Nutraceutical Therapy in Male Infertility

Oxidative stress from reactive oxygen species or reactive nitrogen species can affect male fertility. Sources of reactive oxygen species include but are not limited to lifestyle factors, environmental toxins, medications, and infections. Specifically, in the male genital tract, mitochondria from leukocytes and immature sperm cells create reactive oxygen species. The imbalance of reactive oxygen species and antioxidants can lead to DNA damage, resulting in decreased sperm motility morphology, count and viability. Infertile men have been shown to have an increased level of reactive oxygen species compared to fertile controls. Nutraceuticals are products derived from food that have health benefits, and may include amino acids, isolated nutrients, or dietary supplements. Many of these products have antioxidant properties and can help scavenge reactive oxygen species, thus shifting the balance. Some of the antioxidants that have been studied include CoEnzyme Q10, l-carnitine, vitamin C, vitamin E, zinc, selenium, lycopene, and N-acetylcysteine. Supplementation of these antioxidants in infertile men has been shown to improve semen parameters. In this article, we evaluate the effect of various antioxidants on semen parameters. We recommend that in men with idiopathic infertility who have impaired semen parameters, in particular, decreased sperm motility can be candidates for nutraceutical therapy

WITHDRAWN: Re: Vasectomy and Prostate Cancer Incidence and Mortality in a Large US Cohort

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.eururo.2016.11.008. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

Symptomatic sacrococcygeal joint dislocation treated using closed manual reduction: A case report with 36-month follow-up and review of literature

Dislocation of the sacrococcygeal joint is a rare injury from trauma to the buttocks, most often from falling backwards. Standard of care for this injury has not been determined because it is rare. Left untreated this can cause coccydynia in the long-term. Here we present a case report to describe the treatment of an anterior sacrococcygeal dislocation with closed manual reduction. A 13-year-old female presented to the emergency department with buttock pain after slipping backwards down the stairs. On X-ray the coccyx was in bayonette apposition to the anterior distal sacrum and shortened by 6 mm. To manage the injury, closed manual reduction of the sacrococcygeal joint was performed. To our knowledge, this is the first successful case of sacrococcygeal dislocation treated with closed manual reduction, resulting in complete relief of symptoms at 36 months follow-up. Sacrococcygeal dislocations can be treated with closed manual reduction, resulting in lower morbidity and faster recovery compared to surgical treatment

Management of mammalian bites to the external genitalia: a scoping review.

OBJECTIVE: To review existing publications to determine the approaches for the medical and operative management of mammalian bites to the external genitalia. MATERIALS AND METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Review guidelines were followed. Four databases were searched. Articles were independently screened and analysed by two reviewers. Publications were included if detailed summaries of genitalia bites and management were documented. Discrepancies were resolved by a third reviewer. Data were extracted from the final article cohort. RESULTS: A total of 42 articles were included in this scoping review with 67 cases of mammalian bites to the genitalia reported in the cohort. The most common injury site was the penis (44.9%). Dog and human bites were the most common type of mammalian bites (61.2% and 26.9%, respectively). In all, 13.4% of cases were managed with medical therapy while 86.6% of cases required surgical intervention. The most common intervention was wound irrigation, debridement, and primary closure (32.8%). Although uncommon, other operative approaches included skin flaps (7.5%) and grafts (4.5%), re-implantation (4.5%), urethroplasty/repair (7.5%), penectomy (3.0%), scrotoplasty (3.0%), and perineal urethrostomy (1.5%). The reported complication rate was 19.4%. The mean follow-up time was 39.9 months. CONCLUSION: Trauma related to mammalian bites is associated with high utilisation of healthcare resources and cost. Although management of such bites to the genitalia is controversial, surgical intervention is often warranted ranging from simple debridement of devitalised tissue to complex reconstructive surgery. This review underscores the need for further investigation of mammalian bites to the genitalia to improve surgical options and monitor for long-term complication rates

Re-examining Prostate-specific Antigen (PSA) Density: Defining the Optimal PSA Range and Patients for Using PSA Density to Predict Prostate Cancer Using Extended Template Biopsy

To compare the predictive accuracy of prostate-specific antigen (PSA) density vs PSA across different PSA ranges and by prior biopsy status in a prospective cohort undergoing prostate biopsy. Men from a prospective trial underwent an extended template biopsy to evaluate for prostate cancer at 26 sites throughout the United States. The area under the receiver operating curve assessed the predictive accuracy of PSA density vs PSA across 3 PSA ranges (10 ng/mL). We also investigated the effect of varying the PSA density cutoffs on the detection of cancer and assessed the performance of PSA density vs PSA in men with or without a prior negative biopsy. Among 1290 patients, 585 (45%) and 284 (22%) men had prostate cancer and significant prostate cancer, respectively. PSA density performed better than PSA in detecting any prostate cancer within a PSA of 4-10 ng/mL (area under the receiver operating characteristic curve [AUC]: 0.70 vs 0.53, P 10 mg/mL (AUC: 0.84 vs 0.65, P < .0001). PSA density was significantly more predictive than PSA in detecting any prostate cancer in men without (AUC: 0.73 vs 0.67, P < .0001) and with (AUC: 0.69 vs 0.55, P < .0001) a previous biopsy; however, the incremental difference in AUC was higher among men with a previous negative biopsy. Similar inferences were seen for significant cancer across all analyses. As PSA increases, PSA density becomes a better marker for predicting prostate cancer compared with PSA alone. Additionally, PSA density performed better than PSA in men with a prior negative biopsy