Background: Testosterone is crucial in male genital development during puberty. This study primarily aimed to compare genital size in Caucasian men with and without clinically significant prostate cancer (csPCa). The secondary aim was to assess genital size differences in csPCa patients stratified by tumor grade. Methods: We conducted an observational cross-sectional study on consecutive patients undergoing prostate biopsy Each patient underwent systematic and cognitive-targeted transrectal biopsy. csPCa was defined as PCa with Gleason Score (GS) >= 7, tumor volume >= 0.5 cc, or extra-prostatic extension; other PCa and negative biopsies were classified as non-csPCa. Penile length was measured with the stretched test, and testicular volume by ultrasonography. Results: A total of 156 patients (64 csPCa and 92 non-csPCa) were enrolled. Median age was comparable between groups (68.9 vs. 66.6 years; p = 0.289). Median (interquartile range (IQR)) stretched penile length (SPL) was 15.0 (14.0-16.3) cm in the csPCa group and 15.0 (13.0-15.2) cm in the non-csPCa group (p = 0.301). Median (IQR) right testicular volume was 12 (10-14) cc in both groups (p = 0.752), while left testicular volume was 10 (7-13) cc in the csPCa group and 12 (10-14) cc in the non-csPCa group (p = 0.172). Among csPCa patients, those with GS >7 had a longer SPL (16.0 (15-17) cm) compared to GS = 7 patients (14.5 (14-15) cm) (p = 0.012), with no significant differences in testicular volume. Conclusions: In Caucasian men, genital dimensions did not differ between those with and without csPCa. Within the csPCa group, longer SPL was observed in patients with higher-grade tumors. These findings suggest a possible association between genital size and tumor aggressiveness, which warrants further investigation.
Male hypogonadism, also referred to as testosterone deficiency (TD) in several clinical guidelines, is a common but frequently underdiagnosed condition that affects multiple domains of male health. This narrative review summarizes current evidence on the diagnosis and management of male hypogonadism, with emphasis on testosterone replacement therapy (TRT). Advances in the understanding of testosterone physiology, particularly the saturation model, have reshaped clinical perspectives. We review the effects of TRT on sexual function, metabolic health, bone density, mood, and physical function. Its relationship with cardiovascular risk, prostate safety, and lower urinary tract symptoms is also examined, highlighting the reassuring findings of the landmark TRAVERSE trial (Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy trial). Evidence also supports cautious use in men with comorbidities such as obstructive sleep apnea and previously treated prostate cancer. A guideline-based, individualized approach, prioritizing symptomatic men with confirmed biochemical deficiency, remains essential to optimize outcomes while minimizing risks.
Background: This study aimed to evaluate the effects of dynamic video education compared to static images and verbal information on pain perception and anxiety in patients undergoing transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Methods: A prospective comparative study was conducted including patients scheduled for TRUS-Bx. Participants were assigned to three groups: control (verbal information), video (verbal plus dynamic video), and image (verbal plus static images). Pain intensity was measured using the Visual Analog Scale (VAS), and anxiety was assessed with the State-Trait Anxiety Inventory (STAI) before and after the procedure. Statistical analyses were performed using SPSS software. Depending on data distribution, group comparisons were conducted using either the Kruskal-Wallis test or Analysis of Variance (ANOVA). An a priori power analysis was performed using G*power to determine the appropriate sample size. A p-value of < 0.05 was considered statistically significant. Results: A total of 223 male patients undergoing TRUS-Bx were included in the study, with 73 (32.7%) in the Control Group, 83 (37.2%) in the Video Group, and 67 (30.1%) in the Image Group. Post-procedural pain levels increased significantly in all groups. The video group reported significantly lower pain scores compared to the image group (p = 0.004), indicating the effectiveness of dynamic video education in reducing pain perception. Significant differences were observed in post-procedural state anxiety (STAI-1), with a p-value of 0.041 between groups and anxiety increased after the procedure overall. Conclusions: Dynamic video education significantly reduces pain perception during TRUS-Bx but does not have a significant impact on acute procedural anxiety.
Background: Histone lactylation is a recently identified epigenetic modification arising from lactate metabolism. This study aimed to determine whether lactate-induced histone lactylation contributes to the regulation of apoptosis in mouse Germ Cell-1 (GC-1) cells under hypoxic stress. Methods: A hypoxia-induced cell model was established to examine lactate accumulation, histone lactylation, and apoptosis in GC-1 cells. The experimental groups included the normoxia control (Con group), hypoxia (Hy group), hypoxia + sodium oxamate (Hy + Oxa group), and L-lactate treatment (Nala group). Lactate levels, histone lactylation, apoptosis-related gene and protein expression, and apoptosis rates were assessed by lactate assays, Western blot, immunofluorescence, quantitative real-time polymerase chain reaction (qRT-PCR), and Annexin V/propidium iodide (PI) flow cytometry. Results: After 36 h of hypoxia, cell viability decreased to (58.55% +/- 6.20%) (p < 0.001). Hypoxia exposure caused increase in intracellular lactate concentration and induced histone lactylation (p < 0.01). Compared with the Con group, cells in the Hy group exhibited increased expression of pro-apoptotic markers Bax and caspase-3, reduced Bcl-2 expression, and higher apoptosis levels (p < 0.05). The Hy + Oxa group showed reduced histone lactylation and decreased apoptosis compared with the Hy group (p < 0.05). The Nala group exhibited patterns similar to the Hy group, including increased histone lactylation and enhanced apoptosis (p < 0.05), confirming that lactate regulates apoptosis through histone lactylation. Furthermore, both hypoxia and exogenous lactate significantly reduced the ratios of phosphorylated phosphatidylinositol 3-kinase (p-PI3K)/PI3K and phosphorylated protein kinase B (p-AKT)/AKT, whereas oxamate partially restored their activity (p < 0.05). Conclusions: Hypoxia-induced lactate accumulation promotes apoptosis of GC-1 cells by enhancing histone lactylation, particularly at the H3K18 site, partly through suppression of the PI3K/AKT signaling pathway. These findings provide new mechanistic insights into hypoxia-associated male infertility and suggest that histone lactylation may represent a potential therapeutic target.
Background: Carvacrol, a bioactive compound derived from the herb Origanum vulgare, is recognized for its ability to reduce inflammation, oxidative stress, and prevent apoptosis. Lipopolysaccharide (LPS) is a potent trigger that initiates an inflammatory process, oxidative stress, and damage to germ cells within the testes. The purpose of this research was to explore the protective ability of carvacrol against LPS-induced testicular damage in rats. Methods: The study was conducted over a two-week period, during which 32 adult Wistar rats were randomly assigned to four groups: Control (saline), LPS (1 mg/kg/day), and C25 and C50 (receiving carvacrol (25 and 50 mg/kg/day) 30 min before LPS administration). Histopathology, sperm parameters and the expression of apoptosis-related genes were assessed. The results were analyzed with Statistical Package for Social Science (SPSS). Results: Findings revealed that LPS significantly decreased sperm (p <0.001) and the normal sperm proportion (p = 0.02) relative to the Control. Carvacrol treatment notably increased sperm count (p <0.001) and improved sperm morphology in both C25 (p = 0.006) and C50 (p < 0.001). Furthermore, Johnson's score (p = 0.008 and p < 0.001), epithelial thickness (p = 0.002 and p < 0.001), and seminiferous tubule diameter (both p < 0.001) were significantly improved in C25 and C50 compared with LPS. Moreover, in C25 and C50, compared with LPS, carvacrol significantly reduced the gene expression of Bax (p = 0.01 and p = 0.02; in that order) and caspase-3 (both, p < 0.001). Conclusions: The findings indicate that carvacrol can effectively mitigate LPS-induced testicular dysfunction, potentially through its antiapoptotic properties. These results highlight the therapeutic capacity of carvacrol in ameliorating testicular injury caused by various pathological conditions. However, additional studies are needed to verify its efficacy and safety in other models and to elucidate molecular pathways involved before carvacrol can be considered a therapeutic agent in clinical settings.
Background: Varicocele is a vascular disorder defined by anomalous dilatation of the pampiniform plexus and the presence of tortuous veins. Despite numerous hypotheses advanced to clarify its pathophysiology, the foundational processes involved remain incompletely understood. Epicardial adipose tissue, located between the myocardium and visceral epicardium, functions as a metabolically active endocrine organ and has been linked to systemic inflammation, endothelial dysfunction, oxidative stress, and atherosclerosis. We aimed to investigate the relationship between echocardiographically measured epicardial fat thickness (EFT) and the presence and severity of varicocele. Methods: In this cross-sectional study, 50 patients with high-grade varicocele, 50 patients with low-grade varicocele, and 100 group-matched healthy controls based on age and body mass index were enrolled. All participants underwent comprehensive urological evaluation, followed by referral to the cardiology department for cardiac assessment and echocardiographic measurement of EFT. Results: EFT was significantly higher in the varicocele group in comparison to controls (p = 0.048), whereas other study variables did not exhibit significant difference across the groups (p >= 0.05). In the three-group comparison (controls, low-grade varicocele, and high-grade varicocele), EFT differed significantly only between controls and the high-grade varicocele group (p = 0.037). Multivariable logistic regression analysis identified EFT as an independent predictor of high-grade varicocele (odds ratio: 1.853; 95% confidence interval: 1.155-2.973; p = 0.011). Conclusions: These results suggest that EFT may be associated with progression rather than initiation of varicocele. A multidisciplinary approach integrating cardiovascular and urological perspectives may be beneficial for identifying factors that contribute to varicocele progression.
Background: We aimed to evaluate the accuracy, completeness, and reproducibility of ChatGPT versions 3.5, 4.0, and 5.0 in responding to patient-oriented and guideline-based questions on Optilume (R) therapy. Methods: Twenty structured questions were developed from patient Frequently Asked Questions (FAQs) social media forums, and procedural guidelines, covering five thematic domains: Device Mechanism and Indications, Procedural Technique, Outcomes and Efficacy, Complications, and Postoperative Management. Each question was posed to ChatGPT versions 3.5 (free), 4.0 (subscription), and 5.0 (latest subscription). Two independent urologists graded responses using a four-point scale (completely correct, correct but incomplete, partially misleading, completely incorrect). Question difficulty and source type (FAQ vs. guideline-based) were also analyzed. Reproducibility was assessed using Cohen's kappa. Results: Overall, ChatGPT performance improved progressively with each version. Combined success rates (completely correct + correct but incomplete) were 75% for 3.5, 85% for 4.0, and 90% for 5.0. Device Mechanism and Procedural Technique domains achieved the highest accuracy across all versions, while Outcomes, Complications, and Postoperative Management improved notably in versions 4.0 and 5.0. FAQs were answered more accurately than guideline-based questions, with version 5.0 reaching 90% vs. 60%, respectively. Response accuracy increased with repeated versions, even for medium-and high-difficulty questions. Reproducibility was excellent, with Cohen's kappa ranging from 0.82 to 0.91. Conclusions: ChatGPT, particularly versions 4.0 and 5.0, provides accurate, reproducible, and clinically relevant information on Optilume therapy.
Background: Limited data exist regarding the sperm retrieval rate through testicular sperm extraction (TESE) in hypogonadotropic hypogonadal azoospermic men, as well as the fertilization and pregnancy outcomes associated with intracytoplasmic sperm injection (ICSI) using sperm retrieved. The objective of this study was to evaluate sperm retrieval rates through microscopic TESE and to analyze the outcomes of ICSI in hypogonadotropic hypogonadal men who remained azoospermic following gonadotropin therapy. Methods: We conducted a retrospective evaluation of microscopic TESE and ICSI outcomes in hypogonadotropic hypogonadal patients who remained azoospermic after gonadotropin therapy between 2004 and 2024. Results: Sperm was successfully retrieved from 14 out of 17 patients (82.4%) after gonadotropin treatment. However, no statistically significant differences were found between patients with successful sperm retrieval and those without. ICSI outcomes were performed using frozen-thawed sperm in 12 of the 14 patients, while 2 patients did not proceed with ICSI outcomes. The mean age of the partners was 27 +/- 7.1 years. A total of 25 high-quality embryos were transferred across 18 transfer cycles, yielding an implantation rate of 28%. Six cycles resulted in clinical pregnancy, and four of these pregnancies resulted in live births. Conclusions: Gonadotropin therapy can successfully reverse azoospermia in most hypogonadotrophic hypogonadal male patients. For those who remain azoospermic after gonadotropin treatment, testicular sperm can still be retrieved through microscopic TESE, offering a viable option for assisted reproductive technology and the potential for achieving live births.
Background: To investigate whether intramuscular vitamin B12 treatment has an effect on ejaculaory functions in male patients with vitamin B12 deficiency. Methods: Male patients diagnosed with vitamin B12 deficiency in the internal medicine outpatient clinic of our hospital between October 2024 and March 2025 and started to receive intramuscular vitamin B12 treatment were included in study. The scores obtained from the self-estimated intravaginal ejaculation latency time (IELT), premature ejaculation diagnostic tool (PEDT), and premature ejaculation profile (PEP) questionnaires, reflecting the ejaculatory status of these patients before treatment, were recorded. After 3 months of treatment, these scores were re-recorded via phone calls, and scores recorded before and after treatment were compared. Results: The study included 54 patients. The mean age of the patients was 43.46 +/- 13.3 years, the mean pretreatment IELT was 2.4 +/- 1.4 min, and the mean pre-treatment PEDT score was 11.5 +/- 4.6. In both the whole patient group and the premature ejaculation (PE) group, a statistically significant difference was observed in the items of perceived control over ejaculation, satisfaction with sexual intercourse, and interpersonal difficulty related to ejaculation from the PEP questionnaire forms completed after treatment, with no significant change found in the item of personal distress related to ejaculation. In terms of IELT and PEDT, no differences were observed in the whole patient group after treatment, whereas a statistically significant improvement was observed in the PE group. Conclusions: Intramuscular vitamin B12 may delay ejaculation times and improve sexual satisfaction levels in male patients based on the responses given by the patients to the questions in the survey forms. Clinical Trial Registration: The study was retrospectively registered with ClinicalTrials.gov as: NCT07036497.
Background: Premature ejaculation (PE) is a common and distressing condition with a multifactorial etiology and limited tolerable long-term treatment options. Current literature suggests that neuromodulatory approaches that simultaneously target peripheral reflex pathways and central regulatory mechanisms may provide additive therapeutic benefits. Methods: In this single-center, block-randomized clinical study, 120 men with PE were assigned to an observation group (n = 60) or a control group (n = 60). The observation group received pudendal nerve electroacupuncture (PNEA) combined with repetitive transcranial acupuncture stimulation (rTAS) twice weekly for 8 weeks, whereas the control group received PNEA alone on the same schedule. Fifty-three participants in the observation group and 55 in the control group completed follow-up. Outcomes, including intravaginal ejaculation latency time (IELT), Premature Ejaculation Diagnostic Tool (PEDT), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) scores, were assessed at baseline and at week 8. Results: At week 8, the observation group exhibited a longer IELT and greater reductions in PEDT, SAS, and SDS scores than the control group (all p < 0.05). Overall response rates were 94.34% in the observation group and 83.64% in the control group (p = 0.12). No serious adverse events were observed, and reported adverse events were mild and transient. Conclusions: Compared with PNEA alone, combined PNEA+ rTAS provided greater improvements in ejaculatory latency and overall symptom burden over 8 weeks while maintaining good tolerability. These findings support integrated peripheral-central neuromodulation as a promising therapeutic option for PE and indicate that further confirmation in randomized, sham-controlled trials with longer follow-up is warranted. Clinical Trial Registration: The study was retrospectively registered with the International Traditional Medicine Clinical Trial Registry (ITMCTR) as: ITMCTR2025002555.
Background: Male infertility results from a complex interplay of hormonal, testicular, and clinical factors. Identifying reliable non-invasive markers of spermatogenic function remains clinically relevant. This study evaluated the independent associations of follicle-stimulating hormone (FSH), testicular volume, and luteinizing hormone (LH) with sperm concentration and developed a parsimonious predictive model for predicting oligozoospermia. Methods: We retrospectively analyzed 521 men with infertility between 2020 and 2024. Clinical variables, testicular volume, and reproductive hormones were assessed, including FSH, LH, and total testosterone (TT). Multivariable linear regression estimated predictors of log-transformed sperm concentration. For oligozoospermia (<15 & times; 10(6)/mL), a baseline clinical model (with age, body mass index (BMI), smoking, and varicocele) was compared with a parsimonious enhanced model (baseline model + FSH + testicular volume + LH). Model performance was evaluated using the area under the curve (AUC), triangle AUC, calibration, and bootstrap internal validation. Results: FSH (beta = -0.0265; p < 0.001) and testicular volume (beta = 0.0474; p = 0.0006) were independent predictors of sperm concentration, while LH showed a weaker effect (beta = -0.012; p = 0.04). The baseline clinical model showed limited discrimination (AUC = 0.65), whereas the enhanced model achieved superior performance (AUC = 0.75; triangle AUC = +0.10) with good calibration (slope approximate to 1.02) and an optimism-corrected AUC of 0.73. Sensitivity analysis in men with normal sperm counts (>= 20 & times; 10(6)/mL; n = 92) showed results consistent with the main findings. Conclusions: A simple combination of FSH, testicular volume, and LH provides internally validated, moderately discriminative prediction of oligozoospermia beyond standard clinical parameters. These non-invasive biomarkers may help early risk stratification in male infertility, although external validation remains warranted.
Background: Male infertility is a complex, multifactorial condition contributing to approximately 50% of infertility cases. Among these, asthenozoospermia (reduced sperm motility) accounts for around 13% of male infertility cases. This study aims to investigate the mitochondrial ND3 gene variants in asthenozoospermic infertile men in Jordan. Methods: 188 semen samples (117 asthenozoospermic and 71 normozoospermic) were collected from the in-vitro fertilization (IVF) unit at the Jordanian Royal Medical Services. Mitochondrial DNA (mtDNA) was extracted and amplified, and the Mitochondrially encoded NADH dehydrogenase subunit 3 (MT-ND3) gene was sequenced, followed by the identification of genetic variants. Results: Seventeen single-nucleotide polymorphisms (SNPs) were detected in the MT-ND3 gene in the examined samples. One novel synonymous variant (m.10313 A>T) was identified exclusively in the normozoospermic group, while the remaining variants were previously reported in the National Center for Biotechnology Information (NCBI) databases. Six missense variants were found: two in the asthenozoospermic group (rs41487950 T>C (Ile9Thr) and rs1603222800 G>A (Ala103Thr)), three in the normozoospermic group (rs202131419 G>A (Gly29Ser), rs193302928 T>C (Val88Ala), and rs1603222776 T>C (Met89Thr)), and one common variant (rs2853826 A>G (Thr114Ser)) in both groups. Additionally, eleven synonymous variants were identified in the study population. Conclusions: Although no statistically significant associations were found between the identified MT-ND3 gene SNPs and asthenozoospermia, several detected variants in asthenozoospermic samples are predicted to alter the protein's structure. Sample size is a limitation of the current study; therefore, further investigations are required to assess the potential impact of these variants on male infertility across diverse populations.
Background: Focused shockwave therapy (fSWT) has now taken its place in the algorithm for the treatment of vascular erectile dysfunction (ED) in current guidelines. Radial wave therapy (rWT) has started to be applied with the same indication in recent years and positive results have been reported. We aimed to compare the long-term effectiveness of fSWT and rWT in ED. Methods: A two-center study enrolled 200 patients aged 40 to 70 years with ED complaints. Patients were non-randomly allocated to either fSWT or rWT groups based on the clinic they visited. Results: After 3 months, the mean International Index of Erectile Function (IIEF) score for patients in the fSWT group was significantly higher compared with the baseline (13 +/- 2.9 vs. 20.4 +/- 4.7, p < 0.001), and the same trend was observed at 1 year (13 +/- 2.9 vs. 18.1 +/- 4.9, p < 0.001). Similarly, in the rWT group, the mean IIEF score was significantly higher at 3 months (13.1 +/- 3 vs. 22.8 +/- 4.6, p < 0.001) and 1 year (13.1 +/- 3 vs. 19.4 +/- 4.9, p < 0.001) compared with the baseline. However, there was no significant difference in the mean IIEF score changes between the two groups at both 3 months and 1 year. The proportion of patients giving a positive response to the Sexual Encounter Profile-2 (SEP-2) question was 81% at 3 months and 63.2% at 1 year in the fSWT group, and 88.9% at 3 months and 71.6% at 1 year in the rWT group, with no significant difference between the groups. Conclusions: Both fSWT and rWT are effective treatments for vascular-related ED, showing comparable efficacy in improving IIEF scores. Clinical Trial Registration: The study was retrospectively registered with https://www.isrctn.com/ as: ISRCTN14000407.
Background: This study retrospectively evaluated the efficacy of low-intensity extracorporeal shock wave therapy (Li-ESWT) in the treatment of mild and mild/moderate erectile dysfunction (ED) and compared changes in sexual function parameters of couples before and after the procedure. Methods: This study included 32 couples. The five-item International Index of Erectile Function (IIEF-5), the Erection Hardness Scale (EHS), and the male Arizona Sexual Experiences Scale (mASEX) were administered to patients who presented to the urology outpatient clinic with mild and mild/moderate ED. In addition, the female Arizona Sexual Experiences Scale (fASEX) was by their partners before the procedure. All male patients then underwent Li-ESWT. At the sixth month after the procedure, IIEF-5, EHS, and mASEX were again completed by the male patients, while fASEX was completed by their female partners. Pre-procedure and post-procedure values were compared statistically. Results: The differences between pre-and post-procedure IIEF-5 and EHS scores of male patients were statistically significant (p < 0.05). The total mASEX score and four sub-scores of male patients decreased compared to pre-procedure levels, and the differences were statistically significant (p < 0.05). However, the difference in the psychological stimulation score was not statistically significant (p> 0.05). The total fASEX score and all sub-scores of female partners decreased after the procedure compared to pre-procedure scores, and these differences were statistically significant (p < 0.05). The decrease in the number of cases of male/female sexual dysfunction in both groups after the procedure was also significant (p < 0.05). Conclusions: In young patients with mild or mild/moderate ED, Li-ESWT resulted in a high treatment success rate at six months after the procedure. Furthermore, both male and female sexual dysfunction improved simultaneously, with improvements observed in all female sexual function parameters. In male patients, improvements were observed in four different sexual functions, while psychological stimulation remained unchanged.
Background: Artificial urinary sphincter (AUS) implantation is the standard of care for moderate-to-severe stress urinary incontinence (SUI), but long-term outcome data remain limited. We aimed to assess AUS' long-term efficacy, complications, explantation rate, and patient satisfaction. Methods: We retrospectively reviewed 70 male patients who underwent AUS (American Medical Systems (AMS) 800TM) implantation for SUI at our tertiary center between 2008 and 2022. Neurogenic patients were excluded. Clinical and perioperative data were analyzed, including comorbidities (e.g., diabetes, hypertension), history of pelvic radiotherapy, previous urethral stricture and/or surgical treatments (e.g., suburethral sling, prior AUS). Patients completed the International Prostate Symptom Score (IPSS), International Consultation on Incontinence-Urinary incontinence Short Form (ICIQ-UI SF), Overactive Bladder Symptom Score (OABSS), and ICIQ-Satisfaction questionnaires during follow-up. Main outcomes were continence and explantation rates. Results: The mean age at surgery was 66.5 years, with a mean follow-up of 72 months. AUS explantation occurred in 21 cases (30%): 11 due to mechanical failure and 10 due to infection. Among the 36 patients alive and actively using their AUS, 33.3% reported no incontinence episodes, 30.6% one episode or less per day, and 36.1% multiple episodes per day. However, 38.5% of the latter reported losing small quantities of urine. The median ICIQ-UI SF score was 4, with 75% of patients using one or fewer pads daily. The median IPSS score was 3 and OABSS score was 1, indicating low lower urinary tract symptoms prevalence. Patient satisfaction was high, with 85.7% rating their surgical outcome as excellent and 94.7% stated they would recommend AUS or choose to undergo the procedure again. Conclusions: AUS is an effective long-term treatment for male SUI, achieving social or absolute continence in many cases. Patient satisfaction remains high despite the need for revisions or explantations.
Background: We aimed to investigate the relationship between erectile dysfunction (ED), the atherogenic index of plasma (AIP) and the testosterone-to-estradiol (T/E2) ratio. Given the role of metabolic and hormonal imbalances in ED, we sought to determine whether these parameters could serve as potential biomarkers for ED risk assessment. Methods: A retrospective included 117 ED patients and 115 controls. Participants' demographic, clinical and biochemical data were collected, including body mass index (BMI), lipid profile and hormone levels. The AIP was calculated as log10 (triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C)) and the T/E2 ratio was determined. Univariate and multivariate logistic regression analyses were conducted to assess the associations between these factors and ED. Results: ED patients had significantly higher AIP levels (0.639 +/- 3.02) compared to controls (0.131 +/- 0.15, p < 0.001). Additionally, the T/E2 ratio was significantly lower in ED patients (10.96 +/- 5.97) than in controls (17.31 +/- 8.12, p < 0.001). Obesity, as indicated by a higher BMI, was also strongly associated with ED (p < 0.001). Multivariate analysis identified BMI Odds Ratio (OR: 1.354, p < 0.001), E2 levels (OR: 1.080, p < 0.001) and AIP (OR: 2.31, p < 0.001) as independent predictors of ED. Conclusions: We suggest that both metabolic and hormonal imbalances contribute to ED pathophysiology. The increased AIP levels observed in ED patients highlight the potential role of lipid metabolism dysfunction and atherosclerosis in erectile function impairment. The reduced T/E2 ratio indicates the influence of hormonal imbalance, particularly the detrimental effects of increased aromatization of testosterone into estradiol. Given that AIP and T/E2 are associated with cardiovascular and endocrine health, they may serve as valuable biomarkers for early ED risk assessment. These results emphasize the importance of lifestyle interventions, weight management and metabolic optimization in preventing and managing ED.
Background: The consumption of soda drinks has risen in recent years. Excessive intake of soda beverages has been linked to numerous detrimental effects. This study sought to examine the impact of soda consumption on the fertility of male mice. Methods: Twenty male mice were allocated to a control group and a soda group. After four months, blood samples from mice were used to estimate male sex hormones, prolactin, adropin, endothelin-1, and nitric oxide (NO). Additionally, the testis was obtained for semen analysis and assessment of testicular lipid peroxidation (LPO), reduced glutathione (GSH), catalase, glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) levels. Furthermore, testicular tissue NO synthase immunohistochemistry was estimated for the mice in the two groups, while the semen was obtained from caudae epididymides. Results: Soda drinking significantly raised body weight and lowered the testicular weight/body weight ratio. Compared with the control group, the soda group had increased endothelin-1 and NO and decreased testosterone and adropin levels. Soda consumption lowered testicular catalase, GSH-Px, and SOD and elevated LPO. Regarding semen analysis, soda significantly decreases sperm count and motility, whereas it increases abnormal sperm (NOS) immunohistochemistry compared with the control group. Conclusions: The study concludes that the high consumption of soda beverages reduces the fertility of male mice via the induction of oxidative stress. This stress diminishes sperm counts and motility while augmenting the prevalence of defective sperm. In addition, soda drinking decreases testosterone and adropin levels.
Background: This study aimed to assess and compare the prevalence of sexual and psychological disorders among infertile and fertile men at a healthcare center in Dakar. Methods: We conducted a descriptive, comparative, and cross-sectional study from April 2023 to August 2023. The study included male patients aged 18 and over being treated for male infertility (group 1) as well as patients or companions of fertile patients of the same age range (group 2). We designed a questionnaire assessing the sociodemographic characteristics of respondents, the psychological impact using the Hospital Anxiety and Depression Scale (HADS), erectile function using the International Index of Erectile Function (IIEF-15), and premature ejaculation using the Premature Ejaculation Profile (PEP). Results: Our sample consisted of 86 respondents in each group. The average age of respondents in both groups was 41.02 +/- 8.26 years (range: 27 to 60 years). Participants in group 1 had significantly lower average scores for erectile function, orgasmic function, sexual desire, sexual satisfaction, and overall satisfaction compared to participants in group 2 (p < 0.05). The average total PEP score in group 1 (12.52 +/- 3.27) was significantly lower than that in group 2 (13.99 +/- 2.05) (p = 0.001). The average total score for anxiety and depressive disorders in group 1 was significantly higher than that in group 2 (p < 0.001). The presence of anxiety disorders in group 1 was correlated with a decrease in IIEF-15 subdomain scores and PEP. In addition, reductions indifferent IIEF-15 subdomains were correlated with a lower PEP score. Conclusions: Infertile men have more severely altered IIEF-15, PEP, and HADS scores compared to fertile men. The presence of anxiety disorders in group 1 was correlated with lower IIEF-15 subdomain scores and PEP. The presence of erectile disorders was associated with premature ejaculation in infertile patients.
Background: The study aimed to assess the impact of varicocele grade and laterality on semen quality in infertile men and their association with reproductive outcomes following microsurgical varicocelectomy. Methods: This retrospective study included 2871 infertile men diagnosed with clinical varicocele at a tertiary urology center (2005-2022). Varicocele grade (I-III) and laterality (unilateral/bilateral) were classified per World Health Organization (WHO) 2000 guidelines. Semen analysis followed WHO 1999/2010 criteria. A subgroup underwent microsurgical varicocelectomy and was followed for 12 months to assess spontaneous pregnancy and time to conception. Results: Unilateral varicocele was found in 64.9% and bilateral in 35.1%. Grade II varicocele predominated (80.6%), with Grades I and III comprising 11.4% and 8.0%, respectively. Normal semen parameters were observed in 55.5% of patients; the remainder had abnormalities such as asthenozoospermia (28.9%), oligozoospermia (6.9%), and azoospermia (3.9%). Semen quality did not differ significantly across grades or laterality (p > 0.05). Among surgical patients, 40.7% achieved spontaneous pregnancy within 12 months (mean time to conception: 4.3 +/- 0.03 months). Neither varicocele grade nor laterality significantly influenced pregnancy rates or timing. Conclusions: Varicocele grade and laterality were not significantly associated with semen quality or postoperative pregnancy outcomes. These findings support individualized patient selection for varicocelectomy, considering broader clinical and reproductive factors rather than varicocele classification alone.
Background: This study assessed sexual quality of life and related issues among men with testicular cancer in Turkey using a standardized questionnaire, while examining differences by treatment method and cancer stage. Methods: A total of 168 men undergoing treatment at Erciyes University Urology Outpatient Clinic were included. Eligible participants were aged 18 or older, cognitively able to complete questionnaires, and either in active treatment or follow-up. Data were collected through a descriptive questionnaire, a sexual problems form, and the Sexual Quality of Life Scale-Male (SQLS-M). Descriptive statistics summarized demographics and clinical characteristics. One-way ANOVA with post-hoc tests evaluated differences in SQLS-M by treatment type and stage. Pearson correlation and independent t-tests were used to examine associations. Statistical significance was set at p < 0.05. Results: Younger age was significantly associated with higher SQLS-M scores (r = -0.16, p = 0.001). Patients with seminoma and those in Stage I reported significantly higher sexual quality of life than non-seminoma and advanced-stage patients (p < 0.05). Treatment type also had a significant effect (F = 12.09, p < 0.001); men who underwent surgery alone reported higher scores than those receiving chemotherapy, radiotherapy, or combined therapies. Post-hoc analyses confirmed surgery as the most favorable modality (p < 0.05). Conclusions: Sexual quality of life in men with testicular cancer is influenced by age, cancer type, stage, and treatment. Younger patients, those with seminoma, early-stage disease, and those treated with surgery alone reported better outcomes, while chemotherapy, radiotherapy, and combined therapies were associated with more dysfunction and lower satisfaction. These findings highlight the importance of addressing sexual health in cancer care and incorporating supportive strategies into treatment planning to preserve long-term quality of life.
