Background: Ureaplasma parvum (UP) is commonly isolated in the genitor-urinary tract and may cause various clinical features, including microscopic hematuria (MH). Some UP serovars are more commonly related with specific urogenital disease, but the evidences have been conflicting. This study primarily aimed to research the possible associations between specific UP serotypes and genito-urinary pathogenicity in female patients showing MH with/without chronic micturition urethral pain (CMP). Methods: This study retrospectively reviewed 276 female patients having MH with/without CMP, who visited health screening center or female infertility clinic. All patients underwent multiplex polymerase chain reaction (PCR) tests with vaginal and urine samples to evaluate the infection rate and serotypes of UP. The antimicrobial susceptibility of UP and the predictors of CMP among UP infected patients were also analyzed. All patients were followed up at least for 6-months. Results: Forty-nine patients (17.8%) showed urinary UP infection. Urinary UP serotyping showed the prevalence of seorvar-1, -3, -6 and -14 were 24.5%, 30.6%, 18.4% and 26.5%, respectively. 79.6% of the urinary UP positive patients accompanied vaginal UP infection. 22 patients of the cohort (8.0%) had CMP whereas serovars-3 and -14 accompanied CMP in 54.5% and 41.0% cases, respectively. No serovars-6 infection case had CMP. 26.4% of the cohort were infertile whereas 10.9% of these infertile patients were positive for urinary tract infection with UP serotype-3 or -14. Doxycycline, josamycin and pristinamycin were the most active antibiotics with the lowest rate of resistance (0.0%) for treating UP. At 1-month post-initial treatment with doxycycline, all UP serotypes were eradicated and no patient complained of urethral discomfort. However, simultaneous urinary and vaginal reinfection of serovar-3 (5 cases) and serovar-5 (1 case) were confirmed at 3-months post-initial doxycycline therapy. The logistic regression analyses revealed that serovars-3 [hazard ratio (HR) 1.354, P value 0.018] and -14 (HR 1.103, P value 0.046) were significantly associated with CMP in female patients having MH. Conclusions: UP serovars-3 and -14 infections could be associated with CMP in female patients having MH. Doxycycline, josamycin and pristinamycin were effective for treating UP. Serovar-3 showed higher reinfection rate than other serotypes after antibiotics treatment.

Aim: To evaluate the effects of prostatic apex shape variations on positive apical margin rate (PAM) after radical prostatectomy (RP) by undertaking a comparative study of robot-assisted laparoscopic radical prostatectomy (RALP) versus open radical prostatectomy (ORP). Methods: A total 3,324 cases of RP (1,004 ORP and, 2,320 RALP) from January 2004 to March 2017 were retrospectively reviewed. All patients underwent preoperative magnetic resonance imaging (MRI) and the cohorts were stratified into 4 categories according to prostatic apical shape at the mid-sagittal plane. Between ORP and RALP groups, age, body mass index, preoperative prostate-specific antigen, biopsy and pathological Gleason score (GS), clinical and pathological stage and prostatic apex shapes were compared. Logistic regression analyses were performed to evaluate significant predictors of PAM. Propensity adjustments were undertaken before statistical analysis to minimize the lack of randomization. Results: ORP and RALP groups showed no significant differences in age, BMI, PSA, biopsy and pathological GS, clinical and pathological stage as well as prostatic apical shape variations. The ORP group showed a PAM of 17.5% that was significantly higher than 12.3% of RALP group (p<0.001). Both groups showed the highest PAM with apical type 3, which is the apex covering the posterior aspect of membranous urethra (ORP 33.9%, RALP 28.5%). In unadjusted data, multiple logistic regression analysis showed that prostate apical type 3 was a significant independent predictor of PAM but other apex types were not. Conclusions: Prostate apical type 3 was a significant independent predictor of PAM. The RALP group showed better outcomes in terms of PAM compared with the ORP group. Preoperative MRI might be a potentially useful tool for preoperative designing of the surgical modalities.

Lee DH, et al. Investig Clin Urol. 2024 Oct;65:e68. https://doi.org/10.4111/icu.20240191

Objective: To evaluate the long-term effects of dutasteride on male fertility and determine the cutoff treatment duration that causes significant and persistent decreases in semen parameters.Methods: This was a single-center, randomized, controlled study that evaluated 200 men (ages 28 to 39 years). Forty men were allocated to each study group, divided according to the duration of dutasteride treatment, as follows: 24 months (group 5). All subjects received dutasteride 0.5 mg/day for management of androgenetic alopecia then discontinued dutasteride for 6 months.Results: The baseline mean testosterone level in the study subjects was 4.8 ng/mL. No significant differences were found between study groups in sperm concentration, normal morphology, and vitality. Semen volume and sperm total/progressive motility were significantly reduced as the duration of dutasteride treatment increased. All study groups showed an increase in total sperm motility and semen volume after discontinuation of dutasteride. Compared with group 1, groups 2–5 showed significant decreases in semen volume and sperm total motility, with the odds ratios becoming smaller as the duration of dutasteride treatment increased. Receiver operating characteristic analysis showed the cutoff values for persistent impairment of semen volume and total sperm motility to be 17.8 and 20.3 months, respectively. Conclusion: Long-term use of dutasteride may lead to male infertility by persistently impairing semen volume and sperm motility.

Introduction: Some previous studies reported recreational use of phosphodiesterase type 5 (PDE-5) inhibitors by ingesting the medicine with alcohol in patients with erectile dysfunction, but the rate of misuse in general population has never been researched. Aim: To investigate the frequency of concomitant alcohol consumption with PDE-5 inhibitors in the general male population. We secondarily analyzed the influence of alcohol on PDE-5 inhibitor. Methods: 325 men with erectile dysfunction (age 34–78) who received PDE-5 inhibitors at a single medical institution from January 2016–February 2018 were included in the study. All patients fulfilled a survey questionnaire assessing (i) average alcohol consumption amount, (ii) previous use of PDE-5 inhibitors with alcohol and purpose of concomitant alcohol use, (iii) and background knowledge about PDE-5 inhibitors' side effects. Main Outcomes Measures: The main outcome measure was frequency of concomitant alcohol consumption with PDE-5 inhibitors in the general male population. Results: Overall 148 patients committed concomitant alcohol use (group 1), and 177 patients did not (group 2). No significant differences were observed between 2 groups regarding types of PDE-5 inhibitors used and underlying disease. Group 2 had significantly more patients with the correct knowledge concerning concomitant alcohol use than group 1 (24.9% vs 13.5%). Group 1 had more patients with average alcohol consumption >15 drinks/week (64.8% vs 14.1%). The reasons for concomitant alcohol use were curiosity (35.1%), enhancing sexual desire (27%) and recommendation from friends (16.9%). Group 1 showed significantly greater complications, including headache (23.6% vs 7.3%) and facial flushing (69.6% vs 12.4%), than group 2. 1 patient in group 1 experienced severe chest discomfort and underwent coronary artery angiography, but no severe obstructive lesion was observed. Conclusion: 45.5% of middle- to old-age men committed concomitant use of PDE-5 inhibitor with alcohol because of recreational purpose, and this alcohol abuse might lead to severe complications, including chest discomfort and dizziness.

Baeck JH, et al. Investig Clin Urol. 2022 Nov;64:e2. https://doi.org/10.4111/icu.20220253