Does Testicular Sperm Improve Intracytoplasmic Sperm Injection Outcomes for Nonazoospermic Infertile Men with Elevated Sperm DNA Fragmentation? A Systematic Review and Meta-analysis.

CONTEXT: For nonazoospermic infertile men with elevated sperm DNA fragmentation (SDF), it is unclear whether the use of testicular sperm for intracytoplasmic sperm injection (ICSI) may offer advantages over ejaculated sperm. OBJECTIVE: To determine whether ICSI outcomes (fertilisation rate, pregnancy rate, miscarriage rate, and live birth rate) are better with testicular sperm than with ejaculated sperm for men with elevated SDF. EVIDENCE ACQUISITION: We searched the Cochrane Central, EMBASE, MEDLINE, Web of Science, and Scopus databases (1946-2023) in February 2023 for relevant human comparative studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. EVIDENCE SYNTHESIS: Out of 2032 records, nine studies (more than 536 participants, mean age range 33-40.5 yr for males and 30.1-37.9 yr for females) were included in the systematic review and meta-analysis. Pooled estimates demonstrated that the pregnancy rate was significantly higher with testicular than with ejaculated sperm according to a sperm chromatin structure assay (SCSA)/sperm chromatin integrity test (SCIT) (odds ratio [OR] 2.51; p = 0.001) and terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) assays (OR 3.65; p = 0.005). The live birth rate was significantly higher according to SCSA/SCIT (OR 2.59; p = 0.005). There were no significant differences in the fertilisation rate or miscarriage rate. CONCLUSIONS: Although significant improvements in pregnancy and live birth rates were observed with testicular sperm, the strength of findings is limited by availability and quality of evidence, both of which undermine recommendations for clinical practice. Standardised randomised controlled trials are needed to definitively determine whether the use of testicular sperm improves ISCI outcomes for men with high SDF. Until such evidence exists, ICSI after testicular sperm extraction or aspiration should not be routinely performed. PATIENT SUMMARY: Our review showed that for infertile men with a high level of DNA damage in their sperm, use of sperm extracted from the testicles may give better results than ejaculated sperm for a particular IVF (in vitro fertilisation) technique. However, there is a lack of high-quality data.

The management of erectile dysfunction in men with diabetes mellitus unresponsive to phosphodiesterase type 5 inhibitors.

INTRODUCTION: Erectile dysfunction is associated with diabetes mellitus with an estimated prevalence of 52.5% in the diabetic population. The first-line therapy for erectile dysfunction is phosphodiesterase type 5 inhibitors, but data suggest that diabetic men may be less responsive than non-diabetic men. Thus, other treatments, including intracavernosal injections, intraurethral prostaglandin, vacuum erection devices and penile prosthetic surgery, should be considered in management of diabetic men with erectile dysfunction refractory to phosphodiesterase type 5 inhibitors. Furthermore, combination therapy of phosphodiesterase type 5 inhibitors and other oral treatments such as arginine or l-carnitine may have synergistic effects resulting in better outcomes. In addition, there are novel therapies such as low-intensity shockwave therapy and stem-cell therapy, which may also be effective in targeted treatment modalities. Furthermore, studies suggest that erectile dysfunction can be improved by targeting concurrent comorbidities or metabolic diseases such as depression, hypertension, hypogonadism, and dyslipidaemia. We present an evidence-based narrative review focusing on the management of erectile dysfunction in diabetic men who have not responded to phosphodiesterase type 5 inhibitors. CONCLUSIONS: Both clinicians and patients should be aware of the different management options in diabetic patients who have not responded to phosphodiesterase type 5 inhibitors.

Penile implant surgery-managing complications.

Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments or vacuum constriction devices. Contemporary literature suggests that penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient's quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. Several factors - such as appropriate patient selection, methodical preoperative assessment and patient optimization, specific intraoperative protocols and postoperative recommendations - can reduce the risk of surgical complications. This narrative review discusses the diagnosis and management of both intraoperative and postoperative complications of penile prosthesis surgery.

[Validation of MRI and 18F-FDG-PET coregistration in patients with primary brain tumors]. / Evaluación del corregistro de imágenes de resonancia magnética y tomografía por emisión de positrones con 2-desoxy-2-flúor-d-glucosa marcada con flúor-18 en pacientes con patología tumoral cerebral.

OBJECTIVE: To evaluate the role of PET and MRI fused image study inpatients with primary brain tumors previously treated, to determine the presence of radionecrosis vs residual tumor viability. METHODS: Primary brain tumors were diagnosed by biopse and MR. 18FDG-PET scan and T1 enhanced MRI follow-up studies were performed between 3 and 5 months after treatment. The 18F-FDG uptake was semiquantitavively calculated by a region-of-interest based Tumor hotspot/normal brain tissue index. RESULTS: Fifty-seven patients were studied, 37 had high grade gliomas; 9 had oligoastrocytomas; 5 had Embrionary tumors; I had a meningyoma and I had an oliodendroglial tumor. All MR studies showed tumor enhancement, without determine wether if it was radionecrosis or tumor viability. PET/MR fused study diagnosed 21 negative studies (30%) and 36 positive results (70%). Tumor hotspot/normal brain tissue index correlated well with the visual analysis registered. CONCLUSIONS: Visual analysis in the contrast enhanced MR overestimates the tumoral area, without defining a possible diagnosis between tumor viability and radionecrosis. Metabolic activity in the 18F-FDG PET study in the enhanced area, determines the presence of residual tumor viability. Therefore, coregistration can be used to obtain a more specific diagnosis optimizing the cinical use.

Evaluación del corregistro de imágenes de resonancia magnética y tomografía por emisión de positrones con 2-desoxy-2-flúor-d-glucosa marcada con flúor-18 en pacientes con patología tumoral cerebral / Validation of MRI and 18F-FDG-PET coregistration in patients with primary brain tumors

Objetivo: Determinar la efectividad del co-registro de imágenes PET/RM (tomografía de emisión de positrones y resonancia magnética) en el diagnóstico de recidiva tumoral vs.. radionecrosis en pacientes con patología tumoral cerebral primaria previamente tratados. Material y métodos: El diagnóstico de tumor cerebral se determinó por RM e histopatología. Después de 3 a 5 meses postratamiento se realizó RM y PET como parte del seguimiento. El análisis de dichas imágenes se hizo de manera visual y semicuantitativa mediante la obtención de un índice de captación de 18F-FDG de tejido tumoral/ tejido cerebral sano. Resultados: Se estudiaron 57 pacientes; un total de 37 gliomas astrocíticos, 9 gliomas mixtos, 5 tumores embrionarios, 1 tumor meníngeo y 1 tumor oligodendroglial . Todas las imágenes de RM presentaban áreas de reforzamiento, dejando sospecha entre radionecrosis o viabilidad tumoral; con el co-registro PET/RM se diagnosticaron 21 estudios negativos (30 %) y 36 positivos (70 %). El índice tejido tumoral/tejido cerebral sano se correlacionó adecuadamente con los resultados visuales obtenidos. Conclusión: La RM sobreestima el área tumoral a valorar. La presencia de la actividad metabólica analizada mediante PET sobre las áreas de reforzamiento por RM permite determinar la presencia de viabilidad tumoral. Esto aumenta la certeza diagnóstica de ambas técnicas de imagen.

OBJECTIVE: To evaluate the role of PET and MRI fused image study inpatients with primary brain tumors previously treated, to determine the presence of radionecrosis vs residual tumor viability. METHODS: Primary brain tumors were diagnosed by biopse and MR. 18FDG-PET scan and T1 enhanced MRI follow-up studies were performed between 3 and 5 months after treatment. The 18F-FDG uptake was semiquantitavively calculated by a region-of-interest based Tumor hotspot/normal brain tissue index. RESULTS: Fifty-seven patients were studied, 37 had high grade gliomas; 9 had oligoastrocytomas; 5 had Embrionary tumors; I had a meningyoma and I had an oliodendroglial tumor. All MR studies showed tumor enhancement, without determine wether if it was radionecrosis or tumor viability. PET/MR fused study diagnosed 21 negative studies (30%) and 36 positive results (70%). Tumor hotspot/normal brain tissue index correlated well with the visual analysis registered. CONCLUSIONS: Visual analysis in the contrast enhanced MR overestimates the tumoral area, without defining a possible diagnosis between tumor viability and radionecrosis. Metabolic activity in the 18F-FDG PET study in the enhanced area, determines the presence of residual tumor viability. Therefore, coregistration can be used to obtain a more specific diagnosis optimizing the cinical use.