Tycho M.T.W. Lock

Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial.

CONTEXT Serum testosterone levels decline significantly with aging. Testosterone supplementation to older men might beneficially affect the aging processes. OBJECTIVE To investigate the effect of testosterone supplementation on functional mobility, cognitive function, bone mineral density, body composition, plasma lipids, quality of life, and safety parameters in older men with low normal testosterone levels. DESIGN, SETTING, AND PARTICIPANTS Double-blind, randomized, placebo-controlled trial of 237 healthy men between the ages of 60 and 80 years with a testosterone level lower than 13.7 nmol/L conducted from January 2004 to April 2005 at a university medical center in the Netherlands. INTERVENTION Participants were randomly assigned to receive 80 mg of testosterone undecenoate or a matching placebo twice daily for 6 months. MAIN OUTCOME MEASURES Functional mobility (Stanford Health Assessment Questionnaire, timed get up and go test, isometric handgrip strength, isometric leg extensor strength), cognitive function (8 different cognitive instruments), bone mineral density of the hip and lumbar spine (dual-energy x-ray absorptiometry scanning), body composition (total body dual-energy x-ray absorptiometry and abdominal ultrasound of fat mass), metabolic risk factors (fasting plasma lipids, glucose, and insulin), quality of life (Short-Form Health 36 Survey and the Questions on Life Satisfaction Modules), and safety parameters (serum prostate-specific antigen level, ultrasonographic prostate volume, International Prostate Symptom score, serum levels of creatinine, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, hemoglobin, and hematocrit). RESULTS A total of 207 men completed the study. During the study, lean body mass increased and fat mass decreased in the testosterone group compared with the placebo group but these factors were not accompanied by an increase of functional mobility or muscle strength. Cognitive function and bone mineral density did not change. Insulin sensitivity improved but high-density lipoprotein cholesterol decreased; by the end of the study, 47.8% in the testosterone group vs 35.5% in the placebo group had the metabolic syndrome (P = .07). Quality-of-life measures were no different except for one hormone-related quality-of-life measure that improved. No negative effects on prostate safety were detected. CONCLUSION Testosterone supplementation during 6 months to older men with a low normal testosterone concentration did not affect functional status or cognition but increased lean body mass and had mixed metabolic effects. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN23688581.

Apoptosis regulation in the testis: involvement of Bcl-2 family members.

Using immunohistochemical techniques and Western blot analysis, the possible role of Bcl‐2 family members Bax, Bcl‐2, Bcl‐xs, and Bcl‐xl in male germ cell density‐related apoptosis and DNA damage induced apoptosis was studied. The apoptosis inducer Bax was localized in all mouse and human testicular cell types, but despite the fact that irradiation induces its transcriptional activator, p53 in the human, Bax expression did not change after irradiation. The apoptosis inhibitor Bcl‐2 appeared to be present in late spermatocytes and spermatids and was up‐regulated in these cells after a dose of 4 Gy of X‐rays. Finally, Bcl‐x was expressed in both the mouse and human testis. The apoptosis inhibiting long transcripts of Bcl‐x, Bcl‐xl, were expressed in spermatogonia and spermatocytes and were up‐regulated after X‐irradiation. The apoptosis inducing shorter form of Bcl‐x, Bcl‐xs, was found to be expressed only in somatic cells, like peritubular and Leydig cells. While Bax is important in germ cell density regulation, Bax expression did not change after DNA damage inflicted by X‐radiation. Hence, spermatogonial apoptosis after X‐irradiation may not be induced via the apoptosis inducer Bax. Furthermore, as Bcl‐xl, but not Bcl‐2, is present in spermatogonia and spermatocytes, Bcl‐xl may regulate germ cell density, possibly in cooperation with Bax. As Bcl‐xl expression is enhanced after irradiation, this protein may also have a role in the response of spermatogonia and spermatocytes to irradiation. Mol. Reprod. Dev. 56:353–359, 2000.

α‐Blockers to assist stone clearance after extracorporeal shock wave lithotripsy: a meta‐analysis

Study Type – Therapy (meta‐analysis)
Level of Evidence 1a

Arterioureteral Fistulas: Unusual Suspects - Systematic Review of 139 Cases

An arterioureteral fistula (AUF) is a rare but life-threatening condition bordering on the expertise of the urologist, vascular surgeon, and interventional radiologist. We reviewed published cases in order to better recognize and treat patients with an AUF. Of all 139 patients, 13% died of an AUF-related cause; in this group, only 22% of the fistulas were recognized before treatment. The diagnosis AUF should be considered in patients with unexplained hematuria who have a history of pelvic cancer or vascular surgery. Angiography and ureteral contrast studies most often confirmed AUFs. Patients treated with endovascular technique had the most favorable outcome.

Percutaneous Nephrolithotomy: Factors Associated with Fever After the First Postoperative Day and Systemic Inflammatory Response Syndrome

OBJECTIVE Fever after the first postoperative day (POD1) after percutaneous nephrolithotomy (PCNL) is most likely caused by an infection that increases hospital stay and healthcare costs. The aim of this study was to find factors associated with fever after POD1 and systemic inflammatory response syndrome (SIRS). PATIENTS AND METHODS Ninety patients underwent 117 PCNLs. Patient characteristics, stone burden, and pre- and postoperative treatments were analyzed for association with fever (temperature >or=38 degrees C) and SIRS using univariate analysis. RESULTS In 35% of the patients with fever (temperature >or=38 degrees C), fever was present after POD1. Twelve patients developed signs of SIRS (11.2%). In univariate analysis, significant association was observed between fever after POD1 and previous ipsilateral PCNL (p = 0.022, odds ratio OR = 3.1), and between SIRS and paraplegia (p = 0.005, OR = 10.7) and caliceal stones (p = 0.03, OR = 4.8). CONCLUSIONS Previous ipsilateral PCNL increases the risk of fever after POD1. Paraplegic patients are at risk for developing SIRS after PCNL.

Metastatic Cancer of the Prostate Managed with Buserelin Versus Buserelin Plus Cyproterone Acetate

We recruited 71 previously untreated patients with metastatic prostatic carcinoma to 2 separate consecutive prospective phase 2 studies done by the same group of investigators according to the same protocols in which only the treatment regimens differed. Of the patients 58 were treated with the luteinizing hormone-releasing hormone analogue buserelin alone (0.4 mg. 3 times daily intranasally) and 13 were treated with buserelin combined with cyproterone acetate, a potent antiandrogen (50 mg. 3 times daily orally). The objective of the study was to investigate the efficacy, safety and tolerability of the medication used during at least 12 months by studying adequate endocrine parameters, the rate and duration of response, as well as the rate of progression and possible side effects. All endocrine parameters were studied in 1 laboratory. Modified response criteria of the National Prostatic Cancer Project were used. The endocrine studies showed an effective suppression of plasma testosterone to castration levels by buserelin after an initial increase during the first 2 weeks. Luteinizing hormone and follicle-stimulating hormones were lowered significantly and could not be re-stimulated by the intravenous application of luteinizing hormone-releasing hormone. There was no correlation of plasma testosterone with response and progression. However, a significant correlation existed between higher basal cortisol levels at entry, and after 3 and 6 months, and progression. Response is reported for all patients at the 12-month interval and did not seem to differ among treatment groups. The rate of progression after all patients had been treated for 1 year was 37.9 per cent in the buserelin group and 41 per cent in the buserelin plus cyproterone acetate group. Three early deaths occurred in the buserelin group. Except for impotence, only mild side effects were noted. Our study shows that treatment of metastatic prostatic cancer by means of the luteinizing-hormone-releasing hormone analogue buserelin is safe and effective. The results obtained are compatible with those obtained by castration. In our study a superiority of total androgen withdrawal over testicular suppression alone could not be shown.

Semen cryopreservation and usage rate for assisted reproductive technology in 898 men with cancer.

An undesired side effect of cancer treatment is potential subfertility or infertility. Timely cryopreservation of semen is the best modality to ensure fertility. This retrospective data analysis established the usage rate of cryopreserved semen from cancer patients. Pubertal and post-pubertal patients who could become infertile as a result of cancer (treatment) were offered the option to cryopreserve semen prior to treatment. Of the 898 patients who cryopreserved their semen in our hospital, 96 (10.7%) used this for assisted reproductive technology. The live birth rates for intrauterine insemination, in-vitro fertilization, intracytoplasmic sperm injection and cryopreserved embryo transfer were 13%, 29%, 32% and 17%, respectively. Of all couples involved, 77% achieved parenthood, i.e. 60 of the 78 patients (with complete follow-up) fathered at least one child.

In vitro comparison of renal stone laser treatment using fragmentation and popcorn technique

To study the effectiveness of two laser techniques clinically used to fragment renal stones: fragmenting technique (FT) and popcorn technique (PT).

Comparing thulium laser and Nd:YAG laser in the treatment of genital and urethral condylomata acuminata in male patients

To date therapies for condylomata acuminata of the male genital are known for high recurrence rates and bothersome side effects, while urethral warts are not always reachable by most traditional therapies.

Electroejaculation in psychogenic anejaculation

OBJECTIVE To evaluate the results of treatment with electroejaculation (EEJ), intrauterine insemination (IUI), and IVF/intracytoplasmic sperm injection (IVF/ICSI) in patients with psychogenic anejaculation (PAE). DESIGN Retrospective clinical study. SETTING Academic tertiary referral fertility center. PATIENT(S) Eleven male patients diagnosed with psychogenic anejaculation (PAE) were included. Median age at the time of first treatment with EEJ was 33.0 (interquartile range, 29.0-36.0) years. INTERVENTION(S) Electroejaculation, IUI, and IVF/ICSI. MAIN OUTCOME MEASURE(S) Semen analysis, fertilization rate, implantation rate, pregnancy rate, and delivery rate. RESULT(S) A total of 60 EEJs were performed in 11 patients. Mean VCM (volume [mL] × concentration [sperm cells/mL] × percentage progressive motile cells) of the retrieved sperm of all EEJs was 17.5 × 10(6) (SD 16.5 × 10(6)). Yielded semen was used in a total of 26 ICSI procedures in seven couples. The fertilization rate was 65.6% (80 of 122). The ICSI cycles resulted in five pregnancies; of these, one resulted in a spontaneous abortion in the first trimester. Three couples were treated with 34 IUI cycles, which resulted in live births in four pregnancies. CONCLUSION(S) Electroejaculation is a suitable and effective treatment that can be used in men with psychogenic anejaculation. The retrieved semen can be used successfully in assisted reproductive technology treatment. In this study EEJ resulted in pregnancies and the birth of eight healthy children.