Basic and Clinical Andrology最新文献

Male infertility, particularly asthenozoospermia (AZS), has become an increasingly severe global public health issue. Obesity induced by a high-fat diet (HFD) is considered a key factor in the development of AZS, although its exact molecular mechanisms remain unclear. This study employs bioinformatics analysis to explore the key genes and potential regulatory mechanisms of HFD-induced obesity in AZS, which were validated by animal experiments. First, on the basis of GEO transcriptomic data, we identified nine common differentially expressed genes (DEGs) between HFD-induced obesity and AZS. Using LASSO regression and support vector machine methods, we subsequently identified C1QBP and PPIL1 as critical genes associated with HFD-induced AZS. Furthermore, a core gene‒transcription factor coexpression network revealed that MYC is likely an upstream transcriptional regulator of these two core genes. According to single-cell RNA-seq data, C1QBP and PPIL1 are predominantly expressed in spermatogonia, whereas MYC is primarily localized in stromal cells and is closely correlated with AZS. Additionally, through genome-wide enrichment analysis, we identified several key pathways regulating both HFD-induced obesity and AZS, including cell proliferation and differentiation (MYC targets and mTOR signalling), energy metabolism, cellular stress and homeostasis, and immune and inflammatory responses. The results of animal experiments demonstrated that HFD-induced obesity significantly impaired sperm motility in male rats, accompanied by decreased testosterone levels and increased oxidative stress. At the molecular level, the expression of MYC and mTOR in the HFD obesity/AZS group was significantly reduced (P < 0.01), whereas PPIL1 expression was significantly increased (P < 0.01). Moreover, L-carnitine partially reversed these changes, indicating potential therapeutic value. In conclusion, our study suggests that HFD-induced obesity may lead to AZS through the upregulation of PPIL1 levels and the inhibition of the MYC and mTOR signalling pathways.

Background: Sleep quality has been increasingly recognized as an important determinant of overall health, yet its influence on male fertility remains underexplored. This study investigated the association between male sleep quality and reproductive outcomes, including semen characteristics, hormone profiles, and partner pregnancy success, in infertile couples.

Results: A total of 727 male partners from infertile couples were evaluated between October 2023 and February 2025. Sleep quality was assessed using Pittsburgh Sleep Quality Index and categorized as good or poor. Poor sleep quality was reported in 75.1 percent of participants. Men with poor sleep quality showed significantly lower sperm concentration (β = -1.39, 95% confidence interval = -2.11 to -0.67, p < 0.001), reduced progressive motility (β = -1.25, 95% confidence interval = -1.61 to -0.88, p < 0.001), and decreased total motility compared with those reporting good sleep. No significant associations were observed between sleep quality and hormone concentrations, including follicle-stimulating hormone, luteinizing hormone, estradiol, prolactin, and testosterone. Poor male sleep quality was also linked to a lower probability of achieving clinical pregnancy (odds ratio = 4.67, 95% confidence interval = 3.08 to 7.09, p < 0.0001).

Conclusions: Poor male sleep quality is associated with impaired semen quality and reduced chances of pregnancy in couples with infertility. These findings highlight the potential value of improving sleep as a modifiable factor to enhance male reproductive health and fertility outcomes.

Background: To compare surgical and long-term patient-reported outcomes (PRO) between excisional (Nesbit) and incisional (Yachia) corporoplasty for correction of uncomplicated Peyronie's-related penile curvature in a large, single-surgeon cohort. A retrospective audit identified men who underwent Nesbit or Yachia corporoplasty (2015-2021). Operative data was extracted from records. A structured telephone survey captured long-term PRO.

Results: The cohort comprised 101 men (Nesbit = 31, Yachia = 70). Nesbit patients were younger (55 vs 59.7 yr; p = 0.02) and had greater baseline curvature (55° vs 45°; p = 0.01). Every case was surgically successful (residual curvature < 20° in 100%, < 10° in 58% overall, p = 0.66). Yachia procedures were shorter (45 vs 71 min; p < 0.05) but required > 2 plications more often (41% vs 7%; p = 0.01). The PRO survey had a 74.3% response rate, with a median follow-up of 5 years. 'Patient Global Impression of Improvement' scores reflected strong improvement with median scores of 1 ("very much better") and 2 ("much better") in the Nesbit and Yachia groups respectively (p = 0.35). However, this perceived improvement did not translate uniformly into long-term satisfaction. Only 66.7% of respondents reported being "completely" or "mostly" satisfied with the overall outcome (p = 0.60). The most frequent cause of dissatisfaction was perceived penile shortening, reported by 85% of men. Erectile function declined postoperatively in 30% of Yachia and 15% of Nesbit patients (p = 0.03), though this is possibly confounded by the older age of the Yachia cohort. Bothersome curvature recurrence and post-operative cosmesis did not significantly impact satisfaction in either group.

Conclusions: Both Nesbit and Yachia corporoplasties provide effective and durable results with comparable long-term patient satisfaction. Regardless of technique, subjective reporting of penile shortening was particularly pervasive and was highly bothersome. This underscores the need for meticulous pre-operative counselling.

Background: Infections of the urogenital tract are recognized as potential contributors to male subfertility or infertility. Ureaplasma parvum is frequently detected in semen samples, yet its specific impact on semen quality and the potential benefit of antibiotic treatment remain uncertain.

Results: In a retrospective cohort of 3,464 semen samples collected for fertility evaluation, Ureaplasma parvum was identified in 12.4% of cases using a multiplex PCR assay. Semen volume was significantly lower in infected individuals compared to uninfected controls. However, no significant differences were observed in sperm concentration, motility, morphology, or inflammatory markers. Among 124 men with documented pathogen eradication and follow-up semen analysis, doxycycline treatment led to a significant increase in sperm concentration (4.01 ± 4.69 to 9.20 ± 15.63 million/ml, p = 0.01) and motility (18.97 ± 16.04% to 29.66 ± 22.18%, p = 0.002). Peroxidase-positive leukocytes declined (1.84 ± 0.74 to 0.68 ± 0.79 million/ml, p = 0.005). In contrast, no significant changes were observed in men with normal baseline semen parameters.

Conclusion: The mere detection of Ureaplasma parvum does not appear to compromise semen quality and may not warrant routine antibiotic treatment. Nevertheless, in Ureaplasma parvum-positive patients with abnormal semen parameters and elevated inflammatory markers, targeted antibiotic therapy may improve sperm quality. These findings support a selective treatment strategy, emphasizing clinical context and inflammatory status rather than routine screening or treatment of all infected individuals.

Background: High paraplegia, primarily affecting young men during their reproductive years, often results in ejaculatory dysfunction and infertility. Testicular sperm aspiration (TESA) combined with intracytoplasmic sperm injection (ICSI) offers a viable path to biological parenthood for this population. However, evidence on nursing strategies supporting such procedures is limited. This study aimed to evaluate the clinical and psychosocial outcomes of patients with high paraplegia due to spinal cord injury who underwent TESA-ICSI and explore the effectiveness of specialized nursing interventions.

Case presentation: A retrospective case series was conducted on nine male patients with high paraplegia treated at Sir Run Run Shaw Hospital (Zhejiang, China) between January 2021 and October 2023. The mean age of the patients was 31.89 ± 4.83 years, with injury durations ranging from 1 to 13 years. Psychological evaluations using the SAS, SDS, SSRS, and WHOQOL-BREF scales revealed that three patients had anxiety, four had depression, and most had moderate to high social support. The WHOQOL-BREF scores indicated generally good perceived quality of life (score range, 82-91). TESA was performed under local anesthesia, with perioperative nursing measures including bladder management, wound care, and infection prevention. Viable sperm were successfully retrieved in all cases without complications. Eight couples proceeded to ICSI, with viable embryos obtained in all. Six couples achieved pregnancy (66.7%)and live births. One case ended in miscarriage due to trauma, and one couple had no embryos suitable for transfer.

Conclusion: Comprehensive nursing interventions, including psychological support, ethical evaluation and procedural adaptations, may facilitate the successful application of TESA-ICSI in men with high paraplegia, highlighting the need for standardized interdisciplinary nursing protocols to optimize fertility outcomes in this underserved population.

Background: Epigenetic mechanisms influencing sperm production and function are closely linked to male infertility. Among these, tRNA-derived fragments have recently been identified as important modulators of cellular stress responses and gene expression. The purpose of this study was evaluate the potential role of 5'tRF-Glu-CTC in the context of assisted reproductive technologies (ART) outcomes by comparing its differential expression in the seminal plasma of oligozoospermic and normozoospermic infertile men.

Results: Total RNA was extracted from seminal plasma, and 5'tRF-Glu-CTC expression was measured by qRT-PCR. Sperm DNA fragmentation index (DFI) was assessed via the TUNEL assay. The results revealed significantly elevated 5'tRF-Glu-CTC expression in the oligozoospermic group compared to the normozoospermic group (15.58 ± 4.34 vs. 12.53 ± 4.99; fold change: 1.692; P = 0.024). Sperm DFI showed a significant negative correlation with both the progressive motile sperm (ρ = -0.537, P = 0.015) and the total progressive motile sperm count (ρ = -0.509, P = 0.026). However no significant differences in DFI was observed between the oligozoospermic and control groups (P > 0.05). Analysis of ART outcomes revealed that male partners of couples who achieved pregnancy had lower mean 5'tRF-Glu-CTC expression and DFI, although these differences did not reach statistical significance (P > 0.05).

Conclusions: These results suggest that 5'tRF-Glu-CTC might be serve as a potential biomarker and could play a role in the pathophysiology of oligozoospermia.

Background: Varicocele (VC) is a significant contributor to both primary and secondary male infertility. VC can lead to progressive, time-dependent damage to testicular function, as demonstrated in both animal and human studies. To assess testicular tissue alterations, we conducted the first systematic review and meta-analysis on the effects of VC on testicular stiffness and volume. A literature search was conducted in June 2024 without language or geographic restrictions. The search included the databases PubMed, Embase, and Medline. We reviewed the literature to identify all published clinical trials using shear wave elastography (SWE) to evaluate the stiffness and volume of varicocele-affected and normal testes. The reference lists of the retrieved studies were examined. We conducted a systematic review and meta-analysis.

Results: Seven articles, encompassing 1118 testes, were selected from a pool of eighty-seven. The analysis revealed that the stiffness of varicocele-affected ipsilateral testes was higher than that of normal testes (p < 0.05), and the stiffness of normal testes was higher than that of contralateral testes (p < 0.05). Regarding volume, the varicocele-affected ipsilateral testes were smaller than the contralateral testes (p < 0.05), with no significant difference between the contralateral and normal testes (p > 0.05).

Conclusions: This meta-analysis indicates that VC impacts the stiffness and volume of both testes. SWE is an effective technique for assessing testes affected by VC, but a large-scale, multicenter randomized controlled study is needed for further confirmation.

Background: Surgical repair can be offered to patients with scrotal pain of suspected varicocele origin. The estimated success rate of pain resolution is approximately 80%, although recent publications have been inconsistent. Predictive variables for successful outcomes remain contested. The current study aimed to evaluate the efficacy of microscopic repair in resolving varicocele pain and to identify variables that predict successful outcomes.

Results: During the study period, microscopic subinguinal varicocelectomy was performed in 59 patients with varicocele-related pain. Grade III left varicocele was present in 36 (61%) patients. The median width of the left varicocele, as measured by ultrasound, was 4.2 mm (IQR 4-5), with reflux identified in 39 (66%) patients. The most common type of pain-dull pain-was present in 39 (66%) patients. Exertional pain and sharp pain were reported by 11 (19%) and 9 (15%) patients, respectively. The median follow-up time was 24 months (IQR 13-35), while 46 (78%) patients were contacted by telephone more than 12 months after surgery. Fifty (85%) patients reported complete pain resolution, while partial resolution and persistent pain were reported by 4 (6%) and 5 (9%) patients, respectively. Two variables that increased the risk of pain persistence were repeat varicocele repair surgery and pain as a secondary or additional indication for surgery. Follow-up time of more than 12 months after surgery reduces the risk of pain persistence.

Conclusions: A varicocelectomy is a good option for resolving painful varicocele in most patients, especially those whose only indication for surgery is pain. Repeat varicocele surgery appears to increase the risk of persistent pain. A longer follow-up period (more than 12 months after surgery) increases the chances of pain resolution.

Background: Priapism represents a rare urological emergency characterized by persistent penile erection unrelated to sexual stimulation. Although chlorpromazine-induced priapism has been documented, the synergistic interaction with phosphodiesterase type 5 inhibitors resulting in refractory cases necessitating penile prosthesis implantation constitutes a novel clinical scenario requiring comprehensive documentation.

Case presentation: We report a 56-year-old male who developed refractory ischemic priapism following self-administration of oral chlorpromazine for hiccups, taken 24 h after tadalafil 20 mg for erectile dysfunction. The patient had previously experienced a transient priapism episode 10 years earlier following isolated chlorpromazine use, establishing chlorpromazine as the primary etiological agent. Despite comprehensive management including corporal aspiration, intracavernosal sympathomimetic injection, and distal T-shunt creation, the patient developed recurrent priapism requiring penile prosthesis implantation.

Conclusions: This case demonstrates compelling evidence of a dangerous chlorpromazine-tadalafil interaction resulting in treatment-refractory priapism. The synergistic pharmacological effects of alpha-adrenergic blockade and phosphodiesterase type 5 inhibition created a severe clinical presentation necessitating immediate penile prosthesis implantation. Healthcare practitioners must recognize this potentially devastating drug interaction and implement preventive measures through comprehensive medication reconciliation and patient counseling.

Background: The tunica albuginea is a key anatomical structure supporting penile implants. Several factors can lead to anatomical penile defects, contributing to penile prosthesis malfunction.The aim is to describe the consequences of malleable penile implant fractures, their contribution to tunica albuginea defects, and management outcomes.

Results: All patients underwent malleable device surgery were reviwed retrospectively in our center. We included three patients with malleable penile implant disruption. Two patients underwent concomitant plication corporoplasty (PC) with device replacemen and one patient with device replacement only that showed intact tunica albuginea. The mean age at revision was 71.3 years. All patients achieved device stability and reported successful vaginal penetartion after PC and device replacement, with a median follow-up of 28 months.

Conclusions: Malleable penile device fractures are extremely rare findings. They can cause tunica albuginea disruption and tears, compromising penile penetration and device stability. Device replacement combined with PC is an essential component of successful vaginal pentration.