Efficacy and safety of two disposable circumcision suture devices for circumcision in adults: a prospective comparative multicenter study.

The objective of this study was to evaluate and compare efficacy and safety of two different Disposable circumcision suture devices (DCSDs). A prospective comparative non-randomized multicenter study was performed between November 2019 and February 2023. Patients underwent circumcision using a DCSD (CircCurerTM or the ZSR® device) according to the surgeon preference and device availability. A total of 378 patients were circumcised; 184 using CircCurerTM and 194 patients using ZSR®. No differences in baseline characteristics were observed. CircCurer and ZSR Groups showed similar rates of operative time (7.7 ±2.1 vs 7.3 ±2.0 min), surgical site infection (1.1% Vs 1.5%), edema (13% Vs 8.2%), hematomas (2.7% Vs 1.1%), and postoperative pain (2.5 Vs 2.0 points). ZSR Group had a significantly higher rate of clip fallout (62.9% Vs 38%, p < 0.001). At 2 months, patients of both groups reported a median satisfaction of 9 (8-9) points. Main limitation consist in non-randomized study. DCSDs seem to be effective and safe, with short operative times, uncommon and mild complications, and high patient satisfaction. ZSR® device has a higher rate of spontaneous staple dropout.

mpMRI-US Fusion-Guided Targeted Cryotherapy in Patients with Primary Localized Prostate Cancer: A Prospective Analysis of Oncological and Functional Outcomes.

Targeted therapy (TT) for prostate cancer (PCa) aims to ablate the malignant lesion with an adequate margin of safety in order to obtain similar oncological outcomes, but with less toxicity than radical treatments. The main aim of this study was to evaluate the recurrence rate (RR) in patients with primary localized PCa undergoing mpMRI/US fusion targeted cryotherapy (FTC). A secondary objective was to evaluate prostate-specific antigen (PSA) as a predictor of recurrences. We designed a prospective single-center single-cohort study. Patients with primary localized PCa, mono or multifocal lesions, PSA ≤ 15 ng/mL, and a Gleason score (GS) ≤ 4 + 3 undergoing FTC were enrolled. RR was chosen as the primary outcome. Recurrence was defined as the presence of clinically significant prostate cancer in the treated areas. PSA values measured at different times were tested as predictors of recurrence. Continuous variables were assessed with the Bayesian t-test and categorical assessments with the chix-squared test. Univariate and logistic regression assessment were used for predictions. A total of 75 cases were included in the study. Ten subjects developed a recurrence (RR: 15.2%), while fifty-six (84.8%) patients showed a recurrence-free status. A %PSA drop of 31.5% during the first 12 months after treatment predicted a recurrence with a sensitivity of 53.8% and a specificity of 79.2%. A PSA drop of 55.3% 12 months after treatment predicted a recurrence with a sensitivity of 91.7% and a specificity of 51.9%. FTC for primary localized PCa seems to be associated with a low but not negligible percentage of recurrences. Serum PSA levels may have a role indicating RR.

Effects of age and oligoasthenozoospermia on telomeres of sperm and blood cells.

RESEARCH QUESTION: How do age and normo- or oligoasthenozoospermia affect telomere length dynamics in spermatozoa and blood? DESIGN: Sperm and blood samples were collected from a cohort of 37 men aged 25 and under and 40 men aged 40 and over, with either normozoospermia (NZ) or oligoasthenozoospermia (OAZ). Telomere length was evaluated using quantitative fluorescence in-situ hybridization. Telomerase mRNA (TERC and TERT) and shelterin (TRF1) gene expression were analysed using quantitative real-time polymerase chain reaction. TRF1 protein immunoreactivity was also evaluated using immunofluorescence. RESULTS: Mean sperm telomere length (STL) increased with age in the NZ group; older NZ men accumulated the longest telomeres (P < 0.001). In peripheral blood mononuclear cells (PBMC), mean telomere length decreased with age in NZ groups, although not reaching statistical significance. Interestingly, the younger OAZ group had the shortest mean telomere length (versus young NZ, P = 0.0081; versus old NZ, P = 0.0116; versus old OAZ, P = 0.0009) and accumulated the highest percentage of short telomeres compared with the other groups (overall P = 0.0017). Analysis of TERC and TERT mRNA expression in spermatozoa and PBMC did not show significant differences among groups. Statistically significant positive correlations were found between STL and seminal parameters in younger NZ men (P = 0.009 for sperm count and P = 0.007 for total progressive motility). Protein immunoreactivity of TRF1 in blood was not significantly different in all groups analysed. CONCLUSIONS: The OAZ group did not show the increase of STL with age that is seen in NZ individuals, suggesting that telomere length elongation mechanisms fail in OAZ patients. In PBMC, younger OAZ individuals showed significantly shorter mean telomere length, suggesting that this parameter could be a good biomarker of OAZ in younger OAZ patients. Telomerase gene and TRF1 mRNA expression and TRF1 protein immunoreactivity did not differ significantly between groups, and so these factors cannot be used as OAZ biomarkers.

[Assessment of the erectile function and patients' perception of improvement in Spanish patients with erectile dysfunction]. / Evaluación de la función eréctil y la percepción de mejoría en pacientes españoles con disfunción eréctil.

OBJECTIVE: This study has been carried out to assess the hardness of erection and the perception of improvement in erectile function with the treatments received during the last month. MATERIAL AND METHOD: Descriptive, observational, multicenter, cross-sectional study carried out in 30 urology sites in Spain. Patients diagnosed of erectile dysfunction receiving treatment during at least the last month have been enrolled. Hardness of erection has been assessed with the erection hardness score and improvement perception has been estimated with the global assessment question. RESULTS: A 63% of patients had a hardness of erection that was insufficient for penetration, but 75% of patients referred that their erectile function had improved with treatment. After adjustment for other factors, erection hardness score values were not significantly different among patients being treated with alprostadil topical cream, compared to patients being treated with the combination of phosphodiesterase 5 (PDE5) inhibitors plus alprostadil topical cream or with PDE5i other than sildenafil alone. However, patients treated with alprostadil topical cream had a significantly higher chance of referring an improvement in their erectile function compared to patients treated with PDE5i, despite the fact that they had received treatment for a shorter period of time. CONCLUSION: Hardness of erection is just another factor of erectile function, but it is not the only one influencing improvement perception by patients.

Evaluación de la función eréctil y la percepción de mejoría en pacientes españoles con disfunción eréctil / Assessment of the erectile function and patients' perception of improvement in Spanish patients with erectile dysfunction

Objetivo. Este estudio se ha llevado a cabo para valorar la dureza de erección y la percepción de mejoría de la función eréctil con los tratamientos recibidos en el mes anterior. Material y método. Se trata de un estudio descriptivo, observacional, multicéntrico y transversal, llevado a cabo en 30 centros de urología de España. Se han reclutado pacientes con disfunción eréctil que hubieran recibido tratamiento durante al menos un mes. La dureza de la erección se ha valorado con el cuestionario de dureza de erección y la percepción de mejoría con la pregunta de valoración global. Resultados. El 63% de los pacientes presentaba una dureza de erección insuficiente para lograr la penetración, pero el 75% referían haber mejorado con el tratamiento. Tras ajustar por varios factores, los valores del cuestionario de la dureza de erección no fueron significativamente diferentes entre los pacientes tratados con alprostadilo crema los tratados con inhibidores de la fosfodiesterasa 5 (iPDE5) combinados con alprostadilo crema y los tratados solo con iPDE5 distintos a sildenafilo. Sin embargo, los pacientes tratados solo con alprostadilo crema sí tuvieron una probabilidad significativamente superior a la de los tratados con iPDE5 de percibir una mejoría de la función eréctil con el tratamiento recibido, incluso a pesar de haber estado en tratamiento durante menos tiempo. Conclusión. La dureza de la erección es solo un elemento más de la función eréctil, pero no es el único que influye sobre la percepción de mejoría de los pacientes

Objective. This study has been carried out to assess the hardness of erection and the perception of improvement in erectile function with the treatments received during the last month. Material and method. Descriptive, observational, multicenter, cross-sectional study carried out in 30 urology sites in Spain. Patients diagnosed of erectile dysfunction receiving treatment during at least the last month have been enrolled. Hardness of erection has been assessed with the erection hardness score and improvement perception has been estimated with the global assessment question. Results. A 63% of patients had a hardness of erection that was insufficient for penetration, but 75% of patients referred that their erectile function had improved with treatment. After adjustment for other factors, erection hardness score values were not significantly different among patients being treated with alprostadil topical cream, compared to patients being treated with the combination of phosphodiesterase 5 (PDE5) inhibitors plus alprostadil topical cream or with PDE5i other than sildenafil alone. However, patients treated with alprostadil topical cream had a significantly higher chance of referring an improvement in their erectile function compared to patients treated with PDE5i, despite the fact that they had received treatment for a shorter period of time. Conclusion. Hardness of erection is just another factor of erectile function, but it is not the only one influencing improvement perception by patients

Should we consider telomere length and telomerase activity in male factor infertility?

PURPOSE OF REVIEW: The purpose of this review is to analyze what is known to date about the relation between telomeres and male fertility, and if it is possible for telomeres, or elements related to them, to be used as new prognostic biomarkers in fertility treatment. RECENT FINDINGS: Cells in germ series, including spermatozoids, have longer telomeres (10-20 kb), and do not seem to undergo the shortening that takes place in somatic cells with age as they present telomerase activity. Longer telomere length found in the sperm of older fathers, influences their offspring possessing cells with longer telomere length. Infertile patients have spermatozoids with shorter telomere length than fertile people, but telomere length does neither correlate with the sperm concentration, mobility or morphology, nor with the DNA fragmentation indices (DFI) of spermatozoids. Embryo quality rate and transplantable embryo rate are related with the telomere length of spermatozoids (STL), but pregnancy rates are not affected. SUMMARY: Telomere length and telomerase levels can be used as biomarkers of male fertility. Higher STL can have beneficial effects on fertility, thus the use of spermatozoids with longer telomere length in an assisted reproduction technique (ART) could be one way of solving some infertility cases.

Alfabloqueantes: efectos en la mejora de la disfunción eréctil y el deseo sexual en pacientes con hipertrofia prostática benigna / Alpha blockers: effects on improvement of erectile dysfunction and sexual desire in patients with benign prostatic hypertrophy

Objetivos. Valorar el impacto de la HIperplasia benigna de próstata tanto en la CAlidad de vida como en la función Sexual (estudio HICAS), así como los beneficios del uso de alfabloqueantes, en especial la silodosina. Material y método. Estudio epidemiológico observacional, multicéntrico y de ámbito nacional. La recogida de datos se realizó de forma retrospectiva. En el estudio participaron un total de 175 urólogos, que incluyeron 900 pacientes. La estadística descriptiva, de todas las variables de análisis descritas, se ha realizado incluyendo medidas de tendencia central y dispersión para las variables cuantitativas, y frecuencias absolutas y relativas para las variables cualitativas. Resultados. Un 31,6% de los pacientes referían falta de deseo al inicio del tratamiento, porcentaje que disminuyó al 26,6% en el momento actual (p < 0,0001). En el momento de inicio del tratamiento el 64,6% de los pacientes presentaban una disfunción eréctil leve o ausente, aumentando al 71% en el momento actual (p = 0,0002). Conclusiones. La adecuada selección de los pacientes que se pueden beneficiar del tratamiento con alfabloqueantes, y la explicación de los beneficios y efectos secundarios de los mismos redunda no solo en la mejoría de los síntomas del tracto urinario inferior, sino también en los índices de disfunción eréctil. En este caso, silodosina ha demostrado excelentes resultados en ambos campos, tanto administrado como monoterapia como asociado a IPDE5. Así mismo, el uso de silodosina ha mejorado el parámetro de deseo sexual, en contra de lo que ocurre con el uso de inhibidores de la 5-alfa-reductasa (AU)

ObjectivesTo assess the impact of benign prostatic hyperplasia on both quality of life and sexual function as well as the benefits of using alpha-blockers, especially silodosin.Material and methodEpidemiological observational, multicenter nationwide study in which the data collection was performed retrospectively. A total of 175 urologists, who recruited 900 patients, participated in the study. Descriptive statistics of all variables were carried out, including measures of central tendency, dispersion for quantitative variables, and absolute and relative frequencies for qualitative variables.ResultsAt the beginning of treatment, 31.6% of the patients reported a lack of desire. This proportion decreased to 26.6% at the end of the study (P < .0001). When the treatment was initiated, 64.6% of patients had mild or absent erectile dysfunction. This has increased to 71% at the present time (P = .0002).ConclusionsAdequate selection of patients who may benefit from treatment with alpha-blocker, explanation of their benefits and side effects will not only improved lower urinary tract symptoms, but also erectile dysfunction scores. In this case, the most uroselective alpha-blocker silodosin has shown excellent results in both fields, both when administered as monotherapy or associated with PDE5 inhibitors. Furthermore, use of silodosin improved sexual desire parameter as opposed to use of 5 alpha reductase inhibitors (AU)