World Journal of Mens Health最新文献

Purpose: The success of assisted reproductive technology (ART) relies heavily on semen parameters, and it is influenced by the length of the abstinence period. The World Health Organization (WHO) recommends a 2- to 7-day abstinence period. Even so, efficacy is still suboptimal. Thus, this study aims to determine whether shorter abstinence periods (<2 days) can improve semen parameters.

Materials and methods: This study is a systematic review and meta-analysis. A literature search was performed across five databases: PubMed, Embase, ProQuest, Scopus, and Wiley Online Library using the PICO format. Retrieved articles were assessed according to eligibility criteria and the PRISMA flow diagram. Those eligible for quantitative analysis were assessed using forest plots. Risks of bias were tested using the Newcastle-Ottawa Scale.

Results: A total of 22 studies and 31,640 samples were included. Studies showed that short abstinence periods significantly reduced semen volume (mean difference [MD] -0.83, p<0.01), sperm concentration (MD -8.39, p<0.01), and DNA fragmentation (MD -3.82, p<0.01). No differences in sperm morphology were identified. Meanwhile, the overall effect for total (MD 2.30, p<0.05) and progressive motile sperm (MD 2.18, p<0.01) was significantly increased. Subgroup analysis on oligospermia patients revealed a significant increase in normal sperm morphology (MD 1.64, p<0.01) along with reduced DNA fragmentation (MD -3.30, p<0.05). However, no significant changes were seen among other sperm parameters.

Conclusions: In conclusion, our findings suggest a shorter abstinence period could be beneficial due to its effect on sperm motility and DNA fragmentation. Additionally, oligospermia patients will benefit from improved sperm morphology. These findings can provide insight for future guidelines to promote a shorter abstinence period for improving ART outcomes.

Purpose: To assess the effects of testosterone replacement therapy (TRT) compared to placebo or other medical treatments in men with sexual dysfunction.

Materials and methods: We performed a comprehensive search with no restrictions on publication language or status up to 29 August 2023. We only included randomized controlled trials (RCTs).

Results: We identified 43 studies with 11,419 randomized participants. We found that TRT likely results in little to no difference in erectile function assessed with the IIEF-EF (mean difference [MD]: 2.37, 95% confidence interval [CI]: 1.67 to 3.08; I²=0%; 6 RCTs, 2016 participants; moderate-certainty evidence) compared to placebo. TRT likely results in little to no change in sexual quality of life assessed with the Aging Males' Symptoms scale (MD: -2.31, 95% CI: -3.63 to -1.00; I²=0%; 5 RCTs, 1,030 participants; moderate-certainty evidence) compared to placebo. TRT also likely results in little to no difference in cardiovascular mortality (risk ratio: 0.83, 95% CI: 0.21 to 3.26; I²=0%; 10 RCTs, 3,525 participants; moderate-certainty evidence) compared to placebo. TRT also likely results in little to no difference in treatment withdrawal due to adverse events, prostate-related events, or lower urinary tract symptoms.

Conclusions: TRT for men with sexual dysfunction showed no difference in erectile function, sexual quality of life, or cardiovascular mortality compared to placebo. Furthermore, it also appears to no difference in treatment withdrawals due to adverse events, prostate-related events, or lower urinary tract symptoms.

Leukocytospermia, defined as a leukocyte concentration in semen exceeding 1×10⁶ leukocytes/mL, significantly impacts male reproductive health by affecting sperm functionality and fertility outcomes. This condition arises from various etiological factors, including infections, autoimmune responses, lifestyle factors, and other physiological conditions. Adverse effects on sperm associated with leukocytospermia include acrosome damage and abnormalities in the sperm midpiece and tail. The review explores the complex interplay between leukocytospermia and oxidative stress, emphasizing the harmful effects on sperm DNA integrity and overall sperm quality. Due to the multifactorial nature of leukocytospermia, diagnosing this condition presents several challenges. Effective management strategies discussed include the use of antibiotics, anti-inflammatory agents, and assisted reproductive technologies. Diagnostic methods range from traditional peroxidase staining to more advanced techniques such as immunocytochemistry and flow cytometry, which offer higher sensitivity and specificity. Infections of the male genital tract, particularly male accessory gland infection and male genital tract infection, play a significant role in the etiology of leukocytospermia. These infections lead to an inflammatory response, resulting in leukocyte infiltration into the semen. Systemic conditions like diabetes mellitus and autoimmune disorders also contribute to leukocytospermia by provoking inflammatory responses that facilitate leukocyte presence in semen. This review underscores the importance of a comprehensive diagnostic approach that includes patient history, physical examination, and advanced laboratory tests. Treatment is tailored to the identified underlying cause, whether infectious or non-infectious. Lifestyle modifications, such as reducing stress, improving diet, and avoiding environmental toxins, are also recommended to enhance semen quality. For clinicians, this review provides a concise yet thorough overview of leukocytospermia, integrating the latest research findings and clinical insights to aid in the effective management of this condition, ultimately aiming to improve patient care in male reproductive health.

There has been much controversy about the effectiveness of prostate cancer (PC) screening in the treatment of PC. Recently, with the increase in advanced and metastatic PCs, prostate-specific antigen (PSA) screening is again emphasized. However, no systematic study has examined the factors influencing PSA screening behavior. This study highlights the importance of socioeconomic factors, such as income, education, marital status, insurance status, and medical accessibility, in PC screening behavior. We conducted a search for articles related to PSA screening through Cochrane, Embase, and PubMed, and we chose 40 articles. And we divided factors associated with PSA screening into two groups, such as individual characteristic factors and socioeconomic factor. In addition to identifying individual factors that could affect both medical providers and patients, this review will also highlight the importance of socioeconomic factors including income, education, marital status, insurance status, and medical accessibility affecting PC screening behavior. Future guidelines should integrate these socioeconomic factors, particularly for patients with unfavorable socioeconomic status.

Purpose: Evidence of an association between leukocyte telomere length (LTL) and prostate cancer (PCa) is accumulating; however, their shared genetic basis remains unclear.

Materials and methods: Using summary statistics obtained from the genome-wide association study (GWAS), we quantified the global and local genetic correlations between two traits. Subsequently, we identified potential pleiotropic loci, common tissue-enriched regions, and risk gene loci while inferring assumed causal relationships.

Results: Our study demonstrated a global genetic correlation between LTL and PCa (genetic correlation=0.066, p=0.017), which was further confirmed in local genomic regions. Cross-trait GWAS meta-analysis revealed 44 shared loci, including 10 novel pleiotropic single nucleotide polymorphisms appearing concurrently in significant local genetic correlation regions. Notably, two new loci (rs9419958; rs3730668) were additionally validated to co-localize. For the first time, we identified a significant shared genetic enrichment of both traits in the small intestine tissue at the terminal ileum, with functional genes in this region affecting both LTL and PCa. Concurrently, Mendelian randomization analysis indicated a positive causal relationship between LTL and PCa.

Conclusions: In conclusion, our study makes a significant contribution to the ongoing debate concerning the potential association between longer LTL and a higher risk of PCa. Additionally, we provide new evidence for the development of therapeutic targets for PCa and propose new directions for future risk prediction in this regard.

Purpose: Ferroptosis is a type of iron-dependent regulated cell death characterized by increased bioavailability of redox-active iron, loss of GPX4 antioxidant capacity, and oxidation of polyunsaturated fatty acid-containing phospholipids mediated by reactive oxygen species (ROS). The aim of this study was to evaluate the effect of oxidative stress induced by arachidonic acid (AA) on ferroptotic cell death in human spermatozoa.

Materials and methods: Spermatozoa from normozoospermic donors were exposed to AA (5, 25, and 50 µM) for 1 hour at 37 ℃, including an untreated control. Oxidative stress was confirmed by evaluation of cytosolic and mitochondrial ROS production, viability, mitochondrial membrane potential (ΔΨm) and motility. Subsequently, molecular markers of ferroptosis including iron content, levels of GPX4, SLC7A11, ACSL4, IREB2 and lipid peroxidation were evaluated. The analyses were carried out using either flow cytometry, a microplate reader or confocal laser microscopy.

Results: AA-induced oxidative stress showed increased cytosolic and mitochondrial ROS production accompanied by impairedΔΨm, viability and motility in human spermatozoa. These results were associated with biochemical and molecular markers related to ferroptotic cell death including an increase in iron content in the form of ferrous (Fe²⁺) ions, SLC7A11, ACSL4, IREB2, a decrease in the level of GPX4, and an increase in the level of lipid peroxidation compared to the untreated control.

Conclusions: This study revealed that AA-induced oxidative stress induces cell death with biochemical characteristics of ferroptosis in human spermatozoa, demonstrating another mechanism of alteration of sperm function induced by oxidative stress and could establish new therapeutic objectives to prevent the decrease in sperm quality mediated by oxidative stress.

Purpose: Intracavernosal injections are used to treat erectile dysfunction. Patient compliance with intracavernosal injections is required for success, though factors influencing compliance are unknown. This study aimed to identify factors that influence compliance with intracavernosal injections among men with erectile dysfunction.

Materials and methods: A retrospective analysis was conducted using men who were prescribed intracavernosal injections between 2017 and 2022 at an academic medical center in a cosmopolitan area. Custom Python code was used to capture the first and last prescription refill events, and the duration of intracavernosal injection use was calculated. Additional patientrelated data, including demographics and comorbidities, were gathered through chart reviews. Cox Proportional Hazards Regression models were used to evaluate the effects of predictor variables on the duration of intracavernosal injection use.

Results: A total of 4,072 patients were included in the analysis. The study revealed that age significantly predicted discontinuation of intracavernosal injection therapy, showing an elevated hazard ratio of 1.007 for each additional year of age (p<0.001). Men who preferred to speak Spanish as their primary language was a significant predictor of discontinuation of injection therapy, showing a hazard ratio of 1.163 compared to those who preferred English (p=0.004). Men with a history of prostate cancer treatment stayed on treatment for 80 days fewer on average than those without (p=0.002).

Conclusions: Older age, prior history of prostate cancer treatment, and men who preferred to speak Spanish were all identified as factors potentially associated with reduced continuation of intracavernosal injection therapy for erectile dysfunction. Understanding these factors can help healthcare providers in both patient selection and counseling when discussing treatment options for erectile dysfunction.

Purpose: Cardiovascular disease (CVD) is more prevalent in men than women, but the mechanisms responsible for this are not fully understood. We aimed to evaluate differences in trimethylamine (TMA), a microbial metabolite and its oxidized form, trimethylamine N-oxide (TMAO), which is thought to promote atherosclerosis, between men and women with coronary heart disease (CHD), using as a reference a non-CVD population.

Materials and methods: This study was carried out within the framework of the CORDIOPREV study (NCT00924937; June 19, 2009), a clinical trial which included 827 men and 175 women with CHD, with a non-CVD population of 375 individuals (270 men and 105 women) as a reference group. Plasma TMA and TMAO were measured by HPLC-MS/MS. The carotid study was ultrasonically assessed bilaterally by the quantification of intima-media thickness of both common carotid arteries (IMT-CC).

Results: We found higher TMAO levels and TMAO/TMA ratio in CHD men than CHD women (p=0.034 and p=0.026, respectively). No TMA sex differences were found in CHD patients. The TMA and TMAO levels and TMAO/TMA ratio were lower, and no differences between sexes were found in the non-CVD population. TMAO levels in CHD patients were consistent with higher IMT-CC and more carotid plaques (p=0.032 and p=0.037, respectively) and lower cholesterol efflux in CHD men than CHD women (p<0.001).

Conclusions: Our results suggest that CHD men have augmented TMAO levels compared with CHD women, presumably as a consequence of higher rate of TMA to TMAO oxidation, which could be associated with CVD, as these sex differences are not observed in a non-CVD population.

Purpose: In this systematic review and meta-analysis, we investigated assisted reproductive technology (ART) success in infertile men with clinical varicocele and abnormal semen parameters who underwent varicocele repair (VR) before the ART procedure as compared to those who did not.

Materials and methods: A comprehensive search of the Scopus, PubMed, Embase, and Cochrane Library databases was conducted using a specific query string to identify studies examining the impact of VR on ART outcomes, including fertilization rate, clinical pregnancy, pregnancy loss, and live-birth rate, until October 2023. Outcomes were analyzed based on the type of ART. Studies on VR in infertile men with non-obstructive azoospermia and those who underwent ART only due to female factor infertility were excluded from the study.

Results: Out of 1,554 articles reviewed, only 9 met the inclusion criteria for the study. All the included articles were observational studies. The variability in study quality in the included literature resulted in a moderate overall risk of bias. Data analysis showed that for intrauterine insemination, there was no difference in the clinical pregnancy rate (odds ratio [OR] 1.01, 95% confidence interval [CI]: 0.42, 2.45; p=0.97). However, for intracytoplasmic sperm injection (ICSI), men with VR showed a significant improvement in fertilization rate (mean difference 10.9, 95% CI: 5.94, 15.89; p<0.01), clinical pregnancy rate (OR 1.38, 95% CI: 1.07, 1.78; p=0.01) and live-birth rate (OR 2.07, 95% CI: 1.45, 2.97; p<0.01), compared to men who did not undergo VR.

Conclusions: The findings of this systematic review and meta-analysis suggest that VR has a positive impact on pregnancy and live birth rates after ICSI. However, biases like small sample sizes and heterogeneous populations highlight the need for larger, well-designed prospective studies to validate these findings.

Purpose: This study aimed to examine the therapeutic effects of injection of conditioned medium of adipose-derived mesenchymal stem cells (ADMSC-CM) in a surgically created varicocele model in comparison with varicocelectomy.

Materials and methods: Twenty-eight male Wistar Albino rats were randomly divided into four groups: sham group, varicocele group, varicocelectomy group, and ADMSC-CM injection group. Sperm parameters were analyzed in samples taken from the epididymis after treatment. Malondialdehyde and superoxide dismutase (SOD) levels in blood samples were examined by biochemical analysis. The testicular tissues were stained with hematoxylin-eosin for histological examination (Johnsen's Score). Additionally, Western Blot analyzes were performed to detect Claudin-11 levels, the functional protein of the blood-testis barrier, in testicular tissues.

Results: Varicocelectomy and ADMSC-CM treatments significantly improved mean sperm parameters (concentration, progressive motility, motility, normal sperm morphology) (p≤0.05 for all). Both treatment groups had increased SOD levels along with a decrease in malondialdehyde levels (p≤0.05 for all). No significant difference was observed between the ADMSC-CM group and the varicocelectomy group in preserving normal testicular histology according to Johnsen's Score (p=0.114). Levels of Claudin-11 were significantly higher in the varicocelectomy and ADMSC-CM groups compared to the varicocele group (p≤0.05 for all).

Conclusions: The therapeutic effects of ADMSC-CM in varicocele model may involve secretion of anti-inflammatory and regenerative factors from ADMSC. ADMSC-CM injection appears to be a promising new strategy in the treatment of varicocele.