World Journal of Mens Health最新文献

Purpose: To evaluate the efficacy and safety of Prunella vulgaris (PV) extract in men with lower urinary tract symptoms (LUTS).

Materials and methods: In this 12-week, randomized, double-blind, placebo-controlled clinical trial, 80 men aged 40-75 years with moderate LUTS (International Prostate Symptom Score [IPSS] ≥8 and ≤19) were randomized to receive PV extract (600 mg/day) or placebo. The primary outcome was the change in total IPSS from baseline to week 12. Secondary outcomes included changes in IPSS subscores, quality of life (QoL), uroflowmetry, and prostate volume. Safety was assessed by adverse events and laboratory parameters.

Results: A total of 75 participants completed the trial (PV group, n=39; placebo group, n=36). At week 12, the PV group showed a significantly greater reduction in total IPSS compared to placebo (-5.2±4.6 vs. -2.8±4.3; p=0.014). Significant improvements were also observed in voiding subscore (-3.3±3.7 vs. -1.6±3.2; p=0.020) and QoL (-1.2±1.4 vs. -0.7±1.3; p=0.044). There were no significant differences in maximum flow rate or prostate volume. The incidence of adverse events was low and similar between groups.

Conclusions: PV extract improved LUTS and QoL in men with LUTS was well tolerated. These findings suggest its potential as a safe and effective phytotherapeutic option for managing male LUTS.

Purpose: This study aimed to investigate the biomolecular effects of finasteride on rat brain tissue during and after discontinuation.

Materials and methods: Twenty-four 14-week-old male Wistar rats were randomly assigned to three groups: Group 1 (control), Group 2 (finasteride-treated), and Group 3 (finasteride-withdrawn). Serum testosterone and dihydrotestosterone levels were measured at the end of the study period. Brain tissues were analyzed using real-time polymerase chain reaction (RT-PCR), western blotting, and immunohistochemistry, with c-Fos employed as a non-specific biomarker of neural cellular activity.

Results: In Group 2, serum dihydrotestosterone levels, 5-alpha reductase type 1 protein expression, and c-Fos phosphorylation showed a decreasing trend (p=0.067, p=0.015, p=0.123, respectively, versus Group 1), but rebounded in Group 3 (p=0.044, p=0.033, p=0.049, respectively, versus Group 2). In contrast, 5-alpha reductase type 2 protein expression was significantly reduced in Group 2 (p=0.017 vs. group 1) and remained suppressed in Group 3 (p=0.029 versus Group 1, p>0.999 versus Group 2). The mean intensity of immunohistochemistry revealed decreased 5-alpha reductase type 2 and c-Fos protein levels in Group 2 (p=0.008 and p=0.017, respectively). After withdrawal, c-Fos protein levels recovered in Group 3 (p=0.031 versus Group 2), whereas 5-alpha reductase type 2 levels remained unchanged (p=0.682 versus Group 2).

Conclusions: Suppression of c-Fos-related neural activity in rat brain tissue could be temporarily maximized by both type 1 and type 2 5-alpha reductase inhibition by finasteride administration, and this suppression could be relieved by the restoration of 5-alpha reductase type 1 expression after finasteride discontinuation.

Purpose: To investigate the relationship between immature spermatogenic cells (IGC) in semen and sperm retrieval (SR) rate of microdissection testicular sperm extraction (m-TESE) in patients with non-obstructive azoospermia (NOA).

Materials and methods: 95 patients with NOA who underwent m-TESE between 2019 and 2024 were included. These patients underwent comprehensive clinical, laboratory, and histopathological evaluations. Multivariable logistic regression analysis was used to explore the association between several variables and m-TESE success rate in patients with NOA, and a predictive model was developed. Model validity and stability were assessed through five-fold cross-validation.

Results: A positive SR was observed in 40.0% of patients undergoing m-TESE. Multivariate logistic regression analysis identified mean testicular volume (TV) (p=0.023, odds ratio [OR]=1.382, 95% confidence interval [CI]=1.046-1.826, area under the ROC curve [AUC]=0.681), IGC in semen (p<0.001, OR=13.757, 95% CI=3.663-51.671, AUC=0.785), and Johnsen score (p=0.005, OR=2.642, 95% CI=1.339-5.213, AUC=0.707) as significant predictors of positive SR, with IGC demonstrating the strongest predictive value. Four predictive models were constructed using the three factors: models A (Mean TV+Johnsen score, AUC=0.726±0.039), B (Mean TV+IGC, AUC=0.859±0.021), C (Johnsen score+IGC, AUC=0.864±0.029), and D (Mean TV, Johnsen score+IGC, AUC=0.874±0.028). Models showed significant improvements in predictive performance. The validity and stability of models B, C, and D containing IGC were better than those of model A without IGC (p<0.05).

Conclusion: The presence of IGC in the semen of patients with NOA may serve as a predictive factor for successful SR using m-TESE. Models incorporating IGC significantly enhanced stability and validity, highlighting their potential clinical utility.

Purpose: Literature on the trends in the disease burden of HIV and other sexually transmitted infections (STIs) in older men remains sparse. We aim to investigate the burden and trends of these diseases at the global, regional, and national levels.

Materials and methods: Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were used to analyze the age-standardized incidence rate (ASIR) and the age-standardized disability-adjusted life-years rate (ASDR) due to HIV and other STIs in older men. We calculated the average annual percentage change (AAPC) to analyze the 1990-2021 temporal trends.

Results: Globally, the ASIR of HIV in older men showed a downward trend (AAPC, -1.99; 95% confidence interval [CI], -2.11 to -1.86). The ASDR of HIV increased from 1990 to 2004, and then gradually declined after reaching a peak in 2004. The increase in the ASIR of other STIs between 1990 and 2021 was slight (AAPC, 0.07; 95% CI, 0.05 to 0.09) but the ASDR of other STIs decreased substantially (AAPC, -1.42; 95% CI, -1.48 to -1.36). Regionally, Sub-Saharan Africa and Caribbean had the highest ASIR and ASDR of HIV and other STIs. The largest regional-level increase in the ASIR of HIV between 1990 and 2021 was observed in Oceania (AAPC, 10.6; 95% CI, 9.43 to 11.79). Nationally, the trends in the burden of these diseases in older men varied significantly across 204 countries and territories.

Conclusions: Significant advancement has been achieved in alleviating the global burden caused by HIV and other STIs over the past three decades. With population growth and aging, HIV and other STIs in older men remain health challenges worldwide. Our findings are useful for policymakers to understand the epidemiology of these diseases and establish efficient strategies for prevention.

Purpose: To evaluate the effectiveness of a cross-reference system (CRS) in improving the reproducibility of membranous urethral length (MUL) measurements by reducing the interrater variability.

Materials and methods: A total of 100 patients who underwent robot-assisted radical prostatectomy (RARP) and preoperative MRI were enrolled. MUL measurements were independently performed by two urologists with different levels of experience, both before and after CRS implementation. The radiological reference MUL served as the baseline for comparison. Interrater variability and agreement with the radiological reference were assessed.

Results: Mean MUL values measured by both raters and the radiological reference showed no significant difference after CRS implementation. However, interrater measurement error was substantially reduced after CRS implementation, and Bland-Altman analysis demonstrated markedly narrower limits of agreement. At 6 months, preoperative MUL showed no significant association with continence (area under the curve [AUC] and Brier score unaffected by CRS). By 12 months, MUL remained a significant predictor of continence (unadjusted odds ratio [OR]: 0.79, p=0.003; adjusted OR: 0.76, p=0.001), and CRS modestly improved discrimination (ΔAUC +0.02) and calibration (ΔBrier: -0.01).

Conclusions: A systematic CRS-based measurement approach improved MUL reproducibility by reducing interrater variability. These findings emphasize the need for standardized MUL measurements to enhance the anatomical accuracy and continence prediction after RARP.

Purpose: As an emerging therapeutic option for erectile dysfunction (ED), micro-energy treatment (MET) including low-intensity extracorporeal shockwave therapy, low-intensity pulsed ultrasound, and electromagnetic fields, has attracted increasing attention. We summarized the current literature to assess the therapeutic effect and find optimal treatment scheme of MET for ED.

Materials and methods: A comprehensive search of PubMed, Web of Science, and Embase up to April 2025 was performed. Studies reporting on ED treated with various METs were included. The International Index of Erectile Function and the Erection Hardness Score were used to evaluate the therapeutic effect. Subgroup analysis was performed to explore the influence of energy type, treatment course, treatment frequency, patients' characteristics, combination therapy, and setup parameters on efficacy.

Results: A total of 32 randomized controlled trials with 1,986 patients were enrolled. MET group demonstrated better erectile function than control at 1, 3, 6, and 12 months post-treatment (p<0.05). No significant difference was observed among different energy types, treatment courses, or setup parameters. Patients' comorbidities and responsiveness to phosphodiesterase 5 inhibitors did not influence efficacy. Treatment twice weekly was superior to once (p<0.05). Vasculogenic ED responded better than neurogenic ED (p<0.05). Combination with other basic therapies enhanced efficacy of MET (p<0.05).

Conclusions: MET was effective for various types of ED, especially vasculogenic ones, with efficacy lasting up to 1 year and no discrepancy among different energy forms. Twice-weekly treatment with course no more than 4 weeks was an appropriate therapeutic protocol. Moreover, combining MET with other therapies could produce synergistic effect.

Purpose: Artificial intelligence (AI) tools have demonstrated considerable potential for the dissemination of medical information. However, variability may exist in the quality and readability of prostate-cancer-related content generated by different AI platforms. This study aimed to evaluate the quality, accuracy, and readability of prostate-cancer-related medical information produced by ChatGPT and DeepSeek.

Materials and methods: Frequently asked questions related to prostate cancer were collected from the American Cancer Society website, ChatGPT, and DeepSeek. Three urologists with over 10 years of clinical experience reviewed and confirmed the relevance of the selected questions. The Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) was used to assess the understandability and actionability of AI-generated content. The DISCERN instrument was used to evaluate the quality of the treatment-related information. Additionally, readability was assessed using four established indices: Automated Readability Index (ARI), Flesch Reading Ease Score, Gunning Fog Index, and Flesch-Kincaid Grade Level.

Results: No statistically significant differences were observed between ChatGPT and DeepSeek in PEMAT-P scores (70.66±8.13 vs. 69.35±8.83) or DISCERN scores (59.07±3.39 vs. 58.88±3.66) (p>0.05). However, the ARI for DeepSeek was higher than that for ChatGPT (12.63±1.42 vs. 10.85±1.93, p<0.001), indicating greater textual complexity and reading difficulty.

Conclusions: AI tools, such as ChatGPT and DeepSeek, hold significant potential for enhancing patient education and disseminating medical information on prostate cancer. Nevertheless, further refinement of content quality and language clarity is needed to prevent potential misunderstandings, decisional uncertainty, and anxiety among patients due to difficulty in comprehension.

Purpose: This study evaluates the impact of a structured online medical statistics webinar on researchers in andrology, both clinicians and non-clinicians. The objectives were to: 1) emphasize the critical role of statistical literacy in medical and biomedical research, 2) evaluate participants' baseline knowledge, 3) determine the impact of the webinar on knowledge acquisition and satisfaction, and 4) analyze the influence of gender and institutional setting on learning outcomes.

Materials and methods: The Global Andrology Forum (GAF) conducted a webinar comprising four expert-led lectures on medical statistics and male infertility research. Participants completed three online surveys evaluating baseline characteristics, pre- and post-course knowledge, and satisfaction.

Results: Post-webinar analysis showed a significant improvement in statistical knowledge, with the mean percentage of correct responses rising from 55.6% (95% confidence interval [95% CI]: 51.35-59.86) to 66.8% (95% CI: 62.48-71.14) (p<0.05). Female participants demonstrated over twice as much a greater average score increase (16.1) compared to males (7.9), though the difference was not statistically significant (p=0.092). Participants from public institutions showed the most substantial improvement (p<0.001), while private sector participants had a more modest and non-significant increase (p=0.054). Overall satisfaction was high, with 77.6% of participants indicating that they would recommend the course to their colleagues.

Conclusions: This structured online webinar significantly improved the participants' statistical knowledge, highlighting the importance of such training in medical research. The high levels of participant satisfaction and positive feedback regarding the course underscore the webinar's success. This study highlights the potential for future targeted online statistical educational initiatives and the need for such training for researchers in andrology and biomedicine.

Purpose: With increasing life expectancy worldwide, many patients experience non-life-threatening yet debilitating conditions that affect their quality of life. Among these, lower urinary tract symptoms, a representative urologic disease in men, continue to affect a significant number of aging males in the era of population aging. South Korea and the United States have distinct healthcare systems with notable advantages and limitations. This article aimed to analyze current treatment trends in South Korea using the National Health Insurance Database and compare them with United States trends through literature reviews.

Materials and methods: We obtained statistical medical data using the Korean Healthcare Big Data Opening System provided by the Korea Health Insurance Review and Assessment Service. Data were collected across four categories: medical treatment for benign prostatic hyperplasia (BPH), surgical treatment for BPH, overactive bladder (OAB), and nocturia. The collected data were analyzed based on annual patient cases, medical expenses, age distribution, and prescribed medications.

Results: Medical expenses for BPH surged significantly from $165 million in 2019 to $266 million in 2023. Although medication prescriptions followed a similar upward trend, the increase in surgical procedures was relatively modest. For OAB, medical costs have also shown a sharp rise, from $40 million in 2019 to $59 million in 2023, with a proportional increase in prescription volume. Regarding nocturia, anticholinergics (32.7%) and alpha-blockers (31.3%) were the most frequently prescribed medications, whereas desmopressin accounted for 19.9%.

Conclusions: It is essential to acknowledge the treatment disparities arising from differences in the healthcare systems of the United States and Korea and to adopt a patient-centered approach that prioritizes health in various contexts. A gradual transition toward developing a patient-centered and progressive healthcare system is imperative globally to address these disparities.

Purpose: Despite numerous studies on coenzyme Q10 (CoQ10) as a treatment for idiopathic male infertility (IMI), clear clinical guidance remains lacking. This systematic review and meta-analysis (SRMA) aimed to evaluate the efficacy of CoQ10 and determine the optimal dose, formulation, and treatment duration compared to placebo or other therapies.

Materials and methods: We searched PubMed, Science Direct, and Cochrane Library using relevant keywords to identify studies assessing CoQ10's effects on sperm parameters, seminal CoQ10 levels, and clinical pregnancy rates in men with IMI. Study quality was assessed using the Revised Cochrane Risk of Bias tool (RoB2), and meta-analyses were conducted using Review Manager 5.4. The protocol was registered in PROSPERO (CRD42024513515).

Results: Nine studies comprising 781 participants (430 treatment, 351 control) met the inclusion criteria. CoQ10 supplementation significantly improved sperm concentration (mean differences [MD]: 10.22×10⁶/mL [3.51-16.93], p=0.003), seminal volume (MD: 0.17 mL [0.03-0.31], p=0.02), total sperm motility (MD: 4.95% [1.15-8.75], p=0.01), and seminal CoQ10 levels (MD: 37.04 ng/ml [31.24-42.84], p<0.001). It also significantly increased clinical pregnancy odds (odds ratio: 6.02 [1.97-18.41], p=0.002). Subgroup analysis showed that treatment duration >3 months significantly improved sperm morphology (p<0.05). Three studies reported no adverse effects, while one noted mild, transient side effects.

Conclusions: CoQ10 supplementation in men with IMI significantly improves semen quality, seminal CoQ10 levels, and clinical pregnancy rates, particularly when used for over 3 months. CoQ10 therapy in infertile men with IMI is generally safe, whether used alone or in combination with other antioxidants.