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2020| May-June | Volume 22 | Issue 3
Online since
April 14, 2020
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ORIGINAL ARTICLES
High body mass index predicts multiple prostate cancer lymph node metastases after radical prostatectomy and extended pelvic lymph node dissection
Antonio B Porcaro, Alessandro Tafuri, Marco Sebben, Tania Processali, Marco Pirozzi, Nelia Amigoni, Riccardo Rizzetto, Aliasger Shakir, Maria Angela Cerruto, Matteo Brunelli, Salvatore Siracusano, Walter Artibani
May-June 2020, 22(3):323-329
DOI
:10.4103/aja.aja_70_19
PMID
:31347517
Our aim is to evaluate the association between body mass index (BMI) and preoperative total testosterone (TT) levels with the risk of single and multiple metastatic lymph node invasion (LNI) in prostate cancer patients undergoing radical prostatectomy and extended pelvic lymph node dissection. Preoperative BMI, basal levels of TT, and prostate-specific antigen (PSA) were evaluated in 361 consecutive patients undergoing radical prostatectomy with extended pelvic lymph node dissection between 2014 and 2017. Patients were grouped into either nonmetastatic, one, or more than one metastatic lymph node invasion groups. The association among clinical factors and LNI was evaluated. LNI was detected in 52 (14.4%) patients: 28 (7.8%) cases had one metastatic node and 24 (6.6%) had more than one metastatic node. In the overall study population, BMI correlated inversely with TT (
r
= −0.256;
P
< 0.0001). In patients without metastases, BMI inversely correlated with TT (
r
= −0.282;
P
< 0.0001). In patients with metastasis, this correlation was lost. In the overall study population, BMI (odds ratio [OR] = 1.268;
P
= 0.005) was the only independent clinical factor associated with the risk of multiple metastatic LNI compared to cases with one metastatic node. In the nonmetastatic group, TT was lower in patients with BMI >28 kg m
−2
(
P
< 0.0001). In patients with any LNI, this association was lost (
P
= 0.232). The median number of positive nodes was higher in patients with BMI >28 kg m
−2
(
P
= 0.048). In our study, overweight and obese patients had a higher risk of harboring multiple prostate cancer lymph node metastases and lower TT levels when compared to patients with normal BMI.
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4,240
442
REVIEW
Insight on multiple morphological abnormalities of sperm flagella in male infertility: what is new?
Wei-Li Wang, Chao-Feng Tu, Yue-Qiu Tan
May-June 2020, 22(3):236-245
DOI
:10.4103/aja.aja_53_19
PMID
:31210147
The syndrome of multiple morphological abnormalities of the sperm flagella (MMAF) is a specific kind of asthenoteratozoospermia with a mosaic of flagellar morphological abnormalities (absent, short, bent, coiled, and irregular flagella). MMAF was proposed in 2014 and has attracted increasing attention; however, it has not been clearly understood. In this review, we elucidate the definition of MMAF from a systematical view, the difference between MMAF and other conditions with asthenoteratozoospermia or asthenozoospermia (such as primary mitochondrial sheath defects and primary ciliary dyskinesia), the knowledge regarding its etiological mechanism and related genetic findings, and the clinical significance of MMAF for intracytoplasmic sperm injection and genetic counseling. This review provides the basic knowledge for MMAF and puts forward some suggestions for further investigations.
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6
8,191
841
ORIGINAL ARTICLES
Postnatal germ cell development in cryptorchid boys
Li-Hua Dong, Simone Hildorf, Erik Clasen-Linde, Kolja Kvist, Dina Cortes, Jørgen Thorup, Claus Yding Andersen
May-June 2020, 22(3):258-264
DOI
:10.4103/aja.aja_48_19
PMID
:31274480
Cryptorchidism is associated with infertility in adulthood. Early orchiopexy is suggested to reduce the risk. Information is lacking on the potential link between infant germ cell maturation and the risk of future infertility. The objective of the study was to evaluate age-related germ cell development in cryptorchidism. Immunostaining for markers of germ cell development (octamer-binding transcription factor 3/4 [OCT3/4], placental alkaline phosphatase [PLAP], KIT proto-oncogene [C-KIT], podoplanin [D2-40], Lin-28 homolog A [LIN28], and G antigen 7 [GAGE-7]) was performed in testicular biopsies from 40 cryptorchid boys aged 4–35 months. Germ cell numbers and distributions were evaluated in cross sections of seminiferous tubules, with and without immunostaining.
OCT3/4
,
D2-40
, and
LIN28
were generally expressed in the early stages of germ cell development, as shown by positive expression in germ cells in the central region of seminiferous tubules. In contrast,
PLAP
and
GAGE-7
were expressed in both central and peripheral parts of the tubules in the early stages of development and expressed mainly in a peripheral position with advancing age. Germ cell maturation was delayed in this study population as compared with that observed in our previous study on germ cell markers in a healthy population. The number of GAGE-7-positive germ cells per tubular cross section obtained by immunostaining was significantly higher than that obtained by standard hematoxylin and eosin staining. Double immunostaining revealed heterogeneity in germ cell development in cryptorchid testes. These results shed light on the pathophysiology of germ cell development in boys with cryptorchidism.
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FSH dosage effect on conventional sperm parameters: a meta-analysis of randomized controlled studies
Rossella Cannarella, Sandro La Vignera, Rosita A Condorelli, Laura M Mongioì, Aldo E Calogero
May-June 2020, 22(3):309-316
DOI
:10.4103/aja.aja_42_19
PMID
:31274479
Follicle-stimulating hormone (FSH) represents a therapeutic option in normogonadotropic patients with idiopathic oligozoospermia. The aim of this review was to evaluate the possible dose- and drug-dependent efficacy of FSH treatment on conventional sperm parameters. We performed a comprehensive systematic review via a meta-analysis of all available randomized controlled trials, in which FSH administration was compared with placebo or no treatment when administered to normogonadotropic patients with idiopathic oligozoospermia. Of the 971 articles that were retrieved, 5 were finally included, including a total of 372 patients and 294 controls. Overall, FSH treatment was effective in ameliorating the sperm concentration, total count, progressive motility, but not normal forms. On the basis of the weekly dosage, the studies were classified into those using low (175–262.5 IU per week), intermediate (350–525 IU per week), and high (700–1050 IU per week) doses. At low doses, FSH improved only sperm motility. At intermediate doses, FSH ameliorated sperm concentration and morphology. Total sperm count and progressive motility showed a trend toward the increase. At high doses, FSH increased sperm concentration, total sperm count, and progressive motility. Sperm morphology showed a trend toward the increase. Finally, both highly purified FSH (hpFSH) and recombinant human FSH (rhFSH) improved sperm concentration, total sperm count, progressive motility, but not morphology. No different efficacy was observed between these two preparations. This meta-analysis provides evidence in favor of high FSH doses. The FSH efficacy was not related to the preparation type (recombinant vs highly purified). Further studies are needed to evaluate the effectiveness of long-standing treatment regimes.
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INVITED ORIGINAL ARTICLE
Both comorbidity burden and low testosterone can explain symptoms and signs of testosterone deficiency in men consulting for sexual dysfunction
Giulia Rastrelli, Giovanni Corona, Mario Maggi
May-June 2020, 22(3):265-273
DOI
:10.4103/aja.aja_61_19
PMID
:31249270
Low testosterone (T) is frequent in men with chronic illnesses. The clinical features of T deficiency (TD) overlap with those of chronic diseases. The aim of this study is to evaluate the relative contribution of chronic disease score (CDS) and low T to the presence of TD symptoms. A consecutive series of 3862 men (aged 52.1 ± 13.1 years) consulting for sexual dysfunction were studied. Several clinical and biochemical parameters were collected, including the structured interview, ANDROTEST, for the assessment of TD symptoms. Penile color Doppler ultrasound (PCDU) was also performed. Based on the medications taken, the CDS was calculated. For a subset of 1687 men, information on mortality was collected (follow-up of 4.3 ± 2.6 years). Higher CDS was associated with lower free and total T (TT) as well as with higher ANDROTEST score. When introducing CDS and TT in multivariable models adjusted for age, severe erectile dysfunction and impaired morning erections were associated with both CDS (odds ratio and 95% confidence interaval, OR [95% CI] = 1.25 [1.13; 1.37] and 1.38 [1.29; 1.48], respectively) and low TT (OR [95% CI] = 1.11 [1.00; 1.23] and 1.13 [1.06; 1.21], respectively). Similar results were obtained for PCDU parameters. Hypoactive sexual desire was associated with low TT (OR [95% CI] = 1.21 [1.13; 1.30]), whereas it was inversely related with CDS (OR [95% CI] = 0.91 [0.84; 0.97]). When considering mortality for major cardiovascular events, TT <8 nmol l
−1
, but not CDS, was a significant predictor (hazard ratio [95% CI] = 5.57 [1.51; 20.63]). Chronic illnesses are associated with an overt TD. Both chronic diseases and low T can be involved in determining symptoms present in subjects complaining for sexual dysfunction. This should be considered in the diagnostic workup for TD.
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473
ORIGINAL ARTICLES
Correlation of oxidation reduction potential and total motile sperm count: its utility in the evaluation of male fertility potential
Ahmad Majzoub, Mohamed Arafa, Walid El Ansari, Mohammed Mahdi, Ashok Agarwal, Sami Al-Said, Haitham Elbardisi
May-June 2020, 22(3):317-322
DOI
:10.4103/aja.aja_75_19
PMID
:31339113
Oxidative stress (OS) is detrimental to sperm functions, and the oxidation reduction potential (ORP) is a good measure of OS as it considers the balance between oxidants and reductants. Total motile sperm count (TMSC) is viewed as the single most important semen analysis parameter that can predict male infertility severity, and its correlation with ORP has never been undertaken. The objectives of this study were to assess the correlation between ORP and TMSC, to identify the ORP cutoff value based on the TMSC result, and to compare this cutoff value with previously reported ORP cutoff values in literature. One thousand one hundred and sixty-eight infertile patients and 100 fertile controls were enrolled. Demographic and semen data of the participants were retrieved and analyzed. Wilcoxon's rank-sum test compared variables between infertile men and fertile controls; Spearman's correlation assessed the static ORP (sORP)-TMSC relationship for the whole sample and among each group individually. Using a 20×10
6
TMSC threshold, receiver operator characteristic (ROC) analysis determined the sORP cutoff associated with the highest predictive values. TMSC was significantly negatively correlated with sORP across all participants (
r
= 0.86,
P
< 0.001), among infertile patients (
r
= 0.729,
P
< 0.001), and among fertile controls (
r
= 0.53,
P
< 0.001). A 20-million TMSC threshold determined an sORP cutoff value of 2.34 mV/10
6
sperm/ml to be associated with 82.9% sensitivity, 82.8% specificity, 91.5% positive predictive value (PPV), 68.5% negative predictive value (NPV), and 82.9% overall accuracy. Compared with previously reported cutoff values in searched literature, the 2.34 mV/10
6
sperm/ml cutoff value identified in our study yielded the highest overall diagnostic accuracy in the evaluation of infertile men.
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3
4,806
482
Histologically proven hepatic steatosis associates with lower testosterone levels in men with obesity
Frederique Van de Velde, Marlies Bekaert, Anne Hoorens, Anja Geerts, Guy T'Sjoen, Tom Fiers, Jean-Marc Kaufman, Yves Van Nieuwenhove, Bruno Lapauw
May-June 2020, 22(3):252-257
DOI
:10.4103/aja.aja_68_19
PMID
:31274482
Men with obesity often present with low testosterone (T) and sex hormone-binding globulin (SHBG) levels. Several mechanisms for this have been proposed, but as SHBG is secreted by hepatocytes and sex steroids undergo hepatic metabolization, this study investigates whether severity and histological components of nonalcoholic fatty liver disease (NAFLD) are associated with sex steroid levels in obese men. This cross-sectional study included 80 obese men (age: 46 ± 11 years; body mass index: 42.2 ± 5.5 kg m
−2
). Serum levels of total T and estradiol (E
2
) were measured using liquid chromatography coupled with tandem mass spectroscopy (LC/MS-MS) and SHBG and gonadotropins by immunoassay. Liver biopsies were evaluated using Steatosis, Activity, and Fibrosis scoring. Participants with steatohepatitis had similar median (1
st
quartile–3
rd
quartile) total T levels (7.6 [5.0–11.0] nmol l
−1
vs
8.2 [7.2–10.9] nmol l
−1
;
P
= 0.147), lower calculated free T (cFT) levels (148.9 [122.9–188.8] pmol l
−1
vs
199.5 [157.3–237.6] pmol l
−1
;
P
= 0.006), and higher free E
2
/T ratios (10.0 [6.4–13.9] x10
-3
vs 7.1 [5.7–10.7] x10
-3
;
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5,330
571
Testicular ultrasound inhomogeneity is an informative parameter for fertility evaluation
Giorgia Spaggiari, Antonio R M Granata, Daniele Santi
May-June 2020, 22(3):302-308
DOI
:10.4103/aja.aja_67_19
PMID
:31274478
Testicular volume (TV) is proposed to be a positive predictor of male fertility status, because of the relation known between the TV and the seminiferous tubule content. Independently of the measurement methodology, the role of TV and testicular ultrasound (US) assessments is still debated in andrological clinical practice. In this retrospective cohort study, we evaluated TV and testis US role in the diagnostic workup of andrological patients. All consecutive outpatients undergoing single-operator testis US (Modena, Italy) from March 2012 to March 2018 were enrolled, matching sonographic, hormonal, and seminal data. A total of 302 men were referred and evaluated for gynecomastia, suspected hypogonadism, couple infertility (CI), or sexual dysfunction. In the hypogonadal group, TV was lower compared to that in other groups (
P
< 0.001), and a significant, direct correlation between TV and testosterone level was observed in nonandrogen-treated patients (
R
= 0.911,
P
< 0.001), suggesting that testicular size could be related to the testosterone-secreting compartment. In the CI group, normozoospermic patients showed higher TV compared to men with impaired semen quality (
P
= 0.003) and azoospermia (
P
= 0.003). However, TV was not able to discriminate between patients presenting normal and altered semen quality. On the contrary, testis US inhomogeneity was more frequent in patients with impaired sperm quality (55.0%;
P
= 0.007) and azoospermia (40.0%;
P
= 0.012), compared to patients with normozoospermia (5%), identifying thereby the sonographic pattern as an informative parameter of the fertility status. Therefore, in the CI workup, US evaluation seems to be more informative than the TV assessment alone.
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4,917
482
INVITED OPINION
Testosterone therapy: a friend or a foe for the aging men with benign prostatic hyperplasia?
Giulia Rastrelli, Linda Vignozzi, Mario Maggi
May-June 2020, 22(3):233-235
DOI
:10.4103/aja.aja_86_19
PMID
:31424029
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5,507
714
ORIGINAL ARTICLES
Implementation of an in-house flow cytometric analysis of DNA fragmentation in spermatozoa
Anne Sofie Rex, Chunsen Wu, Jørn Aagaard, Jens Fedder
May-June 2020, 22(3):246-251
DOI
:10.4103/aja.aja_51_19
PMID
:31339111
An increased amount of DNA fragmentation in the spermatozoa (SDF) is linked to male infertility. The Sperm Chromatin Structure Assay (SCSA) is widely used for analysis of SDF. However, the current software (SCSASoft
®
) linked to this assay is licensed and often located within larger diagnostic centers. In this study, we present a protocol for using other types of software than SCSASoft
®
to determine the SDF index (DFI) with clinical relevance. This protocol is engineered after collecting and analyzing 254 samples from fertility patients and sperm donors over a 15-month period. DFI is analyzed using a strict protocol where the spermatozoa are treated with a strong acid (pH 1.2) followed by acridine orange. DFI is determined by a standard flow cytometric software, FACSDiva 6.1.3. Analysis of the outcome of the fertility treatment is included for 137 patients receiving either intrauterine inseminations (IUI) or timed coitus (TC). The results show that the chance of pregnancy declines as DFI increases. We also found that the male DFI affects the chance of pregnancy independent of the female age. We have shown that a standard flow cytometric software can be used when determining a clinical relevant DFI. These findings are a significant step toward implementing the analysis as a part of the routine, in-house diagnosing of the male fertility patient and subsequently optimizing the treatment course of the couple with reduced human and financial costs.
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5,211
566
Vacuum therapy prevents corporeal veno-occlusive dysfunction and penile shrinkage in a cavernosal nerve injured rat model
Sheng-Qiang Qian, Feng Qin, Shuang Zhang, Yang Yang, Qiang Wei, Run Wang, Jiu-Hong Yuan
May-June 2020, 22(3):274-279
DOI
:10.4103/aja.aja_57_19
PMID
:31249269
Erectile dysfunction and penile shrinkage are the common complications after radical prostatectomy. Penile rehabilitation is widely applied after the surgery. Vacuum therapy is one of the three penile rehabilitation methods used in the clinical setting, but its mechanism is not well known. This study was designed to investigate whether vacuum erectile device (VED) can prevent corporeal veno-occlusive dysfunction and penile shrinkage in the bilateral cavernous nerve crush (BCNC) rat model. Adult male Sprague–Dawley rats were randomly assigned into three groups: sham group, BCNC group, and BCNC + VED group. After 4 weeks, penile length and intracavernosal pressure (ICP) were measured, and then the middle part of the penis was harvested after dynamic infusion cavernosometry to complete the following items: smooth muscle/collagen ratios and collagen I/III ratios; ultramicrostructure of the tunica albuginea, endothelial cell, and smooth muscle cell; and the expression of calponin-1 and osteopontin. The penile shortening, peak ICP and ICP drop rate after alprostadil injection were significantly improved with vacuum therapy after 4-week treatment. Compared with BCNC group, VED significantly increased smooth muscle/collagen ratios, decreased collagen I/III ratios, and preserved the ultramicrostructure of the tunica albuginea, endothelial cell, and smooth muscle cell. The data also showed that animals exposed to VED could partially reverse the expression of calponin-1 and osteopontin induced by BCNC. In conclusion, vacuum therapy is effective to prevent penile shrinkage and veno-occlusive dysfunction in penile rehabilitation, which may be associated with well-preserved structure and function of the tunica albuginea, endothelial cell, and smooth muscle cell.
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22,582
496
Sperm DNA fragmentation in Chinese couples with unexplained recurrent pregnancy loss
Xiao-Bin Zhu, Qian Chen, Wei-Min Fan, Zhi-Hong Niu, Bu-Fang Xu, Ai-Jun Zhang
May-June 2020, 22(3):296-301
DOI
:10.4103/aja.aja_60_19
PMID
:31339112
We aimed to study the association between sperm DNA fragmentation and recurrent pregnancy loss (RPL) in the Chinese population via a retrospective observational study of Chinese couples who had experienced RPL between May 2013 and August 2018. The study population included 461 men from couples with RPL and 411 men from a control group (couples with clinical pregnancy via
in vitro
fertilization owing to female causes). Routine semen analysis, sperm chromatin analysis, and microscopic (high-power) morphological analysis were performed using semen samples. Semen samples were assessed for volume, sperm count, and motility. The sperm DNA fragmentation index (DFI) was calculated, and the median DFI was obtained. Men were categorized as having normal (37.8%; DFI ≤ 15.0%), moderate (33.6%; 15.0% < DFI < 30.0%), or severe (28.6%; DFI ≥ 30.0%) DNA fragmentation levels. The percentage of men with severe DNA fragmentation was significantly higher in the RPL (42.3%) group than that in the control group (13.1%), whereas the percentage of men with normal levels of DNA fragmentation was significantly lower in the RPL group (22.8%) than that in the control group (54.7%). Subsequent analysis also demonstrated that the sperm DNA fragmentation rate had a moderate reverse correlation with the sperm progressive motility rate (
r
= −0.47,
P
< 0.001) and the total motile sperm count (
r
= −0.31,
P
< 0.001). We found a positive correlation between RPL and sperm DNA fragmentation. The results suggest that increased sperm DNA damage is associated with RPL.
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4,990
584
INVITED OPINION
The role of the general practitioner in men's health
Janine David
May-June 2020, 22(3):229-232
DOI
:10.4103/aja.aja_15_19
PMID
:31044752
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5,832
643
LETTER TO THE EDITOR
Relationships between biological aging and male reproductive monitors
Giorgio Cavallini, Fabrizio Scroppo
May-June 2020, 22(3):330-332
DOI
:10.4103/aja.aja_27_19
PMID
:31274474
[FULL TEXT]
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3,987
372
A fertile male with a single sY86 deletion on the Y chromosome
Yin Jia, Zi-Guang Niu, Wei-Yu Li, Qin Qin, Ting-Ting Sun, Feng Zhang, Shan-Rong Liu
May-June 2020, 22(3):333-334
DOI
:10.4103/aja.aja_94_19
PMID
:31535627
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3,488
433
ORIGINAL ARTICLES
Contemporary trends in radical prostatectomy and predictors of recovery of urinary continence in men aged over 70 years: comparisons between cohorts aged over 70 and less than 70 years
Young Ju Lee, Jin-Woo Jung, Sangchul Lee, Sang Wook Lee, Jeong Hyun Kim, Sung Kyu Hong, Seok-Soo Byun, Sang Eun Lee, Seong Jin Jeong
May-June 2020, 22(3):280-286
DOI
:10.4103/aja.aja_62_19
PMID
:31249271
We evaluated contemporary trends in radical prostatectomy (RP) in men aged >70 years and investigated associations of selected variables with recovery of urinary continence (UC) in two age groups: >70 and ≤ 70 years. A retrospective cohort of 2301 eligible patients attending our institution from 2004 to 2015 was reviewed. Patients were divided into two groups based on age at surgery (>70 years [n = 610] vs 70 years [n = 1691]) and four groups by year of surgery. Over the study period, the proportion of patients aged >70 years gradually increased up to 30.0%, and the rate of robot-assisted RP and neurovascular bundle (NVB) saving increased continually to 80.0% and 67.4% of older patients, respectively. Although the rate of recovery of UC within 12 months (3 months) in patients aged >70 years was lower than that in those aged ≤ 70 years (81.5% [52.6%]
vs
88.6% [60.9%], respectively; both
P
< 0.001), the gap between age groups in the rate of recovery within 12 months narrowed from the second quarter of the study period. Among younger patients, age, robot-assisted RP, prostate volume, membranous urethral length (MUL), and NVB saving were predictors of recovery of UC within 3 or 12 months. In contrast, only age and MUL were predictors of recovery of UC within 3 and 12 months in patients aged >70 years. Therefore, unlike younger patients, only variables (age and MUL), possibly associated with the inherent function of the urinary sphincter, were predictors of recovery of UC in patients aged >70 years.
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A 30-year retrospective study of rare ectopic seminal tract opening cases
Hong-Fei Wu, Jia-Geng Zhu, Jian-Zhong Lin, Guang-Dong Shi, Jia-Qi Yu, Wei-Zhang Xu, Hong-Bo Yu
May-June 2020, 22(3):287-291
DOI
:10.4103/aja.aja_63_19
PMID
:31274477
Ectopic seminal tract opening is a rare congenital malformation. Until recently, there has been a lack of comprehensive reporting on the condition. The purpose of this retrospective study is to summarize the experience of diagnosis and treatment of this condition based on 28 clinical practice cases throughout the past 30 years. We conducted auxiliary examinations on such patients including routine tests, imaging examinations, and endoscopy. Among these 28 cases, there were ectopic opening of vas deferens into enlarged prostatic utricles (6 cases); ejaculatory ducts into enlarged prostatic utricles, Müllerian ducts cysts, and urethras (18 cases, 2 cases, and 1 case, respectively); and ectopic opening of the unilateral vas deferens and the contralateral ejaculatory duct into enlarged prostatic utricle (1 case). The size of the enlarged prostatic utricle, the type of ectopic seminal tract opening, and the opening's location effectively assisted in the selection of clinical treatment methods, including transurethral fenestration of the utricle, transurethral cold-knife incision, open operation, laparoscopic operation, and conservative treatment. Satisfactory effect was achieved during follow-up. In conclusion, a definite diagnosis and personalized treatment are especially important for patients with ectopic seminal tract opening.
[ABSTRACT]
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4,391
421
Surgical treatment of pelvic fracture urethral distraction defects in boys: which approach is suitable?
Lin Wang, Hai-Lin Guo, Hui-Quan Shu, Jie Gu, Chong-Rui Jin, Fang Chen, Ying-Long Sa
May-June 2020, 22(3):292-295
DOI
:10.4103/aja.aja_64_19
PMID
:31274481
Pelvic fracture urethral distraction defects (PFUDDs) are relatively infrequent in boys, and treatment for PFUDDs presents one of the most difficult problems in urological practice. Anastomotic urethroplasty is considered an ideal surgical procedure for PFUDDs in boys. However, various surgical approaches for anastomotic urethroplasty have been proposed, including a simple transperineal approach, a transperineal intercorporal septal separation approach, a transperineal inferior pubic approach, and a combined transpubic-perineal approach. This study aims to determine which surgical approach is best for PFUDDs in boys. We retrospectively identified 22 boys with PFUDDs aged 2–14 years who underwent anastomotic urethroplasty via different approaches between January 2008 and December 2017. Follow-up was performed in all the 22 patients for 6–123 (mean: 52.0) months. Finally, 20 of the 22 boys (90.9%) were successfully treated, including 1 of 2 patients treated with a simple transperineal approach, 3 of 3 with a transperineal approach with intercorporal septal separation, 14 of 15 with a transperineal inferior pubic approach, and 2 of 2 with a combined transpubic-perineal approach. Two patients had failed outcomes after the operation, and stenosis recurred. Based on the outcome of the 22 patients, we can draw a preliminary conclusion that most boys (20/22) can be treated with a transperineal inferior pubic approach or simpler procedures without the need of completely removing or incising the pubis. The combined transpubic-perineal approach can be used in cases of extremely long urethral distract defects.
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