of treatment satisfaction (EDITS) and sexual health inventory (SHI) questionnaires were used to assess patient satisfaction. Global questions were asked regarding improved libido, energy and erections. Results: 44 of 65 eligible patients participated. Co-morbidities included smoking (34%, 37 pack yrs), diabetes (34%), cardiovascular disease (64%) and hypertension (54%). Average duration of ED was 5.8 years. Mean pretreatment serum testosterone was 132.3 ng/dL (normal 180 – 650). Identifiable etiologies for hypogonadism included AIDS (3), bilateral orchiectomy for cancer/trauma (3), and cranial surgery/radiation/trauma (5). Pre-treatment ED was characterized as mild (9%), moderate (26%) or severe (65%).

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