Effect of Selective Dorsal Neurectomy on Erectile Function in Rats.

OBJECTIVE: This study aimed to investigate the effect of penile selective dorsal neurectomy (SDN) on erectile function in rats. METHODS: Twelve adult male Sprague-Dawley rats (15 weeks old) were divided into three groups (n=4 per group): in control group, rats received no treatment; in sham group, rats underwent a sham operation; in SDN group, rats underwent SDN with half of the dorsal penile nerve severed. The mating test was performed, and the intracavernous pressure (ICP) assessed six weeks after the surgical treatment. RESULTS: At postoperative six weeks, the mating test revealed no significant difference in mounting latency and mounting frequency among the three groups (P>0.05), while the ejaculation latency (EL) was significantly longer and ejaculation frequency (EF) lower in the SDN group than in the control and sham groups (P<0.05). There were no significant differences in preoperative and postoperative ICP and ICP/mean arterial blood pressure (MAP) among the three groups (P>0.05). CONCLUSION: SDN does not adversely affect the erectile function and sexual desire of rats, and at the same time it can reduce EL and EF, providing an application basis for SDN in the clinical treatment of premature ejaculation.

High SAA1 Expression Predicts Advanced Tumors in Renal Cancer.

Renal cell carcinoma (RCC) is the most frequent malignant tumor of the kidney. 30% of patients with RCC are diagnosed at an advanced stage. Clear cell renal cell carcinoma (ccRCC) is the most common pathological subtype of RCC. Currently, advanced ccRCC lacks reliable diagnostic and prognostic markers. We explored the potential of SAA1 as a diagnostic and prognostic marker for advanced ccRCC. In this study, we mined and analyzed the public cancer databases (TCGA, UALCAN and GEPIA) to conclude that SAA1 was up-regulated at mRNA and protein levels in advanced ccRCC. We further found that hypomethylation of SAA1 promoter region was responsible for its high expression in ccRCC. Receiver operating characteristic curve (ROC) indicated that high SAA1 levels could distinguish advanced ccRCC patients from normal subjects (p < 0.0001). Kaplan-Meier curve analysis showed that high SAA1 levels predicted poor overall survival time (p < 0.0001) and poor disease-free survival time (p = 0.0003). Finally, the functional roles of SAA1 were examined using a si-SAA1 knockdown method in RCC cell lines. Our results suggest that SAA1 may possess the potential to serve as a diagnostic and prognostic biomarker for advanced ccRCC patients. Moreover, targeting SAA1 may represent as a novel therapeutic target for advanced ccRCC patients.

Influencing Factors for Erectile Dysfunction of Young Adults with No Response to PDE5i.

Erectile dysfunction (ED) is a common male disorder. Although orally-administered phosphodiesterase type 5 inhibitors (PDE5 inhibitors) are now recognized as the primary pharmacological treatment method for ED, 20%-30% of the patients treated with PDE5 inhibitors exhibit no significant effects. This study aims to investigate the influencing factors of ED in young adults with no response to PDE5 inhibitors. ED patients who would take PDE5 inhibitors were included and investigated with a questionnaire. Patients with no response to PDE5 inhibitors (tadalafil and sildenafil) served as study group, and those with response to PDE5 inhibitors as control group. Then Chi square test and logistic regression analysis were applied to find the potential influencing factors. In total, 378 ED patients were included. Ninety-three (24.6%) cases were non-responsive to PDE5 inhibitors, and the remaining 285 (75.4%) responded to PDE5 inhibitors. In multiple logistic regression analysis, we found that history of drinking (OR=3.152; 95%CI 1.672-6.975), spousal noncooperation (OR=2.994; 95%CI 1.589-5.638), number of fixed sex partners (OR=0.358; 95%CI 0.132-0.651), duration of ED (OR=3.356; 95%CI 1.352-8.333), and depression (OR=3.689; 95%CI 1.579-8.979) could be the influencing factors for ED patients' non-response to PDE5 inhibitors. In conclusion, history of drinking, spousal noncooperation, number of fixed sex partner, long duration of ED, and depression could be the influencing factors for ED patients' non-response to PDE5 inhibitors. Patients and doctors should pay attention to these factors.

An epithelial-mesenchymal transition-related long non-coding RNA signature to predict overall survival and immune microenvironment in kidney renal clear cell carcinoma.

Kidney renal clear cell carcinoma (ccRCC) is a malignant tumor originating from renal tubular epithelium, lncRNAs can regulate the occurrence and development of EMT by targeting EMT transcription factors. We constructed a new survival signature based on EMT-related differentially expressed lncRNAs obtained from the Cancer Genome Atlas (TCGA-KIRC). We first determined 1377 EMT-related lncRNAs, lncRNA AL035661.1 with the largest correlation coefficient and the target gene was PFN2 (cor = 0.843; P= 1.37E-146). Meanwhile, we found an AUC of 0.758 in our signature and we predicted the AUC values of the patients' 1, 2, 3-year survival rate as 0.768, 0.749, and 0.762 in TCGA cohort, respectively. Multivariate COX analysis was performed to determine if risk score was an independent prognostic predictor of OS. The results indicated that our risk score can be an independent predictor for OS (Univariate: HR = 1.350, 95% CI = 1.276-1.428, P< 0.001; Multivariate: HR = 1.295, 95% CI = 1.201-1.396, P< 0.001). We identified novel EMT-related lncRNAs markers for ccRCC prognosis. The underlying mechanism between EMT-related lncRNAs in ccRCC and tumor immunity is still unclear and requires further study.

GPX1, a biomarker for the diagnosis and prognosis of kidney cancer, promotes the progression of kidney cancer.

Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney, and its diagnosis and prognosis still lack reliable biomarkers. Glutathione peroxidase 1 (GPX1) has been identified to be highly expressed in a variety of human malignancies. However, few studies have studied the expression of GPX1 and its biological functions in RCC. We attempted to assess the potential of GPX1 as a promising biomarker for RCC diagnosis and prognosis. In this study, we analyzed and explored the public cancer databases (TCGA and ONCOMINE) to conclude that GPX1 is highly expressed in RCC. Meanwhile, we evaluated the expression of GPX1 at the levels of RCC cells and tissues to verify the results of the database. Moreover, high GPX1 levels were positively correlated with short overall survival time, distant metastasis, lymphatic metastasis, and tumor stage. Receiver operating characteristic curve (ROC) analysis showed that high GPX1 levels could distinguish RCC patients from normal subjects (p < 0.0001). Kaplan-Meier curve analysis revealed that high GPX1 levels predicted shorter overall survival time (p = 0.0009). Finally, the functional roles of GPX1 were examined using a GPX1 sh-RNA knockdown method in RCC cell lines. In summary, our results suggest that GPX1 may have the potential to serve as a diagnostic and prognostic biomarker for RCC patients. Moreover, targeting GPX1 may represent as a new therapeutic strategy and direction for RCC patients.

Anatomic Basis and Clinical Effect of Selective Dorsal Neurectomy for Patients with Lifelong Premature Ejaculation: A Randomized Controlled Trial.

INTRODUCTION: Although guidelines from the American Urological Association and European Association of Urology do not consider surgical treatment for premature ejaculation (PE), the use of selective dorsal neurectomy (SDN) has increased for many years in Asian countries. AIM: To evaluate anatomic basis and clinical effect of SDN in patients with PE in mainland China. METHODS: All of the patients included in the study had redundant foreskin, and they were assigned to 2 groups: group 1, composed of 46 patients with redundant foreskin, and group 2, composed of 96 patients with redundant foreskin and PE. The patients in group 2 were further randomly classified into group 2a (n = 48) and group 2b (n = 48). MAIN OUTCOME MEASURES: The number of dorsal penile nerve branches were compared among group 1, group 2a, and group 2b. Preoperative and postoperative intravaginal ejaculatory latency time (IELT), 5-item version of the International Index of Erectile Function, Premature Ejaculation Diagnostic Tool, and postoperative complications were compared between group 2a and group 2b. RESULTS: The patients in group 2 had a greater number of dorsal penile nerve branches of 1-2-mm-diameter, ≥2-mm-diameter, and total branches than group 1. The postoperative IELT of group 2a (257.7 ± 205.7 seconds) was longer than that of group 2b (49.3 ± 26.1 seconds). Group 2a had more ejaculation controllability and lower Premature Ejaculation Diagnostic Tool scores than group 2b after the surgery (P < .001). We did not observe permanent numbness in glans, wound infection, or hematoma in any patients. CLINICAL IMPLICATION: SDN is an effective treatment for lifelong PE patients who had poor response to medicine or refused oral medication. STRENGTH & LIMITATIONS: This study has some strengths. First, the study made a comprehensive comparison based on both the numbers of dorsal penile nerve branches and the effect. Second, a randomized controlled trial design was used for the evaluation of SDN. It also possesses a limitation-we did not determine how many dorsal nerves should be selectively resected for each person to achieve optimal IELT prolongation. CONCLUSION: The dorsal penile nerve branches of patients with lifelong PE are more and thicker than those without lifelong PE, and SDN is effective in improving lifelong PE by IELT prolongation and ejaculation controllability, with few postoperative complications. Liu Q, Li S, Zhang Y, et al. Anatomic Basis and Clinical Effect of Selective Dorsal Neurectomy for Patients with Lifelong Premature Ejaculation: A Randomized Controlled Trial. J Sex Med 2019;16:522-530.

Erectile Dysfunction and Depression: A Systematic Review and Meta-Analysis.

BACKGROUND: Some studies have reported that exposure to depression increases the risk of erectile dysfunction (ED), whereas others have observed no association. Moreover, additional studies have reported that exposure to ED increases the risk of depression. AIM: To identify and quantitatively synthesize all studies evaluating the association between ED and depression and to explore factors that may explain differences in the observed association. METHODS: We conducted a systematic review and meta-analysis. We searched Medline, Ovid Embase, and the Cochrane Library through October 2017 for studies that had evaluated the association between ED and depression. Studies were included in accordance with Patient Population or Problem, Intervention, Comparison, Outcomes, and Setting (PICOS) inclusion criteria. OUTCOMES: The odds ratio (OR) was regarded as the effect size, and the heterogeneity across studies was assessed using the I2 statistic. RESULTS: We identified 49 eligible publications. The pooled OR for studies evaluating depression exposure and risk of ED was 1.39 (95% CI: 1.35-1.42; n = 46 publications with 48 studies). Although we observed large heterogeneity (I2 = 93.6%), subgroup analysis indicated that it may have been as a result of variations in study design, comorbidities, ED assessment, depression assessment, the source of the original effect size, etc. No significant publication bias was observed (P = .315), and the overall effect size did not change by excluding any single study. The pooled OR for studies evaluating ED exposure and risk of depression was 2.92 (95% CI: 2.37-3.60; n = 5 publications with 6 studies). No significant heterogeneity (P < .257, I2 = 23.5%) or publication bias (P = .260) was observed. CLINICAL IMPLICATIONS: Patients reporting ED should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for ED. STRENGTHS AND LIMITATIONS: There are several strengths to this study. First, evaluations of the association between ED and depression are timely and relevant for clinicians, policymakers, and patients. Second, we intentionally conducted 2 meta-analyses on the association, allowing us to include all potentially relevant studies. However, our study also possesses some limitations. First, the OR is a measure of association that only reveals whether an association is present. Thus, this study was unable to determine the direction of causality between ED and depression. Second, the high heterogeneity among studies makes it difficult to generalize the conclusions. CONCLUSION: This study demonstrates an association between depression and ED. Policymakers, clinicians and patients should attend to the association between depression and ED. Liu Q, Zhang Y, Wang J, et al. Erectile dysfunction and depression: A systematic review and meta-analysis. J Sex Med 2018;15:1073-1082.

Association Between Left Renal Vein Entrapment and Varicocele Recurrence: A Cohort Study in 3042 Patients.

The recurrence rates after varicocelectomy vary from 0.9% to 32.2%, especially for patients with the left renal vein entrapment (LRVE). This study aims to study the association between LRVE and varicocele recurrence, and to find the risk factors of LRVE. With the design of a cohort study, we included 3042 varicocele patients who would undergo modified inguinal microscope-assisted varicocelectomy (MHMV). 858 (28.21%) patients with LRVE were as the study group, and 2184 (71.79%) patients without LRVE were as the control group. Compared with the control group, BMI was lower (p < 0.001) in study group. Totally, 18 patients had recurrence after surgery, so the recurrence rate was 0.59%. Seventeen patients (1.98%) in study group and 1 patients (0.05%) in control group had recurrence, and significant statistical difference was found between the two groups (p < 0.001). The risk ratio of LRVE for varicocele recurrence is 43.27. In conclusion, the recurrence rate of our MHMV is the lowest (0.59%). There is association between LRVE and varicocele recurrence, and varicocele patients with LRVE have higher probability of recurrence rate after varicocelectomy. BMI could be a risk factor of LRVE. Thus, for varicocele patients, especially those with lower BMI, attentions should be payed to LRVE.

Abnormal brain structure as a potential biomarker for venous erectile dysfunction: evidence from multimodal MRI and machine learning.

OBJECTIVES: To investigate the cerebral structural changes related to venous erectile dysfunction (VED) and the relationship of these changes to clinical symptoms and disorder duration and distinguish patients with VED from healthy controls using a machine learning classification. METHODS: 45 VED patients and 50 healthy controls were included. Voxel-based morphometry (VBM), tract-based spatial statistics (TBSS) and correlation analyses of VED patients and clinical variables were performed. The machine learning classification method was adopted to confirm its effectiveness in distinguishing VED patients from healthy controls. RESULTS: Compared to healthy control subjects, VED patients showed significantly decreased cortical volumes in the left postcentral gyrus and precentral gyrus, while only the right middle temporal gyrus showed a significant increase in cortical volume. Increased axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) values were observed in widespread brain regions. Certain regions of these alterations related to VED patients showed significant correlations with clinical symptoms and disorder durations. Machine learning analyses discriminated patients from controls with overall accuracy 96.7%, sensitivity 93.3% and specificity 99.0%. CONCLUSIONS: Cortical volume and white matter (WM) microstructural changes were observed in VED patients, and showed significant correlations with clinical symptoms and dysfunction durations. Various DTI-derived indices of some brain regions could be regarded as reliable discriminating features between VED patients and healthy control subjects, as shown by machine learning analyses. KEY POINTS: • Multimodal magnetic resonance imaging helps clinicians to assess patients with VED. • VED patients show cerebral structural alterations related to their clinical symptoms. • Machine learning analyses discriminated VED patients from controls with an excellent performance. • Machine learning classification provided a preliminary demonstration of DTI's clinical use.

Modified Inguinal Microscope-Assisted Varicocelectomy under Local Anesthesia: A Non-randomised Controlled Study of 3565 Cases.

Varicocele is a common abnormality, but the conventional microsurgical subinguinal varicocelectomy (CMSV) has some disadvantages. We invented Modified Inguinal Microscope-Assisted Varicocelectomy (MIMV) under local anesthesia. This study aims to evaluate MIMV by comparing it to CMSV in operating duration, time to return to normal activity, postoperative complications, achievement of natural pregnancy and improvement of semen quality for patients with infertility, pain score for those with scrotal pain, and so on. We enrolled 3089 patients who underwent MIMV and 476 who underwent CMSV in our hospital. Both the operating duration and the time to return to normal activity of MIMV was shorter than that of CMSV (P < 0.001). The recurrence rate (P < 0.001) and injury rate of vas deferens (P = 0.011) after MIMV were lower than that after CMSV. Moreover, patients with MIMV showed higher degree of satisfaction with the surgery experience and outcome than those with CMSV (P < 0.001). However, no statistical difference was found between the two groups in scores of pain due to surgery, postoperative varicose veins diameters, reflux duration, and the postoperative complications of wound infection, hydrocele, atrophy of testis, epididymitis, and scrotal hematoma. In summary, MIMV is a promising varicocelectomy and could be applied more in clinical practice.

Treatment for Vas Deferens Obstruction Following Childhood Herniorrhaphy.

OBJECTIVE: To enhance the management of inguinal obstruction, and to present the procedures and results of our surgical strategy for vas deferens obstruction following childhood herniorrhaphy. METHODS: We treated a total of 56 patients diagnosed with obstructive azoospermia following bilateral inguinal herniorrhaphy. First, conventional inguinal open surgery was performed. If the abdominal vas was not identified in the inguinal region, laparoscopy was used to retrieve the deeper abdominal vas deferens, which was obstructed above the internal inguinal ring. Then, microsurgical vasovasostomy (VV) was performed. Overall patency and natural pregnancy rates were determined. RESULTS: We terminated the surgery in 16 patients with pasty vasal fluid and no sperm. When bilateral remnants of the vas deferens were found, laparoscopic mobilization was not required, and 22 (55.0%) patients underwent bilateral VV with patency and natural pregnancy rates of 90.9% (20 of 22) and 50.0% (11 of 22), respectively. When a unilateral end could not be found, 7 (17.5%) patients underwent unilateral laparoscopy-assisted VV plus unilateral VV, with patency and natural pregnancy rates of 85.7% (6 of 7) and 42.9% (3 of 7), respectively. When bilateral ends were not found, 11 (27.5%) patients underwent bilateral laparoscopy-assisted VV, with patency and natural pregnancy rates of 81.8% (9 of 11) and 27.3% (3 of 11), respectively. Overall, our surgery yielded a patency rate of 87.5% (35 of 40) and a natural pregnancy rate of 42.5% (17 of 40). CONCLUSION: Our treatment for vas deferens obstruction following childhood herniorrhaphy yielded good postoperative outcomes in terms of sperm concentration and motility, vas patency, and natural pregnancy, with no complications.