Wanshou Cui

The TGF-β1/Smad/CTGF Pathway and Corpus Cavernosum Fibrous-Muscular Alterations in Rats With Streptozotocin-Induced Diabetes

Diabetes-associated erectile dysfunction is associated with increased extracellular matrix deposition and reduced smooth muscle content in the corpus cavernosum. The mechanisms of these processes are not well understood. In this study, we investigated fibromuscular changes in the corpus cavernosum of rats with streptozotocin-induced diabetes to determine the mechanisms underlying pathologic changes in penile structure and function. Forty 8-week-old Sprague-Dawley rats were randomly distributed into control and diabetic groups. Diabetes was induced by a one-time intraperitoneal injection of streptozotocin 60 mg/kg. Twelve weeks later, erectile function was measured by cavernous nerve electrostimulation with real-time intracorporal pressure assessment. The penis was harvested for histologic examination (Masson trichrome stain, picrosirius red stain, Hart elastin stain, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling, and immunohistochemistry) and Western blot. Diabetes significantly attenuated erectile response to cavernous nerve electrostimulation. Diabetic animals exhibited a decreased smooth muscle/collagen ratio in the corpus cavernosum. The ratio of collagen I to II fibers was significantly lower in the corpora of diabetic rats compared with controls. Cavernous elastic fibers were fragmented in diabetic rats. There was up-regulation of the transforming growth factor β1/Smad/connective tissue growth factor signaling pathway in diabetic rats. Phospho-Smad2 expression was higher in smooth muscle cells and fibroblasts of diabetic rats, as was the apoptotic index. The up-regulation of the transforming growth factor β1/Smad/connective tissue growth factor signaling pathway might play an important role in diabetes-induced fibrous-muscular structural changes and deterioration of erectile function.

Activation of VEGF and ERK1/2 and improvement of urethral function by adipose-derived stem cells in a rat stress urinary incontinence model.

OBJECTIVE To investigate the injected autologous adipose-derived stem cells (ADSCs) in improving stress urinary incontinence in a rodent model of parturition-related stress incontinence and the possible mechanism. METHODS The 40 rats were developed stress urinary incontinence models by postpartum balloon dilation of the vagina for 4 hours followed by bilateral ovariectomy. ADSCs were isolated from the peri-ovarian fat and labeled with thymidine analog 5-ethynyl-2-deoxyuridine (EdU). Twenty stress urinary incontinence rats received peri-urethral injection of phosphate-buffered saline as the negative controls and the other 20 stress urinary incontinence rats received peri-urethral injection of EdU-labeled ADSCc. Twenty control rats underwent sham ovariectomy without balloon dilation and served as positive controls. Four weeks later, voiding function was assessed by cystometry. Urethral histologic examination (Masson trichrome stain, picrosirius red stain, Hart elastin stain, Gordon and Sweet stain, and immunohistochemical stain) and Western blot were performed on urethral tissues. RESULTS Both leak point pressure and bladder capacity were significantly increased in ADSC-treated rats, compared to the balloon-injured ovariectomized rats. Histologic examination revealed normalized appearance of the fibromuscular structure of the urethra as well as increased peri-urethral blood vessel density in ADSC-treated rats. On Western blot, vascular endothelial growth factor and P-extracellular signal-regulated kinases (ERKs)1/2 protein was expressed at a higher rate in tissues from ADSC-treated rats compared to phosphate-buffered saline-treated rats. CONCLUSION Peri-urethral injection of ADSCs is associated with more normal urinary function and urethral structure in rats with parturition-related incontinence. The activation of vascular endothelial growth factor and ERK1/2 may be responsible for the paracrine effects from ADSCs.

Spontaneous pregnancy rates in Chinese men undergoing microsurgical subinguinal varicocelectomy and possible preoperative factors affecting the outcomes

OBJECTIVE To investigate pregnancy rates after microsurgical varicocelectomy in Chinese infertile men with clinical varicoceles and to identify preoperative factors affecting the outcomes. DESIGN Retrospective data analysis. SETTING University infertility clinic. PATIENT(S) One hundred seventy-six consecutive Chinese men with infertility and clinical varicoceles who underwent varicocelectomy from January 2010 to December 2011. Semen data were available for 145 patients, and pregnancy data were available for 66. INTERVENTION(S) Varicocelectomy was performed on all patients. MAIN OUTCOME MEASURE(S) Spontaneous pregnancy rates and improvement in semen parameters after varicocelectomy. RESULT(S) We followed 145 men (82.4%) for a median of 21 months (range 12-36 months) after varicocelectomy. For 109 patients (75.2%), both sperm concentration and forward motility improved. Overall, 45.5% (66/145) of female partners achieved spontaneous pregnancy at a mean follow-up of 11.7 ± 6.2 months. On univariate analysis, preoperative high sperm concentration (≥20 million/mL) and high sperm motility (≥25%) were positively associated with spontaneous pregnancy. On multivariate analysis, only preoperative sperm concentration was an independent predictor. CONCLUSION(S) Microsurgical varicocelectomy could improve semen quality and spontaneous pregnancy rates. Only preoperative sperm concentration was an independent predictor of spontaneous pregnancy. Patients with high initial sperm concentration may benefit from varicocelectomy for spontaneous pregnancy.

Penile prosthesis implantation in Chinese patients with severe erectile dysfunction: 10-year experience

We retrospectively evaluated the clinical outcome of penile prosthesis implantation (PPI) in Chinese patients with severe erectile dysfunction (SED). From July 2000 to December 2011, 224 patients (mean age: 35.9±11.8 years, range: 20-75 years) with SED underwent PPI by experienced surgeon according to standard PPI procedure at our centre. A malleable prosthesis (AMS 650) was implanted in 45 cases (20.1%), and a three-piece inflatable prosthesis (AMS 700 CXM or AMS 700 CXR) was implanted in 179 cases (79.9%). Surgical outcomes, including postoperative complications, clinical efficacy and couple satisfaction, were evaluated over than 6 months postoperatively using medical record abstraction, IIEF-5, quality of life (QoL) scores, and the patient/partner sexual satisfaction score proposed by Bhojwani et al. Of the 224 patients eligible for the study, 201 subjects (89.7%) completed follow-up. All of patients could perform sexual intercourse post PPI with the mean postoperative IIEF-5 and QoL scores were 20.02±2.32 and 5.28±0.76, respectively, which were significantly improved compared with the preoperative scores (6.29±1.5 and 2.13±0.84, P<0.01). Of the 201 men, mechanical malfunction occurred in four cases (2.0%) and three cases were re-implanted new device, and two cases (1.0%) developed a mild curvature of the penis. Scrotal erosion with infection occurred in one case with diabetes mellitus (0.5%) and required complete removal of the implanted AMS 700 CXM. Satisfactory sexual intercourse at least twice per month was reported by 178 men (88.6%), and overall satisfaction with the PPI surgery was reported by 89.0% of men and 82.5% of partners. Patient satisfaction in the three-piece inflatable prosthesis group was higher than in the malleable prosthesis group (P<0.05). Satisfaction, however, between the types of prostheses, did not differ in the partner survey. PPI is a safe and effective treatment option for Chinese patients with SED and experienced surgeon perform PPI according to standard PPI procedure could reduce the postoperative complications of PPI and could improve patient satisfaction ratio and QoL.

Al-Ghorab Shunt plus intracavernous tunneling for prolonged ischemic priapism.

To investigate the efficacy and safety of the corpus cavernosum-corpus spongiosum shunt (Al-Ghorab Shunt) plus intracavernous tunneling (CC-CSS+ICT) for prolonged ischemic priapism (PIP). Twelve patients with PIP were enrolled in this study. The mean age of patients was 38.3 ± 9.2 years old and the mean duration of PIP was 2.8 ± 1.0 days (range, 1.5-4 days). All patients received CC-CSS+ICT for treating PIP. The penile hardness score (PHS) and pain visual analogue score (PVAS) were used to assess the efficacy of the surgery 1, 3, and 5 days after surgery. Color duplex Doppler ultrasonography, International Index of Erectile Function, and quality of life (QOL) were used for evaluating penile morphology, erectile function, QOL, and response to sildenafil treatment. The mean duration of follow up was 21.6 ± 10.1 months. Penile detumescence was successfully restored for all 12 patients postsurgery, with the mean PHS and PVAS significantly decreased compared with that presurgery at different time points (1, 3, 5 days postsurgery; P < .001). The cavernosal arterial blood flow observed with the mean PSV at 1, 3, and 5 days postoperation were 17.79 ± 2.04, 19.14 ± 1.58, and 7.73 ± 2.02 cm/s respectively. All patients suffered from corpus cavernosum fibrosis and erectile dysfunction postoperation; only 2 cases (16.7%) with a short duration of PIP (1.5 days) showed response to sildenafil treatment, and 3 cases (25.0%) with severe fibrosis were satisfied with sexual life after excision of penile corpus cavernosum scar and penile prosthesis implantation. The CC-CSS+ICT could quickly reduce penile rigidity and pain for improving the symptoms of PIP and suggests a safe and effective therapeutic method for PIP.

Microsurgical vasoepididymostomy is an effective treatment for azoospermic patients with epididymal obstruction and prior failure to achieve pregnancy by sperm retrieval with intracytoplasmic sperm injection

STUDY QUESTION Can microsurgical vasoepididymostomy (MVE) be used to treat azoospermia in men with epididymal obstruction who have had a prior attempt at sperm retrieval with ICSI and failed to achieve a pregnancy? SUMMARY ANSWER MVE is an effective treatment for epididymal obstruction. WHAT IS KNOWN ALREADY MVE is an effective treatment for non-vasectomized patients with epididymal obstruction. However, ICSI is the preferred treatment for patients with obstructive azoospermia in some reproductive centers. The clinical pregnancy rate in per ICSI cycle is <40% and more than half of couples need repeated ICSI. Some couples cannot bear the high medical costs or the pain associated with repeated IVF/ICSI. Therefore, MVE may be an alternative treatment for such patients. STUDY DESIGN, SIZE AND DURATION This retrospective study investigated whether MVE could be used to treat patients with epididymal obstruction and a previous failed ICSI attempt. From January 2009 to July 2012, 268 patients underwent MVE for epididymal obstruction in our center; we included 68 who had experienced failure of at least one cycle of ICSI in this study. MATERIALS, SETTING, METHODS We studied 68 patients with obstructive azoospermia who were treated by MVE and had previously undergone surgical sperm recovery and ICSI. The patients were divided into two groups according to the sperm retrieval method used in their ICSI attempt: percutaneous epididymal sperm aspiration (PESA) (41.2%, 28/68) and testicular sperm extraction (TESE) (58.8%, 40/68). We evaluated the obstructive causes, patency, pregnancy and live birth rates and the effect of sperm retrieval methods on the outcome of MVE. MAIN RESULTS AND THE ROLE OF CHANCE In total, 62 patients (91.2%) showed epididymal obstruction, 2 (2.9%) intratesticular obstruction and 4 (5.9%) vasal obstruction. The mean age was 30.4 ± 5.3 years (range 22-48 years). We followed up 53 (85.5%) at a mean follow-up of 19.8 ± 9.1 months (range 6-43 months). The total patency and natural pregnancy rates were 79.2% (n = 42) and 35.8% (n = 19), respectively. The overall live birth rate was 28.3%. The results of MVE did not differ between the two groups: PESA and TESE. LIMITATIONS, REASONS FOR CAUTION A randomized controlled trial comparing pregnancy rates, live birth rates, risks and medical costs of MVE and IVF/ICSI is needed. The size of our sample was limited, so we did not reveal significantly different patency, pregnancy and live birth rates between PESA and TESE. A larger sample size is needed to evaluate the effect of sperm retrieval on patency, pregnancy and live birth rates. WIDER IMPLICATIONS OF THE FINDINGS Epididymal obstruction is the most common obstructive cause in non-vasectomized patients. Data from this study have shown that MVE is an effective therapy for such azoospermic patients with epididymal obstruction and prior failed ICSI for pregnancy. Obstructive causes should be differentiated to select optimal therapy for patients with obstructive azoospermia in reproductive centers. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. The authors have no competing interests to declare.

Clinical Features and Treatment Options for Chinese Patients With Severe Primary Erectile Dysfunction

OBJECTIVES To investigate clinical features of Chinese patients with severe primary erectile dysfunction (S-PED) and to identify the ideal treatment options for this population. METHODS Patients with PED were screened for enrollment in our study. Sexual history, marital status, and erectile function were evaluated by inquiry including International Index of Erectile Function-5. Individuals with severe PED (defined as refractory to management with phosphodiesterase type 5 inhibitor [PDE5i]) underwent serum hormone analysis, penile color duplex Doppler ultrasound, neuroelectromyogram, and cavernosography as appropriate. Long-term treatment results were determined. RESULTS Among 220 PED patients, 72 (32.7%) suffered from severe PED (PDE5i nonresponse). Mean age was 31.5 +/- 4.5 years and mean duration of attempts at sexual activity was 2.4 +/- 3.2 years, Sixty-eight men (94.5%) had organic etiologies for erectile dysfunction, including arteriogenic (n = 13), venogenic (n = 35), endocrinologic (n = 6), neurologic (n = 9), and cavernosal fibrosis (n = 5). Sixteen men (22.2%) had been divorced. Mean erectile function and quality-of-life were significantly improved (P <.001) in the 25 men (34.7%) who were treated by penile prosthesis implantation, at a mean follow-up of 5.6 years. Satisfaction with penile prosthesis for patients and partner was 93.4% and 92.3%, respectively. CONCLUSIONS Severe PED has a major impact on young couples life quality. Venous leak is the most common cause of severe PED. Penile prosthesis implantation is safe and effective for severe PED.

Tissue Engineering Penoplasty With Biodegradable Scaffold Maxpol-T Cografted Autologous Fibroblasts for Small Penis Syndrome

In this study, we investigated the safety and efficacy of a poly acid-co-glycolide biodegradable scaffold (Maxpol-T) coated by autologous fibroblasts (AF) for penile girth enlargement in small penis syndrome (SPS). Eighty patients with SPS were enrolled in a clinical study at 2 medical centers; 69 patients completed the study protocol. Scrotal skin was harvested under local anesthesia, and AFs were cultured and seeded on a Maxpol-T scaffold; the cografted scaffold was implanted under the Bucks fascia of penile shaft via a circumcising incision. Patients were followed up at 1, 3, and 6 months to evaluate penile girth changes. Patient satisfaction was assessed via Visual Analogue Scale and scored on the International Index of Erectile Function-5 (IIEF-5). Mean preoperative penile girth in the flaccid and erect state was 8.18 ± 0.83 cm and 10.26 ± 1.22 cm, respectively. At the 6-month postoperative follow-up, mean penile girth in the flaccid and erect state was increased to 12.19 ± 1.27 cm and 13.18 ± 1.31 cm, respectively (P < .001 for change in both flaccid and erect state). Sixty-five patients (94.2%) reported satisfaction with the procedure. Among them, 4 cases (5.8%) were dissatisfied, 7 cases (10.1%) were satisfied, 26 cases (37.7%) were very satisfied, and 32 cases (46.4%) were extremely satisfied. All men maintained IIEF-5 scores of more than 22. Complications included prolonged subcutaneous edema in 3 patients (4.3%) and pinpoint erosion at the suture area in 3 patients (4.3%). Implantation of autologous fibroblasts seeded on a Maxpol-T collagen scaffold holds promise as a safe and novel technique for penile girth enhancement in patients with SPS.

Causes of Suspected Epididymal Obstruction in Chinese Men

OBJECTIVE To explore the causes of epididymal obstruction in China and the success of reconstructive surgery. MATERIALS AND METHODS From February 2006 to December 2009, 134 consecutive azoospermic men with suspected epididymal obstruction underwent scrotal exploration. We excluded 11 men who had undergone vasectomy and 5 with inguinal hernia repair. The findings of scrotal exploration and outcomes of reconstructive surgery were reviewed. RESULTS Epididymal obstruction was found in 162 of 258 (62.8%) suspected blocked reproductive tract units (2/patient). The etiology of obstruction was idiopathic for 144 units (88.9%), infection for 16 (9.9%), and surgical for 2 (1.2%). The etiology for the remaining 96 obstructed units (37.2%) was intratesticular obstruction for 59 (61.5%), vasal obstruction for 24 (25%) and vasal atresia for 13 (13.5%). Of the 134 patients, we identified sperm in the epididymis on ≥ 1 side in 96 (71.6%). These 96 patients underwent vasoepididymostomy, and 46 (63.9%) had sperm on postoperative ejaculation. CONCLUSION Idiopathic obstruction was the most common cause of epididymal obstruction in this Chinese sample, which differed from the U.S. experience. Microsurgical vasoepididymostomy is effective for idiopathic epididymal obstruction.

Role of Nocturnal Penile Erection Test on Response to Daily Sildenafil in Patients With Erectile Dysfunction due to Pelvic Fracture Urethral Disruption: A Single-center Experience

OBJECTIVE To evaluate the results of nocturnal penile erection test and response to daily sildenafil in patients with erectile dysfunction (ED) due to pelvic fracture urethral disruption. METHODS From January 2010 to January 2012, we included 38 patients with ED due to pelvic fracture urethral disruption. The mean age was 33.1 years (range, 22-49 years). All were evaluated subjectively and objectively by the International Index of Erectile Function-5, nocturnal penile tumescence and rigidity (NPTR) test, and penile Doppler ultrasonography. Patients received daily sildenafil 50 mg for 3 months. RESULTS Thirty-one patients were followed up: 54.8% showed response to sildenafil defined as reporting successful vaginal penetration and intercourse. Patients with neurogenic, arterial, and venous EDs did not differ in efficiency rates (P = .587). However, the penile erectile rigidity recorded by NPTR test affected efficiency significantly (P = .046). Patients with tip rigidity >40% had the highest response rate (76.9%), but the response rate for patients with tip rigidity <20% was only 22.2%. CONCLUSION NPTR recording can reveal resident erectile function in patients with ED due to trauma and is significant for selecting pharmacologic treatment as optimal therapy.