Fermented Maillard reaction products attenuate stress-induced testicular dysfunction in mice.

Chronic stress can cause psychological diseases and affect male fertility and the reproductive system. Maillard reaction of milk proteins improves their functional and nutritional properties through modification of proteins. Previously, we determined that Maillard reaction product (MRP) from milk casein and MRP fermented (FMRP) with Lactobacillus rhamnosus 4B15 (4B15) had anti-anxiolytic effects in mice under chronic stress. Therefore, we aimed to investigate the effects of MRP and FMRP on chronic stress-induced testicular dysfunction in mice through quantitative real-time PCR (qRT-PCR) and in situ hybridization analysis. Mice were pretreated with MRP and FMRP for 10 wk; simultaneously, from the third week of the experimental period, they were exposed to unpredictable chronic mild stress (UCMS) for 7 wk. The expression levels of the luteinizing hormone subunit ß (Lhb) and follicle-stimulating hormone subunit ß (Fshb) were remarkably reduced after exposure to UCMS. However, treatment with MRP and FMRP inhibited the UCMS-induced reduction, with FMRP showing especially significant inhibition. Moreover, the expression of steroidogenesis-related genes [luteinizing hormone receptor (Lhr), follicle-stimulating hormone (Fshr), 3-ß hydroxysteroid dehydrogenase 2 (Hsd3b2), and steroidogenic acute regulatory protein (StAR)] were significantly reduced in response to UCMS. In contrast, the transcript levels of these genes were highest in the MRP-treated mice. Mice pretreated with FMRP also exhibited higher levels of gene expression compared with the nonstressed mice. Moreover, UCMS significantly downregulated the expression of genes associated with testicular function [i.e., a disintegrin and metallopeptidase domain 5 (Adam5), Adam29, bone morphogenetic protein 2 (Bmp2), tektin 3 (Tekt3), and sperm adhesion molecule 1 (Spam1)]. However, the administration of MRP and FMRP prevented the UCMS-induced reduction in the expressions of above genes. The localization of Lhr, Srd5a2, Adam29, and Spam1 was confirmed by in situ hybridization analysis and the results were consistent with those of qRT-PCR. Consequently, these results indicated that MRP and FMRP, manufactured by the heat treatment of milk casein and fermentation with probiotic 4B15, have the potential to prevent chronic stress-induced testicular dysfunction.

Potential gonadotoxicity of treatment in relation to quality of life and mental well-being of male survivors of childhood acute lymphoblastic leukemia.

PURPOSE: Results of earlier studies concerning quality of life (QOL) and psychosocial coping of childhood acute lymphoblastic leukemia (ALL) survivors have been inconsistent. Some treatments for ALL affect testicular function and we hypothesized that this may influence the QOL and psychosocial coping of male survivors. Our aims were to assess the QOL and psychosocial coping of male long-term ALL survivors and to evaluate the effect of both testosterone level and the potential gonadotoxicity of various treatment modalities on them. METHODS: Fifty-two male long-term survivors treated for childhood ALL at Helsinki University Hospital between 1970 and 1995, and 56 age- and gender-matched controls were studied. The participants completed a self-report questionnaire including questions on sociodemographics, RAND-36 to assess QOL, General Health Questionnaire and Beck Depression Inventory to assess mental well-being, and CAGE to assess alcohol abuse/dependence. Testosterone levels were measured, and treatment details were reviewed. RESULTS: ALL survivors in general had QOL close to that of controls or population norms. Decreased QOL was seen in physical health-related subscales, and vitality and emotional well-being were lowered in survivors with more gonadotoxic treatment modalities. No single independent factor in the treatment or the level of testosterone could, however, be found to clearly explain the variation in QOL scores of the survivors. Mental well-being of most of the survivors was good, but a subgroup with previous cyclophosphamide treatment or testicular irradiation showed increased risk of psychiatric morbidity. CONCLUSIONS: The male ALL survivors generally cope well, but increased focus on specific risk groups seems to be necessary. Further studies using patient interviews would probably point out issues concerning the QOL and psychosocial coping of ALL survivors, which may not emerge in these screening studies. IMPLICATIONS FOR CANCER SURVIVORS: In general, more attention should be paid for physical functioning of childhood ALL survivors. Increased focus should also be on QOL and mental well-being of survivors with more gonadotoxic treatment modalities and those whose diagnosis was made in their adolescence.

Chronic testicular pain in adult men: an integrative literature review.

Past investigations of chronic testicular pain provide a sparse representation of the men with this condition and lack key details to aid our understanding of this important men's health condition. As a chronic pain syndrome, more research is necessary to understand the phenomenon of chronic testicular pain and the pain experience of these men. This integrative literature review provides a summary of the current state of the science of chronic testicular pain in men, identifies the gaps in our knowledge, and provides recommendations to address this knowledge gap.

A one-stop clinic for men with testicular anxiety.

INTRODUCTION: Testicular lumps and orchalgia both cause considerable anxiety, usually related to concerns about possible cancer. PATIENTS AND METHODS: We established a rapid-access testicular clinic staffed by a urologist and a specialist ultrasonographer in order to delay the time to a definitive diagnosis. RESULTS: Over a 30-month period, 845 men underwent clinical examination and scrotal ultrasonography. Overall, 4% of men were found to have testicular cancer. The majority of men were found to have normal testes or minor abnormalities and could be re-assured. CONCLUSIONS: This one-stop clinic reduces the time to a definitive diagnosis which may reduce anxiety suffered by men with testicular complaints and allows rapid identification of those harbouring a testicular malignancy.

The use of a suprascrotal or 'wink' incision for placing a testicular prosthesis.

OBJECTIVE: To describe a suprascrotal technique of testicular prosthesis insertion that obviates the difficulties and complications associated with either the inguinal or scrotal approach, as although the insertion of a testicular prosthesis is common there are few reports of the various techniques of insertion, associated complication rates, and patient satisfaction. PATIENTS AND METHODS: Eight males (aged 14-26 years) who had had a previous orchidectomy, had a testicular prosthesis inserted using a suprascrotal incision. A 2-cm semilunar incision is made just above the scrotum, 2-3 cm lateral to the penis ('wink' incision). The prosthesis is inserted after developing the intrascrotal space with blunt dissection. All patients tolerated the procedure well and all were outpatient procedures. RESULTS: After a median follow-up of 12 months, all patients were satisfied with the aesthetics of the prosthesis. Incisions were hidden by pubic hair. There were no wound infections at the incision site, and no reports of any pain or discomfort associated with the prosthesis. CONCLUSION: The 'wink' incision is an attractive alternative for inserting a testicular prosthesis; the advantages of the suprascrotal approach include: (i) the incision is hidden by pubic hair; (ii) no difficult dissection through fibrotic tissue in patients who have had previous inguinal surgery; and (iii) avoidance of direct contact between the prosthesis and suture line, minimizing the risk of infection, erosion and postoperative pain, while maintaining a pouch of adequate size.

Outcome studies among men with micropenis.

Adult stretched penile length (SPL) was determined among 22 males who were diagnosed with micropenis. These adult SPL values were compared with SPL at the time of diagnosis, age of diagnosis and etiologic category in 20 men who were diagnosed before puberty. A portion of this group completed a structured questionnaire interview, the Social Adjustment Self Report Questionnaire and the Hopkins Symptom Checklist to assess social and psychosexual milestones and the presence of psychiatric morbidity. Results show that the majority of men who had been diagnosed with micropenis had an adult SPL within 2 standard deviations of the normal adult mean, with only a minority showing values below this. It appeared that men with micropenis might have greater than average interval SPL growth between diagnosis and adulthood; it remains unclear whether this supranormal growth represents a catch-up phenomenon or results from augmentation by intermittent androgen therapy. There was no clear relationship between SPL at diagnosis and SPL in adulthood. The responses to the questionnaires indicated that men who had been diagnosed with micropenis were comparable to control men in regard to gender issues, body image, social fitness, sexuality, work, family adjustment and the presence of psychopathology.

[Acceptance of silicone testicular prostheses in long-term follow-up]. / Akzeptanz von Silikonhodenprothesen im Langzeitverlauf.

The loss of a testicle is a psychological trauma, in particular for young men. The cosmetic defect can be corrected by implantation of a silicone testicular prosthesis (STP). The recurring discussion regarding the problems of silicone implants mainly concerns breast implants. STPs are made of equivalent material. Since we have been using STPs for 20 years, we wanted to research the opinion of our patients regarding these issues. Between 1978 and 1998, 51 STPs were implanted--37 times by groin incision and 14 times by scrotal incision--in 51 patients. The average age of the patients at the time of the operation was 23.3 years (14.3-55.4). Three implants had to be removed early. A questionnaire was distributed to all patients with STPs; 39 of the questionnaires were returned completed. The results--10.1 years postoperative--showed no serious late complications, an acceptance rate of 97% by the patients and about 50% by their female partners. Therefore, we will continue to offer the option for implantation of STP to our patients.

Local infiltration and spermatic cord block for inguinal, scrotal and testicular surgery.

This was a prospective study involving 372 male patients. Surgical procedures including simple inguinal hernia repair, inguinal lymph node biopsy, hydrocelectomy, testicular biopsy, testicular fixation, orchidectomy and scrotal exploration were performed under local anaesthesia using various quantities of 0.5% xylocaine with adrenaline depending on the procedure, in the form of spermatic cord block and local infiltration nerve blocks. No premedication was given to any patient and only five patients (1.34%) were given intraoperative sedation due to anxiety. No complication directly attributed to the anaesthetic agent used or the technique of spermatic cord and nerve blocks were reported during the study. Three hundred and sixty patients (96.77%) were operated on as outpatients and were happy and satisfied to return home on the same day. This experience confirms that spermatic cord block accompanied by local infiltration with 0.5% xylocaine with adrenaline is simple, safe and effective technique that should be used more widely in outpatient urological and general surgical settings in this locality. It provides excellent intra-scrotal and inguinal anaesthesia. Furthermore, the technique is cost effective, and personnel effective since no anaesthetist is required for the procedure which is usually carried out by the surgeon. This would enable many more people to afford the surgical procedures.

Our experience with testicular prosthesis implantation.

The authors survey the history of the testicular prosthesis implantations in Hungary. They summarize their experiences in the mirror of the results of their own cases. Authors establish that this operative procedure is very important for the young patients to the regeneration of the esthetic role of the testes, prevent the psychogenous complications, and set up again the so-called "man symbol function".

Testicular prostheses: the patient's perception.

There is a paucity of data to determine if the insertion of a testicular prosthesis is effective in overcoming the psychological effects of an absent testis. A review of 25 patients who had had testicular prostheses showed a high overall level of satisfaction in the 19 patients who were traced. This satisfaction was subject to some qualification.