Basic and Clinical Andrology最新文献

Purpose: To investigate the therapeutic potential of Acrorus tatarinowii in oligoasthenozoospermia and its related mechanism through modulation of the BCL2/Bax/Caspase3 signaling pathway.

Methods: Initially, using the TCMSP and Disgenet databases, active ingredients of Acrorus tatarinowii were identified and their target genes associated with sperm-related diseases were elucidated.Subsequently, an oligoasthenozoospermia mouse model was induced and treated with Acrorus tatarinowii. Serum hormone levels were assessed by ELISA, testicular histopathology by HE staining, and target gene expression by qPCR and Western blotting.

Results: Acrorus tatarinowii treatment significantly upregulated BCL2 expression in the testes of oligoasthenozoospermic rat. This was accompanied by improved histopathological features in testicular tissues, reduced LH and FSH levels in serum.

Conclusion: Acrorus tatarinowii exerts therapeutic effects in oligoasthenozoospermia by regulating the BCL2/Bax/Caspase3 pathway, maybe by inhibiting apoptosis, and promoting germ cell proliferation. These findings highlight its potential as a natural remedy for male infertility associated with sperm function disorders.

Background: Manual counting for semen analysis is recommended by the World Health Organization. Technicians performing this usually record their results on a paper worksheet and then enter the data into an electronic laboratory information system. One disadvantage of this approach is the chance of post-analytical transcription errors, which can be reduced by checking the computer entries before reporting by another technician. Such practice inevitably increases the running cost and delays the reporting time. The present study was to establish a paperless electronic data entry system for semen analysis and compare its precision with the conventional paper method. During semen analysis, readings on the cell counter were video recorded. The precision of the paper record entries was determined by comparing them with the corresponding video records. Patient characteristics and semen analysis results were input directly into an in-house developed data entry system via a tablet computer immediately after analysis. The same set of data was also handwritten on a paper form and was subsequently input into a standard computerized database according to routine practice. The agreement of the data entries between the two systems was then compared.

Results: A total of 787 semen analyses were included in the study, involving 201 samples in Phase I and 586 samples in Phase II of the study. Phase I was the initial learning period. The overall rate of transcription error of the paper form was 0.07%, whereas that of the paperless system was 0.17%. In phase II, the paperless system was modified according to users' comments. The transcription error rate of the paper form was 0.05%, while that of the paperless system was substantially reduced to 0.01% (p = 0.008).

Conclusion: The paperless system is a reliable tool for recording data from semen analysis compared with the conventional paper form. However, training is needed to reduce the error rate of the paperless system.

Background: To evaluate the effects of penile revascularization surgery on penile vascular hemodynamics and to assess the utility of the resistive index (RI) as an objective parameter for postoperative patient follow-up.

Methods: This study included a total of 35 patients who underwent penile revascularization. Penile color Doppler ultrasonography was performed preoperatively and at the third postoperative month to evaluate cavernosal arteries, dorsal arteries, deep dorsal vein, and inferior epigastric artery. During these evaluations, peak systolic velocity, end diastolic velocity, and resistive index were measured. The International Index of Erectile Function questionnaire was administered before surgery and at the third postoperative month. In addition, corpus cavernosum electromyography and cavernosometry tests were performed in all cases preoperatively. Anastomotic patency was assessed using computed tomography angiography at the end of the follow-up period.

Results: The mean preoperative resistive index values were determined to be 0.74 ± 0.07 and 0.73 ± 0.09 cm/s for the right and left cavernosal arteries, respectively, and these values increased to 0.95 ± 0.09 and 0.96 ± 0.06 cm/s, respectively, at the last postoperative control. The mean International Index of Erectile Function-5, 15 scores for the right and left cavernosal arteries were 8.52 ± 4.83 and 19.4 ± 8.54, respectively, preoperatively, and these scores improved to 15.26 ± 4.50 and 35.76 ± 13.65, respectively, at the last postoperative follow-up.

Conclusion: The results of this study suggest that the resistive index can be used as an objective parameter in the diagnosis of erectile dysfunction of vascular origin and in the follow-up and management of the disease following penile revascularization.

Trial registration: NCT06350019/04/03/2024 (retrospectively registered).

Background: Primary ciliary dyskinesia (PCD) is a heterogenous disease caused by mutations of miscellaneous genes which physiologically play an important role in proper structure and/or function of various cellular cilia including sperm flagella. Besides male infertility, the typical phenotypes, based on decreased mucociliary clearance, are lifelong respiratory issues, i.e., chronic bronchitis leading to bronchiectasis, chronic rhinosinusitis, and chronic otitis media. Moreover, since motile cilia are important during embryological development in the sense of direction of gut rotation, 50% of affected individuals develop situs inversus - so-called Kartagener's syndrome.

Case presentation: We present two cases of PCD as a rare cause of male infertility.

Conclusions: Primary ciliary dyskinesia should be suspected in infertile males having (sub)normal sperm concentration values with persistent zero motility together with patient's and/or family history of respiratory symptoms like bronchiectasis, chronic cough, rhinitis, recurrent sinusitis, and otitis media. Due to more than 50 identified mutations until now, the causal mechanism of male infertility is miscellaneous and not in all cases known in detail. Besides impaired sperm motility, other mechanisms significantly decreasing efficacy of assisted reproduction techniques play a pivotal role. Thus, proper diagnostic work-up including, among others, sperm DNA fragmentation, is mandatory to avoid ineffective treatment burden.

The annulus is an electron-dense ring structure that surrounds the axoneme and compartmentalizes the sperm flagellum into two parts: the midpiece and the principal piece. The function of the annulus as a diffusion barrier in the mature spermatozoon is now well described but its function during spermiogenesis remains unclear. The intriguing spatio-temporal dynamics of the annulus during spermiogenesis and its position at the interface of the two main flagellar compartments have been highlighted for more than 50 years, and suggest a major role in this process. During the last decade, numerous studies contributed in establishing a repertoire of proteins known to be located at the annulus. Mutant mouse models of invalidation of these proteins have provided essential information and clues for novel hypotheses regarding the functions and regulation of this structure. Importantly, the recent identification in humans of homozygous mutations of genes coding for annulus proteins and leading to sterility have reinforced the importance of this ring structure for sperm physiology and male fertility. This review provides a comprehensive description of all the knowledge obtained in the last several years regarding the annulus composition and functions, both in mice and in humans.

Background: Acephalic spermatozoa syndrome is a rare but severe type of teratozoospermia. The familial trait of acephalic spermatozoa syndrome suggests that genetic factors play an important role. However, known mutations account for only some acephalic spermatozoa syndrome patients, and more studies are needed to elucidate its pathogenesis. The current study aimed to elucidate the pathogenesis of acephalic spermatozoa syndrome caused by PMFBP1 mutation.

Results: We identified a homozygous splice site mutation (NM_031293.2, c.2089-1G > T) in PMFBP1 through Sanger sequencing. Western blotting and immunofluorescence analyses revealed that this splice site mutation resulted in the absence of PMFBP1 protein expression in the patient's sperm cells. We generated an in vitro model carrying the splice site mutation in PMFBP1 and confirmed, through RT‒PCR and Sanger sequencing, that it led to a deletion of 4 base pairs from exon 15.

Conclusion: A homozygous splice site mutation results in a deletion of 4 bp from exon 15 of PMFBP1, thereby affecting the expression of the PMFBP1 protein. The absence of PMFBP1 protein expression can lead to acephalic spermatozoa syndrome. This finding elucidates the underlying cause of acephalic spermatozoa syndrome associated with this specific mutation (NM_031293.2, c.2089-1G > T) in PMFBP1.

Background: Premature ejaculation (PE) is one of the most common diseases in andrology and leads to serious male sexual dysfunction. Although several targeted oral drug therapies are used to treat PE, they often face challenges related to imprecise targeting and adverse effects. Acupuncture has shown potential in prolonging ejaculation time and improving couples' sexual quality of life. This review aims to summarize the benefits of acupuncture in treating PE and explore its probable neurobiological mechanisms.

Results: The review included eight clinical trials involving 679 patients, of which 294 were treated with acupuncture. Furthermore, this review analyzed acupuncture points, needle retention time, treatment duration, and their probable neurobiological mechanisms. The proposed mechanisms include stimulating the frontal functional lobe, inhibiting spinal cord neural pathways, regulating serotonin levels, enhancing 5-hydroxytryptamine receptor IB excitability, reducing penile sensitivity, and modulating hormone levels.

Conclusions: Acupuncture is a viable alternative or complementary therapy for PE, and neurobiological mechanisms appear to play a key role, but further experimental validation is needed.

Background: Testicular microlithiasis (TM) is characterised by microcalcifications in the testes and has been associated with infertility. This has led to studies of semen analysis in men with the condition. This systematic review aimed to compare semen parameters in men with TM and those without. Men with classic TM (≥ 5 microcalcifications per sonographic image) were also compared to those with limited TM (< 5 microcalcifications per sonographic image). Additionally, testicular volume and hormone levels were analysed as secondary outcomes. This review was carried out according to PRISMA guidelines and registered on PROSPERO. The quality of included studies was assessed using the Newcastle-Ottawa Scale.

Results: Embase, MEDLINE, World of Science and Scopus were searched. Abstracts were screened against inclusion/exclusion criteria by two independent reviewers. Eligible studies included data on semen parameters in men with TM where semen analysis was done according to World Health Organisation recommendations. Studies with populations consisting of men with testicular cancer were excluded. After searching the databases, 137 papers were found and 10 studies involving 611 men with TM were included in the analysis. In the studies that compared sperm concentration in men with TM to controls, six (100%) found lower sperm concentration in the TM group. Six studies compared sperm motility, of which 4 (66.7%) showed lower motility in the TM group compared to controls. Five studies compared sperm morphology, with three (60%) finding a lower percentage of normal morphology in the TM group compared to controls. Six studies compared classic TM with limited TM. All six (100%) found a lower sperm concentration in the classic TM group compared to the limited TM group. Results also suggested that more extensive disease is associated with poorer sperm concentration.

Conclusions: This review suggests that TM is associated with decreased semen parameters, particularly sperm concentration. However, clinical outcomes should be investigated by studying pregnancy rates in males with TM. Future research that controls for confounding variables, involves larger sample sizes, and utilises advanced sperm function tests is also advised. Further research is important for establishing clinical guidance and suggestions for fertility follow-up in men with TM.

Background: Stuttering priapism is characterized by recurrent, self-limited episodes of penile erection lasting from a few minutes to a maximum of three hours, often resolving spontaneously. These episodes can occur with or without sexual stimulation. If not treated promptly and effectively, stuttering priapism can severely impact a patient's quality of life, leading to significant psychological distress and anxiety related to sexual performance. Although it has been associated with various hematological disorders and pharmacological treatments, many cases of stuttering priapism remain idiopathic, meaning they have no identifiable cause. Currently, no conclusive randomized clinical trials exist on the management of idiopathic stuttering priapism. This study aims to review the existing literature on the pathophysiology and management of idiopathic stuttering priapism and propose an algorithm to assist physicians in its evaluation and treatment.

Results: A systematic literature review was conducted using the PubMed database, focusing on the terms "idiopathic," "stuttering," "ischemic," and "priapism." The search identified 23 relevant references published between 1991 and 2022. The selection and analysis of these studies adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and results were described qualitatively. Recent research into the effectiveness, sustainability, tolerability, and side effects of various treatments for idiopathic stuttering priapism has enhanced the understanding of its underlying molecular mechanisms. Various treatments, targeting different mechanisms, have been identified that can potentially reduce the frequency and severity of episodes and improve patient outcomes.

Conclusion: Current research predominantly addresses the acute treatment of idiopathic stuttering priapism rather than strategies to alter the disease's overall course. The limited number of treatment reviews, case reports, and the low level of evidence available, combined with the absence of randomized clinical trials, prevent the establishment of a consensus on treatment protocols. As a result, idiopathic stuttering priapism remains under-recognized and under-treated. This review proposes a management framework to help clinicians access and apply the available literature effectively, minimizing the reliance on extensive case reports and review articles.