Cystic Dysplasia of the Rete Testis Accompanying an Inguinal Hernia: A 63-Year-Old Man

Cystic dysplasia of the rete testis (CDT) is a very rare congenital benign testicular tumor that is often associated with ipsilateral genitourinary anomalies. It is usually found in the pediatric population and must be differentially diagnosed from a malignant lesion. Here we report the case of a 63-year-old man with a left inguinal hernia who visited our urologic outpatient clinic. Scrotal ultrasonography showed a left direct inguinal hernia in the inguinal area and a well-circumscribed cystic lesion containing multiple minute cysts with echogenic foci occupying almost one-third of the left testicular parenchyma. Testicular tumor markers were within the normal range and a computed tomography scan of the abdomen showed no genitourinary abnormalities. We presumed that the left testicular lesion was malignant, and the patient underwent radical orchiectomy. However, the pathologic examination revealed a CDT. Here we present this case of a 63-year-old man with an inguinal hernia accompanied by multiple cystic lesions on the left testis

Structures of three ependymin-related proteins suggest their function as a hydrophobic molecule binder

Ependymin was first discovered as a predominant protein in brain extracellular fluid in fish and was suggested to be involved in functions mostly related to learning and memory. Orthologous proteins to ependymin called ependymin-related proteins (EPDRs) have been found to exist in various tissues from sea urchins to humans, yet their functional role remains to be revealed. In this study, the structures of EPDR1 from frog, mouse and human were determined and analyzed. All of the EPDR1s fold into a dimer using a monomeric subunit that is mostly made up of two stacking antiparallel beta-sheets with a curvature on one side, resulting in the formation of a deep hydrophobic pocket. All six of the cysteine residues in the monomeric subunit participate in the formation of three intramolecular disulfide bonds. Other interesting features of EPDR1 include two asparagine residues with glycosylation and a Ca2+-binding site. The EPDR1 fold is very similar to the folds of bacterial VioE and LolA/LolB, which also use a similar hydrophobic pocket for their respective functions as a hydrophobic substrate-binding enzyme and a lipoprotein carrier, respectively. A further fatty-acid binding assay using EPDR1 suggests that it indeed binds to fatty acids, presumably via this pocket. Additional interactome analysis of EPDR1 showed that EPDR1 interacts with insulin-like growth factor 2 receptor and flotillin proteins, which are known to be involved in protein and vesicle translocation

Effects of Vitamin D Supplementation on Testosterone, Prostate, and Lower Urinary Tract Symptoms: A Prospective, Comparative Study

Purpose: Several studies have associated the serum vitamin D level with total testosterone levels and the prostate volume. Herein, we investigated the effect of vitamin D supplementation on testosterone, prostate, and lower urinary tract symptoms (LUTS) in men. Materials and Methods: Men over 40 years of age diagnosed with a vitamin D deficiency (25[OH]D <20 ng/mL) who received vitamin D supplementation for one year were included in the study and administered 25,000 IU of cholecalciferol every 2 weeks. Prostate ultrasound, uroflowmetry, postvoid residual urine volume measurement, and serological tests (serum testosterone levels, etc.) were performed upon diagnosis and one year later. Participants also answered the International Prostate Symptom Score (IPSS) and Aging Males’ Symptoms Scale (AMS) questionnaires. Results: A significant increase was observed in the vitamin D level following one year of vitamin D supplementation, with a significant decrease in the postvoid residual urine volume, total IPSS score and without a significant change in the prostate volume. Improved psychological subscale score of AMS questionnaire was observed with a statistical significance. Conclusions: Vitamin D supplementation suppressed the increase in the prostate volume and improved the LUTS. Although there is no direct effect on serum testosterone levels, vitamin D supplementation helped improve hypogonadal symptoms

Effect of a Combination of Dutasteride and Parenteral Testosterone Undecanoate on Testosterone Deficiency Symptoms and Prostate in Patients with Testosterone Efficiency and Benign Prostatic Hyperplasia

Background and objective The effect of a combination of testosterone and 5-Alpha reductase inhibitors (5-ARIs) on serum tes-tosterone levels, TD symptoms, and the prostate are not sufficiently established. Therefore, we exam-ined the effects of long-acting parenteral testosterone undecanoate (TU) and dutasteride used in combination for the treatment of BPH patients with TD. Subjects and methods We selected 130 patients with a prostate volume (PV) > 30 g from those diagnosed with TD and had received parenteral TU for 1 year. These patients were assigned to the following two groups: Group I, which comprised patients who received TU injections along with dutasteride, and Group II, which included patients with TU-only treatment. Statistical analyses were performed between the two groups to compare the results of serological tests, symptom questionnaire scores, and PV. Results No significant differences were observed in the baseline characteristics such as mean age, comorbidi-ties, testosterone levels, symptom questionnaire scores between the two groups. There were no signifi-cant differences in the testosterone levels or the change in testosterone levels after treatment between the two groups. The PV was significantly increased in Group II and significantly decreased in Group I. Both groups showed a significant increase in the total scores and all subscale scores of the IIEF and AMS after treatment. Group II had a significantly higher total IIEF score than Group I and a signifi-cantly lower score in the sexual function subscale of the AMS after treatment. Conclusions The combination of TU and dutasteride considerably improved serum testosterone levels, alleviated TD symptoms, and effectively reduced PV in patients with TD and BPH. However, compared with the TU-only treatment, the combination was less effective in improving symptoms related to sexual func-tion. Therefore, dutasteride should be used with caution when treating BPH patients with TD, who mainly complain of sexual dysfunction

Effect of a Combination of Omega-3 and Oral Testosterone Undecanoate On Serum Testosterone Levels in Patients with Testosterone Deficiency

Background and Objective Oral testosterone undecanoate (TU) is taken up by the intestinal lymphatic system. Thus, the dietary lipid content affects TU absorption. This study aimed to investigate the effect of combined omega-3 fatty acids (OMG3) and oral TU on serum testosterone levels in patients with testosterone deficiency (TD). Material and Methods Sixty consecutive patients with symptomatic TD and low serum total testosterone (TT) levels were enrolled and divided randomly into group 1, oral TU 80 mg twice daily for 30 days, and group 2, OMG3 and oral TU 80 mg twice daily for 30 days. Serum TT concentrations and male function scales were evaluated at baseline and 7 days and 1 month post-treatment. Dietary habits were investigated, and caloric and lipid intakes were measured during the treatment periods. Results The groups did not differ in terms of mean age, body mass index, comorbidities, initial serum TT concentrations, and IIEF/AMS scores. After 7 days and 1 month of treatment, serum TT concentrations were only significantly increased in group 2. The degree of increase in TT was higher in group 2 than in group 1 at 7 days and 1 month, although the difference was only significant at 1 month. Both groups exhibited significant improvements in IIEF and AMS scores at 1 month, with no significant inter-group difference. A diet diary study revealed that 23.3% and 20% of both groups did not eat breakfast and both groups consumed <12 g of lipids and <500 Kcals, without significance differences. Conclusion We observed a significant increase in serum TT concentration after 1 month of treatment with the com-bination of OMG3 and oral TU, compared to with oral TU monotherapy. Therefore, the combination of OMG3 and oral TU can be considered for the treatment of TD in Korean patients with irregular break-fast habits

Predictive factors for elevated prostate specific antigen and hematocrit levels during testosterone replacement therapy in patients with testosterone deficiency

Objective: We examined risk factors associated with prostate specific antigen (PSA) and hematocrit (hct) elevation during testosterone replacement therapy (TRT) in patients with testosterone deficiency (TD). Methods: We retrospectively analyzed the medical records of patients receiving TRT for ≥3 months. We investigated the following parameters: age, body mass index, comorbidities, TRT type, TRT duration, pre-TRT prostate volume, pre- and post-TRT serological tests, prostate biopsies, prostate cancer diagnoses, pre- and post-TRT aging male symptom scale scores, hct elevation, and PSA elevation. The patients were divided into two groups based on the PSA elevation status for comparison, following which we analyzed the predictive factors for PSA elevation. They were also divided into two groups based on hct elevation status. Results: The PSA elevation group showed a statistically significantly higher mean age, pre-TRT prostate volume, and PSA level compared to the non-elevation group. The PSA non-elevation group showed a significantly higher percentage of smokers, while the PSA elevation group showed a statistically significantly higher prevalence of benign prostatic hyperplasia (BPH_LUTS). The results demonstrated that a large pre-TRT prostate volume, high pre-TRT PSA levels, BPH_LUTS, and being a non-smoker were the contributing factors for PSA elevation. The hct elevation group showed statistically significantly higher pre-TRT Hb, hct, and post-TRT testosterone levels, and dyslipidemia rates, as well as a non-statistically significant prevalence of testosterone enanthate (TE) and testosterone undecanoate (TU) intramuscular injection. The pre-TRT Hb and hct levels were contributing factors for hct elevation during TRT. TE injection showed marginal statistical significance. Conclusions: We identified large prostate volumes, high PSA levels, BPH_LUTS, and being non-smokers prior to TRT as risk factors for PSA elevation during TRT. Interestingly, we found that TRT-induced hct elevation was likely to occur in patients with high pre-TRT Hb and hct levels. Additionally, the hct levels should be monitored when using TE for TRT

Which Exercise Is Better for Increasing Serum Testosterone Levels in Patients with Erectile Dysfunction?

Purpose: We investigated the correlations of serum total testosterone (TT) levels with body composition and physical fitness parameters in patients with erectile dysfunction (ED) to know the best exercise for testosterone deficiency. Materials and Methods: Eighty-seven ED patients underwent serum TT assessment as well as body composition and basic exercise testing. The bioelectrical impedance analysis was used to assess body composition. Seven types of basic exercise tests were used to determine physical fitness. Correlations between serum TT levels and body composition/physical function parameters were evaluated using partial correlation analyses. A serum TT cut-off value was obtained for the parameters significantly correlated with serum TT levels. Results: The subjects had a mean serum TT level of 342.1 ng/dL. Among the body composition parameters, body and abdominal fat percentages showed statistically significant negative correlations with serum TT levels. Among the basic exercise test parameters, only the cycle ergometer test for cardiorespiratory fitness showed a statistically significant positive correlation with serum TT levels. Conclusions: Serum TT levels in patients with ED, may be increased by reducing fat percentage and improving cardiorespiratory fitness via aerobic exercise