Asian journal of andrology最新文献

Recent data from clinical trials have shown that neoadjuvant therapies significantly improve the pathological outcomes of prostate cancer patients. This study aimed to assess the specific pathological and prognostic effects of these therapies in a real-world, multicenter cohort. Additionally, we explored how factors such as the duration of neoadjuvant therapy and pretreatment imaging modality impact overall treatment outcomes within this therapeutic framework. Data were collected from 407 patients with locally advanced prostate cancer (LAPC) who underwent radical prostatectomy following neoadjuvant therapy. Kaplan-Meier estimates were used to evaluate the four primary clinical endpoints. The log-rank test was used to assess whether significant differences existed between patients grouped according to neoadjuvant therapy duration and pretreatment imaging modality. After a median follow-up period of 36 months, the median progression-free survival (PFS) for the entire cohort was 19 months. An analysis of different durations of neoadjuvant therapy revealed that compared with a 3-month regimen, a 6-month regimen was significantly associated with a greater extent of pathological downstaging and more favorable values for drug response indicators (Pearson test, P = 0.018). Additionally, the 6-month regimen significantly improved the clinical endpoints of PFS (log-rank test, P = 0.0075) and metastasis-free survival (MFS; log-rank test, P = 0.0069). Kaplan-Meier analysis of patients grouped according to preoperative imaging modality revealed that the use of 68 Ga-labeled prostate-specific membrane antigen-directed positron emission tomography/computed tomography ( 68 Ga-PSMA PET/CT) before treatment, as opposed to traditional imaging, led to significant improvements in the clinical endpoints of PFS (log-rank test, P = 0.0059) and radiographic progression-free survival (rPFS; log-rank test, P = 0.016).

Erectile dysfunction is a complex and prevalent complication of diabetes, and effective treatments are lacking. Oxidative stress, fibrosis, and apoptosis are closely associated with the development of diabetes mellitus-related erectile dysfunction (DMED). Notably, ginsenoside Rb1 (Rb1) exerts antioxidant effects and displays promise in the treatment of DMED. This study evaluated the therapeutic efficacy of Rb1 in a rodent streptozotocin-induced DMED model. Thirty-two rats were randomly assigned to three groups: control group, DMED group, and DMED + Rb1 group. DMED was induced in male rats via an intraperitoneal injection of streptozotocin. After 8 weeks of Rb1 gavage, erectile function was assessed by the electrical stimulation of the cavernous nerve. In addition, western blot, quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assay, immunofluorescence, terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling (TUNEL) staining, and Masson's trichrome staining were performed to verify the relevant factors and protein expression. Rb1 effectively improved the erectile function of the corpus cavernosum, decreased collagen content, and increased smooth muscle content in rats with diabetes. Rb1 decreased the levels of the pro-inflammatory factors (interleukin [IL]-6, tumor necrosis factor alpha [TNF-α], and IL-1β), and increased the levels of the anti-inflammatory factors (IL-10 and IL-4). Moreover, the activities of superoxide dismutase and catalase and levels of nitric oxide (NO) were increased, whereas malondialdehyde activity was decreased. Additionally, Rb1 activated the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/endothelial nitric oxide synthase (eNOS) signaling pathway and inhibited cell apoptosis. Rb1 can improve erectile function in rats with DMED by increasing the activity of the PI3K/AKT/eNOS pathway, reducing oxidative stress, inhibiting inflammation and apoptosis, and alleviating corpus cavernosum fibrosis.

Accurate classification between non-clinically significant prostate cancer (non-csPCa) and clinically significant prostate cancer (csPCa) is essential for effective risk stratification and optimal management of prostate cancer. This study aimed to evaluate the consistency between preoperative and postoperative assessments of non-csPCa, and identify preoperative variables that can effectively predict the risk of csPCa. We analyzed data from 277 patients initially classified as non-csPCa after biopsy who underwent radical prostatectomy (RP) between August 2015 and January 2024. Univariate and multivariate logistic regression analyses were performed to identify predictors of csPCa. Receiver operating characteristic curves, calibration curves, and decision curve analyses were used to evaluate the performance of the nomogram model. Differences in biochemical recurrence rates between the non-csPCa group and csPCa group were analyzed using the log-rank test. Overall, 183 (66.1%) patients were reclassified as csPCa on the basis of postoperative pathology, with this group showing a higher incidence of biochemical recurrence versus non-csPCa (14 cases vs 0; P = 0.004). The following factors were independent predictors of csPCa: age, free prostate-specific antigen (fPSA)/total prostate-specific antigen (tPSA) ratio, cumulative cancer length, clinical tumor stage, and PSA density. In addition, a nomogram was developed with good predictive accuracy (area under the curve: 0.782). The substantial inconsistency between biopsy and RP pathology findings in the classification of non-csPCa highlights the limitations of biopsy-only management. The developed nomogram predicting the risk of csPCa provides urologists with a valuable tool for improved risk stratification and PCa management.

The study aimed to assess the long-term device survival of a 3-piece inflatable penile prosthesis (PP) in patients with erectile dysfunction (ED). This retrospective observational longitudinal study involved patients with drug-refractory ED who underwent primary 3-piece inflatable PP implantation at a single center from 1992 to 2019. The outcomes included complications of various inflatable PP models, and Kaplan-Meier analysis was used to estimate the probability of PP survival. Of the total 426 patients, 140 (32.9%) were implanted in the period of 1992-2000, 128 (30.0%) in the period of 2001-2008, and 158 (37.1%) in the period of 2009-2019. The PP used in the study included AMS 700 CX (62.0%, n = 264), AMS 700 CXR (7.7%, n = 33), AMS Ultrex Plus (10.3%, n = 44), and Alpha I (20.0%, n = 85). The overall complication rate was 28.2% (120/426), and the majority happened after 6 months. The causes of device removal included mechanical failure (11.0%, n = 47), infection (3.9%, n = 17), cylinder extrusion (6.3%, n = 27), and unspecified (0.2%, n = 1). Of the total mechanical failures ( n = 47), 18 (38.3%) occurred in the cylinders, 10 (21.3%) occurred in the pump, 7 (14.9%) occurred in the reservoir, 6 (12.8%) occurred in the connections, and 6 (12.8%) were nonspecific. Global average survival rates of the PP at 1 year, 5 years, 10 years, and 15 years were 96.2%, 86.7%, 77.5%, and 58.7%, respectively. The 3-piece inflatable PP has an excellent device survival rate at 5 years and 10 years.

Age-related erectile dysfunction (ARED) represents a significant clinical challenge due to the interplay between chronic comorbidities and age-related physiological decline. This study investigated the therapeutic potential of near-infrared photobiomodulation therapy (NIR-PBMT) in ARED mice, focusing on molecular and physiological mechanisms of complex erectile function restoration. Aged mice received NIR-PBMT (4 J cm -2 ) every 48 h for 2 weeks. Erectile function was evaluated using the maximum intracavernosal pressure/mean arterial pressure (ICP max /MAP) ratio following cavernous nerve stimulation. Histological analysis and western blotting revealed significant improvements in penile tissue architecture, including increased smooth muscle content, reduced collagen deposition, and altered expression of senescence markers (p21 and phosphorylated H2A histone family member X [ γ -H2A.X]) and endothelial nitric oxide synthase (eNOS). In vitro studies using human corpus cavernous endothelial cells (HCCECs) demonstrated that NIR-PBMT reduced cellular senescence (assessed via SA- β -galactosidase staining), enhanced nitric oxide (NO) production, and improved mitochondrial network integrity. Angiogenesis assays further confirmed the pro-angiogenic effects of NIR-PBMT. Collectively, these findings highlight NIR-PBMT as a promising non-invasive therapy for ARED, acting through multiple pathways to reverse pathological remodeling and restore endothelial function. Future translational research is necessary to validate its clinical efficacy and optimize treatment protocols.

This study examines the global burden and prevalence of male infertility using data from the Global Burden of Disease Study 2021 (GBD 2021 Study), encompassing 204 countries from 1990 to 2021. By analyzing disability-adjusted life years (DALYs) and prevalence trends, alongside lifestyle, environmental, and disease-related factors, including the impact of coronavirus disease 2019 (COVID-19), we identified significant temporal and regional disparities. Using joinpoint regression, decomposition analysis, and Bayesian age-period-cohort models, the results revealed a rising global burden, with DALYs increasing from 15.8 to 18.6 per 100 000 and the age-standardized prevalence rising from 2752.5 to 3218.9 per 100 000 over three decades. Low- and middle-sociodemographic index (SDI) regions presented the highest burden, driven by demographic shifts and epidemiological challenges. The COVID-19 pandemic further exacerbated healthcare disparities, particularly in resource-limited settings. These findings underscore the urgent need to integrate male infertility into global health agendas, emphasizing tailored interventions and policy reforms to address socioeconomic impacts and mitigate rising burdens, especially in low- and middle-SDI regions.

Erectile dysfunction (ED) is a common condition affecting men worldwide. The U.S. Food and Drug Administration (FDA) has approved phosphodiesterase type 5 inhibitors (PDE5Is), including sildenafil, tadalafil, vardenafil, and avanafil, for treating ED. However, real-world studies on adverse events (AEs) linked to PDE5Is are limited. This study comprehensively assessed the safety of PDE5Is based on reports from the FDA adverse event reporting system (FAERS) database from January 2004 to June 2024. The disproportionality analysis was used to evaluate the safety profiles of PDE5Is. Based on demographic stratification, correlational analysis and signal differences examination in subgroups were performed in different PDE5Is. Among the 53 517 AEs reports collected from the FAERS database, we identified 135, 73, 72, and 7 preferred terms associated with sildenafil, tadalafil, vardenafil, and avanafil, respectively. The study detected AEs listed on the FDA-approved label of each PDE5I. However, some AEs not listed on the labels were also identified. Some AEs listed by the FDA for PDE5Is were insignificant signals in our analysis. Significant differences were found among PDE5Is across age, weight, and onset time categories. We detected AEs related to the nervous, cardiovascular, and ocular systems that were not listed on the labels of the four PDE5Is, warranting further research on the underlying mechanisms. Additionally, significant differences in PDE5I-associated AEs were observed across age, weight, and onset time, highlighting the need for tailored patient management.

Erectile dysfunction (ED), a condition affecting nearly 150 million men worldwide, is expected to impact over 300 million by 2025. Phosphodiesterase type 5 inhibitors (PDE5Is) remain the first-line treatment for ED, yet a subset of patients exhibit inadequate responses. For these individuals, the inflatable penile prosthesis (IPP) offers an effective alternative, with the three-piece IPP being particularly favored for its high satisfaction and low complication rates. However, the challenge of optimal reservoir placement, particularly in the extraperitoneal space of Retzius (SOR), has prompted investigations into alternative approaches. SOR placement is associated with complications, such as injury to iliac vessels, bladder puncture, and bowel perforation. Various alternative sites have been proposed, including epigastric extraperitoneal, intraperitoneal (IP), high submuscular (HSM), and lateral retroperitoneal (LRP) positions, each aiming to mitigate these risks while improving patient outcomes. Comparative studies have shown that methods such as IP and HSM reduce the risk of vessel compression and bladder injury, often yielding higher satisfaction rates compared with SOR. However, each technique carries unique drawbacks, including risks of palpability, improper placement, and longer operative times. This review synthesizes current evidence on reservoir placement strategies, evaluates their advantages and limitations, and highlights crucial considerations for patient selection, providing a comprehensive overview of IPP implantation techniques and their evolving roles in the management of ED.

Men with erectile dysfunction offered penile prostheses have high satisfaction rates when properly counselled. These devices have undergone significant advancements in design, surgical techniques, and perioperative management, enhancing patient outcomes, satisfaction, and safety. This review summarizes the latest innovations, including novel non-antimicrobial prevention strategies and disposable surgical tools that may reduce infection risks. Furthermore, advances in operative techniques, including safer alternative reservoir placement, have minimized the complications. Additionally, innovations in postoperative management, such as multimodal analgesia and nerve blocks, have improved patient recovery and comfort. Lastly, emerging technologies, including shape-memory alloys and electronic-controlled devices that represent potential future breakthroughs are described.