Outcomes In Male Patients Research Articles

Somatic mutational landscape reveals mutational signatures and significantly mutated genes of cancer immunotherapeutic outcome and sex disparities

BackgroundCurrently developed molecular markers can predict the effectiveness of cancer immunotherapy and screen beneficiaries to some extent, but they are not stable enough. Therefore, there is an urgent need for discovering novel biomarkers. At the same time, sex factor plays a vital role in the response to immunotherapy, so it is particularly important to identify sex-related molecular indicators.MethodsWe integrated a pan-cancer cohort consisting of 2348 cancer patients who received immune checkpoint inhibitors and targeted sequencing. Using somatic mutation profiles, we identified mutational signatures, molecular subtypes, and frequently mutated genes, and analyzed their relationships with immunotherapeutic outcomes. We also explored sex disparities of determined biomarkers in response to treatments.ResultsWe found that male patients exhibited better immunotherapy outcomes and higher tumor mutational burden. A total of seven mutational signatures were identified, among which signatures 1 and 3 were associated with worse immunotherapy outcomes, while signatures 2 and 6 correlated with better outcomes. Gender-based analysis revealed that mutational signature 1 continued to show a worse immunotherapy outcome in female patients, whereas signature 6 demonstrated a better outcome in male patients. Based on mutational activities, we identified four potential molecular subtypes with gender differences and relevance to treatment outcomes. PI3K-AKT, RAS signaling pathways, and 68 significantly mutated genes were identified to be associated with immunotherapy outcomes, with nine genes (i.e., ATM, ATRX, DOT1L, EP300, EPHB1, NOTCH1, PBRM1, RBM10, and SETD2) exhibiting gender differences. Finally, we discovered co-mutated gene pairs and TP53 p.R282W mutations related to treatment outcomes, highlighting their gender-specific differences.ConclusionThis study identified several molecular biomarkers related to cancer immunotherapy outcomes in terms of mutational signatures, molecular subtypes, and mutated genes, and explored their gender-relatedness in order to provide clues and basis for clinical treatment efficacy evaluation and patient selection.

Racial disparities impacting diagnosis and outcomes of male patients with squamous cell carcinoma of the anus: A retrospective cohort study

Racial disparities impacting diagnosis and outcomes of male patients with squamous cell carcinoma of the anus: A retrospective cohort study

CN35 Screening recommendations for and outcomes of male patients (pts) with germline BRCA (gBRCA)

CN35 Screening recommendations for and outcomes of male patients (pts) with germline BRCA (gBRCA)

Myosteatosis and muscle loss impact liver transplant outcomes in male patients with hepatocellular carcinoma.

Sarcopenia is associated with unfavourable long-term survival in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). However, the impact of myosteatosis and muscle loss on patient prognosis has not been investigated. Seven hundred fifty-six HCC patients who received LT at 3 transplant centres were included. Computed tomography (CT) images of recipients were collected to measure skeletal muscle index (SMI) and skeletal muscle radiodensity (SMRA). The impact of myosteatosis on the prognosis of sarcopenic and non-sarcopenic patients was studied separately. Muscle status was evaluated based on the presence of sarcopenia and myosteatosis. The muscle loss of 342 males was calculated as the relative change of SMI between pre- and post-LT evaluations. Cox regression models were used to identify predictors of overall survival (OS) and recurrence-free survival (RFS). The study comprised 673 males and 83 females. The median follow-up time was 31months (interquartile range, 19-43months). Prior to LT, 267 (39.7%) and 187 (27.8%) males were defined as sarcopenic (low-SMI) and myosteatotic (low-SMRA), respectively. For sarcopenic recipients, the presence of myosteatosis was followed by a 23.6% decrease in 5year OS (P<0.001) and a 15.0% decrease in 5year RFS (P=0.014). Univariate and multivariate analyses revealed that muscle status was an independent predictor of OS [hazard ratio (HR), 1.569; 95% confidence interval (CI), 1.317-1.869; P<0.001] and RFS (HR, 1.369; 95% CI, 1.182-1.586; P<0.001). Postoperatively, a muscle loss >14.2% was an independent risk factor for poor OS (HR, 2.286; 95% CI, 1.358-3.849; P=0.002) and RFS (HR, 2.219; 95% CI, 1.418-3.471; P<0.001) in non-sarcopenic recipients (N=209). Pre-transplant myosteatosis aggravated the adverse impact of sarcopenia on liver transplant outcomes in male HCC patients. Post-transplant muscle loss might assist in prognostic stratification of recipients without pre-existing sarcopenia, intriguing new insights into individualized management.

Evaluation of Patellar Tendon Structural Changes following Biological Treatments: Secondary Analysis of Double-Blinded Clinical Trial of Bone Marrow Mesenchymal Stromal Cells and Leukocyte-Poor Platelet-Rich Plasma.

Objective quantification of tendon structural changes through imaging is only achieved by evaluating tendon structure using ultrasound tissue characterization (UTC) technology. This study compares the effects of bone marrow mesenchymal stromal cells (BM-MSC) and leukocyte-poor platelet-rich plasma (Lp-PRP) on tendon structure and clinical outcomes in male patients with patellar tendinopathy measured with UTC at 3, 6, and 12 months after treatment. This is a double-blinded clinical trial with a randomized active control study with 20 male patients diagnosed with patellar tendinopathy who underwent BM-MSC and Lp-PRP. Bilateral ultrasound tissue characterization scans of the patellar tendon were carried out after 3, 6, and 12 months, as well as tests for strength and pain. UTC patellar tendon was analyzed at the insertion, proximal, and mid-tendon. BM-MSC showed a greater capacity to promote further positive changes than Lp-PRP. Lp-PRP presented higher disorganized echo-type II in the mid-tendon (p = 0.04; ES = 1.06) and III (p = 0.02; ES = -1.47) after 3 months in the Lp-PRP group. Similar results were seen after 6 and 12 months. Pain and strength data show improvement in the treated tendon. BM-MSC treatment demonstrates a superior capacity to promote tendon regeneration and organization, restore strength, and reduce pain compared to Lp-PRP, after 3, 6, and 12 months in male patients with patellar tendinopathy.

P-028 Pregnancy and perinatal outcomes in male patients with temporary ejaculation failure undergoing assisted reproductive technology

Abstract Study question When temporary ejaculation failure occurs on the oocyte retrieval day, choose surgical sperm retrieval or oocyte cryopreservation? Summary answer TESA-ICSI and oocyte cryopreservation are both relatively efficient and safe way. Embryos have better developmental potential through TESA-ICSI. What is known already Nearly 9% of men among couples who use assisted reproductive technology have temporary ejaculation failure (TEF) on the oocyte retrieval day. If they fail to provide semen sample, the couples may face three choices (1. surgical sperm retrieval; 2. oocyte cryopreservation; 3. canceling the oocyte retrieval). The aim of the study was to compare the impact of testicular sperm aspiration (TESA) or oocyte cryopreservation on the clinical outcomes of intracytoplasmic sperm injection (ICSI) patients with TEF. Study design, size, duration The retrospective study included 345 male patients with TEF in our University-affiliated IVF center from 2015 to 2021. Participants/materials, setting, methods Three hundred and forty-five male patients were divided into two groups. Two hundred patients chose TESA-ICSI (the TESA group), while another 145 patients chose oocyte cryopreservation, waiting for the man’s next successful sperm ejaculation and subsequent ICSI (the frozen oocyte group). We investigated the embryo development, pregnancy and perinatal outcome, and included the data from fresh embryo transfer (ET) cycle. Herein, all patients in the frozen oocyte group received hormone replacement and fresh ET. Main results and the role of chance Firstly, there were no significant difference in the female BMI, FSH, antral follicle count (AFC), AMH, and male semen quality between the two groups. For embryo development, both two groups have the similar normal fertilization rate (71.5% vs 69.7%, P = 0.242). However, the frozen oocyte group has lower rate of Day3 high quality embryo (31.1% vs 49.3%, P &amp;lt; 0.001), available embryo rate (49.8% vs 55.8%, P = 0.043), and available blastocyst rate (18.6% vs 33.7%, P &amp;lt; 0.001). For pregnancy outcome, the clinical pregnancy rate (44.2% vs 50.0%), pregnancy loss rate (4.8% vs 2.9%) and live birth rate (38.5% vs 46.1%) were similar. And there were no significant differences in the rates of Gestational diabetes mellitus, hypertensive disorders of pregnancy, placenta previa and fetal malformation between the two groups. Limitations, reasons for caution This study only included data from fresh embryo cycles, not yet from thawed embryo cycles. Although we presented complete embryo development data for each couple, there may be some bias in pregnancy and perinatal outcomes due to the lack of data from thawed embryo cycles. Wider implications of the findings The present study suggested that TESA-ICSI and oocyte cryopreservation are both relatively efficient and safe way to help the patients encountering TEF. Due to the embryos with better developmental potential through TESA-ICSI, choosing the surgical sperm retrieval might have more have more advantages, and this has to be further verified. Trial registration number REC No. (2023(S142))

Association of myosteatosis with short-term outcomes in patients with acute-on-chronic liver failure

Sarcopenia (low muscle mass, i.e., quantity) is associated with poor clinical outcomes in patients with acute-on-chronic liver failure (ACLF). In this study, we aimed to illustrate the clinical prognostic value of myosteatosis (muscle fat infiltration) for short-term mortality in patients with ACLF. We retrospectively enrolled consecutive patients with ACLF between January 2019 and January 2022. Computed tomography-based body composition analysis was performed at the third lumbar vertebral level to determine skeletal muscle radiation attenuation. Fine and Gray’s competing risk regression model, with liver transplantation as a competing risk, was used to assess the factors associated with 90-day mortality. A total of 431 patients with ACLF were included. Myosteatosis and sarcopenia were observed in 261 (60.6%) and 87 (20.2%) patients, respectively. Competitive risk regression showed that age (HR 1.021, 95% CI 1.000–1.043, P = 0.042), APASL ACLF Research Consortium (AARC) score (HR 1.498, 95% CI 1.312–1.710, P < 0.001), and sarcopenia (HR 1.802, 95% CI 1.062–3.060, P = 0.029) were independently associated with increased 90-day mortality. Subgroup analysis of male patients with HBV-ACLF revealed that myosteatosis (HR 2.119, 95% CI 1.101–4.078, P = 0.025) was promising prognostic factors for 90-day mortality after being adjusted for ascites, acute kidney injury, AARC score, and sarcopenia. Myosteatosis is predictive of short-term outcomes in male patients with HBV-ACLF. Our results emphasise the importance of focusing on muscle fat infiltration in patients with HBV-ACLF. Further studies are warranted to investigate the underlying mechanisms and potential therapies for myosteatosis.

The association of gender with functional outcome in thrombolysed stroke: A secondary analysis of INTRECIS study

Background and PurposeSex differences in acute ischemic stroke have been widely investigated, but the difference in acute ischemic stroke patients who received intravenous thrombolysis is not well understood. The current study was to investigate the issue based on a prospective cohort. MethodsFrom the Intravenous Thrombolysis Registry for Chinese Ischemic Stroke within 4.5h onset (INTRECIS) cohort, a total of 953 eligible patients with acute ischemic stroke were enrolled in final analysis. Based on 3-month modified Rankin scale score (mRS), patients were classified into good outcome group (mRS 0–1) and poor outcome group (mRS 2–6). Univariate and multivariate logistic regression analyses were used to identify predictive factors for clinical outcome in male or female patients. ResultsOf the 953 patients treated with intravenous thrombolysis, 314 (32.9 %) were women. At day 90, we found no significant gender differences in good outcome (72.5 % vs 65.6 %, adjusted p = 0.414). We got the same results after propensity score matching (69.5 % vs 63.4 %, adjusted p = 0.637). Furthermore, we found that initial National Institute of Health Stroke Scale (NIHSS) score (odd ratio [OR] 0.877; 95 % CI 0.847–0.909, p < 0.001) and serum creatinine (OR 0.993; 95 % CI 0.986–1.000, p = 0 0.043) were found to be independent risk factors for poor outcome in male patients, while initial NIHSS score (OR 0.879; 95 % CI 0.839–0.920, p < 0.001), age (OR 0.970; 95 % CI 0.946–0.995, p = 0.017), systolic blood pressure (OR 0.984; 95 % CI 0.972–0.996, p = 0.007) and small artery occlusion (OR 2.718; 95 % CI 1.065–6.936, p = 0.036) in female patients. ConclusionsIn this study, we found no gender difference in clinical outcome of thrombolysed stroke patients, but a difference in risk factors predicting outcome in male vs female patients was identified for the first time.

Sex Differences in Outcomes after Endovascular Thrombectomy for Patients with Acute Ischemic Stroke

Introduction: Endovascular thrombectomy (EVT) is the standard of care for patients with large-vessel occlusion acute ischemic stroke (AIS). There may be differing recanalization effectiveness based on patients’ sex, and understanding such variations can improve patient outcomes by adjusting for differences. We aimed to assess the sex differences in outcome after EVT for patients with AIS. Methods: We retrospectively analyzed 250 consecutive AIS patients who underwent EVT from July 2019 to February 2022 across two large comprehensive tertiary care stroke centers in China. Outcomes of male patients were compared to females, where poor outcome was defined as a modified Rankin score (mRS) of 3–6 at 90 days. Results: Male patients had higher rates of symptomatic intracranial hemorrhage (sICH) (12.50% vs. 4.05%, p = 0.042) and higher hospitalization costs (114,541.08 vs. 105,790.27 RMB, p = 0.024). Male patients also had a longer median onset-to-needle time (ONT) (146.00 [104.00, 202.00] versus 120.00 [99.25, 144.75], p = 0.026). However, there were no differences in hospitalization length (p = 0.251), 90-day favorable outcome (p = 0.952), and 90-day mortality (p = 0.931) between the sexes. Conclusion: Female patients had lower hospitalization costs and sICH rates than males after EVT for AIS. Identifying such differences and implementing measures, including adaptations to workflow optimization, would help to reduce the ONT and last known normal-to-puncture time seen in males to improve patient outcomes. Despite such variations, favorable outcomes and mortality are similar in female and male AIS patients.

(264) Outcome of Intra-Cytoplasmic Sperm Injection ICSI with Testicular Sperm Aspiration (TESA) In Patients with High Sperm DNA fragmentation, Hospital Experience

Abstract Introduction Sperm DNA fragmentation (SDF) is considered as an important biomarker in the assessment of male fertility potential with contradictory results regarding its effect on ICSI. In our study we focus on the outcomes of Intra-Cytoplasmic Sperm Injection (ICSI) in male patients with high SDF using testicular spermatozoa (TESA). Objective To evaluate intra- cytoplasmic sperm injection (ICSI) outcomes in male patients with high SDF using testicular spermatozoa and analysis of the cofactors (Age, Smoking, Chemical Exposure and usage of Anti-oxidants agents) Methods Retrospective study, institutional experience. Results In our study, we evaluated 41 men with high-SDF levels who had a previous ICSI cycle from their ejaculates. A subsequent ICSI cycle was performed using spermatozoa retrieved through testicular sperm aspiration. The mean (SD) SDF level is 33.7%. live birth rate was 29.2% (12 out of 41) In addition of that, we analyzed the cofactors of men such as Age, Smoking, Chemical Exposure and usage of Anti-oxidants agents. The mean age is 33 %. Men received anti oxidants agent prior to TESA were 9 out of 12 (75%) Conclusions Intra-cytoplasmic sperm injection (ICSI) outcomes in male patients with high SDF using testicular spermatozoa has higher clinical pregnancy and higher chance of live-birth. The rate is higher with those who received anti-oxidant supplements for at least 6 moths. Disclosure No.

Perioperative outcomes in male patients undergoing cystectomy, radical colorectal procedure or total pelvic exenteration.

Total pelvic exenteration (TPE) in men is a surgical procedure to treat genitourinary and colorectal malignancies. Despite improvement in multimodal strategies and technology, mortality is still high and literature is limited about perioperative outcomes comparison to other radical procedures. We analyzed National Surgical Quality Improvement Program (NSQIP) baseline database of all male patients undergoing cystectomy, low anterior resection/abdominoperineal resection (LAR/APR) or TPE from January 1, 2005 to December 31, 2016. Postoperative complications within 30 days after surgery were measured including: Wound infection, septic complications, deep vein thrombosis, cardiovascular events, and return to the operating room or mortality, etc. Differences between groups were analyzed using analysis of variance (ANOVA) tests. A total of 7,375 patients underwent radical cystectomy, 49,762 underwent LAR/APR and 792 underwent TPE. Cystectomy patients were on average older compared to TPE or LAR/APR patients (P<0.001). In univariable and multivariable analysis, patients undergoing TPE had greater infectious and septic complications compared to cystectomy (odds ratio =1.09; 95% confidence interval (CI): 1.06-1.12) and LAR/APR (odds ratio =1.08; 95% CI: 1.05-1.11). Moreover, TPE had a slightly higher mortality within the 30-day postoperatively than those who underwent LAR/APR (odds ratio =1.01; 95% CI: 1.00-1.02) and cystectomy (odds ratio =1.01; 95% CI: 1.00-1.01). Men undergoing TPE had greater rates of infections and postoperative complications compared to those undergoing radical cystectomy and LAR/APR. From a clinical standpoint, TPE has high morbidity that could provide opportunity for quality improvement projects with the goal of mitigating high complication rates.

Predicting disease progression in cirrhotic patients after transjugular intrahepatic portosystemic shunt implantation: A sex-stratified analysis

BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) has been extensively used to treat portal hypertension-associated complications, including cirrhosis. The prediction of post-TIPS prognosis is important for cirrhotic patients, as more aggressive liver transplantation is needed when the post-TIPS prognosis is poor. AIM To construct a nutrition-based model that could predict the disease progression of cirrhotic patients after TIPS implantation in a sex-dependent manner. METHODS This study retrospectively recruited cirrhotic patients undergoing TIPS implantation for analysis. Muscle quality was assessed by measuring the skeletal muscle index (SMI) by computed tomography. Multivariate Cox proportional hazard models were utilized to determine the association between SMI and disease progression in cirrhotic patients after TIPS implantation. RESULTS This study eventually included 186 cirrhotic patients receiving TIPS who were followed up for 30.5 ± 18.8 mo. For male patients, the 30-mo survival rate was significantly lower and the probability of progressive events was higher (3.257-fold) in the low-level SMI group than in the high-level SMI group. According to the multivariate Cox analysis of male patients, SMI &lt; 32.8 was an independent risk factor for long-term adverse outcomes after TIPS implantation. A model was constructed, which involved creatinine, plasma ammonia, SMI, and acute-on-chronic liver failure and hepatic encephalopathy occurring within half a year after surgery. This model had an area under the receiver operating characteristic curve of 0.852, sensitivity of 0.926, and specificity of 0.652. According to the results of the DeLong test, this model outperformed other models (Child-Turcotte-Pugh, Model for End-Stage Liver Disease, and Freiburg index of post-TIPS survival) (P &lt; 0.05). CONCLUSION SMI is strongly associated with poor long-term outcomes in male patients with cirrhosis who underwent TIPS implantation.

Outcomes of male patients with HR+/HER2– advanced breast cancer receiving palbociclib in the real-world POLARIS study

PurposeData on treatments for male breast cancer patients are limited owing to rarity and underrepresentation in clinical trials. The real-world POLARIS study gathers data on palbociclib use for the treatment of hormone receptor–positive/human epidermal growth factor receptor 2–negative (HR+/HER2–) advanced breast cancer (ABC) in female and male patients. This sub-analysis describes real-world palbociclib treatment patterns, clinical outcomes, and quality of life (QoL) in male patients.MethodsPOLARIS is a prospective, noninterventional, multicenter, real-world study of patients with HR+/HER2– ABC receiving palbociclib. Assessments included medical record reviews, patient QoL questionnaires (European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire–Core 30), site characteristics questionnaires, and physician treatment selection surveys. Variables included demographics, disease history, global health status/QoL, clinical assessments and adverse events. Analyses were descriptive in nature. For clinical outcomes, real-world tumor responses and progression were determined by physician assessment in routine clinical practice. Real-world progression-free survival (rwPFS) was described using the Kaplan–Meier method.ResultsAt data cutoff, 15 male patients were enrolled (median age, 66 years). Nine patients received palbociclib as a first-line treatment and 6 as a second-line or later treatment. Patients received a median of 20 cycles of palbociclib. Neutropenia was experienced by 2 patients and grade ≥ 3 adverse events were reported in 11 patients. Global health status/QoL scores remained generally consistent during the study. One patient (6.7%) achieved a complete tumor response, 4 (26.7%) a partial response, and 8 (53.3%) stable disease. Median rwPFS was 19.8 months (95% CI, 7.4–38.0). Median follow-up duration was 24.7 months (95% CI, 20.0–35.7).ConclusionThis real-world analysis showed that palbociclib was well tolerated and provides preliminary data on treatment patterns and outcomes with palbociclib in male patients with HR+/HER2– ABC, helping inform the use of palbociclib in this patient subgroup.Trial identifierNCT03280303.

P-400 Fertility preservation in male patients with cancer: a systematic review and meta-analysis

Abstract Study question Whether the fertility preservation can benefit male patients with cancer. Summary answer Sperm cryopreservation is an effective fertility preservation method and may benefit patients with cancer. What is known already Sperm cryopreservation is the only way to efficiently preserve male fertility. It is an important procedure in assisted reproductive technologies (ART). Recently, due to remarkable advances in cancer treatment, an increasing number of studies have reported the outcomes of sperm cryopreservation in patients with cancer. Study design, size, duration Systematic review and meta-analysis to summarize the current evidence on sperm cryopreservation and reproductive outcomes in male patients with cancer. 69 non-randomized studies were included in the meta-analysis. These included 32,234 patients referred for sperm analysis and 23,178 whose sperm was cryopreserved at least once. CENTRAL, CNKI, Cochrane Systematic Reviews, EMBASE, MEDLINE, PUBMED, and Web of Science were searched from inception through December 31, 2021. Participants/materials, setting, methods All studies reporting on offering or attempting to cryopreserve sperm before or during cancer treatment in male patients considered at risk of treatment-related fertility impairment were included. The pooled failed-to-cryopreserve, sperm disposal and sperm use rate in male patients with cancer. Meanwhile, the pooled pregnancy, miscarriage and delivered rates after sperm cryopreservation in male patients with cancer. Main results and the role of chance 69 non-randomized studies were included with 32,234 patients referred for sperm analysis and 23,178 patients cryopreserving at least one sperm sample. The pooled failed-to-cryopreserve rate was 10% (95% confidence interval [CI], 8–12%), and the sperm disposal and sperm use rate were 23% (95% CI, 16–30%) and 9% (95% CI, 8–10%). The pregnancy, miscarriage, and delivery rates were 28% (95% CI, 22–33%), 13% (95% CI, 10–17%), and 20% (95% CI, 15–25%), respectively. Subgroup analysis showed higher pregnancy and delivery rates and a lower failed-to-cryopreserve rate in recent studies than in older ones. Clinical pregnancy rates per cycle of 34% (27–41%), 24% (14–35%), and 9% (5–15%) and delivery rates per cycle of 23% (17–30%), 18% (11–26%), and 5% (1–9%) for ICSI, IVF, and IUI, respectively. Limitations, reasons for caution The use of average results obtained in each included study without the patient-level data might represent the first source of bias. Furthermore, we did not analyze data on congenital abnormalities based on pregnancy outcomes because congenital abnormalities were rarely reported. Wider implications of the findings Our study supported previous reports that sperm cryopreservation was an effective method of fertility preservation in male patients with cancer. Meanwhile, frozen sperm use rate in our review underestimated the actual rate, making it meaningful to actively recommend fertility preservation to patients with cancer. Trial registration number not applicable

LBA01-20 DETRUSOR ULTRASTRUCTURAL STUDY PREDICTS LONG TERM VOIDING OUTCOMES IN MALE PATIENTS WITH DETRUSOR UNDERACTIVITY WHO UNDERWENT TRANSURETHRAL RESECTION OF PROSTATE (TURP)

You have accessJournal of UrologyCME1 Apr 2023LBA01-20 DETRUSOR ULTRASTRUCTURAL STUDY PREDICTS LONG TERM VOIDING OUTCOMES IN MALE PATIENTS WITH DETRUSOR UNDERACTIVITY WHO UNDERWENT TRANSURETHRAL RESECTION OF PROSTATE (TURP) Amanda Chung, Vincent Tse, and Lewis Chan Amanda ChungAmanda Chung More articles by this author , Vincent TseVincent Tse More articles by this author , and Lewis ChanLewis Chan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with detrusor underactivity (DU) have a variable voiding outcome after TURP which may not be predicted by urodynamics. Our previous detrusor ultrastructural studies demonstrated that features of ‘myohypertrophy pattern’ were associated with bladder outlet obstruction(BOO) and poor short term voiding outcomes. We report the largest ultrastructural study on DU and correlate detrusor ultrastructure features with long term voiding outcomes in men with urodynamic proven DU who have had TURP. METHODS: Patients with urodynamic diagnosis of DU or BOO who underwent TURP were studied. Detrusor biopsies were obtained at cystoscopy and processed for electron microscopy. Detrusor ultrastructural features including myohypertrophy pattern (cell size, irregularity), degeneration and elastosis were assessed using a simplified protocol with observers blinded to clinical data. Postoperative voiding outcomes (mean 16yrs) were correlated with ultrastructural features and urodynamic parameters. RESULTS: 27 patients (mean age 78 yrs) were recruited (23 DU and 4 BOO). In DU patients, the mean postvoid residual urine (PVR) was 630ml (IQR 240-985). Postoperatively all BOO patients voided, 9 DU patients (39%) were catheter-free at 3 months, 14 patients (61%) required catheterisation. At long term follow-up, only 29% DU (6/21) patients were catheter-free. Functional parameters including PVR, Voiding efficiency and Bladder contractility index did not correlate with voiding outcomes. Ultrastructural studies of DU patients showed voiding outcome after TURP was significantly associated with myocyte irregularity/derangement (p=0.034) and collagenosis (p=0.041). Overall, moderate to severe changes of ‘myohypertrophy’ pattern (myocyte size variation, increased cell separation, increased intercellular collagen, degeneration) predicted poor long term voiding outcomes (p=0.029, OR of catheter-dependence 5.5). CONCLUSIONS: Detrusor ultrastructural features of myocyte irregularity, degeneration, collagenosis (moderate to severe ‘myohypertrophy pattern’) are associated with impaired detrusor contractility and predicted poor long term voiding outcomes and catheter dependence after TURP. Detrusor biopsy with ultrastructural analysis can be a useful diagnostic and prognostic tool in men with DU considering surgery. Source of Funding: Royal Australasian College of Surgeons Foundation Scholarship © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1185 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Chung More articles by this author Vincent Tse More articles by this author Lewis Chan More articles by this author Expand All Advertisement PDF downloadLoading ...

Early initiation of agalsidase alfa treatment improves clinical outcomes in male patients with classical Fabry disease: A Fabry Outcome Survey (FOS) analysis

Early initiation of agalsidase alfa treatment improves clinical outcomes in male patients with classical Fabry disease: A Fabry Outcome Survey (FOS) analysis

Identification of Potential Key Genes Linked to Gender Differences in Bladder Cancer Based on Gene Expression Omnibus (GEO) Database.

Growing evidence strongly indicates pivotal roles of gender differences in the occurrence and survival rate of patients with bladder cancer, with a higher incidence in males and poorer prognosis in females. Nevertheless, the molecular basis underlying gender-specific differences in bladder cancer remains unknown. The current study has tried to detect key genes contributing to gender differences in bladder cancer patients. The gene expression profile of GSE13507 was firstly obtained from the Gene Expression Omnibus (GEO) database. Further, differentially expressed genes (DEGs) were screened between males and females using R software. Protein-protein interactive (PPI) network analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Ontology (GO), and Kaplan-Meier survival analyses were also performed. We detected six hub genes contributing to gender differences in bladder cancer patients, containing IGF2, CCL5, ASPM, CDC20, BUB1B, and CCNB1. Our analyses demonstrated that CCNB1 and BUB1B were upregulated in tumor tissues of female subjects with bladder cancer. Other genes, such as IGF2 and CCL5, were associated with a poor outcome in male patients with bladder cancer. Additionally, three signaling pathways (focal adhesion, rheumatoid arthritis, and human T-cell leukemia virus infection) were identified to be differentially downregulated in bladder cancer versus normal samples in both genders. Our findings suggested that gender differences may modulate the expression of key genes that contributed to bladder cancer occurrence and prognosis.

Clinical features and outcomes of male patients with lymphangioleiomyomatosis: A review.

Lymphangioleiomyomatosis (LAM) is a rare disease involving multiple systems, which is divided into sporadic LAM (S-LAM) and tuberous sclerosis complex-LAM, mostly affecting women who are in childbearing age stage. Data on male patients are limited and scattered. Therefore, it is necessary to conduct a systematic review to investigate the clinical features, diagnosis, treatment, and outcomes of LAM in male. We performed a literature review by searching for all the published reported cases of LAM in male during the past 35 years (April 1986-October 2021). 36 male patients described in 26 references were included in this article. The median age of onset was 34 years (interquartile range: 1-79). The most common initial manifestations were cough, dyspnea, respite, and hemoptysis, with pulmonary complications such as pneumothorax and chylothorax. Five patients (13.9%) were asymptomatic at admission. Nearly half of the 36 male patients had thin-walled air-filled cysts that were visible throughout both lungs. Considering the abovementioned atypical clinical features, misdiagnosis was committed in 8 patients (22.2%). In addition, patients with tuberous sclerosis complex lymphangioleiomyomatosis often have no pulmonary manifestations at onset but present multiple extrapulmonary manifestations and have higher rates of renal angiomyolipomas than patients with S-LAM (P < 0.01). Eventually, 4 patients with S-LAM eventually died. Physicians should increase the awareness of LAM in male. Early monitoring of various systems should be recommended to ensure early management and active follow-up. Tuberous sclerosis complex patients should immediately be tracked for the onset of LAM disease to improve prognosis.

Body mass index has a non-linear association with three-month outcomes in men with acute ischemic stroke: An analysis based on data from a prospective cohort study.

Despite reports of a connection between body mass index (BMI) and stroke outcome, the findings remain debatable. In this investigation, we sought to determine whether BMI was associated with the probability of 3-month unfavorable outcomes in patients with acute ischemic stroke (AIS). This is a second analysis based on a cohort study. 1,897 people with AIS who were treated at a hospital in South Korea from January 2010 to December 2016 were included in the study. The linear relationship between BMI and unfavorable outcomes for AIS patients was evaluated using a binary logistic regression model. The generalized additive model (GAM) and smoothed curve fitting (penalized spline approach) were employed to see if there was a non-linear association between BMI and unfavorable outcomes in patients with AIS. The binary logistic regression model did not detect any statistically significant correlation between BMI and unfavorable outcomes in AIS patients after controlling for variables. The association between them, however, was non-linear, with the BMI inflection point occurring at 23.07 kg/m2. Each 1 kg/m2 rise in BMI on the left side of the inflection point was linked to a 12% lower risk of unfavorable outcomes (OR= 0.88, 95% CI: 0.82 to 0.96, p = 0.003). We stratified the AIS patients by gender to further explore their relationship. The results showed a specific non-linear relationship and saturation effect of BMI (kg/m2) with 3-month unfavorable outcomes in male patients but not in female patients. The inflection point for BMI was 23.35 kg/m2. When BMI was below 23.35 kg/m2 in men with AIS, BMI was inversely associated with unfavorable outcomes (OR=0.89,95% CI:0.80-0.98). A particular non-linear connection and saturation effect between BMI (kg/m2) and 3-month unfavorable outcomes were present in male patients with AIS but not in females. 23.35 kg/m2 was the BMI's inflection point. The probability of unfavorable outcomes was substantially and inversely associated with BMI in men with AIS when it was less than 23.35 kg/m2. Men with AIS should have a BMI of no less than 23.35 kg/m2 to reduce the probability of unfavorable outcomes following AIS.

Sacral Neuromodulation Outcomes in Male Patients With Pelvic Pain and Fecal Incontinence

Sacral neuromodulation (SNM) is an effective third line treatment however there is limited data involving male patients with OAB or non-bladder conditions (chronic pelvic pain and fecal incontinence (FI)). In this retrospective study, we followed 17 male patients with non-bladder conditions to assess efficacy, personal satisfaction, need for other treatments and complications.