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: Pentosan polysulfate sodium (PPS) is the only pharmacological intervention approved by the US Food and Drug Administration for treating interstitial cystitis (IC) to date. However, PPS may induce an adverse event, maculopathy, which can be a significant challenge. To determine the risk of PPS-induced maculopathy in patients with IC.

Materials and methods: PubMed and Embase were systematically searched through July 2024. Two authors also independently and manually searched all relevant studies. We included national level cohort studies using healthcare claim big data or real-world data with the following criteria: (1) patients diagnosed with IC; (2) interventions included PPS as an active treatment; (3) comparisons were specified as non-PPS interventions; and (4) the primary outcome of interest was the risk of maculopathy. The pairwise meta-analysis was performed to compare the PPS treatment group with control used in IC. The primary outcome measure was the hazard ratio (HR), odds ratio (OR), and proportional report ratio (PRR) of maculopathy after receiving the PPS treatment, as compared to non-PPS interventions.

Results: A comprehensive literature search was conducted, and identified 6 studies with 411,098 patients. The pooled risk for maculopathy due to PPS in patients with IC was significant (HR, 1.678; 95% confidence interval [95% CI], 1.066-2.642]). The heterogeneity test produced a Higgins' I-squared statistic, which was 83.6%. In the subgroup analysis of follow-up period of less than 5 years (HR, 1.285; 95% CI, 1.139-1.449) and more (HR, 1.341; 95% CI, 1.307-1.375) were statistically significant, indicating that the patients with IC who had a long-term PPS treatment were more likely to have maculopathy than the control groups.

Conclusions: This is the first study to investigate the relationship between PPS and its association with the risk of maculopathy in patients with IC through a systematic review and meta-analysis.

Purpose: Premature ejaculation (PE) is a commonly encountered male sexual dysfunction (MSD) with various definitions, diagnostic criteria, and treatment options, leading to significant heterogeneity and controversy in its management. This study aimed to explore the global practice patterns of the diagnosis and management of PE.

Materials and methods: A cross-sectional, global, online survey on PE was conducted using a questionnaire developed by an international cohort of experts. Results were analyzed using R version 4.1.2. Additionally, expert recommendations were formulated using a modified Delphi method.

Results: The survey was completed by 264 participants from 41 countries. The majority of respondents were below the age of 45 years and were urologists focusing on andrology and sexual health. PE diagnosis was primarily based (by 61.5%) on an intravaginal ejaculatory latency time of less than one minute. Lifelong PE was the most common category reported (47.7%), and most respondents (84.2%) observed ante-portas PE in less than 25% of cases. Distinguishing PE from erectile dysfunction was challenging for many respondents (60.7%). Diabetes mellitus was the most common comorbidity (17.1%). Pharmacological therapy was the most common treatment method (34.3%), with dapoxetine being the most preferred medication (37.9%). Surgical methods were infrequently used. Emerging treatments like hyaluronic acid gel glans augmentation were favored by only 11.7%. Patient satisfaction was the primary criterion for successful PE treatment (55.9%), and cost was a significant concern for many (35.5%).

Conclusions: This global survey highlights significant diversity in the diagnostic and treatment strategies for PE. Standard diagnostic criteria are generally accepted, off-label medication is widely used in therapy, and the role of surgery is still controversial. A multi-modal therapy approach, tailored to the patient's specific needs, is favored. Further research into the neurobiology of PE and the development of effective and safe options is crucial for improving the management of PE.

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: 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.

Sex and gender differences significantly influence the prevalence of obesity, patterns of fat distribution, metabolic health outcomes, and responses to treatment. While women generally exhibit a higher overall prevalence of obesity, men are more susceptible to visceral fat accumulation, which increases the risk of cardiovascular disease (CVD), type 2 diabetes, and other obesity-related complications. This review examines the biological, genetic, and sociocultural foundations of sex-based differences in obesity. Estrogen plays a crucial role in regulating subcutaneous fat deposition and brown adipose tissue (BAT) activity in women, whereas men tend to accumulate more visceral fat and demonstrate reduced BAT thermogenic function. Genetic investigations, including genome-wide association studies, have identified sex-specific loci associated with central adiposity and fat metabolism. Additionally, emerging research indicates distinct gut microbiome profiles between obese men and women. Sociocultural and psychosocial factors, such as gender norms, body image perception, and healthcare-seeking behavior, also influence the risk and management of obesity. Women are more inclined to seek treatment and participate in structured weight-loss programs, while men often face under diagnosis due to stigma and limited healthcare access. These sex-based differences are evident in comorbidities, with women being more vulnerable to obesity-related cancers and mental health disorders, whereas men experience an earlier onset of CVD and diabetes. Despite these distinctions, most obesity interventions lack gender-specific considerations. This review underscores the necessity for sex- and gender-tailored strategies in the prevention, diagnosis, and treatment of obesity. A more nuanced understanding of these differences can improve clinical outcomes and inform policy development for equitable obesity care.

Purpose: Higher annual center volume for artificial urinary sphincter (AUS) implantation is associated with improved survival without device removal. We assessed the impact of four centralization scenarios on AUS removal rates, patient travel burden, and workload redistribution to inform healthcare policy.

Materials and methods: We conducted a national, population-based cohort study using the Observapur database, which includes all men in France treated for prostate cancer or benign prostatic hyperplasia who underwent their first AUS implantation between 2006 and 2018. Patients were identified using reimbursement codes; 7,776 had complete geographic data. We modeled four centralization scenarios: (A) closure of very low-volume centers (<1 AUS procedure/year); (B) closure of low-volume centers (<5 procedures/year); (C) closure of centers performing <10 procedures/year with reallocation to high-volume centers (>20 procedures/year); and (D) closure of centers with the highest AUS removal rates. The primary outcome was the predicted 1- and 2-year AUS removal rate. Secondary outcomes included changes in travel distances and workload redistribution.

Results: Annual closures ranged from 25 centers (Scenario A) to 138 centers (Scenario C), affecting 381 (Scenario A) to 3,250 (Scenario C) patients. Travel distances increased from -1.8 km (Scenario A) to +43.6 km (Scenario C). AUS removal risk was reduced across all scenarios at 2 years: Scenario A (24.0%), B (25.2%), C (33.8%), and D (19.3%). Workload redistribution was highest in Scenario C, where 65 centers experienced a >50% increase in procedures.

Conclusions: Centralizing AUS implantation improves patient outcomes by reducing device removal rates, but the impact on additional workload varies. Scenario C offers the greatest survival benefit but imposes the highest travel and workload burden. Moderate centralization (Scenarios A or B) provides a balanced approach, improving outcomes while maintaining accessibility and feasibility.

Purpose: To assess the prevalence and predictors of absence of internal spermatic vein (ISV) reflux during varicocele embolization in infertile male.

Materials and methods: Demographic, clinical and laboratory data from 237 infertile males treated with percutaneous varicocele embolization between January 2017 and November 2024 were analyzed. Each patient underwent color Doppler ultrasound (CDUS) and semen analysis, both repeated 6 months post-procedure. Semen analysis values were based on 2021 World Health Organization reference criteria. Descriptive statistics and logistic regression models tested the association between predictors and embolization failure.

Results: Median age was 28 (IQR 22-34) years. Median preoperative semen parameters included sperm concentration of 22 (10.0-44.5) ×10⁶/mL, progressive motility of 35% (25%-40%), and normal morphology of 3% (2%-5%). Nearly half (48.9%) had CDUS grade ≥4 varicocele. Venous access was achieved via the right internal jugular vein in 46.4% and right common femoral vein in 53.6% of cases. Treatment was not performed in 1.3% of patients due to failure in catheterizing the spermatic vein and in 10.5% due to absence of ISV insufficiency during Valsalva. ISV reflux was more frequently absent in patients with grade III vs. grade IV-V varicocele (72.0% vs. 48.3%, p=0.02). After 2020, expert-driven ultrasound reduced the rate of phlebography-negative varicoceles (40% vs. 60%, p=0.03). Patients with confirmed varicocele had lower sperm concentration (20×10⁶/mL vs. 26 ×10⁶/mL, p=0.02). Grade III varicocele (OR 5.2; p=0.01) and higher sperm concentration (OR 1.1; p=0.03) were independent predictors of absent ISV reflux. Those with grade III varicocele and sperm count >20 ×10⁶/mL had a 96% likelihood of reflux absence.

Conclusions: Grade III varicocele and higher preoperative sperm concentration independently predicted the absence of ISV reflux, highlighting their role in patient selection. After expert-driven US implementation, the rate of no varicocele at phlebography significantly decreased.

Purpose: Little is known about Asian cisgender men's body image dissatisfaction (BID) and its variation among heterosexual, homosexual, and bisexual men. This study aimed to explore and better understand their specific BID concerns regarding various body parts and desired changes in physical attributes (DCPA), shedding light on the intersection of BID and sexual orientation among Asian men.

Materials and methods: A cross-sectional anonymous survey was conducted among participants recruited through the popular online forum, PTT, which attracts a large youth population in Taiwan. The inclusion criteria were: cisgender men; aged 18 years or older; Taiwanese citizens. The prevalence and levels of BID for nine specific body parts and prevalence of DCPA were compared by sexual orientation. Pairwise mean differences and multivariable logistic regression models, adjusting for age and body mass index, were estimated for subgroup comparisons.

Results: Of 632 participants, 376 self-identified as heterosexual, 185 as homosexual, and 71 as bisexual. The overall BID score and four body-part BID scores (i.e., facial features, skin, muscles, and penis) significantly differed by sexual orientation, with homosexual and bisexual men exhibiting higher BID than heterosexual men. Further DCPA analysis found significant sexual orientation differences regarding 27 DCPA items. Homosexual men most often reported desiring to change 18 of these DCPA, whereas bisexual men most often endorsed the remaining nine DCPA (e.g., an upward curve of the penis, a larger glans).

Conclusions: These findings reveal sexual orientation disparities in BID and DCPA, providing valuable insights for addressing body image concerns among Asian men.