Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians

Calcifying aponeurotic fibroma: a case report [Kalsifiye aponörotik fibrom: Olgu sunumu.]

Calcified aponeurotic fibroma is a rare benign fibrous tumor with well-characterized histopathologic features. It is usually seen in distal extremities of children and youngsters. A 23-year-old male patient underwent surgical excision of a free, painless soft tissue mass that developed in the palmar aspect of the left hand. Histopathologic examination showed fibroblastic proliferation areas and dense collagenous stroma surrounding calcifications and chondroid metaplasia. The diagnosis was made as calcified aponeurotic fibroma. No recurrences were detected within a year follow-up

Hard flaccid syndrome: Initial report of four cases

Hard flaccid (HF) is a group of symptoms that significantly affects a man’s sexual and social life. As this syndrome has only been reported in several patient forums, exact prevalence of this rare condition is unknown. Currently, no scientific literature exists of the syndrome. We, hereby, aimed to present four cases suffering from HF and compare the common signs and symptoms with those reported in patient forums. We searched internet forums, chat groups, and private support groups to collect information about symptoms of HF patients. We have identified several complaints regarding penis, erections, libido, urination, and ejaculation. Moreover, we have also collected common findings of laboratory and imaging tests that are used in the workup of HF. The majority of the HF patients is in their 20s–30s. Patients usually seek medical advice due to the following complaints: penile sensory changes (numb or cold), semi-rigid penis at the flaccid state, decreased frequency of morning and/or nocturnal erections, loss in erectile rigidity, difficulty in achieving and maintaining their erections, need for excessive physical or visual stimulation to become erect, and pain on ejaculation and/or urination. Psychological symptoms are usually present ranging from mild anxiety to severe depression. Moreover, laboratory and imaging tests are often unremarkable. Our cases included men between the ages of 22 and 34 years of age and they all reported the onset of their symptoms after a trauma during sexual intercourse or tough masturbation. Compared with reports in patient forums, many of these symptoms (except the urination problems) were observed in our patients and the imaging/laboratory tests were inconclusive. The patients were provided daily/on-demand phosphodiesterase-5 inhibitors, which were not effective. Currently, HF syndrome has not been universally recognized by urologists and a number of patients seem to suffer from this disorder. In order to raise awareness of this clinical phenomenon, HF must be recognized by professional organizations and a better understanding of the disorder must be established. © 2019, Springer Nature Limited

Does the mitochondrial genome much more stabile in the aggressive papillary thyroid cancers ('PTCs)? - the preliminary findings

[No Abstract Available

Does the mitochondrial genome much more stabile in the aggressive papillary thyroid cancers ('PTCs)? - The preliminary findings

[No Abstract Available

Her-2/neu, estrogen and progesterone receptor expression in WHO grade I meningiomas [WHO grade I meningiomlarda Her-2/neu, östrojen ve progesteron reseptör ekspresyonu]

Objectives: Meningiomas are generally benign central nervous system neoplasms, which frequently express progesterone receptor (PR) and rarely express the estrogen receptor (ER). The significance of Her-2/neu expression in meningiomas is unclear. We evaluated the correlation with Her-2/neu, PR, ER expressions and clinicopathologic parameters in World Health Organization (WHO) Grade I meningiomas. Patients and Methods: In total, 53 cases of meningiomas were included in this study. Formaline-fixed, paraffin-embedded tissue sections were immunostained for Her-2/neu, PR and ER. Results: Whereas 27 (50.9%) of meningiomas were positive for PR, no reaction was determined for ER. Her-2/neu overexpression was observed in 12 (22.6%) cases. There was positive correlation between Her-2/ neu and PR expressions (p=0.015). Her-2/neu expression was frequently seen in meningothelial type (p=0.03). There were no correlations with Her-2/neu, ER, PR and other clinicopathologic parameters. Conclusion: The results of our study show that despite there being PR expression at a high rate in grade I meningiomas, ER expression is a rare finding. Moreover, Her-2/neu expression has been detected more often in the PR positive and meningothelial type. © Medical Journal of Trakya University. Published by Ekin Medical Publishing. All rights reserved

A qualitative analysis of Internet forum discussions on hard flaccid syndrome

Hard flaccid (HF) syndrome is a complex symptom that significantly impacts a man’s sexual and social life. Since there is currently only one case series available in the literature regarding HF syndrome, it has not been recognized as a real medical condition. HF syndrome has mostly been reported in several patient forums and its exact definition, prevalence, etiology, and treatment are unknown. We hereby, aimed to understand the nature of HF syndrome and how it is perceived among men. Online forum sites in the English language were systematically evaluated to perform a descriptive qualitative assessment. “Hard flaccid; forum” term was searched in Google® and data were collected from forum posts. Datasets were analyzed using thematic analysis within a three-month period (September 2018–November 2018) and were combined to triangulate analysis. A total of 12 forum discussions, containing 6150 comments, were analyzed. Themes that arose included: “I would like to ensure that I have HF”; “How did I end up like this?”; “Seeking support for treatment choices – who will help me?”; “How can I cope with this condition?”. Thematic analysis revealed that most HF cases began after a traumatic event. The reported incidence of HF-related symptoms varies considerably. The most commonly associated symptoms of HF are penile semi-hardness in the flaccid state, penile sensory changes, erectile dysfunction, and emotional distress. Although it is not recognized by major medical authorities, many men appear to suffer from symptoms related to HF syndrome. Future basic science and clinical studies must be conducted to understand the exact pathophysiology of HF syndrome and to develop effective therapies. © 2019, The Author(s), under exclusive licence to Springer Nature Limited

Evaluation of androgen receptor and androgen receptor splice-variant 7 in bladder cancer; a novel approach into an ancient topic

Purpose: The contribution of androgen receptors (AR) on bladder cancer has been demonstrated in pre-clinical studies, however in clinical studies, only the canonical AR (AR-FL) protein was measured by immunohistochemistry and conflicting results were obtained. To get better insight into the alterations of AR signalling, we used western blotting (WB) method and simultaneously measured both mRNA and protein levels of AR-FL and AR-V7. Methods: 23 naive non-muscle invasive bladder cancer patients and 12 healthy individuals were included. AR-FL protein, AR-FL mRNA, AR-V7 protein and AR-V7 mRNA levels were quantitatively measured by WB and qRT-PCR. Results: While AR-FL protein and AR-V7 mRNA were significantly higher in bladder cancer, AR-FL mRNA and AR-V7 protein were lower. AR-V7 mRNA level was higher in patients with tumour size over 3 cm and AR-FL protein was higher in single tumours (p < 0,005). The small sampling size and the inclusion of only male participants were the main limitations. Conclusions: The increase of AR-FL protein in bladder cancer supports the contribution of the AR pathway in bladder cancer. The presence of high AR-FL protein despite low mRNA levels may be due to a disruption in post-transcriptional regulatory mechanisms. AR-V7 was demonstrated for the first time in bladder tissue and found significantly different in bladder cancer tissues. Our study reached new and valuable findings and will shed light on the studies that aim to clarify the role of the AR pathway in bladder cancer