Do sperm parameters and infertility affect sexuality of couples?

We aimed to analyse the relationship between sperm parameters and International Index of Erectile Function (IIEF) score, the Female Sexual Function Index (FSFI) score, the testosterone (T) level in infertile men and between FSFI score and partners’ fertility. Patients were divided into three groups; (group 1: azoospermia [n = 57], group 2: sperm count <15 million [n = 41], group 3: sperm count >15 million [n = 81]). Patients and their partners filled the IIEF and FSFI forms. The normality of the tests was analysed with Kolmogorov–Smirnov and Shapiro–Wilk tests. Spearman's rho test, a nonparametric test, was used to correlate the data. A value of p < .05 was considered statistically significant. There was a positive correlation between the sperm count, other sperm parameters, morphology and motility and IIEF score, FSFI score and T (p = .037, .028 and .041 respectively). We found a positive correlation between IIEF score and FSFI score (p = .182). Infertile partners’ FSFI score was lower than fertile partners’ scores (p = .023). Male infertility causes severe sexual dysfunction in couples, and female sexual dysfunction increases in parallel to that of men. Male sexual function also tends to decrease with low sperm count. While the clinician evaluates infertile couples, psychological and sexual functions should also be evaluated and patients should not be deprived of appropriate treatment.     

Endocrine contribution to the sexual dysfunction in patients with advanced chronic kidney disease and the role of hyperprolactinemia

In this study, we investigated the prevalence of sexual dysfunction among males with advanced chronic kidney disease and the effect of treating hyperprolactinemia among these patients. In this prospective study, patients were assessed with history, physical examination, hormonal assessment, and two questionnaires, IIEF and AIPE. Patients with hyperprolactinemia received treatment with cabergoline 0.5 mg once per week for 6 months and were re-evaluated. A total of 102 patients were included in this study, 75 (73.53%) were on hemodialysis, 13 (12.75%) on peritoneal dialysis and 14 (13.73%) on medical treatment alone. Ninety (88.24%) patients had premature ejaculation, 85 (83.33%) had anything from mild-to-moderate-to-severe erectile dysfunction. The incidence of hypogonadism and hyperprolactinemia was 34.4%. Patients treated with cabergoline (n = 26) showed a significant increase in LH levels (p = .003) and a significant decrease in prolactin levels (p = .003). Testosterone levels and the incidence of erectile dysfunction or premature ejaculation did not improve significantly. There is a high incidence of sexual dysfunction among patients. Treatment of hyperprolactinemia is effective in correcting prolactin levels, but does not improve erectile dysfunction or premature ejaculation. Therefore, treating hyperprolactinemia is not an overall effective treatment for erectile dysfunction in these patients.     

Female Sexual Dysfunction in Peritoneal Dialysis and Hemodialysis Patients

Background. Sexual dysfunction (SD) is a common problem in end-stage renal disease (ESRD). In contrast to basic and clinical research in the field of male SD, the sexual problems of women have received relatively little attention and are often under-treated. We evaluated sexual function in female ESRD patients using the validated Female Sexual Function Index (FSFI) and relation with QOL, depression, and some laboratory parameters. Methods. 117 ESRD patients (85 peritoneal dialysis [PD], 32 hemodialysis [HD], mean age 48.5 ± 13.9 years) were enrolled. All patients had been dialyzed (PD or HD) for more than three months. In addition, an age-matched married control group of 48 subjects (mean age 47.1 ± 12.7 years) were enrolled in the study. All patients were asked to complete three questionnaires of the FSFI, Beck Depression Index (BDI) and SF-36. Results. Female sexual dysfunction was found in 80 of the 85 peritoneal dialysis patients (94.1%) and all of the HD patients (100%), but in only 22 subjects of the control group (45.8%). A significant negative correlation was found between total FSFI score and age (r = ?0.288, p = 0.002), BDI score (r = ?0.471, p < 0.001), mental-physical component score of QOL (r = ?0.463, p < 0.001 and r = ?0.491, p < 0.001, respectively) in PD and HD patients. The rates of depression were 75.3, 43.8, and 4.2% in the PD and HD patients and control subjects, respectively. Conclusion. Female sexual dysfunction is common problem ESRD. This problem especially related with depression and QOL. Thus, sexual function should be evaluated in female subjects to determine its impact on quality of life.     

Buried penis in adults as a complication of circumcision: Surgical management and long-term outcomes

We aimed to evaluate the feasibility and long-term functional outcomes of surgical correction of adult buried penis patients due to complications of childhood circumcision. A retrospective analysis was performed for patients who underwent treatment for buried penis between 1997 and 2019. An autologous split-thickness skin graft (STSG) was used. Surgical management steps included circumcision, resection of the bands between the corpora and other tissues, harvesting of STSG from femoral region and graft application. Surgical and functional outcomes were the primary end points. Thirteen patients were included with a mean age of 22.4 years and median body mass index 27. Patients had similar symptoms, including sexual dysfunction, inadequate penile length, impossible penetration and decreased quality of life. No early post-operative complication was seen. During a median of 44-month follow-up, post-operative long-term complications were seen in 4 (30%) patients: decreased graft sensation (n = 2); graft contracture five months after surgery (n = 1); and retarded ejaculation (n = 1). Patients’ post-operative three-month International Index of Erectile Function (IIEF) score and sexual satisfaction score (SSS) significantly increased compared with patients’ pre-operative scores (IIEF; 22.8 vs. 14.1, p = .03, SSS; 8.7 vs. 3.2, p < .01). Buried penis is a rare but challenging condition. Patients had excellent graft acceptance with successful functional outcomes.     

Efficacy and safety of sildenafil for treating erectile dysfunction in patients on dialysis

OBJECTIVE: To assess the efficacy of sildenafil for erectile dysfunction (ED) in patients on haemodialysis (HD) or peritoneal dialysis (PD), as men with end-stage renal disease (ESRD) often have sexual dysfunction (up to 82% among those on chronic dialysis). PATIENTS AND METHODS: Forty-one patients with ED and in ESRD participated in an open-label prospective study. Thirty patients on HD and 11 on PD were asked to complete the International Index of Erectile Function (IIEF) and Fugl-Meyer life-satisfaction scale before and after sildenafil treatment. A total score in the erectile function domain of < or = 25 was accepted as indicating ED. All patients were started on a 25-mg dose, which was increased to 50 mg if there was no response after two trials. In addition, the overall efficacy question was used to evaluate satisfaction, and patients reported any side-effects during treatment. RESULTS: The erectile function and intercourse satisfaction domains improved significantly in both groups (P < 0.01). After sildenafil treatment, two-thirds of those on HD (20/30) and nine of the 11 on PD recovered their erectile function. The pretreatment scores on the IIEF and four domains (except sexual desire) of those responding were significantly higher than in those not responding (P < 0.05). The satisfaction rate on the overall efficacy question was 80% and 82% for the HD and PD groups, respectively. At least one side-effect was seen in 17 patients (43%); one had severe hypotension in the PD group. Overall, mild headache (seven patients, 18%) and flushing (12, 30%) were reported most often. CONCLUSIONS: Sildenafil is a safe and satisfactory drug for improving erectile function in patients with ESRD. Patients were satisfied whether treated by HD or PD. Pretreatment scores on the IIEF may be useful for predicting the success of treatment.     

Serum uric acid is associated with high blood pressure in pediatric hemodialysis patients

Serum uric acid (UA) is positively associated with hypertension (HTN). HTN is common in pediatric patients receiving hemodialysis (HD) and peritoneal dialysis (PD). We assessed the relationship between UA and BP in 63 pediatric dialysis patients by measuring pre-treatment UA levels and BP in HD patients and in-center UA levels and blood pressure (BP) in PD patients. UA levels were similar in both groups [6.8 ± 0.2 (HD) vs. 6.5 ± 0.3 (PD), p = 0.6]. Pre-treatment systolic BP percentile was associated with a high UA level [91.9 ± 2.3 (>6.0 mg/dL) vs. 79.3 ± 5.8 mm Hg (≤6.0 mg/dL), p = 0.01] in HD patients only. There was a negative relationship between UA and dialysis vintage (r = −0.31, p = 0.01). In both groups, there was no relationship between UA and Kt/V. In HD patients, fluid overload was unrelated to UA level [4.2 ± 0.6% (≤6.0 mg/dL) vs. 4.3 ± 0.3% (>6.0 mg/dL), p = 0.9]. Moreover, pre-HD treatment systolic BP percentile correlated with UA (beta 0.36, p = 0.02) independent of volume. UA levels were higher in patients receiving anti-hypertensive medications [6.3 ± 0.2 (No Meds] vs 7.0 ± 0.2 (BP Meds) mg/dL,  p= 0.01]. Finally, there was no relationship between serum UA and normalized protein catabolic rate (r = 0.14; p = 0.4). In summary, serum UA impacts BP in pediatric HD patients, independent of volume, nutritional and weight status.     

The clinical significance of abnormal ejaculation by silodosin. Is it important?

We aimed to evaluate the effect of the abnormal ejaculation (AEj) on patients using silodosin in terms of drug cessation. We also analysed the possible factors that may affect the decisions of patients with AEj to proceed or change their medication. The patients (n = 118) treated with silodosin 8 mg daily were prospectively analysed. In order to evaluate the erectile function, ejaculatory function, depression and sexual satisfaction; IIEF, MSHQ-EjD, Beck's depression and Golombok-Rust questionnaires were given to patients respectively. Patients were re-evaluated at the 3rd month of their treatment. The rate of AEj was 52.5%. Nearly 42% of the patients with AEj desired to stop their medication whereas it was 7.1% at patients without AEj (p < .001). The pre-treatment International Prostate Symptom Score (IPSS) and the decrease in IPSS score were significantly lower in patients who demand to stop their treatment (p < .05). AEj was significantly higher in patients who wanted to stop their medication (p < .001). Even if they had an AEj, patients who were happy with the clinical efficacy of silodosin did not want to change their drug. In addition to this, pre-treatment ejaculatory status was an important indicator for patients to decide drug cessation due to AEj side effect of silodosin.     

Relationship Between Inflammation and Sex Hormone Profile in Female Patients Receiving Different Types of Renal Replacement Therapy

Background

Patients with end-stage renal disease (ESRD) experience female sexual dysfunction (FSD). The purpose of this study was to compare FSD in different types of renal replacement therapy and control patients.

Methods

The study was consisted of 47 renal transplantation (RT), 46 hemodialysis (HD), and 28 continuous ambulatory peritoneal dialysis (CAPD) patients and 36 healthy control subjects. All groups were evaluated with the following scales: Female Sexual Function Index (FSFI) questionnaire, Short Form (SF)–36 questionnaires, and Beck Depression Inventory (BDI). Demographic data, laboratory values, and hormone levels were obtained. The patients with FSFI score <26.55 were accepted as experiencing sexual dysfunction.

Results

Overall, total FSFI scores in RT, HD, CAPD, and control were 22 (range, 2–35), 22.4 (4–34), 18.35 (2–34), and 29.6 (2–35), respectively. The mean total FSFI score was not different in patients receiving different kinds of renal replacement therapy (P > .05) although they were significantly worse then the control group (P < .001). On regression analysis, age was significantly associated with FSD (β = −0.14; P = .001). In addition, the physiologic health domain of SF-36 was significantly better in control groups (P < .001). The difference in terms of mean of BDI score did not reach statistical significance among patient groups (P > .05). Female sexual dysfunction score was negatively correlated with BDI (r = −0.371; P < .001) and positively correlated with the mental-physical components score of SF-36 (r = 0.423 [P < .001] and r = 0.494 [P < .001], respectively) in all patients groups. Regarding the hormones of the patients, there was a significant difference between RT and the HD and CAPD groups in dihydroepiandrosterone sulfate (DHEAS; P < .001), RT and HD in prolactin (P < .001), and RT and CAPD in free testesterone (P < .001).

Conclusions

Renal transplantation, hemodialysis, and peritoneal dialysis patients were at more risk of developing sexual dysfunction and lower quality of life scores than healthy subjects. Notably, the mode of renal replacement therapy had no impact on female sexual function.     

Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer

Background  Bladder and sexual dysfunction are well-documented complications of rectal cancer surgery. This study aimed to determine whether laparoscopy can improve the outcome of these dysfunctions or not. Methods  The study included 63 of the 116 patients who underwent surgery for rectal cancer between 2002 and 2006. Bladder and male sexual function were studied by means of a questionnaire on the basis of the International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF). In addition, bladder function was determined by means of postvoid residual urine measurement and uroflowmetry. Postoperative functions were compared with the preoperative data to detect subjective functional deterioration. Outcomes were compared between patients who underwent open (group 1, n = 29) and laparoscopic (group 2, n = 34) total mesorectal excision. Results  Only minor disturbances of bladder function were reported for one patient (3%) in group 1 and three patients (9%) in group 2 (p > 0.05). Impotency after surgery was experienced by 6 of 17 preoperatively sexually active males (29%) in group 1 and 1 of 18 males (5%) in group 2 (p = 0.04). Similarly, 5 of 10 women (50 %) in group 1 and 1 of 14 women (7%) in group 2 felt that their overall level of sexual function had decreased as a result of surgery (p = 0.03). Conclusions  Open rectal cancer resection is associated with a higher rate of sexual dysfunction, but not bladder dysfunction, compared with laparoscopic surgery. Laparoscopic rectal cancer surgery offers a significant advantage with regard to preservation of postoperative sexual function and constitutes a true advance in rectal cancer surgery compared with the open technique. The proposed advantages can be attributed to improvement in visibility by the magnification feature of laparoscopic surgery. Presented orally at the 8th National Endoscopic Laparoscopic Surgery Congress, Antalya, Turkey, 1–4 July 2007.     

Erectile function and gonadal hormones levels in men with end‐stage renal disease: It's relevance to duration of haemodialysis

In this study, we evaluated the relationship between haemodialysis (HD) duration and erectile function status and gonadal hormones serum levels in adult men with end‐stage renal disease (ESRD). A total of 118 men with ESRD on chronic HD were eligible for analysis. The erectile dysfunction (ED) was defined and graded according to the international index of erectile function (IIEF‐5) score. The serum levels of follicle stimulating hormones (FSH), luteinising hormone (LH), testosterone (TST), prolactin (PRL) and estradiol (E2) were measured using the standard laboratory technique. The mean age was 48.97 ± 14.68 years and mean duration of HD was 4.58 ± 3.03 years. The overall prevalence of ED was 78.8%; from them 31.2% had severe grade. The prevalence of ED was comparable in HD duration categories [≤5 years (79.7%), 5–10 years (76.5%), >10 years (80.0%); p > 0.05]. The percentage of abnormal serum levels of FSH, LH, TST, PRL, E2 were 5.1%, 1.6%, 18.6%, 90.7% and 0.0% respectively. No significant relationships were observed between HD duration and IIEF‐5 score or gonadal hormones serum levels (p < 0.05). We concluded that HD duration has no effect on erectile function status and gonadal hormones serum levels. Other factors may be relevant to these conditions in this particular group of patients.     

Does obesity based on body mass index affect semen quality?—A meta-analysis and systematic review from the general population rather than the infertile population

Whether obesity affects the quality of semen has become the focus of research. However, there are some deficiencies in the past research, because the vast majority of known infertile patients were included in the study samples. Taking infertile men as the research object to analyse the impact of obesity on semen quality, which cannot accurately prove that the impact on semen quality is caused by obesity, because the impact on semen quality may also be caused by other factors. Therefore, we selected ordinary obese men rather than infertile patients to conduct a systematic review and meta-analysis of the effects of obesity on semen parameters. The results showed that obesity had no effect on sperm concentration (SMD: −0.15, 95% CI: −0.32 ~ 0.02, p = .088) and percentage of normal sperm morphology (SMD: −0.17, 95% CI: −0.66 ~ 0.32, p = .487), but decreased semen volume (SMD: −0.32, 95% CI: −0.52 ~ −0.12, p = .002), total sperm number (SMD: −0.77, 95% CI: −1.31 ~ −0.23, p = .005), percentage of forward progression (SMD: −0.95, 95% CI: −1.7 ~ −0.19, p = .014) and percentage of viability (SMD: −0.812, 95% CI: −1.532 ~ −0.093, p = .027). Therefore, obesity affects semen quality to a certain extent, and maintaining normal weight may be one of the effective ways to improve male fertility.     

Acute stunning effect of hemodialysis on myocardial performance: A three-dimensional speckle tracking echocardiographic study

The effects of acute changes during hemodialysis (HD) on the myocardium are not yet known. The invention of three-dimensional speckle tracking echocardiography (3DSTE) has offered clinicians a new method to assess the movements of ventricular segments simultaneously in three spatial directions. The aim of this study was to evaluate the effect of first weekly standard HD process on the left ventricle (LV) and right ventricle (RV) global and regional myocardial function in patients with normal left ventricle ejection fraction using 3DSTE-derived indices. Patients (n=38) receiving maintenance HD in our clinic who have no known cardiovascular disease are examined just before and after a HD session using 3DSTE. Demographic and comorbidity data, renal replacement treatment characteristics, and laboratory test results are recorded. 3DSTE analysis is performed to calculate the LV global longitudinal, circumferential area and radial peak systolic strain, as well as RV septum and free-wall longitudinal strain and fractional area change. Patients are aged 52.8 ± 13.6 years and 52.6% of them are male. Mean dialysis duration is 56 months. The LV strain values of the patients changed markedly before and after HD (GLS: −14.2 ± 5.2, −11.1 ± 4.6 [P < .001], GCS: −14.8 ± 4.2, −12.4 ± 5.28 [P < .009]; GRS: 41.5 ± 16, 33.3 ± 16.5 [P = .003]; AREA −24.7 ± 7.2, −20.1 ± 7.6 [P = .001], respectively). We could not demonstrate any improvement in RV strain values before or after HD. LV strain values are positively correlated with blood pressure variability during the dialysis sessions. LV function is preserved better after HD in patients on beta or calcium channel blocker therapy compared to those who do not use these agents (P < .001, P < .01, respectively). HD treatment results in deterioration in all LV strain directions but not in RV. Strain assessment may improve vascular risk stratification of patients on chronic HD.     

Is there relationship between serum uric acid levels and lower urinary tract symptoms,prostate volume,and PSA in men without cancer? A prospective population-based study

There are conflicting results about uric acid (UA) effect on the prostate. We investigated the relationship between UA and PSA, free PSA, prostate volume and international prostate symptoms score (IPSS) in benign prostate hyperplasia (BPH). This study was conducted in BPH men without cancer who were referred for annual health workup (N = 910) from 2017 to 2020. The mean ages were 67.28 ± 9.2 years. UA was positively related to IPSS and PSA (r = 0.210, p = .023 and r = 0.156, p = .041 respectively) and also negatively related to free/total PSA ratio (r = −0.332, p = .01) but not related to prostate volume (r = 0.036, p = .696). After adjustment for age, BMI and prostate volume, there were significant relationships between hyperuricaemia and PSA, free/total PSA ratio, and IPSS (95% CI: 0.254–1.645, OR = 0.647, p = .039; 95% CI: 0.076–0.899, OR = 0.270, p = .033 and 95% CI: 1.011–3.386, OR = 1.851, p = .038 respectively). These results should be considered during the general assessment of the patients with BPH. The findings raise the possible hypothesis of relationship between serum UA with IPSS and PSA which should be investigated by future studies.     

Sexual Dysfunction after Elective Endovascular or Hand-Assisted Laparoscopic Abdominal Aneurysm Repair

ObjectiveTo evaluate the incidence of sexual dysfunction and retrograde ejaculation after elective endovascular aneurysm repair (EVAR) and hand-assisted laparoscopic surgery (HALS) for abdominal aortic aneurysm (AAA).MethodsA total of 100 patients eligible for elective repair of infrarenal AAAs were randomised in two groups: EVAR and HALS. The quality of sexual function was evaluated using the International Index of Erectile Function (IIEF), a 15-item questionnaire. Patients completed the IIEF preoperatively and at 12 months. The incidence of retrograde ejaculation was also evaluated.ResultsOne- and 12-month mortality rates were zero. Three patients in the EVAR group (6%) and two patients in the HALS group (4%) reported an erectile dysfunction (p = NS). The quality of sexual function at 1 year was similar in both groups: total score of 66 in the EVAR group versus 68 in the HALS group (p = 0.66). Retrograde ejaculation was detected in three cases in the HALS group versus no case in the EVAR group.ConclusionsThe HALS technique could be a minimally invasive alternative for sexually active males unsuitable for EVAR repair.     

Vascular Dysfunction in ESRD Patients Under Replacement Therapy

Endothelial dysfunction (ED) is an important factor in the pathogenesis of atherosclerosis, which is the major cause of mortality and morbidity in ESRD patients. Endothelium exerts a number of vasoprotective effects, such as vasodilatation, suppression of smooth muscle cell growth, and inhibition of inflammatory responses impairment of endothelial functions can leads to vascular dysfunction. This study involved 25 ESRD patients on regular hemodialysis (HD) (group 1), 15 ESRD patients on intermittent peritoneal dialysis (PD) (group 2) and 20 healthy control subjects (group 3). For all groups complete medical history and thorough examination, biochemical Laboratory tests including renal function tests, calcium, phosphorus, intact PTH and Echocardiography. Endothelial function was assessed by Flow mediated dilatation of the brachial artery (FMD) evaluated non-invasively by B-mode ultrasonography. Comparison of FMD of brachial artery shows significant difference between hemodialysis group and control (p < 0.001), peritoneal dialysis group and control group (p < 0.001), and between hemodialysis and peritoneal dialysis group (p < 0.001). Multiple regression test for brachial artery flow mediated dilatation shows significant correlations with age (p < 0001), serum LDL (p = 0.04), hematocrit value (p < 0.001), serum PTH (P = 0.01) and presence of DM (p = 0.009). No correlation is found with duration of dialysis (p = 0.57), total cholesterol (p = 0.62), serum triglyceride (p = 0.10) nor with calcium phosphorus products (p = 0.08). Endothelial function is impaired in ESRD patients. PD patients had more endothelial dysfunction when compared to HD patients. ED is independently affected by age, LDL, PTH, hematocrit and presence of diabetes mellitus. The main correctable factors affecting ED are Hematocrit, PTH, and LDL.     

Health‐related quality of life after kidney transplantation: who benefits the most?

The influence of dialysis modalities on HRQoL before and after kidney transplantation (KT) and the role of adherence to medication on HRQoL have not been fully studied. Sixty four dialysis patients who answered the 15D HRQoL survey during dialysis were surveyed again after KT. Adherence and employment were also investigated. The mean 15D score was highest among home hemodialysis patients (HHD) and lowest among in‐center hemodialysis patients (icHD). After KT, the mean 15D score improved significantly in 78.6% of peritoneal dialysis patients (PD), 47.6% of HHD, and 53.8% of icHD. Then, mean 15D score remained unchanged in 28.6% of HHD and in 23.1% of icHD patients. A deterioration in the 15D score occurred in 14.3% of PD, 23.1% of icHD, and 23.8% of HHD patients, and this was influenced by the number of pills (P = 0.04). Adherence to medication was the lowest in PD, timing being the most challenging task showing a connection to higher creatinine concentration (never forgot 1.41 mg/dl vs. forgot 2.08 mg/dl P = 0.05). Employed patients had a higher mean 15D score. The icHD and PD patients benefited the most from KT and HHD the least. Low pill burden and employment were linked to a better HRQoL.     

Estimation of residual renal function using beta-trace protein: Impact of dialysis procedures

Beta-trace protein (BTP), a low molecular weight protein of 23-29 kDa, has been proposed as a promising biomarker to estimate residual renal function (RRF) in patients on maintenance hemodialysis (HD). Indeed, BTP is cleared by native kidney but not during conventional HD session. By contrast, the removal rate of BTP using convective processes (mainly hemodiafiltration [HDF]) and peritoneal dialysis (PD) has been little or not investigated. Therefore, an aim of this study was to evaluate the impact of dialysis procedures (high-flux HD, on-line post-dilution HDF and PD) on BTP removal in comparison with beta-2 microglobulin (B2M) and cystatin C (CYSC) removals after a single session. In addition, the ability of BTP to predict RRF in PD was assessed. This observational cross-sectional study included a total of 82 stable chronic kidney disease patients, 53 patients were on maintenance dialysis (with n = 26 in HD and n = 27 in HDF) and 29 were on PD. Serum concentrations of BTP, B2M, and CYSC were measured (a) before and after a single dialysis session in HD and HDF anuric patients to calculate reduction percentages, (b) in serum, 24-hour-dialysate and 24-hour-urine in PD patients to compute total, peritoneal, and urinary clearance. RRF was estimated using four equations developed for dialysis patients without urine collection and compared to the mean of the urea and creatinine clearances in PD. The concentrations of the three studied molecules were significantly reduced (P < .001) after dialysis session with significantly higher reduction ratio using HDF compared to HD modality (P < .001): BTP 49.3% vs 17.5%; B2M 82.3% vs 69.7%; CYSC 77.4% vs 66% in HDF and HD, respectively. In non-anuric PD patients, B2M and CYSC were partly removed by peritoneal clearance (72.3% and 57.6% for B2M and CYSC, respectively). By contrast, BTP removal by the peritoneum was negligible and a low bias for the BTP-based equation to estimate RRF (−1.4 mL/min/1.73 m²) was calculated. BTP is significantly removed by high-flux HD or HDF, thereby compromising its use to estimate RRF. By contrast, BTP appears as a promising biomarker to estimate RRF in PD patients since it is not affected by peritoneal clearance, unlike B2M and CYSC, and it is well correlated to RRF.     

Associated factors with psychological distress in Moroccan breast cancer patients: A cross-sectional study

ObjectivesTo estimate the prevalence of psychological distress (PD) in Moroccan breast cancer patients, and to determine clinical and social demographic factors associated with PD.MethodsIt was a cross-sectional study where we included all female breast cancer patients that did not have other malignancies. Judgment criteria were based on the Hospital Anxiety and Depression Scale (HADS), and the Distress Thermometer (DT). Threshold values of 15 and 3 were fixed to detect patients on PD by the HADS and the DT, respectively. We analyzed data by calculation of Cronbach's alpha coefficient for the reliability of measurements, and by simple and multiple logistic regressions.Results446 women were enrolled. Cronbach's alpha coefficient was 0.801, 0.669 and 0.639 respectively for the HADS, HAD-A and HAD-D questionnaires. 120 patients (26.9%) had a HADS global score ≥15. HAD-A and HAD-D sub-scores were ≥11 in 25 (5.6%) and 30 (6.7%) patients respectively. In multivariate analysis, adjusted for the education level, marital status, taking analgesic and/or anxiolytic treatment, and current treatment type; we found that the occurrence of a distant metastasis [OR = 14.427 p < 0.001], lack of social family support [OR = 4.631 p < 0.001], living a difficult emotional [OR = 2533 p = 0.034] and/or financial [OR = 2.09 p = 0.037] situation, and younger (<50 years) age [OR = 2.398 p = 0.002], were independent associated factors with PD as assessed by the HADS.ConclusionsSocial family support, emotional and financial difficulties should be investigated in all Moroccan breast cancer patients, especially among younger ones, in order to detect those at risk of PD and offer them appropriate support.     

Association between human papillomavirus infection and sperm quality: A systematic review and a meta-analysis

Human papillomavirus (HPV) has a high incidence rate in both males and females. HPV infection in women has been shown to affect fertility and lead to foetal death and pregnancy loss. However, research on HPV infection in men is limited. The aim of this study was to study the effect of HPV infection in semen on sperm quality and present the findings of previous studies through a meta-analysis. Databases including PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, WanFang data and China National Knowledge Infrastructure were searched for relevant studies. A systematic review and meta-analysis were performed, and 17 studies were included for analyses based on a set criterion. Meta-analyses indicated that HPV infection in semen significantly reduced sperm concentration (SMD = −0.12, 95% CI: −0.21 to −0.03, p = .009), sperm motility (SMD = −0.55, 95% CI: −0.780 to −0.33, p = .000), sperm viability (SMD = −0.55, 95% CI: −0.780 to −0.33, p = .000) and sperm morphology (SMD = −0.34, 95% CI: −0.61 to −0.07, p = .015). The high-risk HPV (HrHPV) infection could significantly reduce sperm count (SMD = −0.65, 95% CI: −1.11 to −0.18, p = .007) compared with high-risk HPV (LrHPV) infection. In conclusion, HPV infection in semen significantly reduced sperm quality, and the HrHPV infection could significantly reduce sperm count compared with LrHPV.     

Erectile dysfunction and the effects of sildenafil treatment in patients on haemodialysis and continuous ambulatory peritoneal dialysis.

BACKGROUND: Sexual dysfunction, including erectile dysfunction, is common in patients with uraemia. Despite successful treatment of male sexual dysfunction with sildenafil in non-uraemic population, its efficacy in dialysis patients is unknown. PATIENTS AND METHODS: In this study, 35 male HD patients (mean age 48+/-12 years) and 15 male CAPD patients (mean age 44+/-12 years) were included. In the baseline period, haemoglobin, serum urea, and albumin, Kt/V, several hormonal parameters, Beck depression scale, and penile Doppler blood flow, (peak systolic velocity after intracavernous papaverine administration) were measured. The international index of erectile function (IIEF) form was used to evaluate erectile dysfunction. Sildenafil was given to patients with erectile dysfunction at a dose of 50-100 mg/day twice a week. RESULTS: The percentage of erectile dysfunction was similar between patients on HD (71%) and those on CAPD (80%). Patients with erectile dysfunction were significantly older and had lower free-testosterone serum levels and penile blood flow than those without. In linear regression analysis for baseline IIEF score, penile blood flow was the only independent variable associated with erectile dysfunction. IIEF score increased to a similar extent after sildenafil treatment in both HD patients (from 8.10+/-5.54 to 21.70+/-9.61, P<0.001) and CAPD patients (from 9.90+/-3.87 to 21.60+/-10.18, P=0.011). Changes in IIEF scores after sildenafil treatment were associated with baseline penile blood flow as an independent variable by linear regression analysis. Adverse events observed during sildenafil treatment were dyspepsia in two patients and headache in one patient. CONCLUSION: The rate of erectile dysfunction is high in dialysis patients. Penile blood flow is the most important factor for predicting both the development of erectile dysfunction and the response to sildenafil therapy in such patients. Oral sildenafil is an effective, reliable, well-tolerated treatment for uraemic patients with erectile dysfunction.