Translational andrology and urology最新文献

Background: According to the current situation, the treatment of oligoasthenospermia with Western medicine is still full of challenges. Qiang Jing decoction (QJD) is used for treating male infertility as a traditional Chinese medicine (TCM) prescription. In this study. we will try to uncover the molecular mechanism of QJDs in treating oligoasthenospermia based on the proteomics technology.

Methods: In this study, sperm quality from oligoasthenospermia model, QJD treatment, and control rats were analyzed. Tandem mass tag (TMT) quantitative proteomics was used for the comparative analysis of protein abundance in rat testis of different treatment.

Results: The therapeutic effect of QJDs on spermatogenesis function by improving sperm quality was confirmed in the present experiment. In addition, our results showed that the majority of proteins related to spermatogenesis were significantly downregulated in oligoasthenospermia model rats compared to the control group, whereas these proteins' expression levels were recovered after the QJD treatment. In the meantime, immunohistochemistry was used to determine PI3K/AKT (phosphoinositide 3 kinase/serine-threonine kinase) signaling pathway-related protein expression profiles. In brief, we think QJD improved sperm density and quality by activating spermatogenesis-related protein expression and PI3K/AKT signaling pathway.

Conclusions: The results of this study may help to establish a foundation for further functional studies of key protein-mediated for improving sperm quality and alleviating oligoasthenospermia.

Background: With the dramatic rise of telemedicine in the post coronavirus disease 2019 (COVID-19) pandemic, our objective was to develop a totally virtual multidisciplinary kidney stone clinic and assess patient satisfaction of this format.

Methods: The virtual multidisciplinary stone clinic began July 2021 and continued monthly. Prior to the beginning of each clinic, providers from the urology, nephrology, and dietitian teams meet virtually to discuss the patients. Patients would then log into WebEx virtual platform and providers would subsequently log into the patient's virtual room, to review radiology, laboratory results, and dietary logs then provide counseling. Patients were then sent a survey via electronic mail regarding their experience. A 5-point Likert scale was used for responses ranging from strongly disagree to strongly agree. Scores were averaged to rank results.

Results: A total of 122 patients were sent surveys, and a total of 31 surveys were completed. Sixty-one percent of patients strongly agree and 13% agree that they felt comfortable using the virtual platform. When asked if they prefer using the virtual platform for their visit, 70% of patients agreed or strongly agreed and only 16% of patients disagreed or strongly disagreed. In regards to potential advantages of a virtual visit, the Likert scores were averaged and ranked from most to least important with improved timeliness (3.7) and ease of scheduling into day (3.6) the highest rated advantages. Most patients did not find any concerns using the virtual platform, however the ability to see the provider in-person and connecting personally was of highest concern with an average Likert score of 2.3. Overall, 83% of patients agreed or strongly agreed that the multidisciplinary stone clinic satisfied their kidney stone related questions regarding treatment and prevention.

Conclusions: A virtual multidisciplinary kidney stone clinic can be implemented with high patient satisfaction scores and help overcome the limitations of physical clinic space and provider schedule coordination. There are few disadvantages to using the platform.

Background: Tolvaptan has been shown to be effective in the treatment of autosomal dominant polycystic kidney disease (ADPKD). However, there is limited evidence regarding optimal dosing and its application within the Chinese population. In this study, we aimed to determine whether a lower tolvaptan dose could effectively control ADPKD in Chinese patients.

Methods: This retrospective, single-center cohort study was conducted in a real-world setting and included all patients newly diagnosed with rapidly progressive ADPKD who initiated tolvaptan treatment and maintained it for at least 12 months. Data were collected at baseline and at 1, 2, 4, 8, and 12 months after treatment initiation. Patients began with morning/evening tolvaptan doses of 7.5 mg/7.5 mg, and the dose was subsequently adjusted based on effectiveness and tolerability. The patients were categorized by baseline estimated glomerular filtration rate (eGFR) and final daily tolvaptan dose. Changes in eGFR and other key physiological indicators after treatment were compared within each group.

Results: The study included 43 patients with ADPKD, of whom 20 were female, with a median age of 34.3 years (range, 16-85 years). At 12 months, eGFR improved by 5.48 mL/min/1.73 m² [95% confidence interval (CI): 2.68-8.29] (P<0.001) compared to baseline. Significant improvements were observed in patients with baseline eGFR levels of 30-59, 60-89, and ≥90 mL/min/1.73 m² (P=0.007, 0.045, and 0.02, respectively), as well as in medium and high dose groups (P=0.002 and 0.02, respectively). At 12 months, the annual height-adjusted total kidney volume (HtTKV) growth slope decreased by -0.17 %/year (95% CI: -0.33 to -0.01) (P=0.04). Significant decreases were observed in patients with an eGFR of 30-59 mL/min/1.73 m² (P=0.008) and in the medium dose group (P=0.03). Thirst was reported in 22 (51.2%) patients, all of whom experienced mild symptoms. No liver-associated adverse events were noted.

Conclusions: Tolvaptan is well tolerated at low initial doses in Chinese patients with ADPKD. Significant improvements in eGFR and reduced HtTKV growth were observed in the overall population and across various baseline eGFR and final dose groups.

Background: Low-intensity shockwave therapy (LiSWT) is an emerging non-invasive and restorative therapy for erectile dysfunction (ED) with demonstrated efficacy and few adverse events. Although LiSWT has been shown to improve erectile function amongst men with ED, few studies have examined its long-term durability. We present the long-term results of a randomized controlled trial (RCT) assessing erectile function after LiSWT.

Methods: A total of 30 patients with baseline ED seen at the University of Virginia were randomized to LiSWT or sham treatment. Patients in the sham group crossed over at 1 month and were unblinded. After initial trial completion, patients enrolled in the long-term outcome study were considered one combined cohort. Patients were treated twice weekly for 3 consecutive weeks with a Storz^® Duolith™ device delivering 3,000 shockwaves at 0.1 mJ/mm² to the distal penis, the base of the penis, and the crura. Primary outcomes were changes in Sexual Health Inventory for Men (SHIM) and Erection Hardness Score (EHS) from baseline (3 months pre-treatment) up to 36 months post-treatment. Changes in SHIM and EHS scores were evaluated using linear mixed effects models. Patient satisfaction was assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) index.

Results: The mean baseline SHIM score was 10.8±0.94. At 12-, 24-, and 36-month assessment following treatment, the mean SHIM scores were 15.6±1.27 (P<0.001), 15.0±1.14 (P<0.001), and 12.2±1.43 (P=0.31). The mean baseline EHS score was 1.87±0.17. At 12-, 24-, and 36-month assessment following treatment, the mean EHSs were 2.70±0.24 (P<0.001), 2.66±0.21 (P<0.001), and 2.29±0.26 (P=0.10). The median [interquartile range (IQR)] EDITS score was 48.9 (22.7, 74.4), indicating moderate satisfaction with LiSWT. There were no adverse events recorded.

Conclusions: Our analysis demonstrates sustained long-term improvement in erectile function after LiSWT for a heterogeneous cohort. While limited by population size, the results suggest durable improvement in erectile function for the first 2 years with a peak treatment effect at 1 year. Treatment effect appears to decline between 2 and 3 years.

Clinical trial registration: ClinicalTrials.gov, NCT04434352.

Background: Prostate biopsies are an invasive procedure that can lead to anxieties and fear before the examination. Prostate magnetic resonance imaging (MRI) is seen as a non-invasive test although it is known that "scanxiety" affects many patients. Transrectal ultrasound (TRUS)-guided prostate biopsies and multiparametric prostate MRI (mpMRI) are commonly used methods in patients with suspected prostate cancer (PCa). This study investigates fears and anxieties towards the TRUS and mpMRI.

Methods: All patients scheduled for mpMRI or TRUS biopsy between January and December 2018 were asked to participate in this single-center study. A total of 196 completed questionnaires were returned and included.

Results: On a 5-point Likert scale the fear of the examination was lower for the mpMRI [1.53; 95% confidence interval (CI): 1.38 to 1.69] than for a TRUS biopsy (2.47; 95% CI: 2.21 to 2.71). In detail, patients with a scheduled TRUS biopsy had significantly higher levels for fear of pain [2.49 (95% CI: 2.19 to 2.78) vs. 1.51 (95% CI: 1.35 to 1.67); P<0.001] and fear of complications [2.71 (95% CI: 2.45 to 2.98) vs. 2.11 (95% CI: 1.89 to 2.32); P=0.001]. There was no relevant difference about the fact that patients knew what to expect [3.02 (95% CI: 2.68 to 3.35) vs. 2.99 (95% CI: 2.70 to 3.26); P=0.47] and the expectation that the examination will go over well [3.24 (95% CI: 2.92 to 3.57) vs. 3.27 (95% CI: 3.00 to 3.58); P=0.55].

Conclusions: On average, fear levels were moderate before mpMRI and TRUS biopsy. Patients are more afraid of TRUS biopsy than mpMRI but the differences were low. The biggest fear remains the fear of the result of the examinations independently of the method.

Background: Sarcopenia, characterized by low muscle mass, and aberrant adiposity changes, including visceral fat accumulation, has been associated with impaired physiologic stress response and wound healing. Artificial urinary sphincter (AUS) placement is the preferred surgical treatment for men with severe post-prostatectomy incontinence. Given the higher rates of maladaptive body composition changes in this older, high comorbidity population, this study explores their impact on AUS outcomes.

Methods: A retrospective analysis was performed including men who underwent primary AUS placement at the Mayo Clinic from 1999 to 2023 for post-prostatectomy incontinence and had cross sectional imaging available within 12 months prior to AUS implant. Sarcopenia and body composition were assessed from the available computed tomography (CT) scan using an algorithm that measures the area of different tissues at the L3 abdominal cross-section. The study investigated the association between sarcopenia [defined as skeletal muscle index (SMI) <52.4 cm²/m²] and adiposity (defined by total visceral and subcutaneous fat area) with all-cause reoperation, including specific etiologies of device infection/erosion, urethral atrophy, and device malfunction, using Cox proportional hazards models.

Results: There were 111 patients who had available imaging within the study timeframe, 61 (55%) of whom were classified as sarcopenic. Follow-up did not differ significantly between the two groups [2.11 (0.53-4.78) vs. 2.52 (0.36-5.80) years, P=0.52]. Sarcopenic patients had a lower body mass index (BMI) (29.1 vs. 32.7 kg/m²; P<0.001). No significant difference in overall device survival was observed between sarcopenic and non-sarcopenic patients (P=0.94) on Cox survival analysis. Sarcopenic patients had higher device infection rates, accounting for 16.7% (3/18) of device failures in the sarcopenic cohort compared to none in the non-sarcopenic cohort.

Conclusions: Sarcopenia was prevalent among AUS patients but did not significantly impact overall device survival. These findings suggest that AUS placement may be feasible to perform in well-selected sarcopenic patients.

Background: Adult acquired buried penis (ABP) is a heterogenous condition and surgical treatment typically includes several steps. Additionally, there is no consensus on which current procedural terminology (CPT) codes to utilize for these steps. Our objective is to characterize the variability in CPT codes reported for ABP surgeries. We hypothesize that the heterogeneous disease process combined with a lack of consensus on appropriate CPT codes will result in marked variability in CPT codes reported during surgery for ABP.

Methods: Data was collected from American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) between 2007-2020. We included adults undergoing surgery for ABP. All CPT codes were grouped into different anatomic categories: penile procedures, scrotal procedures, pannus-related procedures, urethral procedures, tissue transfers, and skin grafts. Codes not fitting these categories were labeled "Other".

Results: Our study included 146 patients. There were 413 total CPT codes reported with 82 unique codes in our cohort. The average number of codes per patient was 2.8, with a range from 1 to 9. There were many unique codes in each anatomic category: 18 different codes within penile procedures, 7 within pannus procedures, 8 within skin grafting, 4 within scrotal procedures, 7 within tissue transfers, and 19 within urethral. There was marked variability in individual code use with each code being reported anywhere from 1 to 58 times. Urologists were the primary surgeons in 69% (n=101).

Conclusions: We found marked variability in CPT codes reported during surgery for ABP. This suggests the need for our stakeholder organizations to support efforts that would allow consensus on which codes should be utilized for this increasingly recognized condition.

Background: Allium tuberosum Rottler improves sexual function and is used in the treatment of impotence and spermatorrhea. However, its chemical composition and mechanism of action remain unclear. This study investigates the chemical composition and mechanism of action of Allium tuberosum Rottler co-processed with salt and wine (GZP) in modulating testicular mitochondrial autophagy for the treatment of asthenozoospermia in mice.

Methods: Adenine gavage + cyclophosphamide intraperitoneal injection was used to establish the model of asthenozoospermia, and six Allium tuberosum Rottler processed products were compared in the pharmacological efficacy for the treatment of asthenozoospermia in mice. The liquid chromatograph mass spectrometer (LC-MS) assay was performed to analyse the compositional changes in the GZP. The mechanism of GZP in the treatment of asthenozoospermia in mice was further investigated. The mitophagy was detected by transmission electron microscope (TEM) and immunofluorescence, respectively. Reactive oxygen species (ROS) were detected by probe. Protein expression was determined by Western blotting.

Results: GZP exhibited optimal therapeutic effects on asthenozoospermia in mice. It showed the best therapeutic effect in improving the total number of spermatozoa, sperm survival rate, improving sperm viability and reducing sperm deformity rate, alleviating the abnormal pathological morphology of mice testis, and increasing the serum testosterone (T), follicle-stimulating hormone (FSH) and prolactin (PRL) levels in mice. The LC-MS detection found that Allicin showed the most significant increase in GZP. Besides, GZP reduced ROS level and inhibited mitophagy in mice testicular tissues. Meanwhile, it restrained the expression of PINK1, Parkin, Light chain 3II (LC3-II)/Light chain 3I (LC3-I) and Caspase-3 proteins.

Conclusions: GZP improves asthenozoospermia via inhibiting excessive mitophagy and protects the integrity of mitochondria by blocking the PINK1/Parkin signaling pathway. During which, the Allicin may play an important role.