Exosomes as Potential Biomarkers for Erectile Dysfunction, Varicocele, and Testicular Injury

Optimal male reproductive health is dependent upon critical mediators of cell-cell communication: exosomes or extracellular vesicles. These vesicles are nano‐sized particles released into a variety of bodily fluids, such as blood and semen. Exosomes are highly stable and can carry genetic and other molecules, including DNA, RNA, and proteins, which provide information about their origin cells. To identify exosomes as potential biomarkers or therapeutic mediators in male sexual and reproductive disorders like erectile dysfunction (ED), varicocele, and testicular injury. A PubMed search was performed to highlight all articles available relating to exosomes and extracellular vesicles in the pathogenesis of different male sexual and reproductive disorders, and their importance in clinical use as both diagnostic markers and potential therapeutic mediators. Various male reproductive system disorders, such as ED, varicocele, and testicular injury, are linked to increased or decreased levels of exosomes. Exosomes have a higher number of molecules such as DNA, RNA, and proteins, which can give a more precise and comprehensive result when compared to other biomarkers. Exosomes can be considered as plausible diagnostic biomarkers for male sexual and reproductive diseases, with considerable advantages over other diagnostic procedures such as invasive tissue biopsy. Exosomes can carry cargo such certain drugs and therapeutic molecules making them a promising therapeutic approach. Several studies have begun to test treating various male sexual reproductive disorders with exosomes. Exosomes deliver many components that can regulate gene expression and target signaling pathways. Understanding how extracellular vesicles can be utilized as biomarkers in diagnosing men, particularly those with idiopathic erectile dysfunction, will not only aid in diagnosis but also help with making therapeutic targets. Khodamoradi K, Golan R, Dullea A, et al. Exosomes as Potential Biomarkers for Erectile Dysfunction, Varicocele, and Testicular Injury. Sex Med Rev 2021;XX:XXX–XXX

An Update on the Use of Wearable Devices in Men’s Health

Men’s health represents an often-overlooked aspect of public health. Men have higher mortality rates worldwide and are more negatively affected by chronic conditions such as obesity and heart disease, as well as addiction to alcohol and tobacco. Men also have health issues such as prostate cancer and male sexual dysfunction which only affect them. Because of the skewed burden of morbidity and mortality on men, it is imperative from a public health perspective to make a concerted effort to specifically improve men’s health. The use of wearable devices in medical practice presents a novel avenue to invest in men’s health in a safe, easily scalable, and economic fashion. Wearable devices are now ubiquitous in society, and their use in the healthcare setting is only increasing with time. There are commercially available devices such as smart watches which are available to lay people and healthcare professionals alike to improve overall health and wellness, and there are also purpose- built wearable devices which are used to track or treat a specific disease. In our review of the literature, we found that while research in the field of wearable devices is still in its early stages, there is ample evidence that wearable devices can greatly improve men’s health in the long-term

Androgen Receptor Signaling is Similar in Human Corpus Cavernosum in Men with Different Serum Testosterone Levels

Testosterone (T) plays an important role in male reproductive function and tissue development. Normal serum T levels vary between 300 and 1000 ng/dl. It is not known, however, if varying serum T levels alter androgen receptor (AR) signaling in tissue. To measure AR signaling levels in human corpus cavernosal tissue in males with different serum T levels. Participants were selected from a group of males undergoing surgical management for erectile dysfunction (ED; penile prosthesis placement). T levels were measured 1 week before surgery and a sample of corpus cavernosal tissue was procured during surgery. The tissue was homogenized, measured for protein concentration, and used for western blot analysis. VEGF was selected as an AR marker and actin was used for protein normalization. VEGF and actin expression levels were analyzed using western blot analysis and ImageJ was used for quantification of antibody expression. AR signaling was measured in terms of VEGF expression. Above a T level of 200 ng/dl, there was no significant difference found in VEGF expression. Only one patient had a T level less than 200 ng/dl, limiting the generalizability of these results. In addition, all patients had a history of ED, and controls (patients without ED) were not included in the study. Above a serum T level of 200 ng/dl, there was no significant difference in AR signaling. This finding suggests that there could be a saturation level present in corpus cavernosal tissue that is approximately 200 ng/dl. Serum testosterone levels above a certain threshold may not be necessary for biological functions. Instead, it is most likely that there is an approximate serum testosterone level that fully saturates tissue androgen receptors and results in peak function in men

Medical Malpractice Lawsuits Involving Urology Trainees

To distinguish the various characteristics of medical malpractice lawsuits involving trainees to prevent future litigation. LexisNexis, an online legal research database containing legal records from the United States, was retrospectively reviewed for malpractice cases involving urology interns, residents, or fellows from January 1, 1988 to December 31, 2020. A total of 16 cases were included, of which 7 (43.8%) involved urological allegations while 9 (56.2%) involved non-urological allegations. 5 of the cases consisting of non-urological adverse outcomes led to mortality. Procedural error was claimed in 12 (75.0%) cases, negligence in 7 (43.8%), delayed evaluation in 6 (37.5%), lack of informed consent of procedure or complications in 5 (31.2.%), failure to pursue treatment in 4 (25.0%), inexperienced trainee in 2 (12.5%), failure to supervise trainee in 2, lack of informed consent of trainee involvement in 1, incorrect diagnosis in 1, and prolonged operative time in 1 case. Malpractice education, careful supervision, awareness during perioperative care, and detailed communication between patients and physicians should be highlighted in training programs to improve patient outcomes and mitigate risk of future malpractice