中华男科学杂志最新文献

Objective: To investigate the clinical effect of physical intervention combined with medical nutritional weight loss (PI+MNWL) in the treatment of short penis in obese children.

Methods: One hundred and twenty obese children with a short penis were included and equally divided into three groups: PI+MNWL, MNWL, and self-guided diet, who underwent PI+MNWL, MNWL intervention under the supervision of professional nutritionists in the hospital, or self-guided diet intervention at home, respectively, all for 30 days. We measured the penile parameters, including stretched penile length (SPL), flaccid penile length (FPL) and penile diameter (PD), of the children before and after treatment, and compared them among the three groups.

Results: After intervention, the body weight of the children was significantly decreased in all the three groups (27.1－94.1［53.59±11.88］ kg vs 23.0－85.1［49.01±11.61］ kg， P < 0.05). The weight of children in 3 groups decreased to different degrees, and the difference was statistically significant (P < 0.05). MNWL was found remarkably more effective than self-guided weight loss in reducing the body weight of the children (P < 0.05). Based on weight loss achieved through medical nutrition combined with physical intervention, the FPL in the PI+MNWL group increased from (1.93 ± 0.76) cm before treatment to (3.41 ± 1.41) cm after one course of comprehensive treatment, with a statistically significant difference (P < 0.05). Similarly, SPL increased from (3.75 ± 0.76) cm before treatment to (4.98 ± 0.64) cm, and PD increased from (1.32 ± 0.21) cm before treatment to (1.61 ± 0.66) cm, both showing statistically significant differences (P < 0.05). In the MNWL group , FPL increased from (2.01 ± 0.81) cm to (2.77 ± 0.84) cm after one course of treatment, with a statistically significant difference (P < 0.05). Additionally, SPL increased from (4.03 ± 0.84) cm before treatment to (4.40 ± 0.76) cm, also demonstrating statistical significance (P < 0.05), while PD increased from (1.37 ± 0.21) cm before treatment to (1.42 ± 0.22) cm, with statistical significance (P < 0.05). FPL and SPL increased significantly in the PI+MNWL group compared to the MNWL group (P < 0.05, P < 0.01). However, there was no significant difference in PD between the two groups following the intervention (P > 0.05).

Conclusion: MNWL is more effective than self-guided diet in controlling the body weight of children, while the combination approach of PI+MNWL is even superior to the management of short penis in obese children, with the advantages of improving the appearance and increasing the exposed length of the penis.

The intestinal flora is involved in the development of prostate cancer through various mechanisms. And radiotherapy has a significant effect on the composition of the intestinal flora, which triggers clinical symptoms and affects the efficacy of radiotherapy. The mechanisms of the correlation of intestinal flora, prostate cancer and radiotherapy will be described in this article aiming to provide a reference for more effective prevention and prediction of prostate cancer, enhancement of the effectiveness of prostate cancer treatment as well as improvement of patients' quality of life.

Objective: To explore the clinical application of transurethral steam thermal ablation of the prostate as an ultra-minimally invasive treatment of benign prostatic hyperplasia (BPH).

Methods: We treated 18 BPH patients by transurethral steam thermal ablation of the prostate in our hospital, and followed them up for 6－12 months after operation. We obtained the IPSS, maximum urinary flow rate (Qmax), IIEF-5 scores, Male Sexual Health Questionnaire-Ejaculatory Dysfunction-Short Form (MSHQ-EjD-SF) scores and quality of life (QOL) scores from the patients and compared them before and after surgery.

Results: Operations were successfully completed in all the cases, with no intraoperative complications, and all the patients were discharged on the second day after surgery. At the 6-month follow-up after surgery, the Qmax increased from (10.08 ± 2.06) ml/s before surgery to (7.51 ± 3.21) ml/s, the IPSS decreased from 23.72 ± 1.87 to 8.06 ± 1.39, and the QOL score decreased from 5.11 ± 0.58 before surgery to 1.28 ± 0.46. The differences in these indicators were statistically significant (P<0.05). And these is no significant difference in the MSHQ-EjD-SF and IIEF-5 score(P>0.05).

Conclusion: Transurethral steam thermal ablation of the prostate is a safe, effective and almost non-invasive surgical strategy for the treatment of BPH, with a good prospect of clinical application.

Objective: To investigate the genetic causal relationship of leukocyte telomere length (LTL) with prostatitis, orchitis and epididymitis by two-sample Mendelian randomization (MR).

Methods: Using LTL as the exposure factor and prostatitis, orchitis and epididymitis as outcome factors, we mined the Database of Genome-Wide Association Studies (GWAS). Then, we analyzed the causal relationship of LTL with prostatitis, orchitis and epididymitis by Mendelian randomization using inverse variance weighting (IVW) as the main method and weighted median and MR-Egger regression as auxiliary methods, determined the horizontal multiplicity by MR-Egger intercept test, and conducted sensitivity analysis using the leaving-one-out method.

Results: A total of 121 related single nucleotide polymorphisms (SNPs) were identified in this study. IVW showed LTL to be a risk factor for prostatitis (OR = 1.383, 95% CI: 1.044－1.832, P = 0.024), and for orchitis and epididymitis as well (OR = 1.770, 95% CI: 1.275－2.456, P = 0.000 6).

Conclusion: Genetic evidence from Mendelian randomized analysis indicates that shortening of LTL reduces the risk of prostatitis, orchitis and epididymitis.

Objective: To investigate the effect of laparoscopic high ligation of spermatic cord vein in patients with chronic prostatitis and varicocele prostatitis.

Methods: A total of 90 varicocele patients were selected from January 2016 to December 2020, including 33 patients with chronic prostatitis. Changes of white blood cell count, National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) score and serum testosterone level in the expressed prostate secretion (EPS) were observed before and after the operation of laparoscopic high ligation of spermatic vein.

Results: All patients were followed up three months after the surgery. There was no significant difference in the white blood cell counts in EPS, NIH-CPSI score, and serum testosterone level in patients with varicocele-only who underwent high ligation surgery after the operation. However, the white blood cell count in the EPS of patients with chronic prostatitis was lower than that before 3 months of operation ( ［12.39±4.23］×109/L vs ［21.36±5.05］×109/L). The NIH-CPSI score was significantly lower than that before operation ( ［12.71±6.21］ vs ［26.76±8.43］). And the serum testosterone level was higher than that before operation (［4.34±1.77］ng/ml vs ［2.36±1.05］ng/ml).

Conclusion: Laparoscopic high ligation of the spermatic vein in patients with chronic prostatitis and varicocele could effectively reduce the number of white blood cells in the EPS, boost the level of serum testosterone and improves symptoms of chronic prostatitis.

The adverse effects of obesity on male reproductive function are mainly manifested as the abnormal development of the reproductive system, decrease of testosterone level, decline of sperm quality, and impact on the health of offspring, while its regulatory mechanism is far from being clarified. This paper expounds the influence of obesity on the male reproductive system in the aspects of population epidemiology and animal experiments, presents an overview on the action mechanisms of obesity from the perspectives of the hypothalamus-pituitary-testis axis, blood-testis barrier, inflammatory reaction, oxidative stress, testicular germ cell apoptosis, and impact of paternal obesity on the health of offspring, aiming to shed some light on the clinical treatment and prevention of obesity-related male reproductive dysfunction.

Objective: To study the mode of cell death in the penile cavernosum tissue of male rats in the hypoandrogenic state.

Methods: We equally randomized 36 10-week-old SD male rats into six groups: 4-week sham-operation (4-wk SO), 8-week sham-operation (8-wk SO), 4-week castration (4-wk C), 8-week castration (8-wk C), 4-week castration + testosterone replacement (4-wk C+T), and 8-week castration + T replacement (8-wk C+T). The rats in the SO groups received incision of the scrotal skin with preservation of the testis and epididymis, those in the C groups underwent bilateral orchiectomy and epididymectomy, and those in the C+T groups were subcutaneously injected with T propionate at 3 mg/kg qd alt. We measured the ratio of maximum intracavernous pressure to mean arterial pressure (ICPmax/MAP), the concentration of serum T and the level of nitric oxide (NO), and determined the expressions of active caspase-1 and caspase-3 in the penile cavernosum of all the animals.

Results: The ICPmax/MAP ratio, serum T and NO levels and smooth muscle / collagen ratio were significantly lower in the C than in the SO and C+T groups (all P<0.05). The rats in the 4-wk C group, compared with those in the SO group, showed dramatic increases in the rates of endothelial cell pyroptosis (［15.31 ± 0.55］% vs ［0.78 ± 0.53］%, P<0.01), endothelial cell apoptosis (［16.32 ± 0.97］% vs ［0.88 ± 0.39］%, P<0.01), total cell pyroptosis (［9.67 ± 0.49］% vs ［1.53 ± 0.24］%, P<0.01) and total cell apoptosis (［11.27 ± 0.94］% vs ［1.68 ± 0.15］%, P<0.01) in the penile cavernous tissue, and so did those of the 8-wk C group in the rates of endothelial cell pyroptosis (［27.37 ± 0.65］% vs ［1.02 ± 0.65］%, P<0.01), endothelial cell apoptosis (［24.27 ± 0.54］% vs ［1.00 ± 0.63］%, P<0.01), total cell pyroptosis (［14.85 ± 0.55］% vs ［1.72 ± 0.52］%, P<0.01) and total cell apoptosis (［15.92 ± 0.53］% vs ［1.27 ± 0.31］%, P<0.01). The rats of the 8-wk C group exhibited an even more significant elevation than those of the 4-wk C group in the rates of endothelial cell pyroptosis (［27.37 ± 0.65］% vs ［15.31 ± 0.55］%, P<0.05) and endothelial cell apoptosis (［24.27 ± 0.54］% vs ［16.32 ± 0.97］%, P<0.05) .

Conclusion: Pyroptosis and apoptosis are the main modes of death of endothelial cells in the penile cavernosum of male rats after 4 weeks of castration and, with the progression of the disease, both increase with minimally expressed caspase-1 and caspase-3 in the smooth muscle cells. Endothelial cells and smooth muscle cells have different modes of death in different stages of hypoandrogenism.

Objective: To investigate the influencing factors of pathological positive surgical margins (PSM) after radical resection of prostate cancer.

Methods: The clinical data of 407 patients who underwent radical resection of prostate cancer in our hospital from 2011 to 2020 were retrospectively analyzed. And the patients were divided into two groups according to postoperative pathological results. Single factor analysis was used to evaluate the differences in postoperative Gleason score, preoperative total prostate-specific antigen (tPSA), preoperative serum free prostate-specific antigen to preoperative tPSA ratio (fPSA/ tPSA), clinical stage, postoperative pathological stage, operation method, age, body mass index (BMI), diameter and volume of prostate tumor. Multivariate logistic regression was used to determine the independent risk factor of PSM.

Results: Among 407 patients with prostate cancer, 179 cases (43.98%) were positive. Univariate analysis showed that there were significant differences in postoperative Gleason score, preoperative tPSA, clinical stage and postoperative pathological stage between the two groups (P<0.05). And Gleason score, preoperative tPSA and pathologic stage were independent risk factors for PSM.

Conclusion: There are relationships between PSM and postoperative Gleason score, tPSA, clinical T stage, postoperative pathologic pT stage. Among them, postoperative Gleason score (Gleason=7 points, Gleason≥8 points), preoperative total prostate-specific antigen (tPSA > 20 μg/L), and postoperative pathologic pT stage (pT3a, pT3b) were independent risk factors for positive pathological margins of prostate cancer.

Objective: To evaluate the efficacy and safety of denosumab in the treatment of prostate cancer with bone metastases.

Methods: Relevant studies were retrieved from PubMed, EMBASE, Cochrane, Web of Science, Sinomed , CNKI and Wanfang databases. The Cochrane risk-of-bias assessment tool was used to evaluate the quality of included studies, and relevant data were extracted. meta-analysis was performed using RevMan 5.4 and RStudio software, and forest plots were generated.

Results: Six randomized controlled trials (RCTs) were included. Compared with the control group, denosumab significantly reduced the risk of skeletal-related events (HR=0.78, 95% CI: 0.62-0.93). In terms of safety, denosumab did not increase the risk of total adverse events, severe adverse events and the adverse events higher than CTC grade 3.

Conclusion: Denosumab can delay the time to first skeletal-related event with good safety. However, due to the limitations of this study, further high-quality, large-sample, multicenter RCTs are needed to confirm these findings.