Translational andrology and urology最新文献

Background and objective: In-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) has become increasingly prevalent even in cases without significant male factor infertility; however, stagnant live-birth rates, both nationally and internationally, have driven more research into sperm selection. To date, nothing has replaced swim-up and density-gradient preparation methods and therefore we sought to review the state of the science.

Methods: A PubMed search was performed between years of 1989 and 2024 for English research articles reporting data on sperm selection technology in assisted reproductive technology.

Key content and findings: IVF with ICSI is increasingly prevalent even in men with normal semen parameters. Despite technologic advances and widespread use, reproductive outcomes with ICSI have been stagnant. This market for opportunity growth has allowed for sperm selection techniques to grow exponentially with heterogeneity in utilization and a paucity of positive reproductive outcomes. Swim-up and density-gradient centrifugation remain the most utilized sperm selection techniques. Various future technologies show promise including epigenetics, sperm biomarkers and a potential role of artificial intelligence; however, more research is needed.

Conclusions: Given unchanged IVF success rates, sperm selection technologies hold promise to improve reproductive outcomes beyond traditional ICSI. At present, no technique has shown superiority to swim up and density centrifugation.

Background: Overweight and obese individuals are steadily increasing in recent years. Male overweight or obesity has adverse impact on reproductive functions. The study aimed to evaluate the potential impact of paternal overweight or obesity on sperm quality and clinical pregnancy outcome in patients undergoing intrauterine insemination (IUI) treatment.

Methods: This retrospective study included 1,036 couples from our reproductive center between July 2019 and August 2022. All males were categorized into normal weight, overweight, or obese groups according to their body mass index (BMI). Baseline characteristics and reproductive hormones were analyzed. Semen parameters, clinical pregnancy and live birth outcomes were compared among the different BMI groups.

Results: There were no significant differences in sperm concentration, total sperm motility, progressive sperm motility, normal sperm morphology and sperm DNA fragmentation index (DFI) among the three groups. However, the obese group exhibited a significantly decreased semen volume compared to the other two groups (P<0.01). No differences were found in clinical pregnancy rate (CPR), abortion rate (AR) and live birth rate (LBR) among the groups (P>0.05). Slight higher ARs were observed in overweight and obese groups compared to normal group (13.64%, 21.05% vs. 11.11%, P=0.49).

Conclusions: These data suggest that male obesity leads to a significant decrease in semen volume. It is thus recommended that male BMI should be regarded as one of the predictors for IUI treatment to avoid a decrease in semen volume.

Background: Cancer treatment delay is a global health system issue. However, data concerning the impact of treatment delays on survival in bladder cancer remain controversial. This study sought to evaluate the impact of time from diagnosis to treatment on survival outcomes of bladder cancer patients in the US Surveillance, Epidemiology, and End Results (SEER) database.

Methods: The SEER was searched from 2000 to 2020 for bladder cancer patients. Logistical regression was used to explore potential factors related to treatment delay. Kaplan-Meier curves were generated to investigate the overall and cancer-specific survival. Multivariate Cox proportional hazards regression models were used to evaluate the effects of covariables on survival outcomes in bladder cancer with treatment delay.

Results: There were 12,686 eligible patients included in this study. A total of 2,379 patients experienced an initial treatment delay. Initial treatment delay was related to worse survival. Sex, age, pathological grade, clinical stage, and surgery were associated with increased odds of initial treatment delay. In the patients with initial treatment delay, age, advanced stage, lymph node involvement, high pathological grades and metastasis were independent predictors of poor overall survival and cancer-specific survival, while marital status at diagnosis, surgery, chemotherapy, and radiotherapy were found to improve both overall survival and cancer-specific survival.

Conclusions: Significant disparities in pathological/clinical variables could contribute to treatment delay. Surgery, chemotherapy, and radiotherapy benefited the survival of patients with treatment delays.

Background: Ablation procedures have garnered significant attention as a minimally invasive treatment of prostate diseases. However, the feasibility and safety of applying high-frequency irreversible electroporation (H-FIRE) to ablate the Beagle prostate for benign prostatic hyperplasia (BPH) treatment have not been thoroughly explored, the appropriate range of parameters has not been determined. In order to ensure the feasibility and safety of prostate ablation surgery, we conducted a study using Beagle dogs as subjects to investigate prostate tissue.

Methods: We utilized a composite steep pulse therapy device to perform ablations on 26 lateral lobes of the prostate in 13 Beagles, employing various parameters for different needle distances. The effectiveness of this device was assessed through the observation of the ablation area, intraoperative muscle tremors, postoperative hematological examination, and gross inspection.

Results: The findings of our study revealed that 1,000 to 2,000 v/cm in electric field strength, combined with 5 µs pulse width and pulse number 100, is a safe parameter range for ablation of prostate tissue. At the same time, the large electric field strength (2,000 v/cm) has the best ablation effect with the biggest continuous and thorough ablation area. All parameters of H-FIRE were safe for Beagles.

Conclusions: H-FIRE ablation for prostate is safe and effective in dogs, which has the potential to be a useful addition to the range of minimally invasive treatments available for the treatment of BPH against this backdrop of increasing surgical practice.

Background: Pelvic lymph node dissection (PLND) is regarded as a crucial component of radical prostatectomy (RP); however, it also increases the probability of postoperative complications. This study aimed to investigate the significance of PLND in the treatment of prostate cancer.

Methods: A total of 1,474 patients with complete clinical data were retrospectively analyzed. Multivariable logistic regression analysis was used to identify the factors of PLND and lymph node metastasis (LNM). Propensity score matching (PSM) was performed to balance baseline characteristics between patients in different groups, along with Kaplan-Meier survival analysis to explore the impact of PLND on oncological outcomes.

Results: Of the 1,474 patients, 956 (64.9%) underwent PLND, and 159 (16.6%) had LNM. The positive rate of lymph nodes in the extended PLND (ePLND) group was higher than that in the obturator resection group (20.58% vs. 10.05%, P<0.001). Multivariable Logistic regression showed that age, serum prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade, clinical T stage and risk stratification were correlated with PLND during RP (P<0.05); ISUP grade, clinical T staging and risk stratification increased the risk of LNM (P<0.05). After PSM, patients in RP group had similar survival compared to the PLND group (P=0.80); the ePLND group and obturator resection group also achieved equivalent survival (P=0.16). Among lymph node-positive patients, the disease progression-free survival in the adjuvant therapy group seemed superior to the non-adjuvant therapy group (P<0.001); and the adjuvant therapy group had better survival than those without PLND (P=0.02).

Conclusions: ePLND is recommended for patients with indications of lymphadenectomy, which can significantly optimize the detection rate of positive lymph nodes and provide guidance for subsequent adjuvant therapy.

Background: Patients with an active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] infection are at a higher risk of post-operative mortality. In this retrospective case-control study, we analyzed the post-operative safety of patients undergoing cystoscopy with ureteral stent placement for obstructing ureteral calculi who tested positive for COVID-19.

Methods: We retrospectively identified patients who underwent cystoscopy and ureteral stent placement between June 5, 2020 and December 31, 2022 as an add-on case. Patients were stratified by whether they had a positive COVID-19 test on admission. Baseline characteristics were compared using Students t-test for continuous variables and Pearson chi-square test for categorical variables. Univariate and multivariate logistic regression analysis was performed to identify predictors of postoperative 30-day mortality.

Results: A total of 1,408 patients underwent add-on cystoscopy with ureteral stent placement for an obstructing calculus, of which 55 (3.9%) patients had a positive COVID-19 test. When stratified by COVID-19 status, both groups were similar with regards to age, sex, race, co-morbidities, indications, procedure duration, and type of anesthesia administered. Of the 137 patients that were admitted to the intensive care unit (ICU), 9 patients were COVID-19 positive (16.4% vs. 9.5%, P=0.09). On multivariate logistic regression, patients with COVID-19 had a higher odds of 30-day mortality [odds ratio (OR) =7.06; 95% confidence interval (CI): 2.03-24.47; P=0.002] when controlling for age, co-morbidities, vaccination status, anesthesia type, and indication for the stent.

Conclusions: Patients that underwent cystoscopy and ureteral stent placement for an obstructing ureteral stone with a concurrent COVID-19 diagnosis had an increased risk of perioperative 30-day mortality.

Background: Radical cystectomy (RC) patients are at significant risk for venous thromboembolism (VTE). Current predictive models, such as the Caprini risk assessment (CRA) model, have limitations. This research aimed to create a novel predictive model for forecasting the risk of VTE after RC.

Methods: This single-center study involved RC patients treated between January 1, 2010 and December 31, 2019. The individuals were divided into training and testing groups in a random manner. Multivariate and stepwise logistic regression were utilized to create two novel models. The models' performance was compared to the commonly used CRA model, employing metrics including net reclassification improvement (NRI), integrated discrimination improvement (IDI), and receiver operating characteristic (ROC) curve analyses.

Results: A total of 272 patients were enrolled, among whom 36 were diagnosed with VTE after RC. Model A and Model B were then conducted. The area under ROC of Model A and Model B is 0.806 [95% confidence interval (CI): 0.748-0.856] and 0.833 (95% CI: 0.777-0.880), respectively, which were also determined in the testing cohorts. The two new Models were superior both in classification ability and prediction ability (NRI >0, IDI >0, P<0.01). Model A and Model B had a concordance index (C-index) of 0.806 and 0.833, respectively. In decision curve analysis (DCA), the two new models provided a net benefit between 0.02 and 0.84, suggesting promising clinical utility.

Conclusions: Regarding predictive accuracy, both models surpass the existing CRA model, with Model A being advantageous due to its fewer variables. This easy-to-use model enables swift risk assessment and timely intervention for high-risk groups, yielding favorable patient outcomes.

Background: Embryonal rhabdomyosarcoma (ERMS) of the prostate is a rare and aggressive malignant tumor in adults with a poor prognosis in general. The main presenting symptoms are dysuria and acute urinary retention. Prostate ERMS is easily misdiagnosed, which leads to delays in treatment.

Case description: We report the case of a previously healthy 31-year-old man who presented with dysuria for 3 months. Digital rectal examination (DRE), ultrasound, and computed tomography (CT) were suggestive of the possibility of a 2.0 cm × 3.0 cm abscess in the left lobe of the prostate. Prostate-specific antigen (PSA) was at a normal level, and C-reactive protein (CRP) concentration was elevated. The patient underwent surgical drainage by transurethral incision of the prostatic abscess. There was a significant improvement in the maximal urinary flow rate on postoperative day 5. However, the patient presented with acute urinary retention again on the 20th postoperative day. DRE and pelvic magnetic resonance imaging (MRI) showed a recurrence of an enlarged mass in the left lobe of the prostate. PSA level was again normal. Cystoscopy revealed a large neoplasm arising from the prostate obstructing the bladder outlet, and a diagnostic transurethral resection of this prostate tumor was performed. Histopathology revealed the mass to be an embryonic rhabdomyosarcoma. Subsequently, the patient was transferred to the Oncology Department and received chemoradiotherapy. After chemoradiotherapy, the size of the prostate became normal. Unfortunately, the patient deteriorated rapidly and eventually succumbed to multiple organ failure 1 year after the initial presentation.

Conclusions: Due to its non-specific presenting symptoms, prostate ERMS can be easily misdiagnosed, which can lead to treatment delay. Multimodality approaches, including neoadjuvant/adjuvant chemotherapy, radiotherapy, and radical resection, can improve the survival rate and reduce ERMS patient mortality.

Background: Renal cell carcinoma (RCC) is a heterogeneous disease. Identifying effective biomarkers is crucial for improving prognostic accuracy and therapy outcomes. This study investigates cell division cycle-associated 3 (CDCA3) as a novel biomarker for prognostic assessment and immunotherapy response in RCC.

Methods: This study analyzed multi-omics data from The Cancer Genome Atlas (TCGA) for kidney renal clear cell carcinoma (KIRC), kidney renal papillary cell carcinoma (KIRP), and kidney chromophobe (KICH) subtypes to evaluate CDCA3 expression and its clinical implications. Functional enrichment and immune infiltration analyses were performed using bioinformatics tools gene set enrichment analysis (GSEA) and xCell. The prognostic value of CDCA3 was assessed through Cox regression and Kaplan-Meier survival analysis. Immunohistochemistry (IHC) was employed to confirm CDCA3 expression at the protein level in RCC samples.

Results: Higher CDCA3 expression correlated with poor survival outcomes and reduced response to programmed cell death protein 1 (PD-1) blockade therapies. Statistical analysis indicated that CDCA3 was an independent prognostic factor for poor survival in RCC. CDCA3 was consistently overexpressed in RCC tissues compared to normal tissues and was associated with adverse clinical features, including high Th2 cell infiltration and suppression of immune pathways.

Conclusions: CDCA3 is a promising biomarker for RCC, offering insights into the tumor's prognosis and potential response to immunotherapy. The strong association between CDCA3 expression and poor therapeutic outcomes suggests that CDCA3 could be targeted in future therapeutic strategies.

Background: The treatment of complex ureteral stricture has always been a hot and difficult topic in urology. The aim of our study is to investigate the feasibility and clinical efficacy of labial mucosal graft (LMG) onlay ureteroplasty without omental wrap for ureteral stricture with occlusion and present our initial experience.

Methods: We retrospectively reviewed perioperative and follow-up data of 12 patients admitted to The First Affiliated Hospital of Chongqing Medical University who underwent the LMG ureteroplasty with ureteral occlusion from April 2022 to September 2023. After stricture and occluded segments were incised longitudinally, the LMG was used to expand the ureteral lumen without omental wrap.

Results: All patients had successful surgery with no intraoperative complications. The median length of ureteral stricture was 3.5 cm (range, 3-5 cm), the median length of the occlusion was 1.5 cm (range, 1-2 cm), the median length of the LMGs is 4.5 cm (range, 4-6 cm). Ureteroscopy confirmed that the reconstructed ureteral lumen was unobstructed except for one patient with thin film-like ureteral stricture. Only one patient had slight contracture at the graft site, which did not affect movement of lip and appearance. No persistent and obvious discomfort was observed at the graft site in the remaining patients.

Conclusions: Our experience suggests that LMG onlay ureteroplasty without omentum wrap appears to be a feasible and safe option for reconstruction of ureteral occlusion.