Background: In recent years, the area of minimally invasive, targeted therapy for kidney tumors has seen considerable advancement; however, little progress has been made in the evaluation of renal angiomyolipoma (RAML). We aimed to investigate the efficacy of emergency ultraselective arterial embolization for the treatment of fatal massive bleeding caused by RAML.
Methods: At The First Hospital of Jilin University, a retrospective study was conducted between January 1, 2019 and March 1, 2024. The enrolled patients were those experiencing intense flank pain with a ruptured RAML and hemorrhage as confirmed through computed tomography (CT) and magnetic resonance imaging (MRI) in the emergency department. We performed renal arteriography and vascular ultraselective embolization in patients with ruptured and bleeding RAML. Patient information, including age, sex, tumor size, embolic material, several blood laboratory parameters, and postembolization syndrome (PES) occurrence, was retrospectively analyzed. PES was defined as the occurrence of fever, pain, nausea, or vomiting.
Results: This study ultimately enrolled 27 patients. After emergency embolization, 27 patients had 100% stable red blood cells and hemoglobin, and 7 patients had a single lesion and underwent surgical resection after the bleeding was stabilized. After emergency embolization, 22 patients experienced relief of low back pain as compared to pretreatment conditions, and the rate of lower back pain relief was 81.48%. Significantly higher creatinine and urea nitrogen levels were observed in three patients prior to the operation, and these levels reverted to their original state after renal function protection therapy. Despite varying levels of PES, all of the patients' symptoms returned to their normal levels following symptomatic treatment, with no significant impact on their quality of life or recovery period.
Conclusions: Emergency ultraselective arterial embolization for the treatment of bleeding in fatal RAML is safe, rapid, and effective and has few complications. The use of iodized oil can not only serve an embolic function but also provide a tracer effect in subsequent reexamination.
Background: Male infertility is a global health problem. There is an increasing attention on the association of metabolic status with spermatogenesis. However, the impacts of metabolic factors on semen parameters are still unclear. To provide evidence for developing appropriate interventions on disease screening and prevention, we performed a Mendelian randomization (MR) analysis to assess causality between various metabolic factors and abnormal spermatozoa.
Methods: We conducted a two-sample MR study to appraise the causal effects of 16 metabolic factors (including indexes of metabolic traits, glucose metabolism, lipid profile, adipokines, uric acid and metabolic diseases) on abnormal spermatozoa from genome-wide association studies (GWASs). Filtering with strict criteria, eligible genetic instruments closely associated with each of the factors were extracted. We employed inverse variance weighted for major analysis, with supplement MR methods including MR-Egger and weighted median. Heterogeneity and pleiotropy tests were further used to detect the reliability of analysis.
Results: After rigorous quality control in this MR framework, we identified that body fat percentage [odds ratio (OR) =1.49, 95% confidence interval (CI): 1.01-2.20, P=0.046] and resistin (OR =1.55, 95% CI: 1.11-2.19, P=0.01) were causally associated with a higher risk of abnormal spermatozoa. In terms of other indexes of metabolic traits, glucose metabolism, serum lipid profile and uric acid and metabolic diseases including type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD), no causal effects were observed (P>0.05).
Conclusions: Our MR analysis provides robust evidence that body fat percentage and resistin are risk factors for abnormal spermatozoa, suggesting implications of identifying them for potential interventions and clinical therapies in male infertility. Further investigation in larger-scale GWASs on subgroups of abnormal spermatozoa will verify impacts of metabolic factors on spermatogenesis.
Background: Ureteroarterial fistula (UAF) is a rare yet potentially life-threatening condition, which is challenging for urologists. It is traditionally treated by open surgical repair and endovascular repair. Intraureteral repair (IUR) was also previously reported, however all at the expense of normal kidney function. Here we present a case of unexpected UAF during urologic procedure which was successfully treated by a self-expanding Allium ureteral stent.
Case description: A 62-year-old woman diagnosed with bilateral ureteral stricture was admitted into our hospital for Allium stents insertion. However, she encountered an intraoperative emergency of UAF after ureteral balloon dilatation with presentation of urinary tract hemorrhage and hemodynamic instability. After consulting vascular surgeons, a clinical diagnosis of UAF was made. Three Allium stents were inserted in series. Urinary tract hemorrhage subsided immediately and circulation stability was quickly restored. Moreover, hydronephrosis was significantly relieved. No further hemorrhage occurred in the following 3 years.
Conclusions: Allium ureteral stent could be a feasible option for patients with UAF and should be considered by urologists. Our experience suggests that IUR with Allium stent could plug UAF effectively in an emergent setting. In addition, it preserves normal kidney function satisfactorily. Base on such merits, Allium stent provides a real possibility for IUR of UAF, which could potentially change the current treatment guideline.
Background: Both clomiphene citrate and its isomer, enclomiphene, have become widespread within urologic practice; thus, understanding these medications' comparative benefits and risks is crucial for optimizing treatment and providing improved therapeutic options. We sought to investigate the longitudinal benefits and risks associated with enclomiphene, compared to clomiphene, and to provide valuable insights for clinicians when making treatment decisions in the management of hypogonadism.
Methods: We retrospectively studied patients at our academic center who had been prescribed clomiphene and, later, enclomiphene for hypogonadism. Baseline laboratory values were documented for each patient before being prescribed clomiphene, followed by subsequent values for each variable in the most recent visit before stopping clomiphene and any noted adverse effects experienced during this time. The same process was repeated for enclomiphene, using the clomiphene levels as an updated baseline. Two-tailed t-tests were employed using R to analyze the longitudinal impacts of clomiphene and enclomiphene on serum hormone values as well as a regression analysis to estimate the odds ratio (OR) for adverse events between the two therapies.
Results: Among 66 patients, enclomiphene exhibited a median testosterone increase of 166 (vs. 98 ng/dL, P=0.20) with lower estradiol change than clomiphene (-5.92 vs. 17.50 pg/mL, P=0.001). Adverse effects were statistically significantly less frequent with enclomiphene, including decreased libido (P=0.001), reduced energy (P=0.044), and mood changes (P=0.03). Regression analysis confirmed lower odds of adverse events with enclomiphene [OR: 0.18; 95% confidence interval (CI): 0.07-0.44, P=0.02].
Conclusions: Our findings demonstrate that enclomiphene provides improvement in testosterone levels with a lower rate of documented adverse events. These findings support enclomiphene as a comparable treatment option for hypogonadal men while minimizing the risk of adverse effects. Further research and more extensive studies are warranted to validate these conclusions and explore the additional long-term effects of enclomiphene to guide future patient counseling regarding these medications.
Background: Infertility, an escalating public health issue, exacerbates psychological distress, especially anxiety, among affected individuals. This study explores the intricate relationships between family function, self-efficacy, and social support in moderating anxiety levels in male infertility patients. Understanding these dynamics offers valuable insights for crafting effective psychological interventions.
Methods: This study involved 202 male infertility patients through convenience sampling, employing the Self-Efficacy Scale, Social Support Rating Scale, Family Function Scale, and Anxiety Self-Rating Scale for assessment. Structural equation modeling (SEM) with Bootstrap analysis was utilized to explore the relationships among these variables.
Results: Analysis of 202 male infertility patients revealed a notable prevalence of anxiety (67.8%), with family function directly and indirectly influencing anxiety levels through self-efficacy and social support. SEM highlighted the mediating roles of self-efficacy and social support between family function and anxiety, demonstrating significant direct (family function on anxiety) and indirect effects (family function to anxiety via social support and self-efficacy). Notably, a chain mediation effect, where family function impacts anxiety through the sequential influence of social support and self-efficacy, accounted for a significant portion of the total effect on anxiety. These findings emphasize the critical role of enhancing family function, self-efficacy, and social support to reduce anxiety among this population.
Conclusions: This study underscores the significant impact of family function on the psychological well-being of male infertility patients, with self-efficacy and social support serving as pivotal mediators. Improving these factors could effectively mitigate anxiety, suggesting that interventions targeting family dynamics, self-efficacy enhancement, and social support networks are essential for addressing the psychological distress associated with infertility. Future research should consider these dynamics to develop more comprehensive treatment and intervention strategies aimed at this vulnerable group.
Background: Liver transplantation (LT) has been recognized as the most effective therapy for end-stage liver disease (ESLD). However, the question of whether LT can improve erectile function in patients with ESLD remains controversial. Therefore, we conducted this meta-analysis to evaluate the association between LT and erectile dysfunction (ED).
Methods: According to the PRISMA guidelines, studies were included after conducting searches in four databases from March 2024 onwards. These databases included PubMed, Cochrane Library, Web of Science, and Embase. The primary outcome of interest was to compare the International Index of Erectile Function (IIEF) scores between patients after and before LT. Standardized mean differences (SMDs) and their corresponding 95% confidence intervals (CIs) were utilized to assess the relationship between LT and ED.
Results: The results showed that the LT group had higher IIEF-5 domain scores for erectile function compared to the control group (SMD =-0.31, 95% CI: -0.53 to -0.09), P=0.007). No heterogeneity or publication bias was detected in the results. Additionally, the IIEF-15 domain score was also found to be improved after LT. Specifically, the LT group had higher domain scores for erectile function (SMD =-0.77, 95% CI: -1.07 to -0.48, P<0.001), orgasmic function (SMD =-0.82, 95% CI: -1.12 to -0.52, P<0.001), sexual desire (SMD =-0.89, 95% CI: -1.19 to -0.59, P<0.001), intercourse satisfaction (SMD =-0.92, 95% CI: -1.22 to -0.62, P<0.001), and overall satisfaction (SMD =-0.87, 95% CI: -1.17 to -0.57, P<0.001).
Conclusions: It is suggested by our meta-analysis that LT may contribute to improvements in erectile function among men with ESLD. This improvement may be related to the remarkable improvement in endocrine hormone disorders observed after LT. However, future studies with better designs and larger sample sizes are still needed to confirm our conclusions. Additionally, attention to erectile function before and after surgery in patients with liver failure is crucial.
Background: Prostate cancer (PCa) is a prevalent malignancy in men, with early diagnosis being crucial for treatment and prognosis. This study evaluates the diagnostic efficacy of two-dimensional ultrasound imaging score (2DUS), contrast-enhanced ultrasound score (CEUS), and ultrasound elastography score (UES) in PCa.
Methods: The PCa group consisted of patients diagnosed with primary PCa who underwent radical prostatectomy at the second hospital of Shanxi Medical University between January 2022 and December 2023. The benign lesion group consisted of patients diagnosed with benign prostatic hyperplasia (BPH)through prostate biopsy during the same period. We compared ultrasound scores at PCa and BPH patients using receiver operating characteristic (ROC) curve analysis. The study collected comprehensive patient data and analyzed variations in 2DUS, CEUS, and UES to identify relationships between preoperative ultrasound findings and the pathological states of PCa patients.
Results: PCa patients exhibited significantly higher ultrasound scores (P<0.001). Optimal cut-offs were 2.110 for 2DUS, 3.235 for CEUS, and 2.790 for UES, yielding area under curves (AUC) of 0.789, 0.817, and 0.898. The combined score provided an AUC of 0.933, with 83.33% sensitivity and 90.70% specificity. In the form of that patients with tumor stage III-IV, pathological grade III, poor differentiation, and pelvic lymph node metastasis exhibited significantly higher scores in 2DUS, CEUS, and UES compared to those with tumor stages I-II, pathological grades I-II, moderate and high differentiation without pelvic lymph node metastasis, respectively (P<0.05).
Conclusions: The combined use of 2DUS, CEUS, and UES scores is highly effective for early PCa detection, surpassing individual scores in accuracy, and is beneficial for staging and differentiation.
Background: The transverse preputial island flap (TPIF) procedure remains one of the classic single-stage procedures for severe hypospadias repairs. The incidence of postoperative complications remained high. This study aims to describe a modified urethral anastomosis technique during the TPIF procedure for severe hypospadias repairs and report its outcomes.
Methods: Data were collected retrospectively from consecutive patients who underwent the TPIF procedure by the same pediatric urologist between January 2018 and June 2023. Collected information included age at surgery, operative details, and outcomes at follow-up. Wide-based oblique anastomosis (WOA) technique was used as a modified urethral anastomosis in all cases. In brief, the dorsal edge of anastomosis was breadthwise anchored to the corpus cavernosum with 4-5 stitches, forming a spade-shaped anastomotic surface.
Results: A total of 72 patients were included in the study. The location of the corpus spongiosum division was penile in 27 patients (37.5%) and proximal in 45 patients (62.5%). The median glans width was 13 mm (range, 6-30 mm). The median ventral curvature after degloving was 45° (range, 30-150°). At a median follow-up of 4.1 years, complications occurred in 15 patients (20.8%), including nine cases of fistula, seven cases of urethral diverticulum and two cases of meatal stenosis. No cases of urethral stricture (US), urethral dehiscence, or ventral curvature occurred. Subsequent reoperations for diverticulum repairs showed that the dorsal side of the anastomosis was extensively fixed to the corpus cavernosum, forming a wide-based, spacious lumen.
Conclusions: WOA technique is straightforward and effective, especially in the prevention of postoperative US.
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