Translational andrology and urology最新文献

Stress urinary incontinence (SUI) is one of the pelvic floor disorders affecting tens of million of women worldwide. In general, non-surgical options have relatively limited efficacy. The most effective treatment is mid-urethral sling surgery which carries substantial risks of perioperative and postoperative complications. Regenerative therapy with the injection of several types of stem cells and stem cell products is promising but further investigation is needed before clinical implementation can be considered. In recent years, the application of microenergy therapy as a non-invasive treatment for SUI has received increasing attention. Preclinical animal studies of these models have demonstrated that low-intensity extracorporeal shockwave therapy (Li-ESWT) and microenergy acoustic pulse (MAP) therapy are capable of regenerating urethral sphincter tissue and pelvic floor muscles leading to improved urinary continence. One pilot clinical trial with Li-ESWT also reported improved quality of life in women with SUI as well as the symptoms. The objective of this review is to summarize the potential mechanisms associated with Li-ESWT and MAP therapies of SUI: (I) activation of tissue-resident stem cells; (II) regeneration of musculature in the urethra and pelvic floor; (III) improvement in biomechanical property of pelvic floor muscles; (IV) modulation of cellular signaling pathways. Further studies of the molecular mechanisms, optimal treatment dosage and schedule, and potential long-term side effects are needed to provide this non-invasive regenerative therapy for millions of women with SUI.

Background and objective: Stress urinary incontinence (SUI) is the involuntary loss of urine affecting 1-3% of the male population. To manage leakage, patients may try a plethora of penile clamps. and may even consider artificial urinary sphincters (AUS) or sling implantation. We aimed to synthesize the evolution of the modern clamp, AUS, and sling through a comprehensive patent search.

Methods: Patents were found through the databases of United States Patent and Trademark Office (USPTO), GooglePatents, and the World Intellectual Property Office Patentscope, covering patents published through January 6, 2024.

Key content and findings: We found 30 different patents (10 clamps, 13 AUS, and 7 slings), including the patents pertaining to the functionalities and design of five commercially available penile clamps, the American Medical System 800 (AMS 800), the InVance, AdVance, AdVance XP, and Virtue Slings. The clamps, spanning back to 1938 with Bard Cunningham's clamp, have undergone significant refinements. For example, inventors such as Edson S. Outwin and Juan F. V. Wiesner, have modified the location of the primary pressure point. Accessibility has also improved with inventors, such as Gerald French and John W. Timmons, fastening the clamps with Velcro^®, as opposed to the screw and ratchet catch closing mechanism, as in Cunningham's clamp. Similarly, the AUS has greatly evolved since Foley's 1947 "Artificial Sphincter and Method", which was the primary AUS precedent to Mark Polyak's AUS invention, which covered the essential elements and functionalities, such as the incorporation of a balloon reservoir, for the AMS 800. In addressing AUS limitations, inventors such as David W. Anderson and Louisa Thomas have created non-hydraulic AUSs. Likewise, the male sling has seen an evolution in the method of securement, from the use of fixed bone anchors in the InVance sling to the transobturator route used in the AdVance XP, avoiding bone complications. Additionally, innovation in sling adjustment of urethral compression allows for adjustable urethral elevation and distal compression respectively. Recent patents have claimed technological integration for clamps, AUS, and slings, especially concerning automation.

Conclusions: Overall, patents have built upon the limitations of previous devices. However, there is still a need to innovate for increased clamp comfort and reduced reoperation rates for the AUS and sling.

Background: Hypospadias is one of the most common congenital malformations in men. The transverse preputial island urethroplasty is widely used in China, especially for moderate and severe cases due to its convenient prepuce of the penis. This analysis aims to delineate the time to first complication following transverse preputial island urethroplasty.

Methods: We analyzed the clinical data and follow-up results of children who underwent hypospadias repair by transverse preputial island urethroplasty in Beijing Children's Hospital, Capital Medical University from December 2018 to December 2019 retrospectively. Postoperative complications included urethral fistula, urethral diverticulum, urethral stricture, persistent chordee. Univariate analysis of clinical variables and time to complication was performed using Kaplan-Meier survival curve.

Results: One hundred and sixty-five patients were identified. During the follow-up period, complications occurred in 101 cases (61.2%). Ninety-four percent of complications occurred within 1 year. Among children who experienced complications, Kaplan-Meier survival analysis showed that age less than 18 months and the severity of hypospadias were statistically significant (P=0.005 and P=0.04, respectively). The time to urethral diverticulum was significantly longer than that of urethral fistula and urethral stricture.

Conclusions: More than 90% of complications after the transverse preputial island urethroplasty of hypospadias occurred within 1 year, with those related to proximal hypospadias presenting earlier than those of midshaft/distal hypospadias. Surgeons may consider a more frequent follow-up within the first year after surgery to detect these complications as early as possible.

Background and objective: The aim of the present report was to provide an overview of the use of the artificial urinary sphincter (AUS) in adult females with stress urinary incontinence (SUI) over the past 50 years.

Methods: A literature search was conducted in December 2022 and January 2023 using the MEDLINE and Embase databases, screening for randomized controlled trials (RCTs), prospective and retrospective series and reviews on AUS. Only articles published in English or French were included. The search strategy involved a free text protocol and the narrative review reporting checklist was completed.

Key content and findings: The AUS is a device used over the past 50 years for SUI caused by intrinsic sphincter deficiency (ISD). It has the theoretical ability to simulate the function of a biological urinary sphincter. Although the role of the AUS for females with ISD remains heterogeneous from one part of the world to the other, the existing literature demonstrates that AUS yields satisfactory functional outcomes in female SUI patients, comparable or better to what has been reported in male AUS series. Hence, the main barrier to its adoption has so far been the technical challenge of its implantation at the bladder neck. Regarding the results of AUS implantation in females, we included in this review 3 reviews, retrospective studies and 1 prospective study. In recent years, robotic techniques of female AUS implantation have spread significantly with promising outcomes including numerous reports suggesting that it may decrease its morbidity. In the near future, the development of electromechanical devices may further expand the role of AUS in the management of female SUI.

Conclusions: While the use of AUS in female patients provides excellent functional outcomes, it has been limited to scarce centers. However, due to the rise of minimally invasive approaches, it has started spreading again over the past few years. The future of AUS is likely to be bright, fed by technological advances of the device and robotic surgical system, high level of evidence studies and joint efforts of the urological community to facilitate its diffusion across the world.

Background: Cardiometabolic index (CMI) is a well-promising indicator for predicting obesity-related diseases. Testosterone decline and deficiency importantly affect men's health, and may be associated with obesity and excessive deposition of visceral adipose tissue. We aimed to explore the association between CMI and serum testosterone in US adult males.

Methods: The present cross-sectional study was conducted among adult males with complete data about CMI and testosterone in 2013-2016 National Health and Nutrition Examination Survey (NHANES). CMI was calculated as follows: triglyceride (TG) (mmol/L)/high-density lipid-cholesterol (HDL-C) (mmol/L) × waist-to-height ratio (WHtR). Multivariable regression and subgroup analyses were conducted to explore the association between CMI and testosterone.

Results: We included 2,209 male participants for the final analysis. After adjusting for confounders, CMI was found to show a negative correlation between testosterone [minimally adjusted model: β=-10.56, 95% confidence interval (CI): -12.76, -8.36, P<0.001, fully adjusted model: β=-0.04 (-4.88, 4.81), P=0.99]. Multivariate-adjusted beta also showed testosterone levels were significantly lower in the two highest CMI groups (Q3, Q4) compared to the lowest group (Q1). In the subgroup populations, the relationship between CMI and testosterone was affected by age, race, education level, hypertension, and smoking status (P-interaction <0.05). Furthermore, receiver operating characteristic (ROC) curve analysis indicated that triglyceride-glucose-body mass index (TyG-BMI) (0.67, 95% CI: 0.65, 0.70) was the best predictor of low testosterone (results), although CMI was comparable in its predictive value (0.68, 95% CI: 0.65, 0.71).

Conclusions: Higher CMI scores were associated with lower testosterone levels in adult males in the United States, with this correlation being influenced by factors such as age, race, education level, hypertension, and smoking status. CMI was comparable to other metabolic indexes for predicting testosterone deficiency, although TyG-BMI was the best overall predictor.

Background and objective: The current AMS 800 artificial urinary sphincter (AUS) device is designed to simulate the function of the biological urinary sphincter to prevent urinary flow through mucosal coaptation, compression, and pressure transmission. The challenges in designing the AMS 800 device involve not only the mechanical operation of the artificial sphincter device but also producing a device that is effective, safe, and durable for patients in the long term. The following article provides a narrative review regarding the evolution and development of the AMS 800 devices over the years and evaluates the advances in surgical techniques relating to AMS 800 implantation.

Methods: Available literature pertaining to the AMS 800 device was reviewed from the MEDLINE and EMBASE databases between 1 January 2000 to 31 December 2022. Emphasis is placed on key scientific publications including previous reviews and clinical guidelines relevant to AMS 800 device(s) and surgical techniques.

Key content and findings: From the engineering point of view, the current AMS 800 device is ingenious and has stood the test of time. The basic design of this modern AUS consists of 3 separate components namely a pressure regulating balloon (PRB), an inflatable cuff, and a control pump. Continued innovations in device design and technology, coupled with refinements in surgical techniques over the past 5 decades have ensured that the AMS 800 device is and remains the standard of care in male stress urinary incontinence. While the long-term AMS 800 efficacy, safety, and durability are well documented, it is not without its limitations and complications. Mechanical and non-mechanical complications can occur especially in high-risk populations (such as in radiated patients) despite strict adherence to surgical principles and manufacturer's guidelines.

Conclusions: Continued innovations in device design, technology, and surgical techniques have ensured that the AMS 800 device is an effective and safe treatment for male stress urinary incontinence (SUI). Future directions in the treatment of male SUI likely reside in cellular regenerative therapy and nanotechnology to restore, replace, or simulate the damaged native urinary sphincter.

Background: Polyorchidism, defined by the presence of more than two testes, is a rare congenital condition with an unclear etiology. It is hypothesized that the abnormal division of the genital ridge in the fetal embryonic period is responsible for the development of one or more supernumerary testicles. Due to the rarity of polyorchidism and its wide range of clinical presentations, the management of polyorchidism is unclear. Although up to a third of patients have reported associated scrotal pain, most cases of polyorchidism present without symptoms and are discovered incidentally during the evaluation and treatment of other conditions. When rarely reported, polyorchidism typically presents as triorchidism. Because the optimal management of polyorchidism has not yet been established, this case report aims to demonstrate the importance of an individualized treatment plan tailored to each patient's clinical presentation and goals for treatment.

Case description: This case report describes an extremely rare case of chronic orchialgia secondary to polyorchidism with quadorchidism in a 30-year-old man with three separate left testicles drained by two epididymides coming off of the left spermatic cord, and a solitary right testicle. The patient's clinical presentation and desire for permanent sterilization guided his treatment plan.

Conclusions: Orchiectomy of the supernumerary testes completely resolved the patient's scrotal pain, however, counseling on fertility and testosterone deficiency is indicated prior to consideration of orchiectomy.

Background: Procedural simulators can facilitate teaching and improve learning vasectomy surgical techniques. The objectives of this scoping review were to identify available vasectomy simulators (scrotal models), and to assess their characteristics and potential suitability for optimal transfer of surgical skills of most recommended techniques in clinical practice.

Methods: We performed searches up to December 2023 using PubMed and Google search engines to identify existing vasectomy simulators. Articles and Web pages reporting vasectomy simulators were also examined using a snowball strategy. In addition, we asked members of the Vasectomy Network, an international Google discussion group, if they knew any other simulators. Two members of the research team performed the initial evaluations of the physical and functional characteristics of retrieved simulators. All team members made consensus on final evaluations.

Results: We retrieved 10 relevant scrotal models through PubMed (n=2), Google (n=4), and the Vasectomy Network (n=4). Three were commercially available simulators produced by Gaumard^® in the USA and seven were homemade models. All had limited visual and haptic realism of internal and external structures. Most, however, were suitable for simulating some basic skills of the no-scalpel technique to deliver the vas deferens. Fascial interposition could not be simulated with any model. Commercially available models had no advantage over homemade models.

Conclusions: Most vasectomy simulators currently available allow learning some basic surgical skills of the procedure but have limitations for optimal learning of the recommended techniques and skill transfer in clinical practice. There appears to be a need to develop and evaluate new simulators with enhance visual and haptic characteristics for teaching and learning vasectomy techniques.

Background: Cancer survivors in the adolescent and young adult generation often experience marriage, pregnancy, and childbirth after treatment; thus, fertility preservation is very important. In male patients, testicular sperm extraction (TESE) is sometimes performed due to azoospermia. Such a procedure is called oncological TESE (onco-TESE). In the present study, we aimed to define onco-TESE as TESE for fertility preservation in cancer patients, including those receiving gonadotoxic treatment.

Methods: Seventeen male patients with cancer who had undergone onco-TESE for fertility preservation at Yokohama City University Medical Center between April 2014 and March 2023 were included in the study.

Results: Motile testicular sperm were acquired by TESE in 9 out of 17 cases. Among patients who had initiated chemotherapy before surgery, Motile sperm could be acquired by onco-TESE in 3 out of 9 cases. In chemotherapy-naive patients, Motile sperm were acquired by onco-TESE in 6 out of 8 cases. In the end, sperm cryopreservation was performed in 10 patients. Cryopreserved sperm were used in 2 of the 10 cases, and live birth was achieved after intracytoplasmic sperm injection in both cases.

Conclusions: Before starting gonadotoxic treatment, it is important to confirm whether the patient desires to bear children. If having a baby is desired, a referral to a reproductive medicine doctor is recommended. Fertility preservation before starting gonadotoxic treatment is preferable, but fertility preservation could be considered even after such a treatment.