Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Enfortumab vedotin shows promise as a targeted therapy for advanced urothelial carcinoma, particularly in patients who have previously received platinum-based chemotherapy and an immune-checkpoint inhibitor. The EV-301 phase III trial demonstrated significantly improved overall survival and response rates compared to standard chemotherapy. However, more data, especially from larger real-world studies, are needed to further assess its effectiveness in Japanese patients. METHODS: A total of 6007 urothelial cancer patients inducted with pembrolizumab as a second-line treatment were analyzed. Among them, 563 patients received enfortumab vedotin after pembrolizumab, while 443 patients received docetaxel or paclitaxel after pembrolizumab, and all were included in the study for efficacy as a life prolonging agent. RESULTS: The enfortumab vedotin group showed a longer overall survival than the paclitaxel/docetaxel group (p = 0.013, HR: 0.71). In multivariate analysis, enfortumab vedotin induction was the independent risk factor for overall survival (p = 0.013, HR: 0.70). There were no significant differences in cancer-specific survival. CONCLUSIONS: Enfortumab vedotin prolonged the overall survival for Japanese advanced or metastatic urothelial carcinoma patients compared to paclitaxel or docetaxel after pembrolizumab treatment.

DOI： 10.3390/cancers15174227

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Publishing type：Research paper (scientific journal)   Publisher：Frontiers Media SA  

Introduction: Several healthy euploid births have been reported following the transfer of mosaic embryos, including both euploid and aneuploid blastomeres. This has been attributed to a reduced number of aneuploid cells, as previously reported in mice, but remains poorly explored in humans. We hypothesized that mitochondrial function, one of the most critical factors for embryonic development, can influence human post-implantation embryonic development, including a decrease of aneuploid cells in mosaic embryos.

Methods: To clarify the role of mitochondrial function, we biopsied multiple parts of each human embryo and observed the remaining embryos under in vitro culture as a model of post-implantation development (n = 27 embryos). Karyotyping, whole mitochondrial DNA (mtDNA) sequencing, and mtDNA copy number assays were performed on all pre- and post-culture samples.

Results: The ratio of euploid embryos was significantly enhanced during in vitro culture, whereas the ratio of mosaic embryos was significantly reduced. Furthermore, post-culture euploid and culturable embryos had significantly few mtDNA mutations, although mtDNA copy numbers did not differ.

Discussion: Our results indicate that aneuploid cells decrease in human embryos post-implantation, and mtDNA mutations might induce low mitochondrial function and influence the development of post-implantation embryos with not only aneuploidy but also euploidy. Analyzing the whole mtDNA mutation number may be a novel method for selecting a better mosaic embryo for transfer.

DOI： 10.3389/fcell.2023.1215626

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PURPOSE: Postoperative sleep disturbances are common. Although several studies have examined the effect of melatonin on postoperative sleep disturbances, the results have not reached any definitive conclusion. We sought to conduct a systematic review to compare the effects of melatonin and melatonin agonists on postoperative sleep quality with those of placebo or no treatment in adult patients who underwent surgery under general or regional anesthesia. METHODS: We searched MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Web of Science, ClinicalTrials.gov, and the UMIN Clinical Trials Registry up to 18 April 2022. Randomized clinical trials examining the effects of melatonin or melatonin agonists in patients undergoing general or regional anesthesia with sedation for any surgery were eligible for inclusion. The primary outcome was sleep quality measured using a visual analog scale (VAS). The secondary outcomes were postoperative sleep duration, sleepiness, pain, opioid consumption, quality of recovery, and adverse events. A random-effects model was used to combine the results. We assessed study quality with the Cochrane Risk of Bias Tool version 2. We applied a trial sequential analysis to assess the precision of the combined results. RESULTS: Eight studies (516 participants) were analyzed for sleep quality. Of those, four studies used only a short duration of melatonin, either on the night before and the day of surgery or only on the day of surgery. A random-effects meta-analysis showed that melatonin did not improve sleep quality measured by VAS compared with placebo (mean difference, -0.75 mm; 95% confidence interval, -4.86 to 3.35), with low heterogeneity (I2, 5%). Trial sequential analysis revealed that the accrued information size (n = 516) reached the estimated required information size (n = 295). We downgraded the certainty of the evidence because of the high risk of bias. The effect on postoperative adverse events was comparable between the melatonin and control groups. CONCLUSION: Our results indicate that melatonin supplementation does not improve postoperative sleep quality measured with the VAS compared with placebo in adult patients (GRADE: moderate). STUDY REGISTRATION: PROSPERO (CRD42020180167); registered 27 October 2022.

DOI： 10.1007/s12630-023-02442-1

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With advances in cancer treatment, such as cytotoxic chemotherapy and radiotherapy, grave new sequelae of treatment have emerged for young cancer survivors. One sequela that cannot be overlooked is male infertility, with reportedly 15% to 30% of cancer survivors losing their fertility potential. Cytotoxic therapy influences spermatogenesis at least temporarily, and in some cases, permanently. The degree of spermatogenesis impairment depends on the combination of drugs used, their cumulative dose, and the level of radiation. The American Society of Clinical Oncology has created an index to classify the risks to fertility based on treatment. Medical professionals currently use this risk classification in fertility preservation (FP) programs. FP programs are currently being promoted to prevent spermatogenesis failure resulting from cancer treatment. For patients who are able to ejaculate and whose semen contains sperm, the semen (sperm) is cryopreserved. Moreover, for patients who lack the ability to ejaculate, those with azoospermia or severe oligozoospermia, and those who have not attained puberty (i.e., spermatogenesis has not begun), testicular biopsy is performed to collect the sperm or germ cells and cryopreserve them. This method of culturing germ cells to differentiate the sperm has been successful in some animal models, but not in humans. FP has recently gained popularity; however, some oncologists and medical professionals involved in cancer treatment still lack adequate knowledge of these procedures. This hinders the dissemination of information to patients and the execution of FP. Information sharing and collaboration between reproductive medicine specialists and oncologists is extremely important for the development of FP. In Japan, the network of clinics and hospitals that support FP is expanding across prefectures.

DOI： 10.5534/wjmh.220102

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s12630-023-02442-1

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Other Link： https://link.springer.com/article/10.1007/s12630-023-02442-1/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Varicocelectomy is well known to improve the pregnancy outcome of patients with clinical varicoceles in assisted reproductive technologies as well as spontaneous conception. Therefore, this study aimed to evaluate the additional effects of oral antioxidant therapy after varicocelectomy on the pregnancy outcome in the assisted reproductive technology setting. METHODS: This study was a retrospective cohort study. The subjects were couples among whom the male partner had undergone varicocelectomy and was scheduled for subsequent assisted reproductive technology. Pregnancy outcomes were followed retrospectively in 62 couples with male partners who received tocopherol (antioxidant group) and 37 couples who did not (control group). The tocopherol and control groups were assigned dependent on the decision of the physician in charge and the patient's request. The clinical pregnancy rates per couple and embryo transfer, time to pregnancy, and the number of cycles during transfer to pregnancy were evaluated. RESULTS: No significant differences were observed in the pregnancy rate per couple (antioxidant group 70.9% vs. control group 64.9%, P = 0.55) and per embryo transfer (50.4% vs. 39.6%, P = 0.22). Regarding the time to event analyzed by adjusted restricted mean survival time, the mean time to pregnancy was significantly shorter in the antioxidant (tocopherol) group (14.2 vs. 17.4 months, P = 0.025). No significant difference was observed in the embryo transfer cycle to pregnancy (mean embryo transfer cycles: 2.6 vs. 3.0, P = 0.238). CONCLUSIONS: Additional oral tocopherol nicotinate as antioxidant therapy after varicocelectomy was shown to shorten the time to pregnancy. It is recommended that add-on effects be tested in more well-designed randomized controlled trials to examine whether it improves assisted reproductive outcomes.

DOI： 10.3389/frph.2023.1325566

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Introduction: Malignant bone and soft tissue tumors, commonly called sarcomas, predominantly originate in bone and soft tissues and typically affect individuals at a younger age. Following the resection of the primary tumor, treatment often necessitates radiation therapy and gonadotoxic chemotherapy, the specifics of which depend on the disease's stage Conversely, there is a notable concern regarding the potential loss of fertility due to these treatments. Consequently, it is recommended that men consider sperm cryopreservation before initiating treatment. This study aims to assess spermatogenesis in male patients diagnosed with malignant bone and soft tissue tumors before and after chemotherapy. Methods: This study involved 34 male patients diagnosed with malignant bone and soft tissue tumors and subsequently underwent sperm cryopreservation before initiating treatment. Medical records included details about the primary disease, age, marital status at presentation, semen analysis results, treatment regimen and number of courses, post-treatment semen analysis, renewal status and outcomes. Results: The mean age at the time of sperm cryopreservation was 22.8 years. The median semen volume was 2.5 mL, sperm concentration was 32.6 million/ml, and sperm motility was 38.5%. Following chemotherapy, semen analysis was conducted on 12 patients, with ifosfamide being the predominant drug used in all cases. Among these 12 patients, eight retained viable spermatozoa, and two successfully achieved spontaneous pregnancies resulting in live births. In one of the remaining four cases where no sperm were detected in ejaculate, a live birth was achieved through intracytoplasmic sperm injection using cryopreserved sperm. Discussion: While ifosfamide, the primary chemotherapy drug for patients with malignant bone and soft tissue tumors, was associated with severe impairments in spermatogenesis, recovery of spermatogenesis was observed in many cases. However, there were instances of prolonged azoospermia. Even in such cases, assisted reproduction using cryopreserved sperm remained viable for achieving parenthood. In light of these findings, offering patients the opportunity for fertility preservation is advisable.

DOI： 10.3389/fphar.2023.1324339

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/iju.15047

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The ALSYMPCA trial revealed radium-223 (Ra-223) to be a life-prolonging agent for bone metastatic castration-resistant prostate cancer (CRPC). However, only 2.8% of enrolled patients in that clinical trial were Asian, and no Japanese patients were enrolled. Several retrospective studies have been published concerning Japanese bone metastatic CRPC patients receiving Ra-223. However, no study has yet reported the correlation between Ra-223 induction and the survival in Japanese bone metastatic CRPC patients. This study investigated the effect of Ra-223 as a life-prolonging agent in a large Japanese healthcare fee database. METHODS: A total of around 410 000 prostate cancer patients were extracted from this database, and 25 934 were diagnosed with CRPC. In these patients, the age, date of the CRPC diagnosis, date of Ra-223 induction, and prognosis were analyzed. RESULTS: A total of 1628 patients received Ra-223, and 6693 patients were diagnosed with bone metastasis CRPC, with the remaining 17 613 patients diagnosed with CRPC without bone metastasis. The patients who completed six courses of Ra-223 showed a significantly more favorable overall and cancer-specific survival than those who received ≤5 courses (p < 0.0001 and p < 0.0001, respectively). For time from CRPC diagnosis date to death, the Ra-223 induction group showed a significantly more favorable prognosis with regard to both the overall and cancer-specific survival than the bone metastatic CRPC patients without Ra-223 (p < 0.0001 and p < 0.0001, respectively). CONCLUSIONS: Bone metastatic CRPC patients who received Ra-223 showed a significantly better prognosis than bone metastatic CPRC patients who did not receive Ra-223.

DOI： 10.1111/iju.15008

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Introduction: We report a case series of six patients with a chief complaint of infertility who underwent microsurgical varicocelectomy for intratesticular varicocele (ITV) after undergoing orchiopexy for undescended testis in their childhood. Case presentation: The patients' median age was 34 years. The median age at which orchiopexy was performed was 4.5 years. All the cases of ITV were accompanied by extratesticular varicocele (ETV). All the patients underwent a microsurgical subinguinal varicocelectomy. At 3 months after operation, the ITV and ETV had disappeared in all the cases. Sperm density and motility increased in five and four patients, respectively. Conclusion: ITV occurs at a relatively high frequency after orchiopexy for undescended testis. Disorder of the valvular function of the testicular vein in peeling the testicular vessels was thought to be a primary cause and is often found on the left side. Doppler ultrasonography of the testis is considered important for diagnosis.

DOI： 10.1002/iju5.12498

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. MATERIALS AND METHODS: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic's Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. RESULTS: Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA's. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. CONCLUSIONS: Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.

DOI： 10.5534/wjmh.210191

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PURPOSE: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. MATERIALS AND METHODS: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. RESULTS: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. CONCLUSIONS: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

DOI： 10.5534/wjmh.220048

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OBJECTIVE: To evaluate the efficacy of keishibukuryogan, a traditional Kampo formula known to be an anti-Oketsu (impaired microcirculation and non-physiological blood congestion) drug, in combination with an anti-oxidant for the treatment of varicoceles. METHODS: We retrospectively analyzed 119 patients with palpable and subclinical varicoceles who were treated with 7.5 g/day of keishibukuryogan and 600 mg/day of tocopherol nicotinate. Their motile sperm concentrations at the start of medication and after 3 months were compared. As a subgroup analysis, a comparison test was carried out between patients with a high-grade varicocele and those with a low-grade varicocele. RESULTS: The mean age of the study patients was 35.6 years. Among them, 17, 41, 44 and 17 had subclinical, grade 1, grade 2 and grade 3 varicoceles, respectively. Overall, the differences in motile sperm concentration (millions/mL) before and after treatment were not significant (median 0.58, 95% confidence interval -0.12 to 1.56; P = 0.115). The results of the subgroup analysis showed that the motile sperm concentration in patients with a low-grade varicocele significantly increased (median 1.21, 95% confidence interval 0.45-2.47; P = 0.024); however, no significant improvements were seen in patients with a high-grade varicocele. CONCLUSIONS: The results of the present study showed that the combination of keishibukuryogan and an anti-oxidant had a limited effect on varicoceles, but they suggest that it is effective for the treatment of low-grade varicoceles.

DOI： 10.1111/iju.14746

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Language：English   Publishing type：Research paper (scientific journal)  

Klinefelter syndrome and monozygotic twins are both rare. The reports of monozygotic twins with Klinefelter syndrome to have undergone fertility treatment are uncommon. This case report describes a case of 30-year-old monozygotic adult twin brothers diagnosed with nonmosaic Klinefelter syndrome following the complaint of infertility. The result of semen analysis showed cryptozoospermia (very low sperm count) and azoospermia (zero sperm count) with physical findings and lifestyles being very similar. They both underwent microtesticular sperm extraction. One had successful sperm retrieval and achieved pregnancy through intracytoplasmic sperm injection, whereas the other did not. Testicular pathological findings showed Sertoli cell-only syndrome. To the best of our knowledge, this is the first report on monozygotic adult twins both of whom underwent microtesticular sperm extraction and resulted in different outcomes.

DOI： 10.1111/and.14266

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DOI： 10.4103/aja2021112

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PURPOSE: In this pilot study, the authors compared the effects of antioxidant co-supplementation therapy and methylcobalamin therapy in patients with impaired semen quality. METHODS: Eighty-four subjects who visited male infertility clinics and showed abnormal semen test results were randomly subjected to one of the two therapies: antioxidant co-supplementation therapy with vitamin C, vitamin E, coenzyme Q10, and flaxseed oil or methylcobalamin therapy. The oxidation-reduction potential (ORP) and 8-hydroxy-2'-deoxyguanosine levels were used as indicators of oxidative stress levels in semen. Semen analysis was also performed. RESULTS: The authors obtained results from 67 patients who had completed 3 months of treatment. Neither antioxidant co-supplementation therapy nor methylcobalamin therapy changed the semen parameters significantly (except for the sperm concentration, which was increased by the latter therapy). When the pre-treatment ORP value in semen was higher than the cutoff value, both therapies significantly increased the sperm concentration. The 8-hydroxy-2'-deoxyguanosine level did not yield any meaningful predictive value with regard to increased sperm concentrations. CONCLUSIONS: Both antioxidant co-supplementation therapy and methylcobalamin therapy increased the sperm concentration in patients with impaired semen quality when the basal ORP levels in their semen were elevated.

DOI： 10.1002/rmb2.12450

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BACKGROUND: Newly emerging serious post-treatment complications among young male cancer survivors involve fertility and sexual function, preventing them from pursuing a normal family life. METHODS: We studied and summarized published studies that assess the relationship between cancer treatments and reduced spermatogenesis or sexual dysfunction. MAIN FINDINGS: Infertility often occurs because of anticancer therapies that impair spermatogenesis. While some patients postremission functionally recover fertility, others experience a decreased sperm count and azoospermia. Fertility-preserving modalities are currently being promoted worldwide to preserve spermatogenesis following cancer therapy. Patients who can ejaculate and have sperm in their semen should cryopreserve semen. However, for patients who have never ejaculated before puberty or in whom spermatogenesis has not been established, testis biopsy is performed to collect and preserve sperm or germ cells. Fertility preservation is gaining popularity and requires continuous information dissemination to oncologists and cancer treatment professionals. Furthermore, male sexual dysfunction predominantly involves erectile dysfunction and ejaculation disorder. CONCLUSION: Although preventive and therapeutic methods for these disorders have been established within urology, patients and medical professionals in other fields remain uninformed of these advances. Therefore, dissemination of information regarding fertility preservation techniques should be accelerated.

DOI： 10.1002/rmb2.12481

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English  

DOI： 10.1002/iju5.12378

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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DOI： 10.1111/iju.14678

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INTRODUCTION: The circadian rhythm of melatonin secretion is disturbed after general anaesthesia, leading to postoperative sleep disturbance. Small studies investigating the preventive effect of melatonin administration on postoperative sleep disturbance have not reached any conclusions. Therefore, we will conduct a systematic review and meta-analysis to obtain conclusive results. METHODS AND ANALYSIS: We prepared this protocol following the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines. We will conduct a search for randomised controlled trials that evaluated the effect of melatonin and melatonin agonists on postoperative sleep quality in adult patients undergoing general anaesthesia or regional anaesthesia with sedation. We will exclude patients undergoing regional anaesthesia without sedation. Relevant studies will be searched in the following eight databases: MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Web of Science and four preregistration sites from inception to 1 January 2021. No language restrictions will be applied. Two authors will independently scan and select eligible studies and perform data extraction and assessment of the risk of bias. The Visual Analogue Scale scores for sleep quality will be combined as the mean difference with a 95% CI using a random-effect model; we will use I2 to assess heterogeneity. We will evaluate the quality of trials using the Cochrane methodology and assess the quality of evidence using the Grading of Recommendation Assessment, Development and Evaluation approach. If appropriate, trial sequential analysis will be performed. ETHICS AND DISSEMINATION: No ethical approval is required for this meta-analysis, as it does not include individual patient data. We will disseminate the results of this meta-analysis in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020180167.

DOI： 10.1136/bmjopen-2020-047858

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Language：Japanese   Publisher：医学図書出版(株)  

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Background: Between 30% and 80% of patients with male infertility produce excessive reactive oxygen species (ROS) in their ejaculate even though the cause of male infertility is unexplained in approximately half of cases. The strong connection between oxidative stress (OS) and male infertility has led recent investigators to propose the term "Male Oxidative Stress Infertility (MOSI)" to describe OS-associated male infertility. Methods: We searched the PubMed database for original and review articles to survey the effects of OS on male infertility, and then verified the effects and treatments. Main findings: Seminal plasma contains many antioxidants that protect sperm from ROS, because low amounts of ROS are required in the physiological fertilization process. The production of excessive ROS causes OS which can lower fertility through lipid peroxidation, sperm DNA damage, and apoptosis. Several assays are available for evaluating OS, including the MiOXSYS® analyzer to measure oxidation-reduction potential. Several measures should be considered for minimizing OS and improving clinical outcomes. Conclusion: Accurately diagnosing patients with MOSI and identifying highly sensitive biomarkers through proteomics technology is vital for better clinical outcomes.

DOI： 10.1002/rmb2.12353

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Background: At present, one out of six couples is infertile, and in 50% of cases, infertility is attributed to male infertility factors. Genetic abnormalities are found in 10%-20% of patients showing severe spermatogenesis disorders, including non-obstructive azoospermia. Methods: Literatures covering the relationship between male infertility and genetic disorders or chromosomal abnormalities were studied and summarized. Main findings Results: Genetic disorders, including Klinefelter syndrome, balanced reciprocal translocation, Robertsonian translocation, structural abnormalities in Y chromosome, XX male, azoospermic factor (AZF) deletions, and congenital bilateral absence of vas deferens were summarized and discussed from a practical point of view. Among them, understanding on AZF deletions significantly changed owing to advanced elucidation of their pathogenesis. Due to its technical progress, AZF deletion test can reveal their delicate variations and predict the condition of spermatogenesis. Thirty-nine candidate genes possibly responsible for azoospermia have been identified in the last 10 years owing to the advances in genome sequencing technologies. Conclusion: Genetic testing for chromosomes and AZF deletions should be examined in cases of severe oligozoospermia and azoospermia. Genetic counseling should be offered before and after genetic testing.

DOI： 10.1002/rmb2.12336

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Introduction: Post-orgasmic illness syndrome is a rare condition that occurs after ejaculation and persists for 2-7 days and is characterized by flu-like symptoms, which can significantly reduce quality of life. Case presentation: A 21-year-old unmarried man was referred to our hospital due to flu-like symptoms that developed after ejaculation by masturbation and persisted for about 2 days. The patient's free testosterone level was slightly lower than normal. Nonsteroidal anti-inflammatory drugs were initially administered and helped relieve headache and muscle pain. Thereafter, the patient was able to ejaculate three times a week. In addition, after administering testosterone enanthate once or twice a month, his general fatigue significantly improved, and he could ejaculate every day. Conclusion: The pathophysiology of post-orgasmic illness syndrome has not been fully elucidated. The treatments for this condition must be accurately selected according to pathophysiology.

DOI： 10.1002/iju5.12184

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Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞人工知能(AI)の医療分野への進出は目覚ましく,生殖医療分野も例外ではない。ARTにおいてはすでに胚の発育などからの妊娠予測,グレード分類などで応用が始まっている。これをICSI時の精子の選別に応用できないか,われわれは研究を続けている。現在までにAIにより精子を認識することは可能となり,ICSIに適した精子の選別,TESE時の探索補助のシステム開発を行っている。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00535&link_issn=&doc_id=20200602180012&doc_link_id=10.18888%2Fsp.0000001272&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fsp.0000001272&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞はじめに 人工知能(artificial intelligence: AI)とは通常「コンピュータが人間と同じような情報処理を行うシステム」と考えられているが,実際のところ厳密な定義はなく,人のもつ知的な情報処理をするソフトウェア全体のことを指し,情報を獲得し処理,そこから問題を自ら判断・解決していく能力をもつ.すでにさまざまな分野で応用されており,医療の分野でも近年のコンピュータ技術の進歩やビッグデータ処理技術の向上により,画像診断・病理診断の分野で人間よりもはるかに短時間に診断を下せるようになりつつある.われわれはAIを用いて生殖補助医療(assisted reproductive technology: ART)のなかで精子の探索・選別を行うためのシステム開発・研究を行っている.今回はこれまでの経緯と,現在進行中の研究について紹介する.

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01564&link_issn=&doc_id=20200619060015&doc_link_id=10.11477%2Fmf.1409210067&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1409210067&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Advanced treatments have improved the prognosis of cancer survivors. Anticancer drugs generate large amounts of cellular reactive oxygen species (ROS), but their direct effects on sperm ROS production are unclear. We examined 64 semen samples of men who had received cancer chemotherapy, 467 semen samples of men consulting for idiopathic infertility, and 402 semen samples of partners of female patients as a control group. ROS production was calculated as the integrated chemiluminescence between 0 and 200 seconds after the addition of luminol to unwashed semen. We found that their ROS-positive rate of semen samples in the chemotherapy group was significantly higher than that in the control group. We compared the sperm parameters (concentration and motility) and the ROS production levels between chemotherapy subgroups and one of the remaining subgroups with positive ROS, and we found that only sperm motility was significantly lower in the samples in the postchemotherapy subgroup than in the idiopathic infertility subgroup, and that both sperm parameters were significantly lower in those from postchemotherapy subgroup than in the control subgroup. The ROS production level per million spermatozoa in the postchemotherapy subgroup was significantly higher than that in the control subgroup. Additionally, we compared variables, such as age, sperm features, and the duration from the end of the treatment to the first consultation between ROS-positive and ROS-negative subgroups in samples from men in the postchemotherapy group, but we found no significant differences. Of the men in the postchemotherapy group, three underwent a long-term antioxidant therapy, and all of them had low ROS semen levels after that. In conclusion, the production of ROS in semen detected by chemiluminescence from men who undergo cancer chemotherapy is similar to that of men with idiopathic infertility, and long-term oral antioxidant therapy may reduce the amount of ROS in the semen.

DOI： 10.3390/antiox8100449

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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DOI： 10.1016/j.fertnstert.2019.07.484

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Language：Japanese  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(一社)日本性機能学会  

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Language：English  

Introduction: Iatrogenic ureteral injury is sometimes seen in daily clinical practice, and gynecological surgery carries the highest risk of ureteral injury among iatrogenic surgical ureteral injury. Case presentation: A 61-year-old woman was referred to our department for right ureteral stricture and hydronephrosis after total hysterectomy. We initially attempted ureteral stenting, but hydronephrosis redeveloped 1 month after ureteral stent removal. We performed ureteroscopy via an antegrade approach and successfully incised and dilated the ureter. Conclusion: We encountered a case of severe ureteral stenosis after total hysterectomy that was successfully treated endoscopically using ureteroscopy via an antegrade approach.

DOI： 10.1002/iju5.12061

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DOI： 10.1159/000501716

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Urethral stenosis is a disease in which the lumen of the urethra becomes constricted by fibrosis. Such stenoses have been treated by urethral dilation using a bougie and optical internal urethrotomy (OIU). Recently, high-pressure balloon dilation (BD) has been developed as a new treatment method for urethral stenosis. The present study compared the effectiveness of urethral dilation by BD and OIU. METHODS: Twenty-two patients of urethral stenosis were treated at Yokohama City University Medical Center between 2005 and 2015. Of these, 13 underwent BD, whereas OIU was performed in 9. BD was performed at 30 atm twice for 5 min each time. In OIU, an endoscopic knife was used to cut out the stenotic lesion in 3 directions. The endpoint was set as restenosis, which required additional surgical treatment, including BD, OIU, and the use of a urethral bougie. RESULTS: The causes of urethral stricture were endoscopic surgery (n = 7; 31.8%), development after total prostatectomy (n = 4; 18.2%), iatrogenic reasons associated with catheter insertion (n = 5; 22.7%), development after a prostate needle biopsy (n = 3; 13.6%), and unknown (n = 3; 13.6%). The site of the stenotic lesion site was the anastomosis (n = 3; 13.6%), bladder neck (n = 6; 27.3%), prostatic urethra (n = 4; 18.2%), anterior urethra (n = 7; 31.8%), and membranous urethra (n = 2; 9.1%). The stenosis-free rate was 84% for those undergoing BD and 22% for those receiving OIU. The median stenosis-free time was significantly longer after BD than OIU (1675 vs. 244 days, respectively; P < .01). CONCLUSION: The stenosis-free time was significantly longer after BD than OIU.

DOI： 10.1111/luts.12208

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Language：English  

Introduction: Testicular epidermal cysts in Klinefelter syndrome are very rare. We report a case of Klinefelter syndrome associated with a testicular epidermal cyst. To our knowledge, this is the first report showing successful spermatozoa retrieval from the affected testis. Case presentation: A 25-year-old married man was referred to our hospital with right scrotal induration, which was in lower pole of the right testis. Testicular cancer tumor markers were normal; endocrinological findings indicated hypergonadotropic hypogonadism. Semen analyses revealed azoospermia. Preoperative chromosome test result: 47, XXY karyotype; ultrasonography report: 1.9-cm internal heterogeneous echoic mass in the right testis (malignancy not discarded). Because the patient hoped for children, he underwent high orchiectomy with ipsilateral testicular sperm extraction (200 spermatozoa from normal testicular tissue) for future fertilization procedures. Tumor pathology was an epidermal cyst. Conclusion: While performing orchiectomy for testicular tumors, sperm retrieval should be attempted from normal tissues in patients planning for children.

DOI： 10.1002/iju5.12037

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Institute of Electrical Engineers of Japan  

Automatic sperm detection is in high demand for supporting Testicular Sperm Extraction (TESE). On the other hand, detection of sperms in samples of TESE is difficult because there are a lot of germ cells resembling sperms. This paper realizes automatic sperm detection for TESE by using Adaptive Thresholded Boosting (ATBoost) which is robust to overlap of feature distributions between positive samples and negative samples. In this paper, we evaluated our sperm detection method in two stages from the view point of robustness to the overlap. First, we quantitatively evaluated the overlap of the feature distributions in TESE in the metric of Bayes error rate. Second, we evaluated robustness of our sperm detection method as for the overlap. These two results show that our sperm detection method is very effective for TESE.

DOI： 10.1541/ieejeiss.139.1461

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Bentham Science Publishers B.V.  

Background: Renal transplantation is a useful option for allowing female renal failure patients of childbearing age to achieve pregnancy. However, there have been a few reports on the effects of renal transplantation on infertility treatment in male renal failure patients. We herein report two cases in which male patients underwent infertility treatment after renal transplantation. Case Presentation: Case 1: A 51-year-old Asian (Japanese) man underwent transplantation (the donor was his wife) for renal failure due to Autosomal Dominant Polycystic Kidney Disease (ADPKD). At two years after transplantation, he visited the reproduction center in our institute due to infertility. A semen analysis revealed oligoasthenozoospermia. He ultimately failed to achieve pregnancy and gave up on infertility treatment. Case 2: A 47-year-old Asian (Japanese) man underwent renal transplantation (the donor was his sister) due to renal failure caused by diabetes mellitus. At three years after renal transplantation, he visited the reproduction center in our institute for infertility. Due to ejaculation disability and the absence of sperm in the patient’s urine after masturbation, he was diagnosed with anejaculation. Thus, testicular sperm extraction (TESE) was performed. Twenty-three motile spermatozoa were successfully retrieved by microdissection TESE (micro-TESE). ICSI was subsequently performed and a good embryo was transferred. His wife achieved pregnancy and is expected to deliver this October. Conclusion: We report two cases of male infertility treatment after renal transplantation.

DOI： 10.2174/1874303X01912010001

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Blackwell Publishing Ltd  

Klinefelter syndrome is a condition in which a male patient has one Y chromosome and one or more extra X chromosomes. It is the most common sex chromosome disorder. Klinefelter syndrome is distinguished by many clinical features, such as infertility, high gonadotropin and low testosterone levels, increased height, and sparse body and facial hair. We report the case of a 32-year-old man who visited our hospital complaining of male infertility. Semen analysis showed azoospermia, and chromosomal analysis revealed a 47,XY,i(X)(q10) karyotype, which is a rare variant of Klinefelter syndrome. No spermatozoon was found on microdissection testicular sperm extraction, and the testis biopsy histology showed only Sertoli cells and hyalinised seminiferous tubules. 47,XY, i(X)(q10) has an additional isochromosome made of the long arm of the X chromosome, which shares some features of classical Klinefelter syndrome in many aspects, but patients are usually shorter than average height and have normal intelligence. In addition, to the best of our knowledge, no successful sperm extractions from 47,XY, i(X)(q10) patients were reported in the literature. The reports of patients who have undergone microdissection testicular sperm extraction are very rare. Further reports and studies of this chromosomal abnormality are needed.

DOI： 10.1111/and.13024

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Language：English   Publishing type：Research paper (scientific journal)  

Oxidative stress is a primary cause of vascular endothelial damage. In the prostate, ischemia increases the levels of reactive oxygen species, growth factors and cytokines, and induces the development of angiogenesis, which results in cancer progression. The expression levels of an oxidative stress marker, 8-hydroxyguanosine (8-OHdG), were compared between prostate cancer and non-neoplastic prostate tissues. A prostate tissue microarray composed of 10 cases of prostatic adenocarcinoma and 70 cases of benign prostatic hyperplasia was immunohistochemically stained for 8-OHdG. All cases expressed 8-OHdG. The levels of 8-OHdG expression in prostatic cancer (30.0% moderate and 70.0% strong) were significantly higher than those in benign prostatic hyperplasia (71.4% moderate and 28.6% strong; (p<0.01). Notably, 8-OHdG is expressed more highly in prostate cancer tissues in comparison to benign prostate tissues.

DOI： 10.3892/mco.2018.1665

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Aspergillosis in patients with impaired immunity usually presents with invasive pulmonary infection and dissemination to a variety of organs via hematogenous spread. Aspergilloma in the retroperitoneal cavity is a rare disease with only a few cases reported in the literature. To the best of our knowledge, the present case of a retroperitoneal aspergilloma with no surgical history is only the second report in the literature. CASE PRESENTATION: A 65 year-old man, who had been receiving immunosuppressive treatment for rheumatoid arthritis with vasculitis for 9 years, was referred to the Urology Department with a retroperitoneal mass. This was confirmed by computed tomography performed during treatment for pulmonary aspergilloma. Because it was not possible to rule out malignant disease (e.g., liposarcoma), surgical exploration was performed. Pathological examination revealed aspergillus hyphae with fat necrosis, and retroperitoneal aspergilloma was diagnosed and appropriately treated. The tumor did not recur subsequently. CONCLUSION: Our present case emphasizes that pharmacological treatments for aspergilloma in the retroperitoneal cavity have poor drug transitivity, so the relative effectiveness of pharmacological response is not useful for differentiating retroperitoneal aspergilloma from malignant disease.

DOI： 10.1186/s12894-018-0381-0

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Korean Society for Reproductive Medicine  

We report the case of a 46-year-old Chinese male patient who visited our clinic complaining of infertility. Semen analysis revealed azoospermia, and azoospermia factor c region partial deletion (b1/b3) was detected using Y chromosome microdeletion analysis. Testicular sperm extraction was performed after genetic counseling. The bilateral ductus deferens and a portion of the epididymis were absent, whereas the remaining epididymis was expanded. Motile intratesticular spermatozoa were successfully extracted from the seminiferous tubule. On histopathology, nearly complete spermatogenesis was confirmed in almost every seminiferous tubule. To our knowledge, this is the first case report of b1/b3 deletion with a congenital bilateral absence of the vas deferens and almost normal spermatogenesis.

DOI： 10.5653/cerm.2018.45.1.48

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Korean Society for Reproductive Medicine  

Onco-testicular sperm extraction is used to preserve fertility in patients with bilateral testicular tumors and azoospermia. We report the case of a testicular tumor in the solitary testis of a patient who had previously undergone successful contralateral orchiectomy and whose sperm was preserved by onco-testicular sperm extraction. A 35-year-old patient presented with swelling of his right scrotum that had lasted for 1 month. His medical history included a contralateral orchiectomy during childhood. Ultrasonography revealed a mosaic echoic area in his scrotum, suggesting a testicular tumor. The lesion was palpated within the normal testicular tissue along its edge and semen analysis showed azoospermia. Radical inguinal orchiectomy and onco-testicular sperm extraction were performed simultaneously. Motile spermatozoa were extracted from normal seminiferous tubules under microscopy and were frozen. Eventual intracytoplasmic sperm injection using the frozen spermatozoa is planned. Onco-testicular sperm extraction is an important fertility preservation method in patients with bilateral testicular tumors or a history of a previous contralateral orchiectomy.

DOI： 10.5653/cerm.2018.45.1.44

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

Prostate basal cell carcinoma (PBCC) accounts for 0.01% of all prostate cancers. A 68-year-old man complained of dysuria for 5 years on his initial visit. His PSA level was 3.87 ng/mL. Due to a diagnosis of benign prostate hyperplasia, he underwent transurethral resection of the prostate. A pathological examination revealed that basal cell-like atypical cells made alveolar with palisadal layout. Immunohistochemical analysis showed positive 34β12, P63, and Ki-67. Based on these findings, PBCC was diagnosed. Then, we performed radical prostatectomy. He was free from recurrence 22 months after the operation. We herein report an extremely rare case of PBCC.

DOI： 10.1159/000487389

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：IEEE  

This research aims to realize sperm selection support system for assisted reproductive technology. Sperm detection is one of the important component technology. High detection rate is required even the expense of false positive detections so as not to miss promising sperms as much as possible. False positive rate control is key technology for assure high detection rate and adaptive threshold adjustment methods in boosting is proposed. Our experiments evaluate and compare adaptive thresholding method and normal thresholding method as for detection rate and false positive rate of sperm detection.

DOI： 10.1109/SMC.2018.00339

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Publishing type：Research paper (international conference proceedings)   Publisher：IEEE  

DOI： 10.1109/SMC.2018.00339

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Language：Japanese   Publisher：医学図書出版(株)  

精索静脈瘤に対する顕微鏡下低位結紮術33例の初期治療成績につき検討した。年齢は35.5±6.5歳(平均±標準偏差)。術前運動精子濃度は1.9±2.0M/mL、術後3・6ヵ月の運動精子濃度は5.5±8.0M/mL(P<0.014)、6.5±7.8M/mL(P<0.002)と有意な改善がみられた。明らかな合併症を認めなかった。諸家の報告通り、顕微鏡下低位結紮術は安全かつ良好な治療効果が期待できる。(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

BACKGROUND: Paraganglioma is an extra site of pheochromocytoma. Paraganglioma in the bladder is a very rare disease accounting for 0.06% of all bladder tumors. CASE PRESENTATION: A 77-year-old Japanese man was referred to our department for the further examination of a bladder tumor detected on preoperative computed tomography of his gastric cancer. Cystoscopy revealed a submucosal tumor in the upper area of his bladder, so transurethral resection of the bladder tumor was performed. During transurethral resection of the bladder tumor, his blood pressure sharply increased, and a pathological examination showed paraganglioma in his bladder. Postoperative I-123-metaiodobenzylguanidine scintigraphy detected a higher intake of his bladder tumor. Laboratory examinations showed a slightly increased noradrenaline level of 530 pg/ml and reduced platelet count at 167,000/μL. Based on the progression of his gastric cancer, no additional therapy was performed on his bladder tumor. Eight months after surgery, he died from aspiration pneumonitis. CONCLUSIONS: Here we report a rare case of paraganglioma in the bladder. We discuss paraganglioma based on previous studies.

DOI： 10.1186/s13256-017-1473-2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ediciones Doyma, S.L.  

In the above published article, errors have been detected in the values of motility and concentration, and also in the caption of Figure 2. The corrected values are: Motility 0.538 Concentration 0.641 The corrected figure caption is: Figure 2 The scatterplots of the relationship between SMI and each semen parameter using the Spearman correlation coefficient. There was significant correlation between SMI and motility (ρ = 0.538), concentration (ρ = 0.641), straight-line velocity (VSL) (ρ = 0.352), curvilinear velocity (VCL) (ρ= 0.360), mean amplitude of lateral head displacement (mALH) (ρ = 0.60), and progressive motility (PM) (ρ = 0.578), respectively (p ≤ 0.001).

DOI： 10.1016/j.androl.2017.09.001

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：John Wiley and Sons Ltd  

Purpose: To determine whether reactive oxygen species (ROS) in semen samples could be measured with the Monolight™ 3010 Luminometer. Methods: Using the Monolight™ 3010 Luminometer, the ROS was measured in the unprocessed semen samples of infertile male patients, as well as the luminescence of 190 semen samples. The samples were classified as "luminescence-detectable" (n = 89) and "luminescence-undetectable" (n = 101). Thereafter, the luminescence of the semen samples that had been obtained from the 715 infertile patients was measured and compared by using Sperm Motility Analyzing System measurements. Moreover, in order to investigate the ROS measurement consistency, the chemiluminescence values of 84 samples were measured concurrently by using the Monolight™ 3010 Luminometer and the 1251 Luminometer™. Results: The semen volume, sperm motility, and progressive motility of the samples were significantly higher in the luminescence-undetectable samples. The sperm motility, straight-line velocity, curvilinear velocity, mean amplitude head displacement, beat cross frequency, and progressive motility showed an inverse correlation with the logarithmic-transformed luminescence level in the luminescence-detected samples. The integrated chemiluminescence levels in the 84 samples were correlated. Conclusion: The substance that was measured in the unprocessed semen with the Monolight™ 3010 Luminometer and stimulated chemiluminescence is ROS.

DOI： 10.1002/rmb2.12052

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)西日本泌尿器科学会  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER DOYMA SL  

Objective: To investigate the relationship between the Sperm Motility Index and the presence Reactive oxygen of reactive oxygen species, in semen.
Methods: We retrospectively analyzed Sperm Motility Index measured by the Sperm Quality Sperm Motility Index Analyzer and reactive oxygen species levels in 92 semen samples of infertile male patients who visited the Ebina Ladies' Clinic between September 2011 and June 2012. Using the same semen samples, we also analyzed 8 sperm parameters measured by computer-assisted semen analysis and validated the relationship with the Sperm Motility Index.
Results: The presence of reactive oxygen species in semen was positive in 19 samples and negative in 73 samples. In the reactive oxygen species-positive group, there was a significant negative correlation between the logarithm of reactive oxygen species level and Sperm Motility Index (p = 0.039).
Conclusions: This is the first study to find a significant negative correlation between Sperm Motility Index and reactive oxygen species level. This result indicates that the presence of reactive oxygen species in semen may inhibit the fertilization ability of spermatazoa as measured by the Sperm Motility Index. (C) 2016 Asociacion Espanola de Andrologia, Medicina Sexual y Reproductiva. Published by Elsevier Espana, S.L.U. All rights reserved.

DOI： 10.1016/j.androl.2016.08.002

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS INC  

Density gradient centrifugation can separate motile sperm from immotile sperm and other cells for assisted reproduction, but may also remove antioxidants from seminal plasma, resulting in oxidative stress. Therefore, we investigated reactive oxygen species (ROS) concentrations and distribution in semen before and after density gradient centrifugation. We assessed semen volume, sperm concentration, sperm motility, and ROS levels before and after density gradient centrifugation (300 x g for 20 minutes) in 143 semen samples from 118 patients. The ROS removal rate was evaluated in ROS-positive samples and ROS formation rate in ROS-negative samples. Thirty-eight of 143 untreated samples (26.6%) were ROS-positive; sperm motility was significantly lower in these samples than in ROS-negative samples (p < 0.05). After density gradient centrifugation, only seven of the 38 ROS-positive samples (18.42%) exhibited a ROS-positive lower layer (containing motile sperm) with a ROS removal rate of 81.58%, whereas the upper layer was ROS-positive in 24 samples (63.16%). In the ROS-negative group (n = 105), ROS was detected in 19 samples after centrifugation (18.10%, ROS generation rate), of which 18 were ROS-positive only in the upper layer or interface and the other was ROS-positive in both layers. Density gradient centrifugation can separate motile sperm from immotile sperm as well as remove ROS (including newly generated ROS). This data supports the view that density gradient centrifugation can select motile spermatozoa without enhancing oxidative stress. ABBREVIATIONS: ROS: reactive oxygen species; SOD: superoxide dismutase; GPx: glutathione peroxidase; DNA: deoxyribonucleic acid; DGC: density gradient centrifugation; IUI: intrauterine insemination; IVF: in vitro fertilization; HEPES: 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid; EDTA: ethylenediaminetetraacetic acid; HTF: HEPES-buffered human tubal fluid; IMSI: intracytoplasmic morphologically selected sperm injection; SMAS: sperm motility analyzing system; CASA: computer-assisted semen analyzer; WHO: World Health Organization.

DOI： 10.1080/19396368.2017.1294214

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Language：Japanese   Publisher：医学図書出版(株)  

男性不妊症の多くは薬物療法が必要である。今回われわれは薬物療法を行った男性不妊症患者66名を対象とし、治療効果と治療後の妊娠有無について検討した。平均年齢は38.4歳で66例中34例が治療有効で、13例(38.2%)に妊娠が認められた。一方、治療無効の32例での妊娠は6例(18.8%)であった。薬物療法で精液所見が改善した群では改善しなかった群と比較して有意差はないものの高い妊娠率(P=0.069)を認めており、不妊治療に男性不妊診療が介入するメリットは十分にあると考えられた。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

BACKGROUND: Most patients with testicular cancer are infertile; thus, the preservation of the sperm after surgery is an important factor to consider. We report two cases of bilateral testicular cancer in patients who underwent bilateral higher orchiectomy and simultaneous testicular sperm extraction. CASE PRESENTATION: Two Asian-Japanese men were referred to our hospital with bilateral testicular tumors. Both of the patients were preoperatively diagnosed with azoospermia and requested testicular sperm extraction at the time of higher orchiectomy. In one patient, sperm was successfully harvested and then frozen. In the other patient, sperm could not be retrieved from the patient's testis. In both patients, the pathological diagnosis was seminoma. Testicular tumors often occur in patients of reproductive age. The preservation of sperm before chemotherapy or bilateral orchiectomy is necessary for patients with testicular tumors who wish to be fathers. CONCLUSIONS: Onco-testicular sperm extraction might be an option for patients with testicular cancer and azoospermia or severe oligospermia.

DOI： 10.1186/s13256-017-1303-6

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDKNOW PUBLICATIONS & MEDIA PVT LTD  

This study investigated the correlation between sperm motion parameters obtained by a computer- assisted semen analyzer and levels of reactive oxygen species in unwashed semen. In total, 847 patients, except for azoospermic patients were investigated. At the time of each patient's first consultation, semen parameters were measured using SMAS (TM) or CelISoft 3000 (TM), and production of reactive oxygen species was measured using a computer- driven LKB Wallac Luminometer 1251 Analyzer. The patients were divided into two groups: reactive oxygen species - positive and negative. The semen parameters within each group were measured using one of the two computer- assisted semen analyzer systems and then compared. Correlations between reactive oxygen species levels and sperm motion parameters in semen from the reactive oxygen species - positive group were also investigated. Reactive oxygen species were detected in semen samples of 282 cases (33.3%). Sperm concentration (P &lt; 0.01; P &lt; 0.01), motility (P &lt; 0.01; P &lt; 0.05), and progressive motility (P &lt; 0.01; P &lt; 0.01) were markedly lower in the reactive oxygen species - positive group than in the reactive oxygen species - negative group. Among the sperm motion parameters in the reactive oxygen species - positive group, sperm concentration (P &lt; 0.01; P &lt; 0.01), motility (P &lt; 0.05; P &lt; 0.01), mALH (P &lt; 0.05; P &lt; 0.01), and progressive motility (P &lt; 0.05; P &lt; 0.01) also showed inverse correlations with the logarithmic transformed reactive oxygen species levels. Therefore, this study demonstrated that excessive reactive oxygen species in semen damage sperm concentration, motility, and other sperm motion parameters.

DOI： 10.4103/1008-682X.173933

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SCI PRINTERS & PUBL INC  

OBJECTIVE: To evaluate the efficacy of varicocele repair in patients with nonobstructive azoospermia.
STUDY DESIGN: Ten patients with nonobstructive azoospermia and clinical varicoceles who underwent varicocele repair were retrospectively investigated. According to the postoperative appearance of motile spermatozoa in the ejaculate, the patients were divided into 2 groups: Responder and Nonresponder. The outcomes of each group were investigated.
RESULTS: There were 4 (40%) patients in the Responder group. Serum follicle -stimulating hormone levels were significantly higher in the Nonresponder group than in the Responder group (19.9 +/- 6.4 IU/mL vs. 10.8 +/- 4.0 IU/mL, p &lt;0.05). Mean sperm concentration was 5.4 million spermatozoa/mL in the Responder group. One patient achieved a spontaneous pregnancy, and another achieved an assisted pregnancy. In the Nonresponder group 5 patients underwent microdissection testicular sperm extraction (micro-TESE) postoperatively. In 1 patient, motile spermatozoa were successfully retrieved. Histopathological findings in the other 4 patients were Sertoli-cell-only.
CONCLUSION: The present study suggested that var-icocele repair could be considered in men with non obstructive azoospermia who have clinical varicoceles. Moreover, varicocele repair seemed to improve sperm retrieval rate during microTESE for those in the Non responder group.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

A 66-year-old male was referred to our hospital for further examination of a scrotal mass. Because of the risk of testicular cancer, we first clamped the vessels as a course of higher orchiectomy. Then, we approached the tumor through the scrotum and successfully resected it while preserving the testis. A histopathological diagnosis revealed an epidermal cyst. We herein report a rare case of an intrascrotal epidermal cyst successfully treated while preserving the testis.

DOI： 10.1159/000445826

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

The patient was a 33-year-old man attending the infertility clinic with primary infertility of 3 years duration. The semen examination showed oligozoospermia and suspected primary male infertility. He had a history of chronic sinusitis and respiratory disease. His chest X-ray showed dextrocardia. Abnormality of the ultrastructure of the cilia of the tract epithelium was found by electron microscopy, and further examination revealed bronchoectasis. We gave him a diagnosis of Kartagener syndrome from these findings. Kartagener syndrome consists of bronchiectasis, sinusitis and situs inversus and is considered a form of primary ciliary dyskinesia (PCD). PCD is also a cause of motor impairment of sperm flagella. This case had successful in-vitro fertilization pregnancy with spermatozoa from the patient.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

This study included 10 patients who had developed mumps orchitis previously and had visited our hospital from January 1997 to November 2007. The present illness, testicular volume and semen analysis of 7 of these patients were retrospectively investigated. Semen analyses and pregnancy statuses were followed up over time. The mean age of the 7 patients was 33 years (range, 21-43 years). Four patients had unilateral (right side) orchitis, and three had bilateral orchitis. In the unilateral orchitis group, 1 patient had an atrophic testis. Findings of semen analysis were severe oligozoospermia in three and mild oligozoospermia in one. None of the patients in the bilateral orchitis group, had atrophic testes. Findings of semen analysis were azoospermia in one and severe oligozoospermia in two patients. Findings of semen analysis in most patients improved gradually, and wives of 2 patients eventually achieved pregnancy. Dysfunction of seminiferous tubules in the diseased testis is thought to be reversible when treated adequately in the initial phase. In the patients not conceiving successfully, testicular sperm extraction (TESE) and assisted reproductive technique (ART) are thought to be effective ways to achieve pregnancy.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

A 43-year-old man came to our clinic complaining of infertility and semen analysis showed azoospermia. Analysis of chromosomes showed a mosaic 45, XO/46, X, +marl/46, X, +mar2 karyotype, and the marker chromosomes were considered to be two kinds of ring Y chromosomes. Y chromosome microdeletion analysis showed partial deletion of Azoospermie Factor (AZF) a, and complete deletion of AZFb and AZFc. The patient gave up having a child because these results indicated that no sperm would be collected even if Testicular Sperm Extraction (TESE) were performed.

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

A 51-year-old man visited our hospital with a chief complaint of left renal mass detected by ultrasonography in another hospital. Enhanced computed tomography (CT) revealed a hypovascular tumor measuring about 9 cm in the left kidney, tumor thrombus in the inferior vena cava and paraaortic lymph nodes metastases. Radical left transperitoneal nephrectomy with removal of the thrombus from the left renal vein were performed. Paraaortic lymph nodes dissection was partially performed because of the solid adhesion to aorta. Histological examination revealed collecting duct carcinoma (CDC). He was treated with systemic chemotherapy (gemcitabine plus nedaplatin) followed by sunitinib. Duration of stable disease after initiation of therapy was seventeen months, and survival after surgery was 31 months. It would be worthwhile to prospectively evaluate the antitumor activity of tyrosine kinase inhibitors against metastatic CDC.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

A 50-year-old woman complaining of right flank pain visited our hospital. Computed tomography revealed adrenal gland tumor measuring 10 cm in diameter, and multiple bone and liver metastases. It was diagnosed as a malignant pheochromocytoma by means of endocrinological examination and metaiodobenzylguanidine scintigraphy. Although 8 courses of cyclophosphamide, vincristine and dacarbazine therapy were performed, the tumor grew larger gradually, and the bony pain progressed and became uncontrollable with oxycodone hydrochloride. After zoredronic acid and strontium-89 were administered, the bony pain reduced, and the opioid usage could be reduced. In accordance with disease progression, the bony pain progressed again, but the readministration of strontium-89 could diminish the pain again. To our knowledge, this is the first case of malignant pheochromocytoma which strontium-89 was administered, and was effective.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

We investigated 470 male patients who came to the Reproduction Medical Center of Yokohama City University Medical Center complaining of infertility between April 2, 000 and August 2013. We analyzed the chromosomes of 90 patients whose sperm concentration was below 1.0 × 107/ml. Nineteen of the 90 (21.1%) patients showed sex chromosomal anomalies including 12 Klinefelter syndrome (47, XXY or 46, XY/47, XXY), Robertsonian translocation, 2 autosome-autosome translocation, Y-autosome translocation, 46, X with marker chromosome (46, Xmar+), XX male and Y chromosome macrodeletion (46, XYq-). While patients with chromosomal abnormalities except XX male or some of 46, XYq-may succeed in reproduction using testicular sperm extraction- intracytoplasmic sperm injection, we need to inform the patients about the risks of chromosomal abnormalities in the resulting fetus.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We report a case of Henoch-Schonlein purpura that developed after radical cystectomy. The patient was a 70-year-old man who visited our hospital with a chief complaint of asymptomatic macroscopic hematuria and was diagnosed with invasive bladder cancer. After providing one course of gemcitabinc and cisplatin therapy as neoadjuvant chemotherapy, radical cystectomy was performed. Due to postoperative formation of an abscess just beneath the rectus abdominis muscle, the patient was administered antibiotic treatment. Purpura developed on postoperative day 23, and was diagnosed as Henoch-Schonlein purpura based on skin biopsy. Symptoms disappeared approximately 3 weeks later, after initiating treatment with diaphenylsulfone and prednisolone.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 46-year-old man complaining of infertility was referred to our hospital. He was diagnosed with oligozoospermia, asthenozoospermia and hyperprolactinemia probably induced by sulpiride for depression, because semen quality gradually improved after cessation of sulpiride administration. Five months after the cessation, his serum prolactin level declined to the normal level, and his wife achieved spontaneous pregnancy.

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

症例は64歳男性で、貧血精査のためのCTで左腎癌、多発肺転移と診断され経腰的根治的左腎摘出術を行った。病理診断は腎細胞癌、淡明細胞型、G3、V(+)、ly(-)、pT3bN0(腎静脈腫瘍塞栓)であった。術後IFNαを導入するも、頭痛精査のMRIで多発脳転移を認め、4ヵ月に2回のガンマナイフを行った。5ヵ月目に右腎転移も出現し、第2薬としてスニチニブを導入した。胸部単純CTで両肺に多発肺転移を認め、腹部単純CTで3cm大の右転移が認められた。スニチニブ50mg/日で導入し、ガンマナイフ後より脳浮腫予防で内服のプレドニゾロン15mg/日を徐々に漸減し13日目より5mg/日とした。13日目より発熱、腎機能障害を認め、スニチニブによる副作用と判断し15日目よりスニチニブを休薬した。16日目より呼吸困難が出現し胸部CTで両肺野に瀰漫性間質影・網状影が認められた。間質性肺疾患を疑い、気管支肺胞洗浄、気管支鏡肺生検を行った。BALの細胞分画でリンパ球増加を認め、細菌検査では感染性肺炎を示唆する所見はなかった。TBLBの病理組織所見では均一に肥厚した肺胞隔壁にリンパ球主体の浸潤を認め、スニチニブによる間質性肺疾患と考えられた。休薬10日目の胸部CTで間質性陰影は消失しプレドニゾロン併用の上、スニチニブを減量し再開した。間質性肺疾患の再燃なく経過したが脳転移が認められた。腫瘍の進行と判断し、スニチニブを中止し、第3薬としてeverolimusを投与中である。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J01269&link_issn=&doc_id=20121005420004&doc_link_id=40019429492&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F40019429492&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 64-year-old Japanese man who presented with a lelt renal mass (diameter, 9 cm) and multiple lung metastases, underwent translumbar left radical nephrectomy. Histological examination revealed the presence of clear cell-type, G3, pT3b renal cell carcinoma. Interferon-alpha (IFN-α) was administered postoperatively. Although the lung metastases were well controlled, radiological examination showed right renal metastasis and multiple brain metastases. yKnife was performed and chemotherapy was changed to sunitinib (50 mg/day). The patient developed a high fever on day 13
therefore, sunitinib administration was stopped on day 15. The next day, he presented with dyspnea, and chest computed tomography (CT) showed diffuse ground-glass opacities in both lungs. Bronchioalveolar lavage showed a predominance of lymphocytes, without any evidence of infection. We diagnosed the patient with interstitial lung disease (grade 3) attributable to sunitinib administration. After cessation of sunitinib therapy, chest CT showed that the shadows had resolved. We administered half of the previous dose of sunitinib 2 weeks after cessation of sunitinib therapy for complete resolution of the lung metastases. After the 2nd course of sunitinib, radiological examination showed tumor progression. Therefore, we replaced sunitinib with everolimus. Interstitial lung disease due to snitinib therapy may be rare
however, its occurrence should be considered when administering sunitinib.

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

81歳男性。66歳時に膀胱癌に対して膀胱全摘術+両側尿管皮膚瘻造設術を施行、病理診断はG2pT2pN0であり、M-VACによる化学療法2コース施行後は再発もなく経過していた。今回、難治性の亀頭部紅斑が出現して来院、尿道洗浄液の細胞診を行なったところclass IVで、尿道内の再発が疑われた。生検により病理所見は尿道内には明らかに腫瘍性を疑う所見はみられなかったが、亀頭発赤部には異型細胞の孤在性あるいは集簇した増殖があり、続発性Paget病が疑われ、原因は膀胱癌と考えられた。以後、治療として経会陰的尿道摘除術を施行した結果、亀頭部の病理所見からPaget細胞が確認され、免疫学的染色ではcytokeratin 7とcytokeratin 20の陽性が認められた。但し、尿路上皮癌からの続発性Paget病を示唆する所見であるも皮下組織への浸潤は認められず、尿道内も粘膜には腫瘍は認められなかった。これらのことから、本症例は非連続性の亀頭部続発性Paget病と診断された。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J01269&link_issn=&doc_id=20120809420007&doc_link_id=40019362516&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F40019362516&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

An 81-year-old man had undergone total cystectomy and bilateral ureterocutaneostomy at the age of 66 years. Furthermore, no recurrence or metastasis was observed
but at the age of 80 years he observed a painless rash around the external urethral orifice. As urothelial cancer was suspected, the urethra and glans were biopsied. Through immunohistochemical staining (cytokeratin 7 and 20), the glans biopsy indicated secondary Paget's disease of transitional epithelial origin. A urethrectomy was performed as progression from the urethra was suspected. The pathological examination revealed Paget cells at the glans, but the tumor was not observed permeating into the corpus cavernosum. This presents a rare case of secondary Paget' s disease originating from a bladder tumor, and appearing in the glans without intraurethral progression.

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 35-year-old man with a complaint of right scrotal swelling was referred to our hospital. He had received testicular sperm extraction several times due to azoospermia. He received a high orchiectomy, and the pathological findings showed the tumor was pure seminoma. From the normal testicular tissue, sperm cells were extracted. Intracytoplasmic sperm injection was performed but the fertilization was not accomplished.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Clinical observations were made on 40 males with chlamydial urethritis at Yokohama City University Medical Center from January 2000 to March 2007. Three patients had positive reaction to chlamydial PCR without pus in the urine or any other symptom with their partners' positive reaction to chlamydial PCR. Nine (22.5%) of forty patients did not appear after their first medical examination. Single oral dose of 1,000 mg of azithromycin was useful. To prevent the spread of chlamydial urethritis, explanation of the importance of second visit seems to be necessary. (Rinsho Hinyokika 63 : 597-600, 2009).

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Language：Japanese   Publisher：医学図書出版(株)  

症例は63歳男性。発熱、会陰部痛にて当科受診。会陰から陰茎根部に発赤、圧痛を伴う腫脹を認めた。血液検査では炎症所見と高血糖を認め、糖尿病に伴う陰茎海綿体炎の診断で抗生剤投与とインスリン療法を開始した。解熱は得られたが疼痛、腫脹は改善しないため、超音波検査、MRI、試験穿刺を行い、陰茎海綿体膿瘍と診断した。切開排膿術施行し、症状は改善した。術後一年間、膿瘍の再発を認めない。(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

症例は41歳、男性。主訴は右季肋部痛。腹部CTにて後腹膜腔に巨大な腫瘤を認めた。画像上は悪性を否定しえないため後腹膜開放腫瘍生検・切除術を施行した。病理組織診断では、後腹膜に発生した炎症性偽腫瘍であり、原因は胆嚢結石症に対して施行した腹腔鏡下胆嚢摘出術時の落下胆石によるものと判明した。(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.99.443_2

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Language：Japanese  

A 30-year-old man present with infertility for 2 years. Magnetic resonance imaging (MRI) revealed two right testes in the scrotum and inguinal region, respectively. Semen analysis revealed cryptozoospermia. Polyorchidism was considered to have caused spermatogenic dysfunction and male infertility. We performed right high orchiectomy and simultaneous testicular sperm extraction on the same testis. To our knowledge, this is the first case of testicular sperm extraction performed for patients with polyorchidism.

DOI： 10.14989/ActaUrolJap_65_10_425

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Language：Japanese   Publisher：(一社)日本性機能学会  

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Language：Japanese   Publisher：日本遺伝カウンセリング学会  

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Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞人工知能(AI)は人のような知的な情報処理を実現するソフトウェアやプログラムであり,すでに医療の分野にも応用され始めている。われわれは顕微授精(ICSI)の精子選別におけるAIの応用が培養士の業務負担軽減につながると考え,精子選別支援システムの開発を行っている。AIによる精子認識は偽陽性率が高いなどの課題はあるもののスピーディーに行うことができており,現在は良好精子を選別するためのデータ蓄積・訓練を行っている。本システム開発が培養士の精子同定作業をサポートできる可能性は十分あると考えられ,今後さらに精度を高めて,よりよいシステムの開発を目指していきたい。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00535&link_issn=&doc_id=20190626060017&doc_link_id=10.18888%2Fsp.0000000886&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fsp.0000000886&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(NPO)日本がん・生殖医療学会  

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Language：Japanese   Publisher：金原出版(株)  

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Language：English   Publisher：ELSEVIER DOYMA SL  

DOI： 10.1016/j.androl.2017.09.001

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

症例は31歳男性。2年間の不妊および精液量の減少を主訴に当科受診。血液検査でLH、FSH、teststeroneがいずれも低値であり、Male hypognadotropichypogonadism(MHH)が疑われた。LH-RH負荷試験でLH、FSHともに低反応であり、MHHと診断となった。精査目的の頭部MRIでトルコ鞍内に腫瘍を認め、脳神経外科に紹介経蝶形骨洞手術を施行され、Rathke嚢胞の診断となった。第10病日に経過良好にて退院となった。(著者抄録)

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：国立病院総合医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

当院・関連施設を受診したムンプス精巣炎罹患後の造精機能障害7例について検討した。精巣容積については1例で片側精巣の萎縮をきたしていたものの、他の精巣は正常大であった。精液所見では両側例3例のうち無精子症は1例で、残る2例は乏精子症であった。片側例4例では、3例が高度乏精子症、1例が軽度の乏精子症であった。1例を除き6例は精液検査の測定が精巣炎罹患より6ヵ月以内と比較的急性期であり、ライディッヒ細胞機能低下を伴う造精機能障害がみられたが、その後の精液検査では片側例では全例、両側例では2例で精子濃度の改善を、また片側例3例、両側例2例で運動率の改善を認めた。妊娠成立の転帰が判明したものは2例(28.6%)で、うち1例は配偶者が自然妊娠し、他の1例はビタミンB12製剤の内服を継続し、体外受精にて配偶者が妊娠に至った。

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：金原出版(株)  

不妊を主訴に精液検査を行った549名1329検体を対象に、ルミノールによる化学発光法を用いてROSを定量的に測定し、各種精液検査パラメータとの相関について検討した。その結果、ROS陽性検体は481検体(36.2%)であった。ROS陽性群は陰性群と比べ、有意に運動率および頭部振幅の低下を認めた。さらにROS値と有意な負の相関を認めた精液検査パラメータは、精子濃度、運動率、曲線速度、頭部振幅であった。

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2014393480

Language：Japanese   Publisher：泌尿器科紀要刊行会  

50歳女。初診の約2年前より右季肋骨部腫瘤を放置していたが、今回、右季肋部痛が出現して転移性肺腫瘍を認め、悪性褐色細胞腫が疑われた。所見では血中および尿中アドレナリン・ノルアドレナリン濃度ともに著明に上昇しており、副腎シンチグラフィ(I123-MIBG)から副腎発生の悪性褐色細胞の多発、骨転移と診断された。全身化学療法としてcyclophosphamide、vincristine、dacarbazine併用のCVD療法にて血中カテコールアミン濃度は減少したが、CVD療法2コース中に全身の骨痛の増悪がみられ、これに対しベースのオピオイドとして徐放性塩酸オキシコドンを、レスキューとして速放性塩酸オキシコドン内服を開始し増量も行ったが疼痛のコントロールは不良であった。そこで、多岐にわたる疼痛部位に対し除痛効果を期待し、ゾレドロン酸の投与と共にストロンチウム-89を74MBq投与したところ、骨髄抑制はgrade 1以上は認められなかった。一方、CVD療法は継続されたが、転移巣の増大と骨痛増強は変わらず、5コース終了よりは徐放性塩酸オキシコドンの副作用と思われる吐気や便秘が増強し、患者の希望によりストロンチウム-89を再投与することとなった。その結果、改善が得られ、徐放性塩酸オキシコドンの減量が可能となり、レスキュー薬を使用せず、CVD療法は8コースまで続けられた。しかし以後、骨髄抑制の増悪と原発巣と転移巣増大に伴う腫瘍出血が生じ、濃原赤血球および血小板輸血を施行したが、患者は最終的に全身状態の悪化で死亡となった。

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

51歳男。健診で左腎腫瘍を指摘後、著者らの施設へ紹介となった。腹部ダイナミックCTでは左腎髄質より腎の造影効果の低い最大径9cmの腫瘍が認められ、内部には中心性壊死と思われるlow density areaを確認された。更に腎静脈内には腫瘍塞栓を伴い、一部が下大静脈まで達して腎門部に多発する最大径19mmのリンパ節腫大が認められ、臨床病期はT3bN2M0であった。以上、これらの所見を踏まえ、根治的左腎摘出術および腫瘍栓摘出術を施行したところ、病理組織所見では腎盂粘膜は悪性変化の乏しい集合管癌(pT3bN2、G2&gt;3)であった。そこで、この集合管癌に対して入院の上で化学療法GN療法(ゲムシタビン 1500mg/day、ネダプラチン 75mg/day)を2コース行なった。しかし、終了時には傍大動脈リンパ節はほぼ不変であったことから、外来通院にてスニチニブ投与を4週間内服させ、2週間の休薬のスケジュールで11コース(治療開始17ヵ月)行ない、傍大動脈リンパ節はSDが得られた。一方、多発肝転移が出現したため薬剤の変更が検討されたが、患者の希望によりスニチニブは継続された。その結果、傍大動脈リンパ節は約10%の縮小したが、15コース目(治療開始23ヵ月)に著明な甲状腺機能低下を来し、レボチロキシンナトリウムの追加投与が行われ、16コース以降はスニチニブの減量投与も継続された。だが、24ヵ月後、癌性腹膜炎による腹水貯留を認め、腹腔穿刺とスニチニブの継続にて対処したが、全身状態の悪化で18コース目に中止、緩和的対応を試みるも、患者は最終的に治療開始より2年7ヵ月目に死亡となった。

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会  

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Language：Japanese   Publisher：医学図書出版(株)  

症例は45歳、女性。自転車同士の衝突で腹部にハンドルを打撲し受傷。CT上、後腹膜血腫あり当院救急搬送となった。搬送時、バイタルサインは比較的安定していたが腹部造影CTにて深在性右腎損傷、および造影剤の血管外漏出および著明な後腹膜血腫を認めた。その後血圧低下をきたしたため緊急TAEを施行し、血圧は安定したが、後腹膜への尿溢流および発熱が持続したため経皮的後腹膜ドレナージを施行。また、腎動態シンチグラフィーにて尿路の途絶あり、開放手術を行い腎修復を試みるも困難につき、腎摘出に至った。(著者抄録)

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

症例は46歳男性で、1年間の不妊を主訴に、婦人科にて乏精子症・精子無力症を指摘され、当科紹介となった。初診時の精液所見および血中プロラクチン濃度検査より、原因としてスルピリドによる薬剤性高プロラクチン血症が考えられたため、同薬剤を内服中止とした。内服中止2ヵ月後には精液所見の改善を認め、その後、配偶者は自然妊娠するに至った。

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(株)医学書院  

症例は74歳,男性。関節リウマチに対し21年間シクロホスファミドの投与を受けていたが,出血性膀胱炎・萎縮膀胱により回腸導管による尿路変向術施行。その3年後,外尿道からの出血を主訴に来院。遺残膀胱に腫瘍を認めたためTUR-BTを施行したが,浸潤性膀胱癌の診断にて膀胱全摘術に至った。自験例は,本邦における28例目のシクロホスファミド誘発性と思われる尿路上皮癌症例である。(著者抄録)

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2012040979

Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(株)医学書院  

症例は35歳,男性。主訴は右精巣腫大。無精子症にて精巣内精子採取(TESE)を複数回施行し,徐々に精巣腫大を自覚した。軽度の腫瘍マーカー上昇を認め,悪性を否定し得ないため右高位精巣摘出術を施行した。病理組織診断では精上皮腫であったが,正常精巣組織からは精子細胞が採取されたため,これを培養し,卵実質内精子注入法(ICSI)を行ったところ,受精卵を得たが妊娠は成立しなかった。(著者抄録)

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2010307045

Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会  

DOI： 10.5980/jpnjurol.99.395_1

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Language：Japanese   Publisher：神奈川県医師会  

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Presentation type：Poster presentation  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Symposium, workshop panel (nominated)  

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Presentation type：Oral presentation (general)  

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Presentation type：Poster presentation  

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Presentation type：Symposium, workshop panel (nominated)  

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Presentation type：Symposium, workshop panel (nominated)  

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