中华男科学杂志最新文献

Objective: To explore the effect of dietary modification-assisted multimodal therapy in the prevention and treatment of chronic prostatitis.

Methods: A total of 132 cases of chronic prostatitis treated in the Outpatient Department of our hospital were randomly divided into an observation group (n = 68) and a control group (n = 64), the former following the Mediterranean dietary pattern, the latter adhering to their own dietary habits, and meanwhile both receiving lifestyle guidance, psychological counseling, symptomatic medication and physiotherapy according to their specific symptoms. The patients were followed up for 4 weeks, therapeutic effects were observed and comparisons were made between the two groups in the NIH-CPSI scores before and after treatment.

Results: Compared with the baseline, the quality of life (QOL) scores, pain and urination discomfort scores and total NIH-CPSI scores were significantly decreased in both the observation and the control groups after treatment (P < 0.05), even more decreased in the former than in the latter, but with no statistically significant difference between the two (P > 0.05). The rate of therapeutic effectiveness was higher in the observation group than in the control (87.1% vs 79.7%, but showed no statistically significant difference between the two groups (P > 0.05).

Conclusion: Multimodal therapy is suitable for the management of different clinical manifestations of individual patients, while dietary habits vary from person to person as well as from region to region. Therefore, scientific dietary modification for the prevention and treatment of CP/CPPS needs further exploration.

Objective: To study the expression of the Homeobox C6 (HOXC6) gene in the homeobox family in PCa, its effect on the biological behavior of PCa cells and its action mechanism.

Methods: Based on the studies of HOXC6 retrieved from the database of Gene Expression Profiling Interactive Analysis (GEPIA), we analyzed the expression of HOXC6 in PCa and the relationship of its expression level with the survival prognosis of the patients. We detected the expression of the HOXC6 protein in PCa tissues and cells by Western blot, stably interfered with the expression of the HOXC6 gene in human PCa DU145 and PC-3 cells and normal prostatic epithelial RWPE-1 cells using the siRNA plasmid, and determined the effects of HOXC6 on the proliferation, migration and invasiveness of PCa cells by CCK8, plate cloning and scratch healing and Transwell invasion assays. Using the GEPIA database, we analyzed the correlation of the Wnt tumor inhibitory factor-secreted frizzled-related protein 1 (SFRP1) gene with HOXC6, and detected the expressions of HOXC6, SFRP1, Wnt and β-catenin in PC-3 cells after siRNA-HOXC6 transfection by Western blot.

Results: The expression of HOXC6 was dramatically higher in the PCa than in the normal prostate tissue (P< 0.01), and in the PCa cells than in the normal prostatic epithelial cells (P< 0.01). Bioinformatics analysis indicated a lower survival rate of the PCa patients with a high than those with a low HOXC6 expression (P = 0.011). The relative expression of the HOXC6 protein, absorbance value, number of clones formed and number of invaded cells were significantly lower in the siRNA group than in the negative controls (P< 0.05). According to the GEPIA database, highly expressed SFRP1 was associated with a good prognosis of PCa, and the protein expressions of Wnt and β-catenin were markedly increased while that of SFRP1 decreased in the PCa PC-3 cell line (P< 0.05). The expressions of the Wnt and β-catenin proteins were decreased and that of SFRP1 increased significantly in the siRNA-HOXC6 transfection group compared with those in the siRNA negative control and PCa PC-3 groups (P< 0.05).

Conclusion: HOXC6 is highly expressed in PCa tissues and related to the proliferation, migration and invasiveness of PCa cells. HOXC6 promotes the growth of DU145 and PC-3 cells in PCa by inhibiting the SFRP1/Wnt/β-catenin signaling pathway, and may be a potential target for clinical treatment of PCa.

Objective: To explore the clinical value of prostatic exosomal protein (PSEP) and PSA in the diagnosis of PCa with PSA in the gray zone (4－10 μg/L) and Prostate Imaging Reporting and Data System category 3 (PI-RADS-3) lesions.

Methods: From 2019 to 2022, 211 patients with the PSA gray zone and PI-RADS-3 lesions underwent prostate multi-parameter MRI, prostate needle biopsy or transurethral resection/enucleation of the prostate. We collected the baseline urine samples from the patients, examined the content of PSEP in the urine by ELISA and evaluated the performance of PSEP and PSA in the diagnosis of PCa.

Results: Among the total number of patients, 57 were confirmed with PCa (the positive group) and the other 154 with benign prostate conditions (the negative group) by biopsy pathology. The free PSA level (fPSA), free to total PSA ratio (f/tPSA) and PSEP content were dramatically lower in the positive than in the negative group (all P< 0.01). Uni- and multivariate analyses showed f/tPSA and PSEP to be independent factors for predicting PCa with the PSA gray zone and PI-RADS-3 lesions, with the AUC values of 0.70 and 0.78, best cutoff values of 0.18 and 1.45 μg/L, sensitivity of 84.21% and 70.18%, and specificity of 58.44% and 77.27%, respectively (P< 0.01). The multivariate model with combined use of f/tPSA and PSEP (AUC: 0.82, best cutoff value: 0.31, sensitivity: 82.46%, specificity: 75.32%) outperformed either f/tPSA or PSEP alone in the diagnosis of PCa with the PSA gray zone and PI-RADS-3 lesions (P< 0.01, P = 0.04).

Conclusion: For patients with the PSA gray zone and PI-RADS-3 lesions, f/tPSA and PSEP are significant predictors of PCa. The multivariate model of PSEP combined with f/tPSA can replace f/tPSA in the detection of PCa to improve diagnostic performance and avoid unnecessary prostate biopsy.

Objective: To investigate the clinical and genetic characteristics of a male carrier of exceptional complex chromosome rearrangement (CCR) and the outcome of preimplantation genetic testing for chromosomal structural rearrangement (PGT-SR).

Methods: Using the modified high resolution G banding technique and whole-genome low-coverage sequencing (WGLCS), we analyzed the cellular karyotype and molecular karyotype of a male carrier of CCR, performed an analysis of the single-sperm chromosome copy number and conducted PGT-SR for the patient by next-generation sequencing (NGS). In addition, we reviewed the literature on reported male carriers of CCRs and summarized their normal/balanced sperm ratios and PGT-SR outcomes.

Results: The karyotype of the patient was 46,XY,der(5)inv(5)(q14.3q23.2)t(5;14;11) (q23.2;q31.1;q21),der(11)t(5;14;11);der(14)t(5;14;11), with the translocation breakpoints located in the intergenic region. Single-sperm sequencing revealed 20.0%（7/35）of normal haploids in the male's spermatozoa， and the results PGT-SR showed a proportion of 25.0%（4/16）of normal/balanced embryos. After thawing and transferring of 2 euploid blastocysts, a healthy male infant was successfully delivered.

Conclusion: The proportion of normal haploids in the spermatozoa of male CCR carriers may be higher than theoretically predicted, and PGT-SR can effectively improve the pregnancy outcome in male CCR carriers and provide valuable data for genetic counseling.

Objective: To observe the clinical effect of electrophysiological technique in treating chronic prostatitis.

Methods: Choose 40 patients of chronic prostatitis/chronic pelvic pain syndrome (chronicprostatis/chronicpelvicpainsyndrome, CP/CPPS) in People's Hospital in Zhijin and People's hospital in Guizhou Province from January 2022 to April 2023, The patients were randomly divided into control group (n=20) and treatment group (n=20). The treatment group received low-frequency neuromuscular electrical stimulation combined with drug therapy, while the control group received drug therapy alone. The improvement of prostatitis symptom score (NIH-CPSI) and International Prostatitis Symptom score (IPSS) before and after treatment was compared and analyzed.

Results: A total of 37 patients were followed up (1 patient in the treatment group withdrew due to hypersensitivity to the electrode; 2 patients in the control group were lost to follow-up. )There was no significant difference in baseline data between the two groups (P > 0.05). The NIH-CPSI score and IPSS score before and after treatment were compared between the two groups, and the difference was statistically significant (P< 0.05). The IPSS score of the two groups after treatment was compared, the average reduction of the treatment group was 15.84±0.92 points, and that of the control group was 7.17±0.40 points, and the difference was statistically significant (t=4.792, P< 0.05). The NIH-CPSI score of the two groups after treatment was compared, and the average reduction was 17.47±0.92 points in the treatment group and 10.56±0.49 points in the control group. The difference between the two groups was statistically significant (t=6.654, P< 0.05).

Conclusion: The effect of electrophysiological combined drug therapy is obviously better than that of simple drug therapy. Electrophysiological therapy for chronic prostatitis has definite clinical effect and is worth promoting and applying.

Of the complex causes of testicular pain, intervertebral disc degeneration is a nonnegligible one, which, however, often fails to get sufficient attention from doctors in clinical practice and consequently leads to misdiagnosis or missed diagnosis. This paper presents an overview of the pathogenesis and treatment of intervertebral disc-induced testicular pain in traditional Chinese and Western medicine, aiming to improve clinicians' understanding of this problem and provide some reference for the diagnosis and treatment of unexplained testicular pain. According to traditional Chinese medicine, the pathogenesis of intervertebral disc-induced testicular pain may be associated with exogenous cold and dampness, damp-heat invasion of Yin organs, qi and blood stagnation, and closely related to the liver, kidney and governor meridian. Western medicine believes that its pathogenesis may be related to nerve root stimulation, nerve root entrapment, Waller degeneration, referred pain, nerve hypersensitivity and other factors.

Objective: To observe the clinical efficacy of traditional Chinese medicinal (TCM) compress combined with herbal fumigation in the treatment of acute epididymitis.

Methods: This study included 74 cases of acute epididymitis treated in our hospital from December 2021 to December 2023. Using the single blind and random number methods, we divided the patients into a trial (n = 37) and a control group (n = 37). On the basis of routine medication with antibiotics, we treated the patients in the trial group by TCM compress combined with herbal fumigation and those in the control group by dyed pure water compress combined with herbal fumigation. At 3, 7 and 14 days of treatment, we obtained the pain scores and maximum epididymal diameters from the patients and compared them between the two groups before and after treatment.

Results: There were no statistically significant differences between the control and trial groups in the baseline pain scores (6.79 vs 6.85, P>0.05) and maximum epididymal diameters of the patients (［1.61 ± 0.39］ vs ［1.59 ± 0.42］ cm, P>0.05) or in the pain scores after 3 days of treatment (4.63 ± 0.95 vs 4.45 ± 1.87, P>0.05). Compared with the controls, the patients of the trial group showed significantly lower pain scores (3.78 ±1.03 vs 1.02±0.36, P<0.05) and a higher overall effectiveness rate (75.68% vs 91.89%, P<0.05) at 7 days, and markedly shorter maximum epididymal diameters at 3 days (［1.45 ± 0.38］ vs ［1.23 ± 0.72］ cm, P<0.05) and 7 days (［1.21 ± 0.29］ vs ［0.98 ± 0.15］ cm, P<0.05). No statistically significant differences were observed between the control and trial groups in the pain scores (0.79 ± 1.12 vs 0.67 ± 0.86, P>0.05), maximum epididymal diameters (［0.94 ± 0.33］ vs ［0.92 ± 0.21］ cm, P>0.05) or overall effectiveness rate (91.89% vs 97.30%, P>0.05) after 14 days of treatment.

Conclusion: On the basis of routine medication with antibiotics, TCM compress combined with herbal fumigation can effectively relieve pain, reduce local swelling, accelerate recovery and shorten the course of treatment in patients with acute epididymitis, and is therefore worthy of clinical promotion and application.

Objective: To evaluate the potential causal relationship between inflammatory factors and PCa using the two-sample Mendelian randomization (MR) method.

Methods: We selected summary statistics of genome-wide association studies (GWAS) (n = 14 824) on 91 inflammatory factors, with PCa as the outcome in the latest 9th edition of FinnGen database for MR analysis. We evaluated the causal relationship between inflammatory factors and PCa using the odds ratio (OR) and 95% confidence interval (CI) of such regression models as inverse variance weighting (IVW), MR-Egger regression, simple mode (SM), weighted mode (WM) and weighted median estimator (WME), with IVW as the main statistical method for this study. We further verified the results of MR by Bayesian analysis, and evaluated the heterogeneity of genetic instrumental variables, pleiotropic effects and sensitivity of single nucleotide polymorphisms (SNP) as instrumental variables to the exposure-outcome relationship by Cochran's Q test, MR-Egger intercept test and leave-one-out cross validation.

Results: IVW showed that among the 91 inflammatory factors, interleukin-22 receptor A1 (IL-22RA1) and sulfotransferase 1A1 (ST1A1) were correlated positively with the risk of PCa； IL-22RA1：IVW（OR ［95% CI］: 1.12 ［1.00－1.25］, P = 0.04）；ST1A1：IVW（OR ［95% CI］: 1.08 (1.00－1.16), P = 0. 03）, while Chemokine ligand 11 (CXCL11) and interleukin 17 A (IL-17 A) negatively with the risk of PCa； CXCL11：IVW（OR ［95% CI］: 0.88 ［0.81－0.95］, P = 0.00）；IL-17A：IVW（OR ［95% CI］: 0.91 ［0.84－0.98］, P = 0.02）. No potential horizontal pleiotropy was detected by MR-Egger intercept analysis (P > 0.05, IL-22RA1 = 0.885, ST1A1 = 0.949, CXCL11 = 0.391, IL-17A = 0.884), nor biased SNPs in the MR pleiotropy residual sum and outlier (MR-PRESSO) test (P > 0.05, IL-22RA1 = 0.479, ST1A1 = 0.629, CXCL11 = 0.326, IL-17A = 0.444), or heterogeneity P > 0.05, IL-22RA1 = 0.543, ST1A1 = 0.677, CXCL11 = 0.336, IL-17A = 0.494). Leave-one-out sensitivity analysis indicated no significant impact of individual SNP sites on the overall causal relationship prediction, suggesting the reliable results of analysis.

Conclusion: Among the 91 inflammatory factors, IL-22RA1 and ST1A1 have a positive causal relationship, while CXCL11 and IL-17A have a negative causal relationship with PCa.

Ferroptosis is a form of cell death resulting from the disruption of iron metabolism within cells and excessive accumulation of lipid peroxides. Research indicates that, under the influence of various pathogenic factors, ferroptosis impacts the male reproductive system and fertility by affecting the synthesis of testicular hormones and regulation of cellular functions through different pathways and numerators. This paper provides an overview of the action mechanisms of ferroptosis in the testis and its correlation with pathogenicity, offering some new insights into the treatment of male reproductive system diseases.

The testis, as one of the important reproductive organs in men, has two major functions of secreting androgens and producing sperm. Androgen and spermatogenesis are the key factors for the evaluation of the testicular function. The lack of androgen or the decline of spermatogenic function is both a symbolic manifestation and a "product" of testis aging. In order to gain a deeper insight into the relationship between testis aging and overall health, this article reviews the relevant literature based on the correlation of androgen deficiency with various systemic diseases and the belief in the impacts of testis aging on the health of the cardiovascular and nervous systems through different channels, the development and progression of metabolic diseases, orthopedic diseases, PCa, kidney disease, peptic ulcer and other diseases. All these suggest that adequate attention should be paid to the studies of male reproductive health and its impact on overall health, so as to provide some new ideas and evidence for clinical diagnosis and treatment of relevant conditions.