Translational andrology and urology最新文献

Background: Studies have shown that many diseases can be correctly predicted by the ratio of non-high-density lipoprotein cholesterol (NHDL-C) to serum high-density lipoprotein cholesterol (HDL-C) (NHHR). However, the association between NHHR and erectile dysfunction (ED) risk is unknown. This study looked into the probable link between NHHR and ED occurrence.

Methods: This study made use of data from the National Health and Nutrition Examination Survey (NHANES), which was carried out between 2001 and 2004. The NHDL-C level was divided by the HDL-C level to calculate the NHHR. To look at the connection between ED and NHHR, the researchers employed a range of statistical techniques, such as subgroup analysis, multivariate logistic regression modeling, and smoothed curve fitting.

Results: In the end, 3,961 individuals were enrolled for the study, 2,800 of whom did not have ED, and 1,161 of whom did. NHHR had a strong negative association with ED occurrence. For every unit increase in NHHR, the prevalence of ED fell by 9% in the fully adjusted model. Participants in the highest quartile (Q4) of the NHHR experienced a significantly lower incidence of ED than those in the lowest quartile (Q1). Curve fitting revealed a negative association between NHHR and ED; however, interaction tests and subgroup analysis demonstrated that the substantial relationships between the various subgroups of variables were independent.

Conclusions: Evidence points to a direct correlation between a lower incidence of ED and greater NHHR levels.

Background: Primary gender-affirming vaginoplasty (GAV) may be limited by insufficient natal genital skin and the burdensome requirement for preoperative hair removal in transfeminine individuals. To address these challenges, we introduce the robotic-assisted "tubularized augmented peritoneal cap (TAPCap)" technique, incorporating decellularized fish skin xenografts (FSXs) for primary full-depth GAV.

Methods: Thirty-two consecutive transfeminine individuals who underwent primary TAPCap vaginoplasty using FSX between July 2023 and April 2025 were retrospectively chart reviewed. Collected data included baseline medical and surgical history, intraoperative data, and postoperative results. The robotic surgical technique involved using a peritoneal cap to line the proximal neovagina, tubularized FSX for the mid-vaginal segment, and penile skin to form the introitus.

Results: All 32 patients underwent robotic TAPCap vaginoplasty with FSX without intraoperative complications. The 30-day postoperative complication rate greater than Clavien-Dindo grade II was 6.2%, with a 3.1% readmission rate. At the conclusion of surgery, median vaginal depth was 16 cm. At a median follow-up of 147 days, 93.8% of patients remained adherent to dilation, and final median depth and width of the neovaginal canal were 14.25 cm and 3.18 cm, respectively. Vaginal stenosis occurred in 15.6% of patients, and 9.4% underwent revision of the neovaginal canal.

Conclusions: TAPCap vaginoplasty with FSX is a practical approach that may reduce reliance on genital skin and eliminate the need for preoperative hair removal. Early outcomes suggest adequate neovaginal dimensions and low revision rates. Further studies are required to evaluate the long-term viability of graft integration and its cost-effectiveness.

Background: Currently, amine oxidase copper-containing 1 (AOC1) is less studied in cancer. There are few studies on the relationship between AOC1 and prognosis in prostate cancer. This study explores the expression profile of AOC1 in normal prostate tissue and prostate cancer, and investigates the relationship between the expression of AOC1 and prognosis of prostate cancer.

Methods: The expression of AOC1 in 101 prostate cancer tissues and 22 normal prostate tissues was detected by immunohistochemistry. The AOC1 protein levels in the urine and blood samples of patients with prostate adenocarcinoma were examined by independent samples t-test.

Results: AOC1 had a low positive expression rate (4.0%, 4/101) in prostate adenocarcinoma tissues, which was significantly lower than that (90.9%, 20/22) in adjacent normal tissues. The cancer-specific survival (CSS) for AOC1-positive patients was significantly shorter than AOC1-negative cases (31.750±8.384 vs. 79.068±4.818 months, P<0.001). Cox multivariate regression analysis showed that AOC1 positivity was the only survival factor of both cancer-specific survival (P=0.005) and progression-free survival (P=0.01). The AOC1 protein levels in the urine and blood samples showed no significant differences between preoperative prostate cancer patients and three months after operation of prostate cancer (P=0.43, P=0.41, respectively).

Conclusions: AOC1 has low expression in prostate adenocarcinoma, and its positive expression may be associated with tumor prognosis.

Background: Microdissection testicular sperm extraction (micro-TESE) is an important technique for retrieving sperm in cases of non-obstructive azoospermia (NOA). However, the success rate of sperm retrieval using micro-TESE remains suboptimal. This has created an urgent clinical need to identify reliable predictive indicators that can accurately determine which NOA patients are likely to benefit from the procedure. Current literature lacks comprehensive studies correlating non-invasive ultrasound-based testis parameters with micro-TESE outcomes, highlighting a gap in the ability to preoperatively predict surgical success. This study aimed to investigate potential preoperative predictors of surgical success.

Methods: We retrospectively analyzed data from 167 men with azoospermia treated at our hospital between January 2020 and December 2024. We investigated the correlations between Johnsen score and various parameters, including testicular volume (TV), rete testis thickness (RTT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T), using Spearman rank correlation analysis. Additionally, we employed binary logistic regression to evaluate the predictive ability of these parameters for micro-TESE outcomes.

Results: Our findings revealed significant positive correlations of Johnsen score with age, RTT, and TV (r=0.136, 0.783, and 0.706, respectively), and negative correlations with FSH and LH (r=-0.723 and -0.515, respectively). Our binary logistic regression model was Logit(P)=-6.828 + 4.753 × RTT - (-0.059) × FSH + 0.061 × LH. The sensitivity, specificity, Youden index, and area under the curve (AUC) values for predicting the results of micro-TESE were 85.6%, 95.0%, 0.81, and 0.950 [95% confidence interval (CI): 0.927-0.974], respectively.

Conclusions: RTT is strongly correlated with Johnsen score; a combination of RTT, TV, FSH, and LH can serve as a reliable preoperative predictor of micro-TESE outcomes. These findings may improve patient selection for micro-TESE, thereby enhancing the overall success rates of this procedure in NOA patients.

Background: There is increasing evidence supporting the association between urinary microbiota and bladder cancer (BCa). However, the understanding of the relationship between intratumoral microbiota and BCa remains limited. The objective of this study is to characterize the intratumoral microbiota potentially linked to BCa, and identify microbial differences among patients with different tumor grades.

Methods: Surgical resection tissue samples were prospectively collected from BCa patients without preoperative therapy. The presence of bacteria within the tissue samples was assessed using fluorescence in situ hybridization (FISH). Following this, 16S rRNA sequencing and subsequent analyses were conducted, including microbial diversity, community composition, and gene function prediction.

Results: After a rigorous pathological diagnosis and exclusion process, 15 BCa tissues and 12 adjacent normal tissues were collected. FISH analysis revealed the presence of bacteria in both BCa tissues and adjacent normal tissues. No significant differences in alpha and beta diversity were observed between two groups. Bacillus, Bacillaceae, Thermoomonas, Enterococcaceae and Enterococcus were significantly increased in BCa tissues versus adjacent normal tissues. Additionally, compared with low-grade BCa, enriched Ramlibacter and depleted Escherichia-Shigella, Bacteroides, Bifidobacterium, Parabacteroides, and Lactococcus were found in patients with high-grade BCa.

Conclusions: Our study characterized the intratumoral microbiota characteristics of BCa and provided initial evidence of potential associations between specific bacteria and tumor grade. These findings suggest novel candidate biomarkers and potential therapeutic targets for BCa, but the exact application potential remains to be verified by functional experiments.

Background: Distal penile +/- meatus and fossa navicularis urethral stricture disease (USD) presents major reconstructive challenges owing to poor local vascularity and a high risk of dorsal graft failure. This study describes the novel Dorsal External Skin Augmented Inlay (DESAI) flap urethroplasty, a single-stage technique designed to achieve durable patency in distal ischemic urethral strictures while preserving glans morphology and cosmesis.

Case description: A prospective case series of seven men (mean age 54.7±13.9 years) with distal penile USD and impaired local vascularity underwent DESAI flap urethroplasty by a single reconstructive urologist between 2020 and 2025. Four patients (57.1%) had previous failed reconstructions and one (14.3%) had prior pelvic radiotherapy (RT). Functional outcomes were assessed using maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and disease-specific quality-of-life (QoL) measures pre- and post-operatively. Statistical significance was defined as P<0.05. Mean follow-up was 7.3±6.6 (median 4; range 3-22) months. Mean Qmax increased from 7.6±9.5 to 19.9±6.9 mL/s (P=0.002). Mean IPSS improved from 20.4±4.0 to 2.9±2.5 (P<0.001), and mean QoL scores from 3.3±1.0 to 1.1±0.6 (P<0.001). A transient early decline in IIEF-5 (20.7±6.0 to 16.0±6.3; P<0.001) was observed. All patients (100%) had successful post-operative outcome defined as Qmax ≥15 mL/s without reintervention and reported subjective improvement in voiding and cosmetic satisfaction. No fistula, dehiscence, or flap necrosis occurred.

Conclusions: The DESAI flap urethroplasty provides a reliable, vascularised, single-stage solution for distal USD. By circumventing the need for graft neovascularisation, it achieves excellent functional recovery and patient satisfaction with minimal morbidity. Further multi-centre validation and long-term follow-up are warranted to confirm durability and broader applicability.

Background: Sperm DNA fragmentation index (SDF) is a key biomarker for male infertility; however, traditional SDF measurements include non-viable sperm, reducing clinical relevance. The viable SDF may provide greater diagnostic accuracy. This study aimed to explore the potential of viable SDF cutoff and assessed its predictive value for male fertility.

Methods: This cross-sectional study enrolled men undergoing reproductive evaluation at a tertiary reproductive medical center. Semen analysis followed the World Health Organization (WHO) 5th edition guidelines. Total and viable SDF were measured using the sperm chromatin structure assay, with viability assessed using Far Red staining. Spearman's correlation analysis examined relationships between viable SDF, total SDF, and standard semen parameters. Using the 25% total SDF cutoff, patients were grouped into high (≥25%, n=96) and low (<25%, n=131) categories. Receiver operating characteristic (ROC) curve analysis identified the optimal viable SDF cutoff. Multivariate logistic regression analysis determined independent influencing factors for viable SDF, and ROC curves assessed model performance.

Results: A total of 227 men undergoing male reproductive evaluation were included in the study. The mean total and viable SDF were 21.89%±14.95% and 10.31%±12.21%, respectively. Viable SDF showed significant negative correlations with progressive and total motility and a strong positive correlation with total SDF. ROC analysis identified a viable SDF cutoff of 9.79% [area under the curve (AUC) =0.813; sensitivity =76%, specificity =66%]. Significant discrepancies were observed between groupings based on total and viable SDF thresholds. Notably, 23 men with total SDF ≥25% had viable SDF <9.79%, whereas 44 with total SDF <25% had viable SDF >9.79%. A clinical cutoff of 9.79% for viable SDF shows superior diagnostic performance over total SDF.

Conclusions: Viable SDF provides a more accurate assessment of clinically relevant (functional) sperm DNA damage because it evaluates DNA fragmentation specifically in membrane-intact, fertilization-competent sperm, rather than in the total sperm population.

Background: Robot-assisted nephroureterectomy (RANU) often requires intraoperative repositioning. Standard single-docking techniques use a four-arm port layout, which may not be optimal for patients with smaller body habitus. Therefore, this study aimed to evaluate the feasibility and safety of a modified three-arm port configuration for single-position, single-docking RANU.

Methods: We retrospectively analyzed 10 consecutive patients with upper tract urothelial carcinoma (UTUC) who underwent RANU using this modified configuration at a single center (Oct 2023-Oct 2024). The procedure was performed with the Da Vinci Xi system, utilizing a three-arm triangular port placement designed to minimize robotic arm collision. The affected kidney, entire ureter, and bladder cuff were excised en bloc.

Results: All procedures were completed successfully without repositioning or conversion. Mean operative time was 218 min (range, 170-290 min). The mean postoperative hemoglobin decrease was 9.3 g/L (range, 1-19 g/L). The average postoperative hospital stay was 8.7 days (range, 6-10 days). One patient (10%) had a Clavien-Dindo grade I complication (lymphatic leakage). All surgical margins were negative. Pathological stages were pT1 (30%), pT2 (60%), and pT3 (10%). At a median follow-up of 9.5 months, 1 patient (10%) experienced bladder recurrence.

Conclusions: The modified three-arm port configuration appears to be a feasible and safe approach for single-docking RANU, particularly suited to patients with smaller body frames. It demonstrates satisfactory perioperative and initial oncological outcomes in this preliminary series. Furthermore, the three-arm technique may potentially reduce operative costs. This technique may offer a practical minimally invasive option for UTUC, though validation in larger cohorts is warranted.