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MINISTRY OF HEALTH OF UZBEKISTAN
DEVELOPMENT CENTRE OF MEDICAL EDUCATION
Tashkent Medical Academy
"Approved"
Prorector for educational proceedings of TMA
Prof. Teshaev O.R.
«_____»_________________ 2012
Department: UROLOGY
Subject: Urology
PEDAGOGICAL TECHNOLOGY
SUBJECT:
VARICOCELE, PEYRONIE'S DISEASE,
ERECTILE DYSFUNCTION AND MALE INFERTILITY
Educational-methodical course book
(For teachers and students of medical institutes)
Tashkent-2012
Compiled by:
Mirkhamidov D.H. - TMA, Associate professor of Urology, MD, associate
professor.
Nuraliyev T.Yu. - Assistant of Urology department, TMA
Reviewers:
Gaybullaev A.A. - Head of Urology and Operative Nephrology department of
TIAME, Ph.D.
Fakirov A.Z. - TMA, Associate professor of Pediatric Surgery, MD, associate
professor.
Methodical course book approved:
- by a meeting of ICC TMA, protocol № __ "___"_______ of 2012.
- by the Academic Council of TMA, protocol № ___ of "___"____ 2012.
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Pedagogic technology
Topic 6
Varicocele. Peyronie's disease. Erectile dysfunction.
Male infertility
Amount of students: 10
Form of the practical
occupation
Plan of the practical
occupation
Purpose of educational
occupation
Occupation duration: 6 hours
Practical class in a topic
-
Varicocele. Concept, an etiology and pathogenesis,
classification, clinic symptoms, diagnostics and treatment.
- Peyronie’s disease. Concept, an etiology and pathogenesis,
classification, clinic symptoms, diagnostics and treatment.
- Erectile dysfunction. Concept, an etiology and pathogenesis,
classification, clinic symptoms, diagnostics and treatment.
- Male infertility. Concept, an etiology and pathogenesis,
classification, clinic symptoms, diagnostics and treatment.
To generate general idea about: Varicocele. Peyronie's disease.
Erectile dysfunction. Male infertility.
To teach students to reveal the basic symptoms of varicocele.
peyronie's disease, erectile dysfunction, male infertility.
Acquisition and strengthening of the received theoretical
knowledge.
Acquisition of practical skills.
Application acquisition of knowledge and skills in practice.
Development of logical thinking of students.
Formation structural thinking of students.
Formation of own thinking of students
The Pedagogical problems:
Acquaint the reason and
mechanism of the origin
symptoms of varicocele.
peyronie's disease, erectile
dysfunction, male infertility.
Results:
The student should know an etiology, a pathogenesis, clinic,
diagnostics, differential diagnostics, treatment and preventive
maintenance
of
following
diseases:
varicocele.
peyronie's disease, erectile dysfunction, male infertility; to
palpate of male external genitals; to interpret laboratory,
urodynamic, ultrasonic, X-ray, instrumental and other methods
research results of this diseases; to evaluate the effectiveness of
treatmen, criteria for cure; to carry out reabilitational and
prophylactic medical examination
Methods and technology of
the education
Practical education, demonstration, work in small groups –
interactive game “a round table” or “spiderweb”.
Facilities of the education
Uniform methodical system on a topic of education, slides,
banners, a distributing material, situational problems,
examination of patients in department of urology, the case
record.
Face-to-face, collective and individual work.
The educational room equip with means of training where
probably to apply methods of training, “Erectile dysfunction”
room
Oral, written, the decision of situational problems and computer
test problems, analysis of supervised patients, demonstration of
Forms of the education
Conditions of the education
Monitoring and estimation
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the master practical skills.
Subject: Urology. Topic N6:
Technological card of practical occupation
“Varicocele. Peyronie's disease. Erectile dysfunction. Male infertility”
Maintenance of activity:
Activity of teacher
Activity of the student
1 stage. Introduction (15 minutes)
1.1. Stated the name of a theme of practical employment, the Listened and wrote down.
purpose, the maintenance and expect results are more its.
Wrote down the name of a
1.2. Gave the short information on a theme of practical theme.
employment. Acquainted students the plan of carrying out of Answered questions.
employment.
1.3. Acquainted the list of the basic and additional literature.
1.4. For attraction of students to the vigorous activity asked
questions.
2 stage. Basic process (150 minutes)
2.1. Showed visual materials on all questions of the plan of practical Listened, studied, wrote
employment. By use of banners and razdaptochnogo of a material down,
defined,
asked
interviewed on a theme of employment. Asked to write down high questions.
lights of a theme of employment. Checked knowledge and degree of Wrote down high lights.
development of a material students by use of stands in a thematic Answered questions.
office.
Actively
participated
in
For definition of base knowledge interviewed. Popravalyaet and interactive
games.
rezumiruyet answers.
Participated on kuratsiya of
2.2. In small groups spent interactive games us methods «a round patients, studied case records.
table».
Solved test problems.
2.3. In common with students spent kuratsiya of patients in
stationary branch (poll of patients, objective survey) and acquainted
a material the case record.
2.4. Spent computer test poll in an educational room.
3 stage. Final stage (15 minutes)
3.1. Did the general conclusion on a theme.
Listened, active students was
3.2. Otseniyevayet of knowledge and skills of actively participat estimat. Wrote down the task
students.
for independent work. Wrote
3.3. Declared the questions stud on the next employment and it down a theme of the
asked to be prepar independently.
following
employment,
3.4. Gave the task for the following employment:
prepared.
1) To draw an organizer "Pyramid" on varicocele.
2) Declared a theme of the following topic «Benign prostatic
hyperplasia Varicocele, Peyroni desease, erectile dysfunction and
man's infertility» and it asked to be prepar for practical
employment.
3) Acquainted questions on control of the knowledge.
4) Acquainted the list of the necessary literature.
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Subject: Varicocele. Peyronie's disease. Erectile dysfunction. Male infertility
Occupation venue, equipment
- Department of Urology;
- A set of posters, computer slides, tables;
- Computer.
The duration of the lesson
Occupation duration: 225 min
Lesson purpose:
- to create general idea about varicocele, Peyronie's disease, erectile dysfunction, male infertility
- to give classification,
- to explain an etiology and pathogenesis
- to explain clinic symptoms
- to explain diagnostics and differential diagnostics
- to explain treatment(conservative and operative therapy)
Objectives:
The student should know:
- classification varicocele, Peyronie's disease, erectile dysfunction, male infertility
- diagnostics
- modern methods of treatment
The student should be able to:
Should carry out independently practical skills:
- palpation of male external genitals.
- identify 3 form of varicocele
- interpret sperm analysis
- differentiate organic and psychotogen erectile dysfunction
- define indications and contraindications for appointment of sildenafil citratis.
Motivation
Knowing the symptoms of urological diseases is the basis for the understanding of pathological
processes occurring in the body of patients. Acquired knowledge of symptoms of urological diseases
will allow general practitioners to correctly diagnose urological diseases, acute conditions to identify
and assign an effective treatment.
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Interdisciplinary communication and inside subject connections
Teaching this topic is based on the knowledge bases of students of biochemistry, normal and
abnormal anatomy, and topographic anatomy with operative surgery, histology, normal and
pathological physiology of the genitourinary system. Besides, this subject is connected with therapy,
surgery, obstetrix and gynecology
Obtained in the course of training, knowledge will facilitate students to understand the
aetiopathogenesis and clinic of urology, to carry out a differential diagnosis, to determine the tactics
and treatment of urological patients.
These diseases are widely widespread among a male. These patients can address to GP and the
doctor must to direct patients correctly.
The content of lessons
Theoretical part
Varicocele.
Concept.
Varicocele - a varicose veins grozdevidnogo plexus that develops mainly from the left side,
sometimes a varicocele occurs on both sides or only on the right side. Varicocele develops most often
between the ages of 14-15 years.
Cause
The idiopathic varicocele occurs when the valves within the veins along the spermatic cord do
not work properly. This is essentially the same process as varicose veins, which are common in the
legs. This results in backflow of blood into the pampiniform plexus and causes increased pressures,
ultimately leading to permanent damage to the testicular tissue due to disruption of normal supply of
oxygenated blood via the testicular artery.
Varicoceles develop slowly and may not have any symptoms. They are most frequently
diagnosed when a patient is 15–30 years of age, and rarely develop after the age of 40. They occur in
15-20% of all males, and it is the main cause of male infertility.
98% of idiopathic varicoceles occur on the left side, apparently because the left testicular
vein connects to the renal vein (and does so at a 90-degree angle), while the right testicular vein drains
at less than 90-degrees directly into the significantly larger inferior vena cava. Isolated right sided
varicoceles are rare.
A secondary varicocele is due to compression of the venous drainage of the testicle. A pelvic or
abdominal malignancy is a definite concern when a right-sided varicocele is newly diagnosed in a
patient older than 40 years of age. One non-malignant cause of a secondary varicocele is the so-called
"Nutcracker syndrome", a condition in which the superior mesenteric artery compresses the left renal
vein, causing increased pressures there to be transmitted retrograde into the left pampiniform
plexus. The most common cause is renal cell carcinoma (a.k.a. hypernephroma) followed by
retroperitoneal fibrosis or adhesions.
Pathophysiology
The term varicocele specifically refers to dilatation and tortuosity of the pampiniform plexus,
which is the network of veins that drain the testicle. This plexus travels along the posterior portion of
the testicle with the epididymis and vas deferens, and then into the spermatic cord. This network of
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veins coalesces into the gonadal, or testicular, vein. The right gonadal vein drains into theinferior vena
cava, while the left gonadal vein drains into the left renal vein at right angle to the renal vein, which
then drains into the inferior vena cava one of the main function of the plexus is to lower the temp to the
testicles, during vericocele this function is lost, hence the most common complication of untreated
vericocele is higher temp to testes resulting in testicular atrophy causing infertility.
The small vessels of the pampiniform plexus normally range from 0.5–1.5 mm in diameter.
Dilatation of these vessels greater than 2 mm is called a varicocele.
Recent studies have shown that the detrimental effect of varicocele on the sperm production is
progressive and due to reduction in supply of oxygenated blood and nutrient material to the sperm
production sites, which persistently reduces the quality and the quantity of the sperms, leading to
reduction in their fertility capacity with time.
Diagnosis. Symptoms and signs.
Upon palpation of the scrotum, a non-tender, twisted mass along the spermatic cord is felt.
Palpating a varicocele can be likened to feeling a bag of worms. When lying down, gravity may allow
the drainage of the pampiniform plexus and thus make the mass not obvious. This is especially true in
primary varicocele, and absence may be a sign for clinical concern. The testicle on the side of the
varicocele may or may not be smaller compared to the other side.
Varicocele can be reliably diagnosed with ultrasound, which will show dilatation of the vessels
of the pampiniform plexus to greater than 2 mm. The patient being studied should undergo a
provocative maneuver, such as Valsalva's maneuver (straining, like he is trying to have a bowel
movement) or standing up during the exam, both of which are designed to increase intra-abdominal
venous pressure and increase the dilatation of the veins. Doppler ultrasound is a technique of measuring
the speed at which blood is flowing in a vessel. An ultrasound machine that has a Doppler mode can
see blood reverse direction in a varicocele with a Valsalva, increasing the sensitivity of the
examination.
Recent studies have shown that varicocele is a bilateral disease and the diagnosis of the right
side is missed by physical examination and even by ultrasonography. The examination should be
performed by ultrasonography — color flow doppler performed by highly experienced sonographer or
radiologist that will diagnose varicocele by demonstrating back-flow in the right and in the left
spermatic veins.
Tactics.
In the presence of symptoms and objective signs of the disease the patient should be referred to
a urologist or invite a specialist for advice.
Peyronie's Disease
Peyronie's Disease (also known as "Induratio penis plastica", or more recently chronic
inflammation of the tunica albuginea, is aconnective tissue disorder involving the growth of fibrous
plaques in the soft tissue of the penis affecting up to 10% of men. Specifically, scar tissue forms in
the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa causing pain,
abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening. A variety of
treatments have been used, but none have been especially effective.
A certain degree of curvature of the penis is considered normal, as many men are born with this
benign condition, commonly referred to as congenital curvature.
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The disease may cause pain; hardened, big, cord-like lesions (scar tissue known as "plaques");
or abnormal curvature of the penis when erect due to chronic inflammation of the tunica albuginea.
Although the popular conception of Peyronie's Disease is that it always involves curvature of the penis,
the scar tissue sometimes causes divots or indentations rather than curvature. The condition may also
make sexual intercourse painful and/or difficult, though many men report satisfactory intercourse in
spite of the disorder. Although it can affect men of any race and age, it is most commonly seen
in Caucasian males above the age of 40, especially those of blood type A+, but has been seen in men as
young as 18.
The disorder is confined to the penis, although a substantial number of men with Peyronie's
exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet. About 30
percent of men with Peyronie's Disease develop fibrosis in other elastic tissues of the body, such as on
the hand or foot, including Dupuytren's contracture of the hand. An increased incidence in genetically
related males suggests a genetic component.
Diagnosis
A urologist can diagnose the disease and suggest treatment, although it is easily diagnosed
by general practitioners or family doctors. An ultrasound can provide conclusive evidence of Peyronie's
disease, ruling out congenital curvature or other disorders.
Symptoms:
-
painful erections
-
curved erection
-
erectile dysfunction
-
palpation of small knot and scar tissue forms in the tunica albuginea
Causes
The underlying cause of Peyronie's Disease is not well understood, but is thought to be caused
by trauma or injury to the penis usually through sexual activity although many patients often are
unaware of any traumatic event or injury.[9]
There is also an association that a class of anti-hypertensive drugs known as calcium channel
blockers may be a possible cause of or exacerbate the disease, although it has not been proven.
However, all beta blocker drugs list Peyronie's disease as a possible side effect.
In some cases, medications may help. Surgery to treat Peyronie's disease is generally only
recommended if the curvature and pain are severe enough to prevent sexual intercourse. Surgery, such
as the "Nesbit operation", is considered a last resort and should only be performed by highly skilled
urological surgeons knowledgeable in specialized corrective surgical techniques.
MALE INFERTILITY
Introduction. The European Association of Urology (EAU) consensus group on male infertility
consider that male infertility is an interdisciplinary subject in its own right, with paternity in a sterile
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partnership being the primary clinical objective. This understanding of male infertility implies cooperation with non-urologists in all aspects of infertility in daily work, and knowledge of other
pertinent guidelines, issued by well-accepted authorities such as the World Health Organization
(WHO), the ESHRE Andrology Special Interest Group [1] and the European Academy of Andrology.
Accepting these recommendations, the EAU consensus group on male infertility is convinced that the
following guidelines will help European urologists in their interdisciplinary situation to focus on their
special skills and knowledge and to achieve a better understanding of the outcome for the male patient
and the couple.
Definition
Infertility is the inability of a sexually active, non-contracepting couple to achieve pregnancy in
one year’ [WHO]
Epidemiology and aetiology
About 25% of couples do not achieve pregnancy within 1 year, of whom 15% seek medical
treatment for infertility and less than 5% remain unwillingly childless. Infertility affects both men and
women. Male causes for infertility are found in 50% of involuntarily childless couples. If there is a
single factor, the fertile partner may compensate for the less fertile partner. In many couples, however,
a male and a female factor coincide. Infertility usually becomes manifest if both partners are sub-fertile
or have reduced fertility. Reduced male fertility can be the result of congenital and acquired urogenital
abnormalities, infections of the genital tract, increased scrotal temperature (varicocele), endocrine
disturbances, genetic abnormalities and immunological factors [2]. No causal factor is found in 60-75%
of cases (idiopathic male infertility). These men present with no previous history associated with
fertility problems and have normal findings on physical examination and endocrine laboratory testing.
Semen analysis reveals a decreased number of spermatozoa (oligozoospermia), decreased motility
(asthenozoospermia) and many abnormal forms on morphological examination (teratozoospermia).
Usually, these abnormalities come together and are described as the oligo-astheno-teratozoospermia
(OAT) syndrome.
Table 1: Aetiology and distribution (%) of male infertility among 7,057 men [2]
• Sexual factors 1.7
• Urogenital infection 6.6
• Congenital anomalies 2.1
• Acquired factors 2.6
• Varicocele 12.3
• Endocrine disturbances 0.6
• Immunological factors 3.1
• Other abnormalities 3.0
• Idiopathic abnormal semen (OAT syndrome) or no demonstrable cause 75.1
The unexplained forms of male infertility may be caused by several factors, such as chronic
stress, endocrine disruption due to environmental pollution, reactive oxygen species and genetic
abnormalities.
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Prognostic factors
The main factors influencing the prognosis in infertility are:
• Duration of infertility
• Primary or secondary infertility
• Results of semen analysis
• Age and fertility status of the female partner.
When the duration of infertility exceeds four years of unprotected sexual intercourse, the
conception rate per month is only 1.5%. At present, in many Western countries, women postpone their
first pregnancy until they have finished their education and have started a professional career.
However, the fertility of a woman of 35 years of age is only 50% of the fertility potential of a woman
aged 25 years. By the age of 38 years, this has reduced to only 25%, and over the age of 40 years it is
less than 5%. Female age is the most important single variable influencing outcome in assisted
reproduction.
Investigations
Routine investigations include semen analysis and hormonal determinations. Other
investigations are described according to the special situation.
Semen analysis
In non-obstructive azoospermia, semen analysis shows normal ejaculate volume and
azoospermia after several centrifugations have been performed. A recommended method is semen
centrifugation at 600 g for 10 min and thorough microscopical examination of the pellet (x600). The
upper fluid is then re-centrifuged (8000 g) for an additional 10 min and examined. All samples can be
stained and re-examined under the microscope.
Hormonal determinations
Generally, the levels of FSH are mainly correlated with the number of spermatogonia. When
these cells are absent or markedly diminished, FSH values are usually elevated. When the number of
spermatogonia is normal but there is complete spermatocyte or spermatid blockage, FSH values are
within normal range. However, on an individual patient basis, FSH levels do not provide an accurate
prediction of the status of spermatogenesis [9-11]. Preliminary data indicate a stronger correlation
between low inhibin B level and spermatogenic damage. At present, the routine determination of
inhibin B is not suggested.
Combination obstructive/non-obstructive azoospermia. Some azoospermic patients may present
with a combination of obstructive and spermatogenic pathologies and increased serum FSH levels [9].
It is therefore advisable to perform testicular biopsy in azoospermic patients with elevated FSH levels,
who are known or suspected of having seminal duct obstruction, or when the size and/or consistency of
one testis has decreased.
Testicular biopsy
Testicular biopsy is indicated in patients without evident factors (normal FSH and normal
testicular volume) to differentiate between obstructive and non-obstructive azoospermia. Testicular
biopsy can also be performed as part of a therapeutic process in patients with clinical evidence of nonobstructive azoospermia who decide to undergo ICSI. Spermatogenesis may be focal. In these cases,
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one or more seminiferous tubules are involved in spermatogenesis while others are not [15-17]. About
50-60% of men with non-obstructive azoospermia have some seminiferous tubules with spermatozoa
that can be used for ICSI. Most authors recommend taking several testicular samples given the possible
regional differences. Other authors support the hypothesis that a single sample is demonstrative of the
total histological pattern [15,20]. Many authors find a good correlation between diagnostic biopsy
histology and the likelihood of finding mature sperm cells during testicular sperm retrieval and ICSI.
Semen analysis
Andrological examination is indicated if semen analysis shows abnormalities (Table 2). Since
semen analysis still forms the basis of important decisions concerning appropriate treatment,
standardization of the complete laboratory work-up is highly desirable. Ejaculate analysis has been
standardized by the WHO and propagated by continuing work and publications in the WHO Laboratory
Manual for Human Semen and Sperm-Cervical Mucus Interaction (4th edition) [1]. The consensus is
that modern spermatology has to follow these guidelines without exclusions.
Overview of standard values for semen analysis according to the 1999 WHO criteria
• Volume ≥ 2.0 ml
• pH 7.0-8.0
• Sperm concentration ≥ 20 million/ml
• Total no. of spermatozoa ≥ 40 million/ejaculate
• Motility ≥ 50% with progressive motility or 25% with rapid motility
within 60 min after ejaculation
• Morphology ≥ 14% of normal shape and form*
• Viability > 50% of spermatozoa
• Leukocytes < 1 million/ml
• Immunobead test (IBT) < 50% spermatozoa with adherent particles
• MAR test** < 50% spermatozoa with adherent particles
Changes in a spermogram
Normozoospermiya of- 40 million and more in sperm, 50% and more with progressive movement, 50%
and above normal forms spermatozoa, 75% and more from number of live spermatozoa. All
parameters have normal level.
Oligozoospermiya — concentration of spermatozoa less than 20 million/ml or less than 40 million
spermatozoa in sperm.
Teratozoospermiya — less than 50% of spermatozoa with normal morphology
Astenozoospermiya — less than 50% of spermatozoa have progressive advance movement
Nekrozoospermiya — lack of mobile spermatozoa
Oligoastenoteratozoospermiya — a combination of 3 options of deviations
Polizoospermiya — quantity of spermatozoa more than 200 million/ml
Azoospermiya — absence in sperm spermatozoa, but is possible existence of cages spermatogenesis.
Aspermiya — absence of sperm.
Gematospermiya – presence of blood at seed liquid
11
Used in this lesson, new teaching technologies:
"Round Table".
The method provides for joint activities and active participation in the classroom each student,
the teacher works with the entire group.
Embarks on a circle piece of paper with the job. Each student writes his answer sheet and passes
the other. All write down their answers, followed by discussion: crossed out the wrong answers, the
number of correct - evaluate the student's knowledge.
To think about each answer the student is given 3 minutes. Then, the answers are discussed. At
the end of the method of teacher comments on your answer is correct, its validity, the activity level of
students.
This methodology promotes student speech, forming the foundations of critical thinking as In
this case, the student learns to assert his view, analyze responses band members - participants of the
contest.
Questions:
1. At what age does varicocele meet more often?
2. What is the difference idiopathic and symptomatic varicocele?
3. Tell about varicocele’s form.
4. Tell about treatment of varicocele.
5. What is the Peyronie's disease?
6. Clinic symptom’s of the Peyronie's disease
Definition of childless marriage
8. The form of male infertility.
9. Characteristic of normal sperm
7.
Analitical part:
Situational tasks:
27 years old man has infertility last 3 years. At inspection it is revealed reduction of the sizes left testis,
dilation of gonodal veins
1. Preliminary diagnose
2. What diagnostic methods must be use?
3. With what diseases it is necessary to differentiate
4. Your recommendation
5. Your treatment
Answers:
1. Varicocele, left side, 3 stage
2. Orchidometry. Sperm analyze
3. Hydrocele. Orchoepididimitis. Testis cancer.
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4. Phlebography, phlebomanomery
5. Sclerotherapy or operation of Ivanisevich
Practical part
The interview with the patient in the urology department, conducting physical examination
7. Forms of control knowledge, skills and abilities
- Viva voice examination;
- Writing;
- Solution of tasks;
- Tests.
8. Criteria for evaluating the current control
№
Achievement
as a
1.
Achievement as a
Achievement as a percentage (%) and
percentage (%) and
scoring the student's
knowledge level
rating
percentage (%)
and scoring the
student's
knowledge level
rating
scoring the student's knowledge level
rating
86-100
Excellent "5"
Independently analyses
Uses in practice
Shows high activity, a creative approach
to the conduct of interactive games
Correctly solves the case studies with full
justification for the answer
Understands the subject matter
Knows, says confident
Has a faithful representation
2.
71-85
Uses in practice
Good "4"
Shows
high
activity
during
the
interactive games
Correctly solve situational problems, but
the rationale for the answer not full
enough
Understands the subject matter
Knows, says confident
13
Has a faithful representation
3.
4.
55-71
54 and less
Knows, says not sure
Satisfactorily
"3"
Has a partial view
Unsatisfactorily
"2"
It does not accurately represent
Do not know
9. Chronological map of classes
№
Stages of training
Forms
employment
of Continued
resident
a
of
Property in the
minutes. 225
1.
Lead-in tutor (study subjects).
2.
Discussion topics practical training, assessment of The
survey,
baseline knowledge of students with new explanation
educational technologies (round table, case studies,
slides), as well as checking the source of students'
knowledge, the use of visual aids (slides, models,
phantoms, ultrasound, x-ray, etc.).
3.
Summing up the discussion.
15
4.
Giving students tasks to perform the practical part
of training. Cottage explanations and notes for the
task. Self-Supervision.
30
5.
The assimilation of skills a student with a teacher Medical
history, 40
(Supervision thematic patient)
clinical role-playing
case studies
6.
Analysis of the results of laboratory and work with the clinical 30
instrumental studies thematic patient, differential laboratory
diagnosis, treatment plan and rehabilitation, instruments
10
an 50
prescriptions, etc.
7.
Talk degree goal classes on the basis of developed Oral questioning, test, 30
theoretical knowledge and practical experience on debate, discussion of
the results of the student, and with this in mind, the practical work
evaluation of the group.
8.
Conclusion of the teacher on this lesson. Information,
Assessment of the students on a 100 point system questions for
and its publication. Cottage set students the next training.
class (a set of questions)
14
20
self-
Questions
1. What is varicocele?
2. Tell 3 stages of varicocele.
3. Tell complications of varicocele.
4. Tell indications for operative treatment of varicocele.
5. What is the Peyronie's disease?
6. What is reason curve of penis in Peyronie's disease?
7. Modern treatment of Peyronie's disease
8. What is the erectile dysfunction
9. The form of erectile dysfunction
10. What kind of drugs may be reason of erectile dysfunction
11. What kind of type of male infertility do you know?
12. Tell normal characteristic of sperm
13. What do you known about extracorporal fertilization
Recommended literature
1. Tutorial: "Urology." M. Medicine, 2004
2. Manual of Urology in 3 volumes. Ed. Acad. NA Lopatkina M, 1998.
3. Emergency urology. A. Pytel, II Zolotarev. M. Medicine, 1985.
More:
1. Martin I. Resnick. Secrets of Urology. 1998.
2. Directory of GP. J. Mert. M. practice. 1998.
3. Urology and Andrology at the questions and answers. Ed. OA Tiktinsky, V. Mickle. "Peter". St.
Petersburg, 1998. - 377s.
4. Urology by Donald Smith. Ed. E. Tanago and Dzh.Makanincha. Translated from English. "Practice."
M. 2005. - 819s.
5. Internet: (www.uroweb.ru; www.uro.ru; www.medscape.com; www.medicalstudents.com;
www.uroweb.org; www.bju.org; www.europeanurology.com).
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