A modified single-armed technique for microsurgical vasoepididymostomy

This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy （VE） in patients with epididymal obstructive azoospermia. From September 2011 to December 2011, microsurgical two-suture longitudinal intussusception VEs were performed using our modified single-armed suture technique in 17 men with epididymal obstructive azoospermia at our hospital. Two of these patients underwent repeated VEs after previous failed VEs, and one patient underwent unilateral VE because of an occlusion of the left abdominal vas deferens. The presence of sperm in the semen sample at 3 months postoperation was used as the preliminary endpoint of this study. Each patient provided at least one semen sample at the 3-month time point, and the patency was assessed by the reappearance of sperm （〉 104 m I- 1） in the semen. The mean operative time for the modified technique was 219 min. Patency was noted in 10 men （58.8%）, including one patient who underwent repeated VE. The patient who underwent unilateral anastomosis manifested no sperm postoperatively in his semen. Sperm granulomas were not detected in this cohort. The results of this study demonstrate that our modified technique for microsurgical longitudinal intussusception VE is effective. We believe that it is a practical alternative that may reduce operation time and obviate the suture crossing.

Recent advances in andrology-related stem cell research

Stem cells hold great promise for regenerative medicine because of their ability to self-renew and to differentiate into various cell types. Although embryonic stem cells （BSC） have greater differentiation potential than adult stem cells, the former is lagging in reaching clinical applications because of ethical concerns and governmental restrictions. Bone marrow stem cells （BMSC） are the best-studied adult stem cells （ASC） and have the potential to treat a wide variety of diseases, including erectile dysfunction （ED） and male infertility. More recently discovered adipose tissuederived stem cells （ADSC） are virtually identical to bone marrow stem cells in differentiation and therapeutic potential, but are easier and safer to obtain, can be harvested in larger quantities, and have the associated benefit of reducing obesity. Therefore, ADSC appear to be a better choice for future clinical applications. We have previously shown that ESC could restore the erectile function of neurogenic ED in rats, and we now have evidence that ADSC could do so as well. We are also investigating whether ADSC can differentiate into Leydig, Sertoli and male germ cells. The eventual goal is to use ADSC to treat male infertility and testosterone deficiency. （Asian JAndrol 2008 Mar; 10： 171-175）

Long-term sexual activity status and influencing factors in men after surgery for hypospadias

The aim of this study was to compare the long-term postoperative status of hypospadiac patients by analysing their sexual psychology, sexual behaviour, sexual function and influencing factors. A total of 130 hypospadiac patients hospitalized between January 1988 and December 2007 were followed up with questionnaires using Zung＇s Self-rating Depression Scale （SDS）, Self-rating Anxiety Scale （SAS）, a self-designed sexual function questionnaire and a 5-item version of the International Index of Erectile Function （IIEF-5）. The surveys served to evaluate the effects of hypospadias type, number of operations and surgical procedures on sexual psychology, sexual behaviour and sexual function. The control group consisted of 50 healthy adults. The postoperative SDS / SAS scores and occurrences of depression/anxiety in hypospadiac patients were significantly higher than those of normal controls （P 〈 0.001）. Patients with proximal hypospadias and multiple procedures differed from those with distal hypospadias and a single procedure in all parameters of sexual psychology （P 〈 0.05）. The average penile lengths and circumferences ofhypospadiac patients under either erect or flaccid conditions were significantly shorter than those of normal controls （P 〈 0.001）. A similar difference existed between patients with distal and proximal hypospadias （P 〈 0.01）. There was no significant difference in any parameter of sexual function between patients with different numbers of operations and surgical procedures. Hypospadiac patients were clearly impaired in sexual psychology and penile development. The severity of hypospadias and number of operations were key factors that influenced the sexual psychology of patients. This finding indicated the importance of long-term follow-up and psychological counselling for hypospadiac patients postoperatively.

Stem cell-based therapies for fertility preservation in males:Current status and future prospects

With the decline in male fertility in recent years,strategies for male fertility preservation have received increasing attention.In this study,by reviewing current treatments and recent publications,we describe research progress in and the future directions of stem cell-based therapies for male fertility preservation,focusing on the use of spermatogonial stem cells(SSCs),SSC niches,SSC-based testicular organoids,other stem cell types such as mesenchymal stem cells,and stem cell-derived extracellular vesicles.In conclusion,a more comprehensive understanding of the germ cell microenvironment,stem cell-derived extracellular vesicles,and testicular organoids will play an important role in achieving male fertility preservation.

The clinical curative effect of transurethral resection of the ejaculatory duct for iatrogenic ejaculatory duct obstruction after prostatic hyperthermia

Dear Sir, I am a urologic doctor from Urology Department of The First Affiliated Hospital of Sun Yat-Sen University of Medical Science. Recently our group find there are some patients diagnosed with iatrogenic ejaculatory duct obstruction （EDO） after prostatic hyperthermia. This finding showed it was dangerous that some nullibreeding patients of prostatitis were treated with prostatic hyperthermia, which could induce EDO and urethrosten.osis.

Microsurgical vasovasostomy for the treatment ol ntractable chronic scrotal pain after vasectomy

Dear Editor, We present herein two rare cases of intractable chronic scrotal pain after vasectomy. The patients were effectively treated with microsur-gical vasovasostomy （MVV）. We also discuss the possible aetiologies of the pain and other surgical options.

Comparison of Efficacy of Two Vitrification Solutions for Mouse Morulae

Objective To study the efficacy of two vitrification solutions for mouse morulae Methods Good morulaes of NIH mice were collected and used to test toxicity of the vitrification solutions EDS40 （40% ethylene glycol, 18% dextran and 0.5 tool sucrose） and EFS40 （40% ethylene glycol, 18% ficoll and 0.5 tool sucrose）. Fine vitrified morulae were packaged in 0.25 mL plastic straws and immersed into liquid nitrogen and cryopreserved for about 2-3 months. Then the straws were heated rapidly, washed in Ham＇s F12 medium and cultured. The viability was determined by morphology and blastocyst formation after being cultured for 48 h. Some embryos were transplanted to recipients after being cultured for 12-14 h. The number of pregnant recipients and young born was counted and analyzed by Chi-squared test. Results The toxicity of EDS40 solution was significantly lower than that of EFS40 （P〈0.05） and the number of embryos developed to the blastocysts after vitrification in EDS40 was significantly higher than in EFS40 （P〈0.05）. The number of zona pellucida and the number of pregnancy and birth integrated after vitrification cryopreservation had no significant difference between EDS40 and EFS40 （P〉0.05）. However, the embryo fineness rates after vitrification in EDS40 was significantly better than in EFS40 （P〈0.01）. Conclusion EDS40 solution has less toxicity and better cryoprotect effect on embryos than EFS 40.

Transsphenoidal surgery for prolactinomas in male patients:a retrospective study

Male patients with prolactinomas usually present with typical hyperprolactinemia symptoms,including sexual dysfunction and infertility.However,clinical factors related to sexual dysfunction and surgical outcomes in these patients remain unclear.This study aimed to investigate the outcomes of male patients with prolactinomas after transsphenoidal surgery and the risk factors affecting sexual dysfunction.This study was conducted on 58 male patients who underwent transsphenoidal surgery for prolactinomas between May 2014 and December 2020 at the First Affiliated Hospital of Sun Yat-sen University,Guangzhou,China.We evaluated the sexual function of patients before and after surgery through International Index of Erectile Function-5 scores,libido,and frequency of morning erection.Of the 58 patients,48(82.8%)patients had sexual intercourse preoperatively.Among those 48 patients,41(85.4%)patients presented with erectile dysfunction.The preoperative International Index of Erectile Function-5 scores in patients with macroprolactinomas were significantly higher than those in patients with giant prolactinomas(17.63±0.91 vs 13.28±1.43;P=0.01).Postoperatively,the incidence of erectile dysfunction was 47.9%,which was significantly lower than that preoperatively(85.4%;P=0.01).Twenty-eight(68.3%)patients demonstrated an improvement in erectile dysfunction.Tumor size and invasiveness were significantly correlated with the improvement of erectile dysfunction.Preoperative testosterone<2.3 ng ml^(-1)was an independent predictor of improvement in erectile dysfunction.In conclusion,our results indicated that tumor size and invasiveness were important factors affecting the improvement of sexual dysfunction in male patients with prolactinoma.The preoperative testosterone level was an independent predictor related to the improvement of erectile dysfunction.

A novel experience of deferential vessel-sparing microsurgical vasoepididymostomy

Microsurgical longitudinal intussusception vasoepididymostomy （LIVE） has been widely used to treat epididymal obstructive azoospermia since 2004. Although the deferential vasculature plays an important role in supplying blood to the testis and epididymis, little attention has been paid to the potential benefits of sparing the deferential vessels during the anastomosis in LIVE. This study aimed to evaluate the efficacy and safety of deferential vessel-sparing LIVE in humans. From December 2013 to December 2015, 69 azoospermic men with epididymal obstruction due to a genital infection, trauma, or idiopathic factors underwent deferential vessel-sparing LIVE in the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. The outcomes of these patients were analyzed retrospectively. The mean age was 31.1 years for men and 28.3 years for their partners. Fifty-nine （85.5%, 59/69） men were followed up after surgery for approximately 16 months. Patency was noted and confirmed by semen analysis （〉10 000 sperm/ml） in 83.1% （49159） of men. The natural pregnancy rate was 40.7% （24/59） by the end of the study, with 87.5% （21124） of these natural pregnancies achieved within 12 months after surgery. No severe adverse events or complications were observed. In this study, we present a novel technique for sparing the deferential vessels during LIVE. The preliminary outcomes show this technique to be safe with favorable patency and pregnancy rates.

Effects of velvet antler polypeptide on sexual behavior and testosterone synthesis in aging male mice

Twenty-four-month-old male C57BU6 mice with low serum testosterone levels were used as a late-onset hypogonadism （LOH） animal model for examining the effects of velvet antler polypeptide （VAP） on sexual function and testosterone synthesis. These mice received VAP for 5 consecutive weeks by daily gavage at doses of 100, 200, or 300 mg kg-1 body weight per day （n = 10 mice per dose）. Control animals （n = 10） received the same weight-based volume of vehicle. Sexual behavior and testosterone levels in serum and interstitial tissue of testis were measured after the last administration of VAP. Furthermore, to investigate the mechanisms of how VAP affects sexual behavior and testosterone synthesis in vivo, the expression of steroidogenic acute regulatory protein （STAR）, cytochrome P450 cholesterol side-chain cleavage enzyme （P450scc）, and 3β-hydroxysteroid dehydrogenase （3βHSD） in Leydig cells was also measured by immunofluorescence staining and quantitative real-time PCR. As a result, VAP produced a significant improvement in the sexual function of these aging male mice. Serum testosterone level and intratesticular testosterone （ITT） concentration also increased in the VAP-treated groups. The expression of STAR, P450scc, and 3β-HSD was also found to be enhanced in the VAP-treated groups compared with the control group. Our results suggested that VAP was effective in improving sexual function in aging male mice. The effect of velvet antler on sexual function was due to the increased expression of several rate-limiting enzymes of testosterone synthesis （STAR, P450scc, and 3β-HSD） and the following promotion of testosterone syothesis in vivo.

Establishing a nonlethal and efficient mouse model of male gonadotoxicity by intraperitoneal busulfan injection

An ideal animal model of azoospermia would be a powerful tool for the evaluation of spermatogonial stem cell(SSC)transplantation.Busulfan has been commonly used to develop such a model,but 30%–87%of mice die when administered an intraperitoneal injection of 40 mg kg^?1.In the present study,hematoxylin and eosin staining,Western blot,immunofluorescence,and quantitative real-time polymerase chain reaction were used to test the effects of busulfan exposure in a mouse model that received two intraperitoneal injections of busulfan at a 3-h interval at different doses(20,30,and 40 mg kg^?1)on day 36 or a dose of 40 mg kg^?1 at different time points(0,9,18,27,36,and 63 days).The survival rate of the mice was 100%.When the mice were treated with 40 mg kg^?1 busulfan,dramatic SSC depletion occurred 18 days later and all of the germ cells were cleared by day 36.In addition,the gene expressions of glial cell line-derived neurotrophic factor(GDNF),fibroblast growth factor 2(FGF2),chemokine(C-X-C Motif)ligand 12(CXCL12),and colony-stimulating factor 1(CSF1)were moderately increased by day 36.A 63-day,long-term observation showed the rare restoration of endogenous germ cells in the testes,suggesting that the potential period for SSC transplantation was between day 36 and day 63.Our results demonstrate that the administration of two intraperitoneal injections of busulfan(40 mg kg^?1 in total)at a 3-h interval to mice provided a nonlethal and efficient method for recipient preparation in SSC transplantation and could improve treatments for infertility and the understanding of chemotherapy-induced gonadotoxicity.

Psychological burden prediction based on demographic variables among infertile men with sexual dysfunction

There has been increasing interest in the psycho-socio-relational and sexual disorders of infertility,as the risk of psychological burden among in fertile men with sexual dysf un ctio ns is sign ifica nt.The purpose of this study was to develop and to validate a predictive model to estimate in dividual psychological burde n among in fertile men with sexual dysf unction and study the associati on betwee n them.Comprehe nsive data were collected for in fertile men(n=480)who sought treatme nt for infertility in a reproductive medici ne center between June 2012 and December 2013.Using independent predictors of psychological burden from the least absolute shrinkage and selection operator,univariable and multivariable analyses were developed into two models.Predictive accuracy was compared between the models.We explored the association between sexual dysfunction and psychological burden.A total of 480 patie nts were an a lyzed using 10-fold cross-validatio n.In depende nt predictors of psychological burde n were incorporated into a model to measure anxiety(corrected-area under curve(AUC):77.3%)and a model to measure depression(corrected-AUC:70.2%).Anxiety and depression were both associated with erectile dysfunction(P<0.05),with anxiety demonstrating the strongest association.Only anxiety was associated with premature ejaculation(P>0.05).Premature ejaculation was not found to be associated with depression(P>0.05).Predictive models for psychological burden among infertile men with sexual dysfunction are presented,and we found that there is an association between psychological burden and sexual dysfunction.According to the models,proper counseling and treatment of sexual dysfunction in infertile men may reduce the psychological burden,help attain natural pregnancy,and improve the quality of life.

The effect of the degree of left renal vein constriction on the development of adolescent varicocele in Sprague-Dawley rats

Experimental models have allowed inquiry into the pathophysiology of varicocele （VC） beyond that possible with human patients. A randomized controlled study in rats was designed to clarify the influence of the degree of left renal vein constriction on the development of adolescent VC. Fifty adolescent male Sprague-Dawley rats （Rattus norvegicus） were randomly assigned to five groups of 10： the experimental groups （I-IV） underwent partial ligation of left renal veins with 0.5-, 0.6-, 0.7-, and 0.8-mm diameter needles, respectively. The control group （V） underwent a sham operation. The diameter of the left spermatic vein （LSV） was measured at baseline and 30 days postoperatively. In addition, the lesion of the left kidney was examined with the naked eye and assessed by Masson＇s trichrome staining. VC was successfully induced in 2 （20%）, 4 （40%）, 7 （70%）, and 10 （100%） rats in groups I-IV, respectively. The other rats failed to develop VCs primarily due to left renal atrophy. No VC was observed in group V. The postsurgical LSV diameters in VC rats in groups III and IV were 1.54 ± 0. 16 and 1.49 ± 0.13 mm, respectively （P〉 0.05）, and their increments were 1.36±0. 10 and 1.31±0. 10 ram, respectively （P 〉 0.05）. These results suggest that suitable constriction of the left renal vein is critical for adolescent VC development. In addition, the 0.8-mm diameter needle may be more suitable for inducing left renal vein constriction in adolescent rat models.

Erectile dysfunction is associated with subclinical carotid vascular disease in young men lacking widely-known risk factors

This study aimed to gain insight into the underlying pathogenesis of erectile dysfunction in young men under the age of 40 years without widely-known risk factors. Compared with normal controls, patients with erectile dysfunction had increased carotid intima- media thickness, fasting levels of blood glucose and insulin, and homeostatic model assessment index, as well as lower flow-mediated vasodilation and testosterone levels （P 〈 0.05）, though all of these values were within their respective normal range. Multivariate logistic regression analysis identified carotid intima-media thickness, flow-mediated vasodilation, insulin level, and homeostatic model assessment index as significant predictors of erectile dysfunction. Young men with flow-mediated vasodilation 〈10.65% were 11.645 times more likely to have erectile dysfunction, young men with carotid intima-media thickness 〉0.623 mm had a 4.16-fold, and young men with homeostatic model assessment index 〉1.614 had a 5.993-fold greater risk of having erectile dysfunction. In conclusions, in young men with normal results from general clinical screening, an increased carotid intima-media thickness and homeostatic model assessment index and reduced flow-mediated vasodilation were associated with a higher incidence of erectile dysfunction. Erectile dysfunction may appear before the detection of traditional cardiovascular risk factors and may be the earliest clinical sign of subclinical cardiovascular disease.

Application of the Mathieu combined tunnel technique for repairing glans dehiscence after failed hypospadias repair

Repairing glans dehiscence after failed hypospadias repair is challenging for pediatric surgeons.Here,we introduced and evaluated a newly modified Mathieu technique,Mathieu combined tunnel(MCT),which involves multiple custom-designed flaps for the shortage of flap source material after repeated operations;we also constructed a tunnel to avoid the glans incision that may carry new risks of dehiscence.This retrospective study included 26 patients who were consecutively admitted to the First Affiliated Hospital of Sun Yat-Sen University(Guangzhou,China)for glans dehiscence repair after failed hypospadias repair from October 2014 to October 2020;sixteen patients underwent surgery using the MCT(MCT group)and ten patients underwent surgery using the tubularized incised plate(TIP)technique(TIP group).The operative time,blood loss,postoperative complications,normal urethral meatus rate,success rate,and Hypospadias Objective Penile Evaluation(HOPE)score were compared between the two groups.The MCT group achieved an overall satisfactory penile appearance and voiding function,with a higher rate of normal urethral meatus(15/16,93.8%)and a lower rate of glans dehiscence(1/16,6.2%),compared with the TIP group(70.0%and 30.0%,respectively).However,these differences were not statistically significant,possibly because of the limited number of patients(all P>0.05).Mean postoperative HOPE scores were similar in the MCT group(mean±standard deviation:8.83±0.89)and TIP group(8.94±0.57)(P>0.05).No significant differences were found between the two groups in terms of blood loss and success rate,nor in the rates of various complications(e.g.,fistula,urethral stricture,and glans dehiscence).In conclusion,the MCT technique appears to be feasible and reliable for repairing glans dehiscence after failed hypospadias repair.

An alternative surgical technique for varicoceles:a preliminary experience of the microsurgical spermatic(distal end)-inferior or superficial epigastric vein anastomosis in symptomatic varicoceles associated with perineal pain

Many therapies are effective in treating varicoceles,including dilation of the pampiniform plexus in males.The most common method of treatment is varicocelectomy.We aimed to assess an alternative technique(microsurgical spermatic[distal end]-superficial or inferior epigastric vein anastomosis)that preserves the normal blood flow pattern for varicocele treatment.We retrospectively analyzed 27 men with varicocele between October 2019 and July 2020.All patients underwent microsurgical spermatic(distal end)-superficial or inferior epigastric vein anastomosis.The prognosis was reviewed retrospectively with an additional survey conducted 3 months after surgery.The mean±standard deviation of the age was 26.1±7.3 years in patients with microsurgical spermatic(distal end)-superficial or inferior epigastric vein anastomosis.The maximum diameter of the varicocele vein,perineal pain score,sperm density,and forward movement of sperm improved over 3 months after surgery.Microsurgical spermatic(distal end)-superficial or inferior epigastric vein anastomosis is a safe and efficient surgical treatment for varicoceles.

A giant adult paratesticular rhabdomyosarcomar

Dear Editor, Rhabdomyosarcoma （RMS） is a rare malignant neoplasm that can involve the bladder, prostate, vagina, or paratesticular area. 2he peak incidence ofparatesticular RMS occurs at 2-5 years of age. Herein, we report a case of adult paratesticular RMS that is relatively uncommon. A 20-year-old man presented with a mass in the left scrotum that had been progressively growing over a period of 1 month. 3he patient had found a pea-size neoplasm in the scrotum during bathing 1 month previously. Subsequently, it grew quickly in the scrotum without causing pain and fever. The physical examination resulted in the detection of a soft mass with mild tenderness in the left scrotum.