Background: Acute ischemic priapism is a time-dependent urological emergency in which failure of stepwise conservative treatment requires emergency surgical shunting, and prolonged cavernosal ischemia may cause permanent erectile dysfunction. The parameters available at presentation that identify which patients will fail conservative therapy and require shunting are poorly defined, and leukocyte-based inflammatory markers have not previously been examined in this emergency. We therefore assessed whether these parameters are associated with the need for surgical shunting, with post-priapism erectile dysfunction as a secondary outcome. Methods: Among 23 adults with acute ischemic priapism, 15 were managed conservatively and 8 required surgical shunting; admission leukocyte-based inflammatory markers and ischemia duration were examined for their association with the need for surgical shunting. Results: Patients who required shunting had a markedly longer ischemia duration (median 48 versus 7.5 hours) and a higher admission white blood cell count (median 13.3 versus 10.0 × 10⁹/L), with higher neutrophil and monocyte counts, whereas composite inflammatory indices such as the neutrophil-to-lymphocyte ratio and the systemic immune-inflammation index did not differ. The admission white blood cell count discriminated the need for surgical shunting with an area under the curve of 0.84, comparable to ischemia duration (0.82); a threshold of approximately 13 × 10⁹/L gave 75% sensitivity and 87% specificity, while the composite indices were non-discriminatory. The white blood cell count correlated only moderately with ischemia duration, indicating information not fully explained by elapsed time. Post-priapism erectile dysfunction, a secondary outcome, was related only to older age. Conclusions: In acute ischemic priapism, a longer ischemia duration and a higher early leukocyte count at presentation are associated with the need for emergency surgical shunting, whereas composite inflammatory indices are not; these simple, immediately available parameters may support early risk stratification and merit validation in larger, multicentre studies.
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.
