中华男科学杂志最新文献

Objective: To explore the clinical effect of sexual therapy combined with physical methods in the treatment of primary intravaginal anejaculation (PIAE) and its possible action mechanism.

Methods: Ninety PIAE patients with anxiety symptoms were equally randomized into three groups and treated by sexual therapy combined with vacuum negative pressure hydro pneumatic / pneumatic bubble massage (group A), sexual therapy (group B) or (vacuum negative pressure hydro pneumatic / pneumatic bubble massage (group C). After 15 cycles of treatment, the therapeutic effects were compared among the three groups of patients.

Results: The effectiveness rates in groups A, B and C were 86.67%, 46.67% and 30.00%, respectively, with statistically significant differences in the total effectiveness rate, the effective rate of the treatment of anxiety symptoms of the patients and their partners, and the effectiveness rate of the treatment of idiosyncratic masturbation (P<0.05). Pairwise comparison showed that the total effectiveness rate was dramatically higher in group A than in groups B and C (P<0.01), with no statistically significant difference between the latter two groups (P>0.05), that the effectiveness rate of the treatment of anxiety symptoms of the patients and sexual partners was remarkably higher in groups A and B than in C (P<0.01), with no statistically significant difference between the former two groups (P>0.05), and that the effectiveness rate of the treatment of idiosyncratic masturbation was significantly higher in group A than in B and C (P< 0.01), with no statistically significant difference between the latter two (P>0.05).

Conclusion: PIAE is often accompanied by negative psychological state of the patients and their partners and idiosyncratic masturbation, which responds well to sexual therapy combined with vacuum negative pressure hydro pneumatic / pneumatic bubble massage.

Ferroptosis is an iron-dependent form of programmed cell death triggered by the excessive accumulation of lipid peroxides on the cell membrane. Recent studies have found that ferroptosis can be induced by exposure of the testis tissue and germ cells to some high-risk factors, accompanied by various characteristic reproductive system injuries, including changes in cell morphology, ferroptosis-related physicochemical indicators and gene expressions. This review focuses on the association of ferroptosis with male reproductive system diseases from three key aspects: iron metabolism abnormalities, Cystine/GSH/GPX4 axis imbalance, and lipid peroxidation.

Pyroptosis, as a new programmed death mode, plays an important role in the development and progression of prostate cancer, and the drugs targeting the pyroptosis pathway, as a new therapeutic strategy, may produce a significant influence on the treatment of prostate cancer . However, the precise mechanism of cellular pyroptosis remains unclear, necessitating further investigation. This paper presents a summary of the role of cellular pyroptosis in prostate cancer over recent years. It includes a discussion of the mechanism of pyroptosis, its role in prostate cancer development, and its clinical applications. This will provide clinicians with a new strategy for treatment and drug development.

Objective: To investigate the incidence of comorbid ED with lower urinary tract symptoms (LUTS) and its risk factors in BPH patients.

Methods: Based on inclusion and exclusion criteria, we selected BPH patients visiting the outpatient department of the Second Xiangya Hospital of Central South University from January 2020 to January 2023. We collected the general and clinical data from the patients, including age, height, body weight, abdominal circumference, hip circumference, blood pressure, blood routine, liver function, kidney function, blood lipids and fasting blood glucose, obtained their IPSS, quality of life (QOL) scores, and IIEF-5 scores by questionnaire investigation, and performed data processing and analysis with the SPSS 22.0 software.

Results: The incidence rate of comorbid ED with LUTS in the BPH patients rose with the increase of age, 36.46% in the 45－49-year group, 43.72% in the 50－54-year group, 53.66% in the 55－59-year group, 69.23% in the 60－64-year group, and 78.74% in the 65－70-year group. The lipid accumulation product (LAP), visceral adiposity index (VAI), triglycerides and glucose (TyG), hepatic steatosis index (HSI), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) were correlated positively with IPSS scores and negatively with IIEF-5 scores, while LDL-C and total cholesterol (TC) negatively with IPSS scores and positively with IIEF-5 scores.

Conclusion: The incidence of comorbid ED with LUTS in BPH patients increases with age. The risk factors for this comorbidity include hypertension, dyslipidemia, diabetes, BMI, and lifestyle, and the risk of the condition can be effectively assessed by LAP, VAI, TYG, HSI, BMI, WHtR, WHR, TG and HDL-C.

Objective: To evaluate the efficiency of the four domestic language models, ERNIE Bot, ChatGLM2, Spark Desk and Qwen-14B-Chat, all with a massive user base and significant social attention, in response to consultations about PCa-related perioperative nursing and health education.

Methods: We designed a questionnaire that includes 15 questions commonly concerned by patients undergoing radical prostatectomy and 2 common nursing cases, and inputted the questions into each of the four language models for simulation consultation. Three nursing experts assessed the model responses based on a pre-designed Likert 5-point scale in terms of accuracy, comprehensiveness, understandability, humanistic care, and case analysis. We evaluated and compared the performance of the four models using visualization tools and statistical analyses.

Results: All the models generated high-quality texts with no misleading information and exhibited satisfactory performance. Qwen-14B-Chat scored the highest in all aspects and showed relatively stable outputs in multiple tests compared with ChatGLM2. Spark Desk performed well in terms of understandability but lacked comprehensiveness and humanistic care. Both Qwen-14B-Chat and ChatGLM2 demonstrated excellent performance in case analysis. The overall performance of ERNIE Bot was slightly inferior. All things considered, Qwen-14B-Chat was superior to the other three models in consultations about PCa-related perioperative nursing and health education.

Conclusion: In PCa-related perioperative nursing, large language models represented by Qwen-14B-Chat are expected to become powerful auxiliary tools to provide patients with more medical expertise and information support, so as to improve the patient compliance and the quality of clinical treatment and nursing.

Objective: To investigate the genetic and clinical characteristics of 46, XX testicular disorders of sex development (DSD).

Methods: We collected the clinical data on the patients with 46,XX testicular DSD diagnosed in the Center of Reproductive Medicine of the First Affiliated Hospital of Nanjing Medical University from January 2017 to January 2023, and analyzed their genetic and clinical characteristics and the SRY gene chromosomal location for those with SRY-positive.

Results: A total of 26 patients were included in this study, all with 46,XX and deletion of the AZFa, b and c regions, with a mean height of (168.3±5.9) cm, body weight of (64.0±7.5) kg, BMI of (22.66±2.79) kg/m2, left testis volume of (2.53±1.16) ml and right testis volume of (2.74±1.34) ml. The semen volume of the patients averaged 1.35 (0.18－2.78) ml, FSH (36.85±18.01) IU/L, LH (19.71±9.71) IU/L, and T (6.08±2.71) nmol/L. The SRY-negative patients had a higher incidence rate of development disorders in the reproductive system than the SRY-positive ones (5/6 vs 3/20, P = 0.004), but no statistically significant differences were observed in the other parameters. The SRY gene was localized at the end of Xp in 13 of the 14 SRY-positive cases, and at chromosome 15 in the other 1.

Conclusion: 46,XX testicular DSD has some similarity and heterogeneity in genetics and clinical characteristics.

Based on the traditional Chinese medicine theories and modern medical theories, Professor XU Fu-song, a famous veteran Chinese medicine physician in China, established the theory of "inner kidney and outer kidney", emphasizing concomitant treatment of inner kidney and outer kidney, which plays an important guiding role in deepening the understanding of the pathogenesis and clinical diagnosis and treatment of male infertility. This article summarizes the relevant academic thoughts and experiences of Professor XU, with an analysis of his advanced ideas in the field of male reproduction.

Prostate cancer (PCa) is one of the common tumors in the genitourinary system, with an increasing morbidity and mortality in China. Recent studies show that autophagy plays an important pathophysiological role in many diseases, including cancers. Besides, some miRNAs are also key regulatory factors for autophagy in PCa cells, and play an important role in the development, progression, diagnosis and treatment of PCa. In-depth studies of miRNAs may contribute to the discovery of some valuable diagnostic methods and novel treatment strategies. This article reviews the progress in researches on the role of autophagy-related miRNAs in PCa, aiming to provide some reference for the diagnosis and treatment of the malignancy.

Phthalate esters are plasticizers that people are often exposed to in daily life. They are closely related to our lives and generally exist in the air, soil and water. Studies show that the exposure to phthalates is associated with male reproductive damage. When the concentration of phthalates reaches a certain level in the body, it can reduce the count and motility of sperm, induce abnormalities in the reproductive system and organs, and affect male fertility. This review summarizes the advances in the studies of the metabolic pathway of phthalate esters in the human body, the mechanism underlying their damage to the male reproductive system and their antagonistic effect.

Objective: To establish a predictive scoring model for bladder neck contracture (BNC) after laparoscopic enucleation of the prostate with preservation of the urethra (Madigan surgery) and explore the preventive measures against this postoperative complication.

Methods: We included 362 cases of BPH treated by laparoscopic Madigan surgery from January 2019 to March 2022 (45 with and 317 without postoperative BNC) in the training group and another 120 cases treated the same way in the verification group, collected the clinical data on the patients and evaluated the results of surgery. Using the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression, we analyzed the risk factors for postoperative BNC and constructed a predictive scoring model for evaluation of the factors.

Results: Compared with the baseline, the IPSS, quality of life (QOL) score and postvoid residual urine volume (PVR) were significantly decreased (P < 0.05) while the maximum urinary flow rate (Qmax) remarkably increased (P < 0.05) in the BPH patients at 3 months after surgery. Eight non-zero characteristic predictors were identified by LASSO regression analysis. Multivariate logistic regression analysis showed that short clinical experience of the surgeon, concurrent prostatitis, bladder rinse solution temperature <34℃, catheter blockage, urethral balloon injection volume >40 ml and postoperative constipation were independent risk factors for postoperative BNC (P < 0.05). The best cut-off value was 2.36 points in both the training and the verification groups. The results of evaluation exhibited a high discriminability of the predictive scoring model.

Conclusion: Laparoscopic Madigan surgery is a safe and effective method for the treatment of BPH. Short clinical experience of the surgeon, concurrent prostatitis, bladder rinse solution temperature <34℃, catheter blockage, water injected into the urethral balloon >40 ml and postoperative constipation were independent risk factors for postoperative BNC. The predictive scoring model constructed in this study has a good discriminability and is simple and feasible, contributive to the prediction of postoperative BNC in BPH patients undergoing laparoscopic Madigan surgery.