PURPOSE:Benign prostatic hyperplasia (BPH) and rheumatoid arthritis (RA) have both been associated with inflammatory processes; however, their association remains unclear. This study explored the prospective association between BPH and the subsequent risk of RA using data from the UK Biobank, and further evaluated whether the systemic immune-inflammation index (SII) and the neutrophil-to-lymphocyte ratio (NLR) are associated with this relationship. MATERIALS AND METHODS:A total of 222,891 males without RA or prostate cancer at baseline were included. BPH was identified through self-report, hospital ICD-10 codes (N40), and primary care records. Incident RA was defined using hospital ICD-10 codes (M05 to M06). Multivariable Cox proportional hazards models were applied to assess the association between BPH and risk of incident RA. Mediation analyses were used to explore the potential role of SII and NLR in this association. Sensitivity analyses, including subgroup analyses, multiple imputation, exclusion of early RA cases, and competing risk models, were performed to test robustness. RESULTS:During a median follow-up of 14 years, 2,252 incident RA cases were documented. After multivariable adjustment, BPH was associated with a higher risk of RA (hazard ratio=1.19, 95% confidence interval: 1.03 to 1.37). The association remained consistent across sensitivity analyses. Mediation analyses suggested that SII and NLR may partly account for the observed association between BPH and RA (4.28% and 7.25%, respectively). CONCLUSIONS:BPH was associated with an increased risk of RA, and systemic inflammatory markers were also associated with this relationship.
PURPOSE:Evidence linking body mass index (BMI) change to prostate cancer risk remains inconsistent despite known associations between adiposity and prostate carcinogenesis. MATERIALS AND METHODS:We conducted a population-based cohort study of 1,332,372 Korean males who completed health examinations in 2009 and 2013 and were followed through 2017. BMI was classified using Asia-Pacific criteria, and changes between 2009 and 2013 defined 25 groups. Prostate cancers were ascertained by ICD-10 (International Classification of Diseases, 10th Revision) codes. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) controlling for demographics, lifestyle factors, and comorbidities. RESULTS:Over 12.7 million person-years, 9,147 prostate cancers were identified. BMI trajectories displayed distinct risk patterns. Remaining underweight (aHR, 0.76; 95% CI, 0.61 to 0.96) or moving from underweight to normal (aHR, 0.65; 95% CI, 0.47 to 0.91) was associated with lower risk, whereas persistent overweight (aHR, 1.18; 95% CI, 1.10 to 1.27), persistent obesity I (aHR, 1.19; 95% CI, 1.12 to 1.27), and transition from overweight to obesity I (aHR, 1.14; 95% CI, 1.03 to 1.27) were associated with higher risk compared with persistent normal BMI. Among males with obesity I, weight loss to normal BMI was associated with reduced risk compared to persistent obesity I (aHR, 0.63; 95% CI, 0.46 to 0.87). Smoking amplified the adverse associations of persistent overweight and obesity. However, persistent obesity II (≥30 kg/m²) was associated with lower risk among males <60 years (aHR, 0.62; 95% CI, 0.44 to 0.89), though this finding should be interpreted with caution as it may reflect detection bias. CONCLUSIONS:The impact of longitudinal adiposity patterns varied by smoking status and age, supporting personalized, lifestage-specific prevention emphasizing weight management and lifestyle modification.
PURPOSE:Leydig cell tumors (LCTs) are rare, usually benign testicular tumors for which frozen section examination is commonly recommended during testis-sparing surgery (TSS). We report a 27-year single-center experience, emphasizing the role of imaging for conservative surgery decision-making. It shows our experience using expert radiology assessment to direct TSS without frozen section examination. MATERIALS AND METHODS:In this retrospective observational study, we reviewed our institutional database of testicular tumors treated between 1998 and 2025. Patients with histologically confirmed LCTs were included. Clinical presentation, hormonal profile, imaging characteristics, surgery type, and intraoperative frozen section use were analyzed. RESULTS:Among 481 testicular tumors, 68 (14.14%) were LCTs. Within the histologically confirmed LCTs cohort, preoperative expert radiology assessment achieved 97% (66/68) concordance with the final pathology. Partial orchiectomy was performed in 62 cases (91.18%), total orchiectomy in 6 (8.82%). Median age was 36 years. Median follow-up was 75 months. No malignant LCTs were observed. All patients remained in complete remission. The most common reasons for consultation were infertility (n=41, 60.29%) where systematic ultrasound screening discovered the lesion, gynecomastia (n=4, 5.88%), Klinefelter syndrome work-up (n=4, 5.88%; 2 additional cases identified within the infertility group, total n=6) and palpable nodule (n=4, 5.88%). Median ultrasound tumor size was 7 mm (range: 2 to 32 mm). CONCLUSIONS:Radiological characteristics effectively differentiated LCTs, suggesting that direct TSS without frozen section examination might be feasible when expert radiological evaluation is available. Our findings reflect radiology-pathology concordance within histologically confirmed LCTs rather than diagnostic accuracy in an unselected population. This approach optimizes surgical workflow, preserves endocrine function and fertility. No recurrence was observed. Frozen section examination should be maintained where expert radiology consultation is unavailable or diagnostic uncertainty exists. Prospective validation is required before omitting frozen section examination outside expert centers.
PURPOSE:Male sex is a recognized risk factor for colorectal adenoma, yet whether the associations of Helicobacter pylori, atrophic gastritis (AG), and intestinal metaplasia (IM) with colorectal adenoma differ by sex remains unclear. This study evaluated the sex-stratified and combined associations of anti-H. pylori IgG seropositivity, AG, and IM with conventional colorectal adenoma. MATERIALS AND METHODS:This multicenter cross-sectional study included 806 participants from a Korean health-screening cohort who underwent gastroscopy with H. pylori testing and colonoscopy within 3 years. Anti-H. pylori IgG seropositivity was determined by enzyme-linked immunosorbent assay, AG and IM were assessed endoscopically. Multivariable logistic regression models were adjusted for age, sex, body mass index, smoking, and alcohol consumption. RESULTS:Colorectal adenoma was identified in 209 participants (25.6%). Anti-H. pylori IgG seropositivity was independently associated with colorectal adenoma (adjusted odds ratio [aOR], 1.848; 95% confidence interval [CI], 1.323 to 2.581; p<0.001). AG was not significant after adjustment. IM was independently associated in a separate model (aOR, 1.648; 95% CI, 1.125 to 2.415; p=0.010), but showed only borderline significance in the combined model when including H. pylori seropositivity (aOR, 1.440; 95% CI, 0.973 to 2.131; p=0.068), whereas anti-H. pylori IgG seropositivity remained significant. Participants with both H. pylori seropositivity and IM showed the highest odds of colorectal adenoma. In sex-stratified analyses, anti-H. pylori IgG seropositivity was independently associated in males (aOR, 1.811; 95% CI, 1.147 to 2.860; p=0.011) but not in females, whereas IM was independently associated in females (aOR, 2.086; 95% CI, 1.129 to 3.856; p=0.019) but not in males. Formal interaction tests were not statistically significant. CONCLUSIONS:Anti-H. pylori IgG seropositivity and IM were associated with conventional colorectal adenoma, whereas AG was not significant after adjustment. Sex-stratified analyses suggested potential sex-related patterns, with H. pylori seropositivity appearing more prominent in males and IM appearing more prominent in females.
Male infertility is a global reproductive health issue, and sperm from the majority of infertile males exhibit motility defects. Although anatomical and endocrinological etiologies underlying male infertility have been identified and become targets for clinical treatment, approximately 15% to 40% of cases are still classified as idiopathic infertility, with causal factors remaining unresolved. Recent advances in genomic analyses have identified diverse genetic variants explaining idiopathic male infertility. In this review, we summarize the current understanding of infertility-causing genetic variants, particularly those encoding proteins that constitute the radial spoke complexes which are critical structural complexes in the sperm tail essential for motility.
PURPOSE:Erectile dysfunction (ED) is a prevalent and distressing consequence of radical prostatectomy (RP) and radiotherapy (RT) for prostate cancer, profoundly impacting quality of life. Despite a wide array of available interventions, their comparative effectiveness remains uncertain in the absence of head-to-head trials. MATERIALS AND METHODS:We conducted a systematic review and network meta-analysis (NMA) of studies evaluating medical interventions for ED following RP or RT. MEDLINE, Embase, and Scopus were searched for eligible studies. Risk of bias (RoB) was assessed using the Cochrane RoB 2 and ROBINS-I tools. A random-effects NMA was performed, with efficacy expressed as odds ratios (ORs) and 95% confidence intervals (CIs). The certainty of evidence was evaluated using the GRADE framework. The primary outcome was recovery of erectile function, assessed using validated measures or the proportion achieving successful intercourse. RESULTS:Forty-one studies (n=4,157 participants) met inclusion criteria. Following RP, combination therapies were most effective: tadalafil plus intraurethral alprostadil gel (OR 24.8), tadalafil plus vacuum erection device (OR 12.3), and tadalafil plus low-intensity shockwave therapy (OR 8.2) demonstrated the highest odds of functional recovery versus placebo. Following RT, on-demand tadalafil was the most effective intervention (OR 8.0). Pooled analysis of RP studies showed a significant mean improvement in International Index of Erectile Function scores favouring active interventions over control (mean difference 4.5, 95% CI: 2.4-6.5, I²=62%), with longer intervention duration associated with greater improvement. Overall certainty of evidence was low to very low due to RoB, imprecision, and inconsistency. CONCLUSIONS:Combination therapies appear most effective for ED recovery after RP, while on-demand phosphodiesterase type 5 inhibitors are most efficacious after RT. These findings provide novel comparative evidence; however, cautious clinical application and further high-quality research are warranted.
PURPOSE:To determine response rates and predictors of circulating testosterone and sperm concentration improvement in hypogonadal men with oligospermia treated with clomiphene citrate 50 mg daily. MATERIALS AND METHODS:Records of 166 men with testosterone <3.5 ng/mL and sperm concentration <15 million/mL treated for ≥3 months between January 2020-2025 were retrospectively analyzed. Testosterone responders were defined as achieving T ≥3.5 ng/mL. Sperm concentration responders were defined as those with any improvement. Multivariate logistic regression identified predictors of treatment response for both outcomes. RESULTS:Overall, 151 men (91%) normalized testosterone, with median levels rising from 2.9 (interquartile range 2.8-2.9) to 4.6 (3.9-5.5) ng/mL, a median increase of 1.7 (0.6-2.3) ng/mL (p<0.001). Sperm concentration improved in 118 men (71%), increasing from 4.0 (1.4-8.0) to 5.6 (2.1-10.9) million/mL, a median gain of 1.6 (0.7-2.9) million/mL (p=0.01). However, 48 men (29%) experienced a paradoxical decline, with a median decrease of -3.3 (-6.6 to 0.0) million/mL. Baseline estradiol independently predicted testosterone response (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.01-1.35, p=0.04), while lower baseline sperm concentration predicted greater sperm improvement (OR 0.84, 95% CI 0.70-0.99, p=0.04). CONCLUSIONS:Clomiphene citrate 50 mg daily normalized testosterone in 9 of 10 men with hypogonadism and oligospermia. Baseline estradiol predicted testosterone response, while sperm improvements were more likely in men with lower baseline counts. Although sperm concentration increased in most patients, clinical relevance was modest and nearly one-third worsened. Clomiphene citrate may be considered for testosterone optimization, particularly in men with higher estradiol, but fertility expectations should be managed.
PURPOSE:Phosphodiesterase type 5 inhibitors (PDE5i) are widely used to treat erectile dysfunction (ED). However, a subset of men does not respond to these agents or seek restoration of natural erections. Regenerative therapies (RT), including low-intensity shock wave therapy (LiSWT), platelet-rich plasma (PRP) therapy, and stem cell therapy (SCT), have emerged as potential alternative treatment options. This article reviews the available evidence and presents the Global Andrology Forum (GAF) graded statements and recommendations for the use of RT in ED. MATERIALS AND METHODS:A GAF expert panel conducted a literature review of the PubMed and Scopus databases up to February 2025 to identify studies on RT for ED. Surveys and a modified Delphi consensus method were employed to develop position statements and clinical recommendations. These were graded according to the "GRADE" classification system as either "strong" or "weak." Recommendations receiving strong ratings from at least 80% of experts were classified as "strong," while others were classified as "weak." RESULTS:Seventeen statements and recommendations were accepted and graded by a panel of 36 GAF experts from 18 countries. Eleven were classified as "strong," and six as "weak." CONCLUSIONS:Current evidence indicates modest short-term benefits of LiSWT in young and middle-aged men with mild-to-moderate vasculogenic ED. The efficacy of PRP and SCT remains uncertain. The GAF statements and recommendations highlight the lack of standardized treatment protocols and insufficient evidence of long-term effectiveness and emphasize the need for further research and clinical trials. Meanwhile, patients and healthcare providers should remain cautious when applying RT for ED. Clinicians should avoid overclaiming the benefits of RT to patients and provide a realistic prognosis based on current evidence.
PURPOSE:Research productivity is a key indicator of academic performance and is shaped by access to resources, collaborative engagement, and effective communication. This study aimed to evaluate the impact of resource availability, research collaboration, and the use of digital communication tools (DCTs) on researchers' productivity. MATERIALS AND METHODS:This cross-sectional study used an online questionnaire to evaluate the influence of DCTs on research productivity among eligible Global Andrology Forum members. The questionnaire collected data on demographics, research output, collaboration patterns, DCT preferences, and institutional support. The productivity data of participants were extracted from Scopus and Google Scholar. The economic status of the participants' country was obtained from the World Bank. Two-group comparisons used the Mann-Whitney U test, while multi-group comparisons used the Kruskal-Wallis test with post hoc analyses when significant. Spearman's correlation analysis and a multivariable robust linear regression model were used to assess associations and evaluate the robustness of the findings, respectively. RESULTS:A total of 141 of 144 researchers completed the survey, representing 37 countries across diverse economic settings. Researchers from high-income countries demonstrated significantly higher productivity than those from middle-income countries. DCTs (WhatsApp and Zoom) were widely used for messaging and virtual meetings. Time spent on WhatsApp was positively correlated with research performance, including number of publications (ρ=0.224, p=0.008), total citations (ρ=0.259, p=0.002), most cited article (ρ=0.215, p=0.011), h-index (ρ=0.289, p=0.001), co-authorship (ρ=0.223, p=0.008), and international collaboration (ρ=0.274, p=0.001). Researchers who spent more than 4 hours per week on WhatsApp demonstrated significantly higher productivity indicators. CONCLUSIONS:DCTs and structured global research networks are essential for strengthening research capacity and promoting equitable participation across regions. While economic constraints may limit productivity, effective use of digital collaboration platforms can help narrow these gaps by expanding networking opportunities, enabling meaningful collaboration, and enhancing overall research output.
PURPOSE:Fournier gangrene (FG) is a life-threatening necrotizing infection with a high mortality rate. Conventional prognostic indices, including the Fournier Gangrene Severity Index (FGSI), depended on static parameters and may not adequately capture baseline metabolic vulnerability. Myosteatosis, which is the pathological infiltration of fat within skeletal muscle, has been associated with poor outcomes in cancer and critical illness. This study evaluated the prognostic significance of myosteatosis in FG using artificial intelligence (AI)-based computed tomography (CT) analysis. MATERIALS AND METHODS:We retrospectively analyzed 40 male patients with FG, whose diagnosis was confirmed based on clinical, radiological, and surgical findings. Preoperative CT scans at the L3 level were assessed using AI-based software to quantify skeletal muscle quality. Quantitative parameters were automatically extracted to evaluate muscle quality. Patients were classified into myosteatosis or non-myosteatosis groups according to established cut-off values. Clinical characteristics, FGSI, septic shock, and in-hospital mortality were compared between groups. Predictors of in-hospital mortality were evaluated using multivariate logistic regression. RESULTS:Of 40 patients, 22 (55.0%) had myosteatosis. These patients had higher rates of septic shock (45.5% vs . 11.1%, p<0.05) and in-hospital mortality (31.8% vs . 5.6%, p<0.05) than those without myosteatosis. Survivors demonstrated significantly higher normal attenuation muscle area (79.1±31.5 vs. 46.2±22.3, p<0.05) and lower myosteatosis percentage (37.9%±16.8% vs. 56.5%±15.2%, p<0.05). Multivariate analysis identified myosteatosis, FGSI >9, and cardiovascular disease as independent predictors of in-hospital mortality. CONCLUSIONS:AI-based CT analysis of myosteatosis is a reproducible method for assessing muscle quality in the FG. Myosteatosis was independently associated with septic shock and in-hospital mortality beyond body mass index and FGSI, suggesting its potential as a novel imaging biomarker for early risk stratification and individualized treatment planning.
PURPOSE:Radium-223 (Ra-223) is a bone-targeting radiopharmaceutical used to treat symptomatic bone metastases in men with castration-resistant prostate cancer (CRPC), but there are no reliable biomarkers to guide timely therapeutic adjustments. This study explored the prognostic significance of early prostate-specific antigen (PSA) dynamics during Ra-223 therapy in patients with CRPC and bone metastases. MATERIALS AND METHODS:This multi-institutional, retrospective cohort study analyzed 243 patients with CRPC and bone metastases treated with Ra-223 between January 2018 and December 2023 at Chang Gung Memorial Hospital, Taiwan. PSA and alkaline phosphatase (ALP) levels were recorded before and after two cycles of Ra-223 treatment (PSA 2M, ALP 2M). Additionally, the association between PSA, ALP, and clinical outcomes, including response, visceral metastasis-free survival (VMFS), and overall survival (OS), was assessed. Kaplan-Meier analysis, multivariate Cox regression, and receiver operating characteristic curve analysis were used to evaluate the prognostic value of PSA 2M. RESULTS:Patients whose PSA 2M increase≤40% demonstrated significantly better pain control (p=0.003), improved VMFS (p=0.005), and longer OS (p=0.012) compared to those whose PSA 2M increase>40%. Kaplan-Meier analyses confirmed shortened VMFS (p=0.005) and OS (p=0.012) in patients with a PSA 2M increase of >40%. In multivariate Cox regression analyses, baseline opioid use and completion of Ra-223 injections were independent predictors of VMFS, while baseline ALP>94, PSA 2M increase>40%, and completion of Ra-223 injections were independently associated with OS. CONCLUSIONS:Early PSA dynamics during Ra-223 therapy can predict clinical outcomes in patients with CRPC and bone metastases. Patients with a PSA 2M increase of >40% had worse pain control, shorter VMFS and OS, and may benefit from early therapeutic modifications, including combination therapies. These findings underscore the importance of early biomarker-driven interventions to optimize treatment outcomes.
PURPOSE:This study aimed to investigate age-related changes in serum testosterone levels and their associations with metabolic factors in a large, population-based cohort of Korean men. Although the age-related decline in testosterone has been established in Western populations, large-scale data in Asian men remain limited. Understanding regional differences is important for defining testosterone reference thresholds and associated health risks. MATERIALS AND METHODS:Data from 27,687 men aged ≥40 years who underwent routine health examinations at 20 hospitals across South Korea (2015-2024) were retrospectively analyzed. Clinical parameters included age, body mass index (BMI), fasting glucose, lipid profile, and prostate-specific antigen (PSA). Men receiving testosterone therapy or medications affecting androgen metabolism, or with a history of orchiectomy, chemotherapy, or testicular radiation, were excluded. Serum testosterone was measured from morning samples using chemiluminescent immunoassay, and biochemical hypogonadism was defined as total testosterone <2.5 ng/mL. Age-related trends were examined using ANOVA, and multivariable linear regression identified associations with metabolic variables. RESULTS:The mean testosterone level was 4.8±1.8 ng/mL, showing a significant linear decline of approximately 0.021 ng/mL per year (p<0.001). The prevalence of biochemical hypogonadism increased from 5.5% (40-49 years) to 11.6% (≥70 years). In multivariable analysis, higher BMI, fasting glucose, and triglyceride levels were independently associated with lower testosterone, while PSA, high-density lipoprotein, and low-density lipoprotein were not significant. CONCLUSIONS:This large nationwide study demonstrates a negative association between serum testosterone levels and age among Korean men. Obesity, hyperglycemia, and hypertriglyceridemia were additional contributors to reduced testosterone levels. Regular hormonal assessment and metabolic risk management are recommended for early detection and prevention of testosterone deficiency. Longitudinal studies are needed to clarify causal pathways and long-term outcomes.
Non-obstructive azoospermia (NOA) is the most severe form of male infertility, characterized by defective spermatogenesis and a complete absence of sperm in the ejaculate. Biological fatherhood for affected patients relies on identifying rare foci of active spermatogenesis within the testes through microdissection testicular sperm extraction (micro-TESE) which is the current gold standard approach. Optimizing sperm retrieval is challenging since success depends on both surgical precision and laboratory detection accuracy. Artificial intelligence (AI) has recently emerged as a promising tool to improve these processes. A comprehensive literature review of recent studies was performed to assess how AI is being applied in NOA management. Research using machine learning (ML) and convolutional neural networks (CNNs) for sperm detection, prediction of successful retrieval, and diagnostic classification was analyzed. Emphasis was placed on model accuracy, clinical feasibility, and integration into current surgical and laboratory workflows. AI-based image recognition systems show strong accuracy in identifying rare sperm within the complex surrounding cellular environment. These tools minimize operator fatigue, enhance detection speed, and ensure greater level of consistency across laboratories. Early studies indicate that AI-assisted methods outperform manual identification by offering faster and more reliable results. Furthermore, predictive AI models are being developed to estimate sperm retrieval outcomes and support patient selection. Integrating AI into surgical and laboratory practice has the potential to reduce subjectivity and inefficiency in NOA management by offering more objectivity in the process of sperm identification and outcome prediction, in addition to delivering a personalized, data-driven reproductive care. Continued clinical validation and ethical oversight will be essential before these technologies can be fully adopted in reproductive medicine.
