Yan-Feng Li

Clinical analysis of the characterization of magnetic resonance imaging in 102 cases of refractory haematospermia

To analyze the pathogenesis of persistent and refractory haematospermia and to evaluate the aetiological diagnostic value of magnetic resonance imaging (MRI) for this type of haematospermia. Clinical data from 102 patients with persistent and refractory haematospermia was retrospectively analysed. Data collected included history, symptoms, as well as ultrasound and MRI of the morphological features of the bilateral seminal vesicles (SV) and ejaculatory duct (ED) areas. Criteria for inclusion were haematospermia symptoms that occurred more than six times, that lasted more than 6 months, and that did not improve after >1 month of conservative treatment. Patients underwent seminal vesiculoscopy with a post‐surgery follow‐up of 3–48 months [average (18.1 ± 10.3) months]. Of the 102 patients that underwent MRI examination, data from 88 patients (86.3%) showed typical and characteristic changes in the ED area, including the signal intensity changes in 60 (58.8%), SV volume changes in 32(31.4%), the formation of cysts such as prostatic utricular cysts in 27 (26.5%), Müllerian cysts in 4 (3.9%), ED cysts in 5 (4.9%) and a SV cyst in 1(1.0%). The MRI findings were confirmed by seminal vesiculoscopy and all patients received appropriate treatment. In 14 patients (13.7%), no obvious abnormal changes were observed with MRIs, however, these patients were diagnosed and successfully managed using seminal vesiculoscopy. Some degrees of ED obstruction was usually found during surgery. The symptoms of haematospermia disappeared 1–2 months after surgery in all patients. Two patients had a recurrence of haematospermia, underwent the same treatment, and recovered during the follow‐up period. The aetiology of the most cases of the refractory haematospermia can be distinguished using the three‐dimensional MRI. Typical abnormalities observed on MR images are signal intensity, SV volume changes and cyst formation. MRI has significant etiological diagnostic value and provides reliable information for the subsequent treatment of patients with persistent and refractory haematospermia.

ORIGINAL ARTICLE: Immunocontraceptive Effect of DNA Vaccine Targeting Fertilin β in Male Mice

Citation Sun Z, Jin F, Li Y, Zhang J. Immunocontraceptive effect of DNA vaccine targeting fertilin β in male mice. Am J Reprod Immunol 2010; 63: 282–290

Immunocontraceptive effect of DNA vaccine targeting fertilin beta in male mice.

Citation Sun Z, Jin F, Li Y, Zhang J. Immunocontraceptive effect of DNA vaccine targeting fertilin β in male mice. Am J Reprod Immunol 2010; 63: 282–290

The establishment and evaluation of a new model for the prediction of prostate cancer

Abstract To develop a new prostate cancer predictor (PCP) model using the combination of total prostate-specific antigen (tPSA), free PSA (fPSA), and complexed PSA (cPSA). The diagnoses of all the included patients were confirmed pathologically in Daping Hospital between December 1, 2011 and December 1, 2014. There were 54 PCa cases and 579 benign prostatic hyperplasia (BPH) cases with tPSA levels of 2 to 10 ng/mL, and 48 PCa cases and 147 BPH cases with tPSA levels of 10 to 20 ng/mL. Logistic regression and receiver operating characteristic curve (ROC) analyses were employed to compare the value of PCP (PCP = tPSA / fPSA × √cPSA) with tPSA, fPSA, the ratio of fPSA to tPSA (%fPSA), and cPSA for the differential diagnosis of PCa and BPH. Meanwhile, bootstrapping analysis was used to calculate the distribution and confidence intervals (CIs) for the area under the curve (AUC), and Hosmer–Lemeshow tests were used to calculate P values. When tPSA levels were 2 to 10 ng/mL, the AUC of PCP (0.680) was significantly higher than that of tPSA (0.588), fPSA (0.571), %fPSA (0.675), and cPSA (0.613). When the sensitivity for the diagnosis of PCa was 90.7%, the specificity of PCP (22.8%) was higher than that of tPSA (11.1%), fPSA (11.2%), %fPSA (17.4%), and cPSA (15.5%). When tPSA levels were 10 to 20 ng/mL, the AUC of PCP (0.686) was significantly higher than that of tPSA (0.603), fPSA (0.643), %fPSA (0.679), and cPSA (0.647). When the sensitivity for the diagnosis of PCa was 91.7%, the specificity of PCP (29.3%) was higher than that of tPSA (10.9%), fPSA (10.2%), %fPSA (23.1%), and cPSA (18.4%). PCP is a novel model for the prediction of PCa; it has more predictive value than tPSA, fPSA, %fPSA, and cPSA when tPSA levels are 2 to 20 ng/mL.

AB151. Clinical study on the treatment of lifelong premature ejaculation with paroxetine hydrochloride and tamsulosin

Objective There are quite a few researches about SSRIs and alpha-receptor blockers on the treatment of premature ejaculation (PE), but few researches focus on the combination use of them. In this study, we evaluate the efficacy and safety of combine and alone use of paroxetine hydrochloride and tamsulosin on the treatment of lifelong PE. Methods 352 cases of men with 18–65 years of age, a history of lifelong PE and an intra-vaginal ejaculation latency time (IELT) <120 sec were included in this study. The patients were randomized divided into three groups. Group A were treated by paroxetine hydrochloride 20 mg/d for 8 weeks; group B were treated by tamsulosin 0.2 mg/d for 8 weeks; group C were treated by paroxetine hydrochloride and tamsulosin at the same dosage as above for 8 weeks. The effects were evaluated by the mean change and folds increase in geometric mean IELT and the mean change in all four measures of the premature ejaculation profile (PEP), the adverse events (AEs) and vital sign measurements were recorded at each visit. All the data were statistically analyzed. Results The reliable data from 322 patients were achieved. The geometric mean IELT in group A was significantly increased from 1.15 to 8.13 min after treatment (P<0.001); the geometric mean IELT in group B was significantly increased from 1.26 to 2.78 min after treatment (P<0.01); the geometric mean IELT in group C was significantly increased from 1.18 to 9.52 min after treatment (P<0.001). The increased folds of geometric mean IELT in group C (8.07 folds) was significantly higher than that in group B (2.21 folds) and group A (7.07 folds) (P<0.001). The mean PEP scores that include measures of perceived control over ejaculation, satisfaction with sexual intercourse, ejaculation-related personal distress, and ejaculation-related interpersonal difficulty were significantly improved in all groups after treatment (P<0.001). The mean PEP scores in group C have more significant improvements than that in group A and B (P<0.01). The prevalence of AEs in group A, B, C were 9.26% (10 cases), 3.81% (4 cases) and 8.26% (9 cases), respectively. Conclusions Paroxetine hydrochloride combined with tamsulosin produce more better therapeutic effects than use them separately. It could be a priority for the treatment of lifelong PE.

AB080. Study on the endoscopic minimally invasive operation of male distal reproductive tract region

Objective To evaluate the clinical effects of the transurethral endoscopic minimally invasive operation on the treatment of severe, persistent hematospermia in cases that were refractory to conservative treatments by retrospectively analyzing the clinical data of the patients treated in our hospital. Methods Clinical data from 216 patients with persistent and refractory hematospermia in our hospital since January 2009 to May 2015 was retrospectively analysed. Data collected included history, symptoms, as well as ultrasound and MRI of the morphological features of the bilateral seminal vesicles (SV) and ejaculatory duct (ED) areas. Criteria for inclusion were hematospermia symptoms that occurred more than six times, that lasted more than 6 months, and that did not improve after >1 month of conservative treatment. Patients underwent transurethral resection of the ejaculatory duct (TURED) and/or seminal vesiculoscopy and with a post-surgery follow-up. The effects and advantages of transurethral endoscopic treatment of refractory hematospermia were discussed. Results The age range of the patients was 21-80 years (mean age =43.2 years). Hematospermia among patients lasted between 6 and 120 months (mean duration 35.2 months). The operation types includes: (I) seminal vesiculoscopy + seminal vesicle irrigation; (II) transurethral resection of the cysts including the seminal vesicle cyst, utricular cyst, Mullerian duct cyst, Wolffian duct cyst and the fulguration of the cyst wall; (III) lithotripsy to the stone of seminal duct; (IV) the fulguration of the abnormal blood vessels at posterior urethra. The operation time ranged from 20-65 min (mean, 33 min). Blood losses ranged from 5 to 20 mL (mean, 12 mL). The seminal vesiculoscopy examination and related procedure were successfully performed in 211 patients, and were failed to perform the procedure in five patients because of the atrophy or abnormal anatomy of the seminal vesicles. Pathological examination were performed in some patients with suspicious lesions and revealed that the SV specimens had non-specific, chronic inflammation in the wall of the SV, but without tuberculosis or neoplasm. 204 patients were followed up for 2-72 months (mean, 35 months). The hematospermia of all the patients were disappeared within 2-6 weeks and 94.6% (193/204) of the patients did not appear the hematospermia anymore. 5.4% (11/204) of the patients present a recurrence after 5-20 months, six of them performed the second time seminal vesiculoscopy and were recovered later, five of them were recovered by the conservative treatment (oral drug administration). No intra- or post-operative obvious complications were observed. 3.9% (8/204) of the patients complained that the orgasms were slightly decreased in orgasmic intensity after operation, but 96.1% (196/204) of the patients did not complain any change of the orgasms. Conclusions The transurethral seminal vesiculoscopy examination and related procedure including dilation of ejaculatory ducts, incision of the verumontanum or the distal end of the ejaculatory ducts, and incision or resection of the relevant cysts represent a kind of simple, effective, safe and reliable approaches for the management of refractory cases of hematospermia that do not respond to conservative treatments.

Reduction of fertility in male mice immunised with pSG.SS.C3d3.YL.Bin1b recombinant vaccine

Abstract Objectives To study the anti-fertility effect of a DNA vaccine using Bin1b as the target antigen in male mice. Methods A novel recombinant eukaryotic vector containing a fusion gene sequence of mouse Bin1b in tandem with three copies of C3d fragment (C3d3) was used to construct pSG.SS.C3d3.YL.Bin1b. The correct expression of the Bin1b-C3d3 protein was confirmed in transfected HEK293 cells by indirect immunofluorescence and western blot analysis. The fertility of immunised mice was determined by a mating experiment and sperm motility test. Anti-Bin1b antibody titres in sera were examined by ELISA assays. Binding activity of C3d3 fragment of the fusion protein was verified in C3d receptor-expressing Raji cells and flow cytometric analysis. Results Immunisation of pSG.SS.C3d3.YL.Bin1b recombinant DNA vaccine significantly decreased sperm motility and compromised fertility in male mice. ELISA results showed that the titres of anti-Bin1b IgG in sera of immunised mice increased markedly with the immunisation process. Further, the anti-fertility effect of pSG.SS.C3d3.YL.Bin1b was significantly better than that of pSG.SS.YL.Bin1b DNA vaccine and generated higher titres of anti-Bin1b antibody. Conclusions Our results show that recombinant DNA vaccine targeting Bin1b can markedly reduce fertility in male mice, providing an alternative approach for birth control. Chinese Abstract 摘要 目的研究以Bin1b作为雄性小鼠靶抗原的DNA疫苗的抗生育作用。 方法使用包含小鼠Bin1b与三拷贝C3d片段（C3d3）融合基因序列的新型重组真核载体构建pSG.SS.C3d3.YL.Bin1b。间接免疫荧光和蛋白印迹分析证实Bin1b-C3d3蛋白在转染HEK293细胞中正确表达。交配试验和精子运动试验来确定免疫小鼠的生育能力。ELISA 检测血清中的抗Bin1b抗体滴度。C3d受体表达Raji细胞和流式细胞分析验证融合蛋白中C3d3片段的结合活性。 结果免疫接种pSG.SS.C3d3.YL.Bin1b重组NDZ疫苗显著降低雄性小鼠的精子运动力，损害其生育能力。ELISA 结果表明，免疫过程中雄性小鼠抗Bin1b抗体IgG的血清滴度显著降低。而且，pSG.SS.C3d3.YL.Bin1b产生较高的抗Bin1b抗体滴度，其抗生育效应明显优于pSG.SS.YL.Bin1b DNA疫苗的抗生育效应。 结论我们的研究结果表明，以Bin1b为靶抗原的重组DNA疫苗能够显著降低雄性小鼠的生育能力，为生育控制提供了一种新的方法。 关键词 抗生育能力，Bin1b，C3d，重组载体疫苗

AB205. Clinical analysis of the characterization of magnetic resonance imaging and endoscopic therapy in refractory hematospermia

Objectives To assess the etiological diagnostic value of magnetic resonance imaging (MRI) by analysis of the pelvic MRI manifestations or characteristic changes around the ejaculatory duct area and to evaluate the therapeutic effect of transurethral minimally invasive endoscopic treatment in the persistent and refractory hematospermia patients who are ineffective to the conservative treatment. Methods The morphological features and characteristic changes around the area of the bilateral seminal vesicles (SV) and ejaculatory duct (ED) in 76 patients with persistent and refractory hematospermia as well as 41 adult males who performed the MRI but did not have urinary reproductive system diseases (as the healthy control group) were retrospectively analyzed. All the 76 patients followed by undergoing transurethral minimally invasive endoscopic examination and treatment based on the MRI imaging characteristic. The therapeutic effect was followed up, analyzed and summarized. Results Based on the analysis to the normal morphological features of the bilateral SVs and ED areas of pelvic MRI images in 41 cases of health adult men, it was found that 88.2% (67/76) patients with persistent and refractory hematospermia showed typical and characteristic changes in the ED and SVs area in MRI imaging. The main characteristic changes are: (I) 61.8% (47/76) patients showed the signal intensity changes in seminal vesicle, in which 24 patients with old hemorrhage showed middle to high signal intensity on both T1-weighted images (T1WI) and T2-weighted images (T2WI), while the other 23 patients with fresh hemorrhage showed high signal intensity on T1WI)and low signal intensity on T2WI; (II) 34.2% (26/76) patients showed significant cystic dilatation (the width of SV is bigger than 1.7 cm or the diameter of the inner tubular structure is bigger than 5 mm) in unilateral or bilateral SV, with or without the internal signal intensity changes; (III) 36.8% (28/76) patients showed the formation of cysts in the ejaculatory area such as prostatic utricular cysts (PUC) in 27.6% (21/76) patients, Müllerian duct cysts (MDC) in 3.9% (3/76) patients, Ejaculatory duct cysts (EDC) in 3.9% (3/76) patients, and an Seminal vesicle cyst (SVC) in 1.3% (1/76) patients. 11.8% (9/76) patients did not show any obvious abnormal changes in MRI imaging. All the patients were successfully performed observation, dilation, incision or irrigation to their ejaculatory duct and related area under the transurethral endoscopy. No obvious complications were found during and after the surgeries. The biopsies were performed in some of the patients and the pathology confirmed that all the tissue from SV only have non-specific chronic inflammation. No tumor was found in the area of prostate, ED and SV. All the patients were followed-up for 3-36 months (average 18 months). The hematospermia and their related symptoms in most of all of them were disappeared after surgery, except for two patients experienced a recurrence of hematospermia after 5 and 11 months of surgery. The two patients underwent the same treatment again as described above, and recovered during the followed-up period. The urination and ejaculation are usually as well as before surgery. Only two old patients complained about that the orgasm and pleasant sensation slightly decreased, the other 97.4% (74/76) patients have normal orgasm and pleasant sensation after surgery. Conclusions The etiology of the most cases of the refractory hematospermia can be distinguished using the three-dimensional MRI imaging. Typical abnormalities observed on MR images are signal intensity, SV volume changes and cyst formation. MRI has significant etiological diagnostic value and provides reliable information for the subsequent treatment of patients with persistent and refractory hematospermia. The transurethral endoscopic technique such as the dilatation of the ED, incision of the verumontanum or distal ejaculatory duct, incision or excision of the cyst in this region is a simple, safe, reliable and effective treatment method for the patients with persistent and refractory hematospermia.

Role of fluorescence in situ hybridization in the diagnosis of urothelial cancer in asymptomatic hematuria patients

The present study aimed to investigate the feasibility and validity of fluorescence in situ hybridization (FISH) in the diagnosis of urothelial cancer (UC) in asymptomatic hematuria patients. Probes to the pericentromeric regions of chromosomes 3, 7 and 17, and to the 9p21 band were used in FISH at detecting UC in 53 hematuria patients negative on imaging, cystoscopy and cytology but highly suspicious for UC. Among 53 asymptomatic patients with hematuria, 15 were FISH-positive, of whom 13 were followed for 3-12 months. Of these 15 patients, 5 were finally diagnosed with bladder UC and 2 with renal pelvis cancer. Among 38 patients who were FISH-negative, none developed UC during the follow up period. FISH is a significant additional and complementary method for detection of UC in hematuria patients who were negative on cystoscopy and cytology but suspicious for UC.

ORIGINAL ARTICLE: Immunocontraceptive Effect of DNA Vaccine Targeting Fertilin β in Male Mice: DNA VACCINE TARGETING FERTILIN β

Citation Sun Z, Jin F, Li Y, Zhang J. Immunocontraceptive effect of DNA vaccine targeting fertilin β in male mice. Am J Reprod Immunol 2010; 63: 282–290