Testicular Sperm is Superior to Ejaculated Sperm for ICSI in Cryptozoospermia:
An Update Systematic Review and Meta-analysis
Yi-No Kang 1, Ya-Wen Hsiao2
, Chien-Yu Chen1,3,4,5 & Chien-Chih Wu1,5,6,7
1Centre for Evidence-Based Medicine, Department of Education,
Taipei Medical University Hospital 2
School of Medicine, College of Medicine, Taipei Medical University 3
Department of Anesthesiology, Taipei Medical University Hospital 4
Department of Anesthesiology, School of Medicine, College of Medicine,
Taipei Medical University 5
Department of Education and Humanities in Medicine, School of Medicine,
College of Medicine, Taipei Medical University 6
Department of Urology, Taipei Medical University Hospital 7
Department of Urology, School of Medicine, College of Medicine, Taipei Medical University
Abstract
Intracytoplasmic sperm injection (ICSI) is well established and provides patients
with severely impaired sperm quality with an opportunity to father a child.
However, previous studies do not clearly indicate whether male with
cryptozoospermia should use testicular sperm or ejaculated sperm for ICSI. The
newest systematic review of this topic also gave a controversial conclusion that
was based on incorrect pooling result. Moreover, two clinical studies published
after the systematic review. In the present update systematic review and
meta-analysis, a comprehensive citation search for relevant studies was
performed using the Cochrane library databases, Embase, Ovid MEDLINE,
PubMed, ScienceDirect, Scopus, and Web of Science up to September 2017.
The search returned 313 records, in which six studies were included in
quantitative synthesis. These studies involved 578 male infertility patients who
had undergone 761 ICSI cycles. The risk ratios favour fresh testicular sperm for
good quality embryo rate (1.17, 95% CI 1.05–1.30, P = 0.005), implantation
rate (95% CI 1.02–2.26, P = 0.04), and pregnancy rate (RR = 1.74, 95% CI
1.20–2.52, P = 0.004). In conclusion, the existing evidence suggests that
testicular sperm is better than ejaculated sperm for ICSI in male with
cryptozoospermia
男性學論文獎臨床組第二名
Sexual Activity, Sexual Dysfunction, and Sexual Life Quality among Psychiatric
Hospital Inpatients with Schizophrenia
Mi-Chia Ma, PhD1
Jian-Kang Chao, MD, PhD2,3* Jia-Yi Hung, PhD4M
Su-Ching Sung, PhD5 I-Hsin Candy Chao, BA6
1Department of Statistics, National Cheng Kung University, Tainan, Taiwan 2
Superintendent, Pingtung branch, Kaohsiung Veterans General Hospital, Pingtung, Taiwan 3
Department of social work, National Pingtung University of Science & Technology, Pingtung, Taiwan 4
Department of Health Administration, Tzu Chi University of Science and Technology,
Hualien County, Taiwan 5
Institute of Allied Health Sciences and Department of Nursing,
Chang Gung University of Science and Technology, Taiwan 6
Faculty of Business, University of Technology Sydney, Sydney, Australia
Background: Sexual dysfunction occurs commonly in patients with psychiatric illness
and may be related to the primary mental disorder, comorbidity with sexual disorders or
medical illness, or medications used for mental disorders treatment, but the magnitude
of this problem is unknown.
Aim: To estimate the prevalence of current sexual activity, sexual dysfunction, and
sexual attitude and influence of factors on patients with schizophrenia. Methods: This study used a cross-sectional design with a total of 317 patients diagnosed
with schizophrenia. The subjects completed a demographic questionnaire, sexual
attitude scale, sexual dysfunction scale, and sexual behavior scale. Descriptive analysis,
difference analysis, and logistic regression model were used to identify relevant variables
that may affect sexual life quality.
Outcomes: Age, sexual satisfaction, and patient symptoms may predict sexual life
quality on patients with schizophrenia. Results: The mean age of patients was 47.71 ± 9.54 years old. About the sexual
activities, 53% of subjects had sexual intercourse experience, and 41.3% reported
currently having sexual intercourse. The mean ± SD age for first sexual intercourse was
20.83 ± 5.95 years old (median was 20.0 years old). Moreover, women older than 50
years had significantly higher medians for the Brief Psychiatric Rating Scale (BPRS) score,
higher proportions of sexual dysfunction, and lower proportions of feeling important to
sexual life quality than men. For participants with age≦50 years old, there was a
significant relationship among BPRS group (mean score >2.5 vs ≦2.5), sexual
dysfunction (P < .001), sexual life quality (P < .001), and sexual satisfaction (P =.006).
Among the predictors of feeling important to sexual life quality, sexual satisfaction (odds
ratio=7.005, 95% CI=4.126-11.892, p<0.001) and BPRS score (odds ratio=4.501,
95% CI=2.042-9.923, p<0.001) were significant independent factors after adding the
interaction of age group and BPRS group. Clinical Translation: This study also reveals the close relationship between sexual
satisfaction and BPRS score, which may predict sexual life quality of patients with
schizophrenia. Limitations include the possibility of underreporting and bias associated
with self-report measurement. Conclusion: Sexual life quality and sexual dysfunction on patients with schizophrenia
are associated with interaction among psychological, sociological, and
biochemical-pharmacological factors.
男性學論文獎基礎組第一名 財團法人鳳凰泌尿科學文教基金會論文獎
SLC9A3 Protein is Critical for Acrosomal Formation in
Postmeiotic Male Germ Cells.
Ya-Yun Wang1
, Han-Sun Chiang2
, Chiao-Yin Cheng2
, Yi-No Wu3
, Yung-Chih Lin2
,
Hsuan-Che Liu2
, Wei-Kung Tsai4
, Yen-Lin Chen1,5, Ying-Hung Lin2,*
Department of Chemistry, Fu Jen Catholic University, New Taipei City, Taiwan1
Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University,
New Taipei City, Taiwan2
School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan3
Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan4
Department of Pathology, Cardinal Tien Hospital, New Taipei City, Taiwan5
Abstract
Solute carrier family 9 isoform 3 (SLC9A3), a Na⁺/H⁺ exchanger, regulates the
transepithelial absorption of Na⁺ and water and is primarily expressed on the
apical membranes of the intestinal epithelium, renal proximal tubule, epididymis,
and vas deferens. Loss of the Slc9a3 allele in mice enhances intestinal fluid and
causes diarrhoea as a consequence of diminished Na⁺ and HCO3
-
absorption.
Hence, the loss also causes male infertility and reveals the abnormal dilated
lumen of the rete testis and calcification in efferent ductules. However, whether
loss of Slc9a3 alleles also disrupts mammalian spermatogenesis remains
unknown. First, through immunoblotting, we determined that SLC9A3 is highly
expressed in the murine testis compared with the small intestine, epididymis, and
vas deferens. During murine spermatogenesis, SLC9A3 is specifically expressed in
the acrosome region of round, elongating, and elongated spermatids through
immunostaining. Furthermore, SLC9A3 signals are enriched in the acrosome of
mature sperm isolated from the vas deferens. In Slc9a3 knockout (KO) mice,
compared with the same-aged controls, the number of spermatids on the
testicular section of the mice progressively worsened in mice aged 20, 35, and 60
days. Sperm isolated from the epididymis of Slc9a3 KO mice revealed severe acrosomal defects. Our data indicated that SLC9A3 has a vital role in acrosomal
formation during spermiogenesis.
男性學論文獎基礎組第二名 財團法人鳳凰泌尿科學文教基金會論文獎
Spontaneous Regeneration of Nerve Fiber and Irreversibility of Corporal Smooth
Muscle Fibrosis after Cavernous Nerve Crush Injury: Evidence from Serial
Transmission Electron Microscopy and Intracavernous Pressure
Wu YN1, Chen KC1,2, Liao CH1,3, Chiang HS3,4,5
School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.1
PhD Program in Nutrition & Food Science, Fu Jen Catholic University, New Taipei City, Taiwan;
Department of Urology, Cathay General Hospital, Taipei, Taiwan.2
Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan.3
Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University,
New Taipei City, Taiwan.4
Department of Urology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.5
Abstract
Objective: To determine the pathophysiological progresses following bilateral cavernous
nerve crushing injury, as an index for a treatment point and establishment of adequate
treatment strategies for neurogenic erectile dysfunction.
Materials and Methods: Thirty-six rats were assigned to 1 of 6 groups, and bilateral
cavernous nerve crushing or sham surgery was performed. Functional testing and
ultrastructural analyses were performed immediately and at 7, 14, 21, and 28 days after
the cavernous nerve (CN) injury (n = 6).
Results: Intracavernos pressure lowered progressively from 7 days to 14 days post-injury,
and histologic staining revealed that the number of neuronal nitric oxide
synthase-positive nerve fibers on the dorsal penile nerve decreased significantly and
progressively from 7 days until 21 days post-injury. Furthermore, ultrastructural analyses
revealed axon loss and demyelination of the CN at 7 and 14 days post-injury. However,
it is followed by partial spontaneous recovery of erectile function and regeneration of the
CN at 28 days post-injury, suggesting that these time points may be useful for evaluating
the effects of drug treatments. Furthermore, we found that CN injury-induced damage to
corporal smooth muscle cells was irreversible; therefore, focusing on protecting the
corpus cavernosum from apoptosis may be more important than nerve protection when
assessing treatment mechanisms in the CN injury model.
Conclusion: Our study makes a significant contribution to the human diagnostic
pathology literature because it describes characteristics of relevant tissue in the rat and
provides information regarding time points that may be useful for future studies of
pathologic mechanisms or treatment evaluations.
江萬煊教授傑出研究論文獎
Low-intensity Extracorporeal Shockwave Therapy can Improve Erectile Function
in Patients who Failed to Response to Phosphodiesterase Type 5 Inhibitors
Chia-Chun Tsai1,2, Chii-Jye Wang2,3, Yung-Chin Lee2,3, Yen-Ting Kuo4
, Hsiao-Hua Lin5
,
Ching-Chia Li1,2,3, Wen-Jeng Wu1,2,3, Chia-Chu Liu2,3,6,*
1 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
2 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University,
Kaohsiung, Taiwan 3
Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University,
Kaohsiung, Taiwan 4
Management Offices, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University,
Kaohsiung, Taiwan 5
Department of Laboratory Medicine, Pingtung Hospital, Ministry of Health and Welfare,
Pingtung, Taiwan 6
Department of Urology, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
Abstract
Managing patients with erectile dysfunction (ED) who failed to respond to
phosphodiesterase type 5 inhibitors (PDE5is) is a challenging task. Recently,
low-intensity extracorporeal shockwave therapy (LI-ESWT) was reported to
improve ED by enhancing perfusion of the penis. The current study was
performed to evaluate whether combined treatment with LI-ESWT and PDE5is
can restore erectile function in patients who failed to respond to PDE5is alone.
This was an open-label single-arm prospective study. ED patients with an
erection hardness score (EHS) ≦2 under a maximal dosage of PDE5is were
enrolled. Sociodemographic information and detailed medical history were
recorded. LI-ESWT treatment consisted of 3,000 shockwaves once weekly for 12
weeks. All patients continued their regular PDE5is use. The EHS and the 5-item
version of the International Index of Erectile Function (IIEF-5) were used to
evaluate the change in erectile function 1 and 3 months after LI-ESWT. A total of
52 patients were enrolled. After LI-ESWT treatment, 35 of the 52 patients (67.3%)
could achieve an erection hard enough for intercourse (EHS ≧ 3) under PDE5is
use at the 1-month follow-up. Initial severity of ED was the only significant
predictor of a successful response (EHS1: 35.7% vs. EHS2: 78.9%, p = .005).
Thirty-three of the 35 (94.3%) subjects who responded to LI-ESWT could still
maintain their erectile function at the 3-month follow-up. LI-ESWT can serve as a
salvage therapy for ED patients who failed to respond to PDE5is. Initial severity of
ED was an important predictor of a successful response.
臺灣楓城泌尿學會男性學論文獎
The Application of p2PSA% and Prostate Health Index in Prostate Cancer
Detection: A Prospective Cohort in a Tertiary Medical Center
Yung-Ting Chenga, Chih-Hung Chiang a,b, Yeong-Shiau Pu a, Shih Ping Liu
a,
Yu-Chuang Lu a , Yi-Kai Chang a , Hong-Chiang Chang a , Kuo-How Huang a ,
Yuan-Ju Lee a , Po-Ming Chow a , Shih-Chun Hung a , Chao-Yuan Huang a a Department of Urology, National Taiwan University Hospital, Taiwan b Department of Urology, Taipei Veterans General Hospital, Yuanshan Branch, Taiwan
Abstract
Background/Purpose: Prostate specific antigen (PSA) with low specificity that
causes unnecessary prostate biopsies increases clinical morbidities, psychological
stress, and medical expenses. We aimed to test the accuracy and cut-off value of
Prostate Health Index (PHI) in men for prostate cancer detection. Methods: We prospectively enrolled 213 men who underwent prostate biopsy
with PSA≦10 ng/ml or abnormal findings on digital rectal examination. Total PSA
(tPSA), free PSA (fPSA) and p2PSA levels were measured by serum samples
before prostate biopsy. PHI was calculated as (p2PSA/fPSA) x √tPSA.
Multivariable logistic regression analyses were used to predict the risk of cancer
and detect clinically significant prostate cancer. Results: 33 (27.0%) patients were confirmed with the diagnoses of prostate
cancer by prostate biopsy. The levels of p2PSA, %p2PSA, and PHI showed
statistically significant differences between prostate cancer patients and
non-cancer patients. %p2PSA and PHI had the highest area under the receiver
operating characteristic curve (AUC) of 0.723 and 0.772 (both p <0.001),
respectively, predicting cancer detection at biopsy than other predictors (tPSA,
fPSA, %fPSA, and PSA density (AUC: 0.544, 0.538, 0.593, and 0.664,
respectively). In multivariable logistic regression, %p2PSA had a statistical
significant odds ratio 8.51 (p = 0.003) and PHI had an odds ratio with marginal
significance 4.18 (p = 0.06). Conclusion: %p2PSA and PHI increased the diagnostic accuracy with
significantly greater sensitivity and specificity than tPSA. We determined an
optimal cut-off value of PHI among Taiwanese population. These findings
support the usefulness in the decisional process of prostate biopsy.
男性學論文獎住院醫師組
Preoperative Treatment with 5α-reductase Inhibitors and the Risk of Hemorrhagic
Events in Patients Undergoing Transurethral Resection of the Prostate:
A Population-based Cohort Study
Ti-Yuan Yang 1,2, Marcelo Chen 1,3, Wun-Rong Lin 1,2, Chung-Yi Li
4,5, Wei-Kung Tsai 1,2,
Allen W. Chiu 1,2,6, Ming-Chung Ko 7,8 1 Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan 2 Department of Medicine, Mackay Medical College, Taipei, Taiwan 3 Department of Cosmetic Applications and Management, Mackay Junior College of Medicine,
Nursing and Management, Taipei, Taiwan 4 Department of Public Health College of Medicine, National Cheng Kung University, Tainan, Taiwan 5 Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan 6School of Medicine, National Yang-Ming University, Taipei, Taiwan 7Department of Urology, Taipei City Hospital, Taipei, Taiwan 8 Department of Health Care Management, National Taipei University of
Nursing and Health Sciences, Taipei, Taiwan
Abstract
Objectives: To assess the associations between preoperative treatment with 5-alpha reductase inhibitors and the risks of blood transfusion during transurethral resection of
the prostate and blood clot evacuation or emergency department visits for hematuria
within 1 month after surgery. Method: We used data from the Taiwan National Health Insurance Research Database
in this population-based cohort study. A total of 3,126 patients who underwent first-time
transurethral resection of the prostate from 2004 to 2013 were identified. Adjusted odds
ratios estimated by multiple logistic regression models were used to assess the
independent effects of the preoperative use of 5-alpha reductase inhibitors on the risks
of perioperative hemorrhagic events after adjustment for potential confounders. Results: Two hundred and ninety-seven (9.4%) patients were treated with 5-alpha reductase inhibitors for <3 months, and 65 (2.1%) patients were treated for ≥3 months
prior to undergoing transurethral resection of the prostate. The blood transfusion rates
for patients who were not treated with 5-alpha reductase inhibitors (controls), patients
who were treated with 5-alpha reductase inhibitors for <3 months, and patients who
were treated with 5-alpha reductase inhibitors ≥3 months were 9.5%, 8.8%, and 3.1%,
respectively. 5-alpha reductase inhibitors tended to decrease the risk of blood
transfusion; however, this association was not statistically significant (adjusted odds
ratio=0.14, 95% confidence interval: 0.02-1.01). Age ≥80 years, coagulopathy, and a
resected prostate tissue weight >50 g were associated with significantly higher risks of
blood transfusion than other parameters. Conclusions: This nationwide study did not show that significant associations exist
between 5-alpha reductase inhibitor use before transurethral resection of the prostate
and the risks of blood transfusion and blood clot evacuation or emergency visits for
hematuria.