[Etiologic factors of erectile dysfunction in men with type 2 diabetes mellitus].

OBJECTIVE: To investigate the relationship of erectile dysfunction (ED) with blood vessel-, nerve- and androgen-related factors in young and middle-aged men with type 2 diabetes mellitus (T2DM) in order to provide some clinical evidence for early prevention and treatment of ED. METHODS: We divided 53 male T2DM patients under 50 years into an ED group (IIEF-5 score < or = 21, n = 28) and a non-ED (NED) group (IIEF-5 score > or = 22, n = 25). We detected the levels of blood lipid, glucose, total testosterone (TT), sex hormone-binding globulin (SHBG), sulfate dehydroepiandrosterone (DHEA-S), calculated free testosterone (cFT), and examined the complications of macroangiopathy (MA), diabetic retinopathy (DR) and diabetic peripheral neuropathy (DPN), and compared the above indicators between the two groups. RESULTS: There were no significant differences between the two groups in age, diabetes duration, body mass index, blood pressure, and blood lipid and glucose levels (P > 0.05). The incidence rate of DR was significantly higher in the ED than in the NED group (39.3% vs 4.0%, P < 0.05), but no statistically significant differences were found in the levels of TT, cFT, SHBG and DHEA-S and the incidence rates of MA and DPN between the two groups (P > 0.05). CONCLUSION: The incidence of ED is closely related to DR in young and middle-aged men with T2DM. Therefore particular attention should be paid to the erectile function of T2DM patients with DR as early as possible.

[Value of degree diagnosis with color Doppler flow imaging in the treatment of male erectile dysfunction].

OBJECTIVE: To study the value of degree diagnosis with color Doppler flow imaging (CDFI) in the treatment of male erectile dysfunction (ED). METHODS: After CDFI and intracavernosal vasoactive agent injection (ICI) with papaverine 60 mg and prostaglandin E(1) 10 microg, 198 male ED patients were divided into 4 groups by their penile stiffness based on the Schramek criterion. The therapeutic methods such as antibiotics for prostatitis, sexual behavior therapy, sildenafil, vacuum constriction device (VCD), vena fistula repairing operation, prosthetic implantation and enhanced external counterpulsation (EECP) were recommended to the patients according to their different penile stiffness degree and their different preferences. RESULTS: Prior to ICI, there was no significant difference in the cavernosa artery peak systolic velocities (PSV), end diastolic velocities (EDV), resistant indexes (RI), dorsal artery PSV, EDV, RI and deep dorsal vein velocity (V) (P > 0.05). After ICI, the cavernosa artery PSV, EDV and RI were significantly different (P < 0.05) while other indices were not (P > 0.05). The patients were treated differently according to their preferences. The selective goal-oriented therapy increased the satisfactory rate to 91.91% (182/198). CONCLUSION: Based on the penile stiffness degree with CDFI plus ICI, different therapeutic methods yield a better clinical outcome.

[Verapamil and hypothermia protect spermatogenesis of torsioned testes in rats].

OBJECTIVE: To investigate the protective effect of verapamil and hypothermia on the spermatogenesis of rats after testicular torsion. METHODS: Sixty healthy pubertal male Sprague-Dawley rats were equally divided into 5 groups: A (testis torsion), B (testis torsion + verapamil), C (testis torsion + hypothermia), D (testis torsion + verapamil + hypothermia) and E (control). After treatment, the left testis was removed for the observation of the histological changes under the microscope and measurement of the percentage of apoptotic cells by flow cytometry. RESULTS: HE staining showed disordered arrangement, reduced layers and decreased number of spermatogenic cells, apoptotic bodies, necrosis and partial invasion of inflammatory cells in all the groups but E, most obvious in Group A. The apoptosis rates of germ cells in Groups A, B, C, D and E were (32.11 +/- 2.20)%, (20.18 +/- 1.50)%, (20.02 +/- 1.90)%, (13.75 +/- 1.40)% and (8.56 +/- 0.90)%, respectively, and the Makler scores in the 5 groups were (14.47 +/- 1.35), (15.45 +/- 0.75), (15.48 +/- 0.75), (16.22 +/- 0.72) and (19.60 +/- 0.56), respectively, both with statistically significant differences (P < 0.01). CONCLUSION: The increased apoptosis of germ cells after testicular torsion-and-reposition may reduce the spermatogenesis of the testis. Either verapamil or local hypothermia can enhance testicular resistance against injuries, and the combination of the two can more efficiently prevent the germ cells from apoptosis.

Predictive significance of serum inhibin B on testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men.

The purpose of this study was to determine the diagnostic accuracy of serum inhibin B (INHB) as a predictor of the retrieval outcome of testicular haploid gametes (spermatids and testicular spermatozoa) in nonobstructive azoospermic men. Serum hormone levels, testicular volume, and histological evaluation were performed in 403 Chinese nonobstructive azoospermic men. Testicular haploid gamete was successfully retrieved in 213 of 403 patients (52.85%). The haploid gamete group always had higher INHB levels than the non-haploid gamete group. According to the receiver operating characteristic (ROC) curve analysis, INHB was a good predictor of testicular haploid gamete retrieval outcome in all patients (sensitivity: 77.93% and specificity: 91.58%) and patients with normal follicle-stimulating hormone (FSH; sensitivity: 88.52% and specificity: 70.83%). The area under the ROC curve (AUC) of INHB was similar to that of FSH in all patients or patients with normal FSH. In patients with elevated FSH, INHB was superior to FSH in predicting the presence of haploid gamete (AUC: 0.73 vs 0.55, P < 0.05), with a sensitivity of 60.00% and a specificity of 80.28%. It concluded that serum INHB as an effective marker for spermatogenesis was a significant predictor of testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men. Especially, INHB is superior to FSH in predicting the presence of haploid gamete in the patients with elevated FSH.

Outcome of implanting penile prosthesis for treating erectile dysfunction: experience with 42 cases.

AIM: To report a short-time result of three-piece inflatable penile prosthesis (IPP) implantation on treating patients with organic erectile dysfunction (ED). METHODS: Three-piece IPPs were implanted in 42 Chinese patients with ED refractory to systemic treatment between May 2002 and May 2004. The etiologies of ED were neurogenic (28 with paraplegia and seven with traumatic nervi-erigentes injury); congenital venous leakage (5 cases), fibrosis of corpus cavernosum (1case) and Klinefelter's syndrome (1 case). The follow-up period ranged from 24 to 57 months. RESULTS: Implantation procedures were successfully performed upon all 42 patients. The length of implanted prosthesis was from 13 cm to 18 cm, and the diameter was 1 cm. The implanted prosthesis was made by the Medical Instrumentation Company of Muping (Muping, Shandong, China). Localized infection occurred in only one patient and mechanical complications occurred in five patients. Coitus could be performed in 41 cases (97.6%). Three patients with congenital venous leakage made their spouses pregnant after implantation. CONCLUSION: Implantation of three-piece IPP is an effective and safe modality for treating patients with ED. It can be well accepted by Chinese patients because of its efficacy.

The application of color Doppler flow imaging in the diagnosis and therapeutic effect evaluation of erectile dysfunction.

We aim to investigate the correlations between hemodynamic parameters, penile rigidity grading, and the therapeutic effects of phosphodiesterase type 5 inhibitors using color Doppler flow imaging after intracavernosal injection in patients with erectile dysfunction. This study involved 164 patients. After intracavernosal injection with a mixture of papaverine (60 mg), prostaglandin E 1 (10 mg), and lidocaine (2%, 0.5-1 ml), the penile vessels were assessed using color Doppler flow imaging. Penile rigidity was classified based on the Erection Hardness Score system as Grades 4, 3, 2 or 1 (corresponding to Schramek Grades V to II). Then, the patients were given oral sildenafil (50-100 mg) and scored according to the International Index of Erectile Function (IIEF-5) questionnaire. The number of patients with penile rigidities of Schramek Grades II to V was 14, 18, 21, and 111, respectively. The IIEF-5 score was positively correlated with the refilling index of the penile cavernosal artery (r = 0.79, P< 0.05), the peak systolic velocity (r = 0.45, P< 0.05), and penile rigidity (r = 0.75, P< 0.05), and was negatively correlated with the end diastolic velocity (r = -0.74, P< 0.05). For patients with erectile dysfunction, both the IIEF-5 score after sildenafil administration, which is correlated with penile rigidity, and the hemodynamic parameters detected using color Doppler flow imaging may predict the effects of phosphodiesterase type 5 inhibitor treatment and could provide a reasonable model for the targeted-treatment of erectile dysfunction.

[Treatment of erectile dysfunction by implantation of domestic made three-piece inflatable penile prosthesis, a retrospective study of 29 cases].

OBJECTIVE: To evaluate the effect of implantation of domestic made three-piece inflatable penile prosthesis on erectile dysfunction (ED). METHODS: Domestic made three-piece inflatable penile prosthesis were implanted through an incision at the border of penis and scrotum on 29 patients with ED refractory to non-operative treatment, among which 23 being with neurogenic ED, including 18 paraplegia cases and 5 cases of traumatic injury of nervi erigentes; 4 cases with ED caused by arteriovenous fistula; I case with ED caused by fibrosis of corpus cavernosum, and 1 case with ED caused by Klinefelter's syndrome. Follow-up was conducted for 3 - 36 months to survey the clinical effect. RESULTS: Operation was successfully performed upon all 29 patients. Follow-up after operation lasted 3 - 36 months, 18 months on average. Fluid exudation of penile prosthesis and localized infection occurred in 1 patient and mechanic complication occurred in 2 patients. Maintained sexual intercourse rate was 28/29. 3 ED patients with primary arteriovenous fistula made their spouses pregnant after treatment. CONCLUSION: With excellent covertness and at low cost, implantation of domestic made three-piece inflatable penile prosthesis is effective and well accepted by ED patients.

[Treatment of the paraplegic patient with erectile dysfunction by implantation of China-made three-piece inflatable penile prosthesis].

OBJECTIVE: To evaluate the effect of the treatment on paraplegic patients with erectile dysfunction (ED) by implantation of China-made three-piece inflatable penile prosthesis. METHODS: Eighteen paraplegic patients with ED refractory to non-operative treatment were implanted with three-piece inflatable penile prosthesis through an incision at the border of penis and scrotum. The rate of maintained coitus and the satisfactory coitus of spouse were obtained by inquiring and letter visiting. RESULTS: Operations were successfully performed upon all 18 patients. Follow-ups after operations ranged from 3 months to 36 months, mean follow-up being 18 months. Fluid exudation from penile prosthesis and localized infection occurred in one patient and mechanic complication occurred in two. Maintained coitus rate was 17/18. Ejaculation reflection occurred in three patients. CONCLUSIONS: Treatment of paraplegic patient with ED refractory to non-operative treatment by implantation of China-made three-piece inflatable penile prosthesis has good concealment and rehabilitative effect, with similar mechanical troubles to imported products. With excellent covertness, implantation of three-piece inflatable penile prosthesis is well accepted by ED patients.

The association between testicular microlithiasis and semen parameters in Chinese adult men with fertility intention: experience of 226 cases.

OBJECTIVE: To investigate the association between testicular microlithiasis (TM) and semen parameters in Chinese adult men with fertility intention. MATERIALS AND METHODS: We retrospectively reviewed the ultrasonography results of the reproductive system of 16,204 consecutive adult male patients in our hospital with fertility intention from November 2012 to October 2013. TM was diagnosed by scrotal ultrasonography. Patients with TM were divided into classic testicular microlithiasis (CTM) or limited testicular microlithiasis (LTM). The clinical data of CTM, LTM, and non-TM groups, especially of patients in whom sperms were found in semen analysis, were collected and analyzed. RESULTS: There were 226 men (1.39%) diagnosed with TM. The mean age was 28.96 ± 5.12 years (range, 21-46 years), whereas mean testicular volume was 15.38 ± 4.90 mL (range, 1.62-31.23 mL). CTM and LTM were detected in 141 (62.39%) and 85 patients (37.61%), respectively. Among 200 patients who underwent semen analysis, sperms were found in 159 men (79.5%; 97 men with CTM and 62 men with LTM). One hundred and twenty cases without TM (ie, non-TM group) were collected in the control group. Sperm concentration, total motility, and percentage of progressively motile of CTM, LTM, and non-TM groups was (38.01 ± 31.58 million/mL vs 52.31 ± 33.26 million/mL vs 67.16 ± 36.94 million/mL; P <.001), (46.03 ± 23.69% vs 55.37 ± 24.16% vs 62.08 ± 20.45%; P <.001), and (35.88 ± 20.17% vs 43.15 ± 21.08% vs 47.10 ± 17.84%; P <.001), respectively. CONCLUSION: TM is associated with worse semen parameters in adult men with fertility intention. The extent of microlithiasis correlates inversely with semen parameters.

Kidney cancer cells secrete IL-8 to activate Akt and promote migration of mesenchymal stem cells.

BACKGROUND: Mesenchymal stem cells (MSCs) are multipotent adult stem cells that have the capability of homing to cancer cells. Thus, MSCs play an important role in the development, metastasis, and drug resistance of cancers. The mechanisms underlying the homing of MSCs in kidney cancer are still poorly understood. METHODS: In the present study, enzyme-linked immunosorbent assay was used to measure the level of IL-8 in patients with kidney cancer and in the culture medium of kidney cancer cells. Immunofluorescence staining and reverse transcription polymerase chain reaction were utilized to explore the main receptor for IL-8 in MSCs. Transwell migration assay was performed to measure the migration ability of MSCs and Western blot test was performed to test the activation of signaling pathways. RESULTS: The serum level of IL-8 was markedly increased in patients with kidney cancer, and 2 kidney cancer cell lines were found to secrete IL-8. MSCs had high expression of the IL-8 receptor (CXCR2). Blocking IL-8 or CXCR2 could decrease the migration ability of MSCs. IL-8 could significantly increase Akt phosphorylation in MSCs. CONCLUSIONS: Kidney cancer cells secrete IL-8 to activate the Akt signaling pathway via CXCR2 on MSCs, inducing the migration of MSCs, which may be one of the important mechanisms underlying the homing of MSCs in kidney cancer.

Color Doppler flow imaging diagnosis and treatment selection for erectile dysfunction.

BACKGROUND: Targeted therapy for erectile dysfunction (ED) involves fewer screening tests and provides a variety of treatment choices for patients. Although the advantage of targeted therapy in diagnosis and therapy for ED has been recognized, the rational mode for oriented ED therapy has not been established. This study aimed to investigate targeted diagnosis and therapy for ED. METHODS: A total of 198 patients with ED were included in the study. After intracavernosal vasoactive agent injection was given, color Doppler flow imaging was performed and penile rigidity was classified as Schramek grade 5 (10 minutes duration), grade 4 (10 minutes duration), grade 3 and grade 2, defining four patient groups as group V (143 cases), group IV (23 cases), group III (18 cases), and group II (14 cases). Appropriate and acceptable treatment was recommended to patients according to erection grade. RESULTS: In 198 patients with ED, the peak systolic velocity, end diastolic velocity, and resistance index in the cavernosal artery and dorsal artery and the flow velocity in the deep dorsal vein were not significantly different before injection (P > 0.05). After injection, peak systolic velocity, end diastolic velocity, and resistance index in the cavernosal artery were different among the four groups (P < 0.05). Between each two groups, the difference in resistance index was significant (P < 0.05). The statistical differences in other indexes were not significant (P > 0.05). Selective targeted therapy based on erection grade by color Doppler flow imaging improved the clinical satisfaction rate to 91.91% (182/198). CONCLUSIONS: Based on the routine diagnosis of ED, blood flow indexes in the cavernosal artery are measured by color Doppler flow imaging following minimally invasive intercavernosal injection, which is combined with the Schramek grade of erection. The most appropriate and acceptable treatment is recommended according to the different groups, which improves the clinical satisfaction of treatment for ED and is an ideal model of targeted diagnosis and treatment.