Andrology

Men live 7.59 years less than women. Data from the Brazilian Institute of Geography and Statistics (IBGE) reveals that although life expectancy for men increased from 63.15 to 69.42 years from 1991 to 2009, it is still well below the average for women.

The main cause of death in men was ischemic heart disease, including acute myocardial infarction. In all, 49,128 men died from this cause. Cerebrovascular diseases were the second leading cause of death for men, with 45,180 deaths. The two causes can be grouped together as cardiovascular diseases, totaling 94,308 deaths in men. These diseases are mainly caused by endothelial lesions (blood vessels).

These lesions are first visible in the smaller vessels, such as the penile artery (1-2 mm). Occlusion of these vessels causes erectile sexual dysfunction (ESD) or lack of erection.

Ponholzer et al showed that coronary artery disease is 65% higher in men with moderate to severe SD than in normal men.

Inman et al observed that patients with SDB have an 80% higher risk of acute myocardial infarction compared to normal individuals. Men between the ages of 40 and 49 with moderate to severe ESRD have a 50 times greater risk of developing cardiovascular disease.

In addition to ESRD, we have another important factor for cardiovascular disease in men: the reduction in testosterone with age, known as Late Onset Hypogonadism (LOH), which affects 6% of the male population at the age of 40 and 12.3% at the age of 69.

Recent data in the literature shows that the age-related increase in the risk of coronary heart disease appears in conjunction with a reduction in testosterone.

Patients undergoing hormone blockade, i.e. removal of testosterone from circulation (castration) due to prostate cancer, are at high risk of coronary heart disease due to the marked reduction in serum testosterone. Male hormone replacement is an important factor in the quest to reduce the incidence of cardiovascular disease. It leads to a reduction in cholesterol, greater exercise tolerance, greater sensitivity to insulin action (helping to control diabetes), a reduction in the thickness of the artery wall and a reduction in inflammatory factors in the endothelium (vessel).

Considering the above, every man must recognize that he is neither immortal nor immune to disease. Recognizing your limitations and seeking appropriate medical care is essential to living a healthy life.

Hormone replacement will be necessary in patients with hypogonadism. This is characterized by a clinical condition in which low testosterone levels are found in association with specific signs and symptoms. When hypogonadism occurs in older men, the condition is generally called andropause or late onset hypogonadism, also referred to as LOH (Late Onset Hypogonadism). It is estimated that hypogonadism affects 6% of the male population by the age of 40 and 12.3% by the age of 69.
In the United States alone, approximately 2.4 million people are affected.
The diagnosis is made when there are low levels of testosterone in the blood with associated signs and symptoms:

• Fatigue/weakness.
• Reduced libido.
• Reduction of "energy".
• Erectile dysfunction (erection problems).
• Reduced muscle mass.
• Osteoporosis.
• Increased abdominal fat.
• Cognitive impairment (forgetfulness, slow thinking).
• Insomnia

Hormone replacement improves and reverses all the associated symptoms. However, it must be accompanied by regular visits to your urologist. Some changes can arise with the continued use of testosterone and need to be monitored continuously.

Penile prostheses are devices implanted inside the penis of men with erectile dysfunction, allowing them to achieve erections. These implants are generally recommended when less invasive treatments have failed. There are two types of penile implants: semi-rigid and inflatable. Each works differently and has its own pros and cons.
A penile prosthesis is inserted through surgery. Before choosing your penile prosthesis, make sure you understand the surgery required, including the risks, complications and aftercare.

The semi-rigid penile prosthesis is a surgically implanted device that enables a man with erectile dysfunction to achieve an erection. It consists of two cylinders that are constantly firm but flexible, meaning they can be bent. All components are implanted and are generally not visible outside the body.
These cylinders occupy the space that was previously filled with blood during an erection. They do not affect penile sensitivity and allow the patient to continue ejaculating. The glans also continues to fill with blood (in cases where this occurred before the surgery).
When desired by the patient, the penis with the prosthesis can be “bent” to the side or another direction to make it less noticeable. The advantage of this prosthesis is that it does not require a pump or fluid reservoir to function, making it easier to use. The chance of mechanical failure is also lower. The disadvantage is that the “erection” is less physiological and continuous, although the penis can be bent.
Its placement is performed through an incision in the scrotal sac. Once the wound heals, it becomes barely noticeable.

Vasectomy is the fourth most used form of contraception in the United States, after condoms, the female pill and tubal ligation. When compared to the latter, vasectomy is just as effective, but simpler, faster, safer and cheaper. It takes less time off work and is performed under local anesthesia. Post-operative complications are less serious and rarer than those of tubal ligation1.

Currently, the recommended technique (used by Dr. Alexandre Miranda) is the non-scalpel vasectomy, as it has the following characteristics less chance of bleeding, pain during surgery, scrotal pain, infection and bruisingcompared to the traditional technique (with two small cuts). It also provides a faster recovery for returning to daily and sexual activities2.

In the technique used by Dr. Alexandre Miranda the vas deferens (the tubes that connect the testicles to the urethra and through which the sperm pass) are accessed through the scrotum in one place, without any cuts. No stitches are required at the end of the procedure.

1. Sharlip ID, Belker AM, Honig S, et al. Vasectomy: AUA guideline. The Journal of urology. 2012;188:2482-2491.
2. Cook LA, Pun A, Gallo MF, Lopez LM, Van Vliet HA. Scalpel versus no-scalpel incision for vasectomy. The Cochrane database of systematic reviews. 2014;3:CD004112.

Vasectomy is one of the safest and most effective definitive methods of birth control. It is safer and more effective than ligation performed by women.

The no-cut vasectomy technique is different from the traditional one: it doesn't require the use of a scalpel. The surgeon uses specific instruments to make a small hole through which the vas deferens (the tubes through which sperm pass) are cut, ligated and cauterized. The hole is so small that no stitches are needed to close it.

It is estimated that 2-6% of men who have had a vasectomy want to have it reversed.
The surgery is carried out using a microscope and microsurgical material, as it is a microscopic procedure where the threads are thinner than a strand of hair.
The chance of pregnancy in patients who undergo reversal less than 3 years ago is 97%; between 3-8 years is 53%; between 9-14 years is 44% and over 15 years is 31%.
Dr. Alexandre Miranda has experience in vasectomy reversals. He is currently the head of the Andrology section at the Federal Hospital of Ipanema and responsible for reversals at the hospital.