Lycopene and male infertility

Excessive amounts of reactive oxygen species （ROS） cause a state of oxidative stress, which result in sperm membrane lipid peroxidation, DNA damage and apoptosis, leading to decreased sperm viability and motility. Elevated levels of ROS are a major cause of idiopathic male factor infertility, which is an increasingly common problem today. Lycopene, the most potent singlet oxygen quencher of all carotenoids, is a possible treatment option for male infertility because of its antioxidant properties. By reacting with and neutralizing free radicals, lycopene could reduce the incidence of oxidative stress and thus, lessen the damage that would otherwise be inflicted on spermatozoa. It is postulated that lycopene may have other beneficial effects via nonoxidative mechanisms in the testis, such as gap junction communication, modulation of gene expression, regulation of the cell cycle and immunoenhancement. Various lycopene supplementation studies conducted on both humans and animals have shown promising results in alleviating male infertility--lipid peroxidation and DNA damage were decreased, while sperm count and viability, and general immunity were increased. Improvement of these parameters indicates a reduction in oxidative stress, and thus the spermatozoa is less vulnerable to oxidative damage, which increases the chances of a normal sperm fertilizing the egg. Human trials have reported improvement in sperm parameters and pregnancy rates with supplementation of 4-8 mg of lycopene daily for 3-12 months. However, further detailed and extensive research is still required to determine the dosage and the usefulness of lycopene as a treatment for male infertility.

Robotic laparoendoscopic single-site surgery(R-LESS) ：current status in urology

Laparoendoscopic single-site surgery(LESS)is technically challenging;it can reduces instrument triangulation and robust retraction and is associated with a steep learning curve.The instruments of the daVinci  surgical system(Intuitive Surgical)are designed with seven degrees of motion mimicing the dexterity of the human hand and wrist.This inherent feature of the robotic arm provides superior ergonomics when performing LESS,especially for complex reconstructive surgery.This review analyzes the evidence supporting current and future application of robotic technology in the field of urologic LESS.

Artificial intelligence in andrology-fact or fiction:essential takeaway for busy clinicians

Artificial intelligence (AI) is revolutionizing the current approach to medicine. AI uses machine learning algorithms to predict the success of therapeutic procedures or assist the clinician in the decision-making process. To date, machine learning studies in the andrological field have mainly focused on prostate cancer imaging and management. However, an increasing number of studies are documenting the use of AI to assist clinicians in decision-making and patient management in andrological diseases such as varicocele or sexual dysfunction. Additionally, machine learning applications are being employed to enhance success rates in assisted reproductive techniques (ARTs). This article offers the clinicians as well as the researchers with a brief overview of the current use of AI in andrology, highlighting the current state-of-the-art scientific evidence, the direction in which the research is going, and the strengths and limitations of this approach.

Laparoscopic resection of gastric gastrointestinal stromal tumors presenting as left adrenal tumors

Gastrointestinal stromal tumors (GISTs) are rare gastrointestinal malignancies. They are rarely seen near the urinary tract. In a literature review, only one case of GIST presenting as a left adrenal tumor was reported. We report two documented cases of gastric GISTs mimicking left adrenal tumors which were successfully treated with pure laparoscopic adrenalectomy and wedge resection of the stomach by excising the tumor from the stomach with serial fi ring of endoscopic gastrointestinal staplers. The surgical margins were clear, and the patients recovered smoothly. No adjuvant therapy with imatinib was prescribed. During the surveillance for 9 mo and 44 mo respectively, no tumor recurrence and metastasis were documented. Laparoscopic tumor excision, when adhering to the principles of surgical oncology, seems feasible and the prognosisis favorable for such tumors.

Squamous cell carcinoma of the scrotum: A look beyond the chimneystacks

Despite the low incidence, squamous cell carcinoma(SCC) remains the most common scrotal malignancy featuring a propensity for recurrence and metastasis. In recent years there has been a significant change in the epidemiology of scrotal SCC. Surgery is the mainstay of treatment for resectable disease. Sentinel lymph node dissection similar to algorithm for patients with penile SCC can reduce the morbidity of routine lymph node dissection. Emerging treatments for advanced and metastatic SCC are at the cusp of significantly changing management of this disease. We have performed a comprehensive review of scrotal SCC with a focus on these topics.

A genomic approach to active surveillance： a step toward precision medicine

In the last 25 years, Prostate Specific Antigen （PSA） screening has resulted ina large gap between the likelihood of being diagnosed with and of dying of prostate cancer, leading to the clinical problems of overdiagnosis and overtreatment. Despite the favorable outcomes reported for active surveil- lance, its clinical use is limited, with 〉90% of men in the US diagnosed with potentially indol- ent disease undergoing immediate treatment with radiation or surgery. We have designed a novel strategy of molecular profiling of prostate cancers, allowing an assessment of tumor aggres- siveness to be based on tumor tissue obtained at biopsy.

Predictive parameters of the efficacy of varicocele repair: a review

Varicocele has a prevalence of 15%in the population and represents a primary cause of infertility in 40%of cases and a secondary cause in approximately 80%of cases.It is considered the major correctable cause of male infertility.Despite its high prevalence in the infertile population,a large number of patients with varicocele do not experience reproductive difficulties.For this reason,it is still highly debated which parameters could be used to predict which patients with varicocele will be most likely to benefit from its repair.The main international and European guidelines state that treatment should only be considered in infertile patients with abnormal sperm quality.However,these guidelines do not help physicians to identify which of these patients may benefit from the treatment.Therefore,this narrative review collects the evidence in the literature on the usefulness of some factors as predictors of improvement,highlighting how some of them may be effective in an initial selection of patients to be treated,while others are promising but further studies are needed.Finally,a brief consideration on the possible role of artificial intelligence is proposed.

Specialized sperm function tests in varicocele ant Ihe future of andrology laboratory

Varicocele is a common medical condition entangled with many controversies. Though it is highly prevalent in men with infertility, still it marks its presence in males who do have normal fertility. Determining which patients are negatively affected by varicocele would enable clinicians to better select those men who benefitted the most from surgery. Since conventional semen analysis has been limited in its ability to evaluate the negative effects of varicocele on fertility, a multitude of specialized laboratory tests have emerged. In this review, we examine the role and significance of specialized sperm function tests with regards to varicocele. Among the various tests, analysis of sperm DNA fragmentation and measurements of oxidative stress markers provide an independent measure of fertility in men with varicocele. These diagnostic modalities have both diagnostic and prognostic information complementary to, but distinct from conventional sperm parameters. Test results can guide management and aid in monitoring intervention outcomes. Proteomics, metabolomics, and genomics are areas; though still developing, holding promise to revolutionize our understanding of reproductive physiology, including varicocele.

Correlation of oxidation reduction potential and total motile sperm count:its utility in the evaluation of male fertility potential

Oxidative stress(OS)is detri me ntal to sperm fun ctio ns,and the oxidation reductio n pote ntial(ORP)is a good measure of OS as it considers the balance betwee n oxidants and reducta nts.Total motile sperm count(TMSC)is viewed as the single most im porta nt semen analysis parameter that can predict male infertility severity,and its correlation with ORP has never been undertaken.The objectives of this study were to assess the correlation between ORP and TMSC,to identify the ORP cutoff value based on the TMSC result,and to compare this cutoff value with previously reported ORP cutoff values in literature.One thousand one hundred and sixty-eight infertile patients and 100 fertile controls were enrolled.Demographic and semen data of the participants were retrieved and analyzed.Wilcox on's rank-sum test compared variables betwee n infertile men and fertile controls;Spearman's correlation assessed the static ORP(sORP)-TMSC relationship for the whole sample and among each group individually.Using a 20×10^6TMSC threshold,receiver operator characteristic(ROC)analysis determined the sORP cutoff associated with the highest predictive values.TMSC was significantly negatively correlated with sORP across all participants(r=0.86,P<0.001),among infertile patients(r=0.729,P<0.001),and among fertile controls(r=0.53,P<0.001).A 20-million TMSC threshold determined an sORP cutoff value of 2.34 mV/106sperm/ml to be associated with 82.9%sensitivity,82.8%specificity,91.5%positive predictive value(PPV),68.5%negative predictive value(NPV),and 82.9%overall accuracy.Compared with previously reported cutoff values in searched literature,the 2.34 mV/10^6sperm/ml cutoff value identified in our study yielded the highest overall diagnostic accuracy in the evaluation of in fertile men.

Management of prostatosymphyseal fistula following photoselective vaporization of the prostate:Case series and systematic review of the literature

Background:This study is aimed to describe our institutional experience and review the literature to date on prostatosymphyseal fistula(PSF),or puboprostatic fistula,following bladder outlet procedures such as transurethral resection of the prostate(TURP)or laser photoselective vaporization of the prostate(PVP).Materials and methods:We retrospectively queried our institutional experience for management of PSF following PVP performed for symptomatic benign prostatic hyperplasia.We also performed a systematic literature review for PSF following PVP or TURP.Finally,we describe our surgical approach to the management of this challenging condition.Results:We identified 7 cases of PSF following PVP from our institution,as well as an additional 7 cases following PVP and 9 cases following TURP from literature review.The diagnosis of PSF was made between 0.5 and 24 months following PVP,and the most specific symptoms were pubic pain and difficulty ambulating.Most patients requiring several evaluations before the diagnosis was made using appropriate imaging studies.Seventy percent of patients required surgical intervention including fistula repair or prostatectomy.Our surgical approach has evolved,and we now routinely perform robotic fistula repair with Y-V plasty and interposition flap with excellent results.Conclusions:Puboprostatic fistula is a rare and poorly described complication of PVP or TURP.To the best of our knowledge,this case series of PSF following PVP represents the largest series to date and doubles the number of reported cases in the literature.Robotic fistula repair with interposition of either peritoneal or perivesical fat flaps appears to be a viable management strategy.

Spermatozoa protein alterations in infertile men with bilateral varicocele

Among infertile men, a diagnosis of unilateral varicocele is made in 90% of varicocele cases and bilateral in the remaining varicocele cases. However, there are reports of under-diagnosis of bilateral varicocele among infertile men and that its prevalence is greater than 10%. In this prospective study, we aimed to examine the differentially expressed proteins （DEP） extracted from spermatozoa cells of patients with bilateral varicocele and fertile donors. Subjects consisted of 17 men diagnosed with bilateral varicocele and 10 proven fertile men as healthy controls. Using the LTQ-orbitrap elite hybrid mass spectrometry system, proteomic analysis was done on pooled samples from 3 patients with bilateral varicocele and 5 fertile men. From these samples, 73 DEP were identified of which 58 proteins were differentially expressed, with 7 proteins unique to the bilateral varicocele group and 8 proteins to the fertile control group. Majority of the DEPs were observed to be associated with metabolic processes, stress responses, oxidoreductase activity, enzyme regulation, and immune system processes. Seven DEP were involved in sperm function such as capacitation, motility, and sperm-zona binding. Proteins TEKT3 and TCP11 were validated by Western blot analysis and may serve as potential biomarkers for bilateral varicocele. In this study, we have demonstrated for the first time the presence of DEP and identified proteins with distinct reproductive functions which are altered in infertile men with bilateral varicocele. Functional proteomic profiling provides insight into the mechanistic implications of bilateral varicocele-associated male infertility.

A novel set of surgical instruments facilitate the procedure of laparoscopic pyeloplasty

Background Open pyeloplasty has been historically described as the gold standard for the surgical treatment of ureteropelvic junction obstruction （UPJO）, even if new techniques have recently gained a prominent role in this field. Laparoscopic pyeloplasty （LP） is not widely prevelant because of the technically challenging nature and it represents the gold standard for UPJO only in expert hands. To overcome some difficulties and technical challenges encountered during pure laparoscopic pyeloplasty, we designed a set of new instruments and assessed them using porcine model.

Symptomatic male with subclinical varicocele found on ultrasound evaluation

Scrotal pain is a commonly encountered complaint in urology practice. It occurs in around 2%-10% of patients with varicocele.Despite a relatively common association, the effect ofvaricocele on pain is much less investigated than its relation with infertility. Biggers and Soderdahl were the first to explore surgical treatment for pain attributed to a clinical varicocele in 1981, reporting an improvement rate of 48% after surgery.

Asymptomatic postpubertal male with equally sized normal testicles with palpable left varicocele

Varicoceles are a common finding in the general public. The incidence appears to increase later in life with a contemporary study finding an increase in incidence of 10% per decade of life） While common in the general population, they are even more common among those presenting for a fertility evaluation, as high as 39% in some series and are often initially diagnosed during such examinations） Others present without symptoms or fertility issues and are found incidentally on a physical exam by a general practitioner.

Predictive factors for spontaneous stone passage in diabetic patients with acute ureteric colic

To the Editor:According to the data from the National Health and Nutrition Examination Survey(2007–2010),the prevalence of kidney stones in the United States(US)population is 8.8%.[1]A prior US population study has found that the prevalence of kidney stones increases with obesity,diabetes,and metabolic syndrome;for individuals with type 2 diabetes,the severity of disease is associated with a greater risk of kidney stones.[1,2]Choi et al[3]reported that a diagnosis of diabetes was a significant predictive risk factor for failure of spontaneous stone passage(SSP)possibly secondary to ureteral edema and those diabetic patients should be considered for candidates for more invasive treatment.However,this study included only 26 diabetic patients,and only 31 of 366 patients failed to spontaneously pass their stones both of which may limit the power to predict SSP of diabetes.[3]This is an important question to answer given the volume of stones in the US and the consequences of changes in SSP rates between patient groups.Therefore,through a retrospective analysis of the database of emergency renal colic visits in Cleveland Clinic Foundation,we evaluate the association of diabetes on SSP and investigated the predictive factors of SSP in diabetic patients.