UNASSIGNED: Triple A syndrome, caused by autosomal recessively inherited mutations in the AAAS gene is characterized by alacrima, achalasia, adrenal insufficiency, and neurological impairment. To the best of our knowledge, no patients of both sexes have been reported to have offspring. Our aim was to assess the causes of infertility in male patients with this multisystemic syndrome, and to present a female patient that spontaneously conceived a child.
UNASSIGNED: Cross-sectional study.
UNASSIGNED: Six males aged 19-48 years were included. Gonadotropins, testosterone, DHEAS, androstenedione, inhibin B, anti-Mullerian hormone measurements and testicular ultrasound were performed.
UNASSIGNED: All six male patients had impaired general health and neurological symptoms including erectile and ejaculatory dysfunction. None of them had an offspring. The only demonstrated cause of infertility in our male patients was erectile and ejaculatory dysfunction which precludes sexual intercourse. Our patients had normal libido but were sexually abstinent. Except for low adrenal androgen levels, the concentrations of all measured hormones as well as testicular ultrasound were normal which may indicate the possibility of spermatogenesis in male patients with triple A syndrome. Little is known about fertility in female patients, but based on our observations spontaneous pregnancies seem to be possible.
UNASSIGNED: Our results contribute to still scarce knowledge on fertility in patients with Triple A syndrome and as well represents a foundation for further research on causes of infertility and possible treatment options.

Although α1-adrenoceptor (α1-AR) antagonists used to treat benign prostatic hyperplasia can cause ejaculation disorders, the aetiology of this adverse event is still controversial. Therefore, we investigated the effects of antagonists with different affinities for α1-AR subtypes on ejaculatory function and their mechanisms of action in normal rats. In the spontaneous seminal emission (SSE) test, systemically administered prazosin, terazosin, tamsulosin and naftopidil decreased the weight of ejaculated seminal material in a dose-dependent manner; the potency order was as follows: tamsulosin > terazosin > prazosin > naftopidil. The selective α1D-AR antagonist BMY7378 had no effect on SSE. Intrathecal tamsulosin and naftopidil did not inhibit SSE. Tamsulosin, the most potent, was ineffective as a single dose and significantly increased seminal vesicle fluid in rats treated for 2 weeks but did not significantly change retrograde ejaculation. These results indicated that the difference in inhibitory potency of the five α1-AR antagonists against SSE was due to the involvement of α1A-AR subtypes. Our results further suggested that α1-AR antagonist-induced ejaculatory dysfunction at the peripheral level was mainly due to the loss of seminal emission, although some retrograde ejaculation may also be involved.

OBJECTIVE: To demonstrate the different techniques used to perform successful penile vibratory stimulation (PVS) to induce ejaculation in men with spinal cord injuries (SCIs).
METHODS: A video demonstration of the PVS procedure performed in men with SCIs using the FertiCare 2.0 medical vibrator.
METHODS: Major University Medical Center.
METHODS: Men with SCIs.
METHODS: Spinal cord injury is the leading cause of anejaculation in young men. After SCIs, most of these men will need a method of assisted ejaculation to achieve biological fatherhood. In this study, a newly designed and tested vibrator (FertiCare 2.0) was used to induce ejaculation. The initial assessment of each patient included a standard history, physical examination, level of injury determination using the International Standards for Neurological Classification of Spinal Cord Injury as well as assessment of the hip flexor reflex and the bulbocavernosus reflex. Patients with a level of injury at or rostral to T6 were pretreated with 10-40 mg of sublingual nifedipine to manage autonomic dysreflexia. A single vibrator was applied to the dorsum, or frenulum, of the glans penis. Stimulation is delivered in 2-minute increments to a maximum of 10 minutes per visit. Application of two vibrators or abdominal electrical stimulation concurrently with PVS was used in select patients. Ejaculated semen was collected in a sterile cup and examined after liquefaction. Bladder preparation using sperm wash medium was performed in patients suspected of experiencing retrograde ejaculation.
METHODS: Successful ejaculation after performing the PVS procedure in men with SCIs.
RESULTS: Penile vibratory stimulation was successful in 86% of men whose level of injury was T10 or rostral. The total motile sperm count in antegrade ejaculates produced using PVS was >5 million (lower limit considered for intrauterine insemination) in 71% of ejaculates. No complications because of PVS were observed in 3,700 trials performed by our group and none in the patients presented in this video.
CONCLUSIONS: Penile vibratory stimulation is a safe and effective method for the management of ejaculatory dysfunction in men with SCIs. Penile vibratory stimulation can be performed by the male partner after an initial evaluation by a specialized provider, and the ejaculate can be used to perform home insemination.

BACKGROUND: Men who have sex with men (MSM) face many challenges and biases in healthcare. Within urology there is a need to better understand how prostate cancer impacts MSM given the unique ways in which side effects that accompany treatment may affect this population. The goal of this study is to explore the experience of MSM with prostate cancer to advance the existing literature in this area and inform implementation and delivery of clinical practice and policy guidelines.
METHODS: Four focus groups were conducted with a semi-structured interview guide. Using a phenomenological qualitative approach consistent with grounded theory [1] and naturalistic inquiry principles we sought to better understand the direct experiences of MSM with prostate cancer. Audio transcriptions were thematically analyzed to identify themes that impact MSM throughout their prostate cancer journey. An iterative, team-wide classification process was used to identify, organize, and group common codes into higher-order categories and themes.
RESULTS: Patient\'s choice of provider and their interactions with the healthcare system were strongly impacted by their sexual identities. Participants commented on navigating the heteronormative healthcare environment and the impact of assumptions they encountered. MSM experienced the sexual side effects of prostate cancer treatment in unique ways. Issues with erectile dysfunction and ejaculatory dysfunction had significant impacts on patient\'s sexual experience, with some describing being forced to explore new modes of sexual expression. Anejaculation was a theme that was distressing for many participants. The emotional impact of a prostate cancer diagnosis was significant in the men interviewed. Common themes included loss of identity and fear for future relationships.
CONCLUSIONS: MSM have unique concerns after prostate cancer treatment that differ from men who don\'t identify as MSM. It is critical that providers familiarize themselves with the concerns of this patient population regarding prostate cancer treatment. An important step toward reducing heteronormative bias in prostate cancer care is to better understand the goals, identity, and sexual practices of MSM and to provide informed anticipatory guidance.

暂无摘要。

UNASSIGNED: Social platforms such as YouTube have become sources of information about diseases as they can be easily and rapidly accessed. However, this also has the risk of ill-intentioned content and misleading information.
UNASSIGNED: To evaluate the reliability of YouTube video content about delayed ejaculation treatment.
UNASSIGNED: YouTube videos were searched using the terms \"delayed ejaculation,\" \"retarded ejaculation,\" \"inhibited ejaculation,\" and \"anejaculation.\" Videos were excluded if they were not in English, were not related to the subject, or did not have audio and visual content. In accordance with the scientifically proven accurate information, the videos were separated as reliable (Group 2, n: 112) and unreliable videos (Group 1, n: 94). The groups were compared in respect of the video characteristics, and the scores obtained in the DISCERN-5, Global Quality Scale, the Patient Education Materials Assessment Tool Audiovisual, and the Journal of the American Medical Association scales. Intraclass correlation test was used to evaluate the level of agreement between the two investigators.
UNASSIGNED: Of the 1200 videos, 994 were excluded. No significant difference was determined between the Group 1 and Group 2 in respect of the median number of views [1672 (4555) vs 1547 (28,559), p = 0.63] and likes [10 (42) vs 17 (255), p = 0.07]. There was a greater number of videos in the Group 2 (54.4%) and the points obtained on the scoring scales were significantly higher than the Group 1 (p < 0.001). The videos originating from universities/professional organizations/non-profit physician/physician group were comprised the majority of the reliable videos (55.3%) and the unreliable videos had more content related to treatment (71.4%) (p < 0.001).
UNASSIGNED: Although there was a greater number of reliable videos related to the problem of delayed ejaculation, the content could be misleading and should be avoided by patients seeking treatment without consulting a physician.

It is the responsibility of the clinician to assess for the presence of erectile dysfunction, ejaculatory dysfunction, or diminished libido in men presenting for evaluation of infertility. Referral to a reproductive urologist or other appropriate specialist with the requisite expertise in the evaluation and treatment of such conditions, including appropriate treatment of testosterone deficiency, is often warranted. This article replaces the article of the same name, last published in 2018.

暂无摘要。

Background and Objectives: Ejaculatory dysfunction (EjD) is a common male sexual disorder that includes premature ejaculation, delayed ejaculation, retrograde ejaculation, and anejaculation. Although psychological and pharmacological treatments are available, traditional, complementary, and alternative medicine (TCAM) is reportedly used. However, the clinical evidence for TCAM in EjD remains unclear. Therefore, this study aims to systematically review human clinical trials investigating the use of TCAM to treat EjD. Materials and Methods: A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted by searching Scopus and PubMed databases. Controlled clinical trials investigating a cohort of male patients diagnosed primarily with EjD and undergoing any TCAM intervention compared to any comparison group were included. Quality of the studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials. Results: Following article screening, 22 articles were included. Of these, 21 investigated TCAM in premature ejaculation, and only 1 investigated TCAM in retrograde ejaculation. Different TCAM categories included studies that investigated lifestyle, exercise and/or physical activities (n = 7); herbal medicine supplements (n = 5); topical herbal applications (n = 4); acupuncture or electroacupuncture (n = 3); vitamin, mineral and/or nutraceutical supplements (n = 1); hyaluronic acid penile injection (n = 1); and music therapy (n = 1). Only 31.8% (n = 7) of the included studies were found to have a low risk of bias. The available studies were widely heterogenous in the TCAM intervention investigated and comparison groups used. However, the included studies generally showed improved outcomes intra-group and when compared to placebo. Conclusions: Different TCAM interventions may have an important role particularly in the management of PE. However, more studies using standardized interventions are needed.

OBJECTIVE: Ejaculatory dysfunction is the most common side effect of benign prostatic hyperplasia surgery. Modified techniques have emerged with the aim of preserving antegrade ejaculation without compromising obstruction relief. None are standardized or validated. The PARTURP study is a randomized study investigating partial versus complete prostate resection. We conducted an investigator consensus meeting to define the ideal surgical technique to achieve both correct obstruction relief with ejaculation preservation.
METHODS: An expert consensus meeting involving all investigators of the PARTURP study took place to define a common technique using the nominal group methodology. The objectives were to define the areas to be resected and the areas to be preserved; to define the criteria for proper obstruction relief; to define the criteria for proper ejaculation preservation.
RESULTS: All investigators (n = 15) attended the consensus meeting, and agreement between all the participants was obtained. The anatomical landmarks to be preserved are located around the verumontanum and along the posterior part of the prostatic urethra. These structures must be preserved up to 2 cm from the verumontanum. The participants agreed on the need to preserve the urethral mucosa in all the areas to be preserved and to reach the enucleation plane in the areas of resection.
CONCLUSIONS: Anatomical landmarks for ejaculation-sparing surgery have been defined by the investigators of the PARTURP randomized study. These landmarks will be used during the study, and the clinical outcomes of this ejaculation-sparing technique will be compared with complete resection with up to 3 years follow-up.