Andrology

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Andrology focuses on male infertility, sexual disorders, gender identity issues, sex affirmation surgery, cosmetic and reconstructive genital surgery, reconstructive urethra surgery, oncoandrology, male menopause, late onset hypogonadism, andrological infections and STDs, prostatopathy and pediatric andrology.   - German Medical Group Team -

Andrology is a branch of modern medicine bordering on several specialties simultaneously. This includes endocrinology, urology, sexopathology, as well as specialties related to microsurgery, plastic and vascular surgery. Apart from being a specialist, andrologist is also a physician qualified to provide assistance in the areas of dermatology and venology.

The andrologist performs the necessary diagnostics to identify the diseases in genital sphere and develops appropriate preventive measures. In other words, this is a purely “male” doctor, whose competence falls into all those features that determine the differences between men and women, namely anatomical, psycho-sexual, and endocrinological features.

There's a separate paediatric speciality within andrology. The pediatric andrologist deals with the anatomical, psycho-sexual, physiological and endocrinological features of boys, including the treatment and prevention of reproductive system diseases.

  • improving of reproductive health
  • diagnosis and combination treatment of male sexual disorders
  • diagnosis and combination treatment of male infertility
  • diagnosis and combination treatments of prostate diseases, urethra and genitals:
    • chronic prostatitis
    • chronic pelvic pain syndrome
    • benign prostate hyperplasia
    • STD
    • medical examination before fertilization
  • surgical correction of congenital and acquired genital anomalies like deformations and hypoplasia
  • penile and urethral reconstruction
  • correction of obstructive urethral stricture, hypospadia, epispadias and urethral stricture treatment
  • Peyronie's disease conservative and surgical treatment
  • hormonal and surgical gender reassignement methods
  • diagnosis and treatment of late boys sexual and physical development
  • diagnosis and treatment of congenital genital development disorders
  • correction of male age-related disorders:
    • treatment of androgen deficiency in the aging male and sexual disorders
    • correction of adipositas, loss of bones and gynecomastia
  • diagnosis and treatment of acraturesis and involuntary urination (women and men)
  • inflammatory conditions of male and female urogenital system (cystitis, pyelonephritis)

Among andrologists there are the following highly specialized doctors:

  • Andrologist urologist - treats urogenital diseases in order to restore the disrupted male health;
  • pediatric andrologist - deals with puberty disorders and congenital anomalies of the genitals of children under 18;
  • andrologist endocrinologist - treats diseases related to endocrine organs (adens emitting hormones) and affecting male sexual and reproductive function;
  • andrologist surgeon - is engaged in surgical service of genitals diseases, as well as plastic surgeries on external genitalia, including cosmetic defects elimination;
  • andrologist fertility specialist - deals with the problem of infertile couples;
  • andrologist sexologist - deals with the male problems of a sexual nature;
  • andrologist oncologist – deals with the treatment of tumors of male genital organs.

Andrologist urologist

As mentioned earlier, there are many specialists engaged in the treatment of male urogenital system diseases. This raises the question: what's the difference between andrologist and urologist.

Let's consider these differences more closely:

  • Urologist specializes in the diagnosis and treatment of the urogenital system in male and female patients, while andrologist treats identical diseases in male patients only.
  • Even the sciences of urology and andrology differ from each other. In case of urology the treatment is aimed at restoring the work of the urinary system, while andrology also solves the problem of male sexual viability.
  • In order to become specialists, urology students have to receive a diploma after graduation, while andrologists are already highly specialized doctors.

It is safe to say that there is a huge difference between an andrologist and urologist. Another thing worth noting is the difference between urologist and urologist andrologist. In case of urology the treatment deals with the urinary system diseases only, while urology-andrology requires the treatment of both urinary and reproductive systems problems.

Let us consider in more detail what diseases an andrologist urologist treats in men and in what cases you need to see one. An appointment is required for those who noticed certain erection problems.

In addition, urologist-andrologist can educate the patient on the subject of contraception methods as well as help to choose the most efficient method in every clinical case. The specialist will also explain what to do if conception does not occur, providing the absence of reproductive function problems in the sexual partner.

Considering the andrologist urologist specialty in detail, it is necessary to mention the ability to identify and eliminate various inflammatory processes localized in the genital organs.

Also this specialist treats various genital organs diseases, as well determines the cause for the appearance of rashes and other abnormal masses. He deals with male planning of future pregnancy, and offers a professional consultation before the conception.

One should see an andrologist and urologist at least 2 times a year, and men at their 50s should see these doctors even more often. This approach to your health will certainly help to identify the development of diseases in the early stages.

Surgery Andrologist

There are a number of the reproductive function pathologies, which can be treated by surgical measure only, so you should know who an andrologist surgeon is and when it's necessary to see one.

It is necessary to see this specialist and undergo the recommended treatment in case of following diseases:

  • Hypospadias. The disease can be treated by the surgical measure only, because the conservative medication does not provide any visible therapeutic benefits. I most cases the expected response to treatment is positive. Theoretically, the surgery is best to be performed for young patients between 6 and 18 months of age.
  • Hydrorchis. Andrologist surgeon helps to get rid of the associated testicular dropsy through Ross operation. During the surgery a small incision in the pelvic area is made, which heals quickly.
  • Spermatocele. This is a kind of a cystic formation. If its size exceeds 1,5cm a surgical treatment is necessary.
  • Cryptorchidism. Surgery treatment shall be performed for children from 12 months. If the testicles are located in the abdominal cavity, the surgery has to be performed before the age of 1 year.

A surgeon andrologist is a specialist dealing with both acquired and congenital types of diseases affecting the external genital organs.

Andrologist endocrinologist

It is a medical specialization dealing with the diagnosis and treatment of male reproductive system pathologies. It is quite broad and intertwined with other medical specialties. Let's consider who the endocrinologist andrologist is, what kind of diseases he treats, and when it is necessary to see him.

This specialist deals with the treatment of male reproductive system diseases that evolved due to hormonal disorders. That is why during the consultation, the doctor will require the patient to undergo a blood examination to determine the level of hormones.

Andrologist endocrinologist treats the following pathologies:

  • Paraphimosis;
  • Hypospadias;
  • Bladder exstrophy;
  • Priapism;
  • Tumors on the penis;
  • Prostate adenoma;
  • Hypogonadism;
  • Cryptorchidism;
  • Epispadias;
  • Peyronie's disease;
  • Short frenulum of the penis;
  • Tumors in the testicles;
  • Prostate cancer.

In case of suspicion on the development of one or several pathologies, it is necessary to see a doctor as soon as possible. The specialist will conduct a thorough diagnosis, prescribe the correct treatment, and refer to other narrow specialists, if necessary.

Andrologist sexologist

In case of infertility problems, it is necessary to see an andrologist sexologist. In most cases, such a specialized doctor is difficult to find in public health facilities, especially in small towns and villages.

During the diagnosis, the specialist will prescribe a series of tests that will help evaluate the level of reproductive health. Some patients are not sure what kind of specialist to see with a spermogram. In this case you can see a sexopathologist or an andrologist.

Also, some patients wonder who an andrologist gynecologist is. This specialization allows a doctor to treat both male and female patients. This physician is qualified to examine and treat reproductive system diseases of both genders.

Pediatric andrologist

Let's consider this medical specialty in more detail. Pediatric andrologist treats the following diseases:

  • Varicocele;
  • Spermatocele;
  • Hydrorchis;
  • Hypospadias;
  • Epispadias;
  • Webbed penis;
  • Cryptorchidism;
  • Phimosis.

Parents should pay attention to the child’s complaints. If the boy mentions the following uncomfortable conditions, please consult a doctor as soon as possible:

  • Urinary retention or acraturesis;
  • Pain in the preputium or glans penis;
  • Discomfort or pain while walking or sitting;
  • Constriction in the scrotum;
  • Unusual bulging in the scrotum;
  • Congenital abnormalities;
  • If there are no obvious sexual characters at the age of 13;
  • The boy is overweight;
  • In case of enuresis after 4-years age;
  • Mismatch in the size of testicles and other genital organs.

You should also consult a specialist in case of acute pain, fever, purulent discharges and enlarged lymph nodes.

FBC (Full Blood Count) and UA (Urine Analysis) - methods common for all branches of medicine, including andrology. In addition, a biochemical blood assay is prescribed, but all of these analyses are not specific.

Analyses used specifically for the male diseases diagnosis are as follows:

  • Spermogram;
  • examination of prostate secretion;
  • examination of the male sex hormones level.

Spermogram is a method that gives a clear picture of the condition of a man’s sperm. In most cases, this analysis helps to detect the cause of infertility.

The prostate secretion examination is necessary in the diagnosis of the prostate gland diseases and in determining the causes of infertility.

Specific instrumental methods in andrology are:

  • Cystography, which helps to visualize the prostate gland;
  • prostate biopsy;
  • testicles and prostate ultrasound investigation.

Transrectal ultrasound investigation of the prostate

The standard diagnostic procedure for the urogenital system pathology detection in andrology remains the transrectal ultrasound investigation of the prostate gland. In most cases, this analysis is enough to identify prostate disorders. The results are analyzed by the specialist during differential diagnosis of diseases.

The transrectal ultrasound investigation of the prostate is a comprehensive analysis conducted to obtain the full information about the state of the organ. It requires that complex examination of the prostate by means of ultrasonic waves. Reflected from the examined organ, ultrasonic waves create a picture which is used for diagnostics. This analysis is obligatory for every man over 40 years. The transrectal ultrasound examination of the prostate is one of the most effective methods of research and diagnostics. Based on the data obtained during the penetration of an ultrasonic wave, the doctor receives a detailed and accurate image of the structure and shape of the prostate gland and detects or excludes pathology. During the procedure the endoscope is inserted rectally, that is, through the rectum.

Transrectal ultrasound helps to examine the integrity and clarity of the contours of the prostate gland capsule. The doctor assesses the symmetry of the prostate and its internal structure. Using this technique, the following diseases can be identified in the early stages:

  • Tumors;
  • benign prostatic hyperplasia;
  • cystic lesions and concretions;
  • prostatitis;
  • impotence;
  • male infertility.

Transabdominal Prostate Ultrasound

This analysis is carried out mainly for preventive purposes. This procedure is safe and does not cause any discomfort to patients. Thanks to ultrasound, the andrologist can obtain the necessary data on the condition of the prostate gland and other small pelvis organs, which may also undergo changes in case of prostate disease.

Ultrasound investigation allows to identify the pathology of the organ and diagnose the urogenital system diseases. Despite the convenience of the transabdominal technique, in case of serious prostate gland disorders suspicion, a patient is recommended to undergo the transrectal ultrasound or transurethral examination.

Scrotum organs ultrasound examination

In the process of the scrotum ultrasound examination, the testicles, their appendages and membranes, the spermatic cords, deferent canals, the surrounding tissues and regional lymph nodes are examined.

Indications for the scrotum ultrasound in andrology are:

  • Pain in the scrotum area;
  • cryptorchidism;
  • suspicion of inguinal hernia with partial entry into the scrotum;
  • testicle swelling or hardening, detected by external examination and palpation;
  • blood in the semen;
  • diagnosed varicocele (phlebeurysm of the spermatic cord);
  • male infertility;
  • impotence.

Also, an ultrasound scrotum scan is performed as a preventive examination for the tumor processes early detection and the assessment of blood circulation in the testicles.

Penile ultrasound

Penile ultrasound is one of the most common studies of male genital organs in case of various pathologies. This modern diagnosis method in andrology has several advantages: it is informative, safe, generally available, and also absolutely does not cause unpleasant or painful sensations. In addition, penile ultrasound can be performed multiple times, and in some cases this method of research is the only alternative.

Indications for penile ultrasound:

  • Penile injury;
  • peyronie's disease;
  • preparation for plastic surgery in this area;
  • erectile dysfunction;
  • neoplasms visible or palpable;
  • preparation for surgery;
  • swelling or pain when urinating;
  • pain or discomfort during sexual intercourse;
  • suspicion of a foreign object or diverticula of the urethra;
  • stricture (narrowing) of the urethra.

Prostate MRI (Magnetic resonance image)

In modern medical practice, prostate gland MRI is recognized as the basic procedure for diagnosis in andrology. This method of high-precision research is the key to success in the treatment of many diseases. In case of prostate cancer suspicion, after a rectal palpated examination and in case of increased PSA (prostate-specific antigen) detected in the blood examination for the cancer-specific marker, the doctor makes a decision (with the patient's consent) to perform a prostate biopsy. MRI is not the primary diagnostic procedure for prostate gland cancer.

The main indication for the prostate MRI is the diagnosis of prostate cancer. An MRI scan is usually performed after a biopsy has confirmed prostate cancer in order to determine whether prostate gland cancer is limited or the process has spread beyond the prostate.

In addition, prostate MRI is used to diagnose other prostate diseases:

  • Prostatitis or prostate abscess;
  • prostate adenoma.

MRI of male external genital organs

Among indications are penis injuries of a different nature, including those occurred during sexual intercourse: in cases of sharp bend of the erect penis during careless sex, attempts of violent intercourse or hitting with heavy objects.

Other indications are scrotum and testicles injuries which are the result of compression or bruises, rarely a knife or gunshot wound. Insulated damage to the scrotum may occur when hitting the bike frame, saddle, when doing exercises on uneven bars and other sports equipment. Scrotum injuries are often accompanied by a hematoma, sometimes of quite impressive size. As a result, the scrotum increases in volume, and the folds of the skin are smoothed by compression.

The indications for MRI studies of the external genital organs are such diseases as Peyronie's disease and priapism, periurethral abscess, post-traumatic fibrosis and erectile dysfunction, as well as any nonspecific pain in the groin or in the scrotum.

Cavernosography

Cavernosography is a type of contrast X-ray study, which is an x-ray image of the erect penis in several projections after the injection of X-ray contrast agents. It allows to collect data about the venous system and cavernous bodies state, to detect the vessels through which the pathological outflow of blood is carried out, to detect fibrous plaques, sclerosis or atrophy in the cavernous bodies.

Cavernosography reveals structural changes in the cavernous tissue and the severity of venous "leakage" in patients suffering from erectile dysfunction, which is a determining factor in choosing a treatment method. It allows to make a prognosis of the particular treatment method's effectiveness depending on the severity of organic disorders in each individual patient. In addition, it helps to assess the structure of the cavernous bodies of the penis, the presence of sclerosis or atrophy, as well as plaques typical Peyronie's disease.

Cavernosography is prescribed to determine the proportions of the penis shaft when deciding whether to perform a surgical treatment in patients suffering from erectile dysfunction of mixed origin. It is used not only to diagnose and determine the treatment tactics of organic erectile dysfunction, but also to assess the severity of injury to the penis.

Prostatography

Prostatography - a method of x-ray examination of the prostate gland. Allows you to visualize the prostate, assess its size, shape, position and internal structure. The technique is used to diagnose the mass of the prostate gland, inflammatory and dystrophic processes.

Prostatography is used in andrology, urology and oncology. The examination is carried out on an outpatient basis, for some types of prostatography invasive manipulations are necessary. In particular, there are several types of contrasting, applied depending on the objectives of the examination.

Andrologists, urologists, or oncologists are qualified to prescribe this procedure. Complaints indicating disorders in the structure and function of the prostate are:

  • Blood in the urine;
  • difficult or painful urination;
  • ineffectual urge to urinate;
  • pain in the perineum;
  • impotence.

These symptoms may be the result of prostatitis, abscess, prostate adenoma or prostate gland cancer, as well as many other pathologies.

The basis of conservative treatment of inflammatory diseases in andrology are etiotropic and pathogenetic methods of its implementation. The main treatment principle is the impact aimed at eliminating the infection:

  • Pathogenic bacteria;
  • viruses;
  • chlamydia;
  • mycoplasma;
  • microscopic fungi;
  • aerobic and anaerobic infections that can be detected by means of bacteriological culture, immunofluorescence methods, molecular hybridization methods, serological diagnostics and gas-liquid chromatography.

The widespread use of antibiotics and chemotherapy drugs contributes to the variability of bacteria, oftentimes in cases of prostatitis, urethritis, vesiculitis, epididymitis, caused by urogenital infection. The immune system does not "recognize" the pathogenic microorganism, therefore relapses occur, which later leads to reproductive and copulatory dysfunctions of sexual partners.

Conservative treatment of prostatitis, vesiculitis, urethritis, epididymitis depends on the course of the disease. If it's acute course of the disease, treatment can sometimes be started without taking into account the etiological factor. In this case antibacterial therapy should be timely and intensive enough, as well as combined with the desensitizing drugs. In the chronic course of the disease, it is necessary to take into account the etiological and pathogenetic factors. Treatment should be aimed at preventing relapses. Antibacterial drugs should be selected depending on the microflora sensitivity. It is necessary to alternate them with antiseptics, immunomodulators, physiotherapy, and it is advisable to study the immunological status of the patient.

Currently, the introduction of modern diagnosis technologies and treatment of diseases in noted in andrology, especially surgical treatment.

In andrology, as well as in other areas of medicine, and surgery in particular, the so-called endoscopic and laparoscopic treatment methods are widely used. These methods are used in the treatment of prostate and other diseases, for example, with varicocele. One of the endoscopic interventions advantages in andrology is less level of invasiveness for the patient, a shorter postoperative period and the most acceptable cosmetic effect.

Andrology deals with the treatment of such diseases as congenital anomalies of the urogenital system. In particular, urethra development defects - hypospadias and epispadias. Treatment of these diseases requires plastic surgery. Currently, various one-stage methods of surgical treatment of these anomalies have been developed, whereas a few decades ago such operations required several stages.

Surgical andrology also deals with prostate diseases. These include prostate adenoma and prostate cancer. If earlier these diseases required extensive intervention, today endoscopic techniques such as TURP and others are widely used.

Usage of endoscopic and minimally invasive methods of treatment are quite popular even in the treatment of prostate cancer. One of these minimally invasive and effective modern methods of treating prostate cancer is photodynamic therapy. In this case, the patient is injected with the so-called photosensitizer, which increases the sensitivity of the tumor to laser irradiation. The advantage of this method is that healthy cells are not affected.

In the treatment of such a common disease as varicocele, varicose of the spermatic cord, less invasive and even laparoscopic methods of surgery, such as sclerotherapy, are also commonly used.

Laparoscopic interventions in andrology are also not a novelty. Their advantage is that they do not require extensive wide incisions, and all intervention is carried out through a small puncture-incision and its progress is monitored on the screen.

Microsurgical interventions are also performed in andrology, for example, when restoring the integrity of an organ. These are very intensive interventions that require filigree technique and repair small vessels and nerves.

Male plastic surgery - intimate surgery in andrology, is especially worth mentioning. It includes interventions aimed at lengthening the penis, restoring its shape, eliminating birth defects, etc. This area of andrology has achieved great success.

Among other male genital organs diseases, which andrology deals with, one can mention the plastic of the penis frenulum, curvature, prosthetics of the penis and testicles. Andrological problems also include phimosis (narrowing of the foreskin) and paraphimosis. In this case, a circumcision of the foreskin is carried out. It is also used in other diseases treatment, such as viral warts and early ejaculation.

The reason for consulting an andrologist may be:

  • Erectile dysfunction.
  • Diminished secretion of male sex hormones (male hypogonadism).
  • Anorchia, abnormality arising during the prenatal period. The disease is characterized by the absence of testicles and appendages, deferent ducts and prostate, the scrotum and penis underdevelopment.
  • Cryptorchidism (undescended testicle into the scrotum or its improper lowering).
  • Small penis syndrome. This collective term refers to an insufficient length of the penis (less than 9.5 cm) which can be caused by congenital diseases, inflammation, injuries and testicular tumors, diabetes, pituitary and hypothalamus damages.
  • We speak about male infertility when the organism does not produce enough mature sperm or they are not delivered to the female body. In some cases, male infertility is associated with chromosomal abnormality.
  • Enlarged female-type mammary glands (actual and false gynecomastia).
  • Lack of sexual desire and other libido disorders, as well as ejaculatory disorders (lack of seminal fluid, early or delayed ejaculation).
  • Hyperprolactinemia syndrome (prolactin hypersecretion), which occurs more often in women. Triggered by diseases that cause hypothalamus dysfunction, pituitary lesions, primary hypothyroidism, chronic renal insufficiency, cirrhosis of the liver, taking certain medications, etc.
  • An age-related androgenic deficiency (male menopause), in which testosterone levels decrease in blood and typical clinical symptoms appear (sexual dysfunction, physical exhaustion, etc.).
  • Endocrine diseases caused by androgens impaired synthesis and metabolism (observed in diseases of the adrenal glands, thyroid pathology, diabetes, hypothalamic and pituitary pathologies, obesity).
  • Transsexualism, when the patient considers himself belonging to the opposite gender for more than 2 years in the absence of mental diseases and disorders in the structure and functions of the genital glands.
  • Cancer or benign prostatic hyperplasia, cancer of the penis or kidney.
  • Urethritis, which can be infectious (specific and non-specific) and non-infectious. The cause of specific infectious urethritis are venereal diseases agents (gonococci, chlamydia, trichomonas, ureaplasmas, mycoplasmas, herpes simplex virus) . Nonspecific urethritis can be caused by adenoviruses and bacteria that normally inhabit the rectum or oral cavity. Non-infectious urethritis may develop in case of allergic reactions, injuries or urethral stricture.
  • Orchitis (testicular tissue inflammation), which develops as a result of infectious diseases (pneumonia, chicken pox, mumps, etc.), urogenital system diseases or injuries.
  • Epididymitis (epididymis inflammation), which may occur as a result of perineum and scrotum injuries, blood stasis in the pelvis, STDs or as a result of infectious diseases.
  • Prostatitis (prostate gland tissues inflammation and swelling), developing in cases of disorders of blood circulation in the pelvic organs, prolonged abstention, dysimmunity, hypothermia, etc.
  • Balanoposthitis (preputium and glans penis inflammation) It may be primary (caused by a bacterial or fungal infection) or secondary (caused by urethra infection). The disease is triggered by diabetes mellitus allergic diseases and insufficient hygiene of the genital organs.

The andrologist can also treat androgenic alopecia (hair loss), bladder pathologies, and urinary problems.

Symptoms in case of which you should contact an Andrology Center

The man should see an andrologist on case of the following symptoms:

  • Pain during sexual intercourse;
  • pain and burning sensation when urinating;
  • unusual discharges from the urethra;
  • external genitals itching;
  • libido decrease and problems with potency;
  • erectile dysfunction;
  • infertility and other reproductive disorders.

Author: MD Friedemann Meisse on Jameda.

GermanMedicalGroup + 49 (7221) 39-65-785 Flugstrasse 8a 76532 Baden-Baden Germany Andrology Andrology 2018-10-19 Andrology

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