Microdissection testicular sperm extraction (mTESE) is commonly performed to retrieve sperm in the testes for assisted reproductive techniques in patients with idiopathic nonobstructive azoospermia (iNOA). However, the success rate of sperm retrieval varies among individuals. We aim to investigate the association between clinical parameters and sperm retrieval outcomes in patients with iNOA. We searched PubMed, EMBASE, and Web of Science from database inception to August 2, 2023. The main measure was whether sperm retrieval was successful in patients with iNOA who underwent mTESE. Pooled estimates of the sperm retrieval rate and weighted mean differences were calculated using random-effects models. The overall sperm retrieval rate was 36.8% (95% confidence interval [CI]: 27.5%-46.0%, I2 = 95.0%) in nine studies comprising 1892 patients with iNOA. No significant differences were found in age, testicular volume, serum total testosterone concentrations, or inhibin B concentrations between positive and negative sperm retrieval outcomes. Lower anti-Müllerian hormone concentrations in patients with iNOA were associated with a positive outcome of mTESE (weighted mean differences: -2.70; 95% CI: -3.94--1.46, I2 = 79.0%). In conclusion, this study shows a significant relationship between anti-Müllerian hormone and sperm retrieval outcomes in patients with iNOA, while age, testicular volume, total testosterone, and inhibin B show no significant association. These findings have important implications for assessing the potential success of sperm retrieval and selecting appropriate treatment strategies in patients with iNOA.
We investigated the prognostic importance of noninvasive factors in predicting sperm retrieval failure in idiopathic nonobstructive azoospermia (iNOA). We studied 193 patients with nonobstructive azoospermia who underwent microsurgical testicular sperm extraction. The Chi-square test and Mann-Whitney U tests for clinical parameters and seminiferous tubule distribution were used for between-group comparisons. A logistic regression analysis was conducted to identify predictors of retrieval failure. Area under the receiver operating characteristic curve for each variable was evaluated, and the net clinical benefit was calculated using a clinical decision curve. Patients with iNOA had a lower sperm retrieval rate than those with known causes. Moreover, testicular volume was an independent factor affecting sperm extraction outcomes (odds ratio = 0.79, P < 0.05). The testicular volume cut-off value was 6.5 ml (area under the curve: 0.694). The patients with iNOA were categorized into two groups on the basis of the distribution of seminiferous tubules observed. The sperm retrieval rate and testicular volume were significantly different between the groups with a uniform or heterogeneous tubule distribution. There was also a significant association between a uniform tubule distribution and testicular volume. In conclusion, a testicular volume of more than 6.5 ml effectively predicts microsurgical testicular sperm extraction failure due to a uniform tubule distribution in patients with iNOA.
Objectives: To analyze the factors affecting the patency rate of microsurgical single-stitch longitudinal intussusception vasoepididymostomy and to explore the possible causes of failure. Methods: The clinical data of 87 patients with epididymal obstructive azoospermia who underwent microsurgical vasoepididymostomy from January 2015 to February 2018 in the First Affiliated Hospital of Fujian Medical University were analyzed retrospectively. We observed the patency rate postoperatively and evaluated several factors that possibly related to the patency rates. Preoperative examinations included peripheral blood chromosomes, Y chromosome microdeletions, sex hormones, seminal plasma, etc. After admission, microsurgical single-stitch longitudinal intussusception vasoepididymostomy was performed. During the follow-up, the semen was evaluated to assess the patency rate and the time to patency. Results: The patient's age ranged from 21 to 42 years and the mean age was(25±3) years. Infertility lasted for 1-8 years and the mean infertility time was(2.2±1.1) years. The longitudinal intussusception vasoepididymostomy was successfully completed in 80 patients , 5 cases gave up the anastomosis surgery because of multiple segment obstruction of the vas deferens, complete obstruction of the epididymis or testicular obstruction. Two cases underwent crossed vasovasostomy( sperm was present in the ejaculate in 1 case postoperatively). Of all the patients, 72 were successfully followed up. The follow-up time was 3-29 months, with an average of (12.0±1.7)months. Excluding 3 cases of follow-up time less than 12 months who still had no sperm in the ejaculate, 69 patients' data were in cluded in the final statistics, of which 50 cases with return of sperm in the ejaculate, the overall patency rate was 72.5%(50/69), concentration of sperm was 0.1-137.2 million/ml, and the mean concentration was(29±21) million/ml; with the progressive motile sperm rate ranging from 0-57.9%, the mean rate was(29.9±21.1)%. The patency rates of motile sperm and immobile sperm found in epididymal fluid during surgery were 82.2%(37/45) and 54.2%(13/24), respectively. The patency rate of bilateral and unilateral anastomoses was 77.6%(45/58) and 45.5%(5/11), respectively; the patency rate of caput anastomosis was 47.8%(11/23), and 84.8%(39/46) for corpus or caudal anastomosis. 17 patients achieved natural pregnancy postoperatively, the rate was 34.0%(17/50). Conclusions: The therapeutic effect of microsurgical single-stitch longitudinal intussusception vasoepididymostomy is satisfactory. The motile spermatozoa in epididymal fluid, bilateral surgery and corpus or caudal anastomosis can improve the patency rate postoperatively.目的： 分析显微镜下单针缝线纵向套叠输精管－附睾吻合术的复通率影响因素并探讨复通失败的可能原因。 方法： 回顾性分析2015年1月至2018年2月间在福建医科大学附属第一医院男科行显微镜下输精管－附睾吻合术的87例附睾梗阻性无精子症患者的临床资料，观察术后复通情况等，探讨影响复通率的可能因素。术前行各项检查如外周血染色体、Y染色体微缺失、性激素、精浆生化等。入院后行显微镜下单针缝线纵向套叠式输精管－附睾吻合术，术后随访复查精液评估复通率、复通的时间等。 结果： 患者年龄21～42(25±3)岁。不育时间1～8(2.2±1.1)年。80例成功完成输精管－附睾吻合术，5例因双侧输精管多段梗阻、附睾整段梗阻或睾丸内梗阻等放弃手术，2例施行交叉输精管－输精管吻合1例术后出现精子。72例成功随访，随访时间3～29(12.0±1.7)个月。排除3例随访时间<12个月且未出现精子的患者，69例纳入最后统计，其中50例术后精液检查发现精子，总体复通率为72.5%(50/69)，精子浓度[0.1～137.2(29±21)]×10(6)/ml；精子前向运动百分率0～57.9%(29.9±21.1)%。术中附睾液中找到活动精子与不动精子的复通率为82.2%(37/45)、54.2%(13/24)；双侧与单侧吻合的复通率为77.6%(45/58)、45.5%(5/11)；附睾头部、体尾部吻合的复通率为47.8%(11/23)、84.8%(39/46)。术后17例患者配偶自然妊娠，自然妊娠率为34.0%(17/50)。 结论： 显微镜下单针缝线纵向套叠输精管－附睾吻合术的疗效满意，附睾液中找到活动精子、双侧吻合、体尾部吻合可提高复通率。.
Macrophages are a key inflammatory cell that plays a critical role in acute and chronic kidney diseases. Toll-like receptor (TLR) 4 is highly expressed on inflammatory macrophages and has been shown to trigger acute renal inflammation. However, the role of macrophage-specific TLR4 in progression of chronic kidney disease remains unclear, which was investigated in the present study in a mouse model of unilateral ureter ligation (UUO).
Microsurgical vasoepididymostomy is an effective surgical method for treating epididymal obstructive azoospermia but the surgical outcomes can be affected in some non-vasectomized epididymal obstructive azoospermia patients with concurrent vas-deferens obstruction. This study aimed to explore the clinical characteristics and surgical outcomes in non-vasectomized epididymal obstructive azoospermia patients with versus without concurrent vas-deferens obstruction.
Objective: To analyze the effectiveness of transurethral seminal vesiculoscopy in the treatment of persistent hematospermia, and oligoasthenozoospermia and azoospermia from ejaculatory duct obstruction. Methods: The clinical date of 56 cases of persistent hematospermia, or azoospermia/oligoasthenozoospermia from ejaculatory duct obstruction treated with transurethral seminal vesiculoscopy between November 2013 and January 2016 in the First Affiliated Hospital of Fujian Medical University were reviewed. A total of 30 cases were persistent hematospermia for 6 months to 3 years, with no response to routine antibiotic therapy for >4 weeks; 24 cases were obstructive azoospermia; and the other 2 cases were extreme oligoasthenozoospermia. Transrectal ultrasound of the prostate and seminal vesicles, and pelvic magnetic resonance imaging (MRI) were performed before the surgery, finding seminal vesicle dilation in 28 cases, ejaculatory duct dilation in 18 cases, seminal vesicle and ejaculatory duct dilation in 7 cases, seminal vesicle dilation with ejaculatory duct cyst in 2 cases, and bilateral ejaculatory duct dilation with prostatic utricle cyst in 1 case. After the transurethral seminal vesiculoscopy, follow-up examinations were performed to assess the effectiveness of the surgery for ≥3 months. Results: The surgery was successful in all the patients, with the duration of surgery ranging from 30 to 148 minutes. Among the 30 patients with hematospermia, calculi in ejaculatory duct or seminal vesicle was found in 20 cases, while inflammation or dark red jelly-like substances in seminal vesicle was seen in all cases. In the follow-up of 9.7 months (3.0-13.0 months), hematospermia in 26 (26/30, 86.7%)patients was relieved or cured after 1-6 times of ejaculation; the other 4 (4/30, 13.3%)cases still had hematospermia. In postoperative semen analysis for the 24 cases of azoospermia from ejaculatory duct obstruction, sperms were detected in 16(16/24, 66.7%)cases, but sperms were not found after 6 months following the surgery in 1 of the 16 case, thus re-obstruction was suspected; in the other 8 (8/24, 33.3%)cases, sperms could not be found in multiple semen analyses in >12 months after the surgery. The 2 cases of extreme oligoasthenozoospermia had obvious improvement in routine semen analysis in 1 and 3 months after the surgery. Except for 1 case of scrotum swelling after surgery, no postoperative complications (retrograde ejaculation, urinary incontinence, or rectal injury) were observed. Conclusions: Transurethral seminal vesiculoscopy was an effective therapy for persistent hematospermia. More strict operation indication and careful performance are necessary for azoospermia oligoasthenozoospermia from ejaculatory duct obstruction.
Abstract Although observational studies have identified an association between smoking and prostatitis, the causal relationship between the two factors remains uncertain. To clarify this association, we used the Two-sample Mendelian randomization (TSMR) method. We obtained exposure and outcome data from publicly available databases. To assess the association between smoking and the risk of prostatitis, we employed multiple statistical approaches, including inverse-variance weighted (IVW), weighted median, weighted mode, MR-Egger, and sample mode. To minimize bias, we conducted Cochran's Q test, generated a funnel plot, utilized MR-Egger analysis, employed the Leave-one-out method, and performed the MR pleiotropy residual sum and outlier test. Based on our TSMR analysis, we found a significant positive correlation between smoking and the risk of prostatitis (OR = 2.26, p-value = 0.019). Furthermore, we observed no heterogeneity in the study as indicated by the Cochran Q-test (p = 0.533 for MR-Egger; p = 0.650 for IVW). Additionally, there was no conclusive evidence of horizontal pleiotropy. Overall, our TSMR analysis provides strong supportive evidence for a causal relationship between smoking and an increased risk of prostatitis. Quitting smoking may reduce the damage caused by smoking to the prostate. This study provides a new mindset for the management of prostatitis.
Abstract Background Oligoasthenoteratozoospermia (OAT) is one of the most complex aggregators of male gametic problems. However, the genetic etiology of OAT is still largely unknown. Objectives To reveal the new genetic factors responsible for male infertility owning to OAT and reveal the outcomes of the affected patients from intracytoplasmic sperm injection (ICSI). Materials and methods Two infertile men with typical OAT were recruited in 2018 and retrospected a cohort that included 47 patients with OAT from 2013 to 2021. Fifty healthy men with proven fertility served as control subjects. To identify the novel pathogenic variants, whole‐exome sequencing and Sanger sequencing were used. In silico analysis revealed the affecting of the variants. Field emission scanning electron microscopy was employed to observe the morphological defects of the spermatozoa. Immunofluorescence was used to analyze the expression and localization of the related protein. CRISPR/Cas9 was used to generate the mouse model. ICSI was used as a treatment for the patients and to assess the effects of the pathogenic variant on fertilization and embryo development. Results We identified a loss‐of‐function mutation NM_001170574.2:c.823G > T (p.Glu275*) in X‐linked TENT5D from two patients with OAT. This variant is highly deleterious and has not been found in the human population. The count of patients’ spermatozoa is dramatically decreased and displays multiple morphologic abnormalities with poor motility. Tent5d knockout mice are infertile and exhibit parallel defects. ICSI could rescue the infertility of the Tent5d knockout male mice. Moreover, the proband was treated with ICSI and achieved a successful pregnancy outcome for the first time. Subsequent mutation screening identified no TENT5D mutations among 47 additional patients with OAT and 50 control subjects. Conclusion Mutation in TENT5D results in OAT and male infertility, and this terrible situation could be rescued by ICSI.
Review question / Objective: We examined the discontinuation rate with tadalafil alone or in combination with a-blockers (ABs) for treatment of male lower urinary tract symptoms (LUTS) with or without Erectile Dysfunction (ED). Condition being studied: Discontinuation therapy associated with LUTS medication (tadalafil alone or in combination with ABs). METHODS P a r t i c i p a n t o r p o p u l a t i o n : P a t i e n t s reporting intake of LUTS therapyused INPLASY 1 International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY PROTOCOL Discontinuation Rate with Tadalafil Alone or in Combination with a-Blockers for Treatment of Male Lower Urinary Tract Symptoms with or without coexisting Erectile Dysfunction
Background This study aimed to compare the outcomes of double−armed two−suture longitudinal intussusception microsurgical vasoepididymostomy (LIVE) and single−armed two−suture LIVE techniques in patients with epididymal obstructive azoospermia (EOA). The main outcomes assessed were patency rates, patency time, semen quality and natural pregnancy rates. Methods Data from patients with EOA who underwent two−suture LIVE were obtained from databases including PubMed, EMBASE, and Web of Science. Weighted data were analyzed using a random−effects model, and weighted mean differences were reported. Results A total of 1574 patients with EOA from 24 studies were included. The overall patency rate was approximately 68% (95% confidence interval [CI]: 63–72%), with a patency time of approximately 4.63 months (95% CI: 4.15–5.12). The sperm concentration reached 26.90 million/ml and the sperm motility was 23.74%. The natural pregnancy rate was 38% (95% CI: 31–46%). The different definitions of patency do not seem to have any meaningful impact when comparing patency rates. There was no significant difference in patency rates, patency time, semen quality and natural pregnancy rates between the double−armed and single−armed LIVE techniques. Conclusion The single−armed LIVE is a potential alternative surgical option when high quality double−needle sutures are not easily accessible.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)
'/%3e%3cuse xlink:href='%23a' transform='rotate(144 450 300)'/%3e%3cuse xlink:href='%23a' transform='rotate(216 450 300)'/%3e%3cuse xlink:href='%23a' transform='rotate(288 450 300)'/%3e%3c/svg%3e)