RESUMEN
OBJECTIVE: To investigate the expressions of testicular GnRH and steroidogenic enzymes and their correlations with intratesticular T levels (ITT) and serum hormonal parameters in infertile men. DESIGN: Prospective case study. SETTING: University reproductive laboratory and clinics. PATIENT(S): Thirty-four azoospermic men. INTERVENTION(S): The mRNA transcript levels of GnRH-I, GnRH-II, GnRH-R, and five steroidogenic enzymes in the testes of azoospermic men were determined by quantitative real time polymerase chain reaction. The ITT level was determined by radioimmunoassay. MAIN OUTCOME MEASURE(S): Transcript levels of genes and ITT determination. RESULT(S): The mRNA transcript levels of GnRH-I, GnRH-II, GnRH-R, cytochrome P450 side-chain cleavage (CYP11A1), and 3beta-hydroxy-steroid dehydrogenase type 2 enzyme (HSD3B2) as well as the ITT levels were significantly increased in patients with spermatogenic failure, especially in men with Sertoli cell-only syndrome. GnRH-I and -II mRNA transcript levels positively correlated with HSD3B2 mRNA transcript levels, ITT levels, and serum FSH levels. CONCLUSION(S): Increased testicular GnRH transcripts, steroidogenic enzyme transcripts, and ITT levels are associated with spermatogenic failure in infertile men. Testicular GnRH is involved in the regulation of human spermatogenesis and steroidogenesis.
Asunto(s)
Azoospermia/genética , Regulación Enzimológica de la Expresión Génica , Hormona Liberadora de Gonadotropina/genética , ARN Mensajero/análisis , Testículo/química , Testosterona/análisis , Transcripción Genética , Adulto , Azoospermia/enzimología , Enzima de Desdoblamiento de la Cadena Lateral del Colesterol/genética , Hormona Folículo Estimulante/sangre , Humanos , Masculino , Progesterona Reductasa/genética , Estudios Prospectivos , Precursores de Proteínas/genética , Receptores LHRH/genética , Testículo/enzimología , Regulación hacia ArribaRESUMEN
AIM: To describe an unusual symptom of benign prostatic hyperplasia (BPH). METHODS: A patient presented to our urology clinic having experienced post-coital gross hematuria for 2 years. He had not experienced lower urinary tract symptoms (LUTS). A series of examinations were performed to determine the source of bleeding. RESULTS: The prostate was defined as the active bleeding source responsible for the patient's post-coital hematuria. Endoscopic fulguration did not alleviate the symptom. The use of dutasteride, a dual inhibitor of 5alpha-reductase, solved the problem. CONCLUSION: This study reports for the first time that post-coital gross hematuria is one of the clinical presentations of BPH, which can be successfully treated with 5alpha-reductase inhibitor.
Asunto(s)
Coito/fisiología , Hematuria/etiología , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/diagnóstico , Inhibidores de 5-alfa-Reductasa , Azaesteroides/uso terapéutico , Dutasterida , Inhibidores Enzimáticos/uso terapéutico , Hematuria/tratamiento farmacológico , Hematuria/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/fisiopatología , Sistema UrinarioRESUMEN
OBJECTIVES: To conduct a cohort study in men older than 40 years in Taiwan to evaluate the prevalence of erectile dysfunction (ED) by self-report and the use of the abridged, five-item version of the International Index of Erectile Function (IIEF-5). METHODS: From July to August 2003, 990 Taiwanese men older than 40 years of age completed a telephone survey designed to assess ED prevalence and sexual functioning. ED was identified through respondent self-report and investigator assessment using the IIEF-5 instrument. Data were analyzed using the analysis of variance test, t test, and chi-square test, with Yates' correction or Fisher's method. RESULTS: The prevalence of self-reported ED was 13.1%, with 26.2% of this subgroup subsequently deemed to not have ED by IIEF-5 assessment. Among the subgroup of men self-reported to not have ED, 18.8% were found to have ED by IIEF-5 assessment. In total, 26.0% of respondents had ED by IIEF-5 assessment. The ED prevalence increased with age and a history of chronic illness. The frequency of sexual contact and sexual satisfaction were also reduced in the respondents with ED. CONCLUSIONS: The prevalence of self-reported ED in Taiwanese men older than 40 years of age was 13.1% compared with 26.0% using the IIEF-5 assessment. Estimates of ED prevalence in the general population should not rely on self-reporting alone because it is likely to underestimate the true prevalence of ED.
Asunto(s)
Disfunción Eréctil/diagnóstico , Disfunción Eréctil/epidemiología , Encuestas y Cuestionarios , Adulto , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , TaiwánRESUMEN
BACKGROUND: DAZ gene family is crucial for human spermatogenesis that requires the precise co-ordination of cell cycle events. CDC25A is recognized as the downstream substrate of DAZ gene family and is thought to function on the M-phase regulation of cell cycles. We investigated the expression profiles of CDC25A in the testes of infertile men and evaluated the relationship between CDC25A levels and testicular phenotype, clinical hormonal parameters and sperm retrieval results. METHODS: The protein and mRNA transcript levels of CDC25A in the testes of 40 azoospermic men were determined by immunohistochemistry and quantitative real-time-PCR. CDC25A in human spermatozoa was investigated by western blotting and immunofluorescence staining. RESULTS: The CDC25A protein was expressed mainly in spermatocyte, spermatid and spermatozoa. CDC25A transcript levels were significantly decreased (P = 0.0009) in patients with spermatogenic failure, especially in men with meiotic arrest and Sertoli cell-only syndrome. Significantly higher CDC25A transcript levels were detected in patients with successful sperm retrieval than in patients with failed sperm retrieval (P = 0.005). CONCLUSIONS: Decreased CDC25A is associated with spermatogenic failure and failed sperm retrieval in infertile men. Further studies are necessary to explore the functional roles of CDC25A in human spermatozoa.
Asunto(s)
Infertilidad Masculina/metabolismo , Espermatogénesis , Fosfatasas cdc25/fisiología , Adulto , Azoospermia , Ciclo Celular , Cartilla de ADN/química , Humanos , Inmunohistoquímica , Masculino , Microscopía Confocal , Microscopía Fluorescente , Fenotipo , ARN Mensajero/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Sensibilidad y Especificidad , Espermatozoides , Testículo/metabolismoRESUMEN
We describe an unusual complication of coital trauma in a 29-year-old man who presented with a 3-year history of hematospermia and post-coital gross hematuria. Using urethroscopy under a semi-tumescent penis, an isolated urethral injury with active bleeding was detected at the prostatic urethra. The patient was successfully treated with transurethral fulguration. We suggest that isolated posterior urethral injury is one of the causes of male coital trauma, which might be asymptomatic when the penis is flaccid but show symptomatic bleeding when the penis is erect.
Asunto(s)
Coito , Uretra/lesiones , Enfermedades Uretrales/etiología , Adulto , Eyaculación , Femenino , Hematuria , Humanos , MasculinoRESUMEN
BACKGROUND: M-phase promoting factor (MPF), which is comprised of Cyclin B and a catalytic subunit, Cdc2, is a key enzyme required for cells to enter M phase in both mitosis and meiosis. MPF activity is controlled by the stimulatory dephosphorylation of the Cdc25 family and the inhibitory phosphorylation of Wee1. We determined the levels of mRNA transcripts of MPF and its regulators in the testes of infertile men, and evaluated the relationship between the transcript levels and patients' testicular phenotypes and sperm retrieval results. METHODS AND RESULTS: The mRNA transcript levels of CDC2, CCNB1, CCNB2, CDC25A, CDC25B, CDC25C and WEE1 in the testes of 37 azoospermic patients were examined by quantitative real-time polymerase chain reaction. Significant decreases in CDC2, CCNB1, CCNB2, CDC25A, CDC25C and WEE1 mRNA transcript levels were detected in patients with spermatogenic failure. CDC2 mRNA transcript levels correlated significantly with those of CCNB1 and CCNB2 mRNA. Significantly higher CDC2, CCNB1, CCNB2, CDC25C and WEE1 mRNA transcript levels were detected in 18 patients with successful sperm retrieval than in 11 patients with failed sperm retrieval. CONCLUSIONS: We suggest that the decreased mRNA transcripts of MPF and its regulators play important roles in human spermatogenesis.
Asunto(s)
Regulación hacia Abajo , Regulación de la Expresión Génica , Infertilidad Masculina/genética , Factor Promotor de Maduración/genética , Testículo/metabolismo , Adulto , Proteínas de Ciclo Celular/genética , Humanos , Masculino , Proteínas Tirosina Quinasas/genética , ARN Mensajero/análisis , ARN Mensajero/metabolismo , Espermatogénesis/genética , Testículo/química , Transcripción Genética , Fosfatasas cdc25/genéticaRESUMEN
We describe a sequential deteriorated change of sperm count in a 30-year-old infertile man with nonmosaic Klinefelter's syndrome. His initial semen analysis revealed oligozoospermia; however, the sperm count decreased progressively, which resulted in azoospermia over a period of 3 years. By testicular sperm extraction, a few spermatozoa were recovered. We analyzed the germ cells with three-color fluorescence in situ hybridization, and the presence of a 46,XY lineage was found. We suggest that progressive depletion of germ cells might occur in men with nonmosaic Klinefelter's syndrome and that these men should undergo semen cryopreservation or sperm recovery as early as possible.
Asunto(s)
Síndrome de Klinefelter/complicaciones , Oligospermia/etiología , Recuento de Espermatozoides , Adulto , Linaje de la Célula , Criopreservación , Progresión de la Enfermedad , Humanos , Hibridación Fluorescente in Situ , Cariotipificación , Síndrome de Klinefelter/genética , Síndrome de Klinefelter/patología , Masculino , Oligospermia/genética , Preservación de Semen , Espermatogonias/patologíaRESUMEN
OBJECTIVES: To investigate the transcriptional levels of four azoospermia factor genes in the testis of azoospermic men and to investigate the association between transcriptional levels and the results of sperm retrieval. METHODS: Thirty-eight azoospermic men with normal karyotype and without Y chromosome gene deletions were enrolled. The amounts of USP9Y (ubiquitin specific protease 9, Y chromosome), DBY (dead box on the Y), RBMY1 (RNA-binding motif on the Y, 1), and DAZ (deleted in azoospermia) transcripts were examined by quantitative competitive-reverse transcriptase-polymerase chain reaction. The steady-state concentrations of mRNA encoding for each gene in each testicular sample were normalized by the amounts of a housekeeping gene (glyceraldehyde phosphate dehydrogenase [GAPDH]). Differences in the transcript ratios (gene transcript/GAPDH transcript) among patients with different testicular histologic findings (normal spermatogenesis, hypospermatogenesis, maturation arrest, Sertoli cell-only syndrome) were analyzed. For each gene, the association between the transcript ratios and the results of sperm retrieval was evaluated. RESULTS: No statistically significant difference was found in the transcript ratios of USP9Y and DBY among the four histologic patient groups (P = 0.33 and P = 0.21, respectively). In contrast, statistically significant decreases were found in the transcript ratios of RBMY1 and DAZ in patients with spermatogenic failure (P = 0.0002 and P = 0.002, respectively). The transcript ratios of USP9Y and DBY were not associated with the results of sperm retrieval, and the transcript ratios of RBMY1 and DAZ revealed a positive association with successful sperm retrieval. CONCLUSIONS: The decreased transcriptional levels of RBMY1 and DAZ in patients with spermatogenic failure may reflect the generalized loss of germ cells. The transcriptional levels of RBMY1 and DAZ may have the potential of becoming useful parameters in the prediction of successful sperm retrieval.
Asunto(s)
Cromosomas Humanos Y/genética , Endopeptidasas/genética , Oligospermia/genética , Proteínas/genética , ARN Mensajero/biosíntesis , Proteínas de Unión al ARN/genética , Proteínas de Plasma Seminal/genética , Recolección de Tejidos y Órganos , Transcripción Genética , Adulto , Biomarcadores , ARN Helicasas DEAD-box , Proteína 1 Delecionada en la Azoospermia , Sitios Genéticos , Humanos , Masculino , Antígenos de Histocompatibilidad Menor , Proteínas Nucleares , ARN Mensajero/genética , Recuento de Espermatozoides , Maduración del Esperma/genética , Espermatogénesis/genética , Testículo/metabolismo , Recolección de Tejidos y Órganos/métodos , Ubiquitina TiolesterasaRESUMEN
INTRODUCTION: Tadalafil is a phosphodiesterase type 5 inhibitor for the treatment of erectile dysfunction (ED). Past clinical trials have assessed its efficacy and safety in western populations. Tadalafil has not been investigated in a large clinical trial with a South-east Asian population. AIM: To assess the efficacy and safety of on-demand tadalafil for the treatment of ED in a 12-week, double-blind, placebo-controlled study in Taiwan. METHODS: Men with mild to severe ED of various etiologies were randomized to receive placebo, tadalafil 10 mg, or tadalafil 20 mg, taken as needed (maximum once daily). Efficacy assessments included the International Index of Erectile Function, the Sexual Encounter Profile (SEP) diary, and a Global Assessment Question (GAQ). RESULTS: Tadalafil significantly improved erectile function compared with placebo (P < 0.005, all measures). At endpoint, the patients receiving tadalafil reported a greater mean per-patient percentage of successful intercourse attempts (SEP question 3: 70.0%, 10 mg; 78.0%, 20 mg) than placebo-treated patients (42.8%) and a greater proportion of improved erections (GAQ: 92.3% and 84.6% vs. 54.5%). Most treatment-emergent adverse events were mild or moderate. The most common adverse events were back pain, dyspepsia, and myalgia. CONCLUSIONS: Tadalafil was an effective, well-tolerated therapy for men in Taiwan with ED of broad-spectrum severity and etiology.
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Carbolinas/uso terapéutico , Disfunción Eréctil/tratamiento farmacológico , Inhibidores de Fosfodiesterasa/uso terapéutico , Administración Oral , Anciano , Dolor de Espalda/inducido químicamente , Carbolinas/administración & dosificación , Carbolinas/efectos adversos , Método Doble Ciego , Dispepsia/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Fosfodiesterasa/administración & dosificación , Inhibidores de Fosfodiesterasa/efectos adversos , Placebos , Tadalafilo , Taiwán , Resultado del TratamientoRESUMEN
OBJECTIVES: To perform a global loss of heterozygosity (LOH) analysis on a cohort of urothelial carcinoma to investigate the clinical implication of specific chromosomal loss. Allelic deletions detected as LOH have been used to study the markers for carcinogenesis. METHODS: We examined the allelic loss on 14 chromosomal regions in a total of 71 cases of urothelial carcinoma. The results were analyzed in relation to biologic indicators of urothelial carcinoma and the clinical outcome with a mean follow-up of 101 months. RESULTS: The incidence of LOH in order of frequency was 9p (54.9%), 9q (49.3%), 13q (40.8%), 14q (40.8%), 10q (39.4%), 17p (39.4%), 8p (38.0%), 21q (36.6%), 11p (31.0%), 18q (23.9%), 4q (21.1%), 3p (16.9%), 6q (14.1%), and 1q (8.5%). Positive association with one of the indicators was observed in 3p, 9p, 9q, 10q, 14q, and 18q. The chromosomes that correlated with two biologic indicators were 4q, 6q, 11p, 17p, and 21q. Univariate analysis found that patients having combined 9p and 14q deleted tumors had particularly poor long-term survival compared with those with other patterns of chromosomal alterations (P = 0.01). In the multivariate model, nonpapillary tumors had a greater risk of recurrence, and stage classification was the only important indicator in predicting patient survival (P = 0.04). CONCLUSIONS: LOH assessment does not provide independent prognostic value compared with stage classification. However, chromosomes 4q, 6q, 9p, 11p, 14q, 17p, and 21q may harbor important tumor suppressor genes involved in the progression of urothelial carcinogenesis.
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Alelos , Carcinoma de Células Transicionales/genética , Perfilación de la Expresión Génica/métodos , Pérdida de Heterocigocidad/genética , Neoplasias de la Vejiga Urinaria/genética , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Transicionales/patología , Deleción Cromosómica , Mapeo Cromosómico , Estudios de Cohortes , Femenino , Genotipo , Humanos , Neoplasias Renales/genética , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Neoplasias Ureterales/genética , Neoplasias Ureterales/patología , Neoplasias de la Vejiga Urinaria/patologíaAsunto(s)
Carcinoma de Células Transicionales , Neoplasias Renales , Pelvis Renal , Neoplasias Primarias Múltiples , Anciano , Carcinoma de Células Transicionales/complicaciones , Carcinoma de Células Transicionales/diagnóstico por imagen , Hematuria/etiología , Humanos , Neoplasias Renales/complicaciones , Neoplasias Renales/diagnóstico por imagen , Pelvis Renal/diagnóstico por imagen , Masculino , Neoplasias Primarias Múltiples/complicaciones , Neoplasias Primarias Múltiples/diagnóstico por imagen , Radiografía , UltrasonografíaRESUMEN
OBJECTIVE: To identify the DAZL transcript and protein location in human spermatozoa. DESIGN: In vitro experiment. SETTING: University-based reproductive genetics laboratory. PATIENT(S): A fertile volunteer. INTERVENTION(S): Reverse transcription-polymerase chain reaction (RT-PCR), Western blot, and immunostaining for DAZL. MAIN OUTCOME MEASURE(S): Expression of DAZL in human spermatozoa. RESULT(S): The DAZL-specific primers yield a 128 bp product in ejaculate. A protein of approximately 33.5 kDa was detected by Western blot analysis. Immunofluorescence staining showed strong homogeneous staining in the midpiece of spermatozoa and weak staining in the principal piece. A speckled-type distribution was found in the head region. CONCLUSION(S): The DAZL transcript and protein are present in human spermatozoa. The roles of DAZL protein in sperm motility and in the sperm-oocyte interaction await further investigation.
Asunto(s)
Biosíntesis de Proteínas , ARN Mensajero/biosíntesis , Proteínas de Unión al ARN , Espermatozoides/metabolismo , Secuencia de Aminoácidos , Western Blotting , ADN Complementario/genética , Electroforesis en Gel de Poliacrilamida , Humanos , Inmunohistoquímica , Masculino , Microscopía Confocal , Microscopía Fluorescente , Datos de Secuencia Molecular , Oligospermia/genética , Oligospermia/metabolismo , Proteínas/genética , ARN Mensajero/genética , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
A 47-year-old man complained of a constellation of prostatitis-like symptoms for 4 years. Physical examination revealed a firm nodule within the scrotum. Surgical excision was performed under local anesthesia and microscopic examination confirmed scrotal calcinosis. The patient remained symptom free for at least 12 months after excision. Although the real mechanism of prostatitis-like symptoms is unknown, this rare disease may be considered in the differential diagnosis or etiologies of chronic prostatitis, and meticulous physical examination of the scrotum is necessary for patients presenting with chronic prostatitis syndrome.