Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.

Analysis of suprapubic and transrectal measurements in assessment of prostate dimensions and volume is transrectal ultrasonography really necessary for prostate measurements?

The objective of this study was to evaluate the correlation of suprapubic ultrasonography and transrectal ultrasonography in measurements of prostate dimension and volume. One hundred consecutive patients with lower urinary tract symptoms were examined by suprapubic and transrectal ultrasonography modalities in a same session. Measurements of the 3 dimensions of the prostate [anteroposterior, transverse, and craniocaudal] and its volume performed by suprapubic ultrasonography were compared with the corresponding measurements by transrectal ultrasonography in order to determine the correlation of the measurements. Prostate volumes were calculated using the ellipsoid formula. Data were further analyzed in subgroups according to prostate volumes smaller or larger than 50 mL, measured by suprapubic ultrasonography. The mean prostate volume of the 100 patients, measured by suprapubic and transrectal ultrasonography were 65.9 +/- 35.8 mL and 62.5 +/- 32.0 mL, respectively [r = 0.94; P < .001]. The craniocaudal diameters had the strongest correlation among dimension measurements [r = 0.89 P < .001]. Suprapubic and transrectal ultrasonography measurements also showed significant correlations for both prostates smaller or larger than 50mL. Eighty-five percent of the patients had both volume measurements under or above this limit. There was strong correlation between suprapubic and transrectal ultrasonography measurements of the prostate sizes, including both for volume or specific dimension measurements

Outcome of repeated micro-surgical testicular sperm extraction in patients with non-obstructive azoospermia / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the outcome of repetitive micro-surgical testicular sperm extraction (mTESE) attempts in non-obstructive azoospermia (NOA) cases, in relation to patients' initial testicular histology results.</p><p><b>METHODS</b>A total of 68 patients with NOA in whom mTESE had been performed in previous intracytoplasmic sperm injection (ICSI) attempts were reviewed.</p><p><b>RESULTS</b>Among the 68 patients with NOA, the first mTESE yielded mature sperm for ICSI in 44 (64%) (Sp(+)), and failed in the remaining 24 (36%) (Sp(-)). Following their first trial, 24 patients decided to undergo a second mTESE. Of these 24 patients, no spermatozoa were obtained in 5 patients, and Sp(+) but no fertilization/pregnancy were achieved in 19. In these 24 cases, mTESE was successively repeated for two (n = 24), three (n = 4) and four (n = 1) times. The second attempt yielded mature sperm in 3/5 patients from the Sp- group and 16/19 patients from the Sp(+) group. At the third and fourth trials, 4/4 and 1/1 of the original Sp(+) patients were Sp(+) again, respectively. Distribution of main testicular histology included Sertoli cell-only syndrome (16%), maturation arrest (22%), hypospermatogenesis (21%) and focal spermatogenesis (41%). Overall, in repetitive mTESE, 24/29 (82%) of the attempts were finally Sp(+).</p><p><b>CONCLUSION</b>Repeated mTESE in patients with NOA is a feasible option, yielding considerably high sperm recovery rate. In patients with NOA, mTESE may safely be repeated one or more times to increase sperm retrieval rate, as well as to increase the chance of retrieving fresh spermatozoa to enable ICSI.</p>

Detecting of mycoplasma genitallium in male patients with urethritis symptoms in Turkey by polymerase chain reaction

The aim of this study was to investigate the incidence of Mycoplasma genitalium in the urine samples of 63 male patients who had urethritis symptoms. Along with Neisseria gonorrhoeae [N. gonorrhoeae] and Chlamydia trachomatis [C. trachomatis]. We also investigated Mycoplasma hominis [M. hominis] and Ureaplasma urealyticum [U. urealyticum], both of which are known to cause urethritis. Microorganisms were investigated in urine samples of the patients with polymerase chain reaction. The study was conducted between September 2003 - February 2004 at the Department of Microbiology and Clinical Microbiology Ankara University School of Medicine, Ankara, Turkey. A total of 63 urine samples were analyzed and 6 [9.52%] patients had N. gonorrhoeae, 4 [6.34%] had C. trachomatis, while 4 [6.34%] urines were positive in terms of M. genitalium. Nevertheless, 3 [4.76%] patients had U. urealyticum and 2 [3.17%] patients had M. hominis. One urine sample was positive in terms of both N. gonorrhoeae and U. urealyticum, and another urine sample was positive in terms of both M. hominis and U. urealyticum. The results were compared with the control group and found no statistically significant difference. Mycoplasma species are found in normal flora of urogenital system and also as an agent of urogenital infection. In our study, we found low microorganism rates when compared with Europe and America. This difference may be due to the conservative sexual behavior in Turkey

Characteristics of sildenafil erections in healthy young men / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To determine the effect of sildenafil citrate on the nocturnal penile erections (i.e. time to onset, the duration of erection, and the interval between first and second erections) of healthy young men.</p><p><b>METHODS</b>Twenty-two potent men, 23-29 years old, were recruited for the study. All subjects completed three sessions over consecutive nights using the RigiScan monitoring device (Dacomed, Minneapolis, USA). After a first night of adaptation, night 2 records were their baseline values, and on night 3 they received 100 mg of sildenafil citrate. Statistical comparisons were done between the second and third night data.</p><p><b>RESULTS</b>The mean time to onset of the first erection with sildenafil citrate was (34+/-18) min, whereas it was (74+/-24) min (P 0.0001) without sildenafil citrate. The number of erections observed during the first 5 h after sildenafil citrate medication was 3.6+/-0.5 in contrast to 2.4+/-0.5 with no medication (P=0.001). The interval between first and second erections was shorter with sildenafil citrate: (52+/-26) min vs. (85+/-34) min (P = 0.01). The duration of the last erection was statistically significantly longer with the sildenafil citrate: (64 +/-33) min vs. (42 +/-28) min (P 0.001).</p><p><b>CONCLUSION</b>Healthy young men achieved erection within 34 min after sildenafil citrate administration, which is shorter than the 1 h interval proposed by the manufacturer. The interval between the first and second erections was shorter and the duration of the last nocturnal erection was longer.</p>