World Journal of Mens Health最新文献

This paper explores the common pathological links between diabetic neuropathy (DN), affecting over 50% of men with type 2 diabetes mellitus and erectile dysfunction (ED) affecting approximately 75%. Current guidelines for DN only consider drugs to modify neurological pain pathways without influencing the underlying pathologies. By blocking pain pathways, most of these drugs can adversely affect ED and sexual function but these issues are rarely discussed in clinics where the relief of pain is considered as paramount. Because of the close overlap of vascular and neurological processes involved in DN and ED, and their high prevalence, this paper investigates the evidence for chronic dosing with phosphodiesterase 5 inhibitors. These drugs have established benefits for endothelial dysfunction, glucose metabolism and nerve regeneration, thus treating the underlying processes rather than simply blocking pain fibres. Because of the high prevalence of DN and ED, perhaps the time has come for early prevention rather than waiting for the development of intractable symptoms that are often poorly responsive to conventional treatments.

Purpose: Antioxidant (AOX) therapy has long been investigated for the management of male infertility. It has potential benefits, but persistent controversy affects its broad acceptance and clinical utility. This study aimed to develop standardized, evidence-based guidelines for AOX use by synthesizing the best available evidence and achieving global expert consensus.

Materials and methods: A comprehensive literature review was conducted by senior experts of the Global Andrology Forum (GAF). Additionally, data on the real-life use of oxidative stress (OS) testing and AOX use obtained from the largest global survey of practicing physicians conducted by GAF, which served as a reference point for this study. In phase one, 151 international specialists (>5 years' experience) participated in a modified Delphi process to evaluate AOX therapy in male infertility. Experts reviewed draft statements and rated agreement on a 10-point Likert scale. Statements achieving >80% consensus (with score >7/10) were accepted. The original eight statements were expanded to 19 and finalized into 18. In phase two, 84 senior physicians (>10 years' experience) graded the Delphi-approved statements using the GRADE approach.

Results: Four out of the 18 statements failed to reach consensus and were excluded. Of the final 14 statements, seven (50%) were graded as "Strong" and seven (50%) as "Weak." Current evidence indicates that AOX therapy can reduce OS, improve sperm quality, and potentially enhance reproductive outcomes. However, benefits vary by agent, regimen, and patient population. The guidelines emphasize the need to document OS and to consider underlying factors before initiating AOX therapy, and caution against indiscriminate or prolonged use.

Conclusions: Developed through a dual-validation process and endorsed by a globally diverse expert panel, these GAF guidelines represent the first standardized, evidence-based guidelines for AOX use in male infertility. By addressing heterogeneity in research and practice, they provide clinicians with practical, safe, and patient-centered recommendations for rational AOX therapy worldwide.

Purpose: The impact of varicocele on testicular function remains debated. This systematic review and meta-analysis evaluated its effects on reproductive hormones, testicular volume, and semen parameters.

Materials and methods: A comprehensive search was conducted in PubMed and Scopus for studies published up to January 2025, following the PECO model: Population-adult men; Exposure-varicocele; Comparator-men without varicocele; Outcomes-reproductive hormone levels, testicular volume, and semen quality.

Results: Of 1,622 records, 32 studies met the inclusion criteria. Men with varicocele had significantly higher follicle-stimulating hormone (FSH) (mean difference [MD] 2.18 IU/L, 95% confidence interval [CI] 1.37-2.99, p<0.001) and luteinizing hormone (LH) levels (MD 0.63 IU/L, 95% CI 0.08-1.17, p=0.02), and significantly lower total testosterone (MD -0.71 ng/mL, 95% CI -1.20 to -0.23, p=0.004). No significant differences were observed in free testosterone, prolactin, or estradiol levels between men with and without varicocele. However, testicular volume was significantly reduced in the varicocele group-both on the right (MD -1.40 mL, 95% CI -2.69 to -0.12, p=0.03) and left side (MD -2.97 mL, 95% CI -4.03 to -1.91, p<0.001). Men with varicocele also had significantly lower sperm concentration (MD -34.72 ×10⁶/mL, 95% CI -48.41 to -21.03, p<0.001), motility (MD -20.62%, 95% CI -29.69 to -11.55, p<0.001), vitality (MD -14.75%, 95% CI -24.60 to -4.90, p=0.003), and normal morphology (MD -10.15%, 95% CI -16.53 to -3.78, p=0.002).

Conclusions: Varicocele is associated with elevated FSH and LH levels, alongside reductions in total testosterone, testicular volume, and semen quality. These findings indicate a detrimental effect on both spermatogenesis and Leydig cell function. Clinicians should consider these hormonal and functional impairments when evaluating and managing infertile men with varicocele.

Purpose: Erectile dysfunction (ED) significantly impacts quality of life and intimate relationships. ED results from a complex interaction of physiological, psychological, and lifestyle factors. While conventional treatments focus on symptom management, regenerative therapies like platelet-rich plasma (PRP) aim to address underlying causes, offering curative potential. However, evidence for PRP's efficacy in vasculogenic ED remains inconclusive. This systematic review and meta-analysis (SRMA) evaluates the effectiveness of penile PRP injections for vasculogenic ED and updates clinical guidelines based on recent evidence.

Materials and methods: Conducted per MOOSE guidelines and registered with PROSPERO (CRD42023430295), this SRMA included observational studies and randomized controlled trials (RCTs) assessing PRP for vasculogenic ED. The PECOS framework guided eligibility, focusing on RCTs comparing PRP to placebo for meta-analysis. Data on study characteristics, PRP protocols, and outcomes using validated erectile function measures and penile Doppler parameters were extracted. Quality was assessed using Cochrane risk of bias and CONSORT guidelines. Statistical analysis employed random or fixed-effects models based on heterogeneity, with publication bias evaluated via funnel plots.

Results: Of 111 abstracts screened, 28 met inclusion criteria, and 3 RCTs alongside 2 observational comparative studies were reviewed. Meta-analysis of the RCTs showed significant improvement in erectile function for PRP versus placebo (mean difference 3.28, 95% confidence interval 1.46-5.11, p<0.001). Sensitivity analysis confirmed result's robustness, and no publication bias was detected. Side effects were rare, with isolated cases of plaque formation and hematoma. Studies combining PRP with low-intensity shock wave therapy showed enhanced efficacy.

Conclusions: PRP therapy appears promising for vasculogenic ED, but additional research is necessary to establish definitive clinical guidelines.

Purpose: Radical prostatectomy remains the primary treatment for localized prostate cancer (PCa). Despite its use for over two decades, the benefits of robot-assisted radical prostatectomy (RARP) remain unclear. We evaluated the surgical, functional, and oncological outcomes between RARP and open radical retropubic prostatectomy (RRP).

Materials and methods: This prospective cohort study included men who underwent radical prostatectomy between March 2016 and April 2020. We excluded patients who received preoperative androgen-deprivation therapy, had an initial prostate-specific antigen level of >50 ng/mL, had a clinical T stage of ≥T3b, and those aged under 50 or over 80 years. The primary outcome was the 90-day complication rate. Surgical and oncologic outcomes were compared. Continence and potency recovery were depicted using Kaplan-Meier curves and assessed using the log-rank test. To balance baseline characteristics, stabilized inverse probability of treatment weighting (sIPTW) was used.

Results: Among the 1,306 patients assessed, 1,055 were included after exclusion and adjustment using the sIPTW (RARP, n=835; RRP, n=220), with a median follow-up of 39 months. The RARP group had a significantly lower 90-day complication rate than the RRP group (8.9% vs. 26.4%; p<0.001). The RARP group showed significantly better surgical outcomes, including estimated blood loss and surgical margins. At 36 months, the pad-free rates were 86.1% and 88.4% for the RARP and RRP groups, respectively (log-rank test, p=0.642). Potency recovery was superior in the RARP group (11.4% vs. 5.2%; log-rank test, p=0.001). Biochemical recurrence (RARP, 23.7%; RRP, 27.9%; p=0.246) and rates of additional treatment (RARP, 23.5%; RRP, 28.1%; p=0.202) were not different. Single-institution study is a potential limitation.

Conclusions: The findings indicate that RARP is associated with a better safety profile and surgical outcomes without compromising short-term oncologic outcomes than RRP. While continence recovery was comparable between the methods, RARP may offer superior potency recovery.

Purpose: To develop a new diagnostic tool, the LUTS/BPH score, for male lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), which integrates the International Prostate Symptom Score (IPSS), prostate size, and urinary flow rate.

Materials and methods: From an initial pool of 75,199 subjects, 12,891 patients met the inclusion criteria. For the statistical analysis used to develop the new LUTS/BPH score, data were refined through outlier removal, normalization, and the collection of relevant variables. Weights for the relevant variables were determined using principal component analysis (PCA).

Results: The new LUTS/BPH score was developed using the three variables: IPSS, prostate size, and maximum urinary flow rate (Qmax). The LUTS/BPH score was calculated by normalizing these variables and applying PCA to determine the weights, resulting in weights of 0.62 for IPSS, -0.64 for Qmax, and 0.46 for prostate size (PCA score=0.62×IPSS -0.64×Qmax+0.46×prostate size). To simplify the LUTS/BPH score calculation in practice, weights were adjusted using IPSS as the reference variable (weight set to 1) and rounded to the first decimal place. The final LUTS/BPH score formula is "LUTS/BPH score=IPSS-Qmax+0.7×prostate size". Based on this distribution, the LUTS/BPH score can classify symptom severity into three categories: (1) Mild symptoms <2, (2) Moderate symptoms: 2-42, and (3) Severe symptoms ≥43.

Conclusions: The newly developed LUTS/BPH score is an objective and quantifiable diagnostic tool for male LUTS due to BPH, supplementing the currently used IPSS with additional key diagnostic indicators such as prostate size and urinary flow rate.

Purpose: Infertility affects approximately 10% to 20% of couples globally, with male factors contributing to nearly 50% of infertility cases. Among these, represents a severe form of male infertility, though its etiology remains largely unknown. CFAP119 has been implicated in sperm flagellar formation and is essential for fertility in mice; however, its role in human fertility has not been established.

Materials and methods: Whole exome sequencing (WES) was performed to identify pathogenic variants in a patient with asthenoteratozoospermia, and the functional impact of the mutations was assessed using in silico and in vitro analysis. Intracytoplasmic sperm injection (ICSI) was applied to assist fertilization for the patient.

Results: In this study, we identified a novel biallelic missense mutation in CFAP119 in a patient with asthenoteratozoospermia through WES. Immunofluorescence staining and western blotting demonstrated that the variants impaired the protein expression. Morphological analysis of the patient's sperm revealed severely malformed tails and head abnormalities. Ultrastructural examination also confirmed significant defects in the sperm flagella "9+2" microtubule composition. Additionally, in silico analysis predicted interactions between CFAP119 and flagellum development related proteins, including CFAP74, CFAP221, which were further validated by co-immunoprecipitation. Notably, the patient with the CFAP119 mutation successfully achieved healthy offspring through ICSI.

Conclusions: Our findings revealed novel pathogenic variants within CFAP119 in patient with asthenoteratozoospermia, expanding our understanding of the genetic etiology of male infertility and providing valuable insights for future diagnostic and therapeutic approaches.

Purpose: Surgery for benign prostatic hyperplasia (BPH) has undergone technical innovations in recent years. The aim of this study was to evaluate the factors associated with postoperative infectious in patients treated surgically for BPH.

Materials and methods: TOCUS is a multicenter, retrospective study including all patients treated for prostatic BPH surgery requiring screening for asymptomatic bacteriuria (ABU) from January 2016 to April 2023. The primary endpoint was occurrence of an infectious complication (surgical site infection or febrile urinary tract infection [UTI]) defined by postoperative fever associated with a clinical, biological and radiological exam suggestive of prostatitis or pyelonephritis, occurring within 30 days after surgery.

Results: In our study, 498 patients were included. Median age at surgery was 71 years (interquartile range [IQR] 65-77). Median operative time was 70 minutes (IQR 47-105). Patients mostly underwent endoscopic techniques (95.2%), while 4.8% underwent open simple prostatectomy. The postoperative infection rate was 5.1%. Even though infected patients had positive preoperative urine culture (UC) (96.0%), only 68.0% received preoperative antibiotic therapy. UTI in the previous year was an associated factor for postoperative infection (odds ratio [OR] 4.84, 95% confidence interval [CI] 1.78-13.69, p=0.002), as were positive preoperative mono or bimicrobial UC (OR 35.44, 95% CI 3.51-864.11, p=0.006) and preoperative polymicrobial UC (OR 48.13, 95% CI 7.03-977.27, p<0.001). Preoperative antibiotic therapy (OR 0.46, p=0.367) and antibiotic prophylaxis (OR 1.79, p=0.303) were not associated with infectious complications. There was no significant difference between the different surgical techniques in terms of postoperative infection (p=0.11).

Conclusions: This study did not find an association between the surgical technique used for BPH treatment and postoperative infectious risk. However, ABU, whether monomicrobial, bimicrobial, or polymicrobial, was strongly associated with postoperative infectious complications, with no impact of preoperative antibiotic therapy or antibiotic prophylaxis.

Purpose: Lower urinary tract symptoms (LUTS) in men substantially impair quality of life and are commonly treated with alpha-blockers or 5-alpha reductase inhibitors, which may cause adverse effects. Elaeagnus multiflora and Cynanchum wilfordii, traditional herbal remedies, have shown potential benefits in testosterone regulation and benign prostatic hyperplasia (BPH); however, clinical evidence supporting their efficacy in LUTS remains limited. This study evaluated the efficacy and safety of the E. multiflora and C. wilfordii complex (NET1701) in men with LUTS.

Materials and methods: In this randomized, double-blind, placebo-controlled trial, 100 men aged 40-80 years with moderate LUTS (International Prostate Symptom Score [IPSS] 8-19) were randomized to receive NET1701 (325 mg/d) or placebo for 12 weeks. The primary outcome was the change in total IPSS from baseline to 12 weeks. Secondary outcomes included IPSS subscores, maximum urinary flow rate (Qmax), post-void residual volume (PVR), serum testosterone levels, and safety.

Results: At 12 weeks, the NET1701 group showed a significantly greater reduction in total IPSS compared with placebo (-5.67±3.86 vs. -1.00±4.30; p<0.0001). Significant improvements were observed in several IPSS subscores, including incomplete emptying, frequency, intermittency, and weak stream (p<0.05). Although Qmax and PVR did not differ significantly between groups, urinary symptom-related quality-of-life scores improved significantly in the NET1701 group (p<0.0001). NET1701 was well tolerated, with no severe adverse events reported.

Conclusions: The E. multiflora and C. wilfordii complex (NET1701) significantly improved LUTS severity and quality of life without notable adverse effects. These findings suggest that NET1701 may represent a promising phytotherapeutic option for the management of male LUTS. Further long-term studies are needed to confirm its sustained efficacy and safety.

Purpose: This study aims to investigate the localization and expression of pericytes in the rat corpus cavernosum (CC) following testosterone deficiency induced by castration and after testosterone replacement therapy (TRT).

Materials and methods: Thirty 12-week-old male Sprague-Dawley rats were assigned to three groups: control (n=10), castration-only (n=10), and castration groups treated with daily testosterone propionate injections (n=10). After 4 weeks, markers for endothelial cells (ECs; CD34, Flk1, and VE-cadherin), pericytes (NG2), and smooth muscle cells (smooth muscle actin) were analyzed using immunofluorescence and western blot analysis.

Results: Confocal microscopy revealed that EC markers were predominantly localized within the cavernosal sinusoidal endothelium, while NG2⁺ pericytes were primarily observed in the subtunical region. Castrated rats exhibited reduced immunoreactivity of CD34⁺ ECs, SMA⁺ SMCs, and NG2⁺ pericytes compared to those of the control group. TRT restored these markers to levels approaching those of the control group. Protein expression levels of CD34 and NG2 exhibited similar patterns.

Conclusions: Pericytes are predominantly located in the subendothelial region of the CC, and testosterone levels significantly influence their expression. Further studies are necessary to evaluate the effect of different durations of TRT on cellular expression.