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   Table of Contents - Current issue
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March-April 2017
Volume 19 | Issue 2
Page Nos. 143-264

Online since Wednesday, February 1, 2017

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REVIEW  

Understanding prostate-specific antigen dynamics in monitoring metastatic castration-resistant prostate cancer: implications for clinical practice p. 143
Atsushi Mizokami, Kouji Izumi, Hiroyuki Konaka, Yasuhide Kitagawa, Yoshifumi Kadono, Kazutaka Narimoto, Takahiro Nohara, Amit K Bahl, Mikio Namiki
DOI:10.4103/1008-682X.179159  PMID:27270339
Availability of novel hormonal therapies as well as docetaxel and cabazitaxel treatment for metastatic castration-resistant prostate cancer (CRPC) has changed the outlook for this group of patients with improvements in progression-free survival and overall survival. Physicians often diagnose the progression of prostate cancer using serum prostate-specific antigen (PSA). However, serum PSA is not always correlated with the clinical status in CRPC. To evaluate the PSA dynamics with greater precision, understanding of the control of PSA and of the mechanisms of development of CRPC is needed. Moreover, it is necessary to use new hormonal therapies with an appropriate timing to optimally improve the prognosis and the QOL of the patients. In the present review, we ascertain the PSA dynamics and the mechanisms of the development of CRPC to assist in optimal utilization of the new treatments for mCRPC.
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INVITED ORIGINAL ARTICLE Top

Dog sperm head morphometry: its diversity and evolution p. 149
Carles Soler, Ana Alambiaga, Maria A Martí, Almudena García-Molina, Anthony Valverde, Jesús Contell, Marcos Campos
DOI:10.4103/1008-682X.189207  PMID:27751991
Dogs have been under strong artificial selection as a consequence of their relationship with man. Differences between breeds are evident that could be reflected in seminal characteristics. The present study was to evaluate differences in sperm head morphometry between seven well-defined breeds of dog: the British Bulldog, Chihuahua, German Shepherd, Labrador Retriever, Spanish Mastiff, Staffordshire Terrier, and Valencian Rat Hunting dog. Semen samples were obtained by masturbation and smears stained with Diff-Quik. Morphometric analysis (CASA-Morph) produced four size and four shape parameters. Length, Ellipticity, and Elongation showed higher differences between breeds. MANOVA revealed differences among all breeds. Considering the whole dataset, principal component analysis (PCA) showed that PC1 was related to head shape and PC2 to size. Procluster analysis showed the British Bulldog to be the most isolated breed, followed by the German Shepherd. The PCA breed by breed showed the Chihuahua, Labrador Retriever, Spanish Mastiff, and Staffordshire Terrier to have PC1 related to shape and PC2 to size, whereas the British Bulldog, Valencia Rat Hunting dog, and German Shepherd had PC1 related to size and PC2 to shape. The dendrogram for cluster groupings and the distance between them showed the British Bulldog to be separated from the rest of the breeds. Future work on dog semen must take into account the large differences in the breeds' sperm characteristics. The results provide a base for future work on phylogenetic and evolutionary studies of dogs, based on their seminal characteristics.
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Sperm kinematic, head morphometric and kinetic-morphometric subpopulations in the blue fox (Alopex lagopus) p. 154
Carles Soler, Jesús Contell, Lorena Bori, María Sancho, Almudena García-Molina, Anthony Valverde, Jan Segarvall
DOI:10.4103/1008-682X.188445  PMID:27751987
This work provides information on the blue fox ejaculated sperm quality needed for seminal dose calculations. Twenty semen samples, obtained by masturbation, were analyzed for kinematic and morphometric parameters by using CASA-Mot and CASA-Morph system and principal component (PC) analysis. For motility, eight kinematic parameters were evaluated, which were reduced to PC1, related to linear variables, and PC2, related to oscillatory movement. The whole population was divided into three independent subpopulations: SP1, fast cells with linear movement; SP2, slow cells and nonoscillatory motility; and SP3, medium speed cells and oscillatory movement. In almost all cases, the subpopulation distribution by animal was significantly different. Head morphology analysis generated four size and four shape parameters, which were reduced to PC1, related to size, and PC2, related to shape of the cells. Three morphometric subpopulations existed: SP1: large oval cells; SP2: medium size elongated cells; and SP3: small and short cells. The subpopulation distribution differed between animals. Combining the kinematic and morphometric datasets produced PC1, related to morphometric parameters, and PC2, related to kinematics, which generated four sperm subpopulations - SP1: high oscillatory motility, large and short heads; SP2: medium velocity with small and short heads; SP3: slow motion small and elongated cells; and SP4: high linear speed and large elongated cells. Subpopulation distribution was different in all animals. The establishment of sperm subpopulations from kinematic, morphometric, and combined variables not only improves the well-defined fox semen characteristics and offers a good conceptual basis for fertility and sperm preservation techniques in this species, but also opens the door to use this approach in other species, included humans.
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ORIGINAL ARTICLES Top

Prenatal and pubertal testosterone exposure imprint permanent modifications in the prostate that predispose to the development of lesions in old Mongolian gerbils p. 160
Manoel F Biancardi, Ana PS Perez, Cássia RS Caires, Luiz R Falleiros, Rejane M Góes, Patrícia SL Vilamaior, Diógenes R Freitas, Fernanda CA Santos, Sebastião R Taboga
DOI:10.4103/1008-682X.170436  PMID:26780870
The prostate is an accessory sex gland that develops under precise androgenic control. It is known that hormonal imbalance may disrupt its development predisposing this gland to develop diseases during aging. Although the hypothesis regarding earlier origins of prostate diseases was proposed many years ago, the mechanisms underlying this complex phenomenon are poorly understood. Therefore, the aim of this study was to evaluate the prostates of old male gerbils exposed to testosterone during intrauterine and postnatal life using morphological, biometrical, stereological, Kariometric, immunohistochemical, and immunofluorescence analyses. Our findings demonstrate that prenatal and pubertal exposure to testosterone increases the susceptibility to the development of prostate diseases during aging. The presence of a more proliferative gland associated with foci of adenomatous hyperplasia in animals exposed to testosterone during the prenatal and pubertal phase show that the utero life and the pubertal period are important phases for prostatic morphophysiology establishment, which is a determinant for the health of the gland during aging. Therefore, these findings reinforce the idea that prostate disease may result from hormonal disruptions in early events during prostate development, which imprint permanently on the gland predisposing it to develop lesions in later stages of life.
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46 XX karyotype during male fertility evaluation; case series and literature review p. 168
Ahmad Majzoub, Mohamed Arafa, Christopher Starks, Haitham Elbardisi, Sami Al Said, Edmund Sabanegh
DOI:10.4103/1008-682X.181224  PMID:27297128
Forty-six XX disorder of sex development is an uncommon medical condition observed at times during the evaluation of a man's fertility. The following is a case series and literature review of phenotypically normal men diagnosed with this karyotype. Our goal is to comprehend the patients' clinical presentation as well as their laboratory results aiming to explore options available for their management. A formal literature review through PubMed and MEDLINE databases was performed using "46 XX man" as a word search. A total of 55 patients, including those conveyed in this article were diagnosed with a 46 XX karyotype during their fertility evaluation. The patients' mean age ± s.d. was 34 ± 10 years and their mean height ± s.d. was 166 ± 6.5 cm. Overall, they presented with hypergonadotropic hypogonadism. Sexual dysfunction, reduced hair distribution, and gynecomastia were reported in 20% (4/20), 25.8% (8/31), and 42% (13/31) of the patients, respectively. The SRY gene was detected in 36 (83.7%) and was absent in the remaining seven (16.3%) patients. We found that a multidisciplinary approach to management is preferred in 46 XX patients. Screening for remnants of the mullerian ducts and for malignant transformation in dysgenetic gonads is imperative. Hypogonadism should be addressed, while fertility options are in vitro fertilization with donor sperm or adoption.
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Level of education and mortality after radical prostatectomy p. 173
Michael Froehner, Rainer Koch, Stefan Propping, Dorothea Liebeheim, Matthias Hübler, Gustavo B Baretton, Oliver W Hakenberg, Manfred P Wirth
DOI:10.4103/1008-682X.178487  PMID:28051039
Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over- or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education (college, university degree, master craftsmen, comparable profession, or others), histopathological tumor stage (organ confined or extracapsular), lymph node status (negative or positive), and prostatectomy specimen Gleason score (<7, 7, or 8-10) who underwent radical prostatectomy between 1992 and 2007. Overall, prostate cancer-specific, competing, and second cancer-related mortalities were study endpoints. Cox proportional hazard models for competing risks were used to study combined effects of the variables on these endpoints. A higher level of education was independently associated with decreased overall mortality after radical prostatectomy (hazard ratio [HR]: 0.75, 95% confidence interval [95% CI]: 0.62-0.91, P = 0.0037). The mortality difference was attributable to decreased second cancer mortality (HR: 0.59, 95% CI: 0.40-0.85, P = 0.0052) and noncancer mortality (HR: 0.73, 95% CI: 0.55-0.98, P = 0.0345) but not to differences in prostate cancer-specific mortality (HR: 1.16, 95% CI: 0.79-1.69, P = 0.4536 in the full model). In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy.
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Serum testosterone level predicts the effective time of androgen deprivation therapy in metastatic prostate cancer patients p. 178
Yue Wang, Bo Dai, Ding-Wei Ye
DOI:10.4103/1008-682X.174856  PMID:26975487
Androgen deprivation therapy (ADT) is the standard of care for patients with metastatic prostate cancer. However, whether serum testosterone levels, using a cut-off point of 50 ng dl−1 , are related to the effective time of ADT in newly diagnosed prostate cancer patients remains controversial. Moreover, recent studies have shown that some patients may benefit from the addition of upfront docetaxel chemotherapy. To date, no studies have been able to distinguish patients who will benefit from the combination of ADT and docetaxel chemotherapy. This study included 206 patients who were diagnosed with metastatic prostate cancer and showed progression to castrate-resistance prostate cancer (CRPC). Serum testosterone levels were measured prospectively after ADT for 1, 3, and 6 months. The endpoint was the time to CRPC. In univariate and multivariate analyses, testosterone levels <50 ng dl−1 were not associated with the effective time of ADT. Receiver operating characteristic and univariate analysis showed that testosterone levels of ≤25 ng dl−1 after the first month of ADT offered the best overall sensitivity and specificity for prediction of a longer time to CRPC (adjusted hazard ratio [HR], 1.46; 95% confidence interval [95% CI], 1.08-1.96; P = 0.013). Our results show that serum testosterone level of 25 ng dl−1 plays a prognostic role in prostate cancer patients receiving ADT. A testosterone value of 25 ng dl−1 after the first month of ADT can distinguish patients who benefit from ADT effectiveness for only a short time. These patients may need to receive ADT and concurrent docetaxel chemotherapy.
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Fatty acid intake in relation to reproductive hormones and testicular volume among young healthy men p. 184
Lidia Mínguez-Alarcón, Jorge E Chavarro, Jaime Mendiola, Manuela Roca, Cigdem Tanrikut, Jesús Vioque, Niels Jørgensen, Alberto M Torres-Cantero
DOI:10.4103/1008-682X.190323  PMID:27834316
Emerging evidence suggests that dietary fats may influence testicular function. However, most of the published literature on this field has used semen quality parameters as the only proxy for testicular function. We examined the association of fat intake with circulating reproductive hormone levels and testicular volume among healthy young Spanish men. This is a cross-sectional study among 209 healthy male volunteers conducted between October 2010 and November 2011 in Murcia Region of Spain. Participants completed questionnaires on lifestyle, diet, and smoking, and each underwent a physical examination, and provided a blood sample. Linear regression was used to examine the association between each fatty acid type and reproductive hormone levels and testicular volumes. Monounsaturated fatty acids intake was inversely associated with serum blood levels of calculated free testosterone, total testosterone, and inhibin B. A positive association was observed between the intake of polyunsaturated fatty acids, particularly of omega-6 polyunsaturated fatty acids, and luteinizing hormone concentrations. In addition, the intake of trans fatty acids was associated with lower total testosterone and calculated free testosterone concentrations (P trend = 0.01 and 0.02, respectively). The intake of omega-3 polyunsaturated fatty acids was positively related to testicular volume while the intake of omega-6 polyunsaturated fatty acids and trans fatty acids was inversely related to testicular volume. These data suggest that fat intake, and particularly intake of omega 3, omega 6, and trans fatty acids, may influence testicular function.
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The association between sexual function and prostate cancer risk in US veterans p. 191
Daniel F Zapata, Lauren E Howard, Jennifer Frank, Ross M Simon, Cathrine Hoyo, Delores J Grant, Stephen J Freedland, Adriana C Vidal
DOI:10.4103/1008-682X.184869  PMID:27586025
Sexual dysfunction and prostate cancer are common among older men. Few studies explored the association between these two illnesses. We examined whether sexual function is associated with prostate cancer risk among older men. Among 448 men undergoing prostate biopsy at the Durham Veterans Affairs Hospital, sexual function was ascertained from the Expanded Prostate Cancer Index Composite sexual assessment. We tested the link between sexual function and prostate cancer risk adjusting for multiple demographic and clinical characteristics using logistic regression. Multinomial logistic regression was used to test the associations with risk of low-grade (Gleason ≤6) and high-grade (Gleason ≥7 or ≥4 + 3) disease versus no cancer. Of 448 men, 209 (47%) had a positive biopsy; these men were less likely to be white (43% vs 55%, P = 0.013), had higher prostate-specific antigen (PSA) (6.0 vs 5.4 ng ml−1 , P < 0.001), but with lower mean sexual function score (47 vs 54, P = 0.007). There was no difference in age, BMI, pack years smoked, history of heart disease and/or diabetes. After adjusting for baseline differences, sexual function was linked with a decreased risk of overall prostate cancer risk (OR: 0.91 per 10-point change in sexual function, P = 0.004) and high-grade disease whether defined as Gleason ≥7 (OR: 0.86, P = 0.001) or ≥4 + 3 (OR: 0.85, P = 0.009). Sexual function was unrelated to low-grade prostate cancer (OR: 0.94, P = 0.13). Thus, among men undergoing prostate biopsy, higher sexual function was associated with a decreased risk of overall and high-grade prostate cancer. Confirmatory studies are needed.
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Indirect comparison between abiraterone acetate and enzalutamide for the treatment of metastatic castration-resistant prostate cancer: a systematic review Highly accessed article p. 196
Wei Zhang, Teng-Yun Wu, Qi Chen, Xiao-Lei Shi, Guang-An Xiao, Lin Zhao, Chuan-Liang Xu, Tie Zhou, Ying-Hao Sun
DOI:10.4103/1008-682X.178483  PMID:27212123
This study was designed to evaluate the efficacy, tolerability, and sequential administration of abiraterone acetate (AA) and enzalutamide (Enz) for metastatic castration-resistant prostate cancer (mCRPC). A literature search was performed with PubMed, Embase, and Web of Science databases to identify relevant studies. Reviewed literature included published phase III trials of AA or Enz in mCRPC and studies regarding their sequential administration. Given the difference in control arms in AA (active comparator) and Enz (true placebo) randomized phase III studies, indirect comparisons between AA and Enz in mCRPC showed no statistically significant difference in overall survival in prechemotherapy and postchemotherapy settings (HR: 0.90, 95% CI, 0.73-1.11; HR: 0.85, 95% CI, 0.68-1.07). Compared with AA, Enz may better outperform control arms in treating mCRPC both before and after chemotherapy regarding secondary endpoints based on indirect comparisons: time to prostate-specific antigen (PSA) progression (HR: 0.34, 95% CI, 0.28-0.42; HR: 0.40, 95% CI, 0.30-0.53), radiographic progression-free survival (HR: 0.37, 95% CI, 0.28-0.48; HR: 0.61, 95% CI, 0.50-0.74), and PSA response rate (OR: 18.29, 95% CI, 11.20-29.88; OR: 10.69, 95% CI, 3.92-29.20). With regard to the effectiveness of Enz following AA or AA following Enz, recent retrospective case series reported overall survival and secondary endpoints for patients with mCRPC progression after chemotherapy. However, confirmatory head-to-head trials are necessary to determine the optimal sequencing of these agents.
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Regeneration of rat corpora cavernosa tissue by transplantation of CD133+ cells derived from human bone marrow and placement of biodegradable gel sponge sheet p. 203
Shogo Inoue, Katsutoshi Miyamoto, Shunsuke Shinmei, Koichi Shoji, Jun Teishima, Kazuhiro Sentani, Wataru Yasui, Akio Matsubara
DOI:10.4103/1008-682X.179155  PMID:27270338
The objective is to develop an easier technique for regenerating corpora cavernosa tissue through transplantation of human bone marrow-derived CD133 + cells into a rat corpora cavernosa defect model. We excised 2 mm × 2 mm squares of the right corpora cavernosa of twenty-three 8-week-old male nude rats. Alginate gel sponge sheets supplemented with 1 × 10 4 CD133 + cells were then placed over the excised area of nine rats. Functional and histological evaluations were carried out 8 weeks later. The mean intracavernous pressure/mean arterial pressure ratio for the nine rats (0.34258 ± 0.0831) was significantly higher than that for eight rats with only the excision (0.0580 ± 0.0831, P = 0.0238) and similar to that for five rats for which the penis was exposed, and there was no excision (0.37228 ± 0.1051, P = 0.8266). Immunohistochemical analysis revealed that the nine fully treated rats had venous sinus-like structures and quantitative reverse transcription polymerase chain reaction analysis of extracts from their alginate gel sponge sheets revealed that the amounts of mRNA encoding the nerve growth factor (NGF), and vascular endothelial growth factor (VEGF) were significantly higher than those for rats treated with alginate gel sheets without cell supplementation (NGF: P = 0.0309; VEGF: P < 0.0001). These findings show that transplantation of CD133 + cells accelerates functional and histological recovery in the corpora cavernosa defect model.
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Clinical efficacy of a combination of Percoll continuous density gradient and swim-up techniques for semen processing in HIV-1 serodiscordant couples p. 208
Osamu Inoue, Naoaki Kuji, Hiroe Ito, Mitsutoshi Yamada, Toshio Hamatani, Aimi Oyadomari, Shingo Kato, Hideji Hanabusa, Keiichi Isaka, Mamoru Tanaka
DOI:10.4103/1008-682X.173442  PMID:26908065
To evaluate the clinical efficacy of a procedure comprising a combination of Percoll continuous density gradient and modified swim-up techniques for the removal of human immunodeficiency virus type 1 (HIV-1) from the semen of HIV-1 infected males, a total of 129 couples with an HIV-1 positive male partner and an HIV-1 negative female partner (serodiscordant couples) who were treated at Keio University Hospital between January 2002 and April 2012 were examined. A total of 183 ejaculates from 129 HIV-1 infected males were processed. After swim-up, we successfully collected motile sperms at a recovery rate as high as 100.0% in cases of normozoospermia (126/126 ejaculates), oligozoospermia (6/6), and asthenozoospermia (36/36). The recovery rate of oligoasthenozoospermia was 86.7% (13/15). In processed semen only four ejaculates (4/181:2.2%) showed viral nucleotide sequences consistent with those in the blood of the infected males. After using these sperms, no horizontal infections of the female patients and no vertical infections of the newborns were observed. Furthermore, no obvious adverse effects were observed in the offspring. This protocol allowed us to collect HIV-1 negative motile sperms at a high rate, even in male factor cases. We concluded that our protocol is clinically effective both for decreasing HIV-1 infections and for yielding a healthy child.
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The application of laparoscopic Doppler ultrasound during laparoscopic varicocelectomy in infertile men p. 214
Li-Qiang Guo, Xiu-Lin Zhang, Yu-Qiang Liu, Wen-Dong Sun, Sheng-Tian Zhao, Ming-Zhen Yuan
DOI:10.4103/1008-682X.189622  PMID:27678469
The aim of this study is to evaluate the benefits of laparoscopic Doppler ultrasound (LDU) application during laparoscopic varicocelectomy (LV), and to compare the surgical outcomes and complications between LDU-assisted LV (LDU-LV) and conventional LV for infertile patients with varicoceles; 147 infertile patients were randomly divided into two groups. Operative and postoperative parameters, semen parameters, and the pregnancy rate were compared. There were no differences in baseline demographics. The operative time was significantly longer in LDU-LV group than LV group. The incidence of postoperative hydrocele was 1.4% (1/72) in LDU-LV group versus 10.7% (8/75) in LV group, which showed a significant difference (P < 0.05). However, other surgical outcomes, such as postoperative hospital stay, postoperative recurrence, and testicular atrophy, were similar between the two groups. Sperm concentration and sperm motility were significantly increased in both groups at 3, 6, and 12 months after surgery (P < 0.01), and they were higher in LDU-LV than LV group in 12 months after surgery (34.21 ± 6.36 vs 29.99 ± 6.04 for concentration, P < 0.05; 40.72 ± 8.12 vs 37.31 ± 6.12 for motility, P < 0.05). Sperm morphology was comparable between the two groups. The pregnancy rate showed no significant difference (44.4% of the LDU-LV vs 37.3% of the LV, P > 0.05). In conclusion, compared with LV, LDU-LV could safely and effectively ligate all spermatic veins and preserve spermatic arteries without leading to high varicocele recurrence and postoperative hydrocele. Given the benefits that sperm counts as well as sperm motility favoring LDU-LV, we recommend that LDU should be routinely used as an effective tool to improve outcomes and safety of laparoscopic varicocelectomy.
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Resolution of erectile dysfunction after an andrological visit in a selected population of patients affected by psychogenic erectile dysfunction p. 219
Giorgio Cavallini
DOI:10.4103/1008-682X.172646  PMID:26806083
The aim of this study was to ascertain whether some patients with psychogenic erectile dysfunction (PED) who chose psychotherapy spontaneously improved their sexual function immediately after diagnosis. Two hundred eighty-five patients with PED were retrospectively studied. Complete resolution of PED was analyzed regarding age, primary or secondary PED, marital status, domestic status, prevailing attitude of the female partner to the dysfunction, duration of their partnership, social status, duration of PED, International Index of Erectile Function score, and prevailing attitude of the patient after a diagnosis of PED. The data were analyzed using post-hoc tests. PED was resolved in 32.3% of the patients immediately after diagnosis. These patients were older, more frequently affected by secondary ED, more frequently living with their partner, and more frequently resigned or happy with the diagnosis of PED than the patients who did not resolve their PED. A nonchalant or cooperative female attitude to PED improved the possibility of PED resolution. The other variables did not influence PED resolution. Our data showed that a clear-cut diagnosis of psychogenic erectile deficiency and some psychosocial factors were critical for the management of some patients with PED.
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Dietary n-6:n-3 ratio and Vitamin E improve motility characteristics in association with membrane properties of boar spermatozoa p. 223
Qing Liu, Yuan-Fei Zhou, Run-Jia Duan, Hong-Kui Wei, Jian Peng, Si-Wen Jiang
DOI:10.4103/1008-682X.170446  PMID:26763547
This study was aimed to evaluate the effects of dietary n-6:n-3 ratio and Vitamin E on the membrane properties and motility characteristics of spermatozoa in boars. Forty Duroc boars were randomly distributed in a 2 × 2 factorial design with two n-6:n-3 ratios (14.4 and 6.6) and two Vitamin E levels (200 and 400 mg kg−1 ). During 16 weeks of treatment, fresh semen was collected at weeks 0, 8, 12, and 16 for measurements of motility characteristics, contents of fatty acids, membrane properties (membrane fluidity and membrane integrity), and lipid peroxidation of the spermatozoa. The semen was diluted in Beltsville Thawing Solution (BTS) extender and stored at 17°C, and the sperm motility was assessed at 12, 36, 72, and 120 h of storage. The 6.6 n-6:n-3 dietary ratio increased the contents of n-3 polyunsaturated fatty acids (PUFAs) and docosahexaenoic acid (DHA) and improved the membrane integrity and membrane fluidity of the spermatozoa, resulting in notably increased total motility, sperm progressive motility, and velocity parameters of fresh semen. Feeding diet with Vitamin E (400 mg kg−1 ) prevented sperm lipid peroxidation, and resulted in higher total motility and sperm progressive motility in fresh and liquid stored semen. In conclusion, the adjustment of n-6:n-3 ratio (6.6) and supply of Vitamin E (400 mg kg−1 ) successfully improved sperm motility characteristics and thus may be beneficial to the fertility of boars, which might be due to the modification of the physical and functional properties of spermatozoa membrane in response to dietary supplementation.
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A possible relationship between serum sex hormones and benign prostatic hyperplasia/lower urinary tract symptoms in men who underwent transurethral prostate resection p. 230
Yu Wu, Hong Pan, Wei-Ming Wang, Ding Xu, Liang Zhang, Zheng-Qin Gu, Qiang Bai, Jun Qi, He-Feng Huang
DOI:10.4103/1008-682X.171575  PMID:26763548
In this study, we examined the relationship between sex hormone levels and lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) who underwent transurethral surgery. The study was conducted in 158 patients who came to our hospital for surgery. Clinical conditions were assessed by body mass index (BMI), digital rectal examination, International Prostate Symptom Score (IPSS) and transrectal ultrasound (TRUS). The levels of sex hormones (including total testosterone (TT), estradiol (E 2 ), progesterone (P), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin (PRL)) and prostate-specific antigen (PSA) were reviewed. Correlations were determined through statistical analysis. The mean age was 72.06 ± 8.68 years. The total IPSS was significantly associated with the TT level (r = −0.21, P= 0.01). Other sex hormone levels were not correlated with total IPSS. However, some ratios such as E 2 / TT (r = 0.23, P= 0.00) and FSH/LH (r = −0.17, P = 0.04) were associated with total IPSS. Further analysis showed that the nocturia was associated with age (r = 0.16, P= 0.04), BMI (r = 0.21, P = 0.01), and TT (r = −0.19, P= 0.02). Moreover, we divided the patients into two subgroups based on IPSS severity (<20 or ≥20). The mean TT level was in the normal range, but it was significantly related to the presence of severe LUTS. In summary, our study has shown that the severity of LUTS is associated with TT, E 2 / TT and FSH/LH in men who underwent prostate surgery. Increasing nocturia was observed in lower testosterone patients. Additional larger studies are needed to elucidate the potential mechanisms.
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Body mass index effects sperm quality: a retrospective study in Northern China p. 234
En-Yin Wang, Yan Huang, Qing-Yun Du, Gui-Dong Yao, Ying-Pu Sun
DOI:10.4103/1008-682X.169996  PMID:26732109
Excess weight and obesity have become a serious problem in adult men of reproductive age throughout the world. The purpose of this retrospective study was to assess the relationships between body mass index and sperm quality in subfertile couples in a Chinese Han population. Sperm analyses were performed and demographic data collected from 2384 male partners in subfertile couples who visited a reproductive medical center for treatment and preconception counseling. The subjects were classified into four groups according to their body mass index: underweight, normal, overweight, and obese. Of these subjects, 918 (38.3%) had a body mass index of >25.0 kg m−0 2 . No significant differences were found between the four groups with respect to age, occupation, level of education, smoking status, alcohol use, duration of sexual abstinence, or the collection time of year for sperm. The results clearly indicated lower sperm quality (total sperm count, sperm concentration, motile sperm, relative amounts of type A motility, and progressive motility sperm [A + B]) in overweight and obese participants than in those with normal body mass index. Normal sperm morphology and sperm volume showed no clear difference between the four groups. This study indicates that body mass index has a negative effect on sperm quality in men of subfertile couples in a Northern Chinese population. Further study should be performed to investigate the relationship between body mass index and sperm quality in a larger population.
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Prostate cancer antigen 3 moderately improves diagnostic accuracy in Chinese patients undergoing first prostate biopsy p. 238
Fu-Bo Wang, Rui Chen, Shan-Cheng Ren, Xiao-Lei Shi, Ya-Sheng Zhu, Wei Zhang, Tai-Le Jing, Chao Zhang, Xu Gao, Jian-Guo Hou, Chuan-Liang Xu, Ying-Hao Sun
DOI:10.4103/1008-682X.167715  PMID:26780868
Prostate cancer antigen 3 (PCA3) is a biomarker for diagnosing prostate cancer (PCa) identified in the Caucasian population. We evaluated the effectiveness of urinary PCA3 in predicting the biopsy result in 500 men undergoing initial prostate biopsy. The predictive power of the PCA3 score was evaluated by the area under receiver operating characteristic (ROC) curve (AUC) and by decision curve analysis. PCA3 score sufficed to discriminate positive from negative prostate biopsy results but was not correlated with the aggressiveness of PCa. The ROC analysis showed a higher AUC for the PCA3 score than %fPSA (0.750 vs 0.622, P = 0.046) in patients with a PSA of 4.0-10.0 ng ml−1 , but the PCA3-based model is not significantly better than the base model. Decision curve analysis indicates the PCA3-based model was superior to the base model with a higher net benefit for almost all threshold probabilities, especially the threshold probabilities of 25%-40% in patients with a PSA of 4.0-10.0 ng ml−1 . However, the AUC of the PCA3 score (0.712) is not superior to %fPSA (0.698) or PSAD (0.773) in patients with a PSA >10.0 ng ml−1 . Our results confirmed that the RT-PCR-based PCA3 test moderately improved diagnostic accuracy in Chinese patients undergoing first prostate biopsy with a PSA of 4.0-10.0 ng ml−1 .
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Two-micrometer thulium laser resection of the prostate-tangerine technique in benign prostatic hyperplasia patients with previously negative transrectal prostate biopsy p. 244
Jian Zhuo, Hai-Bin Wei, Fei Zhang, Hai-Tao Liu, Fu-Jun Zhao, Bang-Min Han, Xiao-Wen Sun, Jun-Lu , Shu-Jie Xia
DOI:10.4103/1008-682X.168790  PMID:26732107
The 2-μm thulium laser resection of the prostate-tangerine technique (TmLRP-TT) has been introduced as a minimally invasive treatment for benign prostatic hyperplasia (BPH). This study was undertaken to assess the clinical efficacy and safety of TmLRP-TT for the treatment of BPH patients with previously negative transrectal prostate biopsy. A prospective analysis of 51 patients with previously negative transrectal prostate biopsy who underwent surgical treatment using TmLRP-TT was performed from December 2011 to December 2013. Preoperative status, surgical details, and perioperative complications were recorded. The follow-up outcome was evaluated with subjective and objective tests at 1 and 6 months. TmLRP-TT was successfully completed in all patients. Mean prostate volume, operative duration, and catheterization time were 93.3 ± 37.9 ml, 69.5 ± 39.5 min, and 6.5 ± 1.3 days, respectively. The mean International Prostate Symptom Score, quality of life score, maximum urinary flow rate, and post-void residual urine volume changed notably at 6-month follow-up (22.5 ± 6.9 vs 6.1 ± 3.2, 4.8 ± 1.3 vs 1.1 ± 0.9, 7.3 ± 4.5 vs 18.9 ± 7.1 ml s−1 , and 148.7 ± 168.7 vs 28.4 ± 17.9 ml). Two (3.9%) patients required blood transfusion perioperatively, while 3 (5.9%) patients experienced transient hematuria postoperatively, and 2 (3.9%) patients received 3 days recatheterization due to clot retention. TmLRP-TT is a safe and effective minimally invasive technique for patients with previously negative transrectal prostate biopsy during the 6-month follow-up. This promising technology may be a feasible surgical method for previously negative transrectal prostate biopsy in the future.
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Comparison of surgical effect and postoperative patient experience between laparoendoscopic single-site and conventional laparoscopic varicocelectomy: a systematic review and meta-analysis p. 248
Zheng Zhang, Shu-Juan Zheng, Wen Yu, You-Feng Han, Hai Chen, Yun Chen, Yu-Tian Dai
DOI:10.4103/1008-682X.181194  PMID:27212128
The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy (LESSV) and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design (RCT and non-RCT). The odds ratio (OR) or standardized mean difference (SMD) and their 95% confidence intervals (95% CIs) were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work (overall: SMD = −1.454, 95% CI: −2.502-−0.405, P = 0.007; non-RCT: SMD = −2.906, 95% CI: −3.796-−2.017, P = 0.000; and RCT: SMD = −0.841, 95% CI: −1.393-−0.289, P = 0.003) and less pain experience at 3 h or 6 h (SMD = −0.447, 95% CI: −0.754-−0.139, P = 0.004), day 1 (SMD = −0.477, 95% CI: −0.905-−0.05, P = 0.029), and day 2 (SMD = −0.612, 95% CI: −1.099-−0.125, P = 0.014) postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect (improvement of semen quality and scrotal pain relief), and complications (hydrocele and recurrence) yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.
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LETTERS TO THE EDITOR Top

An infertile male with dilated seminal vesicles due to functional obstruction p. 256
Michael D Font, Alexander W Pastuszak, John R Case, Larry I Lipshultz
DOI:10.4103/1008-682X.179858  PMID:27320475
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The importance of laparoscopy in the surgical reconstruction of inguinal vas injury p. 258
Hong-Tao Jiang, Ji-Nan Guo, Zeng-Qin Liu, Qian Yuan, Zhen-Yu Zhou, Yu Liu, Ke-Feng Xiao, Jiang-Gen Yang
DOI:10.4103/1008-682X.170438  PMID:26732110
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A missense mutation in the androgen receptor gene causing androgen insensitivity syndrome in a Chinese family p. 260
Lin Li, Wen-Miao Liu, Mei-Xin Liu, Shu-Qi Zheng, Ji-Xia Zhang, Feng-Yuan Che, Shi-Guo Liu
DOI:10.4103/1008-682X.172647  PMID:26806084
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Superficial angiomyxoma of penis: a case report of a 6-year follow-up p. 262
Yi-Chen Wang, Xiao-Ming Li, Gan-Ping Zhong, Zhe Xing, Zhi-Ping Wang
DOI:10.4103/1008-682X.175784  PMID:26975493
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INVITED COMMENTARY Top

Sexual dysfunction and prostate cancer risk: one more piece of a complex puzzle p. 264
Paolo Capogrosso, Francesco Montorsi, Andrea Salonia
DOI:10.4103/1008-682X.190330  PMID:27873768
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