Supplementation of Cryomedium with Catalase and N-acetylcysteine Improves Human Sperm Post-thaw Motility and DNA Integrity

Purpose：Reactive oxygen species have been suggested as a major contributing factor to cryodamage of the spermatozoa. Accordingly, antioxidant supplementation has been used to yield significantly improved quality of frozen sperm post-thaw. We sought to investigate outcomes with a combination of antioxidantscatalase and N-acetylcysteine respectively. Methods：The cryomedium supplemented with 200U/ml catalase, 5 mM N-acetylcysteine and their combination was used. Semen samples were collected from normozoospermic men （n＝20）and aliquots frozen in each dose of antioxidant tested. Post-thaw semen analysis by computer aided sperm analysis was performed. In addition, sperm viability （Eosin-Y staining） and sperm DNA fragmentation（TUNEL assay）were quantitated. Results：Combined catalase and N-acetylcysteine supplementation during cryopreservation resulted in significantly improved post-thaw recovery of total motility（from 39.4±15.8％ to 49.2±16.1％） and percentage of sperm vitality （from 46.2±13.3％ to 53.2±11.8％）（mean±SD, p＜0.05）. Catalase improved post-thaw DNA integrity analysis for doublestranded breaks using TUNEL assay. Conclusions：These results indicated that the combination of intracellular and extracellular antioxidants resulted in the pronounced effect in improving post-thaw quality of human spermatozoa

Spermatogenic Dysfunction in Azoospermic Japanese Men Caused by Y Chromosome Microdeletions

Genetic factors are responsible for approximately 15％ of male infertility. The azoospermia factors AZFa, AZFb（P5/proximal P1）, and AZFc（b2/b4） present on Yq are most important for spermatogenesis. Here,we evaluated frequencies of microdeletions of AZFa, AZFb, AZFc in azoospermia due to spermatogenicdysfunction in the Japanese population. The overall prevalence of Y chromosome microdeletions in infertilemen was 8.1％（79/980）. The prevalence of Y chromosome microdeletions in AZFa, AZFb, AZFabc, AZFbc （P5/distal P1 or P4/distal P1） and AZFc was 0.1％ , 0.8％ , 0.7％ , 2.0％ and 4.4％ , respectively. Microdissection for testicular sperm extraction failed in all patients with microdeletion in AZFa, AZFb, AZFabc, and AZFbc, although sperm could be retrieved in 28/43 patients with AZFc deletions（62.2％）. The presence of an AZFc deletion was associated with significantly better sperm retrieval than the 33.0％ retrieval rate in idiopathic non-deleted azoospermic men undergoing microdissection for testicular spermextraction at our institution during the study period. We conclude that Y chromosome microdeletion testing is essential for genetic and preoperative counseling in these patients

Tissue-specific differentially methylated regions of the human VASA gene are potentially associated with maturation arrest phenotype in the testis

Numerous CpG islands containing tissue-specific differentially methylated regions (TDMRs) are potential methylation sites in normal cells and tissues. The VASA (also known as DDX4) gene is believed to be under the control of TDMRs. A total of 131 male patients with idiopathic azoospermia or severe oligospermia were evaluated histologically, and the methylation status of CpG islands in the VASA gene was screened. Genome DNAs were obtained from testicular biopsy and modified with sodium bisulfite, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was applied. This system is capable of analyzing both the methylated and unmethylated CpG island in the genome. The methylation analysis is conducted by an epigram as graphic data. On histological assessment, 17 of 131 patients revealed maturation arrest (MA).In all, 6 of the 17 patients showed particularly high VASA TDMR methylation rates, whereas the remaining 11 patients and controls had low methylation rates. This study may imply that the VASA TDMR methylation is significantly higher among patients with MA, in whom the VASA gene expression was silenced. This finding represents an important contribution to the molecular basis of meiotic arrest as one possible cause of idiopathic infertility. © 2009 The Japan Society of Human Genetics All rights reserved

Androgen replacement therapy contributes to improving lower urinary tract symptoms in patients with hypogonadism and benign prostate hypertrophy: A randomised controlled study

金沢大学附属病院泌尿器科Purpose. We performed a randomised controlled study regarding the effects of androgen replacement therapy (ART) on lower urinary tract symptoms (LUTS) in hypogonadal men with benign prostate hypertrophy (BPH). Methods. Fifty-two patients with hypogonadism and BPH were randomly assigned to receive testosterone (ART group) as 250 mg of testosterone enanthate every 4 weeks or to the untreated control group. We compared International Prostate Symptom Score (IPSS), uroflowmetry data, post-voiding residual volume (PVR) and systemic muscle volume at baseline and 12 months after treatment. Results. Forty-six patients (ART group, n=23; control, n=23) were included in the analysis. At the 12-month visit, IPSS showed a significant decrease compared with baseline in the ART group (15.7±8.7 vs. 12.5 ± 9.5; p < 0.05). No significant changes were observed in the control group. The ART group also showed improvement in maximum flow rate and voided volume (p < 0.05), whereas no significant improvements were observed in the controls. PVR showed no significant changes in either group. In addition, the ART group showed significant enhancement of mean muscle volume (p < 0.05), whereas no significant changes were seen in the controls. Conclusion. ART improved LUTS in hypogonadal men with mild BPH. © 2010 Informa UK, Ltd

Protocol for developing a core outcome set for male infertility research:an international consensus development study

Abstract STUDY QUESTION We aim to develop, disseminate and implement a minimum data set, known as a core outcome set, for future male infertility research. WHAT IS KNOWN ALREADY Research into male infertility can be challenging to design, conduct and report. Evidence from randomized trials can be difficult to interpret and of limited ability to inform clinical practice for numerous reasons. These may include complex issues, such as variation in outcome measures and outcome reporting bias, as well as failure to consider the perspectives of men and their partners with lived experience of fertility problems. Previously, the Core Outcome Measure for Infertility Trials (COMMIT) initiative, an international consortium of researchers, healthcare professionals and people with fertility problems, has developed a core outcome set for general infertility research. Now, a bespoke core outcome set for male infertility is required to address the unique challenges pertinent to male infertility research. STUDY DESIGN, SIZE, DURATION Stakeholders, including healthcare professionals, allied healthcare professionals, scientists, researchers and people with fertility problems, will be invited to participate. Formal consensus science methods will be used, including the modified Delphi method, modified Nominal Group Technique and the National Institutes of Health’s consensus development conference. PARTICIPANTS/MATERIALS, SETTING, METHODS An international steering group, including the relevant stakeholders outlined above, has been established to guide the development of this core outcome set. Possible core outcomes will be identified by undertaking a systematic review of randomized controlled trials evaluating potential treatments for male factor infertility. These outcomes will be entered into a modified Delphi method. Repeated reflection and re-scoring should promote convergence towards consensus outcomes, which will be prioritized during a consensus development meeting to identify a final core outcome set. We will establish standardized definitions and recommend high-quality measurement instruments for individual core outcomes. STUDY FUNDING/COMPETING INTEREST(S) This work has been supported by the Urology Foundation small project award, 2021. C.L.R.B. is the recipient of a BMGF grant and received consultancy fees from Exscentia and Exceed sperm testing, paid to the University of Dundee and speaking fees or honoraria paid personally by Ferring, Copper Surgical and RBMO. S.B. received royalties from Cambridge University Press, Speaker honoraria for Obstetrical and Gynaecological Society of Singapore, Merk SMART Masterclass and Merk FERRING Forum, paid to the University of Aberdeen. Payment for leadership roles within NHS Grampian, previously paid to self, now paid to University of Aberdeen. An Honorarium is received as Editor in Chief of Human Reproduction Open. M.L.E. is an advisor to the companies Hannah and Ro. B.W.M. received an investigator grant from the NHMRC, No: GNT1176437 is a paid consultant for ObsEva and has received research funding from Ferring and Merck. R.R.H. received royalties from Elsevier for a book, consultancy fees from Glyciome, and presentation fees from GryNumber Health and Aytu Bioscience. Aytu Bioscience also funded MiOXYS systems and sensors. Attendance at Fertility 2020 and Roadshow South Africa by Ralf Henkel was funded by LogixX Pharma Ltd. R.R.H. is also Editor in Chief of Andrologia and has been an employee of LogixX Pharma Ltd. since 2020. M.S.K. is an associate editor with Human Reproduction Open. K.Mc.E. received an honoraria for lectures from Bayer and Pharmasure in 2019 and payment for an ESHRE grant review in 2019. His attendance at ESHRE 2019 and AUA 2019 was sponsored by Pharmasure and Bayer, respectively. The remaining authors declare no competing interests. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials (COMET) initiative registration No: 1586. Available at www.comet-initiative.org/Studies/Details/1586. TRIAL REGISTRATION DATE N/A. DATE OF FIRST PATIENT’S ENROLMENT N/A

ジョセイ コツバン ゾウキ ダツ カンジャ ニ タイスル Tension-free Vaginal Mesh シュジュツ ノ ハイニョウ キノウ ト Quality of Life ニ アタエル カイゼン コウカ ノ ケントウ

骨盤臓器脱にTVM 手術を施行した51 症例を対象としてUFM, 残尿量,P-QOL,ICIQ-SF 及びIPSSを調査することによりTVM 手術の下部尿路症状,排尿機能とQOL に与える改善効果を評価した.周術期成績と解剖学的改善度は良好であり,IPSS による下部尿路症状の評価では夜間頻尿以外のすべての項目で有意に改善した.またP-QOL を用いたQOL 評価でも有意な改善を示した.本研究では骨盤臓器脱に対してTVM 手術が下部尿路症状,排尿機能,QOL を短期間の評価ながら改善する事を示した.今後は解剖学的治療効果のみでなく,排尿や性機能を含めて長期間評価することが必要と考えられた.The aim of this paper is to describe the perioperativemedical outcome, complications and the improvement ofvoiding function and their quality of life( QOL) in 51 casesof tension-free vaginal mesh (TVM) for the treatment ofpelvic organ prolapse( POP) at our institute. Perioperativemedical outcome and anatomical restoration were good atsix months after the operation. Lower urinary tract symptomand QOL of the patients were statistically much improvedbased on the results of IPSS and prolapse quality oflife questionnaire( P-QOL), except for nocturia. This studyshowed improvement of voiding function and QOL for thefemale POP.Further studies will be needed for a long period not onlythe anatomical restoration but also the voiding and sexualfunction

コウサンキュウ セイ ボウコウ エン ノ 1 レイ

症例は36歳男性.頻尿,排尿時痛,残尿感および食思不振を主訴に近医受診.抗生剤投与されるも症状軽快せず,当院紹介受診となる.初診時検査で,白血球,好酸球,IgEの上昇を認め,経腹膀胱超音波検査,MRIで膀胱壁の著明な肥厚を認めた.また,膀胱鏡検査では膀胱三角部を除く膀胱粘膜の著明な浮腫状所見を認め,上部消化管内視鏡検査では胃粘膜及び十二指腸粘膜も同様の浮腫状所見であった.確定診断のため膀胱全層針生検を施行し,病理所見では膀胱平滑筋内に著明な好酸球浸潤を認めたため好酸球性膀胱炎と診断.点滴ステロイド療法を開始し,症状軽快,画像上も改善を認めステロイド内服に切り替えたのち退院した.A 36-years-old man with pollakisuria and digestive symptom was referred to our hospital. A blood test showed inclease of serum white blood cell,eosinophil and IgE. Imaging study showed thickening of bladder wall, and endoscopy of bladder and stomach showed severe mucosal edema. Because there was a suspicion of the allergic diseases, we carried out transabdominal needle biopsy of bladder. Because of the pathological finding of severe eosinophilic infiltration into smooth muscle of urinary bladder, we diagnosed a case of eosinophilic cystitis. After that we started up steroid therapy immediately, he was recovering from pollakisuria and digestive symptom

フククウキョウカ シュジュツ ショケン カラ ノ ジンウ ニョウカン イコウ ブ キョウサクショウ ノ ケイタイ ブンルイ ト ジュツゴ ケイカ

【目的】水腎症の原因である腎盂尿管移行部閉塞(Uretero-Pelvic Junction Obstruction;UPJO)の病因を形態的に分類し,患者背景,術後の経過との関連性について検討した.【方法】2009年3月から2013年4月までに獨協医科大学越谷病院で施行した腹腔鏡下腎盂形成術(Laparoscopic Pyeloplasty;LPP)38症例について検討した.術中所見とビデオの見直しから以下のように3つの病因に分類した.Type 1:血管による閉塞を有するもの.Type 2:肥厚した被膜が腎盂尿管を包み込むもの.Type 3:硬い被膜に包まれ尿管の屈曲,狭窄を認めるもの.上記病因と術前後における症状,腹部超音波所見および利尿レノグラムを用いて評価した手術成績について比較検討した.【結果】38症例を手術ビデオで見直した結果,Type 1は14例,Type 2は13例,Type 3は11例であった.小児症例はType 1の症例が少なく,Type 2およびType 3が多かった.各Typeでの術後の症状,腹部超音波所見,利尿レノグラムの改善率に有意差はなかった.【結語】UPJOの形態と年齢には関連を認めたが,術後成績には明らかな違いは認めなかった.Background:To analyze the relationship between the etiology of ureteropelvic junction obstruction (UPJO) and surgical outcomes using laparoscopic clear view during pyeloplasty. Method:Total 38 patients who underwent laparoscopic pyeloplasty by Anderson-Hynes technique from 2009 March to 2013 April at Dokkyo Medical University Koshigaya Hospital, were enrolled into the study. According to the structure of the ureteropelvic junction under the laparoscopic view UPJO was divided to 3 types, type 1 (n= 14):vascular causes of ureteral obstruction, type 2 (n= 14):the presence of adhesion around UPJ, type 3 (n= 11):the presence of angulation due to ureteral kinks or adhesion. The relationships between types of UPJO and surgical outcomes were analyzed.Results:Many of pediatric patient were included in type 2 and 3. Types of UPJO were not related to operation time, symptom, abdominal ultrasonography, and results of diuretic renogram.Conclusion:Most of pediatric patients with hydronephrosis had no vascular cause. There are no significant differences between each types and surgical success rate in patients underwent laparoscopic pyeloplasty

Antioxidant cosupplementation therapy with vitamin C, vitamin E, and coenzyme Q10 in patients with oligoasthenozoospermia

Objective: Overproduction of reactive oxygen species results in oxidative stress, a deleterious process that damages cell structure as well as lipids, proteins, and DNA. Oxidative stress plays a major role in various human diseases, such as oligoasthenozoospermia syndrome. Materials and methods: We evaluated the effectiveness of antioxidant co-supplementation therapy using vitamin C, vitamin E, and coenzyme Q10 in men with oligoasthenozoospermia. Overall, 169 infertile men with oligoasthenozoospermia received antioxidant therapy with 80 mg/day vitamin C, 40 mg/day vitamin E, and 120 mg/day coenzyme Q10. We evaluated spermiogram parameters at baseline and at 3 and 6 months of follow-up. Results: Significant improvements were evident in sperm concentration and motility following coenzyme Q10 therapy. Treatment resulted in 48 (28.4%) partner pregnancies, of which 16 (9.5%) were spontaneous. Significant improvements in sperm cell concentration and sperm motility were observed after 3 and 6 months of treatment. Conclusions: Vitamin C, vitamin E, and coenzyme Q10 supplementation resulted in a significant improvement in certain semen parameters. However, further studies are needed to empirically determine the effect of supplementation on pregnancy rate