Basic and Clinical Andrology最新文献

Background: Erectile dysfunction is becoming a public health problem, affecting 22% of men over 40 years of age, where one of the first lines of treatment for this pathology is the use of drugs, so it is necessary to know the effectiveness of new non-invasive alternative therapies that limit the consumption of these substances in the general population. Therefore, the aim of this study was to evaluate the efficacy of extracorporeal shock waves therapy for the treatment of erectile dysfunction. To achieve this, a systematic review was carried out through the databases PubMed, Scopus, Science Direct, Cinhal, Medline, and Web of Science; using the search terms, Erectile Dysfunction, Physical Therapy Modalities, Physical Therapy Specialty, Rehabilitation and Shock Wave Therapy.

Results: The search ended with a total of 15 articles, differentiating between two study groups, those patients suffering from organic erectile dysfunction (n = 12) and those suffering from the same pathology after undergoing radical prostatectomy with nerve sparing (n = 3). The combined analysis showed that the group treated with extracorporeal shock waves therapy had a significant increase in erectile function compared to the controls. The Difference in Means was 2.96 points (95% CI: 1.93 to 4.61; p < 0.001; I² = 63.45).

Conclusions: Extracorporeal shock waves therapy appears to have a positive effect in the treatment of erectile dysfunction, with these changes being reflected in different variables such as erectile function, erectile efficacy or sexual satisfaction. Its efficacy seems to increase with interventions that include two weekly sessions and with the application at least 6000 pulses in each session.

Trial registration: PROSPERO Registration code: CRD42021230001.

Background: There are some studies with inconsistent results regarding the association between follicle stimulating hormone (FSH) levels and type 2 diabetes (T2DM) among men. We performed a systematic review and meta-analysis that explored the FSH levels among men with and without T2DM.

Results: Twenty studies with a total sample size of 4,208 (2167diabetic men and 2041 control) were included in this meta-analysis. The standardized mean differences (SMD) in men who had T2DM compared to control group were -0,237 (CI95%: -0,582 to 0,108; P = 0.17; I²: 95,83%; Egger's test: 0.06; Begg's test: 0.15). This finding was significant after sensitivity analysis. Among Asian studies SDM was -0,955 (CI95%: -1,630 to -0,279; p = 0.006; I2: 96.91%; Egger's test: 0.03; Begg's test: 0.01), with diabetic men had lower FSH than control group. African diabetic males the FSH levels was not different than non-diabetics (SMD: 0,386; CI95%: -0,0401 to 0,813; p = 0.07; I2: 94.26%; Egger's test: 0.31; Begg's test: 0.21). Also, among European men the FSH levels was significantly different than non-diabetics (SMD: 0,273; CI95%:0,0960 to 0,450; p = 0.003; I2: 18.41%; Egger's test: P < 0,0001; Begg's test: 0.31).

Conclusion: Our meta-analysis of the current literature suggests that serum FSH levels are significantly lower in Asian men diagnosed with T2DM compared to their non-diabetic counterparts. This finding highlights a potential association between altered FSH concentrations and the pathogenesis of T2DM. Future studies should aim to unravel these mechanistic pathways and to assess the clinical utility of FSH as a biomarker for T2DM risk assessment and management in the male population.

Background: Zinner syndrome is a rare congenital malformation of the male genitourinary system, characterized by a triad: seminal vesicle cyst, unilateral renal agenesis, and ipsilateral ejaculatory duct obstruction. The etiology of this uncommon disease remains largely elusive; however, genetic mutations may contribute to its development. In this report, we present a case of symptomatic Zinner syndrome that was surgically treated, alongside an investigation into the potential genetic basis of the syndrome via whole exome sequencing.

Case presentation: We report the case of an 18-year-old male presenting with urinary pain and was diagnosed with right renal agenesis and a left seminal vesicle cyst following comprehensive imaging. The patient also experienced perineal pain and urgency, without symptoms of frequent urination, dysuria, or hematuria, and no familial history of genitourinary anomalies was documented. He successfully underwent laparoscopic resection of a pelvic mass, with pathological examination confirming a seminal vesicle cyst. Postoperative recovery was uneventful. Whole exome sequencing of blood and tissue samples highlighted myeloma overexpressed gene (MYEOV), B melanoma antigen family member (BAGE), and N-acetylated-alpha-linked acidic dipeptidase 2 (NAALAD2) as potential mutated genes related to Zinner syndrome. Additionally, two predisposing genetic variants were identified.

Conclusions: Zinner syndrome is a rare condition commonly diagnosed via various imaging modalities. Surgical resection remains the most effective treatment for symptomatic cases. Gene sequencing provides valuable insights into the genetic etiology of Zinner syndrome, enhancing our understanding and potentially guiding future diagnostic approaches.

Background: Vasectomy is a commonly used male contraceptive method, but the choice of surgical technique can influence long-term reproductive health outcomes. Previous studies suggest that different vasectomy techniques may lead to varying degrees of tissue damage, oxidative stress, and endocrine dysfunction. However, there is limited research on how these techniques affect overall reproductive system function. Therefore, this study aims to evaluate and compare the effects of two vasectomy techniques on reproductive system parameters in rats.

Methods: Twenty-four specific pathogen-free male Sprague-Dawley rats weighing 250-300 g were randomly divided into four groups: sham operation group, negative control group, traditional vasectomy group, and modified vasectomy group, with six rats in each group. Each group underwent specific vasectomy procedures, followed by a three-month recovery period. Experimental methods included hematoxylin and eosin staining, immunohistochemistry in the epididymis of rats, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling for apoptosis detection, enzyme-linked immunosorbent assay for measuring serum hormone and oxidative stress markers, as well as tests for sexual behavior and anxiety-like behavior.

Results: The modified vasectomy group exhibited improved epididymis morphology compared to the traditional vasectomy group. Immunohistochemistry demonstrated reduced levels of apoptosis in the modified vasectomy group, which was further corroborated by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining, indicating lower cell death. Hormone analysis revealed stable levels in the modified vasectomy group, and oxidative stress markers indicated reduced stress responses. Behavioral test assessing sexual activity and anxiety level was consistent with these findings.

Conclusion: Modified vasectomy techniques provide superior protection of reproductive system functionality in rats compared to traditional methods. These techniques reduce tissue damage, cell apoptosis, and oxidative stress while maintaining endocrine function, offering promising implications for clinical applications.

Background: Gonadotropin dysregulation seems to play a potential role in the carcinogenesis of testicular germ cell tumor (TGCT). The aim of this study was to explore the expression of specific genes related to sex hormone regulation, synthesis, and metabolism in TGCT and to define specific hormonal clusters. Two publicly available databases were used for this analysis (TCGA and GSE99420). By means of hard-threshold regularized KMEANS clustering, we assigned TGCT samples into four clusters defined in respect to different expression of the sex hormone-related genes. We analysed clinical data, protein and gene expression, signaling regarding hormonal clusters. Based on whole-transcriptome gene expression, prediction of anti-cancer drug response was made by RIDGE models.

Results: Cluster #1 (12-16%) consisted primarily of non-seminomatous germ cell tumor (NSGCT), characterized by high expression of PRL, GNRH1, HSD17B2 and SRD5A1. Cluster #2 (42-50%) included predominantly seminomas with high expression of SRD5A3, being highly infiltrated by T and B cells. Cluster #3 (8.3-18%) comprised of NSGCT with high expression of CGA, CYP19A1, HSD17B12, HSD17B1, SHBG. Cluster #4 (23-30%), which consisted primarily of NSGCT with a small fraction of seminomas, was outlined by increased expression of STAR, POMC, CYP11A1, CYP17A1, HSD3B2 and HSD17B3. Elevated fibroblast levels and increased extracellular matrix- and growth factor signaling-related gene signature scores were described in cluster #1 and #3. In the combined model of progression-free survival, S2/S3 tumor marker status, hormonal cluster #1 or #3 and teratoma histology, were independently associated with 25-30% increase of progression risk. Based on the increased receptor tyrosine kinase and growth factor signaling, cluster #1, #3 and #4 were predicted to be sensitive to tyrosine kinase inhibitors, FGFR inhibitors or EGFR/ERBB inhibitors. Cluster #2 and #4 were responsive to compounds interfering with DNA synthesis, cytoskeleton, cell cycle and epigenetics. Response to apoptosis modulators was predicted only for cluster #2.

Conclusions: Hormonal cluster #1 or #3 is an independent prognostic factor regarding poor progression-free survival. Hormonal cluster assignment also affects the predicted drug response with cluster-dependent susceptibility to specific novel therapeutic compounds.

Background: Sperm cryopreservation in patients with testicular germ cell tumours (GCTs) is traditionally performed after orchiectomy. But, some evidence suggests preoperative semen quality to be superior. We aimed to clarify the optimal time-point of cryopreservation.In a retrospective study, semen quality of 163 patients analysed preoperatively was compared with 242 patients analysed shortly after orchiectomy. Descriptive statistical methods with standard tests for comparisons were employed along with stratified analyses regarding the influence of clinical factors.

Results: All major semen parameters were significantly better in the preoperative group: median ejaculate volume (3 ml preoperatively vs. 2 ml postoperatively); median total sperm count (56.9 x10⁶vs.13 x 10⁶), median progressive motility (40% vs. 25%); azoospermia (4.9% vs. 14.9%). Stratified analysis of subgroups did not reveal significant impact of particular clinical factors on the superiority of preoperative semen quality. Limitations relate to the design of group comparison rather than intraindividual longitudinal comparisons and to selective inclusion of patients opting for cryopreservation.

Conclusions: In GCT patients, semen quality before orchiectomy is significantly superior to that found immediately after surgery. This superiority encompasses all major semen quality parameters. Of particular note is a threefold increase of azoospermia postoperatively. GCT patients are best advised to have cryopreservation performed before orchiectomy.

Context: Malignant tumours of the penis are rare. Their incidence varies around the world and increases with age. Treatment is essentially surgical. Surgery may be conservative or radical. We report the anatomoclinical aspects of 5 cases of penile cancer observed in our department.

Case presentations: A 44-year-old patient with a circumcised penis, diagnosed with a fusosarcoma (a rare type of sarcoma) of the penis. Three patients (ages 61, 59, and 70) were diagnosed with squamous cell carcinoma, the most common type of penile cancer. These patients also had circumcised penises. The last case was a metastatic squamous cell carcinoma of the penis in a 68-year-old patient. All patients were immunocompetent and had a circumcised penis. They refused surgery in any form.

Conclusion: The clinical aspects of penile cancer are polymorphous and misleading. Any bulging or indurated lesions on the penis should be biopsied.

Background: To the best of our knowledge, there is a gap in the review of literature about the most suitable varicocelectomy technique in isolating and ligating adherent periarterial vein(s). Consequently, leaving the artery intact or ligating it together with the adherent vein may pose a challenge. We conducted a comparative prospective study to assess the outcomes of the three techniques namely Fisch, sclerotherapy and microvaricoclectomy (MSV).

Results: The patients who underwent MSV showed the longest operative time (66.29 ± 2.78 min), followed by Fisch technique (56.94 ± 3.07 min) then sclerotherapy (55.45 ± 1.99). Thus, the difference in the operative time between the three techniques was statistically significant (P < 0.001). Regarding the postoperative right vein diameter, MSV group showed the largest diameter (2.14 ± 0.15 mm), followed by Fisch technique (2.13 ± 0.15 mm) then sclerotherapy (1.75 ± 0.42 mm). Regarding the postoperative left vein diameter, MSV group showed again the largest diameter (2.17 ± 0.21 mm), followed by Fisch technique (2.14 ± 0.15 mm) then sclerotherapy (1.75 ± 0.42 mm). Moreover, the patients who underwent sclerotherapy showed the highest postoperative progressive sperm motility percent (25.27 ± 4.00%), followed by Fisch technique (21.56 ± 7.30%) then MSV group (19.85 ± 6.33%). Post hoc pair wise comparisons revealed that sclerotherapy and Fisch technique had a significantly higher effectiveness in reducing operative time than MSV. Additionally, it revealed that sclerotherapy technique had a significantly higher effectiveness in reducing postoperative vein diameters measurement than MSV and Fisch technique. Post hoc pair wise comparisons revealed that sclerotherapy technique had a significantly higher effectiveness in improving the postoperative progressive sperm motility percent than MSV. Patients who underwent the 3 techniques demonstrated statistically significant differences between baseline and post-operative vein diameter, reflux duration, sperm concentration, progressive sperm motility, progressive motile count/ejaculate and sperm abnormal forms.

Conclusion: The 3 techniques showed significant improvement in the semen parameters after 3 months in the studied patients. However, sclerotherapy technique showed a significantly higher effectiveness in improving the postoperative progressive sperm motility percent compared to MSV.

The serendipitous discovery that inhibiting type 5 phosphodiesterase (PDE5) using sildenafil, a potent PDE5 inhibitor (PDE5i) initially developed for cardioprotection, introduced the possibility of orally managing erectile dysfunction (ED) led to an increase in research data, which are currently considered groundbreaking for the new discipline of sexual medicine. Findings from a number of laboratories and clinics around the world unanimously demonstrated the following: (i) the major cause of ED is directly or indirectly related to cardiovascular disease (CVD); (ii) ED and CVDs share the same risk factors, which are related mainly to lifestyle choices; (iii) the first therapeutic approach to both ED and CVDs is to transform harmful lifestyles into virtuous lifestyles; and (iv) PDE5is in general, particularly sildenafil, are very safe, if not protective, for use in CVD patients. However, the use of PDE5is has faced several challenges. Many patients and some healthcare providers (HCPs) often share the misconception that using these drugs can increase the risk of CVD. Some patients might desire to fulfill the unmet need for privacy linked to the stigma of being treated for ED or might be enticed by the idea of buying drugs online, either because of shame or cheaper prices, without knowing the risks associated with counterfeit drugs. The aim of this narrative revision of the current literature is to demonstrate that (i) the orodispersible film of sildenafil is safe from a CV perspective; (ii) it is a discreet formulation that respects the need for privacy; and (iii) it is virtually the unique PDE5i formulation too expensive to produce outside the correct channels, making it impossible to be counterfeit.

Background: Hemodynamic alterations in the spermatic vein are implicated in infertility among patients with varicocele (VC). Contrast-enhanced ultrasound (CEUS), a powerful tool for hemodynamic analysis, remains unexplored for VC. This study aimed to demonstrate the feasibility of using CEUS to evaluate spermatic vein hemodynamics in patients with VC and establish a clear correlation between specific hemodynamic patterns and impaired semen parameters. This study included 165 patients with left-sided VC and 50 healthy volunteers. All participants underwent CEUS of the spermatic veins, along with maximum venous diameter and testicular volume measurements and serum sex hormone levels and routine semen analyses. The sperm DNA fragmentation index was measured in 146 patients with VC and 37 healthy controls.

Results: The analyses revealed four distinct blood flow patterns of the spermatic vein: steady flow, intermittent stasis, intermittent reflux, and filling defect. In healthy spermatic veins, the predominant blood flow patterns included steady flow and intermittent stasis. Spermatic veins with VC exhibited a significant increase in the intermittent reflux and filling defect patterns, with the proportion rising as the clinical grade increased. The four patterns were further grouped into the "steady flow & intermittent stasis" and "intermittent reflux & filling defect" patterns for logistic regression analyses; the intermittent reflux & filling defect pattern was revealed as an independent risk factor for impaired sperm concentration, total sperm counts, progressive motility, morphology, and DNA fragmentation index.

Conclusions: This study validated the feasibility of CEUS for assessing the hemodynamics of the spermatic vein and established the intermittent reflux & filling defect pattern as an independent predictor of impaired semen parameters.