Basic and Clinical Andrology最新文献

Background: Varicocele is a major male infertility issue, and Malva sylvestris shows promise as a treatment due to its antioxidant properties. The present study evaluated the protective effects of Malva sylvestris on testicular health, sperm quality, and oxidative stress-related gene expression. Adult male Wistar rats were randomly assigned into five groups (n = 8): the control group, the varicocele model group, the varicocele group with partial occlusion of the left renal vein treated with 750 or 1500 mg/kg Malva sylvestris for 21 days, and a surgical sham group. The epididymal content and Histological analyses of animals testicular tissue were examined to evaluate fertility parameters, and qRT-PCR was employed to determine the expression of SIRT1, FOXO1, NRF2, NF-κB, and TGF-β genes.

Results: Varicocele leads to the induction of apoptosis, the occurrence of DNA damage, a reduction in SIRT1 and FOXO1, and an increase in NRF2, TGF-β, and NF-κB gene expression. According to Histological morphometric analysis, treatment with Malva sylvestris showed the increased thickness of Mean Seminiferous Tubule Diameter and Epithelial Thickness in the spermatogenic epithelium, as well as the presence of a greater number of germ cells and mature sperm. In this study, Malva sylvestris treatment showed antioxidative effects since it upregulated the expression of SIRT1 and FOXO1 genes and downregulated the expression of NF-κB, NRF2, and TGF-β genes.

Conclusion: Based on the findings, Malva sylvestris as cytoprotective agent modulate key antioxidant pathways, including upregulation of SIRT1 and FOXO1 (linked to cellular repair and OS resistance) and downregulation of pro-inflammatory mediators; then, Malva sylvestris as a promising natural antioxidant for managing varicocele-related infertility, offering a potential adjunct or alternative to conventional therapies.

Background: Peyronie's disease progresses through acute (inflammatory) and chronic (fibrotic) phases. Objective biomarkers for phase differentiation are lacking. Neutrophil-to-eosinophil ratio has been evaluated as an inflammatory marker in PD and reported as an important marker in the inflammatory phase. We evaluated the Hemoglobin, Albumin, Lymphocyte, and Platelet score as a non-invasive indicator of Peyronie's Disease phases.

Results: A retrospective cohort of 216 Peyronie's disease patients were analyzed. Blood parameters were collected at diagnosis (acute phase) and follow-up (chronic phase) in 112 patiens. Hemoglobin, Albumin, Lymphocyte, and Platelet scores were compared using receiver operating characteristic curves and paired t-tests. Hemoglobin, Albumin, Lymphocyte, and Platelet scores increased significantly from 36.8 ± 8.2 (acute) to 47.5 ± 10.4 (chronic) in 112 paired patients (p <0.001). Receiver operating characteristic analysis identified a cutoff of>41.2 for chronic phase detection (area under the curve = 0.83, sensitivity 76%, specificity 71%, positive predictive value 73.9%).

Conclusion: The Hemoglobin, Albumin, Lymphocyte, and Platelet score is a cost-effective tool for differentiating Peyronie's Disease phases, aiding clinical decision-making.

Background: Varicocele adversely affects male fertility by impairing semen quality, yet there remains no unified approach that combines advanced imaging and laboratory markers for clinical stratification. To develop a uniform clinical stratification system, we conducted a review of the literature across major databases.

Results: Shear wave elastography thresholds above 5.235 kPa and spermatic vein diameters exceeding 2.5 mm on color Doppler ultrasound demonstrated strong, independent correlations with decreased sperm concentration, motility, and morphology. Among laboratory tests, elevated follicle-stimulating hormone, low inhibin B, and others were consistently linked to poorer semen quality. Biomarkers such as cysteine-rich secretory protein 3 showed potential.

Conclusions: We propose a multimodal stratification framework integrating evidence‑based cutoffs for shear wave elastography and color Doppler ultrasound with key laboratory indices. Adoption of standardized protocols and consensus guidelines will facilitate personalized diagnosis, improve prognostic accuracy, and guide management of varicocele‑decreased semen quality.

Background: Sexual dysfunction is a serious and frequently underrecognized consequence of Post-Traumatic Stress Disorder (PTSD), with profound implications on quality of life. This study aimed to characterize sexual dysfunction observed in French military personnel suffering from PTSD.

Results: This retrospective study included 32 male French military personnel diagnosed with PTSD who participated in a sexual dysfunction screening program at a French National Military Hospital between October 2023 and August 2024. The mean age of participants was 40 years. The Post-Traumatic Stress Disorder Checklist Scale version DSM-5 (PCL-5) and the International Index of Erectile Function version 5 (IIEF-5) were used to assess PTSD and sexual dysfunction severity. Seventy-two percent (n = 23) reported at least one sexual dysfunction, with sexual desire dysfunction being the most common sexual health issue. Approximately 70% perceived the impact of sexual dysfunction on quality of life as high or very high. Significant correlations were found between PCL-5 and IIEF-5 scores, suggesting that the severity of PTSD symptoms impacts sexual health, specifically concerning cluster B (re-experiencing symptoms) and cluster D (negative thoughts and/or feelings) symptoms. Psychiatric symptoms were the primary risk factor, followed by psychotropic treatment and personal factors.

Conclusion: This study highlights the high prevalence of sexual dysfunction among French military personnel with PTSD. The diversity of the clinical presentations and risk factors emphasize the need for comprehensive sexual health assessments in PTSD management. Personalized care strategies targeting both psychiatric and sexual health issues are essential for improving outcomes in this population.

Background: We evaluated the predictors of eventful microsurgical testicular sperm extraction (micro-TESE) from infertile men with Klinefelter syndrome (KS).

Results: The mean age of the patients was 32.4 ± 6.3 years. The mean serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), estradiol (E2) and prolactin were 34.38 ± 14.66, 18.92 ± 6.54, 3.18 ± 2.08, 28.2 ± 10, 11.56 ± 5.09, respectively. The mean right (Rt) testicular and left (Lt) testicular volumes were 2.17 ± 0.83 ml, 2.2 ± 0.89 ml, respectively. Mosaic KS patients showed highly significant TT compared to non-mosaic KS patients. Twenty-six patients out of 50 patients (52%) showed mature sperm in wet preparation, whereas the sperm retrieval rate (SRR) of the patients with mosaic and non-mosaic KS was (57.1) % and (32.1) %, respectively. SR was significantly associated with testicular volume > 2 ml, total testicular volume > 5 ml and LH < 21.29 IU/L (p 0.007, 0.005, 0.044, respectively). FISH testing results showed that higher 46xy and lower 47xxy were significantly associated with successful sperm retrieval (p 0.014, 0.015, respectively). Rt and Lt testicular volumes, total testicular volume, LH and FISH could significantly predict successful SR. No statistically significant correlations were found between micro-TESE and age, serum FSH, serum TT, E2, prolactin. Further, receiver operation characteristic (ROC) curve showed Rt and Lt testicular volumes and total testicular volume and LH level and 46xy could significantly predict successful SR with p 0.007, 0.007, 0.005 and 0.044 and 0.015, respectively. Moreover, the cutoff point and sensitivity and specificity and positive and negative predictive values for Rt and Lt testicular volumes were as follows 2 ml, 73.1%, 61.4%, 52.78, 79.41, 2 ml, 76.9%, 57.8%, 51.28 and 80.65, respectively. While these values for total testicular volume were as follows 5.255 ml, 61.5, 75, 59.26 and 76.74, respectively. Furthermore, these values for LH and 46xy were as follows 17 IU/l, 73.1%, 50%, 46.34, 75.86, 16.35, 84.6, 50, 50 and 84.6, respectively.

Conclusions: Patients with mosaic KS had higher rates of SRR compared to non-mosaic KS.

Background: Bladder cancer is the sixth most common cancer in males. Bacillus Calmette-Guerin (BCG) immunotherapy, the standard for non-muscle-invasive bladder cancer (NMIBC), effectively reduces recurrence and progression. This study examines the impact of intravesical BCG therapy on semen parameters, focusing on hormonal profiles and sperm quality.

Results: This prospective study included 23 sexually active males diagnosed with NMIBC receiving intravesical BCG therapy. Semen analyses were performed prior to treatment and three months following the induction course. Hormonal profiles, comprising total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL), were evaluated. Patients underwent six weekly instillations of 80 mg/ml SII-ONCO-BCG®, commencing four weeks post-TUR-B surgery. Data from clinical, radiological, and laboratory sources were gathered for analysis. Post-treatment evaluation indicated a significant reduction in sperm concentration, total sperm count, progressive motility, and normal morphology (p < 0.05), alongside a notable increase in the percentage of immotile sperm. LH and PRL levels remained stable despite these changes, while FSH levels exhibited a significant increase (p < 0.05).

Conclusion: BCG therapy adversely affects sperm quality, leading to a marked decrease in sperm concentration, total sperm count, progressive motility, and normal morphology. The findings underscore the potential gonadotoxic effects of BCG, necessitating fertility counseling prior to treatment initiation, especially in younger patients. Semen cryopreservation should be regarded as a preventive strategy. While BCG is considered the gold standard for NMIBC treatment, additional long-term studies are necessary to evaluate the reversibility of its effects and to investigate alternative intravesical therapies that present lower reproductive risks.

Background: Tunica albuginea plication is a common surgical treatment for Peyronie's disease that aims to correct penile curvature and improve sexual function. The goal of this study was to evaluate patient-reported outcomes, complications, and predictors of success following plication surgery in a large cohort of patients.

Results: This retrospective, bicenter study included 80 patients with a mean age of 48.6 years and a mean preoperative curvature of 49.2°. Postoperative satisfaction was reported by 67% of patients. Erectile dysfunction developed in 16%, and 13% experienced complications. Among those with preoperative penile pain, 42% continued to report pain postoperatively. Reoperation was required in 12% of cases. Statistically significant associations were observed between greater preoperative curvature and higher patient satisfaction, longer follow-up duration and erectile dysfunction, and longer surgery duration and persistent pain. Patients with complex curvature patterns had a higher risk of reoperation.

Conclusions: Plication surgery is an effective and safe option for treating penile curvature in Peyronie's disease, particularly in patients with more severe deformities. Greater curvature severity predicted higher satisfaction, while longer surgeries and follow-up were associated with increased pain and erectile dysfunction. These findings can help guide patient counseling and surgical planning.

Background: Solo masturbation is not an activity performed exclusively in single males but can also occur among married males, and is often associated with feelings of guilt. This study aimed to explore the prevalence of solo masturbation and associated masturbation guilt and the possible associated factors, including age, residence type (rural or urban), duration of marriage, parental status, income level, education level, body mass index, current smoking and drinking status, anxiety and depression status and their possible associations with the frequency of partnered sex among married heterosexual Chinese males.

Materials and methods: A series of males attending our outpatient clinic were included and analyzed in the study. Approximately 71.2% (334/469) of these males had engaged in masturbation during the studying period, whereas 76.6% (256/334) of those who reported engaging in masturbation reported at least some sense of guilt.

Results: Masturbation frequency was weakly positively associated with young age (OR 1.11) and education level (OR 1.24), whereas weak positive correlations were found between masturbation guilt and young age, anxiety and depression level (ORs ranged from 1.08 to 1.30). In addition, we found that the frequency of partnered sex was weakly positively associated with a masturbation frequency of less than once a month (adjusted OR 1.50) and once a month (adjusted OR 1.35). A weak positive correlation was observed between the frequency of partnered sex and a little sense of guilt (adjusted OR 1.60). In contrast, a weak negative association was observed between the frequency of partnered sex and a very big sense of guilt, with an adjusted OR of 1.67.

Conclusions: In summary, in married heterosexual Chinese males, masturbation along with its associated guilt is a relatively frequent phenomenon. We obtained evidence supporting both compensatory and complementary relationships between masturbation, masturbation guilt and the frequency of partnered sex. Masturbation and its related guilt should receive more attention in clinical practice, given its high prevalence and possible relationship with partnered sex and couple relationships.

Background: Ureaplasma urealyticum belongs to the class Mollicutes and causes non-gonococcal urethritis, an inflammation of the urethra that is linked with impaired semen quality. However, some reports are contradictory, and the reported effect of U. urealyticum on specific sperm variables is not consistent. Thus, this study synthesized findings from published primary data and provides a robust and reliable inference on the impact and associated mechanisms of U. urealyticum on sperm quality.

Methods: A systematic search was conducted until 31st May, 2024, on Cochrane, Google Scholar, and Pubmed. The Population, Exposure, Comparator/Comparison, Outcomes, and Study Design (PECOS) model was adopted. The populations were male in their reproductive ages who were infected with Ureaplasma urealyticum and confirmed positive versus the control who were age-matched non-infected or treated, while the outcomes included conventional semen parameters, seminal fluid leucocyte count, and sperm interleukin-6 (IL-6) concentrations, and the studies were either cross-sectional or longitudinal.

Results: When compared with the control, quantitative analysis demonstrated that U. urealyticum significantly reduced ejaculate volume (SMD 0.33 [95% CI: 0.15, 0.52] p = 0.0004), sperm concentration (SMD 0.47 [95% CI: 0.31, 0.64] p < 0.00001), total sperm motility (SMD 0.73 [95% CI: 0.43, 1.02] p < 0.00001), total motile sperm count (SMD 0.21 [95% CI: 0.17, 0.26] p < 0.00001), normal sperm morphology (SMD 0.88 [95% CI: 0.42, 1.35] p = 0.0002), but increased seminal fluid leukocyte count (SMD -0.82 [95% CI: -1.61, -0.02] p = 0.04). In addition, qualitative analysis revealed that U. urealyticum-positive subjects had significantly higher levels of IL-1β, IL-6, IL-8, TNF-α, peroxidase, leukocytes, neutrophils, CD4 + T cells, and CD8 + T cells in the seminal fluid when compared with the control. Furthermore, higher sperm DNA fragmentation and apoptotic sperm cells were observed in U. urealyticum-positive subjects when compared to the control.

Conclusions: These findings revealed that U. urealyticum lowers semen quality via the upregulation of seminal fluid leukocytes, elastase, pro-inflammatory cytokines, and DNA fragmentation. However, further studies are required to elucidate the mechanisms underlying the association between U. urealyticum and semen quality decline and to develop effective therapies for this condition.

Background: Azoospermia, the most severe form of male infertility, is categorized into two types: non-obstructive azoospermia (NOA) and obstructive azoospermia (OA), which exhibit significant genetic heterogeneity. Azoospermia factor (AZF) deletion is a common cause of NOA, whereas congenital bilateral absence of the vas deferens (CBAVD), a severe subtype of OA, is frequently linked to cystic fibrosis transmembrane conductance regulator (CFTR) gene variants. This case report is the first to document the coexistence of a partial AZFa microdeletion and a homozygous CFTR variant in a CBAVD-affected azoospermic patient with intact spermatogenesis.

Case presentation: A 32-year-old man presented with primary infertility and azoospermia. Clinical evaluation revealed CBAVD (normal hormone levels, low semen volume, pH 6.0, and absence of the vas deferens). Genetic analysis accidentally revealed a 384.9 kb AZFa deletion (sY84 and sY86, but not sY1064, 1182) that removed USP9Y but retained DDX3Y in the proband, his fertile brother, and his father. A homozygous CFTR variant (TG12-5T) was also detected in the proband and his brother and was inherited from heterozygous parental carriers. Microdissection testicular sperm extraction (micro-TESE) revealed intact spermatogenesis, confirmed by histology and immunofluorescence, indicating normal germ cell development.

Conclusion: This case expands the intricate genetic spectrum of azoospermia by illustrating the critical role of DDX3Y in the AZFa region in spermatogenesis and the variable penetrance of CFTR variant (TG12-5T) in CBAVD. These insights may refine diagnostic strategies and underscore the necessity for tailored fertility management in individuals with multifactorial genetic anomalies.