OBJECTIVE:To evaluate the value of testicular viscoelastic parameters in predicting the improvement of semen parameters after varicocelectomy through testicular shear wave dispersion imaging. METHODS:Each patient completed testicular shear wave dispersion imaging and semen analysis before and three months after varicocelectomy. Logistic regression analysis was used to assess the predictive ability of testicular viscoelasticity and ultrasonic parameters for postoperative semen parameters improvement. A nomogram was constructed to develop a predictive model for semen parameters improvement after varicocelectomy. RESULTS:A total of 141 patients were included in the study. Univariate regression analysis showed that bilateral varicocele, internal diameter of the spermatic vein, reflux time, viscosity coefficient, and dispersion slope were predictive factors for postoperative semen parameters improvement. The areas under the ROC curve for reflux time and dispersion slope in predicting postoperative semen parameters improvement were 0.787 and 0.680, respectively. Multivariate regression analysis identified bilateral varicocele (OR: 5.522, CI: 1.415-21.546), reflux time (OR: 1.42, CI: 1.032-1.955), and dispersion slope (OR: 5.16, CI: 1.473-18.076) as significant predictive factors for postoperative semen parameters improvement. A predictive model was established using a nomogram, with an area under the ROC curve of 0.85, demonstrating good calibration (Hosmer-Lemeshow test, p = 0.44) and clinical utility within a threshold probability range of 0.3-0.8. CONCLUSION:Testicular shear wave dispersion imaging is helpful in predicting semen parameters improvement three months after varicocelectomy. A model combining reflux time and varicocele side has higher predictive ability and practical value.

Microdissection testicular sperm extraction (micro-TESE) is an effective method to retrieve sperm from non-obstructive azoospermia (NOA) patients. However, the predictive factors for sperm retrieval rate (SRR) remain confused. The goal of our study was to identify the role of testicular pathological morphometric parameters, including diameter of tubule (DT), height of spermatogenic epithelium (HSE), and thickness of basement-membrane (TBM) in NOA patients, and to develop a predictive model and nomogram to predict SRR based on these morphometric parameters. This study involved two cohorts including 406 men with NOA. A retrospective cohort of 313 males with NOA who underwent micro-TESE at Northwest Women’s and Children’s Hospital (Xi’an, China) were included to build a prediction model of SRR. Then, another retrospective cohort of 93 males with NOA from Ren Ji Hospital (Shanghai, China) were recruited to validate the prediction model. The measurement of testicular morphometric parameters as well as the assessment of Johnsen score and pathological diagnostic types were performed by at least two pathologists. Testicular volumes as well as level of serum hormones including follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T) were also measured. Logistic regressions were used to test potential predictors of SRR. Area under curve (AUC) estimates was used to evaluate the predictive accuracy. The validation datasets were used to validate the prediction model by prediction accuracy. Our study demonstrated that DT and HSE were significantly longer in successful sperm retrieval group than in failed sperm retrieval group. In addition, DT and HSE were positively correlated with Johnsen score, testicular volume, and serum T, while, were negatively correlated with serum FSH and serum LH. On the contrary, TBM demonstrated exact opposite results. Moreover, univariate logistic analyses illustrated that longer DT and HSE was associated with a high SRR, respectively. Further multivariate logistic analyses constructed multi-variables models with better predictive abilities compared with single-variables models. A multi-variables model (predicting score = -0.612–0.018 × DT + 0.040 × HSE + 0.097 × Johnsen score-0.004 × serum FSH) was finally constructed with the best predictive ability (AUC = 0.839, sensitivity = 71.4

Background:The characteristics of testicular viscoelasticity could help identify azoospermia. This study sought to assess the diagnostic value of viscoelasticity for male infertility using high-frequency ultrasound shear wave dispersion (SWD) imaging. Methods:In this prospective study, 330 consecutive patients with male infertility were allocated to the ultrasound normal group, the varicocele group, the non-obstructive azoospermia (NOA) group, and the obstructive azoospermia (OA) group, and 30 healthy volunteers were allocated to the control group. Two physicians with over 10 years of experience each in andrology ultrasound measured the viscosity coefficient, dispersion slope, and elasticity of each testis, respectively. The testicular viscoelasticity was compared among the patients from the four groups and the control group. The inter-reader variability between the two physicians was assessed. The diagnostic efficacy of viscoelasticity for NOA was evaluated by receiver operating characteristic (ROC) curve analysis. Binary logistic regression was used to analyze the risk factors for NOA. Results:Among the 360 participants, the viscosity coefficient, dispersion slope, and elasticity were all higher in the NOA group than the other groups (P<0.001). The inter-reader variability was excellent [intraclass correlation coefficient (ICC): 0.87-0.96]. Comparisons between the patient groups categorized by testicular volume (TV) revealed no statistically significant difference in the elasticity of testes with smaller volumes (5-10 mL) between the OA and NOA groups (P=0.130), but differences in the viscosity coefficient and dispersion slope were observed (P=0.009 and P=0.031, respectively). The ROC curve analysis showed that the viscosity coefficient had the highest diagnostic efficacy for NOA, with an area under the curve (AUC) of 0.834. In the logistic regression, the viscosity coefficient [odds ratio (OR) =665; 95% confidence interval (CI): 1.62-2,732.64], elasticity (OR =1.35; 95% CI: 0.98-1.84), and TV (OR =0.51; 95% CI: 0.44-0.61) were identified as independent risk factors for NOA. Conclusions:The viscosity coefficient, dispersion slope, and elasticity all have diagnostic value for NOA. Unlike elasticity, the differential diagnosis of azoospermia by the viscosity coefficient and dispersion slope is not affected by TV. Testicular viscoelasticity can be effectively used in the differential diagnosis of azoospermia, especially in patients with slightly smaller testicles.

Non-obstructive azoospermia (NOA) belongs to male infertility due to spermatogenesis failure. However, evidence for cell type-specific abnormalities of spermatogenesis disorders in NOA remains lacking. We performed single-cell RNA sequencing (scRNA-seq) and single-cell assay for transposase-accessible chromatin sequencing (scATAC-seq) on testicular tissues from patients with obstructive azoospermia (OA) and NOA. HE staining confirmed the structural abnormalities of the seminiferous tubules in NOA patients. We identified 12 germ cell subtypes (spermatogonial stem cell-0 [SSC0], SSC1, SSC2, diffing-spermatogonia [Diffing-SPG], diffed-spermatogonia [Diffed-SPG], pre-leptotene [Pre-Lep], leptotene-zygotene [L-Z], pachytene [Pa], diplotene [Di], spermatids-1 [SPT1], SPT2, and SPT3) and 8 Sertoli cell subtypes (SC1-SC8). Among them, three novel Sertoli cell subtype phenotypes were identified, namely SC4/immature, SC7/mature, and SC8/further mature Sertoli cells. For each germ or Sertoli cell subtype, we identified unique new markers, among which immunofluorescence confirmed co-localization of ST3GAL4, A2M, ASB9, and TEX19 and DDX4 (classical marker of germ cell). PRAP1, BST2, and CCDC62 were co-expressed with SOX9 (classical marker of Sertoli cell) in testes tissues also confirmed by immunofluorescence. The interaction between germ cell subtypes and Sertoli cell subtypes exhibits stage-specific-matching pattern, as evidenced by SC1/2/5/7 involving in SSC0-2 development, SC3 participating in the whole process of spermiogenesis, SC4/6 participating in Diffing and Diffed-SPG development, and SC8 involving in the final stage of SPT3. This pattern of specific interactions between subtypes of germ cell and Sertoli cell was confirmed by immunofluorescence of novel markers in testes tissues. The interaction was mainly regulated by the Notch1/2/3 signaling. Our study profiled the single-cell transcriptome of human spermatogenesis and provided many potential molecular markers for developing testicular puncture-specific marker kits for NOA patients.

Cavernous nerve injury is an important cause of erectile dysfunction (ED). Although protective nerve technology has been widely used in nerve-sparing radical prostatectomy (nsRP), the incidence of ED is still very high after surgery. The purpose of our study was to evaluate erectile function (EF) and penile length in the non-erectile state (PLNES) following scheduled phosphodiesterase 5 inhibitor (PDE5i), vacuum erectile device (VED) treatment, and combination therapy after nsRP. One hundred patients with localized prostate cancer and normal EF were randomized to scheduled PDE5i group, VED treatment group, a combined treatment group, and the control group without any intervention. The International Index of Erectile Function-5 (IIEF-5) scores and PLNES were evaluated after 6 months and 12 months of treatment. Sexual Encounter Profile (SEP-Question 2 and SEP-Question 3) were evaluated after 12 months of treatment. Ninety-one of the 100 randomized patients completed the study. We found that the 5 mg tadalafil once a day (OaD) combined with VED can help improve IIEF-5 scores in nsRP patients after both 6 months and 12 months. VED alone or combined with tadalafil OaD can help patients maintain PLNES. VED combined with tadalafil OaD can improve the rate of successful penetration (SEP-Question 2) after 12 months. There were no significant differences in the return to target EF after 12 months among the groups. No significant correlation was noted between the variables and return to target EF (IIEF ≥ 17), and between the variables and effective shortening of the patient's penis (shortening ≥ 1 cm) after 12 months of intervention.

Purpose Multiple morphological abnormalities of the sperm flagella (MMAF) are important causes of male infertility. Mutations in DNAH1 are the main causative factors proven so far. We aim to determine the mutational landscape of DNAH1 in Chinese patients with MMAF. Methods Forty-one Chinese patients with MMAF were enrolled and underwent a 10-gene next-generation sequencing panel screening. Results Only the DNAH1 gene was found to have mutations in 12 of these unrelated individuals (29%). Combining published data from two other cohorts of Chinese men with MMAF, we suggest that p.P3909fs*33, p.R868X, p.Q1518X, p.E3284K, and p.R4096L are hotspot mutations. A polymorphism-rs12163565 (G>A)- showed linkage to p.P3909fs*33, suggesting that this involved a founder effect. Four of the 12 patients with DNAH1 mutations were able to use intracytoplasmic sperm injection with their partners and all were successful in obtaining embryos. Conclusions Hotspot mutations were identified for Chinese patients with MMAF. MMAF sub-phenotypes might be associated with different combinations of DNAH1 mutations.

目前已有很多的研究证实,勃起功能障碍患者中,吸烟人数比例显著高于同年龄段正常人.烟吸得越多,则发生勃起功能障碍的比例越高.现代医学认为,吸烟诱发勃起功能障碍主要通过以下两种方式: 急性损害研究认为,大量吸烟引起对勃起功能的急性损伤,主要是尼古丁直接刺激人体内的交感神经,产生很多肾上腺素与去甲肾上腺素.这两种物质会让阴茎海绵体内的平滑肌收缩,导致阴茎无法充血,勃起功能障碍便接踵而来.

目的 探讨超声实时剪切波弹性成像(E成像)联合睾丸体积在鉴别梗阻性及非梗阻性无精子症中的诊断价值.方法 以男科显微手术及组织病理学为金标准,分析58例证实为梗阻性无精子症(OA)、95例证实为非梗阻性无精子症(NOA),其中20例为克氏症(KS NOA)患者和32例健康对照组的睾丸体积及超声弹性图像,统计不同组睾丸体积值及睾丸杨氏模量值,比较其差别,并对两者细化分层,通过ROC曲线分析体积及杨氏模量值鉴别OA及NOA的诊断效能及联合诊断价值.结果 正常组、OA、Non-KS NOA及KS NOA患者杨氏模量测值重复性好,其睾丸中位数(单位kPa)分别为1.8 (1.6-2.0)、1.8 (1.6-2.1)、1.6 (1.2-1.8)和2.5 (1.9-3.0),克氏症患者弹性测值高于其他组患者(P=0.000);OA组高于Non-KS NOA组(P=0.007),与正常组无异(P=0.7);ROC曲线分析显示睾丸杨氏模量值诊断效能低于睾丸体积(Az=-0.681 vs Az=0.886,P＜0.001),但在睾丸体积介于10.1-12.0 mL及弹性介于1.3-1.7 kPa时,睾丸体积及弹性可以互补,从而提高鉴别诊断价值.结论 超声实时剪切波弹性成像技术联合睾丸体积为梗阻性及非梗阻性无精子症的鉴别诊断提供了一种新方法.

长期以来,人们一直把盆底肌训练作为女性用来改善产后性机能状态的“专利”,其实同样适用于男性,尤其适合久坐的办公族男性.长期久坐,盆底肌肉会变得非常松弛,容易诱发前列腺疾病,从而影响男性性功能,导致勃起困难(ED)和射精功能减退.这就是为什么医生通常会对男科患者嘱咐平时要注意训练盆底肌的原因.

及时冷敷发现阴囊血肿后应立即停止活动,有条件的最好在受伤后立即用冰水冷敷患处,在受伤后12小时内不断用冰水或冷水冷敷阴囊,以达到收缩血管、减少局部出血的目的.同时卧床休息,尽量减少不必要的活动.

目的:从大学生自主创作的"性与健康"表演主题探索青少年学生性观念和性态度的改变情况.方法:2010年2月到2014年6月间,在课程中组织学生进行"情景模拟"表演及微电影制作.结果:共收集到95项情景模拟主题和18部微电影.所表演的内容包含多种主题,结局从早期的悲喜剧参半,到后期以喜剧结尾为主.结论:通过创作表演主题,从侧面反映出学生内心真实的性观念和性态度的变化倾向,可作为对以往问卷调查研究结果的补充,为教学改革提供依据.

目的 了解上海社区20 ～ 85岁男性的生殖健康(更年期症状、前列腺症状和性功能)与焦虑抑郁的关系.方法 采用多阶段整群随机抽样法,2013年11月-2014年1月在上海市黄浦区、嘉定区、普陀区、浦东新区抽取的29个街道中共抽取1 366名符合人选条件的调查对象,采用中国中老年男性筛查迟发型性腺功能减退症推荐调查表(SILOH)、老年男子症状问卷(AMS)、国际前列腺症状评分表(IPSS)、慢性前列腺炎症状评分表(NIH-CPSI)、国际勃起功能指数-5表(IIEF-5)、早泄诊断工具(PEDT)、中国早泄患者性功能评价表(CIPE-5)、焦虑自评量表(SAS)和抑郁自评量表(SDS)分别调查男性更年期症状、前列腺症状、性功能和心理健康情况.其中大于40岁者填写SILOH和AMS.分析各种男性生殖健康症状和焦虑抑郁的关系.结果 SAS(或SDS)阳性组与SAS(或SDS)正常组比较,SILOH、AMS、IPSS、NIH-CPSI、IIEF-5、PEDT和CIPE-5各表的得分较差,且各男性生殖问题阳性率较高,差异具有统计学意义.SILOH、AMS、IPSS、NIH-CPSI、IIEF-5、PEDT和CIPE-5各表阳性组与阴性组比较,SAS和SDS的得分较差,且焦虑抑郁的阳性率较高,差异具有统计学意义.结论 男性生殖健康状况与焦虑抑郁等心理问题相互影响.焦虑抑郁加重男性生殖健康状况;生殖健康状况出现问题,易造成焦虑抑郁.

Azoospermia is of great importance to male infertility. Obstructive azoospermia (OA) due to infection is the most prevalent form of OA in China and has been less studied. We aim to observe the treatment outcome of microsurgical vasoepididymostomy (VE) and also to identify the factors relative to the result after reconstructive surgery. Two hundred and eight men presenting with OA due to infection during the study period from July 2010 to July 2013 were prospectively evaluated. Clinical examination, semen analysis, serum follicle stimulating hormone (FSH), and scrotal ultrasound were done before surgical exploration. Among the 198 men who were selected for surgical procedures, 159 candidates underwent microsurgical VE with sperm detected in the epididymal fluid. As for the other 39 cases, reconstruction was not feasible. The average age was 28.5 ± 3.9 years (range 22-38), with average follow-up being 16.5 ± 5.9 months (range 4-28). According to the 150 cases being followed after VE procedures, the total patency rate was 72% (108/150). During follow-up, 38.7% (58/150) natural pregnancies occurred, with overall live birth rate being 32.7% (49/150). Our data suggested that microsurgical VE is an effective therapy for postinfectious epididymal OA. Individualized counseling with prognosis based on etiology should be offered to patients to select optical therapy.

目的:明确从2005到2013期间大学生对性和生殖健康的态度是否发生了改变.方法:分别在2005年4月、2013年5月,随机选取上海市某高校在校学生进行生殖健康问卷调查,现场回收问卷并统一编号.结果:2005年与2013年调研分别收回有效问卷435份和980份.与2005年比2013年调查结果最突出的改变是性态度及性行为的改变.结论:与2005年相比大学生的性态度更为开放.性教育应立足于青年人的实际需要,进行教学改革,并特别重视实践教学.

目的:了解上海市高校大学生对性用品的态度和使用状况,为进一步开展大学生生殖健康教育和服务提供依据.方法:于2014年12月～2015年3月,通过自编网上问卷,以分层整群抽样的方法调查了上海市6所高校的2000名在校大学生.调查内容主要包括:大学生对性用品的了解状况、态度和使用状况.结果:高校大学生对于性用品的总体了解程度不高,对于一般性用品非常了解、比较了解和一般了解的比例分别为6.8％、16.4％和33.3％,大学生对于特殊性用品的了解更少.总体上,高校大学生对于性用品的态度比较开放,对于一般性用品感觉正常使用、感觉很好奇,因为没见过的分别占48.0％、31.7％.高校大学生一般性用品和特殊性用品的总体使用率分别为15.6％和4.0％,使用率随着年级的增高呈上升趋势.大部分大学生不同程度地希望更加深入了解性用品.结论:大学生对性用品的态度比较开放,对性用品了解程度不高;建议在高校生殖健康教育中进一步融入性用品的知识.

在男性不育的治疗中，显微外科技术的介入，使患者通过有效的外科治疗，改善或者恢复生育力。目前男性不育的显微外科治疗包括精索静脉曲张显微结扎术、输精管输精管显微吻合术、输精管附睾管显微吻合术及睾丸显微取精术。精索静脉曲张显微结扎术适用于合并精索静脉曲张的少弱精子症患者，输精管输精管显微吻合术应用于输精管结扎术要求复通者及输精管离断者，输精管附睾管显微吻合术适用于感染或者原发性附睾梗阻患者，这两种手术通过恢复输精管道通畅使患者获得自然授孕的机会。睾丸显微取精术用于非梗阻性无精子症（ non-obstructive azoospermia ， NOA）患者，所取精子结合辅助生殖技术可使患者生育自己的子代。男性不育的显微外科治疗技术的推广，提高了男性不育的整体疗效与治疗水平，成为除辅助生殖治疗以外的重要的治疗组成部分。

Objectives:To evaluate the effect of modified prostate massage in the treatment of chronic pros-tatitis. Methods:There were totally 188 patients diagnosed as type III A prostatitis in the group from January to October in 2013.62 patients received oral tamsulosin hydrochloride sustained release tables (a table one night), levofloxacin lactate tables (twice a day,200mg once),qianliexiao suppository (a piece one night)by rectal admin-istration for 6 weeks.The other 126 patients were treated by modified prostate massage combined with medicines for 6 weeks.The NIH -Chronic Prostatitis Symptom Index (NIH -CPSI)and prostatic massage fluid (EPS)were per-formed before and after treatment.Changes were recorded and compared.Results:The demography and baseline data were similar in the two groups of patients.The subjective symptoms after treatment were significantly improved in CPSI (P <0.05).There were statistical differences between two groups in the decrease of CPSI (P <0.05). Conclusion:The symptoms of the patients with III A prostatitis can be largely alleviated by treatment with tamsulo-sin hydrochloride sustained release tables,levofloxacin lactate tablets and qianliexiao suppository.The treatment effect of oral medicines can be obviously enhanced with modified prostate massage.

目的：探讨抑制素B（InhibinB， InhB）用于预测精索静脉曲张（Varicocele， VC）手术后精液参数的改变情况。方法选取2012年2月至2013年10月上海交通大学医学院附属仁济医院泌尿男科门诊收治的VC型男性不育症患者92例。术前完成相关检测，包括完善病史登记，精液常规分析，卵泡刺激素（follicle-stimulating hormone，FSH）、睾酮（testosterone，T）和InhB检查等。所有患者均接受左侧精索静脉显微结扎术，术后12周随访精液常规分析、FSH、T、InhB。对术前、术后相关指标进行分析比较。结果根据术后12周精液参数改变情况将患者分为改善组（59例）和未改善组（33例），改善组术后12周精子浓度明显提高（P＜0.05），未改善组精子浓度变化差异无统计学意义（P＜0.05）；两组术后InhB水平均有明显提高，术前及术后12周InhB水平，改善组均明显高于未改善组（ P＜0.05）。根据术前InhB水平将患者分为低InhB组（38例）和高InhB组（54例），低InhB组治疗有效率低于高InhB组（P＜0.05）。结论 VC术前InhB水平的高低，与术后精液参数是否能得到明显改善有一定关系，可作为VC患者手术选择参考指标之一。

李先生今年40多岁,发现尿液淋漓不尽很久了,由于工作繁忙一直熬着,最近明显感到下腹胀痛和尿痛他才到医院就诊,医生对他进行详细的检查和问诊后,得出结论——慢性前列腺炎.确诊后,他向医生提出许多疑问,也正如多数读者想要了解的关于慢性前列腺炎的问题一样,下面一一回答大家. 性生活对前列腺炎有影响吗? 李先生认为,患有前列腺炎,就必须注重养生保健,不能有房事,他患病以来与妻子不过性生活,夫妻俩还闹了矛盾.