World Journal of Mens Health最新文献

Purpose: In this study, we investigated the effect of bisphenol-A (BPA) and its major analogs, bisphenol-F (BPF), and bisphenol-S (BPS), on spermatogonial stem cells (SSCs) populations using in vitro SSC culture and in vivo transplantation models.

Materials and methods: SSCs enriched from 6- to 8-day-old C57BL/6-eGFP⁺ male mice testes were treated with varying concentrations of bisphenols for 7 days to examine bisphenol-derived cytotoxicity and changes in SSC characteristics. We utilized flow cytometry, immunocytochemistry, real-time quantitative reverse transcription-PCR, and western blot analysis. The functional alteration of SSCs was further investigated by examining donor SSC-derived spermatogenesis evaluation through in vivo transplantation and subsequent testis analysis.

Results: BPF exhibited a similar inhibitory effect on SSCs as BPA, demonstrating a significant decrease in SSC survival, inhibition of proliferation, and induction of apoptosis. On the other hand, while BPS was comparatively weaker than BPA and BPF, it still showed significant SSC cytotoxicity. Importantly, SSCs exposed to BPA, BPF, and BPS exhibited a significant reduction in donor SSC-derived germ cell colonies per total number of cultured cells, indicating that, like BPA, BPF, and BPS can induce a comparable reduction in functional SSCs in the recipient animals. However, the progress of spermatogenesis, as evidenced by histochemistry and the expressions of PCNA and SSC specific markers, collectively indicates that BPA, BPF, and BPS may not adversely affect the spermatogenesis.

Conclusions: Our findings indicate that the major BPA substitutes, BPF and BPS, have significant cytotoxic effects on SSCs, similar to BPA. These effects may lead to a reduction in the functional self-renewal stem cell population and potential impacts on male fertility.

Purpose: This study elucidates the mechanism of the physiological effect of cannabidiol (CBD) by assessing its impact on lipopolysaccharide (LPS)-induced inflammation in RWPE-1 cells and prostatitis-induced by 17β-estradiol and dihydrotestosterone in a rat model, focusing on its therapeutic potential for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Materials and methods: RWPE-1 cells were stratified in vitro into three groups: (1) controls, (2) cells with LPS-induced inflammation, and (3) cells with LPS-induced inflammation and treated with CBD. Enzyme-linked immunosorbent assays and western blots were performed on cellular components and supernatants after administration of CBD. Five groups of six Sprague-Dawley male rats were assigned: (1) control, (2) CP/CPPS, (3) CP/CPPS and treated with 50 mg/kg CBD, (4) CP/CPPS and treated with 100 mg/kg CBD, and (5) CP/CPPS and treated with 150 mg/kg CBD. Prostatitis was induced through administration of 17β-estradiol and dihydrotestosterone. After four weeks of CBD treatment, a pain index was evaluated, and prostate tissue was collected for subsequent histologic examination and western blot analysis.

Results: CBD demonstrated efficacy in vivo for CP/CPPS and in vitro for inflammation. It inhibited the toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) pathway by activating the CB2 receptor, reducing expression of interleukin-6, tumor necrosis factor-alpha, and cyclooxygenase-2 (COX2) (p<0.01). CBD exhibited analgesic effects by activating and desensitizing the TRPV1 receptor.

Conclusions: CBD inhibits the TLR4/NF-κB pathway by activating the CB2 receptor, desensitizes the TRPV1 receptor, and decreases the release of COX2. This results in relief of inflammation and pain in patients with CP/CPPS, indicating CBD as a potential treatment for CP/CPPS.

Purpose: Twenty five years have passed since the first national survey on erectile dysfunction (ED) in Japan. The Japanese Society for Sexual Medicine conducted a nationwide survey on the actual status of sexual function targeting men over 20 years old in Japan using validated questionnaires commonly used in clinical practice.

Materials and methods: Japanese men aged 20 to 79 years participated in our online epidemiological study on sexual dysfunction. Erectile status was assessed by direct questioning and specific questionnaires. Risk factors and frequencies of sexual intercourse, masturbation, nocturnal erections, and feeling sexual desire were assessed. The prevalence of these risk factors was compared between men with and without ED. Prevalence and frequencies were calculated for each 5-year age group. Main outcomes were the prevalence and number of patients with ED and simultaneous evaluation of age-related variations.

Results: Direct questioning of the men revealed that 13.0% felt troubled by ED. Although 81.0% of them had at least some ED symptoms based on a Sexual Health Inventory For Men score of ≤21, the prevalence of men with ED by Erection Hardness Score (EHS), the most appropriate questionnaire for Japanese with low sexual activity, was 30.9%, indicating that 14,012,596 men have ED. Most risk factors were related with ED, whereas frequencies of sexual intercourse, masturbation, nocturnal erections, and feeling sexual desire were affected by aging. However, the low frequency of these factors in the young generation was surprising.

Conclusions: The EHS-based assessment revealed a prevalence of ED of 30.9%, which affected approximately 14 million men, and that the sexual desire, erection stiffness, orgasms, and satisfaction were lower than expected in young Japanese men, especially those aged 20 to 24 years, although those factors tended to worsen with aging. We believe that these findings actually reveal the current sexual status of men in Japan.

Purpose: We aimed to investigate the relationship between follicle stimulating hormone (FSH) and inhibin B (InhB).

Materials and methods: Data from 1,230 consecutive men presenting for primary couple's infertility were analyzed. Health-significant comorbidities were scored with Charlson comorbidity index. Quartiles of FSH and InhB were considered to determine threshold values. Descriptive statistics and logistic regression models tested association between FSH and InhB values.

Results: Overall, 1,080 (87.8%) men had concordant FSH and InhB values. Conversely, 150 patients (12.2%) had discrepancies in FSH and InhB, with 78 (6.3%) and 72 (5.9%) men reporting both low and high FSH and InhB values, respectively. Infertile men with discordant values were younger (median [interquartile range] 38.0 years [34-41 years] vs. 36.0 years [31-40 years]); had smaller testicular volume (TV) (12 mL [10-15 mL] vs. 15 mL [12-20 mL]); and, had more frequently a sperm DNA fragmentation test >30% (179 [59.1%] vs. 40 [78.4%]) than those with concordant values (all p<0.05). Moreover, a higher frequency of previous cryptorchidism (27.3% vs. 11.9%), lower sperm concentration (3.0 million/mL [0.9-11.0 million/mL] vs. 13.8 million/mL [3.1-36.0 million/mL]), lower progressive sperm motility rates (12.0% [5.0%-25.3%] vs. 20.0% [7.0%-36.0%]), and greater rates of non-obstructive azoospermia (36.4% vs. 23.9%) were found in men with discordant FSH and InhB values (all p≤0.005). At multivariable logistic regression analysis, higher body mass index (odds ratio [OR], 1.08; p=0.001), smaller TV (OR, 0.91; p<0.001), and a history of cryptorchidism (OR, 2.49; p<0.001) were associated with discordant FSH and InhB values.

Conclusions: More than one out of ten infertile men had discordant FSH and InhB values in the real-life setting showing worse clinical profiles than those with concordant levels. Smaller TV and history of cryptorchidism could be used as clinical markers to better tailor the need to test InhB.

Purpose: Although surgical procedures including robotic surgery in radical prostatectomy have evolved, urinary incontinence after surgery are still not resolved. This study was to evaluate the risk of clinically significant incontinence after radical prostatectomy according to various procedural types.

Materials and methods: The retrospective cohort study included prostate cancer (n=14,484) in South Korea between 2002 and 2017 as shown in the National Health Insurance Data. Clinically significant incontinence was defined as postprostatectomy incontinence (PPI) requiring anti-incontinence surgery or received specific medication within months after surgery. The prevalence and relative risks of PPI were evaluated according to different procedural types after propensity score matching (PSM). The risks of PPI were compared among those difference procedural types including robotic-assisted radical prostatectomy (RALP), open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) using the hazard ratio (HR).

Results: Among 25,903 cohort participants including RALP (n=18,937), ORP (n=4,979), and LRP (n=1,987), overall prevalence of PPI was 2.06% (n=536). According to procedural types, prevalence of PPI in LRP, RARP, and ORP were 3.67%, 1.81%, and 2.43%, respectively. Risk of PPI after PSM and after adjustment of age, Charlson comorbidity index, and hospital volume was 0.456 (95% confidence interval [95% CI] 0.30-0.69) between LRP and RARP, 0.67 (95% CI 0.46-0.98) between LRP and ORP, and 1.404 (1.06-1.86) between RARP and ORP. Adjusted HR after PSM was 0.495 (95% CI 0.33-0.74) between LRP and RARP, 0.674 (95% CI 0.46-0.98) between LRP and ORP, 1.242 (95% CI 0.94-1.64) between RARP and ORP.

Conclusions: The prevalence of PPI which needed anti-incontinence surgery was not low among who received radical prostatectomy. Those patients who underwent LRP had higher risk for PPI than those who underwent ORP. However, further research is required to fully determine whether RARP can help to prevent PPI.

Purpose: Information retrieval (IR) and risk assessment (RA) from multi-modality imaging and pathology reports are critical to prostate cancer (PC) treatment. This study aims to evaluate the performance of four general-purpose large language model (LLMs) in IR and RA tasks.

Materials and methods: We conducted a study using simulated text reports from computed tomography, magnetic resonance imaging, bone scans, and biopsy pathology on stage IV PC patients. We assessed four LLMs (ChatGPT-4-turbo, Claude-3-opus, Gemini-Pro-1.0, ChatGPT-3.5-turbo) on three RA tasks (LATITUDE, CHAARTED, TwNHI) and seven IR tasks. It included TNM staging, and the detection and quantification of bone and visceral metastases, providing a broad evaluation of their capabilities in handling diverse clinical data. We queried LLMs with multi-modality reports using zero-shot chain-of-thought prompting via application programming interface. With three adjudicators' consensus as the gold standard, these models' performances were assessed through repeated single-round queries and ensemble voting methods, using 6 outcome metrics.

Results: Among 350 stage IV PC patients with simulated reports, 115 (32.9%), 128 (36.6%), and 94 (26.9%) belonged to LATITUDE, CHAARTED, and TwNHI high-risk, respectively. Ensemble voting, based on three repeated single-round queries, consistently enhances accuracy with a higher likelihood of achieving non-inferior results compared to a single query. Four models showed minimal differences in IR tasks with high accuracy (87.4%-94.2%) and consistency (ICC>0.8) in TNM staging. However, there were significant differences in RA performance, with the ranking as follows: ChatGPT-4-turbo, Claude-3-opus, Gemini-Pro-1.0, and ChatGPT-3.5-turbo, respectively. ChatGPT-4-turbo achieved the highest accuracy (90.1%, 90.7%,91.6%), and consistency (ICC 0.86, 0.93, 0.76) across 3 RA tasks.

Conclusions: ChatGPT-4-turbo demonstrated satisfactory accuracy and outcomes in RA and IR for stage IV PC, suggesting its potential for clinical decision support. However, the risks of misinterpretation impacting decision-making cannot be overlooked. Further research is necessary to validate these findings in other cancers.

Purpose: There is increased interest in regenerative therapies (RTs) to treat erectile dysfunction (ED). However, the need for society's guidelines has led to varied practices. This study aims to investigate current global practices, address the heterogeneity in treatment protocols and evaluations, and establish expert recommendations in clinical practice.

Materials and methods: Senior experts from the Global Andrology Forum (GAF) created a 32-question survey to evaluate the clinical aspects of various RT modalities and compare them with each other and with phosphodiesterase type 5 inhibitors (PDE5is). The survey was distributed worldwide to ED specialists through online Google Forms, the GAF website, international professional societies, and direct emails. The responses were analyzed and are presented as percentage frequencies. Additionally, an expert consensus on recommendations for RT use was reached at via a modified Delphi method.

Results: Out of 163 respondents from 39 countries, the majority (80.1%) were using low-intensity shockwave therapy (LISWT), followed by platelet-rich plasma (PRP) 61.3% and stem cell therapy (SCT) 17.8%. Efficacy comparisons revealed no perceived significant differences among RT modalities (p=0.124). Compared to PDE5is, the efficacy of LISWT and PRP was considered lower by the respondents, while SCT was rated better by almost half of those who used SCT. The duration of improvement varied (p=0.279), with most improvements lasting 1 to 6 months. The treatment protocols used for LISWT were mainly consistent but varied widely for PRP and SCT. Adverse effects were minimal, particularly for LISWT (p<0.001). The costs varied significantly (p<0.001), with SCT being the most expensive. The evidence for efficacy was rated as primarily moderate to strong for LISWT but poor for PRP and SCT (p=0.027).

Conclusions: Most respondents utilized LISWT, followed by PRP, with SCT being the least commonly utilized. The high break heterogeneity in treatment protocols and evaluation of RT underscores the need for further studies and guidelines to establish best practices.

Purpose: We aimed to investigate possible hormonal changes following microdissection testicular sperm extraction (mTESE) in men with non-obstructive azoospermia (NOA) across three referral centers.

Materials and methods: We prospectively analyzed data from 102 consecutive NOA men. Patients with prior hormonal therapies were excluded. Preoperative serum hormone levels (total testosterone [tT], luteinizing hormone [LH], follicle-stimulating hormone [FSH], and 17β-estradiol) were collected, with repeat measurements at 3-month post-surgery. We divided the cohort into two groups using a tT cut-off value of 3 ng/mL: 1) men who kept eugonadal status; and, 2) men who were initially eugonadal but became testosterone deficient (TD) after surgery.

Results: Overall, median (interquartile range [IQR]) age was 37 years (32-40 years). Positive sperm retrieval during mTESE was observed in 34 (33.3%) patients, and 48 (47.1%) underwent bilateral mTESE. Compared to baseline, 3-month postoperative median (IQR) hormonal levels were as follows: tT: 3.71 ng/mL (2.76-5.24 ng/mL) vs. 4.27 ng/mL (3.25-6.07 ng/mL), p=0.32; FSH: 22.0 mIU/mL (12.65-31.47 mIU/mL) vs. 19.5 mIU/mL (11.63-25.8 mIU/mL), p=0.25; LH: 9.0 mIU/mL (5.11-12.4 mIU/mL) vs. 7.6 mIU/mL (5.04-13.4 mIU/mL), p=0.73, respectively. Twelve (13.5%) eugonadal men at baseline showed TD after mTESE. Median (IQR) tT values at baseline and 3-month follow-up were compared between those who preserved eugonadal status after surgery and those who became TD after surgery: baseline levels were 4.46 ng/mL (4.1-6.27 ng/mL) vs. 4.14 ng/mL (3.24-4.98 ng/mL), p=0.09; and, 3-month follow-up levels were 4.58 ng/mL (3.58-5.56 ng/mL) vs. 2.51 ng/mL (2.31-2.76 ng/mL), p<0.001, respectively. Men who developed TD had lower testicular volume (TV) (6 [4-10] vs. 10 [8-12.25] Prader, p=0.001) and karyotype abnormalities (4 [33.3] vs. 1 [1.3], p=0.006).

Conclusions: This multicentric study shows that mTESE in men with NOA does not significantly impact short-time postoperative follow-up tT, LH, and FSH levels. A substantial proportion of men who were initially eugonadal demonstrated tT suggestive for TD at 3-month follow-up. These men had lower TV at baseline and abnormal karyotype.

Purpose: To assess whether an artificial intelligence (AI)-based reassurance-call can inform patients about potential complications and provides reassurance following a prostate biopsy.

Materials and methods: From October 2022 to December 2023, 42 patients aged 40 to 70 years undergoing their first prostate biopsy were recruited. The 'Reassurance-call' service was utilized to inform and monitor patients for complications. Participants were randomized into three groups: AI-assisted Reassurance-call service (Group 1), human-assisted Reassurance-call service (Group 2), and no call (Group 3). The primary outcome measured was patient satisfaction with the Reassurance-call service, assessed using a Likert scale. Secondary outcomes included satisfaction with complication management and anxiety levels, evaluated using the Likert scale, visual analog scale (VAS), and the state-trait anxiety inventory (STAI).

Results: Satisfaction with Reassurance-call averaged 4.20 (standard deviation [SD] 0.56) for Group 1 and 4.71 (SD 0.47) for Group 2, showing a statistically significant difference. Satisfaction regarding complication management using Likert scale was 4.13 (SD 0.52) for Group 1, 4.43 (SD 0.76) for Group 2, and 3.79 (SD 0.80) for Group 3 with no statistically significant differences. Satisfaction regarding complication management using VAS averaged 8.33 (SD 1.23) for Group 1, 8.57 (SD 1.45) for Group 2, and 7.07 (SD 1.86) for Group 3, indicating significant differences. Anxiety levels using STAI averaged 40.00 (SD 10.54) for Group 1, 39.14 (SD 8.29) for Group 2, and 35.00 (SD 9.46) for Group 3, showing no significant differences. Anxiety levels using VAS averaged 5.07 (SD 2.79) for Group 1, 2.21 (SD 2.64) for Group 2, and 3.50 (SD 2.28) for Group 3, with significant differences observed.

Conclusions: AI demonstrated potential in enhancing patient reassurance and managing complications post-prostate biopsy, although human interaction proved superior in certain aspects. Further studies with larger cohorts are necessary to verify the effectiveness of AI-based tools.

Purpose: To investigate the dietary factors affecting male lower urinary tract symptoms (LUTS).

Materials and methods: This retrospective study analyzed men who underwent health check-ups. The men who completed the International Prostate Symptom Score (IPSS) and a dietary questionnaire with 19 items were included in the study. Men with a history of medication for LUTS were excluded from the study. The influences of each dietary habit on total IPSS, voiding symptoms, storage symptoms and quality of life were evaluated separately. Dietary risk group was defined by the number of significant dietary risk factors.

Results: The mean age of 28,463 men was 52.2±8.7 years. After adjusting for age and other conditions, 13 dietary habits (for examples; overeating, preference for salty food, frequently eating sweets, and infrequently eating vegetables, etc.) were the significant risk factors related to worse total IPSS scores. For voiding symptoms, storage symptoms, and quality of life scores, 14, 12, and 12 dietary habits were identified as independent risk factors, respectively. Drinking four or more cups of water per day was related to worse storage symptoms (odds ratio [OR]=1.12, 95% confidence interval [95% CI]=1.09-1.22), but better voiding symptoms (OR=0.90, 95% CI=0.86-0.95). The newly developed dietary risk group showed that total and subtotal IPSS scores increased by the number of bad dietary habits in all age groups, respectively.

Conclusions: This study showed that dietary habits had a significant impact on LUTS. The amount of water consumed had a differential influence on each subdomain symptom.