Efficacy of testosterone replacement treatment for patients with symptoms of late-onset hypogonadism based on real-world patient satisfaction.

Late-onset hypogonadism is generally treated with testosterone replacement treatment. However, the efficacy rate of treatment for patients with low testosterone is not clear because patients without low testosterone are also treated in real-world clinical settings. This study comprised 110 men with low testosterone concentration of <3.0 ng/mL who underwent testosterone replacement treatment. Physical factors, laboratory and endocrinologic profiles, and scores of several questionnaires were assessed. Testosterone replacement treatment was performed with intramuscular injection of 250 mg of testosterone esters every 2-4 weeks, and efficacy was judged by patient satisfaction. After confirming efficacy, changes in several factors by the treatment were evaluated. Finally, the comparison between evaluation by patient satisfaction and by that with the questionnaires was assessed. Among the 110 patients, 77 (70.0%) were satisfied with the treatment, which was effective in 65.7%, 71.4%, and 73.1% of patients with mental, physical, and sexual dysfunction, respectively. The questionnaire scores including the Aging Males Symptoms rating scale were significantly improved in both the satisfaction and non-satisfaction group. However, no significant differences in the amount of change in questionnaire scores were found for all questionnaire scores improved by testosterone replacement treatment between the groups. Patient satisfaction was not associated with improvement of the Aging Males Symptoms score. Although testosterone replacement treatment was effective for 70.0% of the hypogonadal patients, patient satisfaction did not correlate with improvement of questionnaire scores. We concluded that not only questionnaire results but also patient satisfaction is important when evaluating efficacy in patients undergoing testosterone replacement treatment.

Maximum Flow Rate is Lowest in the Early Morning in Hospitalized Men With Nocturia Evaluated Over 24 Hours by Toilet Uroflowmetry.

OBJECTIVES: To investigate urination parameters measured by toilet uroflowmetry in hospitalized men with nocturia over a 24-hour period to clarify the circadian rhythm of urination. Physicians often encounter male patients with complaints of low maximum flow rate only in the early morning. However, this has not been proved scientifically because most urinary examinations are generally performed for outpatients only during the daytime. METHODS: This retrospective study included 117 hospitalized male patients (age, 68.7 ± 12.8 years). The data of 4689 urinations during their hospital stay were evaluated on the ward by toilet uroflowmetry, which is a toilet-type device that allows patients to urinate as usual. The records including voided volume, maximum flow rate, and voiding time were evaluated as averages of 8 time periods of 3 hours each by generalized linear mixed models with an identity link function to adjust for personal bias. RESULTS: Voided volume after adjustment for age was significantly higher during the nighttime (21:00-06:00) than that in the morning (06:00-09:00) and highest from 00:00-03:00. Interestingly, even after adjustment for both voided volume and age, the maximum flow rate from 06:00-09:00 was the lowest. Voiding time after adjustment for age and voided volume was significantly higher during the nighttime (00:00-06:00) than that from 06:00-09:00. CONCLUSION: We clearly showed the circadian rhythm of urination in a group of hospitalized men with nocturia. Maximum flow rate was lowest in the early morning, including just after waking up.

Oral/oesophageal candidiasis is a risk factor for severe infection after kidney transplantation.

AIM: Bacterial and fungal infections are serious, life-threatening conditions after kidney transplantation. The development of oral/oesophageal candidiasis after kidney transplantation is not a reported risk factor for subsequent severe infection. This study was performed to investigate the relationship between oral/oesophageal candidiasis after kidney transplantation and the development of subsequent infection requiring hospitalization. METHODS: This retrospective study included 522 consecutive patients who underwent kidney transplantation at Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital from 1 January 2010 to 1 February 2019. Ninety-five percentage of patients were living donor transplant recipients. Visual examination was performed to detect oral candidiasis, beginning immediately after kidney transplantation; upper gastrointestinal endoscopy was performed 8-10 months after kidney transplantation. Twenty-five patients developed candidiasis (Candida-onset group) and 497 did not (non-Candida-onset group). The follow-up periods were 67 (37-86) months in the Candida-onset group and 55 (34-89) months in the non-Candida-onset group. Severe infection was defined as bacterial or fungal infection requiring hospitalization; viral infections were excluded. RESULTS: Severe infection developed in 9/25 (36%) patients in the Candida-onset group and in 77/497 (15%) patients in the non-Candida-onset group (p = .006). Binomial logistic analysis revealed that Candida infection (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.06-6.06; p = .037) and use of rituximab (OR 1.81, 95% CI 1.12-2.93; p = .016) were significant predictors of subsequent severe infection. CONCLUSION: Oral/oesophageal candidiasis is a risk factor for severe infection after kidney transplantation and suggests an over-immunosuppressive state, which should prompt evaluation of immunosuppression.

Efficacy and Safety of Vibegron Add-on Therapy in Men With Persistent Storage Symptoms After Receiving Alpha 1-Blocker or Phosphodiesterase 5 Inhibitor: A Preliminary Study.

OBJECTIVE: To investigate the efficacy and safety of vibegron add-on therapy in men with persistent storage symptoms receiving α-1 blockers or PDE5 inhibitor for benign prostatic hyperplasia and then determine the independent factors affecting the efficacy of vibegron. METHODS: Vibegron 50 mg was administered for 12 weeks to 42 patients (72.0 ± 8.2 years) with persistent storage symptoms who had taken α-1 blockers (22 patients) or PDE5 inhibitor (20 patients). The primary endpoint was change in the overactive Bladder (OAB) Symptom Score from baseline to end of treatment. The secondary endpoints were changes in each question of several questionnaires, maximum flow rate and residual urine volume. Finally, independent factors affecting the efficacy of vibegron were investigated. RESULTS: Total OAB Symptom Score was significantly decreased (6.21 ± 3.12 vs 4.38 ± 2.46; P < .001). Although each score of several questionnaires, especially for storage symptoms, improved significantly, no significant improvement was found in stress incontinence, straining, bladder pain and urethral pain in the Core Lower Urinary Tract Symptom score. Maximum flow rate and residual urine volume did not change, and no patient discontinued vibegron because of adverse events. Multiple regression analysis showed that OAB Symptom Score, Core Lower Urinary Tract Symptom score, prostate volume and monotherapy with α-1 blocker were independent factors affecting the efficacy of vibegron. CONCLUSION: Add-on therapy of vibegron to monotherapy with α-1 blockers or PDE5 inhibitor for patients with benign prostatic hyperplasia and persistent storage symptoms was effective and safe.

Relationship between serum zinc concentration and semen quality in newly-wed men.

OBJECTIVES: To clarify factors associated with semen quality and confirm whether there is an association between semen quality and serum zinc concentration. METHODS: A semen test was performed on 217 men just after or just before marriage. Variables assessed in the study were: age; symptomatic scores, including sexual function evaluated using several specific questionnaires; endocrinological profiles, especially follicle-stimulating hormone; and serum zinc concentrations. Based on World Health Organization criteria for assessing sperm quality, semen volume ≥1.5 mL, sperm concentration ≥15 million/mL, or sperm motility rate ≥40%, the men were grouped according to whether they had values below or above these criteria. The two groups were compared with regard to the study variables, and correlation between serum zinc concentration and semen quality was evaluated. Independent predictors for inclusion in the group with values below the criteria were investigated further. RESULTS: Of the 217 men included in the study, 45 (20.7%) were categorized as having values below the World Health Organization criteria. The men in this group were significantly older and had significantly worse sexual function, significantly higher follicle-stimulating hormone levels, and significantly lower serum zinc concentrations, than those in the group with values above the criteria. There was no significant correlation between serum zinc concentration and semen quality. However, the independent predictors for having values below the criteria in binomial logistic regression analysis were follicle-stimulating hormone and serum zinc concentration. CONCLUSION: We suggest that semen analysis may be considered in men with a low level of serum zinc and high level of follicle-stimulating hormone when developing a life plan for fertilization.

Oral Testofen, L-Citrulline, Resveratrol, and Caffeine Supplement Drink Improves Sexual Function in Men with Phosphodiesterase 5 Inhibitors: Randomized, Double-Blind, Placebo-Controlled Crossover Pilot Study.

PURPOSE: Sexuality is very important for men's health. Currently, phosphodiesterase type 5 inhibitors (PDE5i) remain the first-line therapy for erectile dysfunction, and no other oral drugs or drinks are approved and used clinically to treat male libido or orgasm dysfunction. In reference to a pharmaceutical dosage document, growing health consciousness is said to have boosted yearly sales of supplement drinks to more than 170 billion yen (1.58 billion US dollars) in Japan. We have created a supplement drink comprised of testofen, L-citrulline, resveratrol, and caffeine. We hypothesized that our supplement drink would be effective for men with sexual dysfunction, and especially libido dysfunction. MATERIALS AND METHODS: In this study, men with sexual dysfunction received a placebo drink for 14 days or our supplement drink (testofen, 600 mg/d; L-citrulline, 800 mg/d; resveratrol, 300 mg/d; and caffeine, 40 mg/d) for another 14 days separated by a 7-day washout period. Patients continued on-demand use of PDE5i. The International Index of Erectile Function (IIEF) score and adverse events were assessed. RESULTS: Twenty patients aged 30-7 years old were enrolled in and concluded the study with no adverse events experienced. The IIEF domains of desire frequency, erection frequency, erection firmness, erection confidence, intercourse satisfaction, ejaculation frequency, orgasm frequency, and overall satisfaction were significantly improved with our supplement drink. CONCLUSIONS: This is the first study to show that our supplement drink may not only be effective for erection but also for libido, orgasm, and ejaculation.

Prevalence of testicular microlithiasis in healthy newlywed men trying for first-time pregnancy.

OBJECTIVES: To investigate the prevalence of testicular microlithiasis and the relationship between testicular microlithiasis, semen parameters and endocrinological profiles in healthy newlywed men trying for first-time pregnancy. METHODS: Men visiting Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan, or D Clinic Tokyo, Chiyoda-ku, Tokyo, Japan, for a first-time examination of fertility underwent scrotal examination, semen analysis and blood tests. Testicular volume measured by orchidometer, semen parameters measured by the Makler counting chamber and endocrinological profiles were compared between men with testicular microlithiasis and without testicular microlithiasis. The correlation between sperm concentration and the number of calcifications, and sperm motility and the number of calcifications, were investigated. RESULTS: Of 739 men, 60 (8.1%) were diagnosed as having testicular microlithiasis. Among them, testicular volume, semen volume and motility were lower than those in the men without testicular microlithiasis. Luteinizing hormone and follicle-stimulating hormone levels were higher in those with than those without testicular microlithiasis. The sperm concentration correlated negatively with the number of calcifications. There was no significant correlation between sperm motility and the number of calcifications. CONCLUSION: Herein, we report the prevalence of testicular microlithiasis in healthy newlywed men. Furthermore, our findings suggest that semen parameters in men with severe testicular microlithiasis tend to be worse.

Endocrinological and symptomatic characteristics of patients with late-onset hypogonadism classified by functional categories based on testosterone and luteinizing hormone levels.

OBJECTIVES: To define the characteristics of patients with late-onset hypogonadism based on endocrinological findings. METHODS: We assessed age, body mass index, laboratory/endocrinological profiles and symptom-specific questionnaire scores of 967 men with late-onset hypogonadism symptoms. The patients comprised four groups by testosterone and luteinizing hormone concentrations: normal group, compensated hypogonadism group, primary hypogonadism group and secondary hypogonadism group. We compared characteristics between the normal group and compensated hypogonadism group in men with normal testosterone concentration, and the primary hypogonadism group and secondary hypogonadism group in hypogonadal men after age adjustment. RESULTS: The normal group, compensated hypogonadism group, primary hypogonadism group and secondary hypogonadism group accounted for 83.6%, 3.4%, 0.8% and 12.2% of patients, respectively. Despite age adjustment, serum dehydroepiandrosterone sulfate and insulin-like growth factor 1 concentrations were significantly lower in the compensated hypogonadism group than the normal group. Only the Aging Males' Symptoms scale mental subscore was significantly different. Serum testosterone and dehydroepiandrosterone sulfate concentrations were significantly lower in the primary hypogonadism group than the secondary hypogonadism group. Only the Aging Males' Symptoms scale sexual subscore was significantly different. CONCLUSIONS: Most patients with late-onset hypogonadism symptoms are in the normal group, with secondary hypogonadism being much more frequent than primary hypogonadism. Current symptomatic differences among these groups are minor. Classifying patients by testosterone and luteinizing hormone levels might provide useful information for follow up.

Port site hernia at the robotic arm port after robotic-assisted laparoscopic radical prostatectomy.

INTRODUCTION: Complications unique to laparoscopic surgery have been reported, including port site hernia. We experienced a case of port site hernia in the robotic right-hand port site measuring 8 mm in diameter after robotic-assisted laparoscopic radical prostatectomy. CASE PRESENTATION: A 56-year-old man was indicated a high prostate-specific antigen level of 37.8 ng/ml. Subsequent prostate biopsy revealed adenocarcinoma with a Gleason score of 4 + 4. The patient underwent robotic-assisted laparoscopic radical prostatectomy in Juntendo Hospital. Although his postoperative recovery was generally good, the patient complained of sudden nausea and acute abdominal pain. A contrast computed tomography scan showed an ileus due to a hernia occurring at the robotic right-hand port, the da Vinci Arm I port. We released incarceration under laparoscopic procedure. CONCLUSION: Since the port diameter is relatively small in robot-assisted surgery, port site hernias are expected to be rare. However, careful attention should be paid to the positional deviation of the remote center.