Andrology最新文献

Background: End-stage renal disease (ESRD) is reported to be associated with the impairment of sex hormones, including decreased testosterone levels and increased follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin levels. Additionally, patients with ESRD often experience impaired spermatogenesis, leading to infertility. However, variations in study methodologies and reported outcomes make it challenging to draw definitive conclusions. Therefore, this study aims to evaluate the effects of kidney transplantation (KT) on these issues, which can be useful in counseling male patients with ESRD.

Methods: A systematic search was conducted in Web of Science, Medline (via PubMed), and Embase (via Scopus) to identify peer-reviewed studies evaluating the impact of KT on sex hormones and reproductive parameters. A systematic review (SR) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review included English-language articles published between January 1975 and December 2024. Excluded from this search were reviews, editorials, book chapters, conference abstracts, case reports, and case series with up to four patients were excluded.

Results: A total of 2939 publications were initially identified, and 23 studies met the inclusion criteria, comprising 738 patients for analysis. Most studies reported a significant increase in testosterone levels 3, 6, and 12 months post-KT. LH and prolactin levels exhibited a trend parallel to that of testosterone. A statistically significant decrease in LH levels was observed at both 1 and 12 months post-KT, while prolactin levels showed a significant reduction at all evaluated time points from 1 to 12 months. In contrast, FSH levels fluctuated over time and did not demonstrate statistical significance at any assessment point. Additionally, KT led to improvements in testis biopsy findings, and all categories of sperm parameters.

Conclusion: This SR demonstrates that KT improves sex hormone levels, sperm parameters, and sexual function in male kidney recipients. However, to gain a more comprehensive understanding of the sexual health of male kidney recipients, the establishment of an international database with prospectively collected data is warranted.

Background: Gonadotropins are synthesized in gonadotropes of the anterior pituitary, and they orchestrate reproductive function in vertebrates. LH and FSH share a common α-subunit that is non-covalently associated with a hormone - and receptor-specific β-subunit. Despite synthesized in the same cell, i.e., gonadotrope the trafficking and secretion patterns of LH and FSH are distinct. FSH is mostly constitutively secreted, whereas LH is stored in dense core granules and is released as a bolus via the regulated pathway in response to gonadotropin-releasing hormone.

Objective: To comparatively review the storage and secretion patterns of gonadotropins in vertebrates.

Materials and methods: Gonadotropin storage patterns are comparatively analyzed in vertebrates starting from primitive fish all the way up to higher mammals. The published work on gonadotropin trafficking/secretion patterns using in vitro and in vivo approaches is critically discussed.

Results: Primitive fish (lampreys and hagfish) express a single gonadotropic hormone. From these early vertebrates, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) have evolved as two distinct hormones. In several species, including teleost fish, monohormonal gonadotropes are present that express either LH or FSH. In higher vertebrates, the majority of the gonadotropes (>90%) are bihormonal and contain both LH and FSH. Both in vitro (cell transfection and expression) and in vivo (transgenic mouse) studies identified that the LHβ caroboxy terminus heptapeptide is a gonadotrope-specific regulated pathway sorting determinant.

Discussion: When FSH is genetically rerouted from the constitutive trafficking mode and is engineered (LHβ heptapeptide fused to FSHβ subunit) to exit via the regulated pathway in gonadotropes of transgenic mice, it resulted in enhanced ovulations due to suppression of atresia and apoptosis and increased pro-survival pathways in ovaries. However, rerouted FSH expressing male mice did not demonstrate any gain of function phenotypes.

Conclusion: Understanding the basic molecular mechanisms of gonadotropin storage/trafficking and secretion may eventually lead to clinical benefits of enhancing female reproductive function and reproductive lifespan.

Background: Perm freezing compromises nuclear integrity. Standardized tools to assess three-dimensional (3D) chromatin alterations are lacking.

Objectives: This study aimed to present a novel protocol for 3D nuclear morphometric analysis of human spermatozoa to measure slow freezing and thawing-induced alterations.

Materials and methods: Human sperm cells were examined before and after freezing using a consistent 3D nuclear morphometric analysis protocol that distinguishes between live and dead spermatozoa. Morphometric assessments were performed by microscopy and image analysis with the NucleusJ2.0/NODeJ software, without introducing denaturing agents. The analysis included measurements of nuclear volume, elongation, flatness, and the volume of hypercondensed chromatin (Hc) regions, along with the relative fluorescence intensity of these zones (RHF intensity). Additional parameters evaluated comprised sperm vitality, motility, DNA fragmentation, and chromatin decondensation.

Results: A quantitative analysis of 4919 sperm nuclei from 10 patients demonstrated significant modifications in the hypercondensed chromatin (Hc) zones, with a marked decrease in sperm vitality and motility (p  <  0.001) and a significant increase in DNA fragmentation (p  <  0.05). At the chromatin level, slow freezing induced a higher number of Hc zones per nucleus (p  <  0.01), a reduction in the average volume of these zones (p  <  0.0001), and a reduced relative fluorescence intensity (p  <  0.01). Notably, these chromatin alterations were most pronounced in viable spermatozoa.

Discussion and conclusion: This study is the first to provide standardized 3D nuclear morphometry measurements for human sperm, offering a novel biomarker to assess male fertility and cryopreservation susceptibility, with potential clinical applications for improving patient care. Slow freeze-thaw cycle induced significant alterations in sperm chromatin, disrupting nuclear organization and forming several smaller, less compacted hypercondensed chromatin zones.

Introduction: The impact of the educational level on the adherence to phosphodiesterase type 5 inhibitors (PDE5i) among men with erectile dysfunction (ED) remains understudied. We aimed to investigate how the educational level influences patient's compliance to newly prescribed PDE5i in men with ED who had never previously used this class of drugs.

Materials and methods: Complete data from 1264 consecutive PDE5i naive men presenting with new onset ED were retrospectively analyzed. Patients were grouped according to their educational level into low (elementary and/or secondary school education), mid (high school), and high (university degrees) educational levels. Baseline health significant comorbidities were scored with the Charlson comorbidity index (CCI). All patients completed the International Index of Erectile Function (IIEF) and the Beck depression inventory questionnaires at baseline. PDE5i were prescribed to all patients. Kaplan-Meier (KM) curves estimated the discontinuation free-survival (DFS) after stratification according to the educational level. Multivariable (MVA) Cox regression addressed the association between the educational level and PDE5is' discontinuation.

Results: Of all, 160 (13%), 573 (45%), and 531 (42%) individuals depicted low, mid, and high educational level, respectively. Median (IQR) age and follow-up time were 51 (39-61) and 8.5 (5.9-11.3) years, respectively. Patients with higher educational level were more likely to be younger (49 vs. 56 years, p < 0.001), reporting lower BMI values (25 vs. 26.3 kg/m², p < 0.001) and lower rates of CCI ≥ 1 (17% vs. 27%, p = 0.009), compared to their lower educational level counterparts. No significant differences were found in terms of duration of PDE5is assumption and IIEF-erectile function (IIEF-EF) across the groups. Kaplan-Meier survival analyses, stratified by the educational level, revealed significantly different patterns of PDE5i discontinuation-free survival across educational levels (log-rank test, p = 0.028). At multivariable Cox regression analysis, higher educational levels were significantly associated with PDE5i discontinuation, even after adjusting for age at presentation, IIEF-EF score, and relationship status simultaneously.

Conclusions: Current findings demonstrated that the higher the educational level, the greater the PDE5is discontinuation rate in men with ED. These results highlight a particular aspect of patients' compliance with PDE5is, enabling improvements in real-life pharmacological management for ED.

Background: The constitutive Leydig cell hormone insulin-like peptide 3 (INSL3) is considered a good estimate of the adult Leydig cell functional capacity and appears to remain relatively consistent throughout adult male life, only gradually declining into old age. Importantly, in younger men it appears to predict hypogonadism and hence later health and morbidity.

Objectives: Here, we have used the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort of boys and young men to assess those factors during pregnancy, infancy, childhood, and adolescence, when the adult-type Leydig cell population is being established, which by association might influence the final circulating INSL3 concentration in young adulthood.

Methods: A wide range of clinical, anthropometric and lifestyle parameters were assessed from up to 2000 boys and young men based on direct medical measurement and/or by targeted questionnaires. Scalar variables used bivariate correlation analysis, whereas comparative statistics, such as t-tests, were applied to categorical variables.

Results: Maternal parameters, such as maternal smoking, gestational age, or being small for gestational age (SGA) appeared to have no association with adult INSL3 levels. Of all the parameters assessed, those with greatest impact on young adult Leydig cell status appeared to be childhood and adolescent body mass index (BMI) and early childhood infectious disease. Particularly, chickenpox in infancy had a marked and significant negative association with INSL3 (reduced by 10%-14%) at both 17 and 24 years. Being overweight (> 85th percentile) at 13 years was associated with a 20% reduction in young adult INSL3. In contrast, childhood and adolescent inflammatory factors and cigarette exposure appeared to have no long-lasting impact on adult Leydig cell status.

Limitations: This retrospective cohort study is limited by relatively small numbers and by its correlative analysis. The hypotheses generated will need to be validated in more extensive, in-depth studies.

Lay summary: The testis hormone INSL3 is considered a good estimate of the gonadal capacity to make testosterone. It is relatively constant throughout adult male life, only gradually declining into old age. Importantly, in younger men reduced INSL3 appears to predict hypogonadism and hence later health and morbidity. Whilst showing low within-individual variation, between individuals INSL3 can vary more than 10- up to 100-fold. The source of this variance is unknown but is believed to have its origin during childhood and adolescence. Analysis of data from the ALSPAC cohort implies that of various parameters assessed, only childhood and adolescent BMI as well as early infectious disease, in particular chickenpox, have any influence on young adult INSL3 concentration, respectively reducing circulating levels each by

Background: The prevalence of hypospadias varied internationally. However, epidemiological data on hypospadias in contemporary China remain limited.

Objectives: We aim to examine the epidemiological characteristics of hypospadias in Chinese population.

Materials and methods: We performed a prevalence analysis using data from the Chinese Birth Defects Monitoring Network from 2010 to 2020. We analyzed the prevalence of overall, isolated, and associated hypospadias by birth year, maternal age, maternal residence, and geographic region. We used Poisson regression with adjusted prevalence rate ratios for assessing the impact of demographic characteristics and Joinpoint regression for analyzing temporal trends.

Results: A total of 11,782 hypospadias cases were identified among 11,575,036 male births with a prevalence of 10.18 per 10,000 male births. Of these, 9700 (82.3%) were isolated and 2082 (17.7%) were associated hypospadias. Of these cases, 639 (5.4%) were classified as anterior hypospadias, 1052 (8.9%) as middle hypospadias, 413 (3.5%) as proximal hypospadias, and 9678 (82.1%) as unspecified hypospadias, based on their severity. The prevalence of overall, isolated, and associated hypospadias increased significantly over the study period. Prevalence also varied significantly by maternal residence, maternal age, and geographical region. Infants with associated hypospadias experienced a significant higher risk of perinatal death. The most frequent associated anomalies involved the cardiovascular, genitourinary, and musculoskeletal systems.

Discussion and conclusion: This study provides contemporary national data on the epidemiology of hypospadias in China. The observed increasing prevalence and variations by severity underscore the need for further etiological, epidemiological, and clinical research.