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.

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.

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.

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.

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.