Basic and Clinical Andrology最新文献

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.

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.