中华男科学杂志最新文献

Objective: To investigate the efficacy and safety of transurethral water vapor thermal therapy (WVTT) using the Rezūm system for benign prostatic hyperplasia (BPH) in the real world.

Methods: A total of 181 patients with BPH were recruited from the Second Affiliated Hospital of Nanjing Medical University from August 2022 to December 2023, of whom 173 patients were treated with WVTT using the Rezūm system, while 8 patients were treated with WVTT combined with TURP. They were followed up at 1, 3, and 6 months postoperatively to assess changes in the IPSS, QoL, Qmax, IIEF-5, and the occurrence of any complications. Results： All 181 surgeries in this group were successfully completed. The operation time of the Rezūm system was (4.6 ± 1.4) minutes. The postoperative indwelling catheterization time was (8.0 ± 2.1) days. With a follow-up of at least 6 months, there was a significant decrease in PV, IPSS and QoL, and a remarkable increase had been found in Qmax as well (P<0.05). There was no significant difference in IIEF-5 before and after the operation (P>0.05). In this groups of patients, postoperative complications mainly included 95 cases (52.5%) of gross hematuria, 6 cases (3.3%) of retrograde ejaculation, 5 cases (2.8%) of urethral stricture, 4 cases (2.2%) of prostatitis, and 10 cases (5.5%) of urinary tract infection. Four cases (2.2%) underwent surgical retreatment for BPH after surgery.

Conclusion: In the real world, the use of Rezūm thermal steam ablation system for the treatment of BPH has satisfactory short-term effect, short surgical time, and significant improvement in IPSS, QoL, Qmax, which does not adversely affect sexual function.

Stem cells therapy is an emerging method for the treatment of erectile dysfunction (ED) in men. Compared with traditional treatment, it has the advantage lies in the ability to treat the pathological damage of the penis in patients with ED, which provides new ideas for solving erectile dysfunction fundamentally. However, due to the special anatomical structure of the penis, the therapeutic effect of stem cells is sometimes unsatisfactory. Therefore, how to improve the effect of stem cells therapy for ED has become a new difficulty. Relevant researches on how to improve stem cell treatment of ED will be reviewed in this article.

Objective: To explore the role of prostate health index (PHI) and its derivatives for early screening in patients with PI-RADS score 3 and prostate-specific antigen (PSA) levels of 4－20 μg/L.

Methods: Clinical data of 203 patients with a score of 3 on the PI-RADS v2.1 scoring system who underwent ultrasound-guided transperineal prostate aspiration biopsy from April 2021 to April 2024 from Provincial Hospital of Shandong First Medical University, Qilu Hospital of Shandong University and Weifang People's Hospital were collected. Patients who met the inclusion criteria were divided into prostate cancer (PCa) group (62 cases) and benign prostatic hyperplasia (BPH) group (141 cases). Serum total prostate-specific antigen (tPSA), serum free prostate-specific antigen (fPSA), and PSA isoform 2 (p2PSA) were routinely detected after admission. And prostate-specific antigen density (PSAD), prostate health index (PHI) and prostate health index density (PHID) were calculated with the basic personal information being collected. The efficacy of each parameter in early screening of patients with PI-RADS score of 3 and PSA level of 4－20 μg/L was assessed using ROC curve approach.

Results: There was no statistical difference in tPSA, fPSA and fPSA/tPSA between the two groups (P>0.05). There was a statistical difference in p2PSA, PSAD, PHI, PHID and age between the two groups (P<0.05). PHI (AUC=0.783 7, 95% CI: 0.711 3－0.856 1) and PHID (AUC=0.782 3, 95% CI: 0.708 3－0.856 4) showed a good predictive ability in the early screening of prostate cancer. In the clinically significant prostate cancer (csPCa) group, the ROC curve areas of PHI and PHID were 0.823 0 and 0.788 5, respectively, which showed better predictive efficacy of prediction of csPCa. The ROC curves of the combined diagnostic indexes were plotted on the basis of the independent ROC curves, and the area under the curve of PHI combined with age, p2PSA and PHID (AUC=0.843 6) was the largest and had the best predictive ability among all the combined diagnostic indexes.

Conclusion: In patients with PI-RADS score 3 and PSA level between 4 and 20 μg/L, PHI and its derivatives (PHI and PHID) provide a new way for early screening of prostate cancer compared with the traditional index tPSA, which has a high value of application in reducing the over-penetration.

Objective： To analyze the symptoms, diagnosis and treatment of upper urinary tract calculi patients combined with mild and moderate benign prostatic hyperplasia (BPH) after ureteral stent implantation. Methods： One hundred and six BPH patients who were hospitalized for upper urinary tract calculi and had ureteral stents retained from January 2019 to December 2022 were selected and divided into 2 weeks group and 4 weeks group according to the time of removal of ureteral stents after surgery. Their general clinical data were analyzed and compared. International Prostatic Symptom Scale (IPSS), postoperative ureteral Stent Symptom Questionnaire (USSQ), and incidence of adverse events after ureteral stent removal were recorded before and after removal. Results： The scores of IPSS were significantly increased in all patients, and symptoms in urinary tract had improved significantly after discharge (P<0.05). Compared with the 2 weeks group, the USSQ score of the 4 weeks group was significantly increased (P<0.05). And no significant adverse event was observed in the 2 weeks group after the removal of ureteral sten. Conclusion： IPSS score and USSQ score increased significantly during stent implantation in BPH patients with lithiasis. And complications increased significantly over time. Following thorough clinical assessment, early ureteral stent removal demonstrates both safety and efficacy, representing an optimal therapeutic approach in selected cases.

Objective: The aim of this study is to investigate the main active substances of Qilin pills by high performance liquid chromatogre-electrostatic field orbitrap mass spectrometry (HPLC-Q-Orbitrap /MS), and explore the mechanism of its action in the treatment of asthenozoospermia by combining network pharmacology and molecular docking.

Methods: (1) Qilin pills were quantitatively and qualitatively analyzed by HPLC-Q-Orbitrap /MS. (2) The top 100 compounds in Qilin pills were screened by content analysis and SwissADME, and their targets were predicted. The asthenozoospermia targets were searched through the database. And a "protein-protein interaction" (PPI) network was constructed. KEGG and GO analysis was performed using the DAVID database. And a "drug-target-pathway" network was constructed. (3) SailVina was used for molecular docking.

Results: (1) A total of 1 275 known components were found and ranked in Qilin pills by HPLC-Q-Orbitrap /MS analysis. (2) The top 100 compounds in Qilin pills predicted a total of 1 053 targets and 184 potential therapeutic targets for asthenozoospermia. KEGG pathway analysis and GO analysis showed that the treatment of asthenozoospermia by Qilin pills may be related to the steroid hormone synthesis pathway, the response to steroid hormones, the chromosomal region of cells and the activity of steroid hydroxylase. The mechanism of Qilin pills in treating asthenozoospermia may be related to regulating the synthesis, metabolism and reaction process of sex hormone in the body. (3) The molecular docking results of its key targets (CYP19A1, ESR1, HSP90AA1, p53, HIF1α and BCL2) showed that the key active ingredients M030, M039, M043, M050, M055 and M073 of Qilin pills had spontaneous binding. It had a binding energy of less than －5 kJ /mol.

Conclusion: The material basis of Qilin pills has been explored by this study. And the mechanism of action of Qilin pills in the treatment of asthenozoospermia is highly bound to the expression and response process of steroid hormones, which provides a theoretical basis for the clinical application of Qilin pills.

Objective: To analyze the effect of altitude on NIH-CPSI score in patients with chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) Methods: Clinical data and the results of NIH-CPSI Questionnaire of the 321 patients with CP/CPPS at different altitudes were collected from March 2021 to March 2022. And the influence of altitudes on NIH-CPSI score of CP/CPPS was analyzed.

Result: The NIH-CPSI score of patients living at an altitude of 4 300 m was significantly higher than that of patients living at an altitude of 1 500 m and 2 200 m. The CP/CPPS patients who lived in the higher altitude had more severe symptoms of pain and urination as well as lower scores of life quality (P<0.05).

Conclusion: NIH-CPSI score increased significantly with higher altitude, indicating more severe symptoms and decreased quality of life in CP/CPPS patients. These findings highlight the need for management strategies for specific heights in patients with CP/CPPS.

Objective: The aim of this study is to re-evaluate the systematic reviews and meta-analyses on statins for the treatment of erectile dysfunction (ED) and construct an umbrella review, thereby providing robust evidence-based for the clinical application of statins in ED treatment.

Methods: A comprehensive computerized search was conducted across CNKI, Wanfang Database, VIP, WOS, Embase, PubMed, and Cochrane Library databases from their inception to September 12, 2024, for all systematic reviews and meta-analyses addressing statin interventions in ED. The methodological quality, reporting quality, and evidence quality of the included studies were assessed and summarized using PRISMA 2020, AMSTAR 2, and GRADE systems.

Results: Four systematic reviews and meta-analyses were included. According to the AMSTAR 2 evaluation, one paper was rated as low quality, while the remaining three were classified as very low quality. PRISMA 2020 evaluation results indicated that the average score of the four included studies was 29, with all being of medium quality but exhibiting partial deficiencies. The proportion of fully consistent items across the four studies ranged from 52.38% to 80.95%. GRADE system tool evaluation revealed 11 outcome indicators, of which only one was rated as intermediate evidence. The remainders were categorized as low or very low evidence, with no high-quality evidence identified.

Conclusion: Statins demonstrate efficacy in treating ED. However, the current quality of relevant systematic reviews is suboptimal, with notable deficiencies in methodological, reporting, and evidential quality. Further high-quality studies are warranted to provide more reliable evidence-based medical guidance for clinical practice.

Magnetic resonance imaging (MRI), as a non-invasive neuroimaging technique, has been widely employed to investigate changes in functional brain regions. In recent years, the application of MRI in the study of lifelong premature ejaculation (LPE) has progressively uncovered the pathological mechanisms underlying abnormalities in LPE-associated brain regions. These mechanisms involve brain areas associated with higher-order cognitive and decision-making regulation, sensory and perceptual processing, as well as emotional regulation and reward systems. The application and findings of MRI in the study of LPE mechanisms will be introduced in this review, with the goal of deepening our understanding of the neuroimaging-based mechanisms of LPE.

Objective: To explore the effect of evidence-based standardized procedures (SOP) on urinary incontinence management in patients with radical prostatectomy.

Methods: Sixty-three patients who underwent radical prostatectomy from October 2022 to September 2023 were included in the control group. And 63 patients who underwent radical prostatectomy from October 2023 to September 2024 were included in the observation group. The patients in the control group received routine perioperative care. As an addition, the SOP on urinary incontinence management was performed in the patients of observation group. The incidence of urinary incontinence, severity of urinary incontinence (1h urine pad test), quality of life (Incontinence Quality of Life Questionnaire) and comfort level (General Comfort Question) of the two groups were compared after 3 and 6 months of surgery.

Results: The incidence of urinary incontinence at 3 and 6 months after operation in the observation group was 36.51% and 19.05%, respectively, which were lower than those (53.97% and 38.10%) of the control group, respectively. And the incidence rates of the two groups decreased significantly (P<0.05).The score of life quality after 3 months of operation was (56.17±12.75) in the control group, which was lower than that (70.41±14.50) of the observation group. The 3-month postoperative comfort score was (52.73±11.26) in the control group and (63.49±13.52) in the observation group. The 6-month postoperative incontinence quality of life score was (64.70±11.38) in the control group and (85.41±12.04) in the observation group. And the 6-month postoperative comfort score was (60.96±8.04) in the control group and (83.49±12.04) in the observation group. The quality of life and comfort scores of the two groups 6 months after operation were significantly improved than those 3 months after operation, and the improvement of the observation group was more obvious than that of the control group (P<0.05). There were significant differences in the degree of urinary incontinence between the two groups at 3 months and 6 months after operation (P<0.05).

Conclusion: SOP management for the patients underwent radical prostatectomy can be an effective method for reducing the incidence of postoperative urinary incontinence, which promotes the recovery of postoperative urinary control.

Objective: To explore the clinical efficacy of Wenshen Chushi Decoction combined with low intensity pulsed ultrasound (LIPUS) on erectile dysfunction (ED) caused by renal deficiency and phlegm-dampness syndrome.

Methods: One hundred and twenty ED patients were included from the Department of Andrology in the First Hospital of Hunan University of Traditional Chinese Medicine. The patients in control group were treated with Wenshen Chushi Decoction. While the patients in observation group were treated with Wenshen Chushi Decoction combined with LIPUS for 8 consecutive weeks. After the treatment, the efficacy was evaluated using the International Index of Erectile Function-5 (IIEF-5) score, Penile Flow Index (PFI), Traditional Chinese Medicine Syndrome Score, Self-Rating Depression Scale (SDS) score, and Self-Rating Anxiety Scale (SAS) score. Safety was also observed. And the efficacy was followed up 4 weeks after the end of treatment.

Results: Fifty-seven cases were enrolled into control group finally with 55 cases in the treatment group. After the treatment, all the patients in both of groups showed an improvement in IIEF-5 scores (P<0.01). Compared with the control group (19.09 ± 2.22), the IIEF-5 score in observation group (20.42 ± 2.39) increased significantly (P<0.01). After the treatment, the scores of PFI, TCM syndrome and SDS in both groups decreased (P<0.01, P<0.05, P<0.01). Compared with the control group (［3.77 ± 1.21］, ［9.91 ± 1.71］ and ［39.88 ± 2.63］ points), the observation group (［2.92 ± 1.08］, ［4.78 ± 1.45］, and ［34.51 ± 2.09］ points） showed a more significant decrease (P<0.01). There was no significant difference in total effective rate between the two groups (P>0.05). During follow-up, the IIEF-5 scores of both groups of patients were higher than those before (P<0.05, P<0.01), and the observation group score was higher than that in the control group (［17.15 ± 3.37］ vs ［13.63 ± 1.96］, P<0.01). No adverse reaction and abnormality of indicators occurred in both of two groups.

Conclusion: Wenshen Chushi Decoction has a significant therapeutic effect on ED caused by renal deficiency and phlegm-dampness syndrome. It can not only improve the quality of erection, but also improve the physical and mental symptoms associated with ED， which makes therapeutic effect lasting longer.