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A number of key misidentification risk points occur during an in vitro fertilization cycle in the laboratory that require robust witnessing. Witnessing protocols, both manual and electronic, are described. In the event of a protocol deviation, guidance for grading, reporting, and risk mitigation is provided.
SEED-ML (Semen Examination and Evaluation Dataset for Machine Learning) is an openly available, multi-parametric clinical dataset specifically designed to support research in male infertility diagnostics and prediction. SEED-ML refers specifically to the dataset repository and its clinical structure, and not to a specific machine learning model or diagnostic method. In this sense, SEED-ML comprises records from 10,124 patients, including detailed semen analysis parameters (pre- and post-capacitation), morphological classifications, and clinical alterations. Infertility diagnosis is categorized into nine clinically relevant classes, ranging from normal fertility to complex multi-factor conditions such as oligoasthenoteratozoospermia. All data were anonymized and curated following strict ethical and privacy guidelines to ensure compliance with applicable medical data protection regulations. The dataset reflects real-world clinical distributions across nine diagnostic classes: Normozoospermia (62.68%), Oligoasthenoteratozoospermia (14.22%), Asthenozoospermia (11.66%), Teratozoospermia (6.71%), Oligozoospermia (1.90%), Asthenoteratozoospermia (1.38%), Oligoasthenozoospermia (0.96%), Oligoteratozoospermia (0.34%), and Azoospermia (0.16%). This detailed categorization provides a realistic clinical distribution for machine learning evaluation. SEED-ML offers a resource for developing and benchmarking machine learning models, enabling research in predictive analytics, decision support systems, and computational andrology. This dataset aims to facilitate interdisciplinary collaboration between clinicians, data scientists, and AI (artificial intelligence) researchers. The dataset is publicly available in Mendeley under a CC BY 4.0 license.
With the remarkable improvement in the survival rate of patients after sphincter-preserving radical resection for rectal cancer, pelvic organ dysfunction has become a core issue affecting patients' quality of life. However, in clinical practice, there is a lack of standardized assessment of pelvic organ function and systematic rehabilitation strategies. To address this issue, the Colorectal Cancer Committee of the Chinese Medical Doctor Association, the Colorectal Cancer Committee of the Chinese Anti-Cancer Association, the Neuromodulation Committee of the Chinese Medical Doctor Association, and the Colorectal and Anal Functional Surgery Branch of the Chinese Society of Andrology jointly initiated the formulation of this consensus. They organized domestic experts engaged in the diagnosis and treatment of rectal cancer and related fields, systematically reviewed relevant domestic and international studies, and combined clinical practice. Centering on the incidence, risk factors, assessment methods, prevention, treatment and rehabilitation of postoperative organ dysfunction in rectal cancer, under the guidance of the integrated concept of "prevention-treatment-rehabilitation", and integrating the multidisciplinary wisdom of gastrointestinal surgery, urology, sexual medicine, rehabilitation medicine and other disciplines, the experts standardized the pelvic organ function assessment strategies, surgical techniques and dysfunction rehabilitation strategies in three stages of "preoperative assessment - intraoperative protection - postoperative rehabilitation", put forward recommendations, and conducted discussions and voting, thus formulating « Expert consensus on the prevention, treatment and rehabilitation of pelvic organ dysfunction after rectal cancer surgery (2026 version) ». This consensus aims to raise the awareness of domestic clinicians regarding organ function protection during the treatment of rectal cancer, standardize the implementation of organ function assessment and surgical methods, develop a rehabilitation strategy for recto-vesical-sexual dysfunction after sphincter-preserving rectal cancer surgery suitable for national conditions to reduce the incidence of organ dysfunction, and provide solutions for the rehabilitation of pelvic organ dysfunction in patients while ensuring the curative effect of radical rectal cancer treatment. 随着直肠癌保肛根治术后患者生存率的显著提升，盆腔器官功能障碍已成为影响患者生活质量的核心问题。但在临床实践中，尚缺乏规范化评估盆腔器官功能和体系化的康复策略。为此，中国医师协会结直肠肿瘤专业委员会、中国抗癌协会大肠癌专业委员会、中国医师协会神经调控专业委员会和中国性学会结直肠肛门功能外科分会联合组织国内从事直肠癌诊疗及相关领域的专家，通过系统梳理国内外相关研究，结合临床实践，针对直肠癌术后器官功能障碍的发生率、危险因素、评估方法、预防和治疗以及康复等问题，以“防-治-康”一体化理念为指导，融合胃肠外科、泌尿外科、性医学科及康复科等多学科智慧，从“术前评估-术中保护-术后康复”三个阶段规范盆腔器官功能评估策略、手术技术和功能障碍康复策略，提出推荐意见并进行讨论和投票，从而制订了《直肠癌手术盆腔器官功能障碍防治与康复专家共识（2026版）》。本共识旨在提高国内医师对于直肠癌治疗过程中器官功能保护的意识，规范器官功能评估和手术方式的实施，为降低器官功能障碍发生率而制定适合我国国情的直肠癌保肛手术后直肠-膀胱-性功能障碍康复策略。.
Sperm DNA fragmentation (SDF) represents strand breaks that may compromise embryo development, reproductive outcomes, and offspring health, particularly when the oocyte's repair capacity is limited. This mini-review provides a clinically pragmatic framework addressing how to test, when to test, and whom to test for SDF, translating biological and laboratory insights into actionable andrology practice. The mechanistic basis of SDF is summarized, including the two-step hypothesis linking defective chromatin packaging to oxidative stress, and the combined influence of paternal and maternal aging on the creation and repair of DNA lesions. Contemporary methods for detecting both single- and double-strand breaks (DSBs), as well as DSB-specific platforms, are reviewed with emphasis on assay-specific cut-offs and clinical indications. Management strategies are outlined, prioritizing andrological optimization through lifestyle modification, antioxidant supplementation, treatment of genital tract infection, varicocele repair, and selected hormonal therapy, followed by retesting after one spermatogenic cycle. For persistently high SDF, selective use of testicular sperm for ICSI (Testi-ICSI) and laboratory adjuncts is discussed, supported by evidence of lower miscarriage and higher live-birth rates in defined high-SDF phenotypes. The limitations of the existing observational evidence base-particularly the paucity of phenotype-targeted randomized controlled trials-are highlighted. The review also underscores the value of embedding SDF testing within quality-managed programs and incorporating systematic audits of indications, treatment effects, and ART outcomes. Beyond ART, SDF assessment is positioned within preconception care, recognizing sperm chromatin integrity as a determinant of reproductive and intergenerational health. Future priorities include randomized trials comparing testicular and ejaculated sperm for ICSI in high-SDF cohorts, validation of DSB-specific assays, and longitudinal offspring follow-up to clarify intergenerational effects. This integrative approach promotes precision rather than proliferation of testing, aligning molecular insight with clinical prudence to improve reproductive and generational outcomes.
Successful fertilization requires spermatozoa to be both mechanically stable and responsive to extracellular signals, a capacity conferred by specialized cytoskeletal proteins. In mammalian spermatozoa, tektins (e.g., Tektin1-5) are filamentous structural proteins predominantly localized to the flagellum, where they stabilize the axoneme and support the motility and functional competence of the spermatozoa essential for fertilization. Given the dynamic redistribution of certain isoforms (e.g., Tektin1-3) to the sperm head during capacitation, hyperactivation, and the acrosome reaction, the molecular mechanisms through which tektins coordinate structural integrity with signaling events remain unclear. Owing to advancements in genetic tools, high-throughput sequencing, and structural biology, significant progress has been made in the past decade in elucidating the roles of tektins in spermiogenesis and fertilization. In this review, we discuss functional evidence from animal models and human genetic studies, summarize the current knowledge linking tektin deficiency or mutation to impaired sperm motility and male fertility, and highlight the potential of these genes as biomarkers and therapeutic targets in precision andrology.
Seborrheic keratosis (SK) is a common benign epidermal tumor for which the optimal noninvasive treatment has not yet been definitely clarified. Hydrogen peroxide 40% (H2O2) is the only U.S. Food and Drug Administration (FDA)-approved topical agent for raised SK, whereas trichloroacetic acid (TCA) is widely used for chemical ablation. This study compared the clinical efficacy, dermoscopic improvement, safety, and patient satisfaction of H2O2 40% versus TCA 70% in SK treatment. In this randomized controlled study, 64 patients were assigned to H2O2 40% (n = 32) or TCA 70% (n = 32) applied over two to four sessions at 2‑week intervals. Outcomes included physician lesion assessment (PLA), lesion dimensions, subjective self-assessment (SSA), dermoscopic features, adverse events, and patient satisfaction. Trichloroacetic acid 70% demonstrated significantly greater efficacy, with complete lesion clearance in 43.8% versus 0% in the H2O2 group (p < 0.001). Dermoscopic clearance was achieved in 56.3% versus 6.3% (p < 0.001), respectively. Patient satisfaction was significantly higher with TCA (p = 0.001). Mild scarring occurred in 25% of TCA-treated patients, while no scarring or pigmentary complications were observed with H2O2. Trichloroacetic acid 70% provides superior clinical and dermoscopic clearance compared with H2O2 40%, albeit with a higher risk of mild scarring; H2O2 is safer but less effective. Limitations include the lack of prospective trial registration, the single-center design, the small sample size with short follow-up, potential performance bias, and limited generalizability. This study was not prospectively registered. HINTERGRUND UND ZIEL: Die seborrhoische Keratose (SK) ist ein häufiger benigner epidermaler Tumor, für den die optimale noninvasive Therapie noch nicht eindeutig geklärt wurde. Wasserstoffperoxid 40% (H2O2) ist die einzige von der U.S. Food and Drug Administration (FDA) zugelassene topische Substanz für erhabene SK, während Trichloressigsäure 70% (TCA) weit verbreitet zur chemischen Ablation eingesetzt wird. In der vorliegenden Studie wurden die klinische Wirksamkeit, dermoskopische Verbesserung, Sicherheit und Patientenzufriedenheit unter H2O2 40% vs. TCA 70% in der Behandlung der SK verglichen. In der vorliegenden randomisierten kontrollierten Studie wurden 64 Patienten entweder der Therapie mit H2O2 40% (n = 32) oder TCA 70% (n = 32) zugeteilt, mit Anwendungen über 2–4 Sitzungen in 2‑Wochen-Abständen. Die Ergebnisse umfassten die ärztliche Beurteilung der Läsion („physician lesion assessment“, PLA), das Ausmaß der Läsion, die subjektive Selbstbeurteilung („subjective self-assessment“, SSA), dermoskopische Merkmale, Nebenwirkungen und die Patientenzufriedenheit. Trichloressigsäure 70% wies eine signifikant größere Wirksamkeit mit vollständiger Abheilung der Läsion in 43,8% gegenüber 0% der Fälle in der H2O2-Gruppe auf (p < 0,001). Eine dermoskopische Abheilung wurde in 56,3% vs. 6,3% der Fälle erzielt (p < 0,001). Dabei war die Patientenzufriedenheit unter TCA signifikant größer (p = 0,001). Eine leichte Narbenbildung trat bei 25% der TCA-behandelten Patienten auf, während unter H2O2 keine Narbenbildung oder Komplikationen wie Pigmentstörungen zu beobachten waren. Mit Trichloressigsäure 70% ist eine überlegene klinische und dermoskopische Abheilung im Vergleich zu H2O2 40% zu erzielen, jedoch mit einem höheren Risiko für leichte Narbenbildung; H2O2 ist sicherer, aber weniger wirksam. Zu den Limitationen gehören die fehlende Registrierung als prospektive Studie, das Design als Einzelzentrum-Studie, die geringe Stichprobengröße mit einer kurzen Nachbeobachtungsphase, potenzieller Performance-Bias und begrenzte Verallgemeinerbarkeit. Diese Studie war nicht prospektiv registriert.
Varicocele is a common cause of male infertility, but the mechanisms by which it disrupts testicular homeostasis and impairs spermatogenesis remain incompletely elucidated. This article reviews current evidence on the multifactorial disturbances in the testicular microenvironment induced by varicocele, with a focus on hemodynamic, biochemical, and structural abnormalities. Anatomical predisposition, venous valve incompetence, and impaired venous return collectively lead to chronic venous hypertension, causing progressive dilation of the pampiniform plexus and severe hemodynamic dysregulation. These primary vascular abnormalities subsequently establish a foundation for downstream cellular damage, including testicular hyperthermia, hypoxia, and metabolic stress. Among these pathological processes, oxidative stress is widely recognized as a central mediator of testicular injury. Excessive reactive oxygen species overwhelm intrinsic antioxidant defenses, disrupt mitochondrial function, damage germ cell DNA, and impair epididymal sperm maturation, ultimately leading to reduced sperm concentration, motility, and viability. Simultaneously, elevated inflammatory cytokines and immune dysregulation further compromise Sertoli and Leydig cell function, activate inflammasome signaling and amplify inflammatory injury. These inflammatory signals also synergize with oxidative damage to disrupt the blood-testis barrier, resulting in increased permeability, autoimmune activation, and accelerated loss of germ cells. Structural impairment of the seminiferous epithelium, mitochondrial dysfunction, and the activation of intrinsic and extrinsic apoptotic pathways further exacerbate spermatogenic failure. Ultimately, varicocele induces a multifaceted and sustained cycle of testicular microenvironment disruption, impairing spermatogenesis at multiple levels-from Sertoli cell function and blood-testis barrier integrity to germ cell survival and sperm DNA stability.
Identification of a preservation medium that accurately retains semen parameters would be advantageous for men requiring semen analysis by allowing them to produce sperm samples at home rather than on site or even facilitate 'mail order' semen analysis. To evaluate the utility of a commercially available refrigeration medium for preserving human semen parameters for use in a diagnostic setting. In patients undergoing diagnostic semen analysis, extender was added to the remainder of each ejaculate following initial 'ground truth' testing. Samples were re-assessed to determine effects of incubation time, temperature, volume of extender and speed of addition. Total and progressive motility and vitality declined slowly at 2-5°C, with some motility remaining even after 4 days. The rate of motility and vitality decline was not consistent between samples, with samples outside the reference range being particularly prone to rapid decline. Varying extender conditions showed that even samples with initially good parameters exhibited inconsistent rates of decline in motility and vitality. This was partially ameliorated by incubation at 20-24°C compared to 2-5°C (p < 0.001), while varying the speed of extender addition (dropwise vs. rapid) or the ratio of extender to initial sample had no effect. Although semen refrigeration medium does allow sperm to retain some motility for several days, the high level of individual patient variability in the rate of decline precludes accurate reconstruction of initial semen parameters from extended samples. However, total sperm count can be accurately measured. There are many commercially available kits for semen analysis; however, the reliability of the results is questionable. Semen extenders could potentially be used for triage for samples within the reference range but where measurements from extended samples fall outside reference ranges, confirmation must be obtained from a fresh sample assayed according to WHO guidelines before any diagnosis can be made. A Study Registration Number is not required as this was not a clinical trial.
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In the context of gamete donation, cytomegalovirus (CMV) serological screening was originally implemented to mitigate concerns about viral transmission, particularly following the HIV epidemic. Although emerging evidence questions the reliability of serological markers in accurately reflecting the presence of the virus in genital secretions, current North American practices still heavily rely on CMV serological testing to identify sperm donors at risk of transmitting CMV during fertility treatments. This review explores the complexities of CMV transmission in assisted reproductive technologies (ART), underscoring the unpredictable nature of viral shedding in semen and the inherent limitations of relying solely on serostatus for risk assessment. Additionally, the available data suggest that the risk of congenital CMV (cCMV) following ART appears low, although significant gaps in the literature highlight the need for more comprehensive studies to better evaluate transmission risks. Finally, this review advocates for the revision of CMV screening societies' guidelines, emphasizing the need for broader, evidence-based preventive strategies. Preventing CMV risk in fertility treatments may include more significant action such as patient education on simple hygiene measures to prevent infection during pregnancy-instead of current, potentially unnecessary measures such as CMV serostatus matching.
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Acute prostatitis is a clinically significant condition in dogs that requires accurate diagnosis and appropriate therapeutic management. According to International Society for Companion Animal Infectious Diseases guidelines, culture and sensitivity testing (CST) is strongly recommended, ideally using prostatic samples when feasible, and antimicrobial therapy should be based on culture results and administered for an adequate duration. This study aimed to evaluate current diagnostic and therapeutic approaches to acute prostatitis among Italian veterinary practitioners, with particular emphasis on culture and sensitivity testing (CST), antimicrobial therapy, and hormonal management. An anonymous observational survey consisting of 18 mandatory questions was distributed online to veterinarians across Italy (February 10-24, 2025). Responses (n = 306) were analyzed descriptively, and intergroup comparisons by facility type [small clinics (SC), large clinics (LC), and veterinary hospitals (VH)] were performed using chi-squared tests. Most respondents (93.1%) reported using a combination of clinical examination, bloodwork, urinalysis, and ultrasound for diagnosis. CST was performed in more than 50% of cases by 70% of VH, but only by 16% of SC. Urine was the most commonly used diagnostic matrix (54.9%), whereas samples of prostatic origin were used in only 20.9% of cases. Financial cost and turnaround time were identified as the main barriers to testing. Empirical antibiotic therapy was reported by 88.6% of veterinarians, most commonly amoxicillin-clavulanic acid (42%) and enrofloxacin (32%). However, only 7.2% of respondents prescribed antibiotics for the recommended duration of ≥4 weeks. Orchiectomy was performed in more than 50% of cases by only 19.6% of respondents. Hormonal therapy was used as a first-line treatment by 71% of practitioners. This study highlights significant deviations from current guidelines in both the diagnosis and treatment of canine prostatitis in general practice. Antimicrobial stewardship, the use of CST, and prostatic sampling should be improved to better align with current recommendations.
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This study was designed to assess whether adrenomedullin (ADM) can alleviate testicular interstitial fibrosis by triggering the GSK-3β/β-catenin/TCF-4 cascade, consequently reducing the levels of connective tissue growth factor (CTGF), fibronectin, and type I collagen. Primary Leydig cells underwent treatment with lipopolysaccharide (LPS) followed by transduction using an adeno-associated virus engineered to express ADM (Ad-ADM). Cell viability was subsequently measured employing the CCK-8 assay. Additionally, the gene and protein expression levels of fibronectin, CTGF, and collagen type I were systematically determined. Treatment with Ad-ADM effectively restored Leydig cell viability and significantly decreased the mRNA and protein expression of CTGF, collagen type I, and fibronectin. Additionally, Ad-ADM inhibited the phosphorylation of GSK-3β and suppressed the activation of β-catenin, which interacts with TCF-4 in LPS-exposed Leydig cells. ADM may thus reduce fibrosis-related factor production in LPS-exposed Leydig cells, ameliorating testicular interstitial fibrosis via activation of the GSK-3β/β-catenin/TCF-4 pathway.
Background/Objectives: Platelet-rich plasma (PRP) is an autologous blood-derived biologic enriched in platelets and bioactive mediators. In urology and sexual medicine, PRP has been promoted for erectile dysfunction (ED) and a growing range of urogenital disorders on the premise that it may support angiogenesis, neuroregeneration, immune modulation, and tissue remodeling. However, clinical uptake has outpaced high-quality evidence, while heterogeneity in PRP preparation, characterization, and delivery limits interpretability and reproducibility. This structured narrative review aims to critically integrate mechanistic, preclinical, and clinical evidence regarding PRP use in ED, Peyronie's disease (PD), stress urinary incontinence (SUI), interstitial cystitis/bladder pain syndrome (IC/BPS), and selected emerging indications. We further aim to identify sources of heterogeneity and propose an actionable minimum reporting framework (PRP-Uro Checklist) to guide future research. Methods: A structured search of PubMed/MEDLINE was conducted for studies published between 2021 and 2025. The relevant literature on PRP use in ED, PD, SUI, IC/BPS, and related indications was included for critical narrative synthesis. Emphasis was placed on PRP classification and preparation variables, outcome measure validity, and sources of heterogeneity across studies. Results: Mechanistic and preclinical evidence supports PRP's potential to modulate nerve repair, angiogenesis, extracellular matrix remodeling, and immune polarization through a complex secretome of growth factors, cytokines, and extracellular vesicles (EVs). Clinical evidence suggests that intracavernosal PRP may improve erectile function in selected populations, but effect size, durability, and superiority over placebo remain uncertain due to small trials, substantial placebo effects, short follow-up, and incomplete biologic characterization. Evidence for PRP in PD, SUI, and IC/BPS remains preliminary and is derived largely from small cohorts, proof-of-concept studies, or uncontrolled designs, although early findings suggest potential symptom benefit and acceptable short-term tolerability. Across indications, inconsistent PRP reporting, particularly the absence of absolute platelet dose, leukocyte quantification, activation method, and standardized treatment protocols, represents a major barrier to reproducibility and evidence synthesis. Conclusions: PRP is biologically plausible and appears broadly safe, but its role in urology and sexual medicine remains investigational and is not yet supported by guideline-level evidence. To enhance reproducibility and interpretation, we propose a Minimum PRP Reporting Checklist for Urology and Sexual Medicine Trials (PRP-Uro Checklist). Future progress requires rigorous standardized reporting, indication-specific biologic characterization, rigorously designed sham-controlled trials, clinically meaningful endpoints, and longer-term follow-up.
Immune checkpoint inhibitors (ICIs) are a cornerstone of systemic therapy for renal cell carcinoma (RCC), used both in the adjuvant and metastatic settings across various lines of treatment, often in combination with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs). These therapies are associated with endocrine immune-related adverse events (irAEs), which can be irreversible and life-threatening if not promptly managed. Using data from the Food and Drug Administration Adverse Reporting System (FAERS), this study aimed to evaluate the real-world occurrence of endocrine irAEs in all approved VEGFR-TKI + ICI combinations for RCC, and to compare these findings with the corresponding VEGFR-TKI or ICI monotherapies. The immune doublet ipilimumab + nivolumab was not considered in this analysis. FAERS database from 2019 Q1 to 2024 Q2 was queried using OpenVigil 2.1-MedDRA-v24 and AERSMine to identify endocrine irAEs reports. Reports were filtered by age, gender, and report severity. The frequency of reported endocrine irAEs associated with VEGFR-TKI + ICI combination therapies was compared to that reported for VEGFR-TKI or ICI monotherapy. Compared with VEGFR-TKI monotherapies, VEGFR-TKI + ICI combinations showed a significant disproportionate reporting of endocrine irAEs, mostly associated with the combination regimens. In contrast, when compared with ICI monotherapy, VEGFR-TKI + ICI showed more heterogeneous disproportionality signals, with generally lower reporting of hypothalamus, pituitary, and hyperglycemic disorders, whereas hypoglycemia and thyroid irAEs were more frequently reported, except for autoimmune thyroid diseases. Combination therapy, compared with VEGFR-TKI monotherapy, was associated with a higher reporting frequency of specific endocrine irAEs, whereas comparisons with ICI monotherapy yielded mixed signals, highlighting regimen- and event-specific differences.
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