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المؤلفون: Tharakan, Tharu, Corona, Giovanni, Foran, Daniel, Salonia, Andrea, Sofikitis, Nikolaos, Giwercman, Aleksander, Krausz, Csilla, Yap, Tet, Jayasena, Channa N., Minhas, Suks
المصدر: Human Reproduction Update EpiHealth: Epidemiology for Health. 28(5):609-628
مصطلحات موضوعية: aromatase inhibitors, gonadotrophins, hypergonadotropic hypogonadism, non-obstructive azoospermia, selective oestrogen receptor modulators, testicular extraction sperm surgery, Medicin och hälsovetenskap, Klinisk medicin, Reproduktionsmedicin och gynekologi, Medical and Health Sciences, Clinical Medicine, Obstetrics, Gynecology and Reproductive Medicine
الوصف: BACKGROUND: The beneficial effects of hormonal therapy in stimulating spermatogenesis in patients with non-obstructive azoospermia (NOA) and either normal gonadotrophins or hypergonadotropic hypogonadism prior to surgical sperm retrieval (SSR) is controversial. Although the European Association of Urology guidelines state that hormone stimulation is not recommended in routine clinical practice, a significant number of patients undergo empiric therapy prior to SSR. The success rate for SSR from microdissection testicular sperm extraction is only 40-60%, thus hormonal therapy could prove to be an effective adjunctive therapy to increase SSR rates. OBJECTIVE AND RATIONALE: The primary aim of this systematic review and meta-analysis was to compare the SSR rates in men with NOA (excluding those with hypogonadotropic hypogonadism) receiving hormone therapy compared to placebo or no treatment. The secondary objective was to compare the effects of hormonal therapy in normogonadotropic and hypergonadotropic NOA men. SEARCH METHODS: A literature search was performed using the Medline, Embase, Web of Science and Clinicaltrials.gov databases from 01 January 1946 to 17 September 2020. We included all studies where hormone status was confirmed. We excluded non-English language and animal studies. Heterogeneity was calculated using I2 statistics and risk of bias was assessed using Cochrane tools. We performed a meta-analysis on all the eligible controlled trials to determine whether hormone stimulation (irrespective of class) improved SSR rates and also whether this was affected by baseline hormone status (hypergonadotropic versus normogonadotropic NOA men). Sensitivity analyses were performed when indicated. OUTCOMES: A total of 3846 studies were screened and 22 studies were included with 1706 participants. A higher SSR rate in subjects pre-treated with hormonal therapy was observed (odds ratio (OR) 1.96, 95% CI: 1.08-3.56, P = 0.03) and this trend persisted when excluding a study containing only men with Klinefelter syndrome (OR 1.90, 95% CI: 1.03-3.51, P = 0.04). However, the subgroup analysis of baseline hormone status demonstrated a significant improvement only in normogonadotropic men (OR 2.13, 95% CI: 1.10-4.14, P = 0.02) and not in hypergonadotropic patients (OR 1.73, 95% CI: 0.44-6.77, P = 0.43). The literature was at moderate or severe risk of bias. WIDER IMPLICATIONS: This meta-analysis demonstrates that hormone therapy is not associated with improved SSR rates in hypergonadotropic hypogonadism. While hormone therapy improved SSR rates in eugonadal men with NOA, the quality of evidence was low with a moderate to high risk of bias. Therefore, hormone therapy should not be routinely used in men with NOA prior to SSR and large scale, prospective randomized controlled trials are needed to validate the meta-analysis findings.
الوصول الحر: https://lup.lub.lu.se/record/af0c7dd8-a106-4f70-b680-e4db144e6e5eTest
http://dx.doi.org/10.1093/humupd/dmac016Test -
2دورية أكاديمية
المؤلفون: Fiard, Gaelle, Chowdhury, Aminah, Potter, Aneirin R., Pook, Celina J., Kelly, Daniel, Emberton, Mark, Yap, Tet
الوصف: ContextFocal therapy has emerged as a promising option to treat well-selected men with localised prostate cancer while preserving healthy prostate tissue and key structures, such as the urethral sphincter and neurovascular bundles. However, how this tissue preservation may translate into improved outcomes, particularly into improved sexual outcomes, is still an active research field.ObjectiveWe conducted a systematic review and meta-analysis of the literature to summarise the existing evidence, in order to provide patients with updated data on what to expect after treatment and help identify gaps in current knowledge that may warrant future research.Evidence acquisitionA systematic literature search was conducted on Medline, EMBASE, Scopus, and Web of Science. The search strategy was defined using the “litsearchr” function in R based on a preliminary “naïve” search using the following terms on Medline: ((“focal therapy” OR “focal treatment”) AND (“prostate cancer”) AND (“sexual function” OR “erectile function”)). A total of 42 studies, comprising 3117 patients treated and 2352 with available sexual outcomes, were included in the qualitative data synthesis and 26 in a random-effect meta-analysis.Evidence synthesisThe five-item International Index of Erectile Function (IIEF-5) was the most frequently used questionnaire (30/42 studies), with completion rates ranging from 24% to 100% at 18–24 mo. A decrease was noted at 3 mo (IIEF-5 decrease estimate −3.70 [95% confidence interval −4.43, −2.96]), with improvements at 6 mo (−2.18 [−2.91, −1.46]) and 12 mo (−2.14 [−2.96, −1.32]). Studies in which patients had an altered baseline sexual function were more likely to report a significant and durable postoperative decrease in erectile function scores. The patient-reported outcome questionnaires used were not designed for a diverse population. Functional outcomes were not the primary endpoint and have not been reported consistently in most studies considered.ConclusionsFocal therapy led to changes in erectile function in ...
وصف الملف: application/pdf
العلاقة: https://orca.cardiff.ac.uk/id/eprint/158536/3/Detailing%20sexual%20outcomes%20after%20focal%20therapy%20-%20POST%20PRINT.pdfTest; Fiard, Gaelle, Chowdhury, Aminah, Potter, Aneirin R., Pook, Celina J., Kelly, Daniel https://orca.cardiff.ac.uk/view/cardiffauthors/A326559R.htmlTest orcid:0000-0002-1847-0655 orcid:0000-0002-1847-0655, Emberton, Mark and Yap, Tet 2023. Detailing sexual outcomes after focal therapy for localised prostate cancer: a systematic review and meta-analysis. European Urology Focus 8 (4) , pp. 926-941. 10.1016/j.euf.2021.09.009 https://doi.org/10.1016/j.euf.2021.09.009Test file https://orca.cardiff.ac.uk/id/eprint/158536/3/Detailing%20sexual%20outcomes%20after%20focal%20therapy%20-%20POST%20PRINT.pdfTest
الإتاحة: https://doi.org/10.1016/j.euf.2021.09.009Test
https://orca.cardiff.ac.uk/id/eprint/158536Test/
https://orca.cardiff.ac.uk/id/eprint/158536/3/Detailing%20sexual%20outcomes%20after%20focal%20therapy%20-%20POST%20PRINT.pdfTest -
3دورية أكاديمية
المؤلفون: MacAskill, Findlay E. N., Torres, Cyndi, Coker, Bolaji, Shabbir, Majed, Sahai, Arun, Yap, Tet
المصدر: Journal of Urology ; volume 211, issue 5S ; ISSN 0022-5347 1527-3792
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4دورية أكاديمية
المؤلفون: MacAskill, Findlay E. N., Sluzar, Piotr, Samy, Ibrahim, Tanaka, Maria Bertononcelli, Megson, Matthew, Qazi, Hasan, Yap, Tet
المصدر: Journal of Urology ; volume 211, issue 5S ; ISSN 0022-5347 1527-3792
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5دورية أكاديمية
المؤلفون: Samy, Ibrahim, Nyantakyi, Adwoa, Minhas, Suks, Thum, Yau meen, Bracewell-Milnes, Tim, Ramsay, Jonathan, Nicopoullos, James, Yap, Tet
المصدر: Journal of Urology ; volume 211, issue 5S ; ISSN 0022-5347 1527-3792
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6دورية أكاديمية
المؤلفون: Sluzar, Piotr, Samy, Ibrahim, Clark, Calum, Carroll, Paul, Yap, Tet
المصدر: Journal of Urology ; volume 211, issue 5S ; ISSN 0022-5347 1527-3792
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7دورية أكاديمية
المصدر: Journal of Urology ; volume 211, issue 5S ; ISSN 0022-5347 1527-3792
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8رسالة جامعية
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9دورية أكاديمية
المؤلفون: Khan, Nawal, Yap, Tet, Kopeika, Julia, Shabbir, Majed
المصدر: Journal of Clinical Urology; Mar2024, Vol. 17 Issue 2, p206-209, 4p
مستخلص: Background & Objectives: Onco-microsurgical testicular sperm extraction (Onco-microTESE) allows the microsurgical extraction of testicular sperm from the unaffected regions of the tumour-bearing testis at the time of radical orchidectomy. We report the case of a 36-year-old hypogonadotropic male with a testicular tumour and non-obstructive azoospermia. Method: A left radical orchidectomy was performed with simultaneous onco-microTESE. Although some sperm were found during the procedure, these were unsuitable for cryopreservation due to abnormal morphology. Given his low testosterone level (4.1 nmol/L), contralateral surgical sperm retrieval at the same sitting was not performed. Histology of the affected testicle demonstrated a classical seminoma and 'Sertoli cell only' appearance. He was subsequently started on clomiphene citrate. Results: After 9 months of clomiphene citrate, repeat semen analysis showed a total of 2.8 million sperm (1 million/mL), with 80% motility. Four vials of semen were cryopreserved, and this ejaculated sperm was used for in vitro-fertilisation (IVF) with intracytoplasmic sperm injection (ICSI). All six harvested eggs were fertilised. By day 5, there were two top grade blastocysts available, one of which was transferred and another frozen. After 9 months, the couple welcomed the birth of a healthy male infant. Conclusion: To our knowledge, this case is the first to demonstrate the benefit of clomiphene citrate in a patient with testis cancer resulting in a reversal of azoospermia and a subsequent live birth with assisted conception. Level of evidence: Not applicable [ABSTRACT FROM AUTHOR]
: Copyright of Journal of Clinical Urology is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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10دورية أكاديمية
المؤلفون: Fiard, Gaelle, Chowdhury, Aminah, Potter, Aneirin R, Pook, Celina J, Kelly, Daniel, Emberton, Mark, Yap, Tet
المصدر: European Urology Focus , 8 (4) pp. 926-941. (2022)
مصطلحات موضوعية: Erectile dysfunction, Focal therapy, Prostate cancer
الوصف: CONTEXT: Focal therapy has emerged as a promising option to treat well-selected men with localised prostate cancer while preserving healthy prostate tissue and key structures, such as the urethral sphincter and neurovascular bundles. However, how this tissue preservation may translate into improved outcomes, particularly into improved sexual outcomes, is still an active research field. OBJECTIVE: We conducted a systematic review and meta-analysis of the literature to summarise the existing evidence, in order to provide patients with updated data on what to expect after treatment and help identify gaps in current knowledge that may warrant future research. EVIDENCE ACQUISITION: A systematic literature search was conducted on Medline, EMBASE, Scopus, and Web of Science. The search strategy was defined using the "litsearchr" function in R based on a preliminary "naïve" search using the following terms on Medline: (("focal therapy" OR "focal treatment") AND ("prostate cancer") AND ("sexual function" OR "erectile function")). A total of 42 studies, comprising 3117 patients treated and 2352 with available sexual outcomes, were included in the qualitative data synthesis and 26 in a random-effect meta-analysis. EVIDENCE SYNTHESIS: The five-item International Index of Erectile Function (IIEF-5) was the most frequently used questionnaire (30/42 studies), with completion rates ranging from 24% to 100% at 18-24 mo. A decrease was noted at 3 mo (IIEF-5 decrease estimate -3.70 [95% confidence interval -4.43, -2.96]), with improvements at 6 mo (-2.18 [-2.91, -1.46]) and 12 mo (-2.14 [-2.96, -1.32]). Studies in which patients had an altered baseline sexual function were more likely to report a significant and durable postoperative decrease in erectile function scores. The patient-reported outcome questionnaires used were not designed for a diverse population. Functional outcomes were not the primary endpoint and have not been reported consistently in most studies considered. CONCLUSIONS: Focal therapy led to changes in erectile ...
وصف الملف: text
العلاقة: https://discovery.ucl.ac.uk/id/eprint/10158777/2/Emberton_Finalauthorversion.pdfTest; https://discovery.ucl.ac.uk/id/eprint/10158777Test/
