Translational andrology and urology最新文献

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.

Buccal mucosal graft (BMG) ureteroplasty, particularly with the anterior-onlay technique, shows promise for treating complex ureteral strictures. However, long and circumferential strictures remain challenging. This study aimed to present the surgical technique of the posterior-inlay and anterior-onlay technique in robotic ureteroplasty with a BMG (RU-BMG). A 37-year-old male patient with a medical background of failed laparoscopic ureteroplasty and multiple endourological interventions was admitted to our hospital. Preoperative anterograde and retrograde pyelography revealed a 5-cm ureteral stricture. During the surgical procedure, the ureteral posterior wall was insufficient to facilitate a complete posterior augmented anastomosis, resulting in a posterior defect subsequent to the partial posterior augmented anastomosis. Ultimately, a BMG was utilized to address the posterior defect initially, followed by anterior-onlay ureteroplasty with a BMG. The Foley catheter was removed 2 weeks after surgery, while the nephrostomy tube was clamped on postoperative day 14. The double-J stent was removed 3 months after surgery. The preoperative serum creatine was 102.9 μmol/L. The surgery was performed successfully within 240 min, with estimated blood loss of 100 mL. The postoperative hospitalization was 4 days. Throughout the 12-month follow-up period, no symptoms or complications were observed, with a serum creatine of 82.0 μmol/L. Computed tomography urography indicated relieved hydronephrosis. In conclusion, RU-BMG using a combination of posterior-inlay and anterior-onlay technique is safe and feasible in the management of ureteral stricture. More cases and longer follow-up for this procedure are needed for better perfection of this procedure.

Background: Artificial urinary sphincter (AUS) is the gold standard for severe male stress urinary incontinence (SUI). This study aims to evaluate the interest of a new cutaneous preparation regarding the risk of early device infection.

Methods: A retrospective review of medical records has been built with all patients who underwent an AUS, implanted by experienced surgeons, between January 2010 and January 2023. Before January 2015, all AUS received a standard protocol (SP) of cutaneous cleansing with soap povidone iodine and disinfection with alcoholic povidone iodine. After January 2015, all AUS received the new protocol (NP) with two cleansings with soap povidone iodine and two disinfections with alcoholic povidone iodine. The primary focus was to compare the risk of early device infection between the two protocols. Multivariate analyses were done with several risk factors such as age, diabetes, underlying pathology (prostate cancer surgery, surgical treatment of benign prostatic hyperplasia or others), past history of pelvic radiation therapy and past AUS implantation.

Results: One hundred and fifty-six cases were enrolled, with 34 following the SP and 122 following the NP. In the univariate analysis, there were 15 explantations in the SP arm versus 8 for the NP arm due to infection (45.5% vs. 25%, P=0.09). The was no difference between the NP and the SP in multiparametric analysis [odds ratio (OR): 0.97; P=0.96]. No other risk factors were associated with increased risk of AUS removal.

Conclusions: Our study showed no correlation between the two types of skin preparation and the risk of AUS removal or revision. Future studies are needed to highlight the legitimate risk factors.

Background: Kidney renal papillary cell carcinoma (KIRP), kidney chromophobe (KICH), and kidney renal clear cell carcinoma (KIRC) are three most common subtypes of renal cell carcinomas (RCC), and its development is a multifaceted process that intricately involves the interplay of numerous genes. Despite recent advances in research on renal cell carcinoma, the prognosis of KIRC patients remains dismal. Therefore, there is an urgent need to explore new prognostic biomarkers and treatment strategies to help clinicians choose more effective treatment methods and accurately predict long-term efficacy. Our study aimed to systematically evaluate the gene expression profiles of three RCC subtypes, especially KIRC, and to identify survival-related biomarker.

Methods: In our present study, we systematically evaluate the genes expression profile difference among three subtypes of RCC, and identify the survival-related key genes signature based on GEPIA2. GeneMANIA was used to identify the functionality-related differentially expressed genes (DEGs). Furthermore, focusing on KIRC, we intersected functionality-related and survival-related DEGs based on two datasets.

Results: We ascertained five DEGs (ANK3, FREM2, KIF13B, MPP7 and SOX6) as key survival-related genes in KIRC. High levels of these five DEGs expressions were strongly associated with favorable prognosis, but not correlated to metastasis. Downregulation of these five DEGs expressions was closely associated with immunomodulators, chemokines, and infiltrating levels of different immune cells, which indicated that these five DEGs were key immune-related novel prognostic biomarkers for KIRC.

Conclusions: The five identified DEGs serve as potential novel prognostic biomarkers for KIRC. However, the crucial factors that lead to the downregulation and functional inactivation of these five key genes need to be explored in future studies.

Background and objective: Premature ejaculation (PE) and erectile dysfunction (ED) are two common sexual symptoms of male sexual dysfunction that can strongly affect men's mental health and quality of life, and they often coexist. This aim of this study was to explore the causes and relationships between PE and ED, with a focus on the progression of PE accompanied by high-frequency ED. A deeper understanding of the causes and treatments for PE combined with ED will help improve clinical diagnosis and treatment.

Methods: We conducted a literature review of the most relevant articles related to the outlined topic in the PubMed, Google Scholar, and Web of Science databases. We did not limit language, covering both English and non-English publications, and include Chinese and English papers published between January 1996 and March 2024.

Key content and findings: The incidence of PE and ED increases with age. Approximately one-third of patients who complain of ED suffer from PE. Similarly, in a large-scale survey in the Asia-Pacific region, more than 30% of patients with PE reported concurrent ED. Various research findings indicate a strong correlation between PE and ED. Some scholars speculate that there is a vicious cycle between PE and ED. Men who attempt to control ejaculation can reduce the level of arousal, leading to ED, whereas men who try to achieve an erection will attempt to increase the level of arousal, which can lead to PE. This cycle of mutual influence may lead to reciprocal aggravation and persistence of sexual dysfunction in both parties. Although some studies have explored the relationship between PE and ED, the specific determinants and underlying factors have not yet been clarified.

Conclusions: There is a close interrelationship between PE and ED, and a vicious cycle may exist between the two. This cycle of mutual influence may lead to the mutual aggravation and persistence of both sexual dysfunctions. However, the specific determining factors and potential factors underlying the correlation between the two have not been clearly identified and require further exploration.

Background: New medications are needed to improve outcomes of castration-resistant prostate cancer (CRPC). Psoralen has been reported to have anti-cancer properties for various tumors, but there are limited reports about psoralen treatment in prostate cancer (PCa). This study aimed to investigate the effect of psoralen on PC3 cells and to investigate potential underlying mechanisms of action.

Methods: The effect of psoralen on the proliferation and cell cycle progression of PC3 cells was determined using Cell Counting Kit-8 (CCK-8) test and flow cytometry, respectively. The differential gene profiles in PC3 cells treated with psoralen were determined with microarray analyses. The effect of psoralen on long non-coding RNA (lncRNA) ENST00000510619 expression in PC3 cells was detected by real-time quantitative polymerase chain reaction (RT-qPCR). The effect of psoralen and transfection of small interfering lnc-RNA (si-lncRNA) ENST00000510619 on cell viability, invasion ability, and migratory activity of PC3 cells were evaluated using the CCK-8 test, transwell assay, and wound healing, respectively.

Results: Psoralen significantly inhibited PC3 cells in a concentration- and time-dependent manner and caused G1 phase and G2/M phase cycle arrests. When screened with a fold change (FC) of ≥2 and a P value of <0.05, 1,716 lncRNAs and 1,160 messenger RNAs (mRNAs) were significantly up-regulated, whereas 3,269 lncRNAs and 3,263 mRNAs were significantly down-regulated in PC3 cells after psoralen treatment. Among the differentially down-regulated lncRNAs in which the signal of the probe showed significant differences compared to the background, lncRNA ENST00000510619 had the highest FC. The expression of lncRNA ENST00000510619 was shown to be down-regulated by psoralen in a concentration-dependent manner. CCK-8 assay, wound healing, and transwell assay showed that both psoralen and si-lncRNA ENST00000510619 transfection significantly inhibited the activity, invasion, and migration of PC3 cells (P<0.01 for all).

Conclusions: Psoralen was confirmed to inhibit proliferation and block the cell cycle in PC3 cells in this in vitro study. The molecular mechanism involves multiple differentially expressed lncRNAs and mRNAs and is related to the down-regulation of lncRNA ENST000000510619 expression. This study provides the experimental basis for the development of psoralen as a novel anti-CRPC drug and for the consideration of lncRNA ENST00000510619 as a potential clinical target for CRPC.