Translational andrology and urology最新文献

Background: The benefit of nephrectomy for all patients with clear cell renal cell carcinoma (ccRCC) remains controversial. This study assessed the impact of nephrectomy on patient prognosis and developed a prognostic model for nephrectomy-treated patients.

Methods: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) and The Cancer Genome Atlas databases. Propensity score matching (PSM) was implemented, followed by univariate and multivariate survival analyses to compare overall survival (OS) between ccRCC patients treated with and without nephrectomy. Subsequently, we developed and internally validated a nomogram for predicting OS in nephrectomy-treated patients using multivariate Cox regression modeling.

Results: OS was significantly better in the nephrectomy group compared to the non-nephrectomy group [hazard ratio (HR) =0.405, 95% confidence interval (CI): 0.382-0.429, P<0.001), with significant benefit observed across all predefined subgroups (all HR <1, P<0.05). Age, gender, tumor stage, tumor-node-metastasis (TNM) stage and differentiation grade were identified as independent risk factors of OS in nephrectomy-treated ccRCC patients. The nomogram incorporating these factors exhibited excellent discrimination, calibration, and clinical utility in training, internal validation, and external test cohorts.

Conclusions: Nephrectomy was shown to significantly improve survival in patients with ccRCC. We developed an effective survival prediction model for these patients, which could aid in identifying high-risk individuals and providing a valuable tool for personalized survival assessments.

Background: For aggressive prostate research, a suitable orthotopic animal model is in demand. This study aims to future establishment of mice prostate cancer model via testosterone dosing after castration, and, as a preliminary experiment, evaluate the changes in prostate and bladder caused by benign prostate hyperplasia (BPH). An animal prostate enlargement model was used to assess bladder smooth muscle changes via immunohistochemical (IHC) markers of the prostate and bladder.

Methods: Injection of testosterone propionate into 12-week-old C57BL/6 mice stimulated prostatic hypertrophy in a mouse model. Three groups of mice were divided into control, castrated mice with a single subcutaneous dose of 50 μL testosterone administration, castrated mice without testosterone administration, and sacrificed 4 weeks later. α-1 adrenoceptor and transforming growth factor-beta (TGF-β) expression in the prostate ventral lobe and β-3 adrenoceptor and Rho-kinase expression in the bladder mucosa were evaluated by IHC staining analyses and compared among the 3 groups.

Results: Prostate weights for the control, castrated, and castrated + testosterone groups were 75±27, 101.9±17, and 130±19 mg, respectively, showing a significant difference in prostate weight between the subject and castration plus treatment groups (P<0.05). IHC data showed that the castrated + testosterone group had significantly higher expression of α-1 adrenoceptor antibody (0±0 vs. 1.25±0.433, P=0.02) in the prostate ventral lobe and β-3 adrenoceptor antibody (0±0 vs. 1±1.41, P=0.0003) and Rho-kinase antibody (0±0 vs. 2±0, P=0.0001) in the bladder mucosa, compared with the control groups.

Conclusions: For our establishment of a prostate cancer model for mice, our in vivo experiments using IHC study demonstrated that the overexpression of α-1 adrenoceptor (prostate enlargement), β-3 adrenoceptor and Rho-kinase (bladder) biomarkers indicated that prostate enlargement can cause bladder muscle atrophy. Further research could be undertaken using this prostate enlargement model for cancer research.

Background: Hyperuricemia (HUA) imposes a substantial clinical and public health burden, affecting 43 million adults in the U.S. and 170 million in China. Increased hydration is often recommended as a preventive measure for HUA, but the quantity-effect correlation between water intake and serum uric acid (SUA) is unclear. This study aimed to investigate the quantity-effect correlation between water intake and SUA.

Methods: This cross-sectional study evaluated the data of 15,174 participants from the National Health and Nutritional Examination Surveys (NHANES) 2009-2018. The SUA levels (mg/dL) of all the participants were tested, and their daily water intake (g) was estimated based on the average of two 24-hour dietary recalls. To more accurately assess individual water consumption, the ratio of water intake to body weight (g/kg) was employed as a treatment variable. Multivariate linear regression models were used to evaluate the association between the two variables. Generalized additive models with smooth curve fittings were also applied. A Sobel-Goodman analysis was conducted to determine whether osmolality served as a mediator between water intake and SUA levels.

Results: The final 15,174 participants had a mean age of 44.28±16.33 years (49.0% male), with SUA quartiles showing significant differences in sex, age, and lifestyle factors. The multivariate regression analyses showed that water intake/body weight was negatively correlated with SUA after adjustment for other confounders. Subgroup analyses stratified by sex showed that this negative correlation was more significant in females. Further, a nonlinear negative correlation between water intake/body weight and SUA was observed in the generalized additive model (P<0.001), showing an L-shaped curve (inflection points: 7.591 and 33.57 g/kg for total plain water consumption/body weight and total moisture intake/body weight, respectively). Plasma osmolality mediated the relationship between water intake/body weight and SUA, with mediating effects of 9.14% and 5.84% for total plain water consumption/body weight and total moisture intake/body weight, respectively.

Conclusions: This study found a negative correlation between water intake/body weight and SUA, particularly in females. Moreover, the negative relationship exhibited nonlinear characteristics, following an L-shaped curve. Plasma osmolality was found to play a mediating role in the reduction of SUA by water intake. These findings support personalized water intake guidance-targeting intake below inflection points (7.591 g/kg for total plain water, 33.57 g/kg for total moisture) may optimize SUA reduction (especially in females) and inform non-pharmacological HUA management in clinical practice.

Background and objective: Age-related erectile dysfunction (ED) is a significant health concern linked to vascular aging, characterized by endothelial dysfunction and vascular smooth muscle alterations. This study aimed to explores the pathophysiological mechanisms of age-related ED in elderly men, providing new directions for diagnosis and the development of novel targeted therapies.

Methods: This review focused on literature from 2000 to 2025 concerning vascular aging and ED. We searched PubMed, Web of Science, and Embase using keywords like "erectile dysfunction", "aging", "vascular endothelium", and "vascular smooth muscle". The selection process prioritized high-quality clinical and innovative preclinical studies in humans or animal models that explored pathophysiology or novel treatments. Exclusion criteria included duplicates, non-peer-reviewed articles, and off-topic studies.

Key content and findings: Key contributors to age-related ED include reduced nitric oxide (NO) bioavailability due to endothelial oxidative stress and inflammation, diminished cavernosal smooth muscle content leading to impaired veno-occlusion, and increased arterial stiffness compounded by metabolic disorders. Chronic inflammation, oxidative stress, hormonal imbalances (particularly testosterone deficiency), and metabolic disruption accelerate these vascular aging processes, making ED an early indicator of systemic vascular pathology. Current treatment strategies mainly include phosphodiesterase-5 inhibitors (PDE5i) and testosterone, both of which are suitable for immediate symptom relief in most ED, although there are serious limitations. Emerging interventions are currently experimental and their evidence is mainly derived from preclinical studies. These include interventions to preserve endothelial NO synthase (eNOS) function, stem-cell regenerative therapies targeting tissue repair, nanotechnology to enhance the efficiency of drug delivery, and modulation of mitochondrial integrity and inflammation.

Conclusions: Age-related ED is a manifestation of systemic vascular pathology. A deeper understanding of its mechanisms underscores its role as an "early warning signal" for overall vascular health. While current treatments like PDE5i and testosterone offer symptomatic relief, they have limitations. Promising future directions lie in novel targeted therapies, such as enhancing eNOS function, stem-cell therapy, and nanotechnology, which are currently in the experimental stage and require further clinical validation.

Background: Prostate cancer is an increasing health concern among aging male populations in China, yet evidence on their screening behaviors remains limited. This study aimed to examine the knowledge, attitudes, and practices (KAP) of middle-aged and elderly males regarding prostate cancer and its early screening.

Methods: This cross-sectional study was conducted at the urologic surgery clinic of the First People's Hospital of Changzhou from September to November 2023.The KAP scores were evaluated using a self-designed questionnaire.

Results: A total of 616 responses were collected, with 518 valid questionnaires included in the analysis. The mean age of participants was 59.47±14.84 years. The mean scores for KAP were 7.58±5.67 (possible range, 0-20), 25.27±2.27 (possible range, 7-35), and 26.11±3.94 (possible range, 7-35), respectively. Multivariate logistic regression showed that knowledge score [odds ratio (OR) =1.066; 95% confidence interval (CI): 1.010-1.124], currently smoking (OR =1.972; 95% CI: 1.087-3.578), and with previous prostate cancer early screening (OR =0.235; 95% CI: 0.142-0.391) were independently associated with proactive practice. Mediation analysis indicated that knowledge directly affected both attitude and practice, with no significant indirect effect on practice (all P<0.05).

Conclusions: Middle-aged and elderly men demonstrate insufficient knowledge but exhibit positive attitudes and proactive practices regarding prostate cancer. This study provides critical insights into the KAP of middle-aged and elderly males regarding prostate cancer screening, an under-researched area in public health.

Background: Focal irreversible electroporation (IRE) has shown promising initial oncological and functional outcomes in the treatment of localised prostate cancer (PCa), although robust evidence to support its efficacy and optimal utilisation is still maturing. We aim to summarise the oncological outcomes, functional outcomes, and safety profile of IRE for the treatment of localised PCa.

Methods: A search was performed across four electronic databases: MEDLINE, Embase, Web of Science, and Cochrane Database of Systematic Reviews; 620 articles were screened after removal of duplicates; 73 full-texts were reviewed.

Results: Thirty-one articles representing 29 studies were included. Focal IRE patients ranged from 10 to 411 patients. Median follow-up ranged from 6 to 60 months. Three studies reported exclusively on salvage-IRE, and three reported on both primary- and salvage-IRE. A combination of all risk-groups was included. Safety margins ranged from 0 to 10 mm. Early post-IRE imaging within 1 month of treatment was performed in 14 studies. Post-treatment biopsy was performed in 23 studies, ranging from 6 to 18 months after IRE. In-field recurrence rates ranged from 0-33% and 0-10% in the primary and salvage settings respectively. Out-of-field recurrence rates ranged from 0-33% and 0-14% respectively. Retreatment rates ranged from 0-37% in the primary setting and 0-24% in the salvage setting. In the primary setting, four studies reported a decrease in pad-free rates, ranging from 1-2%, while six of twelve studies noted improvements in urinary patient-reported outcome measures (PROMs). Baseline erections sufficient for intercourse declined in 10 studies, ranging from 3-22%, and deterioration in sexual function PROMs was reported in eight of 13 studies. In the salvage setting, pad-free rates decreased by 4-33% across three studies, and potency rates declined by 14-22% in four studies. Clavien-Dindo III events occurred in 1-19% of patients across six studies, and two cases of rectourethral fistula were reported.

Conclusions: Oncological outcomes, although still maturing, appear promising. Functional outcomes compare favourably against whole-gland treatment, particularly in the primary treatment setting. Focal IRE appears to have a role in salvage treatment. Comparative studies are needed to evaluate its role amongst the growing array of treatments for localised PCa.

Background: Overactive bladder (OAB) is one of the most common urinary disorders, affecting approximately 16% of the global population. It is strongly associated with obesity, diabetes, and other metabolic risk factors. The ZJU index is an innovative computational tool that integrates body mass index (BMI), fasting blood glucose (FBG), triglycerides (TG), and the alanine aminotransferase (ALT) to aspartate aminotransferase (AST) ratio, and it is highly correlated with lipid metabolism. However, the relationship between the ZJU index and OAB has not been previously explored. This cross-sectional National Health and Nutrition Examination Survey (NHANES) analysis evaluates the ZJU index as a potential OAB predictive tool, informing early intervention strategies.

Methods: This large-scale, cross-sectional study utilized data from the NHANES conducted between 2011 and 2018. Information on the medical history of renal OAB was obtained through questionnaires and recall interviews. The ZJU index was categorized into quartiles, and its association with OAB was examined using multivariate linear and logistic regression analyses, adjusted for potential confounders. The results were further visualized using restricted cubic splines (RCS) regression and threshold effect analysis. Subgroup and sensitivity analyses were also performed.

Results: A total of 15,873 participants aged 20 years and older with complete data were included in the analysis. After controlling for confounding factors using logistic regression, a nonlinear relationship between the ZJU index and OAB was identified. Specifically, the prevalence of OAB increased with higher ZJU index levels [odds ratio (OR) =1.79, 95% confidence interval (CI): 1.57-2.04, P<0.001]. Subgroup analysis revealed that the association was significantly stronger in women (OR =1.03, 95% CI: 1.02-1.04, P<0.001), while no significant relationship was found in men (n=7,816; OR =1.01, 95% CI: 1.00-1.01, P=0.15).

Conclusions: Our study demonstrates that the ZJU index is significantly associated with an increased risk of OAB, particularly in women. Further research is needed to confirm these findings and explore the underlying mechanisms.

Microbial culture is the current standard of care to choose therapeutic antibiotics for infection occurring with inflatable penile prostheses (IPPs). However, next-generation sequencing (NGS) of DNA has proven beneficial for analysis of biofilm composition and relative abundance of specific microorganisms. The main goal of this study is to evaluate whether NGS compared to microbial culture can better guide the management and antibiotic selection and device survival rates. We hypothesize that identifying microbial composition with NGS, as compared with traditional culture, will lead to better therapeutic strategies resulting in improved patient outcomes and device survival. In this present manuscript, we describe the overall study methodology and analyze device survival rates, classify clinical presentations of IPP infections, and determine infected implant microbial composition and antibiotic resistance among an early patient cohort. These early results included 18- to 80-year-old consecutive male patients who received antimicrobial treatment without surgical replacement for at least 7 days since identification of infected IPPs. Subjects were randomized into two analytic arms: traditional culture and NGS. Throughout the study, investigators and patients completed questionnaires to provide data for comparison. To date, of the 9 patients enrolled in the study, 6 eventually underwent device removal due to worsening infection within 7 days of initiating empiric antibiotic treatment. Six patients were seen in a clinic setting, while 3 were seen in the hospital/emergency department: 7 implants were primary, while 2 were secondary. All subjects received a Coloplast IPP but had differing reservoirs and reservoir locations. In cases where penile shaft tenderness was present, the implanted IPP was more often removed within 7 days. In contrast, when no tenderness was reported, the device remained viable for at least 10 days. As of this report, 11 active sites have participated in the study, with ongoing patient enrollment aimed at reaching sufficient sample sizes for statistical comparison. Penile shaft tenderness was a common presentation among patients whose early antibiotic treatment for IPP infection failed. Recruitment of additional patients to this prospective, randomized controlled trial will help to identify favorable presentations of IPP infection. Additional data will allow comparison of implantation outcomes between NGS and traditional culture.

Background: Ultrasound is a widely used and effective imaging modality for evaluation in renal transplantation. This study aimed to provide a comprehensive bibliometric analysis of the research landscape and emerging trends in the use of ultrasound for renal transplant assessment.

Methods: Relevant articles published between January 2010 and June 2025 were retrieved from the Web of Science (WoS; Science Citation Index Expanded) and PubMed [randomized controlled trial (RCT)] databases using the keywords "ultrasound" and "renal transplant". Publications were screened by article type, language, abstract, and keywords. Bibliometric and visualization analyses were performed using VOSviewer and the bibliometrix R package.

Results: A total of 268 original research articles were included. The analysis demonstrated a notable rise in research activity since 2020, accompanied by extensive international collaboration, with the United States identified as the leading contributor. Transplantation Proceedings was the most prolific journal, while Clinical Hemorheology and Microcirculation had the highest citation count. Fananapazir G and Haberal M have the highest number of publications, while Brabrand K and Midtvedt K have the highest number of citations. Zhengzhou University was among the most active Chinese institutions in recent years. Machine learning (ML), shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) have emerged as active research topics in the field.

Conclusions: Ultrasound remains a key research focus in the imaging evaluation of renal transplants, with substantial potential for future advancement. The increasing integration of ML with ultrasound-based techniques represents a promising direction, with the potential to enhance diagnostic accuracy and clinical decision-making in renal transplant assessment.

The rising prevalence of testosterone deficiency has led to increased use of exogenous testosterone therapy, including among men desiring fertility. Conventional testosterone replacement therapies (TRT) restore serum testosterone but suppress gonadotropins, resulting in impaired spermatogenesis. Consequently, newer approaches aim to normalize testosterone levels while preserving fertility potential. Intranasal testosterone provides short-acting, pulsatile testosterone delivery that mimics physiologic diurnal variation. Studies demonstrate normalization of serum testosterone while maintaining follicle-stimulating hormone (FSH) and luteinizing hormone (LH) within reference ranges, supporting the potential for preserved spermatogenesis. Similarly, oral testosterone undecanoate formulations offer noninvasive administration and short-acting pharmacokinetics. Clinical data show maintenance of FSH and LH within normal limits, albeit reduced from baseline, suggesting possible fertility preservation-though data on semen parameters remain limited. Concomitant administration of low-dose human chorionic gonadotropin (hCG) with exogenous testosterone has been shown to sustain intratesticular testosterone (ITT) and spermatogenesis. Multiple studies demonstrate that hCG maintains sperm production even with full gonadotropin suppression from TRT. Finally, enclomiphene citrate, a purified trans-isomer of clomiphene, stimulates the hypothalamic-pituitary-gonadal (HPG) axis, increasing endogenous testosterone while maintaining spermatogenesis. This paper provides an updated overview of these evolving modalities and advances since our 2013 publication, highlighting short-acting testosterone delivery, concomitant gonadotropin support, and selective estrogen receptor modulation. Continued research with larger, long-term studies is essential to confirm their safety, efficacy, and fertility outcomes.