Difference in Nocturnal Erectile Function Between SRPE Patients and Normal People / 中山大学学报(医学科学版)

ObjectiveTo compare the nocturnal erectile function between SRPE patients and normal people. MethodsFrom July 1st， 2019 to December 15th， 2022， a clinical comparative study was conducted on 29 SRPE patients （experimental group） and 58 volunteers （control group） who visited our urology department. The Rigiscan System was used to monitor sleep monitoring time， the number of nocturnal erections and the rigidity， duration and circumference growth of the penis when the erection reached 60%～79% and 80%～100%， respectively. The patients and volunteers were asked to make written records when they woke up， and then the total number of awakenings and the number of awakenings when the penis erection reached 60% and 80% were compared between the two groups. ResultsAge was eliminated by matching. There was no statistically significant difference in sleep monitoring time， rigidity， circumference growth and duration of the penis when the erection reached 60%～79% and 80%～100%. between the two groups. In terms of sleep， there was a statistically significant difference in the total number of awakenings between the two groups［3（2 ~ 4）vs 0（0 ~ 0），P<0.01］ .And the same was true for the number of awakenings when the penis erection exceeded 60%～79% ［1（0 ~ 1）vs 0（0 ~ 0），P<0.01］and 80%～100% ［2（1 ~ 3）vs 0（0 ~ 0），P<0.01］. ConclusionRigiscan monitoring showed that there was no difference between SRPE patients and normal male in nocturnal penile erection function. Painful awakening usually occurs when the penis erection reaches 60%～79% or 80%～100%， which reveals that SRPE may be caused by abnormal sensation of nocturnal erections or pain sensitivity in some of these patients.

Decision regret analysis among Chinese patients receiving penile girth enhancement with acellular dermal matrix / 北京大学学报(医学版)

OBJECTIVE@#To evaluate decision regret among patients receiving penile girth enhancement with acellular dermal matrix (PGE with ADM) and to investigate the potential indicators for decisional regret so as to facilitate the decision-making process for this special group.@*METHODS@#In the study, 78 patients receiving PGE with ADM from Jun. 2016 to Jan. 2019 at Peking University People's Hospital and cooperative hospitals were eligible. Penile girth was taken by only one surgeon 1 week before surgery. Hospital anxiety and depression scale (HAD), international index of erectile function (IIEF) and a 10 cm long visual analogue scale named visualized penile image (VPI) were applied to measure psychological burden, erectile function and satisfaction with penile image respectively at the same time. All the patients were followed up for 3 months. Decision regret scale (DRS) was adopted for measuring decisional regret. Multivariate analysis of variance was applied to investigate the potential indicators for regret. Data analysis process was conducted with SPSS (version 24.0; SPSS, Chicago, IL, USA).@*RESULTS@#Mean penile girth recorded before intervention was (8.29±0.30) cm and increased to (9.46±0.29) cm post surgery (t=76.28, P < 0.01). As for both subscales of HAD measuring psychological burden, a signi-ficant reduction in the mean score was seen, that is, 2.8±1.3 (t=19.28, P < 0.05) for anxiety and 3.0±1.2 (t=20.67, P < 0.05) for depression, respectively. The average score of VPI increased by 3.7±1.1 (t=30.63, P < 0.05). There was no significant change in the average score of IIEF measuring erectile satisfaction (t=1.60, P=0.11). Twenty-nine (38.2%) patients expressed regret to some degree, and the mean DRS score was 23.4±14.8. The scores of DRS correlated negatively with scores of visualized penis image (r=-0.348, P < 0.01), and positively with scores of anxiety (r=0.760, P < 0.01) and depression subscale (r=0.471, P < 0.01). The scores of DRS was irrelevant to those of IIEF (r=0.02, P=0.867). The patients with high annual income (> 120 000 yuan) and education level above undergraduate were more prone to experience decision regret after intervention (P < 0.01).@*CONCLUSION@#PGE with ADM did augment penile girth and lower psychological burden, the regret rate of which was acceptably low among the patients. High income and good education might indicate more post-operative regret. Additional decision-making aids should be offered to patients with high income and education level above high school.

Complications and management for penile augmentation with acellular dermal matrix / 北京大学学报(医学版)

OBJECTIVE@#To investigate and analyze the complications of penile augmentation with acellular dermal matrix (ADM) and following management.@*METHODS@#This was a retrospective review of all patients who received penile augmentation with ADM between June 2016 and January 2019. The patients were evaluated with outpatient physical examination. Related complications and following management were summarized and analyzed.@*RESULTS@#Between June 2016 and January 2019, ADM was used as filling material on 78 patients (mean age: 31.14 years, range: 21-66 years), who were successfully received penile augmentation surgery. In the follow-up three months, the penile circumference was increased by 1.1 cm (0.5-2.1 cm) on average. The mean follow-up time was 12.20 months. In this study, there were 47 (60.26%, 47/78) patients with erectile discomfort, 91.49% (43/47) of whom manifested as erectile traction. There were 12 (15.38%, 12/78) patients with delayed healing, improved by daily regular dressing change. There were 10 (12.82%, 10/78) patients with unobvious augmentation effect. There were 9 (11.54%, 9/78) patients with stamp-like changes of ADM. There were 8 (10.26%, 8/78) patients with wound hematoma and 7 (8.97%, 7/78) patients with foreskin edema, relieved by compression with wrap. There were 4 (5.13%, 4/78) patients with wound infection and 3 (3.85%, 3/78) patients with skin necrosis of the dorsal side, which could be treated with ADM removal and repair surgery with bipedicle scrotal flap. And there were 2 (2.56%, 2/78) patients suffering psychological influence. Finally, most patients with various complications recovered successfully, however 7 patients (8.97%, 7/78) underwent ADM removal surgery.@*CONCLUSION@#Using ADM as filling material could achieve positive effect in penile augmentation but the complications are common and cannot be neglected. Standardized surgical methods, rigorous postoperative care, and adequate notification with patients can effectively reduce the complications of penile augmentation with ADM. To treat properly and timely for complications can obtain satisfactory results.

CMTM2 is involved in spermiogenesis in mice / 北京大学学报(医学版)

OBJECTIVE@#To investigate whether CKLF-like MARVEL transmembrane domain-containing protein 2 (CMTM2) is involved in spermatogenesis in mice. CMTM2 is highly expressed in testis, and could possibly be a potential spermagogenesis specific gene.@*METHODS@#CMTM2-deficient mouse model was generated. Northern, RT-PCR and Western blotting analysis were performed on total RNA derived from wild-type (WT, CMTM2+/+) and CMTM2+/- (heterozygote) and CMTM2-/-(homozygote) mice to examine the CMTM2 level. The number of litters and the number of pups were counted and pregnancy rates calculated. The motility and morphology of the sperm and the histology of testes were analyzed. Serum testosterone and FSH concentrations were also measured. Standard t-tests were used and standard error of means were calculated.@*RESULTS@#CMTM2 was highly expressed in a finely regulated pattern in the mouse testis during spermatogenesis. The body weight of adult mice with CMTM2 deficiency was not significantly different from that of wild type mice. No obvious anatomical or behavioral abnormalities were observed. The testis of CMTM2-/- was smaller than that of CMTM2+/+ mice. The testis diameter in wild mice and CMTM2 null mice were (11.32±1.21) mm vs. (8.29±1.92) mm (P<0.05), and the weights were (101.63±2.33) mg vs. (85.22±2.84) mg (P<0.05), respectively. Female CMTM2 null mice were fertile, indicating that CMTM2 was not required for female gametogenesis. The CMTM2-/- mice produced virtually no sperm, and CMTM2+/- mice sperm count showed a significant decline. In terms of sperm morphorlogy study, more round spermatids could be observed in the heterozygote group, compared with the wild type group; while in the homozygote group, a large amount of round spermatids could be observed because of complete arrest of spermiogenesis. The hormone levels were not significantly different. The CMTM2-/- male mice were sterile due to a late, complete arrest of spermiogenesis. The organized architecture of the seminiferous epithelium of the seminiferous tubules seen in CMTM2+/+ mice was lost in CMTM2-/- mice.@*CONCLUSION@#This study suggests CMTM2 is not required for embryonic development in the mouse but is essential for spermiogenesis, however, further studies are required for more detailed mechanism study.

Considerations on priapism / 中华男科学杂志

Priapism is a rare pathological penile erection, and there are some inadequacies in its definition, classification, diagnosis, and therapeutic strategies. In this article, we sum up our years of experience with priapism and put forward some new views and ideas about its definition, classification, pathophysiologic process, pathological change, diagnostic essentials, therapeutic measures, indications of successful treatment, and post-therapeutic rehabilitation of erectile function. We also describe the clinical features, diagnosis and treatment of some special types of priapism, such as intermittent seizure, sleep-related painful erection, and tumor-related priapism, hoping to help urologists and andrologists in the further understanding and management of priapism.

Transurethral resection of prostate treatment for recurrence of a multilocular prostatic cystadenoma: a case report / 北京大学学报(医学版)

Multilocular prostatic cystadenoma (MPC) is a rare benign tumor that originates from the prostate itself. MPC is usually characterized by large multilocular cysts located between the rectum and bladder. The clinical presentation includes obstructive voiding symptoms, such as poor stream, intermittency, sensation of incomplete emptying, acute urinary retention and sometimes constipation symptoms due to mechanical compression of the lower intestine. Most of the previously reported patients with MPC underwent open surgery. Although the natural history of MPC remains unknown, surgical excision may not always be necessary. Here we report the case of a 49-year-old male, treated by transurethral electroresection of prostate (TURP) for prostate cyst one and half years before．His biopsy of TURP showed benign prostatic tissue with no evidence of malignancy. However, the symptoms of urinary tract obstruction were obviously aggravated after the operation. Acute urinary retention occurred intermittently 3 times. In our hospital, his total prostate specific antigen (tPSA) was 5.440 μg/L, free prostate specific antigen (fPSA) was 1.528 μg/L. After examination, it was considered as benign lesions clearly. In the operation of TURP, we found that the tumor was multilocular cystic. Histologically, the cell was mucus. Concerning the immunophenotype, CK5/6(+) , p40(+), PSA(+), P504S(+), PAX-2(-), PAX-8(-), MUC1(+), MUC5ac(+), the results of special staining were as follows: AB(+), PAS(+). At the end of the follow up 3 months later, the routine semen analysis results showed that his semen volume was 3 mL and the sperm density and sperm mobility were normal. At the end of the follow up eight months later, the patient remained free of lower urinary tract symptoms and there were no signs of recurrence. His international prostate symptom score (I-PSS) had dropped from 32 to 4, and quality of life score (QOL) had dropped from 6 to 2. MPC is a rare benign tumor originating from the prostate. TURP may aggravate the symptoms of lower urinary tract obstruction in patients with MPC, and may be temporarily observed for some asymptomatic young and middle-aged patients.

A randomized clinical trial investigating treatment choice in Chinese men receiving sildenafil citrate and tadalafil for treating erectile dysfunction / 亚洲男科学杂志(英文版)

Sildenafil and tadalafil are efficacious and well tolerated in Chinese men with erectile dysfunction (ED). Recent study results indicate that men with ED in China who were naïve to phosphodiesterase inhibitor type 5 (PDE5) therapy prefer tadalafil 20-mg (on-demand) versus sildenafil 100-mg (on-demand). Differences in psychosocial outcomes may help to explain treatment preference in favor of tadalafil. This open-label, randomized, crossover study compared psychosocial outcomes and drug attribute choices between tadalafil and sildenafil in Chinese men with ED naïve to PDE5 inhibitor therapy. Eligible patients were randomized to sequential 20-mg tadalafil/100-mg sildenafil (n = 190) or 100-mg sildenafil/20-mg tadalafil (n = 193) for 8 weeks each and were asked which treatment they preferred to take for the 8-week extension phase. Psychosocial outcomes were assessed using the Psychological and Interpersonal Relationship Scale (PAIRS), Drug Attributes Questionnaire (DRAQ), and Sexual Life Quality Questionnaire (SLQQ). When taking tadalafil versus sildenafil, men had a higher mean endpoint score on the PAIRS Spontaneity Domain (tadalafil = 2.86 vs sildenafil = 2.72; P < 0.001), and a lower mean endpoint score on the Time Concerns Domain (tadalafil = 2.41 vs sildenafil = 2.55; P < 0.001). A numerical increase in the Sexual Self-Confidence Domain was observed when taking tadalafil versus sildenafil (tadalafil = 2.76 vs sildenafil = 2.72; P = 0.102). The most frequently chosen drug attributes explaining treatment preference were able to get an erection long after having drug, and ability to get an erection every time. SLQQ results were comparable between treatment groups. These psychosocial outcomes may explain why more Chinese men preferred tadalafil versus sildenafil for the treatment of ED in this clinical trial.

Changes in the ultrastructure of sperm flagella in severe idiopathic asthenospermia patients: observation of 22 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To observe the ultrastructural changes of sperm flagella in patients with severe idiopathic asthenospermia.</p><p><b>METHODS</b>Using the transmission electron microscope, we examined the ultrastructure of sperm flagella from 22 patients with severe idiopathic asthenospermia.</p><p><b>RESULTS</b>Ultrastructural anomalies were found in all the 22 patients, 6 with partial or complete absence of internal and external dynamic arms in dedicative of primary ciliary dyskinesia, 1 with hyperplasia, hypertrophy and disordered organization of the fibrous sheath usually referred to as dysplasia of the fibrous sheath, and the other 15 with non-specific flagellar anomalies.</p><p><b>CONCLUSION</b>Examination of the ultrastructure of sperm flagella in severe idiopathic asthenospermia patients can help to distinguish congenital from acquired flagellar structural anomalies and give valuable guidance in the treatment.</p>

Distal cavernosal-glan shunt for ischemic priapism: a long-term follow-up study / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the management of ischemic priapism (IP) by analyzing the clinical and follow-up data of IP patients.</p><p><b>METHODS</b>We retrospectively reviewed the clinical data of 8 IP patients treated in our hospital from January 2004 to June 2010 and analyzed the results of follow-ups by telephone calls and clinic visits.</p><p><b>RESULTS</b>The average age of the patients was 34.5 (23 -41) years and the mean duration of priapism was 84.5 (36 -132) hours. All the patients had received previous detumescence treatment but failed before referred to our hospital. Irrigation/aspiration was performed at first, which achieved complete detumescence in 1 case and partial or transitional detumescence in the other 7. Subsequently, bilateral Al-Ghorab shunt was tried and succeeded in 2 cases but failed in 5. Finally, T-shunt was conducted, which achieved complete resumption in all the remaining 5 cases. Follow-up data were available in 5 of the cases, which were followed up for 12 -66 (mean 54) months. Of the 5 cases, moderate ED occurred in 2, and complete ED in 3. The latter 3 had suffered a longer duration of IP than the former 2.</p><p><b>CONCLUSION</b>If detumescence failes, early intervention by T-shunt can improve the success rate of IP treatment.</p>

Synthesis and experimental study of a novel polymer/gene compound drug controlled release system for the treatment of erectile dysfunction / 中华男科学杂志

<p><b>OBJECTIVE</b>To overcome the deficiency in the current therapies for erectile dysfunction (ED), we designed and synthesized a novel high-efficiency polymer/gene compound drug controlled release system and discussed the feasibility of pH and temperature dually sensitive injectable hydrogel in ED gene therapy.</p><p><b>METHODS</b>We synthesized optimal siRNA gene nanoparticles by characterizing the zeta potential of polylysine (PLL)/siRNA gene compounds, and established a pH and temperature dually sensitive injectable gene compound drug controlled release system via Schiffs reaction between glycol chitosan (GC) and benzaldehyde capped OHC-PEO-PPO-PEO-CHO. Then we demonstrated the sustained release of the system at different temperatures.</p><p><b>RESULTS</b>When the mass ratio of PLL to siRNA was 20:1, the zeta potential of the PLL/siRNA gene compound reached the peak (+23.5 mV) and the siRNA was encapsulated by PLL in the maximal degree. GC and OHC-PEO-PPO-PEO-CHO was crosslinked via benzoicimine reaction when environmental pH was changed from 5.5 to 7.4. The reslease of the siRNA encapsulated in this system kept at a low rate at 37 degrees C, significantly enhanced with the increase of the temperature to 60 degrees C, rising to (122.5 +/- 5.3) microg at 1 000 minutes as compared with (23.8 +/- 6.0) microg at 37 degrees C (P < 0.05).</p><p><b>CONCLUSION</b>The polymer/gene compound drug controlled release system was successfully synthesized, which improved the stability and capacity of gene carriers and achieved siRNA release at different temperatures, promising to be a new approach to the gene therapy of ED.</p>

Application of CUA Guidelines on Prostatitis in the management of chronic pelvic pain syndrome: a nationwide survey / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the application of the Chinese Urological Association (CUA) Guidelines on Prostatitis and its effects on the clinical practice patterns of diagnosing and treating chronic pelvic pain syndrome (CPPS) among Chinese urologists and andrologists.</p><p><b>METHODS</b>We conducted a questionnaire investigation on the application of the CUA Guidelines on Prostatitis among the urologists and andrologists of 173 hospitals in 21 cities of China, and performed statistical analyses on all the eligible questionnaires collected.</p><p><b>RESULTS</b>Of the 1 056 questionnaires distributed, 851 (80.6%) were eligible, of which 71.6% were from the urologists or andrologists in grade 3 hospitals, 80.7% of them with senior or intermediate professional titles and 97.5% had studied the CUA Guidelines. Most of the subjects agreed that Type III prostatitis is a clinical syndrome, whose diagnosis should exclude other conditions with similar symptoms, and whose treatment should aim at relieving pain, alleviating urination symptoms and improving the quality of life. Those who had and those who had not studied the CUA Guidelines differed in their viewpoints on CPPS as illustrated in the book. In clinical practice, the most common treatment options for CPPS were psychological therapy (80.7%), medication (80.4%) and life style adjustment (79.6%), and the most frequently used drugs were phytotherapy (80.0%), alpha-blockers (68.9%) and antibiotics (61.0%).</p><p><b>CONCLUSION</b>CUA Guidelines on Prostatitis has gained a nationwide application and promoted the standardization of the management of CPPS in China.</p>

Androgen replacement therapy improves psychological distress and health-related quality of life in late onset hypogonadism patients in Chinese population / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Late onset hypogonadism negatively impacts on men's psychological well-being. This study was conducted to examine the interrelationship among symptoms of testosterone deficiency, psychological well-being, and quality of life.</p><p><b>METHODS</b>Eligible subjects were randomized into active treatment and control groups, and were asked to complete the following questionnaires at baseline and month 6: aging male's symptoms (AMS) rating scale, hospital anxiety and depression scale (HADS), perceived stress scale (PSS) and the short form health survey-12 (SF-12). In this study, men were treated and monitored for 6 months with oral testosterone undecanoate (TU) capsules or vitamin E/C capsules in a single-blinded fashion. All in the active treatment group were administered a total of 120 - 160 mg TU orally on a daily basis. Total and free T levels between baseline and month 6 were compared.</p><p><b>RESULTS</b>One hundred and sixty eligible subjects were recruited and followed up. In the active treatment group, total serum testosterone concentrations before and after intervention were (7.98 ± 0.73) nmol/L and (13.7 ± 1.18) nmol/L. The mean HADS anxiety subscale scores for the subjects at baseline and at month 6 were 3.47 ± 0.4 and 1.72 ± 0.2, respectively (t = 1.526, P < 0.05). Additionally, the mean HADS depression subscale scores were 4.91 ± 0.6 and 2.39 ± 0.3, respectively (t = 3.466, P < 0.05). The mean scores on PSS for the subjects at baseline and at month 6 were 12.88 ± 2.1 and 9.83 ± 1.7, respectively (t = 4.009, P < 0.05). Significantly improved SF-12 could be observed (t = 1.433 and 1.118, respectively; both P < 0.05). No significant changes were observed in the control group at month 6.</p><p><b>CONCLUSION</b>Androgen replacement not only improves androgen deficiency associated symptoms, but also enhances comprehensive improvement in psychological issues.</p>

A preliminary evaluation of the psychometric profiles in Chinese men with chronic prostatitis/chronic pelvic pain syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>As one of the most commonly diagnosed diseases, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by a variety of complex symptoms. Anxiety and depression are two of the most prevalent clinical manifestations of patients with CP/CPPS, and have adverse effects on the health of the subjects and prognosis of comorbidities. Such psychological disorders, however, have not been deeply and thoroughly studied in China. The aim of this study was to investigate the prevalence and severity of psychological disorders in Chinese adults with CP/CPPS.</p><p><b>METHODS</b>From April 2008 to June 2009, 80 patients and 40 age-matched healthy men participating in a voluntary health examination were recruited. The majority of the subjects completed the questionnaires on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) as well as the hospital anxiety and depression scale (HADS).</p><p><b>RESULTS</b>Of all the participants, 77 (96.3%) patients and 37 (92.5%) healthy controls completed the questionnaires. The average NIH-CPSI total score was 21.0 ± 9.5 for the patients and 2.2 ± 1.5 for the controls (P = 0.03). Of the 77 patients with CP/CPPS, 48 (62.3%), 5 (6.5%), and 1 (1.2%) had anxiety symptoms, depression symptoms, or both anxiety and depression symptoms, respectively. For the controls, the average HADS anxiety and depression scores in patients were 14.5 ± 6.8 and 5.2 ± 4.5, which were both significantly higher than in controls. Moreover, the prevalence and the symptom scores of both the HADS anxiety and depression were higher for the younger age group (< 35 years) than for the older age group (< 35 years).</p><p><b>CONCLUSIONS</b>This preliminary study revealed that male patients with CP/CPPS had a higher prevalence of psychological disorders than in the control subjects. Moreover, the differences of the prevalence and severity of the psychological symptoms between the two different age groups may imply that psychological disorders related to CP/CPPS may be relieved with increasing age. The present study indicated that psychological evaluation is important in men with CP/CPPS, especially in younger men.</p>

Nocturnal penile tumescence and the effect of tadalafil on erectile dysfunction / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the correlation between the results of the nocturnal penile tumescence (NPT) test and the efficacy of tadalafil in the treatment of ED.</p><p><b>METHODS</b>A total of 188 ED patients were divided into a normal NPT group (n = 136) and an abnormal NPT group (n = 52) according to the results of the NPT test. All of them were treated with tadalafil at 20 mg 3 times a week. The IIEF-5 score, SEP2, SEP3 and GAQ score were compared between the two groups before and 1 month after the treatment.</p><p><b>RESULTS</b>Tadalafil treatment significantly improved IIEF-5 score, SEP2 and SEP3 of both groups of the patients (P < 0.01). Compared with the abnormal NPT group, the normal NPT group showed a remarkable increase in the IIEF-5 score, SEP2, SEP3 (P < 0.05) and GAQ score (P < 0.01).</p><p><b>CONCLUSION</b>After 1 month of tadalafil treatment, the normal NPT group achieved a more significant improvement of erectile function and sexual satisfaction than the abnormal NPT group, suggesting that tadalafil has a better therapeutic effect for ED patients with normal NPT.</p>

Partial ejaculatory duct obstruction induces hemospermia syndrome in the rat model / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the pathogenesis of hematospermia syndrome using the rat model of hemospermia induced by partial ejaculatory duct obstruction.</p><p><b>METHODS</b>Fifty male rats were divided into Groups A (n=20) and B (n=30), the former subjected to incomplete ligation of the right ejaculatory duct, while the latter open-close sham operation. Electro-stimulation was performed for ejaculation induction one week after the operation. Those that developed hematospermia in Group A were chosen as Group A1, while those with normal ejaculation in Group B included in Group B1. The semen indexes and seminal vesicle pressure were compared between Groups A1 and B1.</p><p><b>RESULTS</b>Compared with Group B1, Group A1 showed significantly decreased semen volume (P < 0.01), lower sperm motility (P < 0.01) and higher seminal vesicle pressure (P < 0.01), but no statistically significant differences were observed in the WBC count and sperm density in the semen between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>Hemospermia syndrome can be induced by partial ejaculatory duct obstruction, with changes of semen indexes, and it is closely correlated with high seminal vesicle pressure.</p>

Spermatic vein and artery ligation for varicocele / 中华男科学杂志

<p><b>OBJECTIVE</b>To assess the influence of spermatic vein and artery ligation on testicular hemodynamics, spermatogenesis and testis volume in varicocele patients.</p><p><b>METHODS</b>Eighty-eight varicocele patients were randomly divided into a spermatic vein and artery ligation (n = 46) and a spermatic vein and artery preservation group (n = 42). The testicular hemodynamic parameters, testis volume and results of semen analyses were obtained before and 6 months after the surgery and compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences in peak systolic velocity (V(max)), end diastolic velocity (V(min)), mean enveloped velocity (V(mean)) and V(min) of the capsular artery (CA) either between the ligation and preservation groups (P > 0.05) or between pre- and post-operation (P > 0.05). Sperm density, vitality and motility were significantly improved after surgery (P < 0.01), with no significant differences between the two groups (P > 0.05). No significant difference was found in the testis volume between the two groups before and after the operation (P > 0.05).</p><p><b>CONCLUSION</b>Spermatic vein and artery ligation in varicocelectomy does not affect the testicular hemodynamics, spermatogenesis and testis volume of varicocele patients. Both the spermatic vein and artery should be ligated when necessary.</p>

Tadalafil for erectile dysfunction: excellent safety and tolerance / 中华男科学杂志

As a novel phosphodiesterase type 5 (PDE5) inhibitor, tadalafil is administered orally for the treatment of erectile dysfunction (ED). In addition to its outstanding efficacy that lasts 36 hours, tadalafil shows an excellent safety and tolerance, with only a few transient mild to moderate adverse events. Usually ED patients are concomitantly afflicted with multiple pre-existing medical conditions or receive a range of drugs at the same time. Therefore, it is essential to understand its safety in general population and some special high-risk cohorts.

Environment and erectile dysfunction / 中华男科学杂志

Exposure to environmental or occupational substances may affect penile erectile function, and it would add to a growing list of pathogenic risk factors associated with erectile dysfunction. Several lines of evidence gained by clinical epidemiologic and biomedical investigations lend support to this viewpoint. Some environmental toxicants, including smoke, lead, organic solvents, and pesticides, are potential hazards, whose effects on the nervous and hormonal systems have been proposed as the leading mechanisms by which environmental toxicants adversely impact erectile function. A synthesis of current data suggests a possible association between environmental exposure and erectile dysfunction, but evidence is not yet sufficient to support a direct causal link for the time being. More studies are needed to identify specific environmental agents that may harm erectile function and to define their exact action mechanisms in this regard.

Clinical observation of loupe-assisted intussusception vasoepididymostomy in the treatment of obstructive azoospermia (analysis of 49 case reports) / 亚洲男科学杂志(英文版)

To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy (VE) in the treatment of epididymal obstructive azoospermia (EOA), we retrospectively analyzed data from 49 patients with EOA who underwent two-suture longitudinal intussusception vasoepididymostomy (LIVE) between 2000 and 2007. The data included the surgical method, postoperative motile sperm count per ejaculation, percentage of progressive motile sperm and patency and pregnancy outcomes. There were a total of 49 men undergoing scrotal exploration, and epididymal obstruction was found in all cases. Bilateral or unilateral anastomoses were performed in 40 and 6 men, respectively. The postoperative courses of 42 patients were followed up for more than 6 months, and the courses of 38 patients were followed up for more than 1 year. The overall patency and pregnancy rates were 71.4% and 26.3%, respectively. Moreover, progressive motile sperm was more frequently present in those patients who had undergone anastomosis at cauda than at corpus or caput. Pregnancy was achieved only in those patients who had undergone anastomosis at least on one side of the cauda epididymis. We think that the loupe-assisted method, with a lower overall cost and a simplified surgical procedure, can achieve satisfactory patency outcomes and pregnancy results. Data from this paper also suggest that paternity outcomes occur more frequently after anastomoses at cauda than at corpus or caput.

Efficacy of tadalafil for erectile dysfunction: an updated review / 中华男科学杂志

Tadalafil is an effective drug in treating erectile dysfunction (ED), and its clinical efficacy has been confirmed by a great many researches. Tadalafil is distinguished from sildenafil and vardenafil by its prolonged action lasting 36 hours for a sigle dose, compared with about 4 hours for sildenafil. Furthermore, this drug is effective in improving the erectile function of ED patients including those with various comorbid conditions. Tadalafil can help ED patients to regain morning erection and recover the confidence as a man. More and more ED patients choose tadalafil as the first line therapy because of its long efficacy and its conformability to the therapeutic requirement by restoring ED patients to normal, natural and pleasurable sexual life.