World Journal of Mens Health最新文献

Purpose: We aimed to perform a meta-analysis to assess the evolution of sperm parameters and some sex hormones in obese males with idiopathic infertility who underwent bariatric surgery.

Materials and methods: We systematically searched MEDLINE and Embase databases for studies that documented sperm parameters and sex hormones before and after surgery.

Results: Twelve studies have been included with a total of 285 patients. The heterogeneity was deemed moderate, with an I² value of 28%. The random effects model analysis indicated a statistically significant negative association between weight loss surgery and sperm concentration. The standardized mean difference (SMD) was -5.44, with a 95% confidence interval (CI) ranging from -7.65 to -3.22. The p-value was <0.0001. Twelve articles recorded the sperm volume before and after undergoing bariatric surgery. The analysis revealed no statistically significant alteration in sperm volume following surgery (SMD=-0.16, 95% CI -0.53-0.22; p=0.42). We assessed the total sperm count available in seven studies. The analysis did not prove any significant difference between groups (SMD=12.29, 95% CI -15.01-39.58; p=0.38). Evaluated in five studies, semen pH did not evolve significantly (SMD=-0.02, 95% CI -0.12-0.09; p=0.76). Also, total motility did not improve significantly (SMD=0.61, CI -2.86-4.09; p=0.73), and the included studies had a low heterogeneity (I²=29%). Following bariatric surgery, there was a significant increase in levels of both total testosterone and sex hormone-binding globulin (SHBG) (SMD=-6.40, 95% CI -9.12 to -3.67, p<0.00001 for total testosterone and -22.22, 95% CI -26.11 to -18.33, p<0.00001 for SHBG).

Conclusions: Our data suggests that bariatric surgery does not provide any benefits in terms of sperm parameters. Obesity likely affects fertility through processes that are not well understood.

Purpose: Suicide is a substantial public health concern, and there are a variety of contributing factors. Prostate cancer is known to be a disease at high risk of suicide regardless of country and age. Nonetheless, comprehensive information about associated risk levels and underlying determinants remains limited. To systematically evaluate the suicide risk in prostate cancer patients compared to control by systematic review and meta-analysis.

Materials and methods: PubMed, Embase, and the Cochrane Library were searched from the earliest available indexing date through May 2024. The criteria for selecting the subjects were as follows: (1) studies including patients who had prostate cancer, (2) intervention was not specified, (3) comparison was made with people without prostate cancer selected as the control group, and (4) outcomes were measured as standardized mortality ratio (SMR) or relative risk (RR), or hazard ratio (HR) of suicide in prostate cancer. Random-effects model were used to estimate pooled effect sizes. Meta-regression analyses were conducted to identify the potential moderator effects between prostate cancer and the risk of suicide.

Results: A systematic review and meta-analysis of these 25 studies that included a total of 4,987,941 participants were performed. The pooled SMR for overall suicide risk in prostate cancer compared with control groups was 1.251 (95% confidence interval [95% CI]: 1.120-1.383). The pooled RR or HR was 1.712 (95% CI: 1.306-2.243). The suicide risk of prostate cancer patients showed statistically significant in all cases of SMR and RR or HR. The suicide risk was also significantly higher in most subgroup analyses according to age and research follow-up period.

Conclusions: The findings of this systematic review and meta-analysis support the association between prostate cancer and increased risk of suicidal tendencies. Follow-up for prostate cancer patients should be highly integrated with psychiatric and psychological care to improve the psychosocial function of patients.

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: Sex hormones affect development and prognosis of gastric cancer (GC). This study aimed to compare the sex hormone receptor expression between control and GC, and to evaluate its correlation with patient characteristics.

Materials and methods: 110 patients (74 with GC, 36 controls) underwent immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR) for estrogen receptors (ERs) α and β and androgen receptor (AR). The effect of ERs and AR on the clinicopathological and tumor characteristics were analyzed.

Results: The positive rate of ERα, ERβ, and AR in GC tissue was 64.9%, 78.4%, and 60.8% by IHC and 41.4%, 27.6%, and 48.3% in RT-PCR respectively. In control, the positive rate of those was 16.7%, 80.6%, and 38.9% by IHC and 22.2%, 58.3%, and 19.4% in RT-PCR respectively. The IHC and RT-PCR results showed concordance with each other, and ERα and AR expressions were positively correlated with cancer, while ERβ showed the opposite pattern. ERα expression was correlated with Helicobacter pylori negativity (p<0.001), diffuse or mixed-type histology (p=0.014), and undifferentiated histology (p<0.001), and AR expression was related to H. pylori negativity (p<0.001), cardiac cancer (p=0.040), and undifferentiated histology (p<0.001). The higher expression rate of ERα in males and that of AR in females seemed to be related with cancer, showing sex differences.

Conclusions: The expression rates of ERα, ERβ, and AR were different depending on sex, histologic type and H. pylori infection status, which may explain sex-based differences in GC.

Purpose: To evaluate the outcomes of gonadotropin therapy (GT) using human chorionic gonadotropin (hCG) and recombinant follicle-stimulating hormone (rFSH) for inducing spermatogenesis in men with prepubertal-onset hypogonadotropic hypogonadism (HH), compare these outcomes between men with congenital and acquired etiologies, and identify factors associated with successful spermatogenesis.

Materials and methods: This retrospective study included 65 men with prepubertal-onset HH who underwent GT to induce spermatogenesis. Baseline assessments included serum luteinizing hormone (LH), FSH, and testosterone levels, and testicular volume (TV) measurements. Treatment began with hCG injections administered thrice weekly for four weeks, followed by combined rFSH and hCG therapy. Serum testosterone levels were measured after hCG pretreatment. TV and semen analyses were evaluated every three months following the rFSH addition. Successful spermatogenesis was defined as the detection of at least one sperm in a semen sample.

Results: Median baseline testosterone, LH, and FSH levels were 0.10 ng/mL, 0.05 IU/L, and 0.50 IU/L, respectively, with a median baseline TV of 4.0 mL. After hCG pretreatment, median serum testosterone level increased to 3.16 ng/mL. Treatment outcomes were analyzed in 50 patients who continued GT until spermatogenesis induction or for at least 12-months. Following therapy, median TV increased to 9.0 mL. Spermatogenesis was successfully induced in 41 patients (82.0%), with a median induction time of 7.5-months. In these patients, median sperm concentration, total motility, and morphology were 5.2×10⁶/mL, 35%, and 4%, respectively. Success of spermatogenesis induction did not differ between patients with congenital and acquired HH etiologies. Larger baseline TV was the only predictor of successful outcomes. Earlier spermatogenesis was correlated with larger baseline TV. Among six patients seeking conception, four achieved conception.

Conclusions: GT can successfully induce spermatogenesis in 82% of patients with prepubertal-onset HH, regardless of etiology. Baseline TV was confirmed as a predictor of successful outcomes and earlier spermatogenesis induction.

Acute testicular torsion (TT) in children is one of the most common urogenital emergencies, which potentially causes serious clinical outcome including testicular dysfunction, infertility, orchiectomy. Clinically, surgical correction must be performed within 6 hours to preserve the testis. Unfortunately, most children with acute TT came in after the golden time of 6 hours. As a result, testicular function significantly decreases due to ischemic or ischemic-reperfusion (I/R) injury to the testis, and in the worst case, orchiectomy may be required. Acute TT is well known to cause testicular damage through I/R injury mechanism. Ischemic injury can directly lead to tissue damage and organ dysfunction. Following testicular detorsion, testicular reperfusion causes also more severe damage than that induced by ischemia. The immediate restoration of blood flow is the primary therapeutic approach to treat TT. A number of previous experimental studies of TT in animals have been suggested a model of I/R injury in humans, and the use of different types medication and their role in decreasing cellular damage following reperfusion. However, there are currently no effective medications available for the clinical practice. Besides, according to the available evidence, the pharmacological mechanism of the currently known agents to avoid or reduce I/R injury, as well as their toxicity, side effects, safe doses and other issues, remain to be further elucidated in future preclinical and clinical trials. Based on recently published literatures, the authors would like to review the molecular mechanisms and target drug development of testis damage in the I/R injury of acute TT from a pediatric urological perspective.

Purpose: This study explored the anti-inflammatory and analgesic mechanisms of intravesical cannabidiol (CBD) in cyclophosphamide (CYP)-induced interstitial cystitis/bladder pain syndrome (IC/BPS) rats.

Materials and methods: Female Sprague-Dawley rats were divided into four groups of control, IC/BPS, IC/BPS+10 mg/kg CBD, and IC/BPS+100 mg/kg CBD (n=5/group). IC/BPS was induced by CYP injections, followed by intravesical CBD administration. Pain sensitivity and bladder function were assessed via Von Frey tests and cystometrograms. Histological, Western blot, and immunofluorescence analyses were performed on bladder tissues. SV-HUC1 cells were analyzed using western blot and scratch assays.

Results: CBD improved bladder function, reducing instability, prolonging intercontractile intervals, and enhancing detrusor contraction pressure. The CBD 100 mg/kg group showed greater pain relief in Von Frey tests compared with other groups. Histology revealed reduced inflammation, mast cell infiltration, and fibrosis in bladder tissues. CBD decreased TNF-α, COX2, IL-6, and TRPV1 levels and inhibited the TLR4/MyD88/pNF-κB pathway. In SV-HUC1 cells, CBD suppressed epithelial injury and downregulated TRPV1, TLR4, MyD88, p-NF-κB, and Bax/Bcl-xL, demonstrating anti-inflammatory and anti-apoptotic effects.

Conclusions: Intravesical CBD alleviates inflammation by inhibiting the TLR4/MyD88/pNF-κB pathway, reduces neuropathic pain via TRPV1 channels, and improves cell apoptosis and migration in CYP-induced IC/BPS model animals.

Purpose: Esophageal cancer is a predominantly male disease. However, the sex differences associated with esophageal cancer have not been thoroughly investigated. This study aimed to evaluate the differences between esophageal cancer in males and females in the Korean population.

Materials and methods: We assessed patients diagnosed with esophageal cancer between 2005 and 2015 at a tertiary referral center. The clinical features of patients, histopathologic characteristics of tumors, and treatment and survival outcomes were compared between male and female patients.

Results: We enrolled 2,068 patients, comprising 1,924 (93.0%) males and 144 (7.0%) females. The median age at diagnosis was younger for females than males (65 vs. 63 years, p=0.004). Squamous cell carcinoma was the predominant pathological type (99.0% in males and 93.1% in females); however, the proportion of adenocarcinoma cases was higher in females than males (0.8% vs. 5.6%, p<0.001). Multivariate analysis indicated favorable overall survival for female patients (hazard ratio [HR], 0.685; 95% confidence interval [CI], 0.548-0.857) and patients with high body mass index (≥25 kg/m², HR, 0.432; 95% CI, 0.355-0.526), and in early tumor stage (Stage 4, HR, 12.684; 95% CI, 7.451-21.591). The 5-year overall survival (44.8% vs. 53.5%, p=0.016) and recurrence-free survival rates (74.0% vs. 84.3%, p=0.036) were higher in females than in males.

Conclusions: We found significant sex differences in esophageal cancer among the Korean population, with female patients demonstrating distinct clinical characteristics and more favorable survival outcomes compared to male patients. These findings underscore the importance of considering sex-specific factors in the management and prognosis of esophageal cancer.

Varicocele is a common urological disease and varicocele has long been recognized as a condition that could affect male fertility. Although varicocele is the most common surgically correctable cause of male infertility, not all varicoceles require treatment. Because the appropriate diagnosis and management of varicoceles remain less clear in many patients, it is important to diagnose clinically significant varicoceles that can benefit from treatment. Even in the era of widespread assisted reproductive techniques, varicocele has substantial implications in infertility treatment. The Korean Society for Sexual Medicine and Andrology (KSSMA) has sought to develop guidelines for varicocele treatment tailored to clinical practices in Korea. This review summarizes the latest evidence for varicocele treatment, including clinical practice guidelines from various international professional societies, and represents the consensus opinion of experts within the KSSMA.