Comparative efficacy and safety of transurethral laser surgery with holmium laser, KTP laser, 2-micron laser or thulium laser for the treatment of non-muscle invasive bladder carcinoma: a protocol of network meta-analysis.

INTRODUCTION: The potential of transurethral laser surgery in treating non-muscle invasive bladder cancer (NMIBC) has been confirmed, however which types of lasers may be preferentially prescribed remains a debate. The aim of this network meta-analysis is to investigate the comparative efficacy and safety of transurethral laser surgery with four common types of laser including holmium laser, potassium titanylphosphate (KTP) laser, 2-micron laser or thulium laser for the treatment of NMIBC. METHODS AND ANALYSIS: A systematic search will be conducted to search all potentially eligible randomised controlled trials comparing different transurethral laser surgeries with each other or with standard transurethral resection among patients with NMIBC in PubMed, Embase, the Cochrane library, China National Knowledge Infrastructure, Wanfang database and Chongqing VIP from their inception until 31 May 2021. Two reviewers will be asked to independently select eligible studies, and assess the risk of bias of individual study with Cochrane risk of bias assessment tool. A random-effects network meta-analysis based on Markov chain Monte Carlo method will be carried out. Ranking probabilities will be considered to rank all laser types. Quantitative analysis will be carried out by using WinBUGS V.1.4.3. ETHICS AND DISSEMINATION: Ethical approval is not required because this is a network meta-analysis of published data. We will submit all findings to some conferences for preliminary communication and to a peer-reviewed journal for publication. TRIAL REGISTRATION NUMBER: 10.17605/OSF.IO/TD9MW.

Assessment of the health status of middle-aged and elderly men with head scale, SF-36, IIEF5, AMS, and IPSS.

BACKGROUND: Identifying practical and distinguished indicators and influencing factors of male aging may be useful in predicting subsequent aging trends, designing personalized prevention, and improving lifestyle and health. METHODS: A cross-sectional, population-based study was performed in Jiashan County, China in 2016. A total of 690 local male residents, aged 40 to 80 years, were eligible for recruitment. Demographic and lifestyle information was collected through structured interviews. A self-designed head scale, the Medical Outcomes Study 36-item Short Form (SF-36), International Index of Erectile Function (IIEF5), Aging Males' Symptoms (AMS), and International Prostate Symptom Score (IPSS) were used. Analysis of variance, local polynomial regression smoothing curves, multiple linear regression, and partial correlation analyses were performed. RESULTS: All the scales deteriorated with increasing age (P < 0.01), especially from the age of 60. The most significant changes between adjacent age groups were found in IIEF5 scores (16.7, 43.5 and 39.4%). Income, nutrition, personality and neighborhood relationship had an effect on SF-36 and AMS after adjusting for age (P < 0.01). Furthermore, neighborhood relationship modified the age effect on the head scale score and IIEF5 (P = 0.03); nutrition modified the relationship between age and SF-36 (P < 0.01). CONCLUSIONS: Recession of reproductive health may be a distinct predictor of male aging. The associations of social inequalities or personality and health offer potential interventions for men's health in aging. Self-reported scales may limit the precision and more physical fitness tests could be combined for a more precise assessment.

Body Mass Index Changes in Relation to Male Reproductive Hormones: Longitudinal Results From a Community-Based Cohort Study.

The objective of the current study was to explore the relationship between longitudinal change in body mass index (BMI) and reproductive hormones in middle-aged and elderly Chinese men. A cohort study was conducted in a rural area of China. Local male residents aged 40-80 years were recruited at baseline in 2012 and were followed up in 2016. Information about weight, height, waist circumference, sex hormones, smoking status, and medical history were obtained. The change in BMI reported no significant relationship with the change in total testosterone (TT), calculated free testosterone (cFT), and bioavailable testosterone (BioT) in Pearson correlation analyses. When the change in BMI was divided into three groups-"great loss," "normal fluctuation," and "great gain"-TT, cFT and BioT had the highest increase (or the lowest decrease) in men with "normal fluctuation" in BMI compared with the other two groups. The advantage of maintaining a stable BMI was more evident for those who were overweight, non-smoking, and disease-free. There was a tendency of a continuous increase in cFT and BioT with BMI increase in smoking and diseased populations. Maintaining a stable BMI is associated with maintaining normal levels of reproductive hormones, especially in overweight, non-smoking, and healthy men aged over 40 years.

Serum sex hormone-binding globulin is associated with symptomatic late-onset hypogonadism in aging rural males: a community-based study.

Background To investigate whether serum levels of sex hormone-binding globulin (SHBG) and testosterone are associated with symptomatic late-onset hypogonadism (SLOH) in middle-aged and elderly rural Chinese males. METHODS: A population-based cross-sectional study was conducted in Zhejiang rural communities. A total of 965 men (aged 40-80 years) were admitted to the aging males' symptoms (AMS) scale and related physical examinations including body mass index (BMI) and waist circumference were conducted. Serum total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG) and serum lipid levels were measured separately. Serum level of bioavailable testosterone (Bio-T) was calculated. RESULTS: A total of 965 participants were divided into two groups, symptomatic late-onset hypogonadism (SLOH) group (n = 202) (AMS score ≥27) and control group (n = 763), according to total AMS score. Men in the SLOH group were older (61.57±9.06 vs 54.95±8.27 years) and had a smaller waist circumference (81.06±6.89 vs 82.54±6.60 cm) than those in the control group. Moreover, a relatively higher level of SHBG and lower levels of FT, Bio-T, triglyceride (TG) and total cholesterol (T-CHOL) were found in the SLOH group compared with that in the control group (P < 0.05). Receiver operating characteristic curves (ROC) analysis showed that age (AUC = 0.702, P < 0.001) and SHBG (AUC = 0.617, P < 0.001) were potential predictive indicators for SLOH diagnosis, with the best cut-off values of 59 years for age and 44.40 nmol/L for SHBG. CONCLUSIONS: SHBG might be a potential predictor in men with hypogonadism, whereas BMI had no proportionality to the measurement of AMS. Age and SHBG should be used for SLOH diagnosis.

Association of hypogonadism symptoms and serum hormones in aging males.

The association between hypogonadism symptoms and the levels of serum hormones are still in debate. To investigate the relationship between hypogonadism symptoms and serum hormones in middle-aged and elderly Chinese men, this community-based cross-sectional study was conducted based on a total of 965 ageing men. The ageing males' symptom (AMS) scale, International Index of Erectile Function-5 (IIEF-5), International Prostate Symptom Score (IPSS) questionnaires and related variables were assessed. Blood tests for total testosterone (TT), sex hormone-binding globulin (SHBG) and luteinising hormone (LH) were performed. Serum level of free testosterone (FT) and bioavailable testosterone (Bio-T) was calculated. The mean age was 56.34 ± 8.85 years. Total AMS score was significantly associated with all five serum hormones (LH: p < 0.001; SHBG: p < 0.001; TT: p =.043; FT: p = 0.007; Bio-T: p < 0.001). We identified sexual and somatic symptoms were obviously related to five serum hormones, while psychological symptoms seemed to have no association with serum hormones. After adjusting for age and BMI, multiple linear regression analysis indicated that LH had positive correlations with total AMS score, somatic and sexual symptom score (p < 0.05). In conclusion, LH and SHBG had the strongest correlation hypogonadism and might be used as early predictors for symptomatic hypogonadism in the near future.

Monopolar versus bipolar transurethral resection of bladder tumors: An updated systematic review and meta-analysis of existing studies.

BACKGROUND: To compare the efficacy and safety of bipolar and monopolar transurethral resection of bladder tumors (TURBT) in non-muscle invasive bladder cancer (NMIBC) treatment. METHODS: This protocol established in this study has been reported following the preferred reporting items for systematic review and meta-analysis protocols. Web of Science, PubMed, EMBASE, and the Cochrane Library were searched for all randomized controlled trials comparing bipolar TURBT and monopolar TURBT in NMIBC treatment until 31st of June 2020. We will use a combination of Medical Subject Heading and free-text terms with various synonyms to search based on the eligibility criteria. Two investigators independently reviewed the included studies and extracted relevant data. The odds ratio and 95% confidence intervals of were used as effect estimate. I-square (I) test, substantial heterogeneity, sensitivity analysis, and publication bias assessment will be performed accordingly. Stata 15.0 and Review Manger 5.3 are used for meta-analysis and systematic review. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSION: The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also provide helpful evidence of the efficacy and safety of bipolar and monopolar transurethral resection of TURBT in NMIBC treatment. PROSPERO REGISTRATION NUMBER: CRD42020151997.

Longitudinal Trends of AMS and IIEF-5 Scores in Randomly-Selected Community Men 40 to 80 Years Old: Preliminary Results.

INTRODUCTION: Most of conclusions on the relationship between age and reproductive health in aging men relied on cross-sectional data. AIM: To better characterize the natural degradation trajectory of reproductive health of aging men based on longitudinal data. METHODS: A community cohort study was performed in randomly selected men 40 to 80 years old, initiated in 2012 and followed up in 2014 and 2016. Participants were investigated by face-to-face structured interview, including demographic information and International Index of Erectile Function (IIEF-5) and Aging Males' Symptoms (AMS) scales. MAIN OUTCOME MEASURES: The differences among the 3 assessments of IIEF-5 and AMS were analyzed, and progression trajectories were traced. RESULTS: The high degree of variability on AMS and IIEF-5 was evident across individual subjects, as was the variability within individuals. The average IIEF-5 score of 248 subjects decreased from 16.9 to 14.1 during the 4 years, and the total AMS score increased from 22.6-27.0 (P < .001). Longitudinal data, both of individuals and of groups, showed the more rapid increase or decrease on AMS or IIEF-5 scores over 4 years in the 61-70 age group than in other age groups. CLINICAL IMPLICATION: The evidence of the greatest changes on AMS and IIEF-5 scores in the 61-70 age group prompts the importance of early intervention to postpone the degradation of reproductive health. STRENGTH & LIMITATIONS: Compared with cross-sectional data, longitudinal data can provide a more natural progression trajectory of reproductive health of aging male individuals. The low follow-up rate might affect the parameter estimation to some extent. CONCLUSION: Cohort data over 4 years' follow-up showed more abrupt changes on AMS and IIEF-5 scores in the 61-70 age group than in other age groups. Zheng J-B, Liang Q-F, Li J-H, et al. Longitudinal Trends of AMS and IIEF-5 Scores in Randomly-Selected Community Men 40 to 80 Years Old: Preliminary Results. J Sex Med 2019;16:1567-1573.

The impact of age, BMI and sex hormone on aging males' symptoms and the international index of erectile function scores.

OBJECTIVE: To analyze the impact of age, BMI and sex hormone on aging males' symptoms (AMS) and the 5-item version of the international index of erectile function (IIEF-5) scores in middle-aged and elderly Chinese men. METHODS: A population-based cross-sectional study was conducted in Jiashan County. A total of 969 men, aged between 40 and 80 years old, were admitted. Physical examination and the sex hormones were measured, and AMS and IIEF-5 scores were assessed. RESULTS: The oneway ANOVA analysis indicated older age groups had higher AMS total-scores, somatic and sexual sub-scores, and lower IIEF5 scores (all p < .01). Pairwise correlation (rpairwise) analyses showed the significant associations between AMS and age or sex hormone (cFT, Bio-T, SHBG, and LH) levels, and similar for IIEF5. However, when age was adjusted, the correlation coefficients (rpartial) weakened, and correlation significance disappeared, except LH (for AMS: rpartial = 0.096, p = .009; for IIEF-5: rpartial = -0.140, p = .001). Multiple linear regressions confirmed the influence of increased age and LH on the AMS and IIEF5 scores. CONCLUSION: CFT, Bio-T and SHBG failed to yield any additional predicting information when age was adjusted. To improve the male reproductive health, future research should pay more attention on aging-related comorbidities and how to improve general wellness.

The reproductive health indices and sex hormone levels in middle-aged and elderly Chinese men.

OBJECTIVE: The aim of this study was to analyze the age-related recession trajectory of reproductive health indices in middle-aged and elderly Chinese men. METHODS: A population-based cross-sectional study was conducted in Jiashan County, Zhejiang in 2012. Healthy men between 40 and 80 years of age were considered eligible for the study. Physical examination and the sex hormones were measured. The subjects were assessed based on the 5-item version of the International Index of Erectile Function (IIEF-5) for Erectile Dysfunction (ED), and Aging Males' Symptoms (AMS) scale for Symptomatic Late-Onset Hypogonadism (SLOH). RESULTS: TG showed a decrease at age 60 years. Testis volume and TT did not show significant difference among the four age groups; cFT began to decrease at age 50 years and Bio-T decreased faster at age 50 years. SHBG and LH increased faster at age 50 and 70 years, respectively. IIEF5 score decrease faster at age 60 years. AMS scores increased faster at age 70 years. With the increase in age, the symptoms of ED and SLOH became severer. CONCLUSION: Different indices on reproductive health of men showed turning points at different ages. At first, androgenic sex hormones decreased faster, and then erectile dysfunction got severer, and the last overall male syndromes declined.

[Erectile dysfunction in men with lower urinary tract symptoms].

OBJECTIVE: To investigate the incidence of erectile dysfunction (ED) in men with lower urinary tract symptoms (LUTS) and the correlation between LUTS and ED. METHODS: We enrolled 1 000 men aged 40 - 80 years with regular sex partners, evaluated their erectile function using IIEF-5, and investigated LUTS among them by International Prostate Symptom Score (IPSS). We studied the relationship between ED and LUTS by univariate conditional Logistic regression analysis. RESULTS: LUTS were found in 42.81% of the men investigated (426/995), and ED in 76.18% of the subjects (758/995) and 82.16% of those with LUTS (350/426). Logistic regression analysis revealed a significant relation of ED with aging and LUTS (P < 0.01). CONCLUSION: The The incidence of ED is high in men with LUTS and increases with aging and the severity of LUTS.