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Is Li-ESWT effective in diabetic patients with severe erectile dysfunction?

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Asian Journal of Andrology 2022年第5期24卷 521-524页

作者： Müslüm Ergün Osman Akyüz department of urology School of MedicineAtlas UniversityIstanbul 34200Turkey

Noninvasive low-intensity extracorporeal shockwave treatment(Li-ESWT)has been widely used to treat erection disorders.There is no clear information regarding either the selection of patients for the treatment or the treatment protocol.In this study,we aimed to investigate the efficacy of extracorporeal shockwave therapy in diabetic patients with severe erectile dysfunction(International Index of Erectile Function-5[IIEF-5]scores of 5 to 7).Sixty-three diabetes mellitus patients with erectile dysfunction having IIEF-5 scores of 5 to 7 and not showing a recovery of potency despite phosphodiesterase type 5 inhibitor therapy for the past 6 months were included in the study.The patients were evaluated based on their IIEF-5 scores and Erection Hardness Scale scores.The IIEF-5 score(mean±standard deviation[s.d.])increased from 5.29±1.67 to 5.56±1.85,with a difference of 0.27±0.18(P>0.05).The Erection Hardness Scale scores(mean±s.d.),on the other hand,increased from 1.46±0.50 to 1.48±0.50,with a difference of 0.02±0(P>0.05).In conclusion,the response to phosphodiesterase type 5 inhibitors did not change after extracorporeal shockwave treatment in diabetes mellitus patients with severe erectile dysfunction(IIEF-5 scores of 5 to 7).

关键词： diabetes mellitus International Index of Erectile Function-5 score low-intensity extracorporeal shockwave treatment severe erectile dysfunction

Color Doppler ultrasound imaging in varicoceles: Is the difference in venous diameter encountered during Valsalva predictive of palpable varicocele grade?

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Asian Journal of urology 2023年第1期10卷 27-32页

作者： Kelly Lehner Catherine Ingram Utsav Bansal Colleen Baca Adithya Balasubramanian Nannan Thirumavalavan Jason M.Scovell Saneal Rajanahally Matthew Pollard Larry I.Lipshultz Baylor College of Medicine Scott Department of UrologyHoustonTXUSA

Objective:The clinical grading system for varicoceles is subjective and dependent on clinician experience.Color Doppler ultrasound(US)has not been standardized in the diagnosis of varicoceles.We aimed to determine if US measurement of varicocele could be predictive of World Health Organization(WHO)varicocele grade.Methods:Men who presented for either scrotal pain or infertility to a tertiary men’s health clinic underwent physical examination,and varicoceles were graded following WHO criteria(0Zsubclinical,1,2,3).US was used to measure largest venous diameter in the pampiniform plexus bilaterally at rest and during Valsalva maneuver.Receiver operator characteristic curve analysis was used to determine if resting diameter,diameter during Valsalva,or change in diameter between at rest and during Valsalva provided the highest sensitivity and specificity for determining clinical grade.Threshold values for diameter were determined from these receiver operator characteristic curves.Results:A total of 102 men(50 with clinical varicocele and 52 with subclinical varicocele)were included.Diameter at rest was the best ultrasonographic discriminator between subclinical and clinical varicoceles(area under the curve[AUC]Z0.67)with a diameter threshold of 3.0 mm(sensitivity 79%,specificity 42%).Diameter during Valsalva had the greatest AUC for determining clinical Grades 1 versus 2(AUCZ0.57)with diameter threshold of 5.7 mm(sensitivity 71%,specificity 33%).For differentiating between Grades 2 and 3,diameter at rest had the greatest AUC of 0.65 with a threshold of 3.6 mm(sensitivity 71%,specificity 58%).Conclusion:Our results corroborate other studies that have shown a weak correlation between US and clinical grading.The use of diameter during Valsalva was less predictive than diameter at rest and was only clinically significant in differentiating between Grade 1 and 2 varicocele.A standardized method for determining clinically relevant varicoceles on US would allow for improved patient counseling and clinical decision-making.

关键词： Varicocele Ultrasound Doppler Venous plexus Infertility

Intraductal carcinoma of the prostate in prostate biopsy samples: correlation with aggressive pathological features after radical prostatectomy and prognostic value in high-risk prostate cancer

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Asian Journal of Andrology 2020年第5期22卷 519-525页

作者： Sha Zhu Jin-Ge Zhao Jun-Ru Chen Zhen-Hua Liu Guang-Xi Sun Zhi-Peng Wang Yu-Chao Ni Jin-Dong Dai Peng-Fei Shen Hao Zeng department of urology Institute of UrologyWest China HospitalSichuan UniversityChengdu 610041China.

Intraductal carcinoma of the prostate(IDC-P)is an aggressive pathological pattern of prostate cancer(PCa).We investigated the association of IDC-P in prostate biopsy(PBx)with several pathological features after radical prostatectomy(RP)and its prognostic value in high-risk PCa.A total of 418 patients with high-risk PCa after RP were included in this study.IDC-P and its architectural patterns were identified according to the 2016 World Health Organization Classification.Chi-squared test and logistic regression were used to investigate the correlation between IDC-P and post-RP pathological features.Kaplan-Meier curves and Cox regression were applied to explore the prognostic value of IDC-P.IDC-P was identified in PBx in 36/418(8.6%)patients.Logistic regression indicated that IDC-P in PBx was independently associated with several pathological features of RP,including Gleason score 8-10(P<0.001),seminal vesicular invasion(P<0.001),and pathological T(pT)3a(P=0.043).Patients with IDC-P in PBx manifested poorer biochemical-free survival(BFS)than those without IDC-P(37.47 months vs not reached,P<0.001).The addition of IDC-P in several prognostic nomograms could improve the predictive accuracy of these tools.We conclude that IDC-P in PBx is positively associated with several aggressive pathological features after RP in high-risk PCa.In addition,IDC-P in PBx could effectively predict the BFS of high-risk PCa patients after RP.

关键词： biopsy high risk intraductal carcinoma of the prostate prognosis prostate cancer

Peak stent discomfort occurs early and ureteral stent with distal loop design has less paineA pilot prospective randomised singleblinded trial over 2 weeks

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Asian Journal of urology 2020年第4期7卷 357-362页

作者： Kheng Sit Lim Zhi Wei Law Marcus Way Lunn Chow Allen Soon Phang Sim Henry Sun Sien Ho department of urology Singapore General HospitalSingapore department of urology Tan Tock Seng HospitalSingapore

Objectives:The Polarisloop ureteric stent reduces the severity of stent discomfort by minimising stent material in the bladder.Early impact of ureteral stenting on quality of life(QoL)within 1 week remains unclear.The usefulness of the patient-administered ureteral stent symptoms questionnaire(USSQ)during this period of stent insertion was assessed.In this pilot single-blinded prospective randomised study,we investigate 1)the presence of early(within the 1st week)stent discomfort via the visual analog scale(VAS);2)determine the QoL of the loop stent against conventional stent.Methods:Forty adults requiring retrograde unilateral ureteral stent placements were enrolled.Patients with single ureteric stone or benign stricture were selected.Patients were randomised in 1:1 ratio to the loop and pigtail arm.The USSQ was administered before placement(baseline),USSQ and VAS were administered on Day 3,7,and 14.Results:There were no significant differences between the USSQ scores.Median pain scores on Day 3 were lower in the loop stent group(2.9 vs.4.0,pZ0.047).There was a significant reduction in pain from Day 3e7(0 vs.1,pZ0.016)in the pigtail group.Conclusions:Our results suggest that peak stent discomfort occurs but resolves quickly within 1 week of post-stent insertion.The loop stent offers a better pain profile compared with conventional stents at Day 3 but no difference in QoL.The loop stent reduces early pain experience post-stent insertion and may have a role in the care of patients who experience significant stent discomfort previously.

关键词： Quality of life Stent discomfort Ureteral stent symptoms questionnaire Ureteric stents

Validation of laparoscopy and flexible ureteroscopy tasks in inanimate simulation training models at a large-scale conference setting

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Asian Journal of urology 2021年第2期8卷 215-219页

作者： Jirong Lu Karthik Thandapani Tricia Kuo Ho Yee Tiong department of urology National University HospitalSingapore department of urology Singapore General HospitalSingapore urology Service Sengkang HealthSingapore

Objective:Simulation based training with training models is being increasingly used as a tool to help trainees mount the learning curve.However,validation studies of surgical simulators are often limited by small numbers.We aim to evaluate the feasibility of validating simulation-training tasks in laparoscopy and flexible ureteroscopy(FURS)rapidly at a large-scale conference setting for residents.Methods:Seventy-six urology residents from various Asian countries were assessed on their laparoscopic and FURS skills during the 14th Urological Association of Asia Congress 2016.Residents performed the peg transfer task from the fundamentals of laparoscopic surgery(FLS)and completed inspection of calyces and stone retrieval using a flexible ureteroscope in an en-dourological model.Each participant’s experience(no experience,1-30 or>30 procedures)in laparoscopy,rigid ureteroscopy(RURS)and FURS was self-reported.Results:Median time taken to complete the laparoscopic task decreased with increasing laparoscopic experience(209 s vs.177 s vs.145 s,p=0.008)whereas median time taken to complete the FURS tasks reduced with increasing FURS experience(405 s vs.250 s vs.163 s,p=0.003)but not with RURS experience(400.5 s vs.397 s vs.331 s,p=0.143),demonstrating construct validity.Positive educational impact of both tasks was high,with mean ratings of 4.16/5 and 4.10/5 respectively,demonstrating face validity.Conclusion:Our study demonstrates construct and face validities of laparoscopy and FURS simulation tasks among residents at a conference setting.Validation studies at a conference setting can be an effective avenue for evaluating simulation models and curriculum in the future.

关键词： Education Laparoscopy Simulation Ureteroscopy Endourology

Effects of mild/asymptomatic COVID-19 on semen parameters and sex-related hormone levels in men:a systematic review and meta-analysis

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Asian Journal of Andrology 2023年第3期25卷 382-388页

作者： Bang-Wei Che Pan Chen Ying Yu Wei Li Tao Huang Wen-Jun Zhang Sheng-Han Xu Jun He Miao Liu Kai-Fa Tang department of urology The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550004China

Coronavirus disease 2019(COVID-19)has yet to be proven to alter male reproductive function,particularly in the majority of mild/asymptomatic patients.The purpose of this study was to explore whether mild/asymptomatic COVID-19 affects semen quality and sex-related hormone levels.To find suitable comparative studies,a systematic review and meta-analysis was done up to January 22,2022,by using multiple databases(Web of Science,PubMed,and Embase).Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines were used to identify and choose the studies.Meta-analysis was used to examine the semen parameters and sex-related hormones of mild/asymptomatic COVID-19 patients before and after infection.The effects of semen collection time,fever,and intensity of verification on semen following infection were also investigated.A total of 13 studies(n=770)were included in the analysis,including three case-control studies,six pre-post studies,and four single-arm studies.A meta-analysis of five pre-post studies showed that after infection with COVID-19,sperm concentration(I^(2)=0;P=0.003),total sperm count(I^(2)=46.3%;P=0.043),progressive motility(I^(2)=50.0%;P<0.001),total sperm motility(I^(2)=76.1%;P=0.047),and normal sperm morphology(I^(2)=0;P=0.001)decreased.Simultaneously,a systematic review of 13 studies found a significant relationship between semen collection time after infection,inflammation severity,and semen parameter values,with fever having only bearing on semen concentration.Furthermore,there was no significant difference in sex-related hormone levels before and after infection in mild/asymptomatic patients.Mild/asymptomatic COVID-19 infection had a significant effect on semen quality in the short term.It is recommended to avoid initiating a pregnancy during this period of time.

关键词： coronavirus disease 2019 male infertility meta-analysis semen quality severe acute respiratory syndrome coronavirus 2

The comparison of survival between active surveillance or watchful waiting and focal laser ablation in patients with low-risk prostate cancer

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Asian Journal of Andrology 2022年第5期24卷 494-499页

作者： Jia-Kun Li Chi-Chen Zhang Shi Qiu Kun Jin Bo-Yu Cai Qi-Ming Yuan Xing-Yu Xiong Lian-Sha Tang Di Jin Xiang-Hong Zhou Yi-Ge Bao Lu Yang Qiang Wei department of urology Institute of UrologyWest China Hospital of Sichuan UniversityChengdu 610041China department of Biotherapy Cancer CenterWest China Hospital of Sichuan UniversityChengdu 610041China

Prostate cancer(PCa)is the second-most common cancer among men.Both active surveillance or watchful waiting(AS/WW)and focal laser ablation(FLA)can avoid the complications caused by radical treatment.How to make the choice between these options in clinical practice needs further study.Therefore,this study aims to compare and analyze their effects based on overall survival(OS)and cancer-specific survival(CSS)to obtain better long-term benefits.We included patients with low-risk PCa from the Surveillance Epidemiology and End Results database of 2010–2016.Multivariate Cox proportional hazard analyses were conducted for OS and CSS in the two groups.To eliminate bias,this study applied a series of sensitivity analyses.Moreover,Kaplan–Meier curves were plotted to obtain survival status.A total of 18841 patients with low-risk PCa were included,with a median of 36-month follow-up.According to the multivariate Cox proportional hazard regression,the FLA group presented inferior survival benefits in OS than the AS/WW group(hazard ratio[HR]:2.13,95%confidence interval[CI]:1.37–3.33,P<0.05).After adjusting for confounders,the result persisted(HR:1.69,95%CI:1.02–2.81,P<0.05).According to the results of the sensitivity analysis,the inverse probability of the treatment weighing model indicated the same result in OS.In conclusion,AS/WW and FLA have the advantage of fewer side effects and the benefit of avoiding overtreatment compared with standard treatment.Our study suggested that AS/WW provides more survival benefits for patients with low-risk PCa.More relevant researches and data will be needed for further clarity.

关键词： active surveillance cancer-specific survival focal laser ablation low-risk prostate cancer overall survival watchful waiting

Prostate Health Index(phi)and its derivatives predict Gleason score upgrading after radical prostatectomy among patients with low-risk prostate cancer

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Asian Journal of Andrology 2022年第4期24卷 406-410页

作者： Jia-Qi Yan Da Huang Jing-Yi Huang Xiao-Hao Ruan Xiao-Ling Lin Zu-Jun Fang Yi Gao Hao-Wen Jiang Yi-Shuo Wu Rong Na Dan-Feng Xu department of urology Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China department of urology Huashan HospitalFudan UniversityShanghai 200040China.

To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational,prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020.Pathological reclassification was determined by the Gleason Grade Group(GG).The area under the receiver operating characteristic curve(AUC)and logistic regression(LR)models were used to evaluate the predictive performance of predictors.In clinically low-risk patients with biopsy GG≤2,phi(odds ratio[OR]=1.80,95%confidence interval[95%CI]:1.14-2.82,P=0.01)and its derivative phi density(PHID;OR=2.34,95%CI:1.30-4.20,P=0.005)were significantly associated with upgrading to GG≥3 after RP,and the results were confirmed by multivariable analysis.Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG≥2.Compared to the base model(AUC=0.59),addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients(AUC=0.69 and 0.71,respectively,both P<0.05).In conclusion,phi and PHID could predict GS upgrading after RP in clinically low-risk patients.

关键词： Gleason score Prostate Health Index prostate biopsy prostate cancer radical prostatectomy upgrading

Compliance in patients with dietary hyperoxaluria: A cohort study and systematic review

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Asian Journal of urology 2019年第2期6卷 200-207页

作者： Derek B.Hennessey Ned Kinnear Gilbert Rice David Curry Siobhan Woolsey Brian Duggan department of urology Belfast City HospitalBelfastUnited Kingdom department of urology Austin HospitalMelbourneAustralia department of urology Ulster HospitalBelfastUnited Kingdom

Objective:Hyperoxaluria leads to calcium oxalate crystal formation and subsequent urolithiasis.This study aims to analyse the effect of treatment compliance in hyperoxaluria,firstly by analysis of patients with non-primary hyperoxaluria and secondly via systematic review in patients with any hyperoxaluria.Methods:In a retrospective cohort study,adults with non-primary hyperoxaluria managed with dietary counselling in 2013 were enrolled.Twenty-four-hour(24 h)urine collections initially and at 6 months were obtained.Compliance was assessed by self-reported dietary compliance and 24 h urinary volume>2 L.Patients were followed for 24 months.Primary outcomes were urinary oxalate and calcium 24 h load at 6 months,and urolithiasis-related procedural rates at 24 months.A Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)-compatible systematic review of compliance among hyperoxaluric patients was performed.Results:In the cohort study,of 19 eligible patients(4 female)with median age 52 years,10(53%)were considered compliant.Compared with the non-compliant group,these patients had significantly increased subsequent 24 h urinary volume(2250 mL vs.1600 mL;p=0.008)and lower procedural rates(10%vs.56%;p=0.033).Subsequent 24 h urinary oxalate load was nonsignificantly lower in compliant patients.Systematic review regarding compliance in hyperoxaluric patients revealed five studies.Only one utilised dietary counselling or analysed compliant vs.non-compliant patients,finding no difference.None examined the effect of compliance on procedural rates.

关键词： Hyperoxaluria Urolithiasis Recurrent stone former Metabolic stone disease