World Journal of Mens Health最新文献

Purpose: Despite recent popularity, partial plaque excision and sealing with TachoSil has concern about tunica regeneration from graft and lack of long-term results. Previously, we introduced multiple deep grid incisions of Peyronie's plaque to minimize tunical defect with consequent veno-occlusal erectile dysfunction. To assess the efficacy of modified grid incision of plaque and sealing with collagen fleece in postoperative progress of 34 patients for 3 years.

Materials and methods: From Aug 2018, 34 patients with stable Peyronie's disease (PD) underwent surgery involving three major steps: 1) dissection of the neurovascular bundle or urethra according to plaque location, 2) multiple deep grid incisions of plaque for complete curvature correction, and 3) sealing with collagen fleece without suture. We assessed the stretched penile length, totally straightness, penile sonography, erectile function preoperatively and 3, 6, 12 months and annually postoperatively. This study was approved by the Institutional Review Board.

Results: Mean age was 59.4 years (29-72 years). Mean curvature was 53.5 degree (35-100 degree), with hinge and hourglass deformity in 12 and 8 patients, respectively. Five patients required inflatable penile prosthesis (IPP) insertion, with one more at 30 months. The mean follow-up was 42.3 months. Penile rehabilitation, including daily massage, reduced subcutaneous thickening by 12 months postoperatively. All patients initially achieved complete straightness, with two experiencing recurrent curvature. Four patients had subcutaneous hematomas, subsiding in two. Minor skin issues occurred in three IPP patients. Postoperative erectile function was satisfactory in 85.0% of patients. Most regained preoperative length by 1.6 years. Global Assessment Questionniare satisfaction increased from 69.0% at 1 year to 90.0% until 3 years.

Conclusions: The modified grid incision with collagen fleece sealing effectively treats PD without causing tunica albuginea defects. Long-term follow-up is essential for monitoring erectile function and penile length recovery, ensuring successful clinical outcomes.

Purpose: The K-FRAIL scale is a Korean version of the aging questionnaire that allows screening and diagnosis of easily observable aging in the elderly through a simple self-answer questionnaire. The objective of this study was to examine the relation between fraility and clinical symptoms of the lower urinary tract in elderly men using the K-FRAIL scale.

Materials and methods: A prospective study was conducted on 100 patients who underwent urological examination at our hospital from January 2021 to December 2021. Among them, 62 patients who met the study criteria completed the following questionnaires and lower urinary tract symptoms (LUTS) parameters: K-FRAIL, International Prostate Symptom Score (IPSS), prostate specific antigen, transrectal ultrasonography, and uroflowmetry. In this cross-sectional study, we compared the K-FRAIL scale parameters with various clinical examination parameters in elderly men presenting with LUTS. We also assessed the time required to complete the scale.

Results: The age of the subjects was 66.8±5.96 years in the normal group and 71.6±9.83 years in the frail group (p=0.027). In terms of IPSS indicators, the total scores of the natural patient group and the frail patient group were 13.24±5.48 and 20.44±9.67 (p=0.001); in terms of patient serum testosterone indicators, the scores of the natural patient group and the frail patient group were 4.32±1.52 and 3.74±1.64, respectively (p=0.163). The results indicated that IPSS item 7 and serum testosterone were significant predictors (odds ratio [OR]=4.679, p=0.29; OR=0.391, p=0.043, respectively).

Conclusions: The results of this study show that elderly men with fraility are more likely to develop nocturia and lower testosterone. When treating men with fraility, it will be helpful to know these characteristics and treat them.

Purpose: The main objective of this study is to elucidate the role of endothelial-mesenchymal transition (EndMT) regulated by yes-associated protein (YAP) on diabetes mellitus erectile dysfunction (DMED).

Materials and methods: High concentrations of glucose and palmitic acid (HGP) culturing simulated a diabetic condition in vitro. Cell proliferation, migration, tube formation, and marker gene changes of rat cavernous endothelial cells (RCECs) were measured after YAP overexpression or knockdown. Erectile function and histological outcomes were evaluated in vivo.

Results: Nuclear YAP in RCECs was significantly increased after pretreatment with HGP. YAP overexpression enhanced the cell proliferation (0.236±0.004 vs. 0.148±0.008, p<0.001), migration (1.908±0.099 vs. 1.000±0.116, p<0.001), and tube formation (290.6±10.96 and 21,440.3±762.9 vs. 175.0±24.82 and 13,538.6±1,819.0, p<0.001) compared to the control group. Moreover, the ratios of intracavernous pressure (ICP) to mean arterial pressure (MAP) (0.642±0.051 vs. 0.850±0.070, p<0.05), and smooth muscle to collagen (0.155±0.010 vs. 0.274±0.023, p<0.01) were decreased in rats with YAP overexpression. The effects of HGP on CD31, eNOS, CD34, VE-cadherin, vimentin, α-SMA, and p-Smad3 expression were abrogated by inhibiting YAP in RCECs. YAP knockdown also restored the ICP/MAP (0.597±0.019 vs. 0.346±0.033, p<0.01), smooth muscle/collagen (0.13±0.010 vs. 0.08±0.026, p<0.05) and p-Smad3/Smad3 (1.61±0.291 vs. 3.26±0.332, p<0.01) ratios in type 2 diabetic rats.

Conclusions: YAP promotes EndMT to impair erectile function in type 2 diabetic rats by phosphorylating Smad3, providing a new strategy for treating DMED.

Purpose: Benign prostatic hyperplasia (BPH) is a urinary tract disorder that primarily affects geriatric males. Natural materials have been developed to treat and prevent symptoms of BPH. However, a few natural functional foods has been conclusively proven to cure or prevent symptoms of BPH. The study aimed to investigate the anti-proliferative mechanism of Curcumae Radix (CR) and Syzygium aromaticum (SA) extracts using RWPE-1 cells and testosterone propionate (TP)-induced BPH rats.

Materials and methods: In vitro experiments were performed to assess the synergistic anti-proliferative effects of an equal mixture of CR and SA extracts on TP-treated RWPE-1 cells. In animal experiments, TP-induced BPH rats were administrated with saline, CR and SA extracts at 50, 100, and 200 mg/kg or finasteride at 1 mg/kg daily for 6 weeks. Body weight, prostate weight, dihydrotestosterone (DHT), androgen receptor (AR), and prostate-specific antigen (PSA) levels were measured. Additionally, extracellular signal-regulated kinase and NF-κB levels, oxidative stress, and inflammatory stress responses in the prostate were also analyzed.

Results: In this study, the combination of CR and SA extracts synergistically inhibited cell proliferation compared with the effect of each extract in TP-treated RWPE-1 cells. CR and SA extracts inhibited increasing of prostate weight, thickness of prostate epithelium, the level of PSA and DHT in serum. The expression of protein and gene of PSA and AR in prostate of TP-induced BPH rats were also suppressed by the administration of CR and SA extracts. Furthermore, reactive oxygen species and inflammation axis, NOX4-iNOS-COX2 and its associated representative inflammatory cytokine, interleukin-8 were also reduced in the CR and SA extracts-administered BPH rats.

Conclusions: The results suggest that the combination of CR and SA extracts improves BPH through its anti-inflammatory and anti-oxidative effects, demonstrating great potential as an anti-BPH medicine.

Peyronie's disease is an acquired condition characterized by penile deformities caused by fibrosis of the penile tunica albuginea, leading to symptoms such as penile pain, erectile dysfunction, and other associated issues. Despite extensive research, the pathophysiology of this condition remains poorly understood, and standardized diagnostic and treatment protocols are lacking. While clinical guidelines from several professional societies exist, they do not consistently account for factors such as patient ethnicity, geography, and socioeconomic status. Thus, the Korean Society for Sexual Medicine and Andrology (KSSMA) aimed to develop recommendations tailored to clinical practice in Korea. These recommendations summarize the latest evidence, including clinical practice guidelines from various international professional societies, and represent the consensus opinion of an expert group within the KSSMA. They encompass all aspects of Peyronie's disease, including the definition, diagnosis, non-surgical interventions, and surgical treatment options.

Purpose: Mitochondrial dysfunction may impact male erectile function, but the underlying genetic mechanisms remain unclear. The study aims to investigate the causal role for genetically regulated mitochondrial function in erectile dysfunction (ED) and to identify potential drug targets for the treatment of ED.

Materials and methods: The data of gene methylation, gene expression and protein level related to mitochondria were extracted from the corresponding genome-wide association studies (GWAS) database. Discovery and validation datasets for ED were sourced from research by Bovijn et al, the FinnGen database, and the UK Biobank. We performed summary-data-based Mendelian randomization analysis, colocalization analysis, as well as molecular prediction and molecular docking analysis to assess the association between mitochondrial dysfunction and ED. We also identified relevant targets and potential molecules for the treatment of ED.

Results: Through the integration of multi-omics results, we identified an inverse relationship between the expression of the mitochondrial-related gene FIS1 and the risk of ED (odds ratio [OR]: 0.89, 95% confidence interval [CI]: 0.81-0.97, p-value of summary-data-based Mendelian randomization analysis [PSMR]=1.01×10^-2). In FIS1, methylation of cg19802458 and cg08601038 was related to high expression of the FIS1 gene, which is consistent with the protective effects of cg19802458 and cg08601038 methylation against ED. Additionally, elevated levels of FIS1 protein displayed a negative association with ED risk (OR: 0.71, 95% CI: 0.55-0.92, PSMR=1.00×10^-2). Molecular prediction and molecular docking analysis revealed that resveratrol and quercetin had protective effects against ED by targeting FIS1, and had good affinity and binding mode with FIS1, respectively.

Conclusions: This study demonstrated the causal relationship between the mitochondrial FIS1 gene and ED risk and found that resveratrol and quercetin may have therapeutic effects on ED. These discoveries offer fresh perspectives on the pathogenesis of ED and propose preliminary candidate targets and drugs for future treatment of ED.

Purpose: There is a lack of pooled data exploring the time and rates for human chorionic gonadotropin (hCG) monotherapy vs. combination therapies (hCG+human menopausal gonadotropin or recombinant human follicle-stimulating hormone) to restore spermatogenesis in azoospermic men with congenital hypogonadotropic hypogonadism (CHH). We aimed to investigate the time and rates to recover spermatogenesis among azoospermic CHH men receiving monotherapy vs. combination therapy.

Materials and methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines. The search was performed on PubMed, EMBASE, Web of Science, and Scopus databases up to November 2023. Forrest plots were generated to visually present the pooled effect sizes for time to recover spermatogenesis, specifically employing the standardized mean difference (SMD). Publication bias was assessed utilizing funnel plots. PROSPERO ID: CRD42023473615.

Results: The search identified 720 studies meeting inclusion criteria. Our meta-analysis of 1,240 men with CHH revealed significant differences in the time to recover spermatogenesis between combination therapies and monotherapy. The weighted mean recovery time was significantly shorter for combination therapies (10 months) compared to monotherapy (33 months). The SMD under the common effect model was 8.8 for combination therapies and 24.98 for monotherapy, indicating a more rapid recovery with combination therapies, p<0.01. The rates of sperm recovery were 66.76% for combination therapies and 51.9% for monotherapy, p=0.03. Significant heterogeneity was observed in both groups (I²=86% for combination therapies and I²=68% for monotherapy), suggesting considerable variation in individual responses.

Conclusions: The present meta-analysis reveals that in men with CHH, combination therapies expedite spermatogenesis recovery more than monotherapy. Additionally, combination therapies yield a higher rate of sperm appearing in the ejaculate as compared to hCG monotherapy. The significant heterogeneity observed in both groups underscores the variability in individual responses, warranting further investigation and caution in interpreting these results.