Clinical observation of loupe-assisted intussusception vasoepididymostomy in the treatment of obstructive azoospermia(analysis of 49 case reports)

To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy(VE)in the treatment of epididymal obstructive azoospermia(EOA),we retrospectively analyzed data from 49 patients with EOA who underwent two-suture longitudinal intussusception vasoepididymostomy(LIVE)between 2000 and 2007.The data included the surgical method,postoperative motile sperm count per ejaculation,percentage of progressive motile sperm and patency and pregnancy outcomes.There were a total of 49 men undergoing scrotal exploration,and epididymal obstruction was found in all cases.Bilateral or unilateral anastomoses were performed in 40 and 6 men,respectively.The postoperative courses of 42 patients were followed up for more than 6 months,and the courses of 38 patients were followed up for more than 1 year.The overall patency and pregnancy rates were 71.4%and 26.3%,respectively.Moreover,progressive motile sperm was more frequently present in those patients who had undergone anastomosis at cauda than at corpus or caput.Pregnancy was achieved only in those patients who had undergone anastomosis at least on one side of the cauda epididymis.We think that the loupe-assisted method,with a lower overall cost and a simplified surgical procedure,can achieve satisfactory patency outcomes and pregnancy results.Data from this paper also suggest that paternity outcomes occur more frequently after anastomoses at cauda than at corpus or caput.

首次接受5型磷酸二酯酶抑制剂治疗的中国男性勃起功能障碍患者中比较枸橼酸西地那非和他达拉非治疗的开放、多中心、随机交叉研究

本研究旨在比较中国男性勃起功能障碍（ED）患者首次接受5型磷酸二酯酶（PDE5）抑制剂治疗时，西地那非和他达拉非治疗的选择偏爱、疗效和耐受性。本研究对中国男性ED患者偏爱20mg他达拉非或100mg西地那非进行了评估。4周基线评估后，383例合格患者随机接受20mg他达拉非／100mg西地那非序贯治疗或相反顺序给药治疗8周，在之后的8周延长期间患者自主选择治疗方案。采用PDE5抑制剂治疗偏爱问卷（PITPQ）的问题1作为主要疗效指标，PITPQ问题2、国际勃起功能指数．勃起功能域（IIEF．EF）、SEP问题25U3，及药品属性问卷分析次要疗效指标。350例男性患者（91％）完成了随机治疗阶段。8周的延长期治疗中，242（69．1％）例患者偏爱20mg他达拉非以及108（30．9％）例患者偏爱100mg西地那非治疗（P〈O．001）。92（38％）例患者强烈偏爱他达拉非治疗以及37（34_3％）例患者强烈偏爱西地那非治疗。他达拉非和西地那非治疗组的SEP2、SEP3$1]IIEF．EF域评分均有所改善。偏爱他达拉非治疗的患者服药很长时间后可以发生勃起是偏爱他达拉非的主要原因。大于2％的不良反应只含头痛症状。西地那非和他达拉非治疗均有效且安全。在接受他达拉非和西地那非治疗后，更多首次接受PDE5抑制剂治疗的中国男性ED患者偏爱他达拉非治疗。

A randomized clinical trial investigating treatment choice in Chinese men receiving sildenafil citrate and tadalafil for treating erectile dysfunction

Sildenafil and tadalafil are efficacious and well tolerated in Chinese men with erectile dysfunction （ED）. Recent study results indicate that men with ED in China who were naive to phosphodiesterase inhibitor type 5 （PDE5） therapy prefer tadalafil 20-mg （on-demand） versus sildenafil 100-mg （on-demand）. Differences in psychosocial outcomes may help to explain treatment preference in favor of tadalafih This open-label, randomized, crossover study compared psychosocial outcomes and drug attribute choices between tadalafil and sildenafil in Chinese men with ED na＇（ve to PDE5 inhibitor therapy. Eligible patients were randomized to sequential 20-mg tadalafU/lOO-mg sildenafil （n = 190） or 100-mg sildenafil/20-mg tadalafil （n = 193） for 8 weeks each and were asked which treatment they preferred to take for the 8-week extension phase. Psychosocial outcomes were assessed using the Psychological and Interpersonal Relationship Scale （PAIRS）, Drug Attributes Questionnaire （DRAQ）, and Sexual Life Quality Questionnaire （SLQQ）. When taking tadalafil versus sildenafil, men had a higher mean endpoint score on the PAIRS Spontaneity Domain （tadalafil = 2.86 vs sildenafil = 2.72; P 〈 0.001）, and a lower mean endpoint score on the Time Concerns Domain （tadalafil = 2.41 vs sildenafil = 2.55; P 〈 0.001）. A numerical increase in the Sexual Self-Confidence Domain was observed when taking tadalafil versus sildenafil （tadalafil -- 2.76 vs sildenafil = 2.72; P= 0.102）. The most frequently chosen drug attributes explaining treatment preference were able to get an erection long after having drug, and ability to get an erection every time. SLQQ results were comparable between treatment groups. These psychosocial outcomes may explain why more Chinese men preferred tadalafil versus sildenafil for the treatment of ED in this clinical trial.

Penile augmentation with injectable hyaluronic acid gel:an alternative choice for small penis syndrome

There is no well-established procedure for the management of small penis syndrome(SPS),especially when psychological interventions fail.This study aimed at systematically evaluating the physical and psychological benefits of penile augmentation(PA)using injectable hyaluronic acid(HA)gel.Thirty-eight patients receiving PA with HA gel from January 2017 to March 2020 were included and followed up for 1 year.Penile size,erectile function,and psychological burden measured by the Index of Male Genital Image(IMGI),Index of International Erectile Function(lIEF),and Beliefs about Penis Size(BPAS),respectively,were assessed at the beginning and at 1,3,6,and 12 months postinjection.The volume of HA gel injected was 21.5±3.7 ml.Compared to baseline data,flaccid penile girth and length significantly increased by 3.41±0.95 cm(P<0.01)and 2.55±0.55 cm(P<0.01)at the 1^(st)month postinjection,respectively.At the endpoint,despite attenuations,statistically significant improvements in flaccid penis size were still obtained,namely 2.44±1.14 cm in girth(P<0.01)and 1.65±0.59 cm in length(P<0.01).Similarly,erectile penile girth statistically increased by 1.32±1.02 cm(P<0.01)at the 1^(st)month but were only 0.80±0.54 cm bigger than baseline(P<O.01)at the endpoint.At the 1^(st)month,the average score of IMGI and the mean score of IIEF statistically increased by 46.2±10.5(P<0.01)and 7.6±6.2(P<0.01),respectively;the score of BAPS significantly decreased by 18.3±4.5(P<0.01).These alterations remained steady during follow-up.Considering the significant penile size improvement,lasting psychological benefit,and low complication rate,PA with HA might serve as an appropriate alternative for patients with SPS.

Multivariate analysis of factors predicting surgical intervention for hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

Hemorrhagic cystitis(HC),which is characterized by a congested vasculature and extensive hemorrhage in the bladder lamina propria,is often secondary to chemotherapy,external radiation therapy,allogeneic hematopoietic stem cell transplantation(Allo-HSCT),and/or opportunistic infection.[1]The incidence of HC after Allo-HSCT has been reported to range between 1.3%and 20%.[2]The severity of HC may vary from bladder irritation symptoms with mild hematuria,which is observed in most cases and is resolved with conservative management,such as adequate hydration and bladder irrigation,to transfusion-dependent hemorrhage and/or a lower urinary tract obstruction post renal failure.Other strategies,including bladder irrigation with intravesical alum,formalin,aminocaproic acid,or prostaglandin and hyperbaric oxygen therapy,have been reported,with the resolution of bleeding in the majority of cases.[3]However,for patients in whom these measures fail and the lower urinary tract becomes obstructed by numerous blood clots,further surgery,including internal iliac angioembolization,cystoscopy with control of bladder hemorrhage and cystectomy,should be considered.[4]

An analysis of treatment preferences and sexual quality of life outcomes in female partners of Chinese men with erectile dysfunction

The impact of erectile dysfunction is distressing to both males and their female partners, but less attention has been paid to identify female partners＇ preferred treatment and sexual quality of life outcomes. The present analysis explores female partners＇ treatment preference for erectile dysfunction in Chinese Men. This was a phase 4, randomized, open-label, multicenter, crossover study in Chinese men with erectile dysfunction who were na＇fve to phosphodiesterase type 5 inhibitor treatments. Eligible patients were randomized to sequential 20-mg tadalafil/100-mg sildenafil or lO0-mg sildenafil/20-mg tadalafil for 8 weeks each. Of 418 patients, female partners of 64 patients agreed to enter the study; of 64 patients who entered the study with female partners, 63 were randomized, and 62 completed the study. Baseline demographics and disease characteristics were comparable between treatment groups. Significantly more couples preferred tadalafil compared with sildenafil overall （75.4% vs 24.6%; P〈 0.001）, and irrespective of erectile dysfunction severity at baseline （P 〈 0.005）. Significant improvements in sexual quality of life scores were reported at endpoint （Visit 8） in male patients and female partners in both tadalafil and sildenafil treatment groups （P 〈 0.001）. Significantly higher mean changes from baseline were observed for male patients in the tadalafil group compared with the sildenafil group for the erectile function （P = 0.013） and overall satisfaction （P = 0.019） International Index for Erectile Function domains and the spontaneity domain （P〈 0.001） of the Psychological and Interpersonal Relationship Scale. No major safety concerns were reported during the study. Though both treatments were effective, safe, and tolerable, more couples preferred tadalafil compared with sildenafil.