The majority of the young patients usually does not know there is a definite medical figure on uro-andrological diseases, or they simply feel discomfortable talking about andrological issues.
Moreover, most of the young patients do not have a specific figure whom they can rely on about sexual education and sexual healthiness [6].
Alteration of fertility or infertility is an important but underrated health problem among the young male population. Indeed, it is well known nowadays the existence of a reduced fertility even at a young age. [7].
Sometimes it could be related to urological problems, in other cases due to endocrinological issues, sometimes unexplained [8].
A recent systematic review [9] analized the lack of awareness of young patients about uro-andrological disease, assessing the importance of clinicians to instruct young men to familiarise with urological issues (i.e. testicular self examination).
Following our participation to the multicentric study “Ecofood Fertility” and the consequent sampling of seminal fluid and blood tests from each patient attending the study, we carefully analysed the results. What we found was particularly interesting, especially related to the fact that all patients were “urology naive”, volunteers and asymptomatic.
Concerning fertility, only 26% of all patients presented semen analysis with normal parameters; the remaining population turned out having alterations in motility, morphology or concentration of spermatozoa according to WHO parameters. Reference values defined by WHO have changed during decades, lowering its parameters through the years [10].
An interesting meta-analysis, collecting data from 1981 until 2013, described a progressive reduction of male fertility through the years [7]. the authors collected data from studies referred to male infertility related to any kind of pathological disorders.
The main difference with our study regards the selection of patients; as a matter of fact, in our study, following the indication of the pilot project, each one of our patients must be “uro-andrological naive” (defined as not previously aware of andrological problems).
This selection helped us to find patients with a prominent alteration in semen analysis and to give them a medical treatment and further tests to better frame their problem, even considering cryopreservation.
It is still not clear how to behave with asymptomatic patients with a mild alteration of the spermiogram who are not trying to have children [11]. Further studies should be headed in this direction.
Patients diagnosed with suspected left varicocele at the physical examination received the indication of a testicular ECD-US for eventually confirm the diagnosis and indication for surgical treatment.
As suggested by EAU guidelines, surgical treatment is needed in varicoceles with alteration on semen analysis [12;13].
To avoid overtreatment of varicoceles, the availability of semen analysis during first urological visits allows urologists to promptly direct patients to the correct diagnostic and therapeutic choice.
Great relevance, aside from fertility patterns, was given to casual detection of two testicular cancers; patients already knew about their nodularity, but underestimated it.
This result may be surprising but not unexpected considering testicular cancers as a tumour affecting young ages [18].
Both of them went under orchifunicolectomy; a classic seminoma and a mixed non seminoma tumour were confirmed at the definite histology. They are now under oncological follow up.
In case of detection of benign testis tumor in patients with altered fertility, evaluated with semen analysis, testis sparing surgery is a possibility of preserving as more as reproductive function of the organ possible.[19].
Two patients were found with possible hypogonadism after hormonal analysis, and they were addressed to accomplish endocrinological further insights.
Erectile disfunction (ED) in young population is recently gaining attention; it is reported up to 25% of patient from 18 to 40 years suffered at least one episode of ED in life [14];
Imperative is to define eventual organic or psychological cause [15]
Widespread of pornography could have a role [16] in young patients suffering ED, especially to psychological-related.
Role of andrological visit in psychogenic ED is been described in literature [17]
Among our patients, 6 males had the opportunity to discuss their sexual issues (mild erectile dysfunction related to anxiety pattern) for the first time with a qualified figure, finally setting aside their embarrassment. In this case, no pharmacological treatment was necessary; only behavioural therapy or a modification of their lifestyle were sufficient, based on their precise medical history.
Having the chance to talk to a specific professional figure about “taboo” questions certainly helped with therapy and allowed the resolution of the sexual matter.
The limitations in our study were certainly associated to the risk of overdiagnosis in impaired fertility: at the moment of the analysis, few patients already looked for children; for a patient, this could lead to an anxiety state, while he does not even tried to have babies or without diagnosis of couple infertility.
Our study is currently running; increasing numerosity could further confirm our hypothesis of a general urological screening in young male patients.
In our opinion, the cost of a semen analysis (aside from blood and hormonal analysis, which could be done as a II level evaluation), together with an uroandrological examination can be sustainable for the sanitary system, even more if it could lead to a general adjustment of uroandrological health in patients who otherwise could not be aware about their condition and the pathologies they suffer from.