Andrology最新文献

{"title":"Management of Cryptorchidism in Post-pubertal and Adult Age: An Unmet Need in Andrology","authors":"Ettore Caroppo","doi":"10.1111/andr.70311","DOIUrl":"https://doi.org/10.1111/andr.70311","url":null,"abstract":"<p>Undescended testis (UDT), also termed cryptorchidism, is a congenital anomaly that should be corrected as early as possible (ideally between 6 and 12 months of age) to preserve fertility and reduce the risk of tumor development. Despite broad consensus on the importance of timely UDT treatment, it's not uncommon to encounter patients with cryptorchidism presenting later in childhood or even in adulthood.</p><p>In the current issue of <i>Andrology</i>, Wu et al. [<span>1</span>] report data on 194 patients presenting with unilateral (<i>n</i> = 178) or bilateral (<i>n</i> = 16) UDT at a median age of 26 years (range, 18–53). Cryptorchid testes were most commonly located in the inguinal canal or external ring (55.2%), followed by the internal ring (30.5%), intra-abdominal position (7.6%), and sliding or suprascrotal position (6.7%). Patients with bilateral UDT exhibited severe spermatogenic impairment, with semen parameters ranging from azoospermia (observed in 81.2% of cases) to severe oligozoospermia, while 36% of patients with unilateral UDT had at least one abnormal semen parameter. High testicular position was associated with more severe spermatogenic dysfunction (odds ratio 6.01, 95% confidence interval [CI] 1.95–18.49). Histopathological evaluation of the cryptorchid testes at orchidopexy revealed marked impairment of intratesticular spermatogenesis in 81.5% of cases (Johnsen score <8%), with all testes with a Johnsen score >8 being located in the sliding or suprascrotal position before surgery.</p><p>After a follow-up period of 54.6 months, one of the 155 patients under observation developed testicular cancer, specifically seminoma; in another patient, testicular cancer was discovered during orchidopexy, which was converted to orchiectomy, leading to the exclusion of this case from the analysis.</p><p>Although not entirely novel, these findings are clinically relevant because they raise important considerations for the optimal management of cryptorchidism in post-pubertal and adult patients.</p><p>One patient out of 155 developed testicular cancer during a relatively short follow-up period (4.5 years) after orchidopexy. Although this observation is based on a single event, it is noteworthy when compared with the estimated incidence of testicular cancer in the general Chinese population, reported as 2.24 cases per 100,000 subjects (95% CI, 2.16–2.35) [<span>2</span>]. Expressed per 100,000 subjects, one case among 155 individuals corresponds to 645.16 cases per 100,000, yielding a standardized incidence ratio (SIR) of 288.02. Inclusion of the patient with intraoperatively detected testicular cancer would have raised the SIR to 572.35. These estimates should be interpreted with caution because of the limited number of events; however, evidence from a substantially larger cohort (16,983 subjects) showed that patients with cryptorchidism who underwent surgery at 13 years of age or older had a 5.40-fold increased risk of developing test","PeriodicalId":7898,"journal":{"name":"Andrology","volume":"14 6","pages":"1419-1420"},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/andr.70311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148662296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity-Related Functional Hypogonadism Requires Therapeutic Recalibration: Implications for GLP-1–Based Therapies","authors":"Mojca Jensterle, Andrej Janez","doi":"10.1111/andr.70264","DOIUrl":"10.1111/andr.70264","url":null,"abstract":"","PeriodicalId":7898,"journal":{"name":"Andrology","volume":"14 6","pages":"1428-1430"},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antioxidants and Nutraceutical for Male Factor Infertility: Where Does the Evidence Stand?","authors":"Ettore Caroppo, Maurizio Dattilo","doi":"10.1111/andr.70279","DOIUrl":"10.1111/andr.70279","url":null,"abstract":"","PeriodicalId":7898,"journal":{"name":"Andrology","volume":"14 6","pages":"1417-1418"},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Quantification of Oligoasthenozoospermia Induced by Obesity, Reproductive Toxicants, and Their Combination in Rat Models","authors":"Yunlong Yao, Xi Zhang, Lingru Li, Yunzhi Zhang, Shuo Huang, Yulin Zong, Mingrui Li, Fufangyu Zhao, Linghui Zhu, Tianxing Li, Wenlong Sun, Mingyan Shao, Yanfei Zheng","doi":"10.1111/andr.70171","DOIUrl":"10.1111/andr.70171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Oligoasthenozoospermia is a leading cause of male infertility and has been increasingly associated with the global surge in obesity and exposure to reproductive toxicants. Despite extensive research on each factor individually, their combined pathological effects remain poorly understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to investigate how obesity and reproductive toxicants independently and synergistically impair male reproductive function by establishing and comparing rat models of oligoasthenozoospermia induced by each factor and their combination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We constructed three etiologically distinct oligoasthenozoospermia male Sprague–Dawley rat models: a reproductive toxicity model induced by glycosides of <i>Tripterygium wilfordii</i> Hook. f. (GTW), a metabolic dysfunction model induced by a high-fat diet (HFD), and a combined model (HFD + GTW). Animals were randomly assigned and subjected to 12 weeks of treatment. Body weight, metabolic indices, serum sex hormone levels, sperm quality parameters, and histopathological analysis of the testes and epididymis, as well as gut microbiota composition and testicular transcriptome profiles, were systematically evaluated. We also performed quantitative real-time polymerase chain reaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both GTW and HFD independently impaired reproductive function, leading to decreased sperm count and motility, hormonal disturbances, and moderate testicular damage. The combined model exhibited significantly exacerbated reproductive impairment, including extensive spermatogenic cell loss, disrupted testicular architecture, and the lowest sperm quality indices. Multiomics analysis revealed coordinated alterations in gut microbiota composition and testicular transcriptomes, suggesting crosstalk between metabolic and inflammatory signaling pathways. Quantitative real-time polymerase chain reaction confirmed these transcriptomic patterns, showing upregulation of <i>Ahnak</i>, <i>C1r</i>, <i>S1pr1</i>, and <i>Steap4</i>, alongside downregulation of <i>Alkbh7</i>, <i>Tbpl1</i>, <i>Tent5b</i>, and <i>Ldhal6b</i> in the models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study successfully establishes reliable rat models that mimic both individual and combined etiologies of oligoasthenozoospermia. The interaction between obesity and GTW-induced re","PeriodicalId":7898,"journal":{"name":"Andrology","volume":"14 6","pages":"1535-1551"},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/andr.70171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146027879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cyclic Treatment With WIN 18,446, a Potential Male Contraceptive, is as Effective as Continuous Treatment for Suppression of Spermatogenesis in Mice","authors":"Jisun Paik, Jessica M. Snyder, Haley A. Martin, John K. Amory","doi":"10.1111/andr.70227","DOIUrl":"10.1111/andr.70227","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Retinoic acid plays a critical role in spermatogenesis during both spermatogonial differentiation and spermiation. Mice lacking enzymes that synthesize retinoic acid, <i>Aldh1a1/1a2</i>, in the testes are infertile. WIN 18,446 reversibly inhibits spermatogenesis by inhibiting ALDH1A1/1A2 and is a promising approach to male contraception. Previously, we demonstrated the kinetics, efficacy, and reversibility of continuous treatment with WIN18,446 as a male contraceptive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We sought to investigate whether cyclic administration of WIN 18,446 could be as effective at inhibiting spermatogenesis as continuous treatment with WIN 18,446 while reducing the risk of potential testicular damage from continuous treatment. We studied testicular histology and sperm counts in response to continuous vs. cyclic treatment of WIN 18,446 and assessed recovery from the two treatment regimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Male mice were fed a diet containing WIN 18,446 for 15 weeks, followed by a diet without the drug for up to 16 weeks. For cyclic treatment, male mice were fed the WIN 18,446-containing diet for 4 weeks, followed by three cycles of 2-weeks of control diet, followed by 2-weeks of WIN 18,446 diet for 12 additional weeks. After the last cyclic treatment, drug treatment was discontinued, and animals were allowed to recover for 8 weeks. Mice were euthanized at predetermined time points to assess recovery of spermatogenesis by testicular histology and sperm counts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Testis weights and sperm counts were similar between cyclically treated mice and mice treated with WIN 18,446 continuously for 15 weeks. Testes of mice under cyclic treatment contained spermatocytes/spermatids, but not mature, normal spermatozoa, while those from the mice under continuous treatment had only spermatogonia. Importantly, spermatogenesis recovered more quickly when mice were treated cyclically compared to those receiving continuous treatment based on testes weight and histology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cyclic treatment of mice with the ALDH1A inhibitor WIN 18,446 is as efficacious as continuous treatment in suppressing spermatogenesis and may allow for faster recovery of spermatogenesis after the cessation of drug treatment, and reduce the chance of injury to the testes from continuous treatment.</p>\u0000","PeriodicalId":7898,"journal":{"name":"Andrology","volume":"14 6","pages":"1472-1478"},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/andr.70227","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147571278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of Male Fertility Assessment and Treatment Across Historical and Contemporary Paradigms","authors":"Hanif Abdul Rahman, Bazilah Mazlan, Siti Nornadhirah Amdani","doi":"10.1111/andr.70156","DOIUrl":"10.1111/andr.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Male factor infertility accounts for up to 50% of couples' inability to conceive. Despite this significant burden, perspectives on male fertility have evolved over millennia, shaped by cultural, medical, and scientific frameworks. Tracing this trajectory illuminates how historical observations laid the foundations for modern andrological science.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This scoping review maps the evolution of male fertility research from ancient civilizations through contemporary precision medicine approaches, identifying key paradigm shifts, persistent knowledge gaps, and emerging frontiers in the field.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following Arksey and O'Malley's framework, we systematically searched historical medical texts, archaeological records, and biomedical databases (PubMed, Embase, Web of Science) from inception to 2025. Sources encompassing ancient fertility practices, medieval to early modern medical writings, the microscopy revolution, the endocrinology era, and contemporary molecular approaches were included. Data were extracted and synthesized thematically across temporal epochs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our review reveals five major paradigm shifts: (i) ancient empiricism (3000 <span>bce</span> to 500 <span>ce</span>) emphasizing humoral balance and dietary interventions; (ii) medieval stagnation with persistence of Galenic theories; (iii) the microscopic revolution (1677–1900) establishing cellular foundations; (iv) the endocrine era (1900–1990) elucidating hormonal regulation; and (v) the molecular age (1990 to present) introducing genetic, epigenetic, and systems biology approaches. Key milestones include the discovery of spermatozoa, the development of semen analysis, the identification of the hypothalamic–pituitary–gonadal axis, assisted reproductive technologies, and contemporary omics-based diagnostics. Persistent challenges include an incomplete understanding of idiopathic infertility and limited treatment options for specific conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Male fertility research demonstrates remarkable continuity alongside revolutionary breakthroughs. While ancient practitioners recognized lifestyle and environmental factors now validated by modern science, contemporary precision medicine approaches promise personalized diagnostics and targeted interventions. Future directions include int","PeriodicalId":7898,"journal":{"name":"Andrology","volume":"14 6","pages":"1461-1471"},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/andr.70156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Testicular Volume: A Useful Clinical Signal, With Important Measurement Caveats","authors":"Sandro C. Esteves","doi":"10.1111/andr.70223","DOIUrl":"10.1111/andr.70223","url":null,"abstract":"<p>In this well-conducted retrospective cohort study, Kuchakulla et al. [<span>1</span>] examine the role of preoperative total testicular volume as a predictor of clinically meaningful improvement in total motile sperm count (TMSC) following microsurgical varicocelectomy. By focusing on TMSC category upgrading rather than isolated semen parameter changes, the authors address an outcome that is directly relevant to patient counseling and downstream reproductive decision-making. In their study, just over half of men (51%) experienced an upgrade in the TMSC category after microsurgical varicocelectomy, with improvement strongly influenced by baseline spermatogenic reserve. Men who upgraded had higher preoperative TMSC and substantially larger total testicular volume (33.0 vs. 23.4 mL). Importantly, upgrading was not uniform across baseline categories: improvement occurred in 7% of azoospermic men, 60% of those in the in vitro fertilization (IVF) range, and 73% of men initially in the intrauterine insemination (IUI) range, with many transitioning to thresholds compatible with less invasive reproductive options. Using ROC analysis, the authors identified a total testicular volume threshold of ≥25.5 mL, which was associated with a nearly 12-fold increase in the odds of TMSC upgrading, and an upgrade rate approaching 70%, compared with only 20% below this threshold. These data illustrate how testicular volume and baseline TMSC together may help stratify expectations following varicocelectomy and guide counseling regarding the likelihood of shifting from IVF to IUI or natural conception pathways.</p><p>The study also reinforces the biological plausibility of testicular volume as a surrogate marker of male pubertal development [<span>2</span>], spermatogenic reserve [<span>3</span>], and endocrine function [<span>4</span>], aligning with prior observations linking larger testicular size to preserved Sertoli cell mass [<span>5</span>]. In this context, the Kuchakulla et al. findings support the continued integration of testicular volume into the routine preoperative assessment of infertile men with clinical varicocele.</p><p>At the same time, an important methodological consideration deserves emphasis. In this study, testicular volume was estimated exclusively by physical examination (PE), without the use of a Prader orchidometer or scrotal ultrasound. In routine clinical practice, testicular volume is most commonly assessed using a Prader orchidometer or ultrasound. The Prader orchidometer provides a practical bedside estimate and correlates positively with ultrasound-derived testicular volume in both fertile and infertile men, making it a reasonable surrogate in everyday practice [<span>3</span>].</p><p>While bedside Prader orchidometry offers some degree of standardization, it is known to systematically overestimate testicular volume by 2–3 mL compared with ultrasound, particularly in smaller testes [<span>3</span>]. Scrotal ultrasound, when performed ","PeriodicalId":7898,"journal":{"name":"Andrology","volume":"14 6","pages":"1421-1423"},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/andr.70223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Isolated Postprandial Dyslipidemia And Erectile Dysfunction","authors":"Celeste Manfredi, Giampiero Della Rosa, Simone Tammaro, Paolo Chiodini, Vittorio Simeon, Salvatore Panico, Giorgio Ivan Russo, Paolo Capogrosso, Luca Boeri, Andrea Cocci, Marco Falcone, Giuseppe Bellastella, Rocco Damiano, Ferdinando Fusco, Riccardo Autorino, Javier Romero-Otero, Marco De Sio, Davide Arcaniolo","doi":"10.1111/andr.70173","DOIUrl":"10.1111/andr.70173","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postprandial lipid testing is increasingly recognized as a marker of vascular health. However, its relationship with erectile dysfunction (ED) remains largely unexplored. Isolated postprandial dyslipidemia (IPD), in particular, may evade detection using conventional fasting-based assessments, despite potential atherogenic effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the association between IPD and erectile function, comparing the prevalence and severity of ED among men with IPD, combined dyslipidemia (CD), and those without dyslipidemia (WD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>In this cross-sectional study, sexually active men aged ≥18 years underwent same-day fasting and postprandial lipid testing, as well as erectile function evaluation using the International Index of Erectile Function – Erectile Function domain (IIEF-EF) questionnaire. Dyslipidemia was defined according to the 2019 European Society of Cardiology/European Atherosclerosis Society criteria. Patients were categorized as WD (no dyslipidemia), IPD (postprandial abnormalities only), or CD (both fasting and postprandial abnormalities). Multivariable logistic regression was performed, adjusting for age, smoking status, BMI, and hypertension. The primary outcome was the prevalence of ED (IIEF-EF ≤25); secondary outcomes included ED severity and comparisons across lipid profile subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 351 men, ED prevalence was higher in the IPD (55.1%) and CD (57.0%) groups compared to WD (32.8%; <i>p</i> < 0.001). Median (IQR) IIEF-EF scores were 26 (25–28) in the WD group, 22 (20–23) in the IPD group, and 21 (19–23) in the CD group. The differences between WD and both IPD and CD exceeded the minimal clinically important difference (4 points) and were statistically significant (<i>p</i> < 0.001). Adjusted analyses confirmed increased odds of ED in IPD (odds ratio [OR] = 2.36; 95% confidence interval [CI]: 1.41–3.96) and CD (OR = 2.58; 95% CI: 1.43–4.65) versus WD. ED severity was also greater in the IPD and CD groups. No differences emerged between IPD and CD in any outcome. Among IPD subtypes, elevated postprandial triglycerides were most common, but no single lipid abnormality was independently associated with ED severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>IPD is associated with both the prevalence and severity of ED, paralleling the impact of chronic dyslipidemia. Postprandial lipid testing may reveal hidden metabolic risks relevant to sex","PeriodicalId":7898,"journal":{"name":"Andrology","volume":"14 6","pages":"1552-1559"},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145942112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review on the Presentation and Management of Segmental Testicular Infarction.","authors":"Lory Hage, Alexandra Clerget, Aziz Najjar, Isabelle Boulay-Coletta, Balkis El Khouni, Mohamad Abou Chakra, Xavier Durand, Albert Semaan, Igor Duquesne","doi":"10.1111/andr.70337","DOIUrl":"https://doi.org/10.1111/andr.70337","url":null,"abstract":"<p><strong>Background: </strong>Segmental testicular infarction (STI) is a rare and likely underdiagnosed cause of acute scrotal pain. Its clinical and imaging presentation often mimics testicular torsion or malignancy, frequently leading to unnecessary surgical intervention.</p><p><strong>Objectives: </strong>To review reported cases of STI, characterize clinical presentation, imaging features, management strategies, and outcomes, and identify factors associated with diagnostic accuracy and conservative management.</p><p><strong>Materials and methods: </strong>A systematic review was conducted using PubMed and Embase databases, in accordance with PRISMA guidelines. Case reports and case series describing STI were included. Demographic, clinical, imaging, management, and outcome data were extracted. Descriptive and comparative analyses were performed. Factors associated with management were assessed using univariate logistic regression, and predictors of diagnostic accuracy were identified using a Classification and Regression Tree (CART) analysis.</p><p><strong>Results: </strong>Seventy-five studies comprising 99 patients were included. Median age was 34.0 years, and 87.9% presented with acute unilateral scrotal pain. Only 31.3% of cases were initially diagnosed as STI, most commonly being misdiagnosed as testicular tumor or torsion. Ultrasound was the primary imaging modality; low or absent Doppler flow was associated with correct diagnosis and conservative management (OR = 0.26 [0.10-0.68]). Overall, 42.4% of patients were managed conservatively while 30.3% had a total orchiectomy. Misdiagnosis was strongly associated with surgical intervention (p < 0.001). Long-term outcomes did not differ significantly between conservative and surgical management. CART analysis identified palpable mass, imaging strategy, lesion morphology, age, and symptom duration as key contributors to diagnostic accuracy (sensitivity 54%, specificity 46%).</p><p><strong>Discussion: </strong>STI remains frequently misdiagnosed due to overlapping clinical and imaging features with more common testicular pathologies. Diagnostic uncertainty, rather than disease severity, largely drives surgical management.</p><p><strong>Conclusion: </strong>Increased awareness, careful interpretation of Doppler ultrasound findings, and structured diagnostic pathways may facilitate safe conservative management and testicular preservation in patients presenting with scrotal pain.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate-Term Dapoxetine Administration Suppressed Functional Connectivity of Subcallosal Cingulate Cortex in Premature Ejaculation: A Resting-State fMRI Study.","authors":"Jianhuai Chen, Ning Wu, Siwen Liu, Yan Xu, Zhaoxu Yang, Tao Liu, Shaowei Liu, Liqin Dai, Xing Zhang, Peining Niu, Yun Chen","doi":"10.1111/andr.70333","DOIUrl":"https://doi.org/10.1111/andr.70333","url":null,"abstract":"<p><strong>Introduction: </strong>Dapoxetine, a short-acting selective serotonin reuptake inhibitor (SSRI), is commonly prescribed to treat premature ejaculation (PE). Functional connectivity (FC) between dorsolateral prefrontal cortex (DLPFC) and subcallosal cingulate cortex (SCC) has been found to serve as neuroimaging biomarker for predicting SSRI treatment response. Despite the fact that altered FC has been observed in PE patients, the neural mechanisms underlying the rapid-acting effects on brain of immediate-term dapoxetine administration remain unknown. This study aimed to explore the mechanisms underlying this therapeutic effect based on DLPFC and SCC, which are involved in the regulation of ejaculatory reflex.</p><p><strong>Methods: </strong>Resting-state functional magnetic resonance imaging and structural MRI data were acquired from a sample of 40 PE patients before and after immediate-term dapoxetine administration, as well as 40 healthy controls (HCs). Seed-based voxel-wise FC analysis was performed, and whole-brain FC values in regions of interest (ROIs) (bilateral SCC and DLPFC: spheres with 6 mm radius) were calculated. FC values of bilateral DLPFC and SCC were compared between PE patients before and after dapoxetine administration and HCs.</p><p><strong>Results: </strong>Using SCC as ROIs, treatment-naïve PE patients showed decreased FC within the default mode network (p < 0.005) but increased FC with the attention network (p < 0.005) compared to HCs. Following dapoxetine administration, the pattern of alterations compared to HCs changed, now additionally featuring decreased FC between the SCC and the visual network (p < 0.005). Crucially, within-patient comparisons revealed that dapoxetine administration significantly decreased FC between the SCC and both the attention network (p < 0.005) and the visual network (p < 0.005). In contrast, using DLPFC as ROIs revealed widespread hypocomnectivity in patients, which remained unchanged following acute administration.</p><p><strong>Conclusion: </strong>The therapeutic effects of immediate-term dapoxetine administration may act by downregulating FC of SCC and related circuits (promotional factors for PE), but do not enhance FC of DLPFC and related circuits (inhibition factors for PE). The latter may be achieved by long-term dapoxetine administration or other long-acting SSRI treatments.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}