Asian journal of andrology最新文献

To evaluate the prognostic significance of prostate-specific antigen (PSA) decline depth and duration in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC) undergoing abiraterone treatment. We retrospectively analyzed data from 153 high-risk patients with mHSPC receiving first-line abiraterone therapy. Patients were stratified based on PSA dynamics during treatment. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to assess the associations between PSA decline patterns, PSA progression-free survival (PSA-PFS), radiographic PFS (rPFS), and overall survival (OS). Among the 153 patients, 85 exhibited PSA nadir <0.2 ng ml-1, 48 had PSA nadir level ranging from 0.2 ng ml-1 to 4 ng ml-1, and 20 presented with a PSA nadir >4 ng ml-1. During abiraterone treatment, PSA nadir <0.2 ng ml-1 was significantly associated with improved median PSA-PFS (51.0 months vs 18.5 months vs 6.9 months, P < 0.0001), median rPFS (52.0 months vs 24.3 months vs 10.3 months, P < 0.0001), and median OS (not reached vs 48.5 months vs 28.1 months, P < 0.0001) compared with PSA nadir ≥0.2 ng ml-1 and <4 ng ml-1, and PSA nadir ≥4 ng ml-1. In the cohort with PSA nadir <0.2 ng ml-1, achieving PSA <0.2 ng ml-1 within 6 months and maintaining this level for over 10 months significantly enhanced clinical outcomes, as evidenced by median PSA-PFS (not reached vs 26.9 months, P < 0.0001), median rPFS (not reached vs 27.5 months, P < 0.0001), and median OS (not reached vs 44.4 months, P < 0.0001). Cox regression analysis revealed that achieving PSA <0.2 ng ml-1 within 6 months post-treatment and sustaining this level for over 10 months are independent prognostic factors. In high-risk patients with mHSPC receiving first-line abiraterone, sustained PSA suppression is a key indicator of therapeutic response. The rate, depth, and duration of PSA decline are critical prognostic factors.

Androgen insensitivity syndrome (AIS) is a condition that emerges from mutations in the androgen receptor (AR) gene, leading to functional defects and subsequent abnormal development of the urogenital sinus. The aim of this study was to investigate the relationship between genotype and phenotype, surgical treatments, and complications of AIS patients. We retrospectively evaluated the medical records of patients who were diagnosed with AIS after genetic testing and underwent initial surgery at Beijing Children's Hospital, Capital Medical University (Beijing, China), from August 2007 to August 2023. A total of 46 patients were included in this study. Four novel variants, p.Y572S, p.L57dup, p.L882del, and p.V888A, were identified. AR variants are concentrated in the ligand-binding domain (LBD) region (60.9%) and are predominantly missense mutations (78.3%). There was no significant difference in the phenotypes between the LBD group and the non-LBD group (P > 0.05). Nonsense or frameshift mutations may accompany more severe phenotypes or complete androgen insensitivity syndrome (CAIS; P = 0.011). For CAIS patients with inguinal hernias, we recommend that hernia ligation surgery should be performed during childhood and that gonadectomy should be considered during adolescence or postadolescence. Preoperative hormone stimulation (PHS) had a positive effect on penile growth (P = 0.0014). Compared with patients with severe hypospadias, those patients with partial androgen insensitivity syndrome (PAIS) experience fewer complications from urethroplasty. If the conditions for a one-stage operation are not adequately met, it is advisable to perform staged surgery.

Non-obstructive azoospermia (NOA) represents one of the most severe forms of male infertility, with spermatozoa retrieval only possible in about half of the cases. Spermatids can be identified in up to 30% of men with negative spermatozoa during testicular sperm extraction (TESE) procedure. Intracytoplasmic spermatid injection has been proposed for TESE-negative patients desiring biological parenthood. However, significant limitations jeopardize the clinical implementation of this technique. Key challenges include the accurate identification of viable spermatids and the need for artificial oocyte activation. These limitations contribute to lower fertilization, pregnancy, and live birth rates compared to conventional intracytoplasmic sperm injection using mature sperm. Additionally, the absence of rigorous randomized controlled trials and the predominance of low-quality and outdated underpinning studies have significantly jeopardized its clinical implementation. These concerns have led the Practice Committee of the American Society for Reproductive Medicine to consider the technique experimental. Recent advances in microscopy, improved tissue processing, and refined activation techniques have enhanced outcomes. Furthermore, while initial safety concerns about epigenetic modifications persist, follow-up studies of spermatid injection offspring have shown normal development. This review comprehensively explores current evidence regarding intracytoplasmic spermatid injection techniques, focusing on their utilization, efficacy, and safety in men with NOA. We also evaluate spermatid identification and retrieval methods, ethical considerations, technical limitations, and emerging technologies that could enhance outcomes.

The tripartite motif-containing protein 26 (TRIM26) is an E3 ubiquitin ligase with strong oncogenic activity in various cancers. However, its role and molecular mechanism in prostate cancer (PCa) remain elusive. To clarify its role in promoting PCa progression, we evaluated TRIM26 expression in cells and clinical specimens using immunohistochemistry and found that TRIM26 was significantly upregulated in PCa tissue. Moreover, high TRIM26 levels predicted a poor prognosis in patients with PCa. Ectopic overexpression of TRIM26 increased PCa cell proliferation and migration, and this activity was suppressed by TRIM26 knockdown. Notably, TRIM26 activated both protein kinase B (AKT)/mammalian target of the rapamycin (mTOR) and the epithelial-mesenchymal transition (EMT) signaling pathways in PCa cells. Consistent with these findings, TRIM26 knockdown led to decreased activation of these signals. Furthermore, the phosphoinositide 3-kinase (PI3K)/AKT/mTOR signaling pathway activated by TRIM26 was attenuated by the PI3K inhibitor S14161. Similarly, cisplatin, a commonly used anti-PCa drug, downregulated TRIM26 and AKT/mTOR activation, while TRIM26 overexpression reversed AKT/mTOR inactivation. Finally, this finding was also demonstrated TRIM26 expression strikingly promoted tumor growth and activated AKT/mTOR signaling in a PCa xenograft. In conclusion, TRIM26 drives PCa malignancy and may be an attractive target for PCa treatment.

Artificial intelligence (AI)-driven large language models (LLMs) hold potential for medical applications but face challenges, such as inaccurate or outdated training data. In this study, ZhongdaChat-ED, a personalized medical LLM integrating retrieval-augmented generation (RAG) technology, was developed to enhance erectile dysfunction (ED) counseling and clinical decision-making. The model was built using the open-source Deepseek-r1:32b framework, augmented with two specialized databases: a patient health consultation database and a clinical decision support database updated with real-time medical advancements. Two versions of ZhongdaChat-ED were developed: a Consumer Version for patient-facing health consultations and a Professional Version for clinician support. Performance was evaluated against four commonly used LLMs (ChatGPT4, Copilot, Claude, and Gemini) through simulated clinical consultations and case analyses. Three urologists and three patients assessed responses across various dimensions, including accuracy, human caring, ease of understanding, clinical significance, and informational frontier. The Consumer Version outperformed commonly used LLMs in accuracy (4.77/5), human caring (4.86/5), and ease of understanding (4.88/5) with all P < 0.001. The Professional Version demonstrated significantly higher clinical significance (>85.2% case score rate) and informational frontier scores (4.52/5) than those of other models ( P < 0.001). ZhongdaChat-ED effectively addresses limitations of conventional LLMs by leveraging RAG to integrate real-time, domain-specific data. ZhongdaChat-ED shows promise in enhancing patient health consultation and clinician decision-making for ED, underscoring the value of tailored AI systems in bridging gaps between generalized AI and specialized medical needs. Future work should expand multimodal capabilities and cross-disciplinary integration to broaden clinical utility.

Implantation of inflatable penile prosthesis should be considered as a definitive treatment of erectile dysfunction. However, the sole procedure might not allow for optimal dimensional and functional outcomes. The aim of this study was to systematically review the literature and present the findings on the optimal choice of perioperative methods, surgical techniques, and pharmacotherapy to improve penile length, curvature, and erectile function. Fifteen studies and 697 men were included. Nine studies focused on intraoperative techniques only, while 6 described intra- and postoperative methods. Regarding the outcomes, curvature of the penis was reported in 12 studies, penile length in 5 studies, penile girth in 2 studies, and the International Index of Erectile Function-5 (IIEF-5) score in 7 studies. According to this systematic review, extreme angulation can be reduced using plaque/corporal incisions and grafting with collagen fleece, as well as "scratch" technique with postoperative vacuum therapy. Also, among patients with preoperative curvature of approximately 30°-40°, penile plication, corporoplasty, tunica expansion procedure, manual, and at-home modeling can provide good results. In addition, corporal incisions plus grafting, as well as postoperative vacuum therapy might be the most beneficial in terms of length improvement. Importantly, penile implant in combination with the sealing, daily, and early prosthesis activation proved to improve length. Moreover, postoperative vacuum therapy has also been shown to greatly increase penile circumference. Finally, penile implant in combination with the sealing, corporal incisions plus grafting, "scratch" technique, vacuum therapy, and phosphodiesterase-5 inhibitor are all associated with major improvements in sexual function.

Penile prosthetic devices stand as the foremost solution for medication-resistant erectile dysfunction. Frequently, medical conditions triggering erectile dysfunction also led to penile shortening, detrimentally impacting patients' quality of life. This narrative review aims to explore and evaluate the various techniques available for penile lengthening that can be performed concurrently with inflatable penile prosthesis (IPP) insertion. We conducted a comprehensive examination of the literature, utilizing PubMed focusing on key terms such as "penile prosthesis corporal length", "inflatable penile prosthesis and short penis", and "buried penis". The review identified several advanced methodologies for preserving and enhancing penile length during IPP insertion. These techniques include subcoronal IPP insertion, sliding technique, modified sliding technique, multiple slice technique, and circumferential incision with grafting. Supplementary procedures aimed at improving the perception of increased length involve ventral phalloplasty and suprapubic lipectomy. It is worth noting that the maximum length gain seems to be constrained by the length of the neurovascular bundles. In summary, the evidence available in the literature is limited due to the short of case series reported, lack of randomized controlled trials, and heterogeneity of the studies. The literature suggests that for carefully selected patients, surgical penile lengthening procedures performed concurrently with IPP insertion emerge as effective treatments for individuals grappling with penile shortening and severe erectile dysfunction. Well-designed, larger studies are needed to establish the safety and efficacy of these procedures.

The transurethral route is the access of choice for benign prostatic hyperplasia (BPH) surgical treatment. Transurethral resection of the prostate (TURP) has been the gold standard in surgical intervention for BPH; however, the advent of novel surgical techniques and the exploration of new energy sources in recent decades have seen this primacy contested. Nevertheless, the transurethral route harbors numerous challenges and pitfalls that can pose significant risks even for the most experienced endoscopic urologists. Complications associated with transurethral access are well documented yet often underestimated by endoscopic surgeons, primarily because the pathological conditions arising from transurethral surgery typically fall within the realm of those specializing in genitourinary reconstructive surgery. This narrative review describes and critically discusses the specific pitfalls associated with transurethral surgery for BPH. Urethral strictures, transient or permanent postoperative incontinence, reintervention, and de novo /persistent lower urinary tract symptoms (LUTS) represent the main complications of transurethral treatments for BPH. These problems still stand as the foremost challenge for all endoscopists despite recent technological advancements. The use of increasingly miniaturized instruments, more mindful energy application, sphincter-sparing enucleation techniques, and the advent of so-called minimally invasive surgical techniques (MISTs) all contribute to a more conscious and anatomically respectful transurethral approach. An endoscopic transvesical suprapubic access may be another alternative strategy to minimize the complications of transurethral route in the future.

The aim of this narrative review is to provide a comprehensive overview of penile prostheses (PPs) for the treatment of erectile dysfunction (ED), exploring their historical evolution, types, key advancements, clinical outcomes, and future directions. A comprehensive literature search of studies published in English was conducted between January 2000 and April 2024, using databases including PubMed, MEDLINE, Embase, and the Cochrane Library. Search terms included "penile prosthesis", "penile implants", "malleable penile implant", "inflatable penile prosthesis", "two-piece IPP", "three-piece IPP", and "penile implant advancements". The included studies focused on the development, effectiveness, and complications of penile prostheses. These studies are clinical trials, randomized controlled trials, observational studies, systematic reviews, and meta-analyses. Data were synthesized qualitatively and quantitatively. Penile prostheses have significantly evolved since their invention, with notable advancements in both malleable and inflatable models. Malleable prostheses, known for their simplicity and reliability, offer a semirigid state that is beneficial for patients with limited hand dexterity or those undergoing salvage procedures. Inflatable penile prostheses (IPPs), particularly the three-piece models, have seen substantial technological improvements, including enhanced mechanical reliability, reduced infection rates due to antibiotic coatings, and better patient satisfaction. Key innovations include the development of hydrophilic coatings, parylene microcoatings, and antibiotic-impregnated implants, which have collectively reduced complications.