Male genital damage in COVID-19 patients:Are available data relevant?

Over the past few weeks,we have observed increasing concern about the possible impact of coronavirus disease 2019(COVID-19)which is caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2 virus)on male fertility.Precise mechanisms of male reproductive damages are still unclear,but it seems that high temperature resulting from persistent fever and triggering a secondary autoimmune response leading to an autoimmune orchitis are the most likely involved mechanisms.Also,angiotensin conversion enzyme 2(ACE2)plays a highly important role in cellular entry for SARS-CoV-2 and male genital system presents high ACE2 expression.All these preliminary findings suggest that COVID-19 could impact men's reproductive health.Thus,we examined available data including published and unpublished articles to assess the potential risk of COVID-19 in particular on the male reproductive system.

Human Herpes Virus Type 2 ( HSV2 ), Human Cytomegalovirus (HCMV) in the Male Genital Tract and Fertilization

The possibility of infection of the human male genital tract by human herpes virus type 2 (HSV2) or human cytomegalovirus (HCMV) is well established and their sexual transmission has been the object of many studies. Moreover, medically assisted procreation, which helps in numerous fertility problems, raises the question of new viral risks linked to the application of these new technologies. In this review, we shall consider current knowledge in terms of the presence of HSV 2 and HCMV in the different parts of the genital tract of immunocompetent or immunodepressed men. We shall also consider the possibility of viral transmission by the sexual act or by the various techniques used in medically assisted procreation. We shall describe studies in human beings and in animals.

Extra-Pulmonary Tuberculosis in the Uterine Cervix: A Case Report

Tuberculosis of the uterine cervix is grouped under genital tuberculosis. Other sites for genital tuberculosis include the Fallopian tubes and the endometrium. Genital tuberculosis and other types of tuberculosis outside the lungs are referred to as extra-pulmonary tuberculosis (EPTB). Genital tuberculosis presents with unspecific symptoms and signs;and because of this, most often, the diagnosis is made incidentally during investigations for other conditions that present with similar clinical pictures. Therefore, misdiagnosis and wrong treatment are not uncommon. We present a case of tuberculosis of the uterine cervix which was incidentally diagnosed when the patient was being investigated for cervical cancer, and successfully treated with a 6-months rifampicin regimen, 2RHZE/4HRE. Health providers have a duty to highly suspect tuberculosis of the cervix among women who present with abnormal vaginal discharge, abnormal vaginal bleeding and post-coital bleeding especially in countries where HIV and TB are endemic. If properly diagnosed and correctly treated, tuberculosis of the uterine cervix is curable.

A clinical dilemma:abdominal tuberculosis

AIM:To evaluate the clinical,radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis. METHODS:Thirty-one patients diagnosed as abdominal TB between March 1998 and December 2001 at the Gastroenterology Department of Kartal State Hospital, Istanbul,Turkey were evaluated prospectively.Complete physical examination,medical and family history,blood count erythrocyte sedimentation rate,routine biochemical tests, Mantoux skin test,chest X-ray and abdominal ultrasonography (USG) were performed in all cases,whereas microbiological examination of ascites,upper gastrointestinal endoscopy,colonoscopy or barium enema,abdominal tomography,mediastinoscopy,laparoscopy or laparotomy were done when needed. RESULTS:The median age of patients (14 females,17 males) was 34.2 years (range 15-65 years).The most frequent symptoms were abdominal pain and weight loss. Eleven patients had active pulmonary TB.The most common abdominal USG findings were ascites and hepatomegaly.Ascitic fluid analysis performed in 13 patients was found to be exudative and acid resistant bacilli were present in smear and cultured only in one patient with BacTec (3.2%).Upper gastrointestinal endoscopy yielded nonspecific findings in 16 patients.Colonoscopy performed in 20 patients showed ulcers in 9 (45%),nodules in 2 (10%) and,stricture,polypoid lesions,granulomatous findings in terminal ileum and rectal fistula each in one patient (5%). Laparoscopy on 4 patients showed dilated bowel loops, thickening in the mesentery,multiple ulcers and tubercles on the peritoneum.Patients with abdominal TB were divided into three groups according to the type of involvement. Fifteen patients (48%) had intestinal TB,11 patients (35.2%) had tuberculous peritonitis and 5 (16.8%) tuberculous lymphadenitis.The diagnosis of abdominal TB was confirmed microbiologically in 5 (16%) and histo- pathologically in 19 patients (60.8%).The remaining nine patients (28.8%) had been diagnosed by a positive response to antituberculous treatment. CONCLUSION:Neither clinical signs,laboratory,radiological and endoscopic methods nor bacteriological and histopathological findings provide a gold standard by themselves in the diagnosis of abdominal TB.However,an algorithm of these diagnostic methods leads to considerably higher precision in the diagnosis of this insidious disease which primarily necessitate a clinical awareness of this serious health problem.

Diagnosis of abdominal tuberculosis:Experience from 11 cases and review of the literature

AIM:To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS:The records of 11 patients (4 males,7 females, mean age 39 years,range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed. RESULTS:Ascites was present in all cases.Other common findings were weight loss (81%),weakness (81%),abdominal mass (72%),abdominal pain (72%),abdominal distension (63%),anorexia (45%) and night sweat (36%).The average hemoglobin was 8.2 g/dL and the average FAR was 50 mm/h (range 30-125).Elevated levels of cancer antigen CA-125 were determined in four patients.Abdominal ultrasound showed abnormalities in all cases:ascites in all,tuboovarian mass in five,omental thickening in 3,and enlarged lymph nodes (mesenteric,para-aortic) in 2.CT scans showed ascites in all,pelvic mass in 5,retroperitoneal lymphadenopathy in 4,mesenteric stranding in 4,omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathy in 2.Only one patient had a chest radiograph suggestive of a new TB lesion.Two had a positive family history of pulmonary TB.None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two.Laparotomy was performed in 6 cases,laparoscopy in 4 and ultrasound- guided fine needle aspiration in 2.In those patients subjected to operation,the findings were multiple diffuse involvement of the visceral and parietal peritoneum,white ‘miliary nodules’or plaques,enlarged lymph nodes,ascites, ‘violin string’fibrinous strands,and omental thickening. Biopsy specimens showed granulomas,while ascitic fluid showed numerous lymphocytes.Both were negative for acid-fast bacilli by staining.PCR of ascitic fluid was positive for Mycobactenum tuberculosis ( M.tuberculosis) in all cases. CONCLUSION:Abdominal TB should be considered in all cases with ascites.Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.

Tuberculosis of the Uterine Cervix: About a Case and Literature Review

The authors report a case of tuberculosis of the uterine cervix observed at the maternity unit of the Souro Sanon Teaching Hospital (CHUSS) of Bobo-Dioulasso. This is a rare localization of genital tuberculosis and can take the appearance of a cervical cancer. Biopsy with histological study of the lesion confirms the diagnosis. The frequency of this pathology can reach up to 8%. The extension to the endometrium and/or tubes in a young woman may compromise future fertility. Early and well conducted TB treatment allows the ad integrum restitution cervix.

Effect of antitubercular treatment on the pregnancy outcomes and prognoses of patients with genital tuberculosis

This retrospective study aims to demonstrate the effect of antitubercular treatment (ATT) on the pregnancy outcomes and prognoses of patients with genital tuberculosis (GTB) who had received laparoscopy and/ or hysteroscopy. This study included 78 patients with infertility and who were diagnosed with GTB through laparoscopy and/or hysteroscopy over the period of November 2005 to October 2015? The recruited patients were divided into ATT and nonATT groups on the basis of ATT duration. The GTB recurrence rates, menstrual patterns, and pregnancy outcomes of the patients were determined at follow-up. Among the 78 patients, 46 received ATT and 32 did not receive ATT. The menstrual volumes of patients in the ATT group significantly decreased relative to those of patients in the nonATT group. GTB did not recur among all patients regardless of treatment. A total of 11 pregnancies (36.7%) in the ATT group and 19 pregnancies (63.3%) in the nonATT group were observed. Pregnancy rates significantly differed (P = 0.002) between the two groups.ATT may decrease the menstrual volume and pregnancy rates of patients who were diagnosed with GTB through laparoscopy and/or hysteroscopy. In addition, ATT did not improve the prognosis of patients with chronic GTB.

HIV Compartmentalization in Male Genital Tract:Relevance for Viral Eradication

Human immunodeficiency virus(HIV)has been shown to evolve independently in different anatomical compartments.Characterizing HIV genetic evolution in different tissues and cells provides insights into the mechanisms that maintain the viral reservoir.HIV compartmentalization has been well documented in the semen but rarely in male genital tract(MGT)organs.The precise mechanisms that result in the development of HIV compartmentalization in multiple genitourinary sites have been poorly explored due to the difficulty in accessing these tissues.Based on evidence from lymph nodes and gut tissues,mechanisms that may influence compartmentalization include immune pressures,local concentrations of antiviral drugs,clonal expansion of different cell types and inflammation that alters the cellular microenvironment.We reviewed phylogenetic evidences supporting viral compartmentalization between the blood and multiple genitourinary sites in HIV-infected people.Characterizing distinct viral subpopulations enhances our overall understanding of the HIV reservoir inMGTand could ultimately lead to the development of novel therapies to eradicate the virus in tissues.

Age-related changes in seminal polymorphonuclear elastase in men with asymptomatic inflammation of the genital tract

Aim： To investigate age-related inflammatory events in the male genital tract. Methods： In a total of 4 265 randomly collected patients attending the andrological outpatient clinic of the Center for Dermatology and Andrology, University of Giessen, Germany, ejaculate volume, pH-value, sperm concentration, total and progressive sperm motility, concentration of polymorphonuclear （PMN） elastase, number of peroxidase-positive cells and fructose were measured and correlated with patient＇s age. Results： While ejaculate volume, motility and fructose all correlated negatively with age, sperm concentration, PMN elastase and the pH-value showed a positive correlation. The prevalence of male genital tract inflammation （as defined by PMN elastase 〉 250 ng/mL） and its severity increased significantly. PMN elastase did not correlate with sperm motility. Fructose as a marker of seminal vesicle function showed a significant negative relationship with the PMN elastase levels, the number of peroxidase-positive cells and sperm motility. Conclusion： The significant increases of PMN elastase levels as marker of male genital tract inflammation in older men appear to be indicative of age-related changes in local immunoregulatory mechanisms. Because there is no association of PMN elastase with sperm motility, a direct inhibitory effect of this enzyme can be excluded.

Male Sexual Pain Disorders： New Approach

There are several kinds of male genital pain which can cause mental suffering. Usually, they emerge during ordinary urological or andrological examinations. These distresses, sine materia, can be divided into different types. The first type, that is the most frequent one, mainly affects the testicles; usually, this kind of distress lasts a lifetime and it is often associated with surgery and/or frequent examinations to the genitals during childhood. The second type encompasses cases of real penodynia： the patients express their discomfort especially uncovering the glans and, for this reason, this action is never done. This distress is not always referred to as pain, but more often as ＂bothersome＂. Sexual intercourses are permitted. Often the patients undergo a circumcision that usually has a complicated postoperative course. The males of the third type correspond to the women suffering from ＂vaginismus＂. The patients do not even tolerate the approach of the hand to the penis and they make the same actions and the same movements as the vaginismic women. The patients are unable to have sex. This phenomenon is rare. The fourth type is numerous and may be defined as a real male Dyspareunia. The patients complain pain during sexual intercourse and, above all, during ejaculation. The symptom is felt in pelvic-perineum area and it is often diagnosed asprostatitis, but in reality no organic therapy is effective at all. Some clinical cases will be presented and discussed.

Early infant male circumcision:Systematic review,risk-benefit analysis,and progress in policy

AIM To determine whether recent evidence-based United States polices on male circumcision(MC) apply to comparable Anglophone countries,Australia and New Zealand.METHODS Articles in 2005 through 2015 were retrieved from PubM ed using the keyword "circumcision" together with 36 relevant subtopics.A further PubM ed search was performed for articles published in 2016.Searches of the EMBASE and Cochrane databases did not yield additional citable articles.Articles were assessed for quality and those rated 2+ and above according to the Scottish Intercollegiate Grading System were studied further.The most relevant andrepresentative of the topic were included.Bibliographies were examined to retrieve further key references.Randomized controlled trials,recent high quality systematic reviews or meta-analyses(level 1++ or 1+ evidence) were prioritized for inclusion.A risk-benefit analysis of articles rated for quality was performed.For efficiency and reliability,recent randomized controlled trials,metaanalyses,high quality systematic reviews and large welldesigned studies were used if available.Internet searches were conducted for other relevant information,including policies and Australian data on claims under Medicare for MC.RESULTS Evidence-based policy statements by the American Academy of Pediatrics(AAP) and the Centers for Disease Control and Prevention(CDC) support infant and later age male circumcision(MC) as a desirable public health measure.Our systematic review of relevant literature over the past decade yielded 140 journal articles that met our inclusion criteria.Together,these showed that early infant MC confers immediate and lifelong benefits by protecting against urinary tract infections having potential adverse long-term renal effects,phimosis that causes difficult and painful erections and "ballooning" during urination,inflammatory skin conditions,inferior penile hygiene,candidiasis,various sexually transmissible infections in both sexes,genital ulcers,and penile,prostate and cervical cancer.Our risk-benefit analysis showed that benefits exceeded procedural risks,which are predominantly minor,by up to 200 to 1.We estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime.Wide-ranging evidence from surveys,physiological measurements,and the anatomical location of penile sensory receptors responsible for sexual sensation strongly and consistently suggested that MC has no detrimental effect on sexual function,sensitivity or pleasure.United States studies showed that early infant MC is cost saving.The evidence supporting early infant MC has further strengthened since the positive AAP and CDC reviews.CONCLUSION Affirmative MC policies are needed in Australia and New Zealand.Routine provision of accurate,unbiased education,and access in public hospitals,will maximize health and financial benefits.

A case-control study of risk factors for male infertility in Nigeria

Aim： To evaluate the association between selected potential socio-demographic and behavioral risk factors and infertility in Nigerian men. Methods： There were two groups in this study. One group consisted of 150 men with proven male infertility, and the other consisted of 150 fertile men with normal semen parameters. Both were matched for age, place of residence and key socio-demographic variables. They were compared for sexual history, past medical and surgical history, past exposures to sexually transmitted infections and treatment, past and current use of drugs as well as smoking and alcohol intake history. Results： Infertile men were significantly more likely than fertile men to report having experienced penile discharge, painful micturition and genital ulcers, less likely to seek treatment for these symptoms and more likely to seek treatment with informal sector providers. Multivariate analysis showed that male infertility was significantly associated with bacteria in semen cultures, self-reporting of previous use of traditional medications and moderate to heavy alcohol intake, but not with smoking and occupational types. Conclusion： Infertility is associated with various proxies of sexually transmitted infections （STIs） and poor healthcare-seeking behavior for STIs in Nigerian men.

A scoping review of SARS-CoV-2 and male infertility: Concerns and future prospects

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has been detected in the blood,urine,facial/anal swabs,semen,and vaginal discharge;all have been shown to contain SARSCoV-2 RNA.Recent findings have highlighted the prospect of SARS-CoV-2 invading the genital system in addition to other tissues,which might give rise to reproductive concerns.This investigation sheds light on male reproductive tract vulnerability to invasion by SARS-CoV-2 and provides a foundation for further researches into male fertility.Males are infected with COVID-19 at a higher rate than females.As a result,some data suggest that this viral infection might affect the male reproductive system.The probable causes for male genital tract abnormalities in COVID19 are:(1)high expression of angiotensin-converting enzyme 2 in the testes;(2)SARS-CoV-2 infection indirectly induces immune response in the testes;(3)SARS-CoV-2 directly damages male genital cells by virus-receptor binding activity;(4)fever in SARSCoV-2 infected males may cause damages to testicular cells;(5)testosterone level decreased in SAR-CoV-2 infected males;(6)males are more susceptible to COVID-19 than females,which may be due to differences in the physiology of the genital tract.This review seeks to offer some insights into the potential causes of COVID-19 that affect the male reproductive system,as well as future prospect on this issue.

附睾多发炎性肌纤维母细胞瘤一例

附睾炎性肌纤维母细胞瘤(inflammatory myofibroblastic tumor,IMT)国内外仅报道数例,并且都是单发的肿瘤。报告1例附睾多发性IMT病例,患者自行发现右侧阴囊内肿物1年,肿物进行性增大。超声检查提示右侧阴囊内多发实性结节,行右侧阴囊探查术+肿物切除术,术中发现右侧附睾多发类圆形质韧肿物,术后肿物病理证实为IMT,术后随访6个月,未见肿物复发。通过回顾相关文献,认为附睾IMT与发生在附睾的其他肿物临床症状类似,术前一般难以诊断,该肿瘤会进行性增大,有低度恶性潜能,故建议手术切除肿物,术后患者无需特殊治疗,一般不会复发,但需定期复查。

女性生殖器结核对生育的影响及对策

女性生殖器结核(FGTB)是常见的肺外结核,可导致不孕、不良妊娠结局、卵巢储备功能下降,以及影响辅助生殖的成功率。漏诊的FGTB不仅容易导致助孕失败,还会导致严重的母婴并发症。然而,FGTB症状不典型,误诊率高达60%,因此,对FGTB高危人群的及时筛查有着重要的临床意义。目前诊断FGTB的措施包括微生物学检测、聚合酶链式反应、环介导等温扩增、Xpert结核分枝杆菌(MTB)/利福平(RIF)耐药性检测和线性探针检测等分子检测。对FGTB的有效筛查和及时抗结核治疗,有利于改善生育结局、减少结核的垂直传播。本文将从FGTB对生育和辅助生育的影响、FGTB的诊断和治疗等方面进行综述,为FGTB的临床诊疗提供参考。

环状RNA在生殖系统的研究进展

环状RNA(circular RNA,circRNA)是一类不具有5′末端帽子和3′末端多聚腺苷酸尾巴并以共价键形成封闭环状结构的内源性非编码RNA(non-coding RNA,ncRNA)。由于circRNA结构的特殊性,其对RNA外切酶R(ribonucleic acid exonuclease R,RNaseR)具有高度抵抗性,因此在细胞质中的分布相当丰富。高通量测序和生物信息学方法的不断发展揭示了circRNA具有高度保守性、稳定性、疾病特异性和组织特异性的特点,使其在临床早期诊断中具有作为生物标志物的潜能。研究已证实circRNA在女性生殖系统中与卵子发生、卵巢功能不全、卵巢相关性疾病以及在男性生殖系统中与精子发生、睾丸发育之间相互作用,有望成为多种生殖系统疾病新的诊断和治疗靶点。综述circRNA在生殖系统发育中的生物学功能及其调控作用。

男性生殖系结核的诊断与治疗

目的 :探讨男性生殖系结核的诊断与治疗。 方法 :对 15例经病原学或病理学证实的男性生殖系结核患者的诊断、鉴别诊断及治疗进行回顾性分析。 结果 :结合病史、体格检查、精液抗酸杆菌镜检或抗酸杆菌培养和手术标本病理检查可确诊。其中 ,1例为肾结核并发附睾、睾丸结核 ,1例为肾结核并发结核性精囊炎 ,8例为原发性单纯附睾结核 ,5例为原发性附睾、睾丸结核。 4例单纯抗结核药物治疗 ,11例手术治疗。 结论 :男性生殖系结核呈现非典型化趋势 ,精液TB PCR可能为男性生殖系结核的诊断提供了新的途径 ,必要时组织活检可确诊。手术治疗应慎重 ,尤其是对年轻患者。

生殖器结核不孕患者临床资料及IVF结局分析

目的分析生殖器结核(FGT)不孕患者的临床特点及体外受精-胚胎移植(IVF-ET)的治疗结局。方法对198例行IVF治疗的FGT患者的临床资料进行回顾性分析。结果 FGT不孕患者共198例,占IVF助孕患者的5.8%,占输卵管性不孕患者的9.3%。其中盆腔腹膜结核115例,输卵管结核79例,子宫内膜结核4例。139例(70.2%)经开腹或腹腔镜手术确诊,55例(27.8%)通过病史结合子宫输卵管造影(HSG)+结核菌素试验(PPD)确诊,4例(2.0%)通过诊刮或宫腔镜检查确诊。198例患者共行309个取卵周期,381个新鲜及冷冻胚胎移植周期,累计移植周期临床妊娠率37.0%,早期流产率23.4%,异位妊娠率2.1%,活产率27.6%。105例患者获得活产,单胎87例、双胎18例。2例患者经IVF治疗并妊娠后,出现活动性肺结核。结论 FGT不孕患者盆腔及输卵管病变严重,腹腔镜或开腹探查是主要确诊方法。FGT患者IVF临床妊娠率偏低,需警惕治疗中发生活动性肺结核。

Diffusion-weighted MR imaging of normal and abnorma scrotum： preliminary results

Magnetic resonance （MR） imaging of the scrotum represents an important supplemental diagnostic tool in the evaluation of scrotal diseases. Diffusion-weighted （DW） MR imaging is a developing technique, proved to improve tissue characterization. We evaluated the feasibility and diagnostic performance of DW MR imaging in the detection and characterization of scrotal lesions. We retrospectively evaluated 31 scrotal lesions （23 intratesticular and 8 extratesticular） in 26 men. All MR examinations were performed on a 1.5-T unit, using a pelvic-phased array coil. DW sequences were obtained using a single shot, multislice spin echo planar diffusion pulse sequence and a b factor of 0 and 900 s mm-2. The DW MR characteristics and the apparent diffusion coefficient （ADC） values of normal scrotal contents and scrotal diseases were evaluated. Comparison between the ADC values of normal scrotum, benign lesions and scrotal malignancies was performed. The accuracy of conventional sequences, DW images alone and DW imaging combined with conventional images in differentiating benign from malignant scmtal lesions was calculated. The ADC values of testicular malignancies were different from those of normal testis and benign intratesticular lesions, and the ADC values of benign extratesticular lesions from those of normal epididymis （P〈0.05）. The overall accuracy of conventional imaging, DW imaging alone and DW MR combined with conventional sequences in the characterization of intratesticular lesions was 91%, 87% and 100%, respectively. Our findings suggest that DW MR imaging and ADC values may provide valuable information in the diagnosis and characterization of scrotal diseases.

男性外生殖器修复与重建

各种原因引起的外生殖畸形、缺损,以及由此导致相应的排尿功能、性功能、生育功能的障碍和外观异常,是男科诊治中的难点之一,目前尚无相应的诊疗常规和指南。对此,有效的治疗方法是进行修复和重建手术,其关键点是根据局部病变和功能受损情况设计术式,常常需要利用转移皮瓣、带血管皮瓣等各种皮瓣或植皮等方法进行修复。文中介绍了临床上常见的男性阴茎、阴囊畸形和缺损疾病,注重外形的修复和功能的重建,采用泌尿和男科手术技巧,结合显微外科技术、皮瓣和皮肤移植技术等方法进行修复,获得较为满意的外观和较好的功能。术前应充分评估病变程度,合理设计术式,并与患者认真沟通,帮助患者理解和认识手术预期效果及其预后,消除患者心理上对手术的过高期望。有些修复手术难度大、并发症多,需要在临床工作中进一步研究和改进。