Search

Background: Infertile men have a worse overall health status than their fertile counterparts. Objective: We aimed to (1) compare kidney function in men presenting for primary couple's infertility with that of fertile men and (2) assess kidney function impairment toward sperm quality in infertile men. Materials and methods: In this case–control study, 387 consecutive white‐European infertile men were matched by age with 134 same‐ethnicity fertile men. Complete clinical and laboratory data were available for each patient. The Chronic Kidney Disease Epidemiology Collaboration function was used for estimated glomerular filtration rate calculation. Kidney functional impairment was defined as an estimated glomerular filtration rate <90 mL/min per 1.73 m2, according to the Kidney Disease Improving Global Outcomes criteria. Multivariable logistic regression analysis was used to (1) assess the association between kidney function impairment and infertility status and (2) investigate the association between kidney function and semen analysis abnormalities in infertile men. Results: After matching, 34 (8.8%) infertile men depicted at least a mild unknown impairment of kidney function compared to only four (3%) fertile men, with four (3%) of the infertile presenting with an overt kidney function impairment (estimated glomerular filtration rate <60 mL/min per 1.73 m2). There were no differences in terms of age, body mass index and rate of comorbidities between the two groups (all p > 0.05). After adjusting for major confounders, infertility status was associated with a higher risk of reduced estimated glomerular filtration rate (odds ratio 3.20; 95% confidence interval 1.21–5.2; p = 0.002). Conversely, estimated glomerular filtration rate was not associated with sperm abnormalities in infertile men. Conclusions: Mild kidney function impairment was found in 9% of asymptomatic and unaware men presenting for primary couple's infertility investigation. This novel finding corroborates growing data on a significant association of male infertility with a poorer overall male health status and the need for tailored preventive strategies. [ABSTRACT FROM AUTHOR]

Background: Alfa‐fetoprotein (AFP) is a serum glycoprotein highly produced during fetal development. While AFP synthesis drops dramatically after birth, AFP production only persists or returns under specific pathological condition. Objective: We sought to investigate the rate of and the potential meaning of high AFP serum levels in men seeking first medical attention for couple's primary infertility. Materials and methods: Socio‐demographic and clinical data from 1803 non‐Finnish, White‐European primary infertile men were retrospectively analysed. AFP was routinely measured in each patient (high AFP was defined as >7 ng/ml). Men with history of liver diseases, testicular cancer, or other known causes of increased AFP levels were excluded from the final analysis. Semen analyses were based on the 2010 World Health Organization reference criteria. Descriptive statistics and logistic regression models tested the association between serum AFP and clinical variables. Possible nonlinear relationships were graphically explored with locally estimated scatterplot smoothing method. Results: Overall, high serum AFP level was found in 29 (1.7%) patients. Normal versus high AFP levels patients were comparable in terms of body mass index (BMI), Charlson Comorbidity Index, waist circumference, smoking habits, history of cryptorchidism, testicular volume, and serum hormones (i.e., follicle‐stimulating hormone, luteinizing hormone, and total testosterone). Conversely, men with higher AFP levels were older (p = 0.02), had lower sperm concentration (p = 0.003), and were more frequently oligozoospermic and azoospermic (all p ≤ 0.03). At multivariate analysis, high AFP levels were independently associated with oligozoospermia (OR 3.79; p = 0.033) and azoospermia (OR 3.29; p = 0.006). Likewise, if AFP levels increase, patients were found to be older, with higher BMI and to have more comorbidities (all p < 0.05). Discussion: Unexplained high AFP levels account for almost 2% of cases in primary infertile patients without a previous history of associated disorders. Higher serum AFP levels are linked with aberrant sperm counts, older age, obesity, and a greater amount of comorbid conditions. Conclusion: Despite the need for additional validation, these data suggest that serum AFP measurement might have a multifaceted role over the diagnostic work‐up of males presenting for couple's infertility. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction aetiology has been historically identified as organic, psychogenic and mixed. Objectives: To stratify and compare a cohort of patients seeking medical help for erectile dysfunction for the first time according to the newly proposed binary classification of the European Association of Urology guidelines: 'primary organic' versus 'primary psychogenic'. Materials and methods: Complete data from 2009 consecutive patients presenting for erectile dysfunction were analysed. All patients completed the International Index of Erectile Function at baseline. According to the presence of erectile dysfunction‐related risk factors indexed by the European Association of Urology Guidelines on Sexual and Reproductive Health, patients were categorised as having primary organic (≥1 risk factor) or primary psychogenic (0 risk factor) erectile dysfunction. Descriptive statistics compared the two groups. Linear regression analysis tested the association between the number of risk factors and erectile dysfunction severity. Locally estimated scatterplot smoothing method graphically explored the relationship between the number of risk factors for erectile dysfunction and the International Index of Erectile Function domain scores. Results: Median (interquartile range) age at first presentation was 50 (39–61) years. Of all, 1632 (86.2%) and 377 (13.8%) were identified as having primary organic and primary psychogenic erectile dysfunction, respectively. Overall, 1488 (74.1%) patients were >40 years of age; in this subgroup, the most frequent risk factors were age, hypertension (29%), active smoking (42%) and alcohol intake (25.1%). Median (interquartile range) International Index of Erectile Function‐erectile function score was 15 (7–22). Primary organic erectile dysfunction patients depicted lower International Index of Erectile Function‐sexual desire and International Index of Erectile Function‐orgasmic function scores (all p ≤ 0.02), whilst groups did not differ in terms of International Index of Erectile Function‐erectile function, International Index of Erectile Function‐intercourse satisfaction and International Index of Erectile Function‐overall satisfaction scores. Discussion: One out of nine patients complaining of erectile dysfunction depict criteria for primary psychogenic erectile dysfunction. Erectile function severity could be as severe as patients with organic erectile dysfunction. The single‐centre‐based cross‐sectional nature of the study, raising the possibility of selection biases, is our main limitation. Conclusions: One out of nine patients presenting for erectile dysfunction depict criteria suggestive for primary psychogenic erectile dysfunction in the real‐life setting. Patients with primary psychogenic and primary organic erectile dysfunction have comparable erectile dysfunction severity, thus outlining the importance of a comprehensive and tailored management work‐up in every patient seeking medical help for the first time. [ABSTRACT FROM AUTHOR]

Background: A severe male infertility factor has been associated with both lower health status and increased mortality in infertile men. Objectives: To investigate reproductive factors associated with health status impairment in infertile men over a 10‐year time frame since the first clinical evaluation. Materials and methods: Data from 899 infertile men were analysed at baseline between 2003 and 2010. Health‐significant comorbidities were scored with the Charlson Comorbidity Index. Patients were followed up yearly recording any worsening in their health status until 2019. Cox regression models were used to estimate hazard ratios and 95% confidence intervals of Charlson Comorbidity Index score increase. Results: At a median follow‐up of 136 months (Interquartile range: 121, 156), 85 men (9.5%) depicted an increase of their baseline Charlson Comorbidity Index score of at least one point. The most frequent reason for Charlson Comorbidity Index upgrade was cancer (34%), cardiovascular diseases (29%) and diabetes mellitus (22%). Compared to patients without a Charlson Comorbidity Index increase, patients with a Charlson Comorbidity Index increase presented with higher body mass index and follicle‐stimulating hormone values, a higher rate of baseline Charlson Comorbidity Index ≥ 1 (all p < 0.01) and a greater proportion of non‐obstructive azoospermia (p < 0.001). In the Cox regression model, the patient's BMI (p < 0.001), baseline Charlson Comorbidity Index ≥ 1 (p < 0.01) and azoospermia status (p = 0.001) were found to be independently associated with Charlson Comorbidity Index increases. Conclusions: Almost 10% of men presenting for primary infertility had a decrease of the overall health status already in the relatively short 10‐year time frame after the first presentation. Non‐obstructive azoospermic men showed the worst health status impairment and should be strictly followed‐up regardless of their fertility status. [ABSTRACT FROM AUTHOR]

Background: Trends of male factor causes of couples' infertility over time have been poorly investigated. Objective: We investigated trends in the causes of pure male factor infertility (MFI) throughout the last 10 years in a tertiary‐referral academic andrology center. Material and Methods: Baseline characteristics at first presentation from a cohort of 1647 consecutive male factor infertility patients belonging to primary infertile couples between 2008 and 2018 have been comprehensively collected over time. Seven major causes of male factor infertility were identified: varicocoele; history of cryptorchidism; hypogonadism (primary and secondary); obstructive azoospermia; genetic abnormalities; other causes (large group including the remnant conditions of known causes); and idiopathic infertility. Rates of different male factor infertility causes over the study period were analyzed. Multivariable logistic regression models tested the likelihood of male factor infertility causes over time. Estimated trends were explored graphically. Results: Of all, varicocoele was found in 615 (37.3%), cryptorchidism in 124 (7.5%), genetic abnormalities in 61 (3.7%), hypogonadism in 165 (10%), obstructive conditions in 55 (3.3%), other causes in 129 (7.8%) patients, and idiopathic infertility in 498 (30.3%) patients, respectively. Over time, a reduction in the proportions of cryptorchidism and varicocoele (all P < 0.001) cases was observed, along with an increase in the proportions of hypogonadism, other causes of MFI and idiopathic cases (all P ≤ 0.01). Rates of genetic and obstructive cases remained stable. The observed trends were confirmed at logistic regression models. Discussion and Conclusions: A decreasing trend in the proportions of varicocoele and cryptorchidism at first presentation was observed over the last 10 years; conversely, the proportions of idiopathic cases, hypogonadal patients, and infertile men presenting with other male factor infertility causes significantly increased over the same time frame at a single tertiary‐referral academic andrology center. [ABSTRACT FROM AUTHOR]

Background: A number of studies showed that obesity may negatively impact on sperm quality and consequently couple's fertility. Recently, specific attention was given to a clinical condition known as metabolically healthy obesity (MHO). Objectives: To evaluate the effects of MHO on semen and hormonal parameters of men presenting for primary couple's infertility associated with pure male factor infertility (MFI). Materials and methods: Data from a homogenous cohort of 512 white‐European primary infertile men belonging to couples with pure MFI have been cross‐sectionally analyzed. Semen analysis was based on 2010 WHO reference criteria. Patients were segregated into eugonadal, secondary hypogonadal, primary hypogonadal, and compensated hypogonadal. The Harmonized International Diabetes Federation criteria were used to define metabolic syndrome (MetS). Based on BMI and MetS, patients were further segregated into the following: (a) metabolically healthy non‐obese (MHNO); (b) metabolically unhealthy non‐obese (MUNO) (c) metabolically healthy obesity (MHO); and, (d) metabolically unhealthy obesity (MUHO). Main outcome measures were the prevalence of MHO and the impact of MHO on semen and hormonal parameters in this cohort of MFI primary infertile men. Results: Overall, MHNO, MUNO, MHO, and MUHO were found in 462 (90%), 13 (2.5%), 27 (5.2%), and 10 (1.9%) men, respectively. MHO patients had lower total testosterone and SHBG levels (all P <.05) but higher E2 values (P <.005) compared with MHNO men. Groups did not differ in terms of semen parameters. At multivariable logistic regression, analysis MHO was associated with an increased risk of primary and secondary hypogonadism (all P ≤.02) compared with MHNO, after accounting for age and comorbid conditions. Discussion and conclusions: Metabolically healthy obesity is threefold more prevalent than unhealthy obesity in primary infertile men. Despite semen parameters are comparable among groups, MHO patients show worse endocrine parameters and a higher risk of primary and secondary hypogonadism compared with metabolically healthy normal infertile men. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of laser temporal pulse shaping of the super‐pulse thulium fibre laser (SPTFL) and to compare these in controlled in vitro conditions with various holmium: yttrium aluminium garnet (Ho:YAG) pulse delivery modes. Materials and Methods: The SPTFL (Urolase SP, IRE‐Polus, Fryazino, Russia), with an emission wavelength of 1.94 μm, and a Ho:YAG laser (P120H; Lumenis, Yokneam, Israel) with Moses technology were compared. Pulse shape, stone retropulsion and ablation efficiency were evaluated using BegoStones and compared for each laser mode: short (SP), long (LP), and Moses pulse (MP) for Ho:YAG, regular pulse (RP) and dual pulse (DP) for SPTFL. Results: The Ho:YAG SP mode exhibited an asymmetrical pulse shape, with a steep leading slope and a much more gradual trailing slope, without any flat section. Pulses generated by the SPTFL were significantly longer and therefore had lower peak power than those generated by the Ho:YAG laser at equivalent energy settings. Retropulsion for the holmium:YAG LP and MP modes was similar and lower than that for the SP mode, but higher than for the SPTFL (all P ≤ 0.02), with an average stone displacement approximately four times and two times lower for SPTFL as compared to the Ho:YAG laser. Comparison of ablation volumes indicated that the SPTFL induced significantly higher (twofold) ablation than the Ho:YAG laser. Conclusions: The magnitude and initial velocity of stone retropulsion decreased with longer pulse duration and lower pulse peak power, without sacrificing ablation efficiency. These observations are manifest when comparing the Ho:YAG laser with the SPTFL. The novel SPTFL provides greater versatility and control of pulse variables than the Ho:YAG laser. Further clinical investigation of practical benefits achievable with pulse‐shaping SPTFL modes is warranted. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether the position of the working channel affects the effectiveness of flexible ureteroscopy. Materials and Methods: We compared the ureteroscopes Flex‐X2S and Flex‐XC (working channel at the 9 and 3 o'clock positions, respectively) in eight cavities of a K‐Box model, simulating the distribution of the right and left intrarenal calyces. In the first and second settings, each cavity contained a 1‐cm stone, lying on the bottom and fixed on the anterior sheet covering the box, respectively. In the third setting, the posterior and lateral surface of each cavity was draped with graph paper. Once the flexible ureteroscope entered each cavity, we measured and compared (i) the proportion of stone surface targeted by the laser (STL) and (ii) the proportion of graph paper burned by the laser (PBL) obtained with the two instruments. Results: Higher STLs and PBLs were obtained with the 3 o'clock position than the 9 o'clock position in the right posterior and left anterior cavities (mean ± sd STL 87% ± 15% vs 46% ± 38% and 78% ± 35% vs 43% ± 24%, respectively; P < 0.05), and on the right posterior surfaces of the middle‐lower/lower cavities (PBL 72% vs 31% and 77% vs 35%, respectively; P < 0.01) and on the left lateral surface of the lower cavities (PBL 45% vs 25%; P = 0048), respectively. Conversely, the 9 o'clock position provided higher STLs and PBLs than the 3 o'clock position in the left posterior and right anterior cavities (mean ± sd STL 84% ± 20% vs 65% ± 28% and 79% ± 30% vs 44% ± 35%, respectively; P ≤ 0.02), and on the left posterior and right lateral surfaces of the lower cavities (PBL 59% vs 34% and 50% vs 21%, respectively; P ≤ 0.04). Conclusions: The position of the working channel of the flexible ureteroscope should be considered when planning flexible ureteroscopy, especially when dealing with the lower pole. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether postoperative complications affect long‐term functional outcomes of renal patients treated with nephron‐sparing surgery (NSS). Materials and Methods: We performed an observational study, enrolling 596 patients with preoperative normal renal function treated with NSS for clinical T1abN0M0 renal masses. Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for chronic kidney disease (CKD) including as covariates age, comorbidity (scored according to the Charlson comorbidity index), hypertension, tumour size, preoperative estimated glomerular filtration rate (eGFR), eGFR < 60 mL/min/1.73 m2 at discharge, and ischaemia time. Results: A total of 137 patients (23%) developed postoperative complications. At a median (interquartile range) follow‐up of 53 (26–91) months, CKD risk was 19% for patients with postoperative complications and 11% for those without complications. Patients experiencing postoperative complications (HR 1.90, 95% CI 1.26–2.86) were at increased risk of developing CKD during the follow‐up at multivariable analysis, after accounting for confounders. Conclusions: Our data outline how postoperative complications might have a detrimental impact on postoperative renal function in patients submitted to NSS. Improper patient selection, increasing the risk of postoperative complications, could limit the benefit in terms of renal function brought by NSS. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence and the risk associated with prediabetes (PreDM) in primary infertile men. Patients and methods: Data from 744 infertile men were analysed. Health‐significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Serum hormones were measured in every man. Semen analysis was based on 2010 World Health Organization (WHO) reference criteria. PreDM was defined according to the clinical criteria detailed by the American Diabetes Association (Diabetes Care 2014; 37 (Suppl. 1): S81). Descriptive statistics and logistic regression analyses tested the association between PreDM status, hormonal milieu and seminal parameters. The predictive accuracy of all variables was evaluated using the area under the curve, and the clinical net benefit estimated by decision curve analysis (DCA). Results: Of the 744 men, PreDM was found in 114 (15.4%). Men with PreDM (+PreDM) were older, had higher CCI scores, lower total testosterone and sex hormone‐binding globulin but higher follicle‐stimulating hormone (FSH) and 17β‐oestradiol values compared to those without PreDM (−PreDM) (all P ≤ 0.04). Higher sperm DNA fragmentation index (DFI; P = 0.014) and idiopathic non‐obstructive azoospermia (iNOA; P < 0.001) were found more frequently in +PreDM men. At multivariable logistic regression analysis, older age, FSH and iNOA (all P ≤ 0.04) were significantly associated with +PreDM status. DCA demonstrated a clinical net benefit in discriminating men at higher risk of a +PreDM status. Conclusions: About 15% of primary infertile men had criteria suggestive of undiagnosed PreDM. A PreDM status was associated with a greater risk of hypogonadism, higher DFI values and iNOA status. Age, FSH values and iNOA status could be considered as useful parameters to recognise men with PreDM and implement early preventive interventions in those men at risk of the consequences from poor glycaemic control. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between the duration of infertility (DI) and the seminal parameters of a cohort of White‐European primary infertile men. Patients and Methods: Data from 1644 infertile men were analysed. Patients were grouped according to the self‐reported DI into 12‐month time frames. Semen analysis values were assessed based on 2010 World Health Organisation reference criteria. Descriptive statistics tested the difference in clinical, hormonal and seminal parameters between groups. Logistic regression models assessed the impact of DI on semen parameters. Results: A DI of <12, 13–24, 25–36, 37–48, 49–60 and >60 months was found in 207 (12.6%), 651 (39.6%), 387 (23.5%), 168 (10.2%), 92 (5.6%) and 139 (8.4%) men, respectively. Patient's age (P < 0.001) and body mass index (P < 0.001) significantly increased along with DI. Hormonal values were similar across groups. Sperm concentration significantly decreased with DI (P = 0.01). Similarly, a higher rate of non‐obstructive azoospermia (NOA) was more frequently found in men with a longer DI (P = 0.03). There were no differences in semen volume, sperm progressive motility, total motile sperm count (TMSC), and normal morphology across groups. Multivariable logistic regression analysis showed that DI was significantly associated with the risk of oligozoospermia (P < 0.001), TMSC <5 × 106 (P < 0.001), and NOA (P < 0.001). Conclusions: This cross‐sectional study showed that DI had a negative impact on semen parameters in primary infertile men. Sperm concentration was negatively associated with DI and patients with a longer DI reported higher rates of azoospermia. Furthermore, DI was significantly associated with a higher risk of oligozoospermia, low TMSC, and NOA. [ABSTRACT FROM AUTHOR]

We read with interest the study from the Clinical Research Office of the Endourology Society (CROES)-upper tract urothelial carcinoma (UTUC) registry assessing the performance of both fibre optic ureteroscopy and digital flexible ureteroscopy (fURS) when conservatively treating UTUC [1]. Re: Flexible fibre optic vs digital ureteroscopy and enhanced vs unenhanced imaging for diagnosis and treatment of upper tract urothelial carcinoma (UTUC): results from the Clinical Research Office of the Endourology Society (CROES)-UTUC registry Flexible fibre optic vs digital ureteroscopy and enhanced vs unenhanced imaging for diagnosis and treatment of upper tract urothelial carcinoma (UTUC): results from the clinical research Office of the Endourology Society (CROES)-UTUC registry. [Extracted from the article]

The article offers information regarding endorsement of staging role of extended pelvic lymph node dissection (PLND) in prostate cancer (PCa). It mentions that extending the anatomical template by adding nearby nodal stations would further minimize the risk of missing positive lymph nodes. It states that high risk PCa treated with radical prostatectomy and a superextended PLND.