中华男科学杂志最新文献

Erectile dysfunction (ED) is a common disorder in men and lacks effective treatment. Stem cell (SC) possess the potential in self-renewal and multi-directional differentiation, and secrete a variety of active substances. Stem cell therapy, as a promising option for the treatment of ED, is a focus in regenerative medicine research. However, the effect of stem cell therapy alone on ED is limited due to the complexity of the condition and the limitations of SC. Gene modification can enhance the performance of SC in multiple aspects and play the role of targeted genes, and therefore can better improve ED and its related pathological changes than SC therapy alone. In recent years, gene-modified stem cell therapy has become a hotspot in andrological research. This review summarizes the advances in the studies of gene-modified SC in the treatment of ED, aiming to provide some ideas for further research.

Objective: To investigate the value of transrectal ultrasonography (TRUS) in the detection of clinically significant prostate cancer (CsPCa) in patients with intravesical prostatic protrusion (IPP).

Methods: We retrospectively analyzed the data on 128 patients undergoing TRUS-guided prostate biopsy in the General Hospital of Eastern Theater Command and Jiangsu Province Hospital from January 2019 to December 2022. We measured the size of and graded IPP, compared the clinicopathological and ultrasonographic features of the patients in the CsPCa group (Gleason score ≥7) and those in the control group (Gleason score <7), and analyzed the correlation of the IPP grades with the detection rate of CsPCa by multivariate logistic regression analysis.

Results: The prostate volume was significantly higher in the CsPCa group than in the control (［51.3±12.1］ vs ［43.5±11.3］ ml, P< 0.05), while the PSA density (PSAD) remarkably lower in the former than in the latter (［0.45±1.92］ vs ［0.59±2.14］ ng/ml, P< 0.05) and so was the detection rate of CsPCa in the patients with IPP grade 3 than in those with IPP grades 0, 1 and 2 (56.0% vs 85.4%, 87.1% and 80.6%, P< 0.05). Spearman correlation analysis showed that the Gleason score was correlated positively with the prostate volume (r = 0.612) but negatively with PSAD (r = －0.735) and the IPP grade (r = －0.619) (P< 0.05). Logistic regression analysis indicated that IPP grade 3 (OR: 0.690, 95% CI: 0.380－0.995, P = 0.032) was an independent protective factor for CsPCa.

Conclusion: CsPCa is significantly correlated with the IPP grade, and the detection rate of CsPCa by TRUS-guided biopsy is lower in patients with IPP grade 3 than in those with IPP grades 0－2. Therefore, special attention should be paid to false negative probability in case of high-grade IPP.

Objective: To investigate the application effect of comprehensive intervention combined with cognitive psychological care based on the quality chain in patients with BPH.

Methods: We prospectively selected 110 cases of BPH treated in our hospital from January 2022 to March 2023 and equally randomized them into groups A and B, the former given routine intervention, while the latter comprehensive intervention combined with cognitive psychological care based on the quality chain in addition. We analyzed the results of intervention, the patients' scores on Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), improvement of clinical indicators, self-efficacy, disease awareness and treatment compliance, and compared the data obtained between the two groups of patients.

Results: The effectiveness of intervention was significantly better in group B than in A (96.36% vs 65.45%, χ2 = 17.009, P<0.05). Compared with the baseline, the SAS and SDS scores were remarkably improved in the two groups after intervention (P<0.05), even more significantly in group B than in A (P<0.05). Group B also showed a markedly shorter duration of bladder spasm, lower frequency of bladder spasm per day, shorter urethral catheterization time and postoperative hospital stay, better emotion control and health management, more regular schedule, higher disease knowledge awareness, and better treatment compliance than group A (all P<0.05).

Conclusion: Comprehensive intervention combined with cognitive psychological care based on the quality chain is significantly effective in improving BPH patients' clinical indicators, disease awareness and treatment compliance, reducing their depression and anxiety, and enhancing their self-efficacy management.

Objective: To summarize and visualize the status quo, future hotspots and development trend of ED-related researches in China through bibliometric analysis.

Methods: We searched the Web of Science Core Collection (WOSCC) and the database of Chinese National Knowledge Infrastructure (CNKI) for ED-related studies published in China from January 1, 2010 to August 14, 2023. Using the CiteSpace and VOSviewer softwares, we bibliometrically analyzed and visualized the related journals, regions, institutions, authors, key words, co-citations and other indexes of the identified studies.

Results: A total of 2,465 ED-related studies were retrieved, with an increasing number of publications year by year, relatively more in the southeast region, with Sun Yat-sen University ranking the first in the number of published articles (n = 169), LIU Jihong (n = 73), WANG Tao (n = 71) and JIANG Rui (n = 49) as the top three prolific core authors. The first two Chinese journals with the most ED-related publications were Chinese Journal of Andrology (n = 320) and Journal of Sexual Medicine (n = 128), and the latter was also the mostly cited (n = 5 060). Keyword co-occurrence analysis showed that the highest-frequency Chinese terms included impotence, anxiety, andrology, expert consensus, experience of famous doctors, acupuncture, Earthworm protein (Chinese) and hypertension, and the English terms included erectile dysfunction, apoptosis, inflammation, fibrosis, risk and women.

Conclusion: Recent years have wit-nessed a rapid development in ED-related studies in China, with the risk factors and patho-genic mechanisms of ED as hot topics. PDE5 inhibitors and adipose-derived stem cells for the treatment of ED have attracted long and continuous attention and will remain an important target of future research.

Objective: To clarify the causal relationship between obesity and male infertility through Mendelian randomization (MR) study.

Methods: We assessed the causal effect of genetically predicted body mass index (BMI) on the risk of male infertility via a two-sample MR analysis, with the BMIs of 99 998 cases and 12 746 controls as the exposure factor and genetic information on male infertility obtained from a genome-wide association study of 73 479 Europeans. In the univariable MR (UVMR) analysis of the causal relationship, we mainly used inverse variance weighting (IVW), with MR-Egger regression and weighted median filtering as the supplementary methods. Sensitivity analyses including the Cochran's Q test, Egger intercept test, MR-PRESSO, leave-one-out analysis and funnel plot were performed to verify the robustness of the MR results. To evaluate the direct causal effects of BMI on MI risk, multivariable MR (MVMR) was performed.

Results: UVMR indicated a causal relationship between genetically predicted BMI and an increased risk of male infertility (OR: 1.237, 95% CI: 1.090－1.404, P = 0.001). Sensitivity analysis revealed little evidence of bias in the current study (P> 0.05). With such risk factors as type 2 diabetes, alcohol consumption and smoking adjusted, MVMR confirmed a direct causal effect of genetically predicted BMI on the risk of male infertility (P<0.05).

Conclusion: Genetically predicted BMI may be associated with an increased risk of male infertility. Further studies are expected to explore the underlying mechanisms of this association and provide some new strategies for the prevention and treatment of BMI-related male infertility.

Oligoasthenozoospermia (OAS) is one of the most common types of male infertility, which, however, still lacks effective treatment. An increasing number of studies have shown the potential therapeutic value of omega-3 polyunsaturated fatty acid (ω-3 PUFA) in the treatment of OAS. This article presents an overview of the studies on the effects of ω-3 PUFA on fatty acid composition and metabolism, inflammatory response, and oxidative stress in OAS, hoping to provide some new ideas for the treatment of the disease.

Objective: To retrospectively analyze the causes of missed diagnosis of clinically significant PCa (csPCa) by targeted biopsy (TB).

Methods: This retrospective study included 652 males aged (71.32 ± 16.53) years with elevated PSA and abnormal MRI signals detected in our hospital from June 2018 to December 2020. We further examined the patients by transperineal prostatic TB and systematic biopsy (SB), analyzed the detection rates of PCa and csPCa by TB and SB, and investigated the causes of missed diagnosis of csPCa in TB using the fishbone diagram.

Results: The total detection rate of PCa and csPCa by TB combined with SB was 45.7% (298/652), and that of csPCa was 37.4% (244/652), with 38 cases of csPCa missed in TB, including 23 cases of negative TB and 15 cases of low ISUP grade. The causes of missed diagnosis of csPCa by TB included low MRI image quality, PSA density ≤0.15 ng/ml/cm3, target area <10 mm, and PI-RADS 2 score ≤3. The detection rate of csPCa by TB alone was 31.6%, which was increased by 5.8% (P = 0.027) when TB combined with SB.

Conclusion: TB combined with SB yields a higher detection rate of csPCa than either used alone. Missed diagnosis of csPCa by TB is closely related to the characteristics of tumor and MR image of the target area.

Prostate cancer (PCa) ranks as the second most prevalent malignancy among males worldwide at present, and its prevalence keeps rising. Focal therapy not only results in tumor necrosis but also encourages the release of autoantigens originating from the tumor into the bloodstream and activates the host immune system to effectively fight the tumor. However, focal therapy alone may not achieve the total ablation of cancer cells and may cause locoregional recurrence. Immunotherapy, by boosting the body's immune response, destroys tumor cells and prevents immune escape. Recent studies show that focal therapy combined with immunotherapy can produce a better clinical efficacy by enhancing the initial immune response, especially for low- to intermediate-risk confined PCa. This article offers some fresh perspectives on the management of PCa by reviewing the etiology and progression of the malignancy, focal therapeutic options, and advantages and vista of focal therapy combined with immunotherapy.

Objective: To explore the relationship between peripheral lymphocyte subsets and the survival of PCa patients.

Methods: Using the Kaplan-Meier curve and log-rank test, we compared the overall survival (OS) and progression-free survival (PFS) of 100 PCa patients with different levels of lymphocytes. Meanwhile, we investigated the prognostic factors by univariate and multivariate Cox regression analyses, and counted the peripheral lymphocyte subsets by flow cytometry.

Results: Both OS and PFS were significantly prolonged in the PCa patients with high levels of lymphocytes (≥747/μl), CD3+T cells (≥528/μl), CD4+T cells (≥315/μl), CD8+T cells (≥226/μl), B cells (≥105/μl) and NK cells (≥168/μl)(P < 0.001). Univariate and multivariate Cox regression analyses indicated that CD4+T cells ≤ 315/μl was an independent factor for the poor prognosis of PCa (HR=12.58, 95% CI: 3.00－52.73).

Conclusion: Decreased absolute count of peripheral lymphocyte subsets is associated with the poor prognosis of PCa.

The seminal vesicle is an important accessory gland of the male reproductive system. In the past, some scholars focused more on its role in the fertilization process and neglected its relationship with male sexual function. Researches show that the seminal vesicle is involved in multiple processes such as sexual desire, penile erection, and ejaculation. Treatment of sexual dysfunction by medication targeting the seminal vesicle has achieved certain therapeutic effects. This article discusses the relationship between the seminal vesicle and sexual function in terms of physiopathology, clinical study and basic research, hoping to provide some new ideas on the clinical diagnosis and treatment of sexual dysfunction.